A description of Brivaracetam, a novel SV2A ligand, an anti-epileptic with greater potency and significantly reduced behavioural adverse effects compared to Levetiracetam .
A description of Brivaracetam, a novel SV2A ligand, an anti-epileptic with greater potency and significantly reduced behavioural adverse effects compared to Levetiracetam .
Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13Nick Sharratt
Slides from the talk given by Prof. Edzard Ernst to the Plymouth Skeptics in the Pub group 13th Sept 2011
Images removed which may otherwise breach (c)
Slides with a green background are explained to be tongue in cheek. Yellow backgrounds are "take home messages"
Anaesthesia in women and women in anaesthesia - Else Tønnesen - SSAI2017scanFOAM
A talk by Else Tönnesen at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
Headache diagnostc paradigm from former Johns Hopkins Hospital staffNelson Hendler
The medical literature reports that 35%-70% of patients diagnosed with migraine headache do not have this order. The Internet based "expert system" developed by former Johns Hopkins Hospital staff, including the past president of the American Headache Society and American Academy of Pain Management provides an Internet based "expert system" which gives diagnoses with a 94% correlation with diagnosed of these doctors.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
Nursing Research MarchApril 2002 Vol 51, No 2 125 Back.docxcherishwinsland
Nursing Research March/April 2002 Vol 51, No 2 125
� Background: The mechanisms for postoperative nausea and
vomiting are numerous and pathways not well elucidated.
Although many medications have been developed to help
prevent postoperative nausea and vomiting, the search for
better approaches to recovery treatment continues.
� Objective: The purpose of this study was to evaluate the effec-
tiveness of isopropyl alcohol (IPA) inhalation for treatment of
postoperative nausea and vomiting for patients who have
general anesthesia for a surgical procedure.
� Method: Participants were recruited from an urban hospital on
the East Coast of the United States. Participants were
assigned to an experimental or control group and IPA inhala-
tion was compared to the standard anti-emetic treatment for
rescue treatment in the immediate postoperative period.
Postoperative nausea and vomiting was rated using a
descriptive ordinal scale.
� Results: The results of this study show IPA to be effective and
that there was no significant difference between the stan-
dard treatment protocol and treatment with IPA. Treatment
with IPA was significantly more cost effective than standard
drug treatment.
� Discussion: Further research is recommended to evaluate the
length of effectiveness, standard dose needed, most effec-
tive mode of inhalation, and factors blocking IPA effective-
ness.
� Key Words: alternative treatment • IPA • nausea • postopera-
tive • vomiting
oday’s healthcare concerns center on decreasing
costs, shortening hospital stays, and facilitating a
quick return to normal activity for patients. Post-operative
nausea and vomiting (PONV) is a major concern for
patients having same-day surgery under general anesthesia
as it causes increased complications and delays in dis-
charge from the hospital (Hirsch, 1994).
Approximately one-third of the 11 million patients under-
going outpatient surgery under general anesthesia will
experience significant nausea or emesis in the postopera-
tive period (Claybon, 1994). The mechanisms for PONV
are numerous and the causative pathways not well eluci-
dated. Many factors may play a role in an episode of nau-
sea and vomiting, and despite advances in new drug thera-
pies in minimizing the incidence, no ideal drug has been
found to prevent all the causes of PONV.
Aromatherapy is a relatively new and under-researched
alternative treatment that might hold promise in treating
PONV. Isopropyl alcohol (IPA) is among several aromas
displaying possible anti-emetic properties. Isopropyl alco-
hol inhalation is a new treatment with only limited inves-
tigations to date (Langevin & Brown, 1997).
Literature Review
Current PONV treatment strategies are based on the
understanding of the vomiting reflex; however, the lack of
well-elucidated pathways in the control of PONV has con-
tributed to the problems with these treatment strategies
and medications. It has been well documented that some
patients are more susceptible to P.
The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A...Apollo Hospitals
Sudden Sensorineural Hearing Loss (SSNHL) is a hearing impairment of more than 30 dB occurring within a period of upto 3 days in three consecutive pure tone frequencies. Hyperbaric oxygen therapy (HBOT) in recent years has gained relevance for treating SSNHL in combination with other agents. The aim of this study is to review the outcomes in patients with SSNHL treated with HBOT at our centre.
Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13Nick Sharratt
Slides from the talk given by Prof. Edzard Ernst to the Plymouth Skeptics in the Pub group 13th Sept 2011
Images removed which may otherwise breach (c)
Slides with a green background are explained to be tongue in cheek. Yellow backgrounds are "take home messages"
Anaesthesia in women and women in anaesthesia - Else Tønnesen - SSAI2017scanFOAM
A talk by Else Tönnesen at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
Headache diagnostc paradigm from former Johns Hopkins Hospital staffNelson Hendler
The medical literature reports that 35%-70% of patients diagnosed with migraine headache do not have this order. The Internet based "expert system" developed by former Johns Hopkins Hospital staff, including the past president of the American Headache Society and American Academy of Pain Management provides an Internet based "expert system" which gives diagnoses with a 94% correlation with diagnosed of these doctors.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
Nursing Research MarchApril 2002 Vol 51, No 2 125 Back.docxcherishwinsland
Nursing Research March/April 2002 Vol 51, No 2 125
� Background: The mechanisms for postoperative nausea and
vomiting are numerous and pathways not well elucidated.
Although many medications have been developed to help
prevent postoperative nausea and vomiting, the search for
better approaches to recovery treatment continues.
� Objective: The purpose of this study was to evaluate the effec-
tiveness of isopropyl alcohol (IPA) inhalation for treatment of
postoperative nausea and vomiting for patients who have
general anesthesia for a surgical procedure.
� Method: Participants were recruited from an urban hospital on
the East Coast of the United States. Participants were
assigned to an experimental or control group and IPA inhala-
tion was compared to the standard anti-emetic treatment for
rescue treatment in the immediate postoperative period.
Postoperative nausea and vomiting was rated using a
descriptive ordinal scale.
� Results: The results of this study show IPA to be effective and
that there was no significant difference between the stan-
dard treatment protocol and treatment with IPA. Treatment
with IPA was significantly more cost effective than standard
drug treatment.
� Discussion: Further research is recommended to evaluate the
length of effectiveness, standard dose needed, most effec-
tive mode of inhalation, and factors blocking IPA effective-
ness.
� Key Words: alternative treatment • IPA • nausea • postopera-
tive • vomiting
oday’s healthcare concerns center on decreasing
costs, shortening hospital stays, and facilitating a
quick return to normal activity for patients. Post-operative
nausea and vomiting (PONV) is a major concern for
patients having same-day surgery under general anesthesia
as it causes increased complications and delays in dis-
charge from the hospital (Hirsch, 1994).
Approximately one-third of the 11 million patients under-
going outpatient surgery under general anesthesia will
experience significant nausea or emesis in the postopera-
tive period (Claybon, 1994). The mechanisms for PONV
are numerous and the causative pathways not well eluci-
dated. Many factors may play a role in an episode of nau-
sea and vomiting, and despite advances in new drug thera-
pies in minimizing the incidence, no ideal drug has been
found to prevent all the causes of PONV.
Aromatherapy is a relatively new and under-researched
alternative treatment that might hold promise in treating
PONV. Isopropyl alcohol (IPA) is among several aromas
displaying possible anti-emetic properties. Isopropyl alco-
hol inhalation is a new treatment with only limited inves-
tigations to date (Langevin & Brown, 1997).
Literature Review
Current PONV treatment strategies are based on the
understanding of the vomiting reflex; however, the lack of
well-elucidated pathways in the control of PONV has con-
tributed to the problems with these treatment strategies
and medications. It has been well documented that some
patients are more susceptible to P.
The role of hyperbaric oxygen therapy in Sudden Sensorineural Hearing Loss: A...Apollo Hospitals
Sudden Sensorineural Hearing Loss (SSNHL) is a hearing impairment of more than 30 dB occurring within a period of upto 3 days in three consecutive pure tone frequencies. Hyperbaric oxygen therapy (HBOT) in recent years has gained relevance for treating SSNHL in combination with other agents. The aim of this study is to review the outcomes in patients with SSNHL treated with HBOT at our centre.
Sleep and dreams are taken for granted by those not affected by obstructive sleep apnea. Unfortunately in around 10 million population around the world, sleep is a nightly battle which leaves it‟s victims and their bed partners fatigued, stressed and much less healthy.
Untreated sleep apnea is one of the major public health issues we face in common. The emergence of dental sleep medicine as a safe and effective treatment brings hope for the millions of patients looking for alternatives to CPAP treatment.
Oral appliances used to date constitute a relatively heterogeneous group of devices for the treatment of sleep apnea and non-apneic snoring.
