Balance in Transition: Unraveling the Link Between Menopause and Vertigo.

The onset of menopause, marked by hormonal fluctuations and a decline in estrogen levels, is suggested to be linked to increased susceptibility to vestibular disturbances. Estrogen, beyond its established association with reproductive physiology, plays modulatory roles in various physiological systems, including neurosensory function. The vestibular system, crucial for balance and spatial orientation, is influenced by hormonal changes during menopause, potentially contributing to the emergence of vertigo symptoms. This interplay between hormones and the vestibular system is a burgeoning area of research with clinical implications, offering insights into novel diagnostic and therapeutic approaches for managing postmenopausal women with vestibular disorders. The article reviews current scientific literature, delves into the hormonal intricacies of menopause, and investigates potential mechanisms underlying the connection between hormonal fluctuations and vertigo symptoms.

INJURY EPIDEMIOLOGY IN BEACH TENNIS: INCIDENCE AND RISK FACTORS.

Introduction: Due to the growing increase in beach tennis practice in Brazil and the lack of studies on the injuries that occur in this sport, it has become necessary to develop more research on the subject. Objective: to identify risk and protection factors for injuries in beach tennis, in order to generate prevention strategies for musculoskeletal injuries. Method: A cross-sectional epidemiological study, level 3 of evidence, was carried out through an electronic form with 698 Beach Tennis players, who answered questions about their relationship with the practice of the sport and occurrences of injuries. We researched the prevalence of injuries, their types, and their relation with personal physical characteristics and the practice of other sports. Results: We found a positive relationship between injuries when associated with longer exposure time and the presence of a previous injury. We did not find differences regarding BMI, gender, and stretching and muscle strengthening performance. Conclusion: the most frequent non-traumatic injuries were to the elbow and shoulder (tendonitis) and traumatic (sprain) injuries to the knee and ankle. Level of Evidence II; Cohort Study.

Introdução: Devido ao crescente aumento da prática de Beach Tennis no Brasil e a carência de estudos sobre as lesões que ocorrem nesse esporte se faz necessário o desenvolvimento de mais pesquisas sobre o tema. Objetivo: identificar fatores de risco e de proteção para lesões no Beach Tennis, afim de gerar estratégias de prevenção às injurias musculoesqueléticas. Método: realizado estudo epidemiológico transversal nível 3 de evidência através de um formulário eletrônico com 698 praticantes de Beach Tennis, que responderam questionamentos sobre sua relação com a prática do esporte e ocorrências de lesões. Pesquisamos a prevalência das lesões e seus tipos, assim como sua relação com as características físicas pessoais e prática de outros esportes. Resultados: encontramos relação de positividade para lesões quando associadas a maior tempo de exposição e presença de lesão prévia. Não encontramos diferença quanto ao IMC, sexo e a realização de alongamento e fortalecimento muscular. Conclusão: as lesões mais frequentes não traumáticas foram no cotovelo e ombro (tendinite) e traumáticas (entorse) de joelho e tornozelo. Nível de Evidência II; Estudo de Coorte.

Injury epidemiology in beach tennis: incidence and risk factors / Epidemiologia das lesões no beach tennis: incidência e fatores de risco

ABSTRACT Introduction: Due to the growing increase in beach tennis practice in Brazil and the lack of studies on the injuries that occur in this sport, it has become necessary to develop more research on the subject. Objective: to identify risk and protection factors for injuries in beach tennis, in order to generate prevention strategies for musculoskeletal injuries. Method: A cross-sectional epidemiological study, level 3 of evidence, was carried out through an electronic form with 698 Beach Tennis players, who answered questions about their relationship with the practice of the sport and occurrences of injuries. We researched the prevalence of injuries, their types, and their relation with personal physical characteristics and the practice of other sports. Results: We found a positive relationship between injuries when associated with longer exposure time and the presence of a previous injury. We did not find differences regarding BMI, gender, and stretching and muscle strengthening performance. Conclusion: the most frequent non-traumatic injuries were to the elbow and shoulder (tendonitis) and traumatic (sprain) injuries to the knee and ankle. Level of Evidence II; Cohort Study.

RESUMO Introdução: Devido ao crescente aumento da prática de Beach Tennis no Brasil e a carência de estudos sobre as lesões que ocorrem nesse esporte se faz necessário o desenvolvimento de mais pesquisas sobre o tema. Objetivo: identificar fatores de risco e de proteção para lesões no Beach Tennis, afim de gerar estratégias de prevenção às injurias musculoesqueléticas. Método: realizado estudo epidemiológico transversal nível 3 de evidência através de um formulário eletrônico com 698 praticantes de Beach Tennis, que responderam questionamentos sobre sua relação com a prática do esporte e ocorrências de lesões. Pesquisamos a prevalência das lesões e seus tipos, assim como sua relação com as características físicas pessoais e prática de outros esportes. Resultados: encontramos relação de positividade para lesões quando associadas a maior tempo de exposição e presença de lesão prévia. Não encontramos diferença quanto ao IMC, sexo e a realização de alongamento e fortalecimento muscular. Conclusão: as lesões mais frequentes não traumáticas foram no cotovelo e ombro (tendinite) e traumáticas (entorse) de joelho e tornozelo. Nível de Evidência II; Estudo de Coorte.

