Incidence and evolution of nasal polyps in children and adolescents with cystic fibrosis

SummaryNasal polyps are a clinical sign of alert for investigating Cystic Fibrosis (CF).AimsTo study the incidence of nasal polyps in children and adolescents with cystic fibrosis, its possible association with age, gender, clinical manifestations, genotype and sweat chlorine level, and its evolution with topical steroid therapy.MethodsClinical symptoms, sweat chlorine level and genotype were studied in 23 cystic fibrosis patients. Nasal polyps were diagnosed by nasal endoscopy and treated with topical steroids during 6 months, followed by a second nasal endoscopy. Fisher test was used for statistical analysis.ResultsNasal polyps were found in 39.1% of the patients (five bilateral, four unilateral), all older than six years, recurrent pneumonia in 82.6%, pancreatic insufficiency in 87% and malnutrition in 74%. No association was seen between nasal polyps and sweat chlorine level, genotype, clinical sings of severity and nasal symptoms. Seven patients improved in their nasal polyps with topical steroids, six showed complete resolution.ConclusionThe study showed a high incidence of nasal polyps in older children, who span the entire range of clinical severity, even in the absence of clinical nasal symptoms. Topical steroid therapy showed good results. An interaction among pediatricians and otolaryngologists is necessary for diagnosis and follow-up

Hyperactivity and attention deficit syndrome in obstructive sleep apnea syndrome: is there improvement with surgical management?

SummaryNeuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD).AimTo analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery.Patients and MethodsWe studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy.ResultsThere was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients.ConclusionThere was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases

Ensino de línguas estrangeiras e prática médica no projeto let’s go: uma perspectiva humanizada

La sociedad actual cada vez más se caracteriza por el trabajo cognitivo y, en el contexto de globalización, la lengua extranjera (LE) es una primera de las barreras para la inserción del individuo a nivel nacional e internacional. Un facilitador importante del aprendizaje de una segunda lengua es la introducción precoz en la enseñanza de una LE (BROWN, 2001), aprovechando así la curiosidad natural de los niños para introducirles en el aprendizaje de una otra lengua además de su lengua materna. Para eso, el profesor necesita trabajar su habilidad de transmitir conocimientos de modo más comprensible, promoviendo una capacidad esencial para el futuro médico, desde una perspectiva humanizada. En este sentido, este trabajo se centra en experiencias que médicos en su formación académica están realizando al actuar como promotores del aprendizaje de lengua inglesa en el cotidiano de alumnos del 5º año de una escuela de Enseñanza Fundamental en el Proyecto de Extensión Let`s Go, que pretende despertar en los alumnos el interés por la LE y además integrar los estudiantes de la Facultad de Medicina de Botucatu con niños de un medio social diferente para, así,  mejorar sus habilidades interpersonales y de comunicación. Metodológicamente, bajo la orientación y supervisión de profesores del área de enseñanza y aprendizaje de LE y de Medicina, fue desarrollada una apostilla por los estudiantes de la facultad de Medicina para promover las clases de inglés, una vez por semana, para 90 alumnos de tres salas del 5º año de la Enseñanza Fundamental de dos escuelas municipales. Para la evaluación del curso de inglés por los alumnos, fue elaborado un cuestionario y aplicado al inicio y al final del año lectivo. Se observa, de modo general, por el análisis del corpus (cuestionarios) que el Proyecto Lets Go ha logrado llevar a cabo los objetivos propuestos: promover y sensibilizar para el aprendizaje de lengua inglesa, y proporcionar la interacción de los estudiantes de Medicina de Botucatu con la comunidad, según la perspectiva humanizada.Society today is increasingly characterized by cognitive work and, in the context of globalization, a foreign language (FL) is the first barrier that must be overcome to the to the insertion of an individual at a national and international level. An important facilitator to the learning of a second language is the early introduction of a FL (Brown, 2001), making use of child's natural curiosity to introduce them in to the study of another language. For that, the teacher needs to work his skill to transmit knowledge in a more comprehensible way, improving an essential skill for a future doctor, assuming a more humanized posture. In that way, this study focus on the experiences that medical students undergo as promoters of the learning of English for students of the 5th year of the Elementary School, through the extension project Let's Go. This project aims to awaken in children the interest for a FL as well as to interface the students of the Faculty of Medicine of Botucatu with children from a different social context, developing their interpersonal and communication skills. As method, a brochure was produced by the medical students under the supervision and orientation of languages and medicine professors. The brochure is used as material to English classes once a week to 90 children of three classes of the 5th year of the Elementary School of two public schools. In order to evaluate the course, a questionnaire was elaborated and applied at the beginning and at the end of the school year. It is observed that, in general terms, through the analysis of the questionnaires, that the project Let's Go is achieving its objectives: to promote and encourage the learning of English, as well as to interact medical students of the Faculty of Medicine of Botucatu with the community in a humanized perspective.A sociedade atual cada vez mais se caracteriza pelo trabalho cognitivo e, no contexto de globalização, a língua estrangeira (LE) é a primeira das barreiras para a inserção do indivíduo a nível nacional e internacional. Um facilitador importante do aprendizado de uma segunda língua é a introdução precoce na aprendizagem da LE (BROWN, 2001), aproveitando assim a curiosidade natural das crianças para introduzi-las na aprendizagem de uma outra língua além de sua língua materna. Para isso, o professor precisa trabalhar sua habilidade de transmitir conhecimentos de modo mais compreensível, promovendo uma capacidade essencial para o futuro médico, uma postura humanizada. Neste sentido, o presente trabalho focaliza as experiências que os médicos em sua formação acadêmica tem realizando ao atuarem como promotores da aprendizagem de língua inglesa no cotidiano de alunos do 5º ano da escola de Ensino Fundamental, junto ao Projeto de Extensão Let`s Go, que pretende despertar neles o interesse pela LE e também integrar os estudantes da Faculdade de Medicina de Botucatu com crianças de um meio social diferente para aprimorarem, assim, suas habilidades interpessoais e de comunicação. Metodologicamente, sob a orientação e supervisão de professores da área de ensino e aprendizagem de LE e da Medicina, foi desenvolvida uma apostila pelos alunos da faculdade de Medicina para promoverem aulas de inglês, uma vez por semana, para 90 alunos de três classes do 5º ano do Ensino Fundamental de duas escolas municipais. Para avaliação do curso pelos alunos, foi elaborado um questionário aplicado no início e no fim do ano letivo. Observa-se, de modo geral, pela análise do corpus (questionários) que o Projeto Lets Go tem atingido os objetivos: promover e sensibilizar para o aprendizado de língua inglesa, além de proporcionar a interação dos alunos da Faculdade de Medicina de Botucatu com a comunidade, numa perspectiva humanizada

