Sudden Loss Research Articles

Silent Suffering: Recognizing and Addressing the Emotional Impact of Patient Loss on Medical Students

Experiencing patient loss is emotionally challenging for many medical students. This narrative reflects on the author's encounter with sudden patient loss and the complex emotions it evoked. The commentary underscores the need to prioritize emotional support for medical students dealing with patient loss. The author proposes ways to accomplish this, including equipping students with effective coping mechanisms, creating a supportive environment that encourages students to seek debriefing sessions, and incorporating debriefing sessions into clerkship curricula. By normalizing the emotional complexities of patient loss and fostering a culture of support, medical education can better prepare students to navigate the challenges of patient care with compassion and resilience.

MRI-Based Inner Ear Assessment and Cochlin Tomoprotein-Based Evaluation of Perilymphatic Fistula in Patients with Sudden Hearing Loss.

To study the correlation between positive cochlin tomoprotein testing (CTP), magnetic resonance (MR) imaging, and the auditory and vestibular function amongst patients with sudden hearing loss. Prospective case series. We prospectively examined eight patients who presented with sudden hearing loss (>60 dB) with or without vertigo or tinnitus. We performed an ELISA-based CTP detection test using middle ear lavage samples. In addition to the CTP examination, a magnetic resonance imaging (MRI) examination was performed using different sequences (T1 and a T1 sequence with a contrast medium (CM), a T2 sequence, 4 h delayed intravenous gadolinium-enhanced three-dimensional fluid-attenuated inversion recovery (3D FLAIR)). All patients with sudden hearing loss (>60 dB) presented a non-specific contrast enhancement in the cochlea and vestibulum on the affected side on delayed 3D-FLAIR MRI. Four patients had a positive CTP test, suggesting a perilymphatic fistula (PLF). However, no specific MRI signal for a PLF was observed. Using multimodal diagnostic measures, such as CTP testing and different MRI sequences, no correlation could be found in patients with a PLF.

Evaluating fall event definitions relative to lower limb prosthesis users’ lived experiences

Purpose Evaluate specific elements of previously proposed fall and near-fall definitions to determine whether they fully capture lower limb prosthesis (LLP) users’ lived experiences. Methods Semi-structured interviews were conducted with 24 LLP users. Interview transcripts were reviewed, coded, and analyzed using deductive thematic analysis to identify shared experiences and inform revisions to previously reported definitions. Results Four major themes emerged: a fall can be initiated by more than just a loss of balance, loss of balance and losing balance are considered similar, falls are not limited to landing on the ground or floor, and catching yourself and recovering your balance are distinct responses to a loss of balance. Conclusions Two revisions were made to previous definitions to better align with LLP users’ experiences and historically overlooked fall circumstances. A fall is defined as a loss of balance or sudden loss of support where your body lands on the ground, floor, or another object. A near-fall was defined as a loss of balance where you caught yourself or recovered your balance without landing on the ground, floor, or another object. Implementation of these new definitions will aid the collection of accurate, consistent, and meaningful fall data, enhancing aggregation and comparison across studies.

The correlation between corona virus disease 2019 and alopecia areata: a literature review.

Corona virus disease 2019(COVID-19) is one of the most serious respiratory pandemic diseases threatening human health for centuries. Alopecia areata (AA) is a sudden patchy hair loss, an autoimmune disease, which seriously affects the image and mental health of patients. Evidence shows that the risk of autoimmune diseases significantly increases after COVID-19, and is positively correlated with the severity, with a significant increase in the risk of alopecia in those over 40 years old. The relationship between COVID-19 and AA has become a hot topic of current research. Strengthening the research on the correlation between COVID-19 and AA can help to identify and protect susceptible populations at an early stage. This article reviews the research progress on the epidemiological background of COVID-19 and AA, the situation and possible mechanisms of AA induced by COVID-19 or COVID-19 vaccination, and potential treatment methods.

