Emerging pharmacotherapy of tinnitus

Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well-established animal models, heterogeneity of different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology. © 2009 Informa UK Ltd.Fil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Salvi, Richard. State University of New York; Estados UnidosFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentin

Ear, nose and throat injuries at Bugando Medical Centre in northwestern Tanzania: a five-year prospective review of 456 cases.

Injuries to the ear, nose and throat (ENT) regions are not uncommon in clinical practice and constitute a significant cause of morbidity and mortality in our setting. There is dearth of literature on this subject in our environment. This study was conducted to describe the causes, injury pattern and outcome of these injuries in our setting and proffer possible preventive measures. This was a descriptive prospective study of patients with ear, nose and throat injuries managed at Bugando Medical Centre between May 2007 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was performed using SPSS computer software version 17.0. A total of 456 patients were studied. The median age of patients at presentation was 18 years (range 1 to 72 years). The male to female ratio was 2:1. The commonest cause of injury was foreign bodies (61.8%) followed by road traffic accidents (22.4%). The ear was the most common body region injured accounting for 59.0% of cases. The majority of patients (324, 71.1%) were treated as an outpatient and only 132(28.9%) patients required admission to the ENT wards after definitive treatment. Foreign body removal and surgical wound debridement were the most common treatment modalities performed in 61.9% and 16.2% of cases respectively. Complication rate was 14.9%. Suppurative otitis media (30.9%) was the commonest complication in the ear while traumatic epistaxis (26.5%) and hoarseness of voice (11.8%) in the aero-digestive tract were commonest in the nose and throat. The overall median length of hospital stay for in-patients was 8 days (range 1 to 22 days). Patients who developed complications and those who had associated injuries stayed longer in the hospital (P < 0.001).Mortality rate related to isolated ENT injuries was 1.3% (6 deaths). The majority of patients (96.9%) were treated successfully and only 3.1% of cases were discharged with permanent disabilities. Injuries to the ENT regions are not uncommon in our environment and foreign bodies constitute a significant cause of injury. Majority of these injuries can be prevented through public enlightenment campaigns

Positive Association between Tinnitus and Arterial Hypertension

Introduction: Tinnitus is the perception of noise in the absence of an external source and is considered by most authors as a multifactorial symptom. A systematic review concerning the association of tinnitus and systemic arterial hypertension retrieved suggestions of a positive association, but the articles included failed to perform a detailed analysis on the theme. Purpose: To analyze the presence of arterial hypertension in tinnitus and non-tinnitus patients, to analyze differences between tinnitus impact and psychoacoustic measurements in hypertensive and normotensive patients, and to evaluate the association between the presence of tinnitus and the diverse antihypertensive drugs employed. Materials and methods: This includes cross-sectional transversal study, comparing two groups of subjects (144 in the study group with tinnitus and 140 in the control group without tinnitus). Clinical, demographical, audiometrical, and psychoacoustics characteristics of the subjects were compared. Results: Hypertension prevalence in tinnitus subjects was 44.4% against 31.4% in subjects without tinnitus (p = 0.024). Positive associations with tinnitus were found with hypertension treatment with angiotensin-converting enzyme (ACE) inhibitors (p = 0.006), tiazidic diuretics (p < 0.0001), potassium-sparing diuretics (p = 0.016), and calcium channels blockers (p = 0.004). Conclusion: There is an association between tinnitus and arterial hypertension. This association is particularly strong in older patients. Hypertension treatment with diuretics, ACE inhibitors, and calcium channels blockers were more prevalent in tinnitus patients, suggesting that an eventual ototoxicity of these drugs may be involved in tinnitus pathophysiology, a hypothesis that should be evaluated in further studies.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Sao Paulo, Otolaryngol, Sao Paulo, BrazilFac Med Valenca, Otolaryngol, Valenca, BrazilOtolaryngology, Universidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Morphoanatomy of nectaries of Chamaecrista (L.) Moench sections Chamaecrista, Caliciopsis and Xerocalyx (Leguminosae: Caesalpinioideae)

Nectaries are specialized structures that secrete nectar. Several species of Chamaecrista possess nectaries on the petiole, which have been shown to vary widely in morphology and the chemical nature of their secretion. However, a comprehensive investigation of the nectaries of the clade formed by sect. Chamaecrista, Caliciopsis and Xerocalyx has yet to be performed. Our study aimed to confirm whether or not the leaf glands of species of this clade are in fact nectaries, determine the chemical nature of their secretion and expand the morphoanatomical database on leaf nectaries in Chamaecrista with the intention of contributing to the taxonomy and phylogeny of the genus. Samples from herbarium and field-collected material were subjected to standard methods for light and scanning electron microscopy. Four different forms of nectaries were observed: urceolate, patelliform, verruciform and cupuliform. The nectaries were found to comprise a single-layered epidermis, nectary parenchyma, subnectary parenchyma and vascularization. Polysaccharides, lipids, phenolic compounds and proteins were detected in secretions. Although anatomical similarities were observed among the studied species, their morphology differed. Moreover, the glands are indeed nectaries and are similar to those observed in other species of the genus Chamaecrista. These data hold potential taxonomic usefulness for the studied sections

