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ABSTRACT Background The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. Results Of the 26 patients evaluated, 9 (34.6%) had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3%) of the 17 patients who received β-blocker (propranolol), had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2%) patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage) had no bleeding during the follow-up period. Conclusion All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

RESUMO Contexto A eficácia dos beta-bloqueadores e de procedimentos endoscópicos como a ligadura elástica endoscópica para profilaxia primária de ruptura de varizes de esôfago em adultos cirróticos já foram demonstrados por inúmeros ensaios clínicos na população adulta, porém poucos são os estudos envolvendo a faixa etária pediátrica. Objetivo Avaliar a profilaxia primária com β-bloqueador em crianças e adolescentes cirróticos com hipertensão porta. Métodos Estudo de coorte envolvendo 26 pacientes cirróticos. O propranolol foi o β-bloqueador utilizado para a profilaxia. Quando contraindicado o uso de β-bloqueador, ou se efeitos colaterais presentes, os pacientes eram encaminhados para profilaxia endoscópica com ligadura elástica. Os pacientes foram avaliados por endoscopia, e naqueles que foram observadas varizes de médio e/ou grosso calibre ou presença de manchas avermelhadas nas varizes, independentemente do calibre das varizes, a profilaxia primária foi indicada. Resultados Dos 26 pacientes avaliados, 9 (34,6%) tinham contraindicações para o uso de propranolol e foram encaminhados para a profilaxia endoscópica. Seis (35,3%) dos 17 pacientes que receberam β-bloqueador (propranolol) apresentaram sangramento após mediana de tempo de acompanhamento de 1,9 anos. A dose de β-bloqueio variou de 1 mg/kg/dia a 3,1mg/kg/dia e em sete (41,2%) pacientes o propranolol foi suspenso por falha em atingir β-bloqueio ou presença de efeitos adversos, tais como sonolência, broncoespasmo e hipotensão. No grupo de pacientes que receberam a profilaxia endoscópica (ligadura elástica) não foi observado nenhum episódio de hemorragia digestiva alta durante o período de acompanhamento. Conclusão Todos os pacientes que apresentaram hemorragia digestiva alta no presente estudo estavam recebendo profilaxia com propranolol. Foi observado, ainda, elevado número de contraindicações e efeitos colaterais, com consequente encaminhamento para profilaxia endoscópica. A profilaxia endoscópica foi eficaz na redução de episódios de hemorragia digestiva alta.

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BACKGROUND: The efficacy of nonselective ß-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. OBJECTIVE: The objective of this study is to evaluate the primary prophylaxis with ß-blocker in cirrhotic children and adolescents with portal hypertension. METHODS: This is a cohort study encompassing 26 cirrhotic patients. ß-blocker prophylaxis was performed with propranolol. When contraindicated the use of ß-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. RESULTS: Of the 26 patients evaluated, 9 (34.6%) had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3%) of the 17 patients who received ß-blocker (propranolol), had bled after a median follow-up time of 1.9 years. ß-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2%) patients had the propranolol suspended due to fail of the ß-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage) had no bleeding during the follow-up period. CONCLUSION: All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

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ABSTRACT INTRODUCTION: The Sino-Nasal Outcome Test 22 (SNOT-22) is an important tool in assessing the quality of life (QoL) of patients with chronic rhinosinusitis with a validated version in Brazil. The eosinophilic nasal polyposis (ENP) represents most of the cases of nasal polyposis (85-90%) and belongs to the group of chronic rhinosinusitis. It is a chronic inflammatory disease that impacts the QoL of patients, not only causing localized symptoms, but also resulting in a general malaise. The standard treatments (corticosteroids and nasal endoscopic surgery) lead to partial control of symptoms, but relapses are frequent. Macrolide acting as an immunomodulator is a promising tool for more effective control of this disease. Studies are still lacking to assess the real impact on the QoL in patients treated with macrolides. OBJECTIVE: To evaluate the improvement of QL, evaluated using SNOT-22, in patients with PNSE treated with immunomodulatory dose azithromycin. METHODS: This is a paired experimental study in patients with ENP. Comparison of pre-treatment and post-treatment with azithromycin was performed. Patients completed the SNOT-22 questionnaire before the start of treatment and returned for evaluation after eight weeks of treatment. Azithromycin was prescribed at a dose of 500 mg, orally, three times a week, for 8 weeks. RESULTS: SNOT-22 score decreased 20.3 points on average. There was a significant decrease in the SNOT-22 (difference greater than 14 points) in 19 patients (57.6%). There was no significant difference in improvement in SNOT in subgroups with or without asthma/aspirin intolerance. CONCLUSION: Azithromycin resulted in significant improvement of QoL, assessed by SNOT-22, in the studied population.

