Ocorrência de condições psiquiátricas, uso de psicotrópicos e sua relação com o equilíbrio postural em sujeitos com tontura / Occurrence of psychiatric conditions, use of psychotropic medications and its relationship with postural balance in subjects with dizziness

RESUMO Objetivo analisar a ocorrência do diagnóstico psiquiátrico e o uso de psicotrópicos em sujeitos com queixas vestibulares e relacionar a presença dessas condições aos resultados da vestibulometria. Método estudo quantitativo, observacional, transversal, com 131 pacientes, atendidos em um hospital universitário. Foram submetidos à anamnese, inspeção visual do meato acústico externo, provas de equilíbrio estático e dinâmico, Posturografia dinâmica foam laser e vectoeletronistagmografia computadorizada. Resultados amostra composta por 109 mulheres e 22 homens, com média de idade de 55 anos e nove meses. O tipo de tontura mais frequente foi vertigem, com presença de sintomas neurovegetativos. Observou-se expressiva porcentagem de queixa/diagnóstico psiquiátrico, bem como uso de psicotrópicos, sendo principalmente inibidores seletivos da recaptação da serotonina, seguidos dos benzodiazepínicos. Houve relação entre a presença de condições psiquiátricas e mulheres, alterações do equilíbrio estático e alterações nas posições III e VI do Teste de Organização Sensorial. Na vectoeletronistagmografia, houve relação entre a idade e a presença de nistagmo espontâneo de olhos fechados. Conclusão Constatou-se alta ocorrência de condições psiquiátricas entre pacientes com tontura, com uso de psicotrópicos maior que na população geral. Destaca-se a associação entre ansiedade/depressão e alterações nas posições de sobrecarga visual da posturografia dinâmica foam laser. No entanto, não foi observada relação entre essas condições e alterações nas provas da vectoeletronistagmografia.

ABSTRACT Purpose to analyze the occurrence of psychiatric diagnosis and the use of psychotropics medications in subjects with vestibular complaints and to relate the presence of these conditions to the results of vestibulometry. Methods quantitative, observational, cross-sectional study with 131 patients, treated in a university hospital. They were submitted to anamnesis, visual inspection of the external ear canal, static and dynamic balance tests, Foam laser dynamic posturography and Computerized Vectoelectronystagmography. Results sample composed of 109 women and 22 men, with average age of 55 years and nine months. The most common type of dizziness was vertigo, with the presence of neurovegetative signals. A significant percentage of psychiatric complaint/diagnosis was observed, as well as the use of psychotropic medications, mainly serotonin uptake inhibitors, followed by benzodiazepines. There was a relation between the presence of psychiatric complaints with the female gender, alterations of the static balance and alterations in the Sensorial Organization Test positions III and VI. In the Vectoelectronystagmography, there was a relation between age and the presence of spontaneous nystagmus. Conclusion There was a high occurrence of psychiatric complaint/diagnosis among patients with dizziness, with use of psychotropic medications substantially greater than the general population. The evaluation of postural balance revealed an association between anxiety/depression and alterations visual overload positions in the foam laser dynamic posturography. However, no relationship was found between these conditions and alterations in the Vectoelectronystagmography tests.

Resultados a 10 años en trasplantes renales con donantes vivos no relacionados: Experiencia de 22 años / Survival among renal allograft recipients from non related living donors

Background: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). Aim: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. Material and Methods: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. Results: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. Conclusions: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.

Cleansing the world of the germ of laziness: hygiene, sanitation, and the Javanese population in Suriname / Limpando o mundo do germe da preguiça: higiene, saneamento e população javanesa no Suriname

In 1915 the Rockefeller Foundation took its hookworm eradication campaign to Suriname, but was soon disappointed because of opposition from its main target group: the Javanese. Moreover, authorities and planters objected to the construction of latrines because of the costs and their belief that the Javanese were “unhygienic”. In describing the labor migration from Java to Suriname, I show that this “lack of hygiene” was closely related to the system’s organization. I argue that uncleanliness was the consequence of harmful socio-economic and ecological conditions. Secondly I suggest that even though the Foundation did not manage to cleanse Suriname of hookworm, its educational efforts, its emphasis on prevention, and its training of local health workers probably had more impact than Rockefeller officials thought.

