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Objetivo: Analisar a tendência da mortalidade por paracoccidioidomicose (PCM) e caracterizar o perfil sociodemográfico no Brasil e suas regiões geográficas numa série temporal de 25 anos. Métodos: Trata-se de estudo ecológico de séries temporais. Considerou-se como participantes do estudo a população brasileira dividida em faixas etárias, que tiveram como causa básica do óbito a PCM. Para calcular a variação percentual anual (VPA) dos coeficientes, na análise de tendência, foi utilizada a regressão de Prais-Winsten. Os coeficientes de mortalidade foram calculados a nível nacional, segundo as regiões geográficas, sexo e faixa etária e proporcional para as demais variáveis. Resultados: De acordo com os resultados deste estudo, ocorreram 2.101 óbitos por PCM no Brasil. A tendência ao longo dos 25 anos evidenciou um comportamento estável nas regiões Norte e Nordeste. Já no Sul, Sudeste e Centro-Oeste houve uma tendêndia de queda. A mortalidade média no Brasil foi de 84,04/100 mil hab., VPA -3,29 (IC 95% -2,43; -4,14). Levando em consideração a análise dos aspectos sociodemográficos, houve um predomínio de escolaridade ignorada (764; 36%), raça/ cor da pele branca (1.109; 53%), estado civil misto: casado (942; 45%) e solteiro (640; 30%), local de ocorrência do óbito predominantemente no âmbito hospitalar (1.852; 88%). Conclusão: Tanto no Brasil como nas regiões geográficas Sudeste, Sul e Centro-Oeste a mortalidade por PCM apresentou-se com tendência temporal decrescente. Já nas regiões Nordeste e Norte a tendência foi estacionária. O perfil sociodemográfico dos pacientes que foram a óbito apontou para sexo masculino, adultos, de baixa escolaridade, brancos e casados.
Objective: To analyze the trend in mortality from paracoccidioidomycosis (PCM) and characterize the sociodemographic profile in Brazil and its geographic regions in a 25-year time series. Methods: This is an ecological time series study. The study participants were the Brazilian population divided into age groups whose underlying cause of death was PCM. To calculate the annual percentage change (VPA) of the coefficients in the trend analysis, the Prais-Winsten regression was used. National mortality coefficients were calculated according to geographic regions, sex and age group and proportional to the other variables. Results: According to this study, there were 2,101 deaths from PCM in Brazil. The trend over the 25 years showed stable behavior in the North and Northeast regions. In the South, Southeast, and Midwest, there was a downward trend. The average mortality in Brazil was 84.04/100,000 inhab., VPA -3.29 (95% CI -2.43; -4.14). According to the analysis of sociodemographic aspects, there was a predominance of ignored schooling (764 deaths; 36%), white race/skin color (1,109; 53%), mixed marital status: married (942; 45%) and single (640; 30%), and place of death predominantly in the hospital environment (1,852; 88%). Conclusion: In Brazil and in the Southeast, South, andMidwest geographic regions, mortality from PCM showed a decreasing temporal trend. In the Northeast and North regions, the trend was stationary. The sociodemographic profile of the dying patients indicated males, adults, with low education, white, and married.
