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1.
Codas ; 32(6): e20180246, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33206770

RESUMO

PURPOSE: to analyze the postural balance of independent elderly women and their relation with aspects of health, ages and quality of life. METHODS: a total of 44 independent elderly women, classified according to the scales: Index of Independence in Daily Life Activities (DLA) and Instrumental Activities of Daily Life (IADL), aged 70.5 years (+6.64), submitted to the Foam-Laser Dynamic Posturography were used to evaluate the vestibular, proprioceptive and visual functions; the Dizziness Handicap Inventory (DHI) questionnaire on subjects with dizziness and the WHOQOL-Bref quality of life questionnaire. RESULTS: the tests showed a significant difference between the changes in the posturographic evaluation and health aspects such as dizziness complaint (p = 0.02), metabolic diseases (p = 0.04), cardiovascular diseases (p = 0.02) and with the use of continuous medication (p = 0.03), self-reported. The older women presented lower scores in the functional domain of the DHI (p=0.02), showing a lower handicap in activities of daily living and the longer the quality of life in the WHOQOL-Bref psychological domain (p=0.04). CONCLUSION: the presence of dizziness and systemic diseases had a negative impact on postural balance and on the quality of life of the elderly women.


Assuntos
Atividades Cotidianas , Doenças Vestibulares , Idoso , Tontura , Feminino , Humanos , Equilíbrio Postural , Qualidade de Vida , Inquéritos e Questionários , Vertigem
2.
Codas ; 32(5): e20190183, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33174988

RESUMO

The Vogt-Koyanagi-Harada syndrome (VKHS) is a rare, multisystemic and autoimmune disease. The syndrome mainly affects the eyes, followed by bilateral chronic panuveitis, however, the syndrome may also affect the melanocytes tissues, for example, the eyes, inner ear, meninges and skin. The syndrome origin mechanism is not yet completely known. Commonly, the specific ethnic groups that are affected by the VKHS are as follows: Hispanics, Asians, Indians, Native Americans and ethnic groups from the Middle East. The audiological characteristics of the syndrome and the possible audiologist interventions for a specific case will be reported. The patient was attended at the Clinic of Speech Therapy, Faculdade de Odontologia de Bauru (FOB). She is 53 years old and presented audiological complaints. She was diagnosed with VKHS by a specialist doctor. Throughout the audiologist assessment, she presented bilateral sensorineural hearing loss, absent otoacoustic evoked emissions, complaints about postural vertigo and acute tinnitus. The specific case reported presented sudden sensorineural hearing loss, vertigo, tinnitus and bilateral ocular disease. Even though drug treatment was performed, the hearing loss remained. Therefore, before the hearing aid (HA) fitting, the audiologist should perform the hearing management, investigate if the patient takes the drug treatment and the occurrence of suggestive symptoms of the syndrome. These are some points that help in the reference to the specialist doctor and the audiologist strongly participates in what concerns the hearing.


Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva , Zumbido , Síndrome Uveomeningoencefálica , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Pessoa de Meia-Idade , Síndrome Uveomeningoencefálica/complicações , Síndrome Uveomeningoencefálica/diagnóstico , Vertigem
3.
Artigo em Chinês | MEDLINE | ID: mdl-33040507

RESUMO

Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Tontura , Feminino , Cefaleia , Humanos , Masculino , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Vertigem/diagnóstico
4.
Ideggyogy Sz ; 73(9-10): 354-360, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33035412

RESUMO

Background and purpose: Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose - Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. Methods: A 56-year-old male patient's interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. Results: During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion - It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the "seed and soil" theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Conclusion: Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma de Células em Anel de Sinete/secundário , Carcinomatose Meníngea/secundário , Neoplasias Gástricas/secundário , Osso Temporal/patologia , Vertigem/etiologia , Carcinoma de Células em Anel de Sinete/patologia , Transição Epitelial-Mesenquimal , Humanos , Metástase Linfática/patologia , Masculino , Carcinomatose Meníngea/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/patologia
5.
Int J Nanomedicine ; 15: 6211-6223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32904111

