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Purpose: To analyze the effect of auditory-perceptual training by inexperienced speech-language pathologists in the classification of hypernasality in individuals with cleft lip and palate and compare their classification of hypernasality individually, with the gold standard evaluation, before and after this training., Methods: Three inexperienced speech-language pathologists used a four-point scale to assess 24 high-pressure speech samples from individuals with cleft lip and palate, before and after auditory-perceptual training. The speech samples corresponded to six samples of each degree of hypernasality. The speech-language pathologists received auditory-perceptual training during the assessments. They had access to anchor samples and immediate feedback of correct answers regarding the degree of hypernasality in training., Results: There was no significant difference in the overall percentage of correct answers when comparing before and after the auditory-perceptual training. There was a significant association and agreement of the three evaluators with a gold standard evaluation after training, with an increase in agreement for a single evaluator for absent and mild degrees of hypernasality. The dichotomous analysis of the data showed an increase in the Kappa Index of Agreement of this evaluator. Although there was an increase in the Index of Agreement between evaluators for absent, mild, and severe hypernasality, this increase did not reach statistical significance., Conclusion: The auditory-perceptual training provided did not result in a significant improvement in the hypernasality classification for the inexperienced speech-language pathologists, even though the individual data analysis showed that the training favored one of the evaluators. Further studies involving gradual and more extensive auditory-perceptual training may favor the classification of hypernasality by inexperienced SLPs.

Background: Knowledge of facial anatomy is essential for professionals intending to inject hyaluronic acid (HA) into that region, but due to the considerable anatomical variations in region, it does not guarantee the complete safety of the procedure. Similarly, procedures widely disseminated among professionals, such as aspiration and the use of cannulas, do not ensure total safety against vascular occlusion events caused by the filler., Objectives: This article describes a technique for injecting hyaluronic acid into the face guided by Doppler ultrasonography (DUS) in order to ensure greater safety against vascular occlusion events secondary to the procedure., Methods: We describe a Doppler ultrasound-guided filling technique, with an 18 MHZ transducer, consisting of three steps: arterial mapping, real-time ultrasound-guided filling, and assessing the perfusion., Results: The described technique was performed in 480 patients and can be adopted in the routine of professionals who inject hyaluronic acid, especially in areas at high risk for vascular events. Its use results in greater safety against vascular occlusion events secondary to the procedure, without the need for prior aspiration. We conclude that there is a local vasodilation right after the filling that makes it difficult the possibility of extrinsic compression exerted by the filler on the vessel. Furthermore, the product moves to deep planes even with the bevel facing up (toward the epidermis)., Conclusions: We believe that in the future the use of Doppler ultrasound-guided filling technique will be mandatory for professionals who intend to perform HA injection, to both ensure patient safety and provide legal protection for the professional., (© 2021 Wiley Periodicals LLC.)

Background: Numerous studies have reported reduced peripheral brain-derived neurotrophic factor (BDNF) in major depression (MD). However, most of these studies used multidimensional depression rating scales, and failed to identify a relationship between BDNF levels and depression severity. Unidimensional scales are a more valid measure of syndrome severity. In these scales, items are ordered in increasing severity, so that as scores increase, syndrome severity increases; thus, each item adds unique information, and items can be totaled to a meaningful sum. The current study used the HAM-D6, a unidimensional measure of depression, to examine if it could identify a correlation between serum BDNF and depression severity., Methods: Serum BDNF levels and symptom severity were assessed in 163 depressed patients, including those with both unipolar (84.0%) and bipolar (16.0%) depression. The evaluation of depression severity included the total HAM-D17 and 3 subscales, including the HAM-D6., Results: On average, patients presented moderate to severe depression (HAM-D17=21.2±5.5). Overall BDNF levels were 60.4±22.6ng/mL. The correlation between serum BDNF and depression severity was modest and not different when assessed by the HAM-D6 subscale or the HAM-D17 as a whole (z=0.951; p=0.341), despite being statistically significant for the HAM-D6 (r=-0.185; p=0.019; 95% CI: -0.335 to -0.033), but not for the entire HAM-D17 (r=-0.127; p=0.108; 95% CI: -0.272 to 0.027)., Conclusion: We could not identify a strong relationship between serum BDNF levels and depression severity using the HAM-D6. This is in concordance with results of previous studies that reported no correlation between these variables, and indicates that the properties of the clinical measures used cannot explain the results these studies., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Treatment-resistant depression (TRD) is an extremely prevalent clinical condition. Although Interpersonal Psychotherapy (IPT) is an established treatment for uncomplicated depression, its effectiveness has never before been studied in patients with TRD in real-world settings. We investigate IPT as an adjunct strategy to treatment as usual (TAU) for TRD patients in a pragmatic, randomized, controlled trial., Methods: A total of 40 adult patients with TRD (satisfying the criteria for major depressive disorder despite adequate antidepressant treatment) were recruited from a tertiary care facility for this pragmatic trial and blinded to the evaluator. Patients were randomized to one of two treatment conditions: (1) TAU - pharmacotherapy freely chosen by the clinician (n=23) and (2) TAU+IPT (n=17). Assessments were performed at weeks 8, 12, 19 and 24. Changes in the estimated means of the Hamilton Depression Rating Scale score were the primary outcome measure. Secondary outcomes included patient-rated scales and quality of life scales. We used a linear mixed model to compare changes over time between the two groups., Results: Both treatments lead to improvements in depressive symptoms from baseline to week 24 with no significant between group differences in either primary: TAU (mean difference: 4.57; CI95%: 0.59-8.55; d=0.73) vs. IPT+TAU (mean difference: 5.86, CI95%: 1.50-10.22; d=0.93) or secondary outcomes., Limitations: Our relatively small sample limits our ability to detect differences between treatments., Conclusions: Both treatments lead to equal improvements in depressive symptoms. We found no evidence to support adding IPT to pharmacotherapy in patients with TRD., Trial Registration: ClinicalTrials.gov-NCT01896349., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: This study obtained nasalance scores during use of compensatory articulation (CA) and compared nasalance between groups with and without hypernasality and with and without CA., Methods: Speech samples were obtained from 43 individuals with and without velopharyngeal dysfunction during repetition of 20 phrases originating 860 audio recordings and their respective nasometric values. After excluding 143 recordings due to low quality, the remaining 717 samples were rated by three speech language pathologists (SLPs), independently, for presence or absence of hypernasality and CA. Nasalance scores for the 553 samples rated with 100% agreement among the SLPs were grouped according to the auditory-perceptual ratings: Group 1 (G1) - included samples without hypernasality and without CA (n=191); Group2 (G2) - included samples with hypernasality and without CA (n=288); Group 3 (G3) - included samples with hypernasality and with pharyngeal fricative (n=33); Group 4 (G4) - included samples with hypernasality and with glottal stop (n=41)., Results: Analysis of variance (ANOVA) revealed significant difference nasalance scores which were significantly higher for G2, G3, and G4 (p<0.0001) when compared to G1. The use of pharyngeal fricative (G3), particularly during /f/ (p=0.0018) and /s/ (p=0.0017) productions resulted in nasalance scores significantly higher than scores found for G2., Conclusion: Significantly higher nasalance values where identified during use of pharyngeal fricative.