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Ef ficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

Ef ficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

The subjects underwent therapy daily for a total of eight sessions: one initial assessment session and one therapy session on the same day, six therapy-only sessions per day after that, and one final assessment session. However, aiming to preserve the benefits of randomization and the balanced distribution of the prognostic factors, this sample was ana- lyzed regarding the intention to treat, thus the subjects had to attend at least five sessions to be included in the research. When the subject belonged to the control group, the laryngeal vocal exercises were not performed even if they were indicated in the results file. However, both the control and experimental groups performed the same myofunc- tional exercises. The prescription of the exercises that each subject should perform met their needs to maintain the clinical applicability of the study. This means that the subject did not do all exercises, but rather only the ones required in his or her case. Likewise, no more than two myofunctional exercises or more than one vocal exercise were performed for the same goal.
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Surgical procedures used for post-traumatic neurogenic bladder in a cat: report case

Surgical procedures used for post-traumatic neurogenic bladder in a cat: report case

In the present case the upper motor neuron lesion probably caused the relaxation fail of the urethral sphincter with bladder outlet obstruction and increased urine volume over time with bladder distention and an atonic detrusor muscle (De Groat, 2006). Conservative therapy of neurogenic bladder dysfunction includes emptying the urinary bladder either manually or by catheterization, measures to prevent urinary tract infections such as antibiotic treatment, and use of drugs to facilitate bladder emptying such as alpha adrenergic antagonists and skeletal muscle relaxants (Lorenz and Kornegay, 2004; Lees, 2005; Tudury et al., 2006; Windaele, 2008). However, intermittent urethral catheterization was considered unacceptable by the owner, as well as prepubic or subpubic urethrostomy techniques (Fossum et al., 2007). For this reason, another modality of surgical treatment was considered.
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Clinics  vol.66 número2

Clinics vol.66 número2

A comprehensive renal function follow-up, preferably by a pediatric nephrologist, should be routinely performed in children with congenital neurogenic bladder starting early in the course of the disease, as they are at risk of developing permanent renal damage. Unfortunately, in the present study, the first renal evaluation occurred at a mean of 4.2 years of age. At the time of presentation, 7 patients had metabolic acidosis without therapy, 7 patients were hypertensive without antihypertensive treatment and 20 patients demon- strated microalbuminuria without antiproteinuric therapy. Ulsenheimer et al retrospectively analyzed 36 children with myelomeningocele in a Brazilian University Hospital and showed that only 45% had been submitted to an urinary tract evaluation. 12 Kari reported on 11 children with neurogenic
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Int. braz j urol.  vol.29 número1

Int. braz j urol. vol.29 número1

Spina bifida and myelodysplasia are associated with neurogenic abnormalities of the bladder and bowel function. All children with myelodysplasia require an evaluation of their urinary tract with ultrasound and urodynamics to confirm normal bladder and kidney function. Patients with anatomical and functional abnormalities require treatment, the mainstay being intermittent catheterization and anticholinergic medication. The treatment goals for patients with a neurogenic bladder are the preservation of the upper urinary tract, bladder and bowel continence, independence, autonomy, and facilitation of self-esteem. A minority of children will not respond to conservative therapy and will ultimately require surgical intervention. This review will discuss the surgical options for bladder augmentation, bladder neck reconstruction and closure, as well as the methods for the creation of continent catheterizable stomas. The timing, indications, and description for each procedure will be addressed. Finally, the antegrade continence enema procedure will be described for the management of refractory fecal incontinence.
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Int. braz j urol.  vol.29 número2

