The Healthy and Diseased Retina Seen through Neuron-Glia Interactions.

The retina is the sensory tissue responsible for the first stages of visual processing, with a conserved anatomy and functional architecture among vertebrates. To date, retinal eye diseases, such as diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, glaucoma, and others, affect nearly 170 million people worldwide, resulting in vision loss and blindness. To tackle retinal disorders, the developing retina has been explored as a versatile model to study intercellular signaling, as it presents a broad neurochemical repertoire that has been approached in the last decades in terms of signaling and diseases. Retina, dissociated and arranged as typical cultures, as mixed or neuron- and glia-enriched, and/or organized as neurospheres and/or as organoids, are valuable to understand both neuronal and glial compartments, which have contributed to revealing roles and mechanisms between transmitter systems as well as antioxidants, trophic factors, and extracellular matrix proteins. Overall, contributions in understanding neurogenesis, tissue development, differentiation, connectivity, plasticity, and cell death are widely described. A complete access to the genome of several vertebrates, as well as the recent transcriptome at the single cell level at different stages of development, also anticipates future advances in providing cues to target blinding diseases or retinal dysfunctions.

Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies.

OBJECTIVE: Anticitrullinated protein antibodies (ACPA) are a major risk factor for bone loss in rheumatoid arthritis (RA). We have recently shown that ACPA directly induce bone loss by stimulating osteoclast differentiation. As ACPA precede the clinical onset of RA by years, we hypothesised that ACPA positive healthy individuals may already show skeletal changes. METHODS: We performed a comparative micro-CT analysis of the bone microstructure in the metacarpophalangeal joints of ACPA positive and ACPA negative healthy individuals without clinical signs of arthritis. RESULTS: ACPA positive (n=15) and negative (n=15) healthy individuals were not different in age (48.2±4.1 vs 51.4±3.8 years, p=0.57) or gender (eight women and two men in both groups). Bone mineral density was significantly reduced in ACPA positive individuals (mean±SEM 280±11 mg/cm(3)) compared with controls (327±6). Bone loss was based on cortical bone changes, with significant (p=0.044) reduction in cortical thickness in the ACPA positive group (mean±SEM 0.22±0.03 mm) compared with controls (0.32±0.03 mm). Areas of cortical porosity were significantly (p=0.0005) more widespread in ACPA positive (mean±SEM 7.4±1.4%) than in ACPA negative individuals (1.0±0.3%). DISCUSSION: Structural bone damage starts before the clinical onset of arthritis in subjects with ACPA. These findings revise the concept that bone damage is an exclusive consequence of synovitis in patients with RA.

Death ligand TRAIL, secreted by CD1a+ and CD14+ cells in blister fluids, is involved in killing keratinocytes in toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is characterized by an acute detachment and destruction of keratinocytes, affecting large areas of the skin. It is often related to adverse drug reactions. Previous studies have shown that effector CD8+ T cells, which accumulate in the blister fluid, are functionally cytotoxic and act through a classical perforin/granzyme B pathway. It has recently been shown that these cytotoxic T cells also secrete granulysin peptide, which is lethal to keratinocytes. These cytotoxic T cells exert their killer activity against autologous keratinocytes in the presence of the drug. However, they are unlikely to be the only effectors of TEN. We therefore searched for soluble death factors in the blister fluids that might kill keratinocytes. We found that the amounts of interferon-γ, TRAIL and TNF-α proteins were significantly greater in TEN blister fluids than in all controls (normal sera, TEN sera, burns and Eosinophilic pustular folliculitis blister fluids) and TNF-like weak inducer of apoptosis (TWEAK) amounts are also greater in all controls except burns. We showed that these proteins acted in synergy to induce the death of keratinocytes in vitro. We also found that TRAIL and TWEAK were secreted by CD1a+ and CD14+ cells present in the blister fluids. Thus, in addition to MHC class I-restricted cytotoxic T lymphocytes (CTLs), which lyse keratinocytes, ligands secreted by non-lymphoid cells capable of inducing keratinocyte death in an MHC class I-independent manner, also seem to be present in the blister fluids of patients with TEN.

