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The technological development in the cochlear implants (CI) has been producing external processors designed to increase performances in patients facing word in noise recognition conditions. In our study we investigated the neurophysiological responses underlying these abilities, firstly aiming at obtaining an electroencephalographic (EEG) measure of the listening effort experienced by patients. Secondly, we investigated whether the technological progress reduced such listening effort levels in these patients. In parallel to this neurophysiological assessment, also behavioral performances have been evaluated, in order to test the eventual influence of different processors on the outcome of the task execution, that is word in noise recognition task. EEG Theta and Alpha rhythms activity has been estimated in Unilateral CI users undergoing word recognition test in the cocktail party background noise with a signal to noise ratio + 10, when employing four consecutive generations of CI sound processors, using or not the noisereduction filter function. Results showed that from an older processor to a more recent one, an increase in the speech discrimination has been observed, above all in the filtered condition. Comparing the conditions with and without the noisereduction filter, the latter one reported an increase in the EEG Alpha and Theta activity, especially for the two more recent processors. In the comparison between the different generations of sound processors the newer models reported the lowest levels of cognitive effort, as indicated by the lower values of Theta activity. These considerations support the usefulness of the employment of such EEG estimations for the assessment of clinical devices development. The present results also showed that technological evolution improved speech discrimination in noise, reducing the cognitive effort. [ABSTRACT FROM AUTHOR]

A leishmaniose visceral é uma importante zoonose emergente, de origem parasitária, com distribuição mundial e ainda muito negligenciada. Esta enfermidade é causada por protozoários do gênero Leishmania que são intracelulares obrigatórios de células do sistema fagocítico mononuclear de hospedeiros vertebrados. Esta é uma doença relacionada principalmente, à pobreza e a conflitos sociais infectando milhares de pessoas no mundo todo, podendo variar os sintomas e manifestações clínicas. O objetivo deste trabalho foi descrever todos os municípios do Estado de São Paulo que notificaram pela primeira vez, no ano de 2014, casos humanos autóctones. Trata-se de um estudo descrito, utilizando-se dados referentes aos casos humanos autóctones de LLeishmaniose visceral obtidos juntos ao Centro de Vigilância Epidemiológica (CVE) e à Superintendência de Controle de Endemias (SUCEN) do Estado de São Paulo. Foram notificados casos humanos autóctones pela primeira vez no ano de 2014 nos municípios Marabá Paulista, Presidente Epitácio e Iacri. Nenhuma dessas cidades possui casos caninos. Todas possuem registro do vetor: Iacri (2004), Presidente (2009) e Marabá (2012). Segundo o Ministério da Saúde, essas três cidades são classificadas como municípios com transmissão humana, ou seja, municípios onde o ser humano é acometido pela doença. As investigações epidemiológicas são fundamentais na elaboração das estratégias públicas de combate e prevenção às patologias que acometem a sociedade. As estatísticas provenientes dessas investigações permitem identificar populações e fatores de risco precocemente e combatê-los de maneira mais efetiva através das medidas de controle e prevenção mais aplicáveis àquela situação. [ABSTRACT FROM AUTHOR]

A raiva é uma zoonose causada por um vírus do gênero Lyssavirus. Para que ocorra a sua transmissão é preciso o contato físico direto de uma ferida ou das mucosas com a saliva do animal infectado, geralmente por mordedura, que é o principal veículo do vírus. É uma doença de grande importância para a Saúde Pública não só por se tratar de uma enfermidade letal mas também por trazer grandes prejuízos econômicos principalmente quando falamos em criações de grandes animais, prejuízos provocados pela morte de milhares de cabeças, além dos gastos indiretos que podem ocorrer com a vacinação dos animais. Objetivou-se analisar o número de casos de raiva notificados em grandes animais (equinos, bovinos e outros animais de produção) em todo o Brasil no ano de 2014. Trata-se de um estudo descrito utilizandose dados obtidos por meio de um levantamento realizado no Sistema de Informação de Agravos de Notificação (SINAN) do Ministério da Saúde. Observaram-se 744 casos de raiva bovina, sendo: 28 casos na região norte, 86 no nordeste, destaque para a região sudeste com o maior número de casos (392), o sul teve 173 casos e a região centro-oeste com 65. Em relação à raiva equina, registraram-se 111 casos em todo o Brasil, divididos da seguinte maneira: norte (8), nordeste (7), sudeste (64), sul (19) e centro-oeste (13). Ainda ocorreu a notificação em outros animais de produção, totalizando 8 casos (nordeste (2), sudeste (5) e sul (1). A notificação de casos animais de raiva é de inquestionável importância, pois assim é possível estabelecer uma estratégia de controle e prevenção da doença de forma efetiva, evitando assim a doença no ser humano. [ABSTRACT FROM AUTHOR]

