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Abstract We investigated the association between retinal microvascular changes and hearing loss based on the hypothesis that both may result from shared microvascular pathology. Data from 536 older adults from the National Health and Nutritional Examination Survey 2005 to 2006 including sociodemographic and health characteristics, pure‐tone hearing thresholds, and retinal pathologies were collected and analyzed. Associations between retinal and hearing pathologies were modeled with multivariable‐adjusted linear regressions. 75% of participants had hearing loss and 15% of participants had retinopathy. The association between retinopathy, microaneurysms, and blot hemorrhages with better speech‐frequency pure tone average was −2.81 (95% confidence interval [CI]: −5.72 to 0.10), −4.75 (95% CI: −8.73 to −0.78), and −5.34 (95% CI: −8.68 to −2.00), respectively. The presence of retinopathy, microaneurysms, and blot hemorrhages was inversely associated with hearing loss. Further studies are needed to better understand the potential relationship between microvascular pathologies of the eye and ear.

Background PARAGON‐HF (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction) suggested a potential benefit of sacubitril–valsartan in women with preserved ejection fraction. Among patients with heart failure previously treated with angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), we studied whether effectiveness of treatment with sacubitril–valsartan compared with ACEI/ARB monotherapy differed between men and women for both preserved and reduced ejection fraction. Methods and Results Data were derived from the Truven Health MarketScan Databases between January 1, 2011, and December 31, 2018. We included patients with a primary diagnosis of heart failure on treatment with ACEIs, ARBs, or sacubitril–valsartan on the basis of the first prescription after diagnosis. A total of 7181 patients treated with sacubitril–valsartan, 25 408 patients using an ACEI, and 16 177 patients treated with ARBs were included. A total of 790 readmissions or deaths occurred among 7181 patients in the sacubitril–valsartan group and 11 901 events in 41 585 patients treated with an ACEI/ARB. Adjusted for covariates, the hazard ratio (HR) for treatment with sacubitril–valsartan compared with an ACEI or ARB was 0.74 (95% CI, 0.68–0.80). The protective effect of sacubitril–valsartan was evident for men and women (women: HR, 0.75 [95% CI, 0.66–0.86]; P

Abstract 7‐Tesla (T) magnetic resonance imaging may allow for higher resolution images but may produce greater acoustic noise than 1.5‐ and 3‐T scanners. We sought to characterize the intensity of acoustic noise from 7‐ versus 3‐T scanners. A‐weighted sound pressure levels from 5 types of pulse sequences used for brain and inner ear imaging in 3‐ and 7‐T scanners were measured. Time‐averaged sound level and maximum sound levels generated for each sequence were compared. Time‐averaged sound levels exceeded 95 dB and reached maximums above 105 dB on the majority of 3‐ and 7‐T scans. The mean time‐averaged sound level and maximum sound level across pulse sequences were greater in 7‐ than 3‐T (105.6 vs 91.4, P = .01; 114.0 vs. 96.5 dB, P

Zuhirman Zamzami,1 Herman Rayendra,2 Nafisa Az-zahra3 1Urology Division, Surgery Department, Medical Faculty of Riau University, Pekanbaru, Riau, Indonesia; 2Department of Internal Medicine, Consultant of Kidney and Hypertension, Medical Faculty of Riau University, Pekanbaru, Riau, Indonesia; 3Medical Faculty of Riau University, Pekanbaru, Riau, IndonesiaCorrespondence: Zuhirman ZamzamiUrology Division, Surgery Department, Medical Faculty of Riau University, 1 Jalan Diponegoro, Pekanbaru, Riau 28133, IndonesiaTel +62 812-754-9988Fax +62 0761 40644Email zuhirman.zamzami@yahoo.comPurpose: Benign prostate hyperplasia (BPH) with urinary retention can result in kidney dysfunction. Several risk factors might influence deterioration in kidney function. The aims of this study were to assess the association between kidney dysfunction and risk factors in patients with transurethral resection of the prostate (TURP).Methods: We reviewed medical records of BPH patients managed by TURP and having high levels of blood urea and creatinine. Data collected were age, history of hypertension, diabetes mellitus (DM), urinary tract infection (UTI), urinary retention, and urinary tract stones, duration of obstruction, and blood-urea and -creatinine levels before and after TURP. Chi-suare and paired t- tests were used.Results: There were 64 patients in the study. More were aged 60– 69 years (42.2%) than other age-groups, 53.1% had a history of hypertension, 12.5% DM, 35.9% UTI, all urinary retention, 14.1% urinary tract stones, and 92.2% obstruction duration < 14 days. There were significant differences in blood-urea and -creatinine levels between before and after TURP (p< 0.001). There were no significant differences between age-group, hypertension, DM, UTI, urinary retention, urinary stones, or duration of obstruction with kidney dysfunction after TURP (p> 0.001).Conclusion: Age, hypertension, DM, UTI, urinary retention, urinary tract stones, and duration of obstruction can be risk factors of kidney dysfunction in TURP patients, and TURP might improve blood-urea and -creatinine levels. There was no significant association between kidney recovery and kidney dysfunction with the number of risk factors in TURP and pre-TURP patients.Keywords: BPH, TURP, risk factor, blood-urea level, blood-creatinine level, kidney dysfunction