Microbiology of middle meatus in chronic rhinosinusitis.

UNLABELLED: This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31%), coagulase-negative Staphylococcus (CNS) (23%). Gram-negative or facultative microorganisms were isolated in 37% of the samples, anaerobes in 12% and fungi in 14%. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76% of cultures were positive for aerobes and 12% for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40%), Staphylococcus aureus (18%). CONCLUSION: The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.

Fungal rhinosinusitis in patients with chronic sinusal disease.

AIM: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN: clinical retrospective with transversal cohort. MATERIAL AND METHOD: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. RESULTS: The prevalence of FRS was 6.7% and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. CONCLUSIONS: The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.

TWEAK affects keratinocyte G2/M growth arrest and induces apoptosis through the translocation of the AIF protein to the nucleus.

The soluble TNF-like weak inducer of apoptosis (TWEAK, TNFSF12) binds to the fibroblast growth factor-inducible 14 receptor (FN14, TNFRSF12A) on the cell membrane and induces multiple biological responses, such as proliferation, migration, differentiation, angiogenesis and apoptosis. Previous reports show that TWEAK, which does not contain a death domain in its cytoplasmic tail, induces the apoptosis of tumor cell lines through the induction of TNFα secretion. TWEAK induces apoptosis in human keratinocytes. Our experiments clearly demonstrate that TWEAK does not induce the secretion of TNFα or TRAIL proteins. The use of specific inhibitors and the absence of procaspase-3 cleavage suggest that the apoptosis of keratinocytes follows a caspase- and cathepsin B-independent pathway. Further investigation showed that TWEAK induces a decrease in the mitochondrial membrane potential of keratinocytes. Confocal microscopy showed that TWEAK induces the cleavage and the translocation of apoptosis inducing factor (AIF) from the mitochondria to the nucleus, thus initiating caspase-independent apoptosis. Moreover, TWEAK induces FOXO3 and GADD45 expression, cdc2 phosphorylation and cdc2 and cyclinB1 degradation, resulting in the arrest of cell growth at the G2/M phase. Finally, we report that TWEAK and FN14 are normally expressed in the basal layer of the physiological epidermis and are greatly enhanced in benign (psoriasis) and malignant (squamous cell carcinoma) skin pathologies that are characterized by an inflammatory component. TWEAK might play an essential role in skin homeostasis and pathology.

Lugar-escola: espaços educativos / Place-school: educational spaces / Lugar-escuela: espacios educativos / Lieu-école: espaces éducatifs

Este artigo apresenta os debates entre autores que avaliam o ambiente físico de instituições educativas, sua ocupação e, principalmente, a relação entre esses espaços e a aprendizagem dos alunos na escola. Nesse sentido, discorre sobre a relevância do meio físico para os alunos e professores durante o processo de ensino e aprendizagem nos espaços escolares. Assim sendo, o objeto de questionamento é a importância do espaço físico para o ato de ensino, visando a aprendizagem dos alunos. Existem lacunas na ciência pedagógica para o uso desses espaços, as quais resultam em perda de qualidade da aprendizagem quando não há uma apropriação adequada dos espaços escolares, devido à má orientação inicial dos projetos de arquitetura escolar estabelecidos pelo antigo paradigma de utilização das salas de aula. Os professores, a sociedade e a comunidade escolar ainda não estão preparados para visualizar novas possibilidades de usos para os ambientes escolares. A conclusão é que se deve reivindicar, junto aos gestores educacionais, a composição de uma nova arquitetura escolar planejada em conjunto com a comunidade, docentes e alunos para transformar esses espaços em lugares efetivos e colaborativos de ensino e aprendizagem.(AU)

This article presents the debates among authors who evaluate the physical environment of educational institutions, their occupation and, especially, the relationship between these spaces and students' learning. Accordingly, discusses the relevance of the physical environment for students and teachers in the process of teaching and learning in school spaces. Therefore, the object of inquiry is the importance of the physical space for the act of teaching, aimed at student learning. There are gaps in the science of teaching in relation to use of these spaces, which result in loss of quality of learning when there is an inadequate appropriation of school spaces, due to poor initial orientation of the architectural structure of schools, based in the old paradigm of classrooms use. Teachers, society, and school communities are not prepared to see new possibilities of use for school environments. The conclusion is that one should request with the managers, the planning of a new architecture of schools in conjunction with the community, teachers and students to turn these spaces into effective places and of collaborative teaching and learning.(AU)

