Dizziness and prevention of falls in the elderly

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients

Oxidative stress in cerebral small vessel disease dizziness patients, basally and after polyphenol compound supplementation

Leukoaraiosis (LA) is a common radiological finding in elderly, frequently associated with several clinical disorders, including unexplained dizziness. The pathogenesis of LA is multifactorial, with a dysfunction of cerebral microcirculation resulting in chronic hypoperfusion and tissue loss, with oxidative stress involved in this cascade. The aim of this study was to analyse some oxidative stress biomarkers in a cohort of LA patients. In a subgroup of 33 patients with LA and unexplained dizziness, we have then performed an open study to evaluate if 60-day supplementation with a poliphenol compound may modify these biomarkers and influence quality of life, analysed with the Dizziness handicap Inventory (DHI) scale. At baseline, blood oxidative stress parameters values were outside normal ranges and compared to matched healthy controls. After the two months supplementation, we observed a significant decrement of advanced oxidation protein products values and a significant improvement of DHI. Oxidative stress biomarkers may be useful to detect redox imbalance in LA and to provide non-invasive tools to monitor disease status and response to therapy

Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation

Purpose: To assess if a polyphenol compound supplementation (Vertigoval (R)) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology.Methods: In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined.Results: A statistically significant greater decrease was established in the TG for DHI, DVAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment.Conclusion: Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications

Lack of CC chemokine ligand 2 differentially affects inflammation and fibrosis according to the genetic background in a murine model of steatohepatitis

Expression of CCL2 (CC chemokine ligand 2) (or monocyte chemoattractant protein-1) regulates inflammatory cell infiltration in the liver and adipose tissue, favouring steatosis. However, its role in the pathogenesis of steatohepatitis is still uncertain. In the present study, we investigated the development of non-alcoholic steatohepatitis induced by an MCD diet (methionine/choline-deficient diet) in mice lacking the CCL2 gene on two different genetic backgrounds, namely Balb/C and C57/Bl6J. WT (wild-type) and CCL2-KO (knockout) mice were fed on a lipid-enriched MCD diet or a control diet for 8 weeks. In Balb/C mice fed on the MCD diet, a lack of CCL2 was associated with lower ALT (alanine transaminase) levels and reduced infiltration of inflammatory cells, together with a lower generation of oxidative-stress-related products. Sirius Red staining demonstrated pericellular fibrosis in zone 3, and image analysis showed a significantly lower matrix accumulation in CCL2-KO mice. This was associated with reduced hepatic expression of TGF-β (transforming growth factor-β), type I procollagen, TIMP-1 (tissue inhibitor of metalloproteinases-1) and α-smooth muscle actin. In contrast, in mice on a C57Bl/6 background, neither ALT levels nor inflammation or fibrosis were significantly different comparing WT and CCL2-KO animals fed on an MCD diet. In agreement, genes related to fibrogenesis were expressed to comparable levels in the two groups of animals. Comparison of the expression of several genes involved in inflammation and repair demonstrated that IL (interleukin)-4 and the M2 marker MGL-1 (macrophage galactose-type C-type lectin 1) were differentially expressed in Balb/C and C57Bl/6 mice. No significant differences in the degree of steatosis were observed in all groups of mice fed on the MCD diet. We conclude that, in experimental murine steatohepatitis, the effects of CCL2 deficiency are markedly dependent on the genetic background

