Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment

Uso de habitat e comportamento do boto-cinza sotalia guianensis em uma zona estuarina do estado de Sergipe, nordeste do Brasil a biotecnologia vegetal como alternativa para a cotonicu

To clarify the functional mechanisms of habitat use is necessary to analyze it in conjunction with the conduct performed by animals. The occurrence, distribution and use of space are characteristic of a species resulting from habitat selection that is in search of conditions favorable to its survival. One can relate the physical and biological factors of the environment with the ecological characteristics of the species, since these factors act by regulating the ecological success of organisms, and from there you can get important information about the habitat use and behavior of individuals. This study aimed to characterize the use of habitat and diurnal activity expressed by the Guiana dolphin, Sotalia guianensis in an estuarine area of Sergipe state, Brazil, analyzing the influence of tide and time days on the occurrence of animals and behavior s state, and group s size and composition in this cetacean species. From March 2009 to February 2010, focal groups observations of dolphins were made from fixed - point and records snapshots of data taken every 5 min. in the interval from 6 a.m to 6 p.m, in alternating shifts. The results showed that the constant presence of animals in the area of the Sergipe River estuary indicates that this is an important area of occurrence of S. guianensis, which use the region mainly in the morning, at low tide and as a feeding. As in other regions of northeastern Brazil, small groups formed 2-12 individuals were most common, with adults and immatures. The high frequency of immature animals may indicate that this area of the estuary is used as brood area and parental care of pups and young animals, since the immature animals were very associated with adults and monitoring the activities of foraging / feeding may be related to a form of learning or training of such behavior

Estilos de aprendizagem sob a ótica da Psicologia Evolucionista

Among a variety of learning conceptions, David Kolb´s Experiential Learning Theory proposes four different learning styles: diverging, characterized by orientation towards people and multi-perspective vision; assimilating, concerned with ideas and abstract concepts as well as theory formulation; converging, expert in dealing with technical tasks and problem solving; and accommodating, risk taker and good at getting things done. Interesting correlations have been pointed out between Kolb s learning styles, professional careers and genders. With respect to behaviors, specific cognitive skills and interests, sex differences are widely known, and explained by Evolutionary Psychology as the result of distinct selective pressures acting on each gender. The aim of this research was to assess adolescents learning styles and their relation with interests on school and career choices, analyzing possible gender differences. We distributed questionnaires to 221 senior high school students to research their preferences for school disciplines, professional activities and career choices. The Learning Style Inventory specified the learning style of each individual. Our results showed a high frequency of reflective styles, with predominance of females as diverging and males as assimilating. Concerning school and professional interests, there were correlations between styles oriented towards the abstract and technical interests. Moreover, females preferred disciplines related to languages and interpersonal activities while males preferred disciplines related to science and technical activities. There were more males in exact science and engineering careers, and more females in social science and applied social science. Correlations found between learning styles, school and professional interests corroborate Kolb´s propositions, and the findings about gender differences are supported by Evolutionary Psychology theories

Influência da turbidez da água do rio Tietê na ocorrência de plantas aquáticas

As plantas aquáticas são estudadas como um efeito do desequilíbrio causado pela poluição e/ou alagamento dos rios. A quantidade excessiva de plantas, conseqüente desse desequilíbrio, dificulta a navegação e a produção de energia elétrica. O objetivo deste trabalho foi identificar as principais plantas aquáticas do rio Tietê e relacioná-las com a turbidez da água dos diferentes reservatórios. Foram avaliados todos os focos de vegetação aquática emersa, flutuante e submersa, presentes em cada reservatório, em toda a sua extensão, sendo consideradas como importantes as espécies que apresentaram o caráter dominante. Foi observado que os represamentos apresentam problema de plantas aquáticas e a qualidade da infestação varia entre os reservatórios. Foram consideradas como dominantes as seguintes espécies: Brachiaria mutica, Brachiaria subquadripara, Eichhornia crassipes, Egeria densa, Egeria najas, Enidra sessilis e Typha angustifolia. Observou-se que houve uma tendência de maior ocorrência de plantas flutuantes e emersas (marginais) nos reservatórios com maior turbidez e de plantas submersas naqueles com menor turbidez. Para as duas braquiárias, observou-se que a freqüência das espécies aumentou com o aumento da turbidez até o limite de 34,93 NTU. O aguapé ocorreu com altos índices de freqüência (acima de 50%) em todos os reservatórios do rio Tietê, independentemente das características da água. em se tratando das egérias, a freqüência das espécies aumentou gradativamente com a redução da turbidez e a taboa não apresentou uma relação com o índice estudado. A espécie E. sessilis se mostrou bastante dependente da qualidade da água, tendo sua freqüência aumentada com o aumento da turbidez.

