Tratamento clínico de zumbido primário em adultos e idosos: revisão sistemática / Clinical treatment of primary tinnitus in adults and in the elderly: systematic review

O zumbido no ouvido é definido como uma ilusão auditiva ou sensação sonora endógena, não relacionada a nenhuma fonte externa de estimulação. É um sintoma frequente na população idosa. Até hoje, vários autores argumentam que o desconhecimento da etiologia do zumbido, aliado à subjetividade desta manifestação, mais a sobreposição das enfermidades e dos sintomas que, geralmente, acometem os pacientes idosos, dificultam a obtenção de um bom resultado terapêutico. O objetivo desta revisão foi levantar quais os tratamentos clínicos mais utilizados na prática clínica no tratamento do zumbido primário em adultos e idosos. Procedeu-se à verificação do status dos últimos 5 anos de estudos em textos de acesso livre, no banco de dados eletrônicos da PubMed. Apresentaram tratamentos clínicos para o zumbido primário 25 artigos; aqueles com resultados satisfatórios foram quatro artigos sobre acupuntura, dois sobre neuromodulação de resenha coordenada acústica, um sobre uso combinado de amplificação e gerador de som, e um sobre psicoterapia corporal, que incluíam tanto adultos e idosos, tendo a idade média entre 51 a 54 anos. Não se pode afirmar que os tratamentos propostos são eficazes na cura dos sintomas de zumbido em adultos e idosos, mas sim que existem algumas terapêuticas de baixo custo que apresentam respostas relativamente satisfatórias. (AU)

Tinnitus is defined as a hearing illusion or endogenous auditory sensation that is not related to any external stimulation source. It is a frequent symptom among elderly people. To date, many authors have argued that the lack of knowledge about the tinnitus etiology, added to the subjectivity of this manifestation, and the overlap of other diseases and symptoms that often occur with aged patients make the obtainment of a good therapeutic result difficult. The objective of this review was to find the most used clinical treatment in clinical practice for primary tinnitus on adults and elderly. The status of the last five years of studies in free full texts on PubMed database was checked. Twenty-five articles showed clinical treatment for primary tinnitus, with four articles about acupuncture, two about acoustic coordinate reset neuromodulation, one about sound generator associated with conventional amplification, and one about body-psychotherapy which included adults and elderly with an average age between 51 to 54 years old showing satisfactory results. It is difficult to state that the proposed treatment is efficient on healing the tinnitus symptoms on adults and elderly but there are some low-cost therapies showing relatively satisfactory responses. (AU)

Terapia cognitivo-comportamental no transtorno de pânico / Cognitive-behavioral therapy in panic disorder

OBJETIVO: O transtorno de pânico é uma condição crônica e recorrente que prejudica a qualidade de vida e o funcionamento psicossocial dos portadores. Embora os medicamentos sejam efetivos na redução dos ataques de pânico, muitos pacientes não respondem adequadamente a essas intervenções. A terapia cognitivo-comportamental fornece um método alternativo eficaz para tratar transtorno de pânico e evitação agorafóbica. O objetivo do estudo é o de descrever o uso de técnicas cognitivo-comportamentais no tratamento do transtorno de pânico. MÉTODO: Revisão narrativa a partir dos bancos de dados do Medline, SciELO e PsycInfo e de livros-texto especializados. RESULTADOS: Foram descritos os fundamentos da terapia cognitivo-comportamental no tratamento do transtorno pânico e revisadas as evidências de eficácia em curto e longo prazos. O uso de medicação concomitante a terapia cognitivo-comportamental foi também discutido. CONCLUSÕES: A terapia cognitivo-comportamental individual ou em grupo é eficaz para pacientes com transtorno de pânico, seja como tratamento de primeira linha ou como um próximo passo para pacientes com resposta parcial a outros tratamentos.

OBJECTIVE: Panic disorder is a chronic and recurrent condition that impairs an individual's psychosocial functioning and quality of life. Despite the efficacy of psychopharmacological treatment in reducing panic attacks, many patients fail to respond adequately to these interventions. Cognitive behavioral therapy provides an alternative and efficacious method for treating panic disorder and agoraphobic avoidance. The objective of the study is to describe the use of cognitive behavioral therapy for panic disorder. METHOD: Narrative review of data collected from Medline, SciELO and PsycInfo and specialized textbooks. RESULTS: We describe the cognitive-behavioral model for the treatment of panic disorder, and review both short and long-term efficacy findings. We also discuss the role of combined treatment (cognitive behavioral therapy and psychopharmacology). CONCLUSIONS: Cognitive behavioral therapy, either individual or in group, can be used as first-line therapy for panic disorder. This treatment modality can also be indicated as a next step for patients failing to respond to other treatments.

Susceptibility tests to second line drugs and re-treatment of tuberculosis: revisiting early experiences / Las pruebas de sensibilidad a drogas de segunda línea y el re-tratamiento de la tuberculosis: visión retrospectiva de tres estudios

The value of susceptibility tests in guiding antituberculous therapy with second-line drugs remains controversial. We reanalyzed three reports regarding the relationship between in vitro susceptibility of Mycobacterium tuberculosis and the clinical outcome of in-patients treated with these drugs at the Muñiz Hospital, Buenos Aires, during the sixties. These patients had been irregularly treated with a standard regimen consisting of isoniazid, streptomycin and PAS; they developed resistance to at least the first two drugs and persisted culture-positive. Susceptibility testing to ethionamide, cycloserine and kanamycin were performed by the proportion method on Löwenstein Jensen medium. Some level of resistance was detected among isolates from patients not previously treated with these drugs, that could be due to cross resistance with previously administered first line structural analogs. However, the studies evidenced significant association between resistance to ethionamide and cycloserine and prior treatment with these drugs. Increased resistance to all three drugs was detected within the first three months of treatment. In vitro resistance to ethionamide emerged earlier and was the most frequent followed by resistance to cycloserine and kanamycin. The low frequency of resistance to kanamycin could be related to the low dosage of this drug used at that time. Simultaneous resistance to the three agents, but not to two or one drug, appeared to be a marker of treatment failure. An apparent reversion of drug resistance was observed in near 6% of patients, for whom susceptibility tests were repeated on subsequent isolates, indicating this percentage of inconsistency in reproducibility of test results.

La correlación entre resultados de pruebas de sensibilidad a drogas antituberculosas de segunda línea y evolución de los pacientes en tratamiento, aún es discutida. Se reanalizan aquí tres estudios realizados en la década del 60, sobre la relación entre resultados de pruebas de sensibilidad y tratamiento con estas drogas, en pacientes crónicos, internados en el hospital Muñiz, Buenos Aires, que habían sido tratados con el entonces régimen estándar, integrado por isoniacida, estreptomicina y PAS; se habían hecho resistentes al menos a dos de estas drogas y continuaban con cultivo positivo. La prueba de sensibilidad a etionamida, cicloserina y kanamicina se efectuó por el método de las proporciones en medio Löwenstein Jensen. Entre 4 y 13% de los pacientes previamente no tratados con estas drogas presentó cierto nivel de resistencia, fenómeno atribuido a la administración previa de drogas de primera línea con moléculas análogas. Se halló asociación significativa entre resistencia a etionamida y cicloserina, y tratamiento previo con estas drogas. La resistencia a las tres drogas fue detectada en los primeros tres meses de tratamiento, siendo la resistencia a etionamida la más frecuente, y la primera en emerger, seguida por cicloserina y kanamicina, cuya baja frecuencia en alcanzar resistencia estaría relacionada con las bajas dosis administradas. La resistencia simultánea a las tres drogas, pero no a una o dos, resultó marcadora de fracaso terapéutico. Se observó en cerca del 6% de los pacientes aparente reversión de la resistencia, en pruebas hechas en aislamientos sucesivos, interpretada como falla en la reproducibilidad de resultados.

Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients.

BACKGROUND: We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB). METHODS: A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years. RESULTS: Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs. CONCLUSION: In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.

Tuberculosis: resistencia primaria del BK a los quimioterapicos / Tuberculosis: primary resistance of BK to the chemotherapeutic agents

Se presentan los resultados de las pruebas de resistencia hechas a 22 pacientes nuevos, sin tratamientos previos, descubiertos en el Hospital de la Maria en Noviembre de 1982. A pesar de que la muestra no es representativa, la alta proporcion de germenes resistentes (32%) y especificamente a la INH, hace necesario y urgente mas investigacion al respecto o un cambio en la politica de tratamiento.