A cortical biomarker of audibility and processing efficacy in children with single-sided deafness using a cochlear implant.

The goals of the current study were to evaluate audibility and cortical speech processing, and to provide insight into binaural processing in children with single-sided deafness (CHwSSD) using a cochlear implant (CI). The P1 potential to acoustically-presented speech stimuli (/m/, /g/, /t/) was recorded during monaural [Normal hearing (NH), CI], and bilateral (BIL, NH + CI) listening conditions within a clinical setting in 22 CHwSSD (mean age at CI/testing 4.7, 5.7 years). Robust P1 potentials were elicited in all children in the NH and BIL conditions. In the CI condition: (1) P1 prevalence was reduced yet was elicited in all but one child to at least one stimulus; (2) P1 latency was prolonged and amplitude was reduced, consequently leading to absence of binaural processing manifestations; (3) Correlation between P1 latency and age at CI/testing was weak and not significant; (4) P1 prevalence for /m/ was reduced and associated with CI manufacturer and duration of CI use. Results indicate that recording CAEPs to speech stimuli in clinical settings is feasible and valuable for the management of CHwSSD. While CAEPs provided evidence for effective audibility, a substantial mismatch in timing and synchrony of early-stage cortical processing between the CI and NH ear remains a barrier for the development of binaural interaction components.

Outcomes of intubation and endoscopic DCR in functional nasolacrimal duct obstruction.

BACKGROUND: To ascertain the success of lacrimal intubation and DCR in alleviating epiphora due to functional nasolacrimal duct obstruction (FNLDO). METHODS: Consecutive adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to February 2021 were reviewed to identify cases with FNLDO. FNLDO was defined as epiphora with the exclusion of alternate causes of watering on clinical examination, patent lacrimal syringing, normal DCG, and post-sac delay on DSG. Epiphora resolution and improvement rates in FNLDO were compared between lacrimal intubation and endo-DCR. RESULTS: 23 endo-DCRs (20 patients, 65% females, mean age 68.9±12.2) and 41 intubations (29 patients, 61.2% females, mean age 65.0±14.1) performed in FNLDO were included. Resolution of epiphora was achieved in 15 of the DCR procedures (median follow-up 9 months) compared to 14 of intubations (median follow-up 10 months). Significant epiphora improvement (i.e., either improvement or resolution) was noted in 21 DCRs and 24 intubations. Seven patients undergoing intubation as the primary procedure had endo-DCR performed following the intubation. Among respondents to a phone questionnaire, 53.8% who had endo-DCR (median 69 months) and 50% that had intubation (median 28 months) reported significant improvement in epiphora. CONCLUSIONS: Improvement in epiphora due to FNLDO was approximately 59% in intubations, while the success of endo-DCR was higher (91%). The long-term results of these interventions warrant further investigation.

An Israeli national survey on ischemic colitis induced by pre-colonoscopy bowel preparation (R1).

Background and study aims: Ischemic colitis (IC) may occur as a complication of colonoscopy. The aim of this study was to characterize patients with IC that occurred after exposure to bowel preparation laxatives, prior to an elective colonoscopy. Patients and methods: A survey among Israeli gastroenterologists. Information was collected regarding individual cases. Results: Eight patients, who developed IC after bisacodyl ingestion that was taken as part of pre-colonoscopy bowel preparation protocol, were reported. In all patients, severe abdominal pain and/or hematochezia started shortly after the ingestion of the first dose of bisacodyl. IC was found in 7 patients during the planned colonoscopy and in 1 patient using computerized tomography. All patients received supportive treatment and recovered. Conclusions: IC induced by bisacodyl is a rare phenomenon. Regardless of being rare, we would advise withholding bisacodyl bowel preparation in elderly subjects with risk factors for IC that are scheduled for a colonoscopy.

Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve.

