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Educação permanente para qualidade e segurança do paciente em hospital acreditado
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Parente, Angeline do Nascimento

; Ferreira, Glenda Roberta Oliveira Naiff

; Cunha, Carlos Leonardo Figueiredo

; Ramos, Aline Maria Pereira Cruz

; Sá, Antonia Margareth Moita

; Haddad, Maria do Carmo Fernandez Lourenço

; Parente, Andressa Tavares

; Carneiro, Márcia Simão

Acta Paulista de Enfermagem

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2024, Volume 37 elocation eAPE00041

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Abstract Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin’s thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.

Resumen Objetivo Comprender los desafíos enfrentados por la educación permanente para lograr mejorar la calidad y la seguridad del paciente en un hospital público sometido a acreditación hospitalaria. Métodos Estudio descriptivo, transversal y con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 22 profesionales, con duración promedio de 22 minutos, que luego se analizaron e interpretaron mediante el análisis de contenido temático de Bardin. Se utilizaron los softwares Iramuteq para el análisis de corpus textual y BioEstat 5.3 para el análisis del perfil de los participantes. La recopilación de datos se llevó a cabo en junio de 2022, después de la aprobación de los Comités de Ética en Investigación. Resultados Se aplicó el análisis de clasificación jerárquica descendente, generado por Iramuteq. Se obtuvieron tres categorías: Desafíos de la educación permanente mediante el proceso de mejora continua, Educación permanente para la promoción de la calidad y de la seguridad del paciente en el contexto de la acreditación hospitalaria, y Estrategias educativas para la mejora de la calidad y la seguridad del paciente. Conclusión Se identificaron desafíos inherentes a las acciones de educación permanente en salud, tales como resistencia a cambios de cultura, adherencia a las actividades, alta rotación de profesionales y dificultad de autorizar al equipo de enfermería para participar en las actividades relacionadas con la demanda de trabajo.

Resumo Objetivo Compreender os desafios enfrentados pela educação permanente para o alcance da melhoria da qualidade e da segurança do paciente em um hospital público submetido à acreditação hospitalar. Métodos Estudo descritivo, transversal e com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 22 profissionais, durando, em média, 22 minutos, as quais posteriormente foram analisadas e interpretadas por meio da análise de conteúdo temática de Bardin. Adotaram-se os softwares Iramuteq para a análise de corpus textual, e o BioEstat 5.3, para análise do perfil dos participantes. A coleta de dados ocorreu em junho de 2022, após aprovação nos Comitês de Ética em Pesquisa. Resultados Aplicou-se a análise de classificação hierárquica descendente, gerada pelo Iramuteq. Obtiveram-se três categorias: Desafios da Educação Permanente mediante o Processo de Melhoria Contínua; Educação Permanente para a Promoção da Qualidade e da Segurança do Paciente no Contexto da Acreditação Hospitalar; e Estratégias Educativas para a Melhoria da Qualidade e da Segurança do Paciente. Conclusão Identificaram-se desafios inerentes às ações de educação permanente em saúde, tais como resistência à mudança de cultura, adesão às atividades, alta rotatividade de profissionais e dificuldade para liberação da equipe de enfermagem para participar das atividades relacionadas à demanda de trabalho.

https://doi.org/10.37689/acta-ape/2024ao0000041

Translation and cultural adaptation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score-12 into Brazilian Portuguese
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Ceccon, Fabio Pupo

; Aires, Mateus Morais

; Lechien, Jerome R.

; Carvalho, Paulo J.P.C.

