Pierina Lidia Moreau

Fil: Martinelli, Ana Carolina. Universidad Nacional de Cuyo. Facultad de Filosofía y Letra

Questionnaire Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S): sensitivity and specificity study

PURPOSE: To investigate the sensitivity and specificity of the questionnaire Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S) in the hearing screening of elderly people who seek for different health care services (audiological clinic and other clinics). METHODS: The hearing of 78 elderly - 23 attended at the Discipline of Geriatrics and Gerontology of the institution who did not, necessarily, have complaints regarding their hearing, and 55 attended at the Audiology Clinic of the same institution with complaints related to the auditory and/or vestibular systems - was assessed. The HHIE-S questionnaire was applied, and its total score was divided into three categories, according to the handicap perception. RESULTS: A statistically significant relationship was found between handicap and degree of hearing loss in both patients from the Audiology Clinic (p=0.009*) and from the Geriatrics Clinic (p=0.002). In the first group, the HHIE-S questionnaire showed low sensitivity (23.5%) and high specificity (73.7%). In the group of patients from the Geriatrics Clinic, the values of sensitivity (94.7%) and specificity (75%) were both high. CONCLUSIONS: There was positive association between the degree of hearing loss and the handicap referred by both groups of subjects. The HHIE-S questionnaire is a hearing screening instrument with high sensitivity and specificity in identifying hearing loss in elderly people that seek health care services that are not specific for attention related to hearing disorders.OBJETIVO: Investigar a sensibilidade e especificidade do questionário Hearing Handicap Inventory for the Elderly - Screening version (HHIE-S) na triagem auditiva de idosos que procuram diferentes serviços de atenção à saúde (clínica audiológica e outras clínicas). MÉTODOS: Foi avaliada a audição de 78 idosos - 23 atendidos na disciplina de Geriatria e Gerontologia da instituição de origem, que não tinham, necessariamente, queixas relacionadas à audição, e 55 atendidos no Ambulatório de Audiologia da mesma instituição, com queixas relacionadas aos sistemas auditivo e/ou vestibular. Foi aplicado o HHIE-S, cujo escore total foi dividido em três categorias, de acordo com a percepção do handicap. RESULTADOS: Houve relação estatisticamente significante entre handicap e grau de perda auditiva no grupo de pacientes do Ambulatório de Audiologia (p=0,009), e no grupo de pacientes do Ambulatório de Geriatria (p=0,002). No primeiro grupo, o questionário HHIE-S revelou baixa sensibilidade (23,5%) e alta especificidade (73,7%). No grupo de pacientes do setor de Geriatria, foram altos os valores de sensibilidade (94,7%) e de especificidade (75%). CONCLUSÕES: Há associação positiva entre o grau de perda auditiva e o handicap referido em ambos os grupos. O questionário HHIE-S é um instrumento de triagem auditiva com alta especificidade e sensibilidade na identificação de perdas auditivas em idosos que procuram serviços de saúde que não são específicos para atendimentos relacionados às alterações auditivas.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Irmandade da Santa Casa de Misericórdia de São PauloUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de FonoaudiologiaUNIFESP, Depto. de FonoaudiologiaSciEL

Platelet antibody detection by flow cytometry: an effective method to evaluate and give transfusional support in platelet refractoriness

BACKGROUND: Immune platelet refractoriness is mainly caused by human leukocyte antigen antibodies (80-90% of cases) and, to a lesser extent, by human platelet antigen antibodies. Refractoriness can be diagnosed by laboratory tests and patients should receive compatible platelet transfusions. A fast, effective and low cost antibody-screening method which detects platelet human leukocyte/platelet antigen antibodies is essential in the management of immune platelet refractoriness.OBJECTIVE: The aim of this study was to evaluate the efficiency of the flow cytometry platelet immunofluorescence test to screen for immune platelet refractoriness.METHODS: A group of prospective hematologic patients with clinically suspected platelet refractoriness treated in a referral center in Campinas, SP during July 2006 and July 2011 was enrolled in this study. Platelet antibodies were screened using the flow cytometry platelet immunofluorescence test. Anti-human leukocyte antigen antibodies were detected by commercially available methods. The sensitivity, specificity and predictive values of the immunofluorescence test were determined taking into account that the majority of antiplatelet antibodies presented human leukocyte antigen specificity.RESULTS: Seventy-six samples from 32 female and 38 male patients with a median age of 43.5 years (range: 5-84 years) were analyzed. The sensitivity of the test was 86.11% and specificity 75.00% with a positive predictive value of 75.61% and a negative predictive value of 85.71%. The accuracy of the method was 80.26%.CONCLUSION: This study shows that the flow cytometry platelet immunofluorescence test has a high correlation with the anti-human leukocyte antigen antibodies. Despite a few limitations, the method seems to be efficient, fast and feasible as the initial screening for platelet antibody detection and a useful tool to crossmatch platelets for the transfusional support of patients with immune platelet refractoriness.25225

