The difficult coughing child:prolonged acute cough in children

Cough is one of the most common symptoms that patients bring to the attention of primary care clinicians. Cough can be designated as acute ( 8 weeks in duration). The use of the term 'prolonged acute cough' in a cough guideline allows a period of natural resolution to occur before further investigations are warranted. The common causes are in children with post viral or pertussis like illnesses causing the cough. Persistent bacterial bronchitis typically occurs when an initial dry acute cough due to a viral infection becomes a prolonged wet cough remaining long after the febrile illness has resolved. This cough responds to a completed course of appropriate antibiotics.

The lip:A histologic and analytical approach of relevance to esthetic plastic surgery

This is a study done for the first time to understand the histologic features of the lip deeply, quantitatively, and analytically and identify the differences between the outer, intermediate, and inner parts of the lips. Previous researchers did not tackle the histologic features of the lip from this point of view. Half lip was obtained from different well-preserved cadavers where the upper lip, lower lip, and lip angle were evaluated by coronal histologic sections. A total of 43 slides were studied and photographed using light and digital microscopes (Nikon COOLSCOPE, Nikon Corporation, Tokyo, Japan), respectively. The cadavers (26 men and 17 women) were in the age group of 45 to 65 years old, and older than 65 years. Data were entered on a study pro forma and statistically analyzed. Normal histologic features of the upper lip, intermediate, and the inner lip sections were observed. Fibrous septations that sometimes had muscular components inserting into them could be identified. In between these septations, there were loose areas (chambers). The mean numbers of chambers identified in the upper and lower lips were higher in the red areas, and more septations and chambers were identified in the lower lip. New histologic observations were classified into types 1 to 7. Significant relations were identified between the total number of septations and chambers in relation to age group and sex. Higher means of septations and chambers were detected in the age group older than 65 years, and in women as a whole. In conclusion, the findings detected in this work could explain the congenital lip pits that are familial or syndromic and many post-lip augmentation complications. © 2009 Lippincott Williams & Wilkins, Inc.

Interferon-γ stimulates CD14, TLR2 and TLR4 mRNA expression in gingival fibroblasts increasing responsiveness to bacterial challenge

Objective: To investigate the potential effects of IFN-y on the responsiveness of human gingival fibroblasts to bacterial challenge.
Design :mRNA and protein expression of CD14, TLR2 and TLR4 in human gingival fibroblasts was detected by quantitative polymerase chain reaction (Q-PCR) and flow cytometry. The effect of preincubation with IFN-y on subsequent bacterial LPS-induced expression of IL-6 and IL-8 by gingival fibroblasts was determined by ELISA. Bacterial LPS-induced IκBα degradation in human gingival fibroblasts was investigated by western blot.
Results: Human gingival fibroblasts express CD14, TLR2 and TLR4 mRNAs. IFN-y, but not IL-1B, induced mRNA expression of all three receptors and the expression of membrane bound CD14 protein. Pre-incubation of fibroblasts with IFN-y and subsequent stimulation with Escherichia coli LPS or Porphyromonas gingivalis LPS led to increased production of IL-6 and IL-8. LPS-induced pro-inflammatory cytokine production was abrogated by a blocking antibody to CD14. Both E. coli LPS and P. gingivalis LPS induced IκBα degradation in human gingival fibroblasts.
Conclusion: Our data indicate that IFN-y primes human gingival fibroblasts, through the upregulation of CD14 expression, which results in increased responsiveness to bacterial LPS challenge, as determined by pro-inflammatory cytokine production.

A Clinical Support System Based on Quality of Life Estimation

Quality of life is a concept influenced by social, economic, psychological, spiritual or medical state factors. More specifically, the perceived quality of an individual's daily life is an assessment of their well-being or lack of it. In this context, information technologies may help on the management of services for healthcare of chronic patients such as estimating the patient quality of life and helping the medical staff to take appropriate measures to increase each patient quality of life. This paper describes a Quality of Life estimation system developed using information technologies and the application of data mining algorithms to access the information of clinical data of patients with cancer from Otorhinolaryngology and Head and Neck services of an oncology institution. The system was evaluated with a sample composed of 3013 patients. The results achieved show that there are variables that may be significant predictors for the Quality of Life of the patient: years of smoking (p value 0.049) and size of the tumor (p value < 0.001). In order to assign the variables to the classification of the quality of life the best accuracy was obtained by applying the John Platt's sequential minimal optimization algorithm for training a support vector classifier. In conclusion data mining techniques allow having access to patients additional information helping the physicians to be able to know the quality of life and produce a well-informed clinical decision.

