Inhaled Corticosteroids: Hazardous Effects on Voice—An Update

Inhaled corticosteroids (ICS) have become the prevalent treatment in asthmatics. Hazards to voice are under-recognized. A total of 38 patients with voice complaints associated with the use of ICS were assessed by 79 strobovideolaryngoscopy (SVL) examinations, 24 single and 14 multiple SVL. Hoarseness and dysphonia were the primary reasons for referral. The ICS initially used most frequently was Advair Diskus (fluticasone propionate and salmeterol-inhalation powder-[IP]) in 22 patients, followed by Flovent (fluticasone propionate inhalation aerosol-pressurized metered-dose inhaler-[PMDI]) in 11. Duration of ICS usage varied from 2 weeks to 4-5 years. Higher dosage and frequency of use exacerbated problems. Hazards to voice previously unrecognized by real-time indirect mirror or fiberoptic laryngoscopy were identified by meticulous attention to SVL abnormalities. There was essentially no difference in occurrence of abnormalities whether analyzed from the perspective of the initial 38 or all 79 examinations. These included abnormal mucosal wave symmetry/periodicity (76-63%), phase closure (74-63%), glottic closure (63-59%), mucosal wave amplitude/magnitude (50-35%), supraglottic hyperactivity (39-25%), mucosal quality (34-34%), and glottic plane (10-5%).Candidiasis of the larynx was infrequently observed. Fluticasone ICS were a cause of steroid inhaler laryngitis, and the best treatment was their avoidance or cessation. Further prospective studies ideally might include SVL documented as a pretherapy baseline and then repeated in each ICS patient who developed hoarseness/dysphonia.     

An age-structured model for the spread of epidemic cholera: Analysis and simulation

Occasional outbreaks of cholera epidemics across the world demonstrate that the disease continues to pose a public health threat. Traditional models for the spread of infectious diseases are based on systems of ordinary differential equations. Since disease dynamics such as vaccine efficacy and the risk for contracting cholera depend on the age of the humans, an age-structured model offers additional insights and the possibility of studying the effects of treatment options. The model investigated is given as a system of hyperbolic (first-order) partial differential equations in combination with ordinary differential equations. First, using a representation from the method of characteristics and a fixed point argument, we prove the existence and uniqueness of a solution to our nonlinear system. Then we present a finite difference approximation to the model and study the effect of high and low rates of shedding of cholera vibrios on the dynamics of the spread of the disease. The simulations demonstrate the explosive nature of cholera outbreaks that is observed in reality. The contrast of results for high and low rates of shedding of vibrios suggest a possible underlying cause for this effect.     

Ionic liquids form ideal solutions

An understanding of the activity of a solute in solution is vital for utilising the full potential of a reactive species. In this work we determine the activity of metal salts in a variety of ionic liquids. Some solutions behave like classical non-polar solvents whereas other are practically ideal solutions up to 1 mol kg(-1) which allows standard redox potentials to be determined.     

Role of attention in overshoot: frequency certainty versus uncertainty

Overshoot, the elevation in the threshold for a brief signal that comes on close to masker onset, was measured with signal frequency certain (same frequency on every trial) or uncertain (randomized over trials). In broadband noise, thresholds were higher 2 ms after masker onset than 200 ms later, by 9 dB with frequency certainty, by 6-7 dB with uncertainty. In narrowband noise centered on the signal frequency, thresholds at 2 ms were not elevated with certainty, but were elevated 4-5 dB with uncertainty. Thus, frequency uncertainty leads to less overshoot in broadband noise, to more overshoot in narrowband noise. Reduced overshoot in broadband noise may come about because the masker, given its many frequencies, disrupts focusing at onset as much under certainty as uncertainty. Once the initial disruption dissipates, threshold is lower with certainty so overshoot is greater. In contrast, a narrowband noise with frequencies only near the signal does not disrupt focusing when the signal frequency is known beforehand, so overshoot is absent. When frequency is uncertain, the narrowband noise serves to focus attention on the signal frequency; as this requires time, detection near noise onset is poorer than later on, so overshoot is present.     

ChemInform Abstract: Trends in the Frequencies of ν(AsOxHx‐1) [x = 2—4] in Selected As(V)‐Containing Compounds Investigated Using Quantum Chemical Calculations.

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