Imbalance Research Articles

Convergent construct validity and test-retest reliability of both German versions of the original and the revised Niigata PPPD Questionnaire: NPQ and NPQ-R

BackgroundPersistent Postural-Perceptual Dizziness (PPPD) is a frequent chronic functional disorder that manifests with dizziness, unsteadiness, or non-spinning vertigo present for at least 3 months. Characteristic provocation factors are moving or complex visual stimuli and exclusion of organic diseases. To assess the severity and impact of PPPD, Japanese researchers developed the Niigata PPPD Questionnaire (NPQ). The study's aim was to evaluate the concurrent construct validity and reliability [including test-retest reliability, internal consistency, standard error of measurement (SEM), and minimal detectable change (MDC)] of the German version of the NPQ (12 items) and its revised version, NPQ-R, which contains 19 items addressing additional symptoms and symptom behavior.MethodsThe Swiss Reha Rheinfelden and the German Center for Vertigo and Balance Disorders included 265 PPPD patients (mean age 50.2 ± 16.8 years, disease duration 46.3 ± 76.6 months). Patients completed the NPQ and the NPQ-R (twice), the DHI and potentially related constructs: anxiety (ABC-Scale, VSS), depression (HADS), and general health (SF-36) once. To assess the questionnaires' reliability and validity, several statistical measures were calculated, including Spearman's rank correlation coefficients, Intraclass Correlation Coefficients (ICC2, 1), Cronbach's alpha, SEM, and MDC.ResultsOn average, patients scored 29.9 ± 13.2 for NPQ and 52.3 ± 19.6 for NPQ-R. Correlations between NPQ/NPQ-R and (1) disease-specific questionnaires were rs= 0.712 and rs= 0.752 (DHI), rs=0.426 and rs= 0.0.462 (VSS-V), rs= -0.500 and rs= -0.545 (ABC-Scale), (2) anxiety-specific subscales rs = 0.394 and rs = 0.430 (VSS-A) and rs= 0.354 and rs= 0.430 (HADS-A), (3) depression-related subscales rs=0.438 and rs= 0.487 (HADS-D), and (4) general health rs ranged between rs= -0.216 and −0.578 (all SF-36 subscales). Internal consistency, test-retest reliability, SEM and MDC calculated for NPQ/NPQ-R were α = 0.88/α = 0.91, ICC=0.83 (CI 0.77 to 0.0.87), SEM 5.55/8.37, and MDC 15/23 points.ConclusionThe German versions of NPQ and NPQ-R are valid and reliable patient-reported outcome measures for assessing PPPD, demonstrating satisfactory psychometric measurement properties including convergent construct validity and reliability parameters: internal consistency, test-retest reliability, SEM, and MDC as an evaluative measure. The NPQ-R, with its additional subscales addressing associated symptoms and symptom behavior, represents both the patient and clinician perspective on PPPD-specific problems. Therefore, we recommend utilizing the NPQ-R for a comprehensive assessment of PPPD.

Ph Level Analysis Study on Patient Mortality in Hospitals

Chronic diseases are significant health issues classified by WHO into communicable and non-communicable types. Acid-base balance disorders are suspected to exacerbate disease severity, increase mortality risk, and potentially result in death. This research aimed to investigate the relationship between blood pH levels and mortality among hospitalized patients. A cross-sectional observational analysis was employed using medical record data from patients diagnosed with heart disease (CHF, IHD), diabetes mellitus (DM), stroke (ischemic and hemorrhagic), pulmonary disorders (pneumonia, tuberculosis), kidney function disorders (CKD), and sepsis (septic shock). Arterial blood gas analysis (ABG) data were collected from Jogja Hospital patients during 2022-2023. The research involved 194 subjects, categorized into two groups: deceased and surviving patients. Statistical analysis using a t-test compared the average pH levels between the groups. The findings revealed that the average pH level in the living group was 7.325, whereas the deceased group had a more acidic pH of 7.25, with a statistically significant difference (p<0.05). Severe acidosis, often caused by hyperlactatemia, was associated with organ dysfunction and increased mortality risk, particularly among sepsis patients. The research highlights that acidic blood pH, indicative of acidosis, is linked to various etiologies and a poor prognosis. These results underscore the importance of monitoring and managing acid-base balance disorders to improve patient outcomes and reduce mortality.