The prevalence of low back pain in nurses at a university hospital in the eastern area of são paulo / Prevalência de dor lombar em enfermeiros em um hospital universitário da zona leste de são paulo / Prevalencia de dolor de la región lumbar en enfermeros de un hospital universitario de la zona este de são paulo

ABSTRACT Objective: To evaluate the prevalence of low back pain in nurses at a university hospital in São Paulo and establish a relationship with social aspects. Methods: A cross-sectional study was carried out, through the application of a questionnaire containing social questions(weight, age, height, work sector, working hours, physical activity, presence and frequency of low back pain) in addition to the Oswestry questionnaire. Results: One hundred fifty-three nurses participated in the study. Of these, 92.30% of the women and 73.91% of the men presented low back pain, with a third classifying the pain as sporadic. In relation to BMI, pain is lower in those who are underweight (60%) and higher among those who are overweight (96.77%). Most of the sample was sedentary (66%), and of these, 96% had low back pain. There was no difference in the comparison by working hours, in relation to work sector, pain was more present in the following sectors: coordination (100%); children's ward (92%); adult emergency room (90%) and adult ICU (31%). Thirty nurses worked double shifts, and of these, 90% reported low back pain, while among those who worked only at the university hospital, 89.4% reported pain. In relation to working hours, the longer the working day, the greater the pain. In the function assessment (Oswestry), 99 participants obtained a value of up to 30% disability. Conclusion: Based on the results of this work, it is concluded that there is a high prevalence of low back pain in nurses at the Hospital Universitário; however, it was not possible to determine a direct risk factor associated with this high prevalence. Level of Evidence IV; Cross-sectional study.

RESUMO: Objetivo: Avaliar a prevalência de dor lombar em enfermeiros de um hospital universitário da zona leste de São Paulo e estabelecer relação com aspectos sociais. Métodos: Foi realizado um estudo de corte transversal, através da aplicação de um questionário contendo questões sociais (peso, idade, altura, setor de trabalho, carga horária, prática de exercício físico, presença e frequência de dor lombar), além do questionário Oswestry. Resultados: Cento e cinquenta e três enfermeiros participaram do estudo, destes 92,30% das mulheres e 73,91% dos homens apresentaram dor lombar, sendo que um terço classificava a dor como esporádica. Em relação ao IMC, a dor é menor naqueles que estão abaixo do peso (60%) e maior entre aqueles que se apresentam sobrepeso (96,77%). A maioria da amostra era sedentária (66%), sendo que destes, 96% apresentavam dor lombar. Não houve diferença na comparação para período de trabalho, já em relação ao setor de trabalho a dor estava mais presente no setor de coordenação (100%), seguido por enfermaria infantil (92%), pronto socorro adulto (90%) e UTI adulto (31%). Trinta enfermeiros faziam dupla jornada, e destes, 90% relataram dor, já nos que trabalhavam somente no hospital universitário 89,4% relataram dor. Em relação à carga horária, quanto maior a jornada, mais dor. Na avaliação da função (Oswestry), 99 participantes obtiveram um valor de até 30% de incapacidade. Conclusão: A partir dos resultados deste trabalho, conclui-se que existe uma alta prevalência de dor lombar nos enfermeiros do Hospital Universitário, no entanto, não foi possível determinar um fator de risco direto associado à esta alta prevalência. Nível de Evidência IV; Estudo de corte transversal.