Este artículo presenta los debates entre autores que evaluación el entorno físico de las instituciones educativas, su ocupación y, especialmente, la relación entre estos espacios y el aprendizaje de los alumnos en la escuela. En este sentido, discute la importancia del entorno físico a los estudiantes y profesores en la enseñanza y el aprendizaje en espacios escolares. Por lo tanto, el objeto de cuestionamiento es la importancia del espacio físico para la ley de educación, destinado al aprendizaje de los alumnos. Hay brechas en Ciencias de la educación para el uso de estos espacios, que resultar en una pérdida de calidad de aprendizaje cuando hay una adecuada apropiación de los espacios escolares, debido a la deficiente orientación inicial de proyectos de arquitectura escolar establecidos por el viejo paradigma del uso de las aulas. Los maestros, la sociedad y la comunidad escolar no están todavía dispuestos a mostrar nuevas posibilidades de aplicaciones para entornos escolares. La conclusión es que debe reclamar, a lo largo de los administradores educativos, la composición de una nueva escuela de arquitectura planeada conjuntamente con la comunidad, profesores y estudiantes para transformar estos espacios en lugares colaborativo y eficaz de enseñanza y aprendizaje.(AU)

Cet article présente les débats entre auteurs qui évaluent l'environnement physique des établissements d'enseignement, leur occupation et, surtout, la relation entre ces espaces et l'apprentissage des élèves à l'école. En ce sens, discute de la pertinence de l'environnement physique, aux étudiants et enseignants au cours de l'enseignement et d'apprentissage des processus dans les espaces de l'école. Par conséquent, l'objet de l'interrogatoire est l'importance de l'espace physique pour la Loi sur l'éducation, visant à l'apprentissage des élèves. Il y a des lacunes en sciences de l'éducation pour l'utilisation de ces espaces, entraînant une perte de qualité de l'apprentissage lorsqu'il y a un crédit suffisant de places dans les écoles, en raison de la mauvaise orientation initiale de projets d'architecture scolaire mis en place par l'ancien paradigme de l'utilisation des salles de classe. Les enseignants, la société et la communauté scolaire ne sont pas encore prêts à montrer les nouvelles possibilités d'utilisations pour l'environnement scolaire. La conclusion est qu'ils doivent réclamer, le long des gestionnaires de l'éducation, la composition d'une nouvelle école d'architecture prévue en collaboration avec la Communauté, les enseignants et les élèves à transformer ces espaces en place efficace et concertée d'enseignement et d'apprentissage.(AU)

Lugar-escola: espaços educativos / Place-school: educational spaces / Lugar-escuela: espacios educativos / Lieu-école: espaces éducatifs

Este artigo apresenta os debates entre autores que avaliam o ambiente físico de instituições educativas, sua ocupação e, principalmente, a relação entre esses espaços e a aprendizagem dos alunos na escola. Nesse sentido, discorre sobre a relevância do meio físico para os alunos e professores durante o processo de ensino e aprendizagem nos espaços escolares. Assim sendo, o objeto de questionamento é a importância do espaço físico para o ato de ensino, visando a aprendizagem dos alunos. Existem lacunas na ciência pedagógica para o uso desses espaços, as quais resultam em perda de qualidade da aprendizagem quando não há uma apropriação adequada dos espaços escolares, devido à má orientação inicial dos projetos de arquitetura escolar estabelecidos pelo antigo paradigma de utilização das salas de aula. Os professores, a sociedade e a comunidade escolar ainda não estão preparados para visualizar novas possibilidades de usos para os ambientes escolares. A conclusão é que se deve reivindicar, junto aos gestores educacionais, a composição de uma nova arquitetura escolar planejada em conjunto com a comunidade, docentes e alunos para transformar esses espaços em lugares efetivos e colaborativos de ensino e aprendizagem.

