Abstract 1122‐000234: Hemorrhagic Conversion in Patients Undergoing MT with Concurrent IA tPA with or Without IV tPA/Anticoagulation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Jude H Charles ◽  
Saini Vasu ◽  
Tyler Simons ◽  
Dileep R Yavagal
Keyword(s):  
Cohort Study ◽  
Functional Outcome ◽  
Anticoagulation Therapy ◽  
Hospital Death ◽  
P Value ◽  
Vessel Occlusion ◽  
Concurrent Use ◽  
Two Samples ◽  
History Of ◽  
Iv Tpa

Introduction : Introduction There is a growing body of literature on concurrent use of MT and IA tPA use in acute large vessel occlusion ischemic stroke, but few address the risk of IA tPA use in patients also receiving IV tPA or baseline anticoagulation1,23. This cohort study aims to assess the rate of improved functional outcome and complications in patients receiving MT plus IA tPA with or without IV‐tPA or baseline anticoagulation. Methods : In this single institution, retrospective cohort study, medical records of 114 patients undergoing MT who received concurrent IA‐tPA were identified and reviewed. Parameters such as age, sex, admission/discharge mRS scale and NIHSS score, INR, history of anticoagulation use, concomitant IV‐tPA and complications such as any hemorrhage and in hospital death were reviewed. Patients were divided into two groups and two subgroups. First group included patients treated with IA‐tPA who also received IV‐tPA, had an INR above 1.7 or were on anticoagulation therapy. The second group was composed of patients who only received concurrent IA‐tPA. The primary outcomes were hemorrhage, all cause mortality, and good functional outcome (modified Rankin scale equal to or less than 2). The results were calculated and t‐test for two samples analysis was conducted with one‐tail p‐value (<0.05). Results : 74 patients were included in the first group receiving IA‐tPA with either IV‐tPA, or elevated INR or anticoagulated while 40 patients were in the only concurrent IA‐tPA group. 72% versus 60% of the groups respectively have an mRS less or equal to 2 on discharge, p‐value 0.07. 41% of the first group had some type of bleeding on repeat imaging compared to 25% in the IA‐tPA only group, p‐value 0.03. In a subgroup analysis, IV‐tPA alone without prior anticoagulation treatment or an elevated INR, when given in conjunction with IA‐tPA, was an independent risk factor that increased rate of bleeding, 42% versus 25% with a p‐value of 0.04 with an attributable risk of 32%. There was no difference in in‐hospital death rate between the groups. Conclusions : This study shows that in patients receiving MT with concurrent IA tPA with elevated INR>1.7, treatment with anticoagulation at baseline, or concomitant IV‐tPA use increases the risk of hemorrhagic conversion. Therefore, there is a need for careful selection of patients receiving concurrent IA‐tPA. Further investigation is warranted to elucidate which patient groups might maximally benefit from IA‐tPA.

scholarly journals Infantile Nephropathic Cystinosis in Sulaimani Pediatric Teaching Hospital: A Retrospective Cohort Study

2018 ◽  
Vol 3 (1) ◽  
pp. 5-8
Author(s):  
Hunar Jamal Hussein ◽  
Khalid Hama Salih ◽  
Adnan Mohammed Hasan
Keyword(s):  
Cohort Study ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Positive Family History ◽  
The Other ◽  
P Value ◽  
History Of ◽  
Infantile Cystinosis ◽  
Stage Renal Disease ◽  
End Stage