Objects: This study aimed to evaluate the Executive Function (EF) domains in a group of profoundly deaf children treated with cochlear implant (CI) in comparison to normal hearing (NH) children. The secondary aim was to evaluate the influence exerted by the age at cochlear implant activation on EFs., Materials and Methods: 32 children were enrolled into two groups: group A of 17 CI users with a mean age of 8.78 years and group B of 15 NH subjects with a mean age of 7.99 years (SD + 2.3). All subjects were tested using the following tests: the subtests for working memory of the neuropsychological evaluation battery for the developmental age (Batteria di valutazione neuropsicologica per l'età evolutive), inhibition and control of the impulsive response-CAF, and the tower of London test., Results: No children with CIs scored within the normal range in the tests administered for the evaluation of EF domains. The same scores were significantly lower when compared with scores obtained by NH children. Children with younger age at CI activation showed better executive performances in planning, working memory (backward digit span), and cognitive flexibility (categorical fluency)., Conclusion: The results of this study highlight that cochlear implantation plays a role in improving hearing and consequently influences the development of EFs in deaf children.

Purpose: To report our experience in performing cochlear implantation under local anesthesia in a group of patients who were deemed unfit for general anesthesia., Methods: A retrospective chart review was performed to analyze undesirable events and any other discomfort complained by patients during cochlear implantation. Analysis of patient's satisfaction was performed by means of a survey instrument. We have also compared the duration of surgery and hospitalization time with a control group that was implanted under general anesthesia., Result: Twenty-one cochlear implantation in 20 patients were performed under local anesthesia. Age of patients ranged from 38 to 85 years. All interventions were successfully completed without any conversions to general anesthesia. Discomfort during surgery was reported in five cases: vertigo triggered by electrode insertion in two patients, pain during the round window approach in two patients and distress during the use of drill in one case; no patient experienced agitation. During the postoperative period, no complications or unpleasant experiences were reported. Only two patients stated that they would not perform cochlear implantation again under local anesthesia. Lower duration surgery and hospitalization time were found in the local anesthesia group., Conclusion: Local anesthesia with conscious sedation is a safe and effective alternative for cochlear implant candidates considered unfit for general anesthesia. Fundamental for a successful procedure are preoperative counselling, accurate selection of the patients and constant intraoperative assistance. Unfeasibility of facial nerve monitoring and minor detrimental effect on training are the principal disadvantages in performing cochlear implantation under local anesthesia., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Helminths are endoparasites that infect a variety of bird species. Endoparasite infections can cause severe diseases, including kill captive avian hosts and represents a problem to maintenance and conservation. The eggs and larval forms of these parasites are usually eliminated in the host feces. The main interest of this study is to report the occurrence of eggs and oocysts in feces from captive wild birds in Goiânia Zoo and free-living birds in its surroundings. The fecal samples were subjected to parasitological examination to identify the presence of helminths and to classify their eggs based on morphological characteristics. Eggs of nematode parasites (Positive/N) were identified as Ascaridia spp. in Brotogeris chiriri (2/2), Dromaius novaehollandiae (1/1) and Rhea americana (2/2); Ascarididae in Pavo cristatus nigripensis (1/1); Capillaria spp. in Ara chloropterus (1/1) and Penelope jacucaca (1/1); Capillaria plagiaticia in Anodorhynchus hyacinthinus (1/2) and Ara spp. (2/2); Capillaria venusta in Rhamphastus tucanus (1/2); and unidentified nematode eggs from Amazona amazonica (2/2). Eimeria spp. oocyst was founded in feces from A. hyacinthinus (1/2). Considering free-living birds, Diphyllobothrium spp. eggs were founded in Ardea alba (2/2) and Nycticorax nycticorax (2/3). Co-infection of Eustrongylides spp. was founded in A. alba (1/2). This is the first occurrence of: Ascaridia spp. parasitizing B. chiriri; and C. venusta parasitizing R. tucanus. In conclusion, the helminth eggs found in the abovementioned host bird species are consistent with those reported in the literature, and treatment and control protocols were based on their identification.