Correction of postural impairments in children with relapsing-remitting multiple sclerosis

BACKGROUND: Patients with multiple sclerosis who have multifocal lesions of the central nervous system may present various complaints, including loss of balance. Some postural control disorders are detected already at an early stage of the disease. Solving this problem is critical, as it directly causes falls with subsequent injuries and deteriorating quality of life. The Balance Evaluation Systems Test offers benefits over other postural control assessment tests. It enables more personalized therapy, especially in the context of decreased tolerance to physical exercise in patients. AIM: To implement the Balance Evaluation Systems Test for a detailed assessment of postural control, identifying the markers to be used for the development of individual physical rehabilitation programs, as well as to assess the effectiveness of this approach. MATERIALS AND METHODS: This single-center, prospective, continuous, controlled, randomized study involved 38 patients from the pediatric neuropsychiatric department of a Russian children’s clinical hospital (mean age: 13–16 years). All of them had a confirmed diagnosis of relapsing-remitting multiple sclerosis. The patients were examined in the pediatric medical rehabilitation department using the Balance Evaluation Systems Test at the beginning and at the end of a therapeutic exercise course conducted on a daily basis for 10 days. The patients were randomized into two groups, 19 persons each. The control group was offered standard balance exercises; in the experimental group, exercises were selected individually for each patient, considering the identified postural control defects. RESULTS: The treatment resulted in statistically significant changes for patients both in the control and experimental groups (p 0.001). However, when comparing the results after the exercise course between the groups, the experimental group demonstrated more significant changes in postural control (p 0.001). CONCLUSION: Therefore, the Balance Evaluation Systems Test helps develop a personalized physical rehabilitation program showing more effective results. This provides patients with an opportunity to improve their functional status and reduce the risk of falls and injuries, while delaying the progression of disability and improving the quality of life.

Clinical Presentation, Treatment Outcomes, and Demographic Trends in Vestibular Schwannomas: A 135-Case Retrospective Study.

Background: This study presents a comprehensive analysis of 135 cases of vestibular schwannoma (VS) treated between 2006 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. The investigation focuses on the clinical presentation, treatment outcomes, and demographic trends of VS patients, highlighting region-specific insights that fill critical gaps in Eastern European data. Methods: Patients were treated with either open surgery (93.3%) or gamma knife radiosurgery (6.6%). The study identifies predominant symptoms, including hearing impairment, facial palsy, and balance disorders, with variations observed across age and gender subgroups. Comorbidities such as hypertension and obesity were prevalent, and they influenced perioperative risks. Results: Post-treatment outcomes showed a significant correlation between clinical symptoms and treatment modalities, with a majority achieving favorable results. The findings emphasize the need for tailored approaches in VS management and underscore the importance of region-specific factors in influencing clinical outcomes. Conclusions: This study contributes to refining treatment strategies and improving healthcare delivery for VS patients in Romania and beyond.

Application of machine learning for detecting high fall risk in middle aged workers using video-based analysis of the first three steps.

Falls are among the most prevalent workplace accidents, necessitating thorough screening for susceptibility to falls and customization of individualized fall prevention programs. The aim of this study was to develop and validate a high fall risk prediction model using machine learning (ML) and video-based first three steps in middle-aged workers. Train data (n=190, age 54.5±7.7 years, 48.9% male) and validation data (n=28, age 52.3±6.0 years, 53.6% male) were enrolled in this study. Pose estimation was performed using a marker-free deep pose estimation method called MediaPipe Pose. The first three steps, including the movements of the arms, legs, trunk, and pelvis, were recorded using an RGB camera, and the gait features were identified. Using these gait features and fall histories, a stratified K-fold was used to ensure balanced training and test data, and the area under the curve (AUC) and 95% confidence interval (CI) were calculated. Of 77 gait features in the first three steps, we found 3 gait features in men with an AUC of 0.909 (95% CI, 0.879-0.939) for fall risk, indicating an 'Excellent' (0.9-1.0) classification, while we determined 5 gait features in women with an AUC of 0.670 (95% CI, 0.621-0.719), indicating a 'sufficient' (0.6-0.7) classification. These findings suggest that fall risk prediction can be developed based on ML and the first three steps in men; however, the accuracy was only sufficient in men. Further development of the formula is required for women to improve its accuracy in the middle-aged working population.

