The Incidence of Dysphagia in Patients Receiving Cerebral Reperfusion Therapy Poststroke

Background: The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Methods: Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. Results: The moderate and severe degrees of dysphagia were more frequent (P = .013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P = .045). Conclusions: We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy. (C) 2014 by National Stroke Association

Controle autonômico do coração e fração de ejeção na fase crônica do acidente vascular encefálico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Exposição neonatal a drogas ototóxicas e possíveis alterações auditivas

Introduction: Scientific evidence indicates that neonatal exposure to ototoxic drugs cause hearing loss in newborns. Objective: To characterize the use of ototoxic antibiotics in newborns (NB), treated in the Neonatal Intensive Care Unit (NICU) and evaluate possible hearing modifications. Methods: A descriptive cross-sectional quantitative approach, using data from medical records of infants who were at some time in the NICU and used antibiotics, including ototoxic, from January to June 2004 as much as 2010, and the data were compared and analyzed. Parents/guardians of infants born in 2004 were contacted and applied a questionnaire containing questions about the children’s hearing. These children were submitted to audiological evaluation. Results: There was significant reduction in the time of use, the amount of antibiotics prescribed to newborns and Vancomycin prescription in 2010 compared to 2004. The hearing tests of 13 born in 2004 showed: sensorineural hearing loss in only 2 (one with moderate hearing loss and descending configuration in pure tone audiometry and the other with bilateral cochlear impairment); audiometric thresholds within the normal range in 11 patients, and the presence of otoacoustic emissions in 9. In Evoked Auditory Brainstem Response (ABR) no changes were observed. Conclusion: The reduction in the time of use, the amount and types of antibiotics observed may be related to the adoption of a Protocol in 2008, by the service. In contrast, auditory alterations may be related to a neonatal exposure to antibiotics in 2004.

Taste and Temperature in Swallowing Transit Time after Stroke

Background: Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. Methods: The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41–88 years (mean age: 66.2 years) examined 0–50 days after ictus (median: 6 days), with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold) and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold) were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. Results: Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. Conclusions: The results showed that the sequence of offered stimuli influences the pharyngeal transit time in a different way in individuals after stroke and suggest that, when the sour-cold stimulus is offered in a randomized sequence, it can influence the response to the other stimuli in stroke patients. Hence, the sour-cold stimulus could be used as a therapeutic aid in dysphagic stroke patients.

Changes in heart period during endodontic treatment

Background: Tooh extraction was demonstrated to increase sympathetic modulation of the heart, however, it is not understood the effects of endodontic treatment on cardiac autonomic regulation. We evaluated heart rate variability (HRV) during endodontic treatment. Method: 50 male and female patients aged between 18 and 40 years old and diagnosed with irreversible pulpitis or pulp necrosis of the lower molars with indication of gender endodontic treatment were analyzed. HRV was analyzed in the time (SDNN, RMSSD, pNN50) and frequency (LF, HF and LF/HF ratio) domains recorded in the first session of root canal treatment. The indices were analyzed in the following periods: T1) ten minutes before the endodontic treatment, T2) ten minutes after the administration of anesthesia before endodontic treatment, T3) during the entire period of endodontic treatment and T4) thirty minutes after the end of the endodontic treatment. Results: The SDNN, RMSSD and pNN50 indices increased at T2 compared to T1, the pNN50 and RMSSD indices increased at T3 and T4 compared to T2. The LF in normalized units increased at T4 compared to T2 and in absolute units it was increased at T4 compared to T1. The HF in normalized units was reduced at T4 compared to T2 and in absolute units was reduced at T1, T3 and T4 compared to T2. The LF/HF ratio was higher at T4 compared to T2. Conclusion: The global modulation of heart increases after local anesthesia and vagal tone reduce during surgery procedures and after the surgical procedures.

Association between interleukin-6 polymorphism in the-174 G/C region and hearing loss in the elderly with a history of occupational noise exposure

Introduction: The biological processes involved in noise-induced hearing loss (NIHL) are still unclear. The involvement of inflammation in this condition has been suggested.Objective: To investigate the association between interleukin - 6 (IL-6) polymorphism and susceptibility to NIHL.Methods: This was a cross-sectional study with a sample of 191 independent elderly individuals aged >60 years of age. Information on exposure to occupational noise was obtained by interviews. Audiological evaluation was performed using pure tone audiometry and genotyped through PCR by restriction fragment length polymorphism - PCR-RFLP. Data were analyzed using the chi-square test and the odds ratio (OR), with the significance level set at 5%.Results: Among elderly with hearing loss (78.0%), 18.8% had a history of exposure to occupational noise. There was a statistically significant association between the genotype frequencies of the IL-6 - 174 and NIHL. The elderly with the CC genotype were less likely to have hearing loss due to occupational noise exposure when compared to those carrying the GG genotype (OR = 0.0124; 95% CI 0.0023-0.0671; p<0.001).Conclusion: This study suggests there is an association of polymorphisms in the IL-6 gene at position - G174C with susceptibility to noise-induced hearing loss. (C) 2014 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Developmental aspects of early pregnancy in mares

