Association between self-reported hearing impairment and diabetes: a Brazilian population-based study

Background

Some studies have already explored the relationship between diabetes and hearing loss; however, this relationship has still not been well established, especially due to methodological limitations related to lack of control for confounders. The aim of this study was to analyze the association between self-reported hearing impairment and diabetes among adults in Brazil, controlling for sociodemographic and occupational exposure to ototoxic agents.

Methods

This is a cross-sectional study based on data collected by the National Health Survey of 2013 in Brazil. A total of 60,202 individuals aged≥18 years were interviewed. Crude and adjusted prevalence ratios were calculated using the Poisson regression model with robust estimation of the variance. All analyzes were performed considering the appropriated weights imposed by the complex sample design.

Results

Hearing loss prevalence was 2.56% (95%CI: 2.34–2.79). It was higher in males, older age groups, white and individuals with lower levels of schooling. Diabetes was positively and significantly associated with hearing loss in the crude analysis (PR_crude?=?2.92; 95%CI: 2.75–3.11) and also in the analysis adjusted for gender, age, skin color, schooling, smoking, alcohol consumption and occupational exposure (PR_adj?=?1.46; 95%CI: 1.32–1.61).

Conclusions

The present results suggest that individuals with diabetes have higher prevalence of hearing impairment. There is the need of longitudinal studies to investigate if diabetes is a risk factor to hearing impairment.

     

Genetic modification of adeno-associated viral vector type 2 capsid enhances gene transfer efficiency in polarized human airway epithelial cells

Cystic fibrosis (CF) is a common genetic disease characterized by defects in the expression of the CF transmembrane conductance regulator (CFTR) gene. Gene therapy offers better hope for the treatment of CF. Adeno-associated viral (AAV) vectors are capable of stable expression with low immunogenicity. Despite their potential in CF gene therapy, gene transfer efficiency by AAV is limited because of pathophysiological barriers in these patients. Although a few AAV serotypes have shown better transduction compared with the AAV2-based vectors, gene transfer efficiency in human airway epithelium has still not reached therapeutic levels. To engineer better AAV vectors for enhanced gene delivery in human airway epithelium, we developed and characterized mutant AAV vectors by genetic capsid modification, modeling the well-characterized AAV2 serotype. We genetically incorporated putative high-affinity peptide ligands to human airway epithelium on the GH loop region of AAV2 capsid protein. Six independent mutant AAV were constructed, containing peptide ligands previously reported to bind with high affinity for known and unknown receptors on human airway epithelial cells. The vectors were tested on nonairway cells and nonpolarized and polarized human airway epithelial cells for enhanced infectivity. One of the mutant vectors, with the peptide sequence THALWHT, not only showed the highest transduction in undifferentiated human airway epithelial cells but also indicated significant transduction in polarized cells. Interestingly, this modified vector was also able to infect cells independently of the heparan sulfate proteoglycan receptor. Incorporation of this ligand on other AAV serotypes, which have shown improved gene transfer efficiency in the human airway epithelium, may enhance the application of AAV vectors in CF gene therapy.     

Why do women with panic disorders not panic during sex (or do they)? Results of an empirical study on the relationship of sexual arousal and panic attacks

Reported sensations during sexual arousal and panic attacks were compared in women with panic disorder and in controls. Hypotheses: patients with panic disorders report: (1) similar sensations during sexual arousal and panic attacks, but (2) these sensations do not trigger panic during sexual activity, because (3) there is no sense of loss of control in sexual arousal. Thirty women with panic syndrome and 27 age-matched controls were included in this study. The two groups were compared using a self-developed questionnaire. The results do show a significant overlap of reported sensations (80% of sexual sensations identical with panic sensations), but with a different subjective perception for many women. Unexpectedly, most reported sensations during sex (masturbation and partner activity) were experienced as unpleasant. Contrary to our hypothesis, 30% of our sample did panic during sexual activity, 50% experienced a loss of control and 70% of the sample did not panic during sex, in spite of overlapping sensations. These results provide incentives for further studies on this topic.     

Natriuretic hormone and blood pressure in patients with arterial hypertension]

The examination comprised 58 patients with essential hypertension and 17 with nephrogenic arterial hypertension. An analysis of the baseline levels of natural natriuretic factor in patients with essential and nephrogenic hypertension revealed no intergroup differences (55.3 +/- 3.0 and 45.7 +/- 5.2 ng/ml, respectively). The concentration of natural natriuretic factor was significantly higher in even patients with mild arterial hypertension than in healthy persons (28.4 +/- 4.7 and 17.4 +/- 2.9 ng/ml). There was a direct correlation between the level of natural natriuretic factor and blood pressure and left ventricular myocardial hypertrophy. There were higher positive correlations between the levels of natural natriuretic factor and those of hormones of the renin-angiotensin-aldosterone system and catecholamines in patients having a diastolic pressure of greater than 115 mm Hg. A significant increase in natural natriuretic factor levels (92.1 +/- 11.8 ng/ml) was found in the presence of hypertensive crisis.     

Interference of antibody production to hepatitis B surface antigen in a combination hepatitis A/hepatitis B vaccine

A randomized trial comparing 3 manufacturing consistency lots of a combination hepatitis A/hepatitis B vaccine to each other and to hepatitis A vaccine and hepatitis B vaccine given separately and concurrently was done to evaluate safety, tolerability, and immunogenicity. Healthy volunteers >/=11 years of age were divided into 4 groups. Each of 3 groups received a separate consistency lot of the combination vaccine, and 1 group received separate but concurrent injections of hepatitis A and hepatitis B vaccines. Injections were given at weeks 0 and 24. The combination vaccine was generally well tolerated. The hepatitis A portion of the combination vaccine produced clinically acceptable high seropositivity rates 4 and 52 weeks after the first injection. The hepatitis B portion of the vaccine did not produce clinically acceptable seropositivity rates 4 weeks after the second injection. Lack of antibody production may be attributed, at least in part, to immunologic interference.     

