Abstract Introduction: The building of an ostomy generates changes that trigger a health/disease transition. Nurses play a major role in adapting to the new condition. It is important to formalize nursing knowledge that supports nurses’ decision-making in order to incorporate it into information systems that promote evidence-based nursing practice. Objetive: Continuously map the nursing knowledge involved in the process of care planning, focusing on the person living with an ostomy. Methods: Joanna Briggs Institute's scoping review guidance and, the Cochrane Collaboration's guidance on living systematic reviews will be followed to meet the review's objective. Two independent reviewers will evaluate the relevance of the articles, the extraction and synthesis of the data. Studies published in English, Spanish and Portuguese from 2009 onwards, searched in MEDLINE (PubMed), CINAHL (EBSCO), Scopus, JBI Library of Systematic Reviews and Cochrane Central Register of Controlled Trials, OpenGrey, RCAAP and Dart-Europa will be included. Results: It is expected to map the data, diagnoses and nursing interventions centered on the person living with an ostomy, allowing the formalization of the knowledge involved in the design of nursing care for this population group. Conclusion: This scope review will show trends that will support nurses' decision making in order to improve the quality of clinical practice.

Resumen Introducción: Hacer una estomía genera cambios que desencadenan una transición salud/enfermedad. Las enfermeras juegan un papel importante en la adaptación a la nueva condición. Es importante formalizar el conocimiento de enfermería que apoya la toma de decisiones de los enfermeros, para incorporarlo a sistemas de información que promuevan la práctica de enfermería basada en evidencias. Objetivo: Mapear continuamente lo conocimiento de enfermería involucrados en el proceso de diseño del cuidado, centrado en la persona con estomía. Métodos: Se seguirán las pautas del Instituto Joanna Briggs para revisiones de alcance y Cochrane para revisiones sistemáticas en vivo para lograr el objetivo de la revisión. Dos revisores independientes evaluarán la relevancia de los artículos, extracción y síntesis de datos. Se incluirán estudios publicados en inglés, español y portugués a partir de 2009, buscados en MEDLINE (PubMed), CINAHL (EBSCO), Scopus, JBI Library of Systematic Reviews y Cochrane Central Register of Controlled Trials, OpenGrey, RCAAP y Dart-Europa. Resultados: Se espera mapear los datos, diagnósticos e intervenciones de enfermería centrados en la persona con estomía, permitiendo la formalización de lo conocimiento involucrado en el diseño del cuidado de enfermería para este grupo poblacional. Conclusión: Esta revisión del alcance mostrará tendencias que apoyarán la toma de decisiones de las enfermeras para mejorar la calidad de la práctica clínica.

Resumo Introdução: A confeção de uma ostomia gera mudanças que desencadeiam uma transição saúde/doença. Os enfermeiros desempenham um papel importante na adaptação à nova condição. Importa formalizar o conhecimento de enfermagem que suporta a tomada de decisão do enfermeiro, para incorporá-lo em sistemas de informação que promovam uma prática de enfermagem baseada em evidências. Objetivo: Mapear continuamente o conhecimento de enfermagem envolvido no processo de conceção de cuidados, centrado na pessoa que vive com ostomia. Métodos: Serão seguidas as orientações do Joanna Briggs Institute para revisões de escopo e da Cochrane para revisões sistemáticas vivas para se atingir o objetivo da revisão. Dois revisores independentes avaliarão a relevância dos artigos, extração e síntese dos dados. Serão incluídos estudos publicados em inglês, espanhol e português a partir de 2009, pesquisados na MEDLINE (PubMed), CINAHL (EBSCO), Scopus, JBI Library of Systematic Reviews e Cochrane Central Register of Controlled Trials, OpenGrey, RCAAP e Dart-Europa. Resultados: Espera-se mapear os dados, diagnósticos e intervenções de enfermagem centrados na pessoa que vive com ostomia, permitindo formalizar o conhecimento envolvido na conceção de cuidados de enfermagem a este grupo populacional. Conclusão: Esta revisão de escopo mostrará tendências que subsidiarão a tomada de decisão do enfermeiro, a fim de melhorar a qualidade da prática clínica.

