bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study on Total Mercury Content in Surface Water and Backwater Fishes of Periyar
Authors: Baby Libin , M. Liya Jose , Solomon M. A. , Lakshmanan P. T.
Published: September 2024

Aquatic systems are extensively contaminated with heavy metals released due to anthropogenic activities. Mercury is one of toxic elements and its toxicity to humans has been established. The concern about mercuric pollution in the environments started with the incident of ‘Minamata’ in Japan in 1950’s. During the study period, flowing mercury electrode was used for the preparation of caustic at Travancore Cochin Chemicals Ltd (TCC), Eloor and effluents of small industries at Edayar were the sources of mercuric pollution. Surface water samples were collected from 1Km apart from TCC, near to Indian Rare Earth Ltd (IRE), Muttinakam and Mannamthuruth and fishes (male and female) were collected from this region with the help of local fishermen. This study implies the amount of mercury in aquatic system and its influence in different body components of three fishes. Total mercury content in both the samples analysed using cold vapour atomic absorption using Mercury Analyser MA-5840 and loss on mercury on heating processes (fishes) was decreased by the use of Bethge Apparatus. Fishes were Oreochromis mossambicus (Thilapia), Mugil cephalus (Mullet) and Arius arius (Cat fish) which were living in surface to near shore, middle of the river and bottom. The proximate composition (AOAC, 2000) of fishes showed that they were low fat (0.57-4.24%) with high protein content (18.4-21.96%). The total mercury content in surface water varied from 1.667- 3.334ng/ml and it was above tolerance level (1ng/ml) while in fishes followed the order A. arius> M. cephalus> O. mossambicus. Relatively higher concentrations of mercury were noticed in gut and liver than muscle, and also male fishes predominated over female. This study shows that mercury cycle in the habitat water did not influence to any hazardous level in these three fishes.
Passive Smoking - Effects of Second-Hand Smoke on Oral Health
Authors: . Senkutvan , . Jualacatherine , . Preetha , . Bhuvaneshwari , K Balaji , Jacentha S Daffy
Published: September 2024

Worldwide, smoking poses a serious threat to public health. Numerous research has examined how active smoking affects health, and the overall harmful effects of active smoking are widely acknowledged. In contrast, it's unclear how passive smoking affects your health. A number of disorders, including female breast cancer, allergic rhinitis, allergic dermatitis, and food allergies, have been linked to smoking, both actively and passively. The typical oral and nasopharyngeal flora are altered by passive smoking, which increases the risk of upper airway infection. In addition to producing severe periodontitis, implant failure, gingival pigmentation in children and adults, primary and permanent tooth decay, and tooth loss, it can impair alveolar bone density. But research on the effects of passive smoking on health has not been fully compiled and is still mainly inconclusive. Consequently, the total systemic and oral negative consequences of passive smoking exposure are the focus of this review.
Hypersensitivity pneumonitis (HP)- Global and Indian scenario
Authors: Sundaram Padma
Published: September 2024

Pulmonologists face a challenge in the diagnosis of HP which has multiple clinical phenotypes. In all newly diagnosed interstitial lung disease, HP should always be considered. The current guidelines classify HP into two main criteria based on clinical, radiological and pathological subtypes. They are acute/inflammatory HP and chronic/fibrotic HP. Patients who have a positive exposure history with a typical/classical pattern on HRCT and with BAL lymphocytosis, a diagnosis with high confidence can be made. Additional histopathological sampling should be done after multidisciplinary discussion in patients when an alternative diagnosis cannot be established.

All efforts must be undertaken in patients of HP to identify the environmental inducers and eliminate the source to prevent and minimize exposure to the same and prevent the progression of the disease. Systemic corticosteroids still continue to remain the mainstay of treatment. Randomized clinical trials with existing and/new antifibrotic agents are required for effective management of patients with chronic HP. Lung transplantation offers some hope for patients with chronic progressive HP and patients should be evaluated early for the same
Utility of needle core specimen in improving the diagnostic yield of EBUS TBNA
Authors: Abraham Sujith Varghese , Ameer K. A , Arjun P , Kesavan Vinod Kumar
Published: September 2024

OBJECTIVES

EBUS-TBNA has become a highly sensitive, minimally invasive, outpatient procedure for the assessment of mediastinal adenopathy. The standard cytological analysis is the preferred modality for diagnosis from EBUS-TBNA and diagnostic value of needle core specimen is less studied. The current study fills the gap by comparing utility of EBUS needle-core specimen histology to EBUS FNA cytology.

METHODS

196 patients who underwent EBUS-TBNA between January 2017 and March 2020 in a single centre were included in the study. Diagnostic yields of two specimen-processing techniques, fixed slides (cytology) and needle core samples (histology) were compared.

RESULTS

The composite diagnostic index had found disease etiology in 176 of the 196 patients. EBUS cytology specimens were diagnostic in 125 cases (63.77%) and needle core specimen histology in 154 cases (78.57%). Combining both increased the yield to 166 (84.69%). Out of the total 186 in which both samples were available, the additional yield of histology samples over cytology samples was 19.351% whereas, that of cytology over histology was only 5.37%. Evaluation of needle core specimen histology is statistically significant over smear cytology in terms of sensitivity, specificity and diagnostic accuracy (p<0.05). Also, combined evaluation of cytology and histology improved the negative predictive value of the test than both considered separate (p<0.05).

