Dizziness, Falls, and Hearing Loss in Adults Living With Sickle Cell Disease.

OBJECTIVE: The aim of this study was to assess the prevalence of reported dizziness/imbalance, frequency of falls, and hearing loss in adults with sickle cell disease (SCD) and determine the relationship of these self-reported problems both during and in the absence of an SCD crisis. Also, the impact of educational level and health insurance on seeking treatment services, as well as the relationship of falls to stroke, legal blindness, and other orthopedic problems, was assessed. Interrupted blood flow to shared vestibular and auditory arteries supports the notion of increased likelihood of balance deficits and increased falls in this population. DESIGN: A cross-sectional survey study design was used. Adults living with SCD responded to a questionnaire that was distributed online and through traditional mail. STUDY SAMPLE: Adults living with SCD (N = 135) participated in the study. RESULTS: Responses revealed 70% of participants with SCD experienced dizziness/imbalance and 23% reported hearing loss. Furthermore, 33% of participants reported falling one or more times in the last year. The prevalence of dizziness/imbalance, falling, and hearing loss in the respondents with SCD was much higher than that of the general population of the United States. Additionally, for dizziness and falling, the prevalence was higher not only than the national average but also for persons over 65 years of age. A significant association was demonstrated between dizziness/imbalance and hearing loss as well as dizziness/imbalance and falls for adults living with SCD. In fact, participants with self-reported hearing loss were 5.2 times more likely to also report dizziness/imbalance. They were 4.9 times more likely to fall if they also reported dizziness/imbalance. Numbness of the feet was revealed to significantly impact the likelihood of falling in this disease population and should be further studied. Regarding SCD crisis status, dizziness/imbalance and falls were more likely to occur outside of SCD crisis than during a crisis. Furthermore, pain levels were significantly associated with dizziness/imbalance only when respondents were in crisis and not in the absence of a crisis. In crisis, higher pain levels were reported from respondents who also reported dizziness/imbalance than from those who did not report dizziness. No significant relationship was revealed between hearing loss and falls. DISCUSSION: These results provide justification for patient and health care provider education regarding appropriate referrals for vestibular/balance assessments and provision of fall prevention strategies. Future studies on balance and SCD are encouraged.

The Colostomy of Duret for the High Risk Patient.

Background: Heitzer and Duret described the surgical creation of colostomy in the 1700s, more than a century before the introduction of anesthesia. With the ever increasing degree of frailty in patients of advanced age who require surgical intervention, a simplified methodology for the creation of a colostomy based on their original reports is described and the advantages for use in high risk patients and the critical care setting is discussed. Methods: Eleven patients underwent simplified colostomy under local anesthesia, without complication. Results: All colostomies functioned normally within hours. There were no bleeding or infectious complications, nor peri-operative adverse events. Conclusions: Colostomy formation can be safely performed under local anesthesia when the patient is considered too high risk to undergo general anesthesia.

Public Health Response to Zika Virus Exposure of Air Force Members Deployed to Caribbean Islands, 2016.

INTRODUCTION: The emergence of Zika virus disease (ZVD) in areas of military operations provided a new opportunity for force health protection. ZVD infection had an estimated 4:1 asymptomatic-to-symptomatic ratio and can cause neurologic sequelae. MATERIALS AND METHODS: We provide a brief report of a field investigation utilizing laboratory-based surveillance and survey instruments to characterize ZVD risk among personnel deployed to the Dominican Republic in support of Operation NEW HORIZONS (NH). Additionally, we describe a cluster of 3 ZVD cases among 8 aircrew on a short mission to St. Croix (U.S. Virgin Islands). RESULTS: Following Operation NH, 6 of a total 189 deployed cohort members tested positive for ZVD by immunoglobulin M and confirmatory plaque reduction neutralization test (3.2%). Reverse transcription polymerase chain reaction testing in urine or serum was positive in 4 of those 6 cases. All 6 cases reported at least one symptom, with 5 reporting subjective fever and arthralgia and 4 reporting rash. Cases were less likely to have air-conditioned living quarters (odds ratio = 0.1; 95% confidence interval 0.02-0.77; P < 0.03), but were otherwise similar to non-cases. Likewise, in St. Croix, 3/8 tested positive by immunoglobulin M and plaque reduction neutralization test for an attack rate of 38%. Similar to Operation NH, all three cases were symptomatic with subjective fever (67%), arthralgia (67%), and/or rash (100%). CONCLUSIONS: This field investigation identified differing, mission location-dependent ZVD attack rates and a 0:9 asymptomatic-to-symptomatic case ratio. As this was unexpected based on a previous report of a 4:1 ratio, it emphasizes the need to be cautious before generalizing outbreak characteristics between populations while also offering additional practical experience for force health protection.

