Frequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy.

Introduction: The aim of this study was to investigate hearing outcome of stapes surgery, considering the post-operative air and bone conduction (AC&BC) changes, in a frequency specific approach. Materials and Methods: This was a retrospective cohort study. A total of 245 ears (231 patients), who underwent Stapedotomy at our tertiary referral center in a period of 5 years were enrolled in the study. Pure tone audiometry (PTA) was evaluated preoperatively and one month postoperatively. AC, BC, and Air-bone gap (ABG) were documented. Moreover, one-year post-op PTA was also recorded for more than a quarter of the cases. Results: Overall, significant improvements were observed in AC thresholds with a mean AC gain of 20.44±13.64 dB. At higher frequencies the results were poorer (AC gain of 27 dB at 250 Hz vs 7 dB at 8000 Hz). ABG significantly improved at all frequencies after one month. BC thresholds were typically better after surgery. However, there appears to be a worsening trend in BC thresholds at frequencies higher than 2000 Hz. In 68 patients with 1-year follow-up, BC thresholds were slightly worse (but not statistically significant) at most frequencies, in comparison to the one-month results. Conclusions: Stapes surgery significantly improves air and bone conduction hearing, particularly at lower frequencies. Nonetheless, there exists a potential for sensorineural hearing loss (SNHL) at high frequencies. However, the changes are insignificant and not within the speech frequencies. Therefore, patients are typically satisfied with the hearing outcome of the surgery.

Evaluation of the Effect of Antibiotics and Splints on the Result of Septal Mucosal Culture After Septoplasty.

Purpose: Post operation infection after septoplasty is very rare, possibly due to excessive nasal blood supply. Most otorhinolaryngologists recommend antibiotics after septoplasty; however, controversial results were available. Therefore, this study was designed to investigate the effect of antibiotics after septoplasty. Methods: In this study, 90 patients who were candidates for septoplasty were entered the study and divided into three groups. The first group did not receive any oral antibiotics after septoplasty. The second group took 500 mg of oral cephalexin. The third group, for whom splints were used, also received cephalexin. The culture of the nasal mucosa was prepared before and two weeks after surgery and compared between groups. Then, the amount and types of mucosa microorganisms were reported. Data were analyzed using SPSS16. Results: The growth significantly increased in the first group (p = 0.051) and reduced in the second group (p < 0.001). While a decreased growth rate was observed in the third group, it was not statistically significant (p = 0.12). Conclusion: The present study highlighted the beneficial role of prophylactic antibiotics administration in patients without splints on bacterial growth, while it had no effect in patients with splints. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03665-w.

Prognostic factors in pediatric cochlear implant: an outcome-based study.

OBJECTIVE: To determine the prognostic factors in the pediatric cochlear implant (CI) outcome. MATERIALS AND METHODS: This prospective cohort study was conducted on 289 pediatric cases with prelingual hearing loss who received cochlear implantation. Several possible salient factors have been recorded. Auditory and speech evaluations were performed before CI, as well as 6 and 12 months after surgery, using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) tests. RESULTS: According to univariate analysis, age at the time of surgery was a statistically significant factor. Neurological problems in the child, history of newborn infectious diseases, history of hearing aid use, proper parental cooperation, and round window approach were all significantly related to better auditory or speech outcomes. On the other hand, good parental cooperation and age (for CAP) and good parental cooperation, age, history of infectious disease, and hearing aids use (for SIR) are the significant factors in the multivariate setting. CONCLUSION: As evidenced by the obtained results, age, background diseases, history of rehabilitation with hearing aids, and surgical details are essential factors to be taken into account in the case-selection process.

Predictors of in-hospital mortality among patients with symptoms of stroke, Mashhad, Iran: an application of auto-logistic regression model.

