Etiology of dizziness among patients referring to an Iranian ear, nose and throat clinic

Background and Aim: Dizziness is one the most common complaints of patients in the emergency rooms. It has various etiologies and can lead to falling and other life-threatening injuries, especially in the elderly. Dizziness affects the quality of life and results in negative emotional reactions. This research studied the etiology of dizziness in a three-year study. Methods: This study was conducted on 650 patients with the complaint of dizziness, whose specialists suspected them of having possible vestibular involvement, referred to a tertiary audiology clinic from 2015 to 2018. Videonystagmography, electrocochleography and cervical vestibular evoked myogenic potentials were administered. Other medical tests including neurologic examinations, blood analysis, and brain imaging were performed based on patients’ complaints. * Corresponding author: Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Piche-Shemiran, Enghelab Ave., Tehran, 1148965141, Iran. Tel: 009821-77530636, E-mail: [email protected] Results: This was a descriptive study of dizziness prevalence with different etiologies. Patients’ age range was 18-85 years with mean (SD) age: 42.34 (13.12), including 377 (58%) females and 273 (42%) males. Patients’ chief complaints included vertigo in 64.8%, dizziness in 20.2% and imbalance in 15.1%. Vestibular disorders were identified in 49.2% of the referred patients. The patients’ final diagnosis in order of prevalence were as follows: systemic involvement (292 cases), benign paroxysmal positional vertigo (187 cases), unilateral vestibular weakness (63 cases), endolymphatic hydrops (51 cases), bilateral vestibular weakness (37 cases), central involvement (20 cases), cervical (10 cases) and migraine-associated vertigo (8 cases). Conclusion: About 49.2% of the patients referred to the ENT clinic had actual vestibular involvement. Careful history taking, teamwork, and comprehensive evaluations are necessary to differentiate underlying cause and selecting appropriate treatment.

Download Full-text

Isolated Intraocular Rosai-Dorfman Disease

Ocular Oncology and Pathology ◽

10.1159/000497185 ◽

2019 ◽

Vol 5 (6) ◽

pp. 418-423 ◽

Cited By ~ 2

Author(s):

Franz Fogt ◽

Thomas Rüediger ◽

Albert J. Augustin ◽

Dale M. Frank ◽

Andreas Rosenwald ◽

...

Keyword(s):

Uveal Melanoma ◽

Vision Loss ◽

The Elderly ◽

Final Diagnosis ◽

Retrospective Case ◽

Rare Presentation ◽

Systemic Involvement ◽

Rosai Dorfman Disease ◽

The Right ◽

Imaging Patient

Background/Aims: To report a case of Rosai-Dorfman disease (RDD) presenting as a solitary, choroidal mass, initially suspicious for uveal melanoma, in a 72-year-old woman. Methods: Retrospective case report of a single patient. Results: A 72-year-old woman presented with sudden vision loss in the right eye. A month prior, visual acuity was 20/40, but she was noted to have a choroidal mass confirmed with B-scan ultrasonography. Patient’s vision deteriorated significantly a month later and a shallow retinal detachment was newly noted. Magnetic resonance imaging was obtained, demonstrating a hyperintense intraocular tumor on TI imaging. Patient underwent enucleation of the right eye for suspicion of a uveal melanoma. Pathology revealed a mixed cellular infiltrate with histiocytes, some exhibiting emperipolesis. Macrophage immunohistochemical stains were positive, while melanocytic markers were negative. A diagnosis of RDD was made. Subsequently, the patient had a negative workup for systemic involvement. A final diagnosis of intraocular RDD without extraocular and systemic involvement was determined. Conclusion: We describe a rare presentation of RDD as a solitary choroidal mass in an elderly patient with overlapping features of uveal melanoma. Definitive diagnosis could only be made on histology. RDD should be considered in the differential diagnosis of a choroidal lesion in the elderly.

Download Full-text

Abstract 14767: Thrombolysis of Stroke Mimics via Telestroke

Circulation ◽

10.1161/circ.142.suppl_3.14767 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ravyn Howell ◽

Randheer S Yadav ◽

Sushil Lakhani ◽

Sharon Heaton ◽

Karen L Wiles ◽

...

