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)

¹H-NMR quantitative analysis and fingerprints of ginkgo diterpene lactone raw material / 中国中药杂志

Ginkgo diterpene lactone raw material, as a raw material for ginkgo diterpene lactone meglumine injection, is extracted and purified from ginkgo leaf. ¹H-NMR content determination method and fingerprint analysis method were respectively established for ginkgo diterpene lactone raw material. Content determination was conducted in 3 batches of samples by using ¹H-qNMR, and then the results were basically consistent with the results in HPLC method. Twenty-four proton peaks were identified as common fingerprint peaks, and the fingerprint peaks were identified by using the control product and NMR information. Furthermore, 10 batches of samples were analyzed by ¹H-NMR fingerprint. The similarities were all higher than 0.99 and the common peaks were identified with the reference standards. This method is easy, fast, with good precision, stability and repeatability and could provide basis and new ideas for quality evaluation of ginkgo diterpene lactone raw material and its preparations.

Ginkgo biloba para el tratamiento del tinnitus / Ginkgo biloba for the treatment of tinnitus

Resumen INTRODUCCIÓN: Se han propuesto múltiples tratamientos para el manejo del tinnitus, sin embargo, ninguno de ellos ha logrado establecerse como claramente efectivo. Dentro de las alternativas se ha planteado la utilización de Ginkgo biloba. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que el uso de Ginkgo Biloba probablemente no disminuye la severidad del tinnitus. Además, no disminuye la intensidad del tinnitus ni mejora la calidad de vida de los pacientes.

Abstract INTRODUCTION: Multiple interventions have been postulated for the treatment of tinnitus, but none has been established as clearly effective. Ginkgo biloba has been proposed among the alternatives. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including four primary studies, all corresponding to randomized trials. We concluded the use of Ginkgo biloba probably does not decrease the severity of tinnitus. In addition, it does not reduce the intensity of tinnitus or improve the quality of life of patients.

Antioxidant therapy in the elderly with tinnitus / Efeito da terapia com antioxidantes sobre o zumbido em idosos

ABSTRACT INTRODUCTION: Several approaches have been tried for the treatment of tinnitus, from cognitive-behavioral therapies and sound enrichment to medication. In this context, antioxidants, widely used in numerous areas of medicine, appear to represent a promising approach for the control of this symptom, which often is poorly controlled. OBJECTIVE: To evaluate the effects of antioxidant therapy for tinnitus in a group of elderly patients. METHODS: Prospective, randomized, double-blinded, placebo-controlled clinical trial. The sample consisted of 58 subjects aged 60 years or older, with a complaint of tinnitus associated with sensorineural hearing loss. These individuals completed the Tinnitus Handicap Inventory (THI) questionnaire before and after six months of therapy. The treatment regimens were: Ginkgo biloba dry extract (120 mg/day), a-lipoic acid (60 mg/day) + vitamin C (600 mg/day), papaverine hydrochloride (100 mg/day) + vitamin E (400 mg/day), and placebo. RESULTS: There was no statistically significant difference between THI by degree (p = 0.441) and by score (p = 0.848) before and after treatment. CONCLUSION: There was no benefit from the use of antioxidant agents for tinnitus in this sample.

Resumo Introdução: Uma série de abordagens terapêuticas tem sido empregada no tratamento do zumbido, desde terapias cognitivo-comportamentais e de enriquecimento sonoro até terapias medicamentosas. Nesse contexto, os agentes antioxidantes, amplamente utilizados em diversas áreas da medicina, parecem representar uma perspectiva promissora para o controle desse sintoma, que muitas vezes tem um controle clínico insatisfatório. Objetivo: Avaliar os efeitos da terapia com agentes antioxidantes sobre o zumbido em um grupo de pacientes idosos. Método: Ensaio clínico prospectivo, randomizado, duplo-cego e controlado por placebo. A amostra composta de 58 indivíduos com 60 anos ou mais, com queixa clínica de zumbido associado à perda auditiva, do tipo neurossensorial, em graus variados. Esses indivíduos foram submetidos ao questionário THI (Tinnitus Handicap Inventory) antes e após 6 meses de uso da medicação. Os esquemas terapêuticos foram os seguintes: extrato seco de Ginkgo biloba(120 mg/dia), ácido a-lipóico (60 mg/dia) + vitamina C (600 mg/dia), cloridrato de papaverina(100 mg/dia) + vitamina E (400 mg/dia) e placebo. Resultados: O THI após o tratamento foi estatisticamente igual ao THI antes do tratamento, tanto em graus (p = 0,441) quanto em escores (p = 0,848). Conclusão: Não se verificou benefício estatisticamente significativo com o uso de agentes antioxidantes para o zumbido dos indivíduos avaliados.

Beneficial effects of Ginkgo biloba extract on insulin signaling cascade, dyslipidemia, and body adiposity of diet-induced obese rats

Ginkgo biloba extract (GbE) has been indicated as an efficient medicine for the treatment of diabetes mellitus type 2. It remains unclear if its effects are due to an improvement of the insulin signaling cascade, especially in obese subjects. The aim of the present study was to evaluate the effect of GbE on insulin tolerance, food intake, body adiposity, lipid profile, fasting insulin, and muscle levels of insulin receptor substrate 1 (IRS-1), protein tyrosine phosphatase 1B (PTP-1B), and protein kinase B (Akt), as well as Akt phosphorylation, in diet-induced obese rats. Rats were fed with a high-fat diet (HFD) or a normal fat diet (NFD) for 8 weeks. After that, the HFD group was divided into two groups: rats gavaged with a saline vehicle (HFD+V), and rats gavaged with 500 mg/kg of GbE diluted in the saline vehicle (HFD+Gb). NFD rats were gavaged with the saline vehicle only. At the end of the treatment, the rats were anesthetized, insulin was injected into the portal vein, and after 90s, the gastrocnemius muscle was removed. The quantification of IRS-1, Akt, and Akt phosphorylation was performed using Western blotting. Serum levels of fasting insulin and glucose, triacylglycerols and total cholesterol, and LDL and HDL fractions were measured. An insulin tolerance test was also performed. Ingestion of a hyperlipidic diet promoted loss of insulin sensitivity and also resulted in a significant increase in body adiposity, plasma triacylglycerol, and glucose levels. In addition, GbE treatment significantly reduced food intake and body adiposity while it protected against hyperglycemia and dyslipidemia in diet-induced obesity rats. It also enhanced insulin sensitivity in comparison to HFD+V rats, while it restored insulin-induced Akt phosphorylation, increased IRS-1, and reduced PTP-1B levels in gastrocnemius muscle. The present findings suggest that G. biloba might be efficient in preventing and treating obesity-induced insulin signaling impairment.

Otoproteção em cobaias expostas a agrotóxico e ginkgo biloba / Otoprotection in guinea pigs exposed to pesticides and ginkgo biloba

Os agrotóxicos são amplamente utilizados na agricultura e, atualmente, fazem parte do grupo de agentes químicos que podem levar à perda auditiva. A identificação de drogas que, associadas aos ototóxicos, possam atuar como otoprotetores é objeto de estudo. OBJETIVO: Analisar a existência de efeito otoprotetor do extrato de Ginkgo biloba aos possíveis danos cocleares causados pelo agrotóxico do grupo dos organofosforados - metamidofós, avaliando-se as alterações anatômicas por meio da microscopia eletrônica de superfície. MATERIAL E MÉTODO: Estudo experimental prospectivo utilizando 21 cobaias, que sofreram ação da administração de soro fisiológico, agrotóxico e ginkgo biloba isoladamente e associadas, durante sete dias consecutivos. Após, as cócleas foram removidas e avaliadas anatomicamente pela microscopia eletrônica de varredura. RESULTADOS: As cobaias submetidas ao agrotóxico apresentaram alterações morfológicas cocleares, com lesões nas três espiras analisadas na microscopia eletrônica, intensificadas de acordo com a dosagem recebida do agente. As cobaias tratadas com agrotóxico e Ginkgo biloba apresentaram uma manutenção da arquitetura ciliar nas células ciliadas externas em todas as espiras da cóclea. CONCLUSÃO: O extrato de Ginkgo biloba, por sua ação antioxidante, atuou como fator otoprotetor à ototoxicidade pelo agrotóxico em cobaias.

Pesticides are widely used in agriculture, despite the risk of hearing loss related to the exposure to their chemical components. This study looks into protective drugs to counteract the ototoxicity of pesticides. OBJECTIVE: This study aims to analyze the effect ginkgo biloba extract may have in protecting against possible cochlear damage caused by organophosphate pesticides (methamidophos). Anatomic changes are assessed through surface and electron microscopy. MATERIALS AND METHODS: This is a prospective experimental study. Twenty-one guinea pigs were given saline solution, pesticide, and ginkgo biloba alone or combined for seven consecutive days. Then their cochleas were removed and examined in a scanning electron microscope. RESULTS: Pesticide-exposed guinea pigs had morphological alterations in their cochleas and injuries in the three turns analyzed through electron microscopy. Injury intensity varied according to the dosages of the agents given to the test subjects. Guinea pigs treated with pesticide and ginkgo biloba maintained the architecture of their outer hair cells in all cochlear turns. CONCLUSION: The antioxidant properties found in the ginkgo biloba extract protected guinea pigs from pesticide ototoxicity.