RESUMO

Introduction and Aim: Cinnarizine is indicated orally for treating vertigo associated with Ménière's syndrome and has a local anesthetic effect as well. The present study aims to develop an aural Cinnarizine mucoadhesive transfersomal gel to overcome the first-pass metabolism. Methods: Eighteen Cinnarizine transfersomes were prepared by the thin-film hydration technique using different types of phosphatidylcholine and edge activators in different ratios. Formulae were tested for their appearance, entrapment efficiency, and in-vitro drug release after eight hours. F1, F4, F7, F9, F10, and F12 were selected to be examined for particle size, polydispersity index, and zeta potential. According to the previous parameters, F1 and F10 were incorporated into gels using different polymers according to factorial design 23. The eight gels were tested for appearance, pH, mucoadhesion, spreadability, drug content, in-vitro drug release after eight hours, and rheology. The transfersomal gel F1A was subjected to FTIR analysis and in-vivo pharmacokinetic study. Results: The transfersomal dispersion colors were ranging between the white and yellow. Their EE % ranged from 64.36±1.985% to 94.09±1.74%, and their in-vitro release percentages were between 61.82±1.92% and 95.92±1.18%. Also, the vesicles PS ranged from 212.3±30.05nm to 2150±35.35nm, DI from 0.238±0.134 to 1±0.00 and zeta potential from -57.5±2.54 to +4.73±1.57 mV. The transfersomal gels showed pseudoplastic behavior, pH range of 5.5 to 8, a mucoadhesive force of 169.188±1.26 to 321.212±6.94 (dyne/cm2×102), spreadability of 40 ±7.03mm to 138 ±3.77mm, and in-vitro drug release of 81.63±1.128% to 97.78±0.102%. The IR spectra of the (drug-excipients) physical mixture revealed that there were no shifts of incompatibility. The in-vivo pharmacokinetic study illustrated that [AUC]0-24 of F1A was significantly higher than that of tablets at (P< 0.05), equivalent to 703.563±26.470 and 494.256±9.621ɲg.hr/mL respectively. Conclusion: The study revealed that Cinnarizine aural mucoadhesive targeted delivery provides an improved systemic bioavailability over the conventional oral route.


Assuntos
Cinarizina/administração & dosagem , Cinarizina/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Géis/química , Vertigem/tratamento farmacológico , Administração Cutânea , Animais , Área Sob a Curva , Disponibilidade Biológica , Cinarizina/química , Cor , Liberação Controlada de Fármacos , Orelha Média , Géis/administração & dosagem , Concentração de Íons de Hidrogênio , Tamanho da Partícula , Fosfatidilcolinas/química , Coelhos , Espectroscopia de Infravermelho com Transformada de Fourier
7.
Medicine (Baltimore) ; 99(36): e22052, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899066

RESUMO

Reversible splenial lesion syndrome (RESLES) is a clinico-radiological entity that defines a reversible lesion in the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI). The clinical and radiological characteristics of RESLES are poorly defined and most RESLES literature is in the form of case reports. We reviewed the clinical and radiological data from 11 RESLES patients in order to more clearly describe the characteristics of this disorder in adults.Patients included in this study were diagnosed with RESLES from May 2012 to March 2018. We collected clinical, imaging, and laboratory data of 11 adult patients from Neurology Department of the Affliated Yantai Yuhuangding Hospital of Qingdao University. After analyzing various clinico-radiological features and laboratory parameters, including serum sodium, pathogen testing, cerebrospinal fluid (CSF) studies, electroencephalography (EEG), and MRI findings, we made a diagnosis of RESLES based on the criteria proposed previously by Garcia-Monco et al.Of the 11 patients, 7 (63.63%) were male and 4 (36.36%) were female, ranging in age from 24 to 62 years with an average age of 31.48 ±â€Š11.47 years. Seven cases occurred in the months of winter and spring (December-March). The primary clinical symptoms were headache, seizure, disturbance of consciousness, mental abnormality, and dizziness. All 11 patients had lesions in the SCC and all the lesions disappeared or significantly improved on follow-up imaging that was done within a month of symptom resolution.We found 5 (45.45%) patients had a CSF opening pressure >180 mmH2O, in addition to elevated protein and(or) leukocytes levels in 3 (27.27%) patients. The serum sodium concentration in 6 (54.55%) patients was low (<137 mmol/L) and EEG showed nonspecific slowing in waves 4 (36.36%) patients.When we encounter clinical manifestations such as headache accompanied with mental symptoms, disturbance of consciousness or epilepsy, and brain MRI finds lesions of the corpus callosum, we should consider whether it is RESLES. In order to find out the possible cause of the disease, we should carefully inquire about the history of the disease, complete etiology examination, and CSF tests. Of course, it is one of the necessary conditions for the diagnosis that the lesions in the corpus callosum are obviously relieved or disappeared.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/terapia , Corpo Caloso/patologia , Músculos Paraespinais/diagnóstico por imagem , Adulto , Encefalopatias/sangue , Encefalopatias/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/metabolismo , Líquido Cefalorraquidiano/fisiologia , Pressão do Líquido Cefalorraquidiano , Eletroencefalografia/métodos , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Músculos Paraespinais/patologia , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/etiologia , Sódio/sangue , Síndrome , Resultado do Tratamento , Vertigem/tratamento farmacológico , Vertigem/etiologia
8.
Zhen Ci Yan Jiu ; 45(8): 652-6, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32869576

