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ObjectivesThis study sought to determine the absolute and relative associations of diabetes mellitus (DM) and hemoglobin A1c (HbA1c) with sudden and/or arrhythmic death (SAD) versus other modes of death in patients with coronary artery disease (CAD) who do not qualify for implantable cardioverter-defibrillators.BackgroundPatients with CAD and DM are at elevated risk for SAD; however, it is unclear whether these patients would benefit from implantable cardioverter-defibrillators given competing causes of death and/or whether HbA1c might augment SAD risk stratification.MethodsIn the PRE-DETERMINE study of 5,764 patients with CAD with left ventricular ejection fraction (LVEF) of >30% to 35%, competing risk analyses were used to compare the absolute and relative risks of SAD versus non-SAD by DM status and HbA1c level and to identify risk factors for SAD among 1,782 patients with DM.ResultsOver a median follow-up of 6.8 years, DM and HbA1c were significantly associated with SAD and non-SAD (P 30% to 35%, patients with DM and/or elevated HbA1c are at much higher absolute risk of dying from non-SAD than SAD. Clinical risk markers, and not HbA1c, were associated with SAD risk in patients with DM. (PRE-DETERMINE: Biologic Markers and MRI SCD Cohort Study; NCT01114269).

A one-pot procedure for the preparation of functionalized 1,4-dihydropyridines by three-component reaction using substituted heterocyclic aldehydes, ammonium acetate, and substituted β-ketoesters catalyzed by L-proline was described. Present protocol offers excellent yield up to 92%, flexibility with different substitution, convenient operation, and eco-friendliness. The synthesized products were confirmed by 1H-NMR, 13C-APT, and IR spectroscopy. Herein, final confirmation of the targeted motif was made by X-ray single-crystal analysis of representative compounds (4f, 4j, 4k, 4l, and 4o). The chemically synthesized compounds were evaluated for the antiproliferative activity by cell viability (MTT) assay and dual AO/EB (acridine orange/ethidium bromide)-staining method against human A549 lung cancer cell lines. The viability of the treated cell was evaluated adopting MTT assay. According to associated changes in cell membranes during the process of apoptosis, a clear difference was observed between normal cells, early and late apoptotic cells, and necrotic cells. All compounds were found effective against Saccharomyces cerevisiae which was confirmed by increased reactive oxygen species production and DNA damage as compared to untreated yeast cell culture. Altogether, these compounds showed promising hope for application in pharmaceutical aid against yeast infections. [ABSTRACT FROM AUTHOR]

Need: A systematic needs and planning assessment is considered critical prior to large scale program implementation of new interventions (Ekeland et al, 2010; Kidholm et al, 2012) to avoid costly implementation errors (AlDossary et al, 2017) A comprehensive tele-practice model of screening, identification and rehabilitation of children below 6 years with hearing and speech-language disorders is proposed in Tamil Nadu Towards this, a situational analysis was undertaken to understand the perceived needs and readiness for telepractice integration. Aim: To understand the existing needs and assess telepractice readiness among various public-sector stakeholders involved in identification and rehabilitation of children with disability using mixed methods approach Method: Cross-sectional design using mixed methods including Focus Group Discussion (FGD) and Semi-structured interviews (SSI) of various stakeholders and geospatial mapping. Study site: Two representative rural districts in South India, Tamil Nadu, having nearly equal population, area and socio-economic conditions were selected to conduct the study. Material: Purposive homogeneous sampling was used for FGDs and Maximum variation sampling was used for SSIs Fathers and mothers of children with disability under 6 years of age, and various service providers working in public-sector services participated in the study. Procedure: Guide development -- The Bowen's feasibility framework was used as the primary framework (Bowen D.J., et al., 2010) and relevant attributes from various telemedicine frameworks (Addotey- Delove M.N., et al., 2020; Kiberu, et al., 2019; AlDossary et al., 2017; Mauco, et al., 2018) were mapped to these constructs. The interview guides were developed based on this framework. Data collection: The FGDs were conducted inperson in the rural community, and the SSI was conducted in-person or through a secure video-conferencing platform depending on the participant's convenience The FGD and SSI were audio recorded with prior written consent of all participants. For the geospatial analysis, the address of all enumerated children with disability below 6 years of age and service providers (centre and staffing) were obtained for the study sites All public-sector service centres and providers were included Analysis: All recordings were verbatim transcribed and uploaded in NVIVO software v. 12. Each transcript was coded and themes were identified using a deductive approach. For geo-spatial analysis, the geo-locations of providers and patients were obtained using Google Maps platform with latitude and longitude information. Data was imported to a web-based GIS analysis software -- TNG is to obtain buffer maps, distances and spread maps. Results: FGDs were conducted on four groups of mothers, two groups of fathers, two groups of anganwadi teachers and two groups of primary and secondary government teachers SSIs were conducted with 3 ASLPs, 2 welfare officers and 5 special educators. Parental perceptions on availability and accessibility of diagnostic and rehabilitation facilities, barriers and challenges faced in seeking care, as well as satisfaction with quality of care were obtained Caregiver's comfort and agreeability for telepractice, their intention to try and perceived fit of telepractice was identified. The service providers perceived the currently available services for hearing and speech-language disorders to be inadequate and were ready to explore telepractice Yet, they perceived a need for training, capacity building and more community engagement before implementing such services. The visual map of geographic distribution of persons with disability and all service centres in the selected districts revealed regional disparities in availability of services, non-availability of ASLP staffing and the average distance travelled by patient to avail diagnostic and rehabilitation services in these districts. Conclusions: The situational analysis informed us about the key grass root level personnel who can be engaged for telepractice, parental and service provider apprehensions towards telepratice and suitable locations for integrating telepractice in the community. [ABSTRACT FROM AUTHOR]

