Did the speech of patients with Myasthenia Gravis decline over 4 years? / Há declínio na fala de pacientes com Miastenia Gravis ao longo de 4 anos?

ABSTRACT Purpose To compare the speech and voice patterns of myasthenia gravis (MG) patients over four years, and correlate the results with clinical aspects of the disease. Methods Data was collected for 4 years. The clinical assessment tools included the Quantitative Myasthenia Gravis (QMG) score, the Myasthenia Gravis Foundation of America (MGFA) clinical classification, and the Myasthenia Gravis Quality of Life 15-item Scale (MG-QoL). To assess speech, the recorded speaking tasks were analyzed acoustically and given auditory-perceptual ratings. Sex (equal distribution) and age (p=0.949) were used as matching criteria in the final sample, which consisted of 10 individuals in the MG group (MGG) and 10 individuals in the control group (CG). Results After 4 years, the MG participants presented stable health status, increased mild and moderate dysarthria (from 40% to 90% of the subjects), and a significant deterioration in the respiration, phonation, and articulation subsystems. The acoustic analysis showed a decline in articulatory patterns (speech rate p=0.047, articulation rate p=0.007, mean syllable duration p=0.007) and vocal quality (increased jitter p=0.022). In the follow-up comparison, there was a significant difference between the phonation variables (shimmer and harmonic-to-noise ratio) of the MGG and CG. Conclusion The MG patients presented a decline in speech over four years and an increase in mild and moderate dysarthria. Despite presenting stable health status, their respiratory, phonatory, and articulatory subsystems worsened. There was no correlation between speech patterns and clinical characteristics of the disease (severity and motor scale).

RESUMO Objetivo Comparar o padrão de fala e voz de indivíduos com Miastenia Gravis (MG) em um intervalo de quatro anos e correlacionar com aspectos clínicos da doença. Método A coleta de dados foi realizada ao longo de 4 anos. A avaliação clínica foi composta pelo Quantitative Myasthenia Gravis Score (QMGS), pela Myasthenia Gravis Foundation of America Classification (MGFA) e pela escala de qualidade de vida para Miastenia Gravis (MG-QOL). A avaliação da fala foi composta por gravação de tarefas, análise perceptivo-auditiva e análise acústica. A amostra final foi composta por 10 indivíduos em MG e 10 indivíduos no grupo controle (GC), pareados por sexo (distribuição igualitária) e idade (p=0,949). Resultados Após 4 anos, os indivíduos com MG apresentaram estabilidade clínica, aumento do diagnóstico de disartria leve e moderada (de 40% para 90% dos sujeitos) e diminuição significativa no desempenho dos subsistemas da fala: respiração, fonação e articulação. Na análise acústica, houve declínio do padrão articulatório (taxa de fala p=0,047, taxa de articulação p=0,007, duração média das sílabas p=0,007) e qualidade vocal (jitter aumentado p=0,022). Houve diferença significativa nas variáveis fonatórias (shimmer e harmonic-to-noise ratio) entre os grupos MG e GC na comparação do seguimento. Conclusão Indivíduos com MG apresentaram declínio no padrão de fala em um intervalo de quatro anos, com aumento no número de disártricos (leve e moderado). Mesmo com a estabilidade da doença, houve piora dos subsistemas respiratório, fonatório e articulatório. Não houve correlação entre o padrão de fala e as características clínicas da doença (gravidade e escala motora).

Sintomas de disfunções psicológicas após adoecimento crítico / Symptoms of psychological dysfunction after critical illness

Objetivo:estimar a prevalência e identificar fatores associados aos sintomas de ansiedades e/ou depressão. Método: Estudo transversal realizado em um hospital de grande porte. Os dados foram coletados através de ficha sociodemográfica e clínica e escalas para triagem de sintomas de ansiedade e depressão. Nas análises, empregou-se estatística descritiva e modelo de regressão. Resultados: Foram incluídos 83 pacientes, majoritariamente homens, com idade média de 47 anos, cor parda, baixo nível educacional, casados, católicos e com renda mensal inferior a um salário mínimo. 36,3% apresentaram sintomas de ansiedade, 29,5% de depressão e 21% de ambos. Sexo masculino e idade mais jovem associaram-se como proteção para o desenvolvimento de sintomas psicológicos. Conclusão: Pessoas submetidas a cuidados intensivos enfrentam disfunções psicológicas após a alta, portanto, torna-se pertinente a implementação de medidas assistenciais e políticas públicas para o enfrentamento desses prejuízos.(AU)

Objective: To estimate the prevalence and identify factors associated with symptoms of anxiety and/or depression. Method: Cross-sectional study carried out in a large hospital. Data was collected using a sociodemographic and clinical form and scales to screen for symptoms of anxiety and depression. Descriptive statistics and a regression model were used in the analysis. Results: 83 patients were included, mostly men, with an average age of 47, brown, with a low level of education, married, Catholic and with a monthly income of less than one minimum wage. 36.3% had symptoms of anxiety, 29.5% of depression and 21% of both. Male gender and younger age were associated as protective factors for the development of psychological symptoms. Conclusion: People undergoing intensive care face psychological dysfunction after discharge, so it is pertinent to implement care measures and public policies to deal with this damage.(AU)