RESUMO

OBJECTIVE: To observe the short-term and long-term clinical effect on posterior circulation ischemic vertigo treated with "xiao xingnao kaiqiao" acupuncture (minor regaining consciousness and opening orifice) and explore its effect mechanism. METHODS: Ninety patients with posterior circulation ischemic vertigo were randomly divided into a treatment group and a control group, 45 cases in each group. The patients of the two groups were all treated on the base of neurological medicine. In the control group, Flunarizine Hydrochloride was prescribed for oral administration (5 mg, once daily, for 21 days totally). In the treatment group, acupuncture of "xiao xingnao kaiqiao" was provided at Yintang (EX-HN3), bilateral Neiguan (PC6), bilateral Sanyinjiao (SP6), Baihui (GV20), bilateral Fengchi (GB20), bilateral Wangu (GB12) and bilateral Tianzhu (BL10). The needles were retained for 30 min, once daily for 21 days totally. The changes in vertigo score of traditional Chinese medicine (TCM) were observed, and the changes in the mean blood velocity (Vm) of the left vertebral artery (LVA), the right vertebral artery (RVA) and the basilar artery (BA) as well as the vascular pulsatility index (PI) were monitored and determined by transcranial Doppler (TCD). Additionally, the recurrence rate was followed up after 3 months to evaluate the long-term clinical effects. RESULTS: After treatment, the total effective rate of the treatment group was 91.11% (41/45) and 75.56% (34/45) in the control group. The total effective rate in the treatment group was higher than that in the control group (P<0.05). Compared with their own pre-treatment, the vertigo scores of TCM were reduced in either the treatment group or the control group after treatment (P<0.05) and the score in the treatment group was lower than that in the control group (P<0.05). Compared with their own pre-treatment, Vm and PI were all improved after treatment in either group (P < 0.05). After treatment, the improvements in Vm and PI of LVA、RVA and BA in the treatment group were better than those in the control group (P<0.05). In the follow-up after 3 months, the recurrence rate was 19.51% (8/41) in the treatment group and was 50.00% (17/34) in the control group. The recurrence rate in the treatment group was lower than that in the control group (P<0.05). CONCLUSION: "Xiao xingnao kaiqiao" acupuncture obviously relieves the clinical symptoms of posterior circulation ischemic vertigo. The mechanism of acupuncture is potentially related with its effects in improving Vm and PI of LVA,RVA and BA, as well as improving blood supply of brain tissue.


Assuntos
Terapia por Acupuntura , Vertigem/terapia , Artéria Basilar , Humanos , Isquemia/complicações , Resultado do Tratamento , Vertigem/etiologia
9.
Medicine (Baltimore) ; 99(37): e22132, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925764