In mares, the embryo migrates to the uterus between days 5 and 6 postovulation beginning its mobility through all uterine segments, which is essential for the maternal recognition of pregnancy. During the mobility phase, the embryonic vesicle shows a linear growth rate until its fixation between days 15 and 17, when the orientation phenomenon occurs. From fixation to day 28 of pregnancy, the embryonic growth is less evident (plateau) by cross-section ultrasound examination. After this period the linear growth rate is reestablished until day 46. This plateau is attributed to the increased uterine tone that compresses the vesicle and to volume expansion, making it difficult to detect the conceptus growth only by the cross-section diameter. Around day 20, the embryo proper is visualized as an echogenic spot in the ventral aspect of the vesicle. Additionally, development of allantoic sac, embryonic heartbeat, yolk sac regression and posterior umbilical cord formation also can be visualized from days 20 to 40. An intimate interaction between uterus and conceptus is essential for the normal pregnancy development. Color-and spectral-Doppler ultrasonography can be useful for the evaluation of this interface. A gradual increase on uterine vascularity during the early pregnancy and transient changes in endometrial vascularity accompanying the vesicle location during the mobility phase have been described. Around day 38 of gestation, the formation of the endometrial cups begins and, consequently, the synthesis of the equine chorionic gonadotropin (eCG) induces the formation and development of supplementary corpora lutea, which are important to secrete progesterone and to maintain pregnancy until around day 120.

Frontonasal dysplasia: clinical evaluation on audiological and brainstem electrophysiological profiles

Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. No systematic studies describing hearing in this condition were found. AIM: To evaluate hearing sensitivity and sound stimulus conduction from cochlea to brainstem in patients with clinical signs of FND. METHODS: 21 patients with isolated or syndromic FND were submitted to a clinical (otological/vestibular antecedents and otoscopy) and instrumental (pure tone and speech audiometry, tympanometry and brainstem auditory evoked response) hearing evaluation. DESIGN: A clinical, cross-sectional observational prospective study. RESULTS: Hearing thresholds were normal in 15 (70%) patients, abnormal in 5 (25%), mostly with conductive hearing loss; one patient did not cooperate with testing. The tympanometric curve was type A in 30 (72%) ears, type C in 5 (12%), type As in 4 (9%) and type B in 3 (7%). The auditory brainstem response (ABR) showed no abnormalities. CONCLUSION: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in this study. Mild conductive hearing loss found in some is probably related to cleft palate. Further evaluation of hearing pathways at higher levels is recommended.

Os rumos do desenvolvimento nos anos 50: as visões da Cepal e de Roberto Campos Araraquara – SP 2012

In the decade of 1950, the economic policies almost in their entirety, are aimed at promoting domestic industry, culminating finally in the most consistent action planned in favor of industrialization in the economic history of Brazil: the Plano de Metas (Goal’s Plan). This study aims to analyze the Brazilian planning at this moment studying the proposals in the economic thought of the Economic Commission for Latin America and the Caribbean (ECLAC) and Roberto de Oliveira Campos, divergent, but both connected to important reports of the Brazilian economy developed in the period, which served as the basis for policies at the period and even Goal’s Plan, and with enormous influence on the decisions of the 50s. The first one was the most important school of thought in the Third World. Campos was one of the most important thinkers of the economy in the period, one of the most consistent critics of ECLAC, and their proposals were very close to what was actually executed. The paper concludes that, despite the importance of ECLAC thought, this encountered difficulties applying workable solutions to economic growth. The eclectic tone of Roberto Campos brought clarity to his proposals, and these, when applied, have led to growth

A influência da agenda mercosulina na criação do Conselho de Defesa Sul-Americano

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O ethos das obras de autoajuda para terceira idade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação audiológica, metabólica e de qualidade de vida no indivíduo jovem com zumbido usuário de estéreo pessoal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Utiização de altrenogest injetável par o estabelecimento e manutençao da gestação em éguas receptoras de embriões acíclicas

Pós-graduação em Medicina Veterinária - FMVZ

Cuida e ser cuidado: compreendendo as significações desse processo para famíliares cuidadores e idosos dependentes usuários de um Centro Dia

Pós-graduação em Saúde Coletiva - FMB