The role of current audiological tests in the early diagnosis of hearing impairment in children

Introduction: Permanent hearing impairment is a significant and relatively common condition in newborns, affecting at least 1 child per 1000 live births. The early identification of hearing loss is very important in order to begin early rehabilitation and for optimizing normal development of language. Material and methods: We examined 70 children with parental suspicion of a hearing loss. Brainstem Evoked Response Audiometry was performed and the group was divided into three subgroups. The following parameters were analyzed: the average age of hearing loss-identification, the time of parental first suspicion of a hearing loss, as well as risk factors for hearing impairment. Results and discussion: Of 70 children with parental suspicion of a hearing loss, in 17 cases normal hearing or mild hearing loss (up to 40 dB HL) was found (group I), 16 children were suffering from moderate and severe hearing loss (40 to 90 dB HL) (group II), and 37% of children were suffering from profound hearing loss (greater than 90 dB HL) (group III). Up to the age of 2, the diagnosis was made in 17.64% of children in group I, in 25% in group II, and in 58.8% in group III. The average age of hearing loss identification was 2.83, 3.32, 2.32 years in groups I, II, III, respectively, although parents suspected hearing problems at least one year earlier. Presence of hearing impaired family members as well as of risk factors were not sufficient reasons to get a medical check-up. Conclusion: The use of otoacoustic emission testing in routine clinical practice, as well as education of parents and pediatricians, was followed by earlier detection of hearing loss in regard to our previous study (10 years ago). The mean age of diagnosis in our region is still over 2 years, but establishment of a universal screening program may help reduce the age of hearing loss detection.

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Quality improvement of lung cancer patient selection using clinic-based spirometry.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.282 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 282-282

Author(s):

Tony Kin- Ming CL Lam ◽

Reenika Aggarwal ◽

Erin L. Stewart ◽

Katrina Hueniken ◽

Maureen McGregor ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Patient Selection ◽

Screening Program ◽

Lung Cancer Screening ◽

Eligibility Criteria ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Lung Cancer Screening Program

282 Background: Coordinating lung cancer screening requires risk assessment for patient selection. Optimal selection can reduce costs and improve efficiency of low dose computed tomography (LDCT) screening of lung cancer. This study evaluated clinic-based spirometry as a tool to improve patient selection for lung cancer screening. Methods: Eligibility criteria for three large LDCT screening studies were retrospectively applied to the highest risk patients enrolled in the Princess Margaret Lung Cancer Screening Program who had received clinic-based research spirometry. The three studies were: Danish Lung Cancer Screening Trial (DLST), National Lung Screening Trial (NLST), and the Ontario Lung Cancer Screening Program (OLCS). Lung cancer incidence was compared between those who would were included by the screening study eligibility criteria (Group I), those who were excluded by the eligibility criteria but demonstrated obstruction on spirometry (defined as a Forced Expiratory Volume in 1 Second % Predicted (FEV1%) < 90%) (Group II), and those who did not meet eligibility criteria and had no obstruction (FEV1% ≥90) (Group III). Results: The 321 highest risk participants of the screening program had a mean age of 65 years and were 39% male. The median number of pack years in this group was 39. After undergoing spirometry, this cohort was screened using LDCT for a median of 3.3 years (range 1–8.1 years). Under DLST criteria, Groups I and II had virtually identical lung cancer incidences detected by screening at 13.1% and 13.6% of the individuals screened, respectively; Group III had a substantially lower incidence at 6.3%. Results were similar by NLST criteria where the incidence of screen-detected lung cancer were 13.7% for Groups I, 11.1% for Group II, and 8.6% for Group III. Under OLCS criteria, these values were 13.4% (Group I), 13.5% (Group II), and 8.2% (Group III). Conclusions: Individuals who were excluded from LDCT screening because they lacked other clinical eligibility criteria, but had a FEV1 < 90%, had similar lung cancer incidence as patients who had met screening study eligibility criteria. Coordinating care for screening of at-risk individuals could be improved by incorporating spirometric tools.

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Tympanic membrane perforation: correlation of hearing loss with its site and size

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180016 ◽

2018 ◽

Vol 4 (2) ◽

pp. 397 ◽

Cited By ~ 1

Author(s):

Arvinder Singh Sood ◽

Pooja Pal ◽

Amit Kumar

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Linear Correlation ◽

Tympanic Membrane Perforation ◽

P Value ◽

Cross Sectional ◽

Group Iii ◽

Group I ◽

Membrane Perforation ◽

Group Ii

Background: The objectives of the study were correlation of hearing loss with size and site of tympanic membrane perforation. Methods: A cross-sectional prospective study of 100 patients of both sex and age between 11-60 years with perforated tympanic membrane was conducted in the department of Otorhinolaryngology (ENT). Size and site of TM perforation was assessed using otoscope and otomicroscope. Size of perforation was measured with 1 mm thin wire loop and vernier caliper. Patients were divided into three groups according to size; Group I (0-9 mm), Group II (9-30 mm), Group III (>30 mm). The tympanic membrane was divided into five segments anterosuperior, posterosuperior, anteroinferior, posteroinferior and central for the localization of the site of perforation. Data thus collected was statistically analysed. Results: Patients with Group I perforation had an average hearing loss of 31.42±7.15 decibel. Group II had an average hearing loss of 39.42±8.97 decibel. Group III had an average hearing loss of 48.91±7.38 decibel. Maximum hearing loss was noted in patients with central perforation with an average hearing loss of 39.34±9.47 decibel. Average hearing loss was found higher in posterior perforations than anterior quadrant perforations. This difference was however not statistically significant with ‘p’ value of ‘0.689’. Conclusions: Linear correlation was found between size of tympanic membrane perforation and degree of hearing loss. No linear correlation between site of tympanic membrane perforation and hearing loss was found. We found no correlation between duration of disease and size of tympanic membrane perforation with degree of hearing loss.

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Plasma Circulating Levels of Soluble P-Selectin and Thrombospondin-1 (TSP1) Are Elevated in Patients with Cancer and a Shortened Activated Partial Thromboplastin Time (APTT) without Clinical Evidence of Thrombosis: An Inexpensive and Simple Test (APTT) To Be Considered for Its Clinical Value.

Blood ◽

10.1182/blood.v108.11.4098.4098 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4098-4098

Author(s):

Fabiola E. Del Carpio-Cano ◽

Diana Zamora-Rangel ◽

Miguel A. Rosales-Manoatl ◽

Maria R. Rivas-Gonzalez ◽

Eduardo Cervera-Ceballos ◽

...

Keyword(s):

Risk Factors ◽

Coagulation Factors ◽

Laboratory Measurements ◽

Clinical Value ◽

Group Iii ◽

Patients With Cancer ◽

Group I ◽

Group Ii ◽

Circulating Levels ◽

D Dimer

Abstract There is evidence of shortening of the APTT in patients afflicted with and without cancer, and cancer is a well known underlying condition associated with hypercoagulability. Increased levels of coagulation factors such as VIII, IX, XI, II, and fibrinogen have been demonstrated as independent risk factors for venous thromboembolism (VTE). However, there is evidence that high levels of circulating factor VIII levels are not the only determinant for a shortened APTT (Blood2004; 104:3631) and likely the same case for the other factors including fibrinogen levels. A shortened APTT in a patient with cancer with no evidence of a thrombotic event could be of clinical value in particular when the cost of measuring individual coagulation factors previously identified as risk factors for VTE would be very high. A lack of understanding of the underlying mechanism leading to a shortened APTT in the absence of VTE limit its clinical use, particularly for the clinical management of the patient presenting at admission with this phenomenon in association with cancer. In this case-control prospective study, we have investigated a potential mechanism associated with a shortened APTT in patients with cancer without evidence of thrombosis. The rationale for this study was a previous observation supporting a functional role of TSP1 in the generation of thrombin on a cell surface (Thrombosis Research2005; 116: 533). The study was comprised of 69 human subjects subdivided in three separate groups, Group I, was constituted by 23 normal human volunteers, Group II included 23 patients without a shortened APTT and cancer, Group III was comprised of 23 patients with cancer with a shortened APTT (see table). Groups I and II were matched with group III by age and gender. In addition patients in Group II were matched with Group III by the type of cancer. Laboratory measurements included APTT, D-Dimer, soluble E, L, and P-Selectins as well as TSP1. Platelet and neutrophil counts were determined by automated methods. Laboratory measurements demonstrating a significant difference in Group III when compared with Group I and II were P-Selectin and TSP1. These results were independent of the platelet count in Group III. However the significant elevated circulating levels in plasma of P-Selectin in Group III are evidence supporting platelet activation. There was a trend for higher levels of D-Dimer in Group III (P < 0.17) when compared with Group II (P< 0.76), in accordance with previous studies reported in the literature. In summary, this prospective study demonstrates a potential association of a shortened APTT in patients with cancer with elevated circulating levels of soluble P-Selectin and TSP1. Our laboratory is currently investigating in more detail this interesting finding as well as the prospective clinical follow up of patients included in Groups II and III. Plasma Determinations Parameter Group I Group II Group III P Value Normal Range APTT: 24.2–35.3 seconds aPTT 29.3±2.7 28.2±2.3 23±1.0 0.01 sP-Selectin 23.2±4 25.4±9 44.0±11 0.001 TSP1 382±39 871±496 1246±295 0.001