Static Positional Nystagmus in the Healthy Vestibular System.

BACKGROUND: A repeat of the seminal 1973 study on static positional nystagmus (PN) using more accurate recording techniques. PURPOSE: The purpose was to further characterize PN and, using current data, introduce new clinical criteria for its identification. RESEARCH DESIGN: Static PN was recorded in ten positions with vision denied. Each position was analyzed using age, gender, presence, direction, and persistence of nystagmus while taking into account the number of beats and mean slow-phase velocity (SPV). STUDY SAMPLE: One hundred healthy patients who were asymptomatic with no known neurological disorders were tested. INTERVENTION: No intervention was used. DATA COLLECTION: Analysis of variance, descriptive statistics, and confidence intervals were used to describe results. RESULTS: Results showed 74% of normal participants had horizontal nystagmus in at least one position. Only 7% of the observed nystagmus was persistent. The average SPV was 2°/sec. The mean number of positions in which nystagmus was observed was three. Neither age nor gender influenced the occurrence of nystagmus. Forty-three percent of the participants had vertical nystagmus in at least one position; however, the SPV was 2°/sec or less. CONCLUSIONS: The present study demonstrated that intermittent or persistent PN in four or fewer positions should not be considered pathological when the SPV is 4°/sec or less (n = 100). Observance of vertical nystagmus in one position should not be considered pathological if the SPV is 2°/sec or less. Suggested positions for positional testing should include seated-upright, supine, head right, head left, head-hanging, and the precaloric (30° supine) positions. Fixation when PN is observed is indicated.

Role of Food Insecurity in Outbreak of Anthrax Infections among Humans and Hippopotamuses Living in a Game Reserve Area, Rural Zambia.

In September 2011, a total of 511 human cases of anthrax (Bacillus anthracis) infection and 5 deaths were reported in a game management area in the district of Chama, Zambia, near where 85 hippopotamuses (Hippopotamus amphibious) had recently died of suspected anthrax. The human infections generally responded to antibiotics. To clarify transmission, we conducted a cross-sectional, interviewer-administered household survey in villages where human anthrax cases and hippopotamuses deaths were reported. Among 284 respondents, 84% ate hippopotamus meat before the outbreak. Eating, carrying, and preparing meat were associated with anthrax infection. Despite the risk, 23% of respondents reported they would eat meat from hippopotamuses found dead again because of food shortage (73%), lack of meat (12%), hunger (7%), and protein shortage (5%). Chronic food insecurity can lead to consumption of unsafe foods, leaving communities susceptible to zoonotic infection. Interagency cooperation is necessary to prevent outbreaks by addressing the root cause of exposure, such as food insecurity.

Understanding the mechanisms underlying pulsating aerosol delivery to the maxillary sinus: In vitro tests and computational simulations.

