Search

The purpose of this study was to describe laryngeal and acoustic voice hanges associated with laryngeal fatigue (LF) in a prolonged loud reading task. LF may be a symptom caused by factors affecting vocal function such as voice overuse, misuse or abuse. LF affects the pitch, intensity and quality of voice and vibratory patterns of vocal folds. Data were collected from 20 subjects in two groups -nonsingers and trained singers who did not have history of voice disorders- prior to and following experimentally induced LF. ResuIts from this compara tive analysis are presented. Findings about individual variations revealeda trend to maintain or increase vocal pitch in post-test measures. Greater hiatus in glottic closure were observed at the end of the task. However, resuIts from this study failed to show statistically significant differences between groups and moments as a result of the prolonged reading task. Relationships between acoustic and videostroboscopic measures and self-reports provided by the participants could not be clearly established. It was concluded that a twohour loud reading task at a comfortable vocalintensity,as used in this investigation, is not enough to induce vocal abuse states conducive to LF. Other possible reasons associated with the resuIts obtained are discussed.

Este artículo constituyó la ponencia central del XX Aniversario de las Carreras de Terapia Física, Terapia Ocupacional y Terapia del Lenguaje en la Universidad Nacional de Colombia, celebrado en marzo de 1986. Tiene como propósito fomentar la reflexión sobre la relación entre las dimensiones disciplinar y de formación del profesional de servicios humanos en Terapia Física, Terapia Ocupacional y Terapia del Lenguaje, de acuerdo a una concepción humanista.

Background: Borderline changes (BL) with stable renal function is a controversial category in renal transplantation, given its contradictory outcomes. The aim of this study was to compare the clinical outcomes of BL in patients with stable renal function classified as focal and diffuse according to the extent of tubulitis., Methods: Patients with no history of rejection with a surveillance graft biopsy at 3 or 12 months showing BL (n = 40), acute cellular rejection (n = 20) or normal biopsies (n = 20), were included in this study. Biopsies with BL were divided into diffuse BL (BL D ) and focal BL (BL F ) according to the extent of tubulitis. Because of the low frequency of subclinical ACR (ACR ND ) (n = 12), biopsies with ACR and graft dysfunction (ACR D ) (n = 8) were also included. A composite outcome that included the presence of rejection in subsequent biopsies, graft loss, patient death, decrease in GFR ≥30% or presence of de novo DSA (dnDSA) during the first year of follow-up was evaluated., Results: The primary composite outcome occurred in five patients of each of the Normal, BL F and ACR ND , eight patients with BL D and six patients with ACR D (p = 0.105). A trend towards more rejection episodes was observed in the ACR ND and ACR D . Also, a shorter time to rejection in the BL D , ACR ND and ACR D groups compared to BL F and Normal groups (p = 0.039) was observed. During the first year of follow-up, no patient in the ACR ND group developed dnDSA, compared to 15-25% in the other groups. The median time of dnDSA development in the BL F group was 45 months, and in the BL D group was 10 months (p = 0.020)., Conclusion: Classifying BL biopsies with stable renal function into focal and diffuse categories, is a simple and feasible strategy that helps to differentiate between BL D with a phenotype that shows a trend towards worse outcomes, and BL F that behaves more similar to normal biopsies., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The contribution of Image-guided Radiotherapy (IGRT) to modern radiotherapy is undeniable, being the way to bring into daily practice the dosimetric benefits of Intensity-Modulated Radiotherapy (IMRT). Organ and target motion is constant and unpredictable at the pelvis, thus posing a challenge to the safe execution of IMRT. There are potential benefits of IMRT in the radical treatment of cervical cancer patients, both in terms of dose escalation and decrease of toxicity. But it is essential to find IGRT solutions to control the aspects that can lead to geographic miss targeting or organs at risk (OAR) overdose. This review seeks to describe the problems and possible solutions in the clinical implementation of IMRT/IGRT protocols to treat intact cervical cancer patients.

This paper proposes alternative models for the analysis of count data featuring a given spatial structure, which corresponds to geographical areas. We assume that the overdispersion data structure partially results from the existing and well justified spatial correlation between geographical adjacent regions, so an extension of existing overdispersion models that include spatial neighborhood structures within a Bayesian framework is proposed. These models allow practitioners to quantify the association explained by the considered neighborhood structures and the one modelled by additional factors. Finally, using the information provided by the Colombian National Demographic and Health Survey, the usefulness of the proposed models is illustrated by fitting them to infant mortality rates and to data including the proportion of mothers who, after giving birth to their last child, underwent a postnatal screening period in Colombia.