BACKGROUND: Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS). Moreover, transport delays have been documented to affect stroke outcomes. This study aimed to examine the spatial variations in in-hospital mortality among patients with symptoms of stroke transferred by EMS, and determine its related factors using the auto-logistic regression model. METHODS: In this historical cohort study, we included patients with symptoms of stroke transferred to Ghaem Hospital of Mashhad, as the referral center for stroke patients, from April 2018 to March 2019. The auto-logistic regression model was applied to examine the possible geographical variations of in-hospital mortality and its related factors. All analysis was performed using the Statistical Package for the Social Sciences (SPSS, v. 16) and R 4.0.0 software at the significance level of 0.05. RESULTS: In this study, a total of 1,170 patients with stroke symptoms were included. The overall mortality rate in the hospital was 14.2% and there was an uneven geographical distribution. The results of auto-logistic regression model showed that in-hospital stroke mortality was associated with age (OR = 1.03, 95% CI: 1.01-1.04), accessibility rate of ambulance vehicle (OR = 0.97, 95% CI: 0.94-0.99), final stroke diagnosis (OR = 1.60, 95% CI: 1.07-2.39), triage level (OR = 2.11, 95% CI: 1.31-3.54), and length of stay (LOS) in hospital (OR = 1.02, 95% CI: 1.01-1.04). CONCLUSION: Our results showed considerable geographical variations in the odds of in-hospital stroke mortality in Mashhad neighborhoods. Also, the age- and sex-adjusted results highlighted the direct association between such variables as accessibility rate of an ambulance, screening time, and LOS in hospital with in-hospital stroke mortality. Thus, the prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.

A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran.

BACKGROUND: Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. METHODS: This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. RESULTS: Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. CONCLUSION: Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.

Comprehensive vestibular evaluation in patients with Otosclerosis: a case control study.

Aim: Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis. Materials and methods: patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group. Results: A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05). Conclusion: Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03147-5.

Intratympanic Steroid for the Management of Sudden Hearing Loss: Introduction of a Tapering Method.

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL) is a therapeutic challenge. There are several controversies regarding the management protocol of SSNHL. This study aimed to present the results of a novel treatment algorithm, which is a combination of systemic steroids and a tapering intratympanic (IT) dexamethasone regimen. MATERIALS AND METHODS: The past 10 years' medical records of idiopathic SSNHL cases in Ghaem and Emamreza hospital, Mashhad University of Medical Sciences were evaluated. Patients were assessed using standardized methods for pure-tone threshold audiometry. The management method of SSNHL treatment included oral steroids combined with IT administration of dexamethasone once a day for 7 days and continuing it on an alternate day and then weekly basis. Patients' recovery was assessed using Siegel's criteria. RESULTS: This study included a total of 248 cases of idiopathic sudden hearing loss, with a mean age of 40.63±16.19 years. In total, 105 (42.3%) and 143 (57.7%) patients were female and male, respectively. The most common associated symptoms included tinnitus (86.9%, n=205) followed by vertigo (52.1%, n=122). The final hearing outcome of patients showed that 39 (15.7%), 38(15.3%), 86 (34.7%), and 85 (34.3%) patients underwent a complete recovery, partial recovery, slight recovery, and no recovery, based on Siegel's criteria. CONCLUSIONS: The dose, interval, and duration of IT steroid treatment were not universally approved. The treatment method designed based on a tapering of IT steroid injection in combination with already known systemic administration of steroids can be a treatment option in SSNHL patients.

Higher Viral Load of Polyomavirus Type BK but not JC among Renal Transplant Recipients in Comparison to Donors.

BACKGROUND & OBJECTIVE: Polyomaviruses types BK and JC and Cytomegalovirus (CMV) have been shown to be related to kidney transplantation complications. This study aimed to assess the prevalence of these viruses in patients receiving kidney transplantation. METHODS: This cross-sectional study was performed on 40 kidney transplant recipients and 44 donors. Urine samples were used for the extraction of viral DNA. The prevalence of JC and BK viruses and their viral loads were determined by real-time polymerase chain reaction. RESULTS: JC and BK viruses were identified in 31% and 92.3% of all subjects, respectively. The frequency of JC and BK cases was not statistically different between the recipient and donor groups (P>0.05). All patients in the donor group and 96.8% of the recipients were positive for CMV IgG antibody. The mean viral load of BK in donors and recipients was 4.5×1010 and 3.3×1011 copies, respectively. The mean viral load of JC was 8.6×107 copies in donors and 2.9×108 copies in recipients. The distribution of BKV was significantly higher in recipients than donors (P=0.001), while no difference was observed between the two studied groups for JCV. CONCLUSION: This study showed a relatively high prevalence of BK and JC viruria in both renal transplant donors and recipients. The viral load for BKV, but not JCV, was higher in recipients than in donors.

