bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Onset of Tinnitus in Patients with Sudden Deafness
Authors: Cvorovic Ljiljana , Arsovic Nenad , Radivojevic Nemanja , Soldatovic Ivan , Hegemann Stefan C.A.
Published: September 2024

Objective:

We made hypotheses that tinnitus will appear more likely in patients with sudden deafness with superior hearing in unaffected ear or with more severe acute hearing loss.

Methods:

A retrospective cohort study was performed. Five hundred forty-one patients were identified with idiopathic sudden sensorineural hearing loss (ISSHL) from January 1995 to August 2006. The exclusion criteria for this study were as follows: bilateral sudden hearing loss and Meniere disease, previous tinnitus or bilateral tinnitus at initial evaluation, and onset of hearing loss less than 7 days. The cohort enrolled 454 patients. The enrolled patients were classified into two groups: patient with acute onset tinnitus in the affected ear and patients without tinnitus at initial visit. Main outcome measures were patient age, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the unaffected ear.

Results:

Better contralateral hearing (n = 220 versus n = 72, P < 0.001) and younger age (48 versus 55 years, P < 0.001) were independently associated with the acute onset of tinnitus in patients with ISSHL. The degree of asymmetry between the ears did not differ significantly between patients with and without tinnitus. The sex, presence of vertigo, shape of audiogram, and severity of hearing loss were not correlated with tinnitus occurrence.

Conclusions:

Tinnitus triggered by ISSHL was more frequent in patients with better contralateral hearing and of a younger age, irrespective of the severity of hearing loss on the affected side or the asymmetry between the ears.
Negative Responses to Urban Residential Noise as a Social Rebound Effect of Increasing Population Density
Authors: MacCutcheon Douglas
Published: September 2024

Populations in cities are projected to increase globally, densifying urban residential environments with both positive and negative effects. Positive social effects are offset by negative health effects however; urban residential noise has been identified in a large number of studies as a significant contributor to social unrest as well as a risk to physiological and psychological health caused by stress, making this topic highly relevant to the discussion on sustainability urban growth. Focusing on the psychological rebound effect of urban residential noise, this paper attempts to explain how and why auditory aspects of the spatial environment negatively influences urban residents. To provide context and to indicate areas in need of improvement, the legislative challenges to be faced are considered, with Sweden as a prime example of a first world country grappling with the effects of increased urban density. Existing building legislation regarding residential noise is considered in relation to studies investigating the effects of residential noise on psychological and physiological health, outlining areas in need of future development. Then, health responses to residential noise are placed in a broader evolutionary context by considering how these effects might be the result of triggered evolutionary mechanisms for keeping population size optimal. Further, the spatial dimension of hearing is discussed with reference to theories of territoriality in environmental psychology and the concept of auditory territoriality is described.
Determination of a Cutoff for Noise Sensitivity
Authors: Alniacik Asuman , Çakmak Eda
Published: September 2024

Context:

There is a need for a clear cutoff to use noise sensitivity (NS) scale as a prediagnostic tool in research and clinical use.

Aims:

Noise sensitivity questionnaire (NoiSeQ) was adapted into Turkish language (Tr-NoiSeQ); validity and reliability of the Tr-NoiSeQ were assessed. The cutoff for the Tr-NoiSeQ was determined.

Settings and design:

A descriptive study within subject design.

Materials and methods:

A group of 402 participants aged between 18 and 52 years filled the Tr-NoiSeQ and the Turkish version of Weinstein noise sensitivity scale (Tr-WNSS) via internet.

Statistical analysis used:

Cronbach alpha (α) and the Spearman[FIGURE DASH]Brown coefficient were calculated for the reliability; Pearson correlation coefficient (r) and confirmatory factor analysis (CFA) were used for the validity. The receiver-operating characteristic (ROC) curve was used to calculate cutoff value of the Tr-NoiSeQ.

Results:

For the Tr-NoiSeQ, Cronbach α was 0.92, Spearman[FIGURE DASH]Brown coefficient was 0.93 (P < 0.05). A high significant correlation between the Tr-WNSS and the Tr-NoiSeQ was obtained (r = 0.76, P < 0.05). The fit indexes of the model were obtained as (χ
2 = 1361.06, df = 546, P < 0.001), χ
2 / df = 2.49, root mean square error of approximation = 0.06, comparative fit index = 0.83, goodness of fit index = 0.82. The ROC curve showed that the cutoff for the Tr-NoiSeQ was 53 with a 0.92 sensitivity and a 0.85 specificity (P ≤ 0.05).

