Utilização do questionário ERG na avaliação do grau de satisfação dos pacientes submetidos à otoplastia em um serviço de residência médica de otorrinolaringologia

A importância da intervenção cirúrgica em diminuir o sofrimento psicológico e melhorar a autoestima em pacientes com deformidades auriculares já está bem documentada. As pesquisas têm focado nos resultados das terapias com ênfase no paciente, observando principalmente satisfação, resultado funcional e impacto na qualidade de vida. Quantificar alterações na qualidade de vida tem sido um desafio. O uso de inquéritos válidos, a exemplo da Escala de Resultados de Glasgow (ERG), auxiliam na obtenção dos dados. OBJETIVO: Avaliar o impacto na qualidade de vida dos pacientes submetidos à otoplastia realizada em serviço de residência médica, utilizando como base a ERG, bem como sua funcionalidade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo incluindo pacientes submetidos à otoplastia entre julho de 2009 e julho de 2010. Os dados foram coletados por meio de questionário oferecido ao paciente no retorno pós-operatório. RESULTADOS: Trinta e seis pacientes responderam ao questionário. Houve aumento na qualidade de vida, demonstrado pelas medianas positivas obtidas pelo questionário. Não houve diferença significativa quanto aos valores obtidos entre os sexos e entre diferentes faixas etárias. CONCLUSÃO: Os pacientes mostraram-se satisfeitos com o resultado pós-operatório. Houve aumento de qualidade de vida, conforme demonstrado pelos resultados positivos. A ERG pareceu-nos fácil e elucidativa.

Saúde auditiva: adaptação de AASI em indivíduos com anomalias craniofaciais, discussão de casos clínicos

As malformações de orelha são anomalias craniofaciais que ocorrem no período de desenvolvimento embrionário, podem acometer tanto a orelha externa, como a média e/ou a interna, e apresentam-se uni ou bilateralmente. A deficiência auditiva é um dos achados clínicos mais comum, cujo tipo e grau pode variar de acordo com as estruturas comprometidas. Para os casos de malformações bilaterais, a preocupação está relacionada ao desenvolvimento de fala e linguagem, sendo imprescindível o diagnóstico audiológico precoce, seguido de intervenção. As possibilidades de tratamento para as malformações de orelha incluem: a adaptação de aparelho de amplificação sonora individual (AASI) por condução aérea ou por condução óssea, a adaptação de próteses auditivas de orelha média cirurgicamente implantáveis e/ou a reconstrução cirúrgica da orelha. Quando na indicação do AASI, o mais comum é a adaptação do dispositivo auditivo por condução óssea, o qual consiste de um vibrador eletromagnético pressionado contra a mastóide, sustentado por um arco ao redor da cabeça. A onda sonora captada pelo microfone é convertida em vibrações eletromagnéticas que serão transmitidas à cóclea. Porém, é importante investigar as condições anatômicas da orelha externa malformada, de modo a verificar a possibilidade da introdução do molde auricular e da sustentação do dispositivo auditivo retroauricular por condução aérea. O objetivo deste estudo é discutir alguns casos clínicos de indivíduos portadores de malformação de orelha externa e/ou média, usuários de AASI por condução óssea e aérea, atendidos na Divisão de Saúde Auditiva-HRAC-USP-Bauru

In-the-canal versus behind-the-ear microphones improve spatial discrimination on the side of the head in bilateral cochlear implant users

To test whether in-the-canal (ITC) microphones have an impact on spatial discrimination and speech perception by taking advantage of auricular cues.

A bone-thickness map as a guide for bone-anchored port implantation surgery in the temporal bone

The bone-anchored port (BAP) is an investigational implant, which is intended to be fixed on the temporal bone and provide vascular access. There are a number of implants taking advantage of the stability and available room in the temporal bone. These devices range from implantable hearing aids to percutaneous ports. During temporal bone surgery, injuring critical anatomical structures must be avoided. Several methods for computer-assisted temporal bone surgery are reported, which typically add an additional procedure for the patient. We propose a surgical guide in the form of a bone-thickness map displaying anatomical landmarks that can be used for planning of the surgery, and for the intra-operative decision of the implant’s location. The retro-auricular region of the temporal and parietal bone was marked on cone-beam computed tomography scans and tridimensional surfaces displaying the bone thickness were created from this space. We compared this method using a thickness map (n = 10) with conventional surgery without assistance (n = 5) in isolated human anatomical whole head specimens. The use of the thickness map reduced the rate of Dura Mater exposition from 100% to 20% and OPEN ACCESS Materials 2013, 6 5292 suppressed sigmoid sinus exposures. The study shows that a bone-thickness map can be used as a low-complexity method to improve patient’s safety during BAP surgery in the temporal bone.

