ABSTRACT Objectives: Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves “short long-lived people”, rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Material and methods: Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results: Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusions: Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.

RESUMO: Este trabalho descreve a detecção de aglutininas anti-Leptospira spp. em tracajás (Podocnemis unifilis) na região Amazônica. Obtivemos 98 amostras de soro, as quais foram submetidas ao teste de aglutinação microscópica (MAT), utilizando 31 antígenos de diferentes sorogrupos de Leptospira spp. Das 98 amostras de soro coletadas, 35% (34/98) reagiram apresentando titulações de 100 a 3200; 23,53% dessas amostras (8/34) coaglutinaram na presença de dois ou mais sorovares. O sorogrupo mais comum foi Hebdomadis com 26,9% (7/26), seguido de Semaranga com 23% (6/26), Shermani com 19,2% (5/26), Djasiman com 11,5% (3/26), e Australis com 7,7% (2/26). Bataviae, Javanica, e Sejroe foram representados com apenas uma amostra (3,9%). A presença de tracajás reagentes a anticorpos contra Leptospira spp. implica na exposição ao patógeno.

ABSTRACT: We describe anti-Leptospira spp. agglutinin in yellow-spotted river turtles (Podocnemis unifilis)in the Amazon region. Ninety-eight serum samples from individuals housed at the Bosque Rodrigues Alves Zoobotanical Garden of Amazonia, Belém, PA, Brazil, were subject to the microscopic agglutination test (MAT) using 19 different Leptospira spp. antigen serogroups. Thirty-four of the 98 samples (35%) were reactive, with titers ranging from 100 to 3200, and eight 8 reactive samples (23.5%) co-agglutinated under two or more serovars.The most common serogroup was Hebdomadis (26.9%, 7/26), followed by Semaranga (23%, 6/26), Shermani (19.2%, 5/26), Djasiman (11.5%, 3/26), and Australis (7.7%, 2/26); Bataviae, Javanica, and Sejroewere represented by a single sample each (3.9%). The presence of turtles reactive to anti-Leptospira spp. antibodies implies exposure to the pathogen.

ABSTRACT Nosocomial bacterial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is associated with high mortality in neurosurgical patients. There are few reports in the literature on meningitis caused by CRKP. We report two cases of CRKP meningitis after neurosurgery. The K. pneumoniae identification and antimicrobial susceptibility testing were performed using the Vitek Compact System. Minimum inhibitory concentrations of polymyxin B were determined using the broth microdilution method. Molecular typing of K. pneumoniae isolates was investigated using multilocus sequence typing. Antimicrobial susceptibility testing showed that the K. pneumoniae isolates were multidrug resistant and co-produced extended-spectrum β-lactamases and KPC enzymes. The patients were treated with intrathecal polymyxin. Genetic polymorphism analyses revealed two different K. pneumoniae clones (ST1298 and ST2687), which were observed for the first time in CRKP infections. We recommend intravenous administration of intrathecal polymyxin for treating meningitis caused by multidrug-resistant K. pneumoniae .

RESUMO A planície de inundação do alto rio Paraná é uma área estratégica para o patrimônio biológico brasileiro por conter várias unidades de conservação. Objetivamos registrar a ocorrência e a distribuição geográfica das microalgas ocorrentes nesta planície durante 30 anos de pesquisas realizadas na região pelo Núcleo de Pesquisas em Limnologia, Ictiologia e Aquicultura da Universidade Estadual de Maringá. Foram consultadas 80 publicações (periódicos nacionais e internacionais, e livros publicados desde 1994 até 2016), das quais foram consideradas apenas publicações que referenciam algas no nível genérico e infragenérico. Os resultados indicaram 938 espécies de algas (562 perifíticas e 482 planctônicas), das quais 103 coocorrem nos dois habitats. Cosmarium foi o gênero com maior número de espécies no perifíton e Traquelomonas para o fitoplâncton. Este estudo ampliou o conhecimento da biodiversidade de microalgas no Brasil e forneceu dados para futuros estudos ecológicos e biogeográficos.

ABSTRACT The upper Paraná river floodplain is a strategic area for the Brazilian biological and environmental patrimony and contains several conservation units. We aimed to record the occurrence and the geographic distribution of microalgae in this floodplain during 30 years of research carried out by the Center for Research in Limnology, Ichthyology and Aquaculture - State University of Maringá. We consulted 80 publications (national and international journals and books published from 1986 to 2016). We considered only published works that referenced algae at the generic and infrageneric levels. The results indicated 938 species of algae (562 periphytic, 482 planktonic), which 103 co-occur in the two habitats. Cosmarium was the richest genera for periphyton and Traquelomonas for phytoplankton. This study increased the knowledge of microalgae biodiversity in Brazil and provided data for future ecological and biogeographic studies.