Conclusion:

The Tr-NoiSeQ is a valid and reliable tool for use in both clinical practice and research. The Tr-NoiSeQ seems to be consistent with the Tr-WNSS and can be used as a screening tool to evaluate NS in audiology.
Cytomegalovirus Seropositivity as a Potential Risk Factor for Increased Noise Trauma Susceptibility
Authors: Groschel Moritz , Voigt Stefan , Schwitzer Susanne , Ernst Arne , Basta Dietmar
Published: September 2024

Context:

Cytomegalovirus (CMV) represents the leading congenital viral infection in humans. Although congenital CMV due to vertically transmitted infections is the main cause of CMV-related diseases, adult CMV infections might still be of clinical significance. It is still discussed how far CMV seropositivity, due to horizontal infection in immunocompetent adults, is able to induce significant dysfunction. The present study investigates in how far CMV seropositivity is an additional risk factor for an increasing susceptibility to sensorineural hearing loss induced by acoustic injury during adulthood in a guinea pig CMV (GPCMV) model of noise-induced hearing loss (NIHL).

Methods:

Two groups (GPCMV seropositive vs. seronegative) of normal hearing adult guinea pigs were exposed to a broadband noise (5–20 kHz) for 2 hours at 115 dB sound pressure level. Frequency-specific auditory brainstem response recordings for determination of auditory threshold shift were carried out and the number of missing outer hair cells was counted 2 weeks after the noise exposure.

Results:

The data show a slightly increased shift in auditory thresholds in seropositive animals compared to the seronegative control group in response to noise trauma. However, the observed difference was significant at least at high frequencies. The differences in threshold shift are not correlated with outer hair cell loss between the experimental groups.

Conclusion:

The results point to potential additional pathologies in a guinea pig NIHL model in correlation to GPCMV seropositivity, which should be taken into account when assessing risks of latent/reactivated CMV infection. Due to the relatively slight effect in the present data, the aim of future studies should be a more detailed consideration (e.g., larger sample size) and to localize possible target structures as well as the significance of the infection route.
What is Noise Sensitivity?
Authors: Welch David , Dirks Kim N. , Shepherd Daniel , Ong Jessica
Published: September 2024

Background:

Noise sensitivity moderates the association between environmental noise exposure and annoyance and health outcomes.

Methods:

In normally hearing adults, we measured noise sensitivity in three ways: using the noise sensitivity questionnaire, a 3-point self-rating, and the loudness discomfort level (LDL; mean reported discomfort level for tone bursts). We then presented recordings of a 15-second 80 dBLAeq aeroplane overflight and participants rated the annoyance and loudness they experienced.

Results:

The three measures of noise sensitivity were not well correlated with each other, and only the overall LDL was associated with the ratings of loudness and annoyance in response to the aeroplane sounds.

Conclusions:

This implies that our current measures of noise sensitivity may only capture parts of the underlying construct, and therefore underestimate effects due to it on the association between environmental noise and annoyance and health outcomes. We developed a theoretical model to describe the set of factors that may influence a person’s sensitivity to noise and propose that interaction between the systems described is the basis for noise sensitivity. This paradigm alters the focus of noise research from the annoyance caused by the sound, to the sensitization to noise that may occur as a result of the interplay of many factors. We hope that our model will allow research to explore the sensitizing factors for noise more easily and systematically.
The Audiologist’s Role in University Hearing Conservation Programs
Authors: Veith Tonya M.H.
Published: September 2024

Introduction:

All universities that meet state and/or federal requirements for employees’ noise exposure must have a hearing conservation program (HCP). Universities with HCPs and Doctor of Audiology (AuD) programs could reap a range of benefits from interprofessional collaboration between these programs, including enhanced learning opportunities for AuD students; however, it is unclear whether this collaboration occurs consistently in different university settings. Despite a relatively robust literature around occupational audiology and the audiologist’s role in hearing conservation in general, few studies examine this subject in the university setting.

Aim:

This study seeks to provide insights into the role of the university audiologists in university HCPs that could help inform further exploration and potential pilot studies to enhance university-based occupational HCPs, ultimately supporting more rigorous professional training in occupational audiology in AuD programs.

Method:

This study’s primary method was a survey questionnaire delivered to audiologists at U.S. universities. Survey questions explored university audiologists’ role, involvement with their universities’ HCPs, and benefits and barriers to collaboration with the HCPs.

Results:

The results indicate that although audiologists report that they have participated in hearing conservation generally at their universities, the majority of respondents were not actively involved with occupational HCPs.