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Humans , Paracoccidioidomycosis , Sociodemographic Factors , Mortality , Adult , Educational StatusABSTRACT
Background: Syringocystadenoma papilliferum is a benign adnexal neoplasm. Contiguous squamous proliferation has been rarely described in syringocystadenoma papilliferum. Aims: This study aimed to evaluate the spectrum and pathogenesis of contiguous squamous proliferation in syringocystadenoma papilliferum. Materials and Methods: All cases of syringocystadenoma papilliferum diagnosed over the past 12 years were screened for contiguous squamous proliferation. Cases with associated nevus sebaceous were excluded from the study. Immunohistochemistry for GATA3, CK7, BRAFV600E and p16 was performed. PCR for human papilloma virus, type 16 and 18, was carried out. Results: Of a total of 30 cases, 14 cases showed associated contiguous squamous proliferation which included four cases of verrucous hyperplasia, six cases with papillomatosis, two cases with mild squamous hyperplasia and one case each of Bowen’s disease and squamous cell carcinoma. In the cases with non-neoplastic contiguous squamous proliferations, the squamous component did not express CK7 or GATA3. However, the squamous component of premalignant and malignant lesions expressed CK7 and GATA3 concordant with the adenomatous component. BRAF was positive in adenomatous component in five cases while the contiguous squamous proliferation component was negative for BRAF in all but one case. p16 was negative in both components of all cases and PCR for human papilloma virus was negative in all cases. Limitations: Due to the rarity of disease, the sample size of our study was relatively small with two cases in the 2nd group, that is, syringocystadenoma papilliferum with malignant contiguous squamous proliferation. Detailed molecular studies such as gene sequencing were not performed. Conclusion: Syringocystadenoma papilliferum with contiguous squamous proliferation is underreported, and most commonly displays verrucous hyperplasia. The premalignant and malignant contiguous squamous proliferations likely arise from syringocystadenoma papilliferum while the hyperplastic contiguous squamous proliferations likely arise from the adjacent epidermis. Relationship with high-risk human papilloma virus is unlikely. However, further molecular analysis of larger number of cases is required to establish the pathogenesis.
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Objectives To compare the epidemiological, clinical profle, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the frst and second waves of the pandemic. Methods This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the frst (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). Results Of 217 children, 104 (48%) and 113 (52%) were admitted during the frst and second waves respectively. One hundred ffty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-fow oxygen (n=5, 2%), noninvasive ventilation [CPAP (n=34, 16%) and BiPAP (n=8, 5%)] and invasive ventilation (n=45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p=0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the frst wave [8 (6–10) vs. 5.5 (3–8); p=0.0001]. Conclusions Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the frst and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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Patient Safety has been a challenge for healthcare facilities worldwide. Ensuring the safety of the patient is the duty of each healthcare professional as emphasised in the Hippocratic oath, 'ldquo;above all, do no harm'rdquo;. Nurses in the healthcare team are pivotal in the provision of patient care. They spend more time with patients than others and are in direct communication with the patient and family, so they are better placed to mitigate harm. Hence nurses need to be vigilant, engaged and invested in patient safety and improvement in quality care. Nursing education and training too should serve as a platform for increased efforts in this direction and include opportunities for continued learning. Discussed in this paper are two simple measures such as '#39;safety cross and run charts'#39; that can be used to promote patient safety by recognising risks and preventing harm or adverse events.
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Purpose@#Tinnitus is one of the most common health conditions worldwide. Although various methods of treatment have been used, the condition is still difficult to manage or cure. This study aimed to evaluate the therapeutic effects of transcutaneous trigeminal electrical stimulation (TTES) combined with notched sound therapy (NST) on patients with tinnitus. @*Materials and Methods@#A clinical trial was conducted prospectively from September 2020 to September 2021 at a single center in South Korea. In total, 14 patients took part in this trial. Periodic visits and tele-monitoring were used to assess treatment compliance and collect data, including electroencephalography (EEG), photoplethysmography (PPG), tinnitus handicap inventory (THI), tinnitus magnitude index, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and 36-item short-form survey (SF-36) results. @*Results@#Changes after intervention were analyzed with paired t-test. This study showed that alpha waves in the left hemisphere measured by EEG (p=0.024), autonomic nervous system balance (p=0.007), and stress level (p=0.022) measured by PPG significantly changed after intervention. Also, THI scores especially emotional symptoms (p=0.029) and catastrophic symptoms (p=0.043) decreased after treatment. The SF-36 score, both mental component summary and physical component summary score (each p<0.001), increased significantly, whereas the PSQI score (p<0.001) and BDI score (p<0.001) decreased after TTES and NST. @*Conclusion@#Based on the results of our study, we could confirm that TTES combined with NST can significantly improve tinnitus, catastrophic symptoms, and the overall quality of life of patients.