Keyword(s):

Final Diagnosis ◽

National Institutes Of Health ◽

Factitious Disorder ◽

Emergency Rooms ◽

Stroke Mimics ◽

Intravenous Tissue Plasminogen Activator ◽

Stroke Diagnosis ◽

History Of ◽

Stroke Mimic ◽

Similar Episode

Introduction: Telestroke allows stroke expertise for thrombolysis decision making remotely using high-quality bidirectional audiovisual technology. Hypothesis: Intravenous tissue plasminogen activator (IVtPA) is administered via telestroke network to a proportion of patients without a stroke diagnosis (i.e. stroke mimic) Methods: Our academic comprehensive stroke program telestroke program includes 26 spoke Emergency rooms (ERs) through which IVtPA is administered throughout central Ohio. From July 1, 2016 to Sept 30, 2017, nearly all patients who received IVtPA at the outside hospital telestroke ERs were transferred to our institution for post-IVtPA care. Data was collected on final diagnosis, demographics, National Institutes of Health Stroke Scale (NIHSS), door to needle (DTN) time, and outcomes. Results: Among 270 acute ischemic stroke patients who received IVtPA via telestroke, we identified 64 (23.7%) with a stroke mimic diagnosis. Stroke mimics were younger (mean age 56.4 vs 68.2, p <0.0001), more likely female (60.9% vs 45.6%, p 0.03), and had higher DTN times (85.3 vs 69.9 minutes, p 0.0008). The increase in DTN was due to longer time to recommend by the telestroke neurologist for stroke mimic (65.0 vs 53.2 minutes, p 0.0034). The stroke mimic diagnosis included Migraine 26 (40.6%), Factitious disorder 12 (18.8%), Encephalopathy 7 (10.9%), and Unmasking 6 (9.4%). The stroke mimics did not differ from each other based upon initial NIHSS, DTN, or sex. Compared to the other stroke mimics, Migraine and Factitious disorder patients were younger (51.2 vs 63.9 years, p <0.0006), more likely to have a personal history of migraines (42.1% vs 0%, p < 0.0001), and more likely to have functional exam findings (42.1% vs 3.8%, p 0.0007). There were no hemorrhagic complications in the stroke mimic patients. Among all stroke mimics, 26 (40.6%) had a history of similar prior episodes and 10 (15.6%) would have future recurrence of another similar episode, with 2 patients receiving IVtPA again in the future (1 Migraine and 1 Factitious disorder). Conclusions: In a tertiary academic telestroke network, nearly one-quarter of patients receive IVtPA for a non-stroke diagnosis, with migraine and factitious disorder being the most commonly seen.

Download Full-text

Prevalence and Factors Related to Self-Medication for COVID-19 Prevention in the Elderly

Salmand ◽

10.32598/sija.16.1.2983.1 ◽

2021 ◽

Vol 16 (1) ◽

pp. 112-127

Author(s):

Narjes Heshmatifar ◽

◽

Arezoo Davarinia Motlagh Quchan ◽

Zohreh Mohammadzadeh Tabrizi ◽

Leila Moayed ◽

...

Keyword(s):

Significant Relationship ◽

Insurance Coverage ◽

The Elderly ◽

Cross Sectional Study ◽

Emotional Reactions ◽

The Self ◽

Self Medication ◽

Cross Sectional ◽

Factors Affecting ◽

Major Factors

Objectives: The Coronavirus Disease 2019 (COVID-19) crisis and health outcomes are among the major human social events of the 21st century. The unknown nature of the disease and the fear of contagion have caused emotional reactions, including the self-consumption of drugs in the elderly. Therefore, this study investigated factors affecting the self-consumption of drugs for COVID-19 prevention in the elderly. Methods & Materials: This descriptive and cross-sectional study was performed on 342 elderly in Sabzevar City, Iran, in 2020. The research units were selected as clusters from 16 health centers. The necessary data were collected by an online self-medication questionnaire. Data analysis was performed in SPSS. Results: The Mean±SD age of the study participants was 66.2±5.67 years. The frequency of self-medication to prevent COVID-19 was 190(55.5%); analgesics, vitamins, anti-cold, and antibiotics were the most common drugs used. The major factors associated with self-medication in the COVID-19 pandemic were disease prevention, home quarantine, financial problems, experiencing previous self-medication, and others’ advice. There was a significant relationship between self-medication and education and insurance coverage. No significant relationship was observed between gender, occupation, and marital status, and self-medication. Conclusion: Self-Medication in the COVID-19 epidemic is notable as a crisis threatening the elderly’s health. Controlling and monitoring how the drug is used is among the requirements for protection and health promotion in the elderly.

Download Full-text

Isolated intestinal polyarteritis nodosa in an elderly patient

BMJ Case Reports ◽

10.1136/bcr-2020-241431 ◽

2021 ◽

Vol 14 (3) ◽

pp. e241431

Author(s):

Ariana González-Meléndez ◽

Eduardo J Medina-Parrilla ◽

Román Vélez ◽

Luis M Vilá

Keyword(s):

Abdominal Pain ◽

Polyarteritis Nodosa ◽

Elderly Population ◽

Systemic Vasculitis ◽

Exploratory Laparotomy ◽

The Elderly ◽

High Dose ◽

Systemic Involvement ◽

Intestinal Pseudo Obstruction ◽

Single Organ

Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.

Download Full-text

Diffuse idiopathic skeletal hyperostosis in a 33-year-old woman with PCOS and metabolic syndrome: a rare scenario

BMJ Case Reports ◽

10.1136/bcr-2017-223740 ◽

2019 ◽

Vol 12 (10) ◽

pp. e223740

Author(s):

Jojin Jose Chitten ◽

Boblee James

Keyword(s):

Metabolic Syndrome ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

The Elderly ◽

Final Diagnosis ◽

Spinal Pain ◽

Spinal Motion ◽

First Case ◽

Male Preponderance ◽

Postural Abnormalities ◽

Ovarian Syndrome

Diffuse idiopathic skeletal hyperostosis (DISH) is a common degenerative enthesopathy seen in the elderly with male preponderance. It is uncommon in patients before 50 years of age and is extremely rare in patients younger than 40 years. We report a case of 33-year-old unmarried woman who presented with inflammatory spinal pain and stiffness, limited chest expansion, decreased range of spinal motion and postural abnormalities, all of which suggested the diagnosis of ankylosing spondylitis, considering the patient’s age. But, further evaluation led us to the final diagnosis of DISH with associated metabolic syndrome and polycystic ovarian syndrome (PCOS). To the best of our knowledge, our patient is the first reported case of DISH in a woman less than 40 years of age, and also the first case of DISH associated with PCOS and metabolic syndrome.

Download Full-text

A rare case of conjunctival malignant melanoma with orbital invasion

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25425 ◽

2019 ◽

Vol 11 (1) ◽

pp. 77-81

Author(s):

Yogita Rajbhandari ◽

Sharad Gupta ◽

Reena Yadav ◽

Ashma Manandhar ◽

Aye Myat Mon ◽

...

Keyword(s):

Malignant Melanoma ◽

De Novo ◽

The Elderly ◽

Palpebral Conjunctiva ◽

Pigmented Lesion ◽

Primary Acquired Melanosis ◽

Chief Complaints ◽

Wooden Stick ◽

Metastasis Rate ◽

Orbital Invasion

Background: Conjunctival malignant melanoma is a rare ocular malignancy most commonly affecting mostly the elderly population. It is a pigmented lesion which canarise from primary acquired melanosis, de novo or from preexisting nevus. Case: A 63 year old male presented with a chief complaints rapidly increasing mass in the left eye for two months following trauma with a wooden stick. He had preexisting nevus in the same eye. His best corrected visual acuity was 6/12 in right eye and 1/60 left eye respectively. Slit lamp biomicroscopy examination showed 4 cm x 4 cm pigmented mass in the nasal bulbar and inferior palpebral conjunctiva causing mechanical ectropion of the lower lid with keratinization of palpebral conjunctiva. Incisionalbiopsy of conjunctiva showed malignant melanoma. On computed tomography, there was expansion of bony orbit. Considering all the findings, exenteration of the left orbitwas done. Histopathological report of exenterated mass was suggestive of malignantmelanoma of conjunctiva. Conclusion: Conjunctival melanoma is a rare malignant tumor of eye which has high metastasis rate and the treatment option is surgery with adjuvant therapy.