Cystinosis is a rare metabolic autosomal recessive disorder which characterized by intralysosomal accumulation of cystine. There are three forms; infantile nephropathic is the commonest forms. to evaluate clinical presentations and outcome of infantile cystinosis. A retrospective cohort study conducted in Sulaimani Pediatric Teaching Hospital on 25 patients with infantile cystinosis during May 1, 2014, to June 1, 2017. This study has depended on clinical symptoms and signs, and corneal crystallization for the diagnosis of cystinosis. Gender of the patients was 13 (52%) females and 12 (48%) males. The ages were ranged between (1-12 years) with a mean age of (6.25 years). Eight (32%) patients were from Sulaimani city, but the other 17 (68%) patients were from outside of Sulaimani. Moreover, a 17 (68%) of them were Arabic and the other eight (32%) were Kurdish ethnic groups. The study showed a 20 (80%) positive consanguinity with 19 (76%) positive family history of infantile cystinosis. Additionally, the age of first presentations was between (0.25-2 years) with a mean of (0.8 years). Clinical features included a 100% for polyuria, polydipsia, and failure to thrive. Furthermore, 10 (40%) presented with constipation, 23 (92%) photophobia and 5 (20%) blond hair. Complications included 24 (96%) rickets, 14 (56%) renal insufficiency, 5 (20%) hypothyroidism, 4 (16%) genu valgum, 3 (12%) growth hormone deficiency, and 3 (12%) developed end-stage renal disease. Subsequently, two patients died (8%) due to end-stage renal disease. Finally, there was a statistically significant relationship between both renal insufficiency (P-value = 0.042) and hypothyroidism (P-value < 0.001) with Kurdish ethnicity. Conclusion: Incidence of cystinosis was high among consanguineous parents and those patients who had a positive family history of cystinosis. Furthermore, the delay in diagnosis was due to atypical presentations and unavailability of specific investigations.

Abstract T P192: Interventional Stroke Assessment Scale for Eligibility in Endovascular Therapy (ISAS-ET)

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Haitham Dababneh ◽  
Asif Bashir ◽  
Mohammed Hussain ◽  
Sara Misthal ◽  
Mohammad Moussavi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Functional Outcome ◽  
Scoring System ◽  
Randomized Clinical Trials ◽  
Group Analysis ◽  
P Value ◽  
Infarct Core ◽  
Perfusion Studies ◽  
Intravenous Tissue Plasminogen Activator ◽  
Iv Tpa

Background and Purpose: During the last two decades, we have witnessed advancements in the field of endovascular treatment of stroke, especially after showing the benefit of Intravenous tissue plasminogen activator (IV tPA). Despite these innovations in the field, only 55% or less of patients were shown to have good outcomes in multiple randomized clinical trials. Methods: This is a retrospective analysis of all patients (n= 97) who presented to our hospital with ischemic stroke and received mechanical thrombectomy with or without IV tPA between January 2009 and July 2012 and had all possible variables documented in their charts. Statistical analysis was performed using the R statistical package and XLSTAT-Pro 2011. Spearman correlations (P value <0.05) for non-normally distributed data were used to independently evaluate the correlation of all the variables including age, gender, site of occlusion, time to intervention, baseline NIHSS, volume of infarct core at presentation, hypertension, diabetes, hyperlipidemia, atrial fibrillation (AFib), coronary artery disease, prior strokes and disability and smoking with the patient functional outcome at discharge using a modified rankin scale (mRS). mRS of 2 or less represented a good functional outcome. Results: 80 patients had all previously mentioned variables. Group analysis including gender, mean age, mean NIHSS, percentage of AFib and mortality at discharge was as follows: Female 50%, 72.9, 14.5, 31.0% and 13%. There was a significant negative correlation with the outcome if a patient had a NIHSS more than 20, age above 65, presence of AFib, prior strokes or disability, volume of infarct core on perfusion studies or reformat CT angiography more than 75 cm3 (P value <0.05). The scoring system was developed with a score range (0-8), where a high score predicts a better outcome. Infarct core volume 75 cm3 received 2, 1, 0 points respectively; NIHSS20 received 2, 1, 0 points respectively; Age <65 received 1 point; absence of AFib received 1 point, time of onset <3 hours received 1 point, no prior stroke or disability received 1 point. Conclusion: The ISAS scoring system might help with assessment of patient qualification for endovascular treatment. Further prospective studies validating the score are warranted.

