Paulo Franco Taitson

Stylohyoid syndrome: surgical approach.

AbstractThe best-known cervicopharyngeal pain is Eagle syndrome, in which symptomatic elongation of the stylomandibular process occurs and may be accompanied by stylohyoid ligament calcification. Among the causes of elongation of the styloid process, the following may be mentioned: history of trauma, styloid ligament calcification, and formation of bony tissue in the insertion of the styloid ligament. When there is no history of trauma or surgery, it is called the stylohyoid syndrome. In the current study, the clinical case of 34-year-old woman is reported, complaining of pain in the region of the neck, without any history of neck surgery or trauma. A panoramic radiograph and computed tomographic scan showed bilateral elongation of the styloid process. Extraoral surgical intervention was the treatment of choice. It is important to point out that dentists should be aware of this condition to contribute to a better diagnosis and therapeutic procedure.

Birth of healthy twins after intracytoplasmic sperm injection using ejaculated immotile spermatozoa from a patient with Kartagener's syndrome.

This case report demonstrates a successful pregnancy after ICSI combined with hypo‐osmotic swelling test in a couple with Kartagener’s syndrome with complete immotile ejaculated spermatozoa. Our result suggests that even for complete immotile spermatozoa, the use of hypo‐osmotic swelling test is a good alternative to identify viable spermatozoa. When associated with ICSI, it can be a valuable tool to get fertilisation and pregnancy.

Reproductive planning in times of Zika: getting pregnant or delaying plans? The opinion of the Brazilian Society of Assisted Reproduction Committee – a basis for a bioethical discussion

Although the causality between Zika virus, microcephaly, and other central nervous system disorders has been taken for granted by the scientific community, many uncertainties remain. The gap of knowledge at the moment is large enough to remove part of the confidence physicians have on the advice given to patients - and infertile women in particular - on their reproductive plans. Pretreatment serologic screening is a possible strategy to offer more confidence for individuals choosing to bear children regardless of the Zika virus, but the tests currently available do not seem to be sufficiently adequate. Until now, there is no formal recommendation to avoid pregnancy solely because of the Zika virus outbreak, and the choice of becoming pregnant has been regarded as a personal decision to be made by each woman and her family.

Pregnancy after percutaneous epididymal sperm aspiration in an 81-year-old man with obstructive azoospermia.

There has been observed a trend to delay childbearing, reflecting couples desire to have children at older ages. Maternal age is a well‐known factor that influences the achievement of a pregnancy. In contrast, there are few studies examining the effect of paternal age on the outcomes of assisted reproductive technologies (ART), and results are conflicting. Our patient was vasectomised at the age of 60 years, and his wife was 38 years old. A total of four metaphase II oocytes were inseminated 4 h later (day 0) by intracytoplasmic sperm injection using spermatozoa from percutaneous epididymal sperm aspiration. On day 2, the three resulting embryos were transferred (two had four cells, and one had two cells). Two healthy infants were born at the 37th gestational week by caesarean section. Although the effect of paternal age on ART outcomes and results are conflicting, this case report contributes to point out that advanced age of the man has probably lesser negative influence in the reproductive function.

Incidence and anatomy of cardiac malformations in children con- ceived by assisted reproduction techniques - A review

The aim of this study is to identify the occurrence of car- diac malformations occurred in children conceived by as- sisted reproduction techniques (ART) in the international literature in Medline database from 1999 to 2012. The search returned data on 32,000 births, whose 21,000 were conceived naturally and 11,000 were conceived by ICSI and/or IVF. The incidence of cardiac malformations in general population situations was 0.4%. The incidence of cardiac malformations by ART was 1.8% from ICSI and IVF. Among the situations of conceived naturally was observed 88 cases of cardiac malforma- tions, which were: Atrial Septal Defect: 26 cases 29.55%, Change in the interventricular septum: 18 cases 20.45%, coarctation of the aorta: 13 cases 14.77%, aortic stenosis: 11 cases 12.5%, tetralogy of Fallot: 5.68% 5 cases, steno- sis of the pulmonary trunk: 5 cases 5.68% other: 11.37% 10 cases. In cases of cardiac malformations in children conceived by IVF and ICSI, 198 cases were found, which were: CIA: 58 cases 29.30%, Change in the interventric- ular septum: 37 cases 18.69%, coarctation of the aorta: 20 cases 10.10%, aortic stenosis: 18 cases 9.09%, tetral- ogy of Fallot: 11 cases 5.55%, stenosis of the pulmonary trunk: 6 cases 3.03%, Other: 48 cases 24.24%. There remain opened questions about infertility and risk factors involving ART. Further research is clearly required. Health care providers should counsel infertile couples seeking as- sisted reproduction by IVF and technology.

