Hearing loss treated with prednisone efectos,high pitched ringing in the right ear kopfh?rer,ata tinnitus sounds audio,dokter tinus gemist 3 december 2014 xl - Test Out

INTRODUCTION: Gestational malaria is related to very bad perinatal outcomes and antimalarial drugs used during pregnancy can be ototoxic to the fetus.
OBJECTIVE: To determine the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy.
CONCLUSION: The prevalence of hearing loss in newborns of mothers who had vivax malaria and used chloroquine during pregnancy was 3%. Hearing is one of the noblest of senses since its main function is related to the acquisition and development of oral language1,2. Hearing impairment is considered to be highly disabling due to its consequences on human communication, as well as its impact on cognitive and psychosocial development and the development of oral and written language6.
The occurrence of malaria during pregnancy, particularly in the last trimester, can be determinant for infant health, with implications for fetal or neonatal development.
In Brazil, the occurrence of malaria during pregnancy is common in endemic areas such as the states of Roraima, Rondonia, Para, Mato Grosso, Acre, and Amazonas11. In the municipality of Porto Velho (RO) malaria in pregnancy has been shown to be related to poor perinatal outcomes such as preterm birth, extremely low, very low and low birth weight, and death13. In another study, 12 children born to mothers who had been treated with antimalarial drugs during pregnancy had sensorineural hearing loss. In view of the above considerations, the objective of the present study was to verify the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy and to characterize the audiologic findings according to newborn gestational age, birth weight, risk factors for hearing loss, type of malaria infection, type of medication used, and gestational period of malaria occurrence and drug treatment.
A cross-sectional, quantitative, descriptive-analytical, observational study was conducted using a multifactorial approach.
The number of women with malaria during pregnancy, who were admitted to the hospital during the period of data collection, was taken as the basis for sample size calculation.
The study flow chart contains data regarding infant gender, date of birth, type of malaria infection, gestational period of infection, type of medications used, and presence of risk factors for hearing loss established by the Joint Committee on Infant Hearing (JCIH)16 and by the Multiprofessional Committee on Auditory Health (Comite Multiprofissional em Saude Auditiva - COMUSA)17. The puerperal women were contacted by the researcher while still in the maternity ward in order to investigate the occurrence of malaria during pregnancy. After signing the informed consent, the interview was conducted with the puerperal participants.
The tests were performed in a quiet room in the presence of the mother or an accompanying person. The step of diagnostic evaluation was performed at the clinic responsible for the NHS program after hospital discharge. After this procedure, the diagnostic ABR test was performed to quantify and identify hearing impairment. Newborns who have had the electrophysiological threshold for tone bursts at 2000 Hz with bilateral 30 dBHL were considered patients with normal hearing and remained in auditory monitoring the NHS program up to 24 months. For data analysis, the distribution of the occurrence of the type of infection and of the gestational period when malaria occurred was first determined, followed by the determination of the distribution of the type of antimalarial medication used for treatment and the gestational period during which the medication was administered, using the test for equality of two proportions. As for the risk factors for hearing loss found in association with the occurrence of malaria and the use of antimalarial drugs in pregnancy, the use of ototoxic medication by the newborn was the most frequent risk factor and this finding was significant when compared to the other risk factors, except for extracorporeal oxygenation (Table 4). No relationship was observed between the NHS result and type of medication, risk factors for hearing loss, gestational period of infection, use of medication, or type of malaria infection (Table 5). The prevalence of hearing loss in our sample was 3% (n = 1), taking into account that two newborns did not undergo the audiological diagnosis. In the present study, Plasmodium vivax was the most frequent species found in women during pregnancy, as also reported in other studies10,13,19-21. The antimalarial drug most frequently used was chloroquine as recommended by the Brazilian Ministry of Health for the treatment of vivax malaria in pregnancy25. In a study conducted in Porto Velho (RO) on 66 newborns of mothers who used antimalarial drugs during pregnancy, three infants were born to mothers who were treated with primaquine and one was diagnosed with unilateral profound hearing loss21.