Association between phenotype, performance with hearing aids, and genotype of childhood hearing loss in children with and without genetic alteration

PURPOSE: To establish the frequency of genetic mutations related to sensorineural hearing loss (SNHL); to verify if there is association between the degree of SNHL and the presence of genetic alteration; and to verify if the Minimal Response Levels (MRL) with hearing aids vary according to the genetic alteration. METHODS: Thirty hearing aids users with ages between 8 and 111 months were evaluated. The evaluation procedures used were: pure-tone audiometry; the auditory steady state response (ASSR) on sound field, with and without hearing aids; and genetic study of the hearing loss. RESULTS: Three genetic mutations were diagnosed: 35delG, A1555G and A827G, and the children with these mutations showed higher degree of SNHL. There was no difference between the genetic patterns regarding the degree of SNHL, except for patients with A827G mitochondrial mutation, because all subjects with this mutation had profound SNHL. The difference between the MRL obtained with and without amplification, considering the presence of mutation and the degree of SNHL, was higher in children with moderate SNHL without genetic alterations, both in behavioral and electrophysiological evaluations. CONCLUSION: Genetic mutations were found in 36.7% of the sample, justifying the importance of genetic tracking in the hearing habilitation process. Children with genetic mutations showed higher degrees of hearing loss. The different mutation patterns do not directly determine the degree of hearing loss. The best thresholds with amplification were found in children with moderate hearing loss without genetic alterations.OBJETIVO: Estabelecer a frequência de mutações genéticas relacionadas à deficiência auditiva neurossensorial (DANS); verificar se há associação entre grau da DANS e presença de alteração genética e verificar se os Níveis Mínimos de Resposta (NMR) com próteses auditivas variam em função da alteração genética. MÉTODOS: Foram avaliadas 30 crianças, com idades entre 8 e 111 meses, usuárias de próteses auditivas. Os procedimentos de avaliação utilizados foram: audiometria tonal e resposta auditiva de estado estável (RAEE) em campo livre, com e sem as próteses auditivas e estudo genético da DANS. RESULTADOS: Foram diagnosticadas três mutações genéticas: 35delG, A1555G e A827G, sendo que as crianças com tais mutações apresentaram maior grau de DANS. Não houve diferença entre os padrões genéticos em relação ao grau de DANS, com exceção dos pacientes com mutação mitocondrial A827G, pois todos com essa mutação eram portadores de DANS de grau profundo. A diferença entre os NMR obtidos sem e com o uso da amplificação, considerando a presença de mutação e grau de DANS, foi maior nas crianças portadoras de DANS de grau moderado sem alteração genética, tanto na avaliação comportamental quanto na eletrofisiológica. CONCLUSÃO: As mutações genéticas foram encontradas em 36,7% da amostra, o que justifica a importância do rastreamento genético no processo de habilitação auditiva. Crianças com mutações genéticas apresentam o maior grau de DANS. Os diferentes padrões de mutações não determinam diretamente o grau da DANS. Os melhores limiares com o uso da amplificação foram encontrados nas crianças com DANS moderada, sem alteração genética.Universidade Federal de Santa Maria Departamento de FonoaudiologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de FonoaudiologiaUniversidade Estadual de Campinas Laboratório de Genética HumanaUNIFESP, Depto. de FonoaudiologiaSciEL

Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding

Infants and children with neurological impairment, such as cerebral palsy (CP), often experience abnormal ingestion functions, including oropharyngeal dysphagia and gastroesophageal reflux disease, which led to aspiration-related respiratory complications, morbidity, hospitalization, or death. There is a lack of evidence-based, repeatable, infant-friendly instrumental procedures to assess aspiration-risk in infants with CP or other neurological disorders, with also a lack of clinical assessment measures to support the use of more invasive diagnostic techniques. To this purpose, in the current study we explore the feasibility of lung ultrasound (LUS), to assess lung deaeration possibly related to aspiration during meal, in a cohort of 35 subjects affected by CP or other encephalopathies, and 10 controls in the same age-range. We coupled LUS procedure with meal caregiver administration for each child. Our results support the feasibility of this innovative approach in the clinical setting. Exploratory findings revealed a number of lung abnormalities likely related to abnormal ingestion function in subjects. Subgroup analyses revealed possible differences in LUS abnormalities between CP and other encephalopathies, possibly related to different mechanism of disease or dysfunction. Also, some evidences arose about the possible relationship between such LUS abnormalities and feeding and swallowing abilities in CP or other encephalopathies. LUS showed preliminarily feasibility and effectiveness in detecting meal-related LUS abnormalities in a dynamic manner in the clinical setting. This approach demonstrated usefulness as a potential tool for improving assessment and management in complex care of infants and young children with severe neurological disorders