Avaliação radiográfica da adenoide - sugestão de parâmetros de referência

OBJECTIVE:this study aimed to evaluate the usefulness of current radiographic measurements, which were originally conceived to evaluate adenoid hypertrophy, as potential referral parameters.METHODS:children aged from 4 to 14 years, of both genders, who presented nasal obstruction complaints, were subjected to cavum radiography. Radiographic examinations (n = 120) were evaluated according to categorical and quantitative parameters, and data were compared to gold-standard videonasopharyngoscopic examination, regarding accuracy (sensitivity, negative predictive value, specificity, and positive predictive value).RESULTS:radiographic grading systems presented low sensitivity for the identification of patients with two-thirds choanal space obstruction. However, some of these parameters presented relatively high specificity rates when three-quarters adenoid obstruction was the threshold of interest. Amongst the quantitative variables, a mathematical model was found to be more suitable for identifying patients with more than two-thirds obstruction.CONCLUSION:this model was shown to be potentially useful as a screening tool to include patients with, at least, two-thirds adenoid obstruction. Moreover, one of the categorical parameters was demonstrated to be relatively more useful, as well as a potentially safer assessment tool to exclude patients with less than three-quarters obstruction, to be indicated for adenoidectomy.OBJETIVO:o objetivo deste estudo foi de investigar a utilidade de medidas radiográficas destinadas à avaliação da tonsila faríngea a serem utilizadas como potenciais parâmetros de encaminhamento.MÉTODOS:crianças de quatro a 14 anos, de ambos os gêneros, que apresentavam queixas referentes à obstrução nasal foram submetidas à radiografia do cavum. Os registros radiográficos (n = 120) foram avaliados de acordo com parâmetros categóricos e quantitativos, e dados resultantes foram comparados ao exame padrão-ouro de videonasofaringoscopia, em relação às suas taxas de acurácia (sensibilidade, valor preditivo negativo, especificidade e valor preditivo positivo).RESULTADOS:os parâmetros radiográficos categóricos apresentaram baixa sensibilidade para a identificação de pacientes portadores de 2/3 de obstrução do espaço coanal. No entanto, alguns destes parâmetros apresentaram especificidades relativamente altas quando 3/4 de obstrução coanal era o ponto de corte de interesse. Dentre as variáveis quantitativas, um modelo matemático se mostrou mais adequado para identificar pacientes com mais de 2/3 de obstrução coanal.CONCLUSÃO:este modelo demonstrou, assim, ser potencialmente útil como método de rastreamento para identificação de pacientes com pelo menos 2/3 de obstrução adenoidiana. Além disso, um dos parâmetros categóricos analisados demonstrou ser relativamente mais útil e potencialmente seguro para eliminar pacientes queixosos com menos de 3/4 de obstrução a serem indicados à adenoidectomia.Universidade São Francisco Faculdade de OdontologiaUniversidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology, Head and Neck SurgeryUNIFESP, Department of Otorhinolaryngology, Head and Neck SurgerySciEL