This article presents the debates among authors who evaluate the physical environment of educational institutions, their occupation and, especially, the relationship between these spaces and students' learning. Accordingly, discusses the relevance of the physical environment for students and teachers in the process of teaching and learning in school spaces. Therefore, the object of inquiry is the importance of the physical space for the act of teaching, aimed at student learning. There are gaps in the science of teaching in relation to use of these spaces, which result in loss of quality of learning when there is an inadequate appropriation of school spaces, due to poor initial orientation of the architectural structure of schools, based in the old paradigm of classrooms use. Teachers, society, and school communities are not prepared to see new possibilities of use for school environments. The conclusion is that one should request with the managers, the planning of a new architecture of schools in conjunction with the community, teachers and students to turn these spaces into effective places and of collaborative teaching and learning.

Este artículo presenta los debates entre autores que evaluación el entorno físico de las instituciones educativas, su ocupación y, especialmente, la relación entre estos espacios y el aprendizaje de los alumnos en la escuela. En este sentido, discute la importancia del entorno físico a los estudiantes y profesores en la enseñanza y el aprendizaje en espacios escolares. Por lo tanto, el objeto de cuestionamiento es la importancia del espacio físico para la ley de educación, destinado al aprendizaje de los alumnos. Hay brechas en Ciencias de la educación para el uso de estos espacios, que resultar en una pérdida de calidad de aprendizaje cuando hay una adecuada apropiación de los espacios escolares, debido a la deficiente orientación inicial de proyectos de arquitectura escolar establecidos por el viejo paradigma del uso de las aulas. Los maestros, la sociedad y la comunidad escolar no están todavía dispuestos a mostrar nuevas posibilidades de aplicaciones para entornos escolares. La conclusión es que debe reclamar, a lo largo de los administradores educativos, la composición de una nueva escuela de arquitectura planeada conjuntamente con la comunidad, profesores y estudiantes para transformar estos espacios en lugares colaborativo y eficaz de enseñanza y aprendizaje.

Cet article présente les débats entre auteurs qui évaluent l'environnement physique des établissements d'enseignement, leur occupation et, surtout, la relation entre ces espaces et l'apprentissage des élèves à l'école. En ce sens, discute de la pertinence de l'environnement physique, aux étudiants et enseignants au cours de l'enseignement et d'apprentissage des processus dans les espaces de l'école. Par conséquent, l'objet de l'interrogatoire est l'importance de l'espace physique pour la Loi sur l'éducation, visant à l'apprentissage des élèves. Il y a des lacunes en sciences de l'éducation pour l'utilisation de ces espaces, entraînant une perte de qualité de l'apprentissage lorsqu'il y a un crédit suffisant de places dans les écoles, en raison de la mauvaise orientation initiale de projets d'architecture scolaire mis en place par l'ancien paradigme de l'utilisation des salles de classe. Les enseignants, la société et la communauté scolaire ne sont pas encore prêts à montrer les nouvelles possibilités d'utilisations pour l'environnement scolaire. La conclusion est qu'ils doivent réclamer, le long des gestionnaires de l'éducation, la composition d'une nouvelle école d'architecture prévue en collaboration avec la Communauté, les enseignants et les élèves à transformer ces espaces en place efficace et concertée d'enseignement et d'apprentissage.

Microbiology of middle meatus in chronic rhinosinusitis.

BACKGROUND: Nasal endoscopy allows the collection of middle meatus secretion samples and is an alternative method for determining microorganisms in rhinosinusitis. This study assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with ipsilateral maxillary sinus aspirates and microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 114 CRS patients for aerobic, anaerobic, and fungal cultures; maxillary sinus secretions were collected from 13 of these patients. Twenty-three healthy volunteers served as controls. RESULTS: Aerobes were isolated in 86% of CRS patients, anaerobes were isolated in 8% of CRS patients, and fungi were isolated in 11% of CRS patients; the most frequent microorganisms were Staphylococcus aureus (36%), coagulase-negative Staphylococcus (20%), and Streptococcus pneumoniae (17%). Middle meatus and maxillary sinus cultures presented the same pathogens in 80% of cases. In healthy individuals, coagulase-negative Staphylococcus (56%), S. aureus (39%), and S. pneumoniae (9%) were the most frequent isolates. CONCLUSION: The culture of endoscopically collected middle meatus secretions is effective in identifying microorganisms in CRS patients.

