RESUMO
Objectives: To outline the spectrum of vertigo, to elaborate the significance of vascular causes of vertigo, to advocate use of MRI / MRA of carotid artery and vetebrobasilar arterial system in patients with isolated or syndromic vertigo especially when one or more risk factors for a cerebrovascular accident are present. Study design: Prospective study(2009-2011). Results: 91 patients who preened with vertigo were prospectively studied. BPPV, Meniere’s disease and vestibular neuritis comprised about 60% of patients. Posterior circulation syndrome and vertebrobasilar insufficiency was strongly suspected in 13 patients (14.3%). Compression of 8th nerve and cerebellar vermis were documented to be the cause of vertigo in 7 patients (7.7%), cervical vertigo was seen in 6(6.6%) patients. 4 patients (4.4%) had vertigo as a manifestation of complicated CSOM. 3 (3.3%) patients had metabolic vascular syndrome out of which one patient died of stroke about 6 months after his presentation as recurrent episodic vertigo. No diagnosis could be made in 3 patients. Conclusion:A detailed history should be obtained and an elaborate vestibular and neuro-otologic examination done in a patient of vertigo. A diagnosis can be reached in more than 90% of patients. Peripheral vertigo is more common that central vertigo with BPPV, meniere’s disease and acute vestibular neuritis accounting for more than 60% of all cases of vertigo. Vascular causes form a significant group of vertigo patients. Vertigo especially recurrent and syndromic with 1 or more risk factors should not be overlooked and should be regarded a precursor of a future stroke. Patients of vertigo with vascular risk factors like age (elderly), hypertension, smoking, diabetes mellitus, hyperlipidemia and cardiac disease should be evaluated for vertebrobasilar insufficiency by specific investigations like MRI brain, MRA carotids and vertebrobasilar arteries, Doppler USG and risk factors for vascular disease modified by drugs (hypolipidemic, antihypertensive, aspirin) and behavioural changes. Abnormal vessel loops can compress VIII nerve and cause vertigo. These can be reliably diagnosed by MRA. Vertigo can be caused in patients with cervical spondylosis especially in previously diseased vessels (due to atherosclerosis, vasculitis) which get easily compressed by cervical osteophytes.
RESUMO
The objective of the study was to study the microflora and the antibiograms of patients with chronic suppurative otitis media (CSOM) in Kashmir,in order to provide a guidelines for making a protocol for empirical antibiotic therapy. Study design:Prospective study Material and methods: This study was conducted on OPD basis in Department of Ear, Nose and Throat and HNS Government medical college Srinagar kashmir from july 2010 to june 1011 and one hundred twenty five(125) patients with unilateral or bilateral active chronic suppurative otitis media were prospectively studied.They had chronic ear discharge and had not received antibiotics for the previous five days. Swabs were taken from discharging ear's and sent to microbiological section of hospital were culture for bacteria was done Antibiotic sensitivity testing was done with standard antibiotic discs using Kirby-bauer disk diffusion method.4 Results:From the Clinical specimens off the 125 patients microbiological culture was positive in 110 specimens. The most common causal organisms isolated were Staphylococcus aureus (48%) including 8% of methcillin resistant staph aureus and Pseudomonas aeruginosa (16%) followed by coagulase negative.Antibiotic sensitivities of staph aureus (other than MRSA) showed that 72% isolates were sensitivity to gentamicin,55% to ciprofloxacin followed by 36% to cephalosporins(cetazidime,ceftriaxone).For pseudomonas aeruginosa 72% isolates were sensitive to piperacillin/tazobactum 48% to ciprofloxacin and 32% to ceftazidime/ceftriaxone. Of the three antibiotics commonly available as topical eardrops,ciprofloxacin and gentamicin has the highest susceptibility rate.