Transplantation and survival of mouse inner ear progenitor/stem cells in the organ of Corti after cochleostomy of hearing-impaired guinea pigs: preliminary results

In mammals, damage to sensory receptor cells (hair cells) of the inner ear results in permanent sensorineural hearing loss. Here, we investigated whether postnatal mouse inner ear progenitor/stem cells (mIESCs) are viable after transplantation into the basal turns of neomycin-injured guinea pig cochleas. We also examined the effects of mIESC transplantation on auditory functions. Eight adult female Cavia porcellus guinea pigs (250-350g) were deafened by intratympanic neomycin delivery. After 7 days, the animals were randomly divided in two groups. The study group (n=4) received transplantation of LacZ-positive mIESCs in culture medium into the scala tympani. The control group (n=4) received culture medium only. At 2 weeks after transplantation, functional analyses were performed by auditory brainstem response measurement, and the animals were sacrificed. The presence of mIESCs was evaluated by immunohistochemistry of sections of the cochlea from the study group. Non-parametric tests were used for statistical analysis of the data. Intratympanic neomycin delivery damaged hair cells and increased auditory thresholds prior to cell transplantation. There were no significant differences between auditory brainstem thresholds before and after transplantation in individual guinea pigs. Some mIESCs were observed in all scalae of the basal turns of the injured cochleas, and a proportion of these cells expressed the hair cell marker myosin VIIa. Some transplanted mIESCs engrafted in the cochlear basilar membrane. Our study demonstrates that transplanted cells survived and engrafted in the organ of Corti after cochleostomy.

Prevalence of the A1555G (12S rRNA) and tRNA Ser(UCN) mitochondrial mutations in hearing-impaired Brazilian patients

Mitochondrial mutations are responsible for at least 1% of the cases of hereditary deafness, but the contribution of each mutation has not yet been defined in African-derived or native American genetic backgrounds. A total of 203 unselected hearing-impaired patients were screened for the presence of the mitochondrial mutation A1555G in the 12S rRNA gene and mutations in the tRNA Ser(UCN) gene in order to assess their frequency in the ethnically admixed Brazilian population. We found four individuals with A1555G mutation (2%), which is a frequency similar to those reported for European-derived populations in unselected samples. On the other hand, complete sequencing of the tRNA Ser(UCN) did not reveal reported pathogenic substitutions, namely A7445G, 7472insC, T7510C, or T7511C. Instead, other rare substitutions were found such as T1291C, A7569G, and G7444A. To evaluate the significance of these findings, 110 "European-Brazilians" and 190 "African-Brazilians" unrelated hearing controls were screened. The T1291C, A7569G and G7444A substitutions were each found in about 1% (2/190) of individuals of African ancestry, suggesting that they are probably polymorphic. Our results indicate that screening for the A1555G mutation is recommended among all Brazilian deaf patients, while testing for mutations in the tRNA Ser(UCN) gene should be considered only when other frequent deafness-causing mutations have been excluded or in the presence of a maternal transmission pattern.

Survey of hearing disorders in an urban population in Rondonia, Northern Brazil

OBJECTIVE: To identify the prevalence of hearing loss for the population in the urban area. METHODS: A cross-sectional household survey based on the World Health Organization Ear and Hearing Disorders Survey Protocol was conducted in 298 households in the urban area of Monte Negro, Rondonia, Northern Brazil, from 2005 to 2007. Ear examinations, behavioral audiometry and pure tone audiometry were conducted on 577 individuals. RESULTS: The results showed that 3.8% (95%CI 2.17;5.45) of population were classified in the disabling hearing impairment category. The prevalence of moderate hearing impairment was 3.4%; severe impairment was 0.4%; and profound hearing impairment was not found. CONCLUSIONS: The impairing hearing loss prevalence found in this study is within of the international prevalence for this level of hearing loss and smaller than observed in a previous study in the South region of Brazil.

Gender and other factors associated with the use of hearing protection devices at work