Background & Aims: Decompensated cirrhosis patients have an elevated incidence of early readmission, mortality and economic burden. The aims of HEPACONTROL were to reduce early readmission and to evaluate its impact on mortality and emergency department visits., Patients and Methods: Quasi-experimental study with control group which compared two cohorts of patients discharged after being admitted for cirrhosis-related complications. A prospective cohort (n=80), who followed the HEPACONTROL program, which began with a follow-up examination seven days after discharge at the Hepatology Unit Day Hospital and a retrospective cohort of patients (n=112), who had been given a standard follow-up. Outcome variables that were compared between both groups were early readmission rates, the number of emergency department visits post-discharge, financial costs and mortality., Results: The rate of early readmission was lower in the group with HEPACONTROL (11.3% vs 29.5%; P=.003). Also, the mean number of visits to the emergency department post-discharge (1.10±1.64 vs 1.71±2.36; P=.035), mortality at 60days (3.8% vs 14.3%; P=.016), and the cost of early readmission were all lower compared with the group with standard follow-up (P=.029)., Conclusions: HEPACONTROL decreases the incidence of early readmission the rate of emergency department visits and mortality at 60days in patients with decompensated cirrhosis, and it is cost-effective., (Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background & Aims: The early hospital readmission of patients with decompensated cirrhosis is a current problem. A study is presented on the incidence, the impact on mortality, and the predictive factors of early hospital readmission., Patients and Methods: On the study included 112 cirrhotic patients, discharged after some decompensation between January 2013 and May 2014. Multivariate analyses were performed to identify predictors of early readmission and mortality., Results: The early readmission rate was 29.5%. The predictive factors were male gender (OR: 2.81; 95% CI: 1.07-7.35), Model for End-Stage Liver Disease-sodium score ≥15 (OR: 3.79; 95% CI 1.48-9.64), and Charlson index ≥7 (OR: 4.34, 95% CI 1.65-11.4). This model enabled patients to be classified into low or high risk of early readmissions (13.6% vs. 52.2%). The mortality rate was significantly higher among patients with early readmission (73% vs. 35%) (p<.0001). After adjusting for the Model for End-Stage Liver Disease-sodium score, Charlson index, dependence in activities of daily living, educational status, and number of medications on discharge, the early readmission was independently associated with mortality., Conclusions: Early hospital readmission is common, and is independently associated with mortality. Male gender, MELD-Na ≥15, and Charlson index ≥7 are predictors of early readmission. These results could be used to develop future strategies to reduce early readmission., (Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to evaluate and compare the results obtained in a group of implanted otosclerotic patients with a group of cochlear implant (CI) patients not affected by otosclerosis., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: Nine patients affected by profound sensorineural hearing loss caused by otosclerosis and nine patients affected by profound sensorineural hearing loss not caused by otosclerosis were evaluated., Intervention: Cochlear implantation., Main Outcome Measures: Preoperative imaging, intraoperative findings, postoperative facial nerve stimulation, and speech perception performance measures were performed and the data analyzed., Results: Otosclerosis patients showed signs of cochlear ossification both on high-resolution computed tomography scans and intraoperatively. The incidence of facial nerve stimulation was higher in the otosclerosis group, three out of nine, and was generally related to the use of electrical stimulation from the Nucleus 22 cochlear implant. Psychophysical and speech perception measures did not show significant differences between the two groups, despite some otosclerosis patients showing increased electrical thresholds and comfort levels and slightly poorer speech perception performance scores., Conclusions: Patients with otosclerosis who have progressed to profound hearing loss derive significant benefit from cochlear implants; however, an increased risk of cochlear ossification and facial nerve stimulation has to be taken in account during preoperative counseling. The advance in imaging techniques, CI technology and the possibility to stimulate precise regions of the cochlea with lower intensities make it possible for the surgeons and audiologists to readily and successfully manage these complications as they arise.

Cochlear implants (CI) represent the current treatment for patients affected by profound sensorineural hearing loss (SNHL). Initially only deaf adult patients were considered to be candidates for a CI; however, the development of technology and matured experience have expanded the indications for cochlear implantation. Today, CIs are implanted in adults and children and broader indications are followed. There are, however, a number of patients who do not completely fulfill the current indications and who are potential candidates for CI. The duration of deafness and residual hearing represent prognostic indicators for CI performance; however, the candidacy of children with residual hearing and prelingually deafened adults are still under debate. Anatomical variants such as cochlear ossification, cochlear malformation and chronic otitis media represented and still represent for some surgeons a contraindication to CI. The otological experience of CI surgeons and the advent of auditory brainstem implants have changed the approach to these patients, who may still benefit from hearing rehabilitation. This paper briefly analyses and reviews the results obtained in these groups of patients, who were not, at least initially, considered to be candidates for cochlear implantation.

The concept that autoimmunity may damage the inner ear was introduced by McCabe in 1979. Audiovestibular symptoms may occur in isolation or may be mediated by vasculitis in patients affected by systemic autoimmune disorders. Sensorineural hearing loss (SNHL) is typical in Cogan's syndrome but occurs less frequently in Beçhet's syndrome and in systemic necrotizing vasculitides. Patients affected by immune-mediated profound SNHL represent ideal candidates for cochlear implantation as these patients become deaf after years of hearing. The disease itself and the medication taken may, however, influence the prognosis of cochlear implantation in these patients. We retrospectively evaluated the pre- and intraoperative findings as well as the postoperative course and performance of a group of five patients affected by a systemic vasculitis syndrome who received a cochlear implant. Implantation was successful in all patients, no complications occurred and excellent postoperative speech perception was achieved. We conclude that cochlear implantation in patients affected by immune-mediated inner ear disorders is effective although the long-term results remain to be evaluated.