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Variation in Coronary Artery Disease Pattern and Risk Factors among Female Patients of Dierent Age Groups in Bangladesh

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v9i1-2.53992 ◽

2020 ◽

Vol 9 (1-2) ◽

pp. 60-66

Author(s):

Shitil Ibna Islam ◽

Md Nurul Amin ◽

Sahela Nasrin ◽

F Aaysha Cader

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery ◽

Elderly Women ◽

Age Groups ◽

Middle Aged ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Artery Disease

Background & objective: Coronary Artery Disease (CAD) is a devastating life-threatening condition which varies with respect to age and sex. In Bangladesh a large number of patients currently undergoes coronary angiography for a variety of indications. Due to physiological changes after menopause, the females are more prone to develop CAD. So, the risk factors and pattern of CAD in female are subject change with changing ages. The objective of this study was to compare the risk factors and pattern of CAD in female patients of different age groups. Methods: This cross-sectional analytical study was conducted at Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh between September 2005 to August 2016. All female patients (n = 7,627) who underwent coronary angiography during the period were included. They were identified from ICHRI dedicated Cath-lab Database. The patients were divided into three groups based on their age (Group-I ≤45 years, Group-II from age 46 to age 60 and Group-III from age 60 years onwards). A stenosis of ≥ 70% in any of the three major coronary arteries like Left Anterior Descending (LAD), Right Coronary Artery (RCA) and Left Circumflex Artery (LCX) was considered as significant stenosis, while a stenosis of ≥ 50% in left main stem (LMS) was considered significant for left main disease. The data pertaining to their risk factors and angiographic profile were compared among the three age groups to find the association of risk factors and angiographic pattern of the CAD at different age groups. Result: All the risk factors (diabetes, hypertension, dyslipidaemia and CKD) demonstrated their significant presence in Group II and III compared to those in Group I, while they were almost identical between Group II and III. More than 40% of the patients were overweight in all age groups and around 20% were obese including a negligible proportion with morbid obesity. ST-segment elevation MI, NSTEMI (Non-ST-elevation myocardial infarction), prior MI (Myocardial infarction), and ALVF (Acute left ventricular failure) were significantly higher in Group III than the two other groups had. However, unstable angina was significantly higher in age-group I & II and atypical chest pain in Group I. Incidence of Single vessel disease (SVD) was considerably higher in group II. Double vessel diseases DVD), Triple vessel disease (TVD), LM disease was significantly higher in group III compared to two other groups. Normal CAG (Coronary angiography) finding was higher among group I, although it was not significantly different from other two groups. Conclusion: The study concluded that the prevalence of conventional risk factors including overweight/obesity is almost similar between middle-aged and elderly women, while they are significantly lower in early middle-aged group. The elderly women usually present with STEMI (ST-elevation myocardial infarction), non-STEMI, stable CAD, ALVF, while middle-aged women commonly present with UA (Unstable Angina) and early middle-aged women with atypical chest pain. Severe CAD including and LM disease is relatively common in elderly women than those in their early middle-aged and middle-aged cohorts. Coronary artery disease advances with advancing age. Health-care providers should not underestimate the cardiac health of women. Ibrahim Card Med J 2019; 9 (1&2): 60-66

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A study of brachial artery flow mediated dilatation and carotid intima media thickness in subjects having risk factors for coronary artery disease

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20171037 ◽

2017 ◽

Vol 4 (2) ◽

pp. 437

Author(s):