Structural integrity identification based on smart materials and neural networks

This paper presents a non-model based technique to detect, locate, and characterize structural damage by combining the impedance-based structural health monitoring technique with an artificial neural network. The impedance-based structural health monitoring technique, which utilizes the electromechanical coupling property of piezoelectric materials, has shown engineering feasibility in a variety of practical field applications. Relying on high frequency structural excitations (typically>30 kHz), this technique is very sensitive to minor structural changes in the near field of the piezoelectric sensors. In order to quantitatively assess the state of structures, two sets of artificial neural networks, which utilize measured electrical impedance signals for input patterns, were developed. By employing high frequency ranges and by incorporating neural network features, this technique is able to detect the damage in its early stage and to estimate the nature of damage without prior knowledge of the model of structures. The paper concludes with an experimental example, an investigation on a massive quarter scale model of a steel bridge section, in order to verify the performance of this proposed methodology.

Síntese, sinterização e caracterização de ferritas à base de Ni-Zn

Were synthesized different ferrites NixZn1-xFe2O4 (0,4 ≤ x ≤ 0,6) compositions by using citrate precursor method. Initially, the precursors citrates of iron, nickel and zinc were mixed and homogenized. The stoichiometric compositions were calcined at 350°C without atmosphere control and the calcined powders were pressed in pellets and toroids. The pressed material was sintered from 1100º up to 1200ºC in argon atmosphere. The calcined powders were characterized by XRD, TGA/DTG, FTIR, SEM and vibrating sample magnetometer (VSM). All sintered samples were characterized using XRD, SEM, VSM and measurements of magnetic permeability and loss factor were obtained. It was formed pure ferromagnetic phase at all used temperatures. The Rietveld analyses allowed to calculate the cations level occupation and the crystallite size. The analyses obtained nanometric crystals (12-20 nm) to the calcined powder. By SEM, the sintered samples shows grains sizes from 1 to 10 μm. Sintered densities (ρ) were measured by the Archimedes method and with increasing Zn content, the bulk density decrease. The better magnetization results (105-110 emu/g) were obtained for x=0,6 at all sintering temperatures. The hysteresis shows characteristics of soft magnetic material. Two magnetization processes were considered, superparamagnetism at low temperature and the magnetic domains formation at high temperatures. The sintered toroids presents relative magnetic permeability (μr) from 7 to 32 and loss factor (tanδ) of about 1. The frequency response of toroids range from 0,3 kHz to 0,2 GHz. The composition x=0,5 presents both greater μr and tanδ values and x=0,6 the most broad range of frequency response. Various microstructural factors show influence on the behavior of μr and tanδ, such as: grain size, porosity across grain boundary and inside the grain, grain boundary content and domain walls movement during the process of magnetization at high frequency studies (0,3kKz 0,2 GHz)

Anestesia em paciente obstétrica portadora de anemia falciforme e traço talassêmico após plasmaféresis: relato de caso

