Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery

Abstract Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

Knowledge and attitudes towards dementia among final-year medical students in Brazil / Conhecimentos e atitudes em relação à demência de estudantes de medicina brasileiros no final da graduação

Summary Objective: Among all countries, Brazil is expected to have the sixth largest elderly population in 2025. Dementia syndromes are prominent among aging-related diseases. Despite the necessity of and curriculum for training in geriatric medicine to make recommendations on an approach to this theme, adequate training appears to be infrequent. The present study aimed to evaluate the knowledge about dementia and students' attitude towards it during the last semester of the medical course in two of the most important Brazilian medical schools. Method: In our study, a sample of 189 students was invited to complete questionnaires comprising demographic and professional topics, knowledge with respect to cognitive alterations in the elderly and attitudes in dealing with an elderly patient with dementia. Results: A total of 155 students accepted to participate in the study; 92(59.7%) considered that they had good training in cognitive alterations during their undergraduate medical course, while 67 (58.8%) of them declared having had only theoretical training. Regarding knowledge, the students obtained a mean of 6.9, out of a scale from 0 to 14 points. As for attitudes, the students agreed that they can contribute to the life quality of the patient and of the caregiver, and that it is useful to provide the diagnosis to the family. Conclusion: The findings of this study are relevant for overturn the educational barriers of physicians in relation to the care of patients with dementia.

Resumo Objetivo: Em 2025, o Brasil terá a sexta maior população de idosos do mundo. Destacam-se, dentre as doenças relacionadas com o envelhecimento, as síndromes demenciais. Apesar da necessidade de o currículo para a formação médica conter tópicos em geriatria, isso parece ocorrer com pouca frequência. O presente estudo tem como objetivo avaliar conhecimento e atitudes em relação à demência de alunos do último semestre do curso médico em duas das mais importantes escolas médicas brasileiras. Método: Neste estudo, 189 alunos foram convidados a responder questionários que compreendem temas demográficos e profissionais, conhecimento sobre alterações cognitivas em idosos e atitudes frente a um paciente idoso com demência. Resultados: Um total de 155 estudantes aceitou participar do estudo; 92 (59,7%) relataram ter obtido uma boa formação em alterações cognitivas durante o curso de graduação em medicina, e, entre estes, 67 (58,8%) relataram ter tido apenas uma base teórica. Quanto ao conhecimento, os alunos obtiveram uma média de 6,9, considerando uma escala de pontuação de 0 a 14 pontos. Considerando as atitudes, os estudantes concordaram que eles podem contribuir para a qualidade de vida do paciente e de cuidadores, e que é útil dar o diagnóstico para a família. Conclusão: Os resultados deste estudo são relevantes para discutir as barreiras educacionais dos médicos em relação ao tratamento de pacientes com demência.

Teaching medical students about dementia: A brief review / O ensino de demência nas escolas médicas: uma breve revisão

Underdeveloped nations have the largest absolute number of the world's elderly population. Approximately 10.7% of the Brazilian population comprises aged individuals. Aging populations are associated with a higher incidence of chronic degenerative diseases such as dementia. Demented individuals place a high burden of care on healthcare systems and family members. General practitioners should be able to diagnose the most common elderly diseases such as dementia since they act as gatekeepers to specialized care. In Brazil, many medical students work as general practitioners upon graduating. The present study shows some scenarios of medical schools worldwide, including Brazilian, regarding teaching on dementia.

Países subdesenvolvidos têm o maior número absoluto de idosos do mundo. Cerca de 10,7% da população brasileira é constituída por indivíduos com idade igual ou superior a 60 anos. Como o envelhecimento populacional, uma maior incidência de doenças crônico-degenerativas, como a demência, é observada. Indivíduos com demência demandam múltiplos cuidados por parte dos sistemas de saúde e de suas famílias. Os clínicos gerais devem ser capazes de diagnosticar as doenças mais comuns nos idosos, incluindo as demências, já que são eles os profissionais que mais atendem esta população. No Brasil, muitos estudantes de medicina começam a trabalhar como médicos generalistas logo após a graduação em medicina. O presente estudo mostra alguns cenários de escolas médicas do mundo, incluindo algumas brasileiras, acerca do ensino de demências.