Objetivo: Estimar la prevalencia e identificar factores asociados a síntomas de ansiedad y/o depresión. Método: Estudio transversal realizado en un gran hospital. Los datos se recogieron mediante un formulario sociodemográfico y clínico y escalas de detección de síntomas de ansiedad y depresión. En los análisis se utilizó estadística descriptiva y un modelo de regresión. Resultados: Fueron incluidos 83 pacientes, en su mayoría hombres, con edad media de 47 años, morenos, con bajo nivel de escolaridad, casados, católicos y con renta mensual inferior a un salario mínimo. 36,3% presentaban síntomas de ansiedad, 29,5% de depresión y 21% de ambos. El sexo masculino y la menor edad se asociaron como factores protectores para el desarrollo de síntomas psicológicos. Conclusión: Las personas sometidas a cuidados intensivos enfrentan disfunción psicológica después del alta, por lo que es pertinente implementar medidas de atención y políticas públicas para enfrentar este daño.(AU)

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Tumor risk markers in recurrent respiratory papillomatosis

Abstract Objectives: This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. Methods: Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. Results: Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ±SD (standard deviation) of 51.7±26. Conclusions: The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. Level of evidence:: 4.

Puerperal women's perceptions of obstetric violence during labor

Introduction: When perceptions from healthcare users regarding the services offered by health institutions are taken into account, they become a tool to improve the quality of healthcare actions. Objective: To understand the perception of puerperal women about obstetric violence during labor. Methods: A descriptive mixed-methods study was carried out in a maternity hospital in the city of São Paulo with 31 postpartum women from August to November 2020. Quantitative data were collected in the first step, followed by the collection and analysis of qualitative data based on the theoretical framework of social representations and content analysis to decompose the interview material. Results: Two categories were identified from the perspective of the obstetric violence perception, physical abuse, and abandonment during health care. From the perceptions of puerperal women concerning obstetric violence during labor, it was possible to identify that 11 women have experienced it. Of these, 7 did not initially mention violence, but when questioned, they indicated the occurrence of inappropriate or unnecessary practices that fit the obstetric violence definition, and 20 claimed not to have experienced violence. Conclusion: It was evidenced that women sometimes did not recognize that they experienced obstetric violence, and some of those women who did had received inadequate information. There is an urgent need to reflect on the current scenario of childbirth care, reformulation of care practices, and professional awareness of good practices and evidence-based medicine.

Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections

Abstract Objective This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections. Methodology This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays. Results The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively. Conclusion EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Mental suffering in family daily life: a temporal journey according to Merleau-Ponty / Sufrimiento mental en la vida diaria de la familia: un viaje temporal según Merleau-Ponty / Sofrimento mental no cotidiano familiar: trajetória temporal segundo Merleau-Ponty

ABSTRACT Objectives: to describe the family's experience in relation to daily life with a family member experiencing mental suffering. Methods: a qualitative, descriptive, phenomenological study grounded in Merleau-Ponty's ontology of experience was conducted in ten households in a city in the state of Bahia, Brazil, where 24 participants of the Intersubjectivity Wheels reside. The descriptions produced were subjected to the Ambiguity Analytics technique. Results: the descriptions were categorized into: absence as a creative power of the sense of "being" and "not being a family"; and exclusion and acceptance as expressions of mental suffering in the family context. Final Considerations: the experience of mental suffering in the family's daily life is marked by ambiguous feelings, such as joy and sadness, disappointment and satisfaction, lack of love and love. However, experiencing these feelings can mobilize the desire to "become" a family, increase the sense of autonomy and independence, and drive the formation of new family configurations.

RESUMEN Objetivos: describir la experiencia de la familia en relación con la vida diaria de un miembro familiar que experimenta sufrimiento mental. Métodos: se realizó un estudio cualitativo, descriptivo y fenomenológico basado en la ontología de la experiencia de Merleau-Ponty en diez hogares de una ciudad en el estado de Bahía, Brasil, donde residen 24 participantes de los Círculos de Intersubjetividad. Las descripciones producidas fueron sometidas a la técnica de Análisis de Ambigüedad. Resultados: las descripciones se clasificaron en: la ausencia como un poder creativo del sentido de "ser" y "no ser una familia"; y la exclusión y aceptación como expresiones del sufrimiento mental en el contexto familiar. Consideraciones Finales: la experiencia del sufrimiento mental en la vida diaria de la familia está marcada por sentimientos ambiguos, como alegría y tristeza, decepción y satisfacción, falta de amor y amor. Sin embargo, experimentar estos sentimientos puede movilizar el deseo de "convertirse" en una familia, aumentar el sentido de autonomía e independencia, y promover la formación de nuevas configuraciones familiares.

