Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a Case Report

Abstract Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of the Sgarbossa's criteria during the management of hypertensive emergency are rare. My current case is a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa's criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as the Sgarbossa's diagnostic criteria were met. Here, we present a case of developing ST-segment elevation myocardial infarction with left bundle branch block that is indicating for thrombolytic therapy. Thrombolytic therapy was strongly indicated because of a higher developing of Sgarbossa criteria scoring. Thus, the higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa criteria developing during the course of the case to indicating the need for thrombolytic therapy?

Audiological profile in children with autism spectrum disorders

Background: Autism spectrum disorder is defined by the Diagnostic Statistical Manual of Mental Disorders V [DSM V] as a neurobehavioral disorder manifested by persistent deficits in social and communication interaction, deficits in developing, understanding and maintaining relationships, as well as abnormal and fixed interests and repetitive behavior. Symptoms must be present at early childhood and interfere with daily function. The majority of individuals with ASD demonstrate some degree of auditory dysfunction. The level and expression of this dysfunction ranges from deafness and increased thresholds to hyperacusis and difficulty listening with background noise

Objective: The purpose of this study was to characterize the findings of audiological and electrophysiological hearing assessment in individuals with autism and to compare these findings to those obtained in typically developing individuals

Subjects, Materials and Method: Forty one Autistic children are divided into two groups:- group [1] Mild to moderate autism were seventeen children and group [2] Severe autism were twenty four children] were enrolled in this study [Whose ages were 2-6.5 years old] compared with ten typically developing matching peers. All Autistic children in the study had a definite medical diagnosis of Autism according to DSM-5 and based on the severity of symptomatology, ASD children were assessed and divided using CARS score [Childhood autism rating scale]. Audiologic evaluation consisted of a case history, otoscopic examinatioin, behavioral free field evaluation, acoustic immittance measures [Tympanogram and Acoustic reflexes], speech audiometry, measurement of distortion product otoacoustic emissions and auditory brain stem response

Results: Our results support an association between ASD and higher DPOAEs S/N ratios at only 500 and 750 Hz. Moreover, ABR in ASD children showed a significant increase in waves III and V absolute latencies and IIII and I-V inert peak latencies [In both groups of ASD], with inter aural asymmetry as shortened right ear III-V and I-V inter peak latencies reflecting a more right ear advantage [mild to moderate group], in addition to a significant decrease in waves V/I amplitude ratio [Both ASD groups]

Conclusion: The OAE responses of children with ASD were highly significantly only at 500 Hz [Both groups] 750 Hz [Mild to moderate group]. ASD children [either mild to moderate or severe] had a significant increase in ABR waves III and V peak absolute latencies and I-III and I-V inter peak latencies. Asymmetrical ABR findings also noted in children with ASD [mild to moderate group] as shortened right ear III-V and I-V inter peak latencies [more prominent right ear advantage]. In ABR also the amplitude of peak I in response to 90 dB nHL click stimulation was greater than the amplitude of peak V significantly in both groups of ASD children than controls