Evolutionary analysis of genes associated with the sense of balance in semi-aquatic mammals

BackgroundSemi-aquatic mammals represent a transitional phase in the evolutionary spectrum between terrestrial and aquatic mammals. The sense of balance is crucial for mammalian locomotion, and in semi-aquatic mammals, the structural foundation of this sense (the vestibular system) shows distinct morphological adaptations to both aquatic and terrestrial environments compared to their terrestrial counterparts. Despite this, the precise molecular mechanisms driving these adaptations remain elusive. Our study endeavors to unravel the genetic components associated with the sense of balance in semi-aquatic mammals and to examine the evolutionary trajectories of these genes, shed light on the molecular mechanisms underlying the adaptive evolution of balance perception in semi-aquatic mammals.ResultsWe selected 42 mammal species across 20 orders, 38 families, and 42 genera for analysis. We analyzed a comprehensive set of 116 genes related to the vestibular system's development or function. Our findings indicate that 27 of these genes likely experienced adaptive evolution in semi-aquatic mammals. Particularly, genes such as SLC26A2, SOX10, MYCN, and OTX1 are implicated in collectively orchestrating morphological adaptations in the semicircular canals to suit semi-aquatic environments. Additionally, genes associated with otolith development, including SLC26A2, OC90, and OTOP1, likely regulate otolith sensitivity across various locomotor modes. Moreover, genes linked to vestibular disorders, such as GJB2, GJB6, and USH1C, may provide a molecular foundation for averting vertigo amidst intricate locomotor scenarios in semi-aquatic mammals.ConclusionsOur research offers insights into the molecular mechanisms underlying the evolution of the sense of balance in semi-aquatic mammals, while also providing a new research direction for the adaptive evolution of mammals undergoing a secondary transition to an aquatic lifestyle.

Effect of induced astigmatism on vestibulo-ocular reflex

ABSTRACT Clinical relevance The vestibular-ocular reflex stabilises the retinal image and maintains balance during head movement. Astigmatism is one of the common refractive errors that can reduce the quality of visual inputs. Background The purpose of this study was to investigate the effect of induced astigmatism on the function of the vestibular-ocular reflex. Methods This prospective semi-experimental study was conducted on 48 participants aged 20 to 40 years who had no history of neurological, vestibular, or eye disorders. Simple myopic astigmatism was induced using three positive cylindrical lens powers of + 0.50D, +1.50D, and + 2.50D at three axes of 180, 45, and 90 degrees in both eyes. The vestibular-ocular reflex was evaluated by the ocular Vestibular Evoked Myogenic Potential (oVEMP) through acoustic stimulation (a 500 hz tone burst at an intensity of 95 dBnHL) of the ear, with potentials recorded from the lower oblique muscle. The latency of the N1 and P1 waves and the amplitude of N1-P1 were recorded for all participants in the baseline condition (without any induced astigmatism) and under different induced astigmatism conditions. Results The latencies of N1 and P1 significantly increased with the increasing power of induced astigmatism; however, the powers of astigmatism had no effect on the amplitude of N1-P1. The axes of induced astigmatism did not have a significant effect on the latencies and amplitude of N1-P1. Conclusions Induced astigmatism due to retinal image blur can deteriorate the function of the vestibular-ocular reflex by increase in the latencies of N1 and P1 oVEMP waves.

SProtFP: a machine learning-based method for functional classification of small ORFs in prokaryotes.