The inflammatory and metabolic status of patients with sudden-onset sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) is a common emergency symptom in otolaryngology that requires immediate diagnosis and treatment. SSNHL has a multifactorial etiology, and its pathophysiologic mechanisms may be associated with inflammatory and metabolic changes that may affect the cochlear microenvironment or its nervous component, thus triggering the process or hindering hearing recovery. Therefore, the aim of this study was to assess metabolic and inflammatory changes to identify systemic parameters that could serve as prognostic factors for hearing recovery in patients with SSNHL. Thirty patients with a sudden hearing loss of at least 30 dB in three contiguous frequencies were enrolled in this study. Patients were followed up for 4 months and peripheral blood samples were collected at 7 days (V1), 30 days (V2) and 120 days (V3). Interleukins (IL)-1F7, IL-2, IL-4, IL-5, IL-6, IL-10, interferon γ (IFN-γ), tumor necrosis factor α (TNF-α) and adiponectin were quantified in serum. In addition, lipid and glycemic profiles as well as concentration of creatinine, uric acid, fructosamine, peroxide, total proteins and albumin were analyzed. Patients underwent weekly ear-specific hearing tests with standard pure tone thresholds for frequencies of 250-8,000 Hz, speech recognition threshold and word recognition score. Patients with SSNHL were divided into a group of patients who did not achieve hearing recovery (n = 14) and another group who achieved complete and significant recovery (n = 16). Most serologic parameters showed no significant changes or values indicating clinical changes. However, IFN-γ levels decreased by 36.3% between V1 and V2. The cytokine TNF-α showed a statistically significant decrease from V1 to V3 (from 22.91 to 10.34 pg./mL). Adiponectin showed a decrease from 553.7 ng/mL in V1 to 454.4 ng/mL in V3. Our results show that serologic cytokine levels change in the acute phase of manifestation of SSNHL and establish a parallel between systemic changes and improvements in hearing, especially TNF-α, which showed differences in hearing recovery. The use of IFN-γ, TNF-α and adiponectin may elucidate the clinical improvement in these patients.

Access to Sudden Hearing Loss Care at Urgent Care Centers.

To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance. One hundred twenty-five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one-week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self-pay price. Secondary outcomes included other measures of timely/accessible care. Chi-square/McNemar's tests and independent/paired sample t-tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis. Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage-adjusted self-pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45-$48.54, p = 0.046). The rates of referral to an emergency department and self-pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both). Medicaid patients with otologic emergencies face reduced access to care at UCCs. NA Laryngoscope, 2024.

Transient Evoked and Distortion-Product Otoacoustic Emissions in Normal Ear of Patients with Sudden Unilateral Sensory Neural Hearing Loss

Transient Evoked and Distortion-Product Otoacoustic Emissions in Normal Ear of Patients with Sudden Unilateral Sensory Neural Hearing Loss

Posterior semicircular canal involvement in sudden hearing loss

Posterior semicircular canal involvement in sudden hearing loss

Pediatric Limb Ischemia: Our Experience from a Tertiary Hospital in Oman

Introduction: Pediatric acute limb ischemia (PALI) is a consequence of sudden loss of blood flow to an extremity that can progress to irreversible ischemia if not promptly treated. This may unfortunately result in life-changing consequences which include limb loss, limb length discrepancy, emotional trauma, and or financial stress. Due to the rarity of this condition, and the lack of high-quality evidence, treatment strategies have largely been anecdotal or extrapolated from treatment of the adult patient. The article is a guide to improve overall functional outcomes and reduce morbidity of PALI. Methods: The authors retrospectively analysed patient data on the electronic patient record of the hospital between January 2021 and December 2023. The patients with PALI were divided into three broad categories: iatrogenic arterial injury managed with the best medical management, managed surgically; iatrogenic deep vein injury/thrombosis, and trauma. Results: A total of 13 patients were referred during the study period. 9 were male. 8 cases were line related, 2 trauma and 3 acute deep vein thrombosis [DVT]. Two patients succumbed prior to intervention. Eight patients were managed with best medical therapy, two surgically and one by endovascular means. Conclusion: Since experience worldwide is limited with PALI, we decided to share our experience and a propose comprehensive algorithm for the management of PALI emphasizing a multi-disciplinary team approach that we follow at our hospital. Early and decisive involvement of vascular surgeons, hematologists, intervention radiologists, and pediatric intensive care physicians is necessary to achieve the most favorable outcomes.

Incidence of narcolepsy symptoms after taking COVID-19 vaccines: a Jordanian cross-sectional study.