As for the gestational period during which the antimalarial drug was used, no difference was observed between trimesters. In the present study, the number of "pass" results in NHS was higher than the number of "failed" results, in agreement with other studies conducted in the same municipality14,21.
Two of the four newborns who failed the screening test and who were referred to the clinic responsible for the program for diagnostic evaluation did not attend the assessment. The socioeconomic conditions of the families who participate in the NHS program and the lack of knowledge of the consequences of hearing loss are some factors that could explain the evasion in the population studied, considering that the results of the study showed a low educational level of the women who mainly had incomplete elementary school. No relationship was found between the NHS results and the variables weight at birth and gestational age, despite having knowledge that gestational malaria is related to very bad perinatal outcomes, including low birth weight13 which could have enhanced the occurrence of hearing loss in newborns. The most frequent risk factor for hearing loss associated with malaria and antimalarial drug use in pregnancy was the use of ototoxic medication by the newborn, in agreement with other studies21,34.
Urinary tract infection is common among young women and is the most frequent complication during pregnancy30, especially among primiparous women35. The high level of bilirubin requiring blood transfusion was a risk factor for hearing loss in the infant diagnosed in the present study. Elevated serum levels of bilirubin are considered toxic to the auditory pathways and central nervous system39.
Hyperbilirubinemia is one of the risk factors for neonatal deafness and for the development of encephalopathies39, since high levels of bilirubin can damage the auditory system at the peripheral level by altering cochlear hair cells and at the central level in the cochlear, olivary and inferior olivary nuclei41. In addition to blood transfusion, the infant was exposed to ototoxic medication (gentamicin) which can cause different degrees of damage, with cochlear hair cells damage being typical42. The prevalence of hearing loss obtained in this study was more than evident in research conducted at the same hospital5, and the value obtained could have been higher, since two newborns did not undergo the audiological diagnosis. In addition, it highlights the need for audiological follow these children in order to evaluate the occurrence of possible progressive alterations as demonstrated in another study which found 12 cases of hearing loss in children born to mothers who had malaria and used antimalarial drugs in pregnancy15. The main limitation of the present study, which is common in studies involving populations recruited from NHS programs, is failure to attend a visit for diagnostic evaluation.
The prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy was 3% (n = 1), the mothers' newborn diagnosed infected with Plasmodium vivax in the first trimester and treated with chloroquine throughout pregnancy. In addition, it was observed that there is no relationship between the NHS findings with the variables weight of the newborn at birth, gestational age, type of medication, IRDA, pregnancy infection, medication use and infection type.
Paper submitted to the ITJ-SGP (Publishing Management System) on September 24, 2014; and accepted on July 6, 2015.
I originally put these memories on paper to share with my two sons when they become mature enough to comprehend more fully the events described.
As long as I live, I will never forget my secretary, Kathy informing me on Tuesday, September 11, 2001, that an airplane had just struck one of the Twin Towers of the World Trade Center. That moment had an exceptional impact on me, as my nearly seven and nearly four and a half year old sons and I had been studying skyscraper history and construction for the past several months. I ran out to the lobby of my office building, where there was a television and watched in horror as the black smoke billowed out of gaping holes in Tower 1. My heart sank as any doubts about this being a terrorist attack went up in the very smoke that I was now horrifiedly watching along with my colleagues.
I resumed seeing the shocked patients in my office, when my secretary informed me that one of the Towers (Tower 2) had just fallen.
My mind was now miles away from my office, with those innocent victims of the ultimate in hate. I called both of my hospitals, Manhattan, Eye, Ear and Throat and New York-Presbyterian to learn that their emergency rooms had a€?adequate staffing for the time beinga€?.
I now knew that if I were to make a significant contribution to the relief effort, I had to get a slit lamp downtown to treat the rescuers and victims with eye problems on-site. I called the assistant administrator at the Manhattan Eye, Ear and Throat Hospital, Craig Ugoretz, who combed the building and found the one slit lamp microscope that was not bolted to a floor-mounted stand. Not knowing when my next meal would be, or when I would return home, I grabbed a quick bite in a local restaurant. When I arrived at the hospital, the slit lamp was in the lobby, waiting for me at the security desk.