CONCLUSION

Procuring needle core specimens for histological analysis improves the overall diagnostic yield of EBUS-TBNA than cytology alone. EBUS TBNA technique has yielded tissue samples adequate enough to perform molecular profiling for targeted therapies in lung cancer and microbiological investigations related to tuberculosis. Keywords: Endobronchial ultrasound, Mediastinal adenopathy, EBUS needle core biopsy, Cytology
Assessment of adherence to inhalers in asthmatics
Authors: Santhakumar Sonia , Kamarunniza Afsana Ibrahim
Published: September 2024

Background:

Asthma is a chronic disorder which affects the quality of life and causes significant morbidity when uncontrolled. Good control of asthma has now become possible with the advent of preventive inhalers and well-established guidelines. But despite all this, a significant number of patients all over the world still has uncontrolled asthma. Suboptimal asthma control is largely due to poor adherence to inhalers and incorrect inhaler techniques. There are very few studies conducted in India to assess the adherence to inhalers using a validated and easily reproducible questionnaire which simultaneously assess adherence as well as psychometric factors associated with non-adherence.

Materials and Methods:

In this cross-sectional observational single centre study conducted in a tertiary centre in Kerala, India we have assessed the level of adherence to inhalers among 111 patients attending Pulmonology outpatient department between November 2019 to January 2020 using a well-validated Test of adherence to inhalers (TAI) questionnaire.

Results:

The result showed that good adherence to inhaler was seen only in 28.8%of patients, intermediate adherence in 27% and poor adherence in 45%. Overall, 67% of subjects were women, majority of subjects were older than 20yrs. of age and most of them had education of at least tenth standard and all were literate.

Conclusion:

Adherence to inhalers is low among asthmatics. There was a significant relation between TAI score and asthma control test score (ACT). The pattern of adherence was mostly erratic and ignorant types and good inhaler technique were seen in only 22.5%
Analysis of red cell distribution width in patients presented with interstitial lung disease
Authors: Francis Jiss Ann , Arun N.A. , Davis Rennis , Ajith T.A.
Published: September 2024

Background:

Redcell distribution width (RDW) is a prognostic tool of different clinical conditions and a powerful predictor of mortality in elder adults. Increased RDW values were related to underlying chronic inflammation including interstitial lung disease(ILD). RDW as a biomarker to assess the severity of disease in ILD patients was reported. This study was aimed to evaluatethe change in RDW in ILD patients in late stages of the disease.

Methods:

A retrospective observational study was conducted among patients who died with ILD. Values of RDW during the later stages of disease (close to and 2 months beforedeath)werecollected from medical records. Variations of RDW in patients with or without smoking habits, occupational exposures, and types of ILD were also studied. Data were statistically analysed.

Results:

Forty-two patients died with ILD included. The value of RDW at 2 months before death was 15.4 ±1.8, whereas the valueclose to death was 16.1 ±2.4(p=0.030). The change in RDW values during late stages of ILD is significant. There was no association between RDW value 2 months before death with smoking history(p=0.112) or occupation(p=0.119) or types of ILD(P=0.121). But 86% of people with the smoking history presented with abnormal RDW value (>14.5%) at the time of their first presentation itself. No variation in RDW was found among patients with history of smoking status, occupational exposures, or types of ILD

Conclusion:

Increase in RDW was associated with later stages of ILD. Change in RDW value in later stages of can be used as a biomarker for poor survival.
Anthraco-fibrosis-A masquerader?
Authors: Panwala Mithali , Nair Sharada , Nair V. Kesavan
Published: September 2024

Introduction

Anthraco fibrosis is a rare condition which has many clinical and radiological features mimicking or masquerading as pulmonary tuberculosis, carcinoma bronchus and silicosis. The biopsy from the lung lesion is the clincher in the diagnosis.

We are presenting here a case of anthracofibrosis in a manual labourer who was working in the stone -cutting and tiles industry. He was engaged in the job actively for years though he was having co- morbidities like diabetes mellitus, tuberculosis etc. A heavy smoker with a smoking index of 600, he presented with chronic cough, dyspnoea, chest pain and melena. His investigations showed ECG changes suggestive of coronary artery disease and chest X-ray with right upper lobe cavitation and nodules in both lungs. Bronchoscopy revealed bluish pigmentation and nodules in the air ways and narrowing of the bronch in certain areas suggestive of bronchial stenosis. Bronchoscopic biopsy revealed only chronic inflammatory cells. Subsequently, CT guided tru-cut biopsy from the right upper lobe lesion confirmed features of anthracofibrosis. Though there are lakhs of people in India working in the construction industry with work involving stone and tile cutting etc., reports about anthraco fibrosis have been few and far between. Hence this report.
An unusual case of granulomatous pleural effusion
Authors: Abraham Sujith Varghese , Ameer K.A , Arjun Padmanabhan
Published: September 2024

