Postural Control in Older Patients with Benign Paroxysmal Positional Vertigo

Objective. To evaluate the effectiveness of a canalith-repositioning procedure in postural control of older patients with idiopathic benign paroxysmal positional vertigo (BPPV). Study Design. Prospective clinical trial. Setting. A tertiary referral center. Methods. A 9-month follow-up survey with a prospective design was conducted among 33 older patients with BPPV. Patients underwent static posturography (Balance Rehabilitation Unit [BRU]) and were administered the Dizziness Handicap Inventory (DHI) before and after the maneuver. After the treatment, they were compared with 33 healthy older subjects. The posturography parameters were the limit of stability (LOS), the center of body-pressure area (COP), and the velocity of oscillation (VOS) under conditions of visual, somatosensory, and visual-vestibular conflict. Results. One canalith-repositioning procedure relieved most patients' complaints (54.5%), and 100% were relieved with 1 to 3 maneuvers. Total DHI score and all subscales improved after treatment (P < .01). The LOS values pretreatment (mean [SD] 134.27 [55.32] cm(2)) and posttreatment (181.03 [47.79] cm(2)) were significantly different (P < .01). Comparative analysis of COP values showed a relevant statistical difference in 8 of 10 postmaneuver conditions (P < .01). The postmaneuver VOS showed a significant difference under 7 conflict conditions. There were no differences between the healthy older subjects and treated patients for all VOS values under all conditions and for COP values under 9 conditions. Conclusion. The canalith-repositioning procedure promotes remission of symptoms, an increase in LOS, and improvement in postural control under conditions of somatosensory and visual conflict and visual-vestibular interaction.

Futebol, poesia e drama: o espetáculo

O que seria necessário para que se pudesse dizer que uma partida de futebol semelha de alguma forma a um espetáculo teatral, poético, emocional? O artigo propõe um passeio livre pela história dos diferentes tipos de teatro e pelas mudanças sofridas ao longo dos anos. A autora lembra que existe, da metade do século passado para cá, uma nítida divisão que colocou em campos opostos o teatro dramático e o teatro épico, o drama rigoroso contra o texto quase absolutamente livre, Aristóteles contra Brecht. E volta a apresentar as razões pela qual se pode afirmar que existem certos momentos no futebol que o aproximam ainda mais do espetáculo teatral, da dança, da comédia e do drama

Consevatório Drámatico e Musical de São Paulo: a primeira escola de teatro do Brasil

This article studies the Drama and Music Conservatory of São Paulo as an acting school since its foundation in 1906. Although the institution is currently dedicated exclusively to music education, we need to remember that it was the first drama school in South America and represented an important aspect of the growth and modernization of theater in Sao Paulo in the early 1900s. It is on this latter aspect that this study focuses on as it provides background information and examines the role of the institution in the context of São Paulo and Brazilian theater of that period. The essay attempts to understand the artistic orientation of the acting program (until the 1940s when the course was eliminated) and to evaluate its merits and shortcomings throughout the years

Late Adverse Effects of the Coadministration of Valproate and Lamotrigine

Individuals treated with combined valproate-lamotrigine rarely present late adverse effects (unrelated to introduction and titration). We describe four patients in whom such effects occurred after continuous, long-term use of valproate-lamotrigine (at 9 months to 2 years after final antiepileptic drug adjustment). The patients presented heterogeneous disturbances, including ataxia, vertigo, and headache, and rare movement disorders, such as tics and abnormal eye movements. Although these effects are heterogeneous in their occurrence and timing, they can alert physicians to the possibility of late neurologic disturbances, and must be considered in order to avoid unnecessary ancillary tests. Treatment discontinuation is unnecessary, given that a small decrease in dose led to remission of these adverse effects. (c) 2012 Elsevier Inc. All rights reserved.

Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients

The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) and otologic symptoms in patients with and without tinnitus. The influence of the level of depression was also addressed. The tinnitus group was comprised of 100 patients with tinnitus, and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to determine the presence of TMD and depression level. Chi-square, Spearman Correlation and Mann-Whitney tests were used in statistical analysis, with a 5% significance level. TMD signs and symptoms were detected in 85% of patients with tinnitus and in 55% of controls (P = 0.001). The severity of pain and higher depression levels were positively associated with tinnitus (P = 0.001). It was concluded that tinnitus is associated with TMD and with otalgia, dizziness/vertigo, stuffy sensations, hypoacusis sensation and hyperacusis, as well as with higher depression levels.

Static postural balance study in patients with vestibular disorders using a three dimensional eletromagnetic sensor system

The vestibular-ocular reflex assessment is important, but not enough. Tridimensional electromagnetic sensor systems represent a new method to assess posturography. Aim: To assess body sway in healthy subjects who had positive Dix Hallpike and Epley maneuvers and with other vestibular dysfunctions by means of a three-dimensional system. Study design: Prospective. Materials and Methods: We had 23 healthy women, 15 with peripheral vestibular dysfunction found upon caloric test and 10 with positive Epley and Dix Hallpike maneuvers. All tests performed in the following positions: open and closed eyes on stable and unstable surfaces. Results: With the Eyes Open and on a stable surface, p < 0.01 between the control group and the one with peripheral vestibular dysfunction in all variables, except the a-p maximum, full speed and mediolateral trajectory velocity, which had a p < 0.01 between the group with vestibular dysfunction and controls in all positions. The group with positive Epley and Dix Hallpike maneuvers had p < 0.01 at full speed and in its components in the x and y in positions with open and eyes closed on an unstable surface. Conclusion: The tridimensional electromagnetic sensors system was able to generate reliable information about body sway in the study volunteers.

Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study

Abstract Background Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people. Methods This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness. Results The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001). Conclusions The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.

A música em cena na Belle Époque paulistana

No período entre os últimos anos do século XIX até as duas primeiras décadas do século XX, tiveram lugar na cena musical paulistana gêneros teatrais cujo objetivo central era divertir o grande público acima de qualquer outra pretensão. Apesar de cada um deles ter suas próprias convenções e dinâmica de funcionamento, todos tinham na música elemento essencial ao espetáculo. A designação "teatro de revista" tornou-se referência e serviu para nomear um conjunto bem maior de modalidades, que inclui operetas, burletas, mágicas, vaudeviles, zarzuelas, fantasias, entre outras. Elemento importante na produção e divulgação da música no espaço urbano antes do aparecimento e consolidação dos meios de comunicação eletrônicos, o estudo do teatro musicado nos seus diversos e complexos aspectos pode ser fundamental para a compreensão do panorama da música e da cultura popular na cidade de São Paulo.

A teatralização da política: a propaganda abolicionista

Este artigo argumenta que, ao buscar modelos no repertório abolicionista estrangeiro para construir sua propaganda, os abolicionistas brasileiros viram suas possibilidades de escolha restritas pelas oportunidades políticas locais e pela tradição local católica. Contingências que impediram a simples transposição do modelo de ativismo estrangeiro e conduziram a uma atividade criativa de apropriação, em diálogo com o contexto e a tradição brasileiros. Processo que resultou numa reinvenção, uma vez que as artes, sobretudo o teatro, ganharam na propaganda abolicionista brasileira a proeminência que a religião teve na anglo-americana.