; Michel, Luciana Cristina Pereira Ferreira

; Carvalho, Nayara Salgado

; Ceccon, Beatrice Haase

; Sartori, Pedro Gracio Ferreira

; Haddad, Leonardo

Brazilian Journal of Otorhinolaryngology

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apr 2023, Volume 89 N. 2 Pages 264 - 270

Abstract: En | Text: En | PDF: En

Abstract Objective: To describe the process of translation into Brazilian Portuguese and cross-cultural adaptation of the French Reflux Symptom Score-12 questionnaire used for the diagnosis of laryngopharyngeal reflux. Methods: This was across-cultural translation and adaptation study of a health instrument, with a cross-sectional design. It was carried out in eight stages: translation from French into Brazilian Portuguese, cultural adaptation by a panel of experts, application of the first version (pilot test 1), adaptation by a panel of experts, application of the second version (pilot test 2), back translation, reviewing by a committee in conjunction with the author of the original instrument and, application of the final version. The Brazilian Portuguese versions of the questionnaire were applied to individuals with symptoms and signs of laryngopharyngeal reflux who underwent pHmetry and esophageal manometry at the study site. Results: In pilot test 1, the first version of the RSS-12 in Brazilian Portuguese was applied to 30 patients. The patients had no difficulty to understand any of the 12 symptom items, but 15 patients (50%) had difficulty interpreting the symptom frequency score. After adapting the format of the frequency score, a version 2 of the RSS-12 in Brazilian Portuguese was applied to another 23 patients, who completed the questionnaire in full without any difficulty. Along with the review committee, the author of the original RSS-12 considered the version 2 to be adequate and did not propose any changes, so it was approved as the final version of the Brazilian Portuguese RSS-12. Conclusion: The Brazilian Portuguese version of the instrument, called Reflux Symptom Score-12 PT-BR, shows good understanding and linguistic, conceptual and content equivalence, in relation to the original Reflux Symptom Score-12.

https://doi.org/10.1016/j.bjorl.2022.05.005

Combined larynx large cell neuroendocrine and squamous cell carcinoma: a case report
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Hesse, Juliana

; Martins, Leandro Aurélio Liporoni

; Haddad, Leonardo

; Ceccon, Fabio Pupo

einstein (São Paulo)

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2023, Volume 21 elocation eRC0618

Abstract: En | Text: En | PDF: En

ABSTRACT Laryngeal cancer ranks third among the most common head and neck neoplasms. The most common histological subtype is squamous cell carcinoma, and neuroendocrine tumors are rare. An even rarer entity is a composite tumor with both these histologies. This case reports a metastatic combined carcinoma of squamous cells and large neuroendocrine cells, presenting favorable response to treatment with a total laryngectomy followed by adjuvant therapy including chemo-, radio-, and immunotherapy.

https://doi.org/10.31744/einstein_journal/2023rc0618

Effect of speech therapy on quality of life in patients with spinocerebelar ataxia type 3
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Diaféria, Giovana

; Bommarito, Silvana

; Braga Neto, Pedro

; Park, Sung Woo

; Padovani, Marina

; Haddad, Fernanda

; Haddad, Leonardo

; Voos, Mariana Callil

; Chien, Hsin Fen

; Pedroso, José Luiz

; Barsottini, Orlando

Arquivos de Neuro-Psiquiatria

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oct 2022, Volume 80 N. 10 Pages 1017 - 1025

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Individuals with spinocerebellar ataxia type 3 (SCA3) present communication and swallowing disorders, and consequent deterioration in quality of life (QOL). Objective To evaluate the impact of a speech therapy rehabilitation program on the QOL of patients with SCA3. Methods All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The International Cooperative Ataxia Rating Scale scores were 32.4 ± 20.2, and the Scale for the Assessment and Rating of Ataxia scores were 11.8 ± 8.0. The intervention consisted of a 12-session speech therapy rehabilitation program with oral, pharyngeal, and laryngeal strengthening exercises—the so-called ATAXIA–Myofunctional Orofacial and Vocal Therapy (A-MOVT). They all were submitted to pre- and postintervention evaluations using the World Health Organization's Quality of Life (WHOQOL-BREF) assessment, as well as the Living with Dysarthria (LwD), Quality of Life in Swallowing Disorders (SWAL-QOL), and Food Assessment Tool (EAT-10). Results The study sample consisted of 48 patients with SCA3 (STG = 25; CG = 23), mean age was 47.1 ± 11.4 years; mean age at symptom onset was 36.9 ± 11.3 years; disease duration was 11.9 ± 13.3 years. After the 3-month intervention, there were significant changes in the QOL in the STG compared with the CG, when assessed by the LwD (179.12 ± 62.55 vs. 129.88 ± 51.42, p < 0.001), SWAL-QOL (869.43 ± 153.63 vs. 911.60 ± 130.90, p = 0.010), and EAT-10 (5.16 ± 7.55 vs. 2.08 ± 3.85, p = 0.018). Conclusions Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program, because therapy helps to improve difficulty swallowing and dysarthria.