A 56 year old female, a case of EPTB - left sided pleural effusion was evaluated for lack of response to ATT. She underwent pleuroscopy which showed multiple discrete greyish lesions on parietal pleura and biopsy revealed granulomatous lesion. Despite the continuation of ATT for another 2 weeks, the chest tube inserted post pleuroscopy drained 500ml/day. PET CT showed metabolically active mediastinal adenopathy and splenomegaly. She underwent mediastinoscopy and biopsy of the mediastinal node which revealed non-necrotizing granulomas highly suggestive of sarcoidosis. Steroid was initiated and ATT medications were stopped considering sarcoidosis as the diagnosis. Her effusion subsided subsequently and became asymptomatic. She has had no recurrence on follow up so far.
Yellow Nail Syndrome
Authors: Nair Sharada , Nair Kesavan V
Published: September 2024

The ‘Yellow Nail Syndrome’ is a condition characterized by yellowish-brown finger and toe nails, lymphedema of the legs and pleural effusion. It is a rare condition, reported infrequently in literature. This report is of a case of yellow nail syndrome in a 32-year-old female, native of Maldives. She had noticed yellowing of nails along with symptoms of allergic rhinitis ten years ago. She was diagnosed to have asthma with cor-pulmonale from elsewhere. She came here for surgical treatment of leg edema. She was also found to have yellow nails with allergic rhinitis and asthma. There was no evidence of bronchiectasis or pleural effusion which are the usual reported associations. Cardiac evaluation done revealed no abnormality. Bilateral inguinal nodo-venous shunt was done which relieved her edema to a large extent. Her diagnosis was delayed for nearly ten years entailing a lot of financial burden and mental strain.
Pulmonary vasculitis as initial manifestation of Rheumatoid arthritis
Authors: Suhas H S , Sundaram P
Published: September 2024

Rheumatoid arthritis (RA) is an autoimmune disorder of unknown aetiology that characteristically causes progressive, symmetric erosive destruction of bone and cartilage which can lead to deformities that may be often debilitating.

Although joint involvement is the primary manifestation of rheumatoid arthritis, there have been many instances where it can primarily present with extra articular manifestation in the form of subcutaneous nodule formation, vasculitis, inflammatory changes in the eyes, pericardial involvement and lung involvement.

Involvement of respiratory system may be seen in 30-40% patients of rheumatoid arthritis and in 10% of the patients, involvement of the respiratory system may be the initial manifestation and may precede the articular manifestations. It may present in the form of parenchymal involvement manifesting as interstitial lung disease, airway abnormality or with pleural involvement presenting as pleural effusion and rarely may present as pulmonary vasculitis.

We present a rare case of 60-year-old man presenting with pulmonary vasculitis in the form cavitating nodule with effusion with high levels of anti-cyclic citrullinated peptide (anti CCP) and RA levels.
Etanercept induced pleuro-pericardial effusion - a rare adverse effect.
Authors: Shriram S , Sachin D , Padmasundaram
Published: September 2024

Many of the pharmacological agents used in clinical practice can potentially cause some adverse reaction in any part of the pulmonary system. As more drugs are being discovered, the list of pulmonary toxicities also is getting longer. We present a case of a 25 year old man, known case of Ankylosing spondylitis, who presented with orthopnea and was found to have pleuro-pericardial effusion. Investigations revealed exudative eosinophilic fluid with low adenosine deaminase levels. Thoracoscopic pleural biopsy showed dense eosinophilic infiltration of the pleura. Infection and malignancy were ruled out by relevant tests. A diagnosis of drug induced pleuro-pericardial effusion was made by exclusion of other causes.. Etanercept was witheld and patient was started on steroids after which he showed significant improvement on follow up. We suggest Etanercept be considered in the growing list of drugs causing pleuro-pericardial effusion. To our knowledge, a case of pleuro-pericardial effusion with eosinophilic pleural infiltration due to Etanercept specifically has not been previously described.
Bedside decision making-How can we make the cognitive short cuts more efficient?
Authors: Ghosh C. Sudheendra , Ghosh Sarun , Ghosh Sayujya S
Published: September 2024

Bedside clinical decision making by expert physicians invloves various cognitive process described under heuristics. Identification of biases and their correction can make these cognitive short cuts more efficient. It is one of the cost effective way of improving basic clinical skills. A thorough understanding and application of evidence based medicine can further strengthen the clinical management capability of the junior doctor at the bedside.
Predictors of post discharge home oxygen therapy and Bilevel positive airway pressure therapy in stable hypercapnoea
Authors: Kancherla Roopa , Dhanasekaran Senthil , Rajagopal Srinivas , Kattula Dheeraj
Published: September 2024

Background:

Hospital admission for acute exacerbation of COPD (AE-COPD) accounts for 70% of total costs of COPD treatment, and treatment cost is related to the duration of hospital stay. If post-discharge supportive care is required an extra cost will be added. The objectives of this study are to determine the predictive factors of post-discharge supportive care (Domiciliary oxygen, Bi-level positive airway pressure) in known COPD patients who got admitted with acute exacerbation. This is likely to help the treating physician to prime the family and plan an early discharge of the patient with supportive care instead of waiting for the patient to be off oxygen or BiPAP support.

Methods:

This is a retrospective study done at the pulmonology department of tertiary care hospital from January 2018-Jan 2019. Data sources were electronic medical records and the hospital discharge minimum data set. This study included 89 known COPD subjects who were not on prior supportive care (Long term oxygen therapy or home BIPAP) and were admitted for the management of acute exacerbation. Clinical parameters like symptoms at onset and the duration of symptoms (cough, fever, breathlessness, sputum production),comorbidities, initial blood investigations(complete blood counts, serum creatinine, arterial blood gas analysis, sputum culture reports)radiological findings, treatment details, pulmonary function test were evaluated with appropriate statistical tests. Parameters associated with post-discharge supportive care were evaluated.

Results:

A total of 89 patients were included in the study. Four patients were excluded because of the death. Presence of type II respiratory failure related findings like respiratory acidosis PH (P=0.02), elevated bicarbonate HCO3 (P=0.01), elevated carbon dioxide level PCO2 (p=0.007) in the ABG, and the requirement of non-invasive ventilation (P=0.00), Chest X-ray finding of hyperinflation (P=0.03) and treatment-related variables like prolonged duration of hospitalization (P<0.01) were associated with post-discharge supportive care (Home oxygen therapy and BiPAP support) in univariate analysis. In the multivariate analysis hyperinflation (Odds ratio OR-4.73; 95% confidence interval; 1.37-16.33), noninvasive ventilation (OR-4.9; 95% CI: 1.29-18.47), and prolonged duration of hospitalization (OR-1.32; 95% CI: 1.05-1.66) remained significantly associated with post-discharge home oxygen therapy and home BiPAP therapy.

Conclusion:

This study results conclude that severe disease as marked by hyperinflation on Chest X-ray, presence of type II respiratory failure related changes in the ABG and requirement of non-invasive ventilation, and longer duration of hospitalization predicts the post-discharge supportive care. These findings can help the clinician to prepare for earlier discharge with post-discharge supportive care.
Association between depression and level of asthma control
Authors: Shabna Kader K T , Win Ronald B , Nair Reshmi S , Anil Kumar V T , Nair Sanjeev , Kumari K Anitha
Published: September 2024

Background and objectives:

Asthma and depression are two highly prevalent chronic diseases in India and worldwide, imposing unacceptable social and economic burdens on the public health care system. Asthma has long been considered an illness in which mood and emotions contribute to poor control of symptoms. The contribution of psychiatric diseases especially, depression towards poor asthma control was not been widely studied in Indian scenario. Therefore, this study was conducted to find out the potential relationship between the level of asthma control and depression in the Indian scenario.

Materials and methods:

This was a case control study with controlled and uncontrolled adult asthma patients as controls and cases, respectively. The sample size calculated was 168 (84 controlled and 84 uncontrolled) asthma patients. Those with concomitant Asthma COPD overlap/diagnosed psychiatric disorders were excluded. Control of asthma was determined using the GINA 2016 adult asthma control tool and depressive symptoms with Patient Health Questionnaire 9. Data analysis was done using Epi Info 7 software.

Results:

Of the 168 asthma patients in this study, 134(79.7%) were females; mean age was 43.8±16years and mean BMI was 23.5±4. Out of the controlled asthmatics 10(11.9%), and out of the uncontrolled asthmatics 44(52.3%) experienced moderate to severe depressive symptoms (Odds Ratio-8; p<0.001). Other factors associated with poor asthma control included poor medication compliance (p<0.001), rhinosinusitis (p=0.004), low socioeconomic status (p=0.005) and FeV1<60% (p=0.001).

Conclusion:

Depression is associated with poor control of Asthma. Various other factors associated with poor asthma control were also determined.
Absolute Eosinophil Count as a marker to differentiate COVID-19 from other short febrile illness
Authors: Sharada Nair C , Nivya Ravi , Arjun Padmanabhan , Sanjeev Nair , Ameer K A
Published: September 2024

Purpose:

Peripheral blood routine examination results are often abnormal in Covid-19. This study aimed to determine whether absolute eosinophil count can be used as a marker to differentiate covid-19 from other short febrile illness

Materials and Methods:

This was a single-center retrospective descriptive study which studied 1000 laboratory confirmed Covid-19 patients and 300 patients with non-Covid short febrile illness. The peripheral blood routine examination results and relevant demographic parameterson the first day of hospital visit for both groups; and the clinical disease severity category assigned to each patient in the Covid-19 group were obtained from the hospital electronic medical records and analysed at the end of the study using appropriate statistical tools.

Results:

The median AEC was 55 cells/mm3 (13.2-140.4) and 167.57cells/mm3 (83.6-247.4) in the Covid and non-Covid groups respectively (p < 0.001). The median NLR was 2.6 (1.5-5.3) and 2.7 (1.9-4.2) in the Covid and non-Covid groups respectively (p=0.689). Upon comparing mild, moderate and severe clinical disease severity, median AEC was lowest and median NLR was highest in the severe category (p< 0.001)

Conclusion:

A low AEC may help differentiate Covid-19 infection from other short febrile illness when used in conjunction with clinico-radiological features. An initial low AEC and high NLR can predict increased clinical disease severity.
A case of Ewing Sarcoma of the rib with metastasis to chest wall
Authors: Paradkat Deepak , Nair Kesavan , Anusha C.M.
Published: September 2024

A 13-year-old girl presented to the Respiratory Medicine Department with complaints of left sided chest pain, progressive dyspnoea & fever of 1 month's duration. Clinical examination revealed diffuse swelling on antero-lateral aspect of left chest with moderate pleural effusion on the left side. FNAC from the swelling was suggestive of Askin tumor & pleural fluid was hemorrhagic with repeat cytology positive for malignant cells. Histopathology showed neoplastic cells with scanty cytoplasm, hyperchromatic nuclei and rosette formation suggestive of Ewing sarcoma, and on follow-up she developed metastasis in the upper part of chest wall. Because of this rare presentation we are reporting this case.
A rare complication of left pneumonectomy
Authors: Panicker Venugopal , Shahina S , Augustine Preethi , Suresh Arjun , Shajahan PS , Bindu CG
Published: September 2024

Postpneumonectomy syndrome (PPS) is a rare complication of pneumonectomy occurring due to extreme rotation and malposition of mediastinum resulting in dynamic central airway compression between adjacent vascular structures and vertebra. Intrathoracic prosthesis placement is an evolving technique to treat this by alleviating the effects of thoracic dead space. We hereby present a case of post pneumonectomy syndrome which is rare in adults and further rarer following left pneumonectomy as in this case.
Association of thrombocytopenia with severity and outcome of COVID-19
Authors: Babu Carol Hannah , Huliraj N , Kumar Deepak R , Santhosh Kumari K R
Published: September 2024

Background:

Laboratory parameters and their association with clinical outcomes in COVID-19 have been an area of focus of researchworldwide. The role of thrombocytopenia in assessing the disease severity and adverse outcome in patients with COVID-19 is not clearly established. The study aims to find the association of thrombocytopenia with the severity and outcome of COVID-19.

Materials and Methods:

This is a retrospective study conducted in the Department of Respiratory Medicine at a tertiary Centre. 120 RT-PCR confirmed COVID-19 patients, 40 from each category,>18 years of age, admitted from July-September 2020 were included. Mann Whitney Test was used to compare the mean Platelet count between survivors and non-survivors in each category. Statistical significance was set at P< 0.05.

Results:

Of 120 COVID-19 patients, 74 were males (61.67%) and the average age in all 3 categories varies from 49.63-to 54.60. There were 87 survivors (72.5%). A statistically significant association was found between low platelet count and the disease severity and mortality in patients with COVID-19 (P< 0.001). The sensitivity of low platelet count at the time of admission in predicting the mortality was 80% in Category C patients with the cut-off value being 1.13 lakh per microliter.

Conclusion:

The degree of thrombocytopenia was more in patients with severe disease and non-survivors than in survivors of COVID-19. Thus, platelet count may serve as a simple and inexpensive biomarker for disease severity and risk of mortality in patients with COVID-19.
A tale of a puzzling hypoxia
Authors: Divya R , Nirmal Aparna , Anand V , Augustine Jolsana , Cleetus Melcy , Rajesh V
Published: September 2024

Hypoxemia is commonly encountered in pulmonary practice and has several aetiologies. With clinicians routinely employing finger pulse oximetry in medical practice, hypoxia is picked up far more frequently and reliably. Most patients detected to be having hypoxemia have an underlying etiology linked to respiratory or cardiovascular system, although non cardio-pulmonary causes also account for a minority of cases. Oxygen carrying capacity of the blood may be altered in the presence of abnormal haemoglobins like carboxy haemoglobin, methaemoglobin etc and tissue utilisation of oxygen is impaired in cyanide poisoning. We share the case of a middle-aged lady who presented with dyspnoea and profound hypoxia with normal cardiovascular and pulmonary systems on evaluation. Tailored evaluation clinched the etiology of her hypoxia to be methemoglobulinemia and G-6-PD enzyme deficiency was diagnosed during downstream investigation of methemoglobulinemia. The case highlights the need for awareness of metabolic causes of hypoxemia and gives a narrative approach to the diagnosis and management of methemoglobulinemia.
Post Ejaculation Sickness - a rare form of allergy
Authors: Panicker Venugopal , Sulaiman Shajahan P , Suresh Arjun
Published: September 2024

A 20-year-old male with post-ejaculation syndrome (Post orgasmic illness) consisting of low grade fever, general pruritis, pustular eruptions on the face, fatigue, and asthenia. Allergy to autologous semen was confirmed by intradermal testing. The case is reported because of its rarity. The etiology, pathogenesis, and treatment of this rare condition is not known.
Invisible Droplets
Authors: Bhaskar Maheema , Dalal Alpa , Biraris Pavankumar , Tandon Sandeep
Published: September 2024

Coronavirus 19(COVID-19) and Tuberculosis (TB) are both airborne infectious diseases albeit with different incubation periods and onset of disease. The pandemic of COVID-19 has been disruptive to the control of TB and the national TB programme due to lockdowns, diversion of healthcare services and healthcare delivery. The virus has brought into focus public health and medical care issues in our country. It has shown us that combined public health efforts, political will, investment and scientific advancements are needed in the fight against infectious diseases. In this article we discuss the impact of COVID-19 on TB control in India and suggest remedial measures to reinvigorate the battle against TB and future infectious diseases.
Effects of Noise and Chemical Exposure on Peripheral and Central Auditory Pathways in Normal-hearing Workers
Authors: Trabanco Júlio CS , Morita Bruno , Matas Carla Gentile , de Paiva Karina Mary , Moreira Renata R , Sanches Seisse GG , Samelli Alessandra G
Published: September 2024

Objectives:

To assess the effects of noise and chemical exposure on peripheral and central auditory pathways in normal-hearing workers exposed to chemicals or high noise levels and compare the groups with each other and with workers not exposed to either of these agents.