Treatment of corticosteroid-resistant neurosarcoidosis with a short-course cyclophosphamide regimen

BACKGROUND/OBJECTIVES: Many patients with neurosarcoidosis have disease that is refractory to corticosteroids or they are unable to tolerate high-dose corticosteroids because of detrimental side effects. We examined a short-course, pulse-dose regimen using cyclophosphamide to treat such patients. METHODS: We identified a population of patients with neurosarcoidosis refractory to standard therapy with corticosteroids. Patients who were unable to tolerate corticosteroid therapy due to side effects were also included. Alternative therapy for these patients was initiated using i.v. cyclophosphamide. RESULTS: Seven patients were identified for treatment with our cyclophosphamide regimen. The mean duration of therapy was 5.4 months. Four of the seven patients reported symptomatic improvement on therapy, and all seven patients demonstrated objective improvement in either MRI or cerebrospinal fluid abnormalities. Mean corticosteroid dose of the group was reduced from 42 mg/d before therapy to 18 mg/d after therapy. Relapse of neurologic symptoms was noted in one patient after the completion of therapy. One patient acquired an opportunistic infection, and a second patient required hospitalization for a central venous catheter infection. CONCLUSION: Short-course cyclophosphamide appears to be a reasonable, steroid-sparing treatment option for patients with corticosteroid-refractory neurosarcoidosis.     

Directional atherectomy with the omnicath™: A unique new catheter system

Omnicath? is a directional atherectomy catheter that employs deflecting nontraumatizing wires to anchor the cutting window at the atherectomy site. This anchoring system regulates the depth of cut and provides directional control and distal perfusion. The system continuously removes debris through a suction port from the operative site. To demonstrate the performance of the device, the Omnicath? was tested in the external iliac arteries of ten atherosclerotic Hanford miniature swine in which concentric and eccentric lesions were induced. Five animals were sacrificed 3 days after atherectomy; the remaining five animals were sacrificed 6 weeks after the procedure. The acute histology demonstrates depth of cuts varying from partial plaque removal to near full thickness removal of the arterial wall. Histologic sections of the 6 week follow-up group demonstrated minimal healing response. The anchoring wires did not induce either acute injury or neointimal proliferation in the 6 week follow-up period. In conclusion, the Omnicath? permits effective and safe atherectomy in this investigative model.     

How age,outcome severity,and scale influence general medicine clinic patients’ interpretations of verbal probability terms

Objective: To assess whether the type of scale used (scaling effects) and the severity of outcome (outcome severity) influence patients’ numerical interpretations of verbal probability expressions. Design: Cross-sectional survey of patients in a general medicine clinic. Setting: A university-based Department of Veterans Affairs Medical Center. Participants: 210 patients seen consecutively in a general medicine clinic. Measurements and results: The patients were randomized to scale and health outcome (complications of surgery). Two scales (a long form and a short form ) were used to expressly allow patients to choose probabilities less than 1%. The long form had a lower bound of “<1 out of 1,000,000”; the short form had a lower bound of “<1 out of 1,000.” Two complications were used: “death from anesthesia” and “severe pneumonia.” In the context of being told that their surgeon believed that the chance the complication would occur was “rare,” patients were asked to give the numerical estimate of that chance. The values elicited on both scales were significantly different for the two outcomes, with the “rare” risk of death from anesthesia being characterized as less likely than the “rare” risk of severe pneumonia (F=5.24, p=0.023). Linear regression and three-factor analysis of variance showed significant differences in the probabilities elicited for scale, outcome, and age, with older patients generally responding with higher probabilities than did younger patients. Conclusions: These findings suggest that the severity of the associated outcome and the scale used to elicit patients’ numerical estimates of verbal probability expressions influence patients’ quantitative interpretations of the verbal probability statement; and older patients respond with higher probabilities of negative outcomes than do younger patients. Future studies must continue to explore whether verbal probability expressions are adequate for communicating medical risk to patients or whether patients should be provided with numerical estimates of frequency. Supported in part by the National Science Foundation under contract SES-9020984 with Carnegie Mellon University.     

The treatment of acute myeloid leukemia with mitoxantrone,etoposide and low-dose cytarabine in elderly patients - a report of Polish Acute Leukemia Group (PALG) phase II study

The common dilemma in the treatment of elderly patients with acute myeloid leukemia (AML) is whether to use intensive myelosuppresive therapy with higher risk of treatment related mortality (TRM), but a chance for complete remission (CR), or to treat less intensively in order to prolong survival time with a better quality of life. The aim of this prospective, phase II study was to assess the efficacy and toxicity of low dose combination induction treatment consisted of cytarabine at a dose of 10 mg/m2 every 12 h s.c. for 7 days, VP-16 at a dose of 100 mg/day p.o. for 7 days and mitoxantrone at a dose of 6 mg/m2 i.v daily on days 1-3. Two induction courses were planned. In the group of 44 patients 12 (27%) achieved CR, 4 (9%) patients were in PR and there were 9 (20%) early deaths (ED). Age, performance status, preceding myelodysplastic syndrome, karyotype, WBC and % of blasts in bone marrow were not significant prognostic factors for CR probability. The following initial factors appeared to be related to a shorter duration of survival time from the start of treatment: age >70 (p<0.03), poor performance status (p<0.03), and % of BM blasts 50 (p<0.05). We conclude that, despite promising results in the pilot study the efficacy of this induction treatment is not better than the efficacy of other regimens. The hematological toxicity of this treatment seems to be comparable with "3+7" regimen.