PURPOSE: Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome. In some cases, injury to the IBSN can lead to formation of a painful neuroma. The purpose of this study was to report the results of surgical treatment in a series of patients with IBSN painful neuroma. METHODS: We retrospectively identified 37 patients who underwent resection of IBSN painful neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months. Injury to the IBSN resulted from prior orthopedic surgery, vascular surgery, tumor resection, trauma, or infection. Leg pain and health-related quality of life were measured using the numeric rating scale (NRS) and EuroQol 5 dimensions (EQ-5D) questionnaire, respectively. Clinically meaningful improvement in leg pain was defined as reduction in NRS by at least 3 points. Predictors of favorable and unfavorable surgical outcome were investigated using multivariable logistic regression analysis. RESULTS: Patient-reported leg pain, health-related quality of life, and overall satisfaction with the surgical outcome were obtained at 94 ± 52.9 months after neuroma surgery. Postoperative patient-reported outcomes were available for 25 patients (68% of the cohort), of whom 20 patients (80.0%) reported improvement in leg pain, 17 patients (68.0%) reported clinically meaningful improvement in leg pain, and 17 patients (68%) reported improvement in health-related quality of life. The average NRS pain score improved from 9.43 ± 1.34 to 5.12 ± 3.33 (p < 0.01) and the average EQ-5D functional score improved from 10.48 ± 2.33 to 7.84 ± 2.19 (p < 0.01). Overall patient reported satisfaction with the surgical outcome was good to excellent for 18 patients (72.0%). Older age, multiple prior orthopedic knee surgeries, and failed prior attempts to resect an IBSN neuroma were associated with non-favorable surgical outcome. CONCLUSION: We conclude that surgical intervention is efficacious for appropriately selected patients suffering from IBSN painful neuroma.

Ibuprofen use and clinical outcomes in COVID-19 patients.

OBJECTIVE: It was recently suggested that ibuprofen might increase the risk for severe and fatal coronavirus disease 2019 (COVID-19) and should therefore be avoided in this patient population. We aimed to evaluate whether ibuprofen use in individuals with COVID-19 was associated with more severe disease, compared with individuals using paracetamol or no antipyretics. METHODS: In a retrospective cohort study of patients with COVID-19 from Shamir Medical Centre, Israel, we monitored any use of ibuprofen from a week before diagnosis of COVID-19 throughout the disease. Primary outcomes were mortality and the need for respiratory support, including oxygen administration and mechanical ventilation. RESULTS: The study included 403 confirmed cases of COVID-19, with a median age of 45 years. Of the entire cohort, 44 patients (11%) needed respiratory support and 12 (3%) died. One hundred and seventy-nine (44%) patients had fever, with 32% using paracetamol and 22% using ibuprofen, for symptom-relief. In the ibuprofen group, 3 (3.4%) patients died, whereas in the non-ibuprofen group, 9 (2.8%) patients died (p 0.95). Nine (10.3%) patients from the ibuprofen group needed respiratory support, compared with 35 (11%) from the non-ibuprofen group (p 1). When compared with exclusive paracetamol users, no differences were observed in mortality rates or the need for respiratory support among patients using ibuprofen. CONCLUSIONS: In this cohort of COVID-19 patients, ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol or no antipyretic.

Hearing threshold shifts among military pilots of the Israeli Air Force.

BACKGROUND: Military aviators are potentially at risk for developing noise-induced hearing loss. Whether ambient aircraft noise exposure causes hearing deficit beyond the changes attributed to natural ageing is debated. The aim of this research was to assess changes in hearing thresholds of Israeli Air Force (IAF) pilots over 20 years of military service and identify potential risk factors for hearing loss. METHODS: A retrospective cohort analysis was conducted of pure-tone air conduction audiograms of pilots, from their recruitment at 18 years of age until the last documented medical check-up. Mean hearing thresholds were analysed in relation to age, total flight hours and aircraft platform. Comparisons were made to the hearing thresholds of air traffic controllers (ATCs) who were not exposed to the noise generated by aircraft while on duty. RESULTS: One hundred and sixty-three pilots were included, with flying platforms ranging from fighter jets (n=54), combat helicopters (n=27), transport helicopters (n=52) and transport aircraft (n=30). These were compared with the results from 17 ATCs. A marked notch in the frequency range of 4-6 kHz was demonstrated in the mean audiograms of all platforms pilots, progressing with ageing. Hearing threshold shifts in relation to measurements at recruitment were first noted at the age of 30 years, particularly at 4 kHz (mean shift of 2.97 dB, p=0.001). There was no statistical association between flying variables and hearing thresholds adjusted for age by logistic regression analysis. CONCLUSIONS: The audiometric profile of IAF pilots has a pattern compatible with noise exposure, as reflected by characteristic noise notch. However, no flight variable was associated with deterioration of hearing thresholds, and no significant difference from non-flying controls (ATCs) was seen.