Small proteins (≤100 amino acids) play important roles across all life forms, ranging from unicellular bacteria to higher organisms. In this study, we have developed SProtFP which is a machine learning-based method for functional annotation of prokaryotic small proteins into selected functional categories. SProtFP uses independent artificial neural networks (ANNs) trained using a combination of physicochemical descriptors for classifying small proteins into antitoxin type 2, bacteriocin, DNA-binding, metal-binding, ribosomal protein, RNA-binding, type 1 toxin and type 2 toxin proteins. We have also trained a model for identification of small open reading frame (smORF)-encoded antimicrobial peptides (AMPs). Comprehensive benchmarking of SProtFP revealed an average area under the receiver operator curve (ROC-AUC) of 0.92 during 10-fold cross-validation and an ROC-AUC of 0.94 and 0.93 on held-out balanced and imbalanced test sets. Utilizing our method to annotate bacterial isolates from the human gut microbiome, we could identify thousands of remote homologs of known small protein families and assign putative functions to uncharacterized proteins. This highlights the utility of SProtFP for large-scale functional annotation of microbiome datasets, especially in cases where sequence homology is low. SProtFP is freely available at http://www.nii.ac.in/sprotfp.html and can be combined with genome annotation tools such as ProsmORF-pred to uncover the functional repertoire of novel small proteins in bacteria.

Life after benign paroxysmal positional vertigo: one-year analysis of recurrence, headaches, neck pain, falls, and functional vestibular symptoms.

Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms. This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models. 201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events. Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.

Investigation of the Effects of Counseling in Elderly Individuals Attending Vestibular Rehabilitation Program

Subjects: The effects of counseling service given together with vestibular rehabilitation in elderly individuals with a history of age-related-imbalance were examined. Material and Methods: 21 volunteer elderly individuals presbyastasis were included in the study. Sensory Organization Test, Mini-BESTest, Tinetti Balance-Gait Test, daily living activities with in Vestibular Disorders, and quality of life was evaluated. Results: Before the vestibular rehabilitation protocol, counseling was given to the elderly individuals for an average of 45 minutes. Vestibular rehabilitation training was applied in Computerized Dynamic Posturography twice a week for 8 weeks. After the training, balance and walking, activities of daily living, and quality of life improved (P < .05). Conclusions: According to these results, it was concluded that the inclusion of vestibular rehabilitation, which is provided with counseling service, in the rehabilitation program of elderly individuals may be beneficial in improving balance, activities of daily living and quality of life.

Disorder of Water and Electrolyte Balance in Cattle

Ruminants’ water needs depend on several factors. Water and electrolyte imbalances can disrupt production and, reproductive performance as well as overall health. Fluid replacement is a key step in the treatment of diseases such as calf diarrhea. This review work aimed to describe in more detail and indicate the importance of water and electrolyte imbalance disorders in cattle, especially calves, as the most sensitive category of cattle.

Management Strategies of Vestibular Neuritis:- A Review

ABSTRACT A common peripheral vestibular disorder called vestibular neuritis (VN) results in abrupt development of vertigo symptoms without any accompanying auditory symptoms, such as tinnitus, aural fullness, or hearing impairment. The precise cause of VN is yet unknown. The clinical history and test results serve as the foundation for the VN diagnostic criteria. Despite an unclear cause of VN, a thorough understanding of its clinical course and management has been established. Clinically, VN is characterized by a spinning sensation that lasts longer than 24 hours, the absence of cochlear symptoms, and other neurological symptoms. The diagnosis of VN is done by different tests which include a head impulse test, bithermal caloric test, and vestibular-evoked myogenic potential tests. The treatment of VN is based on different stages of this disease such as acute, subacute, and chronic. Antiemetics, vestibular suppressants, and intravenous hydration are some of the symptomatic treatments available. For those with chronic VN, vestibular rehabilitation is a highly useful tool in lowering feelings of lightheadedness and floating. The usefulness of antivertigo medications for VN is not well shown. The purpose of this review article was to explore the current management strategies of VN.

