In the wrong place but perhaps at the right time: a cochlear implant electrode impinging on tympanic membrane

Aim: This case report demonstrates the incidental finding of a cochlear implant (CI) electrode impinging on the tympanic membrane (TM). Background: The cochlear implant is the most successful neural prosthesis that has been developed in the last few decades. It has helped thousands of profoundly deaf recipients to have better hearing and improved quality of life. Nevertheless, extracochlear electrode extrusion or migration would occur and this requires special consideration. Case description: We report a case of a 4-year-old boy who was implanted with bilateral CIs for profound hearing loss postmeningitis at 1 year of age, with an incidental finding of the CI electrode impinging on the medial surface of his left TM. A computed tomography (CT) scan confirmed this finding, and the patient had revision surgery and reimplantation of CI. Conclusion: It is advisable for patients to continue follow-up postimplantation in the otorhinolaryngology (ORL) clinic even after years of CI surgery. The early detection of electrode malfunction, extrusion, migration, or misplacement is mandatory to improve patients’ quality of life and prevent further complications

Outcome of a newborn hearing screening program in a tertiary hospital in Malaysia: The first five years

<b>Background and Objective :</b> Universal newborn hearing screening (UNHS) was started in the Hospital Universiti Sains Malaysia (HUSM) in January 2003. To comply with international standards, we determined the outcome of the newborn hearing screening program for the first 5 years of its implementation, from January 2003 to December 2007. <b>Methods</b> : The program screened all infants who were delivered in HUSM. In a retrospective review, the outcomes in terms of coverage, prevalence of hearing impairment, referral rate for each screening, age at detection of hearing impairment and at hearing aid-fitting were analyzed. <b>Results</b> : Ninety-eight percent of newborns were screened. The study included 16 100 randomly selected newborns. The initial screening referral rate was 25.5&#x0025;. The prevalence of default for second and third screening was 33.9&#x0025; and 40.7&#x0025;, respectively. The mean (SD) age at detection of hearing impairment was 3.3 months (0.86). The mean (SD) age at fitting of a hearing aid was 13.6 (4.8) months.The prevalence of hearing impairment was 0.09&#x0025;. <b>Conclusion</b> : A newborn hearing screening program is an important tool for early diagnosis and treatment. Even though the prevalence of hearing impairment may be low, the problem needs to be addressed early as the development of infants requires normal hearing

Optimization of anthocyanins extracts from roselle (Hibiscus sabdarifa) petals using ultrasonic-assisted extraction method

Roselle petals contain high anthocyanins, a good antioxidant, and natural dark red colorants. Anthocyanins help in reducing risks of cardiovascular disease and colon cancer. But anthocyanins are easily affected by extraction process. Therefore, this study proposed a new method of extracting anthocyanins using ultrasonic-assisted extraction (UAE) from roselle petals with three extraction parameters. The extraction parameters are sample’s particle size (0.125, 0.375 and 0.625 mm), solvent to solid ratio (10:1, 15:1 and 20:1 mL solvent/g solid) and extraction time (5, 10 and 15 min). The optimization of process parameters aims to achieve the highest extraction yield of extract, Total Anthocyanins Content (TAC), and Antioxidant Activity (AA). The results show that 0.125 mm of particle size, 10:1 mL solvent/g solid, 15 min of extraction obtained the best percent mass yield (64.72%), TAC (70.97 mg/L), and AA (90.05%). Method-wise, this study showed that the ultrasonic-assisted extraction gives better quality of roselle petals extracts than the maceration extraction

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine