Application of a Video Head Impulse Test in the Diagnosis of Vestibular Neuritis.

In patients presenting in the emergency department with acute vertigo, a rapid and accurate differential diagnosis is crucial, as posterior circulation strokes can mimic acute vestibular losses, leading to inappropriate treatment. The diagnosis of vestibular neuritis is made based on the clinical manifestation and a bedside otoneurological assessment. In the clinical examination, an evaluation of the vestibulo-ocular reflex is the key element; however, the accuracy of the bedside head impulse test depends on the clinician's experience. Thus, new diagnostic methods are needed to objectify and facilitate such rapid vestibular evaluations. The aim of our paper is to provide a comprehensive review of the video head impulse test's application in the diagnosis of vestibular neuritis. Numerous studies have reported advantages that make this method helpful in detailed otoneurological evaluations; in contrast to the bedside head impulse test, it enables an analysis of all six semicircular canals function and records the covert corrective saccades, which are invisible to the naked eye. As a portable and easy diagnostic tool, it is known to improve the diagnostic accuracy in patients with acute vertigo presenting in the emergency department. Moreover, as it evaluates the vestibulo-ocular reflex across different frequencies, as compared to caloric tests, it can be used as an additional test that is complementary to videonystagmography. Recently, several papers have described the application of the video head impulse test in follow-up and recovery evaluations in patients with vestibular neuritis.

Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere's Disease.

Objectives: The aim of this study was to evaluate the functional outcomes and balance compensation in patients with severe Meniere's disease after vestibular neurectomy. Methods: Pre- and postoperative results were analyzed in twenty patients with unilateral Meniere's disease before and two years after vestibular neurectomy. Clinical evaluation was performed using a subjective grading scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery and the Dizziness Handicap Inventory. Sensory organization test results were analyzed to assess the balance system before and after the surgery. Results: All patients reported a complete resolution of vertigo attacks after the vestibular neurectomy; 95% of patients reported functional level improvement according to a scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery, and the average score decreased from 4.5 to 1.6. Clinical improvement, evaluated with the Dizziness Handicap Inventory, was present in all patients, with the average result decreasing from 81.7 to 16.4. Analyzing both grading systems, differences between pre- and postoperative results were statistically significant. No statistically significant differences were found between the sensory organization test results before and after vestibular neurectomy. Significant correlations were found between a patient's age and postoperative results of the Dizziness Handicap Inventory and posturography. Conclusions: Vestibular neurectomy is an effective vertigo treatment in patients with severe Meniere's disease with no clinical improvement despite conservative treatment. It results in subjective physical, functional, and emotional improvement, enabling patients to return to daily activities and work. An appropriate qualification of patients and comprehensive preoperative evaluation are essential to obtaining satisfactory clinical outcomes.

Regression of Endolymphatic Hydrops in Patient With Meniere's Disease Treated With Vestibular Neurectomy: A Case Report.

Vestibular neurectomy is an effective method eliminating vertigo attacks in patients suffering from disabling Meniere's disease with no clinical improvement despite conservative and intratympanic therapy. Magnetic resonance imaging allows in vivo evaluation of changes manifesting in the inner ear after treatment; however, downgrading of the endolymphatic hydrops after vestibular neurectomy had not been previously described in the literature. In the present article, a case of a patient with unilateral severe Meniere's disease treated with selective vestibular nerve section from middle fossa approach was described. Clinical symptoms and audiovestibular tests were evaluated before and 13 months after the surgery. Complete resolution of vertigo episodes and hearing preservation was achieved. Magnetic resonance imaging was performed before and after the surgery using a 3 Tesla scanner with dedicated protocol after intravenous administration of gadolinium contrast agent. In the follow-up examination, regression of the cochlear and vestibular endolymphatic hydrops was visualized, which may suggest processes occurring in the labyrinth as a result of the vestibular efferent fibers section.

Natural Phytochemicals as SIRT Activators-Focus on Potential Biochemical Mechanisms.

