Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking. PURPOSE: The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV). RESEARCH DESIGN: Study design was a randomized controlled trial. STUDY SAMPLE: A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group. INTERVENTION: Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver. DATA COLLECTION AND ANALYSIS: Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient. RESULTS: All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up. CONCLUSION: We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.

Rotavirus fecal antigen retrieval in infantile intussusception.

This study was designed to assess the plausibility of an association between natural rotavirus infection and intussusception. It was conducted on 21 infants suffering from acute gastroenteritis (GE) complicated by intussusception who were compared to another 40 age- and sex-matched infants suffering from acute GE characterized by watery nonmucoid diarrhea without surgical complications. All enrolled patients were subjected to detailed history documentation, thorough clinical examination and laboratory investigations, complete stool analysis, and detection of rotavirus antigen in stools using the ELISA technique. Plain abdominal X-ray and ultrasound were also performed. The results of this study revealed 24 positive cases for rotavirus antigen in the stools of the acute uncomplicated GE patients (60.0%), while there were only ten positive cases in the intussusception group (47.6%). No significant difference in severity was detected between the two groups studied, especially in terms of signs of dehydration and need for IV fluids (p > 0.05). Most of the rotavirus positive cases among the intussusception group presented either in February or December (p < 0.05) with no significant seasonal pattern among the acute GE group (p > 0.05). In conclusion, rotavirus antigen retrieval from stools of GE patients complicated with intussusception was not statistically different from those detected among acute uncomplicated GE. Additionally, there was no association between seasonality or severity of rotavirus positive cases in acute GE patients and those with intussusception. It is thus prudent to say that wild rotavirus infection in GE patients does not carry an extra risk for the occurrence of intussusception.

Screening for osteoporosis in anorexia nervosa: prevalence and predictors of reduced bone mineral density.

OBJECTIVE: Decreased bone mineral density (BMD) in anorexia nervosa (AN) can be detected easily by dual-energy X-ray absorptiometry (DXA). This study was designed to assess the prevalence of osteoporosis and osteopenia in AN, identify predictors, and determine the diagnostic yield of screening with DXA. METHOD: DXA was used to screen 59 unselected adult patients with a history of AN. RESULTS: Osteoporosis was identified in 18 patients (31%) and osteopenia in 30 (51%). The spine had a lower mean T-score than either the hip or femur. BMI significantly predicted T-score (p = 0.0006) and the odds of having osteoporosis (p = 0.0188). There was a significant association between use of oestrogens and the presence of osteoporosis or osteopenia (p = 0.0491). There was no significant association between duration of AN and T-score. A duration of AN of less than 1 year was found in 12% of those with osteoporosis. CONCLUSION: BMI is a strong predictor of BMD in AN. DXA is an effective screening tool and should probably be offered routinely.

Family planning in the Sudan: a pilot project success story.

PIP: In 1980, the Department of Community Medicine of the University of Khartoum designed an operations research project to test the possibility of getting village midwives to be involved in the delivery of maternal and child health and family planning (MCH/FP) services. From 1981-1983 the project was implemented by the University of Khartoum in cooperation with the Ministry of Health. The project area covered 100 km. It encompassed a largely agrarian population of 93,000 in 90 villages north of Khartoum along the banks of the Nile. The focus was on training and supervising village midwives. Information was provided on contraceptives for birth spacing, distribution of oral contraceptives, and referral for other methods. Also provided to midwives was information for mothers on oral rehydration therapy for children with diarrhea, and distribution of oral rehydration solution packets. Nutrition education was given midwives with emphasis on breastfeeding and weaning procedures. Information was also supplied about vaccination for children under 5 years of age (in collaboration with the Sudan Expanded Program on Immunization). The project was expensive, particularly regarding incentive payments for supervisors and midwives. The project had a very good start, but when incentive payments were withdrawn, it almost collapsed. At first, what midwives could do to provide maternal and child health services was targeted, but as the project went on, there was more concern for involvement of midwives in broader rural health delivery. The project area was a conservative, Islamic one. An extension area was selected 5 hours travelling time from Khartoum in Shendi District of Nile Province. The project was begun in 60 villages of 75,000 inhabitants. The land stretched for 120 km along both banks of the Nile. In the extension area, a small fee (US$.025) was charged per cycle, half going to the midwives, and half towards the health teams' expenses. 21 health zones were created, and a health team created for each. Registers of women aged 15-49 and children 3 years have been set up for each health zone. There have been very good results in the management of diarrhea.^ieng

Planificación de la familia en el Sudán: Exito de un proyecto piloto / Family planning in Sudan: A pilot proyect success story

Un proyecto piloto ejecutado en el Sudán para determinar la aceptabilidad de la planificación familiar en las aldeas islámicas a orillas del Nilo ha sido un completo éxito, hasta el punto que, en lugar de desaparecer como suelen hacerlo los proyectos piloto, sigue siendo parte integrante del servicio de salud

Family planning in the Sudan: a pilot project success story

A pilot project in the Sudan to determine the acceptability of family planning in the Islamic villages along the Nile has proved completely successful- so much so that instead of expiring as most pilot projects do, it continues as an integral part of the health service