Sleeping disorders were reported in many patients who took vaccines during previous pandemics. We aim to investigate the relationship between coronavirus disease 2019 (COVID-19) vaccines and the incidence of narcolepsy symptoms in the Jordanian population. We used a descriptive, cross-sectional, online self-administered survey conducted between December 2022 and May 2023. The survey targeted males and females above the age of 18 years who took any type of COVID-19 vaccine, had no chronic diseases, and had no sleep disorders prior to taking the vaccine. The survey was distributed via social media platforms. A total of 873 participants were included in this study, consisting of 44.4% males and 55.6% females, with the majority being in the 18-29 age group. Most participants (79.8%) received two vaccine doses, with the Pfizer vaccine being the most common. Nearly half of the participants reported excessive daytime sleepiness. Sleep paralysis and hypnagogic hallucinations were reported by a notable proportion of participants, but no significant differences were found among the vaccine types. Sleep attacks and fragmented nighttime sleep were associated with the number of vaccine doses received, suggesting a possible influence of the dose count on these symptoms. The presence of excessive daytime sleepiness, sudden loss of muscle tone, sleep paralysis, and hypnagogic hallucinations showed no significant association with the number of doses taken. We hypothesize a possible link between COVID-19 vaccination and the emergence of narcolepsy symptoms in Jordanian individuals. Additional investigations and continuous monitoring to determine the extent of the risk and uncover potential mechanisms behind this connection should be performed.

Combined simultaneous bilateral central retinal artery and vein occlusion in a patient with lymphoma of the pancreatic head

Combined occlusion of retinal artery and vein is a rare event, and its occurrence in both eyes concurrently in a young patient is an even rare phenomenon. We report such a case in which a 45-year-old female presented with sudden loss of vision, 2 weeks following the third cycle of chemotherapy. Fundus findings and investigations pointed toward combined bilateral simultaneous retinal artery and vein occlusion. Vision did not improve despite treatment. To our knowledge, this extreme presentation of total occlusive disease and its association with lymphoma of the pancreas is the first to be reported in the literature. This case highlights the prothrombotic state induced by pancreatic malignancy and warrants periodic monitoring in such patients.

Impact of Stroke on the Quality of Life of its Survivors

Introduction: Ischemic Stroke is due to sudden loss of blood circulation to an area of the brain, resulting in loss of neurologic function. The incidence in India ranges between 105-152/100,000 people/year. Despite all the advancements in care, stroke continues to be the 2nd leading cause of mortality and the 1st cause of long-term disability. The activities of daily living of patients with chronic stroke affect their Quality of Life (QoL). The majority of stroke survivors continue to live with disabilities, and this can have a profound impact on their QoL. Aims &amp; Objectives: To assess the impact of stroke on the various domains of the quality of life of its survivors, who are treated by the Department of Neurological Sciences, Christian Medical College, Vellore. Methods: A descriptive study design employing a non-probability purposive sampling technique was used to recruit 90 stroke survivors. Written consent was obtained, demographic and clinical variables were collected using interviews, and the impact of stroke on its survivors was assessed using the Stroke Specific Quality of Life (SS-QoL) scale. Results: The participant's mean age group was 48.92±12.97 ranging between 26 -78 years respectively; 67.8% were males, 34.4% of them were unskilled workers, 66.7% had a thrombotic type of ischemic stroke, 56.7% had a moderate National Institutes of Health Stroke Scale grade at admission, 26.7% and 25.6% had a modified Rankin Score of 2 and 1, respectively. Among the participants, 47.8% of them had a stroke at the ages of 31-50 years, and the majority (91.1%) of them had comorbidities. The majority (44.77%) of them had a moderate QoL. Among the SS-QoL domains, the mean scores were the highest in the vision domain (4±1.26) and the lowest in the energy domain (2.47±1.25). There was a significant association between the QoL of stroke survivors and their socioeconomic status (p=0.033), type of ischemic stroke (p=0.047), and limb involvement (p=0.034). A positive correlation (p=0.00) was observed among various QoL domains. Conclusion: These findings provided not just insight into the impact of stroke on the QoL of its survivors but also emphasized the need to sensitize the healthcare care professionals to provide care during both the acute period and also continue to ensure all the domains of a good QoL is addressed during the follow-up and rehabilitation. Keywords: Ischemic Stroke, Quality of Life, Stroke Survivor

Contrast-induced transient cortical blindness

A 58-year-old Malay man with a history of ischemic heart disease, well-controlled diabetes mellitus, and hypertension presented with sudden loss of vision after he underwent angiogram (cardiac catheterization) with contrast. Post-angiogram, his visual acuity deteriorated gradually to no perception of light bilaterally within 1 h duration. Clinically, there was no new intraocular pathology and neurologic examination was normal. An urgent noncontract computed tomography (CT) scan of the brain showed the presence of contrast in the venous sinuses but no obvious acute intracranial hemorrhage. Bilateral frontal and anterior parietal regions appeared hypodense with loss of gray white matter differentiation and relative effacement of the sulci. CT brain reported that infarction or cerebral edema may represent. Patient’s condition was observed, and after 24 h, his vision recovered to baseline and he was discharged well.