Int. braz j urol. vol.29 número2

This is a very good and succinct paper that reminds one of the importance of this operation for all patients including female patients who have neurogenic vesical dysfunction and are unresponsive or unable to comply with the regimen of anticholinergic therapy and clean intermittent catheterization. As highlighted by the authors the main advantages of this procedure were preservation of the native ureterovesical junction and avoidance of a dysfunctionalized bladder. Though a passive drainage system similar to a cutaneous vesicostomy, previous authors have highlighted that vesicostomy in adults has only had mixed success (1). The attractiveness of this surgery includes that of removing the often used suprapubic tube and its secondary associated bladder irritation, and potential hematuria. This paper is very well written though it would have been of interest if the authors had expounded on the incidence of autonomic dysreflexia in their patients pre- and postoperatively. In addition, if the reader is interested, there are several other excellent papers on this operation and its treatment of this difficult clinical malady (1,2). These include reports from Dr. McGuire’s group including one from 1994, which has good explanatory diagrams of the operation and the follow-up paper 5 years later, which provides excellent long term outcome results from this surgery (1,2). Of note is that in those authors’ hands and in this paper’s report, fascial and stomal stenosis mirrored that of the ileal conduit urinary diversion. Both female patients in this study group underwent pubovaginal slings. Previous authors have based their placement of slings on urodynamics with sling being offered for proximal urethral dysfunction and formal bladder outlet closure for a non-salvageable situation (2). Should consideration be given to a suburethral sling or urethropexy in all females undergoing the reconstruction regardless of their urethral support or intrinsic sphincter function? In addition, this paper, as have others (1,2), highlight the need for early postoperative urodynamics to establish operative success in the form of acceptable detrusor leak point pressures. The reader should remind himself of the difference between a Valsalva leak point pressure and a detrusor leak point pressure (3). The authors do elude peripherally in their discussion on the use of ileovesicostomy in patients with hypocontractile bladders. Future elucidation or quantification on the minimal detrusor strength required to be a candidate for this operation will be of great interest. In addition, I hope in the future we will be privileged to read the authors’ reports on the use of incontinent ileovesicostomy in patients with hypocontractile bladders if the clinical series is developed.
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Effects of electrotherapy in treatment of neurogenic bladder in children with occult spinal dysraphism

Effects of electrotherapy in treatment of neurogenic bladder in children with occult spinal dysraphism

Methods We had 49 patients with neurogenic bladder that were treated at the University Children’s Hospital in Belgrade in the period 2003-2008. The first group of children received medicamentous therapy and the second group received medicamentous therapy with transcutaneous electric nerve stimulation. In both groups we evaluated 4 symptoms: daily enuresis, enuresis nocturna, urgency and frequency and 4 urodynamic parameters: lower bladder capacity, unstable contractions and residual urine and detrusor sphincter dyssynergia. Follow-up urodynamic evaluation was done after 3, 6 and 12 months respectively.
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Jellyfish Envenomation Resulting In Vascular Insufficiency And Neurogenic Injury of Upper Limb

Jellyfish Envenomation Resulting In Vascular Insufficiency And Neurogenic Injury of Upper Limb

Surgical fasciotomy and exploration was done owing to the increasing swelling. Intraoperatively, the surgeon noted presence of serous fluid alone, with no signs of infection. A combination of antithrombotic, antibiotics, and antihistamine therapy was commenced in the ward resulting in recirculation of the digits, resolution of finger numbness and weakness (Figure 3a and b). Repeated CTA right upper limb at 6 weeks after the incident shows recirculation over the distal forearm and palmar arches (Figure 2b).

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J. Bras. Nefrol.  vol.36 número4

J. Bras. Nefrol. vol.36 número4

Introduction: The lower urinary tract dysfunction (LUTD) corresponds to changes in the filling or emptying of urine caused by neurogenic, anatomical and functional alterations. Objective: To evaluate the impact of treatment in children and adolescents with LUTD. Methods: Historical cohort of 15 year follow-up with the participation of 192 patients (123F, 69M), aged 0.1 to 16.8 years, analyzed at admission (T0) and at final follow-up (T1). Most patients belong to a neurologic bladder dysfunction group (60.4%). The treatment was uroterapy with behavioral and cognitive intervention, timed voiding, oral hydration, laxative diet, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enema, treatment of urinary tract infection (UTI) and, in refractory cases, surgical procedures such as continent and incontinent urinary diversion (vesicostomy), bladder augmentation and conduit for performing antegrade colonic enema. Results: The main symptoms were daytime urinary incontinence (82.3%), the non-monosymptomatic nocturnal enuresis (78.6%), fecal incontinence (54.2%) and constipation (47.9%). There was a significant reduction of urinary tract infection (p = 0.0027), daytime urinary incontinence (p < 0.001), nocturnal enuresis (p < 0.001), fecal incontinence (p = 0.010) and of vesicoureteral reflux (p = 0.01). There was significant increase in the use of CIC (p = 0.021), of anticholinergic therapy (p < 0.001) and decrease of chemoprophylaxis (p < 0.001). Conclusion: This study showed that
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A eficácia da reabilitação em disfagia orofaríngea