Molecular markers in salivary gland tumours

Salivary gland tumours are uncommon neoplasms of the head and neck. The increase of precise pre-operative diagnosis is crucial for their correct management and the identification of molecular markers would surely improve the required accuracy. With this aim we studied the proteins and the microRNAs expressed from salivary gland neoplasms in order to identify tumour markers able to preoperatively distinguish these neoplasms. We performed a proteomic analysis of fine needle aspiration fluids of malignant tumours in order to draw their proteomic profiles and to point out their significant features. Twenty patients affected by a malignant salivary gland neoplasm and submitted to parotidectomy were included in the study. For comparison, fine needle aspiration citology was performed on 37 pleomorphic adenoma and 14 warthin’s tumour, which are known to be the most frequent histologies among the benign salivary gland neoplasms. Fine needle aspiration samples were processed using a two-dimensional electrophoresis/mass spectrometry-based approach. Ingenuity software was used to search the biological processes to which these proteins belong and to construct potential networks. Fourteen differentially expressed proteins were identified between malignant samples and pleomorphic adenomas, while 22 differentially expressed proteins were identified in malignant tumours compared to warthin’s tumours. The western blot validation of selected differentially expressed proteins was performed on fine needle aspiration fluid and paraffin tissues in order to verify the results. Intriguingly, up-regulated Ig subunits were confirmed to characterize Warthin’s tumour, as suggested in our previous experience. The expression profiling of 798 microRNAs was performed on paraffin section. microRNA expression profiles were detected in 24 salivary gland tumors (14 malignant tumors and 10 benign tumors namely pleomorphic adenoma) by using an highly reproducible and sensitive method, NanoString Technologies. Thirty-two microRNAs were found to be down-regulated in malignant neoplasms compared to benign ones, whereas a significant overexpression of 29 microRNAs was reported in malignant compared to benign lesions. Hierarchical clustering according to differentially expressed microRNAs was performed using nSolver Analysis software with Pearson correlation. The signature of the differentially expressed microRNAs was perfectly able to discriminate benign from malignant lesions. Although further studies are needed in order to improve the accuracy of the tumour markers identified, our research suggests the use of biomarker in salivary gland tumours in order to improve diagnosis. Better diagnosis of salivary gland tumours will allow better clinical decision-making with more appropriate treatment

Analisi del Riflesso Vestibolo-Oculomotore nella Malattia di Menière

La Malattia di Menière è un’affezione idiopatica dell’orecchio interno più spesso monolaterale, sostenuta da idrope endolinfatico. Nonostante le accurate descrizioni anatomo-patologiche, ancor oggi gli aspetti fisiopatologici alla base delle peculiari manifestazioni cliniche non appaiono ben compresi. La diagnosi è fondata sul riscontro anamnestico di episodi ricorrenti di vertigine rotatoria, ipoacusia inizialmente fluttuante, fullness e acufeni; ad ogni modo, una completa valutazione audio-vestibolare è necessaria al fine di definire stadio di malattia, pianificare la terapia e esprimere un qualche giudizio in termini di prognosi La terapia medica consente un buon controllo dei sintomi in circa 2/3 dei pazienti; in caso di mancata risposta la terapia intratimpanica con gentamicina rappresenta una valida prima opzione. La tesi di laurea specialistica è stata volta ad una migliore comprensione del disturbo attraverso l’analisi della funzionalità vestibolare espressa dal Riflesso Vestibolo-Oculomotore (RVO) canalare, studiabile oggi ad un differente range di frequenze mediante Test Calorico (TC) e video Head Impulse Test (vHIT). Abbiamo considerato pazienti gestiti con terapia conservativa e pazienti sottoposti a trattamento ablativo con gentamicina intratimpanica; in entrambi i gruppi è stata considerata l’età di esordio della malattia (superiore o inferiore a 5 anni). Indipendentemente dall’età di malattia abbiamo rilevato una peculiare dissociazione tra i risultati emersi al test calorico (alterato) e vHIT (normale) nei pazienti sottoposti a terapia conservativa. Solo la terapia con gentamicina intratimpanica compromette il RVO ad alta frequenza studiato con il vHIT; tale alterazione verrebbe a costituire un marker di efficacia della stessa terapia, almeno a breve termine

Dizziness and prevention of falls in the elderly

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients

Assessment of Vestibulo-ocular Reflex Gain and Catch-up Saccades During Vestibular Rehabilitation

To assess, in patients referred to vestibular rehabilitation (VR) for persistence of disability after acute unilateral vestibulopathy (AUV), whether the video head impulse test (vHIT) can be a useful technique to define the efficacy of the treatment