RESUMEN: Objetivo: Evaluar la prevalencia del dolor de la región lumbar en enfermeros y enfermeras de un hospital universitario de la zona este de São Paulo y establecer una relación con los aspectos sociales. Métodos: Se realizó un estudio transversal aplicando un cuestionario que contenía preguntas sociales (peso, edad, altura, sector laboral, carga de trabajo, práctica de ejercicio físico, presencia y frecuencia de dolor en la región lumbar), además del cuestionario de Oswestry. Resultados: Participaron del estudio 153 enfermeros y enfermeras, de los cuales el 92,30% de las mujeres y el 73,91% de los hombres presentaban dolor en la región lumbar, y un tercio clasificaba el dolor como esporádico. En cuanto al IMC, el dolor es menor en los que tienen un peso inferior al normal (60%) y mayor entre los que tienen sobrepeso (96,77%).La mayoría de la muestra era sedentaria (66%), y de ellos, el 96% presentaba lumbalgia. No hubo diferencias en la comparación por período de trabajo, pero en cuanto al sector de trabajo, el dolor estuvo más presente en el sector de: coordinación (100%); seguido de la sala infantil (92%); urgencias de adultos (90%) y UCI de adultos (31%). Treinta enfermeros y enfermeras trabajaban en doble turno, y de ellos, el 90% manifestó dolor, mientras que de los que trabajaban sólo en el hospital universitario, el 89,4% manifestó dolor. En cuanto a la carga de trabajo, cuanto más largo es el turno, más dolor. En la evaluación de la función (Oswestry), 99 participantes obtuvieron un valor de hasta un 30% de incapacidad. Conclusión: A partir de los resultados de este estudio, se concluye que existe una alta prevalencia de dolor de la región lumbar en enfermeros y enfermeras del Hospital Universitario, sin embargo, no fue posible determinar un factor de riesgo directo asociado a esta alta prevalencia. Nivel de Evidencia IV; .Estudio Transversal.

Exploring Global Research Trends in Burnout among Nursing Professionals: A Bibliometric Analysis.

Nursing professionals are constantly exposed to several risk factors and high levels of stress that can affect their mental, emotional, and physical health, which can trigger burnout syndrome. This article aims to use bibliometric analysis to investigate burnout research trends among nursing professionals worldwide and to compare the contributions of different countries/institutions, scientific journals, authors, keywords, and citations. A bibliometric study was performed using the Scopus and Web of Science databases, in the period up to November 2021, aiming to search original and review articles in the English language regarding burnout in nursing professionals. The analysis was performed with a sample of 1406 articles. The most cited article indicated that 43% of nurses had high burnout scores, and a similar percentage were dissatisfied with their work. The most productive and most cited country in the world was the United States of America. Regarding the 10 most cited documents, there were no studies that could provide interventions to reduce burnout in nursing professionals, which can result in a need to develop studies on prevention capable of mitigating the problem, in view of the impacts generated on their mental, emotional, and physical health.

Evaluation of genotoxicity after acute and chronic exposure to 2,4-dichlorophenoxyacetic acid herbicide (2,4-D) in rodents using machine learning algorithms.

2,4-Dichlorophenoxyacetic acid (2,4-D) is one of the most widely used herbicides in the world, but its mutagenic and carcinogenic potential is still controversial. We simulated environmental exposure to 2,4-D, with the objective of evaluating the genotoxic effect of acute and chronic exposure to 2,4-D in rodents. We also evaluated the performance of machine learning algorithms in detecting differences in exposure groups through recognition performed from genotoxic characteristics. In the acute phase, 88 Swiss mice were used, distributed in five groups and exposed to nebulizations at different time intervals (24, 48, 72 and 192 hr). In the chronic phase, 88 Wistar rats were used, distributed in two groups (inhaled and oral) and exposed for six months. Femoral bone marrow cells were collected for a micronucleus test and comet assay. Data were evaluated by pattern recognition algorithms. In acute exposure, medium and high concentrations induced DNA damage in the comet assay, but these concentrations did not increase micronucleated cells. In the chronic exposure, there was an increase in micronuclei and DNA damage in the comet assay in all exposed groups regardless of the exposure route. The data showed a robust pattern of distinction between exposed and nonexposed groups to 2,4-D. Our data showed that both acute inhalation exposure and chronic oral and inhalation exposure to 2,4-D can cause genotoxic effects regardless of concentration. Machine learning showed a clear distinction between the control groups and those exposed to 2,4-D, and the effects of exposure are not concentration-dependent.

Diagnosis of Idiopathic GHD in Children Based on Response to rhGH Treatment: The Importance of GH Provocative Tests and IGF-1.