The effect of standardized honey on mucosal healing of the nose and paranasal sinuses after polypectomy: A randomized controlled, double blind pilot study.

OBJECTIVES: Nasal polyposis (NP) is a chronic inflammatory disease. Honey has several anti-microbial, anti-oxidants, healing, and anti-inflammatory properties which may reduce the need for steroids in this situation. Therefore, the aim of this study is to show the effect of standardized honey on mucosal healing of the nose and paranasal sinuses after polypectomy. DESIGN AND METHOD: In this double-blind, randomized, placebo-controlled clinical trial, 28 patients with nasal polyposis underwent functional endoscopic sinus surgery (FESS). Besides common post-op medications, normal saline (as a placebo) and diluted processed honey were used separately in the two nostrils of each patient. Two endoscopic follow-ups using the Philppot-Javer (P-J) scoring system were performed to assess the healing and recurrence of polyps on either side. The secondary outcome measure was the patients' satisfaction rate. RESULTS: The patients' mean age was 38.03±11.9 years. 15(57.7%) had a positive prick test and also 15(57.7%) had dense eosinophilic infiltration in their surgical specimens. In the first and second follow-up sessions, total P-J scores showed better results for honey in comparison to the normal saline side but that results were not significantly different (P=0.93, P=0.07); whereas it is fair to say that in the second follow-up, the ethmoid and maxillary sinuses demonstrated a greater difference compared to the other sites based on their averages but there were not significantly meaningful (P=0.05, P=0.06). The total score also showed better results for honey in comparison to the normal saline side but was statistically insignificant (P=0.07). CONCLUSION: Diluted honey seems to have certain positive effects in reducing post-operative edema and the recurrence of nasal polyps in at least the ethmoid and maxillary sinuses; although this positive effect did not result in significant changes. (www.actabiomedica.it).

Association Between Serum Vitamin D Level and Ménière's Disease.

OBJECTIVES: Ménière's disease (MD) is a well-known inner ear disease; however, the etiopathogenesis is unknown. Several factors may be involved. Meanwhile, vitamin D is reported to have an important role in inner ear physiology. The aim of this study is to evaluate the relation between vitamin D deficiency and MD. STUDY DESIGN: This matched case-control study compared serum vitamin D levels between patients with definite MD and those without it. SETTING: The study was done between August 2018 and December 2019 at Ghaem University Hospital in Mashhad, Iran. METHODS: Twenty-eight patients with definite MD were matched with a group of 84 healthy individuals, regarding age, sex, body mass index, and occupation (indoor vs outdoor). The serum level of vitamin D (25-hydroxyvitamin D3) was measured in both groups. RESULTS: The mean ± SD vitamin D level was 18.9 ± 9.7 ng/mL in the case group and 25.2 ± 13.7 ng/mL in the control group (P = .027). There was a significant difference between the case and control groups according to the results of the conditional logistic regression model (P = .03; adjusted odds ratio, 0.96). In the MD group, 17 (60.7%) patients were vitamin D deficient, 6 (21.4%) insufficient, and only 5 (17.9%) sufficient. CONCLUSIONS: The results of this study show that serum vitamin D level in MD is significantly lower than that of the control group. However, the role of vitamin D supplementation in the management of MD needs further study. LEVEL OF EVIDENCE: 4.

Detection of Lophomonas blattarum (Order: Hypermastigida) from Iranian Patients with Allergic Rhinitis.