Shweta Sahai ◽

Sumit Sinha

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Endothelial Dysfunction ◽

Intima Media Thickness ◽

Healthy Individuals ◽

Group Iii ◽

Group I ◽

Flow Mediated Dilatation ◽

Group Ii ◽

Artery Flow

Background: Endothelial dysfunction (ED) is an early phenomenon in atherosclerosis and often progresses to structural changes and clinical manifestations. Brachial artery flow mediated dilatation (BAFMD) has recently emerged as a reliable tool for assessment of ED. Carotid artery intima media thickness (CCAIMT) is an established tool for the detection of early structural atherosclerosis. This study was done to assess the reliability of BAFMD as a surrogate marker of atherosclerosis by comparing it to CCAIMT.Methods: Seventy-one subjects were divided in to Group I (n = 42, patients with overt cardiovascular disease; abnormal resting ECG or history of myocardial infarction/angina or an abnormal coronary angiogram), Group II (n = 17, apparently healthy individuals, with risk factors, but no overt cardiovascular disease) and Group III (n = 12, control, healthy individuals without risk factors). Ischemia induced BAFMD and CCAIMT were studied using ultrasound imaging along with presence of metabolic abnormalities.Results: Age ranged from 18-70 years with male predominance [42 (49.4%)]. Mean BAFMD in Group I, Group II and Group III was 6.68±3.52%, 7.39±3.62 and 11.65±4.32% respectively. Impaired BAFMD was highest in Group I [31 (73.80%)] compared to other two groups (p = 0.0002). Abnormal CCA-IMT was significantly higher in group I [33 (78.57%)] than in group II [9 (52.94%)] and Group III (3 (25%)] (p = 0.0018).Conclusions: Both BAFMD and CCAIMT can be used interchangeably as surrogate markers for endothelial dysfunction and atherosclerosis. BAFMD is a reliable tool for prediction of early atherosclerosis.

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Concerns of Indian Mothers with Children Having Severe-to-Profound Hearing Impairment at Diagnosis and after 1–3 Years of Therapy

Rehabilitation Research and Practice ◽

10.1155/2012/593405 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Nachiketa Rout ◽

Megha Khanna

Keyword(s):

Hearing Loss ◽

Hearing Impairment ◽

Problem Behaviors ◽

Therapy Group ◽

Speech Development ◽

Language Therapy ◽

Counseling Training ◽

Group I ◽

Emotional Aspects ◽

Group Ii

Counseling training in graduate programs continues to be underrepresented. If parental queries are not addressed adequately, they keep visiting one doctor after another.Objective. The aim of the study is to identify maternal needs of children with hearing impairment at two stages of habilitation, that is, just after diagnosis (group I) and after receiving 1 to 3 years of language therapy (group II).Methods. Two groups of mothers were asked to speak their queries about aural habilitation of their children. Queries were recorded, summarized, and categorized as per their priorities.Results. Group I mothers wanted to know about how the child would learn to listen and speak (45%), causes of hearing loss (33.7%), understanding the ear and hearing (10.2%), understanding the audiogram (7%), and coping with emotional aspects of hearing loss (5%), while group II parents had priorities concerning speech development (24.5%) followed by child independence and employment (17.3%), schooling (15.6%), problem behaviors (11%), amplification device (9.4%), duration of therapy (8%), future of the child (8%), and questions about how can my child get adjusted to the “normal” world (6%).Conclusions. Culture- and language-specific materials to explain these issues need to be developed.

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Congenital and early-onset bilateral hearing impairment in children: the delay in detection

The Journal of Laryngology & Otology ◽

10.1017/s0022215100139246 ◽

1997 ◽

Vol 111 (11) ◽

pp. 1018-1021 ◽

Cited By ~ 6

Author(s):

Eero Vartiainen ◽

Seppo Karjalainen

Keyword(s):

Risk Factors ◽

Hearing Loss ◽

Hearing Impairment ◽

Early Onset ◽

Otoacoustic Emissions ◽

Hearing Screening ◽

Screening Tests ◽

Profound Hearing Loss ◽

Great Cost ◽

Universal Hearing Screening

AbstractA retrospective review of 168 consecutive children with congenital or early-onset bilateral hearing impairment (>25 dB, 0.5–4 kHz, in the better hearing ear) was conducted. Only 39 per cent of the hearingimpaired children were diagnosed within the first two years of life. The age at diagnosis was related to the severity of hearing loss with profound (>95 dB) hearing losses being detected earlier than the other degrees. However, 37 per cent of children with severe to profound (>70 dB) hearing loss were still not diagnosed until after two years of age. Children with severe to profound hearing loss and with known risk factors were diagnosed earlier than children with the same hearing status but with no known risk factors. It was concluded that the behavioural hearing screening tests used in our well-baby clinics are insufficient and, therefore, more reliable methods, preferably evoked otoacoustic emissions, should be used for universal hearing screening of infants and young children in spite of the great cost.