Methods:

A total of 54 normal-hearing workers were divided into three groups (chemical, noise, control) and submitted to the following assessments: conventional and extended high-frequency pure-tone audiometry; transient and distortion-product otoacoustic emissions, the inhibitory effect of the efferent auditory pathway; and Staggered Spondaic Word (SSW) and Pitch Pattern Sequence (PPS) test.

Results:

There were no significant differences between the groups in extended high-frequency hearing thresholds. Significantly lower amplitudes were observed in the noise group for otoacoustic emissions. There were significantly more absences of the inhibitory effect of the efferent system in the noise group. There was no difference between the groups in the SSW test, while in PPS, the noise group performed worse than the control group.

Conclusion:

These findings suggest that noise exposure produced deleterious effects on the workers’ peripheral and central auditory systems, despite their normal hearing thresholds. The chemical group did not have significantly different results from those of the control group. It is important that individuals exposed to noise or chemicals have their auditory pathways monitored with complementary assessments.
Validation of Persian Version of Hyperacusis Questionnaire
Authors: Kashani Masoud Motalebi , Dehabadi Peyman Khaleghi , Karamali Fahimeh , Akbari Hossein
Published: September 2024

Background:

One of the most common hearing disorders is hyperacusis, characterized by decreased sound tolerance or noise sensitivity.

Objective:

The present paper aimed to evaluate the validity of the Persian version of the hyperacusis questionnaire.

Methods:

The sample was comprised of 434 students evaluated at the Kashan University of Medical Science, Isfahan, between July 2019 and February 2020. After translation and retranslation of questionnaire, the content validity was assessed by 15 occupational health experts using content validity index (CVI) and ratio (CVR). Validity and reliability of the scale were examined by using confirmatory factor analysis, the Cronbach alpha, composite reliability (CR), and the average variance extracted (AVE) tests.

Results:

In the exploratory analysis of the Persian version of Khalfa hyperacusis questionnaire, 14 items were created based on three subscales) attentional, social, and emotional dimensions) which explained 46.5% of the total variances. Content validity of 14 questions was approved with CVR > 0.49 and CVI > 0.7. The Cronbach alpha, AVE, and CR indexes were calculated 0.811, 0.761, and 0.901, respectively, which showed that reliability of the scale was adequate.

Conclusions:

It was concluded that this Persian version of the hyperacusis questionnaire has relatively acceptable validity and reliability in Iran. Given that the tool has a small number of questions, it is easily used in different studies.
Contralateral Suppression of Transient-evoked Otoacoustic Emissions in Leisure Noise Exposed Individuals
Authors: Elangovan Thilagaswarna , Selvarajan Heramba Ganapathy , McPherson Bradley
Published: September 2024

Background

Leisure noise may have a significant impact on hearing thresholds and young adults are often exposed to loud music during leisure activities. This behavior puts them at risk of developing noise-induced hearing loss (NIHL). A frequent initial indication of NIHL is reduced hearing acuity at 4 kHz. The objective of the current study was to assess the role of the medial olivocochlear reflex (MOCR) in leisure noise-exposed individuals with and without a 4-kHz notch.

Materials and Methods

Audiological evaluation, including pure-tone and immittance audiometry, was performed for 156 college-going, young adults between May 2019 to December 2019. All participants had averaged pure-tone audiometric thresholds within normal limits, bilaterally. Annual individual exposure to personal listening devices (PLDs) was calculated using the Noise Exposure Questionnaire. The participants were then categorized into exposed (with and without audiometric 4 kHz notch) and nonexposed groups. Transient-evoked otoacoustic emission amplitude and its contralateral suppression were measured using linear and nonlinear click stimuli to study the effect of leisure noise exposure on MOCR.

Results

A significantly reduced overall contralateral suppression effect in participants exposed to PLD usage (P = 0.01) in both linear and nonlinear modes. On the contrary, significantly increased suppression was observed in linear mode for the 4 kHz frequency band in the PLD-exposed group without an audiometric notch (P = 0.009), possibly suggesting an early biomarker of NIHL.

Conclusion

Measuring contralateral suppression of otoacoustic emissions may be an effective tool to detect early NIHL in leisure noise-exposed individuals.
Residential Traffic Noise Exposure and Headaches
Authors: Alkhalawi Eman , Orban Ester , Schramm Sara , Katsarava Zaza , Hoffmann Barbara , Moebus Susanne
Published: September 2024

Context and aim:

The link between headaches and exposure to loud noise in occupational settings has been established. However, the effect of less intense but chronic residential traffic noise exposure on headache occurrence is less clear.

Settings and design:

We included 3,025 participants from the Heinz Nixdorf Recall study in Germany for this cross-sectional analysis.

Methods and material:

Residential road traffic noise exposure at the 2006–2008 address was modelled in A-weighted decibels (dB(A)) according to the European Noise Directive (2002/49/EC) for 24-hour (Lden) and night-time noise (22-6 h, Lnight). Indoor traffic noise exposure was obtained by modifying Lden and Lnight based on residence orientation, window type, and personal window opening habits. Traffic noise exposure below 55, 45 dB(A), 35 and 25 dB(A) were set as the reference for Lden, Lnight, Lden,indoor and Lnight,indoor, respectively. Average number of days with headache per month over the past three months was ascertained during the follow-up (2011–2015) medical interview.