Laryngeal sequelae of recurrent respiratory papillomatosis surgery in children

OBJECTIVE: To evaluate laryngeal sequelae from surgical treatment of recurrent respiratory papillomatosis in children, as well as associated risk factors. METHODS: Case-control study. Medical record data analysis of 50 children with recurrent respiratory papillomatosis, divided into two groups: with and without laryngeal sequelae. The group of patients with laryngeal sequelae was compared to those without sequelae in regard to the onset of disease, age at first surgery, number and frequency of surgeries, disease stage, and type of surgery (CO2 laser, cold forceps). RESULTS: 23 patients (46%) sustained laryngeal sequelae. The most frequent sequela was anterior commissure synechia (17 patients [34%]), followed by glottic stenosis (six patients [12%]). There was no statistically significant difference between groups with and without laryngeal sequelae regarding the disease onset (p = 0.93), age at first surgery (p = 0.68), number of surgeries (p = 0.22), annual frequency of surgery (p = 0.93), presence of papilloma in anterior (p = 0.430) or posterior commissure (p = 0.39), and type of surgery (p = 0.27). The Derkay anatomical score (a staging system that assesses the extent of the disease in the aerodigestive tract) was significantly higher in the laryngeal sequelae group (p = 0.04). CONCLUSION: Laryngeal sequelae are a frequent complication of recurrent respiratory papillomatosis surgical treatment in children, particularly anterior commissure synechiae and glottic stenosis. Advanced stages are associated with increased risk of laryngeal sequelae after surgery.Universidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology and Head and Neck SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology and Head and Neck Surgery Internal Clinic of the Pediatric Otorhinolaryngology DisciplineUNIFESPUNIFESP Pediatric Otorhinolaryngology DisciplineUNIFESP, Department of Otorhinolaryngology and Head and Neck SurgeryUNIFESP, Department of Otorhinolaryngology and Head and Neck Surgery Internal Clinic of the Pediatric Otorhinolaryngology DisciplineUNIFESP, Pediatric Otorhinolaryngology DisciplineSciEL

Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: A systematic review

Objectives: Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy.Methods: Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n = 66) were analyzed and selected by independent examiners. the resultant studies (n = 11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies.Results: Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated disease (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. in addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of blindness by the examiners.Conclusions: Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilWeb of Scienc

Cephalometric evaluation of adenoids: An analysis of current methods and a proposal of a new assessment tool

Introduction: Although the scientific literature recognizes that lateral cephalometric radiographs might be clinically useful, there is no consensus in relation to the best parameter available. Therefore, this research was aimed at evaluating current radiographic assessment methods designed to investigate adenoid hypertrophy and nasopharyngeal obstruction. Methods: Children from 4 to 14 years old with nasal obstruction or oral breathing complaints, suspected to be caused by adenoid hypertrophy, received cephalometric examinations. One hundred twenty radiographic records were evaluated according to several current methods, and data were compared with respective gold-standard videonasopharyngoscopic examinations, in relation to the percentage of choanal obstruction. Results: Groups derived from a grading system had significantly different percentages of choanal obstruction. However, this parameter showed low sensitivity. Significant but moderate correlations were observed between most of the quantitative radiographic parameters and the percentage of choanal obstruction. Alternatively, a regression model was introduced; it demonstrated satisfactory ability to predict choanal obstruction percentage. Despite limitations, this model could also distinguish patients who might benefit from referral to otolaryngologic care. Conclusions: Current adenoid assessment methods have significant limitations. A novel assessment method introduced here might be clinically useful. (Am J Orthod Dentofacial Orthop 2012; 142: 671-8)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilFAPESP: 08/53538-0Web of Scienc

Effectiveness of the human papillomavirus (types 6, 11, 16, and 18) vaccine in the treatment of children with recurrent respiratory papillomatosis

Objective: To evaluate whether the quadrivalent human papillomavirus (HPV) (types 6, 11, 16, and 18) vaccine influences the clinical course of juvenile-onset recurrent respiratory papillomatosis (RRP) when administered to a group of patients with this condition. Methods: Uncontrolled intervention study of patients with juvenile-onset RRP examined at the Pediatric Otorhinolaryngology Clinic, Federal University of Sao Paulo, where nine patients between the ages of nine and 17 received three doses of the prophylactic quadrivalent HPV vaccine (Gardasil) and were followed for one year. Disease staging, intervals between relapses, intervals between surgeries, and the number of surgeries during the year prior to vaccination and during the first year after vaccination were compared. Results: Eight patients were infected with HPV-6 and one with HPV-11. There were no statistically significant differences in the clinical scores (p = 0.083), anatomical scores (p = 0.257), intervals between relapses (p = 0.062), intervals between surgeries (p = 0.357), or the numbers of surgeries (p = 0.180) when the years before and after vaccination were compared. All patients had relapses following vaccination. Conclusion: Patients with juvenile-onset RRP experienced a similar clinical course in the year after versus the year before vaccination with Gardasil. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Univ Fed Sao Paulo, Discipline Pediat Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilRes Incent Fund Assoc, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Infect Dis, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Pediat Otorhinolaryngol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilUniv Fed Sao Paulo, Discipline Infect Dis, Sao Paulo, BrazilWeb of Scienc

Interval walking training in type 2 diabetes: A pilot study to evaluate the applicability as exercise therapy.