Introduction: The increase in mHealth based hearing applications provide improved access to hearing services in low- and middle-income countries (LMICs). Use of mobile/tablet based hearing screening in primary health care initiatives is likely to improve access to early identification of disabling hearing loss, especially among children in underserved regions. Objective: To beta- validate the prototype tablet-based subjective- behavioural hearing screening measures among children below six years for its accuracy in identifying children at risk for 40% or more hearing loss. Material and methods: Tablethearing screening device prototype was developed with hearing screening software coded using Python language. Suitable wireless headphones and speakers were finalised as transducers after checking calibration output. The screening tests incorporated behavioral observation and visual reinforcement audiometry and speech recognition threshold (SRT) screening. Stimuli for each test procedure were also developed as a part of this study. For beta validation of the prototype, 25 children were assessed for their thresholds using the standard audiometer and then through the prototype. Results: Agreement statistics was used to compare the screening results from the standard audiometer and the prototype for each frequency. Perfect agreement was obtained for all frequencies. Friedman test and descriptive analysis was used to compare the thresholds obtained using newly developed non tonal stimuli and the standard warble tone thresholds. On comparison, threshold obtained using non-tonal stimuli was appropriate and can be used as alternative stimuli for pediatric behavioral hearing screening. Results of speech recognition threshold screening revealed that presentation level of 5 dBSL of warble tone would be sufficient to obtain 50% recognition. Conclusions: The prototype was found to be satisfactory in identifying children who are at risk for 40% or more hearing loss. However, scope for improvement in device interface was also identified. [ABSTRACT FROM AUTHOR]

Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by elaborating on the mechanism, safety, efficacy, comparative analysis of treatment and the road ahead, in addition to summarizing the existing data on this treatment. The inferences from this review further consolidate transcatheter arterial embolization as one of the prime options for managing joint pain when it is refractory to conservative treatment and label it as one of the most exciting prospects. A limitation of this review is that most of the data were from open label case series or case reports., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Tele-practice promotes universal and equitable access to quality health services and emerged as an alternative to overcome physical barriers to intervention access in the 90s. There has been a steady increase in adoption since then, and during the COVID-19 pandemic, there was a surge in online modes of healthcare service delivery. Yet, tele-practice adoption and utilization in rural and remote areas are not spontaneous. Therefore, as a first step, prior to the implementation of a comprehensive tele-practice model, a baseline situational analysis was undertaken to assess the needs and readiness of parents of children with disabilities and different cadres of health care providers towards accepting tele-practice services in their settings. This paper describes the process of development of the conceptual framework that guided the baseline needs and readiness assessment (situational analysis)., Methods: The Bowen's feasibility framework served as the primary framework to evaluate the feasibility outcomes of the implementation. Therefore, this framework also guided the baseline situational analysis. For specificity of the framework to tele-practice, several telemedicine planning frameworks relevant for low- and middle-income countries were reviewed to identify and map suitable constructs and attributes to the Bowen's constructs. A description of the framework selection process and a review of each of the selected telemedicine frameworks are provided., Results: The constructs and attributes from this conceptual framework were used to develop the guides for focus group discussions (FGDs) and semi-structured interviews (SSIs). The guides were prepared separately for each stakeholder group., Conclusions: The developed framework facilitated the assessment of needs and readiness suited to the context and among various stakeholders involved in the proposed implementation of the comprehensive model of tele-practice for childhood communication disorders in rural communities., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Jesudass N et al.)