A eficácia da reabilitação em disfagia orofaríngea

Background: efficacy of rehabilitation in oropharyngeal dysphagia. In our country the practice of speech- language pathology in oropharyngeal dysphagia has increased significantly and, at this moment, deserves attention since practice needs to be based on scientific evidence. Therapeutic techniques and the outcome of rehabilitation in oropharyngeal dysphagia have been studied since the 70s, reaching its high point during the 80s and 90s. Few studies have investigated the efficacy of therapy in the rehabilitation of oropharyngeal dysphagia, the vast majority have tried to prove the effects of therapy on the dynamics of swallowing. In Brazil, the studies about oropharyngeal dysphagia have, in great part, investigated assessment procedures, and only a few have worried about rehabilitation. Aim: to present a critical analysis about the efficacy of rehabilitation in oropharyngeal dysphagia. Conclusion: this review of the literature indicates that non-randomized studies have compromised the results, once the casuistic of the researches are very heterogeneous - they include neurogenic and mechanical oropharyngeal dyshagia caused by different etiologies. Besides that, therapeutic programs which are used are not sufficiently described, compromising the reproduction of the methodology by other researchers. These results suggest the need for more randomized studies, which can be initially developed as case studies in order to exclude the control variables of therapy efficacy. Another suggestion is, as proposed by present researches, to use scales that can measure the impact of swallowing training in the nutritional and pulmonary condition of dysphagic patients. An important research area, related to the control of therapeutic efficacy and efficiency, are the studies that aim to establish the decrease in hospital and home care costs as a consequence of speech-language intervention with patients with oropharyngeal dyspahgia.
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Int. braz j urol.  vol.30 número2

Int. braz j urol. vol.30 número2

Results: There were no significant side effects throughout the entire treatment. The first 7- year old boy however developed some dizziness when the dose of terazosine was increased to 2 mg (after 4 weeks of administrating 1 mg), and this disappeared immediately when the dosage was re- duced back to 1 mg daily. The urgency symptoms improved in both boys after 3 weeks of 1 mg terazosine. The secondary enuresis in the 11 year-old boy resolved after 2 months of 2 mg terazosine. Conclusion: It is possible to say that the alpha-blocker medication, terazosine can be admin- istered safely to children with a non-neurogenic bladder dysfunction, also known as the Hinman’s syndrome. These results have shown that dysfunctional voiding, postvoiding residual and upper tract involvement can disappear over time when long term terazosine is given in combination with timed voiding, prophylactic antibiotic therapy and treatment of the associated constipation. Our observa- tions also suggest a permanent effect after discontinuing the medication.
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Neurogenic thoracic outlet syndrome associated with cervical rib

Neurogenic thoracic outlet syndrome associated with cervical rib

The authors present their experience with 5 cases of true neurogenic TOS associated with a cervical rib. All patients were female and had a cervical rib confirmed radiographically pre-operatively. Average age was 34,8 years. Although all patients had been treated with se- veral combinations of diverse drugs and a rehabilitation program before referral to surgery, all described their pain as intense and debilitating before surgical treat- ment. All patients had pre-operative electromyographic abnormalities.

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Biological and behavioral aspects regarding combined systemic management of alcohol dependence

Biological and behavioral aspects regarding combined systemic management of alcohol dependence

First the period of abstinence was evaluated. A sig- niicant (F(1,66)=4.29, p=0.04) diference of almost two months of abstinence between our study groups was recorded, since the group which beneited from behavioral systemic plus standard therapy had an average of almost 7 months of abstinence (6.92±3.2 months), as compared to the group that received only standard medication (5.1±3.8 months) (Fig. 1).

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Texto contexto  enferm.  vol.22 número2 en v22n2a12

Texto contexto enferm. vol.22 número2 en v22n2a12

Praxis physical therapy consisted of the therapeutic use of labor. In Brazil, it was regulated in 1890 through Decree number 206-A, which ap- proved the instructions for medical legal care to mentally disturbed people. It can be noted that this resource was aimed at the “mentally disturbed indigent”, who were able to work in agriculture and industries in the colonies. These places were created primarily to solve the overcrowding prob- lems of poor and homeless people at the National Mental Hospital for Mentally Disturbed People. However, there was also interest in providing therapeutic treatment based on work, mainly in ac- tivities like agriculture, livestock and handicraft. 2
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Eficácia do tratamento cognitivo e/ou comportamental para o transtorno de ansiedade social.

Eficácia do tratamento cognitivo e/ou comportamental para o transtorno de ansiedade social.

Conclusion: Cognitive and/or behavioral therapy is an effective treatment for patients with social anxiety disorder. However, the heterogeneity of the clinical trials evaluated, with reference to treatment features (time of treatment and different protocols) or characteristics of the patients (severity of their clinical picture and how they were recruited) made comparison of results between different treatments diffi cult. More research on cognitive and/or behavioral treatment and new reviews of these interventions are necessary to better assess our fi ndings.