RESUMO Objetivos: descrever a experiência da família em relação ao cotidiano com o familiar em sofrimento mental. Métodos: estudo qualitativo, descritivo, do tipo fenomenológico, fundamentado na ontologia da experiência de Merleau-Ponty, realizado em dez domicílios de uma cidade do estado da Bahia (Brasil), onde residem os 24 participantes das Rodas de Intersubjetividade. As descrições produzidas foram submetidas à técnica Analítica da Ambiguidade. Resultados: as descrições foram categorizadas em: ausência como potência criadora do sentido de "ser" e "não ser família"; e exclusão e acolhimento como expressão do sofrimento mental no contexto da família. Considerações Finais: a experiência do sofrimento mental no cotidiano da família é marcada por sentimentos ambíguos, como alegria e tristeza, decepção e satisfação, desamor e amor. Entretanto, a vivência desses sentimentos pode mobilizar o desejo de "tornar-se" família, aumentar o senso de autonomia e independência, e impulsionar a formação de novas configurações familiares.

Community therapy as a strategy for promoting the mental health of professors in the COVID-19 pandemic / La terapia comunitaria como estrategia de promoción de la salud mental del profesorado en la pandemia de COVID-19 / Terapia comunitária como estratégia de promoção da saúde mental de docentes na pandemia de COVID-19

ABSTRACT Objective: To understand the perception of university professors about Integrative Community Therapy as a mental health promotion strategy. Methods: Qualitative, phenomenological and interventional research, conducted with professors of the Nursing course at the Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil. The experiential descriptions were produced through phenomenological interviews, whose resulting material was analyzed based on the Ambiguity Analytical technique. Results: The professors expressed a lack of interaction between them, a fact that has become a reality in everyday academic life and that has worsened in the emergence of the COVID-19 pandemic. In this context, the Community Therapy circles in a virtual environment proved to be effective in sharing psychosocial and physical demands, as well as in the collective discussion of problem situations and the search for joint solutions. Conclusion: The study highlights the potential of Community Therapy as an integrative and complementary practice to the Brazilian public health care model.

RESUMEN Objetivo: Comprender la percepción de los profesores universitarios sobre la Terapia Integrativa Comunitaria como estrategia para promover la salud mental. Métodos: Investigación cualitativa, fenomenológica e intervencionista, realizada con profesores del curso de Enfermería de la Universidad Estatal del Sudoeste de Bahía, Jequié, Bahía, Brasil. Las descripciones vivenciales se produjeron a través de entrevistas fenomenológicas, cuyo material resultante fue analizado con base en la técnica Analítica de la Ambigüedad. Resultados: Los docentes manifestaron una falta de interacción entre ellos, hecho que se ha hecho realidad en la vida académica cotidiana y que se ha agravado con el surgimiento de la pandemia de COVID-19. En este contexto, las ruedas de Terapia Comunitaria en un entorno virtual demostraron ser efectivas para compartir demandas psicosociales y físicas, así como en la discusión colectiva de situaciones problemáticas y la búsqueda de soluciones conjuntas. Conclusión: El estudio destaca el potencial de la Terapia Comunitaria como práctica integradora y complementaria al modelo de salud pública brasileño.

RESUMO Objetivo: Compreender a percepção de docentes universitários sobre a Terapia Comunitária Integrativa como estratégia de promoção da saúde mental. Métodos: Pesquisa qualitativa, fenomenológica e interventiva, realizada com docentes do curso de Enfermagem da Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brasil. As descrições vivenciais foram produzidas mediante entrevista fenomenológica, cujo material resultante foi analisado com base na técnica Analítica da Ambiguidade. Resultados: As Docentes expressaram carência de interação entre elas, fato que tem se constituído uma realidade no cotidiano da vida acadêmica e que se agravou na emergência da pandemia da COVID-19. Nesse contexto, as rodas de Terapia Comunitária em ambiente virtual se mostraram eficazes ao compartilhamento de demandas psicossociais e físicas, bem como à discussão coletiva de situações-problema e a busca de soluções conjuntas. Conclusão: O Estudo evidencia o potencial da Terapia Comunitária como prática integrativa e complementar ao modelo de atenção à saúde pública brasileiro.

Prevalence of oral injuries and salivary changes in patients with chronic renal failure on hemodialysis: systematic review and meta-analysis

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Dysarthria in hereditary spastic paraplegia type 4

Abstract Objective: To describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. Methods: Cross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). Results: In the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects' performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. Conclusion: Dysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.