Introduction Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection of immunocompromised hosts with significant morbidity and mortality. The current standard of care, trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 15–20 mg/kg/day, is associated with serious adverse drug events (ADE) in 20%–60% of patients. ADEs include hypersensitivity reactions, drug-induced liver injury, cytopenias and renal failure, all of which can be treatment limiting. In a recent meta-analysis of observational studies, reduced dose TMP-SMX for the treatment of PJP was associated with fewer ADEs, without increased mortality.Methods and analysis A phase III randomised, placebo-controlled, trial to directly compare the efficacy and safety of low-dose TMP-SMX (10 mg/kg/day of TMP) with the standard of care (15 mg/kg/day of TMP) among patients with PJP, for a composite primary outcome of change of treatment, new mechanical ventilation, or death. The trial will be undertaken at 16 Canadian hospitals. Data will be analysed as intention to treat. Primary and secondary outcomes will be compared using logistic regression adjusting for stratification and presented with 95% CI.Ethics and dissemination This study has been conditionally approved by the McGill University Health Centre; Ethics approval will be obtained from all participating centres. Results will be submitted for publication in a peer-reviewed journal.Trial registration number NCT04851015.

The investigation evaluates the expertise of healthcare personnel regarding the contamination of hospital ambient air with bacteria. The objective of the investigation is to establish a correlation between participant knowledge and both independent and dependent factors. Cross-sectional analytical research was conducted by three institutions in Najaf City from mid-December 2023 to May 10, 2024. Data from 515 health professionals who completed a random self-reporting questionnaire were analyzed using a statistical instrument. The primary findings suggest that the majority of participants are women, with 51.8% of them falling within the 20-29 age range. Of these women, half have bachelor's degrees (54.6%), and 44.5% have less than five years of experience. 27.0% of the professions were in a laboratory setting, and 30.1% had received training. The data indicates that 13.4% of individuals possessed a high level of general knowledge. We discovered substantial correlations between all sociodemographic factors and knowledge, with the exception of sex, which did not exhibit a significant correlation with knowledge. The survey revealed that the majority of health professionals (68.0%) possessed only middling levels of knowledge. Consequently, it is imperative that local authorities provide ongoing training to health personnel regarding bacterial indoor air pollution in order to elevate these levels. We arrived at the conclusion that there is a substantial correlation between knowledge and training programs. Additionally, we identified a statistically significant correlation between the educational attainment of the preponderance of youthful healthcare professionals. [ABSTRACT FROM AUTHOR]