RESUMO

BACKGROUND: Posterior circulation ischemic vertigo (PCIV) is one of the most complaint symptoms in clinical, and is associated with high risk of recurrence. Current studies show that acupuncture has therapeutic effect on releasing symptom as well as improving the blood flow of posterior circulation. In this review, we aim to assess the efficacy and safety of acupuncture for PCIV. METHODS: Literature of clinical randomized control trials regarding acupuncture for PCIV published before August of 2020 will be searched in databases, including 5 English databases and 4 Chinese databases. For the included studies, methodological quality will be assessed according to Cochrane Risk of Bias Tool, and evidence quality will be evaluated with Grading of Recommendations Assessment, Development and Evaluation guidelines. Data analysis will be performed using Review Manager Software. RESULTS: The primary outcomes involve changes of PCIV symptoms and blood flow velocity of vertebrobasilar. The secondary outcomes include Barthel Index, National Institute of Health Stroke Scale, clinical effectiveness, and adverse reactions. CONCLUSION: Based on current clinical studies, this systematic review and meta-analysis will provide evidence-based basis for the efficacy and safety of acupuncture in treating PCIV. TRIAL REGISTRATION: The protocol for this review has been registered in the INPLASY network (Registration number: INPLASY202070116).


Assuntos
Terapia por Acupuntura , Isquemia Encefálica/terapia , Vertigem/terapia , Isquemia Encefálica/complicações , Humanos , Vertigem/etiologia
10.
PLoS One ; 15(9): e0238436, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877426

RESUMO

Postural control is the ability to maintain equilibrium and orientation in a gravitational environment. Patients with chronic subjective dizziness have some troubles with their postural stability. The present study aimed to assess the benefit of home-based vestibular rehabilitation in patients with chronic subjective dizziness using computerized dynamic posturography. Therefore, 100 subjects, between 19 to 86 years, diagnosed with dizziness were included in the study. Computerized dynamic posturography was performed to assess postural stability. Vestibular rehabilitation programs included exercises tailored to the particular needs of each patient. After vestibular rehabilitation, patients were re-examined using the same tests. Posturographic data were analyzed and compared for before and after vestibular rehabilitation findings. The mean composite scores before the intervention (58,92 ±11,64) was significantly (p<0.01) lower than the mean composite scores after vestibular rehabilitation (73,83 ± 8,26). This result is found to be statistically significant. In conclusion it could be suggested that the effectiveness of vestibular rehabilitation could be verified by means of computerized dynamic posturography as a concrete method.


Assuntos
Tontura/terapia , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/diagnóstico , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Resultado do Tratamento , Vertigem/diagnóstico , Vertigem/terapia , Doenças Vestibulares/patologia , Testes de Função Vestibular/métodos , Núcleos Vestibulares/metabolismo
11.
J Stroke Cerebrovasc Dis ; 29(9): 105043, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807455

RESUMO

BACKGROUND AND PURPOSE: Acute vertigo (sense of motion) can be the sole manifestation of a posterior circulation stroke, and often gets missed in the emergency department (ED). The studies for evaluation of central vertigo have focused on physical exam findings, which require expertise and may not be suitable for rapid triage by a nurse in ED or by paramedics. METHODS: This cross sectional study included retrospective chart review of patients 18 years of age and older who presented to the Adult ED with acute dizziness or vertigo during the calendar year 2017. All the patients with a diagnosis of central or peripheral vertigo were included in the final analysis. Sensitivity, specificity, Likelihood Ratio of positive result (LR (+)) and Likelihood Ratio of negative result (LR (-)) for central and peripheral vertigo were calculated for risk factors, symptoms and physical examination features. Chi-squared test and univariate logistic regression were used to evaluate statistical correlation and to calculate the prevalence odds ratio (POR). RESULTS: Two hundred and forty nine out of 505 (49.3%) patients presenting with dizziness had vertigo. Of these, 14 had central vertigo and 163 had peripheral vertigo. Statistically significant variables were: constant symptoms of vertigo (p 0.000- POR 8.7, 95% confidence interval (CI) 2.3-33.1), no change in symptoms with head movement (p 0.000- POR 10.2, 95% CI 3.0-35.4), dysmetria (p 0.000- POR 56.8, 95% CI 5.8-557.1), and unsteady gait (p 0.000- POR 13.3, 95% CI 3.3-54.3). The sensitivity and specificity to detect central vertigo were 100% and 66.4% respectively if the patient had either unsteady gait, constant symptoms, or no change in symptoms with head movement, [VAIN triad (Vertigo- Ataxia, Incessant, or Non-positional)]. CONCLUSIONS: We suggest that triage with VAIN triad can be used to design prospective studies to develop a triage algorithm for the detection of central vertigo in the ED.


