Functionality and disease severity in spinocerebellar ataxias / Relação entre a função e a gravidade nas ataxias espinocerebelares

ABSTRACT Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases characterized by deterioration of balance and functionality that tends to follow disease progression. There is no established link between formal clinical markers for severity and functional/balance scores that could guide rehabilitation teams. Objective: To evaluate the relationship between functional scales and ataxia severity in order to identify cutoff landmarks for functional loss and estimate the mean SARA (Scale for Assessment and Rating of Ataxia) score for the risk ratings for falls on the BBS (Berg Balance Scale). Methods: Consecutive patients with a molecular diagnosis of SCA (total 89: 31 with SCA2 and 58 with SCA3) were assessed for functionality FIM-ADL (Functional Independence Measure-activities of daily living and Lawton-IADL (instrumental activities of daily living), balance (BBS) and disease severity (SARA). Results: The main disability cutoff landmarks were that the need for supervision for FIM-ADL starts with 12 points on SARA and the need for supervision for Lawton-IADL starts with 14 points on SARA. The first items to require assistance were "expression" and "shopping", respectively. At 20 points on SARA, patients were dependent on all FIM and Lawton items. The item with the greatest impact on distinguishing dependents from independents was "means of transport" in Lawton-IADL and the domain "locomotion" in FIM-ADL. The mean SARA score for patients classified as low risk in the BBS was 9.9 points, and it was 17.4 for medium risk and 25.2 for high risk. Conclusions: Analysis on the correlation between the severity of ataxia and functional scales can form an important guide for understanding the progression of functional dependence among individuals with SCAs.

RESUMO Antecedentes: As ataxias espinocerebelares (SCA) são um grupo de doenças neurodegenerativas caracterizadas pela deterioração do equilíbrio e da funcionalidade, que tende a acompanhar a progressão da doença. Não existe uma ligação estabelecida entre os marcadores clínicos formais de gravidade e escores funcionais e de equilíbrio que possam orientar as equipes de reabilitação. Objetivo: Avaliar a relação entre escalas funcionais e de gravidade da ataxia, buscando identificar pontos de corte para a perda funcional relacionados aos escores de gravidade e aos patamares de Risco de Quedas. Métodos: Uma amostra consecutiva de 89 pacientes com diagnóstico molecular de SCA (31-SCA2 e 58-SCA3) foram avaliados para funcionalidade MIF-AVDs (Medida de independência funcional-Atividades da vida diária) e Lawton-AIVDs (Atividades instrumentais da vida diária), equilíbrio (EEB-escala de Equilíbrio de Berg), e gravidade da ataxia (SARA-escala para avaliação e graduação de ataxia). Resultados: Os principais pontos de corte de deficiência foram: com 12 pontos no SARA começa a necessidade de supervisão para MIF-AVDs e com 14 pontos no SARA começa a necessidade de supervisão para Lawton-AIVDs. Os primeiros itens a necessitar de assistência foram "expressão" e "compras", respectivamente. Com 20 pontos no SARA os pacientes eram dependentes em todos os itens MIF/LAWTON. O item com maior impacto na discriminação entre dependentes e independentes foi "meio de transporte" na Lawton e o domínio "locomoção" na MIF. O escore médio no SARA foi de 9,9 pontos para pacientes classificados com baixo risco na EEB, 17,4 para médio risco e 25,2 para alto risco. Conclusões: A análise da correlação entre a gravidade da ataxia e as escalas funcionais pode ser um importante guia no entendimento da progressão da dependência funcional em indivíduos com SCA.

Predicting Condom Use: A Comparison of the Theory of Reasoned Action, the Theory of Planned Behavior and an Extended Model of TPB / Predizendo o Uso de Preservativo: Uma Comparação entre a Teoria da Ação Racionalizada, a Teoria do Comportamento Planejado (TCP) e um Modelo Estendido de TCP

ABSTRACT It was our goal to give a contribution to the prediction of condom use using socio-cognitive models, comparing classic theories to an extended model. A cross-sectional study was conducted using a questionnaire of self-reported measures. From the students who agreed to participate in the study, 140 were eligible for the full study. A confirmatory analysis was used to assess the predictive value of the researched model. The model tested had slightly better fit indexes and predictive value than classic Theories of Reasoned Action and Planned Behaviour. Although the results found, discussion continues to understand the gap between intention and behaviour, as further investigation is necessary to fully understand the reasons for condom use inconsistency.