Influência dos fatores de risco para aterosclerose na distribuição anatômica da doença arterial periférica em pacientes com isquemia crônica crítica de membros: um estudo transversal / Influence of atherosclerosis risk factors on the anatomical distribution of peripheral arterial disease in patients with chronic limb-threatening ischemia: a cross-sectional study

Resumo Contexto Os fatores de risco para aterosclerose podem ter influência distinta nas doenças cardiovasculares, impactando também no território da doença arterial periférica (DAP). Objetivos Estudar a influência dos diferentes fatores de risco para a aterosclerose na distribuição anatômica da DAP em pacientes com isquemia crítica crônica de membros (ICCM). Métodos Foi realizado um estudo observacional, transversal e analítico, incluindo 476 doentes internados devido à ICCM por DAP. Foram estudados, comparativamente, os pacientes com DAP dos três distintos territórios anatômicos (aortoilíaco, femoropoplíteo e infragenicular) em relação à presença dos fatores de risco para a aterosclerose (idade, gênero, diabetes mellitus, tabagismo e hipertensão arterial). A análise multivariada foi realizada para testar a associação entre os fatores de risco e a distribuição anatômica da DAP. Resultados A média de idade dos pacientes foi de 69 anos, 249 (52%) eram homens, e 273 (57%), diabéticos. Predominaram os pacientes na Categoria 5 da Classificação de Rutherford (353/74%). Na análise multivariada, as mulheres tiveram chance 2,7 (IC: 1,75-4,26) vezes maior de doença do território femoropoplíteo. Os doentes tabagistas tiveram 3,6 (IC: 1,54-8,30) vezes maior risco de doença do território aortoilíaco. Diabéticos apresentaram 1,8 (IC: 1,04-3,19) vezes maior chance de obstrução apenas do território infragenicular. Conclusões O estudo mostrou que gênero, diabetes mellitus e tabagismo influenciam no padrão de distribuição da DAP em pacientes com ICCM. Os doentes diabéticos apresentaram maior chance de doença isolada do território infragenicular, as mulheres tiveram maior risco de DAP do território femoropoplíteo e os tabagistas possuem maior chance comprometimento aortoilíaco.

Abstract Background Atherosclerosis risk factors can have different impacts on cardiovascular diseases and on the anatomical distribution of Peripheral Arterial Disease (PAD). Objectives To study the influence of atherosclerosis risk factors on the anatomical distribution of PAD in patients with chronic limb-threatening ischemia (CLTI). Methods We performed an observational, cross-sectional, and analytical study that included 476 hospitalized patients with CLTI due to PAD. We compared the presence of atherosclerosis risk factors (age, gender, diabetes mellitus, smoking, and hypertension) in patients with PAD involving three different anatomic areas (aortoiliac, femoropopliteal, and infrapopliteal). Multivariate analysis was performed to identify associations between atherosclerosis risk factors and PAD distribution. Results The mean age of the 476 patients was 69 years, 249 (52%) were men, and 273 (57%) had diabetes. Seventy-four percent (353) had minor tissue loss. Multivariate analysis identified three risk factors associated with PAD anatomical distribution (gender, smoking, and DM). Women had a 2.7 (CI: 1.75-4.26) times greater chance of having femoropopliteal disease. Smokers had a 3.6-fold (CI: 1.54-8.30) greater risk of aortoiliac disease. Diabetic patients were 1.8 (CI: 1.04-3.19) times more likely to have isolated infrapopliteal occlusive disease. Conclusions The study showed that gender, DM, and smoking impact on the anatomical distribution of PAD in patients with CLTI. Diabetic patients were more likely to have only infrapopliteal disease, women had a greater risk of femoropopliteal PAD, and smokers had a greater risk of aortoiliac occlusive disease.

Diagnósticos de enfermagem em pacientes adultos com condições cardiovasculares: revisão integrativa da literatura / Nursing diagnosis in adult patients with cardiovascular conditions: an integrative literature review

Objetivo: Identificar os diagnósticos de enfermagem em estudos realizados com pacientes adultos que possuem diagnóstico clínico de condições cardiovasculares. Métodos: Trata-se de uma pesquisa de revisão integrativa da literatura conduzida nas bases de dados BVS, BDENF, CINAHL Database, PubMed, SciELO e ScienceDirect, com os descritores "diagnósticos de enfermagem" e "doença cardiovascular". Resultados: Obtiveram-se dezesseis artigos científicos publicados entre os anos de 2004 e 2020, publicados em sua maioria no idioma português (n=11). Considerando o tipo de estudo, a maioria das pesquisas foi enquadrada como descritiva (n=14). Para a abordagem dos diagnósticos de enfermagem, teve-se como base o Sistema de Linguagem Padronizada da taxonomia da NANDA-I, utilizado na maioria das pesquisas. Quanto ao nível de evidência, os estudos foram classificados como nível IV. Quatro estudos referiram à utilização de Teorias de Enfermagem, com maior frequência de uso da Teoria do Autocuidado de Dorothea Orem (n=2). O diagnóstico de enfermagem mais frequente entre os estudos foi padrão respiratório ineficaz (n=5). Conclusão: Novos estudos acerca da realização de diagnósticos em enfermagem voltados às doenças cardiovasculares, com a utilização de teorias de Enfermagem, precisam ser conduzidos para proporcionar maior embasamento científico à prática de enfermagem. Descritores: Diagnóstico de enfermagem. Teoria de Enfermagem. Cardiologia. Processo de Enfermagem.

