Ronny Tah Yen Ng

Validation of the Brazilian version of mini-test CASI-S

OBJECTIVE To determine CASI-S accuracy in the diagnosis of dementia. METHOD The Cognitive Abilities Screening Instrument - Short Form (CASI-S) was applied in 43 Alzheimers disease (AD) patients and 74 normal controls. AD diagnosis was based on DSM-IV, NINCDS-ADRDA, and CAMDEX. CASI-S includes: registration, temporal orientation, verbal fluency (4-legged animals in 30s), and recall (3 words). Its maximum score is 33 points. A copy of 2 pentagons was added. RESULTS ROC curve showed an accuracy of 0.87, with standard error of 0.032, and 95% confidence intervall between 0.795 and 0.925. The cut-off score for cognitive deficit was 23, with sensitivity of 76.7%, specificity 86.5%, positive likelihood ratio (LR) 5.68, and negative LR 0.27. The cut-off score for subjects 70 years or older was 20, with sensitivity of 71.4% and specificity 97.1%. CONCLUSION CASI-S is a practical test, with high specificity, particularly in individuals above 70 years of age. The adding of the drawing test did not improve its accuracy.

Primitive reflexes and cognitive function

BACKGROUND Data on the prevalence of primitive reflexes (PR) in adulthood, their pathological significance and relationship to age and cognition are controversial. OBJECTIVE To study the relationship between PR and cognition in 30 patients with probable Alzheimers disease (AD) and 154 control subjects. METHOD Diagnosis of probable AD was based on DSM-IV, NINCDS-ADRDA, and CAMDEX criteria. Primitive reflexes were quantified from zero (absent) to 1 (mild) or 2 (markedly present). The Cognitive Abilities Screening Instrument-Short Form (CASI-S) was used to evaluate registration, temporal orientation, verbal fluency and recall. A drawing test was added. RESULTS Most frequent PR among demented and controls were suck (77% and 62%, respectively) and snout (60% and 27%), followed by glabellar (30% and 19%), paratonia (37% and 5%), and palmomental (23% and 5%). None of controls had more than three PR. Frequency of PR tended to increase with age and cognitive deterioration. Grasp and Babinski responses were found only in dementia patients. Primitive reflexes were not correlated with each other, except snout with suck, and snout with glabellar reflex. CONCLUSION The finding of grasp and Babinski sign, or the presence of more than three primitive signs, particularly the combination of paratonia, snout, suck, and palmomental reflexes strongly suggests brain dysfunction, especially when these signs are marked and accompanied by deficits in orientation, recall, verbal fluency, and constructional praxis.

Microbiology of rhinosinusitis in immunosupressed patients from the University Hospital

UNLABELLED Immunosuppressed patients are often susceptible to upper airway infections, especially those of the paranasal sinuses. These can sometimes jeopardize treatment success and even lead to a fatal outcome. OBJECTIVE To study the paranasal microbiology of immunosuppressed patients with clinical evidence of rhinosinusitis, and compare it with that from immunocompetent patients. MATERIAL AND METHOD Retrospective study, in which 42 immunosuppressed and 16 immunocompetent patients were selected. All had clinically evident acute or recurrent rhinosinusitis and were submitted to ethmoidal or sphenoid sinusectomy or maxillary sinus puncture to gather material for microbiological cultures. RESULTS There were 92% positive cultures, and 21% were negative. Of the positive cultures, 38% were bacterial, with P. aeruginosa being the most frequent agent; 64% were fungal, which occurred in the most immunocompromised patients. In the immunocompetent group, there were 62. 5% positive cultures and 37. 5% negative ones. All the positive ones were bacterial, with no fungi. CONCLUSIONS Transplant recipients were prone to develop bacterial rhinosinusitis by Gram positive and Gram negative agents, the most common of the latter being Pseudomonas aeruginosa. Fungal infections occurred in the severely immunosuppressed, and it was absent in immunocompetent patients.

