Migrânea vestibular: aspectos clínicos e epidemiológicos

Introduction: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. Objective: To analyze the clinical and epidemiological profile of patients with VM. Methods: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. Results: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. Conclusion: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Introdução: Migrânea vestibular (MV) corresponde a um dos mais frequentes diagnósticos em otoneurologia, o que justifica a importância de seu estudo, embora tenha sido apenas recentemente reconhecida como entidade nosológica. Objetivo: Analisar os perfis clínico e epidemiológico dos pacientes atendidos em um ambulatório de migrânea vestibular. Método: Estudo retrospectivo, observacional e descritivo, com análise de prontuários dos pacientes do ambulatório de MV. Resultados: O ambulatório é composto por 94,1% de mulheres e 5,9% de homens, com média de idade 46,1 anos. O tempo de cefaleia foi superior ao de vertigem em 65,6% dos pacientes. Observou-se correlação entre os sintomas e o período menstrual. A maioria (61,53%) dos indivíduos apresentou algum sintoma auditivo, sendo o zumbido o mais frequente, embora a audiometria tenha sido normal em 68,51%. A vectoeletronistagmografia apresentou-se normal em 67,34%, enquanto 10,20% apresentaram hiporreflexia e 22,44% hiperreflexia vestibular. Exames eletrofisiológicos não mostraram alterações na maioria dos pacientes. Glicemia dejejum e curva glicêmica foram normais para a maioria dos pacientes, enquanto a curva insulinêmica mostrou-se alterada em 75% dos indivíduos. 82% dos indivíduos com MV apresentaram alguma alteração relativa ao metabolismo dos carboidratos. Conclusão: Migrânea vestibular acomete, predominantemente, mulheres de meia idade, com cefaleia migranosa e vertigem, sendo a primeira de instalação mais precoce. O exame físico no período intercrise, bem como as avaliações auditiva e vestibular, mostram-se, geralmente, normais. O tipo de alteração vestibular mais observado foi a hiperreflexia labiríntica. A maioria os indivíduos avaliados apresentou alterações relativas ao metabolismo dos carboidratos.Univ Fed Sao Paulo UNIFESP, Dept Otorhinolaryngol & Head & Neck Surg, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Otorhinolaryngol & Head & Neck Surg, Sao Paulo, SP, BrazilWeb of Scienc

Vicissitudes das adolescências na semiliberdade: da fragilização dos laços à busca de si

Partimos de una investigación que investigó cómo el caso mueve equipos de medidas socioeducativas de semilibertad, de modo que, en este artículo, también podamos ser tomados por el caso como un hilo común de análisis y reflexiones que demuestran las particularidades contenidas en un contexto de pobreza generalizada y marginación. Nuestro objetivo es complementar la literatura existente sobre medidas socioeducativas, presentando las particularidades de la adolescencia que constatamos en el encuentro con profesionales de semilibertad. El método por utilizar pretende producir una reflexión para articular las singularidades de los casos con la literatura específica. Lo estructuramos en tres tópicos: primero, en las adolescencias con foco en la constitución del yo y del cuerpo propio y su relación con las conductas de riesgo; a continuación, se refleja sobre la relación del adolescente con la familia, más específicamente en lo que se refiere al conflicto generacional; y, por último, se piensa las dificultades en la transmisión generacional. Se concluyó que el abordaje del caso a caso se hace esencial para la construcción de una mirada acerca de los adolescentes en situación de judicialización que vaya más allá de los estereotipos y localice allí al sujeto y sus cuestiones.This paper starts from a research that investigated how the case moves the teams of semi-freedom socio-educative system, in a way that makes it possible, in this article, to be taken by the case as a guiding thread of analyses and reflections that demonstrate the particularities contained in a generalized context of poverty and marginalization. Thus, our goal is to complement the existing literature on socio-educational measures, presenting the particularities of adolescence, which we found by meeting semi-freedom professionals. The method used aims to produce a reflection in order to articulate the singularities of the cases with the specific literature The paper was structured in three topics: first, adolescents with focus on the constitution of the self and of their own bodies, with risky behaviours; then, there is a reflection on the relation of the adolescent with the family, more specifically regarding to the generational conflict; and, finally, the difficulties in generational transmission are thought. We concluded that the case-by-case approach is essential for the construction of a view on the adolescents in a judicial situation, so that it can go beyond the stereotypes and locates the subject and his questions.Parte-se de uma pesquisa que investigou como o caso movimenta as equipes das medidas socioeducativas de semiliberdade, para, no presente artigo, deixar-se levar também pelo caso como um fio condutor de análises e reflexões que demonstram as particularidades contidas num contexto generalizado de pobreza e marginalização. Assim, nosso objetivo é o de complementar a literatura existente acerca das medidas socioeducativas apresentando as particularidades das adolescências com que nos deparamos a partir do encontro com os profissionais da semiliberdade. O método empregado pretende produzir uma reflexão de forma a articular as singularidades dos casos com a literatura específica. Estruturou-se o presente artigo em três tópicos: primeiramente, nas adolescências com foco na constituição do eu e do corpo próprio e sua relação com as condutas de risco; em seguida, reflete-se sobre a relação do adolescente com a família, mais especificamente no que se refere ao conflito geracional; e, por fim, pensa-se as dificuldades na transmissão geracional. Concluiu-se que a abordagem do caso-a-caso se faz essencial para a construção de um olhar acerca dos adolescentes em situação de judicialização que vá para além dos esteriótipos e localize ali o sujeito e suas questões