Objective: To identify the nursing diagnosis in studies carried out with adult patients diagnosed with cardiovascular conditions. Methods: This is an integrative literature review carried out in the databases VHL, BDENF, CINAHL Database, PubMed, SciELO, and ScienceDirect, using the descriptors "nursing diagnoses" and "cardiovascular disease". Results: Sixteen scientific articles published from 2004 to 2020 were found, most in Portuguese (n=11). In regard to the types of study, most researches were descriptive (n=14). The discussion of the nursing diagnosis was based on the Standardized Language System of the NANDA-I taxonomy, used in most researches. Regarding the evidence level, the studies were classified as level IV. Four studies stated to use Nursing Theories, in most cases, the Dorothea Orem's Self-Care Theory (n=2). The most frequent nursing diagnosis among the studies was ineffective breathing pattern (n=5). Conclusion: New studies about nursing diagnoses targeted at cardiovascular diseases, using nursing theories, must be carried out to provide a better scientific support for the practice of nursing. Descriptors: Nursing Diagnosis. Nursing Theory. Cardiology. Nursing Process

Relato da experiência da atuação fonoaudiológica em telessaúde em pacientes neurológicos com disfagia e disartria durante a pandemia de Covid-19 / Experience report of speech therapy in telehealth with neurological patients with dysphagia and dysarthria during the Covid-19 pandemic / Reporte de experiencia de desempeño logopédico en telesalud en pacientes neurológicos con disfagia y disartria durante la pandemia de Covid-19

Introdução: Devido à COVID-19, os pacientes com doenças neurológicas deixaram de frequentar presencialmente as consultas fonoaudiológicas em ambulatórios. Objetivo: Descrever o relato da experiência fonoaudiológica em pacientes com doença neurológica com disartria e/ou disfagia durante a pandemia da COVID-19 através da telessaúde. Método: Trata-se de um relato de experiência. Foram incluídos pacientes do ambulatório de fonoaudiologia de um hospital universitário, que ficaram privados do acompanhamento fonoaudiológico em período pandêmico e que tinham diagnóstico de disfagia e/ou disartria (prévios à pandemia). No total, 43 pacientes foram convidados a participar do estudo. Os indivíduos foram separados de acordo com seu diagnóstico fonoaudiológico: disfagia, disartria e disfagia/disartria. No início, todos foram reavaliados em videochamadas: disfagia (Northwestern dysphagia patient check sheet, Escala Funcional de Ingestão Via Oral e Instrumento de Autoavaliação da Alimentação); disartria (coleta de fala e questionário de autopercepção Radbould Oral Inventory Motor for Parkinson's disease). Após, os pacientes foram alocados aleatoriamente: teleatendimento fonoaudiológico por quatro semanas consecutivas, sendo o outro grupo controle, sem intervenções e/ou orientações. Todos foram reavaliados para a comparação pré e pós-acompanhamento fonoaudiológico. Resultados: Nove participantes concluíram todas as etapas do estudo, sendo 6 (66,66%) homens. A média de idade foi de 60,44 anos (±16,13). Os participantes possuíam diagnóstico médico de doença neurológica, sendo 2 neurogenética (22,22%), 5 neurodegenerativa (55,5%) e 2 neurológicas (22,22%). Não foram observadas diferenças descritivas entre os grupos nas avaliações pré e pós-intervenção. A perda na amostra aconteceu devido à falta de dispositivos tecnológicos e à sobrecarga dos cuidadores. Conclusões: A experiência em tele fonoaudiologia, apesar de ter sido positiva, revelou a dificuldade da sua implementação em pacientes neurológicos de baixa condições sócio financeiras e educacional.

Introduction: Due to COVID-19, patients with neurological disease no longer attend face-to-face speech therapy consultations in outpatient clinics. Objective: To describe the report of the speech therapy experience patients with neurological disease with dysarthria and/or dysphagia during the COVID-19 pandemic through telehealth. Method: This is an experience report. Patients from the speech therapy outpatient clinic of a university hospital who were deprived of speech therapy during a pandemic period and had a diagnosis of dysphagia and/or dysarthria (prior to the pandemic) were included. In total, 43 patients were invited to participate in the study. Individuals were separated according to their speech-language diagnosis: dysphagia, dysarthria, and dysphagia/dysarthria. In the beginning, all were reassessed in video calls: dysphagia (Northwestern dysphagia patient check sheet, Functional Oral Intake Scale, and Food Self-Assessment Instrument); dysarthria (speech collection and self-perception questionnaire Radbould Oral Motor Inventory for Parkinson's disease). Afterward, the patients were randomly allocated: speech therapy telecare for four consecutive weeks, with the other being a control group, without interventions and/or guidance. All were reassessed for comparison before and after speech therapy follow-up. Results:Nine participants completed all stages of the study, 6 (66.66%) men. The mean age was 60.44 years (±16.13). Participants had a medical diagnosis of neurological disease, 2 of which were neurogenetic (22.22%), five neurodegenerative (55.5%), and two neurologic (22.22%). No descriptive differences were observed between groups in pre- and post-intervention assessments. The loss in the sample happened due to the lack of technological devices and the overload of caregivers. Conclusions: The experience in telehealth was positive, revealing the difficulty of its implementation in neurological patients with low socio-financial and educational conditions.