Assuntos
Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência , Acidente Vascular Cerebral/diagnóstico , Vertigem/diagnóstico , Adulto , Idoso , Tomada de Decisão Clínica , Estudos Transversais , Diagnóstico Precoce , Feminino , Marcha , Movimentos da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Triagem , Vertigem/etiologia , Vertigem/fisiopatologia , Vertigem/terapia
12.
Artigo em Chinês | MEDLINE | ID: mdl-32791773

RESUMO

Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.


Assuntos
Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Vertigem/diagnóstico , Vertigem/etiologia , Adolescente , Adulto , Idoso , Encefalopatias/sangue , Encefalopatias/complicações , Encefalopatias/diagnóstico , Encefalopatias/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Nistagmo Patológico/sangue , Nistagmo Patológico/diagnóstico por imagem , Posicionamento do Paciente/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Estudos Retrospectivos , Vertigem/sangue , Vertigem/diagnóstico por imagem
13.
Medicine (Baltimore) ; 99(31): e21405, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756137

RESUMO

BACKGROUND: This systematic review is designed to provide an assessment of the effectiveness and safety of moxibustion therapy for cervical vertigo (CV). METHODS: Relevant randomized controlled trials (RCTs) will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to June 2020. Two authors will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. RevMan V.5.3 software will be used for statistical analysis. RESULTS: The results of this study will provide an assessment of the current state of moxibustion for CV and aim to prove the effectiveness and safety of moxibustion therapy. CONCLUSION: This systematic review will provide a credible Evidence-based for the treatment of CV with moxibustion. STUDY REGISTRATION NUMBER: INPLASY202060004.


Assuntos
Metanálise como Assunto , Moxibustão , Revisões Sistemáticas como Assunto , Vertigem/terapia , Vértebras Cervicais , Humanos
14.
Zhonghua Yi Xue Za Zhi ; 100(32): 2503-2506, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32829596

RESUMO

Objective: To compare the effects of vestibular rehabilitation training and drug therapy on the symptoms of vertigo and disability in patients with vestibular peripheral vertigo. Methods: This prospective study was enrolled 43 patients with vestibular peripheral vertigo who admitted to the outpatient department of Eye & ENT Hospital of Fudan University from January 2018 to December 2018. They were randomly divided into two groups: control group (drug treatment group) and experimental group (drug treatment combined rehabilitation training group). All patients filled in the first vertigo disability rating scale (DHI), specific activity balance confidence scale (ABC) and anxiety self-rating scale (SAS) on the day of treatment and at two, four and eight weeks after treatment intervention, and the data were statistically analyzed. Results: There was no significant difference in gender, age and body weight between the two groups (P>0.05). After treatment (Control group (4w) : DHI (45.5±30.6) , ABC (86.9±12.4) , SAS (37.9±8.2) Experimental group (8w) : DHI (34.8±28.5) , SAS (35.7±7.9) ) , the three scales of the two groups were better than before treatment (Control group: DHI (59.2±25.9) , ABC (79.7±16.7) ,SAS (41.1±6.8) ; Experimental group: DHI (55.2±20.5) , ABC (80.3±18.3) , SAS (41.9±9.1) ) . The comparison of data before and after treatment in each group according to treatment time indicated that DHI and ABC scores in the experimental group showed that the DHI and ABC scores of the experimental group changed significantly at 2 weeks after treatment, and the SAS scores changed at 4 weeks after treatment. The difference was statistically significant (P<0.05). However, there was a statistically significant difference between the control group DHI score 4 weeks after treatment and SAS score 8 weeks after treatment (P<0.05). ABC score did not show statistical difference (P>0.05). Conclusion: The subjective symptoms and anxiety of vertigo and disability in the two groups improved obviously after treatment. Compared with drug therapy alone, drug therapy combined with vestibular rehabilitation training can significantly improve patients' subjective symptoms of vertigo and disability, as well as their anxiety and depression, so as to improve their overall quality of life.


Assuntos
Tontura , Qualidade de Vida , Vertigem , Ansiedade , Humanos , Estudos Prospectivos , Vertigem/terapia
15.
Ideggyogy Sz ; 73(7-08): 241-247, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750240

RESUMO

Background - Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose - The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods - 879 patients were examined at the Semmel-weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results - Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion - The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion - Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.