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J. bras. pneumol.  vol.40 número1

J. bras. pneumol. vol.40 número1

underwent pre-treatment plethysmography. Eight patients were female, with the mean age at diagnosis being 49 ± 11.6 years and the mean age at initiation of tiotropium therapy being 54.9 ± 11.0 years. Six patients had a history of smoking, but only 2 had a history of greater than 5 pack-years.

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Cancer gene therapy

Cancer gene therapy

The pDNA has five conformations, the open-circular (oc), relaxed circular, linear, supercoiled (sc) and the supercoiled denatured conformation. Oc and linear conformations arise through single-stranded and double-stranded nicks, respectively. These plasmid forms have been deemed undesirable for clinical purposes, due to a perceived increased risk of recombination events and integration into genomic DNA (gDNA). These forms may also be subject to more rapid intracellular degradation. Sc conformation is the native pDNA isoform, presents a compact conformation and consists of complete double strand with the normal twist and shape. It is the one of choice in gene therapy due to its outstanding stability, eminent antigenicity and the more efficient for gene transfection of all isoforms. (Abdulrahman and Ghanem 2018; Valente et al. 2014; Ghanem, Healey, and Adly 2013)
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Antiviral therapy for influenza

Antiviral therapy for influenza

The information related to drugs is a typical pharmaceutical feature and pharmacists have always been a source of information providing advices about the medications use in order to achieve a correct and safe therapy. However, due to some conditions, as the elevated number of new drugs, the therapy complexity and the elevated number of publications in this area, pharmacists need to have several and updated sources of information which also must have a wide range allowing the coverage of all hospital specialties. Internet represents the main source of global information which pharmacists can use to access the most updated original documentation published in scientific journals, catalogs and WHO publications, or through systems that index and allows the quick access to the primary sources. Other medications information services as contact with INFARMED for legal aspects associated with a specific drug, medical departments of the pharmaceutical industry for specific data regarding certain medications or other extra-hospital institutions possessing a vaster scientific documentation, can also be used to withdraw important and reliable information. Finally, updated textbooks also represent a compilation of selected and evaluated information, which should be the first to be consulted when dealing with a problem as they can provide more objective and confirmed information. [1] [2] Some of the textbooks consulted during the traineeship were: “Martindale, The Extra Pharmacopeia”; “Handbook on Injectable Drugs, Trissel L.”; “Drug Interactions, Stockley”. Therefore, these available sources of information must be used by the pharmacists with the gold of promoting the safe, effective and economic use of drugs, medical devices and pharmaceutical products. A major aspect also related with this topic is the continuous formation that the pharmacist must have. Therefore, he must attend several formation sessions in order to improve and expand the knowledge related with the general health.
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Int. braz j urol.  vol.30 número3

Int. braz j urol. vol.30 número3

Methods: We retrospectively reviewed the 23 patients with neurogenic bladder dysfunction who underwent PNL at our institution. Neurologic lesions included spina bifida, traumatic spinal cord injury, exstrophy/epispadias, neonatal meningitis, stroke, and spine chondrosarcoma. Bladder management included ileal conduit (n = 8), intermittent catheterization (n = 7), indwelling catheter (n = 7), and ureterosigmoidostomy (n = 1).

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News-Screen

News-Screen

were randomly assigned in a 2:1 ratio to receive either evo- locumab (140 mg every 2 weeks or 420 mg monthly) plus standard therapy or standard therapy alone. Patients were followed for a median of 11.1 months with assessment of lipid levels, safety, and (as a prespecified exploratory ana- lysis) adjudicated cardiovascular events including death, myocardial infarction, unstable angina, coronary revascu- larization, stroke, transient ischemic attack, and heart fai- lure. Data from the two trials were combined.

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Gene therapy: development of a new nanocarrier system for mitochondrial gene therapy

Gene therapy: development of a new nanocarrier system for mitochondrial gene therapy

The Use of pDNA: As mitochondrial gene therapy is concerned, the usage of a plasmid is a must. Therefore, the initial step of this work consisted in the isolation of three pDNA which differ in size: the 2.7kbp plasmid pUC19, the 6.1kbp pVAX1-LacZ and the 14kbp pcDNA3-myc- FLNa S2152A. Plasmids have been isolated in a culture from bacteria, E. coli, and purified using an appropriate kit. Both isoforms, open circular and supercoiled are present. We are, however, aware that for transfection purposes, requirements such as purity and structural stability are relevant. Moreover, according to the guidelines provided by regulatory agencies pDNA should be enriched in the sc isoform (191). This conformation renders DNA to be more compact while ensuring enhanced transfection and expression rate in eukaryotic cells (192).
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