BACKGROUND: Pulsating aerosol delivery has been demonstrated in depositing medications into paranasal sinuses. However, its mechanisms are not fully understood. Influences of the nasal anatomy and sound frequency on intrasinus delivery are not yet clear. OBJECTIVES: This study aimed to gain a better understanding of the mechanisms for enhanced intrasinus delivery with pulsating sound. Specifically, effects of the pulsation frequency, ostium size, and sinus shape on the intrasinus dosage and resonance frequency would be examined. METHODS AND MATERIALS: Both experiments and computational modeling were conducted to understand the pulsating aerosol delivery in both idealized (two-bottle) and realistic nose-sinus models. A computational model of intrasinus pulsation delivery was developed using COMSOL and was cross-validated with both experimental and theoretical results. RESULTS: In contrast to previous studies, seemingly erratic relations between the intrasinus dosage and ostium diameter were observed in experiments, which suggested a more complicated particle transport mechanism. Improved agreement was achieved when grouping the ostium size and sinus volume into the resonance frequency, and therefore, validated the hypothesis that intrasinus deposition strongly depends on the resonance frequency. Extensive computational simulations revealed that the deposition was highest at the resonance frequency and decreased gradually at off-resonance frequencies. The resonance frequency depended on the ostium and sinus morphology, but was independent of the nasal cavity. CONCLUSION: Results of this study verified the hypothesis of resonance being the mechanism for enhanced particle deposition in the maxillary sinus. A better knowledge of the relationship between sinus dosages, pulsating frequency, and nasal morphometry is essential for improving the design of intrasinus delivery devices.

Investigation of inhalation anthrax case, United States.

Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.

A literature review of laboratory-acquired brucellosis.

Brucellosis is a bacterial zoonotic disease which has been associated with laboratory-acquired infections. No recent reviews have addressed the characteristics of laboratory-acquired brucellosis (LAB). English-language literature was reviewed to identify reports of laboratory exposures to Brucella spp. and LAB cases between 1982 and 2007. Evaluation of 28 case reports identified 167 potentially exposed laboratory workers, of whom 71 had LAB. Nine reports were identified that summarized an additional 186 cases of LAB. Only 18 (11%) exposures were due to laboratory accidents, 147 (88%) exposures were due to aerosolization of organisms during routine identification activities, and the circumstances of 2 (1%) exposures were unknown. Brucella melitensis was the causative agent in 80% (135/167) of the exposures. Workers with high-risk exposures were 9.3 times more likely to develop LAB than workers with low-risk exposures (95% confidence interval [CI], 3.0 to 38.6; P < 0.0001); they were also 0.009 times likelier to develop LAB if they took antimicrobial PEP than if they did not (95% CI, 0 to 0.042; P < 0.0001). The median incubation period in case and summary reports was 8 weeks (range 1 to 40 weeks). Antimicrobial PEP is effective in preventing LAB. The incubation period may be used to identify appropriate serological and symptom surveillance time frames for exposed laboratory workers.

Metrics for comparing three word-based software programs used for augmentative and alternative communication.

The purpose of this investigation was to conduct an analysis of a set of metrics developed for comparing features of software used in speech generating devices (SGD) for augmentative and alternative communication (AAC). These metrics - measures of speed, efficiency, and accuracy - were employed during a sentence reconstruction task. Twenty two participants without disabilities reconstructed nine sentences using each of three SGD software programs, counterbalanced to remove order effects. Results revealed differences in the metrics across the software programs that were supported by a social validation survey completed by the participants. These results provide benchmark data about relative speed, accuracy, and efficiency of these software programs in structured use, and can inform professionals in matching potential AAC users with specific features of word-based software.

Shooting habits of U.S. waterfowl hunters.

Exposure to high-intensity impulse noise from the recreational use of firearms is a common cause of noise-induced hearing loss (NIHL). Although recreational firearm users who shoot firearms without proper hearing protection are at risk for NIHL, a specific subgroup involved in hunting waterfowl may also be at risk due to their particular shooting habits. The goal of the present study was to investigate the shooting habits of this particular group of U.S. recreational firearm users. A 23-item written survey was sent to waterfowl hunting club members regarding their shooting behaviors, use of hearing protective devices (HPDs), and auditory status. Results indicated that waterfowl hunters in this study typically used large bore semiautomatic shotguns, did not consistently utilize HPDs during target practice or hunting and were exposed to multiple, unprotected shots during the past waterfowl season. Most subjects reported hunting in reverberant acoustic environments (hunting blinds). This group of recreational firearm users also reported high incidences of hearing loss and tinnitus. Information provided by this study may help hearing conservationists and hearing healthcare providers understand and better educate these shooters regarding the risk of acquiring NIHL.