Mobile phone usage does not affect sudden sensorineural hearing loss.

OBJECTIVE: Recent studies found that mobile phone users had a significantly greater risk of having elevated thresholds in speech frequencies. This study investigated the correlation between the laterality of sudden sensorineural hearing loss, handedness and the preferred ear for mobile phone use. METHODS: The study included all patients who presented with sudden sensorineural hearing loss to the Department of Otolaryngology - Head and Neck Surgery in our tertiary referral medical centre between 2014 and 2016. Patients were asked to indicate their dominant hand and preferred ear for mobile phone use. RESULTS: The study comprised 160 patients. No correlation was found between the dominant hand or preferred ear for mobile phone use and the side of sudden sensorineural hearing loss. There was no correlation between the side of the sudden sensorineural hearing loss (preferable or non-preferable for mobile phone use) and audiometric characteristics. CONCLUSION: No correlation was found between the laterality of ears used for mobile phone and sudden sensorineural hearing loss.

Experimental demonstration of nonlinear pulse propagation in a fiber Bragg grating written in a fiber amplifier.

We study experimentally nonlinear propagation of sub-nanosecond optical pulses in a fiber Bragg grating written in a Ytterbium-doped fiber amplifier (YD-FBG). The magnitude and the sign of group velocity dispersion (GVD) in YD-FBG can be controlled by adjusting the fiber tension. In the case of anomalous GVD, pulse breakup was observed due to modulation instability. However, for the same input pulse power in the normal GVD regime, the output pulse duration was increased, and pulse breakup was not observed. The deterioration of pulse spectrum due to Raman and four-wave mixing effect was also reduced in the normal GVD regime. Since GVD in YD-FBG is six orders of magnitude higher than in standard fibers, the advantages of normal GVD in fiber amplifiers that were demonstrated in previous works for femtosecond and picosecond pulses can be exploited for amplifying sub-nanosecond pulses. The experimental results are in good agreement with numerical simulations. We have also demonstrated a gain coefficient enhancement by a factor of 1.7 due to slow-light propagation in the YD-FBG.

Neutrophil functions in morbidly obese subjects.

The present study aimed to determine different peripheral blood neutrophil functions in 18 morbidly obese subjects with body mass index (BMI) ranging between 35 and 69 kg/m(2) in parallel with age- and gender-matched lean controls. Peripheral blood neutrophil functions of obese subjects and matched lean controls were determined. Neutrophils of obese subjects showed significant elevation of the release of basal superoxides (P < 0.0001), formyl-methionyl-leucyl-phenylalanine (fMLP)-stimulated superoxides (P < 0.0001) and opsonized zymosan (OZ)-stimulated superoxides (P < 0.045) compared with lean controls. Interestingly, there were no differences in phorbol myristate acetate (PMA)-stimulated superoxide production by neutrophils of the obese subjects and controls. There was also a significant elevation of chemotactic (P < 0.0003) and random (P < 0.0001) migration of neutrophils from obese subjects compared with lean controls. Phagocytosis, CD11b surface expression and adherence of neutrophils from obese subjects were not significantly different from those of the lean controls. The elevated superoxide production and chemotactic activity, together with the normal phagocytosis and adherence, suggest that neutrophils from obese subjects are primed and have the capability to combat infections. However, neutrophils in the priming state may participate in the pathogenesis of obesity-related diseases.

Measurement of resonant and nonresonant induced refractive index changes in Yb-doped fiber grating amplifier.

