RESUMO Objetivo Caracterizar pacientes com acidente vascular cerebral (AVC), verificar a prevalência de distúrbios de comunicação oral relacionados e a frequência de encaminhamento para reabilitação fonoaudiológica. Métodos Estudo retrospectivo dos prontuários de 95 pacientes internados por AVC, entre junho de 2007 e junho de 2008, em hospital público da região metropolitana de Porto Alegre. Resultados Dos 95 pacientes, 51 (53,7%) eram do sexo masculino, com média de idade de 59,8 anos; 48 (59,3%) apresentavam histórico de hipertensão arterial; 82 (86,3%) apresentaram AVC tipo isquêmico e 53 (55,8%), distúrbios de comunicação oral. O tempo médio de internação foi de cinco dias. Não houve relação significativa entre o tipo de AVC e distúrbio de comunicação oral, tampouco entre o local da lesão neurológica decorrente do AVC e a ocorrência de distúrbio de comunicação oral. Nenhum dos sujeitos recebeu indicação de avaliação ou tratamento fonoaudiológico durante a internação ou na alta. Conclusão Mais de 50% dos indivíduos acometidos por AVC apresentam distúrbios de comunicação oral durante o período de internação hospitalar. Não houve nenhuma indicação ou solicitação de atendimento fonoaudiológico neste período, tampouco em encaminhamento para atendimento após a alta hospitalar. Estes achados indicam provável falha da inserção fonoaudiológica em equipes que atendem pacientes acometidos por doenças neurológicas, sendo necessário avaliar mais profundamente se isto ocorre devido à ausência do fonoaudiólogo na equipe, ou ao pouco conhecimento dos profissionais sobre a atuação fonoaudiológica junto aos distúrbios de comunicação oral decorrentes de AVC.

ABSTRACT Purpose To characterize patients with stroke and to establish the prevalence of oral communication disorders (CD) related by cerebrovascular accident (CVA) and the frequency of indication or request of speech therapy. Methods A retrospective cross-sectional study from the medical report forms of 95 patients hospitalized for stroke between June 2007 and June 2008 in a regional public hospital. Results Out of the 95 patients, 51 (53.7%) were male (mean age was 59.8 years old), 48 (59.3%) had a history of hypertension, 82 (86.3%) had ischaemic stroke and CD were present in 53 (55.8%) of patients. The mean hospital stay was 5 days. There was no significant relationship between the type of stroke and CD, or between the site of neurological damage due to stroke and the occurrence of CD. None of the subjects received an evaluation or speech-language therapy during hospitalization, and there were no referrals to healthcare after discharge. Conclusion More than 50% of individuals affected by stroke had oral communication disorders during the hospitalization. There was no any indication or request for speech therapy in this period, even after discharge. These findings indicate a probable failure to integrate with the speech therapy staff for the treatment of patients with neurological diseases. It is necessary to further evaluate whether this is due absence of speech therapists in the team or just healthcare professionals lacking knowledge about the possibilities of speech therapy along with disturbances in oral communication due to stroke.

Control of schistosomiasis in Venezuela has been a topic of major interest and controversy among the metaxenic parasitosis. A small area of transmission of approximately 15,000 km2 was thought to be eradicated some years ago. However, some epidemiological characteristics of our transmission area have limited the success on the way toward eradication. Since 1945, when the Schistosomiasis Control Program started, the prevalence in the endemic area has decreased from 14% in 1943 to 1.4% in 1996. Until 1982, the surveillance of active cases was based on massive stool examination. Since then, the Schistosomiasis Research Group (SRG) recommended the additional use of serologic tests in the Control Program and the selective or massive chemotherapy depending on serological and parasitological prevalence of each community. At present, the real prevalence is underestimated due to the fact that approximately 80% of the individuals eliminate less than 100 eggs/g of feces. Those persons could be responsible for the maintenance of the foci going on and therefore limiting the impact of the control measures. Efforts of the SRG are being oriented toward improvement of immunodiagnostic tests by using defined antigens (enzymes) and chemically synthesized peptides, derived from relevant molecules of the parasite, either for antibodies or antigens search. On the other hand, introduction of snail competitors has been a biological weapon in the control of the intermediate host in certain areas. However, the recent reinfestation of water courses by Biomphalaria glabrata, the increased prevalence in some areas, together with important administrative changes at the Control Program of the Minister of Health, have arisen new questions and doubts, challenging the eradication strategy proposed during the last decade.

Schistosomiasis in Americawith the exception of Brazil, behaves as a chronic mild disease with few clinical manifestations due to low parasite burden. These features restrict the clinical and parasitological diagnosis. The most commonly used stool examination method, Kato-Katz, becomes intensitive when the majority of individuals excrete less than 100 eggs/g of feces. In view that antigen-detecting techniques have not been able to reveal light infections, the antibody detecting assays remain as a very valuable diagnostic tool for epidemiological surveillance. The Venezuelan Schistosomiasis Research group (CECOICE) has designed a mass chemotherapy strategy based on sero-diagnosis. Since blood sampling is one of the important limitating factors for large seroepidemiological trials we developed a simple capillary technique that sucessfully overcomed most of the limitations of blood drawing. In this sense, ELISA seems to be the most adecuate test for epidemiological studies. Soluble egg Schistosoma mansoni antigen (SEA) has been largely used in Venezuela. The sensitivity ELISA-SEA in our hands is 90% moreover its specific reach 92% when populations from non-endemic areas but heavily infected with other intestinal parasites are analyzed. The Schistosomiasis Control Program is currently carrying out the surveillance of endemic areas using ELISA-SEA as the first screening method, followed by the Circumoval Precipitin test for validation assay. The results with these two serological techniques allowed us to defined the criteria of chemotherapy in populations of the endemic areas. On the search of better diagnostic technique, Alkaline Phosphatase Immunoenzyme Assay (APIA) is being evaluated in field surveys.