Sialendoscopy for Improvement of Salivary Flow in Patients with Sjögren Syndrome - Comparative Analysis of Intraglandular Washing Solutions

Abstract Introduction Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results A total of 13 female patients with mean age of 53.38 years (range, 27-76 years) were included in this study. After sialendoscopy, 10 patients (76.92 %) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23 %), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77 %). Conclusion This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution.

Dificuldades da assistência ao parto domiciliar na ótica de enfermeiras obstetras / Dificultades en la atención domiciliaria desde la perspectiva de las enfermeras obstetras / Difficulties in home birth care from the perspective of obstetric nurses

Objetivo: investigar as dificuldades encontradas pelas enfermeiras obstetras que estão atuando na assistência ao parto domiciliar. Método: estudo descritivo e de abordagem qualitativa. A coleta de dados foi realizada por meio de uma entrevista semiestruturada com nove enfermeiras obstetras que atendiam partos domiciliares há mais de um ano. Os dados foram analisados segundo a Análise de Conteúdo. Resultados: os depoimentos deram origem a três categorias que revelaram dificuldades relacionadas à: escassez de informações sobre o parto domiciliar; transferência do domicílio para o hospital; e lacunas do processo de trabalho. Conclusão: as enfermeiras obstetras enfrentavam dificuldades de ordem social e prática que fragilizavam e dificultavam a assistência ao parto domiciliar. Estas dificuldades parecem estar relacionadas à falta de regulamentação desse modelo de atenção ao parto nas políticas públicas de saúde do país.

Objetivo: investigar las dificultades encontradas por las enfermeras obstétricas que trabajan en la asistencia al parto domiciliario. Método: estudio descriptivo y de enfoque cualitativo. La recolección de datos se realizó a través de una entrevista semiestructurada con nueve enfermeras obstétricas que realizaban partos domiciliarios durante más de un año. Los datos se analizaron de acuerdo con el Análisis de Contenido. Resultados: de las declaraciones, surgieron tres categorías que revelaron dificultades relacionadas con: escasez de información sobre el parto domiciliario; transferencia de casa al hospital y lagunas en el proceso de trabajo. Conclusión: las enfermeras obstétricas encontraron dificultades sociales y prácticas que debilitaron y obstaculizaron la atención al parto domiciliario. Estas dificultades parecen estar relacionadas con la falta de regulación de este modelo de atención de la prestación en las políticas de salud pública del país.

Objective: to investigate the difficulties encountered by obstetric nurses who are working in home birth care. Method: descriptive study, with qualitative approach. Data collection was performed through a semi-structured interview with nine obstetric nurses who had been attending home births for more than one year. The data were analyzed according to Content Analysis. Results: the statements gave rise to three categories that revealed difficulties related to: scarcity of information about home birth; transfer from home to hospital and gaps in the work process. Conclusion: obstetric nurses faced social and practical difficulties that weakened and hindered home birth care. These difficulties seem to be related to the lack of regulation of this model of delivery care in the country's public health policies.

Sialendoscopy Training: Presentation of a Realistic Model

Abstract Introduction Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments. Objective The aim of this study is to present a novel simulator for training sialendoscopy. Method This realistic simulator was built with a synthetic thermo-retractile, thermosensible rubber which, when combined with different polymers, producesmore than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues. Results The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser. Conclusion This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors.

Effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis without polyposis, / Efetividade da sinuplastia com balão em pacientes com rinossinusite crônica sem polipose,

Introduction: Balloon sinuplasty is a minimally invasive endoscopic procedure, developed with the aim of restoring patency of the paranasal sinuses ostia with minimal damage to the mucosa. Objective: To evaluate the effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis. Methods: This was a prospective cohort study comprising 18 patients with chronic rhinosinusitis without polyposis who underwent balloon sinuplasty. Patients were evaluated for clinical criteria, quality of life (Sino-Nasal Outcome Questionnaire Test-20 SNOT-20]), and computed tomography of the sinuses (Lund–Mackay staging) preoperatively and three to six months after the procedure. Results: Out of 18 patients assessed, 13 were included, with a mean age of 39.9 ± 15.6 years. Ostia sinuplasty was performed in 24 ostia (four sphenoid, ten frontal, and ten maxillary sinus). At the follow-up, 22 (92%) ostia were patent and there was no major complication. There was symptomatic improvement (SNOT-20), with Cronbach coefficients for consistency of the questionnaire items of 0.86 (95% CI: 0.73–0.94) preoperatively and of 0.88 (95% CI: 0.77–0.95) postoperatively, the difference being statistically significant (p <0.001). In addition, there was marked reduction of the computed tomography signs, an average of 4.2 point score (p <0.001). Conclusion: Sinuplasty is effective in reducing symptoms and improving quality of life as a treatment option for chronic rhinosinusitis in selected patients. .

Introdução: Sinuplastia com balão é um procedimento endoscópico minimamente invasivo, desenvolvido com o objetivo de restaurar a patência dos óstios dos seios paranasais com mínimo dano à mucosa. Objetivo: Avaliar a efetividade da sinuplastia com balão em pacientes com diagnóstico de rinossinusite crônica. Método: Estudo de coorte, prospectivo, envolvendo 18 pacientes com rinossinusite crônica sem polipose submetidos à sinuplastia com balão. Foram avaliados critérios clínicos, qualidade de vida (SNOT-20) e tomografia computadorizada dos seios da face (estadiamento de Lund - Mackay) três a seis meses após o procedimento. Resultados: Dos dezoito pacientes avaliados, 13 foram incluídos, com média de idade 39.9 ± 15.6 anos. A sinuplastia foi realizada em 24 óstios (10 frontais, 10 maxilares e 4 esfenóides). Após acompanhamento, 22 (92%) óstios permaneceram patentes, sem ter ocorrido nenhuma complicação maior. Houve melhora sintomática (SNOT-20) com coeficiente de Cronbach para consistência dos itens do questionário de 0,86 (IC95% 0,73 - 0,94) no pré-operatório e 0,88 (IC95% 0,77 - 0,95) no pós-operatório, respectivamente, sendo estatisticamente significativa a diferenca (P< 0,001) e reducão marcante dos sinais à tomografia, em média 4,2 pontos do escore (P<0,001). Conclusão: Sinuplastia mostrou-se efetiva para redução de sintomas e melhora da qualidade devida como opção de tratamento da rinossinusite crônica em pacientes selecionados. .

The Impact of Acute Loss of Weight on Eustachian Tube Function

Introduction The eustachian tube is one of the key structures responsible for the functional balance of the middle ear. Some clinical conditions associated with tubal malfunction can cause extremely unpleasant symptoms. These symptoms could be triggered by acute loss of weight, for example, after bariatric surgery. Objective To evaluate the frequency and intensity of auditory tube dysfunction symptoms in obese patients after bariatric surgery. Methods Nineteen patients with accepted formal indications for bariatric surgery underwent a hearing evaluation (otoscopy, tonal and vocal audiometry, and impedanceometry) and a hearing questionnaire before, at the time of, 3 months after surgery (first postoperative evaluation), and 6 months (second postoperative evaluation) after surgery. Patients with a history of ear disease or ear surgery were excluded. Results None of the patients reported tubal dysfunction symptoms before surgery. Postsurgical results showed that 5 (26.3%) patients presented symptoms related to dysfunction of the eustachian tube at the first postoperative evaluation. After the 6- month follow-up, 9 (47.3%) patients reported symptoms of tubal dysfunction. Conclusion This study suggests that bariatric surgery can cause symptoms of eustachian tube dysfunction, probably due to rapid weight loss and the consequent loss of peritubal fat...