Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology

Effects of different fractions from diesel engines exhaust particles on the frog ciliated epithelium

INTRODUÇÃO: A poluição atmosférica é reconhecida como fonte de possíveis agravos à saúde. Estudos tem demonstrado uma clara associação entre aumento da concentração dos poluentes atmosféricos, especialmente o material particulado proveniente de resíduos de exaustão de motores movidos a diesel, com morbidade e mortalidade respiratória e cardíaca na população geral. Até o presente momento, sabe-se que o material particulado possui ações deletérias sobre as vias aéreas superiores e inferiores; contudo, ainda não são completamente conhecidas as ações tóxicas isoladas das diferentes frações do material particulado do diesel. OBJETIVO: O presente estudo teve por finalidade avaliar o grau de toxicidade das frações orgânicas de baixa, média e alta polaridade e da fração inorgânica do material particulado proveniente da emissão de motores movidos a óleo diesel sobre o epitélio mucociliar. MÉTODOS: Para tanto, utilizou-se como modelo experimental a preparação do palato da rã, que possui um epitélio similar ao das vias aéreas de mamíferos. O estudo foi dividido em duas etapas: Fase I - Quarenta palatos foram utilizados com intuito de titular a concentração de material particulado bruto capaz de promover um aumento significante no tempo relativo de transporte mucociliar. Fase II - Uma vez definida a concentração efetiva, cinqüenta palatos foram expostos aos seguintes tratamentos: material particulado bruto do diesel (sem nenhum tipo de tratamento), material particulado do diesel tratado com hexano (solvente que reduz a quantidade dos compostos orgânicos de baixa polaridade), material particulado do diesel tratado metanol (solvente que reduz a quantidade de compostos orgânicos de polaridade intermediária, gerando aumento relativo da concentração de orgânicos de baixa e alta polaridade) e material particulado do diesel tratado ácido nítrico (solvente que reduz a concentração de compostos inorgânicos, gerando aumento relativo da fração orgânica como um todo). Para fins de controle utilizou-se um grupo com ringer-rã. As variáveis analisadas foram: tempo relativo de transporte mucociliar, freqüência de batimento ciliar e análise histológica, na qual foram avaliados o volume proporcional de muco ácido, muco neutro, muco misto, de cílios, vacúolos, dos núcleos celulares e interstício e espessura epitelial. RESULTADOS: Fase I: A concentração de material particulado bruto capaz de promover um aumento significativo no tempo relativo de transporte mucociliar, e também do volume proporcional de muco ácido (p<0,05), correspondeu a 12mg/L. Fase II: Observou-se: a) aumento significativo no tempo relativo de transporte mucociliar e redução significativa do volume proporcional de muco neutro no grupo ácido nítrico; b) maior volume proporcional de muco ácido no grupo metanol (p<0,05); c) ausência de diferenças entre o grupo controle e o grupo hexano, tanto na análise histológica quanto no tempo relativo de transporte mucociliar. CONCLUSÃO: Os dados obtidos sugerem que os compostos orgânicos de baixa polaridade do material particulado proveniente da emissão de motores movidos a óleo diesel desempenham um importante papel na toxicidade aguda ao epitélio ciliadoINTRODUCTION: Air pollution is recognized as a source of potential health problems. Studies have shown a clear association between increasing concentration of atmospheric pollutants, especially particulate matter from waste exhaust of diesel engines, and respiratory and cardiac morbidity and mortality in the general population. To date, it is well known that particulate matter from diesel exhaust has deleterious actions on upper and lower airways; however, the isolated toxic actions of different fractions of the particulate matter are not yet fully understood. OBJECTIVE: This study aimed at evaluating the degree of toxicity of the organic fractions of low, intermediate and high polarity and of the inorganic fraction of particulate matter from diesel engines on the ciliated epithelium. METHODS: The experimental model used was the frog palate preparation, which has a similar epithelium to that found in mammalian airways. The study was divided into two phases: Phase I - Forty palates were used in order to titrate the concentration of intact diesel particulate matter able to elicit a significant increase in the relative time of mucociliary transport. Phase II Once defined the optimal concentration, fifty palates were exposed to dilutions with the following treatments: intact diesel particulate material (without any treatment), particulate matter from diesel exhaust treated with hexane (solvent which reduces the amount of organic compounds of low polarity), particulate matter from diesel exhaust treated with methanol (solvent which reduces the amount of organic compounds with intermediate polarity, generating a relative increase in concentration of organic compounds with low and high polarity) and particulate matter from diesel exhaust treated with nitric acid (solvent which removes inorganic compounds, eliciting a relative increase of the organic fraction as a whole). For control purposes, a group of frog-ringer was used. The following variables were analyzed: relative time of mucociliary transport, ciliary beating frequency and histological analysis, which evaluated proportional volume of acid mucus, neutral and mixed mucus, cilia, vacuoles, cell nuclei and interstice, and epithelial thickness. RESULTS: Phase I: The effective concentration of intact diesel particulate matter in eliciting a significant increase in the relative time of mucociliary transport, and a proportional increase of acid mucus volume (p<0.05), corresponded to 12mg/L. Phase II: a) The nitric acid treatment caused a significant increase in the relative time of mucociliary transport, and decrease in the proportional volume of neutral mucus. b) A higher proportional volume of acid mucus was found in the methanol group (p<0.05). c) There were no differences between control and hexane groups regarding histological findings and relative time of mucociliary transport. CONCLUSION: The results suggest that organic compounds of low polarity from diesel engines exhaust particles play an important role in the acute toxicity on the ciliated epitheliu