Assuntos
Tontura/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Qualidade de Vida , Vertigem/diagnóstico , Idoso , Tontura/etiologia , Tontura/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuro-Otologia , Vertigem/etiologia , Vertigem/terapia
16.
Lancet Haematol ; 7(9): e640-e648, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32853584

RESUMO

BACKGROUND: Patients with immune thrombocytopenia are at risk of bleeding during surgery, and intravenous immunoglobulin is commonly used to increase the platelet count. We aimed to establish whether perioperative eltrombopag was non-inferior to intravenous immunoglobulin. METHODS: We did a randomised, open-label trial in eight academic hospitals in Canada. Patients were aged at least 18 years, with primary or secondary immune thrombocytopenia and platelet counts less than 100 × 109 cells per L before major surgery or less than 50 × 109 cells per L before minor surgery. Previous intravenous immunoglobulin within 2 weeks or thrombopoietin receptor agonists within 4 weeks before randomisation were not permitted. Patients were randomly assigned to receive oral daily eltrombopag 50 mg from 21 days preoperatively to postoperative day 7 or intravenous immunoglobulin 1 g/kg or 2 g/kg 7 days before surgery. Eltrombopag dose adjustments were allowed weekly based on platelet counts. The randomisation sequence was generated by a computerised random number generator, concealed and stratified by centre and surgery type (major or minor). The central study statistician was masked to treatment allocation. The primary outcome was achievement of perioperative platelet count targets (90 × 109 cells per L before major surgery or 45 × 109 cells per L before minor surgery) without rescue treatment. We did intention-to-treat and per-protocol analyses using an absolute non-inferiority margin of -10%. This trial is registered with ClinicalTrials.gov, NCT01621204. FINDINGS: Between June 5, 2013, and March 7, 2019, 92 patients with immune thrombocytopenia were screened, of whom 74 (80%) were randomly assigned: 38 to eltrombopag and 36 to intravenous immunoglobulin. Median follow-up was 50 days (IQR 49-55). By intention-to-treat analysis, perioperative platelet targets were achieved for 30 (79%) of 38 patients assigned to eltrombopag and 22 (61%) of 36 patients assigned to intravenous immunoglobulin (absolute risk difference 17·8%, one-sided lower limit of the 95% CI 0·4%; pnon-inferiority=0·005). In the per-protocol analysis, perioperative platelet targets were achieved for 29 (78%) of 37 patients in the eltrombopag group and 20 (63%) of 32 in the intravenous immunoglobulin group (absolute risk difference 15·9%, one-sided lower limit of the 95% CI -2·1%; pnon-inferiority=0·009). Two serious adverse events occurred in the eltrombopag group: one treatment-related pulmonary embolism and one vertigo. Five serious adverse events occurred in the intravenous immunoglobulin group (atrial fibrillation, pancreatitis, vulvar pain, chest tube malfunction and conversion to open splenectomy); all were related to complications of surgery. No treatment-related deaths occurred. INTERPRETATION: Eltrombopag is an effective alternative to intravenous immunoglobulin for perioperative treatment of immune thrombocytopenia. However, treatment with eltrombopag might increase risk of thrombosis. The decision to choose one treatment over the other will depend on patient preference, resource limitations, cost, and individual risk profiles. FUNDING: GlaxoSmithKline and Novartis.


Assuntos
Benzoatos/uso terapêutico , Hidrazinas/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Pirazóis/uso terapêutico , Trombocitopenia/tratamento farmacológico , Administração Oral , Adulto , Idoso , Fibrilação Atrial/etiologia , Benzoatos/efeitos adversos , Feminino , Humanos , Hidrazinas/efeitos adversos , Imunoglobulinas Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Assistência Perioperatória , Contagem de Plaquetas , Embolia Pulmonar/etiologia , Pirazóis/efeitos adversos , Resultado do Tratamento , Vertigem/etiologia
17.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
18.
J Laryngol Otol ; 134(8): 727-731, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32830635