Resumo Objetivo: Determinar a prevalência de lombalgia crônica (LBC) e os preditores de força muscular nas costas (FMC) em pacientes com lúpus eritematoso sistêmico (LES). Métodos: Estudo transversal. Selecionaram-se 96 pacientes ambulatoriais com LES por amostragem não probabilística, entrevistados e testados durante consultas médicas. As medidas de desfecho foram: prevalência ocasional de LBC, Índice de Incapacidade de Oswestry, Escala Tampa para Cinesiofobia, Escala de Gravidade da Fadiga e contrações isométricas voluntárias máximas (CIVM) de preensão manual e dos músculos das costas. Usaram-se o coeficiente de correlação e a regressão linear múltipla na análise estatística. Resultados: Dos 96 indivíduos entrevistados, 25 apresentavam LBC, o que indicou uma prevalência circunstancial de 26% (92% mulheres). A correlação entre o Índice de Incapacidade de Oswestry e a contração isométrica voluntária máxima dos músculos das costas foi de r = -0,4, IC 95% [-0,68; -0,01] e entre a CIVM de preensão manual e dos músculos das costas foi de r = 0,72, IC 95% [0,51; 0,88]. O modelo de regressão apresentou o maior valor de R2 observado quando a CIVM dos músculos das costas foi testada com cinco variáveis independentes (63%). Nesse modelo, a força de preensão manual foi a única variável preditiva (ß = 0,61, p = 0,001). Conclusões: A prevalência de LBC em indivíduos com LES foi de 26%. A CIVM dos músculos das costas foi 63% prevista por cinco variáveis de interesse. No entanto, apenas a força de preensão manual foi uma variável preditiva estatisticamente significativa. A CIVM dos músculos das costas apresentou uma relação linear diretamente proporcional à força de preensão manual e inversamente proporcional ao Índice de Incapacidade de Oswestry (ou seja, músculos das costas mais fortes estão associados a menores pontuações de incapacidade).

Abstract Objective: To determine the prevalence of Chronic Low Back Pain and predictors of Back Muscle Strength in patients with Systemic Lupus Erythematosus. Methods: Cross-sectional study. Ninety-six ambulatory patients with lupus were selected by non-probability sampling and interviewed and tested during medical consultation. The outcomes measurements were: Point prevalence of chronic low back pain, Oswestry Disability Index, Tampa Scale of Kinesiophobia, Fatigue Severity Scale and maximal voluntary isometric contractions of handgrip and of the back muscles. Correlation coefficient and multiple linear regression were used in statistical analysis. Results: Of the 96 individuals interviewed, 25 had chronic low back pain, indicating a point prevalence of 26% (92% women). The correlation between the Oswestry Index and maximal voluntary isometric contraction of the back muscles was r = −0.4, 95% CI [−0.68; −0.01] and between the maximal voluntary isometric contraction of handgrip and of the back muscles was r = 0.72, 95% CI [0.51; 0.88]. The regression model presented the highest value of R 2 being observed when maximal voluntary isometric contraction of the back muscles was tested with five independent variables (63%). In this model handgrip strength was the only predictive variable (β = 0.61, p = 0.001). Conclusions: The prevalence of chronic low back pain in individuals with systemic lupus erythematosus was 26%. The maximal voluntary isometric contraction of the back muscles was 63% predicted by five variables of interest, however, only the handgrip strength was a statistically significant predictive variable. The maximal voluntary isometric contraction of the back muscles presented a linear relation directly proportional to handgrip and inversely proportional to Oswestry Index i.e. stronger back muscles are associated with lower disability scores.

Resumo Objetivo: Analisamos a distribuição temporal (períodos de seca e chuva) dos grupos funcionais fitoplanctônicos (biovolume) de lagos conectados a rios barrados (S1 - Paraná) e não barrados (S2 - Baia e S3 - Ivinhema) da planície de inundação do alto rio Paraná, Brasil. Além disso, determinamos os fatores que controlam a montagem da comunidade fitoplanctônica. Métodos amostras de fitoplâncton e variáveis ambientais foram coletadas em períodos secos (2000 e 2001) e chuvosos (2010 e 2011). As espécies fitoplanctônicas foram classificadas em sete grupos funcionais baseados na morfologia (MBFG). Aplicamos Análise de Variância para testar diferenças no biovolume total e dos MBFGs entre lagos e períodos. Além disso, usamos Análise de Redundância para determinar a relação entre os MBFGs e as variáveis ambientais. Resultados O lago relacionado com o rio barrado (S1) apresentou a menor riqueza de espécies. O biovolume fitoplanctônico variou entre os lagos, mas não apresentou diferenças temporais associadas à variação do nível hidrométrico. O lago associado ao rio não barrado e de características semi-lênticas apresentou o maior biovolume, e em S1 (relacionado com o rio barrado) e S3 (relacionado com rio não barrado) registramos menores valores. Organismos filamentosos (MBFG III) estiveram associados com condições de poucos nutrientes, e as diatomáceas (MBFG VI) foram favorecidas nos locais com elevada mistura da coluna da água. Os flagelados dos grupos MBFG II e MBFG V estiveram relacionados a condições de maior profundidade e baixa mistura da água, respectivamente. Conclusão Nossos resultados sugerem que espécies fitoplanctônicas com diferentes traços funcionais controlam a produtividade primária em períodos de chuva e de seca. Por isso, ressaltamos a importância de manter a alta diversidade funcional em lagos para garantir a produtividade primária. Enfatizamos a importância da proteção de ambientes naturais como os lagos de planície de inundação devido a contribuição para a diversidade regional e o fluxo da energia.