Effects of different fractions from diesel engines exhaust particles on the frog ciliated epithelium

INTRODUÇÃO: A poluição atmosférica é reconhecida como fonte de possíveis agravos à saúde. Estudos tem demonstrado uma clara associação entre aumento da concentração dos poluentes atmosféricos, especialmente o material particulado proveniente de resíduos de exaustão de motores movidos a diesel, com morbidade e mortalidade respiratória e cardíaca na população geral. Até o presente momento, sabe-se que o material particulado possui ações deletérias sobre as vias aéreas superiores e inferiores; contudo, ainda não são completamente conhecidas as ações tóxicas isoladas das diferentes frações do material particulado do diesel. OBJETIVO: O presente estudo teve por finalidade avaliar o grau de toxicidade das frações orgânicas de baixa, média e alta polaridade e da fração inorgânica do material particulado proveniente da emissão de motores movidos a óleo diesel sobre o epitélio mucociliar. MÉTODOS: Para tanto, utilizou-se como modelo experimental a preparação do palato da rã, que possui um epitélio similar ao das vias aéreas de mamíferos. O estudo foi dividido em duas etapas: Fase I - Quarenta palatos foram utilizados com intuito de titular a concentração de material particulado bruto capaz de promover um aumento significante no tempo relativo de transporte mucociliar. Fase II - Uma vez definida a concentração efetiva, cinqüenta palatos foram expostos aos seguintes tratamentos: material particulado bruto do diesel (sem nenhum tipo de tratamento), material particulado do diesel tratado com hexano (solvente que reduz a quantidade dos compostos orgânicos de baixa polaridade), material particulado do diesel tratado metanol (solvente que reduz a quantidade de compostos orgânicos de polaridade intermediária, gerando aumento relativo da concentração de orgânicos de baixa e alta polaridade) e material particulado do diesel tratado ácido nítrico (solvente que reduz a concentração de compostos inorgânicos, gerando aumento relativo da fração orgânica como um todo). Para fins de controle utilizou-se um grupo com ringer-rã. As variáveis analisadas foram: tempo relativo de transporte mucociliar, freqüência de batimento ciliar e análise histológica, na qual foram avaliados o volume proporcional de muco ácido, muco neutro, muco misto, de cílios, vacúolos, dos núcleos celulares e interstício e espessura epitelial. RESULTADOS: Fase I: A concentração de material particulado bruto capaz de promover um aumento significativo no tempo relativo de transporte mucociliar, e também do volume proporcional de muco ácido (p<0,05), correspondeu a 12mg/L. Fase II: Observou-se: a) aumento significativo no tempo relativo de transporte mucociliar e redução significativa do volume proporcional de muco neutro no grupo ácido nítrico; b) maior volume proporcional de muco ácido no grupo metanol (p<0,05); c) ausência de diferenças entre o grupo controle e o grupo hexano, tanto na análise histológica quanto no tempo relativo de transporte mucociliar. CONCLUSÃO: Os dados obtidos sugerem que os compostos orgânicos de baixa polaridade do material particulado proveniente da emissão de motores movidos a óleo diesel desempenham um importante papel na toxicidade aguda ao epitélio ciliadoINTRODUCTION: Air pollution is recognized as a source of potential health problems. Studies have shown a clear association between increasing concentration of atmospheric pollutants, especially particulate matter from waste exhaust of diesel engines, and respiratory and cardiac morbidity and mortality in the general population. To date, it is well known that particulate matter from diesel exhaust has deleterious actions on upper and lower airways; however, the isolated toxic actions of different fractions of the particulate matter are not yet fully understood. OBJECTIVE: This study aimed at evaluating the degree of toxicity of the organic fractions of low, intermediate and high polarity and of the inorganic fraction of particulate matter from diesel engines on the ciliated epithelium. METHODS: The experimental model used was the frog palate preparation, which has a similar epithelium to that found in mammalian airways. The study was divided into two phases: Phase I - Forty palates were used in order to titrate the concentration of intact diesel particulate matter able to elicit a significant increase in the relative time of mucociliary transport. Phase II Once defined the optimal concentration, fifty palates were exposed to dilutions with the following treatments: intact diesel particulate material (without any treatment), particulate matter from diesel exhaust treated with hexane (solvent which reduces the amount of organic compounds of low polarity), particulate matter from diesel exhaust treated with methanol (solvent which reduces the amount of organic compounds with intermediate polarity, generating a relative increase in concentration of organic compounds with low and high polarity) and particulate matter from diesel exhaust treated with nitric acid (solvent which removes inorganic compounds, eliciting a relative increase of the organic fraction as a whole). For control purposes, a group of frog-ringer was used. The following variables were analyzed: relative time of mucociliary transport, ciliary beating frequency and histological analysis, which evaluated proportional volume of acid mucus, neutral and mixed mucus, cilia, vacuoles, cell nuclei and interstice, and epithelial thickness. RESULTS: Phase I: The effective concentration of intact diesel particulate matter in eliciting a significant increase in the relative time of mucociliary transport, and a proportional increase of acid mucus volume (p<0.05), corresponded to 12mg/L. Phase II: a) The nitric acid treatment caused a significant increase in the relative time of mucociliary transport, and decrease in the proportional volume of neutral mucus. b) A higher proportional volume of acid mucus was found in the methanol group (p<0.05). c) There were no differences between control and hexane groups regarding histological findings and relative time of mucociliary transport. CONCLUSION: The results suggest that organic compounds of low polarity from diesel engines exhaust particles play an important role in the acute toxicity on the ciliated epitheliu

