Comparação de análises de amostras de falantes por meio de diferentes protocolos perceptivos-auditivo

A escala RASATI foi adotada, no Brasil, em 2002, e sua sigla corresponde, do ponto de vista anatomofisiológico e perceptivo-auditivo, a rouquidão (grau de): irregularidade; aspereza; soprosidade; astenia; tensão e instabilidade6. O protocolo VPAS (Vocal Profile Analysis Scheme) avalia a variedade de ajustes da qualidade vocal nos planos fonatório, articulatório e de tensão, assim como os elementos de dinâmica vocal, como pitch, loudness, taxa de elocução, pausas e suporte respiratório, de acordo com a fonética. Objetivo: comparar os resultados das análises perceptivo-auditiva dos protocolos da RASATI e do VPAS-PB. Metodologia: estudo qualitativo, com amostra de conveniência. As amostras de vozes dos 10 falantes do sexo masculino, com 34 a 39 anos, foram coletadas no Corpo de Bombeiros do estado do Rio de Janeiro. As amostras foram entregues para três juízes de VPAS-PB para a descrição do perfil individual. Em seguida, as amostras foram utilizadas para nova análise vocal, por meio do protocolo da RASATI, baseada na amostra do VPAS-PB, para assim possibilitar a comparação dos dados dos dois protocolos. Resultados: foi possível observar a maior descrição do perfil vocal com mais aspectos contemplados na utilização do protocolo do VPAS-PB, enquanto na RASATI observam-se características que se restringem aos aspectos fonatórios. Conclusão: o VPAS-PB permite ao profissional maiores chances de identificar o problema vocal dentro dos aspectos apresentados, por abordar tanto o trato vocal como a fonte glótica, que é a base do protocolo da RASATI. Esta última, por sua vez, permite que o avaliador identifique os aspectos fonatórios na prática clínica com maior velocidade, visto que aborda somente os aspectos que se referem à fonte glótica, mas não contempla os outros aspectos, como dinâmica vocal e trato vocal

Perfil de crescimento de recém-nascidos prematuros menores de 32 semanas no primeiro ano de vida

Introdução: O crescimento de crianças prematuras nos primeiros anos de vida pode influenciar na sua saúde a curto e em longo prazo. Objetivo: avaliar, no primeiro ano de vida, o perfil de crescimento de crianças nascidas com idade gestacional (IG) ≤ 32 semanas. Metodologia: Estudo de coorte retrospectivo de pacientes nascidos com IG ≤ 32 semanas. Foi feita a classificação de adequação do peso para IG ao nascer e com 40 semanas. Aos 6 e 12 meses de Idade Gestacional Corrigida (IGC), foi feita a classificação antropométrica segundo a Organização Mundial de Saúde (OMS). Foram avaliados as médias dos Escores Z e seus desvios padrões, medianas e os quartis. Resultados: Foram identificados 27 pacientes ≤ 32 semanas. Desses, 22 foram incluídos no estudo. A média de peso, estatura e perímetro cefálico (PC) ao nascer foi respectivamente 1.133 gramas (±328,5), 36,9 cm (±3,8) e 25,9 cm (±2,7). Segundo a classificação da OMS, 83% da amostra encontrava-se eutrófica com IGC 12 meses, porém 28% tinham comprometimento de peso e/ou estatura e/ou de perímetro cefálico para idade. Baixa estatura foi identificada em 11%. Observou-se que 22% da amostra teve alteração da estatura e/ou PC para idade no primeiro ano de vida e também teve alteração do neurodesevolvimento. Conclusões: A avaliação de crescimento de prematuros extremos preconizada pelo OMS (relação peso/altura) como forma de avaliação antropométrica pode deixar lacunas. O crescimento linear e o PC devem ser considerados e valorizados como fator prognóstico para alterações de crescimento e desenvolvimento futuros

Hearing loss among patients with Turner's syndrome: literature review

INTRODUCTION: Turner's syndrome (TS) is caused by a partial or total deletion of an X chromosome, occurring in 1:2,000 to 1:5,000 live born females. Hearing loss is one of its major clinical manifestations. However, there are few studies investigating this problem. OBJECTIVES: To review the current knowledge regarding the epidemiology, etiology, clinical manifestations and diagnosis of hearing impairment in patients with TS. METHODS: A bibliographic search was performed in the Medline and Lilacs databanks (1980-2012) to identify the main papers associating Turner's syndrome, hearing impairment and its clinical outcomes. CONCLUSIONS: Recurrent otitis media, dysfunction of the Eustachian tube, conductive hearing loss during infancy and sensorineural hearing loss in adolescence are the audiologic disorders more common in ST. The karyotype appears to be important in the hearing loss, with studies demonstrating an increased prevalence in patients with monosomy 45,X or isochromosome 46,i(Xq). Morphologic studies of the cochlea are necessary to help out in the clarifying the etiology of the sensorineural hearing loss

