Débora Camila Silva Melo, Sallete Cristina Silva, Ana Luiza Ferreira Araújo
et al.
RESUMO Objetivo verificar a associação entre o grau autorrelatado de gravidade da gagueira, o índice de gravidade da gagueira e o percentual de descontinuidade de fala de adultos que gaguejam. Métodos estudo observacional analítico transversal que analisou a fluência e a gravidade da gagueira em 56 adultos autorrelatados com gagueira. Os participantes preencheram o questionário de caracterização da amostra e foram submetidos à gravação de amostras de fala espontânea pela plataforma Zoom. Para análise da fluência, utilizou-se o Protocolo de Avaliação do Perfil da Fluência, considerando 200 sílabas fluentes. A gravidade foi avaliada pelo Stuttering Severity Instrument, examinando frequência, duração das disfluências e concomitantes físicos. Os dados foram analisados no software SPSS, com os testes Qui-quadrado e Kruskal-Wallis, considerando p≤0,05. Resultados houve associações significativas entre o grau autorrelatado de gravidade da gagueira e o percentual de descontinuidade de fala (p=0,020), e entre o índice de gravidade e o percentual de descontinuidade de fala (p=0,001). Conclusão o estudo destaca a relevância de alinhar a autopercepção com a avaliação de gravidade da gagueira, evidenciando a necessidade de compreender o indivíduo integralmente, em uma perspectiva biopsicossocial ampla.
Markus Magerl, MD, Marc A. Riedl, MD, MS, Luisa Karla Arruda, MD, PhD
et al.
Background: Hereditary angioedema (HAE) is a rare genetic disease, most frequently associated with deficiency or dysfunction in the C1 inhibitor protein. HAE with normal C1 inhibitor (HAE-nC1INH) lacks standardized diagnostic tests, limiting precise prevalence estimates and development of specific treatment guidelines. Objective: This study sought to describe the global frequency, diagnostic pathway, and current treatment patterns of HAE-nC1INH. Methods: Board-certified HAE-treating physicians from accredited Angioedema Centers of Reference and Excellence (ACAREs) were invited to complete a 27-item online survey between December 2022 and April 2023. Results: Thirty physicians from 30 ACAREs across 15 countries reported a mean of 71 (range, 11-148) patients with HAE assessed/treated within the previous 12 months. On average, physicians estimated 24% (range, 2-44%) of patients with HAE were diagnosed with HAE-nC1INH, most of whom were adults (88%). To diagnose HAE-nC1INH, physicians most commonly assessed family history and plasma C4 levels (90% each), and C1 function and quantitative levels (87% each). On-demand and prophylactic treatment patterns varied widely across countries, with an average (range) of 56% (33-100%) of patients receiving on-demand treatment only, and 37% (0-67%) receiving both on-demand and prophylactic treatment. Physicians identified the greatest unmet needs in HAE-nC1INH management as treatment specifically indicated for this patient population and availability of an oral treatment. Conclusion: HAE-nC1INH may be more prevalent than previously reported. Importantly, our findings revealed varying diagnostic and treatment approaches. Validated, accessible diagnostic biomarkers and clinical outcomes derived from rigorous clinical trials assessing mechanistically based treatments would advance understanding and management of HAE-nC1INH.
Krystal April Joy Curso, John Carlo Reyes, Jonathan Rivera
et al.
A 57-year-old woman with a 2-year history of a left infra-auricular mass with no associated symptoms presented with a 6.0 cm ´ 4.0 cm ´ 3.0 cm firm, non-tender, movable mass. No imaging was done. Fine needle aspiration biopsy (FNAB) revealed sheets of epithelial cells that had abundant dense grayish-blue cytoplasm in a mucinous background with abundant lymphocytes (Figure 1), suggestive of salivary gland neoplasm with oncocytic or oncocytoid features (Category IVB, Salivary Gland Neoplasm of Uncertain Malignant Potential).1
Total parotidectomy revealed a 4.3 X 3.2 X 3.0 cm deep lobe lesion with a tan-grey to dark brown, smooth and dull external surface. Cut sections showed a cream-white to pink, lobulated, heterogenous cut surfaces. Microscopically, the lesion was unencapsulated with poorly demarcated borders. The neoplastic cells were arranged in haphazard sheets and surrounded by abundant lymphocytes. The tumor cells had abundant eosinophilic and granular cytoplasm compatible with oncocytes with mild to moderate nuclear atypia. There were occasional cystic spaces that contained mucin though mucocytes were not readily apparent. (Figure 2) Necrosis, perineural and lymphovascular space invasion or anaplasia were not evident.
