Experiencia en estapedostomías en Hospital del Salvador entre 2012 y 2018 / Stapedotomy experience at Hospital del Salvador between 2012 and 2018

INTRODUCCIÓN: La otoesclerosis es una enfermedad de presumible origen metabólico que determina la fijación de la cadena osicular. La estapedostomía con instalación de prótesis es la cirugía de elección en la actualidad para esta patología. OBJETIVO: Describir experiencia y resultados del tratamiento quirúrgico de pacientes con otoesclerosis en el Hospital del Salvador entre los años 2012 y 2018. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes intervenidos quirúrgicamente en nuestro servicio desde enero de 2012 hasta septiembre de 2018 con sospecha de otoesclerosis. RESULTADOS: Se realizaron en total 52 cirugías a 45 pacientes, 40 vía microscópica, 10 vía endoscópica y 2 mixtas, se utilizaron dos modelos de prótesis, Schuknecht - type piston and wire y Stapes-Prothesen. El promedio tonal puro (PTP) por vía aérea prequirúrgico fue de 65 dB, con una diferencia ósea-aérea (gap) promedio de 36 dB. El PTP promedio posquirúrgico fue de 35 dB con gap promedio de 9 dB, logrando en promedio una mejoría de 31 dB en la vía aérea y 27 dB de cierre de gap. El 92% de los pacientes intervenidos lograron mejoría con respecto al gap posoperatorio. CONCLUSIÓN: La estapedostomía es una intervención que si bien no está exenta de complicaciones, ha demostrado ser segura y tener buenos resultados auditivos en la mayoría de los pacientes.

INTRODUCTION: Otosclerosis is a presumable metabolic disease that determines ossicular chain fixation. Stapedotomy with prosthesis installation is the surgery of choice for this pathology at present. AIM: To describe the experience and results of the surgical treatment of patients with otosclerosis in the Hospital del Salvador between 2012 and 2018. MATERIAL AND METHODS: Clinical records were reviewed of patients treated surgically in our department from January 2012 to September 2018 with suspicion of otosclerosis. RESULTS: A total of 52 surgeries were performed in 45 patients, 42 via microscopy and 10 via endoscopy, two models of prostheses were used Schuknecht - type piston and wire y Stapes-Prothesen. The pure tonal average (PTP) by pre-surgical air was 65 dB, with an average air gap (gap) of 36 dB. The average post-surgical PTP was 35 dB with an average gap of 9 db, achieving on average an improvement of 31 dB in the airway and 27 dB of gap closure. 92% of the patients who underwent surgery improved with respect to the postoperative gap. CONCLUSION: The stapedotomy is an intervention that although not free of complications, has been shown to be safe and have good hearing results in most patients.

Hereditary angioedema with C1 inhibitor (C1-INH) deficit: the strength of recognition (51 cases)

Hereditary angioedema (HAE) is a rare autosomal dominant disease due to C1 esterase inhibitor deficiency (C1-INH). The disease is characterized by subcutaneous and submucosal edema in the absence of urticaria due to the accumulation of bradykinin. This descriptive study aimed to evaluate the clinical characteristics of patients with a confirmed diagnosis of HAE referred to our Outpatient Clinic between December 2009 and November 2017. Fifty-one patients (38 F, 13 M) with a mean age of 32 years (range: 7-70 y) were included. Family history of HAE was reported in 70% (36/51) of the cases; 33/46 patients became symptomatic by 18 years of age. The median time between onset of symptoms and diagnosis was 13 years (3 mo-50 y). The most frequent triggering factors for attacks were stress (74.4%), trauma (56.4%), and hormonal variations (56%). The main symptoms were subcutaneous edema in 93.5% (43/46) of patients, gastrointestinal symptoms in 84.8% (39/46), and obstruction in the upper airways in 34.8% (16/46). Hospitalization occurred in 65.2%, of whom 13.3% had to be transferred to the Intensive Care Unit. Prophylactic treatment was instituted in 87% (40/46) of patients, and 56.5% (26/46) required additional treatment to control attacks. Owing to our data collection over a period of 8 years, a significant number of patients were identified by this HAE reference center. Despite early recognition and prophylactic treatment, a high percentage of patients were hospitalized. HAE is still diagnosed late, reinforcing the need for more reference centers specialized in diagnosis and educational projects for health professionals.

Calidad de vida en pacientes chilenas sobrevivientes de cáncer de mama / Quality of life in Chilean breast cancer survivors

Background: Quality of Life (QOL) assessment may evaluate the impact of diseases and their treatment on the overall well-being of patients. Aim: To assess QOL in Chilean breast cancer survivors. Patients and Methods: Ninety one female breast cancer patients aged 60 ± 10 years, who finished their oncologic treatment at least a year prior to the assessment, who were disease free and in medical follow-up were included in the study. They completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 core questionnaire and the breast cancer module QLQ-BR23. Results: Forty eight percent of respondents were long term survivors (more than five years). Global QOL scores were high (73.6 ± 18.2), emotional scale had the lowest scores in QLQ-C30 functional scales (72.1). Symptoms with the highest scores were: Insomnia (= 21.2), pain (= 20.8), and fatigue (= 19.1). Body image, sexual function, and concern about the future were the most relevant problems. Body image was superior in patients with breast-conserving surgery (p = 0.008), and cognitive function was better in patients in early disease stage (p = 0.03) and in those with more than five years of survival (p = 0.04). Conclusions: Even when global QOL scores were high, some symptoms were prevalent. Awareness about these problems and symptoms should improve their diagnosis and treatment.