Introducción: Debido al COVID-19, los pacientes con enfermedades neurologicas ya no asisten a consultas de logopedia presenciales en consultas externas. Objetivo: Describir el relato de la experiencia fonoaudiológica en pacientes con enfermedades neurologicas con disartria y/o disfagia durante la pandemia de COVID-19 a través de telesalud. Método: Este es un relato de experiencia. Se incluyeron pacientes de la consulta externa de logopedia de un hospital universitario, que fueron privados de logopedia durante un período de pandemia y que tenían diagnóstico de disfagia y/o disartria (previo a la pandemia). En total, 43 pacientes fueron invitados a participar en el estudio. Los individuos se separaron según su diagnóstico del habla y el lenguaje: disfagia, disartria y disfagia/disartria. Al principio, todos fueron reevaluados en videollamadas: disfagia (Northwestern dysphagia patient check sheet), Escala de ingesta oral funcional e Instrumento de autoevaluación de alimentos); disartria (cuestionario de recogida de voz y autopercepción Radbould Oral Motor Inventory for Parkinson's disease). Posteriormente, los pacientes fueron asignados aleatoriamente: teleasistencia logopédica durante cuatro semanas consecutivas, siendo el otro grupo control, sin intervenciones y/u orientaciones. Todos fueron reevaluados para compararlos antes y después del seguimiento con logopedia. Resultados: Nueve participantes completaron todas las etapas del estudio, 6 (66,66%) hombres. La edad media fue de 60,44 años (±16,13). Los participantes tenían diagnóstico médico de enfermedad neurológica, 2 de ellas neurogenéticas (22,22%), 5 neurodegenerativas (55,5%) y 2 neurológica (22,22%). No se observaron diferencias descriptivas entre los grupos en las evaluaciones previas y posteriores a la intervención. La pérdida en la muestra ocurrió por la falta de dispositivos tecnológicos y la sobrecarga de cuidadores. Conclusiones: La experiencia en telefonoaudiología, a pesar de ser positiva, reveló la dificultad de su implementación en pacientes neurológicos de baja condición socioeconómica y educativa.

Speech and swallowing characteristics in patients with facioscapulohumeral muscular dystrophy / Caracterização da fala e da deglutição em pacientes com distrofia muscular facioescapuloumeral

ABSTRACT Background: Although facial muscle weakness is common in patients with Facioscapulohumeral Muscular Dystrophy (FSHD), the literature is scarce on the speech and swallowing aspects. Objective: To investigate speech and swallowing patterns in FSHD and assess the correlation with clinical data. Methods: A cross-sectional study was conducted. Patients with clinical confirmation of FSHD and aged above 18 years were included and paired with healthy control individuals by age and gender. Individuals who had neurological conditions that could interfere with test results were excluded. The following assessments were applied: speech tests (acoustic and auditory-perceptual analysis); swallowing tests with the Northwestern Dysphagia Patient Check Sheet (NDPCS), the Eat Assessment Tool (EAT-10), the Speech Therapy Protocol for Dysphagia Risk (PARD), and the Functional Oral Intake Scale (FOIS); disease staging using the modified Gardner-Medwin-Walton scale (GMWS); and quality of life with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The correlation between test results and clinical data was verified by non-parametric statistics. Results: Thirteen individuals with FSHD and 10 healthy controls were evaluated. The groups presented significant differences in the motor bases of phonation and breathing. Regarding swallowing, two (15%) individuals presented mild dysphagia and seven (53.8%) showed reduced facial muscles strength. These results were not correlated with duration of the disease, age at symptoms onset, and quality of life. Dysphagia was related to worsening disease severity. Conclusions: FSHD patients presented mild dysarthria and dysphagia. Frequent monitoring of these symptoms could be an important way to provide early rehabilitation and better quality of life.

