Reabilitação vestibular: utilidade clínica em pacientes com esclerose múltipla Vestibular rehabilitation: clinical benefits to patients with multiple sclerosis

O objetivo desse estudo foi analisar a eficácia do exercício de reabilitação vestibular em dois casos de esclerose múltipla remitente-recorrente. Ambos os casos foram encaminhados do Hospital de Clínicas para o Laboratório de Otoneurologia de uma instituição de ensino e foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular e aplicação do Dizziness Handicap Inventory pré e pós reabilitação vestibular utilizando-se o protocolo de Cawthorne e Cooksey. No primeiro caso, gênero feminino, 35 anos, tempo de doença de seis anos, referiu tontura há três anos, de intensidade moderada de ocorrência frequente, cefaléia, quedas, desvio de marcha à direita e sensação de desmaio (sic). Apresentou no exame labiríntico, síndrome vestibular periférica deficitária bilateral. No segundo caso, gênero feminino, 49 anos, tempo de doença de dois anos, referiu desvio de marcha à direita, dificuldade e/ou dor ao movimento do pescoço, formigamento de extremidade e alteração vocal. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária à direita. Houve melhora significativa em ambos os casos dos aspectos físico, funcional e emocional do Dizziness Handicap Inventory após a realização da reabilitação vestibular. O protocolo utilizado promoveu melhora na qualidade de vida e auxiliou no processo de compensação vestibular.<br>The aim of the present study was to analyze the effectiveness of vestibular rehabilitation exercises in two cases of remittent-recurrent multiple sclerosis. Both cases were referred from the Clinics Hospital to the Laboratory of Otoneurology of the same institution and were submitted to the following procedures: anamnesis, otological inspection, vestibular evaluation, and application of the Dizziness Handicap Inventory before and after vestibular rehabilitation using the Cawthorne and Cooksey protocol. The first case was a 35-year-old female, diagnosed for six years, who referred frequent dizziness of moderate intensity for three years, headaches, falls, deviation of gait to the right and fainting sensations (sic). In the vestibular exam, she presented bilateral peripheral vestibular deficiency syndrome. The second case was a 49-year-old female, diagnosed for two years, who referred deviation of gait to the right, difficulty and/or pain with neck movement, paraesthesia of the extremities and vocal alteration. In the vestibular exam, she presented peripheral vestibular deficiency syndrome to the right. Both cases had significant improvements regarding physical, functional and emotional aspects of the Dizziness Handicap Inventory after vestibular rehabilitation. The protocol used benefitted the subjects' quality of life and favored the process of vestibular compensation

Sensitivity of speleothem records in the Indian Summer Monsoon region to dry season infiltration

In climates with strongly seasonal rainfall, speleothem-based paleoclimate reconstructions are often thought to reflect wet season conditions, assuming a bias toward the season with greater water supply. This is particularly true in monsoon regions, where speleothem records are interpreted to document monsoon strength changes on multiple timescales. Dry season infiltration variability and rainfall seasonality are not typically considered in these reconstructions, even though cave ventilation could bias speleothem growth toward the cooler season. To investigate the influence of dry season infiltration on speleothem geochemistry, we combine a modern, sub-seasonally resolved trace element record from Mawmluh Cave in Northeast India with forward modeling experiments. We find that variations in the amplitude of seasonal signals in speleothem Mg/Ca, which reflects prior carbonate precipitation, are more sensitive to dry season rather than monsoon season infiltration. This sensitivity may be enhanced by dry season cave ventilation. The Mawmluh speleothem Mg/Ca record is consistent with increased dry season rainfall during the 1976–1998 warm phase of the Pacific Decadal Oscillation relative to 1964–2013. Our work demonstrates the importance of considering non-monsoon season rainfall when interpreting speleothem paleoclimate records and suggests that trace elements could provide insight into periods of enhanced dry season infiltration in monsoonal climates

Immunogenetic risk factors for anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis

Wegener's granulomatosis (WG) and microscopic polyangiitis are systemic autoimmune diseases characterized by the presence of ANCA in the sera of patients. Little is known about the aetiologic factors and genetic predisposition as well as the pathogenesis of these disease entities. A slightly decreased representation of HLA-DRB1*13 and HLA-DQB1*0603 individuals was observed in our cohort of ANCA-associated systemic vasculitis (AASV) patients compared with controls. In addition, HLA-DRB1*04 individuals were over-represented in a subgroup of patients with WG in end-stage renal disease as a result of renal vasculitis. In order to identify other genes relevant for these diseases, we investigated highly polymorphic markers in the vicinity of several immunorelevant genes, i.e. tumour necrosis factor (TNF)α, IL-2, IL-5 receptor α (IL-5RA), in a group of 102 patients with AASV and compared the representation with controls. Furthermore, functional polymorphisms were directly analysed in the promotor region of TNFα as well as in the coding region of the FcγIIRA genes. Polymorphisms of the TNFα promotor (TNF-308) as well as in the FcγIIRA gene were excluded as risk factors for the disease in our cohort. No major phenotype distribution differences were observed between patients and controls for the IL-2 and IL-5RA microsatellites. Most importantly, several haplotypes on chromosome 6p appeared strongly associated with proteinase 3 (PR3)-ANCA+ AASV. Thus, as in other autoimmune diseases, different predisposing factors play differential aetiopathogenic roles in various groups of AASV patients