Prophylactic treatment of vestibular migraine

Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including beta-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Barany Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Univ Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, Sao Paulo, SP, BrazilWeb of Scienc

Generation of a Chinese Hamster Ovary Cell Line Producing Recombinant Human Glucocerebrosidase

Impaired activity of the lysosomal enzyme glucocerebrosidase (GCR) results in the inherited metabolic disorder known as Gaucher disease. Current treatment consists of enzyme replacement therapy by administration of exogenous GCR. Although effective, it is exceptionally expensive, and patients worldwide have a limited access to this medicine. In Brazil, the public healthcare system provides the drug free of charge for all Gaucher's patients, which reaches the order of $ 84million per year. However, the production of GCR by public institutions in Brazil would reduce significantly the therapy costs. Here, we describe a robust protocol for the generation of a cell line producing recombinant human GCR. The protein was expressed in CHO-DXB11 (dhfr(-)) cells after stable transfection and gene amplification with methotrexate. As expected, glycosylated GCR was detected by immunoblotting assay both as cell-associated (similar to 64 and 59 kDa) and secreted (63-69 kDa) form. Analysis of subclones allowed the selection of stable CHO cells producing a secreted functional enzyme, with a calculated productivity of 5.14 pg/cell/day for the highest producer. Although being laborious, traditionalmethods of screening high-producing recombinant cellsmay represent a valuable alternative to generate expensive biopharmaceuticals in countries with limited resources.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)CNPq (Conselho Nacional de Desenvolvimento Cientificoe Tecnologico)CNPQ(Conselho Nacional de Desenvolvimento Cientifico e Tecnologico)Fundacao ButantanFundacao Butanta

Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of nonmelanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection

Vestibular migraine: comparative analysis between diagnostic criteria

AbstractIntroductionThere is a strong association between vertigo and migraine. Vestibular migraine (VM) was described in 1999, and diagnostic criteria were proposed in 2001 and revised in 2012.ObjectiveTo compare the diagnostic criteria for VM proposed in 2001 with 2012 criteria with respect to their diagnostic power and therapeutic effect of VM prophylaxis.MethodsClinical chart review of patients attended to in a VM clinic.ResultsThe 2012 criteria made the diagnosis more specific, restricting the diagnosis of VM to a smaller number of patients, such that 87.7% of patients met 2001 criteria and 77.8% met 2012 criteria. Prophylaxis for VM was effective both for patients diagnosed by either set of criteria and for those who did not meet any of the criteria.ConclusionsThe 2012 diagnostic criteria for VM limited the diagnosis of the disease to a smaller number of patients, mainly because of the type, intensity, and duration of dizziness. Patients diagnosed with migraine and associated dizziness demonstrated improvement after prophylactic treatment of VM, even when they did not meet diagnostic criteria

Vestibular migraine: clinical and epidemiological aspects

ABSTRACT INTRODUCTION: Vestibular migraine (VM) is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. OBJECTIVE: To analyze the clinical and epidemiological profile of patients with VM. METHODS: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. RESULTS: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years; 65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. CONCLUSION: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism

Generation of Polyclonal Antibodies Against Recombinant Human Glucocerebrosidase Produced in Escherichia coli

Deficiency of the lysosomal glucocerebrosidase (GCR) enzyme results in Gaucher`s disease, the most common inherited storage disorder. Treatment consists of enzyme replacement therapy by the administration of recombinant GCR produced in Chinese hamster ovary cells. The production of anti-GCR antibodies has already been described with placenta-derived human GCR that requires successive chromatographic procedures. Here, we report a practical and efficient method to obtain anti-GCR polyclonal antibodies against recombinant GCR produced in Escherichia coli and further purified by a single step through nickel affinity chromatography. The purified GCR was used to immunize BALB/c mice and the induction of anti-GCR antibodies was evaluated by enzyme-linked immunosorbent assay. The specificity of the antiserum was also evaluated by western blot analysis against recombinant GCR produced by COS-7 cells or against endogenous GCR of human cell lines. GCR was strongly recognized by the produced antibodies, either as cell-associated or as secreted forms. The detected molecular masses of 59-66 kDa are in accordance to the expected size for glycosylated GCR. The GCR produced in E. coli would facilitate the production of polyclonal (shown here) and monoclonal antibodies and their use in the characterization of new biosimilar recombinant GCRs coming in the near future.FAPESPCNPqFundacao Butanta

Roundtable Discussion: Retrofitting Research. A Global Conversation on Challenges and Opportunities

The conversation was recorded on February 18, 2021, bringing together most of the contributors to this issue of Future Anterior