Microbiologia do meato médio em indivíduos sadios / Microbiology of middle meatus in healthy individuals

Introdução: A microbiologia nasossinusal de indivíduos sadios é pouco documentada. Seu conhecimento permite a determinação dos agentes colonizantes nasossinusais e a monitoração dos padrões de resistência bacteriana. Objetivos: Determinar a microbiologia do meato médio em indivíduos sadios e compará-la com a de pacientes com rinossinusite crônica. Método: Foram incluídos 61 indivíduos sadios. As amostras foram coletadas sob visão endoscópica e submetidas a exame de Gram com contagem leucocitária e cultura para aeróbios, anaeróbios e fungos. 114 pacientes com rinossinusite crônica constituíram o grupo controle. Resultados: Nos indivíduos sadios foram isolados 58 microorganismos, sendo os mais prevalentes Staphylococcus coagulase-negativos, Staphylococcus e Corynebacterium. Fungos foram cultivados em 10%.Todas as amostras apresentaram leucócitos raros ou ausentes. Identificou-se resistência à penicilina em 75% dos Staphylococcus aureus e 69% dos Staphylococcus coagulase-negativos. Quanto à oxacilina, 100% dos Staphylococcus aureus e 92% dos Staphylococcus coagulase-negativos foram sensíveis. No grupo controle foram cultivados 158 microorganismos. Os mais freqüentes foram Staphylococcus aureus e coagulase-negativos. Os Gram-negativos representaram 26% dos aeróbios. Entre as amostras com cultura positiva, 73% apresentavam alguns ou numerosos leucócitos. Conclusão: Ausência ou raridade de leucócitos, Staphylococcus coagulase-negativos e Corynebacterium foram mais freqüentes em sadios, e Streptococcus pneumoniae, anaeróbios, Staphylococcus coagulase-negativos oxacilino-resistentes e Gram-negativos mais freqüentes no grupo controle.

Introduction: The nasosinusal microbiology of healthy individuals is not much documented. Its knowledge allows to determine the nasosinusal colonizing agents and to monitor the patterns of bacterial resistance. Objective: To evaluate the microbiology of the middle meatus in healthy individuals and to compare it with that of patients with chronic rhinosinusitis. Method: 61 healthy individuals were included. The samples were collected under endoscopic view and Gram stained with leucocytes count and aerobic, anaerobic and fungus cultures. 114 patients with chronic rhinosinusitis formed the control group. Results: In healthy individuals 58 microorganisms were isolated. The most frequent ones were coagulase-negative Staphylococcus, Staphylococcus and Corynebacterium. Fungi were cultivated in 10%. There were rare or no white blood cells in all samples. There was penicillin resistance in 75% of the Staphylococcus aureus and 69% of the coagulase-negative Staphylococcus. As for oxacillin, 100% of Staphylococcus aureus and 92% of coagulase-negative Staphylococcus were sensitive. In the control group 158 microorganisms were cultivated. The most common ones were Staphylococcus aureus and coagulase-negative Staphylococcus. Gram-negatives represented 26% of the aerobics. 73% of the samples with positive cultures presented a few or many white blood cells. Conclusion: Rare or no white blood cell, coagulase-negative Staphylococcus and Corynebacterium were more frequent in healthy individuals and Streptococcus pneumoniae, anaerobics and oxacillin resistant coagulase-negative Staphylococcus and Gram-negative were more frequent in the control group.

Microbiologia do meato médio na rinossinusite crônica / Microbiology of middle meatus in chronic rhinosinusitis

Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC) e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31 por cento das amostras, e o Staphylococcus coagulase-negativo (SCN) em 23 por cento. Gram-negativos ou facultativos foram isolados em 37 por cento das amostras, anaeróbios em 12 por cento, e fungos em 14 por cento. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74 por cento das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40 por cento das amostras e o Staphylococcus aureus em 18 por cento. Em 12 por cento dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.