We have measured the refractive index change (RIC) induced in a fiber Bragg grating (FBG) written in a Yb-doped fiber amplifier (YB-FBG) because of the amplifier pumping. The measurement was performed by exploiting the high sensitivity of the YD-FBG transmission to the RIC. We have separated between electronic and thermal contributions to the RIC based on the difference between the time-scales of the two effects. Because of high UV-induced loss in FBGs, the thermal contribution to the RIC is increased, in comparison with previously published work, where no grating was written in the fiber amplifier. The measurement method allows us to find the sign of each contribution to the RIC, and it requires only a few centimeters of fiber. Optimal pumping scheme for reducing the RIC in a YB-FBG is studied.

Low-dose ketamine affects immune responses in humans during the early postoperative period.

BACKGROUND: Anaesthesia and surgery are associated with impairment of the immune system expressed as an excessive proinflammatory immune response and suppression of cell-mediated immunity that may affect the course of the postoperative period. Addition of anaesthetic agents capable of attenuating the alterations in perioperative immune function may exert a favourable effect on patients' healing. We have assessed the effect of preoperative administration of a sub-anaesthetic dose of ketamine on the mitogen response and production of interleukin (IL)-1beta, IL-2, IL-6, and tumour necrosis factor (TNF)-alpha by peripheral blood mononuclear cells (PBMCs), as well as natural killer cell cytotoxicity (NKCC) in patients undergoing abdominal surgery. METHODS: Seventeen patients admitted for elective abdominal surgery were given ketamine 0.15 mg kg(-1) i.v. 5 min before induction of general anaesthesia. Nineteen patients received a similar volume of isotonic saline 5 min before induction of the anaesthesia. PBMCs were isolated from venous blood before and 4, 24, 48, and 72 h after operation for IL-1beta, IL-2, IL-6, and TNF-alpha secretion, and NKCC assessment. RESULTS: Four hours after operation, the cells from patients in the ketamine group showed a significantly suppressed production of IL-6 (P < 0.01) compared with controls. The production of IL-2 did not change from that of the preoperation samples. TNF-alpha secretion was significantly elevated in the control group 4 h after operation (P < 0.05). CONCLUSIONS: Addition of small doses of ketamine before induction of anaesthesia resulted in attenuation of secretion of the proinflammatory cytokines IL-6 and TNF-alpha, and in preservation of IL-2 production at its preoperative level. It is suggested that this anaesthetic may be of value in preventing immune function alterations in the early postoperative period.

Intraoperative transesophageal echocardiography during valve replacement surgery. A review.

Intraoperative transesophageal echocardiography (IOTEE) has become an important diagnostic and monitoring tool in the operating theatre during cardiac and noncardiac operations. However, its routine application during valve replacement operations has not received universal recognition. The cumulative experience, brought up in this review, shows that IOTEE is invaluable during valve replacement operations. It has an important role in the consolidation of operative strategy, although it is generally better to obtain all the anatomical and physiological data and the resultant operative strategy in advance, outside the operating room environment. Important data influencing the operative plan has been reported in 3-29% of operations in various studies. The postpump IOTEE is also essential for numerous reasons: it can rule out important misfortunes, such as leaflet immobilization or perivalvular leak, leaky bioprosthesis or coronary obstruction due to valve struts, and is responsible for second pump-run in 3-6% of cases; it is essential in monitoring the deairing process; it provides the surgeon and the anesthesiologist data on biventricular function and volume and exclusion of dynamic left ventricular outflow tract obstruction, and, therefore, guides pharmacotherapy, volume handling and mechanical assistance, including intra-aortic balloon pump indication and location. In conclusion, IOTEE is an essential tool in patients undergoing valve replacement operations, and should be used on a standard basis.

''BioGlue'' as a possible cause of acute blocked mechanical mitral valve leaflet.

A young patient with aortic and mitral valve infective endocarditis and advanced destruction of the surrounding tissues underwent a complex reconstructive surgery, including double valve replacement, reconstruction of aortic-mitral continuity and ascending aorta. Intraoperative transesophageal echocardiography revealed a blocked mitral leaflet, which was released by valve cleaning and reorientation. The application of biological glue may be a key point for this complication.

[Management of the pediatric dental patient with seizure disorder: prevention and treatment of emergencies].