Sirtuins are a family of proteins with enzymatic activity. There are seven mammalian sirtuins (SIRT1-SIRT7) that are found in different cellular compartments. They are a part of crucial cellular pathways and are regulated by many factors, such as chemicals, environmental stress, and phytochemicals. Several in vitro and in vivo studies have presented their involvement in anti-inflammatory, antioxidant, and antiapoptotic processes. Recent findings imply that phytochemicals such as resveratrol, curcumin, quercetin, fisetin, berberine, and kaempferol may regulate the activity of sirtuins. Resveratrol mainly activates SIRT1 and indirectly activates AMPK. Curcumin influences mainly SIRT1 and SIRT3, but its activity is broad, and many pathways in different cells are affected. Quercetin mainly modulates SIRT1, which triggers antioxidant and antiapoptotic responses. Fisetin, through SIRT1 regulation, modifies lipid metabolism and anti-inflammatory processes. Berberine has a wide spectrum of effects and a significant impact on SIRT1 signaling pathways. Finally, kaempferol triggers anti-inflammatory and antioxidant effects through SIRT1 induction. This review aims to summarize recent findings on the properties of phytochemicals in the modulation of sirtuin activity, with a particular focus on biochemical aspects.

Current Treatment of Melanoma Brain Metastases.

Melanoma is a type of skin cancer in which there is a strong correlation between its occurrence and exposure to ultraviolet radiation. Although it is not the most common skin cancer, it has the highest mortality rate of all skin cancers. The prognosis of patients is significantly worsened by melanoma metastasis to the brain, which often occurs in patients with advanced disease. The formation and development of melanoma metastases to the brain involve a very complex process, and their mechanisms are not fully understood. One of the ways for metastatic melanoma cells to survive and develop cancer in the brain environment is the presence of oncogenic BRAF mutation, which occurs in up to 50% of metastatic melanoma cases. Before discovering new methods of treating metastases, the overall survival of patients with this disease was 6 months. Currently, research is being conducted on new drugs using immunotherapy (immune checkpoint inhibitors: anti-PD-1, anti-CTLA-4) and targeted therapy (BRAF and MEK inhibitors) to improve the prognosis of patients. In this article, we summarize the current state of knowledge about the results of treating brain metastases with new systemic therapies.

Detailed clinical characteristics and its correlation with the diagnostic test results in patients with defined Mnire's disease.

INTRODUCTION: Mnire's disease is characterized by vertigo episodes with nausea and vomiting accompanied by aural symptoms. Diagnosis is based on clinical manifestation and sensorineural hearing loss confirmed in pure tone audiometry. AIM: The purpose was to evaluate clinical features and audiological and vestibular tests in patients with definite Mnire's disease. MATERIAL AND METHODS: Seventy patients were enrolled in this study. The severity of the main clinical symptoms and audiological and vestibular tests were evaluated. The correlation between the clinical features and test results was evaluated. RESULTS: 14.29% of patients presented complete clinical characteristics as the first manifestation of Mnire's disease. 50% of patients suffered from isolated aural symptoms during the early stage of the disease. The subpopulation reporting hearing improvement after vertigo attack (28.57%) was characterized by shorter disease duration than the rest of the group. A statistically significant correlation between disease duration and pure tone average was found. 17.14% of patients reported Tumarkin drop attacks in their past medical history. Neither disease duration nor functional level scale was different in these patients compared to other patients. CONCLUSIONS: Mnire's disease is often characterized by isolated aural symptoms or incomplete clinical manifestation during the early stage of the disease. The correlation between disease duration and pure tone average confirms that endolymphatic hydrops evolution causes hearing loss. A patient's quality of life is a fundamental aspect of clinical assessment. No significant correlation between disease duration and functional level scale was found. Thus Mnire's disease should be considered an individually variable and dynamic phenomenon.

Detailed insight into magnetic resonance assessment of Ménière's disease - description of methodology and imaging findings in a case series.