OBJECTIVE To analyze whether sociodemographic, occupational, and health-related data are associated with the use of hearing protection devices at work, according to gender. METHODS A cross-sectional study was conducted in 2006, using a random sample of 2,429 workers, aged between 18 and 65 years old, from residential sub-areas in Salvador, BA, Northeastern Brazil. Questionnaires were used to obtain sociodemographic, occupational, and health-related data. Workers who reported that they worked in places where they needed to shout in order to be heard were considered to be exposed to noise. Exposed workers were asked whether they used hearing protection devices, and if so, how frequently. Analyses were conducted according to gender, with estimates made about prevalence of the use of hearing protection devices, prevalence ratios, and their respective 95% confidence intervals. RESULTS Twelve percent (12.3%) of study subjects reported that they were exposed to noise while working. Prevalence of the use of hearing protection devices was 59.3% for men and 21.4% for women. Men from higher socioeconomic levels (PR = 1.47; 95%CI 1.14;1.90) and who had previous audiometric tests (PR = 1.47; 95%CI 1.15;1.88) were more likely to use hearing protection devices. For women, greater perceived safety was associated with the use of protection devices (PR = 2.92; 95%CI 1.34;6.34). This perception was specifically related to the presence of supervisors committed to safety (PR = 2.09; 95%CI 1.04;4.21), the existence of clear rules to prevent workplace injuries (PR = 2.81; 95%CI 1.41;5.59), and whether they were informed about workplace safety (PR = 2.42; 95%CI 1.23;4.76). CONCLUSIONS There is a gender bias regarding the use of hearing protection devices that is less favorable to women. The use of such devices among women is positively influenced by their perception of a safe workplace, suggesting that gender should be considered as a factor in hearing conservation programs.

Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

Mapping Nursing language terms of Parkinson's disease

OBJECTIVE Implementing cross-mapping of Nursing language terms with the terminology of NANDA International, contained in records of patients with Parkinson's disease in rehabilitation. METHOD Descriptive study of cross mapping, carried out in three steps. A simple random sample of 67 files of patients who participated in the rehabilitation in the period between March 2009 and April 2013. RESULTS We identified 454 terms of Nursing language that resulted in 54 diagnoses after cross-mapping, present in 11 of the 13 taxonomy domains. The most mapped diagnosis was "Impaired urinary elimination" (59.7%), followed by "Urgent urinary incontinence" (55.2%), "Willingness to self-control improved health" (50.7%), "Constipation" (47.8%) and "Compromised physical mobility" (29.9%). Seven described terms were not mapped due to a corresponding defining characteristic being absent. CONCLUSION It was possible to determine the profile of patients, as well as the complexity of nursing care in the rehabilitation of patients with Parkinson's disease.

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.

Audiometric profile of civilian pilots according to noise exposure

OBJECTIVE To evaluate the audiometric profile of civilian pilots according to the noise exposure level. METHODS This observational cross-sectional study evaluated 3,130 male civilian pilots aged between 17 and 59 years. These pilots were subjected to audiometric examinations for obtaining or revalidating the functional capacity certificate in 2011. The degree of hearing loss was classified as normal, suspected noise-induced hearing loss, and no suspected hearing loss with other associated complications. Pure-tone air-conduction audiometry was performed using supra-aural headphones and acoustic stimulus of the pure-tone type, containing tone thresholds of frequencies between 250 Hz and 6,000 Hz. The independent variables were professional categories, length of service, hours of flight, and right or left ear. The dependent variable was pilots with suspected noise-induced hearing loss. The noise exposure level was considered low/medium or high, and the latter involved periods > 5,000 flight hours and > 10 years of flight service. RESULTS A total of 29.3% pilots had suspected noise-induced hearing loss, which was bilateral in 12.8% and predominant in the left ear (23.7%). The number of pilots with suspected hearing loss increased as the noise exposure level increased. CONCLUSIONS Hearing loss in civilian pilots may be associated with noise exposure during the period of service and hours of flight.

Hearing impairment in patients with tuberculosis from Northeast Brazil

The aim of this paper is to describe the auditory profile of subjects who were given streptomycin treatment for tuberculosis in the years 2000 and 2001, in Recife, Northeast Brazil. The Injury Notification Database at the Municipal Department of Health was consulted and 78 individuals who had been on streptomycin during the period under study were selected. Forty-two individuals were excluded, of whom five were over 59 years of age and two were under 18 years. Nineteen turned out to be deceased, 13 could not be found, two were serving prison terms and one refused to participate. As a result, only 36 subjects participated in the study. These 36 individuals were interviewed and underwent meatoscopy and audiometry. The mean age of the group under study was 38.8 years old and males predominated (79.4%). Twenty-seven patients (75%) showed hearing impairment, the bilateral sensorineural type (63.9%) being the most frequent, mainly affecting the high frequencies over 4000 Hz. In the light of findings showing a high percentage of hearing impairment complaints among users of streptomycin, this issue seems to warrant an in-depth investigation, as does the implementation of an auditory follow-up routine for patients undergoing such chemotherapy for tuberculosis.

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex® 6000 isokinetic dynamometer. The chosen angular velocity was 60 º/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 ± 9.09 Nm / ND = 40.65 ± 9.38 Nm) and extensor (D = 76.92 ± 13.97 Nm / ND = 77.65 ± 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 º/s is proper and safe for isokinetic assessment of elderly people.