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The diagnosis of peritonitis among peritoneal dialysis (PD) patients is based on clinical presentation, dialysis effluent white blood cell (WBC) count, and dialysis effluent culture. Peritoneal fluid WBC count is very important in the initial diagnosis of peritonitis. The purpose of this work was to determine the optimal number of peritoneal WBCs with different clinical presentations at admission to define PD-related peritonitis. Methods: Medical records of chronic PD patients who underwent work-up for suspected peritonitis between 2008 and 2019 were reviewed retrospectively. Results of all peritoneal WBC count tests during this period were collected. Clinical manifestations and follow-up analysis of each peritoneal WBC count were performed. Results: The peritoneal WBC count cutoff of 100/μL recommended by International Society for Peritoneal Dialysis provided specificity of only 35%. Increasing peritoneal WBC count cutoff to 150, 200, and 250/μL provided sensitivity around 98% and gradually increasing specificity. The chi-square automatic interaction detector model of statistical analysis determined that peritoneal WBC count below 230/μL combined with absence of inflammatory markers (fever, increased C-reactive protein) ruled out peritonitis with 99.8% sensitivity. Peritoneal fluid WBC count cutoff of 230/μL provided specificity of 89% and good positive and negative likelihood scores of 8.3 and 0.03, respectively. Peritoneal fluid polymorphonuclear count has lower discriminating ability for peritonitis compared to peritoneal fluid WBC count. Conclusion: Increasing peritoneal fluid WBC count cutoff to 230/μL in suspected PD-related peritonitis could improve specificity without compromising the sensitivity of the test.
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Alagille syndrome is a rare and complex multisystem disorder caused by an autosomal dominant genetic mutation of JAG1 (90% cases) and NOTCH2 (1-2% cases) genes located on the short arm of chromosome 20. This case is reported as per the CARE (for Case Reports, 2013) guidelines. A 14-year old male, known case of chronic cholestatic liver disease of neonatal onset, diagnosed with Alagille syndrome as evident from NOTCH 2 mutation in genetic analysis and paucity of intrahepatic bile ducts on biopsy presented with portal hypertension, growth failure and persistent hyperbilirubinemia.
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Diabetes mellitus is associated with an increased risk of cardiovascular disease, even in the presence of intensive glycaemic control. Both diabetes and insulin resistance bring about a amalgam of endothelial dysfunction and it will abate the anti-atherogenic role of the vascular endothelium. In patients with type 2 diabetes both insulin resistance and endothelial dysfunction appear to lead up to the development of undisguised hyperglycaemia. Hence, in patients with diabetes, endothelial dysfunction may be a censorious early intention for preventing atherosclerosis and cardiovascular disease. For the assessment endothelium- dependent vasodilatation Coronary and peripheral circulations are used. In Ayurveda, endothelial dysfunction can be correlated to Rakthavaha srotho dushti. There are several aetiological factors similar in both Prameha and Rakta dushti. The factors which got vitiated (Dooshya) in Prameha are Mamsa, Meda, Rasa, Rakta, Shukra, Lasika, Vasa, Majja & Oja. Amongst all Meda & Mamsa are main vitiated factors (Dooshya) while Rakta is one of the Dooshya initially. During nourishment, Rakta is nourished prior to Meda & Mamsa. Further it nourishes Meda dhatu too. Endothelial dysfunction is reversible in early stages so that many rasayana drugs mentioned in the Ayurveda can be used here. In the present review briefly outlines some basic concepts of endothelial structure and function, and its dysfunction, relation with diabetes and its Ayurvedic concepts and management.