Conclusion:

Further research is needed to understand how university HCPs are managed and how effective they are. With greater awareness of audiologists’ contributions to university HCPs, their role in this important workplace program could merit expansion.
Calculation of the physiologically developed nighttime noise index from existing noise indices
Authors: Tagusari Junta , Tanaka Yusei , Matsui Toshihito
Published: September 2024

Background:

The effects of noise on sleep and health have been evaluated in earlier studies using noise indices chosen on the basis of practical considerations and not on the physiologic mechanisms of sleep disturbance due to noise exposure. We investigated the neurophysiologic mechanisms of sleep and found that the arithmetic mean of the sound levels above a threshold (

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM1/v/2023-09-22T144912Z/r/image-tiff

) may be used effectively to evaluate the effects of nighttime noise exposure. However, the efficacy of using

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM2/v/2023-09-22T144912Z/r/image-tiff

has only been confirmed in a specific setting; therefore, the reliability of

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM3/v/2023-09-22T144912Z/r/image-tiff

in other situations should be investigated by applying it in epidemiologic studies. In this study, we aimed to obtain an alternative equation for calculating

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM4/v/2023-09-22T144912Z/r/image-tiff

from existing noise indices, given that detailed information on fluctuations in sound levels, needed to calculate

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM5/v/2023-09-22T144912Z/r/image-tiff

according to the definition, is not readily available.

Materials and Methods:

We examined statistical relationships among noise indices namely

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM6/v/2023-09-22T144912Z/r/image-tiff

, the number of noise events above 60 and 70 dB (N
60 and N
70), and the night equivalent sound level (L
night). The study area was around the Kadena military airfield, where the sound levels were recorded at noise monitoring stations.

Results:

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM7/v/2023-09-22T144912Z/r/image-tiff

showed a very strong correlation with N
60 and N
70 but not with L
night. Among regression equations, an equation representing N
60 and the interaction between N
60 and L
night, which is equivalent to the product of N
60 and a linear expression of L
night, showed the highest prediction capability.

Conclusion:

We obtained a regression equation to calculate

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM8/v/2023-09-22T144912Z/r/image-tiff

from N
60 and L
night. Although this alternative equation for

JOURNAL/nohe/04.03/00140329-202123100-00002/math_2MM9/v/2023-09-22T144912Z/r/image-tiff

is only applicable for military aircraft noise, it will aid the re-analysis of existing epidemiologic studies as well as further investigations on the relationship between noise exposure and health effects.
Music Level Preference and Perceived Exercise Intensity in Group Spin Classes
Authors: Lee Lawrance , Shuster Benjamin , Song Yang , Kujawa Sharon G. , Depireux Didier , Hertzano Ronna
Published: September 2024

Context:

Sound levels in fitness classes often exceed safe levels despite studies that show many participants find high sound levels stressful.

Aims:

The objective is to determine if lower sound levels in spinning classes significantly impact exercise intensity and to determine if class participants prefer the music played at lower levels.

Settings and Design:

Observational study of 1-hour group spin classes.

Methods and Materials:

Sound levels were measured in 18 spin classes over two weeks. No adjustments were made in week-1 and sound levels were decreased by 3 dB in week-2. Participant preferences and data on post-class hearing changes were collected via post-class questionnaires (n = 213) and divided into three terciles based on the total sound exposure of corresponding classes.

Statistical Analysis Used:

Unweighted survey generalized linear models are used to sort the causal relationships between different variables simultaneously and participant responses. The Chi-square test is used to reveal statistically significant relationships between two or more categorical variables.

Results:

When mean sound levels exceeded 98.4 dBC, respondents were 23 times more likely to report the music as too loud than too quiet (P < 0.05), and four times more likely to prefer a decrease, rather than an increase, in sound level (P < 0.05). There was no significant difference in respondents reporting high exercise intensity between the middle (95.7–98.1 dBC) and upper (98.4–101.0 dBC) terciles, 67.1% and 71.8%, respectively (P = 0.53). Overall, 25.9% of respondents reported auditory symptoms following classes. Analysis in the context of dBA and dBC produced congruent conclusions and interpretations.

Conclusions:

Sound levels in many fitness classes remain dangerously high. However, music level can be lowered without a significant impact on perceived exercise intensity and many participants prefer lower sound levels than current levels.
Cochlear Synaptopathy Causes Loudness Perception Impairment without Hearing Loss
Authors: Cildir Bünyamin , Tokgoz-Yilmaz Suna , Türkyilmaz Meral Didem
Published: September 2024

Purpose:

In this study, the development of a quantitative measurement method to predict long-term auditory adaptation through the stimuli that have been modulated according to different short-term modulation types was aimed to form a psychoacoustic test battery. It might be used in the evaluation process of individuals with hidden hearing loss.

Methods:

The individuals participating in our study were separated into two groups: high-risk group (n = 39) and low-risk group (n = 30) according to the noise-exposure score. To all participants, auditory brainstem response (ABR), dichotically digit test, Turkish matrix sentence test, otoacoustic emissions test, amplitude modulation detection test, and loudness adaptation test were applied. Stimuli, used in loudness adaptation tests, were provided in three different experiment pairs (experiment 1–2, experiment 3–4, and experiment 5–6).