Web survey during COVID-19 pandemic in São Paulo state: how are medical students sleeping and living?

Objectives: This study aimed at characterizing medical students’ sleep and life quality during the COVID-19 pandemic in São Paulo (SP) state. Material and Methods: All public higher education institutions (HEIs) of SP state were invited to participate. From a list of 56 private HEIs, 16 were randomly selected. The web survey collected: sociodemographic data; factors related to COVID-19; sleep self-assessment; scores in the Epworth sleepiness scale, Pittsburgh sleep quality index, and student and resident life in the health area - questionnaire. Results: The HEIs’ acceptance rate was 25% (8), resulting in 200 participants (response rate 5.04%), aged ≥18 years, 60.5% females. Concerning COVID-19, 89.00% never showed symptoms and/or tested positive, 82.00% declared full adherence to epidemiological measures to prevent the infection’s spread, and 45.00% completed the vaccination schedule against SARS-CoV-2. Sleep deprivation was accompanied by a drop of self-perceived sleep quality from 8 to 6 (in a Likert scale) during COVID-19 pandemics (p≤0.0001), 76.50% were poor sleepers, and 40.00% had drowsiness, especially women (p≤0.05). They also had lower quality of life and unfavorable psychological and physical outcomes than men (p≤0.05). Internship students had a more negative perception of the educational environment (p≤0.05), characterized by an excessive workload. Discussion: Women and internship students are a representative fraction that requires special attention and focused strategies to cope with sleep problems and medical education during COVID-19 pandemics

