Oropharyngeal Geometry of Maxilectomized Patients Rehabilitated with Palatal Obturators in the Trans-surgical Period: Repercussions on the Voice.

INTRODUCTION: Patients undergoing maxillectomies may present alterations in the stomatognathic functions involved in oral communication. Rehabilitative treatment should favor the rescue of these functions, through surgical flaps, obturator prostheses or both. OBJECTIVES: The present study aims to present the impact of the use of the palatal obturator on the oropharyngeal geometry and on the voice of patients undergoing maxillectomies, after adaptation to trans-surgical palatine obturators (TPO). METHODS: Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated during surgery were evaluated. The oropharyngeal geometry was measured by acoustic pharyngometry and the vocal parameters were evaluated through auditory-perceptual and acoustic analyses. The comparison between the results with and without TPO was analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements and acoustic parameters using Spearman's correlation coefficient, all with a significance level of 5%. RESULTS: There was a decrease in the following oropharyngeal measurements with the use of TPO: length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal and vocal tract and area of ​​the oropharyngeal junction. There was no difference in the length of the oral cavity and in the glottic area between situations with and without TPO. In the vocal evaluation, changes in intelligibility and resonance were observed in the situation without TPO and, in only one case, mild hypernasality was detected in the situation with TPO. CONCLUSIONS: It is concluded that the use of TPO brought the oropharyngeal measurements closer to normal values ​​and provided an improvement in speech intelligibility and vocal resonance in maxilectomized individuals.

Efeitos dos exercícios vocais no tratamento da disfagia: revisão integrativa / Effects of vocal exercises on the treatment of dysphagia: integrative review

RESUMO Objetivo verificar as evidências disponíveis sobre o efeito dos exercícios vocais no tratamento da disfagia. Estratégia de pesquisa foi realizado levantamento bibliográfico nas bases de dados PubMed, LILACS, SciELO e MEDLINE, sem restrições quanto ao período de publicação. Critérios de seleção artigos originais, estudos de caso e/ou revisões de literatura publicados nos idiomas português e/ou inglês, disponíveis eletronicamente na íntegra e que abordassem o tratamento clínico com exercícios vocais em adultos e idosos com disfagia. Foram excluídas publicações repetidas nas bases de dados, com população de crianças, com indivíduos que não apresentassem o diagnóstico de disfagia, com exercícios vocais sem especificação, com exercícios exclusivos de deglutição, artigos e/ou resumos sem possibilidade de acesso pelas plataformas institucionais e estudos com modelo animal. Resultados foram encontrados 2.356 artigos, dos quais, após aplicados os critérios de elegibilidade, foram selecionados 8 para a amostra final. Para avaliar os efeitos dos exercícios vocais, os estudos utilizaram avaliação clínica, videofluoroscopia, videoendoscopia e eletromiografia. Quanto aos efeitos dos exercícios vocais na deglutição, observou-se que as técnicas de som plosivo, empuxo, trato vocal semiocluído, som basal, modulação vocal, sobrearticulação, o método Lee Silverman Voice Treatment® e o uso de exercícios de treino de força muscular expiratória apresentaram efeitos positivos na reabilitação da disfagia. Conclusão os estudos com treino de força muscular expiratória, o método Lee Silverman e os exercícios vocais tradicionais demonstraram efeitos positivos no tratamento da disfagia. No entanto, ainda não foi possível comprovar o nível de evidências de todos os estudos.

ABSTRACT Purpose To verify the available evidence on the effect of vocal exercises on the treatment of dysphagia. Research strategy A bibliographic survey was carried out in the PubMed, LILACS, SciELO and MEDLINE databases, with no restrictions on the publication period. Selection criteria Original articles, case studies and/or literature reviews published in Portuguese and/or English, available electronically in full and addressing clinical treatment with vocal exercises in adults and elderly with dysphagia. Publications repeated by the databases, with a population of children, individuals who did not present the diagnosis of dysphagia, with vocal exercises without specification, with exclusive swallowing exercises, articles and/or abstracts without the possibility of access by institutional platforms, and studies with animal model were excluded. Results A total of 2,356 articles were found, of which, after the eligibility criteria were applied, 08 were selected for the final sample. To evaluate the effects of vocal exercises, the studies used clinical evaluation, videofluoroscopy, videoendoscopy and electromyography. Regarding the effects of vocal exercises on swallowing, it was observed that the techniques of plosive sound, buoyancy, semi-occluded vocal tract, basal sound, vocal modulation, overarticulation, the Lee Silverman Voice Treatment method® and the use of expiratory muscle strength training exercises showed positive effects in the rehabilitation of dysphagia. Conclusion It was observed that studies with expiratory muscle strength training (EMST), Lee Silverman method (LSVT®) and traditional vocal exercises demonstrated positive effects in the treatment of dysphagia. However, it has not yet been possible to prove the level of evidence in all studies.

Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment.

Introduction Minor structural alterations of the vocal fold cover are important causes of dysphonia. The variability in the type of alteration and the grade of vocal deviation affects the definition of the conduit and the results of treatment. Objective To characterize the occurrence, the selected treatments adopted and vocal quality before and after treatment in patients with minor structural alterations of the vocal folds cover. Methods This was a cross-sectional study based on the records of patients treated by an interdisciplinary team at the laryngology outpatient clinic of a public university hospital from 2010 to 2018. Data collection consisted of access to a database of information on otorhinolaryngological diagnostic hypotheses, intervention and perceptual-auditory vocal assessments before and after the treatment. Data from 102 subjects were analyzed. Association tests were applied between the perceptual-auditory vocal results and the different alterations found and between these and the adopted treatments. The results of the degrees of vocal deviation before and after treatment were also compared. Results The degree of roughness was associated with the sulcus vocalis, and in this alteration the highest occurrence was mild degree of roughness. There was an improvement in the breathiness and general grade of vocal deviation after treatment. Conclusion Cysts were the most frequent structural alteration in the population studied. There was an association between the degree of general deviation and that of roughness in sulcus vocalis cases. The breathiness and the general grade of vocal deviation improved after treatment regardless of the type of treatment and alteration.

Impact of age in health-related quality of life in older adults with cancer / Impacto da idade na qualidade de vida relacionada à saúde em idosos com câncer

OBJECTIVE: To evaluate the impact of age in health-related quality of life (HRQoL) in older adults with cancer. METHODS: This was a cross-sectional study of 608 older adults diagnosed with cancer. Age groups were considered an independent variable. For the analysis of HRQoL, the mean scores of age groups were compared by analysis of variance and the Scheffé comparison test. For measuring the association between age and HRQoL, we used simple and multiple linear regression analyses. RESULTS: Cognitive function showed the highest scores (average 87.94 ± 26.87), while physical function showed the lowest ones (68.04 ± 28.63). The highest symptom score was observed for financial difficulties (34.21 ± 39.06), followed by pain (29.47 ± 33.92) and insomnia (28.51 ± 37.03). After adjustment, we observed a decrease in physical function (p = 0.028) and an improvement in emotional function (p = 0.003) with increasing age. CONCLUSIONS: In older patients with cancer, age negatively impacted physical function and positively impacted emotional function.

OBJETIVO: Avaliar o impacto da idade na qualidade de vida relacionada à saúde (QVRS) em idosos com câncer. MÉTODOS: Estudo transversal envolvendo 608 idosos diagnosticados com câncer. Os grupos etários foram considerados uma variável independente. Para a análise da QVRS, os escores médios dos grupos etários foram comparados utilizando a análise de variância e o teste de Scheffé. Para medir a associação entre idade e QVRS, foram utilizadas análises de regressão linear simples e múltipla. RESULTADOS: A função cognitiva apresentou os maiores escores (média 87,94 ± 26,87), enquanto a função física apresentou os menores (68,04 ± 28,63). O maior escore de sintomas foi observado em dificuldades financeiras (34,21 ± 39,06), seguido por dor (29,47 ± 33,92) e insônia (28,51 ± 37,03). Após o ajuste, observamos diminuição da função física (p = 0,028) e melhora da função emocional (p = 0,003) com o aumento da idade. CONCLUSÕES: Em pacientes idosos com câncer, a idade impactou negativamente a função física e positivamente a função emocional.

Prospective Analysis of Health-Related Quality of Life in Older Adults With Cancer.