Results:

The amplitude of wave I of ABR increased as the intensity level increased in the low-risk group, whereas the amplitude reduced as the intensity level increased in the high-risk group (P < 0.05). When different carrier frequency stimuli were used in amplitude modulation detection test, we found that loudness adaptation was highest at 1 kHz carrier frequency with background noise (P < 0.05).

Conclusion:

We observed that individuals assumed having hidden hearing loss had high adaptation scores. It was thought that this result might be related to auditory nerve fibers with low spontaneous rate and thus distortion in temporal coding skills might lead to abnormal loudness adaptation, especially with contralateral noise.
Evaluation of Anxiety Sensitivity, Anxiety, Depression, and Attention Deficit Hyperactivity Disorder in Patients with Tinnitus
Authors: Kumbul Yusuf Çağdaş , Işik Ümit , Kiliç Faruk , Sivrice Mehmet Emre , Akin Vural
Published: September 2024

Context

There may be a connection between tinnitus, a common disease in society, and psychiatric disorders. When the literature is reviewed, it has been realized that more data are needed to elucidate this issue.

Aims

The aim of this study is to compare the symptoms of anxiety sensitivity, anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) symptoms in patients with tinnitus with healthy individuals and to investigate the relationship between tinnitus and psychiatric disorder symptoms.

Settings and design

This study was designed as a case–control study.

Materials and methods

Fifty-one patients with tinnitus and 51 healthy controls were enrolled in this study. Clinical severity of the psychiatric variables were evaluated by Beck depression inventory, Beck anxiety inventory (BAI), anxiety sensitivity index-3, and adult ADHD self-report scale (ASRS) in patient and control groups.

Statistical analysis used

Variables are presented as either a number, a percentage, a mean ± standard deviation, or frequency. Chi-squared, Student t tests, and logistic regression analysis were used to examine the relationship between variables.

Results

Logistic regression analysis results indicated that a significant predictive power of BAI for the presence of tinnitus. Based on a backward-elimination regression analysis, ASRSs (inattention subscale scores) were considered to predict a higher tinnitus handicap inventory score.

Conclusion

These findings provide additional evidence that anxiety and attention-deficit (inattentive) symptoms could contribute to the pathophysiology of tinnitus.
The contribution of personal audio system use and commuting by bus on daily noise dose
Authors: Dirks Kim N. , Le Roux L. , Shepherd D. , McBride D. , Welch D.
Published: September 2024

Background:

For many young people, exposure to music from personal audio system use may represent a significant component of daily noise dose. Moreover, there is increasing concern for the hearing of those who listen at high volumes. The purpose of this study was to determine the noise levels experienced on commuter buses, and to investigate how these impact on the volume-setting behavior of young adult personal audio system users.

Methods:

A questionnaire was used to probe transport use, personal audio system-listening behaviors and the extent of understanding about noise-induced hearing loss. The influence of bus noise on volume-setting behavior was determined by measuring, in a lab setting, the sound-level preferences of participants when listening to their favorite song, a generic song, or a podcast in the absence and presence of various levels of bus noise, simulated using output-adjusted recordings made of bus noise. Statistical analysis was conducted using analysis of variance.

Results:

While the bus noise itself was below 85 dB Leq, as the sound level of the buses increased, so did the percentage of commuters who were found to exceed the equivalent of 8 hours of exposure at 85 dB Leq.

Implications:

Investment in buses with lower noise levels or the use of noise-canceling or noise-occluding headphones would help to reduce the likelihood of noise-induced hearing loss for bus commuters.
Impact of Noise Exposure on Risk of Developing Stress-Related Health Effects Related to the Cardiovascular System
Authors: Sivakumaran Kapeena , Ritonja Jennifer A. , Waseem Haya , AlShenaibar Leena , Morgan Elissa , Ahmadi Salman A. , Denning Allison , Michaud David S. , Morgan Rebecca L.
Published: September 2024

Background:

Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses.

Materials and Methods:

This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results:

The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects.

Conclusions:

This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.
Barriers to Free Cataract Surgery during a Surgical Outreach Camp in New Karu LGA, Nasarawa State, Nigeria
Authors: Okudo Adaora C. , Akanbi Oluwatoyin O.
Published: September 2024

Aim:

To determine the proportion of screened cataract patients with vision ≤6/60 that will utilize the free cataract surgical services and to identify the barriers to uptake of the free cataract surgical services.

Settings and design:

A cross-sectional descriptive study.

Materials and methods:

A cross-sectional descriptive study was carried out among 53 cataract patients with vision acuity (VA) ≤6/60 who presented at a cataract surgical outreach camp in New Karu LGA, Nasarawa State from September 10 to 14, 2013, using both quantitative and qualitative measures.

Statistical analysis used:

Data were analyzed using SPSS Version 20 using the descriptive analysis.