JUSTIFICATIVA E OBJETIVOS: A plasmaféresis é a técnica de tratamento de escolha para pacientes com anemia hemolítica grave. Uma de suas conseqüências é a depleção de colinesterase plasmática, o que interfere na metabolização de alguns bloqueadores neuromusculares de uso corrente na prática anestesiológica. RELATO do CASO: Paciente com 26 anos, estado físico ASA IV, gestação de 30 semanas e 3 dias, portadora de anemia falciforme, traço talassêmico e alo-imunização para antígenos de alta freqüência. Apresentou crise de falcização, sendo transfundida com derivado sangüíneo incompatível. Evoluiu com hemólise maciça, sendo admitida com hemoglobina de 3 g/dL e hematócrito de 10%, icterícia intensa, taquicardia, apatia e descoramento. Na avaliação hematológica concluiu-se ser situação de inexistência de sangue compatível para transfusão. Foi tratada com corticoterapia, imunoglobulinas e plasmaféresis. No segundo dia de internação, evoluiu com insuficiência renal aguda e edema pulmonar agudo, piora do estado geral e instabilidade hemodinâmica. Indicada a resolução da gestação em decorrência do quadro clínico da paciente e do sofrimento fetal agudo que se sobrepôs. A paciente foi admitida na sala de operações consciente, dispnéica, pálida, ictérica, SpO2 de 91% em ar ambiente, freqüência cardíaca de 110 bpm e pressão arterial de 110 x 70 mmHg, em uso de dopamina (1 µg.kg-1.min-1) e dobutamina (10 µg.kg-1.min-1). Optou-se por anestesia geral balanceada, com alfentanil (2,5 mg), etomidato (14 mg) e atracúrio (35 mg) e isoflurano. Não se observou intercorrências anestésico-cirúrgicas. Ao final, a paciente foi encaminhada à UTI, sob intubação orotraqueal, e em uso de drogas vasoativas, tendo sido extubada após 3 horas. CONCLUSÕES: Este caso mostrou-se um desafio para a equipe, visto que a paciente apresentava instabilidade hemodinâmica e alteração do coagulograma, condições que contra-indicam a anestesia regional; além disto, a plasmaféresis potencialmente depleta os estoques de colinesterases plasmáticas, o que interfere na anestesia. Entretanto, o arsenal medicamentoso disponível permitiu o manuseio seguro desta situação.

Caracterização de sorotipos em linhagens do gênero Salmonella isoladas de diferentes afecções em animais domésticos

Foram caracterizados os sorotipos, o perfil de sensibilidade microbiana e os achados clínico-epidemiológicos em 53 linhagens do gênero Salmonella isoladas de 41 cães, nove equinos e três bovinos, acometidos por diferentes manifestações clínicas entre 1997 e 2007. Salmonella Typhimurium (45,3%), Salmonella enterica (22,6%), Salmonella Enteritidis (7,5%), Salmonella enterica subsp enterica 4,5,12i (5,7%), Salmonella Newport (5,7%), Salmonella Dublin (3,8%), Salmonella Agona (3,8%), Salmonella Glostrup (3,8%), Salmonella Saintpaul (1,8%) foram os sorotipos encontrados. Ciprofloxacina (100,0%), norfloxacina (100,0%) e gentamicina (100,0%) foram os antimicrobianos mais efetivos, enquanto a maior resistência das linhagens foi observada para ceftiofur (28,5%) e florfenicol (7,0%). As linhagens foram isoladas de animais com enterite, infecção do trato urinário, septicemia, piometra, pneumonia e conjuntivite. Ressalta-se para o predomínio do sorovar Typhimurium nas diferentes manifestações da salmonelose nos animais. Destaca-se, também, a identificação de sorotipos nos animais que também são observados em casos de salmonelose em humanos

Frequência de fatores de risco cardiovascular em voluntários participantes de evento de educação em saúde

INTRODUCTION. Cardiovascular diseases (CVD) are the main cause of death in Brazil.OBJECTIVE. To evaluate the frequency of CVD risk factors In a population attending a health education community event.METHODS. Retrospective study that included 428 completed forms with clinical and demographic information of volunteers attending a public event, in May, 2006. Data were expressed by means and standard deviation or proportions and compared by Student's t test or Chi-square test. Associations between Arterial Hypertension (AH), Diabetes Mellitus (DM) and clinical variables were analyzed by multinomial logistic regression. Significance level was p<0.05.RESULTS. Mean age was 57 +/- 14years, and women represented 58% of the total population. The main cardiovascular risk factors were AH (39.5%), DM (15.4%) and dyslipidemia (25.89%). The frequency of unawareness about these risk factors was respectively 8.4%, 17.5% and 33.1%.. Family history of CVD was reported by 41% while only 67% reported having any information about DM or dyslipidemia. Among obese individuals (IMC >= 30 Kg/m2, 27.3% of the population), systolic blood pressure (133 +/- 16mmHg), diastolic blood pressure (84 +/- 11.5mmHg) and casual glycemia (124 +/- 52.5mg/dl) were higher when compared to non-obese (p<0.05). There was a significant association between obesity and dyslipidemia (p=0.04). Age and IMC were independently associated with AH and DM.CONCLUSION. The high frequency of modifiable cardiovascular risk factors in this population suggests the need for educational programs to promote primary prevention, mainly for the elderly and overweight. [Rev Assoc Med Bras 2009; 55(5): 606-10]