Statistical analysis used:

Prevalence Odds Ratios (POR) of having eight or more headaches per month per 5 dB(A) increase in traffic noise exposure were calculated using logistic regression, adjusting for age, sex, sport, number of chronic conditions, years of education and smoking status.

Results:

The mean age of participants was 58.3. Mean Lden was 54 dB(A). Median monthly headache days was one. No association was seen between traffic noise exposure and having ≥8 headaches/month for all the examined traffic noise indicators. However, traffic noise was positively associated with traffic noise-annoyance and insomnia; and night-time traffic noise-annoyance and insomnia were positively associated with headache.

Conclusion:

In conclusion, our data did not provide any evidence for an association between chronic traffic noise exposure and prevalence of headaches at this population’s exposure levels. This should be explored in different populations given that this is the first study of its type and that noise exposure was generally low in our population.
Impact of Noise Exposure on Risk of Developing Stress-Related Obstetric Health Effects
Authors: Sivakumaran Kapeena , Ritonja Jennifer A. , Waseem Haya , AlShenaibar Leena , Morgan Elissa , Ahmadi Salman A. , Denning Allison , Michaud David , Morgan Rebecca L.
Published: September 2024

Background:

Exposure to noise can increase biological stress reactions and that could increase the risk of stress-related prenatal effects, including adverse obstetric outcomes; however, the association between exposure to noise and adverse obstetric outcomes has not been extensively explored. The objective of this review was to evaluate the evidence between noise exposures and adverse obstetric outcomes, specifically preeclampsia, gestational diabetes, and gestational hypertension.

Materials and Methods:

A systematic review of English language, comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases between January 1, 1980 and December 29, 2021 was performed. Risk of bias for individual studies was assessed using the Risk of Bias Instrument for Nonrandomized Studies of Exposures, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the body of evidence for each outcome.

Results:

Six studies reporting on preeclampsia, gestational diabetes, and gestational hypertension were identified. Although some studies suggested there may be signals of increased responses to increased noise exposure for preeclampsia and gestational hypertension, the certainty in the evidence of an effect of increased noise on all the outcomes was very low due to concerns with risk of bias, inconsistency across studies, and imprecision in the effect estimates.

Conclusions:

While the certainty of the evidence for noise exposure and adverse obstetric outcomes was very low, the findings from this review may be useful for directing further research in this area, as there is currently limited evidence available. These findings may also be useful for informing guidelines and policies involving noise exposure situations or environments.
London Heliport
Authors: Dance Stephen M. , Gomez-Agustina Luis
Published: September 2024

Introduction:

The noise emissions from the operation of heliports situated in cities can have significant adverse impacts on a large number of local residents. Despite its significance, the effect of noise from rotary aircraft operation in an urban setting has not been extensively studied.

Objective:

This paper presents for the first time an objective and subjective investigation into the noise emissions from the London Heliport and the associated impact on local residents.

Method:

Long-term noise monitoring measurements were taken at four locations and a social survey was implemented involving over 1500 respondents. A new objective measurement methodology was designed and developed that allowed individual air movements from the Heliport to be acoustically identified. Subjective results were contrasted with relevant social surveys and to the objective results. Objective results were also compared to planning guidance, local operation conditions and national and international based noise assessment criteria.

Results:

Excessive sound levels were found, both internally and externally, which can be attributed directly to the operation of the Heliport. The high participation rate obtained in the social survey confirmed that noise emissions from the heliport operation cause important/substantial adverse impact on quality or life and well-being of the majority of respondents.

Conclusions:

The level of annoyance reported by respondents appeared higher than the level of annoyance attributed to the noise measurements at monitoring sites. As a study first of its kind, it is expected that the findings will inform and influence future regulatory policy and consequently improve the well-being of many residents.
Negative Effect of High-Level Infrasound on Human Myocardial Contractility
Authors: Chaban Ryan , Ghazy Ahmed , Georgiade Eleni , Stumpf Nicole , Vahl Christian-Friedrich
Published: September 2024

Background:

Human exposure to infrasound is increasing due to man-made factors, such as occupational conditions, wind farms and transportation. The concern among the public regarding the safety of infrasound exposure is growing.

Aims:

To evaluate whether exposure to infrasound interferes directly with human cardiac function and contributes to pathological processes.

Setting:

The University Hospital of Mainz, Germany.

Methods:

Human myocardial tissues, obtained from patients undergoing cardiac surgery, were prepared in small muscle samples and stimulated electrically in-vitro for a period of almost two hours under physiological conditions to induce continuous pulsatile contractions and simulating a working human heart. Two samples were obtained from each donor: one was subjected to infrasound for 60 min and the other served as a control. Their contraction forces (CF) and durations (CD) were measured before and after each testing period and their relative changes (CF% and CD%) were calculated and introduced in a multilinear regression model. The following three infrasound levels of exposure were used in this study: 100, 110 and 120 dBz.