Resumo Antecedentes Indivíduos com ataxia espinocerebelar tipo 3 (AEC3) apresentam distúrbios da comunicação e deterioração da deglutição e, consequentemente, na qualidade de vida (QV). Objetivo Avaliar o impacto de um programa de reabilitação fonoaudiológica na QV em pacientes com AEC3. Métodos Todos os participantes foram alocados aleatoriamente em dois grupos, um grupo intervenção que recebeu terapia fonoaudiológica (GTF) e um grupo controle (GC). As pontuações das escalas: International Cooperative Ataxia Rating Scale (ICARS) foram 32,4 ± 20,2 e da Scale for the Assessment and Rating of Ataxia (SARA) foram 11,8 ± 8,0. A intervenção consistiu em um programa de reabilitação fonoaudiológica de 12 sessões composto por exercícios de fortalecimento oral, faríngeo e laríngeo - denominados ATAXIA - Terapia Miofuncional Orofacial e Vocal (A-TMOV). Todos foram submetidos a avaliações pré e pós-intervenção por meio dos protocolos World Health Organization's Quality of Life (WHOQOL-BREF), Vivendo com Disartria (VcD), Quality of Life in Swallowing Disorders (SWAL-QOL) e Food Assessment Tool (EAT-10). Resultados A amostra foi composta por 48 pacientes com AEC3 (25 no GTF e 23 no GC), média de idade 47,1 ± 11,4anos; média de idade de início dos sintomas 36,9 ± 11,3anos; duração da doença 11,9 ± 13,3anos. Após intervenção de três meses, houve mudanças significativas na QV no GTF em comparação com o GC quando avaliado pelo VcD (179,12 ± 62,55 versus129,88 ± 51,42, p < 0,001), SWAL-QOL (869,43 ± 153,63 versus 911,60 ± 130,90, p = 0,010), EAT-10 (5,16 ± 7,55 versus 2,08 ± 3,85, p = 0,018). Conclusões Pacientes com AEC3 devem receber terapia fonoaudiológica contínua como parte do programa A-TMOV, pois a terapia ajuda a melhorar a dificuldade de deglutição e a disartria.

https://doi.org/10.1055/s-0042-1755203

Disfagia por osteofitose cervical anterior: relato de caso
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Aires, Mateus Morais

; Fukumoto, Gabriela Marie

; Ribeiro, Sarah Lima

; Haddad, Leonardo

; Alvarenga, Eliézia Helena de Lima

CoDAS

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2022, Volume 34 N. 2 elocation e20200435