OBJECTIVE: The aim of the present study was to evaluate health-related quality of life (HRQoL) changes at 6 to 12 months after cancer diagnosis and to assess the impact of age in older adults with cancer. METHODS: A cohort study using patients ≥60 years old diagnosed with cancer. Health-related quality of life scores were calculated according to the European Organisation for Research and Treatment of Cancer questionnaire. Student's t tests for paired samples and a binomial logistic regression were performed. RESULTS: The study included 241 patients. At diagnosis, the affected HRQoL functions were physical and emotional functions, financial difficulties, pain, and insomnia. At follow-up, cognitive function (P < .001) and dyspnea (P = .004) worsened, while emotional function improved (P = .003). DISCUSSION: At the 6 to 12 months of follow-up, older adult cancer patients showed worsening cognitive function and dyspnea and improved emotional function. These HRQoL changes were not associated with age.

Qualidade de vida relacionada à saúde em idosos com câncer / [Health-related quality of life in elderly people with cancer]

Introdução: O aumento exponencial do envelhecimento da população no mundo e da incidência de câncer em idosos tornou-se um problema de saúde pública. Diretrizes atuais recomendam a formação de serviços interdisciplinares. A avaliação geriátrica global e a investigação da qualidade de vida permitem a identificação das condições de sobrevida e a caracterização do idoso de maneira a contribuir para a indicação de terapêutica oncológica individualizada e assistência integral, aspectos pouco conhecidos no Brasil. Objetivo: Analisar a qualidade de vida relacionada à saúde (QVRS) de pacientes idosos quando do diagnóstico de neoplasia maligna e após seis meses a um ano. Métodos: A pesquisa foi composta por dois estudos: o primeiro, transversal; e o segundo, uma coorte prospectiva com idosos com 60 anos ou mais, realizados em um serviço de referência no Nordeste do Brasil. A qualidade de vida foi avaliada de acordo com o questionário de QV da Organização Europeia para Pesquisa e Tratamento do Câncer (EORTC QLQ-C30). Resultados: Artigo 1: Foram incluídos 608 idosos com câncer. Entre as escalas funcionais, a função cognitiva apresentou os mais altos escores (média 87,9±26,9), enquanto a função física os menores (68,0±28,6). Na escala de sintomas, problema financeiro foi o que mais influenciou a QVRS (34,2±39,1), seguido de dor (29,5±34,0) e distúrbio do sono (28,5±37,0). Após ajuste pelas possíveis variáveis de confundimento foi observada pior função física (p=0,028) e melhor função emocional (p=0,003) de acordo com o aumento da faixa etária...

Introduction: The exponential increase of the age of the population around the world and the incidence of cancer on old people became a public health issue. Current guidelines recommend the formation of interdisciplinary services. The global geriatric evaluation and the life quality investigation enable the identification of the condition of survival and the description of the senior in a manner to contribute on the indication of the individualized oncological therapy and intensive assistance, aspects still not well known at Brazil. Aim: Analyze the health related quality of life (HRQoL) of elderly patients that have just being diagnosed with malignant neoplasm and after six months and a year. Methods: The research consisted on two studies: The first two transversals and the last one a prospective cohort with seniors, aged 60 or more, carried out on two services of reference at Brazil’s Northeast. The HRQoL was evaluated according to the European Organization for Research and Cancer Treatment (EORTC QLQ-C30) quality of Life survey. Results: Article 1: were included 608 elderly people with cancer. Taking in consideration the function domain, the cognitive function presented the best HRQoL (87,9 ± 26,9), the physical function domain present the worst scores (68,0 ± 28,6). On the symptoms scale, financial problems present the worst scores (34,2 ± 39,1), seguido de pain (29,5 ± 34,0) and sleep disturb (28,5 ± 37,0). By adjustment for possible variables of confounding was observed worst physical function (p=0,028) and best emocional function (p=0,003), according to the increase of the age range. Article 2: Were included 241 old people, most of them under 75 years of age (69,3%) that went through cancer treatment for six months. 69,3% Were younger than 75 years old. Taking in consideration the function domains the HRQoL on the domain of the cognitive function and the best HRQoL on the emotional domain were observed...