Metástases temporais: a propósito de um caso clínico

A metastização óssea para a cabeça e pescoço é rara. Em 20-35% dos casos, pode ser a primeira manifestação de uma neoplasia oculta. No caso específico do osso temporal, as metástases são originárias, mais frequentemente, da mama, pulmão, rim, próstata e estômago. Apresenta-se o caso clínico de uma doente, do sexo feminino, 71 anos, com Diagnóstico de Carcinoma Ductal tipo Cribiforme na mama esquerda, tendo sido submetida a mastectomia total, quimioterapia e radioterapia. À observação apresentava um quadro clínico de otalgia esquerda, associada a paralisia facial da hemiface ipsilateral, sem outros sintomas otológicos. Foi-lhe diagnosticada Otite Média Crónica agudizada, tendo sido medicada e pedida Tomografia Computorizada ao Ouvido Esquerdo, que demonstrou exuberante espessamento dos tecidos moles epicranianos temporo-parieto-occipitais à esquerda com extensão ao canal auditivo externo do mesmo lado. Por agravamento da sintomatologia, foi internada no Serviço de Otorrinolaringologia deste hospital para administração de terapêutica endovenosa, tendo-se admitido a hipótese diagnóstica de Otite Externa Maligna. Por manutenção do quadro, apesar de terapêutica optimizada, foi submetida a intervenção cirúrgica onde foi efectuada biopsia temporal, tendo sido diagnosticado lesão metastática por carcinoma invasivo da mama.

Caraterização do acesso ao Centro Hospitalar Lisboa Norte, EPE : análise do acesso e da utilização da consulta externa e da urgência do Centro Hospitalar Lisboa Norte, EPE

RESUMO - Introdução: As alterações verificadas no dimensionamento e na redistribuição da rede de prestação de cuidados hospitalares, nomeadamente no que confere à reorganização das áreas de influência, e, cumulativamente, à abertura do Hospital Beatriz Ângelo, tornam evidente a necessidade de se analisar o acesso e a utilização da consulta externa e da urgência, antes e depois destas alterações. Objetivo: Este trabalho de investigação tem como principal objetivo analisar o acesso e a utilização da consulta externa e da urgência do Centro Hospitalar Lisboa Norte e verificar a evolução desse mesmo acesso, no período de 2010 a 2013. Material e Métodos: Estudo descritivo que visa determinar a frequência e a distribuição dos episódios de Consulta Externa e de Urgência do Centro Hospitalar Lisboa Norte. Foram considerados todos os episódios de consulta externa (3785579 episódios) e de urgência (1140052 episódios) ocorridos entre 1 de janeiro de 2010 e 31 de dezembro de 2013. Resultados: Entre 2010 e 2013, verificou-se o aumento de +2,3% no número de primeiras consultas e de +5%, em consultas subsequentes. As especialidades médicas com maior afluência são Oftalmologia, Dermatologia I, Pediatria e Otorrinolaringologia I. Observou-se, no total de consultas, qual a percentagem que, em cada ano, obteve um tempo de espera inferior a 1 mês, entre a marcação e a realização da consulta: 56,7%, em 2010; 54,3%, em 2011; 55% em 2012; 56,2%, em 2013. Verificou-se o decréscimo do número de atendimentos de urgência, no período em análise, de -38,9%. Cerca de 90% dos atendimentos de urgência respeitam a utentes que acorrem diretamente à urgência sem virem referenciados de outras unidades de saúde. Os meses de janeiro e fevereiro são aqueles que registam maior afluência, 9,9% e 8,8%, respetivamente. O período de maior afluência regista-se entre as 9 e as 11 horas, representando 20,7% dos episódios, em 2010, 21,2%, em 2011, 21% e 20,5%, em 2012 e 2013, respetivamente. Conclusão: Face à alteração da área de influência do Centro Hospitalar Lisboa Norte, torna-se necessária a adaptação da capacidade instalada para haja um sobredimensionamento face à procura, bem como a adequação de recursos internos, financeiros, humanos e tecnológicos.

