Long-term Loss Research Articles

REIMAGINING AGING WITH DISABILITY THROUGH TECHNOLOGY

Abstract Individuals aging with long-term disabilities are likely to require support for managing challenges with everyday activities. To effectively promote independence and aging-in-place for this population, we must consider innovative technology solutions that go beyond traditional direct care services. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is an interdisciplinary collaboration between Georgia Tech, the University of Illinois Urbana-Champaign, and Georgia State University, dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. First, Remillard et al., will present interview findings from individuals aging with long-term vision loss on challenges performing instrumental activities of daily living. Next, Mitzner et al., will describe TechSAge research-driven guidelines for designing and delivering wellness classes via video-conferencing to older adults with and without disabilities. Blocker et al., will highlight a field trial evaluating how digital home assistants (e.g., Amazon Echo devices) and smart home devices, along with user-friendly support guides, can support older adults with mobility disabilities at home. Finally, Jones et al., will describe the latest feature of the SmartBathroom laboratory – a SmartBathing Transfer Testbed prototype that will enable us to study of how different bathing environment configurations can impact transfer performance. Margaret Campbell (Retired Senior Scientist for Planning and Policy Support, National Institute on Disability, Independent Living, and Rehabilitation Research) will serve as the discussant for the symposium.

AGING WITH VISION LOSS: EXPLORING EVERYDAY ACTIVITY CHALLENGES AND OPPORTUNITIES FOR TECHNOLOGY INNOVATION

Abstract Vision loss can impact the health of older adults on multiple domains, including physically (e.g., mobility challenges), psychologically (e.g., depression), and socially (e.g., isolation). Older adults with vision loss, and particularly those with long-term vision loss, are likely to experience challenges in performing Instrumental Activities of Daily Living (IADLs), as these activities often require abilities like reading, fine motor movements, and navigating. We conducted structured interviews with 60 older adults aged 60-79 with vision loss for at least 10 years about their challenges with select IADLs (e.g., household tasks, transportation, shopping, finances, and managing health). An analysis of in-depth interview data revealed specific challenge themes associated with engaging in different IADLS, such as challenges with accessibility, physical limitations, assistance from others, communication, and finances. Findings highlight opportunities for technology solutions to support IADL participation and independence for people aging with vision loss.

The Histological Spectrum and Clinical Significance of T Cell-mediated Rejection of Kidney Allografts.

T cell-mediated rejection (TCMR) remains a significant cause of long-term kidney allograft loss, either indirectly through induction of donor-specific anti-HLA alloantibodies or directly through chronic active TCMR. Whether found by indication or protocol biopsy, Banff defined acute TCMR should be treated with antirejection therapy and maximized maintenance immunosuppression. Neither isolated interstitial inflammation in the absence of tubulitis nor isolated tubulitis in the absence of interstitial inflammation results in adverse outcomes, and neither requires antirejection treatment. RNA gene expression analysis of biopsy material may supplement conventional histology, especially in ambiguous cases. Lesser degrees of tubular and interstitial inflammation (Banff borderline) may portend adverse outcomes and should be treated when found on an indication biopsy. Borderline lesions on protocol biopsies may resolve spontaneously but require close follow-up if untreated. Following antirejection therapy of acute TCMR, surveillance protocol biopsies should be considered. Minimally invasive blood-borne assays (donor-derived cell-free DNA and gene expression profiling) are being increasingly studied as a means of following stable patients in lieu of biopsy. The clinical benefit and cost-effectiveness require confirmation in randomized controlled trials. Treatment of acute TCMR is not standardized but involves bolus corticosteroids with lymphocyte depleting antibodies for severe, refractory, or relapsing cases. Arteritis may be found with acute TCMR, active antibody-mediated rejection, or mixed rejections and should be treated accordingly. The optimal treatment ofchronic active TCMR is uncertain. Randomized controlled trials are necessary to optimally define therapy.