Importance: Superior semicircular canal dehiscence (SSCD) is a treatable condition, but current diagnostic modalities have numerous limitations. Clinicians would benefit from an additional tool for diagnostic workup that is both rapid and widely available.Objective: To assess the utility of ambient pressure tympanometry (APT) in the diagnostic workup of SSCD by determining the sensitivity and specificity of APT for SSCD in comparison to other diagnostic modalities.Design: Retrospective cohort study of patients who underwent APT and temporal bone computerized tomography (CT) scans from May 2017 to July 2018.Setting: Tertiary referral center.Participants: APT was performed as part of routine audiological testing on adult patients. We retrospectively analyzed all patients who received both APT and temporal bone CT scans, and divided ears into SSCD and non-SSCD groups based on the presence or absence of radiographic SSCD. Ears with other radiographic findings that could affect tympanic membrane compliance were excluded.Exposures: All patients in this study underwent APT and temporal bone CT scans. Some patients also underwent pure tone audiometry and vestibular evoked myogenic potentials (VEMPs).Main Outcomes and Measures: The primary outcome measures were sensitivity, specificity, and risk ratio of APT for SSCD. Secondary outcome measures include sensitivity of VEMPs and supranormal hearing thresholds.Results: We describe 52 patients (70 ears) who underwent APT and CT imaging (mean age 47.1 years, 67.1% female). APT detected SSCD with 66.7% sensitivity and 72.1% specificity. In symptomatic patients, sensitivity was 71.4% and specificity was 75%. VEMPs performed best at detecting SSCD when defining a positive test as oVEMP amplitude >17 μV, with a sensitivity of 68.2%, similar to APT (p > 0.99). The combination of APT and VEMPs increased sensitivity to 88.9%, better than APT alone (p = 0.031) and trending toward better than VEMPs alone (p = 0.063).Conclusions and Relevance: Rhythmic wave patterns on APT are associated with SSCD and may raise suspicion for this condition in conjunction with consistent results on other diagnostic modalities. Although clinical utility requires confirmation in a larger prospective study, APT is a simple, rapid, and widely available tool warranting further study.

Acinetobacter baumannii (AB) is a gram-negative bacterium and a main source of nosocomial infection that mainly affect immunocompromised individuals. Methylene blue (MB) is commonly used for staining in microbiology but in this article MB is used as resisting agent against AB. The main aim of this study is to find the most possible cure against A. baunannii. Isolated strains of A. baumannii were subcultured on Muller-Hinton agar (MHA) containing MB and sub-cultured on eosin methylene blue (EMB). Then antibiotic susceptibility testing (AST) and minimum inhibitory concentration (MIC) were determined. The A. baumannii isolates were highly inhibited by EMB medium but showed growth on MHA plates containing MB. The results infer that A. baumannii shows sensitivity against Meropenem. In-vitro studied effect of methylene blue shows inhibition against carbapenem resistance A. baumannii growth was also inhibited by EMB agar. AB strains showed sensitivity against synergistic combinational drugs (Meropenem + Amikacin), (Meropenem + Ciprofloxacin) (Imipenem + Tobramycin), these strains showed resistance against additive combinational drugs (Meropenem + Cefepime) and (Imipenem + Tobramycin), (Ciprofloxacin), (Cefepime) as compared with individually. [ABSTRACT FROM AUTHOR]

A four-month long study throughout the summer of 2022 i.e., April, May, June, and July; was conducted to determine Aflatoxin M1 concentration in raw milk retailed in the shops of Lahore, Pakistan. A total of 40 samples (10 per month) were analyzed using the ELISA kit method while considering European Union (50ng/kg), US Food and Drug Regulation Authority (500ng/kg), and Pakistan Pure Food Regulations (500ng/kg) as AFM1 permissible limits. About 82.50% of 40 samples were contaminated with AFM1 while only 17.50% samples were found to be uncontaminated. Of these contaminated samples over 87.88% samples exceeded the safe limit as set by the European Union i.e., 50ng/kg with only 12.12% of the samples being safe for use. On the other hand, only 6.06% of the samples were unfit as per the USFDA & Punjab Pure Food Regulations (PPFR) limit i.e., 500ng/kg. A mean value of 133.57 ± 0.14ng/kg of AFM1 contamination was calculated ranging from 5.43 ± 0.05ng/kg to 964.75 ± 0.04ng/kg in April and July, respectively. The lowest average contamination was recorded in May i.e., 68.35 ± 0.258ng/kg which went progressively higher in the later months due to unusual record-breaking rainfall in the region while highest average contamination was found in the month of July i.e., 228.789 ± 0.075ng/kg. The current study is significantly important as it identify the contamination of Aflatoxin M1 in raw milk in the summer season. [ABSTRACT FROM AUTHOR]