Intensity and physiological responses to the 6-minute walk test in middle-aged and older adults: a comparison with cardiopulmonary exercise testing

The 6-minute walk test (6MWT) is a simple field test that is widely used in clinical settings to assess functional exercise capacity. However, studies with healthy subjects are scarce. We hypothesized that the 6MWT might be useful to assess exercise capacity in healthy subjects. The purpose of this study was to evaluate 6MWT intensity in middle-aged and older adults, as well as to develop a simple equation to predict oxygen uptake ( V ˙ O 2 ) from the 6-min walk distance (6MWD). Eighty-six participants, 40 men and 46 women, 40-74 years of age and with a mean body mass index of 28±6 kg/m2, performed the 6MWT according to American Thoracic Society guidelines. Physiological responses were evaluated during the 6MWT using a K4b2 Cosmed telemetry gas analyzer. On a different occasion, the subjects performed ramp protocol cardiopulmonary exercise testing (CPET) on a treadmill. Peak V ˙ O 2 in the 6MWT corresponded to 78±13% of the peak V ˙ O 2 during CPET, and the maximum heart rate corresponded to 80±23% of that obtained in CPET. Peak V ˙ O 2 in CPET was adequately predicted by the 6MWD by a linear regression equation: V ˙ O 2 mL·min-1·kg-1 = -2.863 + (0.0563×6MWDm) (R2=0.76). The 6MWT represents a moderate-to-high intensity activity in middle-aged and older adults and proved to be useful for predicting cardiorespiratory fitness in the present study. Our results suggest that the 6MWT may also be useful in asymptomatic individuals, and its use in walk-based conditioning programs should be encouraged.

Cefaleas / Headaches

Headache is the most frequent symptom that makes patients to attend a neurologist's office. Is a very common reason to attend general physician as well, so is very important to know how to do a correct diagnosis between primary and secondary headache and to treat the most frequent ones. This review includes migraine, tension type headache and others, from a clinical perspective, with special focuses on clinical clues that allow clinicians a more specific diagnosis and treatment. We want to emphasize how rational treatment should be prescribed and how to avoid rebound headache and others complications related to certain drugs, in particular ergotamines.

Racial inequalities and perinatal health in the southeast region of Brazil

Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (ú4 years, 27.2 and 38.0 percent) and lower family income (ú1 minimum wage, 28.6 and 30.4 percent). Mothers aged less than 20 years old predominated among mulattos (17.0 percent) and blacks (14.0 percent). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8 percent). Preterm birth rate was higher among mulattos (9.5 percent) and blacks (9.7 percent) than whites (5.5 percent). White individuals had higher rates of cesarean delivery (34.9 percent). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics.

Fatores de risco para doenças cardiovasculares em idosos com diabetes mellitus tipo 2 / Cardiovascular risk factors in elderly patients with diabetes mellitus tipo 2

O objetivo deste estudo foi analisar os fatores de risco relacionados às doenças cardiovasculares (FRDCV), em idosos diabéticos do tipo 2, através de um estudo observacional com delineamento transversal, tendo sido realizado com 100 idosos atendidos no Centro Regional de Reabilitação de Araraquara (CRRA), São Paulo, Brasil, de março a dezembro de 2004. Houve predominância de indivíduos casados, sexo feminino, brancos, com baixa renda e baixa escolaridade. Quanto aos hábitos e estilo de vida, predominaram os que mantinham dietas adequadas, sedentários, não fumantes e não etilistas. Entre os 100 indivíduos estudados, 42% apresentaram sobrepeso, 42% obesidade, 71% valores inadequados de circunferência abdominal e 84% de relação cintura-quadril de acordo com o sexo. Em relação aos FRDCV, 54,0% apresentaram hipertensão arterial sistêmica (HAS), 54,0% com hipercolesterolemia, 51,0% de hipertrigliceridemia, 84% com valores elevados de LDL-colesterol, 59% com níveis reduzidos de HDL-colesterol, 78,0% com níveis elevados de glicemia de jejum, 76,0% com níveis elevados de hemoglobina glicada e 57,0% de fibrinogênio. Os resultados demonstraram uma frequência elevada de FRDCV com diferenças em relação ao sexo e a idade.

The aim of this study was to analyze the risk factors related to the cardiovascular diseases (CVRF) in elderly type 2 diabetics. A cross-sectional observational study was carried out on 100 elderly patients attending the Rehabilitation Center of Araraquara (CRRA), São Paulo State, Brazil, from March to December, 2004. The majority were married, female, white, with a low income and low educational level. Regarding habits and style of life, the subjects had an adequate diet, were sedentary, non-smoking and non-drinking. In the population of 100, 42% were overweight, 42% obese, 71% had abovenormal waist measurements and 84% high waist-to-hip ratios. Concerning the CVRF, it was observed that more than half had hypertension, hypercholesterolaemia and hypertriglyceridaemia. 84% had high values of LDLcholesterol and 59% HDL-cholesterol levels below the reference values, 78% high levels of fasting glycemia, 76% glycohemoglobin and 57% fibrinogen and thus subject to cardiovascular risk. The results showed a highfrequency of cardiovascular risk factors, differing according to sex and the age.

Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18 percent in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72 percent were genotype 1 and 34 percent were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78 percent EoT response and 51 percent SVR. Nonresponders showed 57 percent EoT response and 26 percent SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45 percent had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.

Evaluación de la disnea en pacientes portadores de enfermedad pulmonar obstructiva crónica / Evaluation of the dyspnea in carrier patients of chronic obstructive pulmonary disease

La enfermedad pulmonar obstructiva crónica (EPOC) es una causa importante de mortalidad y morbilidad. El test de 6 minutos ha sido utilizado ampliamente para evaluar la capacidad global de ejercicio en pacientes con EPOC, y ha sido correlacionado con el consumo máximo de oxígeno y la función pulmonar. Evaluamos la correlación existente entre rendimiento en el test de 6 minutos (6mwt) con: escala de disnea análoga visual (EAV), escala de borg, escala clínica de disnea y puntaje de severidad de la EPOC. Se utilizó indice de correlación de Pearson con alfa = 0,025. Se evaluaron 24 pacientes EPOC, edad promedio = 64,2 años; promedio de metros caminados 365,6 m. Las correlaciones obtenidas fueron: 6mwt/EAV r = -0,53, p<0,0005. 6mwt/ esc. clínica r = 0,19, p<0,0005; 6mwt/borg r = -0,11 NES. 6mwt/puntaje severidad r = -0,32, p<0,005. Nuestro estudio mostró que para el grupo evaluado existe una correlación inversa entre rendimiento entre 6mwt y las escalas de evaluación de la disnea utilizadas. El 6mwt es una prueba simple, de bajo costo, y posee ventajas por sobre otras pruebas que evalúan la capacidad funcional global de los pacientes con EPOC. Nuevos estudios deberían estar orientados hacia la instauración de programas de rehabilitación pulmonar para mejorar la calidad de vida de estos pacientes

Polineuropatía inflamatoria desmielinizante crónica: presentación de 6 casos / Chronic inflammatory demyelinating polyneuropathy: report of 6 cases

Chronic inflammatory demyelinating polyneuropathy is a heterogeneous disease characterized by symmetrical motor and sensitive alterations, absence of tendom reflexes and increased cerebrospinal fluid protein levels. We report 6 patients with the disease (3 males) aged 41 to 70 years old. Four had tha classical presentation and two had an asymmetrical paresis, that predominated in superior limbs. These patients had proximal block with scarce prolongation of distal nerve conduction velocity. In all patients, underlying illnesses were discarded with a full diagnostic work up. Subjects were followed from 2 to 14 months after the diagnosis. In all, treatment with steroids improved muscle strength and sensivity

Indicadores das condiçöes nutricionais na Regiäo do Polonoroeste: I. Aspectos metodológicos e características sócio-econômicas / Nutritional conditions indicators in Polonoroeste area: I. Methodological aspects and socio-economic characteristics

O trabalho apresenta os princípios metodológicos que nortearam a organizaçäo da Pesquisa Inquérito Nutricional no Polonoroeste. Foram incluídas, também as informaçöes sobre as característics sócio-econômicas e sanitárias das famílias estudadas em 1985 na zona urbana de Cáceres-MT. Destas 74% eram radicadas em Cáceres e 13,5% provinham de outros estados ou de outros países, sendo que 76,2% residiam em zona urbana. Quanto a categoria social e renda 52% eram urbanos e 51,0% recebia menos de 2 salários mínimos. O inquérito näo atingia os 2 setores mais pobres e populosos da cidade onde as condiçöes säo piores e onde vive a maioria da populaçäo que migrou mais recentemente para Cáceres

Isoimunizacao feto-materna. IV. Mortalidade perinatal. / Feto-maternal isoimmunization. IV. Perinatal mortality

Os 66 recem-nascidos de maes sensibilizadas pelo fator Rh entre 1970 e 1977, como ja especificado em trabalho anterior, foram divididos em tres grupos: Grupo l Recem--nascidos Rh-positivo e Coombs direto positivo. Grupo 2 - Recem-nascidos Rhpositivo e Coombs direto negativo. Grupo 3 Recem nascidos Rh-negativo. No presente trabalho, analisa-se a mortalidade perinatal. Dividindo-se o periodo de estudo em etapas de 1970 a 1973 e de 1974 a 1977, pode-se notar que houve queda da mortalidade neonatal. O fato se deve provavelmente a melhor eficacia da assistencia obstetrica e pediatrica, principalmente pela melhor atencao aos fetos com hemoglobina menor que 14 g/ l00 ml e bilirrubina total maior que 5 mmg/ l00 ml. Sao esses os fetos que recebem maior quantidade de anticorpos