Seizures are not infrequent in childhood and may occur during dental treatment. Generalized seizures and particularly the Tonic-clonic (grand-mal) are the most hazardous and may induce self-injury, aspiration, and medical emergency as status epilepticus. The differential diagnosis of isolated seizure attack should consider hyperventilation, hyperglycemia, local anesthetic toxicity, and anoxia. The pediatric dentist should be aware of predisposing factors that may induce seizure attack in their patients. Proper precautionary measures could prevent the attack from occurring or at least reduce its consequences. The diagnosis as to the cause of the seizure, as well as providing proper management, could prevent further complications. This article presents the medical and dental history relevant for prevention of seizure attack in the dental chair, antiepileptic drugs with possible interactions with the dental treatment and management of such attack, should they occurs.

[Respiratory emergencies in the pediatric dental clinic: prevention and treatment].

Emergency situations can occur in the Pediatric Dental Clinic. The purpose of this article is to focus on signs and symptoms of emergencies involving the airway, such as aspiration of foreign bodies, asthma attacks, obstruction of the airway as a consequences of physiological and pathological causes and sedation-induced apnea. Preventive and diagnostic tools, and protocols are presented, as well as a schematic flow chart of the management of airway obstruction due to foreign bodies. A new classification of risk factors that considers the parameters of sleep apnea risk, tonsil size, sedation level, patient's health status and dentist's qualification is also suggested.

[Management of the pediatric dental patient with metabolic and hormonal disorders: prevention and treatment].

Metabolic and hormonal disorders can compromise the safety of child undergoing dental treatment. This article focuses on type I Diabetes mellitus and adrenal cortex disorders, which are more common in children. The pediatric dentist should be fully aware of the child's medical status and modify the treatment plane accordingly. Special attention should be made to the management of the anxious child with or without the need for pharmacological management. This article presents schematic flow chart for treatment emergencies in the diabetic patient and also protocols of treating the child who suffers from primary or secondary adrenal insufficiency.

[Emergencies evolving from local anesthesia in the pediatric dental clinic: prevention and treatment].

A wide range of drugs and dental materials may be used when providing treatment to children. Routine medical and dental history may not provide all the necessary information to prevent allergic reactions, since young patients may be exposed to some of these drugs for the first time in the dental chair. The dentist should be prepared through training to reduce and at the same manage unwanted side effects. This article focuses on the possible adverse reactions following injection of local anesthetics; mainly, allergic and toxic side effects. Signs and symptoms are described and differential diagnosis is considered. The limited and absolute contraindication for administering some common local anesthetics is presented and local anesthetic drug interactions and toxicity relevant to pediatric patients are reviewed.

The safety and efficacy of repeated courses of tissue-type plasminogen activator in patients with stuck mitral valves who did not fully respond to the initial thrombolytic course.

In carefully selected patients with stuck mitral valves, thrombolytic therapy is becoming an established therapeutic modality. However, the management of patient with a suboptimal response to an initial thrombolytic course is unclear. The objective was to evaluate the efficacy and safety of re-administration of tissue-type plasminogen activator (rt-PA) in patients with stuck mitral valves in whom the first thrombolytic course has failed to restore normal prosthetic valve function. The study group included patients who received rt-PA and did achieve a full restoration of valve function after the initial course. Data were gathered on the safety and success rates of additional thrombolytic courses in the same hospitalization period, and their predictors. Twelve patients with stuck mitral valves experienced a total of 13 episodes in which a full resolution of leaflet abnormality was not achieved after the initial thrombolytic course. A repeated thrombolytic course was attempted in 10 patients (11 episodes). Six patients (60%) showed full success rate with repeated thrombolysis, one (10%) showed partial success, and three patients (30%) had no improvement following the second course. These last three were those with initial failure. Age, gender, valve model, worst functional class, time since valve implantation and International Normalized Ratio (INR) levels were similar in both groups. No major adverse events were noted. In this small group of patients with stuck mitral valves, re-administration of rt-PA after a partial response to an initial thrombolytic course was effective and safe. However, total failure of the first thrombolytic course predicted inefficiency of further courses.