Nasal Potential Difference in Cystic Fibrosis considering Severe CFTR Mutations

The gold standard for diagnosing cystic fibrosis (CF) is a sweat chloride value above 60 mEq/L. However, this historical and important tool has limitations; other techniques should be studied, including the nasal potential difference (NPD) test. CFTR gene sequencing can identify CFTR mutations, but this method is time-consuming and too expensive to be used in all CF centers. The present study compared CF patients with two classes I-III CFTR mutations (10 patients) (G1), CF patients with classes IV-VI CFTR mutations (five patients) (G2), and 21 healthy subjects (G3). The CF patients and healthy subjects also underwent the NPD test. A statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, χ 2, and Fishers exact tests, α = 0.05. No differences were observed between the CF patients and healthy controls for the PDMax, Δamiloride, and Δchloride + free + amiloride markers from the NPD test. For the finger value, a difference between G2 and G3 was described. The Wilschanski index values were different between G1 and G3. In conclusion, our data showed that NPD is useful for CF diagnosis when classes I-III CFTR mutations are screened. However, if classes IV-VI are considered, the NPD test showed an overlap in values with healthy subjects.

Válvula fonatória brasileira para traqueotomia: padronização de pressão de diafragma

A traqueotomia esta indicada em condicoes com obstrucao respiratoria alta ou doenca pulmonar obstrutiva cronica. As Valvulas Fonatorias (VF) melhoram a comunicacao, higienizacao e umidificacao das vias aereas dos pacientes traqueotomizados. OBJETIVO: Demonstrar a VF nacional, de menor custo, e sua utilizacao na reabilitacao fonatoria desses pacientes, avaliar resistencia de abertura pelo diafragma, o que confere melhor conforto ao paciente. Forma de Estudo: Experimental, coorte contemporâneo. MATERIAL E METODO: A VF foi utilizada em 32 pacientes. A valvula tem diafragma dentro de um corpo em aco inox com encaixes de plastico. Estudou-se grau de conforto respiratorio de acordo com a resistencia do diafragma da valvula, 40, 50 e 60 shores. RESULTADOS: Obteve-se uso regular da VF acoplada a cânula por todos os pacientes, 26 o fizeram por mais de 12h diarias e destes 14 por 24h diarias. A pressao do diafragma obtida foi de 40 shores para 13 pacientes e 50 shores para 19 pacientes, sem utilizacao de 60 shores. CONCLUSAO: A VF metalica permite fonacao, sem a oclusao digital da cânula, e respiracao sob conforto. Obteve-se resistencia padronizada do diafragma. Atualmente todos os pacientes do estudo utilizam estas VF com fonacao e 43,75% periodo integral.

Brazilian tracheotomy speech valve: diaphragm pressure standardization

UNLABELLED Tracheotomy is performed in cases of upper airway obstruction or chronic pulmonary disorders. The Tracheotomy Speech Valves (TSV) improve communication and airway hygiene and humidification of tracheotomized patients. AIM To show the low cost Brazilian TSV and its use in speech rehabilitation of tracheotomized patients, to evaluate diaphragm opening resistance and comfort to the patient. STUDY DESIGN Experimental, contemporary cohort. MATERIALS AND METHODS The TSV was used in 32 patients. The valve has a diaphragm within a stainless steel body with plastic fittings. We studied the level of respiratory comfort according to the degree of valve diaphragm resistance, 40, 50 and 60 shores. RESULTS All the patients used the TSV coupled to the cannula in a regular basis, 26 of them did it for more than 12 hours daily and from these, 14 used it for 24h daily. The diaphragm pressure obtained was that of 40 shores for 13 patients and 50 shores for 19 patients. 60 shores was never used. CONCLUSION the metal TSV helps with speech without the need for closing the cannula with ones finger, and breathing was comfortable. We achieved standard diaphragm resistance. Currently all the patients from this study use this TSV with speech and 43.75% use it full time.

Nasolaryngoscopy or laryngotracheoscopy: which is the best exam for assessing the airways of children?

UNLABELLED It is not uncommon to find children with respiratory distress. In these cases airway endoscopy is usually required. Doubts about which examination should be used are frequent. AIM to establish which examination is the best to assess the airways of children. MATERIAL AND METHODS a retrospective study assessing 16 children with a history of respiratory distress at the Children Airway Unit of the Pediatric Otolaryngology Department at UNICAMP. All patients underwent nasolaryngoscopy and laryngotracheoscopy between March 2001 and March 2004. Data was analyzed and compared. RESULTS during this study 16 children were assessed; the most frequent indication of exams were: evaluation of prolonged tracheostomy in 10 patients (62%), and subglottic stenosis (31.3%). CONCLUSION assessing airways in children with respiratory distress is essential for a diagnosis. In our study, we concluded that all children with upper airway disease must undergo nasolaryngoscopy, an easy, economic and useful exam that provides information about larynx function. However, if subglottic or traqueal disease issuspected, or if nasolaryngoscopy findings are in conflict with the physical examination, laryngotracheoscopy should be undertaken.