Background Bag-mask ventilation is an essential life-saving skill. The E-C technique of mask holding is the most popular. In patients with suspected cervical injury, the jaw thrust maneuver is recommended instead of the E-C technique with head tilt-chin lift. Should jaw thrust fail to produce adequate chest rise, the operator is advised to switch to the E-C technique with the head tilt-chin lift maneuver with head extension as it is vital to move oxygen into the lungs. We hypothesized that the E-C clamp with the head in the neutral position without head tilt might permit adequate ventilation without producing excessive movement of the cervical spine, which in turn might translate as less strain to the cervical spine. Methods In this prospective, randomized, double-blind, crossover study, we evaluated the relative efficacy of three airway maneuvers in opening the airway in anesthetized and paralyzed adults: jaw thrust, two-handed E-C technique with head in the neutral position, and two-handed E-C technique with head fully extended. The tidal volume generated during mechanical ventilation using these three techniques was considered as the primary outcome. Seventy-two subjects were recruited for this trial and all three techniques of mask holding were performed in each of these subjects in a sequence as dictated by a randomization table. Results The jaw thrust technique provided a mean tidal volume significantly higher than the two-handed E-C technique, with the head in the neutral position (p<0.001). Similarly, the two-handed E-C technique with the head fully extended provided a mean tidal volume significantly higher than the two-handed E-C technique with the head in neutral position (p<0.011). The mean tidal volume obtained with jaw thrust and two-handed E-C technique with head fully extended were comparable (p=0.78). Conclusion The two-handed E-C technique with the head fully extended, and the jaw thrust technique both produce good and comparable tidal volumes. The two-handed E-C technique with the head in a neutral position provides adequate though lower tidal volumes as compared to the other two techniques., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ramakkannu et al.)

This study validated an app-based developmental and speech language screening (SRESHT screener) conducted by Grass Roots Workers (GRWs) among children below six years of age in a rural community in the state of Tamil Nadu (the field)., Method: The study was carried out in two phases, first the training of GRWs and then the validation of the screening conducted by them using the app. For the training, suitable materials were developed, and the GRW's knowledge and skills were evaluated pre- and post-training. Two closed-ended questionnaires were used to evaluate the GRWs' knowledge about the screening tools. The Observed Structured Practical Examination (OSPE) method was used to evaluate their skill. All the participants were selected by convenience sampling and were screened independently by both a Speech Language Pathologist (SLP) and a GRW using the application. Cohen's kappa and percent agreement were used to determine agreement in screening results between the SLP and GRWs., Results: All the GRWs scored at least 75 % and above in both the knowledge and skill assessments conducted post-training. "Substantial agreement" on kappa-based extent of agreement and "almost perfect" agreement on percent agreement were obtained between GRWs and SLP for the app-based screening., Conclusion: The findings of this study imply that the app-based developmental and speech language screening performed in the community by GRWs is valid., Competing Interests: Conflicts of interest of each author/contributor None to declare.

The current study was a first step towards planning the implementation of tele-practice in a South Indian state's public-sector services for childhood hearing and speech, language disorders. The aim was to understand the perceptions of public-sector health care providers (HCPs) regarding their need and readiness to accept and implement tele-practice-based diagnostics and rehabilitation services. A cross-sectional study design was used, which included focus group discussions (FGDs), semi-structured interviews (SSIs) and geo-spatial analysis. Participants in the qualitative component included various cadres of health HCPs in public-sector services. Theoretical saturation and cross-case variance were used to assess the data's sufficiency. A hybrid deductive-inductive thematic analytical approach was used to analyse the data. Geo-tags and geo-locations of addresses of all children with disabilities and all the public-sector service providers were used to generate geospatial maps. The HCPs considered the currently available services for childhood hearing and speech-language disorders to be insufficient and reported shortage of professionals to meet current demands. There was inconsistent availability of suitable equipment and professionals in the existing district-level facilities. HCPs were comfortable using technology, and were willing to investigate tele-practice, but they required training in tele-practice [Q2].

The intermolecular aggregation between the solvent and organic molecules is covered in the current article. 4,4'-(Buta-1,3-diyne-1,4-diyl)dibenzoic acid (DADBA) was used as an organic molecule and dimethyl sulfoxide (DMSO) as a solvent to create the target compound DADBA-DMSO. The material's hydrogen bonding and intermolecular aggregation were determined by appropriate characterization methods, including single-crystal X-ray diffraction (XRD), Fourier-transform infrared (FTIR), photoluminescence (PL), and cyclic voltammetry (CV) analysis. Each hydrogen of the carboxylic group is coordinated by oxygen from the DMSO molecule in the stiff planar layer packing that makes up the DADBA-DMSO crystal structure., (© 2024 John Wiley & Sons Ltd.)

