[Diagnosis and rehabilitation of anterior canal benign paroxysmal positional vertigo]. / Prognozirovanie retsidivov dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya.

OBJECTIVE: To develop a method for predicting otolithiasis recurrence within 1 year after benign paroxysmal positional vertigo (BPPV) episode based on analysis of the anamnesis and standardized characteristics of the clinical symptoms and treatment of the disease. MATERIAL AND METHODS: The study included 640 patients with BPPV, who were divided into two groups: the 1st group (n=458) - patients with no recurrence in 1 year of follow-up; the 2nd group (n=148) - patients with recurrence in the first year after treatment of BPPV episode. In order to identify risk factors, the initial clinical and anamnestic features associated with BPPV (gender, age, comorbidities), clinical symptoms and rehabilitation parameters of the last episode of the disease were analyzed. Diagnostic indices were calculated for the sets of selected features that reliably distinguished both groups of patients with absent/present BPPV recurrence within one year, and based on these, an algorithm was created using a Bayesian sequential diagnostic procedure to predict BPPV recurrence within 1 year of an identified and treated BPPV episode. RESULTS: In the 2nd group there was the significant prevalence of elderly (older 65 years) and female patients. In these patients higher association with hypertension, type II diabetes mellitus, neurological diseases, osteoporosis and lung diseases was observed. Diagnosis and treatment of recurrent patients in the 2nd group correlates with detection of horizontal nystagmus in Dix-Hallpike test in case of horizontal canal BPPV, requirement for several maneuvers per appointment, canal switch during reposition, resistant course of the disease, the need for additional self-treatment for patients between appointments, and the more frequent development of residual vertigo. Prognostic algorithm for predicting recurrence within 1 year of detected and treated posterior and horizontal canal BPPV episode was developed with a prediction accuracy of 75.3% (71.3%; 79%) and 79.4% (71.6%; 85.9%), respectively. CONCLUSION: The use of the algorithm proposed by us will allow not only to prevent the identified risk factors, but also to inform the patient in a timely and sufficient manner about the likelihood of a relapse of the disease in order to prevent the development of functional vertigo, as well as training in universal repositional maneuvers before a repeat consultation of specialist.

[A method for prediction functional dizziness after benign paroxysmal positional vertigo]. / Sposob prognozirovaniya razvitiya funktsional'nogo golovokruzheniya posle pristupa dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya.

OBJECTIVE: To identify risk factors for functional vertigo (FV) in patients with benign paroxysmal positional vertigo (BPPV) based on the analysis of emotional and personality disorders at the time of the occurrence of BPPV and to develop a method for predicting its development. MATERIAL AND METHODS: The study included 93 people, 81 women (87.1%), with benign paroxysmal positional vertigo (BPPV), aged 18 to 65 years, mean age 50 [41.5; 59]). After successful treatment with repositioning maneuvers, patients were re-examined 1 month later. Fifty-three patients underwent a semi-structured interview to identify a history of panic attacks (PA) using DSM-5 diagnostic criteria. After successful BPPV treatment, patients completed the following scales and questionnaires: Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short form (VSS-SF), Numeric analog scale of fear (from 0 to 10), Depersonalization-Derealization Inventory (DDI), PHQ-9, GAD-7, PHQ-15, Holmes-Rahe Stress Inventory, Anxiety Sensitivity Index (ASI). RESULTS: The cohort was divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=76) of complaints for dizziness 1 month after BPPV. The frequency of PA history in group 1 was higher than in group 2 (80 vs 29.3%). Patients from group 1 had higher rates in all scales: DHI (57 vs 49, p=0.048), subscale DHI-E (18 vs 12, p=0.006), and subscale A VSS-SF (9 vs 5, p=0.03); DDI (18 vs 11, p=0.01), GAD-7 (13 vs 4), p=0.0002), Numeric analog scale of fear (10 vs 5, p<0.00005), ASI (55.5 vs 36.5, p<0.005). We developed a predictive method for diagnosis FD after BPPV, which sensitivity is 78.9% (95% CI 67.80-86.94) and specificity 94.12% (95% CI 71.31-99.85). CONCLUSION: The likelihood of developing FV after BPPV can be predicted using the proposed predictive method. Early screening for FV can be used to prevent persistent postural-perceptual dizziness.

[Benign paroxysmal positional vertigo associated with trauma, middle and inner ear diseases]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie, assotsiirovannoe s travmaticheskim vozdeistviem, zabolevaniyami srednego i vnutrennego ukha.

OBJECTIVE: The aim of the study is to compare clinical symptoms and treatment of posttraumatic benign paroxysmal positional vertigo (BPPV), BPPV associated with middle and inner ear diseases and idiopathic BPPV (iBPPV). PATIENTS AND METHODS: 640 patients with BPPV of various canals were enrolled in the study. 455 (71.1%) patients had iBPPV, 185 (28.9%) had secondary BPPV. Among patients with secondary BPPV in 16 (2.5%) patients it was associated with Meniere's disease (MD), in 34 (5.3%) patients - with sudden sensorineural hearing loss (SSHL), in 14 (2.2%) patients - with vestibular neuritis (VN), in 19 (2.9%) patients - with acute and chronic otitis media (OM) and in 75 (11.7%) patients - with chronic sensorineural hearing loss (CSHL). Posttraumatic BPPV was observed in 27 (4.2%) patients. All patients were treated with repositioning maneuvers and observed for recurrences the following 3 years. RESULTS: IBPPV is the most frequent type in population and has the most favorable prognosis. Combined involvement of posterior and horizontal canals is more frequent in BPPV associated with MD, SSHL and OM in comparison with iBPPV (p<0.01). BPPV associated with BM, SSHL and VN is more resistant to treatment with repositioning maneuvers in comparison with iBPPV: successful treatment with one performed maneuver is more rarely and more follow-up visits to the doctor are needed (p<0.01). BPPV associated with MD has higher recurrence rate (p=0.04). The clinical course of BPPV associated with CSHL and posttraumatic BPPV is most similar to iBPPV.

[The use of eeg discriminant analysis in the diagnosis of schizophrenia]. / Ispol'zovanie diskriminantnogo analiza élektroéntsefalogrammy v diagnostike shizofrenii.

AIM: There have been no criteria found so far to quantify the wide range of EEG spectral and coherent indicators, which would allow discrimination between schizophrenia disorders and healthy human states. The goal of this research is to find objective EEG-based schizophrenia criteria through a discriminant analysis and to obtain a linear discriminant function (LDF) with sensitivity and specificity of at least 85%. MATERIAL AND METHODS: The study covered 83 schizophrenia patients and 116 healthy individuals, with similar major characteristics. EEGs were recorded in EDF format using 16 leads under the 10-20 system and ear reference electrodes, with further spectral and coherent analysis. RESULTS: A discriminant analysis has provided LDFs from which a formula with 5 predictors was extracted. The most valuable diagnostic predictors were beta2 and theta rhythm powers in the F3 lead. In the same manner, interhemispheric theta rhythm coherence in the pair T5-T6 and interhemispheric beta rhythm coherence in the pairs F3-C3 and T3-C3 were significant predictors. All of them being negative, the EEG supplied thereby most likely relates to the schizophrenia class. CONCLUSION: The novel methods used for selecting EEG features and choosing their combinations to obtain LDFs and verify the outcomes will give the researcher a powerful and flexible tool to perform an EEG discriminant analysis which allows obtaining linear discriminant functions in short terms without routine procedures, performance of preliminary diagnosis using an expert system based on the obtained LDF, evaluation of treatment efficacy by the LDF score dynamics. During treatment and changes of predicting modules function, variables may increase or decrease depending on the direction of predictors that may serve as an indicator of treatment efficacy.

[Clinical features and treatment of multi-canal benign paroxysmal positional vertigo]. / Mul'tikanal'noe dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: osobennosti diagnostiki i lecheniia.

OBJECTIVE: To reveal clinical features of natural history, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo (m-BPPV). PATIENTS AND METHODS: 640 patients with BPPV are evaluated. 80 (12.5%) patients had m-BPPV, 560 (87.5%) patients had single-canal BPPV. The analyses of involved canals and comparison of the course of the disease and effectiveness of treatment in m-BPPV and single-canal BPPV was done. RESULTS: m-BPPV accounts for 12.5% of all patients with BPPV. In m-BPPV mostly unilateral involvement of posterior and horizontal canals are involved, in bilateral BPPV often both posterior canals are involved. M-BPPV is more often associated with middle and inner ear diseases. Recurrences are more often observed in m-BPPV. For m-BPPV it is typical to have more severe clinical symptoms: constant dizziness, balance problems, intensive nausea and vomiting, frequent falls. M-BPPV is often resistant to treatment with repositioning maneuvers: more maneuvers, more follow-up consultations, carrying out home-based vestibular exercises by patients and use of mechanical chair in some cases are necessary to achieve successful treatment. In patients with m-BPPV residual dizziness after successful treatment often takes place, so that additional diagnosis and assessment is needed.

[Metabolic syndrome diagnosis in patients with arterial hypertension and obesity].

AIM: To develop a universal method of metabolic syndrome (MS) diagnosis which is valid irrespective of the version in patients with documented arterial hypertension (AH) and obesity. MATERIAL AND METHODS: MS was diagnosed according to two versions (WHO and ATPIII) in 517 males and 1041 females aged 20 to 75 years. All the patients had documented obesity and hypertension. RESULTS: Two versions used (WHO and ATPIII) provided the same results only in 44% patients: MS was confirmed in 16% and rejected in 28%. The rest 56% patients had MS only by one of the versions. A computer program has been created for making decision about MS presence in obese patients with hypertension. CONCLUSION: A diagnostic rule has been elaborated for MS diagnosis by associated disorders with accuracy of 94% even in the absence of information about such key components of MS as HDLP and triglycerides.

[An expert system to support diagnostic decision making by a neonatologist]. / Ekspertnaia sistema podderzhki priniatiia diagnosticheskikh reshenii vrachom-neonatologom.

An "NATEX" expert system has been designed, which is intended to support a neonatologist's diagnostic decision making at the first stage of neonatal nursing. While designing the expert system, the authors used the shell "REPROCODE" wherein medical knowledge is presented as hierarchical semantic threshold network with shared attribute space. The designed system is realized on the basis of an IBM PC XT/AT, its operation requires only the processor 80286 and the operating system MS DOS 3.0 or higher. The "NATEX" expert system is employed to diagnose major syndromes of neonatal diseases. The knowledge base of the "NATEX" system has an account of 33 syndromes of neonatal diseases and, with various forms of severities borne in mind, the total number of diagnosed conditions in a baby is 63. In terms of content, it covers all major syndromes assessing the vital systems of the neonatal body and their occurring processes. The total number of symptoms which are necessary and sufficient for making a diagnostic decision as realization of either syndromes is 700.

[Criteria of severity of the pathological process in children with celiac disease]. / Kriterii ostroty patologicheskogo protsessa pri tseliakii u detei.

Assessment of the clinico-anamnestic and morphofunctional parameters in children with celiac disease made it possible to define criteria for the acuity of the pathological process, enabling the diagnosis of the disease phase. The data obtained as a result of morphometric examination of the biopsy material withdrawn from the small intestinal mucosa turned out to be of paramount importance.