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Cutaneous T cell lymphoma (CTCL) are a rare group of diseases caused by uncontrolled proliferation of T cells which belongs to mature T cell lymphoma having indolent nature. Two thirds of the CTCL are comprised of Mycosis Fungoides (MF) and Sezary Syndrome (SS). They are characterized by macules and patches which on later progresses to tumors or nodules with adenopathy and other organ infiltration. If left untreated the risk of developing infection increases with visceral involvement of skin, GI tract, lungs and adrenals. Diagnosis is done by histopathological appearance, cytogenetic analysis, etiology and the functional biology of neoplastic cells. Imaging techniques (MRI and CT) are widely done to assess the staging of disease and other tissue involvement. Radiotherapy, chemotherapy and retinoids have been in use since long time, but possess many side effects. According to Ayurveda, CTCL can be caused by Ahara like Virudha, Agantuja bhavas, Beeja-beejabhaga-beejabhagavayava dushti and Ojas/bala hani. The clinical features can be related with Kushta and in later stage simulates Dhatugata kushta and Granthi-arbuda. The etiopathogenesis of CTCL can be considered as formation of Ama, Agnimandhya, Srothovaigunya, and Balahani. Management will be preventive, curative and palliative with Sodhana, Samana and Rasayana therapies
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Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver pathology with different clinical prognoses; from the simple accumulation of triglycerides within hepatocytes (simple steatosis) to more progressive steatosis with associated hepatitis, fibrosis, cirrhosis, and in some cases hepatocellular carcinoma. Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver injury across the world. It is also strongly related to other pathological conditions, including obesity, diabetes, cardiovascular diseases, and symptoms of metabolic syndrome. Ayurveda also vividly describes Liver Diseases in the context of Kamala (jaundice) and Yakrit Roga (liver diseases) in different classical texts. It can be interpreted as a Santharpanotha Vyadhi (disease which caused by taking excessive nourishing diet) with vitiation of Kapha and Medas, getting Sthanasamsraya in Yakrit (liver) which is Rakthavaha-srothomoola and Pithasthana (location of body humour Pitha). This review will give a better knowledge of etiopathogenesis, as well as a therapeutic method for managing patients by breaking the pathogenesis chain. In this section, we explore the etiology and consequences of NAFLD, along with the therapeutic treatment to this prevalent condition.
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Aluminum vessels are being used from a long time for various cooking purpose. Using cross?sectional study design, 90 participants, 30 in each category of normal, mild – moderate and severe Alzheimer’s disease (AD), aged of 60 years and above were enrolled using SAGE scale. Data on the frequency of usage of aluminum vessel for various types of cooking such as frying, baking, boiling, roasting/sautéing, and packing of food using aluminum foil were collected using the pretested semistructured questionnaire. Results showed that severity of AD was significantly associated (P < 0.05) with usage of aluminum utensils for various cooking purpose in all the three groups, with least total score for usage of aluminum vessels in normal category (3.2) and highest in severe category (18.67). Frying (P < 0.001), boiling (P < 0.05), and roasting/sautéing (P < 0.01) of foods in aluminum vessels was be significantly associated with the AD score. Degree of AD positively correlated with usage of aluminum vessels.
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Tuberculous meningitis (TBM) is an air-borne infectious disease caused by the bacteria Mycobacterium tuberculosis that affects the central nervous system (CNS). Among all the incident cases of TB, CNS TB represents approximately 1% with TBM as the most grievous among all. The basic pathology in TBM is the inflammation of the arachnoid membrane, the pia mater and the cerebrospinal fluid (CSF). It typically presents as mild fever, headache, anorexia and general debility that progress over one to two weeks to cause severe headache, fever, vomiting, confusion, meningismus and cranial nerve deficits. The most common complications of TBM include hydrocephalus, optico-chiasmatic arachnoiditis, seizures and stroke. Out of these, tuberculous cerebrovascular disease is a common neurological sequelae. This case study elaborates the treatment line and observations made in a 29 year old male patient who presented with hemiparesis and significant sensory deficit following an event of tuberculous meningitis. MRI brain was suggestive of basilar meningitis, optico-chiasmatic arachnoiditis, infarcts and tuberculoma with chest X-ray revealing increased bronchovascular markings in bilateral lung fields. Initially on admission, Deepana-pachana was done followed by snehapana with Shadpala ghrta and Virechana as Sodhana karma. Abhyanga, Ushma Sweda, Churna pinda sweda and Jambeera pinda sweda were successively done allied with physiotherapy. Yogavasti with Vedanasthapana gana as Kashaya and Kalka was done intervened by Anuvasana vasti. Succeedingly, Murdhni taila prayoga and Marsha nasya were also incorporated with periodical neurological, hematological and biochemical assessment. On discharge, Brahmi kalyanaka ghrta and Brahma Rasayana were advised inclusive of physiotherapy.