Objectives: The objectives of the current study were to (a) identify long-term tele-audiology services reported to be implemented beyond the research phase and determine whether they are sustained, (b) map the implementation process to Standards for Reporting Implementation Studies guidelines and (c) map the factors that influenced its sustainability to the Implementation Outcomes Framework (IOF) to understand the gaps from an implementation research perspective., Study Design, Setting and Participants: This cross-sectional study included a scoping review of articles describing long-term tele-audiology services from around the world to determine the factors influencing the implementation. Six electronic databases (PubMed, Cochrane Library, Web of Science, Scopus, Google Scholar and ProQuest) were searched for literature published between 2010 and 2023. This was followed by semistructured interviews (SSIs), which were guided by the IOF. Six project implementers were interviewed to obtain an in-depth understanding of factors that influenced sustainability of these tele-audiology services. Thematic analysis of the interview transcripts was carried out using a hybrid inductive-deductive approach., Results: Data were extracted from 32 tele-audiology studies included in the review, which were then mapped to 21 projects. The findings of the scoping review reveal that tele-audiology services were predominantly provided using synchronous telepractice methods. The 'professional-facilitator-patient' model was most commonly used. None of the studies reported the use of implementation research and/or outcome frameworks. Factors that influenced sustainability of tele-audiology services were identified from the combined results of the scoping review and the SSIs. These factors could be mapped to implementation outcomes of acceptability, adoption, feasibility, implementation cost and sustainability., Conclusion: Implementation research and/or outcome framework should be used to guide the implementation processes, its evaluation and measurement of outcomes systematically in tele-audiology service delivery. When such frameworks are used, gaps in information regarding the context influencing implementation, reporting of fidelity and adaptability measures can be addressed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Cisplatin is a very effective chemotherapeutic agent against a variety of solid tumors. Unfortunately, cisplatin causes permanent sensorineural hearing loss in at least two-thirds of patients treated. There are no FDA approved drugs to prevent this serious side effect., Areas Covered: This paper reviews various natural products that ameliorate cisplatin ototoxicity. These compounds are strong antioxidants and anti-inflammatory agents. This review includes mostly preclinical studies but also discusses a few small clinical trials with natural products to minimize hearing loss from cisplatin chemotherapy in patients. The interactions of natural products with cisplatin in tumor-bearing animal models are highlighted. A number of natural products did not interfere with cisplatin anti-tumor efficacy and some agents actually potentiated cisplatin anti-tumor activity., Expert Opinion: There are a number of natural products or their derivatives that show excellent protection against cisplatin ototoxicity in preclinical studies. There is a need to insure uniform standards for purity of drugs derived from natural sources and to ensure adequate pharmacokinetics and safety of these products. Natural products that protect against cisplatin ototoxicity and augment cisplatin's anti-tumor effects in multiple studies of tumor-bearing animals are most promising for advancement to clinical trials. The most promising natural products include honokiol, sulforaphane, and thymoquinone.

Stimuli-responsive controlled drug delivery systems have attracted the attention of researchers in recent decades due to their potential application in developing efficient drug carriers that are responsive to applied stimuli triggers. In this work, we present the synthesis of L-lysine (an amino acid that combines both amine and carboxylic acid groups in a single unit) modified mesoporous silica nanoparticles (MS@Lys NPs) for the delivery of the anticancer bioactive agent (curcumin, Cur) to cancer cells. To begin, mesoporous silica hybrid nanoparticles (MS@GPTS NPs) with 3-glycidoxypropyl trimethoxy silane (GPTS) were synthesized. The L-lysine groups were then functionalized onto the mesopore channel surfaces of the MS@GPTS NPs through a ring-opening reaction between the epoxy groups of the GPTS and the amine groups of the L-lysine units. Several instrumental techniques were used to examine the structural properties of the prepared L-lysine-modified mesoporous silica nanoparticles (MS@Lys NPs). The drug loading and pH-responsive drug delivery behavior of MS@Lys NPs were studied at different pH levels (pH 7.4, 6.5, and 4.0) using curcumin (Cur) as a model anticancer bioactive agent. The MS@Lys NPs' in vitro cytocompatibility and cell uptake behavior were also examined using MDA-MB-231 cells. The experimental results imply that MS@Lys NPs might be used in cancer therapy as pH-responsive drug delivery applications.