Long-Term Loss of Coral Reef in the Gulf of Aqaba Estimated from Historical Aerial Images

Located at the northern tip of the Red Sea, the Gulf of Aqaba coral reef is highly susceptible to anthropogenic pressure associated with the massive development of the two neighboring cities of Eilat and Aqaba. Over the years, the reef has been extensively studied in a number of research and monitoring programs, which provide detailed information on a variety of ecological, physiological, biogeochemical and physical variables. Due to the local nature of these surveys, although the state of the reef at specific times and locations is very well characterized, long-term changes in the spatial characteristics of the reef as a whole have not yet been quantified. Here, through analysis of historical aerial images, we address one of the most important aspects of this knowledge gap and quantify the decrease in coral reef coverage, with respect to a baseline level prior to the establishment of the City of Eilat in 1949. Our results show that along a 8460 m segment of the shoreline at the northwestern edge of the GOA (29°29′–30°N/34°54′–35°E), infrastructure construction has led to the loss of more than 4810 m2 of coral reef. This loss has been caused either directly by the construction (most importantly the Eilat Port) or indirectly by changing environmental conditions, which in turn damage the reef. Our results show that historical aerial images can provide a unique source of information on the spatial characteristics of marine and coastal systems prior to the era of Earth observation satellites.

SÜREKLİLİK VEYA ULUSLARARASI HUKUK KİŞİLİĞİNİN KİMLİĞİ

Makalede süreklilik veya uluslararası hukuk kişiliğinin kimliği konusu incelenecektir. Devletin kimliği ve sürekliliği konusunda süre hususu yalnız siyasi önem taşıyabilir. Onun hukuki önemi yoktur. Bir devletin kimliği ve sürekliliğinin kabulüne ilişkin olarak uluslararası hukukta kesin kural yoktur. Eğer süreklilikte süreye ilişkin kıstasları belirlemeye çalışırsak o zaman: “sürgün hükumetinin” varlığı ve onun savaşı, uluslararası birliğin ayrı ayrı devletlerin kanuna aykırı ilhaka negatif yaklaşımı ve ilhak edilen toprakların halkının devamlı siyasi askeri yaklaşımı dikkate alınmalıdır. Halkın yaklaşımı, onun gizli ve açık siyasi teşkilatlanması, bağımsızlık savaşı uluslararası hukuk kimliği anlamında öncekinin bütün parametreleri ile “aynı” olmasa da “onun gibi” devletin sürekliliği için en önemli kıstas olur. Önceki devletle onarılan devlet arasında kimliği aynılaştırma şartı ve halkın önceki devletin sürekliliğe ilişkin anayasal beyanı da önemli şartlardan sayılmalıdır.

DETERMINATION OF FACTORS ASSOCIATED WITH LONG-TERM ENDOTHELIAL LOSS AND REFRACTIVE RESULT IN PATIENTS WITH ARTISAN PHAKIC LENS.

To determine the changes in endothelial cell density, refractive results, and risk factors associated with endothelial loss in patients with irisclaw phakic intraocular lenses for myopia/myopic astigmatism (Artisan). Data collection was obtained from an existing database with information on patients with a phakic Artisan lens implant between 1998 and 2011 at the Virgilio Galvis Ophthalmology Centre, with at least 5 years of follow-up. As a second stage, an analysis was carried out to identify the change in endothelial cell density and its potential associated factors. A total of 80 eyes with myopic errors were included with a follow-up of 11.9 + 3.48 years. The percentage of total loss of endothelial cells was greater than 25% of the preoperative density in 43.8% of the eyes. A postoperative annual loss > 1.6% was found in 47.0% of the eyes with that information available. 41 eyes (51%) had final endothelial density < 2000 cells/mm2, and 7 (8.8%) eyes had endothelial cell density < 1000 cells/mm2. Among the variables studied, no associated factors for long-term endothelial loss were found. During the course of the study, 8 (10%) phakic intraocular lenses were explanted, including 3 with accelerated endothelial loss, and another 2 with cataract associated and a significantly low endothelial density. The last mean spherical equivalent was -0.81 (±1.01 D), and the final uncorrected distance visual acuity was 0.45 logMar (Snellen 20/56). Artisan-type phakic lenses are a good alternative for the correction of high myopic defects, with predictable refractive results in the long term. However, there is an increased loss of endothelial cells in the long term in a high percentage of patients. Strict postoperative follow-up, including endothelial evaluation, is required, and further studies are warranted.