Ménière’s Disease and Tinnitus

Tinnitus is one of the Ménière’s disease clue symptoms, but by far less studied than vertigo or other types of dizziness. The typical Ménière’s tinnitus is a low pitched fluctuating one. Although controversial, cochlear Ménière’s disease may account for a tinnitus subtype, a fact that may impact on tinnitus diagnosis and treatment. Further studies focused on tinnitus are necessary to clarify at which extent Ménière’s disease may have a role in some types of chronic tinnitus

Intensification of cattle ranching production systems: Socioeconomic and environmental synergies and risks in Brazil

Intensification of Brazilian cattle ranching systems has attracted both national and international attention due to its direct relation with Amazon deforestation on the one hand and increasing demand of the global population for meat on the other. Since Brazilian cattle ranching is predominantly pasture-based, we particularly focus on pasture management. We summarize the most recurrent opportunities and risks associated with pasture intensification that are brought up within scientific and political dialogues, and discuss them within the Brazilian context. We argue that sustainable intensification of pasturelands in Brazil is a viable way to increase agricultural output while simultaneously sparing land for nature. Since environmental degradation is often associated with low-yield extensive systems in Brazil, it is possible to obtain higher yields, while reversing degradation, by adopting practices like rotational grazing, incorporation of legumes and integrated crop-livestock-forestry systems. Technical assistance is however essential, particularly for small- and medium-scale farmers. Sound complementary policies and good governance must accompany these measures so that a ‘rebound effect’ does not lead to increased deforestation and other adverse social and environmental impacts. It is also important that animal welfare is not compromised. Although the discussion is presented with respect to Brazil, some aspects are relevant to other developing countries

Descriptive ecology of bat flies (Diptera: Hippoboscoidea) associated with vampire bats (Chiroptera: Phyllostomidae) in the cerrado of central Brazil

We studied the ectoparasitic bat flies of three phyllostomid vampire bat species. Bats were collected monthly from April 2004-March 2005 in caves within the Cafuringa Environmental Protection Area in the Federal District of Brazil. A total of 1,259 specimens from six species in the Streblidae family were collected from 332 bats. High host affinity from the sampled bat fly species and high prevalence of bat flies confirms the primary fly-host associations (Strebla wiedemanni, Trichobius parasiticus and Trichobius furmani with Desmodus, Trichobius diaemi and Strebla diaemi with Diaemus and T. furmani with Diphylla). Male flies outnumbered females in several associations. Some of the observed associations (e.g., Strebla mirabilis with Desmodus and S. mirabilis, Trichobius uniformis and S. wiedemanni with Diphylla) were inconclusive and the causes of the associations were unclear. There are several explanations for these associations, including (i) accidental contamination during sampling, (ii) simultaneous capture of several host species in the same net or (iii) genuine, but rare, ecological associations. Although various species of vampire bats share roosts, have similar feeding habits and are close phylogenetic relatives, they generally do not share ectoparasitic streblid bat flies. T. diaemi and S. diaemi associations with Diaemus youngi have not been previously reported in this region

FESS extraction of nasal foreign body in an adult patient – clinical case presentation

Представяме клиничен случай на чуждо тяло в носа при пациент на 48 години. По анамнестични данни чуждото тяло е копче, поставено в детска възраст в дясната ноздра. Диагностика и лечение. Преки и косвени разходи от ненавременната диагностика и лечение.------------------------We present a case of nasal foreign body in an adult patient (48 years old) with a history of childhood insertion of a button in the right nostril. Management. Direct and indirect costs of diagnosis and treatment

The past, present and future of Africa's rainforests

The Africanwet tropics contain the second largest area of tropical rainforest in the world (second only toAmazonia), accounting for roughly 30% of global rainforest cover, the lush green heart of an otherwise generally dry continent. These rainforests have global significance and value as reservoirs of biodiversity, as stores and sinks of atmospheric carbon, as regulators of flow of mighty rivers, as sources of moisture to the atmosphere and engines of the global atmospheric circulation, as a key component of the Earth system and its biogeochemical cycles, and as providers of resources and ecosystem services to local communities and the region’s nations. They also have a unique and particular history of changes in climate and human pressure, and face a range of contemporary pressures. Over the twenty-first century, the African rainforest realmhas the potential to witness massive change, both through an expansion of deforestation, hunting and logging, and through the effects of global climate change. This Theme Issue presents a multidisciplinary perspective on the nature and ecology of the African rainforest biome, and examines the current pressures and future threats to this biome. Compared with the other major rainforest regions, Amazonia and Southeast Asia, the African rainforest realm remains understudied, and in particular there have been very few attempts at interdisciplinary synthesis. This Theme Issue is an attempt to address this deficit, and explores what we know about the African rainforests and the threats they face, and what we need to know is this century of rapid change. In some ways, this can be viewed as a complement to similar Theme Issues of this journal focused on the rainforests of Amazonia [1,2] and Southeast Asia [3].JRC.H.5-Land Resources Managemen