Processamento e interpretação de dados 2D e 3D de GPR :aplicações no imageamento de feições kársticas e estruturas de dissolução no campo de petróleo de Fazenda Belém-CE

In Fazenda Belém oil field (Potiguar Basin, Ceará State, Brazil) occur frequently sinkholes and sudden terrain collapses associated to an unconsolidated sedimentary cap covering the Jandaíra karst. This research was carried out in order to understand the mechanisms of generation of these collapses. The main tool used was Ground Penetrating Radar (GPR). This work is developed twofold: one aspect concerns methodology improvements in GPR data processing whilst another aspect concerns the geological study of the Jandaíra karst. This second aspect was strongly supported both by the analysis of outcropping karst structures (in another regions of Potiguar Basin) and by the interpretation of radargrams from the subsurface karst in Fazenda Belém. It was designed and tested an adequate flux to process GPR data which was adapted from an usual flux to process seismic data. The changes were introduced to take into account important differences between GPR and Reflection Seismic methods, in particular: poor coupling between source and ground, mixed phase of the wavelet, low signal-to-noise ratio, monochannel acquisition, and high influence of wave propagation effects, notably dispersion. High frequency components of the GPR pulse suffer more pronounced effects of attenuation than low frequency components resulting in resolution losses in radargrams. In Fazenda Belém, there is a stronger need of an suitable flux to process GPR data because both the presence of a very high level of aerial events and the complexity of the imaged subsurface karst structures. The key point of the processing flux was an improvement in the correction of the attenuation effects on the GPR pulse based on their influence on the amplitude and phase spectra of GPR signals. In low and moderate losses dielectric media the propagated signal suffers significant changes only in its amplitude spectrum; that is, the phase spectrum of the propagated signal remains practically unaltered for the usual travel time ranges. Based on this fact, it is shown using real data that the judicious application of the well known tools of time gain and spectral balancing can efficiently correct the attenuation effects. The proposed approach can be applied in heterogeneous media and it does not require the precise knowledge of the attenuation parameters of the media. As an additional benefit, the judicious application of spectral balancing promotes a partial deconvolution of the data without changing its phase. In other words, the spectral balancing acts in a similar way to a zero phase deconvolution. In GPR data the resolution increase obtained with spectral balancing is greater than those obtained with spike and predictive deconvolutions. The evolution of the Jandaíra karst in Potiguar Basin is associated to at least three events of subaerial exposition of the carbonatic plataform during the Turonian, Santonian, and Campanian. In Fazenda Belém region, during the mid Miocene, the Jandaíra karst was covered by continental siliciclastic sediments. These sediments partially filled the void space associated to the dissolution structures and fractures. Therefore, the development of the karst in this region was attenuated in comparison to other places in Potiguar Basin where this karst is exposed. In Fazenda Belém, the generation of sinkholes and terrain collapses are controlled mainly by: (i) the presence of an unconsolidated sedimentary cap which is thick enough to cover completely the karst but with sediment volume lower than the available space associated to the dissolution structures in the karst; (ii) the existence of important structural of SW-NE and NW-SE alignments which promote a localized increase in the hydraulic connectivity allowing the channeling of underground water, thus facilitating the carbonatic dissolution; and (iii) the existence of a hydraulic barrier to the groundwater flow, associated to the Açu-4 Unity. The terrain collapse mechanisms in Fazenda Belém occur according to the following temporal evolution. The meteoric water infiltrates through the unconsolidated sedimentary cap and promotes its remobilization to the void space associated with the dissolution structures in Jandaíra Formation. This remobilization is initiated at the base of the sedimentary cap where the flow increases its abrasion due to a change from laminar to turbulent flow regime when the underground water flow reaches the open karst structures. The remobilized sediments progressively fill from bottom to top the void karst space. So, the void space is continuously migrated upwards ultimately reaching the surface and causing the sudden observed terrain collapses. This phenomenon is particularly active during the raining season, when the water table that normally is located in the karst may be temporarily located in the unconsolidated sedimentary cap