Anticholinergic activity of 107 medications commonly used by older adults.

The objective of this study was to measure the anticholinergic activity (AA) of medications commonly used by older adults. A radioreceptor assay was used to investigate the AA of 107 medications. Six clinically relevant concentrations were assessed for each medication. Rodent forebrain and striatum homogenate was used with tritiated quinuclidinyl benzilate. Drug-free serum was added to medication and atropine standard-curve samples. For medications that showed detectable AA, average steady-state peak plasma and serum concentrations (C(max)) in older adults were used to estimate relationships between in vitro dose and AA. All results are reported in pmol/mL of atropine equivalents. At typical doses administered to older adults, amitriptyline, atropine, clozapine, dicyclomine, doxepin, L-hyoscyamine, thioridazine, and tolterodine demonstrated AA exceeding 15 pmol/mL. Chlorpromazine, diphenhydramine, nortriptyline, olanzapine, oxybutynin, and paroxetine had AA values of 5 to 15 pmol/mL. Citalopram, escitalopram, fluoxetine, lithium, mirtazapine, quetiapine, ranitidine, and temazepam had values less than 5 pmol/mL. Amoxicillin, celecoxib, cephalexin, diazepam, digoxin, diphenoxylate, donepezil, duloxetine, fentanyl, furosemide, hydrocodone, lansoprazole, levofloxacin, metformin, phenytoin, propoxyphene, and topiramate demonstrated AA only at the highest concentrations tested (patients with above-average C(max) values, who receive higher doses, or are frail may show AA). The remainder of the medications investigated did not demonstrate any AA at the concentrations examined. Psychotropic medications were particularly likely to demonstrate AA. Each of the drug classifications investigated (e.g., antipsychotic, cardiovascular) had at least one medication that demonstrated AA at therapeutic doses. Clinicians can use this information when choosing between equally efficacious medications, as well as in assessing overall anticholinergic burden.

A model of anticholinergic activity of atypical antipsychotic medications.

BACKGROUND: Atypical antipsychotics clozapine, olanzapine, and quetiapine have significant affinity for the muscarinic receptors in vitro, while aripiprazole, risperidone, and ziprasidone do not. Dissimilarity in binding profiles may contribute to the reported differences in the anticholinergic effects of these antipsychotics. However, it is difficult with the available data to predict the likelihood of anticholinergic effects occurring with various doses of an atypical antipsychotic. METHODS: We developed a model to assess the potential anticholinergic activity (AA) of atypical antipsychotics at therapeutic doses. A radioreceptor assay was used to measure in vitro AA at 6 clinically relevant concentrations of aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. Using published pharmacokinetic data, in combination with the measured in vitro AA, dose-AA curves were generated. RESULTS: Clozapine, and to a lesser extent olanzapine and quetiapine showed dose-dependent increases in AA. At therapeutic doses, the AA (in pmol/mL of atropine equivalents) was estimated to range from 27-250, 1-15, and 0-5.4 pmol/mL for clozapine, olanzapine, and quetiapine, respectively. Aripiprazole, risperidone, and ziprasidone did not demonstrate AA at any of the concentrations studied. CONCLUSIONS: Therapeutic doses of clozapine, olanzapine, and, to a lesser extent, quetiapine are associated with clinically relevant AA.

Food commensal microbes as a potentially important avenue in transmitting antibiotic resistance genes.

The rapid emergence of antibiotic-resistant (ART) pathogens is a major threat to public health. While the surfacing of ART food-borne pathogens is alarming, the magnitude of the antibiotic resistance (AR) gene pool in food-borne commensal microbes is yet to be revealed. Incidence of ART commensals in selected retail food products was examined in this study. The presence of 10(2)-10(7) CFU of ART bacteria per gram of foods in many samples, particularly in ready-to-eat, 'healthy' food items, indicates that the ART bacteria are abundant in the food chain. AR-encoding genes were detected in ART isolates, and Streptococcus thermophilus was found to be a major host for AR genes in cheese microbiota. Lactococcus lactis and Leuconostoc sp. isolates were also found carrying AR genes. The data indicate that food could be an important avenue for ART bacterial evolution and dissemination. AR-encoding plasmids from several food-borne commensals were transmitted to Streptococcus mutans via natural gene transformation under laboratory conditions, suggesting the possible transfer of AR genes from food commensals to human residential bacteria via horizontal gene transfer.