RESUMO Antecedentes: Embora haja predomínio de fraqueza muscular facial na distrofia facioescapuloumeral (FSHD), é escassa a literatura sobre aspectos de fala e deglutição. Objetivo: Investigar os padrões de fala e deglutição na FSHD e correlacioná-los com dados clínicos da doença. Métodos: Estudo transversal. Pacientes com confirmação clínica de FSHD e idade acima de 18 anos foram incluídos e pareados por idade e sexo com controles saudáveis. Foram excluídos indivíduos que apresentassem condições neurológicas que pudessem interferir nos resultados dos testes. Aplicaram-se as seguintes avaliações: fala (análise acústica e perceptivo-auditiva); deglutição, por meio do Northwestern Dysphagia Patient Check Sheet (NDPCS), Eat Assessment Tool (EAT-10), Protocolo de Avaliação para Risco de Disfagia (PARD) e Functional Oral Intake Scale (FOIS); estadiamento da doença, por meio da Gardner-Medwin-Walton scale (GMWS); e qualidade de vida, com o Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Resultados de fala e deglutição foram correlacionados com dados clínicos da doença por teste não paramétrico. Resultados: Foram avaliados 13 indivíduos com FSHD e dez controles saudáveis. Houve diferença significativa entre os grupos nas bases motoras fonação e respiração. Na deglutição, dois (15%) indivíduos apresentaram disfagia leve e sete (53,8%), força reduzida da musculatura da face. Esses resultados não foram correlacionados com tempo de doença, idade de início dos sintomas e qualidade de vida. A disfagia esteve relacionada com a gravidade da doença. Conclusões: Pacientes com FSHD apresentaram disartria e disfagia leves. O monitoramento frequente desses sintomas pode ser uma forma importante de proporcionar reabilitação precoce e melhor qualidade de vida.

Atuação do enfermeiro na detecção precoce do câncer de colo uterino: revisão integrativa / Desempeño de las enfermeras en la detección precoz del cáncer cervical uterino: revisión integrativa / Nurses' performance in the early detection of uterine cervical cancer: integrative review

Objetivo: Identificar a atuação do enfermeiro na detecção precoce do câncer de colo do uterino. Método: Trata-se de uma revisão integrativa, realizada em 2021, nas bases de dados SCIELO, PUBMED, LILACS, com os descritores: Neoplasias do Colo do Útero, Enfermagem e Cuidado Centrado no Paciente. A amostra foi de 16 artigos. Resultados: dentre as atuações do enfermeiro destacam-se: Educação em saúde sobre detecção precoce do câncer do colo uterino e incentivo à realização do exame citopatológico; orientação de enfermagem quanto a importância do uso de preservativo nas relações sexuais; consulta de enfermagem, realização do exame citopatológico; vacinação contra HPV; diagnóstico e tratamento precoces. Conclusão: O enfermeiro tem função primordial no decorrer de todo o processo de prevenção e promoção de saúde do câncer de colo uterino, prestando uma assistência integral e humanizada(AU)

Objective: To identify the role of nurses in the early detection of cervical cancer. Method: This is an integrative review, carried out from April to June 2021, in the SCIELO, PUBMED, LILACS databases, with the descriptors: Cervical Neoplasms, Nursing and Patient-Centered Care. Were found 1,389 articles, but the sample consisted of 16 articles. Results: among the nurses' actions, the following stand out: Health education on early detection of cervical cancer and encouragement to perform the Pap smear; nursing guidance on the importance of using condoms during sexual intercourse; nursing consultation, Pap smear test; HPV vaccination; early diagnosis and treatment. Conclusion: The nurse has a primary role throughout the entire process of prevention and health promotion of cervical cancer, providing comprehensive and humanized care.(AU)

Objetivo: Identificar el papel del enfermero en la detección precoz del cáncer cervicouterino. Método: Se trata de una revisión integradora, realizada de abril a junio de 2021, en las bases de datos SCIELO, PUBMED, LILACS, con los descriptores: Neoplasias Cervicales, Enfermería y Atención Centrada en el Paciente. Se encontraron 1389 artículos, pero la muestra estuvo conformada por 16 artículos. Resultados: entre las acciones de las enfermeras se destacan las siguientes: Educación en salud para la detección temprana del cáncer de cuello uterino y estímulo para la realización del Papanicolaou; orientación de enfermería sobre la importancia de usar condones durante las relaciones sexuales; consulta de enfermería, prueba de Papanicolaou; Vacunación contra el VPH; diagnóstico y tratamiento precoces. Conclusión: La enfermera tiene un rol primordial en todo el proceso de prevención y promoción de la salud del cáncer de cuello uterino, brindando una atención integral y humanizada(AU)

Conhecimento, renda e práticas de prevenção acerca do HIV/AIDS entre estudantes universitários / Knowledge, income and prevention practices about HIV/AIDS among university students

Este estudo objetivou verificar se os estudantes universitários têm conhecimento sobre as formas de transmissão do HIV/AIDS e a adoção de práticas de prevenção e se há associação com a renda. A pesquisa contou com 682 estudantes, que responderam a um questionário. Foram analisadas dez questões a respeito das formas de transmissão, o número de acertos e a possível associação com a renda familiar. Na amostra, predominaram as mulheres e a renda inferior a cinco salários mínimos. Seiscentos e oito estudantes (89%) acertaram oito ou mais perguntas acerca das formas de transmissão do vírus. Aqueles com renda familiar menor que cinco salários mínimos apresentaram uma porcentagem maior de acertos em todas as questões sobre a transmissão. Concluiu-se que a maioria tem bom conhecimento em relação à transmissão, porém não utiliza preservativo em todas as relações sexuais, e há maior conhecimento entre estudantes de menor renda.