The paper reports two cases of severe hematoperitoneum due to the traumatic rupture, or so-called explosion, of the liver. During surgery one of these cases underwent ligature of the right and left hepatic arteries, while the other only underwent right hepatic arterial ligature. Selective arteriography at varying intervals after surgery showed that vascular occlusion had taken place together with the creation of an adequate compensation circle. Both patients now lead absolutely normal lives, respectively five and two years after surgery. This technique of hemostasis, which is reserved for use in cases of otherwise unresolvable hepatic hemorrhage, although still rarely used, should form part of every surgeon's general training since it might prove unexpectedly essential.

In order to evaluate the central interferences on the auditory efficiency, the effect of contralateral masking noise on Critical Ratio (CR) has been studied in 14 normal ears (control group), in 12 ears with cochlear disorders and in 6 with retrocochlear lesion (acoustic neuromas); in all cases the impairment was unilateral, while the other ear was normal. CR values were calculated for 1 KHz pulsed tones (duration 500 ms, rise/fall 25 ms, duty cycle of 50%); the masking noise was a wide band (90-20,000 Hz) delivered at 40 dB SL. The results have demonstrated that in the presence of contralateral masking noise, CRs don't modify both in the normal ears and in those with retrocochlear disorder, whereas they increase, almost always, in ears with cochlear deafness. These results demonstrate that the involvement of central auditory pathways, because of contralateral noise, makes the auditory efficiency worse, only in ears with cochlear dysfunctions; this behaviour seems to confirm the peripheral origin of CR.

The efferent pathways exert a control action on the function of the cochlear nucleus and hair cells. Acetylcholine is the neurotransmitter of the centrifugal system and its action can be blocked by atropine. In order to give a contribution to the knowledge of the function of the efferent bundle and of the cochlea efficiency we examined 10 young normal subjects before and after infusion of 1 mg of atropine i.v. a battery of three psychoacoustical tests (Remote Masking, Critical Ratio and Brief Tone Audiometry). After infusion of atropine we have shown an increase of 0.25 Hz hearing threshold, an increase of RC values and a decrease of RM values. It can be concluded that the pharmacological block of the olivo-cochlear bundle determines a stiffness of outer hair cells and basilar membrane; this finding means that the atropine can inhibit the facilitating activity of the efferent system on the cochlear performance.

In order to give a contribution to the genesis of the EOAEs, we have recorded the echoes in 6 subjects affected with unilateral acoustic neuroma, surgically proven (I. group); 11 subjects with sensorineural hearing loss with electrophysiological or balance signs of retrocochlear impairment (II. group) and 10 normally hearing young subjects as control group. In this study EOAEs have been recorded in response respectively to 3 ms 1000 Hz tone-burst and to 200-5000 filtered click, both sending with 2048 stimuli, at a repetition rate of 21 pps and different stimulus intensities ranging from 40 db SPL to saturation threshold in 10 db steps. The results have shown that the EOAEs were present in half of the tested patients in response to the clicks in both I. and II. group and in all the ears to the tone-burst although the 1.0 KHz audiometric threshold mean were > 65 db HL in I. group and in a third of the subjects in the II. group. The properties of EOAEs (detection and saturation threshold, dynamic range and duration) depended on the degree of hearing loss. These results suggest that acoustic tumor could determine a wallerian degeneration of the external fibers of the VIII nerve and consequently a dysfunction of the correspondent external hair cells of the cochlea, while in the II. group a contemporary or secondary involvement of the cochlear structures is possible.

In order to give a contribution to the genesis of the EOAEs, we have recorded echos in 24 subjects with unilateral sudden deafness (I. group); 20 ears with Menière disease (II. group); 22 ears with progressive sensorineural hearing loss (III. group) and 10 normally hearing young subjects as control group. The results have shown that the EOAEs were present in 100% (I. group), 84.6% (II. group) and 86.3% (III. group) in response to the tone-burst; while the echos were present only in the 57.1% (I. group), 38.4% (II. group) and 45.4% (III. group) in response to the click, although the audiometric threshold mean were greater than 45 dB HL for 2-4 KHz and 1 KHz in the three experimental groups except for 2-4 KHz in the subjects with Menière disease (37.5 dB HL). The properties of EOAEs (detection and saturation threshold, dynamic range and duration) depended on the degree of hearing loss. Our results seem to corroborate the hypothesis that EOAEs could be also produced by a passive intracochlear mechanism attributable to the travelling wave of the basilar membrane provoked by the perilymph. In the normal ear this passive mechanism could be superimposed by an active mechanism, linked to the contractile activity of the outer hair cells with a consequent increase in amplitude of the EOAEs for the same stimulus intensity.