Epidemiologia do carcinoma basocelular

O carcinoma basocelular é a neoplasia maligna mais comum em humanos e sua incidência vem aumentando nas últimas décadas. Sua grande frequência gera significativo ônus ao sistema de saúde, configurando problema de saúde pública. Apesar das baixas taxas de mortalidade e de rara ocorrência de metástases, o tumor pode apresentar comportamento invasivo local e recidivas após o tratamento, provocando importante morbidade. Exposição à radiação ultravioleta representa o principal fator de risco ambiental associado a sua gênese. Entretanto, descrevem-se outros elementos de risco: fotótipos claros, idade avançada, história familiar de carcinomas de pele, olhos e cabelos claros, sardas na infância e imunossupressão, além de aspectos comportamentais, como exercício profissional exposto ao sol, atividade rural e queimaduras solares na juventude. Entre 30% e 75% dos casos esporádicos estão associados à mutação do gene patched hedgehog, mas outras alterações genéticas são ainda descritas. A neoplasia é comumente encontrada concomitantemente com lesões cutâneas relacionadas à exposição solar crônica, tais como: queratoses actínicas, lentigos solares e telangiectasias faciais. A prevenção do carcinoma basocelular se baseia no conhecimento de fatores de risco, no diagnóstico e tratamento precoces e na adoção de medidas específicas, principalmente, nas populações susceptíveis. Os autores apresentam uma revisão da epidemiologia do carcinoma basocelular.

Dois testes de imageamento com GPR em problemas de controle ambiental em regiões tropicais: migração de dunas e localização de dutos de óleo enterrados

Because the penetration depth of Ground Penetrating Radar (GPR) signals is very limited in high conductive soils, the usefullness of this method in tropical regions is not yet completly known. The main objective of this researh is to test the usefullness of the method in Brazil. Two typical problems where GPR has been used in Europe and North American were choosed for this test: the first one is to characterize the internal structures of a sand body and the second problem is the localization of old buried pipes lines. The first test was done near the city of São Bento do Norte, in the northern coast of Rio Grande do Norte state, NE Brazil. In this region, there is a sand dune that is migrating very fast in the direction of adjacent settling areas. To characterize the internal structure of the dune and its relationship to the prevailing wind direction, as a preliminary step to understand the dune migration, GPR profiles using the 400 MHz frequency were performed in E-W, N-S, NE-SW, and SE-NW directions over the sand dune intersecting at the top of the dune. The practical resolution of the GPR data is around 30 cm; this was sufficient to distinguish individual foresets inside the dune. After applying the elevation correction to the data, we identified that dips of bedding structures are smallest for the N-S profile, which is perpendicular to the dominant wind direction, largest for the E-W profile, and intermediate for the SW-NE and SE-NW profiles. Foresets in the E-W profile dip with angles varying from 2 to 6 degrees. In the E-W profile, the water table and a horizontal truncation interface separating two generations of dunes were identified, as well as an abrupt directional change in the foreset patterns associated to a lateral contact between two dune generations, the older one extending to the west. The used high frequency of 400 Mhz does not allow a penetration deep enough to map completely these internal contacts. The second test was done near Estreito, a small town near Carnaúbais city, also in Rio Grande do Norte state. In this locality, there are several old pipe lines buried in area covered by plantations where digging should be minimized. Several GPR profiles using the 400 and 200 MHz frequency were performed trying to intercept perpendicularly the possible pipe lines. Because of the high conductivity of the soil, the raw original data can hardly be use to identify the pipe lines. However, after an adequate processing over the 200 MHz profiles, six pipe lines were identified. As a global result of the tests, GPR can be very usefull if the conductivity of the ground is low or, in the case of medium conductivities of the soils, if adequate processing is performed

Interpretação de dados de GPR com base na hierarquização de superfícies limitantes e na adaptação de critérios sismoestratigráficos