Nasal mucus transportability in children with cleft palate

Objectives: Children with cleft palate (CP) have a high prevalence of sinusitis. Considering that nasal mucus properties play a pivotal role in the upper airway defense mechanism, the aim of the study was to evaluate nasal mucus transportability and physical properties from children with CP. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil and Laboratory of Experimental Air Pollution, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil. Methods: Nasal mucus samples were collected by nasal aspiration from children with CP and without CP (non-CP). Sneeze clearance (SC) was evaluated by the simulated sneeze machine. In vitro mucus transportability (MCT) by cilia was evaluated by the frog palate preparation. Mucus physical surface properties were assessed by measuring the contact angle (CA). Mucus rheology was determined by means of a magnetic rheometer, and the results were expressed as log G* (vectorial sum of viscosity and elasticity) and tan delta (relationship between viscosity and elasticity) measured at 1 and 100 rad/s. Results: Mucus samples from children with CP had a higher SC than non-CP children (67 +/- 30 and 41 +/- 24 mm, respectively, p < 0.05). Mucus samples from children with CP had a lower CA (24 +/- 16 degrees and 35 +/- 11 degrees, p < 0.05) and a higher tan delta 100 (0.79 +/- 0.24 and 0.51 +/- 0.12, p < 0.05) than non-CP children. There were no significant differences in mucus MCT, log G* 1, tan delta 1 and log G* 100 obtained for CP and non-CP children. Conclusions: Nasal mucus physical properties from children with CP are associated with higher sneeze transportability. The high prevalence of sinusitis in children with CP cannot be explained by changes in mucus physical properties and transportability. (C) 2008 Elsevier Ireland Ltd. All rights reserved

Dimensões internas nasais de adultos com obstrução nasal

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico

XXVI.—On the branchial currents of the Bivalve Mollusca

Volume: 4Start Page: 242End Page: 24

Áreas seccionais nasais de adultos sadios aferidas por rinometria acústica Nasal cavity geometry of healthy adults assessed using acoustic rhinometry

A rinometria acústica tem sido utilizada como teste específico da permeabilidade nasal. OBJETIVO: O propósito do presente estudo foi determinar valores de referência de áreas de secção transversa da cavidade nasal de adultos sadios pela técnica rinométrica. DESENHO: Estudo clínico prospectivo. CASUÍSTICA E MÉTODO: Trinta voluntários sem evidências de obstrução nasal com idade entre 18 e 30 anos (14 homens e 16 mulheres) foram avaliados antes e após a aplicação tópica de vasoconstritor nasal. As áreas de secção transversa foram medidas nos três entalhes do rinograma correspondentes à válvula nasal (AST1), região anterior (AST2) e região posterior (AST3) das conchas nasais inferior e média. RESULTADOS: Os valores médios (±DP) das áreas aferidas em 60 cavidades antes da vasoconstrição nasal foram os seguintes: 0,54±0,13cm2 (AST1), 0,98±0,31cm2 (AST2) e 1,42±0,44cm2 (AST3). Após a vasoconstrição, os valores médios dos três segmentos analisados foram significantemente maiores (p<0,05). Não foram constatadas diferenças significantes entre os sexos. CONCLUSÃO: As áreas seccionais nasais de adultos obtidas para adultos podem ser usadas para fins de controle no estudo de pacientes com obstrução nasal, em complementação aos volumes nasais relatados anteriormente por nosso grupo.<br>Acoustic rhinometry (AR) has been used as a specific test for nasal patency. AIM: this study aimed to set the reference values for nasal cavity cross-section geometry in healthy adults through AR. STUDY DESIGN: this is a clinical prospective study. MATERIALS AND METHOD: thirty volunteers (14 males and 16 females) without signs of nasal obstruction and aged between 18 and 30 years were enrolled in this study. They were assessed before and after being treated topically with a nasal vasoconstrictor drug. Their nasal cross-sectional areas were measured at the three dips of the rhinogram, corresponding respectively to the nasal valve (CSA1), the anterior (CSA2), and the posterior (CSA3) region of the inferior and middle turbinate. RESULTS: the mean areas (±SD) for 60 nasal cavities before nasal vasoconstriction were: 0.54±0.13cm2 (CSA1), 0.98±0.31 cm2 (CSA2), and 1.42±0.44cm2 (CSA3). After vasoconstriction, the mean values of the three segments analyzed were significantly larger (p<0.05). Gender was not a statistically significant variable. CONCLUSION: The nasal cross-sectional areas obtained for adults may be used for control purposes when studying patients with nasal obstruction, in conjunction with the nasal volume values previously reported by our group