Family History of Venous Thromboembolism (VTE) and the Risk of VTE Recurrence in Patients with a First Unprovoked VTE: A Multicenter Prospective Cohort Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2299-2299
Author(s):  
Karine Gauthier ◽  
Elham Sabri ◽  
Susan R. Kahn ◽  
Philip S Wells ◽  
David Anderson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Family History ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Degree Relative ◽  
National Cohort ◽  
History Of ◽  
Recurrent Vte ◽  
Second Degree

Abstract Abstract 2299 Introduction: The duration of anticoagulation after unprovoked venous thromboembolism (VTE) has been characterized as the most important unanswered question in clinical thrombosis management. This has led to research to identify predictors of recurrent VTE to identify high-risk patients who might warrant indefinite anticoagulation. Many clinicians assume that a family history of VTE is a predictor of recurrent VTE. This study aims to assess the value of family history as a predictor for recurrent VTE. Methods: Prospective multi-center multi-national cohort study recruited patients with a first objectively proven unprovoked VTE who completed 5 to 7 months of anticoagulation therapy. A detailed family history of VTE was completed for every subject. The information recorded included the number of affected relatives, whether they were first or second degree relatives and if the VTE was unprovoked or secondary. Patients were then followed for recurrent VTE. Results: 664 subjects were enrolled between October 2001 and March 2006, 649 subjects were followed for a mean duration of 3.8 years (3.6–3.98 95% C.I.). The mean age of subjects in this cohort was 53 years (min-max 18–95) and 49% of subjects were females. A family history of VTE in at least 1 first-degree relative was recorded for 112 (17.3%) subjects. A total of 142 (21.9%) suspected VTE events were adjudicated as recurrences. The recurrence rate was 5.94% (4.89–7.15 95% C.I.) per patient-year for patients without any family history of VTE, and it was 4.82% (3.02–7.30 95% C.I.) per patient-year in patients with a family history of VTE in at least 1 first-degree relative. In secondary analyses, neither a family history of unprovoked VTE, multiple unprovoked VTE, in first-degree nor second-degree relatives was a predictor of recurrent VTE. A multivariate analysis was performed to adjust for known risk factors for VTE recurrence, but the adjusted hazard ratios were again not significantly different. Conclusion: A family history of VTE is not a predictor for recurrent VTE, and therefore should not be used to segregate unprovoked VTE patients in high- and low-risk categories. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Intracranial Hemorrhage After Reperfusion Therapies in Acute Ischemic Stroke Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Benjamin Maïer ◽  
Jean Philippe Desilles ◽  
Mikael Mazighi
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Tissue Type ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Reperfusion ◽  
Iv Tpa

Reperfusion therapies are the mainstay of acute ischemic stroke (AIS) treatments and overall improve functional outcome. Among the established complications of intravenous (IV) tissue-type plasminogen activator (tPA), intracranial hemorrhage (ICH) is by far the most feared and has been extensively described by seminal works over the last two decades. Indeed, IV tPA is associated with increased odds of any ICH and symptomatic ICH responsible for increased mortality rate during the first week after an AIS. Despite these results, IV tPA has been found beneficial in several pioneering randomized trials and improves functional outcome at 3 months. Endovascular therapy (EVT) combined with IV tPA for AIS patients consecutive to an anterior circulation large-vessel occlusion does not increase ICH occurrence. Of note, EVT following IV tPA leads to significantly higher rates of early reperfusion than with IV tPA alone, with no difference in ICH, which challenges the paradigm of reperfusion as a major prognostic factor for ICH complications. However, several blood biomarkers (glycemia, platelet and neutrophil count), clinical factors (age, AIS severity, blood pressure management, diabetes mellitus), and neuroradiological factors (cerebral microbleeds, infarct size) have been identified as risk factors for ICH after reperfusion therapy. In the years to come, the ultimate goal will be to further improve either reperfusion rates and functional outcome, while reducing hemorrhagic complications. To this end, various approaches being investigated are discussed in this review, such as blood-pressure control after reperfusion or the use of new antiplatelet agents as an adjunct to IV tPA and exhibit reduced hemorrhagic potential during the early phase of AIS.