Results:

Six hundred and sixty-six people registered for the outreach, 552 were examined, 125 had cataract of which 53 had cataract with VA ≤6/60, and were offered the free cataract surgical service. The age range of the participants was 36 to 77 with a mean age of 54 years. Twenty-seven were males and 26 were females. Initially, 64.2% were willing to have surgery, eventually 75.5% took up the free cataract surgical services. Females, residents of New Karu LGA, the uneducated and housewives were less likely to take up the free cataract surgical services and this was statistically significant. The most common barriers identified include 41% were afraid of surgery and 26.1% had heard of a bad outcome previously following cataract surgery.

Conclusion:

There was a high utilization of the free cataract surgical service. Fear of surgery and prior knowledge on poor outcome were major barriers. Community participation played an immense role to increase uptake.
A Study of Ocular Side Effects of Blood Transfusions and Iron Chelators in Thalassemia Patients
Authors: Ramakrishnan Reshma , Choudhary Ayushi , Gandhi Priyanka , Agrawal Mamta , Hastak Aesha , Choudhary Ankita
Published: September 2024

Aim:

To determine the ocular changes and importance of ophthalmic consults in thalassemia patients on iron chelating agents and regular blood transfusions.

Settings and Design:

A cross-sectional study was conducted among thalassemia patients who were on regular blood transfusion and iron chelators.

Materials and Methods:

A detailed history was obtained from 50 thalassemia patients included in the study including birth history, family history, and treatment history which was taken from the parents. Ophthalmic examination performed included visual acuity test for distant and near vision with Snellen chart, color vision obtained with Ishihara plates, contrast sensitivity performed with Pelli–Robson charts, Schirmer test conducted with Whatman strip, intraocular pressure obtained with Perkins tonometer, detailed anterior segment performed with Appasamy Slit Lamp biomicroscope and posterior segment examination with the aid of 90D lenses, and indirect ophthalmoscopy with 20D lenses performed after dilatation. Fundus photograph was taken for all the patients with ZEISS fundus camera. The findings were recorded and documented. Statistical Package AQ6 for the Social Sciences software was used to analyze data obtained.

Results:

Study group included 26 males (52%) and 24 females (48%) of varying age from 4 years up to 18 years of age. Presence of thalassemia disorder was noted in the family of 10 patients (20%). Five (10%) patients had mild visual impairment for distant vision. While, 18 patients (36%) had mild dry eye disease. Fundus abnormalities were seen in 14 patients as arteriovenous tortuosity, tessellated fundus, and desferrioxamine retinopathy. Decreased visual acuity, dry eye, and fundus abnormalities were seen in patients with serum ferritin levels >1000 ng/mL. Fundus abnormalities were seen in patients with higher serum ferritin levels (>1000 ng/mL) and longer duration of treatment. In total, ocular changes were seen in 31 patients (62%).

Conclusion:

Regular ophthalmic consult is necessary for all thalassemia patients on regular blood transfusion and chelation therapy to unmask ocular changes at an early stage and provide optimum visual care.
A case report on letrozole-related maculopathy
Authors: Azeem Sitara , Al Hinai Ahmed , Al Kharousi Nadiya , Al Baimani Khalid , Al Abri Mohamed , Al Fadhil Nawal
Published: September 2024

Letrozole is an oral aromatase inhibitor used in the treatment of hormone receptor-positive breast cancers in postmenopausal women. It acts by inhibiting the conversion of androgens to estrogen thereby lowering the estrogen synthesis in the body. We report a case of bilateral cystoid macular edema (CME) in a postmenopausal woman on letrozole for breast cancer. A 62-year-old female presented with painless gradually progressive bilateral diminution of vision for the past 6 months. Her previous ocular history is unremarkable. Her medical history is known for carcinoma of the breast for which she underwent chemotherapy followed by mastectomy, adjuvant hormonal therapy, and radiotherapy. The patient had been on letrozole for the past 4½ years. At presentation, the best corrected visual acuity in the right eye was 0.4 and 0.5 in the left eye. Fundus examination revealed significant bilateral CME. Optical coherence tomography and fundus fluorescein angiography confirmed the diagnosis. After discussing the possibility of letrozole-related maculopathy with the treating oncologist, letrozole was discontinued and the patient was reassessed. Reduction of macular edema and mild visual improvement was observed when letrozole was subsequently stopped. Although ocular side effects are rare with letrozole, a comprehensive ophthalmic evaluation is recommended for patients who present with visual disturbances for prompt intervention.
Familial exudative vitreoretinopathy complicated with macular hole retinal detachment
Authors: Singh Priyanka , Murthy Hemanth , Rao Kavitha S.
Published: September 2024