In previous work, we demonstrated that the arenavirus Junín virus (JUNV) is able to activate Akt by means of the phosphatidylinositol-3-kinase (PI3K) survival pathway during virus entry. This work extends our study, emphasizing the relevance of this pathway in the establishment and maintenance of persistent infection in vitro. During the course of infection, JUNV-infected Vero cells showed a typical cytopathic effect that may be ascribed to apoptotic cell death. Treatment of infected cultures with Ly294002, an inhibitor of the PI3K/Akt pathway, produced an apoptotic response similar to that observed for uninfected cells treated with the drug. This result suggests that virus-induced activation of the PI3K/Akt pathway does not deliver a strong enough anti-apoptotic signal to explain the low proportion of apoptotic cells observed during infection. Also, inhibition of the PI3K/Akt pathway during the acute stage of infection did not prevent the establishment of persistence. Furthermore, treatment of persistently JUNV-infected cells with Ly294002 did not alter viral protein expression. These findings indicate that despite the positive modulation of the PI3/Akt pathway during Junín virus entry, this would not play a critical role in the establishment and maintenance of JUNV persistence in Vero cells.

Objective: Determining the characteristics and level of bullying in state schools in Ciudad Bolivar (Locality 19) in Bogotá, Colombia., Material and Methods: A sample of 3 226 basic education students was taken, the students being in the sixth to eleventh grades in state schools in the locality of Ciudad Bolivar in Bogotá. The data was collected by applying a survey in which the perception of bullying in the schools was established. SPSS 14.0 was used for statistical analysis., Results: This research took statistical results indicating the level of indifference, aggressiveness and other kinds of violence in the schools. The initial conclusion was that a high percent of students were rejected and humiliated by their peers. The level of bullying depended on the students' scholastic level rather than their socioeconomic level. Bullying situations such as giving students nicknames which they did not like or not including them in class activities were more frequent in the sixth, seventh and eighth grades. Overall, intensity and strategic indices revealed that school is a place where each day brings more suffering, where many violent situations may arise thereby making students feel afraid and that this affects the children's life for a high percentage of the students., Conclusions: The student community from the locality of Ciudad Bolivar in Bogotá, Colombia, is affected by a high number of bullying situations.

Objective: Determining levels of intra-family violence associated with students attending schools in Ciudad Bolivar, Bogotá, Colombia., Material and Methods: The sample consisted of 3,226 students from the 6th to 11th grades attending state schools located in Ciudad Bolivar in Bogotá. The data was collected from a survey in which the students' perception of violence in their homes was determined; data was statistically analysed by using SPSS 14.0., Results: A high percentage of students had difficulty in communicating with their parents and felt rejected and a lack of love from some of the members in their homes. 28.4% of those surveyed (915 students) had been victims of more than 20 of the violent situations; 35% of the students in the sample had a family atmosphere characterised by high levels of violence. The percentage of students who stated that they had been physically mistreated depended on their education level; the highest percentages being presented in the 7th and 8th grades., Conclusions: The middle- and upper-school student community in Ciudad Bolivar in Bogotá, Colombia, is affected by many situations concerning intra-family violence.