scholarly journals Multiple Thrombectomies in the Same Patient within One Month: Case Report of a Patient with Trousseau Syndrome and Acute Ischemic Stroke

2020 ◽  
Vol 10 (9) ◽  
pp. 590
Author(s):  
Kurt Cicilioni ◽  
Brian Cristiano ◽  
J. Paul Jacobson ◽  
Daniel Hoss ◽  
Matthew Lund ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Immune Thrombocytopenia ◽  
Mechanical Thrombectomy ◽  
Lung Nodule ◽  
Anticoagulation Therapy ◽  
Coagulation Cascade ◽  
Vessel Occlusion ◽  
Cancer Trial ◽  
History Of

Background and Importance: Since Trousseau’s initial publication, the development of thromboembolic events related to malignancy has been well established. The pathophysiology of this is understood to be through activation of the coagulation cascade through neoplastic cells themselves or the therapy initiated (chemotherapy or surgery). To date, there have been a variety of studies, such as the OASIS-CANCER trial, which highlight the relationship of hypercoagulability to ischemic stroke. Despite these efforts, clear evidence is lacking for the utilization of antiplatelet or anticoagulation therapy in the secondary prevention of stroke following mechanical thrombectomy in patients with suspected or confirmed malignancy. Clinical Presentation: A 71-year-old female with a history of immune thrombocytopenia, diabetes mellitus, and hypertension who was undergoing an evaluation for a lung nodule, later determined to be adenocarcinoma of the lung, underwent three successful mechanical thrombectomies for acute ischemic stroke with large vessel occlusion over a one month period. This patient had improved National Institutes of Health Stroke Scale (NIHSS) scores following each of her thrombectomies. However, her history of immune thrombocytopenia and underlying malignancy complicated her discharge medication regimen following each of her thrombectomies and may have contributed to her repeat strokes. Conclusion: Clear guidance is lacking regarding the utilization of antiplatelet and anticoagulation therapy in patients with suspected or confirmed malignancy following mechanical thrombectomy. Review of the literature suggests that controlling a patient’s hypercoagulability may lead to improved clinical outcomes, but further clinical trials are warranted.

Abstract 12957: Delay in Qrs Interval Predicts Risk of Heart Failure and In-hospital Mortality in Patients Admitted With Atrial Fibrillation With Rapid Ventricular Response

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Belal Kaseer ◽  
Bassman Tappuni ◽  
Ali AlKhayru ◽  
Awfa Zain Elabidin ◽  
Vahid Namdarizandi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Cardiac Resynchronization ◽  
Hospital Death ◽  
P Value ◽  
Increased Risk ◽  
Ventricular Response ◽  
History Of ◽  
Acute Mi

Introduction: Atrial fibrillation is associated with increased risk of heart failure and mortality. The association of QRS duration (QRSd) with morbidity and mortality is understudied in patient with atrial fibrillation (AF) Hypothesis: We sought to investigate the association of prolonged QRSd (≥120 ms) and risk of heart failure and in-hospital death in patients admitted for AF with rapid ventricular response (RVR) Methods: A retrospective study in a community hospital using EPIC database analyzed 1637 patients from 2013-2018 with admission codes of AF with RVR. The cohort was then stratified based on QRSd ≥120ms vs <120ms. A p-value of <0.05 was considered significant Results: Among the 1637 patients who were admitted with AF with RVR, 233 (14%) had QRS ≥120ms. Patient’s characteristics with QRSd≥120 compared to those with QRSd<120ms were mean age [75.9 (11.8) vs 70.9 (13.6), (P<.0001)], history of CAD [41% vs 28%, odds ratio (OR)= 1.78, 95% confidence interval (CI): 1.3-2.3 (P<.0001)], history of PVD [15% vs 7%, OR=2.38, 95% CI: 1.58-3.59 (P<.0001)], history of acute MI [50% vs 33%, OR=1.99, 95% CI:1.5-2.6 (P<.0001)] and CHA2DS2Vasc score [median (IQR) 5(3, 6) vs 4(3, 5) (P<0.001). QRSd≥120ms was associated with higher BNP value [median (IQR) 537(305, 862) vs 371(186, 655) (P<0.001)] and an increased risk of heart failure [(70% vs 55%, OR=1.93, 95% CI:1.43-2.6 (P<.0001)]. Additionally, higher in-hospital mortality rate was observed in patients with QRSd≥120ms [4.3% vs 1.3%, OR=3.11, 95% CI:1.44-6.75 (P=0.006)] Conclusions: In patients who were admitted with AF with RVR, QRSd≥120ms was associated with a higher burden of cardiovascular disease, CHA2DS2Vasc score and an increased risk of heart failure resulting in worse clinical outcomes. Higher median BNP values suggest that worsening heart failure contributed to higher in-hospital mortality. Heart failure associated mortality could be alleviated with medical management or cardiac resynchronization therapy.

