First report of an outbreak of cerebral coenurosis in Dhofari goats in Oman / Primeiro relato de um surto de coenurose cerebral em cabras Dhofari em Omã

Abstract This study documented the first outbreak of cerebral coenurosis in goats in Salalah, southern Oman. Deaths of 130 (16.6%) adult native goats in a herd (n=780) were reported from January to June 2017. Affected goats showed various nervous signs ended by death. Investigations for thiamine deficiency, polioencephalomalacia, caprine arthritis encephalitis, and listeriosis were negative. Upon necropsy, multiple (1-4) thin-walled cysts 2-3.5 cm in diameter containing clear fluid with numerous clusters of protoscolices in the cerebrum and cerebellum had replaced the brain parenchyma, causing space-occupying lesions. Parasitologically, the recovered cysts were Coenurus cerebralis, based on the arrangement of protoscolices, and the number and size of their hooks. Morphologically, each protoscolex had four suckers and a rostellum with double-crown hooks. The large and small hooks were 157.7±0.5 µm and 115±0.6 µm in length, respectively. Histopathologically, the parasite destroyed the affected tissues associated with multifocal to diffuse lymphocytic, non-suppurative meningoencephalitis; ischemic neuronal necrosis; and malacia. This is the first report of cerebral coenurosis in livestock in Oman, which should alert the local public health authorities for the application of prevention and control measures.

Resumo Este estudo documentou o primeiro surto de coenurose cerebral em cabras em Salalah, Oman. A morte de 130 (16,6%) caprinos adultos nativos (n=780) foi relatada de janeiro a junho de 2017. As cabras afetadas mostraram distúrbios neurológicos, que culminaram em óbito. Investigações para deficiência de tiamina, polioencefalomalácia, encefalite por artrite caprina e listeriose foram negativas. Na necropsia, múltiplos (1-4) cistos de paredes finas com 2-3,5 cm de diâmetro contendo líquido claro com numerosos aglomerados de protoescólices no cérebro e no cerebelo haviam substituído o parênquima cerebral, causando compressão nas estruturas adjacentes. Os cistos recuperados foram identificados como sendo de Coenurus cerebralis, com base no arranjo dos protoescólices, e no número e tamanho de seus ganchos. Morfologicamente, cada protoescólice tinha quatro ventosas e um rostelo com dupla coroa de ganchos. Os ganchos grandes e pequenos tinham 157,7±0,5 µm e 115±0,6 µm de comprimento, respectivamente. Histopatologicamente, o parasita causou a destruição dos tecidos afetados associada à meningoencefalite linfocítica não-supurativa, que variou de multifocal a difusa, necrose neuronal isquêmica e malacia. Este é o primeiro relato de coenurose em ruminantes no Oman, o que deve servir de alerta para as autoridades locais da área de saúde para a aplicação de medidas de prevenção e controle.

Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure

ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

Evaluation of staging accuracy of dynamic MRI in urinary bladder cancer

Background: Urinary Bladder cancer is the second most common neoplasm of the urinary tract worldwide. It accounts for 6-8 % of malignancy in men and 2-3% in women with the highest incidence rates in North American and Europe as well as areas with endemic schistosomiasias in Africa and the middle east

Purpose: To show the staging accuracy of Dynamic MRI in urinary bladder carcinoma

Patients and Methods: This is a Prospective randomized clinical study, study setting: Radiology and Urology Departments, Faculty of Medicine, Ain Shams University, study period: 6 months from August 2017 till February 2018

Results: This study conducted on 20 patients [17 male and 3 females] with age ranged from 42 - 78 years and with mean+/-SD of 55.95+/-9.01 years. 4/20 patients [20.0%] were presented to TURT procedure while 16/20 patients [80.0%] were presented to radical cystectomy

Conclusion: In this study, despite small differences between the results of the MRI and pathology, Dynamic MRI was found to be an accurate modality for assessment of tumor staging, and its routine use in bladder cancer staging can lead to significant improvement of diagnostic accuracy of the staging and treatment planning and hence improvement of the prognosis of the patients and their survival rates. Furthermore, the use of Dynamic MRI systems with higher magnetic field and imaging techniques standardized with higher resolution could further enhance the accuracy of the method. Further studies with larger sample size may also help to validate the results of this study

Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes

Background and study aims: Intra-abdominal and mediastinal lymphadenopathy are often difficult to diagnose, particularly in the absence of a primary lesion. Endosonography [EUS]-guided fine-needle aspiration and cytology [FNAC] has provided an easy and safe access to these lymph nodes, sparing the use of invasive and costly interventions. The main aim of this study is to assess the specificity, sensitivity, and predictive value of EUS-guided FNAC in the diagnosis of benign and malignant lymph nodes. In addition, the study aims to determine significant EUS features that could help in predicting lymph node malignancy

Patients and methods: This prospective study included 142 patients with intra-abdominal or intrathoracic lymphadenopathy who were referred for EUS-guided FNAC because of inaccessibility by other imaging modalities. Ninety [63.3%] patients were found to have malignant lymph nodes, and 52 [36.6%] had lymphadenopathy of benign nature