Uso de la Hibridación Genómica Comparativa-Array (HGC-a) en pacientes con retraso global del desarrollo y fenotipo particular. Revisión sistemática de la literatura

Introducción: la hibridación genómica comparativa en una técnica que permite la exploración de las anormalidades cromosómicas. Su utilidad en la aproximación de los pacientes con retraso global del desarrollo o fenotipo dismórfico, sin embargo, no ha sido explorada mediante una revisión sistemática de la literatura. Metodología: realizó una revisión sistemática de la literatura. Se incluyeron estudios controlados, cuasi-experimentales, de cohortes, de casos y controles, transversales y descriptivos publicados en idiomas inglés y español entre los años 2000 y 2013. Se realizó un análisis de la evidencia con un enfoque cualitativo y cuantitativo. Se realizó un análisis del riesgo de sesgo de los estudios incluidos. Resultados: se incluyeron 4 estudios que cumplieron con los criterios de inclusión. La prevalencia de alteraciones cromosómicas en los niños con retraso global del desarrollo fue de entre el 6 y 13%. El uso de la técnica permitió identificar alteraciones que no fueron detectadas mediante el cariotipo. Conclusiones: la hibridación genómica comparativa es una técnica útil en la aproximación diagnóstica de los niños con retraso global del desarrollo y del fenotipo dismórfico y permite una mayor detección de alteraciones comparada con el cariotipo.

Alteraciones respiratorias durante el sueño en niños con Síndrome Down a la altura de Bogotá

Objetivo: determinar la frecuencia de las diferentes alteraciones respiratorias durante el sueño (ARS) e hipertensión pulmonar (HTP) y establecer la saturación de oxígeno (SpO2) en vigilia, sueño y durante los eventos en niños con Síndrome Down (SD) a la altura de Bogotá (2640m) de acuerdo a grupos de edad e IMC. Métodos: estudio descriptivo de corte transversal, se incluyeron todos los niños con SD con sospecha de ARS remitidos a polisonograma (PSG) de octubre de 2011 a enero de 2013 a la Fundación Neumológica Colombina (FNC). Se dividieron en 3 grupos: apnea obstructiva, apnea obstructiva y central, sin apneas. Resultados: 74 niños, el 36,5% mujeres, edad media 4 años. 47,3% presento apnea obstructiva, más frecuente en >2 años, 35,1% apnea obstructiva y central, más frecuente en < 2 años y 17,6 % sin apnea. SpO2 promedio en apnea obstructiva 84,63%, apnea obstructiva y central: 81,8% y sin apnea: 86,85% (p 0,058). 23% presento obesidad, 16% con apnea obstructiva. 53 pacientes tenían ecocardiograma: 28% HTP, 53,3% tuvo apnea obstructiva y 26,7 apnea obstructiva y central, no diferencias significativas. SpO2 promedio en HTP 88,3% vigilia, 86,2% sueño REM, 85,7 % sueño no REM, no diferencia significativa comparada con pacientes sin HTP. Conclusiones: Las ARS son frecuentes en los niños con SD, La desaturación está presente en los niños con SD independiente del tipo de apnea. A todos los niños SD se les debe practicar un PSG en el primer año de vida.

Prevalencia de alteraciones audiométricas y su relación con exposición a ruido ocupacional y extra ocupacional, en una cohorte de trabajadores de Santander, Colombia, Años 2014-2015

La hipoacusia neurosensorial inducida por ruido (HNIR) definida como la pérdida de la capacidad auditiva secundaria a la exposición ocupacional continua o intermitente a ruido en el lugar de trabajo, es la cuarta enfermedad ocupacional en prevalencia en Colombia. Objetivo: Determinar la prevalencia de alteraciones audiométricas y su relación con exposición a ruido ocupacional y extra ocupacional, en un grupo de trabajadores que asistieron a una IPS de la ciudad de Bucaramanga en el periodo comprendido entre agosto de 2014 y agosto de 2015. Diseño: Se realizó un estudio de corte transversal con 2725 registros de las historias clínicas de fonoaudiología realizadas a los trabajadores con audiometría tonal como parte de los exámenes ocupacionales, entre el 1 de agosto de 2014 al 31 de agosto de 2015, en una Institución Prestadora de Salud (IPS) ocupacional, en la ciudad de Bucaramanga, Santander. Resultados: El 17.2% de los trabajadores presentaron alteraciones audiométricas, de estos el 33,1%, cumplió con los criterios definidos en el estudio para ser calificados como casos probables de hipoacusia neurosensorial inducida por ruido, de estos el 87,8% fueron clasificados como leves, 10,8% como moderados y el 1,2% como moderado severo, no se registraron casos de HNIR severa o profunda. El 62,7% se clasificaron como no HNIR y el 4% correspondió a hipoacusias con afectación de frecuencias conversacionales. Conclusiones: Al aplicar un modelo de regresión logística para controlar las variables de confusión, no se encontró asociación con ninguna de las variables anteriormente descritas. A pesar de esto, existe suficiente evidencia de la relación entre algunas ocupaciones y la HNIR.