RESUMO

OBJECTIVE: The aim of this study was to assess change in temperature, audiometric outcomes and post-operative complications following exposure to different light sources during endoscopic ear surgery. METHOD: A total of 64 patients diagnosed with chronic otitis media with central perforation and pure conductive hearing loss underwent endoscopic type 1 tympanoplasty. The patients were randomised into two groups based on the light source used: xenon or light-emitting diode. Temperature was measured using a K type thermocouple at the promontory and round window niche. Mean temperature change with respect to operating time, mean audiometric change, incidence of vomiting in the first 24 hours, vertigo and tinnitus at the end of the first week were observed. RESULTS: Mean temperature change showed a statistically significant difference with increasing length of operating time with the xenon light source and when the two light sources were compared for a particular time interval. Mean audiometric change showed statistically significant deterioration at higher frequencies (4, 6 and 8 kHz) with the xenon light source but only at 8 kHz for the light emitting diode source. When the mean audiometric change was compared between light sources for a particular frequency, statistical significance was found at 4, 6 and 8 kHz. Post-operative complications were vomiting, vertigo and tinnitus (p-values of 0.042, 0.099 and 0.147, respectively, between two groups). CONCLUSION: Light emitting diodes are associated with less significant middle-ear temperature rises and audiometric changes at higher frequencies when compared to xenon light sources. Hence, xenon should be replaced with cooler light sources.


Assuntos
Endoscopia/métodos , Otite Média/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Adulto , Audiometria/estatística & dados numéricos , Estudos de Casos e Controles , Doença Crônica , Orelha Média/patologia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Duração da Cirurgia , Otite Média/complicações , Procedimentos Cirúrgicos Otológicos/tendências , Complicações Pós-Operatórias/epidemiologia , Janela da Cóclea , Temperatura , Zumbido/epidemiologia , Timpanoplastia/métodos , Vertigem/epidemiologia , Vômito/epidemiologia , Xenônio
19.
Artigo em Chinês | MEDLINE | ID: mdl-32791631

RESUMO

Objective:To evaluate the effect of the support vector machine(SVM) and artificial neutral network(ANN) on the treatment choice of vestibular rehabilitation. Method:Total scores COMP and three ratios of sensory analysis: somatosensory(SOM), visual(VIS), vestibular(VEST) from the sensory organization test(SOT), and physical score(DHI-P), emotional score(DHI-E), functional score(DHI-F) from the dizziness handicap inventory(DHI) were chosen as input of SVM and ANN, rehabilitation program as output. According to the data source of the literatures, we constructed simulation database used as the sample set to conduct model training, and part of the clinical data was used to train the model accuracy. Result:After trainings, the accuracy rate of ANN model was 52.3%, and that of SVM model was 83.4%. The error mainly comes from the serious overlap of each score data interval under the three diagnostic schemes, which easily leads to the misclassification of boundary sample points, which is also a difficult problem to overcome in clinical diagnosis. Conclusion:Vestibular rehabilitation decision based SVM is more accurate than ANN. The use of machine learning to assist decision-making of vestibular rehabilitation scheme has important prospective reference significance in promoting clinical medical informatization and improving medical quality.


Assuntos
Tontura , Vestíbulo do Labirinto , Humanos , Aprendizado de Máquina , Estudos Prospectivos , Vertigem
20.
Artigo em Chinês | MEDLINE | ID: mdl-32842228

RESUMO

Objective:To investigate the long-term efficacy of semicircular canal occlusion in the treatment of refractory Meniere's disease. Method:Fifteen patients with Meniere's disease who underwent semicircular canal occlusion were reviewed. The preoperative and postoperative frequency of vertigo ,quality of life, hearing and tinnitus level were compared. All patients were followed for more than 24 months. Result:Postoperatively, vertigo was controlled effectively in all 15 cases, and the control rate was 100%, of which 11 cases were completely controlled(Grade A) and 4 cases were basically controlled(Grade B). The improvement rate of quality of life was 100%. The hearing worse in 4 cases(26.7%) and stabilized in 11 cases(73.3%). The tinnitus was relieved in 7 cases(46.7%), unchanged in 7 cases(46.7%) and aggravated in 1 case(6.7%). Conclusion:Semicircular canal occlusion can effectively control the vertigo symptoms of refractory Meniere's disease and improve the quality of life. The long-term efficacy of semicircular canal occlusion is definite, but there is a risk of hearing loss.


Assuntos
Doença de Meniere , Humanos , Qualidade de Vida , Estudos Retrospectivos , Canais Semicirculares , Vertigem
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