Results:

The measured CF% corresponded negatively with the infrasound level measured in dBz (R2
 = 0.631; P = 0.018). The decrease measured almost −11% at 110 dBz and −18% at 120 dBz, after correction for control. The CD on the other hand remained unchanged.

Conclusions:

Exposure to high levels of infrasound (more than 100 dBz) interferes with cardiac muscle contractile ability, as early as one hour after exposure. There are numerous additional studies which support this conclusion. These results should be taken into account when considering environmental regulations.
Effect of Constraint-Induced Music Therapy in Idiopathic Sudden Sensorineural Hearing Loss
Authors: Vasiwala Rafiq Ahmed , Elhariri Sherreen Y. , Teng Cheong Lieng , Mohamad Irfan
Published: September 2024

Background:

Idiopathic sudden sensorineural hearing loss (ISSNHL) is commonly encountered in audiologic and otolaryngologic practice. Constraint-induced music/sound therapy (CIMT) is characterized by the plugging of the normal ear (constraint) and the simultaneous, stimulation of the affected ear with music, which is based on a well-established neurorehabilitation approach. Corticosteroid therapy (CST) is the current mainstay of treatment. The prognosis for hearing recovery depends on many factors including the severity of hearing loss, age, and presence of vertigo.

Objective:

To analyze the effectiveness of CIMT with CST in ISSNHL.

Methods:

We performed a systematic search, using specific keywords relevant to our study, in PubMed, Cochrane Central Register of Controlled Trials, and additional sources of published trials till December 2020. We then screened all search results obtained according to our inclusion/exclusion criteria and performed a quality assessment on all studies using the Newcastle–Ottawa scale and using MedCalc, a meta-analysis was performed on suitable studies.

Results:

The recovery rates of three included nonrandomized studies were assessed at 1 to 3 months. A total of 229 (CST: 131, CST + CIMT: 98) patients were pooled for meta-analysis. The meta-analysis using the random-effect model found the relative risk of recovery rate within 3 months to be 1.213 (95% confidence interval 0.709–2.074), a result that is not statistically significant.

Conclusion:

Although our analysis results do not demonstrate the noticeable effect of CIMT in ISSNHL, it can support be a gainful adjunct to CST for better hearing results than CST alone. Therefore, it needs further prospective randomized controlled multicenter trials with a large sample.
Distortion Product Otoacoustic Emissions in Screening for Early Stages of High-frequency Hearing Loss in Adolescents
Authors: Paping Danique E. , van der Schroef Marc , Helleman Hiske W. , Goedegebure André , Baatenburg de Jong Rob J. , Vroegop Jantien L.
Published: September 2024

Objective:

Adolescents may be at risk of noise-induced hearing loss due to recreational sound. The aim of this study was to examine the role of distortion product otoacoustic emissions (DPOAEs) in screening for early stages of high-frequency loss such as can be observed in noise-induced hearing loss.

Setting and design:

This cross-sectional study was embedded within Generation R, an ongoing prospective birth cohort study in Rotterdam, The Netherlands. Data were collected from April 2016 to September 2019.

Methods:

A total of 3456 adolescents with a mean age of 13 years and 8 months old (standard deviation ± 5 months) were included. Pure-tone thresholds were measured in a sound-treated booth. DPOAEs were recorded using an ILO V6 analyzer with primary levels of 65/55 dB SPL and frequency ratio f
2/f
1 of 1.22. Subjects had normal middle ear function at the time of assessment, based on tympanometry results.

Results:

Measurements in 6065 ears showed that DPOAE levels tend to decrease with increasing pure-tone thresholds. However, the intersubject variability of DPOAE levels in ears with the same threshold was large. DPOAE levels could reasonably identify early stages of high-frequency hearing loss.

Conclusion:

The findings of present study indicate that DPOAE measurements can potentially be used for adolescents hearing screening in the high frequencies. Future research is needed to optimize test performance.
The Proposed Criteria for High Perceived Misophonia in Young Healthy Adults and the Association Between Misophonia Symptoms and Noise Sensitivity
Authors: Paunovic Katarina Ž , Milenković Sanja M.
Published: September 2024

Context:

The association between noise sensitivity and misophonia has not been explored in any population, according to the available literature.

Aims:

To assess the proportion of misophonia symptoms among young healthy adults, to propose the criteria for high perceived misophonia, and to explore the association between misophonia with noise sensitivity with adjustment for sex, age, perceived anxiety, and depression.

Settings and Design:

A cross-sectional study on 1132 medical students, aged 21.4 ± 2.1 years.

Methods and Material:

Misophonia symptoms were self-reported using the Amsterdam Misophonia Scale. Nine criteria for high perceived misophonia are proposed. Noise sensitivity was measured with Weinstein scale. Perceived anxiety and depression were measured using the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale, respectively.

Statistical Analysis Used:

Multiple logistic regression.

Results:

Almost half of the students reported the feeling of irritation against people making provoking sounds. Only one in 10 claimed the feeling of loss of self-control when exposed to provoking sounds. High noise sensitivity and high depression were associated with higher odds of meeting the criteria for high perceived misophonia.

Conclusion:

Noise-sensitive students are at higher risk of reporting misophonia symptoms and of being classified with high perceived misophonia. The combination of at least four or more symptoms, which classifies every 10th student with high perceived misophonia, is proposed as a self-assessment tool for epidemiological studies among young healthy adults.