PREVALENCE AND FACTORS ASSOCIATED WITH IRON DEFICIENCY ANEMIA IN PEDIATRICS IN SICKLE CELL PATIENTS IN THE INTERCRITICAL PHASE IN THE DR CONGO

Introduction: Homozygous sickle cell disease in the DR Congo is the most common hemoglobinopathy. Sickle cell disease is manifested by a regenerative anemia whose severity varies greatly depending on the individual. Sickle cell syndromes probably lead to inflammation and iron balance disorders. The objective of this study is to improve management by determining the prevalence of iron deficiency anemia and to study the factors associated with this anemia in sickle cell patients in the inter-critical phase. Method: This is a comparative and analytical study carried out in two hospitals in the city of Bukavu, the Panzi General Reference Hospital and the Ami des Enfants clinic, over a period of one year, from September 1, 2023 to September 31, 2024. This study involved 68 sickle cell anemic patients, of whom 38 had iron deficiency anemia taken as cases and 30 without iron deficiency anemia taken as controls. The inclusion criteria are: being sickle cell in the inter-critical phase, anemic (hb < 11g / dl). Logistic regression allowed us to identify the factors associated with this iron deficiency anemia in sickle cell patients. Results: out of 68 sickle cell anemic patients, 38 had iron deficiency anemia, a prevalence of 55.9%, the average age was 7.8±3.9 years, with a male predominance (65.2%), sex was a factor significantly associated with iron deficiency anemia (OR: 5.2 p: 0.002). Primary school level (47%) was also associated with this iron deficiency anemia (OR: 0.4p: 0.02). Clinically, the factors associated with iron deficiency anemia were the average age of diagnosis of the pathology, i.e. 6.4±3.7 years, (t: 2.1 p: 0.02). The average number of hospitalizations was 4.9±5.5 times, with a significant difference to controls (t: 1.1, p: 0.04). Biologically, the mean hemoglobin level of the cases 6.8±1g/dl was not far from that of the controls i.e. 6.96±1.6 g/dl, their anemia was microcytic at 16% and macrocytic at 8%. The quantitative CRP, its mean is on the other hand very high in the controls i.e. 25.8±30 mg/l against 9±12.6 mg/l (t: -3.5 p: 0.003). The mean ferritin in the cases was 59.6±30.1 ng/l. Hemoglobins A and F of sickle cell patients show that in cases the average Hb A is zero and HbF is 13±7%, and in controls, the average HbA is 2±6ng/l and HBF is 18±7ng/l. The average number of transfusions was equal in cases and controls, i.e. 2.5±2.5 transfusions. Conclusion: Iron deficiency anemia has a high prevalence in sickle cell patients, several factors including sociodemographic, clinical and biological remain associated with this anemia even in the inter-critical phase.

Artificial intelligence-enhanced magnetic resonance imaging-based pre-operative staging in patients with endometrial cancer.

Evaluation of prognostic factors is crucial in patients with endometrial cancer for optimal treatment planning and prognosis assessment. This study proposes a deep learning pipeline for tumor and uterus segmentation from magnetic resonance imaging (MRI) images to predict deep myometrial invasion and cervical stroma invasion and thus assist clinicians in pre-operative workups. Two experts consensually reviewed the MRIs and assessed myometrial invasion and cervical stromal invasion as per the International Federation of Gynecology and Obstetrics staging classification, to compare the diagnostic performance of the model with the radiologic consensus. The deep learning method was trained using sagittal T2-weighted images from 142 patients and tested with a 3-fold stratified test with 36 patients in each fold. Our solution is based on a segmentation module, which employed a 2-stage pipeline for efficient uterus in the whole MRI volume and then tumor segmentation in the uterus predicted region of interest. A total of 178 patients were included. For deep myometrial invasion prediction, the model achieved an average balanced test accuracy over 3-folds of 0.702, while experts reached an average accuracy of 0.769. For cervical stroma invasion prediction, our model demonstrated an average balanced accuracy of 0.721 on the 3-fold test set, while experts achieved an average balanced accuracy of 0.859. Additionally, the accuracy rates for uterus and tumor segmentation, measured by the Dice score, were 0.847 and 0.579 respectively. Despite the current challenges posed by variations in data, class imbalance, and the presence of artifacts, our fully automatic approach holds great promise in supporting in pre-operative staging. Moreover, it demonstrated a robust capability to segment key regions of interest, specifically the uterus and tumors, highlighting the positive impact our solution can bring to health care imaging.

