Opting for two hearing aids: a predictor of long-term use among adult patients fitted after screening

This study is a follow-up of patients fitted with one or two hearing aids, approximately 10 years previously. Our patients were identified through population screening for hearing difficulties when they were aged 50-65 years. At the time, they had a trial of unilateral and bilateral fittings, and then they made their own choice to keep one or two aids. We found that 10 of the 12 who had opted for two aids and were available for follow-up 10 years later continued using at least one aid (83%, 95% CI 55-95). Six of the 17 who opted for unilateral fitting and were available for follow-up used a hearing aid in the long term (35%, 95% CI: 17-59%). Therefore, this study suggests that people who are identified through population screening, are bilaterally impaired, are willing to try bilateral fitting, and choose to continue with two aids, are likely to become long-term users of (one or two) hearing aids. Those who choose to continue with one aid after a trial of bilateral fitting are at high risk of rejecting the aid in the long term. Our sample is small, and we took a number of steps in the analysis in order to clarify whether these findings are reliable. We could not identify any confounding factors. The patients' preference for continuing with bilateral or unilateral aids after fitting was the only predictor of long-term use in our sample. Remarkably, bilateral preference was a better predictor of long-term use than the degree of hearing impairment. We discuss how this study provides useful information for planning population screening for hearing difficulties in middle age.     

Septic endarteritis following percutaneous transluminal coronary angioplasty

We report a case of bacterial arteritis of the external iliac artery complicated by mycotic aneurysm following coronary angioplasty. To our knowledge, this is the first reported instance of arterial wall infection caused by coronary angioplasty at a distance from the insertion site equal to the length of the sheath.     

Electrocatalytic oxidation of NADH at graphite electrodes modified with osmium phenanthrolinedione

We report here a detailed study concerning the electrochemical behavior of Os(4,4′-dimethyl, 2,2′-bipyridine)₂(1,10-phenanthroline 5,6-dione) complex, adsorbed on spectrographic graphite, and about its electrocatalytic activity for NADH oxidation. Cyclic voltammetric measurements, performed in aqueous phosphate buffer solutions, at different scan rates and pH values, allowed us: (i) to relate the redox response of the o-quinone ligand (phendione) to that of the Os(II) central ion; (ii) to confirm that, in aqueous solutions, the phendione based redox process globally involves two electrons and two protons; (iii) to estimate the rate constant for the heterogeneous electron transfer corresponding to the phendione redox couple (k_s≈20.1 s^?1). The second order rate constant for electrocatalytic oxidation of NADH (k_1,[NADH]=0=1.9×10³ M^?1 s^?1, at pH 6.1) as well as its pH dependence (from pH 5.5 to 8.1) were evaluated from RDE experiments, using both Koutecky–Levich and Lineweaver–Burk data interpretations.     

Decreasing morbidity of childhood asthma by regular outpatient follow-up, in Crete

AIM: There is evidence that the prevalence and morbidity of childhood asthma are increasing in many countries despite improvement of therapeutic regimens. We aimed to study possible changes in childhood asthma morbidity in Crete, Greece, by evaluating hospital admissions and emergency room visits for childhood asthma before and after 1-year regular follow-up at a special pediatric pulmonary out-patient clinic. METHODS: We followed-up 118 asthmatic children, aged 1-14 years, at a special pediatric pulmonary outpatient clinic. We evaluated the total number of hospital admissions due to asthma as well as asthma exacerbations during the 12 months before and 12 months after the regular follow-up care at the special pediatric pulmonary outpatient clinic. RESULTS: The total annual number of hospital admissions of the 118 children before and after the regular follow-up was 122 and 19, respectively (reduction of 84%). Similarly, the total number of asthma exacerbations was 771 before and 230 after the 1-year follow-up (reduction of 71%). CONCLUSION: These findings show that regular follow-up care of asthmatic children at a specialized pediatric pulmonary outpatient clinic considerably reduces the morbidity of childhood asthma, thus reducing hospital costs for asthma and improving the quality of life for asthmatic children and their families.     

Restoration of walking in patients with incomplete spinal cord injuries by use of surface electrical stimulation--preliminary results

A group of patients who are good candidates for the application of Functional Electrical Stimulation (FES) to restore reciprocal walking is described. They have incomplete lesions of the spinal cord. Because of the degree of preserved voluntary control, proprioception and sensation some of these patients can achieve crutch assisted walking by means of multichannel electrical stimulation. In a number of cases the patient has sufficient strength and voluntary control in the upper limbs and at least one leg to provide safe standing for short periods in forearm crutches. For these patients a two channel stimulator controlled by a handswitch was applied to achieve safe and practical crutch assisted walking in a relatively short period of time.     