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Osteofitose cervical anterior é uma condição não inflamatória caracterizada por calcificação ou ossificação dos ligamentos paravertebrais anterolaterais da coluna cervical. Acomete 20 a 30% dos idosos, sendo responsável por 1,6% das etiologias identificáveis da disfagia na população senil. Em estados avançados, a disfagia por osteofitose cervical pode levar a complicações como desnutrição, perda de peso e pneumonia aspirativa. Este estudo visa alertar para a suspeição desse diagnóstico à equipe multidisciplinar que cuida do idoso disfágico, possibilitando tratamento oportuno e precoce da condição. É relatado o caso de um paciente masculino de 66 anos com disfagia tipo engasgo para sólidos e refluxo nasal de alimentos há 1 ano. Videoendoscopia da deglutição evidenciou abaulamento da parede posterior da faringe e, à oferta de alimento sólido, restrição à retroflexão da epiglote, refluxo nasal do alimento e grande quantidade de resíduo alimentar sobre a lesão. Tomografia computadorizada de coluna cervical identificou a presença de osteófitos cervicais anteriores entre as vértebras C3 e C6, o maior com comprimento anteroposterior de 12 milímetros, estreitando a coluna aérea ao nível da oro- e hipofaringe. O paciente foi adequadamente tratado com fonoterapia da deglutição. A estratégia inicial de tratamento para a osteofitose sintomática deve ser conservadora, geralmente com boa resposta à fonoterapia da deglutição. Apesar de raramente estarem implicados na etiologia da disfagia, considerando sua alta prevalência, é importante que otorrinolaringologistas e fonoaudiólogos estejam atentos a esse diagnóstico, permitindo tratamento precoce e efetivo para o paciente assistido, melhor prognóstico e menos complicações da disfagia orofaríngea no idoso.

ABSTRACT Anterior cervical osteophytosis is a noninflammatory condition characterized by calcification or ossification of the anterolateral paravertebral ligaments of the cervical spine. It affects 20 to 30% of the elderly, being responsible for 1.6% of the identifiable etiologies of dysphagia in the senile population. In advanced states, dysphagia due to cervical osteophytosis can lead to complications such as malnutrition, weight loss and aspiration pneumonia. This study aims to alert to this diagnosis, enabling early treatment of the condition. The case of a 66-year-old male patient with choking dysphagia for solids and nasal food reflux for 1 year is reported. Fiberoptic Endoscopic Evaluation of Swallowing showed bulging of the posterior pharyngeal wall and, with solid food supply, restriction to the retroflexion of the epiglottis, nasal reflux of the food and a large amount of food residue on the lesion. Cervical spine Computed Tomography identified the presence of anterior cervical osteophytes between the C3 and C6 vertebrae, the largest with anteroposterior length of 12 millimeters, narrowing the air column at the level of the oro- and hypopharynx. The patient was adequately treated with swallowing therapy by speech-language pathologist. The initial treatment strategy for symptomatic osteophytosis should be conservative, usually with a good response to swallowing therapy. Although they are rarely implicated in the etiology of dysphagia, considering its high prevalence, it is important that otolaryngologists and speech-language pathologists are attentive to this diagnosis, allowing early and effective treatment for the assisted patient, better prognosis and fewer complications of oropharyngeal dysphagia in the elderly.

https://doi.org/10.1590/2317-1782/20212020435 1 downloads

Dysphagia in patients with moderate and severe obstructive sleep apnea
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Campanholo, Milena de Almeida Torres

; Caparroz, Fabio de Azevedo

; Stefanini, Renato

; Haddad, Leonardo

; Bittencourt, Lia Rita Azeredo

; Tufik, Sergio

; Haddad, Fernanda Louise Martinho

Brazilian Journal of Otorhinolaryngology

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jul 2021, Volume 87 N. 4 Pages 422 - 427

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução Existem evidências de que o trauma ocasionado pelo ronco na faringe poderia ocasionar disfagia em pacientes com apneia obstrutiva do sono, mas a literatura ainda é escassa para definir quais seriam os fatores associados à presença da disfagia nesses pacientes. Objetivo Avaliar a ocorrência de disfagia e seu perfil clínico e polissonográfico em pacientes com apneia obstrutiva do sono moderada e grave, além de verificar o impacto da disfagia na qualidade de vida desses pacientes. Método Foram selecionados 70 pacientes com apneia moderada ou grave (índice de apneia e hipopneia - IAH > 15 hora). Os pacientes foram submetidos a questionário de sono, qualidade de vida em disfagia e videoendoscopia da deglutição. Resultados Foram incluídos no estudo 70 pacientes, 49 do sexo masculino (70%), com média de 48,9 anos. A videoendoscopia da deglutição apresentou alteração em 27,3% dos pacientes. A alteração mais encontrada foi o escape oral precoce com líquido. Quando comparados os grupos com e sem disfagia, o sexo feminino foi o único parâmetro clínico que mostrou tendência à significância no grupo com disfagia (p = 0,069). Não houve diferença estatística quanto aos achados polissonográficos e quanto ao escore global da qualidade de vida em disfagia na comparação entre os grupos. Conclusão A presença de disfagia em pacientes com apneia moderada a grave é frequente e subclínica, reforça a necessidade de investigação desse sintoma nesse grupo de pacientes. Porém, a presença de disfagia não mostrou pioria na qualidade de vida dos pacientes, sugeriu que, apesar de frequente, sua repercussão é leve. Não houve relevância na associação dos parâmetros clínicos, polissonográficos com a presença de disfagia.