Purpose: The study aimed to describe the methodology and detailed interpretation of magnetic resonance imaging (MRI) in patients with Ménière's disease (MD). Material and methods: MRIs were performed on a 3T scanner. The three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence 4 hours after a double dose of intravenous contrast was added to the standard MRI protocol in patients with clinically diagnosed MD. MRI findings of 7 patients with unilateral MD were analysed using 2 qualitative grading systems by Barath and Bernaerts. Results: In MRI, the following changes in the group of patients with MD were observed: lack of endolymphatic hydrops (cases #1 and #7), various grades of cochlear hydrops (cases #2 and #3), various grades of vestibular hydrops (cases #4, #5, and #6), endolymphatic hydrops herniation into the semi-circular canal (case #6), and more robust perilymphatic enhancement (case #7). Conclusions: In patients with MD, endolymphatic hydrops can be studied on MRI using 3D-FLAIR delayed post-contrast images. The qualitative grading system may be easily used in endolymphatic hydrops assessment. Recently described new radiological signs of MD such as increased perilymphatic enhancement of the cochlea and an extra low-grade VH may increase MD diagnosis sensitivity. MRI not only supports the clinical diagnosis of MD but also may help to understand its pathophysiology.

The Trend of Authentic Leadership Skills in Nursing Education: The Key Role of Perfectionism and Self-Efficacy.

(1) Background: Shaping leadership skills is a complex process, which may be modified by psychological factors such as self-efficacy and perfectionism. The aim of the study was to determine whether perfectionism can be a mediator between self-efficacy, and authentic leadership skills in nursing students; (2) Methods: The cross-sectional study included 615 Polish nursing students (women = 96.3%) was carried out at Medical University of Warsaw in 2019. The following research tools were used: Authentic Leadership Questionnaire, Almost Perfect Scale-Revised (APS-R), and General Self-Efficacy Scale (GSES); (3) Results: The level of perfectionism is a significant mediator of relations between self-efficacy as measured by the GSES and the level of authentic leadership (Sobel test: t = 6.958; p < 0.000). The relation, without a mediating factor, is positive, and the standardized beta coefficient for the feeling of self-efficacy totals beta = 0.470 (p < 0.000), while in the presence of a mediator the strength of the correlation is smaller and amounts to beta = 0.366 (p < 0.000); (4) Conclusions: Personality factors such as self-efficacy and perfectionism play an important role in shaping AL skills of nursing students. Therefore, academic teachers should pay special attention to strengthening students' self-efficacy and adaptive perfectionism. In this context, adequate feedback and reflection may be important.

Changes in endolymphatic hydrops after vestibular neurectomy observed in magnetic resonance imaging - A pilot study.

OBJECTIVES: The aim was to evaluate endolymphatic hydrops in patients with Ménière's disease before and after vestibular neurectomy to verify if the endolymphatic space dilatation, observed in magnetic resonance imaging, regressed within several months after surgery. METHODS: Magnetic resonance imaging was performed after intravenous gadolinium injection in four patients with unilateral definite Ménière's disease before and eight months after vestibular neurectomy. Clinical symptoms, audiovestibular tests, and endolymphatic hydrops in magnetic resonance imaging were evaluated. RESULTS: Endolymphatic hydrops was visualized in preoperative magnetic resonance imaging in three out of four analyzed patients. In the remaining one, an asymmetrical contrast enhancement in the affected ear was found. After the vestibular neurectomy, all four patients presented a complete resolution of vertigo episodes and improved functional level. Significant postoperative hearing deterioration was found in two patients. In the follow-up magnetic resonance imaging, no reduction of the endolymphatic hydrops was visualized. A reduction of asymmetrical contrast enhancement in one patient was found. CONCLUSIONS: Magnetic resonance imaging of the inner ear is a helpful diagnostic tool for Menière's disease. Vestibular neurectomy is an effective treatment for intractable vertigo; however, there is no endolymphatic hydrops regression evidence within several months after the surgery. Therefore, further studies with a long follow-up period and repeated magnetic resonance imaging are needed to assess the vestibular neurectomy's impact on endolymphatic hydrops. Nevertheless, magnetic resonance imaging supports the clinical diagnosis of Ménière's disease and may help understand its pathophysiology.

Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging.