ABSTRACT Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history and transplantation history. Data were analyzed to determine the primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.

ABSTRACT This study evaluated the effect of the addition of conjugated linoleic acid (CLA) to in vitro culture on viability, lipid content, and cryoresistance of bovine embryos at different in vitro culture times. Cumulus oocyte complexes (N = 974) were maturated in vitro for 22 h. In vitro fecundation ensued for 18 h. Viable zygotes were cultivated in vitro in medium supplemented with CLA (100 mM) in the first 72 h (CLA-F), last 72 h (CLA-L), or throughout the culture period (CLA-T). Control embryos (control) were cultivated with no CLA. Embryos were cryopreserved by vitrification for subsequent analysis after devitrification. Effect of CLA on cryoresistance was assessed by cultivating embryos in synthetic oviductal fluid containing 5% fetal bovine serum. Lipid content was quantified using Nile Red staining. No significant difference was observed in cleavage rate, blastocyst:total oocyte ratio, and blastocyst:cleaved oocyte ratio. Culture in CLA-L reduced survival rate 24 h after devitrification compared with CLA-F and CLA-T, although with no statistically significant difference compared with control group. However, CLA-T improved embryo hatching rate and affected lipid content of embryos. Cultures CLA-F and CLA-L increased lipid content compared with control. Yet, lipid content values decreased in embryos treated with CLA-T, but they did not differ significantly from the values observed for oocytes at the germinal vesicle stage. Treatment of bovine embryos with CLA during in vitro cultivation did not affect the production of blastocysts, reducing lipid content and improving cryoresistance. However, the effects of CLA on cryoresistance and lipid content is significant only when embryos are exposed to the compound throughout the cultivation period.

Introduction: Vascular access (VA) for hemodialysis (HD) is the lifeline for End Stage Renal Disease (ESRD) patients. Long-term HD patients often have exhaustion of their venous patrimony for an autologous VA construction and, sometimes, even for a central venous catheter (CVC) placement. Case report: We describe the case of a 43-year-old woman with ESRD due to lupus nephritis, on maintenance HD since 2009. She also had secondary antiphospholipid syndrome and was chronically anticoagulated. Nevertheless, the patient had multiorgan thrombotic events (without sequelae) and several episodes of irreversible thrombosis of arteriovenous fistulas. Her HD course was also marked by multiple severe CVC infections, at different locations; a hemoperitoneum during cholecystectomy, and an immediate thrombosis of the renal artery of a kidney transplant. She was admitted to our hospital after an irreversible dysfunction of a right jugular CVC, with documentation of thrombosis of the superior and inferior vena cava. Exhaustion of the venous patrimony for HD was assumed and it was decided to make an arterio-arterial graft (AAG) of early cannulation. The first cannulation of the AAG was performed two days after surgical intervention, with no complications. The patient performed a twelve hour per week HD treatment with good efficiency. Conclusion: AAG is an alternative for HD patients who have exhausted all their venous patrimony and it can be considered prior to the placement of a CVC as their sole remaining vascular access.

Introduction: Arteriovenous fistula has been associated with improved morbimortality in hemodialysis patients. This has resulted in the “fistula First, catheter last” initiative. Nonetheless, the survival benefit of arteriovenous fistula has been questioned. Methods: We conducted a retrospective observational study of all patients with non-end stage renal disease referred for first vascular access building between January 2014 and December 2015 in our hospital center. Our main goal was to evaluate the clinical impact and burden of building fistula in predialysis patients. Results: During this period, of 178 first arteriovenous accesses placed, 87 patients remained in predialysis and 91 patients started a chronic hemodialysis program. Median follow-up time by a nephrologist was 3.9 (2.5, 9.7) years. The mean age was 65.8±14.7 years, with 50.6% (n=90) of male patients. A higher rate of thrombosis in the predialysis group (26% vs 13%, p=0.037) was observed, but vascular access survival did not differ significantly (55% vs 67%, p=0.12). Mean vascular access placing was higher in the predialysis group (1.4±0.7 vs 1.2±0.4, p=0.006) and less interventions were requested (0.2±0.5 vs 0.3±0.6, p=0.10). Median time from vascular access placement to hemodialysis start was 22 (13, 41) months. At hemodialysis initiation, 10 (10.9%) patients used a central venous catheter; 80 (87.9%) patients an arteriovenous fistula, and one patient a graft. A total of 227 vascular accesses were built; 121 (53.3%) in predialysis vs 106 (46.7%) in incident hemodialysis patients. In a multivariate model, the presence of a functional arteriovenous fistula at hemodialysis start was only associated with a trend to survival benefit (HR 0.38, 95% CI 0.14-1.00, p=0.05). Conclusions: Our results stress the need for an individual approach and for future tools to assess the risk of death and progression to end-stage renal disease, therefore helping reduce the number of unutilized vascular accesses and rising cost of interventions

