Outcome Of Newborn Hearing Screening Program in A Tertiary Care Centre, South India.

Objective To determine the coverage and outcome of Universal Newborn Hearing Screening (UNHS) Program in Government Medical College Manjeri, South India. To study the prevalence of hearing loss (HL) among those children screened, to describe the characteristics of confirmed cases, and the status of speech and language development acquired by them at follow up. Design Hospital based retro prospective study. Methods Data were collected from all newborns who underwent Universal Newborn Hearing Screening (UNHS) over a four-year period (November 2014 to October 2018). Cases with confirmed hearing loss were studied by pre-structured questionnaire and telephonic interview. Speech and language assessments of 10 confirmed cases were conducted after a period of intervention. Results Out of 17,260 babies, 16,625 were screened (96.3%). HL was confirmed for 13 of these, resulting in a prevalence rate of 0.08%. Risk factors for HL were not present in 61.5% of these cases. Confirmation was done at a median age of 6 months with an Interquartile Range (IQR) (4; 12). Interventions in the form of speech therapy and hearing aid were started at a median age of 17.5 months with an IQR (13;25) and the median duration of intervention till the time of assessment was 30 months with an IQR (17;43) Out of 13, five children were managed with hearing aid. Another five required cochlear implant at a median age of 24 months with an IQR (17.5; 33). All received speech therapy. Three children were lost during follow up. On assessment using ISD and REELS, eight out of the remaining 10 children showed a lag in the speech and language development, with a median delay of 19.3 months with an IQR (2; 34.5) Conclusions Coverage of the program was optimal, with almost all newborns successfully screened. More than half of the confirmed children did not exhibit risk factors for HL and therefore might not have been identified early without UNHS. The observed median age of starting intervention for confirmed cases was higher than the age recommended by AAP guidelines and most of the children had language development below those of typically hearing age mates after months of intervention. Key words: Universal Newborn Hearing Screening, Outcome, Oto Acoustic Emission, Hearing loss, Neonates

Study of risk factors in the development of retinopathy of prematurity in late preterms

Context: In India, late preterm babies are susceptible to retinopathy of prematurity (ROP). This study is done to assess the incidence of ROP and also to analyze the risk factors involved in the development of ROP in preterm babies between 34 and 36 weeks of gestation. Aims: Risk factor analysis of ROP in late preterm babies. Settings and Design: This is a prospective observational study done in a tertiary-level multispecialty hospital between January 2020 and January 2022. Materials and Methods: Two hundred and eleven preterm babies born between 34 and 36 weeks of gestation were included in the study. Their systemic comorbidities were identified after reviewing their hospital records. They were followed up till their retina reached maturity. Statistical Analysis: It was carried out using SPSS software version 17. Results: The incidence of ROP was 6.2%. Twelve (92.3%) babies belonged to type 2 ROP. All these babies had a spontaneous resolution of ROP and did not require any intervention. One (7.7%) baby born at 36 weeks of gestation with a birth weight of 1.5 kg, presented at 52 weeks of gestation with Stage 5B of ROP in both eyes. Using univariate regression analysis, SGA status, pleural effusion, chylothorax, congestive cardiac failure, congenital diaphragmatic hernia, hypoxic–ischemic encephalopathy, and any intervention were found to be statistically significant. On multivariate analysis, SGA status and hypoxic–ischemic encephalopathy were statistically significant. Conclusions: All preterm babies born before 37 weeks of gestation should have at least one ROP screening to prevent the development of sight-threatening ROP

Proliferative retinopathy in a diabetic on interferon therapy: A diagnostic dilemma

Hepatitis C virus (HCV) is a blood-borne RNA virus that causes hepatitis C, chronic liver disease, and hepatocellular carcinoma. Patients with HCV infection are now treated with a combination of interferon alpha, which has antiviral and immunomodulatory properties, and ribavirin, an antiviral medication included in the family of nucleoside analogs. Recently, a long acting form of interferon alpha (pegylated interferon) has been developed, which has a more sustained antiviral response. One of the ocular side effects of interferon alpha is proliferative retinopathy related to ischemia. Interferon-associated retinopathy is usually mild and resolves completely, but occasionally, it can become severe

Fresh Water Lens Persistence and Root Zone Salinization Hazard Under Temperate Climate

In low lying deltaic areas in temperate climates, groundwater can be brackish to saline at shallow depth, even with a yearly rainfall excess. For primary production in horticulture, agriculture, and terrestrial nature areas, the fresh water availability may be restricted to so-called fresh water lenses: relatively thin pockets of fresh groundwater floating on top of saline groundwater. The persistence of such fresh water lenses, as well as the quantity and quality of surface water is expected to be under pressure due to climate change, as summer droughts may intensify in North-West Europe. Better understanding through modelling of these fresh water resources may help anticipate the impact of salinity on primary production. We use a simple model to determine in which circumstances fresh water lenses may disappear during summer droughts, as that could give rise to enhanced root zone salinity. With a more involved combination of expert judgement and numerical simulations, it is possible to give an appraisal of the hazard that fresh water lenses disappear for the Dutch coastal regions. For such situations, we derive an analytical tool for anticipating the resulting salinization of the root zone, which agrees well with numerical simulations. The provided tools give a basis to quantify which lenses are in hazard of disappearing periodically, as well as an impression in which coastal areas this hazard is largest. Accordingly, these results and the followed procedure may assist water management decisions and prioritization strategies leading to a secure/robust fresh water supply on a national to regional scale

Cyclosulfamidate Mannose-Configured Cyclitol Allows Specific Allele-Dependent Inhibition of GH47 α-D-Mannosidases Through a Bump-Hole Strategy

Class I inverting exo-acting α-1,2-mannosidases (CAZY family GH47) display an unusual catalytic itinerary featuring ring-flipped mannosides, 3S1 → 3H4‡ → 1C4. Conformationally locked 1C4 compounds, such as kifunensine, display nanomolar inhibition but large multigene GH47 mannosidase families render specific “isoform-dependent” inhibition impossible. Here we develop a bump-and-hole strategy in which a new mannose-configured 1,6-trans-cyclic sulfamidate inhibits α-D-mannosidases by virtue of its 1C4 conformation. This compound does not inhibit the wild-type GH47 model enzyme by virtue of a steric clash, a “bump”, in the active site. An L310S (a conserved residue amongst human GH47 enzymes) mutant of the model Caulobacter GH47 awoke 574 nM inhibition of the previously dormant inhibitor, confirmed by structural analysis of a 0.97 Å structure. Considering that L310 is a conserved residue amongst human GH47 enzymes, this work provides a unique framework for future biotechnological studies on N-glycan maturation and ER associated degradation by isoform-specific GH47 α-D-mannosidase inhibition through a bump-and-hole approach