Ginkgo biloba extract (GbE) enhances the anti-atherogenic effect of cilostazol by inhibiting ROS generation

In this study, the synergistic effect of 6-[4-(1-cyclohexyl-1H-tetrazol-5-yl) butoxy]-3,4-dihydro-2(1H)-quinolinone (cilostazol) and Ginkgo biloba extract (GbE) was examined in apolipoprotein E (ApoE) null mice. Co-treatment with GbE and cilostazol synergistically decreased reactive oxygen species (ROS) production in ApoE null mice fed a high-fat diet. Co-treatment resulted in a significantly decreased atherosclerotic lesion area compared to untreated ApoE mice. The inflammatory cytokines and adhesion molecules such as monocyte chemoattractant-1 (MCP-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and VCAM-1 which can initiate atherosclerosis were significantly reduced by the co-treatment of cilostazol with GbE. Further, the infiltration of macrophages into the intima was decreased by co-treatment. These results suggest that co-treatment of GbE with cilostazol has a more potent anti-atherosclerotic effect than treatment with cilostazol alone in hyperlipidemic ApoE null mice and could be a valuable therapeutic strategy for the treatment of atherosclerosis.

Gingko biloba leaves extract on growth and morphology of trypanosomatids / Efecto del extracto de las hojas de Gingko biloba en el crecimiento y la morfología de tripanosomátidos

Gingko biloba has been one of the most used medicinal plants all over the world in the past years. In this study, our group has studied the effect of a hydroethanolic extract from the aerial parts of this plant on the growth and morphological differentiation of trypanosomatids. Herpetomonas samuelpessoai and Herpetomonas sp were used in this study. The extract was obtained in a Soxhlet apparatus (50 oC, 2 hours). This extract was aseptically added to Roitman’s medium in different concentrations (4, 20, 40, 60, 80 and 100 mg/ml). The growth rate was determined using a Newbauer chamber to count numbers of cells after the extract inoculation (24 and 72 hours later). Smears stained by the Panotic method was used to determine the percentages of pro, para and opisthomastigote forms. The extract inhibited Herpetomonas sp growth in concentrations higher than 20 mg/ml. H. samuelpessoai has been inhibited in doses higher than 40 mg/ml. No morphological differentiation was observed in Herpetomonas sp cell. However, morphological differentiations could be noticed in H. samuelpessoai cell using doses higher than 40 mg/ml. These alterations are probably related to the cell division process, since cells with 3 or 4 nucleus were observed. Also, cytoplasmatic expansions, representing unsuccessful process of cell division were frequently found out. Further ultrastructural analysis using a transmission electron microscope showed cells with homogeneous nucleus or the absence of it. Protozoan protein profile was also analyzed. It was possible to notice changes in both trypanosomatids used in this study. H. samuelpessoai has shown over expression and accumulation of proteins which its degradation is essential to continue the cell differentiation. Also, it is possible to suggest that this extract acts through the modulation of the genetic expression and may be harmful to human cells if not purified.

Gingko biloba es una de las plantas medicinales más utilizadas en todo el mundo en los últimos años. En este estudio, nuestro grupo ha estudiado el efecto de un extracto hidroetanólico de la parte aérea de esta planta sobre el crecimiento y la diferenciación morfológica de tripanosomátidos. Herpetomonas samuelpessoai y Herpetomonas sp se utilizaron en este estudio. El extracto se obtuvo en un aparato Soxhlet (50° C/2 horas). Este extracto se agregó asépticamente a medio Roitman en diferentes concentraciones (4, 20, 40, 60, 80 y 100 mg /ml). La tasa de crecimiento se determinó utilizando una cámara de Newbauer para contar el número de células después de la inoculación de extracto (24 y 72 horas más tarde). Frotis teñidos por el método Panotic se utilizó para determinar los porcentajes de pro, para y las formas opistomastigota. El extracto inhibió el crecimiento Herpetomonas sp en concentraciones superiores a 20 mg /ml. H. samuelpessoai se ha inhibido en dosis superiores a 40 mg /ml. No se observó diferenciación morfológica en la celda Herpetomonas sp. Sin embargo, las diferenciaciones morfológicas se pudo observar en la celda H. samuelpessoai con dosis superiores a 40 mg /ml. Estas alteraciones son probablemente relacionado con el proceso de división celular, ya que las células con 3 o 4 núcleos se observaron. Además, las expansiones citoplasmáticas, lo que representa el proceso fallido de la división celular se encontraron con frecuencia hacia fuera. Un análisis más detallado ultraestructural usando microscopio electrónico de transmisión mostró células con núcleo homogéneo o la ausencia de ella. El perfil de proteínas por Protozoarios también se ha analizado. Fue posible notar cambios tanto en tripanosomátidos utilizados en este estudio. H. samuelpessoai ha demostrado a lo largo de expresión y la acumulación de proteínas que su degradación es esencial para continuar con la diferenciación celular. Además, es posible sugerir que este extracto...