Abstract TP75: Creatinine on Admission Interacts with Intravenous Thrombolysis and Thrombectomy Procedures in Predicting Post-stroke Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nada El Husseini ◽  
Cintasha Redmond ◽  
Seung-Jae Lee ◽  
Ralph B D’Agostino ◽  
Cheryl Bushnell
Keyword(s):  
Functional Outcome ◽  
Tertiary Care ◽  
Intravenous Thrombolysis ◽  
Stroke Outcomes ◽  
Lower Odds ◽  
Post Stroke ◽  
Discharge Disposition ◽  
Discharge Home ◽  
History Of ◽  
Iv Tpa

Background: Renal impairment may be associated with reduced efficacy of thrombolysis, increased hemorrhagic complications and risk of contrast-induced nephropathy associated with catheter angiogram used in thrombectomies. It is unclear if creatinine interacts with IV-tpa and thrombectomy in predicting post stroke outcomes. Methods: This is a retrospective analysis of consecutive patients admitted with acute ischemic stroke to a single tertiary care center between October 2012 and July 2015. Logistic regression analysis was used to evaluate whether there was a differential impact of the association of IV-tpa and/or thrombectomy with discharge disposition (discharge home vs. other) and 3 months functional outcome (modified Rankin Score mRS<3 vs. mRS≥3) based on the admission creatinine (Cr) level (<1.5 and ≥1.5) after adjusting for sex, age, race, NIHSS on admission, history of atrial fibrillation and history of stroke/TIA. Results: A total of 570 subjects were included (48.6% male, 69.4% white, mean age 67years, mean NIHSS 7.1, mean Cr. 1.17 , 13.1% with Cr≥1.5). A total of 18.4% (N=105) received IV-tpa and an additional 6.5%(N=37) received thrombectomy in addition to IV-tpa. About 57% were discharged home and 46% had mRS<3 at 3 months. The mean NIHSS on admission was not significantly different based on creatinine level (7.0 vs.8.1, p=0.271 in subjects with Cr<1.5 and Cr≥1.5 respectively). After adjusting for other relevant variables, the interaction of creatinine with IV-tpa with/without thombectomy was significant in predicting both discharge home (p= 0.0009) and 3 months mRS (p=0.0063). In those with creatinine <1.5, IV-tpa with/without thrombectomy was associated with increased odds of being discharged home (OR=2.81, 95%CI 1.55-5.08), p=0.0006) and a good functional outcome (mRS<3 at 3 months) (OR= 2.91, 1.66-5.10), P=0.0002. In contrast, in those with Cr ≥1.5, IV tpa with/without thrombolysis was associated with lower odds of being discharged home (OR= 0.11; 95% CI 0.01-0.74), p=0.023 and lower odds of having a favorable 3 months functional outcome (mRS<3) (OR= 0.06; 95% CI 0.006-0.80), p=0.033. Conclusions: Creatinine on admission modified the effect of IV-tpa and thrombectomy. Reasons for this interaction warrant further investigation.