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India's “National Policy on older persons” classifies 60 years and above as aged who will constitute 10% of the total population by 2021. It is estimated that depression affects approximately 350 million people worldwide. An increasing geriatric population is associated with rising prevalence of chronic non-communicable diseases; therefore, the magnitude of depression is also expected to grow. Keeping the above background in mind, the present study will be conducted among elderly to determine the prevalence of depression. A cross sectional study was carried among 685 elderly people selected by Cluster Sampling and contacted through house to house survey in urban, rural and tribal areas of Chhattisgarh using a pre designed structured questionnaire i.e. Geriatric depression scale. It was found that 11.8% subjects were having depression, 25.1% were suggestive of depression and 63.1% subjects were not having any depressive symptoms. It is concluded that depression is prevalent among elderly persons residing in tribal area therefore it needs to be identified at an early stage, so that proper interventions can be started at the primary care level to ensure healthy ageing.
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Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
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Background: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. Methods: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy.h Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). Results:162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (log- rank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazard- ratio=2·24; adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. Conclusion: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.
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Objective:To summarize and analyze the clinical features of McCune-Albright syndrome (MAS) in 26 children, to improve the understanding of MAS diagnosis and treatment, and to achieve early clinical diagnosis of MAS.Methods:The clinical data of 26 children with MAS treated in Department of Pediatrics, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2011 to June 2021 were retrospectively analyzed.Their clinical characteristics were summarized and studied. t-test, Mann- Whitney U test, χ 2 test or Fisher′ s exact probability method was used for comparison between groups. Results:(1) Among the 26 MAS patients enrolled, there were 22 females and 4 males.The average onset age of female and male patients was (5.87±2.94) years old and (7.48±3.36) years old, respectively.(2) In female patients, there were 7 cases with the typical triad and 15 cases with the atypical triad.(3) Female patients had the first symptom of vaginal bleeding (8/22) and breast development (14/22). Among the 4 male children, 1 case had " fracture" and 3 cases " lagged behind their peers in height" at the first visit.(4) Compared with the breast development group, the vaginal bleeding group had an earlier onset age[(4.06±1.88) years old vs.(7.82±1.82) years old] ( t=5.023, P<0.001), earlier bone maturation[(1.26±0.07) vs.(1.09±0.13)] ( t=2.933, P<0.05), a greatly lowered predicted adult height[(-2.16±0.98) SDS vs.(-0.96±1.09) SDS]( t=1.352, P<0.05), a lower blood phosphorus level[(1.41±0.14) nmol/L vs.(1.67±0.24) nmol/L] ( t=1.941, P<0.05), and a significantly elevated alkaline phosphatase level[339(313, 656) U/L vs.243(205, 452) U/L] ( U=1.000, P<0.05). All patients (8 cases) in the vaginal bleeding group had fibrous dysplasia of bone.(5) Ten patients progressed to central precocious puberty (CPP). They showed an older average age of onset[(7.27±2.69)years old vs.(4.69±2.68)years old] ( U=44.000, P<0.05), significantly earlier bone maturation at diagnosis[(1.23±0.11) vs.(1.01±0.13)] ( t=1.834, P<0.05), and a lower predicted adult height[(152.00±4.62) cm vs.(162.10±6.91) cm] ( t=3.805, P<0.05), compared with those who did not progress to CPP.(6) Eleven children developed polyostotic fibrous dysplasia of bone, and most common type (8 cases) was polyostotic fibrous dysplasia of bone, primarily at lower limb bones and skulls.(7) Of the 26 children, 20 cases had scattered Café au lait pigments on the skin.The Café au lait pigmented skin lesions in 35% (7/20) cases crossed the midline. Conclusions:With complicated clinical manifestations, MAS is more common and occurs earlier in girls than boys.It is difficult to clinically diagnose MAS in boys due to the insidious onset and atypical symptoms.Female MAS patients with vaginal bleeding as the first symptom usually have an early age of onset, advanced bone age and lower predicted adult height, so they should be monitored and evaluated clinically.Vaginal bleeding is significantly associated with polyostotic fiber dysplasia of bone in MAS patients.Therefore, it is recommended that patients with vaginal bleeding should undergo a routine bone single-photon emission computed tomography scan.This helps understand the situation of occult fiber dysplasia of bone.Patients with later diagnosis and advanced bone age should be aware of the possibility of progression to CPP.