Sensory hair cells are mechanoreceptors required for hearing and balance functions. From embryonic development, hair cells acquire apical stereociliary bundles for mechanosensation, basolateral ion channels that shape receptor potential, and synaptic contacts for conveying information centrally. These key maturation steps are sequential and presumed coupled; however, whether hair cells emerging postnatally mature similarly is unknown. Here, we show that in vivo postnatally generated and regenerated hair cells in the utricle, a vestibular organ detecting linear acceleration, acquired some mature somatic features but hair bundles appeared nonfunctional and short. The utricle consists of two hair cell subtypes with distinct morphological, electrophysiological and synaptic features. In both the undamaged and damaged utricle, fate-mapping and electrophysiology experiments showed that Plp1+ supporting cells took on type II hair cell properties based on molecular markers, basolateral conductances and synaptic properties yet stereociliary bundles were absent, or small and nonfunctional. By contrast, Lgr5+ supporting cells regenerated hair cells with type I and II properties, representing a distinct hair cell precursor subtype. Lastly, direct physiological measurements showed that utricular function abolished by damage was partially regained during regeneration. Together, our data reveal a previously unrecognized aberrant maturation program for hair cells generated and regenerated postnatally and may have broad implications for inner ear regenerative therapies.

Summary: Utricular hair cells (HCs) are mechanoreceptors required for vestibular function. After damage, regeneration of mammalian utricular HCs is limited and regenerated HCs appear immature. Thus, loss of vestibular function is presumed irreversible. Here, we found partial HC replacement and functional recovery in the mature mouse utricle, both enhanced by overexpressing the transcription factor Atoh1. Following damage, long-term fate mapping revealed that support cells non-mitotically and modestly regenerated HCs displaying no or immature bundles. By contrast, Atoh1 overexpression stimulated proliferation and widespread regeneration of HCs exhibiting elongated bundles, patent mechanotransduction channels, and synaptic connections. Finally, although damage without Atoh1 overexpression failed to initiate or sustain a spontaneous functional recovery, Atoh1 overexpression significantly enhanced both the degree and percentage of animals exhibiting sustained functional recovery. Therefore, the mature, damaged utricle has an Atoh1-responsive regenerative program leading to functional recovery, underscoring the potential of a reprogramming approach to sensory regeneration. : The mature mouse utricle, which detects linear acceleration, displays limited regeneration, but whether function returns is unknown. Sayyid et al. show that regenerated hair cells appear and mature over months, resulting in a limited, unsustained functional recovery. Atoh1 overexpression enhances regeneration and leads to a sustained recovery of vestibular function. Keywords: utricle, hair cell, vestibular, sensory, regeneration, proliferation, Atoh1, vestibular evoked potential

ObjectivesTo investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV).MethodsThis is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student’s t-test, χ2 test, and logistic regression analysis were used as appropriate. A p value less than 0.05 was considered statistically significant.ResultsThe prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; p = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, p = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; p = 0.001) and female gender (Relative-risk ratio: 4.563; p = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, p = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver.ConclusionAnxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.

Radial artery thrombosis is a rare complication of cannulation. There are no reported cases of acute thrombosis and severe acute neuropathy in the setting of cannula discontinuation. We report a case of acute radial nerve mono-neuropathy following thrombosis after radial arterial line removal. The thrombus was immediately evident on exam and diagnostic imaging after cannula discontinuation. The patient was consented and promptly taken to OR for immediate repair. Mild radial neuropathy persisted despite immediate repair. Immediate recognition of signs and symptoms is essential for diagnosis and management, especially in the high-risk population.

Resolving independent dominating set is the development of metric dimension and independent dominating set. The set W is resolving independent dominating set for G if W is independent in G, and distinct vertices of G have distinct representations with respect to W. The minimum cardinality of resolving independent dominating set is called resolving independent domination number and denoted by γri(G). In this study, we examined the resolving independent dominating set of flower graphs, gear graphs, and sunflower graphs. [ABSTRACT FROM AUTHOR]