Insalubrity in speech therapy and audiology: a brief review

Purpose: to expose in a brief discussion the questions about the insalubrity pertinent to speech therapists and audiologists’ performance. Methods: a review of the Portal of Legislation of the Brazilian Federal Government about labor laws, health and health professionals was carried out. Results: according to NR-15, activities that are above the level of tolerance foreseen in the regulations are considered unhealthy activities, in which the performance of speech-language therapists and audiologists is directly related to the tolerance limits for biological agents. Conclusion: speech therapists and audiologists as well as several other health professionals present occupational risks in their work. The Brazilian legislation is broad, however, it is necessary to analyze these professionals more deeply with regard to their health.

Uso da radiografia transcraniana para detectar alterações morfológicas no côndilo mandibular

Purpose: to evaluate the accuracy of conventional transcranial radiographs (TRANS) to identify morphological changes in mandibular condyles. Methods: the sample consisted of 36 mandibular condyles, obtained from 18, randomly selected, dried human skulls, without the identification of age, gender, or ethnicity. Three experts in dental radiology examined the TRANS to identify possible changes in the condyles. The fourth examiner performed the macroscopic examination, which was considered the gold standard of the study. The condyles in both TRANS images and macroscopic examinations were classified as mandibular condyles with change (1) or no change (0). Statistical analyses were performed using the X 2 and the receiver operating characteristic (ROC) curve. Kappa intra- and interobserver tests were performed for examiners 1 to 3. Results: the X2 test showed a statistically significant association between changes in the condyle in the TRANS images and the presence of macroscopic changes in the condyle (p ( 0.05). The area under the curve was 0.83, with 96% sensitivity and 70% specificity. The weighted kappa value for intraobserver agreement was 0.78, while the interobserver agreement was 0.71. Conclusion: the use of TRANS proved to be an effective method to detect morphological changes in the mandibular condyle.

Zika virus outbreak: reproductive effects and decreases in the number of births in Brazil