As dental professionals, we have a significant role to play in the early diagnosis, management and care of patients suffering from sleep apnea. Oral appliances play a major role in the non surgical management of OSA and have become the first line of treatment in almost all patients suffering from OSA.
The interplay between anatomic, functional, and neural factors that influence the upper airway patency during wakefulness and sleep is still unclear. Although the role played by the prosthodontists is still in its infancy, there is much to learn and understand in the rapidly evolving field of sleep medicine.
The growing interest of prosthodontists in sleep medicine has contributed immensely toward effective prevention and treatment of OSA and sleep Bruxism for each patient based on his/her individual requirement
No association between prepulse inhibition of the startle reflex and neuropsyc...Benjamin Cortes
Abstract: Sensorimotor gating deficits are relevant in schizophrenia and can be measured using prepulse inhibition (PPI) of the startle reflex. It is conceivable that such deficits may hinder the cognitive functions in schizophrenia patients. In this study, using PPI and a neuropsychological battery, we studied this possibility in a group of 23 acute, neuroleptic-free schizophrenia patients and 16 controls. A non-significant decrease in PPI was found in the patients as compared to the controls, as well as significant differences in the performance of Trail A and B in Wisconsin
Card Sorting and Digit/Symbol Tests. No statistically significant correlations between PPI and neuropsychological performance were found after the correction for multiple comparisons in any group. Our results suggest that PPI deficits in schizophrenia patients may not contribute to the cognitive deficits typical of that illness, at least in patients with a non-significant PPI decrease.
Intensive Aphasia Treatment Program
The North Memorial Stroke Center is the first in the region to offer this innovative outpatient program that includes many hours of intense therapy over the course of three weeks. The program is designed to help participants relearn old ways or develop new alternative ways of communicating. Patients participate in a combination of individual and group treatments sessions for approximately three and a half hours per day, five days a week.
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
2000_1996_review of SD pre-review
1. Figure. Flow chart of literature selection
“Sudden Deafness Hearing Loss” AND “Therapy”
search in PubMed database from January 1976
to December 31 2016
1908
1376
1099
221
Inclusion:
Published in a peer-reviewed
journal in English language
Inclusion:
Articles filtered with keyword
“Human”
Exclusion:
Articles without available abstract
Inclusion
We checked whether papers
stated treatment or not.
779
Inclusion:
Full text
2. Fetterman BL,
Saunders JE,
Luxford WM
Prognosis and treatment of
sudden sensorineural hearing
loss
Am J
Otol.
1996
Jul;17(4):5
29-36.
Retrospective
single
institute
3 837
Rahko T, Kotti V.
Comparison of carbogen
inhalation and intravenous
heparin infusion therapies in
idiopathic sudden sensorineural
hearing loss.
Acta
Otolary
ngol
Suppl.
1997;529:
86-7.
Retrospective
single
institute
3 87
Suckfüll M, Thiery J,
Schorn K,
Kastenbauer E,
Seidel D.
Clinical utility of LDL-apheresis
in the treatment of sudden
hearing loss: a prospective,
randomized study.
Acta
Otolary
ngol.
1999;119(
7):763-6.
Prospective
single
institute
RCT 1b 27
Stokroos RJ, Albers
FW, Tenvergert EM.
Antiviral treatment of idiopathic
sudden sensorineural hearing
loss: a prospective, randomized,
double-blind clinical trial.
Acta
Otolary
ngol.
1998
1998
Jul;118(4):
488-95.
Prospective
single
institute
RCT 1b 44
Minoda R1,
Masuyama K, Habu
K, Yumoto E.
Initial steroid hormone dose in
the treatment of idiopathic
sudden deafness.
Am J
Otol.
2000
Nov;21(6):
819-25.
Retrospective
single
institute
5 250
Fujino M1, Hisashi
K, Yashima N,
Takeshita M,
Fujiwara Y, Chujo K,
Nakagawa T,
Komune S,
Komiyama S.
Treatment of sudden
sensorineural hearing loss with
a continuous epidural block.
Eur Arch
Otorhin
olaryng
ol.
1999;256
Suppl
1:S18-21.
Retrospective
single
institute
5 20
Kallinen J1,
Laurikainen E,
Laippala P,
Grénman R.
Sudden deafness: a comparison
of anticoagulant therapy and
carbogen inhalation therapy.
Ann
Otol
Rhinol
Laryngol
.
1997
Jan;106(1)
:22-6.
