Surgical and functional outcomes of cochlear implantation in post-lingual and cross-over patients: First 5-year review of the National Ministry of Health Malaysia cochlear implant programme.

INTRODUCTION: There has been a paradigm shift in the management of acquired sensory neural deafness in the past 30years. This is due to the emergence of implantable hearing devices such as the cochlear implant. The objective of this study is to identify surgical and functional outcomes of post-lingual and cross-over patients implanted with a cochlear implant under the National Ministry of Heath Cochlear Implant (CI) Program between 2009-2013. MATERIALS AND METHODS: We retrospectively reviewed all postlingual and cross-over recipients of cochlear implants under the National Ministry of Heath CI Programme from 2009 to 2013. The outcomes measured were surgical complications and functional outcome. Surgical complications were divided into major and minor complications. Functional outcomes were measured using Categorical Auditory Performances (CAP) scale. RESULTS: A total of 41 post-lingual and 15 cross-over patients were implanted between 2009 and 2013. The age of implantees ranged from 3.6 years to 63.2 years old. There were two major complications (3.6%), one is a case of electrode migration at three months post implantation, and six months post second implantation. Another was a case of device failure at about one-year post implantation. Both patients were reimplanted in the same ear. There was no minor complication. The CAP score for both groups (overall) showed significant improvement with 96.4% achieved CAP score of five and above at 24 months after implantation (p<0.001). The CAP score showed marked improvement at the first 6 months post implantation and continued to improve with time in both groups. CONCLUSION: The Malaysian National Ministry of Health Cochlear implant (CI) Program between 2009-2013 has been a successful programme with good surgical and functional outcomes among the post lingual and cross-over patients.

Author's reply: Sepsis biomarkers in severe burn patients: Cut-off point or time profile? / Respuesta de los autores: Biomarcadores de sepsis en pacientes quemados graves: ¿punto de corte o perfil temporal?

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Infections in critically ill burn patients / Infecciones en los enfermos quemados críticos

Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations

Los pacientes con quemaduras graves son un subgrupo de pacientes críticos en los que la lesión por quemadura aumenta el riesgo de infección, de respuesta inflamatoria sistémica y de sepsis. Las infecciones suelen estar relacionadas con los dispositivos y la quemadura. La mayoría de las infecciones, al igual que en otros pacientes críticos, están precedidas por la colonización del tracto digestivo y de medidas preventivas que incluyen la descontaminación digestiva selectiva y las medidas de higiene. La escisión precoz de las quemaduras profundas y el uso adecuado de los antimicrobianos tópicos y apósitos se consideran de suma importancia en el tratamiento de las quemaduras. Los pacientes con quemaduras graves suelen tener un cierto nivel de inflamación sistémica. La dificultad para diferenciar inflamación de sepsis es relevante debido a que la terapia difiere entre los pacientes con y sin sepsis. El retraso en la prescripción de antimicrobianos aumenta la morbimortalidad. Además, el uso generalizado de antibióticos en todos estos pacientes es probable que aumente la resistencia a estos y los costes. Desafortunadamente, la utilidad clínica de biomarcadores para el diagnóstico diferencial entre inflamación y sepsis aún no ha sido adecuadamente evaluada. La lesión por quemadura severa induce una respuesta fisiológica que altera significativamente la farmacocinética y farmacodinámica de los fármacos. Estas alteraciones afectan a la distribución y excreción de los antimicrobianos. Sin embargo, la literatura disponible actual muestra que hay una escasez de información para apoyar las recomendaciones de dosis rutinarias

Infections in critically ill burn patients.

Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.

Vibration frequency measurement using a local multithreshold technique.

In this paper, we demonstrate the use of a video camera for measuring the frequency of small-amplitude vibration movements. The method is based on image acquisition and multilevel thresholding and it only requires a video camera with high enough acquisition rate, not being necessary the use of targets or auxiliary laser beams. Our proposal is accurate and robust. We demonstrate the technique with a pocket camera recording low-resolution videos with AVI-JPEG compression and measuring different objects that vibrate in parallel or perpendicular direction to the optical sensor. Despite the low resolution and the noise, we are able to measure the main vibration modes of a tuning fork, a loudspeaker and a bridge. Results are successfully compared with design parameters and measurements with alternative devices.