Single amino acid loss in the dystrophin protein associated with a mild clinical phenotype

Introduction: The dystrophinopathies include a spectrum of muscle diseases caused by mutations in the dystrophin (DMD) gene. The clinical phenotype ranges from severe Duchenne muscular dystrophy to a mild phenotype with elevated creatine kinase (CK). Methods: Clinical and molecular assessment of 7 patients carrying a single amino acid loss in the dystrophin protein (p.His1690del) caused by a c.5068_5070delCAC tri‐nucleotide deletion in exon 36 of the DMD gene. Results: All patients were asymptomatic or oligosymptomatic and had elevated CK levels. Febrile illness, but not exercise, induced muscle symptoms in some patients. None had evidence of cardiomyopathy. Analysis of the short tandem repeat (STR)45 locus and sequencing of exon 36 of the DMD gene indicates that c.5068_5070delCAC is a founder mutation. Conclusions: The c.5068_5070delCAC locus in the DMD gene is associated with a very mild phenotype. Further study is needed to evaluate disease progression in these patients. Muscle Nerve 55 : 46–50, 2017     

Drug pharmacokinetics and the carbon dioxide breath test

The interrelationship of the pharmacokinetics of a drug and the expiration of carbon dioxide formed as a metabolite have been studied. The pharmacokinetic characteristics of the drug that affect the usefulness of the carbon dioxide excretion as a measure of liver function were examined by means of computer simulations. The parent drug extraction ratio, fraction demethylated, volume of distribution, and absorption rate of an oral dosage form all contribute to the carbon dioxide breath test result. A drug that would be a useful substrate when the carbon dioxide breath test is used as a probe for changes in liver function should be at least 50% metabolized by demethylation, have a hepatic extraction ratio of 0.2–0.5, and be administered in a form that is rapidly absorbed.Appendix b. symbols CL _c net clearance of formaldehyde to carbon dioxide - CL _int,f intrinsic hepatic clearance of formation of formaldehyde from parent drug (bound and unbound to plasma proteins) - CL _int,p intrinsic hepatic clearance of total parent drug (bound and unbound to plasma proteins) - CL _sys,f systemic hepatic clearance of formation of formaldehyde from parent drug,Q _H CL _int,f /(Q _H +CL _int,p ) - CL _sys,p systemic hepatic clearance of parent drug,Q _H CL _int,p /(Q _H +CL _int,p ) - E extraction ratio,CL _int,p /(Q _H +CL _int,p - F I-E fraction escaping first-pass metabolism,Q _H/(Q _H +CL _int,p - fm fraction of parent drug metabolized by demethylation to formaldehyde,CL _int,f /CL _int,p - HCHO amount of formaldehyde - [HCHO] concentration of formaldehyde - _a absorption rate constant - M _i metabolite of P formed by routes other than demethylation - M ₁ metabolite of P formed by demethylation - P amount of parent drug in the body - [P] concentration of parent drug measured in arterial blood - P _A amount of parent drug at absorption site - P _L amount of parent drug in the liver - Q _H hepatic blood flow - V _F volume of distribution of formaldehyde - V _p volume of distribution of parent drug     

Blood-brain barrier breakdown during cerebral malaria: suicide or murder?

Cerebral malaria, one of the most serious complications of Plasmodium falciparum infection, is characterized by the sequestration of parasitized red blood cells (PRBCs) in cerebral microvascular beds. The precise mechanisms involved in the onset of neuropathology remain unknown, but parasite sequestration in the brain, metabolic disturbances, and host immune responses all play a role. Sequestration of PRBCs is mediated by different endothelial cell surface receptors, mainly ICAM-1 and CD36. In vitro studies demonstrated that PRBC adhesion to endothelial cells induces over-expression of various adhesion molecules including ICAM-1, expression of iNOS, oxidative stress and finally apoptosis in endothelial cells. In vivo studies, in humans and in mice models of cerebral malaria brought striking evidence of the implication of brain infiltrating cytotoxic effector CD8T lymphocytes in the development of murine cerebral malaria pathogenesis. These cells probably act by direct cytotoxicity against endothelial cells. Cytotoxicity and apoptosis potentially lead blood-brain-barrier disruption and could contribute to the development of cerebral malaria. We propose a key role for endothelial cells in the pathogenesis of cerebral malaria, both by suicide / apoptosis, and / or by murder / cytotoxicity.     

Value of hysteroscopy prior to uterine artery embolisation for fibroids: a hospital based retrospective study

This study was undertaken to evaluate the value of routine hysteroscopy prior to uterine artery embolisation (UAE) for symptomatic uterine fibroids. The study design used is hospital-based retrospective study, and the setting is in a large teaching hospital. We analysed the hospital record of 115 women who were scheduled to undergo UAE at our institution between January 2008 and April 2011. All women had outpatient hysteroscopic assessment of uterine cavity prior the decision to carry out UAE. The mean uterine size on palpation was 15.4 (standard deviation (SD) 3.5) weeks gestation equivalent. Hysteroscopy was successfully completed in 112 (97.4 %). In the women who were hysteroscoped, 50 (44.6 %) had no submucous fibroids; 50 (44.6 %) had type II fibroids, and 12 (10.7 %) were found to have type I or 0 fibroids. All 12 women with type 0 or I submucous fibroids were offered hysteroscopic (n?=?11) or vaginal (n?=?1) myomectomy prior to UAE, but only four agreed. Of these four cases, two cancelled their planned UAE because of symptomatic improvement. The remaining two women, as well as the eight, who declined surgery, underwent UAE. There were no cases of infection, spontaneous expulsion of a fibroid or the need for surgical intervention in this group. This pilot study shows that hysteroscopy prior to UAE changes management in only a small proportion of cases. Selective hysteroscopy, following MRI scanning, may be a more logical protocol to identify women with intracavitary fibroids, who may benefit from hysteroscopic or vaginal myomectomy.