The study aimed to compare the consistency of MRI interpretation of endolymphatic hydrops qualitative assessment of inner ear structures performed by independent observers. MRI with a delayed post-contrast 3D-FLAIR sequence was performed to visualize EH in patients suspected of having or diagnosed with MD. The scans were analyzed independently by three observers. In total, 220 ears were evaluated and, of these, 75 had definite MD, five probable MD, 67 with other Menieriform symptoms, and 73 were asymptomatic. Significant differences in cochlear endolymphatic hydrops (CoEH) grading between all observers were observed. On the Barath scale of vestibular endolymphatic hydrops (VEH), differences were found between the radiologists and otorhinolaryngologist in grading. No differences were noted in VEH on the Bernaerts scale and increased perilymphatic enhancement. Our study showed that evaluation of vestibular endolymphatic hydrops is repeatable between observers and easy to learn. It proved that Bernaerts' modification increased the sensitivity of EH diagnosis. Both parameters, CoEH and VEH, may serve as a differentiation method of EH from normal ears. The distinction between normal and hydropic ears is much easier to perform than EH grading. Therefore, it may be used to diagnose MD rather than EH staging.

Willingness to Oppose Smoking among Pregnant Women.

Even though smoking causes numerous threats to the developing foetus, it is the most common addiction in Polish women of reproductive age. Most studies undertake to examine the subject of opposing second-hand smoking or creating tools to reprimand pregnant women more effectively using a qualitative methodology. The study aimed to determine the profile of a pregnant woman who is willing to oppose the smoking of another pregnant woman. The research was conducted using an original multiple-choice questionnaire. The survey was shared on websites for expecting parents. Completed questionnaires were collected from 11,448 pregnant women. The Wald test for logistic regression was used for statistical analysis. Predictors of whether someone would draw another pregnant women's attention to the fact that smoking is harmful were: intellectual work (OR 1.136; p-value 0.020) and currently being a student (OR 1.363; p-value 0.004), involvement of the child's father (OR 1.377; p-value < 0.001), contact with social campaigns (OR 1.150; p-value 0.005) and knowledge about the consequences of smoking, as well as talking to the midwife about the harmfulness of cigarettes during pregnancy (OR 1.655; p-value < 0.001). Interpersonal relationships leave scope for public health interventions. It is worth enhancing criticism against smoking by specialists through information and education campaigns.

Students' Knowledge about Cervical Cancer Prevention in Poland.

Background and Objectives: In Poland, the rates of morbidity and mortality due to cervical cancer are amongst the highest in Europe. A significant percentage of newly diagnosed cases of cervical cancer are at an advanced stage. Unfortunately, only about 20% of Polish women take part in cervical cancer screening. The aim of the study was to assess students' knowledge of cervical cancer risk factors and prevention. Materials and Methods: The study was provided to Polish students from various universities and faculties between May 2020 and November 2020. The questionnaire was designed specifically for this study and was validated. The chi-square test was used to compare the responses between subgroups. Results: The study was carried out on a group of 995 students (80.6% women, 19% men, 0.4% no data), (average age 21.9 years). Most students knew that the main risk factor for cervical cancer is human papillomavirus (HPV) infection (82% of all responders; 86% of medical students; 73% of non-medical students; p < 0.001). Only 40% of students knew that in Poland the Population Prevention and Early Diagnosis Program is carried out on women aged 25-59 years every three years. Most students correctly indicated that cervical cancer screening in Poland is performed using cervical cytology and were familiar with the basis of cytology. Only 57% of students knew that there are no specific early symptoms of cervical cancer. A total of 78% of all respondents knew that HPV vaccination reduces the risk of cervical cancer. Medical students and students who are sexually active demonstrated a better knowledge of cervical cancer. Conclusions: The Polish students had some knowledge of cervical cancer risk factors and primary and secondary prevention. Significantly better knowledge was demonstrated by medical students. Some efforts should be made to ensure that young people, who are not associated with medicine are better educated about cervical cancer in order to reduce the overall incidence and improve early detection rates.

Intracranial complications after surgical removal of nasal polyps.