On our way it was suggested that I first stop at One Police Plaza to treat the eyes of injured police officers. The police officers that I cared for were still so debris-laden, that their uniforms appeared more khaki than blue from the concrete dust and ash. On the first day alone, I had the honor of caring for the eyes of more than one hundred heroes in every sense of the word. Fortunately, most of the eye injuries were not severe, but were nonetheless incapacitating. During the night, when the steady flow of the injured slowed to a trickle I walked into the Command and Control Center next door to try to learn what was going on outside this fortress.
Still later when the flow of injured officers stopped, I wanted to take the slit-lamp to a€?Ground Zeroa€? itself to care for injured members of the other uniformed services. I went uptown during the night for a few hours to check on my family, clean up and possibly get a nap to prepare for the next day.
It wasna€™t until my second day downtown, during a break, that I first opened the blinds of my improvised emergency room at One Police Plaza to discover that the windows faced out over the devastation.
After my final visit to One Police Plaza to render follow-up care on September 20th, I was escorted to a€?the sitea€? by Sergeant Giuzio from the Office of the Chief of Police. As we went through multiple checkpoints, I began to see large groups of rescue workers walking through the streets.
We walked the blocks of lower Manhattan, through several more checkpoints, to an NYPD a€?staging areaa€?.
The road on which we were walking (West Street), just days before, was under high piles of debris, left by the Towersa€™ collapses. We were now standing adjacent to a€?Ground Zeroa€? on West Street between Building 6 and the World Financial Center.
While I was transfixed by the overwhelming spectacle of this tragedy, the sergeant asked me to stay where I was as he walked up to a tall thin man. As we walked around the corner to the Hudson River side of the World Financial Center both the lights and the clatter of the rescue work faded, somewhat.
Going down Albany Street, we passed a restaurant, where people must have been sitting until the windows were blown in by falling debris.
As we walked onward toward the site of the Tower 7 collapse, there were many tents and tables set up to provide the workers with the essentials of life during their mission.
We passed buildings that looked as if they had been spray-painted gray because of their coating of concrete dust. After the address we said farewell, feeling a sense of comradeship, which was disproportionate to the time we spent together.
As we approached Liberty Street we saw a large group of rescue workers gathered under one of many gasoline-powered floodlights. Taking Douglasa€™ design from concept stage to a scale model rendered in Plexiglas became a year-long father and son project.
Victimsa€™ names are an entirely appropriate means of remembering the dead in all memorials.
It must be noted that there were no recovered or identifiable remains belonging to over one thousand victims of the World Trade Center tragedy. Albeit not universally praised for their architecture, the Twin Towers were an integral part of New York City, which no longer grace our skyline. Both the names of the victims and a reincarnation of the World Trade Center icons could be represented simultaneously by the memorial, as there is no fundamental incompatibility between memorializing both human and material loss. Relics and rubble from the disaster site represent significant and tangible ties to the actual tragic event and location.A  Relics of the disaster should not solely be housed in a museum or off-site (as they are now) in an airplane hangar.


The design evolved into a pair of transparent towers with rectangular areas missing where the airplane impacts occurred, containing standing faA§ade relics inside one Tower and the recovered American flag inside the other. After studying the photo for pensively for several minutes, he said, a€?You have to do something with thisa€?. Within a few weeks, I received not just one, but two letters from the General Counsel of the Lower Manhattan Development Corporation (the organization empowered with the rebuilding of the Ground Zero area). Not knowing where to start, I casually asked an architect, Mark Mascheroni, who has a son at my sonsa€™ school, how much a set of architectural renderings might cost. We met face to face for only the second and final time at a very busy architectural printing shop, Esteban & Co at 139 West 31 Street. As I handed Mansion a check for his work, I asked him to sign the official LMDC release, required for all submission team members. One appropriately placed 3-dimensional rectangular space, devoid of its glass faA§ade, representing the a€?impact voida€? in each Tower (floors 93-98 of the North Tower and floors 78-84 of the South Tower) symbolize the loss from, and location of, the damage from each initial airplane impact. The difference between life and death for thousands of people inside the Twin Towers was the ability or inability to find an intact stairway by which to escape.