Familial exudative vitreoretinopathy (FEVR) is a rare genetically heterogeneous inherited disorder with varied presentation. We report a case of FEVR with a classic tractional component and a rare co-occurrence of macular hole with subtotal retinal detachment. The diagnosis was made on clinical examination and imaging. There have been four cases of full-thickness macular holes reported in the literature and none with macular hole retinal detachment. The patient underwent vitrectomy for the same and had silicone oil removal with attached retina postoperatively. We want to highlight this rare association and emphasize the importance of regular follow-up of FEVR cases which tend to progress after remaining quiescent for years.
Role of corneal epithelial mapping, Corvis biomechanical index, and artificial intelligence-based tomographic biomechanical index in diagnosing spectrum of keratoconus
Authors: Kenia Vaishal P. , Kenia Raj V. , Maru Sneha , Pirdankar Onkar H.
Published: September 2024

AIM:

The aim of the study was to evaluate the utility of epithelial mapping, Corvis biomechanical index (CBI), and tomographic biomechanical index (TBI) in diagnosing the spectrum of keratoconus (KC).

METHODS:

This was a retrospective study where KC subjects with an age between 11 and 50 years were enrolled. Subjects with ocular diseases, history of previous corneal surgery, corneal scars or hydrops, ocular trauma, ocular surface disorder, systemic disease, and poor-quality scans were excluded. KC was classified using Belin ABCD classification system. Epithelial thickness, corneal tomography, and corneal biomechanical measurements were recorded using Fourier-domain optical coherence tomography Avanti with corneal adaptor module, Pentacam HR, and Corvis®ST, respectively. To understand the utility of various corneal parameters in diagnosing spectrum of keratoconus, cutoff values for epithelial thickness at the thinnest location and its standard deviation (SD) were considered 45 and 3 microns, respectively, CBI of 0.5 and TBI of 0.29 was considered.

RESULTS:

Sixty-five eyes (45 – KC, 10 – subclinical KC (SBKC), and 10 – forme fruste [FF]) of 34 patients with a mean ± SD age of 30.73 ± 5.71 were included. In our keratoconic sample, epithelial mapping alone helped diagnose the 77.77% of cases, however, when combined with CBI, it helped diagnose 95.5% cases and when combined with TBI, it was useful in diagnosing 100% of cases. In SBKC group, 40% of cases were detected by epithelial mapping alone, and when combined with CBI, it helped diagnose 70% of cases and TBI further helped diagnose 90% of cases. We did not see any role of epithelial mapping in detecting FFKC cases whereas CBI and TBI helped diagnose 60% and 90% of cases, respectively.

CONCLUSION:

The utility of epithelial mapping as a solitary tool is limited in detecting the spectrum of KC, especially SB and FFKC. However, combining it with corneal biomechanical parameters could help improve the efficacy of diagnosis of KC.
A Clinicopathological Study of Thrombocytopenia, Acute-Phase Reactants, and Blood Culture in Neonatal Sepsis
Authors: Talat Fauzia , Alam Kiran , Akhtar Kafil , Ali S. Monazir
Published: September 2024

Introduction:

Neonatal sepsis is a clinical syndrome described as any systemic bacterial infection in neonates documented by positive blood culture. However, blood culture is positive in only 5.0%–10.0% of suspected cases. Serum concentration of many acute-phase reactants rises in response to infection, which can be used as a non-specific indicator of bacterial sepsis.

Aim and Objectives:

The aim of this study was to correlate the levels of serum markers C-reactive protein (CRP), serum ferritin, and thrombocytopenia with neonatal sepsis.

Materials and Methods:

This was a prospective cross-sectional study conducted in the Neonatal Intensive Care Unit, Department of Paediatrics and Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh from 2019 to 2021 on 172 babies (cases =142; controls = 30). Neonates with sepsis who presented with clinical signs or symptoms of sepsis were taken as case group and healthy neonates served as control.

Result:

Blood culture was positive in 58 (40.8%) neonates in the case group and Klebsiella was present in maximum number of cases. Blood culture was positive in only 8 (13.8%) cases out of 31 cases of mild thrombocytopenia. The total culture-positive organism was 58 (40.8%), with 09 (15.5%) gram-positive, 46 (79.3%) gram-negative organisms, and 03(5.2%) fungus. Positive CRP was seen in 88 (61.9%) neonates in the case group, out of which, positive culture was noted in 38 (65.5%) neonates and negative in 50 (59.5%) neonates. Serum ferritin values >400 µgm/L was seen in 97 (68.3%) neonates in the case group and 6 (20.0%) neonates in control group. The mean serum ferritin in culture positive neonates was 1024 ± 309 µgm/L and in culture-negative neonates was 999 ± 301 µgm/L.