External mill monitoring of wheat flour fortification programs: an approach for program managers using experiences from Jordan.

The fortification of wheat flour with micronutrients is a common strategy to increase vitamin and mineral intake. While wheat flour mills are often inspected by agencies affiliated with national ministries to ensure compliance with national fortification standards, few countries use data derived from these inspections to construct an external monitoring system for use in program management and evaluation. The primary objective of this paper is to assess the performance of the external monitoring system utilized in Jordan according to the US Centers for Disease Control and Prevention's Updated Guidelines for Evaluating Public Health Surveillance Systems. A secondary objective is to present mill monitoring results from 2009 to 2010 in order to demonstrate the data generated by the system. The review concludes that the data required for the system is representative, simple to collect, and can be collected in a flexible manner. The external monitoring system is acceptable to participating agencies and millers and is stable due to mandatory fortification legislation which provides the legal framework for external monitoring. Data on production of fortified flour and utilization of premix can be provided in a timely manner, but on-site mill monitoring and flour sample collection are more challenging due to resource constraints. The frequent collection of a small number of indicators can provide fortification program managers with timely information with which to base decisions. Jordan's external monitoring system successfully documented the performance of each mill and the entire flour fortification program, and can serve as a model for other national fortification programs considering external monitoring approaches.

Three dimensional analysis of chromatic aberration in diffractive elements with extended depth of focus.

The paper presents the polychromatic analysis of two diffractive optical elements with extended depth of focus: the linear axicon and the light sword optical element. Chromatic aberration produces axial displacement of the focal segment line. Thus, we explore the possibility of extending the focal depth of these elements to permit superposition of the chromatic foci. In the case of an axicon, we achieve an achromatic zone where focusing is produced. In the case of the light sword element, we show that the focusing segment is out of axis. Therefore a superposition of colors is produced, but not on axis overlapping. Instead, three colored and separated foci are simultaneously obtained in a single plane. Three dimensional structures of the propagated beams are analyzed in order to provide better understanding of the properties and applications of such elements.

Retraso de la maduración ósea e hipoplasia de los pulgares en un niño de cinco años / Bone age delay and hypoplastic thumbs in a five year-old boy

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[Sensitivity and specificity of criteria of left ventricular hypertrophy for predicting cardiovascular complications in the Bordeaux cohort of hypertensive patients]. / Sensibilité et spécificité des différents critères d'hypertrophie ventriculaire gauche pour la prédiction des complications cardiovasculaires dans une cohorte d'hypertendus bordelais.

Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular complications independently of other known risk factors. Since 1983, we have followed up a cohort of initially untreated hypertensive patients with echocardiographic measurements of left ventricular mass (LVM). We analyzed the data on 474 patients with more than five years' follow-up to assess the prognostic value of LVM and the sensitivity and specificity of the different ways to index for LVM through ROC curves. Forty patients were lost to follow-up. The mean follow-up period was 89 +/- 31 months. A cardiovascular complication was recorded in 40 individuals. There was a strong link between increased LVM and the occurrence of complications. Indexation by body surface area or height to the power 2.7 give the [table: see text] greatest area under the curve (AUC) to discriminate between patient with or without cardiovascular events. To get the same sensitivity in females and in males for the prediction of future events, lower cut-off must be used in females.

Prognostic significance of blood pressure measured on rising.

Previous works using ambulatory blood pressure (BP) monitoring demonstrated that independently of the mean level of BP, the variability in BP, or the day-night range, could have prognostic significance. We have also found that the value of BP on rising in the morning is strongly correlated with left ventricular mass of hypertensive individuals independently of the 24-h value. In the present study, we sought its predictive value for cardiovascular complications in a cohort of hypertensive patients. The population studied belongs to a cohort of initially untreated hypertensive patients recruited since 1983 and followed for more than 5 years. Patients were then treated and followed by their family doctor. At entry, all patients were equipped with a device to measure ambulatory BP. They were requested to trigger a measurement manually on rising in the morning (arising BP). The data on their outcome were collected by a physician unaware of the initial state of the patients. A total of 256 patients have been followed up for 5 years or more, 19 were lost to follow-up. The mean follow-up period was 84 +/- 29 months. Cardiovascular complications were recorded in 23 individuals. The arising systolic BP (SBP) was significantly higher in the group who presented a complication. In a stepwise discriminant analysis including age, office, fitting, arising and 24-h average SBPs only age and arising SBP entered the equation. In conclusion, the single BP value measured by an ambulatory device on rising in the morning seems more discriminant of future cardiovascular events than the value of BP measured on fitting the device or the average of three measurements taken under standardised conditions in the hospital or office.