There are few established easy-to-perform exercise protocols with evidence-based effects for individuals with type 2 diabetes (T2D). A unique exercise regimen, interval walking training (IWT), has been reported to be beneficial for improving metabolic function, physical fitness and muscle strength in adults of overall health. This pilot study aims to demonstrate descriptive statistics of IWT adherence and changes in various data before and after the intervention of IWT in adults with T2D, perform statistical hypothesis testing, and calculate effect sizes. We performed a single-arm interventional pilot study with IWT for 20 weeks. We enrolled 51 participants with T2D aged 20-80 years with glycohemoglobin (HbA1c) levels of 6.5-10.0% (48-86 mmol/mol) and a body mass index of 20-34 kg/m2, respectively. The target was 60 min/week of fast walking for 20 weeks. The participants visited the hospital and were examined at 4-week intervals during this period. Between the start of IWT and after 20 weeks, we measured and evaluated changes in glucose and lipid metabolism data, body composition, physical fitness, muscle strength, dietary calorie intake, and daily exercise calories. All included participants completed IWT, with 39% of them reaching the target length of fast walking over 1,200 minutes in 20 weeks. In the primary outcome, HbA1c levels, and in the secondary, lipid metabolism and body composition, no significant changes were observed except for high-density lipoprotein cholesterol (HDL-C) (from 1.4 mmol/L to 1.5 mmol/L, p = 0.0093, t-test). However, in the target achievement group, a significant increase in VO2 peak by 10% (from 1,682 mL/min to 1,827 mL/min, p = 0.037, t-test) was observed. Effect sizes were Cohen's d = 0.25 of HDL-C, -0.55 of triglyceride, and 0.24 of VO2 peak in the target achievement group, which were considered to be of small to medium clinical significance. These results could be solely attributed to IWT since there were no significant differences in dietary intake and daily life energy consumption before and after the study. IWT could be highly versatile and was suggested to have a positive effect on lipid metabolism and physical fitness. In future randomized controlled trial (RCT) studies, the detailed effects of IWT, focusing on these parameters, will be examined. Trial registration: This trial was registered with the Japanese University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR: Usefulness on interval walking training in patients with type 2 diabetes. 000037303)

Biochemical and functional characterization of BLUF-type flavin-binding proteins of two species of cyanobacteria

BLUF (a sensor of Blue-Light Using FAD) is a novel putative photoreceptor domain that is found in many bacteria and some eukaryotic algae. As found on genome analysis, certain cyanobacteria have BLUF proteins with a short C-terminal extension. As typical examples, TII0078 from thermophilic Thermosynechococcus elongatus BP-1 and Slr1694 from mesophilic Synechocystis sp. PCC 6803 were comparatively studied. FAD of both proteins was hardly reduced by exogenous reductants or mediators except methylviologen but showed a typical spectral shift to a longer wavelength upon excitation with blue light. In particular, freshly prepared TII0078 protein showed slow but reversible aggregation, indicative of light-induced conformational changes in the protein structure. TII0078 is far more stable as to heat treatment than Slr1694, as judged from flavin fluorescence. The slr1694-disruptant showed phototactic motility away from the light source (negative phototaxis), while the wild type Synechocystis showed positive phototaxis toward the source. Yeast two-hybrid screening with slr1694 showed self-interaction of Slr1694 (PixD) with itself and interaction with a novel PatA-like response regulator, Slr1693 (PixE). These results were discussed in relation to the signaling mechanism of the "short" BLUF proteins in the regulation of cyanobacterial phototaxis