Prospective
single
institute
2a 168
3. Am J Otol. 2000 Nov;21(6):819-25.
Initial steroid hormone dose in the treatment of idiopathic sudden deafness.
Minoda R , Masuyama K, Habu K, Yumoto E.
• The purpose of this study was to clarify whether higher doses of steroids improve the prognosis of idiopathic
sensorineural hearing loss (ISHL) and the suitable dose of steroid hormone.
• The study was a retrospective statistical analysis.
• This study was performed at the Department of Otolaryngology, Head Neck Surgery, Kumamoto University
School of Medicine. Two hundred fifty patients with ISHL were analyzed in this study. They were divided into two
groups: those receiving less than a specified daily dose of steroid and those receiving a daily dose greater than
or equal to the specified dose.
• The patients received systemic steroid therapy combined with adenosine triphosphate, vitamins, diuretics,
vasodilators, hyperbaric oxygen therapy, stellate ganglion block, or volume expander.
• The correlation between the initial dose of steroid hormone and the improvement rate was analyzed.
• Spearman's correlation coefficients and partial correlation coefficients between the initial dose and the
prognosis were all significantly negative.
• On the other hand, the correlations between the initial dose and the prognosis were positive in the group
receiving <30 mg/day, whereas they were negative in the group receiving > or =30 mg/day, although these
correlations were not significant.
• The general use of steroid hormone to treat ISHL is not recommended. Furthermore, if steroid hormone is used
for treatment, the use of <30 mg/day of prednisolone is preferable.
Minoda R1,
Masuyama K,
Habu K,
Yumoto E.
Initial steroid
hormone dose in the
treatment of
idiopathic sudden
deafness.
Am J Otol.
2000
Nov;21(6):819-25.
Retrospective single institute 5 250
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
4. Review
Am J Otol. 1999 Sep;20(5):587-92; discussion 593-5.
Management of idiopathic sudden sensorineural hearing loss.
Haberkamp TJ, Tanyeri HM.
OBJECTIVE:
To determine if any consensus exists regarding the efficacy of treatment in idiopathic sudden
sensorineural hearing loss syndrome (ISSNHL).
DATA SOURCES:
A review of the literature from 1966 to the present on Medline database was performed with the
following search criteria: Hearing loss, sensorineural (MeSH terms), sensorineural hearing loss (text
word), deafness (MeSH), and idiopathic or sudden (all fields). Further limiting search terms were
treatment outcomes or controlled studies.
DATA EXTRACTION:
The articles were then analyzed searching for randomized, prospective, controlled studies of single
treatment modalities. Both human and animal studies were included for discussion because of the
paucity of human studies.
CONCLUSION:
No consensus exists on the effective treatment of ISSNHL. Randomized, controlled studies have
demonstrated the effectiveness of systemic steroids, however, follow up studies have questioned the
benefit of steroid therapy.
5. Acta Otolaryngol. 1999;119(7):763-6.
Clinical utility of LDL-apheresis in the treatment of sudden hearing loss: a prospective, randomized study.
Suckfüll M, Thiery J, Schorn K, Kastenbauer E, Seidel D.
Although the pathogenesis of sudden hearing loss (SHL) is not as yet known, the clinical picture and the frequent association with
vascular risk factors make an ischaemic event likely. This study aimed to assess the effect of an extracorporeal procedure (H.E.L.P.) in
removing LDL-cholesterol, fibrinogen and lipoprotein (a) from the plasma, on the recovery of hearing SHL. This procedure using the
HELP-system was compared with the usual standard treatment with prednisolone, dextranes and pentoxifyllin.
We undertook a single centre, prospective, randomized study in which 18 patients were assigned to H.E.L.P.-apheresis and 9 patients
were assigned to standard treatment (2:1 randomization). Audiometric and laboratory testing was performed at baseline, 24 h and 6
weeks after start of treatment. Primary endpoint was the improvement of the average pure-tone threshold between 0.125 and 8 kHz
after 24 h. Twenty-four hours after H.E.L.P. treatment average pure-tone threshold recovered by 10.4 dB and by 26.4 dB after 6 weeks.
The recovery of hearing of the standard treated patients was 5.8 dB and 16.8 dB after 24 h and 6 weeks respectively. LDL-cholesterol,
fibrinogen and lipoprotein (a) were significantly reduced in the HELP treated patients compared with standard therapy, resulting in a
significant improve in plasma viscosity, erythrocyte aggregation and resistance to oxidative stress of LDL particles.
