Tinnitus emerging in the context of a COVID-19 infection seems not to differ in its characteristics from tinnitus unrelated to COVID-19.

Background and aim: COVID-19 is a respiratory disease caused by the new coronavirus SARS-CoV-2, for which the first cases were reported in China, by December 2019. The spectrum of clinical presentations is wide, ranging from asymptomatic cases to a severe acute respiratory syndrome, sometimes with multiple systems involvement. Viral infections, including those related to respiratory virus, may cause hearing loss and, by extent, considering its pathophysiology, tinnitus. A systematic review on inner ear related symptoms in patients with COVID-19 reported 4.5% occurrence rate of tinnitus, with high variance of prevalence between the studies. Our aim is to further explore the relationship between COVID-19 and tinnitus. For this purpose we analyzed a sample of people who had suffered from a COVID-19 infection in the city of Volta Redonda, Brazil. In detail, we compared those with new onset tinnitus during or after the COVID-19 infection with those without tinnitus and those with tinnitus onset before the COVID-19 infection. Methods: Fifty-seven patients over 18 years old and previously diagnosed with COVID-19 confirmed by a RT-PCR test were included. Patients were subdivided in three groups: no tinnitus (NT), tinnitus that already existed before COVID-19 (chronic tinnitus, CT) and tinnitus that arose during or after COVID-19 (post-COVID-19 tinnitus, PCT). Data concerning COVID-19 symptoms, drugs prescribed for COVID-19, tinnitus characteristics, comorbidities and other otological symptoms were collected. For all the patients, tonal audiometry and otoacoustic emissions were performed. Tinnitus patients fulfilled the Tinnitus Handicap Inventory (THI) and visual-analog scales (VAS) for loudness and distress. Patients with CT answered a simple question about the worsening of their tinnitus after COVID-19. Results: PCT was reported by 19.3% of the patients, while 22.8% reported CT. No statistical difference was found between CT and PCT concerning hearing function, tinnitus characteristics and tinnitus distress. There was also no statistically significant difference between PCT and NT with respect to COVID-19 symptoms and pharmacological COVID-19 treatment. Patients with CT reported worsening of their tinnitus after COVID-19. Conclusion: As with other viral infections, inner ear symptoms may be associated with COVID-19. In our sample patients with tinnitus onset before COVID-19 and those with tinnitus onset during or after COVID-19 did not differ significantly in their clinical characteristics and their hearing function, suggesting that tinnitus occurring in the context of a COVID-19 infection is not related to a unique pathophysiological mechanism. The comparison of COVID-19 patients, who developed tinnitus with those who did not develop tinnitus did not reveal any differences in COVID-19 symptoms or COVID-19 treatment. Thus, there was no hint, that a specific expression of COVID-19 is closely related to post COVID-19 tinnitus onset. Although some drugs used to treat tinnitus are known to damage the inner ear cells (especially hydroxychloroquine), we did not see any relationship between the intake of these drugs and tinnitus onset, eventually due to the short prescription time and low doses. Among those patients who had tinnitus before COVID-19 30,8% reported worsening after COVID-19. Overall, tinnitus emerging in the context of a COVID-19 infection seems not to differ from tinnitus unrelated to COVID-19. For further exploring the relationship of tinnitus and COVID-19, large population based studies are warranted.

Contribution for the phytochemical studies of Ageratum fastigiatum

Organic extracts from leaves plus branches plus inflorescences of Ageratum fastigiatum (Gardner) R. M. King & H. Rob., Asteraceae, were fractionated through classic chromatography. The steroids stigmasterol, chondrillasterol and campesterol were isolated from hexane extract. The triterpenes lupeol, taraxasterol, α-amyrin, β-amyrin, pseudotaraxasterol, lupeol acetate and α-amyrin acetate were isolated from ethyl acetate extract. Steroids and triterpenes were identified by GC-MS. The coumarin ayapin was isolated from ethanol extract and identified by NMR. Essential oils of the fresh leaves and fresh inflorescences were obtained by hydrodistillation and analyzed for GC-MS. The main components in both essential oils were α-pinene, limonene and germacrene D.