Endocrine and metabolic disorders in HTLV-1 infected patients

Human T-cell leukemia virus type 1 (HTLV-1) infection is endemic in Japan and several countries in South America, Caribbean and Africa. Endocrine and metabolic disorders have been variably reported to be associated with human T-cell leukemia virus type 1 (HTLV-1) infection. Therefore, the aim of this article was to critically evaluate the current knowledge of the endocrine and metabolic disorders associated with HTLV-1 infection. The literature search used PubMed, Web of Science, and LILACS databases in the past 10 years, utilizing, in various combinations, the following keywords: HTLV-1, adult T-cell leukemia, diabetes mellitus, GLUT-1, osteoporosis, hypercalcemia, autoimmune thyroid disorders, diabetes insipidus, inappropriate antidiuretic hormone secretion; pseudohypoparathyroidism; pseudopseudohypoparathyroidism. The proven endocrine manifestations of the HTLV-1 infection are calcium disorders which occur in some patients with acute HTLV-1/Adult T-cell leukemia/lymphoma. The few reports about thyroid, parathyroid, antidiuretic hormone and diabetes mellitus are insufficient to prove a causal association with HTLV-1 infection. The evidence for an association between endocrine disorders and HTLV-1 infection in general, and in asymptomatic patients is lacking. Given all these uncertainties, the endocrine expression of the HTLV-1 infection composes a promising research line for understanding the pathophysiology of this infectio

Endocrine and metabolic disorders in HTLV-1 infected patients

Human T-cell leukemia virus type 1 (HTLV-1) infection is endemic in Japan and several countries in South America, Caribbean and Africa. Endocrine and metabolic disorders have been variably reported to be associated with human T-cell leukemia virus type 1 (HTLV-1) infection. Therefore, the aim of this article was to critically evaluate the current knowledge of the endocrine and metabolic disorders associated with HTLV-1 infection. The literature search used PubMed, Web of Science, and LILACS databases in the past 10 years, utilizing, in various combinations, the following keywords: HTLV-1, adult T-cell leukemia, diabetes mellitus, GLUT-1, osteoporosis, hypercalcemia, autoimmune thyroid disorders, diabetes insipidus, inappropriate antidiuretic hormone secretion; pseudohypoparathyroidism; pseudopseudohypoparathyroidism. The proven endocrine manifestations of the HTLV-1 infection are calcium disorders which occur in some patients with acute HTLV-1/Adult T-cell leukemia/lymphoma. The few reports about thyroid, parathyroid, antidiuretic hormone and diabetes mellitus are insufficient to prove a causal association with HTLV-1 infection. The evidence for an association between endocrine disorders and HTLV-1 infection in general, and in asymptomatic patients is lacking. Given all these uncertainties, the endocrine expression of the HTLV-1 infection composes a promising research line for understanding the pathophysiology of this infectio

Salivary flow and dental caries in Brazilian youth with type 1 diabetes mellitus

Background: Although type 1 diabetes mellitus (T1DM) has a significant impact on oral health, its association with dental caries is yet not clear. Aim: The aim of this study was to evaluate the salivary flow rate and caries in Brazilian youth with type 1 diabetes mellitus. Setting and Design: A Cross-sectional study was performed in a tertiary university hospital. Materials and Methods: Fifty-one age matched subjects suffering from type 1 diabetes mellitus were selected for the study and evaluated for the following: salivary flow rate, number of decayed, missing and filled tooth in permanent dentition (DMF-T) and decayed, extracted, filled tooth index in the deciduous dentition (def-t); visible plaque index (VPI) and gingival bleeding index (GBI). Statistics and analysis: The t test was utilized when the variables showed normal distribution. The Mann-Whitney test was utilized for comparing non-normal variables. Kolmorgorov-Smirnov test was used to assess the normality assumption. The differences were considered significant when P < 0.05. Results: The age and gender distribution of patients and controls was 11.3 ± 3.4 years (56% males) and 11.9 ± 3.4 years (37% males). The mean glycated hemoglobin value in the diabetics was 9.7 ± 1.9%. Salivary flow rate was lower in the diabetic pateints as compared to controls (P = 0.02). No differences were found in the DMF-T/def-t indices of diabetic and non-diabetic patients (P = 0.43/0.14). VPI was similar in both the groups (P = 0.15). GBI was higher in the diabetics (8.1 vs. 5.18; P = 0.11). There were no differences in the dental caries experience and dental plaque in the two groups. Conclusion: The lower salivary flow rate in diabetics could have been related to their higher GBI. The higher GBI in the diabetics is a matter of concern in the diabetics and is a sign for higher chances of developing periodontal problems

Proteus syndrome: Clinical diagnosis of a series of cases

Objectives: This paper describes the clinical diagnosis of Proteus syndrome (PS) in children referred for evaluation of asymmetric disproportionate overgrowth. Materials and Methods: Retrospective, descriptive, cross-sectional study conducted from January 1998 to December 2010. Results: During the study period, 2011 new patients were evaluated. Thirteen (0.65%) patients presented features suggestive of PS. These patients were formally evaluated based on the revised diagnostic criteria proposed by Biesecker. The mean age was 6.92 ± 5.1 years. Ten patients (76.9%) were females. All subjects had asymmetric disproportionate overgrowth. Other dysmorphic features were as follows: macrodactily (84.6%); linear epidermal nevus (41.6%); hemangioma (30.7%); and lipoma (23%). Six patients fulfilled the diagnostic criteria for PS. Conclusions: The diagnostic rate of only 46.1% of patients with PS confirms the diagnostic difficulties and the need for continuous monitoring and periodic review of these patients since the clinical manifestations of this syndrome become more evident with aging. Molecular tests may help the differential diagnosis of Proteus syndrome when they became commercially available

Postnatal management of growth failure in children born small for gestational age

Objectives: To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. Source of data: A comprehensive and non‐systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms “small for gestational age,” “intrauterine growth restriction,” and “growth hormone”. The publications were critically selected by the authors. Data synthesis: Although the majority of children born small for gestational age show spontaneous catch‐up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2–4 years of age, in those small for gestational age children who remain short, without catch‐up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre‐pubertal period. Conclusions: Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment. Resumo: Objetivos: Discutir a etiologia e as consequências para o crescimento e as indicações, os efeitos e a segurança da terapia com hormônio de crescimento biossintético em crianças pequenas para idade gestacional. Fonte dos dados: Uma busca abrangente e não sistemática foi feita nas bases de dados PubMed, LILACS e SciELO de 1980 até a presente data, com os termos “small for gestational age” (pequeno para a idade gestacional), “intrauterine growth restriction” (restrição de crescimento intrauterino) e “growth hormone” (hormônio do crescimento). As publicações foram selecionadas criticamente pelos autores. Síntese dos dados: Embora a maioria das crianças nascidas pequenas para idade gestacional apresente recuperação espontânea do crescimento durante os dois primeiros anos de vida, algumas delas permanecem com baixa estatura durante a infância, com alto risco de baixa estatura na vida adulta. O tratamento com hormônio de crescimento pode ser indicado, preferencialmente após os dois aos quatro anos, naquelas crianças sem recuperação espontânea do crescimento e com baixa estatura. Seus objetivos são aumentar a velocidade de crescimento e atingir uma altura normal durante a infância e uma altura adulta dentro da altura‐alvo. A resposta ao tratamento com hormônio de crescimento é variável, com melhor resultado se iniciado durante o período pré‐puberal. Conclusões: O tratamento com hormônio de crescimento em crianças baixas nascidas pequenas para idade gestacional é seguro e eficaz para melhorar a estatura adulta. Esforços devem ser feitos para identificar a etiologia do nascimento pequenas para idade gestacional antes do tratamento. Keywords: Small for gestational age, Catch‐up, Growth hormone, Short stature, Adult height, Palavras‐chave: Pequeno para a idade gestacional, Catch‐up, Hormônio de crescimento, Baixa estatura, Estatura adult

Postnatal management of growth failure in children born small for gestational age

Objectives: To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. Source of data: A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms “small for gestational age,” “intrauterine growth restriction,” and “growth hormone”. The publications were critically selected by the authors. Data synthesis: Although the majority of children born small for gestational age show spontaneous catch-up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2–4 years of age, in those small for gestational age children who remain short, without catch-up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre-pubertal period. Conclusions: Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment. Resumo: Objetivos: Discutir a etiologia e as consequências para o crescimento e as indicações, os efeitos e segurança da terapia com hormônio de crescimento biossintético em crianças pequenas para idade gestacional. Fonte dos dados: Uma busca abrangente e não sistemática foi feita nas bases de dados PubMed, LILACS e SciELO de 1980 até a presente data, com os termos “small for gestational age” (pequeno para a idade gestacional), “intrauterine growth restriction” (restrição de crescimento intrauterino) e “growth hormone” (hormônio do crescimento). As publicações foram selecionadas criticamente pelos autores. Síntese dos dados: Embora a maioria das crianças nascidas pequenas para idade gestacional apresente recuperação espontânea do crescimento durante os dois primeiros anos de vida, algumas delas permanecem com baixa estatura durante a infância, com alto risco de baixa estatura na vida adulta. O tratamento com hormônio de crescimento pode ser indicado, preferencialmente após os dois aos quatro anos, naquelas crianças sem recuperação espontânea do crescimento e com baixa estatura. Seus objetivos são aumentar a velocidade de crescimento e atingir uma altura normal durante a infância e uma altura adulta dentro da altura-alvo. A resposta ao tratamento com hormônio de crescimento é variável, com melhor resultado se iniciado durante o período pré-puberal. Conclusões: O tratamento com hormônio de crescimento em crianças baixas nascidas pequenas para idade gestacional é seguro e eficaz para melhorar a estatura adulta. Esforços devem ser feitos para identificar a etiologia do nascimento pequenas para idade gestacional antes do tratamento. Keywords: Small for gestational age, Catch-up, Growth hormone, Short stature, Adult height, Palavras-chave: Pequeno para a idade gestacional, Catch-up, Hormônio de crescimento, Baixa estatura, Estatura adult