Nasolaringoscopia ou laringotraqueoscopia: qual o melhor exame para avaliação da via aérea infantil?

E comum criancas com quadro de desconforto respiratorio alto, sendo importante uma avaliacao atraves de endoscopia da via aerea. OBJETIVO: Avaliar qual o melhor exame para via aerea infantil. MATERIAIS E METODOS: Estudo retrospectivo com 16 criancas do ambulatorio de via aerea infantil do Setor de Otorrinolaringologia Pediatrica da UNICAMP, com historia de stress respiratorio, submetidas a nasolaringoscopia e laringotraqueoscopia de marco de 2001 a marco de 2004. Dados coletados foram equiparados e comparados. RESULTADOS: Foram avaliadas 16 criancas, sendo a indicacao mais comum do exame avaliacao de traqueotomia prolongada em 10 pacientes (62%), seguida de avaliacao de estenose subglotica em tres casos (31,3%). Em 44% dos exames houve falha da NL em mostrar lesoes em subglote. CONCLUSAO: A avaliacao endoscopica da via aerea infantil em criancas com dificuldade respiratoria e essencial para o diagnostico. Concluimos que todas as criancas com patologia de via aerea superior devem ser submetidas a nasolaringoscopia inicialmente, a qual e um exame barato, de facil execucao e que fornece dados importantes inclusive a respeito da funcionalidade da laringe. No entanto, se houver suspeita de patologia subglotica ou traqueal, ou ainda quando os dados nasolaringoscopia nao sao condizentes com exame fisico, e essencial a realizacao da laringotraqueoscopia.

Audiogram Comparison of Workers from Five Professional Categories

Introduction. Noise is a major cause of health disorders in workers and has unique importance in the auditory analysis of people exposed to it. The purpose of this study is to evaluate the arithmetic mean of the auditory thresholds at frequencies of 3, 4, and 6 kHz of workers from five professional categories exposed to occupational noise. Methods. We propose a retrospective cross-sectional cohort study to analyze 2.140 audiograms from seven companies having five sectors of activity: one footwear company, one beverage company, two ceramics companies, two metallurgical companies, and two transport companies. Results. When we compared two categories, we noticed a significant difference only for cargo carriers in comparison to the remaining categories. In all activity sectors, the left ear presented the worst values, except for the footwear professionals (P > 0.05). We observed an association between the noise exposure time and the reduction of audiometric values for both ears. Significant differences existed for cargo carriers in relation to other groups. This evidence may be attributed to different forms of exposure. A slow and progressive deterioration appeared as the exposure time increased.

Neck neurofibromatosis: clinical and surgical features.

Plexiform neurofibromas (PN) are one of the many possible findings on pa-tients affected by the disease.This paper aims at reporting on a case of a pediatric patient with cervical plexiform neurofibromas and the difficul-ties inherent to the treatment.CASE STUDYA four months old male patient, with high respiratory discomfort, was diagnosed with a mass in the rhinopha-rynx that extended all the way to the oropharynx, later described as a plexiform neurofibroma in the pathologist’s report.The CT scan of the area revealed a mass located in the left parotid region. The tumor was diverting the internal carotid artery from its original position and compressing the internal jugular vein. (Picture 1)At 16 months of age the patient underwent a tracheotomy to address the respiratory difficulties. At 18 months he was submitted to a partial excision of the tumor as it was infiltrating in the cervical plexus, brachial plexus, and facial nerve. Biopsy findings also pointed to plexiform neurofibroma.The child is being monitored for worsening of compressive symptoms and signs of malignancy.DISCUSSIONPatients with NF1 have increased chance of developing benign and malig-nant tumors, which may in some cases infiltrate and lead to compression of vital structures and evident deformities.