Ambulatory measurement of the QKD interval normalized to heart rate and systolic blood pressure to assess arterial distensibility--value of QKD(100-60).

BACKGROUND: Reduced distensibility of large arteries plays an important role in cardiovascular risk. Determination of the QKD interval during the ambulatory measurement of blood pressure enables calculation of an index of arterial distensibility. This index, the QKD(100-60), is the theoretical value of QKD at systolic blood pressure of 100mmHg and heart rate of 60bpm obtained from the linear bivariate relationship linking QKD, systolic blood pressure and heart rate on a hundred successive values measured over 24h. This study was designed to examine the relationship between QKD and QKD(100-60) on heart rate and systolic function of the left ventricle, the two parameters governing the pre-ejection time which is part of the QKD interval. METHODS AND RESULTS: In a population of 203 untreated hypertensive patients having benefited from an ambulatory measurement of blood pressure over 24h with QKD monitoring and an M-mode echocardiographic recording of the left ventricle, we found that although mean QKD was linked to heart rate and systolic function of the left ventricle, QKD(100-60) was not. It fell significantly with age, and to a greater extent in the sustained hypertensives than in white-coat hypertensives. CONCLUSION: QKD(100-60) constitutes an index of arterial distensibility independent of the pre-ejection time. As an adjunct to the ambulatory measurement of blood pressure, its determination is simple and completely automatic, thus eliminating observer bias.

Prognostic value of left ventricular mass and its evolution during treatment in the Bordeaux cohort of hypertensive patients.

Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular complications independently of other known risk factors, but so far the predictive value of its evolution under treatment has been studied relatively little. Since 1983 we have followed up a cohort of initially untreated hypertensive patients with echocardiographic measurements of left ventricular mass (LVM). We analyzed the data on 474 patients with more than 5 years of follow-up to assess the prognostic value of LVM and its evolution during treatment for high blood pressure. A total of 40 patients were lost to follow-up. The mean follow-up period was 89 +/- 31 months. A cardiovascular complication was recorded in 40 individuals. There was a strong link between increased LVM and the occurrence of complications (P < .001). At least a second determination of LVM was performed in 311 patients, and the last value before the occurrence of any complication (60 +/- 38 months after the initial examination) was retained. In this subgroup, 28 patients presented with a cardiovascular event. There was a trend toward a reduction of the incidence of events in the group with a regression of LVH as compared to the group with persistent LVH, but there was no difference when patients were split into quartiles according to LVM evolution between baseline and follow-up. Thus, the reduction of LVM on treatment was not a good marker of future cardiovascular events and its seems at least premature to say that LVM fulfils all conditions for a surrogate end point in the evaluation of morbidity/ mortality in the hypertensive.

Three-dimensional object recognition by fourier transform profilometry.

An automatic method for three-dimensional (3-D) shape recognition is proposed. It combines the Fourier transform profilometry technique with a real-time recognition setup such as the joint transform correlator (JTC). A grating is projected onto the object surface resulting in a distorted grating pattern. Since this pattern carries information about the depth and the shape of the object, their comparison provides a method for recognizing 3-D objects in real time. A two-cycle JTC is used for this purpose. Experimental results demonstrate the theory and show the utility of the new proposed method.

A short standardized protocol for measuring the QKD interval: comparison with 24 h monitoring and reproducibility.