Влияние фактора интерференции социальных сетей на процессы консолидации памяти у подростков

The relevance of this study is due to the need to answer the question of how the factors of digital medium affect the development of mental functions in the younder generation. The study was aimed to assess the effects of the social media interference factor on memory (auditory-speech and visual-figurative) consolidation in adolescents. The sample was 130 adolescents aged 11–17. The groups were formed based on the age stages (11–12, 13–14, 15–17 years). The study involved the use of the method for the diagnosis of the short-term auditory-speech and visual-figurative memory span. Viewing video content and reading the fragment of the fiction book were used as interference. A significant decrease in the short-term auditory-speech and visual-figurative memory span was observed in adolescents. The short-term memory span is reduced in the context of social media interference (prolonged continuous viewing the heterogenous visual-acoustic and visualspeech content). The high risk of the long-term memory loss due to the impact of the social media interference factor on memory consolidation in adolescents is empirically proven. The more the duration of the maximum continuous video stream and the total time the adolescents spend on Internet (including social media), the larger is the loss of information.

Dynamic Multichannel Access Based on Deep Reinforcement Learning in Distributed Wireless Networks

With the emergence of innovative applications in vertical industries such as smart home and industrial automation, machine communication has shown a spurt of development. Different from the traditional human-oriented cellular communication, machine communication is characterized by strong uncertainty and abruptness, large-scale concurrent device connection as well as uneven and unsaturated data traffic. This article investigates the dynamic multiple-devices multiple-channels access for unsaturated traffic with retransmission mechanism, which is aimed at reducing the long-term data packet loss resulting from buffer overflows and transmission failure. The instant channel selection will lead to a non-negligible impact on the future decision, motivating us to model this problem as a Markov decision process. Limited by the unknown environment knowledge, we proposed a dynamic access policy based on deep reinforcement learning algorithm to optimally select the channel for transmission or keep silent for Internet-of-Things devices. Simulation results confirm that our proposed channel access strategy can reduce the collision and the packet loss of network. Furthermore, it can also work well when coexisting with the devices that adopt time division multiple access (TDMA) or ALOHA protocol.

Effects of forest management on the spatial distribution of the willow tit (Poecile montanus)

Modification, fragmentation and loss of boreal forest habitats have been intensive during the last century due to forestry practises and land use. This has been related to population declines of many forest species, yet the mechanisms affecting on the background are largely unknown. The willow tit, a primary cavity-nesting species that was once the 4th most common bird species in Finland is nowadays endangered. Earlier findings suggest that the willow tit population is affected by the reduction of nesting sites, decaying snags in forests and the loss of mature forests which contain the food storages during the winter. In this study we are searching for the mechanisms how the forest management methods could explain the decline of the willow tit population. We used long-term breeding data of the willow tit nesting sites from 1990 to 2020 collected in a study area in northern Finland to analyse if forest management affected nearest neighbour distances and natal dispersal and breeding dispersal distances. We used Geographic Information System (GIS) methods to combine the ecological breeding data to accurate spatial forest management and habitat quality data. The data was analysed with linear mixed models. We found that clear-cuttings affected the willow tit dispersal and neighbouring nest distances more than thinnings. Both clear-cuttings and thinnings increased the nearest neighbour distances. The natal and breeding dispersal distances were lengthened by increasing proportions of clear-cuttings. The habitat loss caused by clear-cuttings and the decrease in habitat quality caused by thinnings has had a major role in the decline of the willow tit population. The forest management actions were estimated to explain about 65 % of the willow tit breeding density decrease in the study area. The effects of forest management were witnessed in a cumulative 0–30-year period meaning that forest management causes long-term habitat degradation and loss. Availability of deciduous snags in the forests can compensate the habitat loss to some extent by providing better breeding opportunities. As the effects of clear-cutting were more severe to the willow tit than thinning, we recommend using other forest management methods than clear-cutting as the main management method.

Sequelae of Unreplaced Tooth Loss in Orthodontic Patients: A Cross-Sectional Study in Najran, Kingdom of Saudi Arabia.