Sparse spectral analysis of atrial fibrillation electrograms

Atrial fibrillation (AF) is a common heart disorder. One of the most prominent hypothesis about its initiation and maintenance considers multiple uncoordinated activation foci inside the atrium. However, the implicit assumption behind all the signal processing techniques used for AF, such as dominant frequency and organization analysis, is the existence of a single regular component in the observed signals. In this paper we take into account the existence of multiple foci, performing a spectral analysis to detect their number and frequencies. In order to obtain a cleaner signal on which the spectral analysis can be performed, we introduce sparsity-aware learning techniques to infer the spike trains corresponding to the activations. The good performance of the proposed algorithm is demonstrated both on synthetic and real data. RESUMEN. Algoritmo basado en técnicas de regresión dispersa para la extracción de las señales cardiacas en pacientes con fibrilación atrial (AF).

Surdez súbita : a marcha diagnóstica

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Doente idoso com doença cardíaca em medicina dentária

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Direct electrospinning of 3D auricle-shaped scaffolds for tissue engineering applications.

Thirty-two poly(ε)caprolactone (PCL) scaffolds have been produced by electrospinning directly into an auricle-shaped mould and seeded with articular chondrocytes harvested from bovine ankle joints. After seeding, the auricle shaped constructs were cultured in vitro and analysed at days 1, 7, 14 and 21 for regional differences in total DNA, glycosaminoglycan (GAG) and collagen (COL) content as well as the expression of aggrecan (AGG), collagen type I and type II (COL1/2) and matrix metalloproteinase 3 and 13 (MMP3/13). Stress-relaxation indentation testing was performed to investigate regional mechanical properties of the electrospun constructs. Electrospinning into a conductive mould yielded stable 3D constructs both initially and for the whole in vitro culture period, with an equilibrium modulus in the MPa range. Rapid cell proliferation and COL accumulation was observed until week 3. Quantitative real time PCR analysis showed an initial increase in AGG, no change in COL2, a persistent increase in COL1, and only a slight decrease initially for MMP3. Electrospinning of fibrous scaffolds directly into an auricle-shape represents a promising option for auricular tissue engineering, as it can reduce the steps needed to achieve an implantable structure.

Essays,

A Jesuit reformer and poet [F. [Spee] (19th cent., August, 1885)--Revelations of the after-world (19th cent., February, 1887)--Savonarola (The Weekly register, September, 1899)--M. Emery, superior of St. Sulpice (1789-1811) (Dub. R., October, 1887)--Auricular confession.--The pope and the Anglican archbishops (19th cent., July, 1897)--Ritualism, Roman Catholicism, and converts (Contemp., February, 1879)--On certain ecclesiastical miracles (19th cent., August 1891)--Irresponsible opinion (Macmil., March, 1885)--The ethics of war (19th cent., May 1899)--The passion of the past (Macmil., September, 1887)--Some memories of a prison chaplain (Macmil., February, 1898)--Purcell's life of Cardinal Manning.--Appendix: Some notes on Fr. Ryder's controversy with Dr. Ward.

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

AIMS: The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. METHODS: LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). CONCLUSIONS: LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

Meta-analysis of the influence of chronic kidney disease on the risk of thromboembolism among patients with nonvalvular atrial fibrillation

Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism in patients with nonvalvular AF and the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis method. Data sources included MEDLINE, EMBASE, and Cochrane (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the presence of CKD resulted in an increased risk of thromboembolism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.20 to 1.76, p = 0.0001), particularly in case of end-stage CKD (HR 1.83, 95% CI 1.56 to 2.14, p <0.00001). Warfarin decreased the incidence of thromboembolic events in patients with non-end-stage CKD (HR 0.39, 95% CI 0.18 to 0.86, p <0.00001). Recent data on novel oral anticoagulants suggested a higher efficacy of these agents compared with warfarin (HR 0.80, 95% CI 0.66 to 0.96, p = 0.02) and aspirin (HR 0.32, 95% CI 0.19 to 0.55, p <0.0001) in treating non-end-stage CKD. In conclusion, the presence of CKD in patients with AF is associated with an almost 50% increased thromboembolic risk, which can be effectively decreased with appropriate antithrombotic therapy. Further prospective studies are needed to better evaluate the interest of anticoagulation in patients with severe CKD.