Abstract Aim: We analyzed the temporal distribution (dry and rainy periods) of phytoplankton functional groups (biovolume) from lakes connected to dammed (S1 - Paraná River) and non-dammed rivers (S2 - Baia River and S3 - Ivinhema River) in the upper Paraná River floodplain, Brazil. We also determined the drivers of the phytoplankton community assemblage. Methods Phytoplankton and environmental variables samplings were performed quarterly in dry (2000 and 2001) and rainy (2010 and 2011) periods. We classified the phytoplankton species into seven morphological based functional groups (MBFG). We used analysis of variance to test differences in total phytoplankton biovolume and MBFGs biovolume between lakes and climatic periods. We also used redundancy analysis to determine the MBFGs-environment relation. Results The lake related to the dammed river (S1) presented the lowest species richness. The total phytoplankton biovolume presented differences among the lakes, but we did not register temporal differences associated with water level variation. The lake related to the non-dammed and semi-lentic river (S2) presented the highest biovolume, while S1 (related to the dammed river) and S3 (related to the non-dammed river) exhibited the lowest ones. Filamentous organisms (MBFG III) were associated with poor nutrient conditions and diatoms (MBFG VI) were favored in high water mixing sites. The flagellate groups MBFG II and MBFG V were related to deeper water and lower column mixing conditions, respectively. Conclusions Our results suggest that phytoplankton species with different functional traits drive the primary productivity in the dry and rainy periods. Hence, we highlight the importance of maintaining high functional diversity in lakes to ensure primary productivity. Therefore, we stress the importance of protecting the natural environment such as floodplain lakes because of its contribution to the regional biodiversity and the flow of energy.

Resumo Objetivo: Avaliar a extensão da influência dos reservatórios à montante sobre a variação temporal e espacial do fitoplâncton na calha do rio Paraná e a importância de seus principais tributários na diminuição do processo de oligotrofização neste trecho do rio. Materiais e Métodos Foram realizadas amostragens trimestrais de fitoplâncton e variáveis físicas e químicas da água entre agosto de 2013 e maio de 2015, na calha do rio do rio Paraná e na foz de principais tributários, no trecho compreendido entre a jusante do reservatório de Porto Primavera e o remanso de Itaipu. Para sumarizar a variação da densidade fitoplanctônica em relação às principais variáveis físicas e químicas da água, foi aplicada uma Análise de Redundância (RDA). Resultados Foram identificados 214 táxons durante o estudo. Para riqueza de espécies e densidade fitoplanctônica os valores encontrados foram baixos e sem padrão de distribuição temporal ou espacial, tanto para o rio Paraná quanto para os tributários. No entanto, quando aplicada uma RDA aos dados foi possível verificar a segregação espacial na calha do rio Paraná, com o trecho próximo à barragem relacionado a maiores valores de transparência da água e densidade de Cyanobacteria, exportadas pelos reservatórios à montante. Enquanto que os trechos médio e inferior estiveram associados à maior complexidade do fitoplâncton e maiores concentrações de nutrientes e turbidez. Conclusão Por meio da análise da comunidade fitoplanctônica, foi possível verificar a diminuição do efeito de oligotrofização ao longo do eixo longitudinal do rio Paraná e o importante papel dos tributários para a diminuição deste efeito.

Abstract Aim: To evaluate the influence of upstream reservoirs on the temporal and spatial variation of the phytoplankton community in the Paraná River channel and the importance of its main tributaries in reducing the oligotrophication process along this stretch of the river. Materials and Methods Sampling of phytoplankton and physical and chemical variables was performed quarterly between August 2013 and May 2015, in the Paraná River main channel and in the mouth of the main tributaries, at the stretch located between downstream Porto Primavera reservoir and the backwaters of Itaipu reservoir. To summarize the variation of phytoplankton density in relation to the main physical and chemical variables, we performed a Redundancy Analysis (RDA). Results A total of 214 taxa were identified throughout the study. We registered low values of phytoplankton species richness and abundance, which showed no patterns of temporal and spatial distribution, both for the Paraná River and the tributaries. However, RDA results showed spatial segregation among samples from the Paraná River main channel, such that the stretch located closer to the dam was associated with higher values of water transparency and Cyanobacteria density, exported by upstream reservoirs, whereas the middle and lower stretches were associated with higher phytoplankton complexity and higher nutrient concentration and turbidity. Conclusion Through the analysis of the phytoplankton community we could verify a reduction in the effects of oligotrophication along the longitudinal axis of the Paraná River and the important role of the tributaries in diminishing this effect.