Background and ObjectiveVertigo derived from peripheral vestibular disorders is quite frequently encountered in daily clinical practice and can be a severely disabling symptom associated with substantial impairment of health-related quality of life for the affected patients. Betahistine, a structural analogue of histamine and presumably the most widely prescribed anti-vertigo drug worldwide, has previously been shown to be an effective and safe treatment for these patients. The objective of the present study was to evaluate whether the fixed combination of cinnarizine and dimenhydrinate (Arlevert®) is non-inferior and thus a potentially useful alternative to betahistine dihydrochloride in the treatment of patients suffering from peripheral vestibular vertigo.MethodsIn this prospective, multicenter, double-blind, randomized, non-inferiority clinical trial, outpatients from 8 ENT clinics in Austria, Bulgaria, the Czech Republic and Russia were randomly assigned to receive three times daily one tablet of either the fixed combination cinnarizine 20 mg/dimenhydrinate 40 mg or betahistine dihydrochloride 16 mg for 4 weeks. Primary endpoint was the reduction of the mean vertigo score (MVS), a validated 12-item composite score defined as the mean of 6 vertigo symptoms (dystasia and walking unsteadiness, staggering, rotary sensation, tendency to fall, lift sensation, blackout) and 6 trigger factors for vertigo (change of position, bowing, getting up, driving by car/train, head movements, eye movement), after 4 weeks of therapy, as judged by the patient on a 5-point visual analogue scale (VAS). The non-inferiority margin was set to 0.3. Secondary outcomes included the patient’s and investigator’s judgment of global efficacy, the patient’s rating of impairment of daily activities, and safety/tolerability of the treatments.ResultsThree hundred and six patients (mean age 53.5 years, approximately 60% female) were enrolled and randomized to the fixed combination cinnarizine/dimenhydrinate (n = 152) or betahistine (n = 154) groups; 297 patients completed the study and 294 (146 and 148, respectively) were valid for the per-protocol analysis, which was used for the non-inferiority analysis. Treatment with cinnarizine/dimenhydrinate led to a stronger reduction of the MVS [least squares mean (LSM)] after 4-week therapy (primary endpoint) in comparison to betahistine (0.395 vs 0.488; difference: − 0.093, 95% CI − 0.180; − 0.007, p = 0.035); since the upper limit of the two-sided 95% confidence interval was not only below the non-inferiority margin of 0.3, but also entirely below 0, superiority of the fixed combination could be demonstrated. The combination preparation was also more effective after 1 week of therapy and received more favorable patient’s ratings on overall efficacy and impairment of daily activities. Both treatments were very well tolerated. Only 12 patients (3.92%) reported 13 non-serious adverse events; 2 cinnarizine/dimenhydrinate-treated patients discontinued the study prematurely due to adverse events as compared ...

In the last few decades with the emergence of globalization, migration and brain drain became one of the important factors of economic development and played an important role in the globalization process. The usual flow of high skilled and educated individuals is from developing and under developing countries to the more developed countries such as the USA and Europe. Different factors are influencing on brain drain which are divided into push and pull factors. In this research, we examined Iran's brain drain, we created five hypotheses influencing on brain drain such as military service, gender discrimination, unemployment, infrastructures and hope for future,. The results received from survey and interview shows that military service, gender discrimination and hope for future have significant relationship with brain drain but we are unable to certainly illustrate the impact of unemployment rate and infrastructure on brain drain. Methodology used in this research is combination of interview and survey. Six candidates from the USA, Europe, Malaysia and Iran were interviewed, and we distributed 100 questionnaires among Iranian students currently studying in Russian universities in Moscow. 1.

Bronchial asthma is associated with upper airway (UA) disorders, primarily with allergic rhinitis, which, in turn, occurs in combination with other UA conditions, including hyperplasia of the nasal mucosa. Chronic rhinosinusitis, if confirmed, is a predictor of asthma severity. The pathogenesis of these diseases includes the remodeling (restructuring) of the extracellular matrix and the adjacent UA structures, which is associated with further worsening of the diseases and their resistance to therapy. It is known that remodeling of the lower respiratory tract in bronchial asthma is characterized by epithelial desquamation, hyperplasia of goblet cells, thickening of the basement membrane, fibrosis of the subepithelium, hyperplasia of smooth muscles of the respiratory tract, and increased angiogenesis. At the same time, the UA remodeling in patients with asthma is still poorly understood; the data are still limited and often contradict each other. With isolated allergic rhinitis, the remodeling process is not very much pronounced and is limited, apparently, to a basement membrane thickening. In chronic rhinosinusitis, the UA remodeling manifests by epithelial hyperplasia and an increased sedimentation and degradation of the matrix along with the accumulation of plasma proteins. Despite recent extensive studies, the cellular and molecular mechanisms involved in the respiratory tract remodeling remain largely undetermined, which necessitates further research into these processes. The review addresses several aspects of neuro-humoral control of the extracellular matrix metabolism and the associated remodeling of the upper and lower airway in patients with asthma.

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