Objectives: To determine the adequacy of the Multidimensional Pain Inventory (MPI) for assessing pain impact after spinal cord injury (SCI) and to determine whether the impact of pain can be separated from other consequences of SCI., Design: Postal survey., Setting: General community., Participants: Of the 159 subjects contacted who experienced chronic pain, 120 (75.5%) participated., Interventions: Subjects were mailed the original MPI and a set of additional items specific to SCI., Main Outcome Measure: The MPI., Results: Confirmatory (CFA) and exploratory factor analyses were performed for each section of the MPI. Elimination of several items, including those related to work in section 1 (pain impact), improved the goodness-of-fit index (GFI). A CFA for section 2 (response of significant other) resulted in acceptable GFI after 2 items were deleted. Decrease in activity levels (section 3) because of other consequences of injury was significantly greater after tetraplegia than after paraplegia. In contrast, pain-related reduction in activities was not associated with injury level. Although other consequences of SCI may have greater impact on activities than pain, severe pain is likely to affect activity levels significantly., Conclusion: The MPI appears to be appropriate for use in a SCI population when modified to eliminate questions related to work and to supplement the activity scale with items addressing decreased activity levels due to pain., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Objectives: To determine how chronic pain after spinal cord injury (SCI) interfered with sleep, exercise, work, household chores, and other daily activities and to define which clinical aspects of pain and psychosocial factors best predicted the extent of interference., Design: Postal survey; follow-up to a previous survey conducted 6 months earlier., Setting: General community., Participants: Individuals (n = 217) with traumatic SCI and chronic pain., Intervention: Subjects answered questions regarding frequency of interference caused by pain on 5 activities: sleep, work, exercise, household chores, and other daily activities. Asked to self-report sadness, fatigue, or anxiety; and to describe location, quality, and intensity of pain., Main Outcome Measures: Demographic data (gender, age, level of injury); sociodemographic data (education, employment); self-reported psychosocial outlook; clinical characteristics of pain: location (drawing), quality (descriptors), and intensity (2 numeric rating scales). Regression analysis., Results: The questionnaire was returned by 65.8% of the sample (217/330). A large number of the participants (77.3%) reported frequent interference caused by pain, ie, "often" to "always" in 1 or more of the 5 activities. The combination of high pain intensity and the use of multiple pain descriptors was significantly associated with frequent interference with falling asleep. Frequent sleep interruption was significantly associated with high pain intensity, male gender, anxiety, and higher age at time of injury. In working individuals, frequent interference due to pain was significantly associated with multiple pain descriptors, anxiety, low level of education, and being older at time of injury., Conclusion: Reported extent of pain interference in various areas of activity is related to clinical symptoms of pain as well as to psychologic and psychosocial factors rather than level of injury. The relationship between frequent interference, pain intensity, and multiple descriptors indicate that individuals experiencing several types of pain of high intensity are more likely than others to experience frequent interference with a variety of daily activities including sleep., (Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Objective: To define relationships among various clinical characteristics of pain occurring after spinal cord injury (SCI)., Design: Postal survey., Setting: General community., Participants: Of 330 subjects with SCI reporting chronic pain in a previous survey, 217 volunteered., Interventions: Not applicable., Main Outcome Measures: Detailed pain history., Results: Participants had been injured for an average of 8.2 +/- 5.1 years and 55.4% were tetraplegic. Most subjects marked multiple areas on a pain drawing with the back area most frequently (61.8%) indicated. The most common qualities reported were burning pain (59.9%) and aching pain (54.4%). Burning was significantly associated with pain in frontal parts of torso and genitals, buttocks, and lower extremities, whereas aching was significantly associated with neck and shoulders and back. The factor analysis of the relationships between level of injury, location of pain, quality of pain, pain intensity rating, duration of pain breaks, and time for pain onset resulted in 3 groupings: (1) multiple pain locations, burning pain, lower extremity; (2) aching pain, shoulder and neck, cervical injury; and (3) early onset of pain, no breaks to short breaks of pain, and high average pain intensity., Conclusions: Relationships among various clinical features of pain after SCI reveal common clinical patterns important for increased understanding of pain mechanisms and for the design of therapeutic interventions for pain management.

Remyelination in the adult central nervous system (CNS) is preceded by the generation of new oligodendrocytes (ODCs) but the source of the new ODCs has not been resolved. Adult galactocerebroside positive (O1+)ODCs proliferate when cultured with purified sensory neurons (Wood and Bunge, Nature 320:756-758, 1999), implying that differentiated ODCs could be an important source of new myelinating ODCs. To test this possibility purified O1+ODCs (>96% purity) were plated at low density (20-50 cells/culture) into cultures of purified dorsal root ganglion neurons. Three days after plating, single O1+ODCs were located (209 ODCs/43 cultures) and sequentially observed for 4 weeks. The ODCs began to proliferate by the fifth day after plating and formed large colonies by the third week. Most cells in these colonies were 01- but positive for another ODC antigen, O4. A few O1+, myelin basic protein (MBP)+ODCs, and glial fibrillary acidic protein (GFAP)+cells with astrocytic morphology were observed in some colonies. In similar cultures plated with cell-sorted O1+ODCs (>99.5% purity), ciliary neurotrophic factor (CNTF, 1ng/ml) increased the number and size of colonies, the number of O1+MBP+ODCs (including ODCs producing myelin-like profiles in association with axons) and the number of GFAP+ astrocytes, relative to untreated controls. The results are evidence that CNTF exerts a trophic effect on adult O1+ODCs, and/or their progeny, and that cells generated by division of O1+ODCs can become either new myelin-producing ODC, or astrocytes. This plasticity in regenerative potential of adult O1+ODCs has not been previously demonstrated., (Copyright 1999 Wiley-Liss, Inc.)

