Clinical characteristics of patients with persistent postural-perceptual dizziness

AbstractIntroductionPersistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety.ObjectiveTo evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness.Methodsstatistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness.Results81 patients, average age: 50.06±12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory – Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p<0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors.ConclusionPersistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment

Granulomatoses Nasais: relatos de casos e revisão de literatura direcionada diagnóstico

Introdução: As granulomatoses nasais são inflamações crônicas específicas que podem ser divididas conforme etiologia (infecciosa, desconhecida, induzida por trauma e autoimune). Por terem o poder de disseminação sistêmica representam um importante risco para a vida, sendo essencial um diagnóstico rápido e um adequado tratamento. Objetivo: Descrever 4 casos de granulomatoses nasais e realizar uma breve revisão sistemática focada no diagnóstico. Método: Os artigos foram obtidos utilizando-se as plataformas de busca MEDLINE e LILACS, no período dos últimos 5 anos (2017-2022) e nos idiomas português, inglês e espanhol. Os descritores utilizados para busca foram: “Nasal Tuberculosis Diagnosis”, “Histoplasmosis Nasal Diagnosis”, “Nasal Leishmaniasis Diagnosis” e “Eosinophilic Granulomatosis Polyangiitis Criteria Diagnoses”. Dentre os critérios de inclusão, permaneceram na análise apenas os artigos que tratavam da área nasal ou nasossinusal e que focavam no diagnóstico clínico e/ou laboratorial. Relato de casos: Quatro pacientes atendidos no período de fevereiro de 2019 a fevereiro de 2022, com diagnóstico de granulomatose nasal e tratados pelo serviço de Otorrinolaringologia do Hospital Santa Marcelina de Itaquera, São Paulo/SP, sendo um caso de granulomatose eosinofílica com poliangeíte (GEPA), um de tuberculose, um de histoplasmose e um de leishmaniose. Resultados: Dos 208 artigos encontrados, apenas 25 foram selecionados após avaliação. GEPA: O diagnóstico atualmente baseia-se nos critérios do Colégio Americano de Reumatologia 2022. Tuberculose: O diagnóstico pode ser feito através de achados histopatológicos. Histoplasmose: O padrão-ouro é o achado histopatológico do fungo utilizando-se a coloração com ácido periódico de Schiff (PAS). Leishmaniose: O método considerado padrão-ouro é a biópsia com detecção molecular do DNA do parasita pela PCR.Discussão: Houve uma boa correlação entre os métodos empregados pata o diagnostico desses casos e os sugeridos pelos artigos analisados. Conclusão: Embora infrequentes, as granulomatoses nasais geram muita morbidade, são de diagnóstico complexo e devem ser lembradas nos pacientes com inflamações nasais ou sinusais de difícil resolução com os tratamentos convencionais. Utilizando o roteiro diagnóstico descrito nessa breve revisão, acreditamos que seja possível uma melhora substancial na assertividade diagnostica.Introduction: Nasal granulomatosis are granulomatous inflammation of the tissues of the nose and paranasal sinuses that have high destructive power. They are generated by trauma, inflammation, infection, autoimmune reaction, neoplasia, substance abuse conditions or tics. Objective: To analyze, in order to present an epidemiological profile, clinical characteristics, diagnostic criteria and treatment for four extraordinary etiologies of nasal and/or sinus granulomatosis (GEPA, tuberculosis, histoplasmosis and leishmaniasis) and, based on care protocols, present a guiding flowchart diagnosis and management of nasal granulomatosis. Case reports: Four patients seen from February 2019 to February 2022, diagnosed with nasal granulomatosis and treated by the Otorhinolaryngology service of Hospital Santa Marcelina de Itaquera, São Paulo/SP, Brazil, one case of eosinophilic granulomatosis with polyangiitis (GEPA), one for tuberculosis, one for histoplasmosis and one for leishmaniasis. Conclusion: Although not frequent, nasal granulomatosis generate a lot of morbidity for patients, therefore, they should be diagnosed and treated as soon as possible. As there are several causes for nasal granulomatosis and several complementary exams, the formulation of a diagnostic flowchart helps in this purpose. &nbsp

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception. Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects. Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires. Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex). Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli

Estudo audiológico de uma população idosa brasileira Audiological study of an elderly brazilian population

A população idosa brasileira cresce e representa 8,6% do total populacional. Fatores ambientais, hábitos de vida, sexo e fatores genéticos interferem na evolução da presbiacusia que reduz a qualidade de vida. OBJETIVO: Investigar queixas audiológicas e vestibulares em idosos, executar audiometria tonal, verificar se há diferenças entre os sexos. FORMA DE ESTUDO: Clínico prospectivo de corte transversal. MATERIAL E MÉTODO: 320 pacientes idosos (160 homens e 160 mulheres) foram submetidos a anamnese audiológica e audiometria tonal. Análise estatística dos resultados pelos testes ANOVA, Mann-Whitney e Qui-Quadrado. RESULTADO: As queixas audiológicas e vestibulares (perda auditiva, tinnitus, plenitude auricular, tontura) foram similares entre os sexos (exceção, a tontura: p<0,05); audiometria tonal apresentou diferença significante, com perda auditiva nas altas freqüências entre os homens, e entre as mulheres, curvas descendentes e planas. Esses resultados foram estaticamente significantes (p<0,001). CONCLUSÃO: Os resultados permitem concluir que, quando comparados os sexos, a perda auditiva no idoso possui sintomatologia semelhante, mas apresenta diferenças significativas na audiometria tonal.<br>The Brazilian elderly population is growing, and already represents 8,6% of our total population. Environmental factors, lifestyle, gender and genetics impact the development of presbycusis, which reduces quality of life. AIM: investigate audiologic and vestibular complaints in the elderly; perform tonal audiometry and check to see if there are differences between genders. STUDY: Cross-sectional clinical prospective study. MATERIALS AND METHODS: 320 elderly patients (160 men and 160 women) were submitted to audiologic interview and tonal audiometry. The results were statistically analyzed by the following methods: ANOVA, Mann-Whitney and Chi-Squared. RESULTS: audiologic and vestibular complaints (hearing loss, tinnitus, ear fullness, dizziness) were similar between the genders (except for dizziness: p<0,05); tonal audiometry showed a significant difference, with hearing loss in the high frequencies among men; and among women the curves were descending and flat. These results were statistically significant (P<0,001). CONCLUSION: our results lead us to conclude that, when the genders are compared, hearing loss in the elderly has similar symptoms; however, there are significant differences in tonal audiometry