Abstract Introduction There is evidence that trauma caused by snoring in the pharynx could result in dysphagia in patients with obstructive sleep apnea, but the literature is still scarce to define the factors associated with the presence of dysphagia in these patients. Objectives To analyze the occurrence of dysphagia and its clinical and polysomnographic features in patients with moderate and severe obstructive sleep apnea, in addition to verifying the impact of dysphagia on the quality of life of these patients. Methods Seventy patients with moderate or severe apnea (apnea and hypopnea index - AHI > 15/hour) were selected. The patients underwent a sleep questionnaire, a quality of life in dysphagia questionnaire and a fiberoptic endoscopic evaluation of swallowing. Results A total of 70 patients were included in the study, of which 49 were men (70 %), with a mean age of 48.9 years. The fiberoptic endoscopic evaluation of swallowing was altered in 27.3 % and the most frequent alteration was the premature oral leakage with fluid. Comparing the groups with and without dysphagia, the female gender was the only clinical parameter that showed a trend of statistical significance in the group with dysphagia (p = 0.069). There was no statistical difference regarding the polysomnographic features and in the global quality of life score in dysphagia in the comparison between the groups. Conclusions The presence of dysphagia in patients with moderate to severe apnea is frequent and subclinical, reinforcing the need to investigate this symptom in this group of patients. However, the presence of dysphagia did not result in worsening in patients' quality of life, suggesting that, although frequent, its effect is mild. There was no relevance regarding the association of clinical and polysomnographic parameters with the presence of dysphagia.

https://doi.org/10.1016/j.bjorl.2019.10.004 191 downloads

Physicians’ behavior regarding non-acceptance of oral restriction (nil per os) by dysphagic patient with risk of laryngotracheal aspiration
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Alvarenga, Frederico de Lima

; Haddad, Leonardo

; Silva, Daniel Marcus San da

; Alvarenga, Eliézia Helena de Lima

einstein (São Paulo)

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2020, Volume 18 elocation eAO4952

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Definir o comportamento médico diante de paciente idoso disfágico com risco de aspiração laringotraqueal e mentalmente capaz que não aceita a restrição da via oral. Métodos: Estudo observacional, transversal. Apresentamos um caso clínico de idoso, que vive independente, com queixas clínicas e videoendoscopia da deglutição comprovando disfagia e aspiração, que recusou a proposta de restrição da via oral. Um questionário foi aplicado sobre o processo de decisão do paciente, procurando avaliar se o médico torna-se solidário, e que justifique sua resposta, e se tem ciência da hierarquia dos princípios éticos (reconhecimento do valor da pessoa, autonomia, beneficência, não maleficência e justiça), no processo de decisão e qual o principal princípio que norteia sua decisão. Resultados: Cem participantes foram classificados por tempo de formados em Grupo I (até 10 anos) e Grupo II (mais de 10 anos). Deles 60% tornaram-se solidários à decisão do paciente, sem diferença entre os grupos. O principal argumento foi a autonomia do paciente nos dois grupos. Entre os não solidários, foi o binômio beneficência e não maleficência, e o balanço do risco/benefício e malefício. Considerando a ciência sobre a hierarquia dos princípios que regem a decisão, não encontramos diferença entre eles. A autonomia foi o principal princípio na decisão entre os solidários e a justiça entre os não solidários. Conclusão: O médico foi solidário à decisão do paciente em respeito à sua autonomia, apesar dos riscos ponderados da beneficência e da maleficência, inclusive de morte. Propomos o termo de recusa de conduta formalizada.