An infectious agent new to Brazil arrived in our country in 2015, to cause significant social impact and uproar in the scientific community in the areas of human health and reproduction. The Zika virus, detected in past decades in Africa and Southeast Asia, first appeared in the Brazilian Northeast in October of the said year, primarily in the State of Pernambuco, where 25.9% of the suspected cases were observed. The outbreak stretched into the following year, causing civil unrest, the issuance of health alerts, and apprehension in the scientific community as more information and studies on the infectious disease were needed (Carvalho et al., 2016). The initial symptoms of infection are low-grade fever, maculopapular rash, conjunctivitis, and arthralgia, accompanied by central nervous system disorders caused by the onset microcephaly in intrauterine life. The latter raised questions around the medium and long-term impacts on the motor and cognitive development of affected children, and prompted the establishment of preventive measures and research on other possible virus transmission pathways. As in the case of dengue, a disease already present in Brazil, the Zika virus is also transmitted by a mosquito of the Aedes genus (Aedes aegypti vs. Aedes albopictus). But the Zika virus is not transmitted solely through a simple mosquito bite. Other pathways include blood transfusion, sexual intercourse, and transplacental transmission. Additional possibilities are being studied (Baud et al., 2017). Transmission through sexual intercourse has stimulated discussions on the possible effects it might have in the field of human reproduction. Studies are being held to confirm the time for which the infectious agent stays in the human body. Dissemination of the virus has been reported to occur 41 days after the onset of initial symptoms, but the maximum length of the contagious period has not been established yet. To further complicate matters, infective viral particles have been detected in semen 69 days after infection, while viral RNA has been detected through reverse-transcription (RT)-PCR as many as 188 days after infection (Baud et al., 2017). Despite the lack of studies devised to gather more evidence on the presence and behavior of the virus in gametes and in the reproductive apparatus of individuals of both sexes, semen infected with the Zika virus has been the topic of several study submissions looking into pathogengamete interactions and the possibility of infectious materials making it to human oocytes. In published studies, gametes and animal embryos were susceptible to infection by viral antigens despite glycoprotein-based protection mechanisms such as the zona pellucida, although long-term developmental implications have not been analyzed. These findings may serve as the foundation for the risk factors connected to the transmission of Zika virus in assisted reproductive technologies, since follicular fluid may carry the Zika virus (Washington et al., 2016). Although the site of viral replication in humans has not been determined, it is believed to be located in the prostate or seminal vesicles, preferentially in the testicular and epididymal region, potentially extending the duration of the sexual transmission potential. Through analogies with other studies on brain tissue, the Zika virus is believed to preferentially infect progenitor cells, making spermatogonia its main target. The appearance of orchitis and epididymitis in mice up to sixty days after infection demonstrated the potential of the pathogen to cause tissue damage in the long-term by innate immune response. Evidence of interference with cell division in the testicles poses another significant challenge to male fertility, since it may induce the death of spermatozoa, infertility, and potentially azoospermia, in addition to possible effects on mature sperm cells such as decreasing their motility and ability to fertilize oocytes. The female genitourinary tract has also been analyzed as a possible reservoir of ZIKV and a potential source of chronic risk to fetuses, two factors that significantly complicate prenatal counseling. Nonetheless, the role of bodily fluids and the urinary systems of both sexes in the extension of the infectious potential of viral RNA needs to be better investigated and clarified (Baud et al., 2017; Govero et al., 2016). Fear of the complications associated with infection by the Zika virus have led to a reduction in the number of births in the State of Pernambuco. Hospitals once overcrowded started to have empty beds by the end of 2016. In September of 2015, before the issuance of Zika virus warnings, some 8,000 births were recorded in the State of Pernambuco. In November of 2016, just over ten months since the declaration of state of emergency on account of cases of microcephaly, the number of births dropped by an astounding 27%. In Campinas, São Paulo, the number of births decreased by more than 5.0% in 2016 in relation to 2015, breaking a decade-long string of annual growth rates of two percent. Two reasons were listed by the local Secretary of Health to explain the decrease in the number of births: the economic crisis the country is going through, which may have forced couples to postpone their plans of having children, and the cases of Zika virus infection, which significantly increased the number of babies born with microcephaly. In Belo Horizonte, Minas Gerais, many maternity hospitals recorded decreases in the number of births in the first trimester of 2017. The States Capital also had cases of Zika virus infection. The combination of generalized fear of an outbreak and awareness of the diseases complications pulled the number of births down by more than 20%, particularly among women aged 20-30 years.

Do you know this syndrome? Leopard syndrome

Hypertrophic cardiomyopathy is known as Leopard syndrome, which is a mnemonic rule for multiple lentigines (L), electrocardiographic conduction abnormalities (E), ocular hypertelorism (O), pulmonary stenosis (P), abnormalities of genitalia (A), retardation of growth (R), and deafness (D). We report the case of a 12-year-old patient with some of the abovementioned characteristics: hypertelorism, macroglossia, lentigines, hypospadias, cryptorchidism, subaortic stenosis, growth retardation, and hearing impairment. Due to this set of symptoms, we diagnosed Leopard syndrome.

Primary Occipital Encephalocele in an Elderly Patient.

The encephalocele is a condition characterized by the protrusion of the intracranial contents through a bone defect of the skull. The authors report a clinical case of an 80-year-old woman with primary occipital encephalocele on the right side and that was affected by trauma and presented liquor fistula and infection. Tomographic sections were obtained by injection intravenous of contrast. The images showed bone thickness thinning on the right occipital region and solution of continuity (encephalocele) with regular contours, reduction in brain volume, and hypodensity of the periventricular white substance were observed. The patient was successfully operated.