Em 1915, a Fundação Rockefeller levou sua campanha de erradicação da ancilostomíase ao Suriname, logo sofrendo a oposição de seu principal alvo, os javaneses. Autoridades e proprietários rurais também reagiram à instalação de latrinas devido aos custos implicados e à crença de que os javaneses eram “anti-higiênicos”. Ao descrever a migração de trabalhadores de Java para o Suriname, mostro que a “falta de higiene” ligava-se à organização do sistema. Argumento que a sujeira era consequência de condições ecológicas e socioeconômicas danosas. Sugiro ainda que, embora a Fundação não tenha livrado o Suriname da anciolostomíase, seus esforços educacionais, sua ênfase na prevenção e o treinamento de profissionais de saúde locais tiveram maior impacto do que o imaginado pelos funcionários da agência norte-americana.

Estudo da ototoxicidade em trabalhadores expostos a organofosforados / Ototoxicity study in workers exposed to organophosphate

A exposição ocupacional e ambiental aos agrotóxicos evidencia-se como um grave problema de Saúde Pública em nosso país. Entre os sintomas apresentados, a tonteira se destaca, em decorrência de uma provável ação tóxica. OBJETIVO: O objetivo do estudo é caracterizar os resultados do exame vestibular de trabalhadores rurais expostos ocupacionalmente e ambientalmente aos agrotóxicos organofosforados. MATERIAL E MÉTODO: Foi realizado um estudo de coorte com corte transversal em 18 trabalhadores rurais de Teresópolis, RJ. A faixa etária variou de 16 a 59 anos com uma média de 39,6 anos, sendo 5 trabalhadores do sexo masculino e 13 do sexo feminino. Foram utilizados três questionários com perguntas relacionadas à saúde geral e auditiva e perguntas específicas à tonteira e suas relações com o trabalho. Todos os trabalhadores passaram por uma avaliação clínica e realizaram os exames vectoeletronistagmografia e audiometria. RESULTADOS: Os resultados mostraram que 16 trabalhadores apresentaram alterações do equilíbrio corporal de tipo periférico irritativo e 7 trabalhadores apresentaram perdas auditivas do tipo neurossensorial, sugerindo que os agrotóxicos induzem alterações do sistema vestibular através de uma intoxicação lenta e silenciosa. CONCLUSÕES: O olhar clínico sobre esta população exposta a substâncias neuro-ototóxicas requer uma abordagem interdisciplinar, assegurando uma intervenção terapêutica e preventiva eficaz.

Occupational and environmental exposure to agricultural pesticides represent an important health care problem in our country. Among the symptoms presented, dizziness stands out, because of a probable toxic action. AIM: The goal of our study was to characterize vestibular test results from rural workers occupationally and environmentally exposed to organophosphates used in agricultural pesticides. MATERIALS AND METHODS: We carried out a cohort cross-sectional study with 18 rural workers from Teresópolis, RJ. Age ranged between 16 and 59 years, with a mean value of 39.6 years, 5 were males and 13 females. We used three questionnaires with questions associated with general and auditory health, and more specific questions about dizziness and its association with work. All workers underwent clinical evaluation, audiometry and vectoelectronystagmography. RESULTS: results showed that 16 workers had irritative peripheral body balance disorder and 7 workers had sensorineural hearing loss, thus suggesting that agricultural pesticides cause vestibular alterations through a slow and silent intoxication. CONCLUSIONS: medical care for this population exposed to neurotoxic substances require an interdisciplinary approach, to guarantee efficient preventive and therapeutic measures.

Effects of industrial solvents on hearing and balance: a review.