Each of the two Memorial towers has a footprint of 40 x 40 ft., and is situated in the space in between the two 200 x 200 ft.
The glass panels making up the curtain-walls are inscribed with each victima€™s name, date of birth, occupation, nationality and, when from a uniformed service, the appropriate shield (FDNY, EMS, NYPD, PAPD) (Image 1, Section E).
The glass curtain wall is supported by an internal, open stainless steel frame, reminiscent of the Twin Towersa€™ metal infrastructure whose melting under the intense heat of the jet fuel fires resulted in the Towersa€™ ultimate collapse. 1)The inspiring American flag recovered from the World Trade Center rubble that was solemnly raised by rescuers. A patient of mine, who saw the submission to the contest, was so impressed with Dougiea€™s concept that she arranged a meeting with the world-renowned architect, A. William Stratas, a website developer from Toronto created a wonderful website for contestants to share news of the competition and to discuss their personal experiences.
Stratas and I began to communicate on a regular basis and became long-distance comrades in architecture.
After office hours, I took Dougie to the party followed by a trip to the exhibition of the eight finalists at the Winter Garden of the World Financial Center. After talking to Dougie for a while, she informed me that the man standing directly behind me was Kevin Rampe, the President of the Lower Manhattan Development Corporation.
At the Forum, Dougie was interviewed by Georgett Roberts of the New York Post and by Alan Feuer of the New York Times.
After the photo session and the presentation of the Certificate of Merit to Doug, we were escorted to a locked room called a€?The Family Rooma€?.
Doug was introduced to the winner, Michael Arad, and his associate, Peter Walker, in a conference room.
Aptly stated about the competitors by New York Times reporter Julie Iovine was, a€?Working on their own initiative and against lousy odds, determined to express themselves and to keep memory alive, they spent countless thousands of hours conceiving, drafting, revising and explaining their visionsa€?. As an ophthalmic surgeon, I expressed my personal need to do something constructive in the aftermath of the WTC tragedy by obtaining a portable slit lamp microscope and using it to treat the eye injuries of rescue workers at Ground Zero. I reflected on how many renowned architects begin their creative processes with Lego blocks (or equivalents), or perhaps with rough sketches on cocktail napkins. I discussed my feelings about these comments with a patient, who is an editor of the New York Times. Our teama€™s memorial design now proudly resides on the LMDC website along with the other 5200 entries. One final note is that, several years later, a patient came into my office and informed me that he had just been hired as the General Counsel of an insurance company in Philadelphia, by, of all people, Kevin Rampe. As I wrote in the beginning, I originally put these memories on paper to share with my two sons when they become mature enough to comprehend more fully the events that I have just described. One of the most difficult things that I have ever been called upon to do, was to address the Connecticut Society of Eye Physicians on my experiences and on emergency preparedness, only a few months after the disaster, on December 7, 2001.
I think about the tragedy every day, and particularly my personal memories of experiences that have changed the course of history. A total of 5,193 World Trade Center memorial proposals have been given the heave-ho, but the people who created them aren't slinking quietly back to their day jobs. On December 6, hundreds of teachers, architects, and engineers that didn't make it will gather at New York University to display their work and discuss their discarded ideas. Another participant, Barry Belgorod, plans to bring his 6-year-old son, Doug, to the all-day event. William Stratas, the Canadian Web developer organizing the forum, said the event wouldn't be a rally or a session dedicated to critiquing the eight designs that made it past the 13-member jury.
Only one session is dedicated to discussing the finalist designs, and he said he's anticipating some thoughtful but harsh critique.
December 7, 2003 -- Some 60 people, including a 6-year-old boy, who were among the 5,000 entrants who submitted Ground Zero memorial designs, and lost, met in lower Manhattan yesterday to protest the closed-door judging process that produced the eight finalist proposals.
Contestant Douglas Belgorod, 6, of Manhattan said he used his Lego building set to construct the two towers and had pulled out the blocks to leave a space where the hijacked planes hit. Brian McConnell, 33, an engineer from San Francisco, said he was glad he made the effort to see other people's work. New York heart surgeon Robert Jarvik, 57, said the finalists lacked passion and imagination.