Objective: To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics. Methods: This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems. Results: The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55). Conclusion: The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.

Com a publicação do número 100, celebram-se os 50 anos de Finisterra. Revista Portuguesa de Geografia (1966-2015). Neste texto biográfico, depois de um breve enquadramento, que situa o nascimento da revista, reconstitui-se o percurso das suas estruturas organizativas desde o primeiro número, analisam-se os tipos de textos publicados ao longo do tempo e faz-se uma análise minuciosa e ilustrada dos artigos durante os 50 anos de existência (autores, espaços e temas tratados, idiomas, ilustrações). As principais fases do percurso da revista replicam de algum modo aspectos evolutivos da Geografia. A fase de lançamento (1966-1975) da Finisterra, concebida desde início como uma publicação internacional, acompanhou o aumento do número de geógrafos, bem como o confronto de ideias e de correntes de pensamento contemporâneo. No período seguinte, de consolidação (1976-1994), iniciaram-se alterações nas estruturas organizativas e no aspecto gráfico, ao mesmo tempo que se divulgavam novos temas de investigação geográfica. No período de alterações estruturais (1995-1999) criaram-se outros órgãos consultivos externos, novas normas de publicação e diferentes formas de apresentação dos textos. Pode dizer-se que se lançaram as bases para a fase seguinte, estandardização de procedimentos, internacionalização e difusão em acesso aberto (2000-2015). Nestes anos mantiveram-se as preocupações com o controlo de qualidade dos textos e o aumento da difusão da revista, agora facilitada pela era digital. Em todas as fases, foi determinante o papel dos revisores científicos, cujo empenho silencioso, anónimo e gracioso nos apraz destacar nesta celebração dos 100 números da Finisterra. Parafraseando Ruben A. “o geógrafo não cansa, avança”: são estas as perspectivas para a nova fase, que se iniciará em 2016

With the publication of the 100th issue, Finisterra - the Portuguese Journal of Geography celebrates its 50th anniversary (1966-2015). In this memoir, after a brief historical overview that begins with the creation of the journal, the organisational structures from the first issue onwards are reconstituted before moving on to conduct a thorough and illustrative analysis of the articles published over the 50 year existence of Finisterra. The main stages of the journal's journey somehow replicate the evolutionary aspects of Geography. The launch phase (1966-1975) of Finisterra, conceived from the beginning as an international publication, accompanied the increase in the number of geographers, and the confrontation of contemporary ideas and trends. The next period of consolidation (1976-1994), initiated with changes in structure and graphic layout, while simultaneously publishing new geographic research topics. In the period of structural change (1995-1999) other external advisory bodies, new standards of publishing and different ways of presenting texts were established. It can be said that these changes laid the foundation for the next phase, internationalisation and open access (2000-2015). In these years concerns remained with controlling the quality of texts and increasing the journal's dissemination, now facilitated by the digital age. At every stage, the role of scientific referees has been crucial, whose quiet, anonymous and gracious commitment we would like to highlight in this celebratory 100th issue of Finisterra. Paraphrasing Ruben A. “The geographer does not give up, but moves forward”: these are the prospects for the new phase, which will begin in 2016