This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31 percent), coagulase-negative Staphylococcus (CNS) (23 percent). Gram-negative or facultative microorganisms were isolated in 37 percent of the samples, anaerobes in 12 percent and fungi in 14 percent. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76 percent of cultures were positive for aerobes and 12 percent for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40 percent), Staphylococcus aureus (18 percent). CONCLUSION: The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.

Aparelhos intraorais: uma opção no tratamento do ronco e da síndrome da apneia-hipopneia obstrutiva do sono / Intraoral appliances: an option in the treatment of snoring and sleep obstructive apnea /hipopnea

A síndrome da apneia-hipopneia obstrutiva do sono (SAHOS) é considerada uma doença evolutiva e com alta taxa de morbimortalidade. O uso dos aparelhos intraorais (AIO) tem importante papel no tratamento da SAHOS, especialmente nos casos leves e moderados. O presente artigo faz uma revisão das causas da SAHOS, seu diagnóstico e opções terapêuticas, segundo diretrizes baseadas em evidências atualizadas. Embora os AIOs ainda apresentem resultados inferiores em relação aos aparelhos com continuous positive airway pressure (CPAP), costumam ser melhor tolerados pelos pacientes, uma vez que são menores e esteticamente mais aceitáveis. Os AIOs, especialmente os de avanço mandibular, são alternativas de tratamento para a SAHOS leve e moderada.

Rinossinusite fúngica em pacientes com infecção nasossinusal crônica / Fungal rhinosinusitis in patients with chronic sinusal disease

OBJETIVO: Estudar a rinossinusite fúngica em pacientes com infecção nasossinusal crônica. Nas últimas décadas houve aumento das infecções fúngicas, e a rinossinusite fúngica (RSF) tem sido mais freqüentemente diagnosticada. O conhecimento da flora fúngica, da sua prevalência e da apresentação sintomática em pacientes portadores de rinossinusite crônica (RSC) permitirá um melhor entendimento da doença, fato importante para a realização do diagnóstico, estabelecimento do tratamento e formulação do prognóstico. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MATERIAL E MÉTODO: 62 pacientes com diagnóstico de RSF foram selecionados entre 890 portadores de RSC submetidos à cirurgia endoscópica. Avaliou-se anamnese, exame otorrinolaringológico com videoendoscopia nasal, TC dos seios da face e exames microbiológicos e histopatológico. RESULTADOS: A prevalência de RSF foi de 6,7% em portadores de RSC submetidos à cirurgia endoscópica dos seios paranasais, e o tipo de fungo mais encontrado foi do gênero Aspergillus. Bola fúngica foi encontrada em mais da metade dos casos, e RSFA, em mais de um terço dos pacientes. CONCLUSÕES: A evolução sintomática após a cirurgia endoscópica foi mais favorável nos portadores de bola fúngica, que necessitaram menor número de reintervenções.

Aim: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS) will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. Study design: clinical retrospective with transversal cohort. Material and method: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic surgery. We assessed clinical history otolaryngologic examination with nasal videoendoscopy, CT scan, microbiologic and histopatologic tests. Results: The prevalence of FRS was 6.7 percent and the fungal type most frequently found was the gender Aspergillus. Fungal ball was found in more than half the cases, and allergic fungal rhinosinusitis (AFRS) in more than one third of the patients. Evolution after endoscopic sinus surgery was more favorable in patients with fungus ball, with a minor number of recurrences. Conclusions: The symptomatic evolution following endoscopic surgery was more favorable in patients with fungal ball, who require a lower number of re-interventions.