Ratings of speech naturalness of children ages 8-16 years.

The focus of this cross-sectional study was the investigation of Speech Naturalness (speech that sounds normal or natural to the listener) of 60 normal speaking children and adolescents between the ages of 8 and 16 years. 26 naive adult listeners rated the naturalness of videotaped and computer-presented speech samples, using a 9-point-Likert rating scale (1: highly natural sounding speech and 9: highly unnatural sounding speech). The children and adolescents who participated as speakers were distributed among 5 age groups (8, 10, 12, 14, and 16 yr.) with 6 boys and 6 girls in each group. Each child demonstrated normal articulation, language, voice, and speech fluency skills. Age and sex comparisons indicated boys' and girls' speech was rated comparably; however, 8-yr.-olds' speech was rated as significantly less natural than those of 12-, 14-, and 16-yr.-olds. Preliminary ratings of Speech Naturalness for normal speaking children were presented. Suggestions for the clinical application of the findings as a target criterion in treatment programs with communicatively impaired children were suggested. Replication with a larger and more representative sample is in order.

Perceived effects of high frequency hearing loss in a farming population.

Previous research has suggested that farmers are at increased risk for noise-induced hearing loss (NIHL) due to excessive amounts of loud noise exposure from farming equipment. This study was conducted to determine the perceived effects of hearing loss in a small farming population. Ninety-three subjects, ranging in age from 18 to 75 years and actively engaged in the farming industry, were asked to complete a case history form regarding noise exposure and demographic information. Hearing sensitivity was assessed by obtaining air conduction thresholds at audiometric test frequencies 500-8000 Hz bilaterally. Subjects completed the Self Assessment of Communication (SAC) hearing handicap scale if any threshold in either ear was poorer than 25 dB HL. Study results revealed that the presence of high-frequency hearing loss and perceived hearing handicap increased with age, with the largest effects seen in those over 50 years of age. The, relationship between SAC scores and four hearing handicap formulae utilizing different pure-tone averages was also investigated. The highest correlation coefficients occurred for formulae employing higher frequencies and excluding 500 Hz in the calculation. Implications of this study are that audiologists should be aware of the potential hearing handicap associated with high-frequency hearing loss in the farming population and educational programs concerning the dangers of noise and ways to prevent NIHL should be developed for those in farming occupations.

Hearing loss and hearing handicap in users of recreational firearms.

This investigation sought to establish the prevalence of hearing loss and hearing handicap in a population of 232 recreational firearm users. Hearing handicap was calculated based on four methods using pure-tone threshold data from the American Academy of Ophthalmology and Otolaryngology, American Academy of Otolaryngology-Head and Neck Surgery, National Institute of Occupational Safety and Health, and American Speech-Language and Hearing Association in addition to the self-report Hearing Handicap Inventory for Adults-Screener (HHIA-S). Subjects (45 female and 187 male) ranging in age from 13 to 77 years (mean = 40 years, SD = 15.1) completed a short questionnaire regarding demographics and shooting practices followed by pure-tone air audiometry at Occupational Safety and Health Administration test frequencies of 500 to 6000 Hz. A total of 177 who exhibited varying degrees of hearing loss also received a face-to-face administration of the HHIA-S. Audiometric and HHIA-S results revealed that both high-frequency hearing loss and hearing handicap varied significantly as functions of age and occupation. Significant gender effects were observed audiometrically but not as a function of hearing handicap. HHIA-S scores varied significantly as a function of high-frequency (1000-4000 Hz) hearing loss. Correlation coefficients between the four different pure-tone methods of calculating hearing handicap and the self-reported HHIA-S were highest for pure-tone methods that do not employ 500 Hz in the calculation.