Purpose: Serum IGF-1 (Insulin like growth factor 1) and Growth Hormone (GH) provocative tests are reasonable tools for screening and diagnosis of idiopathic GH Deficiency (IGHD). However, the average cut-off points applied on these tests have a lower level of evidence and produce large amounts of false results. The aim of this study is to evaluate the sensitivity, specificity, and accuracy of IGF-1 and GH stimulation tests as diagnostic tools for IGHD, using clinical response to recombinant human GH (rhGH) treatment as diagnostic standard [increase of at least 0.3 in height standard deviation (H-SD) in 1 year]. Methods: We performed a prospective study with 115 children and adolescents presenting short stature (SS), without secondary SS etiologies such as organic lesions, genetic syndromes, thyroid disorders. They were separated into Group 1 [patients with familial SS or constitutional delay of growth and puberty (CDGP), not treated with rhGH], Group 2 (patients with suspicion of IGHD with clinical response to rhGH treatment), and Group 3 (patients with suspicion of IGHD without growth response to rhGH treatment). Then, they were assessed for diagnostic performance of IGF-1, Insulin Tolerance Test (ITT) and clonidine test (CT) alone and combined at different cut-off points. Results: Based on the ROC curve, the best cut-off points found for IGF-1, ITT, and CT when they were used isolated were -0.492 SDS (sensitivity: 50%; specificity: 53.8%; accuracy: 46.5%), 4.515 µg/L (sensitivity: 75.5%; specificity: 45.5%; accuracy: 52.7%), and 4.095 µg/L (sensitivity: 54.5%; specificity: 52.6%; accuracy: 56.9%), respectively. When we had combined IGF-1 with-2SD as cut-off alongside ITT or CT, we found 7 µg/L as the best cut-off point. In this situation, ITT had sensitivity, specificity and accuracy of 93.9, 81.8, and 90.1%, while CT had 93.2, 68.4, and 85.7%, respectively. Conclusion: Our data suggest that diagnosis of IGHD should be established based on a combination of clinical expertise, auxologic, radiologic, and laboratorial data, using IGF-1 at the -2SD threshold combined, with ITT or CT at the cut-off point of 7 µg/L. Additional studies, similar to ours, are imperative to establish cut-off points based on therapeutic response to rhGH in IGHD, which would be directly related to a better treatment outcome.

Ankle-brachial index and peripheral arterial disease: An evaluation including a type 2 diabetes mellitus drug-naïve patients cohort.

BACKGROUND: Peripheral arterial disease in patients with type 2 diabetes mellitus is an important risk factor for vascular events. Recommendations about whether ankle-brachial index should be performed differ depending on the source; therefore, it is necessary to re-evaluate the most important risk factors associated with peripheral arterial disease and whether it is useful to perform ankle-brachial index in newly diagnosed and drug-naïve patients with diabetes, independent of age or peripheral arterial disease symptoms. METHODS: A total of 711 subjects were divided into groups: group 1, 600 type 2 diabetes mellitus patients, symptomatic or not for peripheral arterial disease; group 2, 61 type 2 diabetes mellitus patients newly diagnosed and drug naïve; and group 3, 50 subjects without diabetes. Ankle-brachial index, medical records and physical examination were performed in all patients, accessing cardiovascular risk factors. RESULTS: Analysing group 1 asymptomatic patient to peripheral arterial disease, we found abnormal ankle-brachial index in 49% (77/156) ⩾50 years and 42% (16/38) <50 years (p = not significant). Considering drug-naïve patients, a peripheral arterial disease prevalence of 39% (24/61) was found; among these, 48% (13/27) were <50 years and 32% (11/34) were ⩾50 years (p = not significant). A forward stepwise regression model was developed, with type 2 diabetes mellitus duration (r2 = 0.12) and sedentary lifestyle (r2 = 0.14) found as independent variable predictors of severity of peripheral arterial disease, related to ankle-brachial index. CONCLUSION: We suggest that, in type 2 diabetes mellitus, ankle-brachial index should be measured at diagnosis. In addition, sedentary lifestyle was strongly associated with presence and severity of peripheral arterial disease.

Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus.

Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control.

O uso do ácido epsilon amino caproico intra-alveolar para o controle do sangramento pós-exodontia em pacientes anticoagulados / The use of epsilon amino caproic acid intraalveolar to control bleeding after extraction in anticoagulated patients

Quando pacientes em uso de anticoagulantes são submetidos a exodontias, há risco de sangramento pós-operatório. A manutenção da terapia anticoagulante tem sido indicada desde que o INR esteja dentro dos níveis terapêuticos. Recursos adicionais para o controle do sangramento, como o uso de ácido épsilon amino capróico (EACA), podem ser adotados. O objetivo deste estudo foi relatar uma série de casos de exodontias seguidas de uso intra-alveolar de EACA, em pacientes em uso de anticoagulantes com INR & # 8804; 3.0. De 25 exodontias, apenas um paciente precisou de intervenção profissional para controlar o sangramento pós-operatório. Os resultados sugerem que o uso de EACA intra-alveolar, associado aos cuidados pós-cirúrgicos de rotina, pode contribuir para a hemostasia em pacientes em uso de anticoagulantes.

When patients on anticoagulants are submitted to dental extractions, there is risk of postoperative bleeding. The maintenance of anticoagulant therapy has been indicate donce the INR is within the therapeutic levels. Additional resources for bleeding control like the use of epsilon amino caproic acid (EACA) may be adopted. The objective of this study was to report a series of cases of tooth extractions followed by the intra-alveolar use of EACA, in patients using anticoagulants with INR ≤ 3.0. From 25 tooth extractions, only one patient needed professional intervention to control postoperative bleeding. The results suggest that the use of intra-alveolar EACA, associated with routine post-surgical care, may contribute to hemostasis in patients using anticoagulants.