The losers -- no, not the losers, the ones who did not win -- stood around doing what they had done for many months online, which is to say they thought, talked, argued, vented, ranted, complained and basically obsessed to the point of meltdown over how to build the best possible World Trade Center memorial. Naturally, there was a bit of surprise when Adrienne Austermann, who goes by the name of Trinity online, turned out to be a woman since many people thought she was a man, and there was more than pleasant applause when Eric Gibbons, also known as Lovsart, took his own turn at the lectern since people really liked the absence of public benches in his plan, benches that might encourage loiterers to hang out eating hot dogs -- not exactly what Mr. All in all, it was a remarkably diverse group, which had among its ranks a financial analyst, an engineer, a graphic designer, a schoolteacher, a sculptor, a union electrician, an ophthalmologist and his 6-year-old boy, and Robert Jarvick, the inventor of the artificial heart. There was also a very simple replica of the towers done in glass that was conceived by Dougie Belgorod, the 6-year-old, who constructed the initial model out of Legoes. At any rate, the idea did not attract the interest of the competition's jury, which -- whenever it was mentioned -- seemed to produce in the crowd of nonwinners the kind of forced affability and small uncontrollable tics one often finds in people trying to suppress great rage. They spent the morning sharing their designs with one another, and in the afternoon set out to draft a Declaration (''Capital D,'' Mr. Later in the afternoon, the nonwinners went down to ground zero, where they stopped off at the World Financial Center to look at the eight designs that had defeated theirs. It smarted having lost, no doubt about it, but all the nonwinners said they would not give up. As long as I live, I will never forget my secretary, Kathy informing me on Tuesday, September 11, 2001, that an airplane had just struck one of the Twin Towers of the World Trade Center.A  Prior to this, it seemed like a normal Tuesday morning, seeing patients in my ophthalmology office on the Upper East Side of Manhattan.
Fortunately, most of the eye injuries were not severe, but were nonetheless incapacitating.A  When the Towers collapsed, there was a cascade of enormous quantities of pulverized concrete and sheetrock, wisps of fiberglass, asbestos dust (the buildings were not asbestos free) and splinters of glass.
Still later when the flow of injured officers stopped, I wanted to take the slit-lamp to a€?Ground Zeroa€? itself to care for injured members of the other uniformed services.A  I was emphatically discouraged from doing this by the staff of the office of the Chief of Police, until buildings stopped collapsing and the ground beneath was more stable. Prevalence of hearing loss in newborns of mothers who had malaria and were treated with antimalaric drugs in pregnancy. All underwent neonatal hearing screening with otoacoustic emissions combined with automatic auditory brainstem response.
Auditory sensory deprivation interferes with the ability to interpret speech sounds and results in economic and educational disadvantages2. The malaria parasites can easily cross the placental barrier or are transmitted through maternal-fetal transfusion9.
The latest survey regarding the proportion of positive slides in pregnant women from the municipality of Porto Velho, Rondonia (RO), was performed in 2010 and revealed 331 cases of malaria in rural and urban areas, including 48 cases caused by P. In a study conducted in the same municipality, two newborns of mothers who had malaria and used antimalarial drugs in pregnancy were diagnosed with mild unilateral sensorineural hearing loss14. This hearing loss was irreversible in eight of these children, with seven presenting profound hearing loss. All puerperal women received information about the objectives and methodology of the study and agreed to the procedures by signing the free informed consent form. Transient otoacoustic emissions (TOAE) and automated auditory brainstem responses (AABR) were measured with an Accuscreen instrument (Madsen).
The results obtained during hearing screening and diagnostic evaluation were recorded on the study flow chart.
Women who confirmed the presence of the disease were invited to participate in the study and received information about the objective and importance of the study and the procedures used.
When necessary, the records of the women and their newborns were accessed to complement the information if the mother could not answer the question or was in doubt. For electrophysiological assessment of hearing, the infants remained lying in the crib or on the mother's lap during natural non-sedated sleep.
For this test, a probe microphone with a latex bulb was introduced into the external auditory canal of the newborn and emissions were evoked with a broadband click at an intensity of 80 dB SPL. For this test, the skin in the areas of electrode placement (high forehead and mastoids) was cleaned to permit adequate impedance. Diagnostic evaluation consisted of tympanometry, diagnostic TOAE, diagnostic ABR, and an appointment with the otorhinolaryngologist. The NHS results were correlated with birth weight and gestational age by analysis of variance (ANOVA). Two of the four infants that failed the NHS and that were referred to the clinic responsible for the program for further tests abandoned the program.
The audiologic findings of this newborn included the bilateral presence of TOAE; absence of waves I, III and V at 90 dB in the click ABR test accompanied by the presence of cochlear microphonism, and tympanometry revealed normal mobility of the tympano-ossicular system. In addition to the fact that the mother had malaria and made use of antimalarial drugs during pregnancy, the newborn was exposed to ototoxic medication (gentamicin) for 9 days and required exchange transfusion due to hyperbilirubinemia. This finding was statistically significant when compared to the occurrence of the disease in the third trimester. The use of primaquine is contraindicated for the treatment of pregnant women, irrespective of the Plasmodium species involved and gestational period, and during the breast-feeding period until 6 months25. This infant had no associated risk factor for hearing loss, suggesting that the medication administered possibly caused or potentiated the occurrence of hearing impairment.
However, the frequency of antimalarial drug use was higher in the second trimester, although the frequency of malaria occurrence was higher in the first trimester of gestation. Despite an attempt to perform an active search, as routinely done, the mothers could not be contacted by telephone.
The infant can be infected at the time of delivery, through hematogenic dissemination, or postpartum36. Neonatal hyperbilirubinemia is toxic to the auditory pathways and central nervous system29 and newborns submitted to exchange transfusion are considered to be at high risk for the development of auditory neuropathy38. In the latter, the yellow color is more intense in the subthalamic nucleus and globus pallidus and may be present in the hippocampus, geniculate bodies, vestibular, cochlear and oculomotor nuclei, cerebellum and spinal cord40.
Other studies have demonstrated a close relationship between hearing impairment and hyperbilirubinemia5,39,40. A close relationship between hearing impairment and use of ototoxic medication has been reported for newborns30,43,44. The chance of these newborns have hearing loss is high, since the NHS was performed with use of combined technical (OAE and AABR), which reduces the chance of false positives. Active search was necessary in various cases of the present sample, but contacting the participants was unsuccessful in two cases.


Audiological findings highlighted in this newborn indicate the presence of alteration in retrocochlear auditory pathways that are compatible with the auditory neuropathy spectrum.
The IRDA, concomitant with malaria and the use of antimalarial drugs during pregnancy, most common was the use of ototoxic medication by the newborn, but hyperbilirubinemia with exchange transfusion was one of the risk indicators found in newborns diagnosed with hearing loss. Charles Mango, from New York-Presbyterian Hospital, had managed to get downtown near the disaster site. Lester, a detention-center designer, is flying in from Kansas City, Mo., to show his design, which involves a kinetic polycarbonate sphere etched with the names of the victims. McConnell used mathematical equations to design his plan for a spire that creates the illusion of infinite height. Stratas posted registration forms online Wednesday morning, as the Lower Manhattan Development Corporation was announcing the finalists.
Stratas insists the forum isn't about political action, some people say they'd like to find power in numbers. Stratas was standing at the lectern, on the fourth floor of the student center at New York University, talking to a group of peers whom he knew intimately but had never met before. Mango said: ''You see, when I came up with my idea, I really thought that I was going to win. Stratas said), which will lay out their displeasure with the competition's eight finalists and which could be released to the public as early as today.
Heys's comment, Zane Kinney, who had flown all the way from Ellensburg, Wash., felt compelled to correct the record. Vincenta€™s (which is not one of my hospital affiliations), which was closer to the scene, but they too had a€?enough medical personnela€? for the task.A  I was referred to a triage center at Chelsea Piers where medical volunteers could go to see a€?if they were neededa€?. Those who failed were referred to audiological diagnosis with evoked otoacoustic emissions and brainstem auditory evoked potential associated with tympanometry (1000 Hz).