Our results suggest that the clinical outcome of SHL after a single extracorporeal LDL-apheresis is superior or at least equal to the more
expensive standard treatment with prednisolone, dextranes and pentoxifyllin. Re-establishment of vascular endothelial function and
improved blood rheology may be the underlying cause. These results must be confirmed in larger-scale trials.
Suckfüll M,
Thiery J,
Schorn K,
Kastenbauer
E, Seidel D.
Clinical utility of LDL-
apheresis in the
treatment of sudden
hearing loss: a
prospective,
randomized study.
Acta
Otolaryngol
.
1999;119(7):763-6.Prospective single institute RCT 1b 27
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
6. Eur Arch Otorhinolaryngol. 1999;256 Suppl 1:S18-21.
Treatment of sudden sensorineural hearing loss with a continuous epidural block.
Fujino M, Hisashi K, Yashima N, Takeshita M, Fujiwara Y, Chujo K, Nakagawa T, Komune S, Komiyama S.
The efficacy of a continuous epidural block was evaluated in the treatment of 20 patients with sudden sensorineural
hearing loss (SNHL).
Ten patients were treated with continuous cervicothoracic epidural block (group A) and the other 10 were treated with
stellate ganglion block (group B).
No significant difference in factors affecting prognosis was noted between the groups. In the epidural block group 70%
achieved substantial hearing improvement, while this occurred in only 30% of patients undergoing stellate ganglion
block. These findings suggest that continuous epidural block can be effective in the treatment of sudden SNHL.
Fujino M1,
Hisashi K,
Yashima N,
Takeshita M,
Fujiwara Y,
Chujo K,
Nakagawa T,
Komune S,
Komiyama S.
Treatment of sudden
sensorineural hearing
loss with a continuous
epidural block.
Eur Arch
Otorhinolar
yngol.
1999;256 Suppl
1:S18-21.
Retrospective single institute 5 20
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
7. Am J Otol. 1998 Sep;19(5):579-83.
What kind of patients are suitable for evaluating the therapeutic effect of sudden deafness?
Sano H, Okamoto M, Shitara T, Hirayama M.
OBJECTIVE:
This study aimed to find out appropriate patients to evaluate the therapeutic effect of sudden deafness.
STUDY DESIGN:
The study design was a retrospective case review.
SETTING:
The study was performed at a university hospital.
PATIENTS:
A series of 443 patients with idiopathic sudden sensorineural hearing loss who visited the authors within 1 week from
the onset participated.
INTERVENTIONS:
Relationship between interval from the onset and treatment prognosis was investigated.
RESULTS:
The significant difference in prognosis related to the days from the onset to the initial visit was noted only in the
patients with the initial hearing level from 50-65 dB. The prognosis of the patients who visited the authors on the
next day from the onset was excellent. Whereas, in the patients with initial hearing level worse than 70 dB, no
significant difference in prognosis was noted among the days of visit.
CONCLUSIONS:
The patients with the initial hearing level worse than 70 dB and who visited the authors within 8 days from the onset
were appropriate for candidates in evaluating the therapeutic effect of sudden deafness.
8. Acta Otolaryngol. 1998 Jul;118(4):488-95.
Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical
trial.
Stokroos RJ, Albers FW, Tenvergert EM.
A subclinical viral labyrinthitis has been postulated in the literature to elicit Idiopathic Sudden Sensorineural Hearing
Loss. An etiological role for the herpes virus family is assumed. Corticosteroids possess a limited beneficial effect on
hearing recovery in ISSHL. In this study, the therapeutic value of the antiherpetic drug aciclovir (Zovirax) on hearing
recovery in 44 ISSHL patients receiving prednisolone is evaluated in a multicentre clinical trial.
The study is designed prospectively, randomized, double-blind and placebo-controlled. Subjective parameters include
hearing recovery, a pressure sensation on the affected ear, disequilibrium or vertigo and tinnitus. Audiometric
parameters include pure tone and speech audiometry. A one-year follow up is obtained.
Both the pressure sensation and disequilibrium or vertigo have a good prognosis, but tinnitus, occurring in most
patients, has a poor prognosis. Hearing recovery prognosis depends on the severity of initial hearing loss, and not on
vestibular involvement. No beneficial effect from combining aciclovir with prednisolone can be established in ISSHL.
Stokroos RJ,
Albers FW,
Tenvergert
EM.