Ototoxicity in Immune Checkpoint Inhibitors Therapy

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Immune checkpoint inhibitors (ICIs) and T-cell therapies are a modern, well-established cancer treatment. The priority of oncological treatment is to cure cancer. However, treatment-related toxicities, i.e. immune-related adverse events (irAEs), continue to emerge and are not that well understood yet. ICIs can cause profound, multiple, and diverse irAEs – the sequelae of unknown mechanisms. One of the organs susceptible to collateral damage is the hearing organ. Complications related to hearing, tinnitus, and balance disorders are extremely burdensome and significantly impair many aspects of the quality of life of patients and survivors.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of the work is to review the literature in the area of ototoxicity of ICIs.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and method:&lt;/b&gt; A systematic search of the Web of Science, PubMed, and Embase databases for studies published until 1 March 2022 was conducted.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Reported clinical symptoms ranged from sudden bilateral hearing loss and imbalance to mild hearing loss or tinnitus with preserved hearing. It was found that the median time from ICI initiation to hearing loss development was 3 months. The hearing impairment was secondary to bilateral sensorineural hearing loss in the majority of patients (&gt;60%), and at least one other irAE accompanied the hearing loss in 2/3 of patients. Hearing loss significantly improved in 45.7% of the patients.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; The majority of cases of ICI-related hearing loss presented in the literature were reversible. Therefore, it is important to develop and implement routine therapeutic algorithms. Further research is needed to define the true prevalence of ICI-related hearing loss, optimal diagnostics, and management.&lt;/br&gt;

Atypical Differentiation Syndrome with Sudden Vision Loss in Acute Promyelocytic Leukemia Treated with ATRA plus ATO: a Clinical Case.

Atypical Differentiation Syndrome with Sudden Vision Loss in Acute Promyelocytic Leukemia Treated with ATRA plus ATO: a Clinical Case.

EFEKTIVITAS INTERVENSI LEE SILVERMAN VOICE TREATMENT (LSVT) BIG DALAM MENINGKATKAN KESEIMBANGAN PADA KASUS STROKE

Stroke is a sudden loss of brain function and triggers unilateral paralysis which can reduce posture and balance control, resulting in difficulty walking. This study aims to determine the effectiveness of LVST-BIG training in improving balance in stroke cases. Based on pre-experimental quantitative research with a one-group pretest-posttest design, this research population took stroke cases in Dibal Village, Ngemplak District, Boyolali with a total sampling technique of 7 people. This intervention was carried out in stroke cases 16 times with a duration of 30 minutes/session. The balance measuring tool uses the Berg Balance Scale instrument. Hypothesis testing using Paired Samples T Test. The results of the research obtained a significance value of 0.000&lt;0.05 which shows that there is a difference in the mean results of the Berg Balance Scale between groups before being given intervention or after being given intervention for stroke conditions in Dibal Village, Ngemplak Boyolali

Aneurysm in the first segment of the superior cerebellar artery: Case report

Introduction: Superior cerebellar artery aneurysms are rare lesions. This location comprises 0.2 % of all intracranial aneurysms, around 60 % debut with subarachnoid hemorrhage, frecuently from small aneurysms.Case report: A 54- year- old famale patient who began with a sudden headache and loss of consciousness that caused her to fall to the ground. She is diagnosed with spontaneous subarachnoid hemorrhage. Angiography was performed, which showed an aneurysm of the left superior cerebellar artery.Conclusion: The diagnosis of subarachnoid hemorrhage secondary to an aneurysm of the anterior pontomesencephalic segment of the superior cerebellar artery is an unusual finding.

Effect of acupuncture intervention time on the therapeutic effect in patients with sudden hearing loss.

To observe the clinical efficacy of acupuncture intervention at different time for patients with sudden hearing loss. According to the timing of acupuncture intervention, 86 patients were divided into early exposure group (n=43) and late exposure group (n=43) . The early exposure group was given acupuncture treatment within 14 days of onset, and the late exposure group was given acupuncture treatment after 14 days of onset. After propensity score matching (PSM, a statistical matching technique for observational data) processing by using SPSS26.0 software, outcomes of 30 cases in the early exposure group and 30 cases in the late exposure group were analyzed. In addition to receiving basic treatment with drugs for vascular dilatation, thrombolysis, nourishing nerve, etc., all patients of the two groups were treated with neck acupuncture ("Neck Seven Meridian Lines" acupuncture), once every other day except Sundays, for a total of 12 time. Before, after the treatment and 3 months after the treatment, the total score of the Tinnitus Handicap Inventory (THI, 0, 2 and 4 points for each of the 25 items, total scores = 100 points) scale was used to evaluate the improvement of tinnitus symptoms caused by hearing loss. The clinical therapeutic effect was evaluated according to the efficacy grading criteria in the Guidelines for Diagnosis and Treatment of Sudden Deafness (2015) and the changes of pure tone audiometry curve. Multivariate Logistic regression was used to analyze the effect of factors that might influence efficacy before propensity score matching. The THI scores of patients in both groups decreased strikingly after the treatment and 3 months' follow-up (P<0.05). Compared with the same time-points of the late exposure group, the total THI scores of post-treatment and 3 months' follow-up were evidently lower in the early exposure group (P<0.05). The effective rate of the early exposure group (22/30, 80.00%) was significantly higher (P<0.05) than that of the late exposure group (16/30, 53.33%). The classification of sudden deafness and the application of traditional Chinese medicine in this study were not independent factors affecting the total effective rate. The time point of acupuncture intervention is an important factor affecting the effect on hearing and tinnitus disability of patients with sudden deafness. The earlier acupuncture treatment is accepted, the better the therapeutic effect is.

Sudden Sensorineural Hearing Loss Before COVID-19, During COVID-19, and After Inactivated Vaccination: Experience From a Tertiary Referral Center in China.

The purpose of this study was to investigate the incidence rate and audiological characteristics of sudden sensorineural hearing loss (SSHL) before the COVID-19 pandemic, during the COVID-19 pandemic, and after inactivated vaccination, and to analyze whether the novel coronavirus or inactivated vaccination have an impact on hearing loss. The clinical data of all patients who visited the hospital in July 2019 (before pandemic), July 2020 (during pandemic) and July 2021 (after the inactivated vaccination at least the first basic dose of COVID-19 vaccination) were retrospective analyzed. All patients diagnosed with sudden sensorineural hearing loss in these three periods were screened, and their incidence rate, hearing characteristics, and prognosis were compared. Overall, the incidence rates of sudden hearing loss in July 2019, July 2020, and July 2021 were 0.59, 0.60, and 0.52% (25 of 4225, 20 of 3322, 28 of 5432), respectively, without significant difference ( χ2 = 0.372, p = 0.830). A significant difference was noted in the incidence of hypertension ( p = 0.02), whereas no significant difference was noted in age ( p = 0.591, p = 0.66), sex ( p = 0.19, p = 0.08), main symptoms ( p = 0.18, p = 0.15), side ( p = 0.483, p = 0.89), audiogram shape ( p = 0.56, p = 0.989), average hearing threshold of affected frequency ( p = 0.81, p = 0.89), average hearing threshold of normal ear affected frequency ( p = 0.65, p = 0.68), average hearing threshold of affected frequency after treatment ( p = 0.49, p = 0.38), days between symptoms onset and hospital visit ( p = 0.62, p = 0.85), treatment plan ( p = 0.551, p = 0.474), and effectiveness ( p = 0.104, p = 0.050). Our study failed to find a correlation between the novel coronavirus pandemic and inactivated vaccination and SSHL, and there was no direct evidence supporting that COVID-19 or inactivated vaccination had an impact on the incidence rate and prognosis of SSHL patients.

Clinical characteristics of patients diagnosed with bilateral sudden sensorineural hearing loss.

This study investigated the etiology, clinical features, and prognosis of patients diagnosed with bilateral sudden sensorineural hearing loss (BSSNHL). The clinical data of 100 patients with bilateral sudden hearing loss as a chief complaint treated at Xiangya Second Hospital of Central South University between January 2010 and August 2022, including clinical characteristics, audiometric data, and prognosis, were retrospectively analyzed. These 100 cases accounted for 8.09% (100/1235) of all patients admitted for sudden sensorineural hearing loss (SSNHL) during the same period. Of these, 71 were simultaneous cases and 29 were sequential cases of BSSNHL. Among the 200 ears analyzed in this study, 13, 36, 57, and 94 had mild, moderate, severe, and profound sensorineural hearing loss, respectively. The overall effective rate after comprehensive treatment was 32%, with significant differences in efficacy and prognosis among different degrees of hearing loss (p < 0.05). Comorbidities of hypertension (24 cases), diabetes (14 cases), and coronary heart disease (9 cases) significantly impacted therapeutic efficacy and prognosis in patients with BSSNHL (p < 0.05). Compared to unilateral SSNHL, BSSNHL exhibits distinctive characteristics.