Electronic rider’s seat control system - pilot studies

The aim of the study was to determine the effectiveness of the sensors, determined on the basis of pressure changes in airbags of our own design, placed between the saddle and the horse’s back. This would allow for the assessment of the flexibility and correctness of the rider’s seat, as well as the strength of its influence on individual parts of the horse’s back. The research included 10 Polish warm blood horses aged 7-12 years (5 mares, 5 geldings). Before the test, each horse was examined by a veterinarian who did not find any body asymmetries and they did not show any abnormalities in the musculoskeletal system. All of the horses were clinically healthy. The horse was subjected to regular training 5 times a week, of which 3 days consisted of dressage work, 1 day of pole and cavaletti work, and 1 day of jumping training and was ridden by a woman, aged 28 and weighing 65 kg, who was at the second sports class level according to the Polish Equestrian Association in dressage and show jumping. The task of the rider’s seat control system was to determine its correctness. For this purpose, airbags were placed between the saddle and the horse’s back. There were four airbags placed in the pad, two of which worked independently and two were connected in a pair (both airbags had the same pressure). The pair of airbags was placed under the front of the saddle, which enabled the analysis of changes in the impact of the rider’s seat on the front pommel. Separated airbags were placed under the back of the saddle, which made it possible to test the impact of the rider’s seat on the pommel with additional separation into the left and right sides, which enabled, for example, the detection of balance problems or asymmetries resulting from defects in the horse’s structure. The results of preliminary research have shown that it is possible to control the quality of the rider’s seat and determine its parameters based on measurements carried out using the proposed system. The analysis of the presented sample time series shows that the rider does not sit symmetrically in the saddle, putting more strain on the left side of the body.

SEX DIFFERENCES IN FACTORS ASSOCIATED WITH FALLS AMONG COMMUNITY-DWELLING OLDER ADULTS WITH OSTEOARTHRITIS

Abstract Osteoarthritis elevates the risk of falling among older adults due to joint pain and stiffness. Research suggests that sleep problems, depression, and fatigue may also relate to falls among those with osteoarthritis, yet sex influences in these associations remain understudied. This study investigated factors associated with falls by sex (male vs. female). A sample of 3,895 community-dwelling older adults with osteoarthritis in the 2016 Health and Retirement Study (2,624 females; 1,271 males) were analyzed using survey-weighted logistic regression. All analyses were controlled for sociodemographic characteristics, including geographic residence, and health-related issues (e.g., balance problems, chronic diseases, and medication use). Most participants were female (64.5%), in their 70s (M = 73.74, SD = 6.4), White (89.0%), had a high school or higher education (89.3%), and non-rural residents (70.9%). For both men and women, balance problems, functional limitations, and cancer increased the risk of falling, while pain, sleep problems, depression, or fatigue were not associated with falls. Among women, being White (OR = 3.87, 95% CI; 1.86, 8.05 compared to Black), rural residence (OR = 1.59, 95% CI: 1.01–2.50 compared to urban residence), and opioid use (OR = 1.60, 95% CI: 1.00, 2.54) increased the risk of falling. Among men, having heart problems (OR = 1.84, 95% CI: 1.24, 2.72) increased the risk of falling. Sex-tailored fall prevention strategies, such as providing rural programs and opioid education for women and increasing awareness and fall education for men with heart problems, are encouraged to support active living among older adults with osteoarthritis.