Antiviral treatment of
idiopathic sudden
sensorineural hearing
loss: a prospective,
randomized, double-
blind clinical trial.
Acta
Otolaryngol
. 1998
1998
Jul;118(4):488-95.
Prospective single institute RCT 1b 44
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
9. Acta Otolaryngol Suppl. 1997;529:86-7.
Comparison of carbogen inhalation and intravenous heparin infusion therapies in idiopathic
sudden sensorineural hearing loss.
Rahko T, Kotti V.
The effect of carbogen (5% carbon dioxide and 95% oxygen) inhalation and intravenous
heparin on sudden sensorineural hearing loss was compared. Forty-four patients received
the former, 43 the latter treatment, respectively. The patients were unselected patients of
the clinic. The PTA (0.5-2.0 kHz) at the pretreatment stage was 62 dB in the heparin and 55
dB in the carbogen group. One month later the corresponding figures were 34 and 32 dB,
the difference being statistically not significant. Thus neither of these methods proved
superior in the treatment of sudden sensorineural hearing loss.
Rahko T, Kotti
V.
Comparison of
carbogen inhalation
and intravenous
heparin infusion
therapies in idiopathic
sudden sensorineural
hearing loss.
Acta
Otolaryngol
Suppl.
1997;529:86-7. Retrospective single institute 3 87
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
10. Ann Otol Rhinol Laryngol. 1997 Jan;106(1):22-6.
Sudden deafness: a comparison of anticoagulant therapy and carbogen inhalation therapy.
Kallinen J, Laurikainen E, Laippala P, Grénman R.
Sudden deafness (SD) is a sudden or rapidly progressive, partial or complete, typically unilateral
sensorineural hearing impairment that has no known specific etiologic factor. This study was designed
to compare, in a group of 168 consecutive patients with SD, the effect of anticoagulant therapy and
carbogen inhalation therapy.
Special attention was paid to the shape of the audiogram relative to the clinical outcome and the
treatment modality. We found that the configuration of the audiogram of SD patients is prognostic of
the outcome, and that patients with a low-frequency-sloping hearing impairment have a better
prognosis compared to the patients with a high-sloping loss. Anticoagulant treatment was most
effective in low-sloping hearing losses, while carbogen inhalation may be more effective for patients
with high-sloping hearing losses.
Kallinen J1,
Laurikainen E,
Laippala P,
Grénman R.
Sudden deafness: a
comparison of
anticoagulant therapy
and carbogen
inhalation therapy.
Ann Otol
Rhinol
Laryngol.
1997
Jan;106(1):22-6.
Prospective single institute 2a 168
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)
11. Am J Otol. 1996 Jul;17(4):529-36.
Prognosis and treatment of sudden sensorineural hearing loss.
Fetterman BL, Saunders JE, Luxford WM.
Most cases of sudden sensorineural hearing loss (SHL) are idiopathic. Consequently, the otologist may
be asked to predict hearing recovery and select a treatment strategy without fully understanding the
disease process. We retrospectively reviewed the charts of 837 patients with SHL to evaluate the
prognostic value of specific clinical parameters and the effectiveness of steroid and vasodilator
treatments. Treatment response was defined by the patient's subjective response and audiological
criteria.
Patients who were treated with steroids and/or vasodilators were more likely to improve. Patients who
improved had a worse initial pure-tone average (PTA) than those who did not improve. In addition,
those with poorer initial speech discrimination scores, worse initial thresholds at 4,000 Hz, younger age,
and greater number of treatments were more likely to improve. Neither the electronystagmogram
results nor the initial audiogram shape were valuable indicators. Recognition of prognostic indicators
can help in counselling patients and in the evaluation of treatment response.
Fetterman BL,
Saunders JE,
Luxford WM
Prognosis and
treatment of sudden
sensorineural hearing
loss
Am J Otol.
1996
Jul;17(4):529-36.
Retrospective single institute 3 837
Evidence Level
1a ランダム化比較試験のメタアナリシス
1b 少なくとも一つのランダム化比較試験
2a ランダム割付を伴わない同時コントロールを伴うコホート研究(prospective study,concurrent cohort studyなど)
2b ランダム割付を伴わない過去のコントロールを伴うコホート研究(historical cohort study,retrospective cohort studyなど)
3 ケース・コントロール研究(後ろ向き研究)
4 処置前後の比較などの前後比較,対照群を伴わない研究
5 case report case series
6 expert’s opinion(専門家委員会報告を含む)