Download Full-text

Reaching Vulnerable Populations through Portable and Mobile Dentistry—Current and Future Opportunities

Dentistry Journal ◽

10.3390/dj7030075 ◽

2019 ◽

Vol 7 (3) ◽

pp. 75

Author(s):

Shailee Gupta ◽

Muna Hakim ◽

Dishant Patel ◽

Lauren C. Stow ◽

Katherine Shin ◽

...

Keyword(s):

Dental Care ◽

School Attendance ◽

Dental Health ◽

The Elderly ◽

Emergency Rooms ◽

Oral Pain ◽

Dental Equipment ◽

Access To Dental Care ◽

Dental Offices ◽

To Receive

The Action for Dental Health Act of 2017 bill is intended to prevent dental disease and divert dental emergencies from high-cost centers (like hospital emergency rooms) to dental offices. Lines 15–17 of the bill include grant funding to support portable or mobile dental equipment, and this should lead to an expansion of opportunities to deliver and receive care through the use of portable dental equipment and mobile dental vans, i.e., portable and mobile dentistry (PMD). Historically, PMD has been valuable to bridge the access gap for those for whom transport can be a challenge, like children and the elderly. However, PMD could be valuable to large employers, allowing the employees to receive dental care with minimal disruption to their workday. Oral pain is known to affect work and school attendance, and improving access to dental care could benefit individuals, families, organizations, and communities.

Download Full-text

ALGORITHM TO STRATIFY THE RISK OF MYOCARDIAL INFARCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME AT PRIMARY EXAMINATION

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-6-394-400 ◽

2020 ◽

Vol 65 (6) ◽

pp. 394-400

Author(s):

A. S. Pushkin ◽

D. Shulkin ◽

L. V. Borisova ◽

T. A. Akhmedov ◽

S. A. Rukavishnikova

Keyword(s):

Machine Learning ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Troponin I ◽

Final Diagnosis ◽

Blood Analysis ◽

Digital Data ◽

Control Group ◽

Laboratory Diagnostics ◽

Coronary Syndrome

The episode of acute coronary syndrome is most often preceded by the development of systemic and local inflammation, which plays a significant role in the pathogenesis of the disease. General clinical blood analysis, directly or indirectly reflecting systemic pathological processes in the patient’s body based on quantitative and morphological assessment of blood composition, is one of the most affordable methods of laboratory diagnostics in modern public health. Taking into account the growing number of digital data obtained by diagnosticians from analytical systems, there is a growing potential for the use of machine learning methods to increase the effectiveness of provided diagnostic information in the interests of the patient. The aim of this study was to create an algorithm for stratifying the risk of myocardial infarction based on the methods of machine learning in patients with acute coronary syndrome at primary examination. A prospective pilot study was conducted. In total 307 patients with acute coronary syndrome (169 men and 138 women) were examined. The average age of patients was 68.6 ± 12.5 years. Retrospectively, the patients were divided into two groups: the main group - patients with the final diagnosis “Myocardial infarction” and the control group with the diagnosis “Unstable angina pectoris”. All patients at hospitalization at the primary laboratory examination along with the study of the concentration of cardiac troponin I by a highly sensitive method were examined by a general clinical blood analysis on an automatic hematological 5-diff analyzer. As a result of the application of the ensemble method as a method of machine learning and artificial neural networks as 6 independent models of the ensemble it was possible to achieve the area under the ROC curve = 0.77 on the test set when assessing the quality of patient stratification. Taking into account the volume of the training sample in 214 patients and the results of similar studies, the achieved stratification quality can be considered acceptable and promising for further accumulation of the database with the purpose of additional training of the developed algorithm and improvement of the disease prognosis accuracy characteristics.

Download Full-text