Conclusions:

The signs and symptoms of neonatal sepsis are non-specific, leading to difficulty in diagnosis and treatment. Biomarkers such as hematological indices, blood culture, and acute-phase reactants could be more reliable in rapid evaluation and early diagnosis of sepsis and may provide a new diagnostic strategy for the neonates with sepsis.
The Relationship of Fractional Exhaled Nitric Oxide Level with Exercise-Induced Bronchoconstriction in Asian Asthmatic Children
Authors: Au Ka-Nam , Chan Eric Yat-Tung , Leung Shuk-Yu
Published: September 2024

Background and Aims:

Exercise-induced bronchoconstriction (EIB) is associated with eosinophilic inflammation of the airway in asthmatic children and studies showed fractional exhaled nitric oxide (FeNO) is associated with it. The aim of this study was to explore the relationship between FeNO and EIB and find a cutoff reference of FeNO for EIB based on existing normative data from healthy Asian children by Yao et al. in 2012.

Materials and Methods:

Asian asthmatic children who had undergone FeNO and exercise challenge test from January 1, 2016 to December 31, 2019 in a local respiratory centre were reviewed retrospectively. The FeNO values of the individuals were converted to z-score with reference to the predicted value of FeNO in Asian children by Yao et al. in 2012. A receiver-operating characteristic (ROC) curve is plotted to identify a cutoff representing EIB.

Results:

Data of 88 Asian asthmatic children aged 5–18 were retrieved. There is a significant overlapping of the FeNO z-scores of normal and mild EIB groups. The cutoff value determined by the Youden index (0.724) to predict moderate or severe EIB in asthmatic patients is 3.276 with sensitivity of 88.9% and specificity of 83.5%

Conclusion:

High FeNO value of z-score 3.276 has high sensitivity and specificity to moderate to severe EIB in Asian asthmatic children. FeNO could be used as a simple test in clinic setting before exercise challenge test is available.
Allergic Rhinitis and Asthma Rather than Atopic Dermatitis Is a Protective Factor for Dengue Fever––A Nationwide Population
Authors: Tsai Chih-Min , Tsai Chang-Ku , Cheng Fu-Jen , Chang Chih-Hao , Yu Hong-Ren
Published: September 2024

Background/Purpose:

Dengue fever (DF) may cause severe morbidity and mortality. Asthma has been proposed as a protective factor for DF. Asthma, allergic rhinitis, and atopic dermatitis are atopic diseases with a common background. Herein, we aimed to determine whether allergic rhinitis and atopic dermatitis are also protective factors for DF, as this aspect remained unknown.

Materials and Methods:

A resampled nationwide population-based retrospective case-control study was conducted. Multivariate logistic regression was used to identify independent protective factors of these atopic diseases for DF. The Kaplan–Meier method was used to compare dengue-free proportions between patients with or without atopic diseases.

Result:

This case-control cohort study included a total of 1119 patients with DF and 4476 age- and sex-matched patients without DF. At least one of these atopic diseases was observed in 1322 patients. Compared to patients with DF, the non-DF group had a high prevalence rate of atopic diseases (16.2% vs 25.5%, P <0.001). Both asthma and allergic rhinitis were protective factors for DF with an odds ratio (OR) of 0.40 (95% confidence interval (CI) 0.25–0.65, P<0.001) and 0.48 (95%CI, 0.38–0.61; P<0.001), respectively. Atopic dermatitis was not a protective factor for DF (OR, 0.96; 95%CI, 0.58–1.58; P=0.873).

Conclusion:

Asthma and allergic rhinitis, rather than atopic dermatitis, can be independent protective factors against DF. Our finding provides insights into the association between allergy and DF.
Comparison of nebulized fentanyl, midazolam, and dexmedetomidine as a sedative premedication in outpatient pediatric dental surgeries
Authors: Medhat Marwa M. , Abd Elnaby Sara M.
Published: September 2024

Background

The preoperative time is traumatic for young children undergoing surgery. Parental separation and needle injection increase preoperative anxiety. Preoperative sedation in children is usually administered via the rectal, oral sublingual, and intranasal routes with different degrees of patient acceptance. Nebulized drug is an alternative method of sedation that is relatively easy to set up.

Materials and Methods

Thirty nine pediatric patients (2–6) years old scheduled for outpatient dental surgeries were randomly allocated in three groups (13 patients each); group (F) received nebulized fentanyl 2 μg/kg 30 min before surgery, group (M) received nebulized midazolam 0.2 mg/kg 30 min before surgery and group (D) received nebulized dexmedetomidine 2 μg/kg 30 min before surgery. The outcome measures included onset of sedation, parental separation, tolerance to mask induction, reaction to intravenous cannulation and preoperative hemodynamic changes (systolic blood pressure, diastolic blood pressure and heart rate).

Results

Children who received nebulized fentanyl and nebulized midazolam had early onset of sedation as compared to dexmedetomidine. In child-parent separation, quality of induction was better with fentanyl and dexmedetomidine as compared to midazolam. Intravenous cannulation score was best achieved with fentanyl as premedication.