BACKGROUND: Ambulatory measurement for the QKD interval is a new method for evaluation of the rigidity of large arterial trunks. Reliable indices of arterial rigidity can be distilled from the large number of measurements (usually around 100) obtained during 24 h monitoring. OBJECTIVE: To describe a shorter standardized protocol (4 h) including a 15 min effort test on an ergometric bicycle designed to reduce examination time and generate a wider range of heart rates and blood pressures, to test the equivalence of this short protocol with 24 h monitoring and to test its reproducibility. DESIGN: The results of the short protocol were compared with 24 h monitoring results for 15 subjects. The reproducibility of the short protocol for 15 subjects examined twice within 7 days was studied. RESULTS: We found a good correlation between the values obtained with this method and those from 24 h recordings, with comparable reproducibilities in the determination of QKD for systolic blood pressure 100 mmHg and heart rate 60 beats/min. CONCLUSION: A short (4 h) standardized protocol including an exercise test could replace 24 h ambulatory monitoring to assess arterial distensibility through QKD measurement.

Nonlinear morphological correlation: optoelectronic implementation.

An optoelectronic implementation of the nonlinear morphological correlation by use of a threshold-decomposition technique and a joint transform correlator architecture is presented. This nonlinear morphological correlation provides improved image detection compared with standard linear optical pattern-recognition correlation methods. It also offers a more robust detection of low-intensity images in the presence of high-intensity patterns to be rejected.

Optoelectronic implementation of the triple correlation.

The auto triple correlation has several fundamental advantages over the ordinary autocorrelation of second order. We present an optoelectronic processor for the computation of the auto triple correlation.

Fractional wavelet transform.

The wavelet transform, which has had a growing importance in signal and image processing, has been generalized by association with both the wavelet transform and the fractional Fourier transform. Possible implementations of the new transformation are in image compression, image transmission, transient signal processing, etc. Computer simulations demonstrate the abilities of the novel transform. Optical implementation of this transform is briefly discussed.

[Criteria for quantification and characterization of aneurysms of the abdominal aorta using ultrasonography. The AFFCA study. French Association of Continuous Education in Angiology]. / Critères de quantification et de caractérisation des anévrysmes de l'aorte abdominale par l'échographie. Etude AFFCA. Association Française de Formation Continue en Angiologie.

OBJECTIVE: To validate ultrasonographic quantification and characterization criteria for aneurysms of the abdominal aorta (AAA) by comparing computed tomography data and surgical findings in order to standardize diagnosis and follow-up of AAA. PATIENTS AND METHODS: A multicentric prospective study included 80 patients with AAA (January to August 1996). Standardized data on quantitative (diameter, surface area) and qualitative (topography, form, wall, thrombus) data were obtained at each ultrasound examination and at surgery. Ultrasound (US) and computed tomography (CT) explorations were performed and interpreted without prior knowledge by independent operators. US findings versus CT reference were compared in 77 cases, US findings versus surgical reference in 31, and CT findings versus surgery reference in 28. RESULTS: Compared with CT-scan, B mode ultrasound (n = 77) underestimated the anteroposterior diameter of the aneurysm (mean difference -2.16 mm; p < 0.001), the anteroposterior diameters of the flow channel lumen (-5.54 mm; p < 0.001) and upper neck of the aneurysm (-2.74 mm; p < 0.001). Surface area measurements were not significantly different both the aneurysmal sac (p = 0.3) and the flow channel lumen (p = 1). Compared with surgical findings, US (n = 30) underestimated the transverse diameter (mean difference (-4.29 mm; p = 0.0037). Compared with surgery, US findings (n = 28) were not significantly different for the anteroposterior ans transverse diameters. Analyzing the form and wall of the AAA, US/CT-scan performance was good for symmetrical fusiform aneurysms (sensitivity 77%, specificity 67%). US and CT-scan were reliable for detecting wall bugles (same sensitivity, 29%). The angle formed by the thrombus with the wall (expressed in degrees) was not significantly different (p = 0.9). When the lower pole of the aneurysm was situated above the aortic bifurcation, US (sensitivity 75%) was more reliable than the CT-scan (sensitivity 50%) compared with surgical findings. CONCLUSION: Ultrasonography should not be limited to the simple positive diagnosis of AAA. A precise analysis of the diameters and surface areas of the aneurysm should be performed.