Alterações fonoaudiológicas e acesso ao fonoaudiólogo nos casos de óbito por câncer de lábio, cavidade oral e orofaringe: um estudo retrospectivo / Speech-language disorders and access to the speech therapists in cases of death from lip, oral cavity and oropharyngeal cancer: a retrospective study

RESUMO Objetivos: identificar as alterações fonoaudiológicas e o acesso ao fonoaudiólogo durante o curso da doença, nos casos de óbito por câncer de lábio, cavidade oral e orofaringe, nos residentes de Olinda - PE, em 2012 e 2013. Métodos: estudo descritivo, retrospectivo, cuja população foi composta pelos óbitos por câncer de lábio, cavidade oral e orofaringe, residentes em Olinda, notificados ao Sistema de Informação sobre Mortalidade e ocorridos nos anos de 2012 e 2013, com assistência integralmente realizada pelo SUS. As informações foram obtidas em entrevistas realizadas com os informantes-chave de cada caso. Para tal, foram utilizados os princípios do protocolo da Autópsia Verbal. As diferenças percentuais foram testadas por meio do teste estatístico Qui- quadrado corrigido de Yates, ou nos casos em que a ocorrência foi inferior a cinco observações, usou-se o Teste Exato de Fisher, com α=5%. Resultados: dos 18 óbitos investigados, em 55,6%, a suspeita de câncer foi por meio da realização do auto-exame, o diagnóstico ocorreu exclusivamente por profissionais médicos, e a língua e a orofaringe aparecem como sítio tumoral de maior ocorrência. Todos os casos apresentaram alguma alteração nas funções estomatognáticas, sendo 88,9% na fala, 83,3% na mastigação e deglutição e 77,8% na voz. Em 27,8% houve a indicação para o tratamento fonoaudiológico, e destes, todos referiram acesso ao profissional no sistema único de saúde. Conclusão: os resultados deste trabalho ratificam que as funções estomatognáticas apresentaram alterações em proporções elevadas, e a despeito disso, poucas pessoas receberam indicação para o acompanhamento fonoaudiológico. No entanto, todos que foram indicados, referiram acesso a este profissional.

ABSTRACT: Purpose: to identify the speech-language disorders and access to speech therapist during the course of the disease, the death cases from lip, oral cavity and oropharynx cancer, in Olinda residents - PE, in 2012 and 2013. Methods: a descriptive, retrospective study whose population consisted of deaths from lip, oral cavity and oropharynx cancer, residents in Olinda, reported to the Mortality Information System and occurred in 2012 and 2013 with full assistance provided by SUS. The information was obtained from interviews with key informants in each case. To do this, the principles of Verbal Autopsy protocol were used. The percentage differences were tested by Chi-square with Yates' correction statistical test, or in cases where occurrence was less than five remarks, it was used the Fisher's Exact Test, with α = 5%. Results: of the 18 deaths investigated, in 55.6%, the cancer suspicion was through self-examination, diagnosis was given exclusively by medical professionals, and tongue and oropharynx appear as tumor site of major occurrence. All the cases showed any change in stomatognathic functions, 88.9% in speech, 83.3% in chewing and swallowing and 77.8% in the voice. In 27.8% there was an indication for speech therapy treatment, and of these, all reported access to a professional in the Health System. Conclusion: these results confirm that stomatognathic functions showed changes in high proportions, and despite this, few people received indication for speech therapy treatment. However, everyone that was indicated, reported access to this professional.

Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study.

OBJECTIVE: To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic. DESIGN: Retrospective study with a case series. SETTING: Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil. PARTICIPANTS: 23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic. MAIN OUTCOME MEASURES: Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans. RESULTS: Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus--the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases. CONCLUSION: Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.

Aspectos epidemiológicos da mortalidade por câncer de boca: conhecendo os riscos para possibilitar a detecção precoce das alterações na comunicação / Epidemiologic aspects of mortality from oral cancer: understanding the risks to enable the early detection of changes in communication