Industrial hearing loss has generally been associated with noise exposure, but there is a growing awareness that industrial solvents can have an adverse effect on the auditory and vestibular systems in man. Both animal experiments and human studies point to an ototoxic effect of industrial solvents, as well as some central auditory and vestibular disturbances. This review examines the research from the last four decades in an attempt to get an overview of the available evidence. Research shows that industrial solvents are ototoxic in rats. The majority of the solvents studied cause a loss of auditory sensitivity in the mid-frequencies in rats, affecting outer hair cells in the order OHC 3 > OHC 2 > OHC 1 . Inner hair cells are generally unaffected. Spiral ganglion cells are most vulnerable to trichloroethylene. Simultaneous exposure to solvents and noise results in a synergistic effect; the pattern of trauma mirrors that due to solvent exposure rather than noise, but is more enhanced. There is a critical level when synergy occurs. The effects of solvents on the vestibular system are neurotoxic and influence the vestibulo-oculomotor system in both animals and humans; humans also present with problems in postural sway. There is a strong suggestion from human studies that solvents are ototoxic in man, but findings show that both the peripheral and central auditory pathways can be affected. Hearing losses can be in the high frequency region or can affect a wider range of frequencies. Hearing loss and balance disturbances can occur at levels below permitted levels of exposure. The synergistic effect of combined exposure to solvents and noise has also been noted in humans, resulting in greater hearing losses than would be expected from exposure to noise and solvents alone. The findings from both human and animal studies indicate that exposure to industrial solvents or to industrial solvents and noise can have an adverse effect on hearing and balance. The implications for industry and hearing conservation are far reaching.

Niveles de plomo en sangre en niños de 8 a 10 años y su relación con la alteración en el sistema visomotor y del equilibrio / Relationship of blood lead levels with visual-motor and equilibrium disturbances in children aged 8 to 10 years

Objetivo. Identificar si existe una asociación negativa entre los niveles de plomo en sangre y la coordinación visomotora y el equilibrio de escolares. Material y métodos. Se realizó un estudio transversal en 255 niños de 8 a 10 años de edad, que asistían a escuelas del Sector 1 del Instituto de Educación Pública del Estado de Oaxaca, durante noviembre y diciembre de 1998. Se aplicaron pruebas de evaluación de percepción visual de Frostig y la subescala de equilibrio Frostig Movement Skills Test Battery y se les tomó una muestra de sangre para determinación de plomo por medio de espectrometría de absorción atómica. Asimismo, se aplicó un cuestionario sociodemográfico se evaluó la historia de salud del niño. Se relacionó el nivel de plomo sanguíneo con los resultados de las pruebas de percepción visual y del equilibrio mediante modelos de regresión múltiple. Se usó la técnica de simulaciones de Montecarlo para probar el efecto de plomo dentro del modelo. Resultados. La media geométrica de las concentraciones de plomo en sangre fue de 11.5 µg/dl (DE geométrica= +6.3, -5.2). El nivel de plomo se relacionó significativamente con el cociente de integración visomotora (p>0.042). Este disminuye 1.78 (IC 95 por ciento -3.51, -0.06) puntos por cada incremento de 10 µg/dl en los niveles de plomo en sangre del niño. De las pruebas que constituyeron este cociente, sólo se relacionó significativamente el plomo con la de coordinación ojo-mano (p=0.045) y de relaciones espaciales (p=0.039). El ingreso familiar también se relacionó significativamente con el cociente de integración visomotora, a mayor ingreso los resultados en las pruebas del niño fueron más altos. Sólo 3.1 por ciento de los niños obtuvieron puntuaciones consideradas clínicamente anormales. No se encontró una relación significativa entre el plomo y el cociente de la respuesta motriz reducida, el cociente de percepción visual general y las pruebas de equilibrio. Conclusiones. La relación negativa entre plomo y la habilidad visomotora concuerda con los resultados encontrados en niños en otros países. Al parecer las concentraciones de plomo en sangre, que son comunes en los niños de Oaxaca, son suficientes para ocasionar una limitación visomotora de naturaleza sutil. Los resultados de este estudio señalan la necesidad de reforzar la iniciativa de reducir la exposición de niños a fuentes de exposición conocidas, en especial barro vidriado y, por lo tanto, reducir niveles poblacionales de plomo en sangre.

An observational study on neurobehavioural effects of acute oxydemeton-methyl (insecticide and acaricide) exposure in rats.

Oxydemeton-methyl, an organophosphate insecticide and acaricide produced decrease in the exploratory behaviour and prolongation of barbitone sodium-induced hypnosis after intermittent aerosol spray inhalational exposure for 1 h in rats compared to the saline control group. Further, CD50 +/- S.E.M. value for pentylenetetrazole (PTZ) and CI50 +/- S.E.M. value for electroshock (i.e. the dose of PTZ and intensity of electroshock producing positive seizure response in 50% of rats) were significantly decreased by acute exposure to oxydemeton-methyl compared to that of saline control group. The study has established the central nervous system depressant effect and proconvulsant potential of oxydemeton-methyl which is widely used by the agricultural workers in the form of field spray.