Claus Bachert, Claus Bachert, Alexandra Hicks
et al.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly a type 2 inflammatory disease associated with type 2 (T2) cell responses and epithelial barrier, mucociliary, and olfactory dysfunction. The inflammatory cytokines interleukin (IL)-4, IL-13, and IL-5 are key mediators driving and perpetuating type 2 inflammation. The inflammatory responses driven by these cytokines include the recruitment and activation of eosinophils, basophils, mast cells, goblet cells, M2 macrophages, and B cells. The activation of these immune cells results in a range of pathologic effects including immunoglobulin E production, an increase in the number of smooth muscle cells within the nasal mucosa and a reduction in their contractility, increased deposition of fibrinogen, mucus hyperproduction, and local edema. The cytokine-driven structural changes include nasal polyp formation and nasal epithelial tissue remodeling, which perpetuate barrier dysfunction. Type 2 inflammation may also alter the availability or function of olfactory sensory neurons contributing to loss of sense of smell. Targeting these key cytokine pathways has emerged as an effective approach for the treatment of type 2 inflammatory airway diseases, and a number of biologic agents are now available or in development for CRSwNP. In this review, we provide an overview of the inflammatory pathways involved in CRSwNP and describe how targeting key drivers of type 2 inflammation is an effective therapeutic option for patients.
Cochlear implant surgery can be highly complex in cases where ossification of the internal ear has taken place. In this case report, we report the use of new technological instruments to optimise the surgical process of implantation. These were the combined use of a surgical approach extended by a subtotal petrosectomy, a pre-operative radiological study with the OTOPLAN software for choosing the most suitable electrode array, and a residual functionality test of the auditory nerve using the ANTS test electrode array prior to inserting the cochlear implant electrode array. These were used to successfully treat a case of total deafness caused by a fracture in the temporal bone complicated with ossification of the basal turn of the cochlea. These instruments ensured that the operation was performed with excellent results, reducing the risk of failure to a minimum in this complex case.
Background and Objectives The serum galactomannan test (GM test) and the (1,3)-β-D-glucan test (G test) are utilized in diagnosing invasive fungal sinusitis. However, their effectiveness in detecting paranasal sinus fungus balls (FBs) has not been established. This study aimed to explore their diagnostic value in patients with FBs. Methods We retrospectively reviewed the medical records of 105 patients (42 with FBs and 63 with chronic rhinosinusitis [CRS]) who underwent serum GM and G tests between June 2020 and May 2021. Olfactory test results and demographics were also analyzed. Results There were 42 FB patients (10 men, 32 women) and 63 CRS patients (27 men, 36 women). The positivity rates for serum GM (7.1% in the FB group vs. 3.2% in the CRS group, p=0.640) and G test (9.5% in the FB group vs. 11.1% in the CRS group, p=0.482) did not differ significantly between groups. The sensitivities of the GM and G tests were 7.1% and 9.5%, respectively, and their specificities were 96.8% and 88.9%, respectively. The positive predictive values were 60.0% for the GM test and 36.3% for the G test, and the negative predictive values were 61.0% for the GM test and 59.6% for the G test. Conclusion Serum GM and G tests demonstrated low sensitivity and high specificity, indicating limited effectiveness in differentiating between patients with FBs and those with CRS. Histological examination remains the gold standard for the definitive diagnosis of FBs.
Song Yeu Wong, Li Yun Lim, Ramiza Ramza Ramli
et al.