Background: Allergic rhinitis (AR) is one of the most common allergic diseases triggered by indoor and outdoor allergens. Certain arthropods, such as mites and cockroaches, contain protozoa like Lophomonas blattarum in their intestines to help with digestion that may have some role in AR. We aimed to determine the frequency of L. blattarum in nasal smears of patients with AR in comparison with healthy controls. Methods: In this prospective cross-sectional study (March 2015-March 2016), 36 patients with a clinical presentation of AR (with a positive prick test including mites) and 34 normal controls were included at ear, nose, and throat (ENT) clinic at Imam Reza Hospital of Mashhad, Iran. Nasal secretions were evaluated to examine presence of L. blattarum in the patients and control group by direct method. Diagnosis of L. blattarum was based on microscopic observation both on direct smear and Giemsa stained specimens. Results: Patients with AR had a higher frequency of L. blattarum in their nasal smears than the control group (25% vs. 2.9%) (P=0.001). Conclusion: We found L. blattarum more frequently in the nasal secretion of AR patients compared with healthy subjects; this protozoon may have some role in this condition. However, the relationship between L. blattarum and AR requires further studies to allow a greater understanding.

Effects of government policies and the Nowruz holidays on confirmed COVID-19 cases in Iran: An intervention time series analysis.

BACKGROUND: Public health policies with varying degrees of restriction have been imposed around the world to prevent the spread of coronavirus disease 2019 (COVID-19). In this study, we aimed to evaluate the effects of the implementation of government policies and the Nowruz holidays on the containment of the COVID-19 pandemic in Iran, using an intervention time series analysis. METHODS: Daily data on COVID-19 cases registered between February 19 and May 2, 2020 were collected from the World Health Organization (WHO)'s website. Using an intervention time series modeling, the effect of two government policies on the number of confirmed cases were evaluated, namely the closing of schools and universities, and the implementation of social distancing measures. Furthermore, the effect of the Nowruz holidays as a non-intervention factor for the spread of COVID-19 was also analyzed. RESULTS: The results showed that, after the implementation of the first intervention, i.e., the closing of universities and schools, no statistically significant change was found in the number of new confirmed cases. The Nowruz holidays was followed by a significant increase in new cases (1,872.20; 95% CI, 1,257.60 to 2,476.79; p<0.001)), while the implementation of social distancing measures was followed by a significant decrease in such cases (2,182.80; 95% CI, 1,556.56 to 2,809.04; p<0.001). CONCLUSION: The Nowruz holidays and the implementation of social distancing measures in Iran were related to a significant increase and decrease in COVID-19 cases, respectively. These results highlight the necessity of measuring the effect of health and social interventions for their future implementations.

Dust as probes: Determining confinement and interaction forces.

Complex plasmas are interesting systems as the charged dust can self-assemble into different types of ordered structures. To understand the mechanisms which govern the transitions from one type of structure to another, it is necessary to know both the dust charge and the confining electric fields within the environment, parameters which are difficult to measure independently. As dust is usually confined in a plasma sheath where the ions stream from the bulk plasma to the negative lower electrode, the problem is further complicated by the ion wake field, which develops downstream of the dust grains in a flowing plasma. The differences in local ion density caused by the wake field change the equilibrium dust charge and shielding distance of the dust grains, and thus affect the interaction between grains. Here we use a molecular dynamics simulation of ion flow past dust grains to investigate the interaction between the dust particles and ions. We consider a long vertical chain of particles confined within a glass box placed on the lower electrode of a Gaseous Electronics Conference rf reference cell. We apply the model iteratively to self-consistently determine the dust charge, electric field, and ion density along the length of the chain as well as the ion flow speed. Simulation results indicate that the ion flow speed within the box is subsonic.

Measurement of net electric charge and dipole moment of dust aggregates in a complex plasma.

Understanding the agglomeration of dust particles in complex plasmas requires knowledge of basic properties such as the net electrostatic charge and dipole moment of the dust. In this study, dust aggregates are formed from gold-coated mono-disperse spherical melamine-formaldehyde monomers in a radiofrequency (rf) argon discharge plasma. The behavior of observed dust aggregates is analyzed both by studying the particle trajectories and by employing computer models examining three-dimensional structures of aggregates and their interactions and rotations as induced by torques arising from their dipole moments. These allow the basic characteristics of the dust aggregates, such as the electrostatic charge and dipole moment, as well as the external electric field, to be determined. It is shown that the experimental results support the predicted values from computer models for aggregates in these environments.