Acute otitis media can be caused by viruses (nonsuppurative inflammation) and bacteria (suppurative inflammation). The suppurative inflammation is a risk factor for endocranial complications, including subdural empyema burdened with a high mortality. The authors present a clinical case of a 67-year-old man treated by surgery for a subdural empyema in the course of the acute suppurative otitis media.

Iatrogenic pneumothorax in a 4-week-old girl: new diagnosis of congenital lobar emphysema.

A 4-week-old female patient presented with severe respiratory distress, hypoxia and apnoeic episodes on a background of a few-day history of coryza and cough. There was significantly reduced air entry on the left side and a displacement of the apex beat to the right of the chest. The examination findings with oxygen desaturations and a right-sided mediastinal shift on chest X-ray led to a diagnosis of tension pneumothorax following which a needle thoracentesis was undertaken. This appeared to worsen the patient's clinical condition; hence, a chest drain was inserted with unsatisfactory clinical improvement. In view of the presentation and lack of clinical improvement after chest drain insertion, the case was transferred to the paediatric respiratory team in a tertiary centre where the diagnosis was revised to congenital lobar emphysema based on chest computer tomography findings. She subsequently benefited from a left upper lobectomy and lingulectomy and was discharged home 4 days after surgery.

Serum VEGF-A concentrations in patients with central nervous system (CNS) tumors.

Angiogenesis plays an essential role in tumors development. In case of central nervous system tumors, the most important role in this process plays VEGF-A. The purpose of this study was to determine the plasma concentration of this agent in patients treated surgically because of intracranial tumors. The study involved 48 adult patients, both sexes, treated surgically because of a brain tumor. The control group consisted of 50 adult volunteers of both sexes, without cancer diagnosis. Based on the studies, it was found that serum VEGF-A levels before surgery are higher in patients with central nervous system tumors (10.39-150.57 pg/ml, median 41.70 pg/ml) than in non-cancer patients (0.00-130.77 pg/ml, median 22.56 pg/ml). The association between serum VEGF-A level and malignancy and histological type of intracranial tumor has not beed confirmed. The highest average preoperative serum VEGF-A level was found in patients with low grade gliomas, slightly lower (close to each other) in those with high grade gliomas and meningiomas, while the lowest level was characteristic for metastatic tumors. High variation in results was observed in patients with low grade gliomas (52.56 pg/ml)-higher than those reported in patients with high grade gliomas (32.38 pg/ml). In the rest types of tumors the differentiation was similar and oscillated within 23.08-27.50 pg/ml.

Stratum corneum molecular mobility in the presence of natural moisturizers.

The outermost layer of the skin, the stratum corneum (SC), is a lipid-protein membrane that experiences considerable osmotic stress from a dry and cold climate. The natural moisturizing factor (NMF) comprises small and polar substances, which like osmolytes can protect living systems from osmotic stress. NMF is commonly claimed to increase the water content in the SC and thereby protect the skin from dryness. In this work we challenge this proposed mechanism, and explore the influence of NMF on the lipid and protein components in the SC. We employ natural-abundance (13)C solid-state NMR methods to investigate how the SC molecular components are influenced by urea, glycerol, pyrrolidone carboxylic acid (PCA), and urocanic acid (UCA), all of which are naturally present in the SC as NMF compounds. Experiments are performed with intact SC, isolated corneocytes and model lipids. The combination of NMR experiments provides molecularly resolved qualitative information on the dynamics of different SC lipid and protein components. We obtain completely novel molecular information on the interaction of these NMF compounds with the SC lipids and proteins. We show that urea and glycerol, which are also common ingredients in skin care products, increase the molecular mobility of both SC lipids and proteins at moderate relative humidity where the SC components are considerably more rigid in the absence of these compounds. This effect cannot be attributed to increased SC water content. PCA has no detectable effect on SC molecular mobility under the conditions investigated. It is finally shown that the more apolar compound, UCA, specifically influences the mobility of the SC lipid regions. The present results show that the NMF components act to retain the fluidity of the SC molecular components under dehydrating conditions in such a way that the SC properties remain largely unchanged as compared to more hydrated SC. These findings provide a new molecular insight into how small polar molecules in NMF and skin care products act to protect the human skin from drying.