Rehabilitation of the afasic patient in speech therapy

Aphasias are considered to be neurological linguistic disorders in which the comprehension and/or expression of oral and/or written language is compromised, thus having a significant potential impact on the quality of life of an individual and his / her family. Although much studied in its neurophysiological mechanism, aphasia is not always discussed in terms of rehabilitation. Therefore, this article aims to discuss the scientific production in speech therapy on the rehabilitation of aphasia. For this purpose, an Integrative Review of Literature was carried out, covering the period from 2000 to 2021 on the Scielo and BVS data platforms of articles available in full and in the Portuguese language, using as a descriptor the unitermo "aphasia", in which the articles found were submitted to the relevance tests I and II, in which the final sample made only those that passed the established criteria. A total of 236 articles were found on the Scielo platform, with only 29 discussing rehabilitation and only 5 on speech therapy. In the BVS platform, 98.901 articles were found, but only 86 were discussing deaf aphasia and were available, none of which addressed speech therapy rehabilitation. The electronic search reached a total of 5 relevant articles that included the theme of speech and hearing rehabilitation to the aphasic patient, all of them being from the Scielo platform. Thus, scientific scarcity on the subject of aphasia becomes evident, and it is necessary to invest in production that encapsulate the therapeutic behavior of the speech-language pathologist. As afasias são consideradas distúrbios linguísticos de cunho neurológico em que a compreensão e/ou expressão da linguagem oral e/ou escrita encontra-se comprometida, tendo desta maneira um potencial significativo de impacto na qualidade de vida de um indivíduo e sua família. Embora muito estudada em seu mecanismo neurofisiológico, as afasias nem sempre são discutidas sob o aspecto de reabilitação. Diante disso, este artigo objetiva discutir sobre a produção cientifica em fonoaudiologia sobre a reabilitação da afasia. Para tanto, foi realizada uma Revisão Integrativa da Literatura, contemplando o período de 2000 a 2021 nas plataformas de dados Scielo e BVS de artigos disponíveis na íntegra e no idioma em português, utilizando como descritor o unitermo “afasia”, em que os artigos encontrados foram submetidos aos testes de relevância I e II, em que fizeram a amostra final apenas aqueles que passaram pelos critérios estabelecidos. Foram encontrados na plataforma Scielo o total de 236 artigos, sendo que apenas 29 discutiam sobre reabilitação e apenas 5 sobre terapia fonoaudiológica. Na plataforma BVS foram encontrados 98.901 artigos, porém apenas 86 discutiam sobre afasia de fato e estavam disponíveis, sendo que nenhum abordava a reabilitação fonoaudiológica. A busca eletrônica alcançou o total de 5 artigos relevantes que contemplassem a temática de reabilitação fonoaudiológica ao paciente afásico, sendo todos da plataforma Scielo. Assim, torna-se evidente a escassez científica sobre o tema de afasia, sendo necessário investimentos para produção que embase a conduta terapêutica do profissional fonoaudiólogo.

Endometriosis intestinal, una causa de suboclusión intestinal poco sospechada. Serie de casos

Endometriosis is defined as the presence of endometrial glands in extrauterine sites. Intestinal deep infiltrating endometriosis is considered when the endometriotic lesion is located more than 5 mm below the peritoneum. Intestinal obstruction due to endometriosis is rare, occurring in approximately 1% of cases. We present three cases with intestinal occlusion as deep infiltrating endometriosis debut. Its symptomatic presentation can mimic multiple gastroenterological entities, mainly irritable bowel syndrome or inflammatory bowel disease so its diagnosis can be difficult. However, suspecting this pathology and diagnosing it is important to define therapeutic behavior and improve the quality of life of our patients.

A Rare Case of Stargardt’s Disease

Objective To describe a clinical case of rare eye diseases – Stargardt’s disease. Material and methods: A detailed clinical examination, fundus autofluorescence, optical coherence tomography and electrophysiological studies were performed. The clinical diagnosis was also genetically confirmed. Results A classic Stargardt’s disease phenotype was found in a 10-year old boy with decreased visual acuity, atrophy of the photoreceptors and retinal pigment epithelium layers in the macula, plus hypoautofluorescence in the fovea. In full-field ERG there was no diffuse cone involvement. Multifocal ERG demonstrated a lower cone activity in the area of the central macula in both eyes, which is characteristic for hereditary maculopathies and differentiates them from cone-rod dystrophies, in which generalized damage of the photoreceptors in the retina may be observed. The genetic studies identified two missense mutations: c.3113C> T (p.Ala1038Val) and c.1622T> C (p.Leu541Pro) in a cis-position and a missense mutation c.2588G> C (p.Gly863Ala) in the other allele of ABCA4 gene. The two pathogenic variants c.3113C> T and c.1622T> C formed a complex allele p. [A1038V; L541P], which was found in the genome of the asymptomatic mother. The other mutation c.2588G> C affects a highly conserved amino acid from the ABCA4 protein (p.Gly863Ala) and was inherited from the patient’s clinically healthy father, who was a heterozygous carrier. Conclusion The comprehensive clinical, electrophysiological and genetic testing of patients with rare hereditary retinal dystrophies is essential for the correct diagnosis and the choice of therapeutic behavior.

Additional treatment with Carnoy solution in surgical therapy of ameloblastomas: Case report

Introduction: Ameloblastoma is a benign neoplasm characterized by the proliferation of odontogenic epithelium that mainly affects the gnathic bones and, due to its invasive and expansive growth, presents high rates of recurrence to surgical treatment. Among the most conservative treatments are enucleation and marsupialization; among radicals, resections are more widespread. Objective: The objective is to present, through a case report, conservative surgical treatment with enucleation followed by the use of the Carnoy solution. Case report: A 24-year-old male patient arrives at the outpatient clinic of Hospital da Restauração with painful complaints of mild and constant intensity in the region of the left mandibular angle, with an evolution of three weeks. After a panoramic X-ray, the presence of the included 38 tooth was associated with an extensive unilocular radiolucent lesion, surrounding the angle and mandibular ramus. Preoperative examinations were performed for incisional biopsy. Histopathological diagnosis was unicystic ameloblastoma. In view of the histopathology obtained, we opted for enucleation of the lesion with concomitant use of direct Carnoy solution in the region of the lesion. Discussion: The choice of therapeutic behavior depends on the size, type of lesion, location and histopathology. After the surgical decision, a radiographic clinical follow-up is necessary to assess possible recurrences. Carnoy's solution is a cauterizing agent with moderate tissue penetration, rapid local fixation and hemostatic action, whose surgical use in cystic lesions has occurred since the beginning of the 20th century. Conclusion: Conservative treatment with the enucleation technique followed by complementary therapy using Carnoy's solution proved to be quite effective.

PERCEPCIÓN DEL PROFESIONAL DE ENFERMERÍA SOBRE LOS CUIDADOS APLICADOS AL PACIENTE EN POSICIÓN DE DECUBITO PRONO ASOCIADO AL COVID-19.

Introducción: En la unidad de cuidados intensivos (UCI) el personal de enfermería cumple un papel importante al momento del cuidado y atención del paciente con COVID-19, en relación a la posición decúbito prono (DP), para mejorar la ventilación pulmonar de estos pacientes. Objetivo: Describir la percepción del profesional de enfermería sobre la aplicación y efectividad de la posición de decúbito prono en el paciente con COVID-19. Métodos: Investigación cualitativa, de tipo fenomenológico, para abordar nuevos conocimientos y prácticas en la pandemia por COVID-19 desde la asistencia de enfermería con una dimensión humanista y comprensiva, utilizando el tipo de muestreo de bola de nieve o cadena en dos hospitales y dos clínicas con Unidad de Cuidados Intensivos del Cantón Ambato, Provincia Tungurahua, Ecuador,se utilizó entrevistas semiestructuradas que permitió descubrir la experiencia vivida de los profesionales de enfermería en cuanto a su percepción del cuidado aplicado al paciente en posición de decúbito prono. Resultados: Se evidenció que la posición DP, no ha sido utilizada anteriormente por el personal de enfermería y empezó a aplicarse por la pandemia de COVID-19, como medida coadyuvante en la conducta terapéutica, ya que contribuye al incremento de la relación ventilación/perfusión y mejoría clínica del paciente. Existen complicaciones como la aparición de úlceras de presión y movilización del tubo endotraqueal. Conclusiones: La percepción del profesional de enfermería sobre la aplicación y la efectividad de la posición en los pacientes con COVID-19, ha sido favorable, se ha obtenido una información clara y precisa de acuerdo a su efectividad. Palabras Claves: Decúbito prono, Profesional de Enfermería, COVID-19 ABSTRACT Introduction: In the intensive care unit (ICU), the nursing staff plays an important role at the time of the care and attention of the patient with COVID-19, in relation to the prone position (PD), to improve the pulmonary ventilation of these patients. Objective: To describe the nursing professional's perception of the application and effectiveness of the prone position in the patient with COVID-19. Methods: Qualitative research, phenomenological type, to address new knowledge and practices in the COVID-19 pandemic from nursing care with a humanistic and comprehensive dimension, using the type of snowball or chain sampling in two hospitals and two In clinics with the Intensive Care Unit of the Ambato Canton, Tungurahua Province, Ecuador, semi-structured interviews were used that allowed discovering the lived experience of the nursing professionals regarding their perception of the care applied to the patient in the prone position. Results: It was evidenced that the DP position has not been used previously by the nursing staff and began to be applied due to the COVID-19 pandemic, as a coadjuvant measure in the therapeutic behavior, since it contributes to the increase of the ventilation/perfusion ratio and clinical improvement of the patient. There are complications such as the appearance of pressure ulcers and mobilization of the endotracheal tube. Conclusions: The nursing professional's perception of the application and effectiveness of the position in patients with COVID-19 has been favorable, clear and precise information has been obtained according to its effectiveness. Key Words: Prone position, Nursing Professional, COVID-19

Concussão Cerebral no Judo – Programa de Retorno ao Treino e Competição

Cerebral concussion consists in a complex traumatic brain injury with functional repercussion, which occurs after a direct or indirect brain trauma, without abnormalities identified in imaging studies. The increasing prevalence of this injury in judo, its clinical severity and the general unawareness of the best therapeutic behavior were the necessary stimulus to conduct a specific orientation program for the sport. These procedures will allow a safe return to train and competition ensuring the athlete’s physical and cognitive integrity.

CURRENT KNOWLEDGE ON THE PATHOGENIC MECHANISMS OF HENOCH-SCHOENLEIN PURPURA IN CHILDREN

The Schӧnlein-Henoch vasculitis is an IgA-mediated inflammation of small vessels. The main clinical manifestation is palpable purpura without thrombocytopenia, manifested by bilateral symmetrical distribution on both lower limbs, abdominal pain, often accompanied by blood in the stools, hematuria with / or without proteinuria. Historically, the disease has been known since 1832. In Bulgaria, although that later Henoch-Schӧnlein purpura (HSP) aroused scientific interest, several publications focused on the pathogenic nature, clinical variations, and potential complications of the disease, as well as options for therapeutic intervention. Modern knowledge about the etiology and pathogenesis of the disease has given new light, respectively a basis for early diagnosis, reduction of complications and recurrences, as well as the avoidance of polypragmatism. It turned out that in HSP there are genetic factors and new aspects, binding until now accepted concept that there are no changes in the coagulation system. The role of factor XIII, as a prognostic indicator of the severity of clinical manifestations and von Willebrand factor (vWF), as a reliable index of the degree of vascular wall damage, has been demonstrated. Plasma imbalance in the Th1 / Th2 ratio was also found and a percentage of NK cells, respectively their immune function, were reduced. This new knowledge about the pathogenic nature of HSP is the basis for a change in the concept of therapeutic behavior, which is aimed at the severity of the clinical course, and not only at the treatment of the disease, which is itself symptomatic.

Congenital complete atrioventricular block from literature to clinical approach – a case series and literature review

Aim: Congenital atrioventricular block (CAVB) is an immunological condition, secondary to the transfer of maternal Ig G antibodies from seropositive mothers. Although the presence of these antibodies is high among pregnant women, the preva-lence of this fetal pathology is low. The aim of this paper is to analyze a series of cases with intrauterine diagnosis of CAVB and to present their follow-up protocol. Material and method: In the period between 2013-2020, five fetuses were diagnosed and followed up in the Pediatric Cardiology Clinic. In each of the cases, assessment of the hemodynamic status was done by calculation of the fetal cardiovascular profile score (CVPS). In the last cases the follow-up protocol was supplemented with longitudinal speckle tracking evaluation of the ventricular function. Results: In the present series, intrauterine death occurred in one case; in another case resumption of atrioventricular conduction was observed. Epicardial pacemaker implantation was required in three of the patients. Conclusion: Completing the evaluation of ventricular function with the longitudinal speckle tracking method in fetuses and newborn patients with congenital atrioventricular block may play an important role in establish-ing therapeutic behavior.