Furthermore, hearing is essential for interpersonal relationships and relationships with the environment2. Any type of hearing loss can compromise language, learning, cognitive development and social inclusion of the child7, and it is therefore important that hearing impairment is detected as early as possible.
A study demonstrated that pregnant women infected with Plasmodium falciparum present clinical and laboratory alterations, such as altered hemoglobin, hematocrit, creatinine, urea, bilirubin, and glucose. The treatment indicated for the mothers was chloroquine, chloroquine combined with quinine, and quinine combined with Fansidar. The study was conducted at the maternity unit of a referral hospital for high-risk pregnancies in the capital of Rondonia. The following eligibility criteria were established for formation of the sample: newborns of women who had malaria in pregnancy, newborns participating in the NHS Program, and newborns born or hospitalized in the maternity unit of the state referral hospital for high-risk pregnancies in Porto Velho (RO) whose mothers agreed to participate in the study by signing the free informed consent form.
Adopting a level of significance of 95% and a sampling error of 6%, the estimated sample size was 35 newborns. Personal data for subsequent contact were also recorded in case it was necessary to schedule a day and time for a new assessment during both the screening and diagnostic evaluation phases. Mothers who agreed to participate in the study signed two copies of the free informed consent form, one was given to them and the other was kept by the responsible researcher. Infants presenting normal outer hair cell function obtained a "pass" result, which occurs automatically.
Tympanometry, which investigates tympano-ossicular system function, excluding possible middle ear alterations, was performed using a 1000-Hz probe tone since it is more sensitive in identifying these alterations in infants aged 0 to 4 months18. The frequency of risk factors for hearing loss was analyzed by the test for equality of two proportions and the NHS results were correlated with variables such as type of malaria infection, gestational period when malaria occurred, type of antimalarial agent and gestational period when it was used. The otorhinolaryngologist requested imaging exams to evaluate possible involvement of the central auditory pathway. The Plasmodium species contracted by the mother during the first trimester of gestation was the vivax type. This result differs from that reported in another study21 conducted in the same city, in which the distribution of malaria was homogenous across the three trimesters. In contrast, the World Health Organization recommends the use of primaquine under medical supervision26. In the present study, the participants reported the use of antimalarial drugs in more than one trimester, as recommended by the Brazilian Ministry of Health that indicate chloroquine as chemoprophylaxis against P. In this respect, it is important for the mother to have a minimum educational level, financial resources and harmony in social and marital relationships to seek the best health measures for her child31. Authors said that the lower the birth weight, the greater the chances of failure in the NHS32,33, which was not observed in this study. This result highlights the need to develop other studies with this population, but in larger samples.
In addition, the rapid discharge of the participants, which is a major obstacle of NHS programs, may have contributed to the small sample size. O conhecimento, a valorizacao da triagem auditiva neonatal e a intervencao precoce da perda auditiva. Hearing aids fitting process in users that are seen in a federal public institution: part I--results and implications with the amplification device. Avaliacao eletrofisiologica de recem-nascidos de maes que fizeram uso de antimalaricos na gestacao. Estudio de los efectos ototoxicos en 725 pacientes tratados con antimalaricos en el hospital central de Maputo (Mozambique). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Accoustic immitance measures in infants with 226 and 1000 hz probes: correlation with otoacoustic emissions and otoscopy examination.
Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recem-nascidos de gravidas com malaria, na Colombia. Achados audiologicos de recem-nascidos de maes que fizeram uso de antimalaricos no periodo gestacional [Resumo n. Fatores de riscos associados a transmissao de malaria humana, em areas de ressacas, nos bairros Novo Horizonte e Zerao, Macapa, Amapa, Brasil. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria.
