Surdez hereditária : mapeamento da Síndrome de Bjornstad

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Surdez hereditária : mapeamento da Síndrome de Bjornstad

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Estudo de associação entre epistaxe, pressão arterial e gravidade de hipertensão arterial sistêmica em pacientes atendidos em ambulatório de referência

A literatura tradicional considera que a hipertensão arterial sistêmica está associada com a epistaxe, baseada principalmente no relato de alta prevalência de hipertensão nos casos que se apresentam com epistaxe. Esse achado é indevidamente extrapolado e embasa a conduta de uso de anti-hipertensivos nesses pacientes. No entanto, a associação pode ter um sentido oposto, já que os pacientes com epistaxe tendem a ter níveis pressóricos mais altos secundariamente à perda aguda de volume sangüíneo e à própria situação de estresse que o sangramento nasal determina. Estudos de base populacional não demonstram a existência da associação, nem mesmo em idosos, considerados grupo de risco para a ocorrência de epistaxe e de hipertensão arterial O objetivo principal deste estudo foi avaliar se existe uma maior freqüência de epistaxe em pacientes ambulatoriais com hipertensão arterial grave, em relação àqueles com hipertensão arterial não grave. Através de um delineamento transversal, estudou-se uma amostra de 323 hipertensos que consultaram no Ambulatório de Hipertensão do Hospital de Clínicas de Porto Alegre. Realizaram-se associações da epistaxe espontânea na vida adulta, categorizada em presente ou ausente, com pressão arterial sistólica e diastólica de forma contínua, com pressões arteriais diastólica e sistólica categorizadas em graves e não graves por elevação de cifras pressóricas (diastólica > 105 mmHg e sistólica > 180 mmHg), com duração de hipertensão (> ou 105 mmHg and sistolic > 180 mmHg), with hypertension duration (> or 180 mmHg (P = 0.926), nor the diastolic pressure > 105 mmHg (P = 0.730) have had a significant association with epistaxis. However, the presence of dilated vessels in the nasal septum was significantly associated with epistaxis (P = 0.0002). A duration of more than 5 years of hypertension (P = 0.084), left ventricular overload (P = 0.069) and the present usage of anti-hypertensive medicaments (P = 0.084) have showed a strong trend to associate with epistaxis. Contrary to the other two variables, the usage of anti-hypertensive drags has tended toward a negative association with epistaxis. The results of this study have allowed the conclusion that, at least in hypertensive outpatients, the severity of hypertension, evaluated by higher pressure figures, does not determine the higher or lower occurrence of spontaneous epistaxis. Perhaps the nonsignificance of such association may be due to the protection as ofifered by the antihypertensive treatment, which artificially decreases the contrasting between the groups, sub-grouping the severe hypertensive patients. Other changes that indicate the severity of hypertension, and that do not undergo, at least acutely, such distortion by the antihypertensive treatment (duration of the hypertensive disease and left ventricular overloading) have had a trend to assodated with epistaxis

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians (p < 0.001). Conclusion The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on OME, either perioperatively and postoperatively, or regarding the option of placing a ventilation tube. This part of the care also varied depending on the respondents' work location and experience in the medical practice

Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood

Abstract Objective: Review evidence about modifiable risk factors for recurrent acute otitis media. Source of data: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors acute otitis media/risk factors. Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. Summary of data: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. Conclusions: The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mothers milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation. J Pediatr (Rio J

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil

Introduction  Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives  To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods  A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results  The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians ( p  &lt; 0.001). Conclusion  The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on OME, either perioperatively and postoperatively, or regarding the option of placing a ventilation tube. This part of the care also varied depending on the respondents' work location and experience in the medical practice

Efeitos sistêmicos da obstrução nasal e da respiração oral persistente na criança

O presente trabalho revisa parte da fisiologia nasal e os efeitos sistêmicos da respiração oral associada com a obstrução nasal crônica. São abordadas as conseqüências nocivas da respiração oral persistente sobre os sistemas respiratório, cardiovascular, nervoso, endócrino e imunológico, além de sua influência no desenvolvimento orofacial.The present article reviews some aspects of nasal physiology, the systemic effects of mouth breathing and nasal obstruction. Special attention is given to its side effects on respiratory, cardiovascular, endocrine and immunological system, as well its role in facial development