A randomized clinical trial with high dose of chloroquine for treatment of Plasmodium falciparum malaria in Brazil

This clinical trial compared parasitological efficacy, levels of in vivo resistance and side effects of oral chloroquine 25 mg/Kg and 50 mg/Kg in 3 days treatment in Plasmodium falciparum malaria with an extended followed-up of 30 days. The study enrolled 58 patients in the 25 mg/Kg group and 66 in the 50 mg/Kg group. All eligible subjects were over 14 years of age and came from Amazon Basin and Central Brazil during the period of August 1989 to April 1991. The cure rate in the 50 mg/Kg group was 89.4% on day 7 and 71.2% on day 14 compared to 44.8% and 24.1% in the 25 mg/Kg group. 74.1% of the patients in the 25 mg/Kg group and 48.4% of the patients in the 50 mg/Kg group had detectable parasitaemia at the day 30. However, there was a decrease of the geometric mean parasite density in both groups specially in the 50 mg/Kg group. There was 24.1% of RIII and 13.8% of RII in the 25 mg/Kg group. Side effects were found to be minimum in both groups. The present data support that there was a high level resistance to chloroquine in both groups, and the high dose regimen only delayed the development of resistance and its administration should not be recommended as first choice in malaria P. falciparum therapy in Brazil

Sinusite fúngica: uma análise clínica em nosso meio / Fungal sinusitis: a clinical analysis

Objetivo: relatar achados microbiológicos, histopatológicos, radiológicos e endoscópicos associados às observações clínicas de pacinetes portadores de sinusite fúngica. Materiais e métodos: foi realizada análise prospectiva de 829 casos compatíveis com sinusopatia crônica, através de tomografia computadorizada e endoscopia nasal, análises clínicas, laboratoriais, microbiológicas e histopatológicas, chegou-se ao diagnóstico de sinusite fúngica em 33 pacientes, os quais foram enquadrados em uma das seguintes classificações_ bola fúngica, sinusite fúngica alérgica, sinusite invasiva aguda (fulminante) ou sinusite indolente ou lentamente invasiva...

Gotejamento pós-nasal como causa de tosse crônica / Post nasal drip as cause of chronic cough

1) Avaliar e descrever os fatores causais de gotejamento pós-nasal (GPN); 2) Analisar o rendimento do diagnóstico da rinoscopia com fibra ótica e tomografia computadorizada de seios paranasais (TC SPN), com o acréscimo da resposta à terapêutica específica. Foram estudados 45 pacientes com tosse crônica e GPN, sem alteraçöes significativas ao exame radiológico do tórax (Rx de tórax). Submetidos a questionário meticuloso, exame físico completo, testes laboratoriais de rotina, Rx de tórax e SPN, testes de funçäo pulmonar (incluindo teste de broncoprovocaçäo), tomografia computadorizada de tórax e SPN, monitorizaçäo do pH esofagiano de 24 horas, fibrobroncoscopia e rinoscopia. Os sinais e sintomas mais freqüentes foram sinal do pigarrear em 30 pacientes (66,7 por cento), tosse produtiva em 23 (51,1 por cento) e aspiraçäo faríngea em 12 (26,7 por cento). As causas mais comuns de GPN foram: rinossinusite em 29 (64,4 por cento), concha bolhosa infectada em sete (15,6 por cento), cistos e pseudocistos em sete (15,6 por cento), rinite em cinco (11,1 por cento), polipose em três (6,6 por cento), degeneraçäo polipóide de cornetos em dois (4,4 por cento) e hipertrofia de adenóide em dois (4,4 por cento). Em 10 casos (3 por cento) a síndrome do GPN era a causa única de tosse e em 35 estava associado a outras condiçöes. 1) A síndrome do GPN é uma causa comum de tosse crônica; 2) Rinosinusite é a causa mais freqüente de GPN (64 por cento); 3) Há menor sensibilidade do Rx comparado com TC SPN; 4) A rinoscopia com fibra ótica constitui alternativa válida para TC SPN com acurácia equivalente.