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Background@#Hearing loss (HL) is the most common chronic disease and has been linked to negative health outcomes. Hearing aids (HAs) are regarded as the gold standard for HL management, however, the adoption rate of HAs is relatively low for various reasons. With this background, hearing devices, such as personal sound amplification products (PSAPs) received significant attention as an alternative to conventional HAs. This study aimed to evaluate the clinical efficacy of PSAPs in patients with mild to moderately severe HL. @*Methods@#Nineteen patients with mild hearing loss (MHL), 23 with moderate hearing loss (MDHL), and 15 with moderately severe hearing loss (MSHL) participated in the study.Electroacoustic analysis, simulated real-ear measurements (REMs), and three clinical evaluations were implemented. @*Results@#All devices satisfied the electroacoustic tolerances. All devices provided sufficient gain for MHL and MDHL audiograms. However, in MSHL audiogram, the gains of PSAPs were insufficient, especially for high frequencies. In terms of clinical evaluations, soundfield audiometry showed significant improvements between aided and unaided thresholds in all groups for all devices (P < 0.001). Significant improvements of word recognition scores were only shown for HAs between aided and unaided conditions. The Korean version of the Hearing In Noise Test did not show any consistent findings for all devices and groups. @*Conclusion@#Certain PSAPs are beneficial for improving hearing and speech perception in patients with HL. Well-chosen PSAPs could be an alternative hearing rehabilitation option for these patients.
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Background@#The aim of this study is to investigate the clinical effectiveness of Ponto in Korea, a recently released percutaneous bone-anchored hearing implant. @*Methods@#16 patients with single-sided deafness (SSD) and mixed or conductive hearing loss who underwent Ponto implantation from December 2018 to September 2020 were enrolled in the study. Puretone audiometry, the Korean version of the Hearing in Noise Test (K-HINT), sound localization test (SLT), and Pupillometry were performed pre- and three months post-operation. Standardized questionnaires, the Hearing Handicap Inventory for the Elderly (HHIE) and Speech, Spatial and Qualities of Hearing Scale (SSQ), were administered. @*Results@#The mean age of subjects was 55.5 (range, 48–67) years. Four males and 12 females participated in the study. The mean puretone average was 73.17 dB hearing level (HL) before surgery and significantly improved to 36.72 dB HL three months after surgery. The mean word recognition score improved from 26.0% to 90.75% after implantation. In the case of K-HINT, there was a significant difference in summation (Z = −2.250, P = 0.024) and head shadow effects (Z = −3.103, P = 0.002). There was no significant difference in root mean square error degree (RMSE) and hemifield identification scores for SLT testing. Pupillometry was performed to measure listening effort and the results revealed that the degree of pupillary dilatation decreased under the condition of quiet, 0 dB signal to noise ratio (SNR) and 3 dB SNR. The total score for HHIE decreased significantly (Z = −3.130, P = 0.002) while the SSQ score increased significantly (Z = −2.216, P = 0.027). @*Conclusions@#The Ponto bone-anchored hearing system showed significant clinical benefit in Korean patients with conductive and mixed hearing loss and SSD.
