Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. We conducted a study to assess the eff ect of systemic and topical antifungal agents-both separately and in combination-in preventing recurrence of AFRS following functional endoscopic sinus surgery (FESS). Our initial study population was made up of 50 adults who were diagnosed with AFRS by clinical, radiologic, histopathologic, and laboratory workup and who subsequently underwent FESS. Postoperatively, these patients were randomized into 5 diff erent treatment groups matched for sex, age, and socioeconomic status. Four of the groups received a diff erent antifungal regimen in addition to convenient medical treatment (CMT), while a fi ft h group served as a control. Th e antifungal regimens included oral itraconazole (group A), fl uconazole nasal spray (group B), combined oral itraconazole and nasal fl uconazole (group C), and irrigation with a fl uconazole solution through the nasal fossa (group D); the group of 10 controls (group E) received CMT only. A total of 41 patients were available for follow-up (9 mo maximum). Recurrence rates in the 5 groups were 66.7, 10.0, 14.3, 28.6, and 75.0%, respectively. Based on our fi ndings, we conclude that treatment with topical fl uconazole as either a nasal spray or an irrigation solution can signifi cantly reduce the rate of recurrence of AFRS aft er FESS.

J Clin Hypertens (Greenwich). 2012;14:144–148. ©2012 Wiley Periodicals, Inc. Peripheral arterial disease (PAD) is a subclinical marker of coronary artery disease and identifies asymptomatic individuals at high risk for cardiovascular disease (CVD) events. The metabolic syndrome (MetS) is a constellation of clinical factors that increases the risk of developing diabetes and CVD. The authors’ objectives were to estimate the prevalence of MetS in patients with PAD and to determine the prevalence of PAD in the population of asymptomatic US adults 40 years and older with MetS. The authors analyzed data from 3 National Health and Nutrition Examination Surveys (NHANES, 1999–2004). Prevalence of MetS as defined by the Third Report of the Adult Treatment Panel criteria and prevalence of associated cardiac risk factors were determined in 5376 asymptomatic participants 40 years and older. Presence of PAD was defined as ankle‐brachial index <0.9. Estimates were weighted with the sample weights accounting for the unequal selection probability of complex NHANES sampling and over sampling of selected population subgroups. Prevalence of PAD in asymptomatic US adults 40 years and older was 4.2%. PAD prevalence in persons with MetS was 7.0% compared with 3.3% in persons without MetS. A total of 38% of the population with PAD also had MetS. High rates of abdominal obesity, hypertension, hyperglycemia, and low high‐density lipoprotein cholesterol are significant contributors to both MetS and PAD. Persons with MetS have twice the risk of having PAD. Of persons with PAD, almost 40% have MetS. The presence of either PAD or MetS should warrant screening for both conditions so that risk stratification and management of risk factors may be performed.

The Framingham Risk Score (FRS) has become the standard tool to determine coronary heart disease (CHD) risk. Recent studies have demonstrated that FRS underestimates CHD risk in a number of patient populations. One strategy that has been proposed to improve the diagnostic accuracy of FRS is to use imaging of subclinical atherosclerosis to define a "vascular age" and use this age to calculate FRS. Both computed tomography assessment of coronary artery calcium (CAC) and ultrasonographic assessment of carotid intima-media thickness (CIMT) have been proposed as modalities that can be employed to assess vascular age. In the present study, the authors compared CAC vs CIMT for the assessment of vascular age and adjustment of FRS. In the cohort as a whole, CAC- and CIMT-derived vascular age correlated well. Further study is needed to verify the accuracy of vascular age-adjusted FRS using both CAC and CIMT and to determine whether there are specific patient demographics that favor either imaging modality.

<p>The safety and reliability of autonomous driving pivots on the accuracy of perception and motion prediction pipelines, which in turn reckons primarily on the sensors deployed onboard. Slight confusion in perception and motion prediction can result in catastrophic consequences due to misinterpretation in later pipelines. Therefore, researchers have recently devoted considerable effort towards developing accurate perception and motion prediction models. To that end, we propose LIDAR Camera network (LiCaNet) that leverages multi-modal fusion to further enhance the joint perception and motion prediction performance accomplished in our earlier work. LiCaNet expands on our previous fusion network by adding a camera image to the fusion of RV image with historical BEV data sourced from a LIDAR sensor. We present a comprehensive evaluation to validate the outstanding performance of LiCaNet compared to the state-of-the-art. Experiments reveal that utilizing a camera sensor results in a substantial perception gain over our previous fusion network and a steep reduction in displacement errors. Moreover, the majority of the achieved improvement falls within camera range, with the highest registered for small and distant objects, confirming the significance of incorporating a camera sensor into a fusion network.</p>

ObjectivesA persistent insufficiency of glottal closure is mostly a consequence of impaired unilateral vocal fold movement. Functional surgical treatment is required because of the consequential voice, breathing and swallowing impairments. The goal of the study was to determine the functional voice outcomes after medialization thyroplasty with using autologous septal cartilage from the nose.MethodsExternal vocal fold medialization using autologous nasal septal cartilage was performed on 15 patients (6 females and 9 males; age range, 30 to 57 years). Detailed functional examinations were performed for all the patients before and after the surgery and this included perceptual voice assessment, laryngostroboscopic examination and acoustic voice analysis.ResultsAll the patients reported improvement of voice quality post-operatively. Laryngostroboscopy revealed almost complete glottal closure after surgery in the majority of patients. Acoustic and perceptual voice assessment showed significant improvement post-operatively.ConclusionMedialization thyroplasty using an autologous nasal septal cartilage implant offers good tissue tolerability and significant improvement of the subjective and objective functional voice outcomes.

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Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of middle ear cleft. The disease is common in all age groups but more prevalent in low socioeconomic group. It is most commonly seen in developing and undeveloped countries affecting 0.5-30% of any community. Local application of antibiotics remains important and first step to get a dry ear. Changes in bacterial flora in last decade and abuse of antibiotics lead to the emergence of multi-drug resistant organisms. Recently, bacterial biofilm are thought to have a major role in much otolaryngologic infection. The formation of biofilm facilitates chronic bacterial infections and reduce efficacy of anti-microbial therapy. It is estimated that biofilm account of approximately 60% of microbial infection in the body. In addition to bacterial biofilm, the role of fungal infections in CSOM needs more attention. Fungal infections of middle ear are common as fungi thrive well in moist pus. There is very little known about mycological aespect of these ears, the importance of which has increasing in the recent years because of the excessive use of broad sepectrum antidiotics, corticosteroids and cytotoxic chemotherapy. Aim: Microbiological examination of chronic suppurative otitis media by detecting bacterial and fungal isolates involved in the infection. Additionally, the detection of the capacity of bacterial biofilm formation. Patients and methods: Forty Patients suffering from chronic suppurative otitis media attending outpatient clinic in Menoufia university hospital and Karmoz insurance hospital were included in this study. Pus discharge was collected using sterile cotton swabs. These samples were cultured for detection of bacterial and fungal infections and Detection of bacterial capability of forming biofilm was done using crystal violet method and by Overnight culture in tryptic Soya Broth (TSB). Results: Most common isolated bacteria were pseudomonas aeurgiosa (37.5%), followed by Klebseilla.spp (10%) and Staph.aeureus (7.5%) and fungal culture gave results to Candida (10%) and Asperigillus (7.5%). Mixed bacterial and fungal infection occurred in (11.7%) of our patients.14 out of 15 cases of pseudomonas infection gave results to biofilm formation(93.3%)and Staph.aeureus infection,3 cases out of 3 cases(100%) were biofilm forming. Conclusion: Routine culture and sensitivity remains the most important step in management of CSOM because of its multi-etiology that makes the empirical therapy impossible. Fungal infection can occur without clinical evidence, therefore, empirical local antifungal therapy is strongly recommended in such cases. Biofilm formation may be responsible for irresponsiveness to antibiotic chemotherapy. Physical removal or inhibition of biofilm may enhance the response to antimicrobial therapy and infection eradication.

ObjectiveTo determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI).MethodsRetrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history.Results375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD− patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD.ConclusionObservation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.