A "White out" pattern in which the background was too bright to detect PGs was observed in 11 sides (22%), and a "Black out" pattern in which the background and PGs were dark was observed in 18 sides (36%). Malignant disease was statistically associated with a "White out" pattern. No factors were found to be related to the "Black out" pattern. CONCLUSION In malignant disease, we should use this novel approach carefully.BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo and its recurrence is fairly common. Several studies correlated the pathophysiological role of different comorbidities-such as diabetes, osteoporosis, vascular, psychiatric and autoimmune diseases-in the development and recurrence of BPPV. The aim of this study is to analyse the pharmacological history of patients with idiopathic BPPV in relation to the risk of developing recurrence. METHODS Data regarding 715 patients aged 12 to 87 years (62.7 ± 14) with non-traumatic BPPV were retrospectively evaluated. These refer to the Vestibular Service, day clinic, and were collected over a 4-year period, between 2014 and 2018. RESULTS Recurrence of BPPV was observed in 220/715 patients (30.76%). A statistically significant correlation (p  less then  0.006) between recurrence and drug consumption was observed for SNC agents (p = 0.0001), vitamin D (p = 0.0005), PPI (p = 0.0007), thyroid hormones (p = 0.0011), and antihypertensives in single use (p = 0.0031). On the contrary, cholesterol-lowering statin drugs, hypoglycaemic agents, antiplatelet medication, estroprogestins and combination of two or more antihypertensives did not show significant correlation. CONCLUSION Specific classes of drugs are significantly associated with recurrence antihypertensive therapy with a singular agent, central nervous system agents, PPIs, vitamin D and thyroid hormones. On the other hand, the lack of correlation between some drugs and recurrence could be linked to the effectiveness of therapy in controlling hypertension, dyslipidaemia and diabetes. Pharmacological history is an essential tool to identify patients at risk of BPPV recurrence.In September 2019, the New York Times (NYT) published the article "Fighting the Shame of Skin Picking," which discussed the cosmetic, social and emotional impacts of body-focused repetitive behaviors (BFRBs). BFRBs, including excoriation disorder, trichotillomania, onychotillomania, and onychophagia, are recurring actions that damage one's physical appearance. The aim of this study is to characterize the demographic information provided and themes raised in the 166 comments posted in response to the article. The most commonly reported condition was skin picking (38.2%), followed by trichotillomania and/or trichophagia (30.3%), onychotillomania (24.7%), and onychophagia (23.6%).  https://www.selleckchem.com/products/ex229-compound-991.html  All conditions had a female predominance. Treatment of body-focused repetitive behaviors was the most common topic of discussion, followed by shame and impact on appearance. Since commenters described significant impairments to quality of life, larger randomized controlled trials on skin picking, trichotillomania, onychophagia, and onychotillomania are necessary to provide evidence-based management to patients.Prurigo nodularis (PN) and lichen simplex chronicus (LSC) are debilitating chronic pruritic diseases that can lead to and be exacerbated by psychosocial distress. However, little is known about the mental health (MH) comorbidities of PN/LSC. We sought to evaluate the likelihood and cost-burden of MH comorbidities and emergencies associated with PN/LSC. Data were examined from the 2002-2012 Nationwide Inpatient Sample, including a representative ~ 20% sample of US hospitalizations (n = 87,053,155 admissions). Inpatients with vs. without PN/LSC had higher odds of MH disorders overall (39.4% vs. 20.0%; adjusted odds ratio [95% confidence interval, CI] 2.26 [2.13-2.41]) and in all 15 individual MH disorders examined. Inpatients with vs. without PN/LSC were more likely to be admitted with a primary diagnosis of a MH disorder (4.5% vs. 2.2%; 2.16 [1.91-2.45]), particularly developmental, psychotic, and mood disorders, history of MH disorders or substance abuse, and cognitive disorders. PN/LSC were associated with prolonged inpatient length of stay, and an excess $0.69 million in inpatient costs of care indirectly related to hospitalization for MH disorders. In conclusion, inpatients with PN/LSC had increased likelihood of comorbid MH disorders and emergencies requiring hospitalization. Optimized approaches are needed for screening and managing MH comorbidities in PN/LSC.PURPOSE We report five rare cases of programmable valve breakage (Codman Hakim-Medos valve) in shunt systems of children with posthemorrhagic hydrocephalus. Only four similar studies have been published in the current literature. METHODS Between 2013 and 2018, five children with posthemorrhagic hydrocephalus were admitted to the pediatric department. All patients had a history of slight blows to the head in a minor trauma and follow up MRI scans. After initial clinical examination, cranial computed tomography (CT) and X-ray were conducted. RESULTS In all cases, pumping the reservoir resulted in very slow refilling. The cranial CT in one patient showed slit ventricles confirming the suspicion of overdrainage, the other cases a slight enhancement of the hydrocephalus. In lateral X-rays of the skull in comparison to the first X-ray control of the shunt valve, the pressure control chamber could be seen dislocated in the inferior part of the reservoir in all cases. Surgery revealed that the shunt valve was broken. The pressure control chamber had dropped to the bottom of the reservoir. After implantation of a new shunt valve, the symptoms resolved completely in all five children. Overall this complication occurred in 4.3% (5 of 85 implanted Codman Hakim-Medos valve) of all children necessitating ventriculoperitoneal shunt implantation between January 2013 and December 2018. CONCLUSION The well-accepted Codman Hakim-Medos programmable valve is part of a tube-system, which is designed to offer the possibility of a reliable and precise treatment of hydrocephalus. Various mechanical and non-mechanical complications of shunt systems have been reported. Valve breakage is a very rare condition, often missed, and must be kept in mind when trauma and prior MRI scan are reported.