Estudio comparativo del tratamiento de la dismenorrea con auriculoterapia y sulindac en estudiantes del Colegio Garaicoa. Cuenca 1996-1997

Con la finalidad de ofrecer un tratamiento alternativo de fácil aplicación, sin efectos colaterales, orientado a disminuir las molestias causadas por la dismenorrea, realizamos un estudio clínico controlado a 60 estudiantes del Colegio Manuela Garaicoa de Calderón, que fueron seleccionadas al azar, de acuerdo con criterios de inclusión y exclusión, de entre 947 alumnas, luego de la aplicación de una encuesta estructurada. Se constituye, al azar dos grupos, de 30 alumnas cada una; el

Caracterización funcional de las proteínas TasA y TapA en la formación de fibras de tipo amiloide en Bacillus subtilis

Las proteínas amiloides son un grupo heterogéneo de proteínas diferentes en secuencia aminoacídica, pero similares en su estructura cuaternaria: fibras enriquecidas en láminas beta, con gran estabilidad, resistencia y capacidad de unión de colorantes específicos, como el rojo congo o la thioflavina T. Estas proteínas han estado tradicionalmente asociadas a patologías neurodegenerativas en humanos como el Alzheimer o el Parkinson. Sin embargo, los miembros dentro de esta familia están ampliamente distribuidas en la naturaleza, desde bacterias hasta humanos, e intervienen en un amplio rango de funciones biológicas, motivo por el que se han denominado “amiloides funcionales”. En bacterias, los amiloides funcionales son responsables de participar en funciones muy diversas como la interacción célula-célula, con superficies abióticas, y formación de biofilms. En Bacillus subtilis, la proteína amiloide TasA es el componente proteico mayoritario de la matriz extracelular del biofilm de este microorganismo y el principal elemento que constituye las fibras amiloides, mientras que la proteína auxiliar TapA, presente en mucha menor proporción, actúa favoreciendo el ensamblaje de las mismas. Estas actúan como un andamiaje proteico donde se disponen el resto de componentes de la matriz extracelular, lo que confiere a esta estructura una mayor estabilidad y, por consiguiente, proporcionan una mayor robustez al biofilm. En este este trabajo se pretende llevar a cabo el análisis de regiones o dominios tanto de TasA como de TapA importantes para la amiloidogénesis, así como para la funcionalidad de ambas proteínas. Para ello, el estudio se ha enfocado desde un punto de vista multidisciplinar, combinando pruebas clásicas de caracterización de amiloides con técnicas de biología molecular y diversas pruebas biofísicas. Los resultados obtenidos hasta la fecha han demostrado la existencia de pequeñas secuencias, dentro de las proteínas TasA o TapA con capacidad para polimerizar en la forma de fibras, lo que muestra su importancia en el proceso de fibrilación y en la funcionalidad de ambas proteínas. En el caso de la proteína TapA, las regiones analizadas ponen de manifiesto la importancia de su extremo amino-terminal tanto en la funcionalidad de la proteína como en su interacción con TasA.

Interatrial block and atrial arrhythmias in centenarians: Prevalence, associations, and clinical implications

Data are lacking on the characteristics of atrial activity in centenarians, including interatrial block (IAB). The aim of this study was to describe the prevalence of IAB and auricular arrhythmias in subjects older than 100 years and to elucidate their clinical implications. We studied 80 centenarians (mean age 101.4 ± 1.5 years; 21 men) with follow-ups of 6–34 months. Of these 80 centenarians, 71 subjects (88.8%) underwent echocardiography. The control group comprised 269 septuagenarians. A total of 23 subjects (28.8%) had normal P wave, 16 (20%) had partial IAB, 21 (26%) had advanced IAB, and 20 (25.0%) had atrial fibrillation/flutter. The IAB groups exhibited premature atrial beats more frequently than did the normal P wave group (35.1% vs 17.4%; P < .001); also, other measurements in the IAB groups frequently fell between values observed in the normal P wave and the atrial fibrillation/flutter groups. These measurements included sex preponderance, mental status and dementia, perceived health status, significant mitral regurgitation, and mortality. The IAB group had a higher previous stroke rate (24.3%) than did other groups. Compared with septuagenarians, centenarians less frequently presented a normal P wave (28.8% vs 53.5%) and more frequently presented advanced IAB (26.3% vs 8.2%), atrial fibrillation/flutter (25.0% vs 10.0%), and premature atrial beats (28.3 vs 7.0%) (P < .01). Relatively few centenarians (<30%) had a normal P wave, and nearly half had IAB. Our data suggested that IAB, particularly advanced IAB, is a pre–atrial fibrillation condition associated with premature atrial beats. Atrial arrhythmias and IAB occurred more frequently in centenarians than in septuagenarians.