Introdução: O aumento crescente da população em hemodiálise tem implicado o recurso a acessos vasculares de maior complexidade técnica. A introdução de modificações na técnica cirúrgica da transposição da veia basílica (TVB) pretende agilizar o procedimento e diminuir a sua morbilidade. Métodos: Análise prospectiva das TVB efectuadas no CHP-HSA entre Setembro de 2005 e Setembro de 2009. Resultados: Efectuaram-se 74 TVB em 74 doentes, os quais tinham, em média, 2 acessos autólogos prévios. A TVB foi o primeiro acesso em 20,3% dos doentes. O intervalo médio de seguimento foi de 14,5 meses. Ocorreram 2 falências nos primeiros 30 dias. A taxa de patência secundária aos 3, 12 e 24 meses foi de 95,7%, 85,1% e 62,2%, respectivamente. A Diabetes associou-se a pior taxa de patência (p=0,018). A taxa de complicações perioperatórias foi de 28,4%, sendo a infecção a mais frequente (n=6, 8,1% do total de TVB). A trombose foi a principal causa de falência, tendo ocorrido em 24,3% de todas as TVB. Conclusões: Reconhece-se a superioridade do acesso autólogo, como a melhor opção de acesso vascular para hemodiálise. A TVB é subutilizada, devido às exigências técnicas e necessidades logísticas. Melhoramos a técnica cirúrgica e de tunelização, ao reduzir o tamanho das incisões e o tempo cirúrgico. Os nossos resultados revelaram uma boa patência a longo prazo, pelo que consideramos que deve ser mais utilizada.

Introduction: The expanding haemodialysis population has lead to increased requirement for more complex vascular accesses. Modifications introduced in basilic vein transposition technique are intended to streamline the procedure and reduce its morbidity. Methods: All patients who underwent BVT from September 2005 to September 2009 in CHP-HSA were prospectively reviewed. Results: Seventy-four BVT were performed in 74 patients. Patients had a mean of 2.0 previous access attempts. BVT was the first access in 20.3% of the patients. Median follow-up was 14.5 months. There were two primary failures. Secondary patency rates were 95.7%, 85.1% and 62.2% at 3, 12 and 24 months, respectively. Diabetes was associated with poor patency. Perioperative complication rate was 28.4%, with infection being the most frequent (n=6, 8.1% of all TVB). Thrombosis was the main cause of failure, occurring in 24.3% of all TVB. Conclusion: Autologous access superiority is well established. BVT is an underused technique due to its surgical expertise needs and logistic demands. We improved the surgical technique and the tunneling technique, reducing the size of the incisions and the time of operation. Our results showed a good secondary patency rate and, in the authors view, this technique should be more widely used.

Angioleiomiomas são tumores benignos raros derivados da musculatura lisa vascular, que geralmente se apresentam como nódulo doloroso solitário nos membros inferiores. Relata-se um caso de angioleiomioma no segundo quirodátilo esquerdo, localização incomum deste tumor.

Vascular leiomyoma are uncommon benign smooth muscle tumors which generally present as a single painful nodule in the lower limbs. We report a case of vascular leiomyoma on the second finger of the left hand, an unusual location for this tumor.

A psoríase é uma doença inflamatória crônica que pode afetar a pele e as articulações. Seu tratamento varia conforme a gravidade e inclui medicamentos tópicos e sistêmicos. Dentre os últimos estão os imunobiológicos, que têm como alvo a célula T. Relatamos um caso que demonstra a estreita relação entre a psoríase, o linfoma e os imunobiológicos.

Psoriasis is a chronic inflammatory disease that can affect skin and joints. Their treatment varies depending on the severity and includes topical and systemic. Among the latter are the immunobiological that target the T cell We report a case that demonstrates the close relationship between psoriasis, lymphoma and biologic therapies.