Background and Objectives: This study describes the development of an International Classification for Functioning, Disability and Health (ICF)-based inventory for tinnitus (ICF-TINI) that measures the impact of tinnitus on the function, activities, and participation of an individual. Subjects and., Methods: This cross-sectional study utilized the ICF-TINI, which included 15 items from the two ICF components of body function and activities. We included 137 respondents with chronic tinnitus. Confirmatory factor analysis validated the two-structure framework (body function, activities and participation). The model fit was assessed by comparing fit values of chi-square (df), root mean square error of approximation, comparative fit index, incremental fit index, and Tucker-Lewis index, with the suggested fit criteria values. Cronbach's alpha was used to assess internal consistency reliability., Results: The fit indices confirmed the presence of two structures in ICF-TINI, while the factor loading values suggested each item's goodness of fit. The ICF-internal TINI exhibited high consistency reliability (0.93)., Conclusions: The ICFTINI is a reliable and valid tool for assessing the impact of tinnitus on an individual's body function, activities, and participation.

Cisplatin is chemotherapy used for solid tumor treatment like lung, bladder, head and neck, ovarian and testicular cancers. However, cisplatin-induced ototoxicity limits the utility of this agent in cancer patients, especially when dose escalations are needed. Ototoxicity is associated with cochlear cell death through DNA damage, the generation of reactive oxygen species (ROS) and the consequent activation of caspase, glutamate excitotoxicity, inflammation, apoptosis and/or necrosis. Previous studies have demonstrated a role of CXC chemokines in cisplatin ototoxicity. In this study, we investigated the role of CXCL1, a cytokine which increased in the serum and cochlea by 24 h following cisplatin administration. Adult male Wistar rats treated with cisplatin demonstrated significant hearing loss, assessed by auditory brainstem responses (ABRs), hair cell loss and loss of ribbon synapse. Immunohistochemical studies evaluated the levels of CXCL1 along with increased presence of CD68 and CD45-positive immune cells in cochlea. Increases in CXCL1 was time-dependent in the spiral ganglion neurons and organ of Corti and was associated with progressive increases in CD45, CD68 and IBA1-positive immune cells. Trans-tympanic administration of SB225002, a chemical inhibitor of CXCR2 (receptor target for CXCL1) reduced immune cell migration, protected against cisplatin-induced hearing loss and preserved hair cell integrity. We show that SB225002 reduced the expression of CXCL1 , NOX3 , iNOS , TNF-α , IL-6 and COX-2 . Similarly, knockdown of CXCR2 by trans-tympanic administration of CXCR2 siRNA protected against hearing loss and loss of outer hair cells and reduced ribbon synapses. In addition, SB225002 reduced the expression of inflammatory mediators induced by cisplatin. These results implicate the CXCL1 chemokine as an early player in cisplatin ototoxicity, possibly by initiating the immune cascade, and indicate that CXCR2 is a relevant target for treating cisplatin ototoxicity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Al Aameri, Alanisi, Oluwatosin, Al Sallami, Sheth, Alberts, Patel, Rybak and Ramkumar.)

Aim: The purpose of this study was to verify the accuracy of the web-based audiometer HEARZAP in determining hearing thresholds for both air and bone conduction., Method: Using a cross-sectional validation design, the web-based audiometer was compared to a gold standard audiometer. Participants in the study totaled 50 (100 ears), of which 25 (50 ears) had normal hearing sensitivity and 25 (50 ears) had various types and degrees of hearing loss. All subjects underwent pure tone audiometry, including air and bone conduction thresholds, using the web-based and gold standard audiometers in a random order. A pause between the two tests was allowed if the patient felt comfortable. The testing for the web-based audiometer and gold standard audiometer was done by two different audiologists with similar qualifications in order to eliminate tester bias. Both the procedures were performed in a sound treated room., Results: For air conduction thresholds and bone conduction thresholds, respectively, the mean discrepancies between the web-based audiometer and the gold standard audiometer were 1.22 dB HL (SD = 4.61) and 0.8 dB HL (SD = 4.1). The ICC for air conduction thresholds between the two techniques was 0.94 and for the bone conduction thresholds was 0.91. The Bland Altman plots likewise indicated excellent reliability between the two measurements, with the mean difference between the HEARZAP and the gold standard audiometry falling within the top and lower limits of agreement., Conclusion: The web-based audiometry version of HEARZAP produced precise findings for hearing thresholds that were comparable to those obtained from an established gold standard audiometer. HEARZAP, has the potential to support multi-clinic functionality and enhance service access., Competing Interests: The authors have declared that no competing interests exists, (Copyright: © 2023 Pandi Renganath, Ramkumar. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)