ABSTRACT Objective: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. Methods: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. Results: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. Conclusion: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.

https://doi.org/10.31744/einstein_journal/2020ao4952 856 downloads

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome
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Caparroz, Fábio Azevedo

; Campanholo, Milena de Almeida Torres

; Regina, Caroline Gomez

; Park, Sung Woo

; Haddad, Leonardo

; Gregório, Luís Carlos

; Haddad, Fernanda Louise Martinho

Brazilian Journal of Otorhinolaryngology

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aug 2019, Volume 85 N. 4 Pages 408 - 415

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução A síndrome da apneia obstrutiva do sono e o refluxo laringofaríngeo são doenças com alta prevalência na população em geral. No entanto, ainda não está claro se são doenças com os mesmos fatores de risco presentes nas mesmas populações ou se há alguma relação entre elas. Objetivo Avaliar e determinar a prevalência de refluxo laringofaríngeo em pacientes com síndrome da apneia obstrutiva moderada e acentuada, bem como determinar os fatores preditivos de refluxo nesses pacientes. Método Estudo de coorte histórica com corte transversal de pacientes entre 18 e 70 anos, encaminhados a um ambulatório de Otorrinolaringologia em serviço terciário, com diagnóstico polissonográfico de síndrome da apneia obstrutiva do sono moderada ou acentuada. Foram aplicados o questionário Reflux Sympton Index e o escore de achados endolaríngeos por meio de videolaringoscopia indireta na população estudada, respeitando os critérios de inclusão e exclusão. Resultados Foram avaliados 56 pacientes, dos quais 64,3% apresentaram refluxo laringofaríngeo (Reflux Sympton Index positivo e/ou Reflux Finding Score positivo). O índice de massa corpórea foi fator preditor da presença de refluxo laringofaríngeo nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada. Nos pacientes cujos Reflux Sympton Index e o escore de achados endolaríngeos foram positivos (12,3%), houve uma tendência à significância para maior índice de apneia e hipopneia e maior porcentagem do tempo de sono com saturação de oxi-hemoglobina abaixo de 90% (p = 0,05). Conclusão A prevalência de refluxo laringofaríngeo foi alta nesse grupo de pacientes com síndrome da apneia obstrutiva do sono moderada e acentuada e o índice de massa corpórea foi fator preditor de refluxo nesses pacientes. Houve uma tendência a maior dessaturacão de oxi-hemoglobina em pacientes com "índice de sintomas de refluxo" e escore de achados endolaríngeos positivos.

Abstract Introduction Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. Objectives To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Methods Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Results Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p = 0.05). Conclusion The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS).

https://doi.org/10.1016/j.bjorl.2018.03.007 1251 downloads

Nasal Polyposis: More than a Chronic Inflammatory Disorder-A Disease of Mechanical Dysfunction- The São Paulo Position
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Pezato, Rogerio

; Voegels, Richard Louis

; Pignatari, Shirley

; Gregório, Luiz Carlos

; Bezerra, Thiago Freire Pinto

; Gregorio, Luciano

; Balsalobre, Leonardo

; Tepedino, Miguel Soares

; Coronel, Nathália

; Pinna, Fabio de Rezende

; Mendes Neto, José

; Oliveira, Pedro

; Macoto, Eduardo

; Stefanini, Renato

; Figueiredo, Claudia

; Haddad, Fernanda

; Pilan, Renata

; Soter, Ana Bezerra

; Melo, Nelson Almeida

; Candido, Danilo Almeida

; Amaral, Jonatas do

; Santos, Rodrigo de Paula

; Zele, Thibaut Van

; Fujita, Reginaldo

; Dreyfuss, Juliana L.