The early tooth loss has an adverse effect on the overall well-being of an individual. The aim of the current study was to highlight the orthodontic complications of long-term tooth loss in the city of Najran. This was a cohort study of patients presenting for orthodontic rehabilitation. A total of 326 patients that presented for orthodontic rehabilitation were examined clinically and data such as age, gender, number of missing teeth, missing teeth, duration of missing teeth, tipping, and overerupted and rotated teeth were recorded. Patients that can be treated with orthodontic space closure were excluded from the study. Patients' data were analyzed using IBM SPSS Statistics and results were presented as simple frequencies and descriptive statistics. Out of 326 patients that presented for orthodontic rehabilitation, 259 patients had missing teeth with its sequelae that will demand prosthodontic rehabilitation with a prevalence rate of 79.4%. There are 97 (37.5%) males and 162 (62.5%) females with M:F ratio of 1:1.7. The age ranged from 15 to 52 years with mean ± standard deviation (28.5 ± 8.5). The age group 21-30 years constitutes the group with the highest number of missing teeth. A total number of 595 (60.2%) teeth were missing, 173 (17.5%) teeth were tipped, and 124 (12.5%) teeth were overerupted, whereas only 97 (9.8%) teeth were rotated (n = 989). Fixed orthodontic appliances (FOAs) were used for all cases with rotation and FOAs + Mini Screws were used for all cases with tipping, overeruption, and/or combinations. The dental loss was managed by prosthesis depending on patients' choice and financial capability ranging from removable/fixed prosthesis and dental implants. Orthodontic consequences of early tooth loss include tipping and rotation of adjacent teeth and overeruption of opposing teeth. Early acknowledgment of tooth replacement after tooth loss is essential in preventing long-term orthodontic adverse effects.

Periodontal risk score: Initiation and model validation for 6,762 teeth.

Tooth-level prognostic systems are valuable tools for treatment planning and risk assessment of periodontally involved teeth. Recently the Miller-McEntire prognosis index was found to outperform comparable systems. However, it had some limitations. The present study aimed todevelop and evaluate the prognostic performance of a modified version that addresses most limitations of the previous model called the periodontal risk score (PRS). Data were retrieved retrospectively frompatients who received surgical and non-surgical periodontal treatment at a university setting.Data on medical history and smoking status at baseline and the last maintenance visitwere collected. Both univariate and multivariate Cox proportional hazard regression models were used to analyze the prognostic capability for predicting tooth loss due to periodontitis (TLP) risk. A total of 6762 teeth (281 patients) werefollowed up for a mean period of 22.6±6.34 (10-47.6y) years. The PRS was successfully able to stratify the risk of TLP at baseline when the three different classes of association were compared for anterior and/or posterior tooth loss. After controlling for maintenance, age, and sex, the index showed an excellent predictive capacity for TLP with a Harrell C-index of 0.947. The periodontal risk score (PRS) displayed excellent predictive capability for anterior as well as posterior tooth loss due to periodontitis. This system was able to predict long-term tooth loss with a very high accuracy in a population treated mainly by dental students and periodontics residents. The use of this/similar prognosis system is advisable as a means to establish tooth prognosis.

Predictive Factors for Acute Kidney Injury and Long-Term Renal Function Loss After Partial Nephrectomy: A Prospective Single-Center Study

To find factors related to postoperative acute kidney injury and long-term significant renal function (RF) loss after partial nephrectomy (PN) in Chinese population. The main outcome was significant RF loss during the last follow-up, which was defined as >25% decrease in estimated glomerular filtration rate. A total of 416 patients were included with median age as 57 (interquartile ranges,IQR 49.8-65.0) year with body mass index as 24.2 (IQR 22.0-26.5) kg/m2 and preoperative estimated glomerular filtration rate as 90.5 (IQR 79.8-101) mL/min. Summarily, 259 (62.3%) patients were male, 54 (13%) had diabetes, 180 (43.3%) hypertension and 80 (19.2%) hyperuricemia. Median (IQR) tumor diameter was 3.1 (2.4-4.1) cm. All patients underwent PN, in which 135 (32.5%) by open PN approach, 109 (26.2%) by laparoscopic PN and 172 (41.3%) by robot assisted PN. RF was followed up for 16.88 (10.15-36.37) months, where 58 (13.9%) patients suffered significant RF loss. Multivariable analysis showed age (P = .0039), body mass index (P = .0049), diabetes (P = .0351), operative time > 110 minutes (P = .0034), diameter classification by Diameter-Axial-Polar score (diameter 2.4 cm-4.4 cm, P = .0225: diameter > 4.4 cm, P = .0207), postoperative acute kidney injury (P < .001) to be predictors of RF loss with area under the curve as 0.850. We prospectively found predictive factors of short and long-term significant RF loss in all operative methods and constructed a clinical nomogram for long-term Chinese patients RF loss.

Long-term effect of dupilumab on prevention of lung function decline in patients with uncontrolled moderate-to-severe asthma: ATLAS trial design.