Double shunt technique for hybrid palliation of hypoplastic left heart syndrome: a case report.

We report a technique to palliate hypoplastic left heart syndrome, with no PDA stenting, but with double polytetrafluoroethylene shunt from pulmonary artery to ascending and descending aorta by combined thoracotomies. A 30-day-old female was operated with this technique. Five months after first operation, the child was submitted to Norwood/Glenn operation. Good hemodinamic recovery and initial clinical evolution was observed. The child was extubated in 8th post operatory day and reentubated in the next day due to pulmonary infection. Despite antibiotic treatment, the child died after systemic infectious complications.

Acoustic analysis of prosody in Sydenham's chorea.

There are few studies of language and speech in patients with Sydenham's chorea (SC). We have done an acoustic analysis of fundamental frequency (F0), duration and intensity of declarative and interrogative sentences made by 20 SC patients, 20 patients with rheumatic fever (RF) without chorea, and compared them with 20 healthy age-matched controls (CO). Each group included 12 females. We found that there is no difference between the RF and CO groups in all studied parameters. Patients with SC, however, presented with a speech characterized by decreased F0 range (difference between minimum and maximum F0), shorter duration of sentences, and higher intensity of the first syllable of sentences. The findings were not influenced by the nature of the sentences (i.e. , declarative or interrogative), but for all variables they were significantly more severe in males than females. In conclusion, we have demonstrated that patients with acute SC have an impairment of modulation of F0 and longer duration of emission of sentences, resulting in a monotone and slow speech. This pattern is similar to what has been described in other basal ganglia illnesses, such as Parkinson's disease, Huntington's disease and Wilson's disease.

Acoustic analysis of prosody in Sydenham's chorea / Análise acústica da prosódia em coréia de Sydenham

There are few studies of language and speech in patients with Sydenham's chorea (SC). We have done an acoustic analysis of fundamental frequency (F0), duration and intensity of declarative and interrogative sentences made by 20 SC patients, 20 patients with rheumatic fever (RF) without chorea, and compared them with 20 healthy age-matched controls (CO). Each group included 12 females. We found that there is no difference between the RF and CO groups in all studied parameters. Patients with SC, however, presented with a speech characterized by decreased F0 range (difference between minimum and maximum F0), shorter duration of sentences, and higher intensity of the first syllable of sentences. The findings were not influenced by the nature of the sentences (i.e. , declarative or interrogative), but for all variables they were significantly more severe in males than females. In conclusion, we have demonstrated that patients with acute SC have an impairment of modulation of F0 and longer duration of emission of sentences, resulting in a monotone and slow speech. This pattern is similar to what has been described in other basal ganglia illnesses, such as Parkinson's disease, Huntington's disease and Wilson's disease.

Há poucos estudos sobre linguagem e fala em pacientes com coréia de Sydenham (CS). Fizemos uma análise acústica da freqüência fundamental (F0), duração e intensidade de sentenças declarativas e interrogativas feitas por 20 pacientes com CS, 20 pacientes com febre reumática (FR) sem coréia, comparando-os com 20 controles saudáveis e pareados por idade (CO). Cada grupo incluiu 12 mulheres. Foi encontrado que não há diferença entre os grupos FR e CO quanto a todos parâmetros estudados. Pacientes com CS, contudo, apresentaram-se com fala caracterizada pela redução da variação de F0 (diferença entre F0 mínima e máxima), duração mais curta das sentenças e maior intensidade da primeira sílaba das sentenças. Os achados não foram influenciados pela natureza das sentenças (i.e. , declarativas ou interrogativas), mas os achados foram mais evidentes em todas as variáveis em homens em contraste com mulheres. Em conclusão, demonstramos que pacientes com CS aguda têm prejuízo da modulação da F0 e duração mais longa da emissão de sentenças, resultando em fala mais lenta e monótona. Esse padrão é semelhante ao que tem sido descrito em outras fecções dos núcleos da base, tais como doença de Parkinson, doença de Huntington e doença de Wilson.

