13 research outputs found
Rhinolithiasis as cause of oronasal fistula
Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.A RinolitĂase Ă© uma doença na qual ocorre a deposição de compostos orgĂąnicos e inorgĂąnicos em torno de um nĂșcleo na cavidade nasal, causando rinorrĂ©ia, obstrução nasal unilateral, odor fĂ©tido, epistaxe, podendo haver complicaçÔes. Os autores apresentam um caso de rinolitĂase com fĂstula oronasal e revisĂŁo de literatura.Universidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Setor de RinologiaUNIFESP, EPM, Setor de RinologiaSciEL
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââ„âII, EF â€35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
The venous hum as a cause of vascular pulsative tinnitus
Tinnitus is one of the most common complaints in medical practice. The venous hum is described as an uncommon cause of vascular tinnitus, seldom remembered or recognized as a clinical entity. AIM: The aim of this paper is to identify the venous hum cases at Tinnitus Ambulatory at UNIFESP-EPM and compare them to literature. MATERIAL AND METHOD: retrospective research of venous hum cases identified at UNIFESP-EPM from April 1997 to April 2003, analyzing the following parameters: age of appearance, frequency, affected side, presence of associated hearing loss and dizziness, improvement and worsening factors, audiometry results, vestibular exam and computadorized tomography of temporal bones, evolution and treatment performed. RESULTS: pulsative tinnitus happened in 7,5% and venous hum in 3% of total cases of the patients with tinnitus, all in women, with no preference for age of appearance, most common at left ear. All patients have improved with clinical treatment and surgery was not needed in any case. CONCLUSION: The venous hum is not an uncommon cause of tinnitus (39% of pulsative tinnitus) as described in literature. Treatment should be performed by acting in responsible and decurrente factors caused by tinnitus. In great number of cases venous hum spontaneously disappears, needing no treatment. Surgical treatment is rarely indicated and must be reserved only in cases with no improvement with clinical treatment.Zumbido Ă© uma das queixas otolĂłgicas mais comuns com que o otorrinolaringologista se depara. O hum venoso Ă© descrito como uma causa pouco comum de zumbido vascular, pouco lembrado ou reconhecido como entidade clĂnica. OBJETIVO: O objetivo do estudo Ă© identificar os casos de hum venoso dentre os pacientes com zumbido pulsĂĄtil atendidos no AmbulatĂłrio de Zumbido da Disciplina de Otorrinolaringologia da UNIFESP-EPM e comparĂĄ-los com a literatura. MATERIAL E MĂTODO: Estudo retrospectivo dos pacientes com hum venoso realizado na UNIFESP-EPM de abril de 1997 a abril de 2003, analisando-se os parĂąmetros: idade de aparecimento, freqĂŒĂȘncia, lado acometido, presença de perda auditiva e tontura associadas, fatores de piora e melhora, resultados de audiometria, exame vestibular e tomografia computadorizada de ossos temporais, evolução e tratamento realizados. Foi utilizado um protocolo de exames e tratamento e os resultados foram comparados com os da literatura. RESULTADOS: O zumbido pulsĂĄtil ocorreu em 7,5% e o hum venoso em 3% do total de pacientes com zumbido, todos no sexo feminino, sem prevalĂȘncia por Ă©poca de aparecimento, acometendo mais a orelha esquerda. Em todos os pacientes houve melhora com tratamento clĂnico, nĂŁo sendo necessĂĄria intervenção cirĂșrgica em nenhum caso. CONCLUSĂO: O hum venoso nĂŁo Ă© uma causa incomum de zumbido (39% dos zumbidos pulsĂĄteis) como citado na literatura. O tratamento deve ser realizado atuando-se sobre os fatores responsĂĄveis pelo zumbido e decorrentes do mesmo. Em grande nĂșmero de casos o mesmo desaparece espontaneamente, nĂŁo necessitando de tratamento. O tratamento cirĂșrgico raramente Ă© necessĂĄrio, devendo ser reservado apenas aos casos em que nĂŁo haja melhora com o tratamento clĂnico.Universidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Departamento de OtorrinolaringologiaUNIFESP, EPM, Depto. de OtorrinolaringologiaSciEL
Tinnitus treatment with Trazodone
Tinnitus is a common symptom, defined as a sound perception in absence of a sound stimulus. AIM: Evaluate if Trazodone, an antidepressant drug, which modulates serotonin at central neuronal pathways, is effective in controlling tinnitus. STUDY DESIGN : Prospective, double blind, randomized, placebo-controlled. Materials and Methods: Study performed with patients presenting tinnitus. 85 patients were analyzed between February and June of 2005. 43 received trazodone and 42 placebo, for 60 days. The clinical criteria of analysis were tinnitus intensity, discomfort and life quality impact by tinnitus, using an analogue scale varying between 0 and 10, scored by patients before and after drug or placebo use. RESULTS: There was a significant improvement in intensity, discomfort and life quality in both groups after treatment; however, there was no significant difference between the drug and placebo groups. Patients with age equal or over 60 years presented better results after treatment. CONCLUSION: Trazodone was not efficient in controlling tinnitus in the patients evaluated under the doses utilized.O zumbido Ă© um sintoma freqĂŒente, definido como percepção sonora auditiva na ausĂȘncia de estĂmulo sonoro. OBJETIVO: Avaliar se a Trazodona, antidepressivo modulador da serotonina nas vias neuronais centrais, atua positivamente no controle do zumbido. Forma de Estudo: Prospectivo, duplo-cego, randomizado, controlado com placebo. MATERIAL E MĂTODO: estudo realizado com pacientes com zumbido. Oitenta e cinco pacientes foram avaliados entre fevereiro e junho de 2005, sendo que 43 pacientes receberam droga e 42, placebo, pelo perĂodo de 60 dias. Os critĂ©rios de anĂĄlise foram intensidade, efeito sobre a qualidade de vida e grau de incĂŽmodo devido ao zumbido, atravĂ©s de escala analĂłgica com notas de 0 a 10 dadas pelos pacientes antes e apĂłs o uso da trazodona ou placebo. RESULTADOS: Em ambos os grupos houve melhora da intensidade, qualidade de vida e incĂŽmodo apĂłs o tratamento, porĂ©m nĂŁo houve diferença significativa entre os grupos droga e placebo. Quando se avaliou os critĂ©rios clĂnicos na faixa etĂĄria maior ou igual a 60 anos, obteve-se melhora nos nĂveis de intensidade, incĂŽmodo e efeito sobre a qualidade de vida apĂłs o tratamento. CONCLUSĂO: A trazodona nĂŁo foi eficiente no controle do zumbido dos pacientes avaliados na dose utilizada