Evaluation of Children Quality of Life after Serous Otitis Media Surgery

Introduction: Otitis media with effusion is a common childhood disease diagnosed with the accumulation of serous fluid or mucous in the middle ear. If not treated, the sustainable effusion leads to change and destruction of middle ear structures. One of the most successful treatment methods is myringotomy and ventilation tube insertion, which leads to improvement of patients' quality of life. The aim of this study was to evaluate children’s quality of life after inserting ventilation tubes. Methods: This prospective cross-sectional study examined the quality of life of the children suffering from otitis media with sustainable effusion, who were candidates for ventilation tube insertion. Otitis Media outcome-22 (OMO -22) questionnaire, was used to record the patients’ problems in a 12-week period before and after surgery. Results: In this study, 70 patients, including 43 (61.4%) boys and 27 (38.6%) girls (1y-13y), who completed the questionnaire, were studied. Treatment with ventilation tubes improved many physical symptoms of the hearing loss along with speech and behavioral symptoms. A significant reduction was observed in the number of physician visits and the use of antibiotics for ear problems. Conclusion: Ventilation tube insertion not only reduced the symptoms of otitis media with effusion, but also improved the children’s quality of life

Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy

AbstractPurposeHypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation.Material and methodsFrom August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms (aged 3–11years old of which 35 were males and 20 females) were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist.In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately.ResultsNo complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 (7.3%) children were higher than normal range (25mmHg) and it decreased significantly after operation (P<0.000) (Preoperative MPAP=32±3mmHg, and six months postoperative follow up, MPAP=11±5mmHg). All the patients’ parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children.The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (P<0.000 preoperative TR=34±8mmHg postoperative TR=19±6mmHg). AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal.ConclusionSevere chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure

Comparing the Efficacy of Surfactant Administration by Laryngeal Mask Airway and Endotracheal Intubation in Neonatal Respiratory Distress Syndrome

Objectives: This study aimed to compare the effcacy of surfactant administration by laryngeal mask airway (LMA) and endotracheal intubation in the management of respiratory distress syndrome (RDS) in preterm infants. Materials and Methods: In a prospective interventional study in NICU at Al-Zahra hospital, 50 premature infants with gestational age of 33-37 weeks and birth weight of 1800 g or more who needed surfactant replacement therapy for RDS were randomly allocated to 2 groups. Twenty-fve neonates in ETT group received surfactant by endotracheal intubation and the LMA were used for the administration of surfactant in 25 neonates (LMA group). Results: The mean gestational age in LMA group was 32.88±1.32 and it was 33.76±2.12 weeks in ETT group (P=0.15). The mean RDS score was not statistically different 2 two groups, 7.68±0.80 vs. 7.24±1.17 (P=0.79). Mechanical ventilation was needed for 1 neonate in the LMA group and 3 infants in the ETT group (P=0.16). After surfactant administration, the mean FiO 2 requirements to maintain oxygen saturation between% 88 to 92% showed a statistically signifcant decrease in both groups. The needed FiO2s were 0.60±0.12 and 0.57±0.12 before surfactant therapy and decreased to 0.42±0.15 and 0.36±0.10 after surfactant administration in LMA and ETT groups, respectively (P<0.001). No choking or vomiting occurred during surfactant therapy in either group. Conclusions: Based on our fndings, the LMA may be a safe and effective alternative way for surfactant administration in late preterm infants. Future multicenter studies are recommended for determining safety and effcacy of LMA in preterm infants

Autism's Impact on Cochlear Implantation Surgery Outcomes in Deaf Children

Introduction:Cochlear implants (CI) provide a hearing sense for severe to profound hearing-impaired patients, both adults and children, and they are a broadly effective and accepted therapeutic method for those patients. Also, Deaf children with comorbidities, including autism spectrum disorders (ASDs), undergo cochlear implantation. ASDs are a group of developing disorders characterized by abnormalities in social interaction and communication with limited repetitive patterns of behavior. This study aimed to assess the effect of Autism on CI surgery outcomes in Deaf Children.Materials and Methods:We followed 12 autistic patients with cochlear implantation and 12 non-autistic cochlear-implanted patients for two years. The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were used to assess 6, 12, and 24 months after cochlear implantation surgery. Results: During the 24-month follow-up, the CAP means scores increased in both groups, and SIR and CAP progresses were considerably greater in non-ASD children (P<0.001). However, in ASD children, the progress of CAP and SIR variables were significant, with 99% and 95% confidence, respectively, at 24 months after surgery.Conclusion:Although the CIs could improve hearing performance in autistic patients, speech development after CIs in autistic children could affected by several factors, including the severity of autism, and this can be effective in providing pre-implant counseling to parents. The application of the alternative communication methods could be taken into account as a potential rehab technique

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.; We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health