Endoscopia nasal (rinoscopia com fibra óptica): sua introdução na rotina clínica do pneumologista / Nasal endoscopy, its introduction in the daily practice of pneumologists

O diagnóstico de sinusites, pólipos, desvios de septo e outras patologias das cavidades nasais e seios paranasais foi facilitado com o aparecimento da endoscopia nasal ou rinoscopia com fibra óptica. O profissional capacitado consegue obter não apenas o diagnóstico da patologia mas pode acompanhar o progresso do tratamento clínico recomendado, bem como o pós-operatório de cirurgias rinosinusais. Talvez a falta de informações adequadas impeça que outros profissionais, além do otorrinolaringologista, utilizem a endoscopia nasal em sua rotina. As técnicas e equipamentos utilizados atualmente são de fácil manejo, possibilitando uma margem mínima de erros diagnósticos. Estas são razões suficientes para que a endoscopia nasal seja introduzida na rotina clínica do pneumologista

Sinuisite fúngica: uma análise clínica em nosso meio / Fungal sinusitis: a clinical analysis in our reality

Sinusite fúngica é uma entidade que vem recebendo especial atenção nos dias de hoje, entre as diversas modalidades de afecções do trato respiratório, devido ao aumento de sua incidência. Para fins de classificação, essa patologia se divide em duas formas: não invasiva (sinusite fúngica alérgica, "bola fúngica" ou micetoma) e invasiva (sinusite fúngica invasiva fulminante, sinusite fúngica indolente ou lentamente invasiva). Sua apresentação clínica é inespecífica, não existindo sinais e sintomas definitivos de seu diagnóstico. Este necessita da comprovação microbiológica, histopatológica, radiológica e endoscópica associadas às observações clínicas. O presente estudo tem como objetivo um relato desses principais achados numa população de 26 pacientes estudados prospectivamente.

Sinusitis fúngica / Fungal Sinusitis

La sinusitis fúngica es una entidad que viene recibiendo especial atención entre las diferentes modalidades de afecciones del tracto respiratorio debido al aumento de su incidencia. Esa patología se divide en dos formas: no invasoras (sinusitis fúngica alérgica y bola fúngica) e invasora (sinusitis fúngica invasora fulminante y sinusitis lentamente invasora). Su clínica no es específica, no existiendo señales y síntomas definitivos de su diagnóstico. Este necesita de la comprobación microbiológica, histopatológica y radiológica asociados a las observaciones clínicas. Se realizó un análisis prospectivo de 962 casos con hallazgos clínicos, endoscópicos, radiológicos y tomográficos compatibles con sinusopatía crónica, los cuales fueron sometidos a procedimientos quirúrgicos endoscópicos sinusal funcional, se llegó al diagnóstico de sinusitis fúngica en 26 (3,75 por ciento) de los pacientes de la serie.

Fungal sinusitis is a clinical entity that has been receiving increasing attention, nowadays, among the several types of upper respiratory tract diseases due to its growing incidence. By means of classification, this pathology can be divided in two forms: non invasive (allergic fungal sinusitis or "fungus ball") and invasive (acute or fulminat invasive fungal sinusitis, slow invasive fungal sinusitis). This affection has an unspecific clinical presentation: there are no clinical signs that can define its diagnosis. The late relies on microbiologic, histopatogic, radiological and endoscopic finds associated with the patient clinical presentation. The purpose of this paper is to present this finding in a prospective study in a 26 patient’s population.

Riscos relativos de gotejamento pós-nasal, hiper-reatividade brônquica e refluxo gastroesofágico em tosse crônica / Chronic cough

Neste artigo abordam-se os mecanismos etiopatogênicos implicdos nos pacientes com tosse crônica, sendo assim considerados aqueles cujos sintomas tenham duração superior a três semanas. Discutem-se os mais recentes avanços que permitiram chegar ao conceito de tríade patogênica da tosse crônica e que estão relacionados ao emprego da tomografia computadorizada de seios paranasais, à monitorização prolongada do pH intraesofagiano e ao teste de broncoprovocação com agentes químicos. O uso do termo tríade patogênica da tosse crônica deve-se à análise de vários estudos na literatura internacional confirmados definitivamente pelo grupo do Pavilhão Pereira Filho, segundo os quais na maioria das vezes ocorre a presença simultânea de duas ou três das seguintes causas: síndrome do gotejamento pós-nasal, hiper-reatividade brônquica e refluxo gastroesofágico. Especulam-se os mecanismos pelos quais os componentes desta tríade estão associados