RESUMO INTRODUÇÃO: O Sino-Nasal Outcome Test 22 (SNOT-22) está entre os principais instrumentos na avaliação da qualidade de vida dos pacientes com rinossinusite crônica, com versão validada no Brasil. A polipose nasossinusal eosinofílica (PNSE) representa a maioria dos casos de polipose nasossinusal (85% a 90%) e pertence ao grande grupo das rinossinusites crônicas. É uma doença inflamatória crônica que impacta sobremaneira a qualidade de vida (QV) dos pacientes, não só pelos sintomas locais, mas também por resultarem em um quadro de mal-estar geral. Os tratamentos padronizados (corticosteroides e cirurgia endoscópica nasal) levam ao controle parcial dos sintomas e as recidivas são frequentes. Os macrolídeos usados como imunomoduladores são uma promissora ferramenta para um controle mais eficaz dessa doença. Ainda faltam estudos para avaliar o real impacto na QV dos pacientes tratados com macrolídeos. OBJETIVO: Avaliar a melhora da QV do paciente portador de PNSE tratado com azitromicina em dose imunomoduladora baseando-se questionário SNOT-22. MÉTODO: Trata-se de estudo experimental autopareado em pacientes com PNSE. Foi realizada a comparação dos pacientes pré-tratamento e pós-tratamento com azitromicina. Os pacientes preencheram o questionário SNOT-22 antes do início do tratamento e no retorno após as oito semanas de tratamento. Foi prescrita azitromicina na dose de 500 mg, VO, três vezes por semana, durante 8 semanas. RESULTADOS: O valor do índice SNOT-22 dos pacientes reduziu 20,3 pontos, em média. Houve diminuição significativa do SNOT-22 (diferença maior que 14 pontos) em 19 pacientes (57,6%). Não houve uma diferença significativa na melhora do SNOT nos subgrupos com ou sem asma/intolerância à aspirina. CONCLUSÃO: A azitromicina resultou em melhora significativa da QV, avaliada pelo questionário SNOT-22, na população estudada.

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INTRODUCTION: The Sino-Nasal Outcome Test 22 (SNOT-22) is an important tool in assessing the quality of life (QoL) of patients with chronic rhinosinusitis with a validated version in Brazil. The eosinophilic nasal polyposis (ENP) represents most of the cases of nasal polyposis (85-90%) and belongs to the group of chronic rhinosinusitis. It is a chronic inflammatory disease that impacts the QoL of patients, not only causing localized symptoms, but also resulting in a general malaise. The standard treatments (corticosteroids and nasal endoscopic surgery) lead to partial control of symptoms, but relapses are frequent. Macrolide acting as an immunomodulator is a promising tool for more effective control of this disease. Studies are still lacking to assess the real impact on the QoL in patients treated with macrolides. OBJECTIVE: To evaluate the improvement of QL, evaluated using SNOT-22, in patients with PNSE treated with immunomodulatory dose azithromycin. METHODS: This is a paired experimental study in patients with ENP. Comparison of pre-treatment and post-treatment with azithromycin was performed. Patients completed the SNOT-22 questionnaire before the start of treatment and returned for evaluation after eight weeks of treatment. Azithromycin was prescribed at a dose of 500 mg, orally, three times a week, for 8 weeks. RESULTS: SNOT-22 score decreased 20.3 points on average. There was a significant decrease in the SNOT-22 (difference greater than 14 points) in 19 patients (57.6%). There was no significant difference in improvement in SNOT in subgroups with or without asthma/aspirin intolerance. CONCLUSION: Azithromycin resulted in significant improvement of QoL, assessed by SNOT-22, in the studied population.

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ABSTRACT INTRODUCTION: Auditory screening in newborns allows for detection of hearing problems early in life. However, middle ear diseases can make the diagnosis more difficult. OBJECTIVE: To evaluate the power reflectance test as an indicator of the middle ear disease and to compare it to tympanometry. METHODS: Case study evaluating 105 newborns and infants who participated in the audiology screening in 2013. The following exams were performed: transient otoacoustic emissions, power reflectance, and tympanometry. RESULTS: In the optoacoustic emission evaluation, approximately 95% of the subjects passed the test. The specificity of power reflectance in all frequencies studied ranged from 75.3% to 95.9%, and that of tympanometry at 1000 Hz ranged from 83% to 87.2%; there was agreement among these exams. CONCLUSION: The outcome of power reflectance tests at 2000 Hz and 3000 Hz showed a correlation with tympanometry and otoacoustic emissions, and these were the most appropriate frequencies to determine middle ear disease through power reflectance measurement. It was also observed that values of power reflectance above reference levels suggested the presence of fluid in the middle ear, and thus a conductive hearing loss.

RESUMO INTRODUÇÃO: A triagem auditiva neonatal nos permite identificar precocemente alterações auditivas. Entretanto, doenças da orelha média podem dificultar o diagnóstico. OBJETIVO: Avaliar o exame de reflectância de potência como um indicador de doença de orelha média e compará-lo com a timpanometria. MÉTODO: Estudo de casos em que foram avaliados 105 neonatos e lactentes que fizeram parte da triagem auditiva em 2013. Foram realizados os seguintes exames: emissões otoacústicas transientes, reflectância de potência e timpanometria. RESULTADOS: Na avaliação das emissões otoacústicas, cerca de 95% passaram. A especificidade da reflectância de potência em todas as frequências pesquisadas variou de 75,3% até 95,9% e da timpanometria em 1.000 Hz variou de 83% até 87,2% e houve concordância entre esses exames. CONCLUSÃO: O resultado do exame de reflectância nas frequências de 2.000 Hz e 3.000 Hz apresentou correlação com os resultados da timpanometria e com as emissões otoacústicas, e foram estas as frequências mais adequadas para a determinação de doença de orelha média pela reflectância de potência. Observou-se que valores da reflectância de potência acima dos padrões sugerem presença de líquido em orelha média, portanto uma alteração condutiva.

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INTRODUCTION: Auditory screening in newborns allows for detection of hearing problems early in life. However, middle ear diseases can make the diagnosis more difficult. OBJECTIVE: To evaluate the power reflectance test as an indicator of the middle ear disease and to compare it to tympanometry. METHODS: Case study evaluating 105 newborns and infants who participated in the audiology screening in 2013. The following exams were performed: transient otoacoustic emissions, power reflectance, and tympanometry. RESULTS: In the optoacoustic emission evaluation, approximately 95% of the subjects passed the test. The specificity of power reflectance in all frequencies studied ranged from 75.3% to 95.9%, and that of tympanometry at 1000Hz ranged from 83% to 87.2%; there was agreement among these exams. CONCLUSION: The outcome of power reflectance tests at 2000Hz and 3000Hz showed a correlation with tympanometry and otoacoustic emissions, and these were the most appropriate frequencies to determine middle ear disease through power reflectance measurement. It was also observed that values of power reflectance above reference levels suggested the presence of fluid in the middle ear, and thus a conductive hearing loss.

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OBJECTIVE: To assess the validity and reliability of the Brazilian Portuguese version of the Brief Assessment of Cognition in Schizophrenia by examining its temporal stability, internal consistency, and discriminant and convergent validity. METHODS: The Brief Assessment of Cognition in Schizophrenia was administered to 116 stable patients with schizophrenia and 58 matched control subjects. To assess concurrent validity, a subset of patients underwent a traditional neuropsychological assessment. RESULTS: The patients with schizophrenia performed significantly worse than the controls (p<0.001) on all subtests of the Brief Assessment of Cognition in Schizophrenia and on the total score, which attests to the discriminant validity of the test. The global score of the Brief Assessment of Cognition in Schizophrenia was significantly correlated with all of the subtests and with the global score for the standard battery. The Brief Assessment of Cognition in Schizophrenia also had good test-retest reliability (rho>0.8). The internal consistency of the Brief Assessment of Cognition in Schizophrenia was high (Cronbach's α  ϝ 0.874). CONCLUSION: The Brazilian Portuguese version of the Brief Assessment of Cognition in Schizophrenia exhibits good reliability and discriminant and concurrent validity and is a promising tool for easily assessing cognitive impairment in schizophrenia and for comparing the performance of Brazilian patients with that of patients from other countries.

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OBJECTIVE: To assess the validity and reliability of the Brazilian Portuguese version of the Brief Assessment of Cognition in Schizophrenia by examining its temporal stability, internal consistency, and discriminant and convergent validity. METHODS: The Brief Assessment of Cognition in Schizophrenia was administered to 116 stable patients with schizophrenia and 58 matched control subjects. To assess concurrent validity, a subset of patients underwent a traditional neuropsychological assessment. RESULTS: The patients with schizophrenia performed significantly worse than the controls (p<0.001) on all subtests of the Brief Assessment of Cognition in Schizophrenia and on the total score, which attests to the discriminant validity of the test. The global score of the Brief Assessment of Cognition in Schizophrenia was significantly correlated with all of the subtests and with the global score for the standard battery. The Brief Assessment of Cognition in Schizophrenia also had good test-retest reliability (rho>0.8). The internal consistency of the Brief Assessment of Cognition in Schizophrenia was high (Cronbach's α  ϝ 0.874). CONCLUSION: The Brazilian Portuguese version of the Brief Assessment of Cognition in Schizophrenia exhibits good reliability and discriminant and concurrent validity and is a promising tool for easily assessing cognitive impairment in schizophrenia and for comparing the performance of Brazilian patients with that of patients from other countries. .

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