Conclusion

Nebulized fentanyl in a dose of 2 μg/kg is better than nebulized midazolam 0.2 mg/kg and nebulized dexmedetomidine 2 μg/kg as far as premedication is concerned because of its early onset of action, deeper levels of sedation, easy child-parent separation and shorter duration of action.
A prospective randomized comparative study of dexmedetomidine versus clonidine as an adjunct to 0.75% ropivacaine in ultrasound-guided supraclavicular brachial plexus block
Authors: Fultambkar Gajanan , Chavla Pradeepa , Budi Vijayanand , Gurram Rammohan , Kukreja Vinay , Nair Abhijit
Published: September 2024

Introduction

Alpha-2 agonists are popular adjuvants used in neuraxial anesthesia like spinal, epidural, caudal anesthesia, and peripheral nerve blocks. The authors compared the efficacy of clonidine with dexmedetomidine as an adjuvant to ultrasound (US)-guided supraclavicular brachial plexus block in adult patients undergoing elective upper limb surgeries.

Materials and methods

After obtaining Ethics Committee approval, 60 American Society of Anesthesiologists’- physical status (ASA-PS) I/II patients were randomized into two groups. Group Clonidine-Ropivacaine (CR) received 1 μg/kg clonidine as an adjuvant and group Dexmedetomidine-Ropivacaine (DR) received 1 μg/kg dexmedetomidine. Patients received an ipsilateral US-guided supraclavicular brachial plexus block with 0.75% ropivacaine (total volume of 20 ml). Demographic data, hemodynamics, the onset of block (sensory, motor), the duration of block (sensory, motor), duration of analgesia and surgery, total number of rescue analgesics, numerical rating scores, and Ramsay sedation score were compared between both groups using appropriate statistical tests.

Results

Heart rates at 30 min, 60 min, 2 h, and 3 h were lower in group DR compared with group CR, which was statistically significant (P=0.0001, 0.0001, 0.021, and 0.026, respectively). The onset of sensory and motor block, duration of sensory and motor block, and duration of analgesia were better in group DR compared with CR, which was statistically significant (P=0.00). The number of rescue analgesics required in group CR in both groups was comparable (P=0.057). Numeric rating scale scores at 12, 18, and 24 h were significantly better in group DR compared with group CR (P=0.0001, 0.039, and 0.036, respectively).

Conclusion

When added as an adjuvant to 0.75% ropivacaine in the US-guided supraclavicular brachial plexus, dexmedetomidine block produced faster onset of sensory and motor blockade, prolonged the duration of sensory and motor blockade, and also prolonged the duration of analgesia, when compared with clonidine.
Characteristics and clinical outcomes of critically ill pregnant patients with COVID-19 disease
Authors: Tharwat Ayman I. , Labib Heba A. , Ali Rania M.
Published: September 2024

Aim

To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients.

Settings and design

This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021.

Methods and material

The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality).

Results

The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU.

Conclusions

Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.
Comparative study between different approaches for the management of postdural puncture headache
Authors: Hassan Ahmed H. , Refaie Bahaa M. , Ahmed Islam M. , Abdelkareem Ayman M.
Published: September 2024

Introduction

The postdural puncture headache (PDPH) is one of the spinal and epidural anesthesia complications. It can be induced by using large gauge-cutting needles or performing numerous trials. Conservative treatment was the primary option for the management of PDPH, sphenopalatine ganglion block (SPGB) can be a suitable and safe option for the treatment of PDPH.

Aim

The aim was to verify the efficacy and safety of transnasal SPGB using either lidocaine 2% or bupivacaine 0.5% as a treatment line for PDPH versus the conventional conservative treatment.

Patients and methods

In total, 120 patients with PDPH following cesarean section under spinal anesthesia were assigned and divided into three groups. Group L (n=40) received transnasal SPGB (lidocaine 2%), group B (n=40) received transnasal SPGB (bupivacaine 0.5%), and group C (n=40) received conservative treatment for 24 h [intravenous (IV) paracetamol 1 g/8 h]. The headache severity was measured by the visual analog scale (VAS) at 0 min, 30 min, 6 h, 12 h, and 24 h post treatment.

Results

No significant difference in the VAS from the baseline between the groups L and B was observed. VAS values were significantly lower in both groups when compared with patients in group C (P<0.05). No significant differences from baseline mean blood pressure, heart rate, or other complications (such as bleeding), were observed between the three groups at any timepoint.

Conclusion

The headache severity in PDPH cases might be reduced more efficiently through SPGB using either lidocaine or bupivacaine, unlike other conservative treatments such as paracetamol.
Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia
Authors: Aly Amani A. , Rifky Mohamed A. , Adwibi Adnan M. , Elhossieny Khadeja M.
Published: September 2024

Background

Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety.

Aim

To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP).

Patients and methods

In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery.

The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications.

Results

There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min.

Conclusion

The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.