Abstract 2226: Predictors Of tPA Non-responders According To Location Of Vessel Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nuno Mendonça ◽  
David Rodríguez-Luna ◽  
Sandra Boned-Riera ◽  
Marta Rubiera ◽  
Marc Ribó ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
History Of ◽  
Hemodynamic Profile ◽  
Ica Stenosis ◽  
Selection Of Patients ◽  
Iv Tpa ◽  
Selection Of

Background and purpose: Information on the clinical and hemodynamic profile of IV tPA non-responders, at different location of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aimed to investigate predictors of failing IV tPA therapy according to occluded vessel and location of clot. Methods: We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred and forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal MCA occlusion (n=251), distal MCA occlusion (n=194), ICA T occlusion (n=61) and BA occlusion (n=42). Recanalization was assessed on TCD at 1 hour of tPA bolus. Results: Among patients with proximal MCA occlusion, the presence of severe extracranial ICA stenosis or occlusion (OR 2.36, 95% CI 1.15-4.84, p=0.02) and age >74 years (OR 1.84, 95% CI 1.02-3.31, p=0.04) independently predicted no recanalization (NR). No independent predictors of NR were identified in patients with distal MCA occlusion. In patients with ICA T occlusion, history of hypertension (OR 12.77, 95% CI 2.12-76.88, p=0.05) and absence of atrial fibrillation (OR 0.12, 95% CI 0.02-0.71, p=0.02) emerged as independent predictors of NR. Similarly, among patients with BA occlusion, atrial fibrillation was as an independent predictor of NR (OR 0.13, 95% CI 0.03-0.72, p=0.02). Conclusions: Absence of atrial fibrillation independently predicts persistent occlusion at 1-h after tPA bolus in patients with ICA T and BA occlusions. The use of relevant predictors of NR and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.

scholarly journals Audiometric thresholds and auditory processing in children with early malnutrition: a retrospective cohort study

2014 ◽  
Vol 132 (5) ◽  
pp. 266-272 ◽  
Author(s):  
Patricia Aparecida Zuanetti ◽  
Maria Fernanda Laus ◽  
Adriana Ribeiro Tavares Anastasio ◽  
Sebastião de Sousa Almeida ◽  
Marisa Tomoe Hebihara Fukuda
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Auditory Processing ◽  
Retrospective Cohort ◽  
Learning Difficulties ◽  
Pure Tone Audiometry ◽  
Early Age ◽  
Two Samples ◽  
Processing Abilities ◽  
History Of

CONTEXT AND OBJECTIVE: Malnutrition is one of the causes of changes in cell metabolism. The inner ear has few energy reserves and high metabolism. The aim of this study was to analyze whether malnutrition at an early age is related to impairment of auditory processing abilities and hearing abnormalities.DESIGN AND SETTING: Retrospective cohort study conducted in a tertiary public hospital.METHODS: 45 children participated, divided as follows: G1, children diagnosed with malnutrition in their first two years of life; G2, children without history of malnutrition but with learning difficulties; G3, children without history of malnutrition and without learning difficulties. Tympanometry, pure-tone audiometry and the Staggered Spondaic Word (SSW) test (auditory processing) were performed. Statistical inferences were made using the Kruskal-Wallis test (α = 5%) and the test of equality of proportions between two samples (α = 1.7%).RESULTS: None of the 45 children participating in this study presented hearing deficiencies. However, at six of the eight frequencies analyzed, the children in G1 presented hearing thresholds lower than those of the other groups. In the auditory processing evaluation test, it was observed that 100% of the children in G1 presented abnormal auditory processing and that G1 and G2 had similar proportions of abnormalities (P-values: G1/G2 = 0.1; G1/G3 > 0.001; G2/G3 = 0.008).CONCLUSIONS: Malnutrition at an early age caused lowering of the hearing levels, although this impairment could not be considered to be a hearing deficiency. Every child in this group presented abnormalities in auditory processing abilities.

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