Resumo:OBJETIVOS:caracterizar os aspectos epidemiológicos da mortalidade por câncer de boca, no município de Olinda, no período de 2008 a 2012.MÉTODOS:foi realizado um estudo epidemiológico, de base populacional, do tipo seccional, a partir dos dados do Sistema de Informação de Mortalidade dos óbitos por câncer de boca no período de 2008 a 2012, em residentes de Olinda. Foi calculado o coeficiente de mortalidade específico por câncer de boca, e foram analisadas as variáveis sexo, faixa etária, raça/cor, grau de instrução, estado civil, ocupação, sitio anatômico do câncer e local de ocorrência do óbito, e as diferenças percentuais foram testadas pelo Qui-quadrado corrigido de Yates (α=5%). Foi mensurada a razão de prevalência (α=5%).RESULTADOS:ocorreram 87 óbitos por câncer de boca, perfazendo um coeficiente de mortalidade específico de 21,5/ 100.000 habitantes. Houve predomínio dos óbitos entre homens, não casados, em pretos ou pardos, com ocupação não braçal, escolaridade inferior a 7 anos de estudo, com localização anatômica do tumor em faringe e língua (p<0,005). As maiores razões de prevalência foram encontradas entre os homens (RP=3,43), em trabalhadores braçais (RP= 2,86) e nos casos em que o câncer ocorreu no palato (RP=4,5).CONCLUSÃO:a identificação dos aspectos epidemiológicos que apresentam os maiores riscos para a mortalidade por câncer de boca orientará o planejamento das intervenções em saúde e em Fonoaudiologia.

Abstract:PURPOSE:to characterize the epidemiology of oral cancer mortality in the city of Olinda, in the period from 2008 to 2012.METHODS:an epidemiological study, population-based, sectional-type, was conducted using data from the Mortality Information System of deaths from oral cancer in the period from 2008 to 2012 in residents of Olinda. The Specific Mortality Coefficient for oral cancer was calculated, and it were analyzed the variables gender, age group, race/skin color, education level, marital status, occupation, anatomic site of cancer and death occurrence location, and the percentage differences were tested using the Yates' corrected Chi-square (α = 5%). Prevalence ratio was measured (α = 5%).RESULTS:there were 87 deaths from mouth cancer, resulting in a Specific Mortality Coefficient of 21.5/100,000. There were more deaths among men, unmarried, black or brown skin color, with non-manual occupation, less than 7 years of education, with anatomical location of the tumor in the pharynx and tongue (p < 0,005). The highest prevalence rates were found among men (PR = 3,43), in manual workers (PR = 2.86) and in cases where the cancer occurred in the palate (PR = 4,5).CONCLUSION:the identification of epidemiological aspects that present the greatest risk for mortality from oral cancer will guide the planning of health interventions and Speech Therapy.

Praziquantel treatment decreases Schistosoma mansoni genetic diversity in experimental infections.

BACKGROUND: Schistosomiasis has a considerable impact on public health in many tropical and subtropical areas. In the new world, schistosomiasis is caused by the digenetic trematode Schistosoma mansoni. Chemotherapy is the main measure for controlling schistosomiasis, and the current drug of choice for treatment is praziquantel (PZQ). Although PZQ is efficient and safe, its repetitive large-scale use in endemic areas may lead to the selection of resistant strains. Isolates less susceptible to PZQ have been found in the field and selected for in the laboratory. The impact of selecting strains with a decreased susceptibility phenotype on disease dynamics and parasite population genetics is not fully understood. This study addresses the impact of PZQ pressure on the genetics of a laboratory population by analyzing frequency variations of polymorphic genetic markers. METHODOLOGY: Infected mice were treated with increasing PZQ doses until the highest dose of 3 × 300 mg/Kg was reached. The effect of PZQ treatment on the parasite population was assessed using five polymorphic microsatellite markers. Parasitological and genetic data were compared with those of the untreated control. After six parasite generations submitted to treatment, it was possible to obtain a S. mansoni population with decreased susceptibility to PZQ. In our experiments we also observed that female worms were more susceptible to PZQ than male worms. CONCLUSIONS: The selective pressure exerted by PZQ led to decreased genetic variability in S. mansoni and increased endogamy. The understanding of how S. mansoni populations respond to successive drug pressure has important implications on the appearance and maintenance of a PZQ resistance phenotype in endemic regions.

Estria das cordas vocais: uma indicaçäo diagnóstica pra a glote ovalar / Vocal cords Stries: a diagnosis indication to ovalar glotis

Os autores descrevem as estrias das cordas vocais (vergetures) como uma patologia pouco comum na Laringologia. Comentam sua histopatologia, salientando as características atróficas e aderentes da mucosa das cordas vocais aos planos profundos. Discutem 32 casos de estrias das cordas vocais associados ou nao a outras patologias e concluem pela importância da suspeita diagnóstica de estrias diante da imagem glótica ovalar.