Indicadores de risco para perda auditiva em neonatos e lactentes atendidos em um programa de triagem auditiva neonatal. Triagem auditiva em um hospital publico de Belo Horizonte, Minas Gerais, Brasil: deficiencia auditiva e seus fatores de risco em neonatos e lactantes. Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia. Perda auditiva neonatal associada a hiperbilirrubinemia por deficiencia de glicose-6-fosfato desidrogenase: relato de caso. Sequelas auditivas e neuropsicomotoras em recem-nascidos de termo ictericos tratados pelos metodos convencionais. Comparacao das alteracoes auditivas em recem-nascidos da UTI neonatal expostos e nao expostos a antibioticos. Medico do Setor de Saude Auditiva e Implante Coclear Universidade de Brasilia - UnB, Professor Substituto Otorrinolaringologia Universidade de Brasilia - UnB.
Professor e orientador do programa de pos-graduacao em Ciencias da Saude e Ciencias Medicas da Universidade de Brasilia - UnB. Their design was a glass replica of the twin towers with rectangular holes where the airplanes struck.
His design includes uniformed honor guards, firefighters and cops watching over a tomb in defense of the nation.
Data were obtained through interviews with the mothers' and analyzing the patient chart and the newborn, and underwent to statistical tests analysis of variance, equality of two proportions and Chi-square test (p = 0.05). Therefore, hearing impairment during the first years of life of a child can interfere with the acquisition and development of speech and language3-5. Newborn hearing screening (NHS) continues to be the only strategy able to detect early hearing alterations that could interfere with the quality of life of an individual5,8. At this hospital, an NHS Program is provided by a private clinic accredited by the National Health System (Sistema Unico de Saude - SUS), where diagnosis and intervention are performed. Excluded were infants born to mothers who were unable to report the occurrence and gestational period of malaria infection and infants born in other maternity units who were therefore not seen at the NHS service of the maternity unit where the study was conducted. It was not possible to include more subjects because the period scheduled was not sufficient to continue the process. Disposable insert earphones and electrodes were used for the two instruments, as well as disposable gloves, gauze and 70% alcohol to clean the infant's face and for fixation of the electrodes.
Risk factors were analyzed by the chi-squared test in order to determine the relationship between the findings and the variables mentioned.
Antimalarial drug use was more frequent in the second trimester of gestation, but most participants reported use of the medication in more than one trimester (Table 2). The results of these exams indicated the presence of bilateral impairment of the retrocochlear auditory pathways, findings compatible with the spectrum of auditory neuropathy.
This divergence may be explained by the difference in the period of data collection between the two studies, since the present study was conducted during the dry season (June to November), with the occurrence of malaria being related to climatic22-24 and environmental factors and an increase in transmission being observed at the end of the rainy season22.
However, this indication has become rare as observed in the present study and other studies in which pregnant women had malaria during pregnancy and were treated with chloroquine14,27. No relationship between the NHS results and gestational age agrees with evidenced by other researchers29. Even if NHS is performed daily, including weekends and holidays, the large number of births per day in the maternity unit where the study was conducted leads to early discharge and the consequent loss of some newborns.
Ary Pinheiro (Porto Velho- RO) causados pela malaria durante a gestacao no periodo de 2001 a 2003 em usuarias do SUS. There was a 70-foot glass sculpture of a pair of hands cupped together reaching for the heavens, and a sort of paddle-wheel thing that people pushed, and when they pushed it, it generated energy, and the energy was used to power spotlights, and the spotlights shone up into the sky, and the intensity of the shine, well, it depended on how many people were pushing the wheel. Cochlear damage initially involves the outer hair cells, generally affecting high-frequency hearing. The final sample consisted of 35 mothers who had malaria and used antimalarial drugs in pregnancy and their children. Subjects who needed to complete the diagnostic phase were referred to the clinic responsible for the NHS program. Infants who failed the test were directly referred for diagnostic evaluation, a procedure adopted by the program to prevent abandonment by the mothers, in addition to the fact that ABR is not affected by vernix which would justify retesting within 15 days. Infection occurred more frequently in the first trimester of gestation and this result was significant when compared to the third trimester (Table 1).
The worldwide impact of the tragedy is emphasized by recognizing the international scope of the loss.
Still, they wanted to remain involved and to contribute something -- anything, please -- because their energies and passions, the collective vat of their creative juices, really, could you throw it all away? Seven World Trade Center was not actually on the same plot of land as the rest of the World, Trace Center complex.



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04.02.2014 admin



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