Abstract Background Chronic rhinosinusitis (CRS) is a common disease characterized by inflammation of the paranasal sinuses, with symptoms such as nasal blockage, facial pain, hyposmia, and headache. While these symptoms are often treated as a common cold, the disease can lead to serious complications if left untreated. We present an unusual case of CRS in which the patient presented to the ophthalmology department with persistent pus discharge from the left upper eyelid for 6 months, despite being treated with multiple courses of antibiotics and undergoing incision and drainage procedures. Case presentation A 69-year-old male patient presented with a 6-month history of persistent pus discharge from the left upper eyelid, despite being treated with multiple courses of oral antibiotics and three incision and drainage procedures. He also complained of yellowish nasal discharge and bilateral nasal blockage for the past year but did not seek medical attention for these symptoms. Physical examination revealed pus discharge from the left upper eyelid and widening of the nasomaxillary groove. Nasoendoscopic examination showed bilateral grade 3 nasal polyps with mucopus secretion. CT scan of the paranasal sinuses revealed that the odd presentation was due to the chronic inflammatory process in the paranasal sinuses, which had led to osteitis and hyperostosis. This patient underwent endoscopic sinus surgery (ESS) with left frontal trephination and fat obliteration of the left frontal sinus. The postoperative histopathological report confirmed the diagnosis of benign inflammatory nasal polyp with acute on chronic inflammation. The patient was asymptomatic at 3-month follow-up post-operation. Conclusion Our case report highlights the importance of considering CRS as a possible underlying cause of such unusual presentations, even when the symptoms may appear unrelated. Early diagnosis and treatment of CRS can prevent serious complications and improve patient outcomes. The inflammatory process of CRS leading to osteitis and hyperostosis of the paranasal sinuses complicates the clinical presentation, distorts the usual anatomical structures, and may complicate the operation. CT scan of the paranasal sinus is highly recommended before any sinus surgery. At times, ESS may not be sufficient to eradicate frontal sinus disease. In these cases, an external approach is necessary with or without obliteration of the sinus cavity.
Sara Loureiro de Souza Ferreira, Daniele Andrade da Cunha, Aline Natalia Simões de Almeida
et al.
ABSTRACT Purpose To carry out an integrative review of the literature on the use of photobiomodulation (PBM) for the head and neck muscles. Research strategy The research took place between June/2019 and March/2021, in the following databases: PubMed, Scopus, Web of Science, LILACS, and SciELO. The MeSH used were Low-Level Light Therapy, Phototherapy, Masseter Muscle, Masticatory Muscles, Tongue, Palate, Mouth, Neck Muscles, and Facial Muscles in English and Portuguese. No limitation was imposed on the year and language of publication. Selection criteria studies that answered the guiding question: what is the use of photobiomodulation to the head and neck muscles?. Results 2857 articles were found, of which 102 were selected for full reading, 52 of those were excluded, giving a total of 50 articles included. The included publications date from 2003 to 2020. Brazil was the country that most published on the topic. With regard to the objectives, 82% of the studies aimed to investigate the analgesic effect of PBM, of these, 50% were related to articular or muscular temporomandibular disorders (TMD). The heterogeneity of the studies makes it impossible to define the dose protocols. Conclusion PBM has been applied to the head and neck muscles mainly for the treatment of pain caused by TMD. There is no treatment protocol to define the doses to be used, due the heterogeneity of the methodologies applied and results found.
Anita Yolanda Portilla, Valeria Almanza, Andrés Darío Castillo
et al.
Este artículo pretende identificar los modelos teóricos que describen el desarrollo de la narrativa oral en niños y establecer cuáles componentes del lenguaje influyen en dicho proceso. Con este propósito, llevamos a cabo una revisión sistemática de las investigaciones más recientes sobre este tema (2000-2019). Analizamos 10 estudios longitudinales que reportan resultados de medidas del lenguaje y la narrativa oral tomados durante el seguimiento de una población de niños y niñas por un periodo de al menos 12 meses. Estas medidas son la conciencia metalingüística, el lenguaje estructural y el discurso narrativo, entre otras. Nuestros resultados indican que la habilidad de contar un relato es uno de los mejores predictores del desarrollo del lenguaje en la etapa preescolar y del aprendizaje de la lectoescritura en la edad escolar. También encontramos que los modelos para explicar este proceso son escasos y que ignoran con frecuencia el componente pragmático.
Julio Rama López, Fernanda A. Muñoz-Proto, Marta Valero-Camps
et al.
Los carcinomas de células pequeñas representan menos del 1% de los tumores malignos de glándulas salivares. Al tratarse de casos muy raros no existe un consenso sobre el tratamiento y epidemiología de estos tumores. Paciente mujer de 78 años con tumoración parotídea izquierda de 1 mes de evolución. PAAF compatible con carcinoma y TAC cervical donde además del nódulo parotídeo se observaba adenopatía cervical ipsilateral con centro necrótico. Tras parotidectomía superficial y vaciamiento cervical funcional izquierdo, el estudio anatomopatológico definitivo mostró carcinoma de células pequeñas con metástasis cervical ipsilateral. El estudio se completo descartando cualquier otro tumor microcítico primario.