RESUMO Tivemos como objetivo contribuir para a predição do uso de preservativo utilizando modelos sociocognitivos, comparando teorias clássicas a um modelo estendido. Um estudo transversal foi conduzido com o uso de questionário de auto-relato. Entre os estudantes que aceitaram participar do estudo, 140 mostraram-se elegíveis a participar do estudo em sua totalidade. Uma análise confirmatória foi utilizada para acessar o valor preditivo do modelo pesquisado. O modelo testado apresentou melhores índices de ajustamento e valor preditivo que as clássicas teorias da Ação Racionalizada e do Comportamento Planejado. Apesar dos resultados obtidos, continua a discussão para entender as discrepâncias entre intenção e comportamento, assim como são necessários mais estudos que permitam melhor compreender a inconsistência nas razões para o uso de preservativos.

Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke

Introduction: Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective: To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods: Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results: The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke...

Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterized by progressive and partially reversible obstruction of pulmonary airflow. AIM: To characterize swallowing in patients with chronic obstructive pulmonary disease and correlate the findings with the degree chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, and smoking. METHOD: We conducted a prospective cohort study of 19 patients (12 men and 7 women; age range, 50-85 years) with confirmed medical diagnosis of chronic obstructive pulmonary disease. This study was performed in 2 stages (clinical evaluation and functional assessment using nasolaryngofibroscopy) on the same day. During both stages, vital signs were checked by medical personnel. RESULTS: Clinical evaluation of swallowing in all patients showed the clinical signs of cough. The findings of nasolaryngofibroscopy highlighted subsequent intraoral escape in 5 patients (26.5%). No patient had tracheal aspiration. There was no association of subsequent intraoral escape with degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking. CONCLUSION: In patients with chronic obstructive pulmonary disease, there was a prevalence of oral dysphagia upon swallowing and nasolaryngofibroscopy highlighted the finding of subsequent intraoral escape. There was no correlation between intraoral escape and the degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking...

Correlation between brain injury and dysphagia in adult patients with stroke

Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20-90%. Some studies correlate the location of a stroke with dysphagia, while others do not. Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke. Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic. Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey. Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type...

Contribuição do estudo do biofilme dentário para o tratamento das doenças periodontais / Contribution of dental biofilm study to the treatmente of periodontal diseases

Microrganismos tem uma tendência bastante forte de se associar a superfícies, sejam estas inertes ou móveis. Uma vez ligados a uma superfície, denominada substrato, é desencadeado um processo elaborado de formação de microcolônias que se estruturam em comunidades organizadas e funcionais. Cada bactéria destas comunidades vive em um cooperativismo metabólico. Este complexo é chamado de biofilme e está presente na maioria das superfícies molhadas da natureza (tecidos humanos, próteses médicas, tubulação de água), podendo causar vários problemas ao meio onde se desenvolve. A placa dentária é um biofilme denominado supragengival quando se acumula na superfície dentária coronariamente à margem gengival e subgengival quando se associa à superfície dentária e a tecidos moles apicalmente à margem gengival. Estas comunidades extremamente estruturadas onde cada elemento desempenha um papel em prol do bem comum são responsáveis por doenças nos seres humanos. Os biofilmes que colonizam as superfícies dentárias e os tecidos orais podem provocar cáries, gengivites e perodontites, que estão entre as infecções mais comuns que afligem os homens. Os microorganismos pertencentes a estas estruturas demostram certa resistência a agentes antimicrobianos e mecanismos de defesa do hospedeiro, o que torna estas infecções difíceis de serem tratadas de forma eficaz. Entender o biofilme, sua composição, estrutura, organização, atividade e como se relaciona com agentes químicos pode ser um meio para melhorar o combate das patologias originadas por ele

O uso do selante sobre fossas e fissuras com lesöes cariosas / The use of sealants on pits and fissures with carious lesions

O presente trabalho foi desenvolvido com intuito de fornecer embasamento teórico a um procedimento clínico, de certa forma polêmico, que é o selamento de fossas e fissuras com lesöes incipientes ou médias de cárie. Após este estudo, observamos que a lesäo de cárie näo evolui sob selante intacto