; Chamon, Wallace

; Alencar, Adriano Mesquita

; Perez-Novo, Claudina

; Stamm, Aldo Cassol

International Archives of Otorhinolaryngology

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jun 2019, Volume 23 N. 2 Pages 241 - 249

Abstract: En | Text: En | PDF: En

Abstract Introduction The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.

https://doi.org/10.1055/s-0038-1676659 601 downloads

10.

What is the Impact of Positive Airway Pressure in Nasal Polyposis? An Experimental Study
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Balsalobre, Leonardo

; Pezato, Rogerio

; Mangussi-Gomes, Joao

; Gregorio, Luciano

; Haddad, Fernanda Louise Martinho

; Gregorio, Luiz Carlos

; Fujita, Reginaldo

International Archives of Otorhinolaryngology

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jun 2019, Volume 23 N. 2 Pages 147 - 151

Abstract: En | Text: En | PDF: En

Abstract Introduction It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE-Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps’ size (p = 0.04). Conclusions Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps’ size, and the nasal patency, asmeasured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.

https://doi.org/10.1055/s-0038-1676095 812 downloads

11.

Transoral robotic supraglottic partial laryngectomy: report of the first Brazilian case
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Cernea, Claudio Roberto

; Matos, Leandro Luongo

; Carlucci Junior, Dorival de

; Leonhardt, Fernando Danelon

; Haddad, Leonardo

; Walder, Fernando

Brazilian Journal of Otorhinolaryngology

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oct 2018, Volume 84 N. 5 Pages 660 - 664

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1016/j.bjorl.2016.01.016 909 downloads

12.

Fast Analysis of Taurine in Energetic Drinks by Electrospray Ionization Mass Spectrometry
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Catharino, Rodrigo R.

; Haddad, Renato

; Godoy, Helena T.

; Eberlin, Marcos N.

; Santos, Leonardo S.

Journal of the Brazilian Chemical Society

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2011, Volume 22 N. 4 Pages 801 - 806

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Espectrometria de massas sequencial usando infusão direta de amostra e ionização por electrospray no modo de ions negativos foi utilizada para quantificar taurina em bebidas energéticas com alta seletividade e sensibilidade, O metodo é simples e rápido (menos de 2 min de corrida) e apresenta alta repetitividade e recuperação. Bebidas energéticas comerciais apresentaram quantidades de taurina em concentrações muito diferentes (menor ou maior) das quantidades declaradas.

Direct infusion electrospray ionization tandem mass spectrometry in the negative ion mode with single reaction monitoring is show to allow high selectivity and sensitivity in the quantification of taurine in energetic drinks. The method is also simple and rapid (less than 2 min run time), with high recovery and repeatability. Commercially available energetic drinks were found to contain taurine in concentrations quite different (lower or higher) from the declared amounts.

3801 downloads

13.

Substrate type as a selective tool against colonization by non-native sessile invertebrates
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Cangussu, Leonardo C

; Altvater, Luciana

; Haddad, Maria Angélica

; Cabral, Ana Caroline

; Heyse, Halina Linzmeier

; Rocha, Rosana M

Brazilian Journal of Oceanography

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sep 2010, Volume 58 N. 3 Pages 219 - 231