Thyroglossal duct and lingual thyroid ectopic lesions are exceedingly rare synchronous findings. Papillary thyroid carcinoma of these ectopic thyroid sites is well understood but still a rare finding. This case points to some management nuances in regard to ectopic thyroid screening with imaging and also shows the effectiveness of minimally invasive transoral robotic surgery for lingual thyroid.
O carcinoma papilífero é a malignidade tireoidiana mais comum. Muitas variantes desse tumor foram descritas, com diferentes características morfológicas e moleculares. Embora a maioria dos casos apresente um excelente prognóstico, a relação entre a arquitetura tumoral e o comportamento biológico dessas neoplasias ainda permanece controversa. OBJETIVO: Apresentamos a experiência de um único serviço acerca da prevalência das variantes do carcinoma papilífero da tireoide e sua relação com os demais fatores prognósticos histopatológicos. MÉTODO: Estudo retrospectivo envolvendo todos os casos submetidos à tireoidectomia por carcinoma papilífero na mesma Instituição ao longo de 11 anos de estudo. RESULTADOS: Foram incluídos 517 pacientes, sendo 81,9% dos casos representados mulheres. A média de idade foi de 47,2 anos. As variantes reconhecidas por terem maior potencial de agressividade corresponderam a 5,6% da amostra. Observamos associação desses subtipos tumorais com maior diâmetro da lesão, estadiamento T, invasão linfovascular e da cápsula da glândula. CONCLUSÃO: Um pequeno percentual de casos de carcinomas papilíferos é representado por variantes reconhecidas por seu maior potencial de agressividade. Existem associações entre essas variantes e diversos outros fatores histopatológicos já reconhecidos por seu valor prognóstico, o que pode, por si, só influenciar no desfecho desses casos.
Viviane Cristina de Castro Marino, Isabela Marchioni dos Santos, Eliana Maria Gradim Fabron
et al.
OBJETIVOS: investigar a ocorrência do ceceio em fricativas produzidas por crianças com alterações oclusais e analisar a influência do contexto silábico da fricativa no julgamento auditivo do ceceio. M ÉTODO: estudo prospectivo, em que as gravações de 428 palavras, produzidas por 15 crianças (idade média de 5 anos e 1 mês) foram julgadas auditivamente por três fonoaudiólogos com experiência no julgamento de alterações de fala. As palavras utilizadas foram constituídas pelas consoantes fricativas não vozeadas, alveolar e pós-alveolar, inseridas em posição tônica, precedida das vogais [i, a, u]. Obteve-se concordância intra-juiz (quase perfeita) e inter-juiz (total, 100%) previamente à análise dos aspectos de interesse. RESULTADOS: embora presente na fala de todas as crianças, identificou-se ceceio em 25,23% do total das palavras. Houve aumento significante do ceceio para: (a) fricativa alveolar em ataque inicial, (b) fricativa alveolar em ataque inicial em relação à coda medial (p=0,001) e (c) fricativa alveolar em relação à fricativa pós- alveolar (p<0,001). Não se observou diminuição do ceceio em relação às vogais co-articuladas. CONCLUSÃO: a ocorrência do ceceio é dependente do contexto silábico, (com maior ocorrência na fricativa alveolar, em posição de ataque inicial), devendo o mesmo ser considerado para fins clínicos e de pesquisa sobre o ceceio.
João Daniel Caliman e Gurgel, Lydio Alves Filho, Vespasiano Lopes de Farias
et al.
1 Master’s degree and doctoral student in medicine (otorhinolaryngology), Medical College of the São Paulo Holy House (Santa Casa de São Paulo). Otorhinolaryngologist and craniomaxillofacial surgeon. 2 Full member of the Brazilian Plastic Surgery Society, plastic surgery. 3 Full member of the Brazilian Plastic Surgery Society. Head of the Craniomaxillofacial Surgery Unit, Dr. Dório Silva Hospital. 4 Member of the Brazilian Otorhinolaryngology and Cervicofacial Surgery Association. Otorhinolaryngologist. 5 Master’s degree in surgery, Rio de Janeiro Federal University. Otorhinolaryngologist. Rio Doce Hospital. Send correspondence to: João Daniel Caliman e Gurgel Av. Nicola Biancardi 1181/104 Centro Linhares ES 29900-209. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on December 31, 2009; and accepted on January 14, 2010. cod. 6862 cAsE REPORT Braz J Otorhinolaryngol. 2011;77(2):268. BJORL