Many patients with asthma experience loss of lung function over time, and in certain patients this can lead to progressive obstructive patterns similar to COPD. Patients with severe asthma may experience accelerated lung function decline (LFD). However, characteristics and risk factors for LFD in asthma have not been well described. Dupilumab may prevent or slow the rate of LFD in patients with uncontrolled, moderate-to-severe asthma. ATLAS trial is designed to evaluate the role of dupilumab in preventing/slowing LFD over a period of 3 years versus standard-of-care therapy. ATLAS (clinicaltrials.gov identifier NCT05097287) is a randomised, double-blind, placebo-controlled, multicentre study that will include adult patients with uncontrolled moderate-to-severe asthma. ∼1828 patients will be randomised (2:1) to dupilumab 300 mg or placebo in combination with maintenance therapy every 2 weeks for 3 years. The primary objective is to assess the effect of dupilumab on preventing or slowing LFD by year 1 in the exhaled nitric oxide fraction (F eNO) population (patients with F eNO ≥35 ppb). The effect of dupilumab in slowing the rate of LFD by year 2 and year 3 in both F eNO and total populations, exacerbations, asthma control, quality of life, biomarker changes and utility of F eNO as a biomarker of LFD will also be evaluated. ATLAS is the first trial assessing the effect of a biologic on LFD, designed to establish the role of dupilumab in prevention of long-term loss of lung function and its potential effect on disease modification, which may provide unique insights into asthma pathophysiology, including predictive and prognostic factors of LFD.

The need for sensory nutrition research in individuals with smell loss

<h2>Summary</h2> Millions of people will now suffer from long-term smell loss as a result of infection with the SARS-CoV-2 virus. Smell is an integral component of the flavor of foods, which is one of the primary drivers of ingestive behavior. When individuals lose their sense of smell, they find food to be less flavorful and less enjoyable, which negatively impacts their quality of life. To compensate, many individuals alter their diet by focusing on tastes, chemesthesis (e.g., chili pepper heat, menthol cooling), and the texture of foods to make it more palatable. Some diet alterations, such as increasing salt use, can result in a lower diet quality, and an increased risk for chronic disease. Sensory nutrition is an area of research that focuses on how the chemical senses (e.g. taste, smell, chemesthesis) and oral somatosensation) affect dietary choices and health. Sensory nutrition strategies designed for individuals with smell loss may help improve the flavor and liking of foods while improving diet quality, and are a necessary area of future research to help improve health and quality of life in the growing population with smell loss.

Processing of auditory information in forebrain regions after hearing loss in adulthood: Behavioral and electrophysiological studies in a rat model.

Hearing loss was proposed as a factor affecting development of cognitive impairment in elderly. Deficits cannot be explained primarily by dysfunctional neuronal networks within the central auditory system. We here tested the impact of hearing loss in adult rats on motor, social, and cognitive function. Furthermore, potential changes in the neuronal activity in the medial prefrontal cortex (mPFC) and the inferior colliculus (IC) were evaluated. In adult male Sprague Dawley rats hearing loss was induced under general anesthesia with intracochlear injection of neomycin. Sham-operated and naive rats served as controls. Postsurgical acoustically evoked auditory brainstem response (ABR)-measurements verified hearing loss after intracochlear neomycin-injection, respectively, intact hearing in sham-operated and naive controls. In intervals of 8 weeks and up to 12 months after surgery rats were tested for locomotor activity (open field) and coordination (Rotarod), for social interaction and preference, and for learning and memory (4-arms baited 8-arms radial maze test). In a final setting, electrophysiological recordings were performed in the mPFC and the IC. Locomotor activity did not differ between deaf and control rats, whereas motor coordination on the Rotarod was disturbed in deaf rats (P < 0.05). Learning the concept of the radial maze test was initially disturbed in deaf rats (P < 0.05), whereas retesting every 8 weeks did not show long-term memory deficits. Social interaction and preference was also not affected by hearing loss. Final electrophysiological recordings in anesthetized rats revealed reduced firing rates, enhanced irregular firing, and reduced oscillatory theta band activity (4-8 Hz) in the mPFC of deaf rats as compared to controls (P < 0.05). In the IC, reduced oscillatory theta (4-8 Hz) and gamma (30-100 Hz) band activity was found in deaf rats (P < 0.05). Minor and transient behavioral deficits do not confirm direct impact of long-term hearing loss on cognitive function in rats. However, the altered neuronal activities in the mPFC and IC after hearing loss indicate effects on neuronal networks in and outside the central auditory system with potential consequences on cognitive function.

Cerebral Metabolic Dysfunction at the Acute Phase of Traumatic Brain Injury Correlates with Long-Term Tissue Loss.

Following traumatic brain injury (TBI), cerebral metabolic dysfunction, characterized by an elevated cerebral microdialysis (CMD) lactate/pyruvate (LP) ratio, is associated with poor outcome. However, the exact pathophysiological mechanisms underlying this association are not entirely established. In this pre-planned analysis of the BIOmarkers of AXonal injury after Traumatic Brain Injury (BIO-AX-TBI) prospective study, we investigated any associations of LP ratio with brain structure volume change rates at 1 year. Fourteen subjects underwent acute-phase (0-96 h post-TBI) CMD monitoring and had longitudinal magnetic resonance imaging (MRI) quantification of brain volume loss between the subacute phase (14 days to 6 weeks) and 1 year after TBI, recalculated as an annual rate. On average, CMD showed an elevated (>25) LP ratio (31 [interquartile range (IQR) 24-34]), indicating acute cerebral metabolic dysfunction. Annualized whole brain and total gray matter (GM) volume change rates were abnormally reduced (-3.2% [-9.3 to -2.2] and -1.9% [-4.4 to 1.7], respectively). Reduced annualized total GM volume correlated significantly with elevated CMD LP ratio (Spearman's ρ = -0.68, p-value = 0.01) and low CMD glucose (ρ = 0.66, p-value = 0.01). After adjusting for age, admission Glasgow Coma Scale (GCS) score and CT Marshall score, CMD LP ratio remained strongly associated with 1-year total GM volume change rate (p < 0.001; multi-variable analysis). No relationship was found between WM volume changes and CMD metabolites. We demonstrate a strong association between acute post-traumatic cerebral metabolic dysfunction and 1-year gray matter atrophy, reinforcing the role of CMD LP ratio as an early biomarker of poor long-term recovery after TBI.

Long-lasting brain fog is related with severity clusters of symptoms in COVID-19 patients.

COVID-19 patients may experience Long-lasting symptoms from weeks to even months. To evaluate long-term cognitive impairment based on the severity of symptoms of COVID-19 infection in a primary health system setting. From a database of 363 patients, 83 cases aged 47 ± 15 years, (58% females) were selected from June to August 2020. In patients who survived the virus, 24 infection-related symptoms were collected to create three severity clusters (mild, moderate, and severe). The follow-up time was at least seven months. Comparing the first two clusters with the severe cluster, the existence of brain fog and risk factors (obesity, hypertension, diabetes, chronic lung disease, and hypothyroidism) were analyzed. Thirty-one patients (37%) had persistent symptoms lasting up to 240 days. Fifty-one patients (61%) experienced brain fog. Concentration was affected by symptom severity (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.26-10.46, p = 0.02). Short- or long-term memory loss was not affected. Moreover, symptom severity was related to brain fog (OR 3.16, 95% CI 1.05-9.51, p = 0.04). Patients with persistent symptoms had a concentration impairment associated with severity patterns (OR 24.3, 95% CI 1.73-340.11, p = 0.03). Brain fog is associated with symptom severity in COVID-19 survivors and lasts for more than eight months.

Measurement of sound levels in a neonatal intensive care unit of a tertiary care hospital, Karachi, Pakistan.

High sound levels in the neonatal intensive care unit (NICU) can alter preterm newborn hemodynamics and cause long-term neuro-developmental delays and hearing loss. The study aims to collate data on sound levels in a level IV NICU of a tertiary care hospital, identify the factors associated with them, and compare them with the international standards set by the World Health Organization (WHO), Environmental Protection Agency (EPA), and American Academy of Pediatrics (AAP). We carried out a cross-sectional study in NICU from 8th April 2019 to 30th June 2019. Sound levels were recorded for 480h, using a portable sound meter, the Larson Davis 824. We captured sound levels on alternate days, during different shifts and shift changes and in open pods and single isolation rooms within the NICU. Additionally, we documented the total census, acuity of care, number of staff, number of procedures, and number of items of equipment used. The data was analyzed using t-test, ANOVA, and logistic regression. The average sound level (Leq) and the maximum level (Lmax) recorded were 60.66±2.99dBA and 80.19±2.63dBA, respectively, which exceeds international recommendations. The sound level gradually decreased from morning to night hours. The major increase in sound was observed during nursing shift change. Similarly, a significant increase in sound was observed in open bays compared to isolation rooms. However, no difference in sound levels was recorded during weekdays and weekends. The number of healthcare professionals and the number of procedures performed were strongly associated with an increased noise level. Sound levels in NICU were beyond the safety range and international recommendations. We observed a significant sound increment during morning hours and at the time of nursing shift change. High sound levels were associated with increased number of healthcare workers and bedside procedures in NICU.