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Objectives@#. This study was conducted to investigate the electroacoustic characteristics of personal sound amplification products (PSAPs), to identify whether PSAPs provide adequate gain and output for three common hearing loss (HL) configurations, and to compare the benefits of a representative PSAP (RPSAP) and a conventional hearing aid (HA) for clinical hearing outcomes as a pilot study. @*Methods@#. The study comprised three phases: electroacoustic analysis, simulated real-ear measurements (REMs), and clinical hearing experiments. Electroacoustic analysis and simulated REMs were performed for three basic PSAPs (BeethoSOL, EarJJang, and Geniesori2) and three high-end PSAPs (Hearing Able, Olive Smart Ear, and SoriIn) using the Aurical Hearing Instrument Test box with a 2-mL coupler. Four electroacoustic characteristics (maximum output sound pressure level at 90 dB SPL, frequency range, equivalent input noise, and total harmonic distortion) were investigated. By simulated REMs, appropriate levels of the six PSAPs for three common HL configurations (mild-to-moderate high-frequency HL, moderate to moderately severe sloping HL, and moderate flat HL) were determined. Clinical experiments compared the performance of RPSAP to HA, both of which were fitted by audiologists using REMs. Clinical experiments were administered using functional gain, a word recognition test, and the Korean version of the Hearing in Noise Test in six participants with bilateral moderate sensorineural HL. @*Results@#. The two high-end devices met all tolerances. One basic and two high-end PSAPs showed appropriate levels for three common HL configurations. In the clinical experiments, the RPSAP showed better performance than unaided, but slightly worse than HA under all test conditions. @*Conclusion@#. Certain PSAPs met all specified tolerances for electroacoustic analysis and approximated prescriptive targets in well-controlled laboratory conditions. The pilot clinical experiments explored the possibility that the RPSAP could serve as a hearing assistive device for patients with moderate HL.
ABSTRACT
Background:Incidence and prevalence of dermatophytosis have increased recently. The clinico-mycological characteristics of dermatophytosis in the past and present were compared to determine the difference, if any, that canexplain the present scenario.Material and Methods:Hospital-based cross-sectional study design with retrospective data comparison was done. The clinico-mycological data of 425 patients in 2019 was compared to 124 patients in 2011 with a Chi-square statistic. Result:Significant differences were observed in the following socio-demographic and disease characteristics in the present compared to the past: female gender (57.9% vs.33.9%, P-0.000002), chronicity (29.4% vs. 16.1%, P-0.003), sharing of clothes (35.3% vs. 20.5%, P-0.0014), co-morbidity of atopy (22.6% vs. 6.5%, P-0.00005), prior use of topical antifungals (64.5% vs. 30.7%, P <0.0001), prior use of systemic antifungals (43.1% vs. 13.7%, P <0.0001), prior use of topical steroids (24.7% vs. 12.1%, P-0.0028), and infection in multiple sites (25.2% vs. 11.3%, P-0.001). T.mentagrophyteswas the most common isolate in the present compared to the past (73.6% vs. 32.8%, P-0.0035). Other isolates were T.rubrum(13.2%) and M.gypseum(13.2%) in 2019 and T.rubrum(53.1%), M. gypseum(9.4%),T. schoenleinii(1.6%) and E. floccosum(3.1%) in 2011.Conclusion:T. mentagrophyteshas emerged as thedominant species. Irrational use of topical and systemic antifungals and steroids has increased considerably.Frequent training of general practitionersregarding appropriate management andeducating patients about avoidance of tight-fitting clothing, personal hygiene, and avoidance of over the counter medications, and adherence to treatment schedule can decrease the disease burden to some extent.