Ginkgo biloba e memória: revisão sistemática / Ginkgo biloba and memory: systematic review

Com o envelhecimento da população, os distúrbios de memória têm-se tornado patologias cada vez mais frequentes. Com exceção de uma minoria dos casos cujas causas são reversíveis, estas doenças possuem prognóstico desanimador, curso inexorável e opções terapêuticas muito limitadas. O medicamento fitoterápico mais frequentemente utilizado para distúrbios de memória é o extrato seco de ginkgo biloba (GB). Suas ações antioxidantes, antiagregantes e vasodilatadoras têm encorajado diversos profissionais a utilizarem-no neste tratamento, porém não há registros convincentes que comprovem a eficácia do uso desta substância para tal fim. Objetivos: Avaliar a eficácia do GB na prevenção e no tratamento de distúrbios de memória. Métodos: Revisão sistemática da literatura dos últimos dez anos dos estudos clínicos duplo-cegos, randomizados, placebo-controlados, publicados na língua inglesa. Resultados e Conclusões: Embora tenhamos obtido poucos ensaios controlados sobre o tema, não há evidências suficientes para se indicar o uso da droga com a finalidade de tratar e/ou prevenir distúrbios de memória.

Effect of Ginkgo biloba on the reproductive outcome and oxidative stress biomarkers of streptozotocin-induced diabetic rats

The aim of the present study was to evaluate the effect of Ginkgo biloba treatment (EGb 761, 200 mg kg-1 day-1) administered from day 0 to 20 of pregnancy on maternal reproductive performance and on the maternal and fetal liver antioxidant systems of streptozotocin-induced diabetic Wistar rats. On day 21 of pregnancy, the adult rats (weighing approximately 250 ± 50 g, minimum number = 13/group) were anesthetized to obtain maternal and fetal liver samples for superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total glutathione (GSH-t) determinations. The uterus was weighed with its contents. The diabetic (G3) and treated diabetic (G4) groups of rats presented significant maternal hyperglycemia, reduced term pregnancy rate, impaired maternal reproductive outcome and fetal-placental development, decreased GSH-Px (G3 = G4 = 0.6 ± 0.2) and SOD (G3 = 223.0 ± 84.7; G4 = 146.1 ± 40.8), and decreased fetal CAT activity (G3 = 22.4 ± 10.6; G4 = 34.4 ± 14.1) and GSH-t (G3 = G4 = 0.3 ± 0.2), compared to the non-diabetic groups (G1, untreated control; G2, treated). For G1, maternal GSH-Px = 0.9 ± 0.2 and SOD = 274.1 ± 80.3; fetal CAT = 92.6 ± 82.7 and GSH-t = 0.6 ± 0.5. For G2, G. biloba treatment caused no toxicity and did not modify maternal or fetal-placental data. EGb 761 at the nontoxic dose used (200 mg kg-1 day-1), failed to modify the diabetes-associated increase in maternal glycemia, decrease in pregnancy rate, decrease in antioxidant enzymes, and impaired fetal development when the rats were treated throughout pregnancy (21 days).

Protective effect of Gingko biloba extract against doxorubicin-induced cardiotoxicity in mice.

Doxorubicin (DXR) causes dose dependent cardiotoxicity in experimental animals and in humans. In chronic doxorubicin cardiotoxicity model mice, the role of G. biloba extract (Gbe) which has an antioxidant property, was investigated. Doxorubicin treated animals showed higher mortality (68%), increased ascites, marked bradycardia, prolongation of ST and QT intervals and widening of QRS complex. Myocardial SOD and glutathione peroxidase activity were decreased and lipid peroxidation was increased. Ultrastructure of heart of DXR treated animals showed loss of myofibrils, swelling of mitochondria, vacuolization of mitochondria. G. biloba extract significantly protected the mice from cardiotoxic effects of doxorubicin as evidenced by lowered mortality, ascites, myocardial lipid peroxidation, normalization of antioxidant enzymes, reversal of ECG changes and minimal ultrastructural damage of the heart. The results indicate that administration of G. biloba extract protected mice from doxorubicin-induced cardiotoxicity.