Anterior canal-sparing bilateral vestibulopathy in MELAS syndrome

Vestibular dysfunction has rarely been reported in MELAS syndrome. A 40-year-old male with long-term diabetes and hearing loss experienced a stroke-like episode with hemisensory disturbance and lactic acidosis. Brain MRI showed temporo-parieto-occipital cortical lesions, and a final diagnosis was made of MELAS syndrome with the mitochondrial 3243A&gt;G mutation. Neuro-otologic evaluations revealed anterior-canal-sparing bilateral impairments of the vestibulo-ocular reflex in the video head impulse test and no caloric paresis. This unique pattern of vestibular dysfunction may aid in diagnosing MELAS syndrome.

Parameters of Iron Metabolism in Patients with Iron Deficiency Anemia and Erosive Lesions of the Gastroduodenal Zone

The most common disease in the world is erosive-ulcerative lesions of the gastroduodenal zone (EULGZ). These are chronic polyetiological, recurrent diseases with disruption of the neuro-endocrine and humoral mechanisms that regulate the secretory-trophic process in the gastroduodenal zone with the development of ulcers. In this disease, ulcers have different localization and clinical course, significantly reduce the quality of life, affect work capacity and personal life. Lack of timely diagnosis and treatment can have adverse consequences. The objective: to analyse the characteristics of clinical and metabolic disorders in iron deficiency anemia (IDA) and its combination with EULGZ in order to develop the methods for assessing the disease severity, optimizing diagnostics and treatment tactics. Materials and methods. The observation group included 26 patients (15 men and 11 women) with iron-deficiency anemia (IDA) on background of EULGZ with localization of ulcerative defects of the mucous membrane in the stomach or duodenal bulb. The diagnosis of IDA was verified on the basis of changes in the basic characteristics of clinical manifestations (signs of anemic hypoxia and sideropenic syndrome), specific changes in peripheral blood and indicators of iron metabolism. Patients with IDA and EULGZ, were examined by endoscopic methods, underwent ultrasound and, if necessary, radiological examination. The control group included 35 primary donors (16 women and 19 men), who underwent two laboratory tests for hepatitis B and C, as well as HIV infection/AIDS. All examined donors underwent a comprehensive examination of peripheral blood and determined biochemical indicators. The indicators of iron metabolism were determined in all participants: iron content in the blood serum (IS), total iron-binding capacity of the blood serum (TIBS). The index of unsaturated iron-binding capacity of blood serum was calculated as the difference between TIBS and IS. The coefficient of transferrin saturation with iron was determined as the ratio of the content of IS to TIBS. The content of transferrin was determined according to the TIBS indicator, ferritin – by the radiometric method. Results. Peripheral blood indicators in primary donors and morphometric changes in peripheral blood in patients with IDA were analyzed. The results of investigations of the indicators of iron exchange in blood serum are presented: iron concentration, total iron-binding capacity of serum and the degree of saturation of serum with iron. It was found that male donors have significantly higher levels of iron and ferritin in blood serum compared to female donors. The dynamic of changes in peripheral blood parameters in patients with IDA caused by long-term blood loss due to EULGZ during the treatment process is shown. Treatment of the EULGZ led to the significant changes of such indicators as the number of erythrocytes, hemoglobin concentration, erythrocyte indices towards normalization. The normalization of the reticulocyte count was observed on the 90th day of treatment. The detected changes in the number of platelets in patients with IDA due to EULGZ were observed in the absence of active bleeding from the digestive tract. Conclusions. As a result of the progression of IDA due to the erosive-ulcerative lesions of the gastroduodenal zone, the imbalance of iron metabolism deepens, serious disorders of iron metabolism develop, especially in the content of plasma ferritin. Patients with IDA caused by long-term blood loss as a result of EULGZ, should be prescribed a drug for oral use containing ferrous sulfate with a mucosa-protective effect at a dose of 2 mg/kg per day, followed by a decreased dose after normalization of the serum ferritin level.