Virtual reality in assessment and treatment of schizophrenia: a systematic review

Objective To conduct a systematic review about the use of virtual reality (VR) for evaluation, treatment and/or rehabilitation of patients with schizophrenia, focused on: areas, fields and objectives; methodological issues; features of the VR used; viability and efficiency of this resource. Methods Searches were performed about schizophrenia and virtual reality in PsycINFO, Academic Search Complete, MEDLINE Complete, CINAHL with Full Text, Web of Science and Business Source Premier databases, using the following keywords: [“schizophrenia”] AND [“virtual reality” OR “serious game”] AND [“treatment” OR “therapy” OR “rehabilitation”]. The search was carried out between November 2013 and June 2014 without using any search limiters. Results A total of 101 papers were identified, and after the application of exclusion criteria, 33 papers remained. The studies analysed focused on the use of VR for the evaluation of cognitive, social, perceptual and sensory skills, and the vast majority were experimental studies, with virtual reality specifically created for them. All the reviewed papers point towards a reliable and safe use of VR for evaluating and treating cognitive and social deficits in patients with schizophrenia, with different results in terms of generalisation, motivation, assertiveness and task participation rate. Some problems were highlighted, such as its high cost and a constant need for software maintenance. Conclusion The studies show that using the virtual reality may streamline traditional evaluation/rehabilitation programmes, allowing to enhance the results achieved, both in the cognitive and in the social field, helping for the legitimisation of this population’s psycho-social inclusion.

South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Characterization of anti-silencing factor 1 in Leishmania major

Anti-silencing factor 1 (ASF1) is a histone chaperone that contributes to the histone deposition during nucleosome assembly in newly replicated DNA. It is involved in chromatin disassembly, transcription activation and in the cellular response to DNA damage. In Leishmania major the ASF1 gene (LmASF1) is located in chromosome 20 and codes for a protein showing 67% of identity with the Trypanosoma brucei TbASF1a. Compared to orthologous proteins, LmASF1 conserves the main residues relevant for its various biological functions. To study ASF1 in Leishmania we generated a mutant overexpressing LmASF1 in L. major. We observed that the excess of LmASF1 impaired promastigotes growth rates and had no impact on cell cycle progress. Differently from yeast, ASF1 overproduction in Leishmania did not affect expression levels of genes located on telomeres, but led to an upregulation of proteins involved in chromatin remodelling and physiological stress, such as heat shock proteins, oxidoreductase activity and proteolysis. In addition, we observed that LmASF1 mutant is more susceptible to the DNA damaging agent, methyl methane sulphonate, than the control line. Therefore, our study suggests that ASF1 from Leishmania pertains to the chromatin remodelling machinery of the parasite and acts on its response to DNA damage.

Spatial variability of noise level in agricultural machines

The knowledge of the spatial variability of noise levels and the build of kriging maps can help the evaluation of the salubrity of environments occupied by agricultural workers. Therefore, the objective of this research was to characterize the spatial variability of the noise level generated by four agricultural machines, using geostatistics, and to verify if the values are within the limits of human comfort. The evaluated machines were: harvester, chainsaw, brushcutter and tractor. The data were collected at the height of the operator's ear and at different distances. Through the results, it was possible to verify that the use of geostatistics, by kriging technique, made it possible to define areas with different levels for the data collected. With exception of the harvester, all of machines presented noise levels above than 85 dB (A) near to the operator, demanding the use of hearing protection.

Involvement of hippocampal NMDA receptors in retention of shuttle avoidance conditioning in rats

The purpose of this research was to evaluate the role of hippocampal N-methyl-D-aspartate (NMDA) receptors in acquisition and consolidation of memory during shuttle avoidance conditioning in rats. Adult male Wistar rats were surgically implanted with cannulae aimed at the CA1 area of the dorsal hippocampus. After recovery from surgery, animals were trained and tested in a shuttle avoidance apparatus (30 trials, 0.5-mA footshock, 24-h training-test interval). Immediately before or immediately after training, animals received a bilateral intrahippocampal 0.5-µl infusion containing 5.0 µg of the NMDA competitive receptor antagonist aminophosphonopentanoic acid (AP5) or vehicle (phosphate-buffered saline, pH 7.4). Infusion duration was 2 min per side. Pre-training infusion of AP5 impaired retention test performance (mean ± SEM number of conditioned responses (CRs) during retention test session was 16.47 ± 1.78 in the vehicle group and 9.93 ± 1.59 in the AP5 group; P<0.05). Post-training infusion of AP5 did not affect retention (mean ± SEM number of conditioned responses during retention test session was 18.46 ± 1.94 in the vehicle group and 20.42 ± 2.38 in the AP5 group; P>0.10). This impairment could not be attributed to an effect on acquisition, motor activity or footshock sensitivity since AP5 affected neither training session performance measured by the number of CRs nor the number of intertrial crossings during the training session. These data suggest that NMDA receptors in the hippocampus are critical for retention of shuttle avoidance conditioning, in agreement with previous evidence showing a role of NMDA receptors in fear memory.