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Objectives: The aim of this work is to define critical warning brainstem auditory evoked potential (BAEP) signs as a marker for the postoperative hearing outcome.
Study design: Retrospective study
Setting: Tertiary referral center
Patients: 162 patients who underwent resection of acoustic neuroma via a transtemporal approach with intraoperative monitoring (IOM) at the Department of Otorhinolaryngology, Plastic, Esthetic and Reconstructive Head and Neck Surgery, from January 2011 to December 2017.
Interventions: BAEP was performed in all patients; while intraoperative direct recording of the cochlear nerve function was done in 131 patients.
Main Outcome Measure: postoperative hearing thresholds (Pure tone audiometry).
Results: The most significant risk factor is the permanent loss of wave V as it increases the risk of postoperative hearing loss by 18 times; followed by three-steps increment of the stimulus intensity as it increases the risk by 5.75 times; and finally the response thresholds obtained during the intraoperative direct recording of cochlear nerve function. Each unite increment of the threshold increases the risk of postoperative hearing loss by 6.7%.
Conclusions: We believe that the intraoperative BAEP critical signs during IOM detected in this study can be used as a helpful tool to predict postoperative hearing loss in patients with acoustic neuroma.
Background: In a 2008-10 study, we found a pretreatment HIV drug resistance (PDR) prevalence of 18.2% in patients at Bugando Medical Centre (BMC) in Mwanza, Tanzania.
Objectives: To determine the prevalence of PDR and transmitted HIV drug resistance (TDR) in patients visiting the BMC from 2013 to 2015.
Methods: Adult outpatients were sequentially enrolled into two groups, separated by whether they were initiating ART. Previous exposure to antiretroviral drugs, except for prevention of mother-to-child transmission, was an exclusion criterion. HIV pol sequences were analysed according to WHO guidelines for surveillance of PDR and TDR.
Results: Two hundred and thirty-five sequences were analysed (138 ART initiators, 97 non-initiators). The prevalence of PDR was 4.7% (95% CI 2.6%-8.2%) overall, 3.1% (95% CI 1.1%-8.7%) for non-initiators and 5.8% (95% CI 3.0%-11.0%) for ART initiators. PDR to NNRTIs and nucleoside or nucelotide reverse transcriptase inhibitors was found in 3.0% (95% CI 1.5%-6.0%) and 1.7% (95% CI 0.7%-4.3%) of patients, respectively. Resistance to PIs was not observed. The prevalence of TDR was 6.0% (95% CI 3.6%-9.8%).
Conclusions: Prevalence of PDR significantly decreased compared with 2008-10 and was below the WHO-defined threshold for triggering a public health response. National and systematic surveillance is needed to inform Tanzania's public health strategy.