The triad of obstructive sleep apnea syndrome, COPD, and obesity: sensitivity of sleep scales and respiratory questionnaires

ABSTRACT Objective: To investigate whether the presence of obstructive sleep apnea syndrome (OSAS) alters the perception of respiratory symptoms and quality of life in COPD patients, by using specific questionnaires, as well as to determine whether scales for assessing daytime sleepiness and for screening for OSAS can be used in the triad of OSAS, COPD, and obesity. Methods: We included 66 patients diagnosed with mild-to-moderate or severe COPD and presenting with a body mass index > 27 kg/m2. After polysomnography, patients completed the Epworth sleepiness scale (ESS), the Berlin questionnaire (BQ), the modified Medical Research Council (mMRC) scale, the Baseline Dyspnea Index (BDI), and the Saint George’s Respiratory Questionnaire (SGRQ). Results: Patients were first divided into two groups: COPD + OSAS (n = 46); and COPD-only (n = 20). The COPD + OSAS group was subdivided into a COPD + mild-to-moderate OSAS group (n = 32) and a COPD + severe OSAS group (n = 14), all of which were compared with the COPD-only group. There was a significant difference in mean FEV1 (L) between the COPD + OSAS groups and the COPD-only group (p = 0.073). The presence of the triad did not lead to significantly higher ESS scores, and scores > 10 had a specificity of 0.58. The BQ did not identify high risk for OSAS in the presence of the triad (specificity of 0.31). There were no significant differences in domain or total scores of the SGRQ between the COPD + OSAS groups and the COPD-only group. Conclusions: The confounding factors present in the triad of OSAS, COPD, and obesity prevented the perception of increased daytime sleepiness and high risk for OSAS. We observed no worsening of dyspnea perception or quality of life

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq