Multiple Venous Malformations as a Cause of Pulsatile Tinnitus.

INTRODUCTION: Pulsatile tinnitus is a relatively common presentation in otolaryngology clinics, most cases of which have a treatable cause. This presentation warrants a thorough workup to identify treatable, and rule out life-threatening, etiologies. We present a case of a patient with pulsatile tinnitus arising from multiple dilated venous channels in the head and neck. Case Presentation. We present the case of a 65-year-old Caucasian female with a two-year history of progressive, bilateral pulsatile tinnitus, which had become debilitating. Computed-tomographic angiography (CTA) studies ruled out an intracranial vascular cause for her symptoms. However, computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed multiple dilated bilateral, low-flow, venous channels throughout the head and neck. The proximity of such dilated venous channels to the temporal bone provides a route for sound to be transmitted to the inner ear. CONCLUSION: Arterial, venous, and systemic etiologies can cause pulsatile tinnitus. Arteriovenous malformations (AVMs) of the head and neck represent less than 1% of cases. In our patient, dilated low-flow venous malformations are the likely source of her symptoms, which is the first reported case in the literature.Peer Reviewe

BEAGLEBOARD EMBEDDED SYSTEM FOR ADAPTIVE TRAFFIC LIGHT CONTROL SYSTEM WITH CAMERA SENSOR

Traffic is one of the most important aspects in human daily life because traffic affects smoothness of capital flows, logistics, and other community activities. Without appropriate traffic light control system, possibility of traffic congestion will be very high and hinder people’s life in urban areas. Adaptive traffic light control system can be used to solve traffic congestions in an intersection because it can adaptively change the durations of green light each lane in an intersection depend on traffic density. The proposed adaptive traffic light control system prototype uses Beagleboard-xM, CCTV camera, and AVR microcontrollers. We use computer vision technique to obtain information on traffic density combining Viola-Jones method with Kalman Filter method. To calculate traffic light time of each traffic light in intersection, we use Distributed Constraint Satisfaction Problem (DCSP). From implementations and experiments results, we conclude that BeagleBoard-xM can be used as main engine of adaptive traffic light control system with 91.735% average counting rate. Lalu intas adalah salah satu aspek yang paling penting dalam kehidupan sehari-hari manusia karena lalu lintas memengaruhi kelancaran arus modal, logistik, dan kegiatan masyarakat lainnya. Tanpa sistem kontrol lampu lalu lintas yang memadai, kemungkinan kemacetan lalu lintas akan sangat tinggi dan menghambat kehidupan masyarakat di perkotaan. Sistem kontrol lampu lalu lintas adaptif dapat digunakan untuk memecahkan kemacetan lalu lintas di persimpangan karena dapat mengubah durasi lampu hijau di setiap persimpangan jalan tergantung pada kepadatan lalu lintas. Prototipe sistem kontrol lampu lalu lintas menggunakan BeagleBoard-XM, kamera CCTV, dan mikrokontroler AVR. Peneliti menggunakan teknik computer vision untuk mendapatkan informasi tentang kepadatan lalu lintas dengan menggabungkan metode Viola-Jones dan metode Filter Kalman. Untuk menghitung waktu setiap lampu lalu lintas di persimpangan, peneliti menggunakan Distributed Constraint Satisfaction Problem (DCSP). Dari hasil implementasi dan percobaan dapat disimpulkan bahwa BeagleBoard-XM dapat digunakan sebagai mesin utama sistem kontrol lampu lalu lintas adaptif dengan tingkat akurasi penghitungan rata-rata sebesar 91.735%

Beneficiary Satisfaction with the Quality of Health Services in Primary Health Care Centers in Aden Governorate, Yemen

Background: Patient satisfaction is a key indicator of healthcare quality and accessibility. Understanding the sociodemographic factors influencing satisfaction can inform improvements in service delivery, particularly in low-resource settings. Objective: To assess patients’ satisfaction with access to primary health care (PHC) services and examine the influence of sociodemographic factors on satisfaction levels. Methods: A cross-sectional analytic study was conducted among 247 beneficiaries attending PHC centers. Data were collected using structured questionnaires covering service access, satisfaction scores, and financial barriers. Satisfaction was measured across multiple domains, and sociodemographic characteristics were analyzed descriptively. Results: Overall satisfaction with PHC access was moderate to high, with the highest ratings given for staff cooperation and explanation of treatment. However, dissatisfaction was notable in areas related to medication availability and cost. Most participants were female (72.5%), married (71.3%), and from low socio-economic backgrounds (67.2%). Financial constraints significantly influenced satisfaction, with 45.7% reporting out-of-pocket expenses as a burden and 58.3% unable to purchase prescribed medications due to cost. Urban residents and individuals with lower educational levels generally reported higher satisfaction, whereas employed and higher-educated participants showed more critical assessments of service access. Conclusion: While patients reported positive experiences with PHC services overall, access inequities remain, particularly regarding medication availability and financial barriers. Sociodemographic factors, especially income and education, play a critical role in shaping patient satisfaction. Policy interventions should address affordability and availability to ensure equitable healthcare access

Prenatal exposure to criteria air pollutants and associations with congenital anomalies: A Lebanese national study

Maternal exposure to air pollution has been associated with a higher birth defect (BD) risk. Previous studies suffer from inaccurate exposure assessment methods, confounding individual-level variations, and classical analytical modelling. This study aimed to examine the association between maternal exposure to criteria air pollutants and BD risk. A total of 553 cases and 10,214 controls were identified from private and public databases. Two subgroups were then formed: one for a matched case-control design, and another for Feature Selection (FS) analysis. Exposure assessment was based on the mean air pollutant-specific levels in the mother's residential area during the specific BD gestational time window of risk (GTWR) and other time intervals. Multivariate regression models outcomes consistently showed a significant protective effect for folic acid intake and highlighted parental consanguinity as a strong BD risk factor. After adjusting for these putative risk factors and other covariates, results show that maternal exposure to PM2.5 during the first trimester is significantly associated with a higher overall BD risk (OR:1.05, 95%CI:1.01–1.09), and with a higher risk of genitourinary defects (GUD) (OR:1.06, 95%CI:1.01–1.11) and neural tube defects (NTD) (OR:1.10, 95%CI:1.03–1.17) during specific GTWRs. Maternal exposure to NO2 during GTWR exhibited a significant protective effect for NTD (OR:0.94, 95%CI:0.90–0.99), while all other examined associations were not statistically significant. Additionally, maternal exposure to SO2 during GTWR showed a significant association with a higher GUD risk (OR:1.17, 95%CI:1.08–1.26). When limiting selection to designated monitor coverage radiuses, PM2.5 maintained significance with BD risk and showed a significant gene-environment interaction for GUD (p = 0.018), while NO2 protective effect expanded to other subtypes. On the other hand, FS analysis confirmed maternal exposure to PM2.5 and NO2 as important features for GUD, CHD, and NTD. Our findings, set the basis for building a novel BD risk prediction model. © 2021 Elsevier Lt

Stuttered swallowing: Electric stimulation of the right insula interferes with water swallowing. A case report

<p>Abstract</p> <p>Background</p> <p>Various functional resonance imaging, magnetoencephalographic and lesion studies suggest the involvement of the insular cortex in the control of swallowing. However, the exact location of insular activation during swallowing and its functional significance remain unclear.</p> <p>Case presentation</p> <p>Invasive electroencephalographic monitoring was performed in a 24-year-old man with medically intractable stereotyped nocturnal hypermotor seizures due to a ganglioglioma. During stimulation of the right inferior posterior insular cortex with depth electrodes the patient spontaneously reported a perception of a "stutter in swallowing". Stimulation of the inferior posterior insular cortex at highest intensity (4 mA) was also associated with irregular and delayed swallows. Swallowing was not impaired during stimulation of the superior posterior insular cortex, regardless of stimulation intensity.</p> <p>Conclusions</p> <p>These results indicate that the right inferior posterior insular cortex is involved in the neural circuitry underlying the control of swallowing.</p

Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial

INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥ 15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. RESULTS: The sample (n=95) was young (26 years), male (82%), with predominantly penetrating injuries (76%). There was no difference in demographics, hemodynamics, or blood product requirement on presentation between PD (n=32) vs non-PD (n=63). Anatomically, PD patients had more grade V duodenal, grade V pancreatic, ampullary, and pancreatic ductal injuries compared with non-PD patients (all p \u3c 0.05). 43% of all grade V duodenal injuries and 40% of all grade V pancreatic injuries were still managed with non-PD. One-third of non-PD duodenal injuries were managed with primary repair alone. PD patients had more gastrointestinal (GI)-related complications, longer intensive care unit length of stay (LOS), and longer hospital LOS compared with non-PD (all p \u3c 0.05). There was no difference in mortality or readmission. Multivariable logistic regression analysis determined PD to be associated with a 3.8-fold greater odds of GI complication (p=0.010) compared with non-PD. In a subanalysis of patients without ampullary injuries (n=60), PD patients had more anastomotic leaks compared with the non-PD group (3 (30%) vs 2 (4%), p=0.028). CONCLUSION: While PD patients did not have worse hemodynamics or blood product requirements on admission, they sustained more complex anatomic injuries and had more GI complications and longer LOS than non-PD patients. We suggest that the role of PD should be limited to cases of massive destruction of the pancreatic head and ampullary complex, given the likely procedure-related morbidity and adverse outcomes when compared with non-PD management. LEVEL OF EVIDENCE: IV, Multicenter retrospective comparative study

Analysis of the human monocyte-derived macrophage transcriptome and response to lipopolysaccharide provides new insights into genetic aetiology of inflammatory bowel disease

The FANTOM5 consortium utilised cap analysis of gene expression (CAGE) to provide an unprecedented insight into transcriptional regulation in human cells and tissues. In the current study, we have used CAGE-based transcriptional profiling on an extended dense time course of the response of human monocyte-derived macrophages grown in macrophage colony-stimulating factor (CSF1) to bacterial lipopolysaccharide (LPS). We propose that this system provides a model for the differentiation and adaptation of monocytes entering the intestinal lamina propria. The response to LPS is shown to be a cascade of successive waves of transient gene expression extending over at least 48 hours, with hundreds of positive and negative regulatory loops. Promoter analysis using motif activity response analysis (MARA) identified some of the transcription factors likely to be responsible for the temporal profile of transcriptional activation. Each LPS-inducible locus was associated with multiple inducible enhancers, and in each case, transient eRNA transcription at multiple sites detected by CAGE preceded the appearance of promoter-associated transcripts. LPS-inducible long non-coding RNAs were commonly associated with clusters of inducible enhancers. We used these data to re-examine the hundreds of loci associated with susceptibility to inflammatory bowel disease (IBD) in genome-wide association studies. Loci associated with IBD were strongly and specifically (relative to rheumatoid arthritis and unrelated traits) enriched for promoters that were regulated in monocyte differentiation or activation. Amongst previously-identified IBD susceptibility loci, the vast majority contained at least one promoter that was regulated in CSF1-dependent monocyte-macrophage transitions and/or in response to LPS. On this basis, we concluded that IBD loci are strongly-enriched for monocyte-specific genes, and identified at least 134 additional candidate genes associated with IBD susceptibility from reanalysis of published GWA studies. We propose that dysregulation of monocyte adaptation to the environment of the gastrointestinal mucosa is the key process leading to inflammatory bowel disease