Cerebral salt wasting syndrome following a traumatic frontal lobe hematoma : A case report

BACKGROUND Cerebral Salt Wasting Syndrome (CSWS) is a rare complication of intracranial pathology characterized by hyponatremia and extracellular volume depletion. It is often confused with other sodium and water balance disorders, such as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Central Diabetes Insipidus (CDI), making early diagnosis and appropriate management crucial. CASE PRESENTATION We present the case of a 68-year-old male with type 2 diabetes mellitus who suffered a traumatic frontal lobe hemorrhagic contusion following a fall. The patient developed polyuria and hyponatremia on the 6th day of admission, initially misdiagnosed as CDI and treated with desmopressin. However, despite treatment, his urine output continued to rise, and hyponatremia persisted. Subsequent evaluations, including urine and serum osmolarity, high urinary sodium levels, and imaging studies, led to the diagnosis of CSWS. Treatment was adjusted to include intravenous isotonic saline and fludrocortisone, significantly reducing urine output and correcting serum sodium levels. The patient was successfully discharged on the 25th day with stable electrolyte levels. CONCLUSION This case highlights the diagnostic challenges in differentiating CSWS from other sodium balance disorders, particularly CDI, in patients with traumatic brain injury. It emphasizes the importance of careful monitoring of urine and serum biochemistry, fluid status, and clinical progression to ensure accurate diagnosis and effective management. Early recognition and appropriate therapy for CSWS, including sodium and fluid replacement, can prevent further complications and improve patient outcomes.

A real-world pharmacovigilance analysis of potential ototoxicity associated with sacubitril/valsartan based on FDA Adverse Event Reporting System (FAERS)

Sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor, is widely used to treat heart failure. Despite its efficacy, sacubitril/valsartan inevitably causes adverse events such as hypotension, renal dysfunction, hyperkalemia, and angioedema. Sacubitril/valsartan-associated ototoxicity is often underreported in clinical studies and real-world settings. This study aimed to systematically characterize ototoxicity profiles using post-marketing data. Disproportionality analysis was performed using the Food and Drug Administration Adverse Event Reporting System (FAERS) database from 2015 to 2023. The reporting odds ratio (ROR) and information components (IC) were used to detect potential ototoxicity associated with sacubitril/valsartan. Significant signals were defined as ROR025 > 1 and IC025 > 0 in at least three reports. From 272,790 reports on sacubitril/valsartan and 10,798 (4.0%) reports on ototoxicity, sacubitril/valsartan and ototoxicity showed significant association (IC025 = 1.57; ROR025 = 2.99). Dizziness, hypoacusis, balance disorder, and deafness were detected as positive signals; hypoacusis was the strongest (IC025 = 3.21; ROR025 = 9.29). Median time to onset was 45 (10–99) days, and 62.4% of ototoxicity events occurred within 90 days of sacubitril/valsartan administration. Hospitalization accounted for 32.5% of ototoxic outcomes, while life-threatening events, death, and disabling accounted for only 3.9%, 3.4%, and 2.0%, respectively. Sacubitril/valsartan treatment increased ototoxicity risks. Therefore, promptly identifying and treating sacubitril/valsartan-related ototoxicity is critical.

A Case Report of Korean Medicine Treatment for Vertigo in Vestibular Function Disorder

A Case Report of Korean Medicine Treatment for Vertigo in Vestibular Function Disorder

The Effect of Frailty on Balance, Fear of Falling, and Dual-Task Performance in Individuals with Type 2 DM.

The aim of this study was to compare balance, fear of falling, and dual-task performance in frail, pre-frail, and non-frail individuals with type 2 DM. The study included 110 voluntary individuals diagnosed with type 2 DM. Individuals with type 2 DM were divided into three groups according to the FRAIL Scale: frail (n = 26), pre-frail (n = 52), and non-frail (n = 32). The FRAIL Scale evaluated individuals' frailty levels, Timed Up and Go Test evaluated dual-task performance (cognitive and motor), and Tinetti Balance and Gait Scale evaluated balance and risk of falls. Considering the Fall Efficacy Scale, Tinetti Balance and Gait Scale, TUGstandard (sec), TUGcognitive (sec), and TUGmotor (sec) results of frail, pre-frail, and non-frail individuals with type 2 DM, a statistically significant difference was found between the groups (p < 0.05). This difference originated from the frail group. Considering the increase in old age and chronic syndromes, such as DM, it brings about, it was concluded that the early evaluation of older adults for frailty and balance was essential and that individually planned intervention could improve prognosis, reduce falls that might occur due to a loss of balance and muscle strength, and enhance the quality of life in older adults.