Due to its high resolution, Ground Penetrating Radar (GPR) has been used to image subsurface sedimentary deposits. Because GPR and Seismic methods share some principles of image construction, the classic seismostratigraphic interpretation method has been also applied as an attempt to interpret GPR data. Nonetheless some advances in few particular contexts, the adaptations from seismic to GPR of seismostratigraphic tools and concepts unsuitable because the meaning given to the termination criteria in seismic stratigraphy do not represent the adequate geologic record in the GPR scale. Essentially, the open question relies in proposing a interpretation method for GPR data which allow not only relating product and sedimentary process in the GPR scale but also identifying or proposing depositional environments and correlating these results with the well known Sequence Stratigraphy cornerstones. The goal of this dissertation is to propose an interpretation methodology of GPR data able to perform this task at least for siliciclastic deposits. In order to do so, the proposed GPR interpretation method is based both on seismostratigraphic concepts and on the bounding surface hierarchy tool from Miall (1988). As consequence of this joint use, the results of GPR interpretation can be associated to the sedimentary facies in a genetic context, so that it is possible to: (i) individualize radar facies and correlate them to the sedimentary facies by using depositional models; (ii) characterize a given depositional system, and (iii) determine its stratigraphic framework highligthing how it evolved through geologic time. To illustrate its use the proposed methodology was applied in a GPR data set from Galos area which is part of the Galinhos spit, located in Rio Grande do Norte state, Northeastern Brazil. This spit presents high lateral sedimentary facies variation, containing in its sedimentary record from 4th to 6th cicles caused by high frequency sea level oscillation. The interpretation process was done throughout the following phases: (i) identification of a vertical facies succession, (ii) characterization of radar facies and its associated sedimentary products, (iii) recognition of the associated sedimentary process in a genetic context, and finally (iv) proposal of an evolutionay model for the Galinhos spit. This model proposes that the Galinhos spit is a barrier island constituted, from base to top, of the following sedimentary facies: tidal channel facies, tidal flat facies, shore facies, and aeolic facies (dunes). The tidal channel facies, in the base, is constituted of lateral accretion bars and filling deposits of the channels. The base facies is laterally truncated by the tidal flat facies. In the foreshore zone, the tidal flat facies is covered by the shore facies which is the register of a sea transgression. Finally, on the top of the stratigraphic column, aeolic dunes are deposited due to areal exposition caused by a sea regression

Auditory evaluation in patients with type 1 diabetes

Objectives: We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes.Methods: Group I consisted of 40 patients with type I diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests).Results: Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group I and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group I ears. All patients of group 2 presented normal audiograms and ABR tests.Conclusions: In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group I who had normal audiometric thresholds.

Critérios histopatológicos para diagnóstico de melanoma maligno cutâneo: análise comparativa de sua freqüência em lesões benignas e melanomas de pequena espessura (< 2 mm)

INTRODUÇÃO: A histopatologia convencional continua sendo o padrão-ouro no diagnóstico dos melanomas cutâneos, apesar do progresso da imuno-histoquímica e da biologia molecular. Os critérios microscópicos existentes para esse diagnóstico são numerosos, porém nenhum deles é específico para se afirmar que uma determinada lesão é maligna quando ele está presente, ou é benigna na sua ausência. Alguns critérios têm uma relevância maior para o diagnóstico em relação a outros. OBJETIVO: Este estudo propõe uma análise daqueles critérios considerados mais importantes, comparando sua presença em lesões melanocíticas benignas e melanomas. MATERIAL E MÉTODOS: Foram estudadas 33 lesões melanocíticas benignas (nevo de Spitz: 13; nevo de Reed: 6; nevo displásico: 6; nevo congênito: 3; nevo adquirido: 3; nevo combinado: 1; nevo recorrente: 1), bem como 101 casos de melanomas extensivo/superficiais: 25 intra-epidérmicos e 76 invasivos de pequena espessura (< 2 mm). RESULTADOS: Alguns critérios mostraram alta freqüência em lesões benignas, apresentando pouca especificidade, enquanto outros tiveram menor positividade nas benignas, e alta freqüência nas malignas, mostrando sua maior especificidade e importância no diagnóstico dos melanomas. CONCLUSÃO: Os cinco critérios que mostraram diferenças estatisticamente significativas na comparação com as lesões benignas foram (em ordem decrescente de freqüência): 1. proliferação linear de células isoladas na camada basal; 2. início e fim da lesão com células isoladas; 3. melanócitos na camada granular; 4. disseminação pagetóide extensa; 5. nucléolos grandes, irregulares ou múltiplos. Os melanomas de pequena espessura não apresentam parte dos critérios considerados mais importantes, como falta de maturação, necrose e mitoses profundas.