Introdução: Os acessos vasculares são responsáveis por elevada morbilidade nos doentes em hemodiálise. A fístula arteriovenosa (FAV) representa o acesso vascular com menor taxa de complicações, pelo que a Consulta de Acessos Vasculares para hemodiálise procura promover o aumento da sua taxa de patência. Métodos: avaliação retrospectiva dos motivos de referenciação à consulta entre 01-01-2008 e 31-12-2009, do resultado das intervenções e análise dos factores relacionados com a patência da FAV. Resultados: Avaliaram-se 697 doentes (58% homens, 30% diabéticos, idade média 64±15 anos) referenciados para construção de acesso (71%), suspeita de estenose (14%), síndrome de roubo (6%) pseudoaneurismas (4%) e hipertensão venosa (HTV) (3%). Os acessos construídos foram FAV simples (n=514; 91% dos doentes), transposição da veia basílica (n=40) e pontagem arteriovenosa com prótese (n=10). A taxa de patência global (às 4 semanas) foi 83% (75%, 93% e 40% respectivamente nas FAVs, transposições e pontagens). A localização proximal da FAV (p <0,01) e avaliação pré-operatória por Dopller (p=0,02) associaram-se a melhor resultado. As estenoses da FAV foram tratadas por angioplastia, endovascular (45%) e cirúrgica (23%), com patência de 95% e 90% respectivamente. O síndrome de roubo foi tratado por redução do débito com banding em 57% dos casos (sucesso 84%) e laqueação da FAV em 16%. A angioplastia endovascular efectuou-se em 57% das HTV com sucesso de 84%. Em 50% dos pseudoaneurismas realizou-se aneurismectomia com manutenção da função da FAV em 90%. Conclusão: Resultados das intervenções sobreponíveis aos das séries internacionais. A avaliação pré-operatória por Ecodoppler favoreceu a patência da FAV.

Background: The vascular access is responsible for high morbidity in for hemodialysis patients. Arteriovenous fistula (AVF) provides the vascular access with lower complication rate, so the Consulta de Acessos Vasculares for hemodialysis promotes actions to increase its patency rate. Methods: Retrospective study of the causes for referral to consultation between 01/01/2008 and 31/12/2009, outcome of proposed interventions and factors favoring AVF patency. Results: We evaluated 697 patients (58% male, 30% diabetic, mean age 64 ± 15 years) referred for construction of access (71%), suspicion of stenosis (14%), steal syndrome (6%), pseudoaneurysm (4%) and venous hypertension (HTV) (3%). The constructed access were simple AVF (n=514, 91% of patients, transposition of the basilic vein (n=40) and prothesic arteriovenous graft (n=10). The global access patency rate (at 4th week) was 83% (with 75%, 93%, 40% for AVFs, transposition and grafts, respectively). Proximal location of AVF (p <0.01) and preoperative Doppler evaluation (p = 0.02) were associated with better outcomes. AVF venous stenosis was treated with angioplasty, endovascular (45%) and surgical (23%), with patency rates of 95% and 90%, respectively. The steal syndrome was treated by AVF reduction with banding in 57% of cases (84% success) and AVF ligation in 16%. Endovascular angioplasty was preformed in 57% of cases of HTV (success of 84%). Aneurysmectomy was performed in 50% of patients with pseudoaneurysms with preservation of AVF patency in 90% of cases. Conclusion: Interventions outcomes were similar to those of international studies. Preoperative evaluation by Doppler ultrasound improved the AVF patency.

OBJETIVO: Analisar a prevalência de déficit auditivo e caracterizar as principais sequelas auditivas e neurológicas pós-meningite, correlacionando o tipo de antibiótico utilizado durante o período de internação e a frequência de surdez, além do tipo de meningite mais prevalente como causa de déficit auditivo. MÉTODOS: Trata-se de um estudo de coorte transversal. Foram enviadas 289 cartas para os responsáveis pelas crianças que apresentaram meningite piogênica entre 28 dias e 24 meses, admitidas no Hospital Couto Maia (HC Maia) entre janeiro de 2002 a dezembro de 2003. A amostra foi constituída por 55 crianças que sobreviveram com ou sem sequelas evidentes, que compareceram para as avaliações audiológica e neurológica. Foi realizada avaliação audiológica completa, incluindo a bateria subjetiva e objetiva de avaliação, com utilização de instrumentos validados para investigação da audição da criança. RESULTADOS: A faixa etária, no momento da avaliação audiológica, variou de dois a cinco anos. A deficiência auditiva foi encontrada em 29% da amostra, sendo a maioria do tipo neurossensorial, bilateral e de grau profundo. As principais sequelas neurológicas encontradas foram epilepsia, hemiparesia, hidrocefalia, disfasia e hiperatividade. CONCLUSÃO: Os resultados destacam a necessidade de monitoramento audiológico e acompanhamento neurológico nas crianças com história prévia de meningite piogênica, especialmente aquelas infectadas em idade precoce, buscando, desta forma, detectar as possíveis alterações auditivas e intervir o mais precocemente possível, por meio de intervenção especializada, protetização e reabilitação da linguagem oral.

PURPOSE: To analyze the prevalence of hearing impairment and to characterize the main auditory and neurological sequelae after meningitis, correlating the type of antibiotic used during the hospitali66zation period and the frequency of deafness, as well as the most prevalent type of meningitis as cause of hearing impairment. METHODS: Two hundred and eighty nine caregivers of children who were diagnosed with pyogenic meningitis between 28 days and 24 months, and had been admitted at Hospital Couto Maia (HC Maia) between January 2002 and December 2003 were contacted. The sample was composed of 55 children that survived with or without evident sequelae, who attended audiological and neurological evaluation. A complete audiological evaluation was carried out, including a subjective and objective battery of evaluation tests, using standardized instruments for investigation of children's hearing. RESULTS: The age range of the subjects when the audiological evaluation was carried out varied from two to five years. Hearing impairment was detected in 29% of the sample, characterizing, mostly, a profound bilateral neurosensory hearing loss. The main neurological sequelae found were: epilepsy, hemiparesy, hydrocephaly, dysphasia, and hyperactivity. CONCLUSION: The results indicate the need for audiological monitoring and neurological follow-up in children with previous history of pyogenic meningitis, especially those infected in early ages, seeking to identify possible hearing impairments and to intervene as soon as possible, through specialized intervention, prothetization, and oral language rehabilitation.

OBJETIVO: Identificar as principais alterações audiológicas em indivíduos portadores de distrofia miotônica de Steinert. MÉTODOS: Cinco indivíduos foram submetidos à audiometria tonal e vocal, imitanciometria, teste de função tubária, pesquisa do reflexo estapediano, declínio do reflexo acústico e aplicação de dois questionários: a) Desempenho da função auditiva; b) Investigação psico-acústica-social. RESULTADOS: O estudo demonstrou que 60% da amostra apresentaram limiares auditivos dentro dos padrões de normalidade, 10% perda condutiva e 30% perda auditiva nas freqüências altas. Em relação aos reflexos estapedianos, observou-se o percentual de alteração de 30% nas freqüências de 0,5 e 1 kHz e de 40% em 2 e 4 kHz. Observou-se declínio do reflexo acústico em 10% da amostra nas freqüências de 0,5 e 1 kHz. CONCLUSÃO: O estudo mostrou que o padrão audiológico típico de perda auditiva em freqüências altas foi observado em 30% da amostra.

PURPOSE: To identify the main hearing disorders in individuals with Steinert's myotonic dystrophy. METHODS: Five individuals were submitted to tonal and vocal audiometry, acoustic impedance tests, examination of Eustaquian tube function, acoustic reflex investigation, and acoustic reflex decay. They also answered two questionnaires: a) Performance of auditory function; b) Psycho-acoustic-social investigation. RESULTS: The study showed that 60% of the sample presented normal hearing thresholds, 10% had conductive hearing loss and 30% had hearing loss in high frequencies. Concerning acoustic reflexes, it was observed that 30% of the subjects presented deficits at 0.5 and 1 kHz and 40% at 2 and 4 kHz. Acoustic reflex decay was observed in 10% of the sample at 0,5 and 1 kHz. CONCLUSION: The study showed that the typical auditory profile of high-frequencies hearing loss was observed in 30% of the sample.

