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At this time, epidural blood patches are the first line of treatment. Dural tears can be prevented to an extent by utilizing minimally invasive techniques and certain positions for lumbar puncture. Surgical, trauma, lumbar puncture, epidural injection patients should be observed very carefully for dural tears and CSF leaks as the presenting clinical manifestations can be highly individualized and misguiding. Because studies have demonstrated a high frequency of dural tears, particularly in spinal surgery patients, there is a need for prospective studies so that clinicians can develop an elaborate prevention strategy and response to avoid serious, unseen complications.Purpose of the study The hyperacute care of ischemic stroke has evolved markedly. It is unclear to which level stroke centre patients should primarily be taken so information of intravenous thrombolysis (IVT) outcomes in smaller centres are needed.Methods All IVT episodes in North Karelia Central hospital in 2016-2017 were analysed retrospectively using hospital registries and individual medical records.Results IVT had been given to 75 patients (47% women) whose median age was 74 years [IQR 64, 81; no gender difference (p = 0.70)]. Median NIHSS on admission was 6 (IQR 4, 10) and onset-to-treatment time (OTT) 125 min (95% CI 112-138 min). Two intracranial bleeding complications were observed. Tanespimycin order Clinical status improved following IVT and 53.4% were independent at six months (85% were independent before the stroke). In a multivariate analysis the NIHSS score was the only predictor (B = 0.12, R2=0.34, p = 0.0001) of modified Rankin Scale (mRS). Large-vessel occlusion (LVO) was identified in 27% (35% women). Their median mRS was 2.0 (25% had died). Endovascular thrombectomy had followed IVT in 30% of the LVO-patients.Conclusions IVT results were generally in this peripheral PSC-level hospital without advanced imaging capabilities, but LVO outcomes need improvement. A mothership strategy should be evaluated.BACKGROUND This article presents the details and findings of a practical implementation of a preliminary model for use in hearing conservation programmes (HCPs) in the mining sector in South Africa. OBJECTIVES The implementation is based on a previously published model, called feedback-based noise monitoring model (FBNMM), and represents its implementation as a tool of predicting occupational noise-induced hearing loss (ONIHL), as well as monitoring and managing HCPs in the mining sector within the South African context. METHOD The article, utilising real miners' data, demonstrates this basic static feedback model with its practical applications such as estimating, monitoring and providing quantitative information to aid miners, mining administrators and policymakers in decision-making around HCPs, as recommended in the previous 2019 publication by Moroe et al. This study was conducted in a South African platinum mine. Evidence on the model's sensitivity and practicability in early identification, intervention and management of ONIHL in the workplace is presented. RESULTS Findings show how the use of the model within an HCP viewed as a complex intervention can allow for early prediction of ONIHL, consequently affording more accurate early intervention as part of preventive audiology within the health and safety goals of mines. CONCLUSION The feedback-based model should be a useful tool for successful implementation and monitoring of HCPs within South African mines.OBJECTIVE The main objective of this article was to present some of the engineering noise control methods that are currently being used across the world in the mining industry, while at the same time interrogating noise control measures that could be applied to effectively reduce noise emissions from the equipment utilised within South African mines. BACKGROUND A brief summary of the hearing conservation programmes used in South Africa is presented. Summarised research on the use of engineering noise control in South Africa is also presented, with an overview of the various engineering noise control methods applied across the world in dealing with occupational noise. METHOD For illustrative purposes, case studies were used to show how engineering noise controls could be used to reduce the noise levels and risks within this context. RESULTS Some of the case studies used have cited a reduction in the noise intensity emitted by machinery from a range of 93 dBA - 104 dBA to a range of 90 dBA - 94 dBA, demonstrating quite a significant reduction in the noise emission of the equipment. This article further provides recommendations on how South African mines could contextualise these methods. CONCLUSION One of the key recommendations is encouraging the South African mining industry towards the documenting and publishing of those engineering noise control methodologies that have proven to be effective for shared best practice. A need was identified for extensive research to be conducted and documented evidence to be made available to assist the South African mining industry with locating and assessing current engineering controls available in South Africa. Machines and processes that require noise control should be identified and, lastly, the current barriers to the use of engineering noise control methodologies should be identified, with the main goals of finding ways to overcome the noise challenges in the mines.BACKGROUND Literature suggests that risk factors for middle ear pathologies, such as traumatic injuries and human immunodeficiency virus (HIV), exist in mines. However, studies on hearing health in mines seem to focus primarily on occupational noise-induced hearing loss and ignore middle ear pathologies. As a result, there is little documented evidence on the trends of middle ear pathologies in mine workers. OBJECTIVES The aim of this study was to explore and document published evidence reflecting trends in middle ear pathologies in mine workers. METHOD A systematic literature review of studies that reported middle ear pathologies in mine workers was conducted. Medline, CINAHL, PubMed, PsychInfo and Google Scholar databases were searched for studies in English published between January 1994 and December 2018 and reporting on trends in middle ear pathologies in mine workers. RESULTS Two research studies met the selection criteria and were included for analysis. One research study used tympanometry with 226 Hz probe tone, while another study used interviews to determine the presence of middle ear pathologies.
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