Influence of Abusive Vocal Habits, Hydration, Mastication, and Sleep in the Occurrence of Vocal Symptoms in Teachers

Some vocal disorders in teachers are associated with occupational factors, but there are few studies that analyze the influence of vocal habits, fluid intake, mastication, and sleep on these disorders. The objective was to analyze the Occurrence of vocal fatigue, hoarseness, and dry throat in elementary and high school teachers and their association with vocal habits, fluid intake, mastication, and sleep. A sample of 422 elementary and secondary school teachers was Studied using a specific questionnaire. The multiple regression analysis showed that hoarseness was associated with absence of water intake (odds ratio (OR) = 1.7; P = 0.047), yelling/speaking loudly (OR = 1.6; P = 0.058), jaw-opening limitations (OR = 3.8; P = 0.003). average of: 6 hours of sleep/light (OR = 1.7; P = 0.039), and waking-up feeling replenished (OR = 2.0; P = 0.020). The presence of vocal fatigue was significantly associated with yelling/speaking loudly (OR = 2.2: P = 0.013), speaking excessively (OR = 2.4; P = 0.023), difficulty to open the mouth to masticate (OR = 6.6; P = 0.003), less than 6 hours of sleep (OR = 4.0; P = 0.008), and waking-up feeling replenished (sometimes OR = 2.8: P = 0.003; or never OR = 3.3 P = 0.002). The presence of dry throat was associated with being a former smoker (OR = 3.3; P = 0.011) and having jaw-opening limitations (OR = 3.9; P = 0.021). In recent years, speech and hearing interventions with teachers have focused on health-care promotion actions and prevention of vocal disorders, prioritizing issues related with hydration and healthy vocal use habits. However, the findings in the present study show the need to further focus on lifestyle habits related to sleep and eating habits.

Intratemporal facial nerve ultrastructure in patients with idiopathic facial paralysis. Viral infection evidence study

The etiology of idiopathic peripheral facial palsy (IPFP) is still uncertain; however, some authors suggest the possibility of a viral infection. Aim: to analyze the ultrastructure of the facial nerve seeking viral evidences that might provide etiological data. Material and Methods: We studied 20 patients with peripheral facial palsy (PFP), with moderate to severe FP, of both genders, between 18-60 years of age, from the Clinic of Facial Nerve Disorders. The patients were broken down into two groups - Study: eleven patients with IPFP and Control: nine patients with trauma or tumor-related PFP. The fragments were obtained from the facial nerve sheath or from fragments of its stumps - which would be discarded or sent to pathology exam during the facial nerve repair surgery. The removed tissue was fixed in 2% glutaraldehyde, and studied under Electronic Transmission Microscopy. Results: In the study group we observed an intense repair cellular activity by increased collagen fibers, fibroblasts containing developed organelles, free of viral particles. In the control group this repair activity was not evident, but no viral particles were observed. Conclusion: There were no viral particles, and there were evidences of intense activity of repair or viral infection.

Prevalence of GJB2 (Connexin-26) and GJB6 (Connexin-30) Mutations in a Cohort of 300 Brazilian Hearing-Impaired Individuals: Implications for Diagnosis and Genetic Counseling

Objective: Hereditary nonsyndromic deafness is an autosomal recessive condition in about 80% of cases, and point mutations in the GJB2 gene (connexin 26) and two deletions in the GJB6 gene (connexin 30), del(GJB6-D13S1830) and del(GJB6-D13S1854), are reported to account for 50% of recessive deafness, Aiming at establishing the frequencies of GJB2 mutations and GJB6 deletions in the Brazilian population, we screened 300 unrelated individuals with hearing impairment, who were not affected by known deafness related syndromes. Methods: We firstly screened the most frequently reported mutations, c.35delG and c.167delT in the GJB2 gene, and del(GJB6-D13S1830) and del(GJB6-D13S1854) in the GJB6 gene, through specific techniques. The detected c.35delG and c.167delT mutations were validated by sequencing. Other mutations in the GJB2 gene were screened by single-strand conformation polymorphism and the coding region was sequenced when abnormal patterns were found. Results: Pathogenic mutations in GJB2 and GJB6 genes were detected in 41 individuals (13.7%), and 80.5% (33/41) presented these mutations in homozygosis or compound heterozygosis, thus explaining their hearing defect. The c.35delG in the GJB2 gene was the most frequent mutation (37/300; 12.4%), detected in 23% familial and 6.2% the sporadic cases. The second most frequent mutation (1%; 3/300) was the del(GJB6- D13S1830), always found associated with the c.35delG mutation. Nineteen different sequence variations were found in the GJB2 gene. In addition to the c.35delG mutation, nine known pathogenic alterations were detected 0 67delT, p.Trp24X, p.Val37lle, c.176_191del16, c.235delC, p.Leu90Pro, p.Arg127His, c.509insA, and p.Arg184Pro, Five substitutions had been previously considered benign polymorphisms: c.-15C>T, p.Val27lle, p.Met34hr, p.Ala40Ala, and p.Gly160Ser. Two previously reported Mutations of unknown pathogenicity were found (p.Lys168Arg, and c.684C>A), and two novel substitutions, p.Leu81Val (c.G241C) and p.Met195Val (c.A583G), both in heterozygosis without an accompanying mutation in the other allele. None of these latter four variants of undefined status was present in a sample of 100 hearing controls. Conclusions: The present study demonstrates that Mutations in the GJB2 gene and del(GJB6 D13S1830) are important causes of hearing impairment in Brazil, thus justifying their screening in a routine basis. The diversity of variants in our sample reflects the ethnic heterogeneity of the Brazilian population.

Effects of hyperbaric oxygen therapy on facial nerve regeneration

Conclusion. Hyperbaric oxygen treatment (HBOT) promoted an increase of the mean axonal diameter in the group evaluated 2 weeks after lesion induction, which suggests a more advanced regeneration process. However, the number of myelin nerve fibers of the facial nerve of the rabbits was similar when compared to the control and treatment groups, in both evaluation periods. Objective. To evaluate the effect of HBOT on the histological pattern of the facial nerve in rabbits exposed to a nerve crush injury. Materials and methods. Twenty rabbits were exposed to facial nerve crush injury. Ten rabbits received HBOT, 10 rabbits comprised the control group. The rabbits were sacrificed 2 and 4 weeks after the trauma. Qualitative morphological analysis, measurement of the external axonal diameters and myelin fiber count were carried out in an area of 185 000 mu m(2). Results. There was an increase in the area of the axons and thicker myelin in the 2 weeks treatment group in comparison with the control group. The mean diameter of the axons was of 2.34 mu m in the control group and of 2.81 mu m in the HBOT group, with statistically significant differences. The 2 week control group had a mean number of myelin fibers of 186 +/- 5.2664, and the HBOT group had a mean number of 2026.3 +/- 302; this was not statistically significant. The 4 week control group presented a mean of 2495.1 +/- 479 fibers and the HBOT group presented a mean of 2359.9 +/- 473; this was not statistically significant.

Measurement of the Viscoelastic Properties of the Vocal Folds

Objectives: Studies of the viscoelastic properties of the vocal folds are normally performed with rheometers that use parallel assigned a fixed value. In tissues subject to variation of thickness plates whose interplate space is usually at between samples, fixed gaps could result in different compressions, compromising the comparison among them. We performed,in experimental study to determine whether different compressions call lead to different results in measurements of dynamic viscosity (DV) of vocal fold samples. Methods: We Measured the DV of vocal fold samples of 10 larynges of cadavers under 3 different compression levels, corresponding to 0.2, 0.5, and 10 N on an 8-mm-diameter parallel-plate rheometer. Results: The DV directly varied with compression. We observed statistically significant differences between the results of 0.2 and 10 N (p = 0.0396) and 0.5 and 10 N (p = 0.0442). Conclusions: The study demonstrated that the level of compression influences the DV measure and Suggests that a defined compression level should be used in rheometric studies of biological tissues.