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Ultrastructural Lesions Produced by Alcohol and Sucrose in the Heart and Liver of C57BL Mice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100068035 ◽

1970 ◽

Vol 28 ◽

pp. 208-209

Author(s):

K.K. SEKHRI ◽

C.S. ALEXANDER ◽

H.T. NAGASAWA

Keyword(s):

Osmium Tetroxide ◽

Male Mice ◽

Alcohol Group ◽

Group Iii ◽

Group I ◽

C57bl Mice ◽

Group Ii

C57BL male mice (Jackson Lab., Bar Harbor, Maine) weighing about 18 gms were randomly divided into three groups: group I was fed sweetened liquid alcohol diet (modified Schenkl) in which 36% of the calories were derived from alcohol; group II was maintained on a similar diet but alcohol was isocalorically substituted by sucrose; group III was fed regular mouse chow ad lib for five months. Liver and heart tissues were fixed in 2.5% cacodylate buffered glutaraldehyde, post-fixed in 2% osmium tetroxide and embedded in Epon-araldite.

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Heterogeneity and Immunochemical Properties of Anti-β2-glycoprotein I Autoantibodies

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615218 ◽

1998 ◽

Vol 80 (09) ◽

pp. 393-398 ◽

Cited By ~ 33

Author(s):

V. Regnault ◽

E. Hachulla ◽

L. Darnige ◽

B. Roussel ◽

J. C. Bensa ◽

...

Keyword(s):

Fluid Phase ◽

Anticardiolipin Antibodies ◽

Dual Reactivity ◽

Group Iii ◽

Important Group ◽

Epitope Specificity ◽

Glycoprotein I ◽

Group I ◽

Group Ii ◽

Sufficient Concentration

SummaryMost anticardiolipin antibodies (ACA) associated with antiphospholipid syndrome (APS) are directed against epitopes expressed on β2-glycoprotein I (β2GPI). Despite a good correlation between standard ACA assays and those using purified human β2GPI as the sole antigen, some sera from APS patients only react in the latter. This is indicative of heterogeneity in anti-β2GPI antibodies. To characterize their reactivity profiles, human and bovine β2GPI were immobilized on γ-irradiated plates (β2GPI-ELISA), plain polystyrene precoated with increasing cardiolipin concentrations (CL/β2GPI-ELISA), and affinity columns. Fluid-phase inhibition experiments were also carried out with both proteins. Of 56 selected sera, restricted recognition of bovine or human β2GPI occurred respectively in 10/29 IgA-positive and 9/22 IgM-positive samples, and most of the latter (8/9) were missed by the standard ACA assay, as expected from a previous study. Based on species specificity and ACA results, IgG-positive samples (53/56) were categorized into three groups: antibodies reactive to bovine β2GPI only (group I) or to bovine and human β2GPI, group II being ACA-negative, and group III being ACA-positive. The most important group, group III (n = 33) was characterized by (i) binding when β2GPI was immobilized on γ-irradiated polystyrene or cardiolipin at sufficient concentration (regardless of β2GPI density, as assessed using 125I-β2GPI); (ii) and low avidity binding to fluid-phase β2GPI (Kd in the range 10–5 M). In contrast, all six group II samples showed (i) ability to bind human and bovine β2GPI immobilized on non-irradiated plates; (ii) concentration-dependent blockade of binding by cardiolipin, suggesting epitope location in the vicinity of the phospholipid binding site on native β2GPI; (iii) and relative avidities approximately 100-fold higher than in group III. Group I patients were heterogeneous with respect to CL/β2GPI-ELISA and ACA results (6/14 scored negative), possibly reflecting antibody differences in terms of avidity and epitope specificity. Affinity fractionation of 23 sera showed the existence, in individual patients, of various combinations of antibody subsets solely reactive to human or bovine β2GPI, together with cross-species reactive subsets present in all samples with dual reactivity namely groups III and II, although the latter antibodies were poorly purified on either column. Therefore, the mode of presentation of β2GPI greatly influences its recognition by anti-β2GPI antibodies with marked inter-individual heterogeneity, in relation to ACA quantitation and, possibly, disease presentation and pathogenesis.

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Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

The Heart Surgery Forum ◽

10.1532/hsf.1325 ◽

2015 ◽

Vol 18 (3) ◽

pp. 098

Author(s):

Cem Arıtürk ◽

Serpil Ustalar Özgen ◽

Behiç Danışan ◽

Hasan Karabulut ◽

Fevzi Toraman

Keyword(s):

Body Temperature ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Extracorporeal Circulation ◽

Group Iii ◽

Oxygen Fraction ◽

Arterial Blood ◽

Group I ◽

Group Ii

Background: The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery.Methods: After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).Results: Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all). Conclusion: Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.

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