This study aimed to verify whether university students have knowledge about the ways of HIV/AIDS transmission and the adoption of prevention practices and if there is an association with income. The survey included 682 students, who answered a questionnaire. Ten questions about the ways of transmission, the number of correct answers and the possible association with family income were analyzed. In the sample, women and income below five minimum wages predominated. Six hundred and eight students (89%) answered eight or more questions about the ways in which the virus was transmitted. Those with a family income of less than five minimum wages had a higher percentage of correct answers in all questions about transmission. The majority has good knowledge regarding transmission, but does not use condoms in all sexual relations, and there is greater knowledge among students with lower income.

Ansiedade e depressão em profissionais de enfermagem de uma maternidade durante a pandemia de COVID-19 / Anxiety and depression in nursing professionals of a maternity during the COVID-19 pandemic / Ansiedad y depresión en profesionales de enfermería de una maternidad durante la pandemia de COVID-19

Objetivo: Estimar a prevalência de sintomas de ansiedade e depressão e seus fatores relacionados, entre os profissionais de enfermagem de uma maternidade, durante a pandemia de COVID-19. Método: Estudo observacional, descritivo e transversal, realizado com 189 profissionais de enfermagem de uma maternidade de referência, em Fortaleza-Ceará. A coleta de dados ocorreu durante três meses − de agosto a outubro de 2020 −, e utilizou-se Formulário Sociodemográfico e Clínico e Escala Hospitalar de Ansiedade e Depressão. Os fatores relacionados para depressão ou ansiedade foram determinados pela análise bivariada, por meio do teste qui-quadrado (nominais) e Wilcoxon (numéricas), com significância de p<0,05. Resultados: Estimou-se a prevalência de sintomatologia ansiosa e depressiva em 58,3% e 29,6% dos participantes, respectivamente. Cerca de 53,5% foram afastados por suspeita de COVID-19 e 58%, infectados pelo vírus. Observou-se que os profissionais que atuavam na emergência, clínica obstétrica e Unidade de Terapia Intensiva materna foram os mais expostos ao risco de ter depressão (p=0,01055). Conclusão e implicações para a prática: Alta prevalência de sintomas de ansiedade e depressão entre os participantes, independentemente de estarem na linha de frente da pandemia ou não. A situação requer acolhimento às demandas da saúde mental

Objective: To estimate the prevalence of anxiety and depression symptoms and their related factors among nursing professionals in a maternity hospital during the COVID-19 pandemic. Method: Observational, descriptive and cross-sectional study carried out with 189 nursing professionals from a reference maternity hospital in Fortaleza-Ceará. Data collection took place over three months, from August to October 2020, using the Sociodemographic and Clinical Form and the Hospital Anxiety and Depression Scale. Factors related to depression or anxiety were determined by bivariate analysis using the chi-square (nominal) and Wilcoxon (numerical) tests, with a significance of p<0.05. Results: The prevalence of anxious and depressive symptoms was estimated in 58.3% and 29.6% of the participants, respectively. About 53.5% were removed due to suspected COVID-19 and 58% were infected with the virus. It was observed that professionals who worked in the emergency, obstetric clinic and maternal Intensive Care Unit were the most exposed to the risk of having depression (p=0.01055). Conclusion and implications for practice: High prevalence of anxiety and depression symptoms among participants, regardless of whether they are on the front lines of the pandemic or not. The situation requires meeting the demands of mental health.

Objetivo: Estimar la prevalencia de síntomas de ansiedad y depresión y sus factores relacionados entre profesionales de enfermería en una maternidad durante la pandemia de COVID-19. Método: Estudio observacional, descriptivo y transversal realizado con 189 profesionales de enfermería de una maternidad de referencia en Fortaleza-Ceará. La recolección de datos ocurrió durante tres meses, de agosto a octubre de 2020, utilizando el Formulario Sociodemográfico y Clínico y la Escala Hospitalaria de Ansiedad y Depresión. Los factores relacionados con la depresión o la ansiedad se determinaron mediante análisis bivariado mediante las pruebas de chi-cuadrado (nominal) y Wilcoxon (numérica), con una significancia de p<0,05. Resultados: La prevalencia de síntomas ansiosos y depresivos se estimó en 58,3% y 29,6% de los participantes, respectivamente. Alrededor del 53,5% fueron retirados por sospecha de COVID-19 y el 58% estaban infectados con el virus. Se observó que los profesionales que actuaban en emergencia, clínica obstétrica y Unidad de Terapia Intensiva materna eran los más expuestos al riesgo de tener depresión (p=0,01055). Conclusión e implicaciones para la práctica: Alta prevalencia de síntomas de ansiedad y depresión entre los participantes, independientemente de si están en la primera línea de la pandemia o no. La situación requiere atender las demandas de salud mental.