Effect of Quiet and Noise on P300 Response in Individuals with Auditory Neuropathy Spectrum Disorder

Abstract Introduction Auditory neuropathy spectrum disorder (ANSD) is a clinical condition in which individuals have normal cochlear responses and abnormal neural responses. There is a lack of evidence in the literature regarding the neural discrimination skill in individuals with ANSD, especially when the signal is presented in the presence of noise. Objectives The present study was performed with the aim to investigate auditory discrimination skill, in quiet and in the presence of noise, in individuals with ANSD and to compare the findings with normal-hearing individuals. Methods A total of 30 individuals with normal hearing sensitivity and 30 individuals with ANSD in the age range of 15 to 55 years old, with the mean age of 27.86 years old, were the participants. P300 response was recorded from both groups using syllable pairs /ba/-/da/ in oddball paradigm and the syllable /da/ in repetitive paradigm in quiet and at +10 dB signal-to-noise ratio (SNR). Results There was significant prolongation in latency and reaction time, and reduction in amplitude of P300 response and sensitivity in both groups with the addition of noise. The topographic pattern analysis showed activation of the central-parietal-occipital region of the brain in individuals with ANSD, whereas activation of the central-parietal region was observed in individuals with normal hearing. The activation was more diffused in individuals with ANSD compared with that of individuals with normal hearing. Conclusion The individuals with ANSD showed a significantly more adverse effect of noise on the neural discrimination skill than the normal counterpart.

Community cancer awareness programs: symptom awareness alone doesn’t suffice

Background: Although cancer is a global public health problem, maximum impact is on developing economies. In India, socio-cultural factors also operate to add the burden. Aim of the study was to delineate factors causing late presentation of cancers to the point of care.Methods: We gave cancer awareness classes to a village community, preceded by a campaign to attend the classes with the help of a local trustee organisation and primary health center. Data was collected from the attendees using a structured questionnaire prepared to dissect out the awareness about cancer symptoms and concerns about treatment.Results: Only 1.8% of the total population of the area under study attended the classes. Out of the 411 attendees, 323 (78.6%) responded to the questionnaire and of them, 294 (91%) identified the site wise symptoms of cancer clearly and 40 (12.4%) detected their own symptoms warranting cancer screening. Commonest concern was the cost of treatment (40.9%). There were people thinking that cancer is not a life-style disease (3.1%), it is genetic (7.7%), it may be due to fate alone (6.2%), it is contagious (5%), and it cannot be cured (3.7%).Conclusions: Despite high health status indices, literacy rate and high knowledge about cancer symptoms, there are still a lot of superstitions about cancer in Kerala. The most common reason preventing people from approaching health care system with early symptoms of cancer is the fear of cost of treatment. Apart from teaching symptoms of cancer, cancer awareness programs should include familiarisation of various financial aids available for cancer treatment.

Russell’s Viper Envenomation-associated Acute Kidney Injury in Children in Southern India.

Objectives: To determine the frequency and risk factors of acute kidney injury in children with Russell’s viper envenomation using Acute Kidney Injury Network definition and classification system. Methods: A prospective observational study recruiting 61 subjects managed as per the National Snakebite Protocol. Results: 45.9% of envenomed children had acute kidney injury. The median (IQR) of the maximum serum creatinine level during hospitalization was 2 (1.3-4.8) mg/dL. The distribution of stages 1, 2 and 3 of acute kidney injury was 32.1%, 17.9% and 50% respectively. Dialysis was required in 35.7% of the children with acute kidney injury. Conclusions: Acute kidney injury is common with Russell’s viper envenomation. Native treatments and bleeding manifestations were associated with acute kidney injury in our patient population.

Clinical rabies: is cure possible.

Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed.

Right ventricular pacing via left superior vena cava.

Negotiating the pacing lead into the right ventricle via left superior vena cava, at times, can be difficult. We report two such cases in which pacing leads were introduced into the right ventricle via left superior vena cava, with the help of stylet tip shaped into a large pigtail loop.

Coexistence of congenital subaortic and sinus of valsalva aneurysms.

We report a rare association of an aneurysm of the sinus of Valsalva and a subaortic aneurysm. Congenital defective union of the aortic wall and ventricular muscle with the fibrous ring is probably the explanation for this condition.