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Substratos de diferentes materiais, cores, texturas e orientação podem influenciar seletivamente no recrutamento de invertebrados sésseis e, assim, influenciar a comunidade resultante. Deste modo, o substrato pode funcionar como barreira contra o estabelecimento de espécies não nativas (NIS, na sigla em inglês). No sul do Brasil, o granito é a principal rocha formadora de costões rochosos naturais disponíveis para organismos incrustantes. Nesta investigação, nós testamos se o granito seleciona o recrutamento de espécies e se poderia, assim, impedir a colonização de espécies introduzidas ou criptogênicas já estabelecidas em substratos artificiais na região. Placas não polidas de granito e de polietileno foram submersas a cada mês em um píer de um iate clube na Baía de Paranaguá. Há uma comunidade já estabelecida sobre colunas de concreto e sobre flutuadores de fibra de vidro presentes no iate clube. Depois de um, dois e doze meses, as espécies presentes nas placas de diferentes materiais foram comparadas entre si e também com outros substratos. O granito foi colonizado por todas as sete espécies introduzidas encontradas na região, e por 18 das 26 espécies criptogênicas, sendo então ineficaz como barreira contra a colonização de NIS.

Different substrates of varying composition, color, texture and orientation may selectively influence recruitment of sessile invertebrates and thereby influence the resultant community. Thus substrates may act as a barrier to the establishment of non-indigenous species (NIS). In southern Brazil, granite is the main rock forming natural rocky walls that are available for encrusting organisms. In this study we tested whether granite selectively influences recruitment and impedes colonization by introduced and cryptogenic species that are already established on artificial substrates within the region. Plates of rough cut granite and of polyethylene were made available each month under a pier at a yacht club in Paranaguá Bay. A community is already established on concrete columns and fiber glass floats on the piers. After one, two and twelve months, the faunal composition of the plates was compared between the two treatments and other artificial substrates. Granite was recruited by all the seven introduced species found in the Bay and by 18 of 26 cryptogenic species and therefore is ineffective as a barrier to NIS colonization.

3813 downloads

14.

Carcinoma de glândula sudorípara écrino
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Leonhardt, Fernando Danelon

; Zanoni, Alessandra

; Ponce, Fabiana

; Haddad, Leonardo

; Scapulatempo Neto, Cristovam

; Cervantes, Onivaldo

; Abrahão, Márcio

Revista Brasileira de Otorrinolaringologia

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apr 2007, Volume 73 N. 2 Pages 286 - 286

Abstract: Pt | Text: Pt | PDF: Pt

9430 downloads

15.

Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2
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Haddad, Leonardo

; Abrahão, Márcio

; Cervantes, Onivaldo

; Ceccon, Fábio Pupo

; Gielow, Ingrid

; Carvalho, Jomar Rezende

; Leonhardt, Fernando Danelon

Revista Brasileira de Otorrinolaringologia

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jun 2006, Volume 72 N. 3 Pages 295 - 302

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar a voz de pacientes portadores de carcinomas iniciais glóticos submetidos à cordectomia com laser de CO2. MÉTODO: Foram avaliados 15 pacientes com diagnóstico de carcinoma espinocelular Tis e T1 glóticos. A avaliação foi feita por meio da análise perceptivo auditiva da voz, pela análise acústica computadorizada e videolaringoestroboscópica. Os pacientes responderam a um questionário de avaliação geral da voz e um protocolo de qualidade de vida relacionado à voz (QVV). Os resultados foram comparados aos de um grupo controle de indivíduos com laringes normais. RESULTADOS: A análise perceptivo-auditiva da voz revelou que a maioria dos pacientes submetidos à cordectomia apresentou algum grau de disfonia, à custa de rouquidão e soprosidade. Considerando os parâmetros acústicos analisados e os valores do grupo controle, observou-se a tendência de um pequeno incremento da freqüência fundamental, mas sem diferença estatisticamente significante; os valores de jitter, shimmer e da proporção harmônico-ruído apresentaram-se significantemente alterados. Os aspectos analisados na videolaringoestroboscopia mostraram-se melhores nas cordectomias menos extensas. Os escores do QVV sugerem que os pacientes tiveram um discreto impacto na qualidade de vida relacionada à voz. CONCLUSÕES: Apesar da presença de alterações na qualidade vocal dos pacientes submetidos à cordectomia com laser de CO2, os resultados funcionais tendem a ser bem aceitos pelos pacientes, com discreta repercussão na qualidade de vida.

AIM: To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD: 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo- stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life. Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2.

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