Cyclodiene insecticides-induced changes in the central depressive effect of chlorpromazine in rats.

Spontaneous motor activity (SMA), conditioned avoidance response (CAR), muscle coordination (MC) and pentobarbital sleep were tested in rats treated orally for 90 days with tolerated doses of the cyclodiene insecticides, aldrin (1 mg/kg) and endosulfan (2 mg/kg). The same tests were repeated in similarly treated animals after injecting chlorpromazine (4 mg/kg, i.p.). Both the insecticides shortened pentobarbital sleeping time indicating their microsomal enzyme inducing property. Aldrin suppressed SMA, CAR and MC, whereas endosulfan stimulated SMA, inhibited CAR and unaltered MC. However, their concurrent action with CPZ did not result in change in the central depressive effects of the latter, but its potency during the course of its action was altered. Its potency 15 min after injection was greater and 60-180 min later was lesser in these animals than that observed in control animals. This finding was interpreted to suggest that aldrin and endosulfan has quickened the biotransformation of CPZ and thereby shortened its duration of action. A temporary promotion of its potency was accounted to its active metabolites, since prior to inactivation, CPZ is known to be metabolized by the microsomal enzymes to active compounds.

Abordagem atual do paciente com tontura ou vertigem / Modern aproach in the management of patients with dizziness and vertigo

O diagnostico preciso dos pacientes com tontura ou vertigem pode permitir a melhor alternativa do tratamento: tratar a causa sempre que possivel. Portanto, e necessaria uma adequada investigacao clinica. O paciente deve ser submetido a um protocolo racional e progressivo que evite custos exagerados e injustificaveis. Apresentamos um protocolo que atua em seis niveis distintos. Todos sao examinados nos primeiros tres niveis: no nivel 1 sao descartadas alteracoes cardiovasculares; no nivel 2 sao descartadas alteracoes numerologicas (exame otoneurologico) e no nivel 3 avalia-se o nistagmo sem inibicao visual (com oculos de Frenzel). De acordo com o caso sao tambem examinados nos niveis seguintes. No nivel 4 sao feitos exames complementares basicos, como testes audiometricos, exames sanguineos, radiografias de coluna cervical. No nivel 5 sao feitos exames em laboratorio vestibular, como eletronistagmografia, craniocorpografia e posturografia. No nivel 6 estao os exames complementares especiais, como os potenciais evocados auditivos, tomografia computadorizada, imagem de ressonancia magnetica e doppler transcraniano e carotideo. E enfatizado o diagnostico diferencial para sindromes vestibulares perifericas e centrais, e as alternativas existentes de tratamento sintomatico

Nistagmo espontáneo y posicional por efecto de la intoxicación aguda por drogas y sustancias químicas en humanos / Spontaneous and positional nystagmus due to acute intoxication by drugs and chemical substances in human

Se realizó una intoxicación experimental en 70 personas jóvenes normales que produjo vértigo o desequilibrio. Se estudiaron dos parámetros: el nistagmo espontáneo y el posicional. Las drogas que se experimentaron fueron de uso común mientras que otras se usan por prescripción terapéutica. Estas drogas actúan sobre la homeostasis del sentido del equilibrio sea por efecto inhibitorio o exitatorio en diferentes niveles del sistema nervioso central. Las sustancias estudiadas fueron: alcohol, ketamina, pentobarbital, nicotina, xileno, etambutol, tricloroetileno, fentanil y droperidol. Todas las drogas, con excepción de la ketamina, produjeron nistagmo espontáneo y porsicional, en algunas personas contra la gravedad y en las otras a favor de ella. La información obtenida lo conduce a uno a predecir cuán mal se sentirá una persona después del uso de drogas como las fenotiazinas, dependiendo del nivel del sistema nervioso que es afectado o cuán bien se sentirá usando un agonista del GABA o un antagonista de acetilcolina, dependiendo del tipo del nistagmo espontáneo o posicional que afecte al paciente en el momento de usar alguna de estas drogas

Recovery of equilibrium after intratympanal gentamicin in Menière's disease

A manutençäo do equilíbrio é baseada na visäo, impulsos vestibulares, na propriocepçäo e na sensaçäo de pressäo dos pés. Após uma lesäo vestibular unilateral, a compensaçäo vestibular depende das informaçöes de todos esses órgäos. É importante que os exercícios de reabilitaçäo vestibular comecem o mais rápido possível e tenham uma certa intensidade. Os efeitos do treino podem ser avaliados através da história clínica, da eletronistagmografia e posturografia dinâmica, mas mesmo a observaçäo com lentes de Frenzel e observaçöes clínicas do teste de Romberg e Unterberger säo de algum valor. Se há pertubaçäo na percepçäo ou na coordenaçäo central dos órgäos, como o cerebelo, a compensaçäo vestibular näo poderá ser totalmente perfeita. A compensaçäo vestibular observada em um caso e em um grupo de pacientes com doença de Menière incapacitante tratados com gentamicina intratimpânica será sinteticamente delineada

Behavioural and biochemical changes produced by repeated oral administration of the insecticide endosulfan in immature rats.

In order to study the response of rats to repeated administration of the insecticide, endosulfan during the period of growth to maturity, food intake, body weight gain, Spontaneous Motor Activity (SMA) and Muscle Coordination (MC) were determined at regular intervals in male immature Wistar rats treated with a tolerated dose of (2 mg/kg/day) orally for 90 days. Twenty-four h after the termination of the treatment, organ weight and protein concentrations were determined. The convulsive action of picrotoxin (4 mg/kg, ip) was tested in another endosulfan-treated group. Food consumption and body weight gain decreased parallely. No changes occurred in the body tissues but for liver which was enlarged and its protein, glutamic oxaloacetic transminase and glutamic pyruvic transaminase concentrations increased. The MC was unaffected. A stimulation of SMA occurred several days (75-90) after commencing treatment and these animals responded greatly than control animals to the convulsive action of picrotoxin. These findings indicated that although endosulfan produced anorexia, there were no signs of undernourishment and motor impairment in these animals. Its toxic action were confined chiefly to the liver and central nervous system.

A comparative study of the driving effects of dextroamphetamine and yogic meditation on muscle control for the performance of balance on balance board.

The work is aimed to compare the relative strength of dextroamphetamine and yogic meditation on the performance of 3 different groups of medical students to concentrate on the task to balance on a balance board. Group A subjects were mediators, group B subjects were given orally 5 and 10 mg of dextroamphetamine in a capsule, 1 hr prior to the test. Group C subjects were given same capsule but with lactose in place of the drug (placebo). This last groups served as control for the study. The balance index calculated taking into account their balance time and error score at each trial of 5 min duration showed that the performance of the group B (drug) had declined with overall percentile fall of 40.6% as compared to the performance of the controls (placebo) whereas, the performance of Group A (meditators) went on steadily and progressively increasing throughout the period of 10 trial days with overall percentile rise of 27.8%. The results were conclusive to confirm earlier reports that amphetamine is not of use for improvement of task rather, it deteriorates the task performance. Contrary to that, yogic meditation is of merit to achieve concentration for mental as well as physical task.

Drogas atotóxicas / Ototoxic drugs

Os autores apresentam um levantamento sobre drogas ototóxicas. Relatam quatro casos de lesäo vestibular causada pelo uso de Gentamicina. Discutem a duraçäo dos sintomas e a demora do desaparecimento completo dos mesmos, concluindo que o comprometimento vestibular näo depende somente da dose e do tempo de administraçäo da droga, que o prognóstico näo deve ser sempre otimista em pessoas de idade avançada, que a funçäo renal deve ser sempre observada, que no caso dos medicamentos empregados, a lesäo vestibular näo se acompanha de lesäo auditiva e que o início dos sintomas pode ocorrer dias após cessada a medicaçäo. Finalmente, comentam diversas drogas e a sua açäo no sistema vestibular

Neuropharmacological actions of some newly synthesized Mannich bases.

Benzamido (alkyl) methyl pyrrolidine Mannich bases were synthetized and subjected to certain neuropharmacological studies. All the bases reduced the pentobarbitone sleeping time and rota-rod grip of rats. The Mannich bases II, III and V raised the minimal electro-shock seizure threshold of rats. The TAB-induced pyrexia was not reduced by the bases I and III in rabbits. None of the bases showed any significant analgesic activity.