Insuficiência renal aguda no pós-operatório de cirurgia cardíaca / Acute renal failure following cardiac surgery

A insuficiência renal aguda (IRA) no pós-operatório de cirurgia cardíaca é causa de maior morbidade e mortalidade. A disfunção renal caracterizada peloaumento da creatinina sérica determina maior número de complicações operatórias e diminuição da sobrevida. Fatores de risco genéticos no pré-operatórioforam determinados, contudo a influência dos fatores de risco intra-operatórios, a circulação extracorpórea e suas variáveis também devem serconsideradas. A cirurgia de revascularização do miocárdio sem circulação extracorpórea tem sido utilizada por diminuir a morbidade. Os fatoresrelacionados à circulação extracorpórea devem ser monitorados no intra-operatório para diminuir o risco de IRA em cirurgia cardíaca. O objetivo destarevisão é avaliar os diferentes fatores de risco para desenvolver IRA no pós-operatório de cirurgia cardíaca, com enfâse naqueles relacionados à circulaçãoextracorpórea.

Acute renal failure after cardiovascular surgery is a risk factor for morbidity and mortality. An increase in serum creatinine is related to kidney dysfunctionwhich determines augmentation of post operative complications and affects long term-survival. Genetic and pre-operative risk factors have been identified,however, cardiopulmonary bypass and its variables might be considered. Myocardial revascularization without cardiopulmonary bypass is being used toattenuate morbidity. Variables related to cardiopulmonary bypass are easily monitored in the operating room and might be treated to attenuate kidneydysfunction. The objective of this review is to evaluate risk factors, especially those related to cardiopulmonary bypass.

Cutaneous amyloidosis associated with primary biliary cirrhosis.

Primary cutaneous amyloidosis is defined as the deposition of amyloid in the skin in the absence of systemic involvement. The association between primary cutaneous amyloidosis and other diseases, although rare, has been documented for connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis. We report the case of a 41-year-old woman who developed primary biliary cirrhosis in association with primary cutaneous amyloidosis. This association has not been reported before in the literature.

Diterpenoids from the aerial parts of Plectranthus ornatus.

Phytochemical investigation of a hexane extract of the aerial parts of Plectranthus ornatus yielded three new neoclerodane diterpenoids (1-3), two labdane diterpenes (4 and 5) obtained for the first time as natural products, and several previously known substances. The structures and relative stereochemistry of 1-5 were established mainly on the basis of NMR spectroscopic studies and by comparison with related compounds.

Manifestaçöes estra-hepáticas do virus da hepatite C - Parte 1 e 2 / Extrahepatic manifestations of hepatitis C vurus

Após a identificação do vírus da hepatite C (HCV), em 1989, diversos estudos vêm demonstrando a "relação" deste agente viral com desordens imunológicas e manifestações, tidas como extra-hepáticas, tornando-se a mais relevante a crioglobulinemia mista. O presente trabalho visa rever estas manifestações do HCV, analisando os dados publicados, citando exemplos pertinentes e resultados de atividades desenvolvidas no ambulatório de Hepatites da Disciplina de Gastroenterologia da Escola Paulista de Medicina (EPM) - UNIFESP. Serão discutidas amplamente as manifestações bem conhecidas e melhor definidas, tais como a indução de auto-anticorpos (antinúcleo e antimúsculo liso), a crioglubulinemia mista (tipos II e III), o linfoma não-Hodgkin (células B), a glomerulonefrite (membranoproliferativa), a porfiria cutânea tarda e o líquen plano. As manifestações menos freqüentes ou mais polêmicas, tidas ainda com supostas, entre as quais se incluem o diabetes mellitus (tipo 2), a tireoidite (Hashimoto), a sialoadenite a fibrose pulmonar, entre outras, também serão abordadas. Em virtude da grande quantidade de artigos levantados, como conseqüência provavelmente da controvérsia de seus resultados, esta revisão, para fins de publicação, será dividida em duas partes.