Bacterial meningitis is still a major public health threat inside developing countries. In Brazil, the Department of Public Health estimates that the prevalence of bacterial meningitis is 22 cases per 100,000 persons. During the neonatal period, the bacterial meningitis develops special characteristics that can result in hearing problems and movement loss due to neurological and psychological damages. This study had the aim to analyze the prevalence of bacterial meningitis and sepsis in newborns during the pregnancy period for those using the public health care system in Salvador-Bahia. One of the goal was to describe the risk factors of bacterial meningitis and sepsis in newborns. A second goal was to identify, based on newborn health records, the difficulties to predict issues with the hearing, neurological and psychological problems. This study has a cross-sectional design. The newborns that were included in this study had bacterial meningitis or sepsis within 0-28 days of life. They were admitted in the maternity wards between June-December 2005 at the newborn intensive unit care. We analyzed 72 reports of newborns and only 11 (17%) were bacterial meningitis or sepsis newborn cases. These cases were associated to high intake of ototoxic drugs that can cause oto and nephrotoxicity, and cause serious sequels on the child development. Nervous system infection is one of the 2 major problems in clinical practice, especially during the first month after birth. During this first month, the nervous system infection develops special characteristics, which are different from regular symptoms and it requires treatment due to the increased risk to develop complications. It is strongly recommended to monitor ototoxic drugs use to prevent effects on the hearing system.

OBJETIVO: Este artigo tem por objetivo analisar a situação do tratamento farmacológico da gagueira, mostrando a eficácia de diferentes abordagens baseadas em drogas psiquiátricas, além de evidenciar a utilização de outros fármacos no tratamento dessa enfermidade. MÉTODOS: Revisão de literatura em base de dados Medline, utilizando os termos stuttering treatment, disfluency, disfluency treatments, botulinum toxin and stuttering treatment, botulinum toxin and disfluency treatment. RESULTADOS: Foram encontrados estudos envolvendo as seguintes drogas: citalopram + clomipramina, paroxetina, olanzapina, citalopram + alprazolam, pimozida, risperidona, tiaprida, clomipramina e desipramina, levetiracetam, divalproato de sódio, clonidina e betanecol, além de ensaios clínicos com a utilização de toxina botulínica tipo A e anestésicos. Os estudos envolvendo citalopram + clomipramina, paroxetina, olanzapina, citalopram + alprazolam, risperidona, clomipramina e desipramina, levetiracetam, divalproato de sódio, lidocaína e toxina botulínica tipo A demonstraram resultados positivos. A maioria das pesquisas relativas ao tratamento farmacológico da gagueira se restringe a estudos de caso e ensaios clínicos com pequenas amostras. CONCLUSÃO: Não existem evidências suficientes que justifiquem a utilização de um tratamento específico para a gagueira. Os estudos apresentados indicam a necessidade da realização de mais ensaios clínicos duplo-cegos e controlados com placebo envolvendo amostras maiores.

OBJECTIVE: This article analyzes the pharmacologic treatment of stuttering, assessing the effectiveness of different treatments using psychiatric drugs and further evidences of other drugs in the treatment of this disorder. METHODS: Search in Medline database, using the terms stuttering treatment, disfluency, disfluency treatments, botulinum toxin and stuttering treatment, botulinum toxin and disfluency treatment. RESULTS: Studies involving the following drugs were found: citalopram + clomipramine, desipramine, paroxetine, olanzapine, pimozide, risperidone, tiapride, levetiracetam, divalproex sodium, citalopram + alprazolam, clonidine and bethanecol, as well as clinical trials with the botulinum toxin A and anesthetics. Studies with citalopram + clomipramine, paroxetine, olanzapine, citalopram + alprazolam, risperidone, clomipramine and desipramine, levetiracetam, divalproex sodium, lidocaine and botulinum toxin A showed positive results. However, the great majority of pharmacological studies in this area are case series or clinical trials with small samples. CONCLUSION: Enough evidences do not exist that justify the use of a specific treatment for stuttering. The presented studies indicate the necessity of accomplishment of more double-blind placebo-controlled trials involving larger samples.