Objectives: To determine the perceived difficulty in dealing with consequences of spinal cord injury (SCI) and to explore patterns of how these complications are perceived., Design: Postal survey., Setting: General community., Participants: Individuals with traumatic SCI (n = 430)., Methods: Subjects (n = 877) were selected from The Miami Project database and were sent a questionnaire in which they were asked to rate their difficulty in dealing with 10 consequences of SCI, on a scale ranging from 0 (not hard at all) to 10 (extremely hard)., Results: The questionnaire was returned by 430 individuals (49%). Five consequences (decreased ability to walk or move, decreased control of bowel, decreased control of bladder, decreased sexual function, and pain) were rated highest (means, 8.2 to 6.2). High ratings of feeling sad were associated with high ratings of most other consequences, and a cluster analysis revealed interrelationships between the ways the various consequences were perceived., Conclusions: Several consequences of SCI are frequently perceived as being very difficult to deal with. Sadness may influence how well a person deals with other consequences of SCI. The observed patterns in perceived difficulty dealing with complications of SCI need to be explored further because they are important in our understanding and treatment of the medical conditions that may follow SCI.

Purpose: To compare the effectiveness of intracavernous administration of sodium nitroprusside and prostaglandin E1 to induce penile erection in men with erectile dysfunction., Material and Methods: 100 patients with erectile dysfunction entered the study prospectively. As part of the diagnostic workup, each patient received an intracavernous injection of 20 microg prostaglandin E1 and a second injection of 600 microg sodium nitroprusside 1-7 days later. A tourniquet was placed at the base of the penis before each injection. The data recorded included time required to initiate tumescence, local and systemic side effects, objective and subjective quality of erections, duration of tumescence and patient satisfaction by means of a personal questionnaire., Results: Prostaglandin E1 induced better overall responses than sodium nitroprusside, the difference being almost significant (p = 0.055). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 81.3 min) than with sodium nitroprusside (mean 65.4 min; p < 0.04). 67% of the patients considered the erections induced with prostaglandin E1 to be of better quality than those with sodium nitroprusside, and only 11% stated that sodium nitroprusside was superior. Side effects were minimal with both drugs, the most frequent side effect being systemic hypotension, which was induced by sodium nitroprusside in 7% of the patients., Conclusions: The moderate risk of systemic hypotension and the lower potency of sodium nitroprusside to induce erections compared to prostaglandin E1 rules out sodium nitroprusside as a routine alternative intracavernous drug in men with erectile dysfunction at the doses employed. Sodium nitroprusside, however, could be used in patients who have intolerance or penile pain with intracavernous prostaglandin E1.

Objectives: The present article summarizes the latest advancements in the physiology of erection, with special reference to the role of the adenylate and guanylate cyclase-nitric oxide system., Methods/results: New aspects in the pharmacological intracavernous treatment of erectile dysfunction are discussed and new drugs in this field are analyzed, such as nitrovasodilators, calcium channel blocker, potassium channel openers, phosphodiesterase inhibitors and the combination of adenylate cyclase stimulators., Conclusions: A high percentage of patients with erectile dysfunction depends on intracavernous injection of vasoactive drugs for erection. However, this route of administration is painful and causes anxiety in many cases. Other routes of administration (oral, topical or intraurethral) have yet to be developed, as well as drugs that can diminish penile venous blood outflow in cases with venous leakage, and can enhance arterial blood supply at the same time. The combination of phosphodiesterase inhibitors with adenylate and/or guanylate cyclase stimulators or potassium channel openers may further enhance the results achieved to date.

Klinefelter's syndrome is characterized by hypergonadotropic hypogonadism, 47,XXY karyotype, gynecomastia, azoospermia and testicular atrophy with hyalinization of seminiferous tubules and hyperplasia of Leydig cells. Some cases of Klinefelter's syndrome with unexplainably low levels of gonadotropins have been reported in the literature. Two additional cases of Klinefelter's syndrome with hypogonadotropic hypogonadism and absence of Leydig cells are described.