Results: EUS-guided FNAC had a sensitivity and specificity of 92% and 100% respectively. It had positive and negative predictive values of 100% and 88% for malignancy, respectively. By logistic regression analysis, EUS features and shortest diameter were found to be potential predictors of malignancy with p-value of <0.0001

Conclusion: EUS-guided FNAC is a powerful modality in the diagnosis of benign and malignant lymph nodes. Additional complementary EUS features could be added to this technique for definitive diagnosis

Intra uterine extra-amniotic versus vaginal misoprostol for termination of second trimester miscarriage: a randomized controlled trial

Background: Termination of pregnancy in the second trimester using prostaglandins has been shown to be safe and effective, Misoprostol has multiple routes of administration; oral, vaginal, buccal, rectal and sublingual

Objective: The study aims to compare the efficacy and safety of intrauterine extra-amniotic and vaginal misoprostol; in a dose of 200 microgram every 4 hours for the termination of pregnancy in cases of second trimester miscarriage

Materials and Methods: A prospective randomized open labeled clinical trial included 180 women with missed miscarriage in gestational age between 13 and 24 wks. Patients were randomized to receive subsequent doses of 200 microg misoprostol every 4 hrs either intra uterine extra-amniotic by Foley catheter or vaginally administered. Randomization was completed using a computer-generated random table. The primary outcome of this study was the mean duration from the initial misoprostol dose until complete fetal expulsion [induction-expulsion interval]

Results: The mean gestational age was 17.74 wks. The mean time to complete miscarriage in the intra uterine extra-amniotic group was 5.27 hrs, which was significantly lower than the vaginal group [9,92 hrs, p=0.001]. Side effects were more common in vaginal group

Conclusion: Intra uterine extra-amniotic misoprostol with a dose of 200 microg every 4 hrs appears to be more effective and safer than vaginal misoprostol in induction of second trimester miscarriage

Comparison of pregnancy outcome between Ultrasound- Guided tubal recanalization and office-based Microhysteroscopic Ostial Dilatation in patients with Proximal Blocked Tubes

Background: The current research to the best of my knowledge is the first to compare the pregnancy outcome between ultrasound-guided tubal recanalization [UGTR] using a special fallopian tubal catheter, and office-based micrhysteroscopic ostial dilatation [MHOD] using the same tubal catherter in infertile women with previously diagnosed bilateral proximal tubal obstruction [PTO]

Materials and Methods: This prospective study reported the pregnancy outcomes for 200 women in private infertility care center in Arafa hospital in Fayoum and in El Minya University Hospital in the period between January 2010 and October 2013 treated as outpatients for their bilateral PTO after the routine hysterosalpingography [HSG]. A Cook's catheter, special fallopian tubal catheter, were used to recanalize the blocked tubes in 100 women [group A] under UGTR, and the same Cook's tubal catheter was used through 2mm microhysteroscope to cannulate both ostia using MHOD in another 100 women [group B]. Pregnancy outcome was determined after the procedures for a 12-month period follow-up

Results: The number of the recanalization of PTO was not significantly different between two groups. As of the 200 blocked fallopian tubes in group A, 140 tubes [70%] were successfully recanalized by passing the ultrasound-guided special cannula, while 150 tubes [75%] were successfully recanalized in group B, using the same tubal catheter through a 2mm microhysteroscope. The cumulative pregnancy rate after the two procedures was not statistically different between two groups. It was 25.9% in group A, while it was 26.3% in group B, after a 12-month period follow-up

Conclusion: UGTR is highly recommended as the first step to manage infertile women due to PTO, as it is easier procedure; however, there is possible to obtain nearly similar results after MHOD

Effect of some antioxidants on the prostate of adult and aged albino rats: a histological and immunohistochemical study.

Effect of some antioxidants on the prostate of adult and aged albino rats. Twenty-five adult and twenty-five aged male albino rats were divided into four groups: group I (control group) group II (zinc sulphate treated group), group III (vitamin E) & group IV (vitamin C) zinc administered in doses of 0.2673 mg for adult rat and 0.693 mg for aged rat, vitamin E administered in doses of 0.973 mg for adult rat and 2.52 mg for aged rat, vitamin C administered in doses of 1.215mg for adult rat and 3.15 mg for aged rat. The prostate glands were processed and stained by H&E, Masson trichrome & immunoreaction of androgen receptor for light microscopic examinations. Morphometric analysis for collagen fibers and immunoreaction area percent was performed and statically analyzed. Zinc showed improvements, in which decrease in number of mucosal fold and increase in immunoreactions of nuclear androgen receptor in ventral lobe also, Decrease fibrosis and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. vitamin E showed improvements, in which decrease in number of mucosal fold, decrease size of acini, decrease of epithelial heights and increase in immunoreactions of nuclear androgen receptor in ventral lobe also, decrease of epithelial heights, decrease fibrosis and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. vitamin C there were improvements, in which decrease in number of mucosal fold, dilatation of acini and slightly increase in immunoreactions of nuclear androgen receptor in ventral lobe also, rarified collagenous fibers and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. It also ameliorated blood vessels congestion. Zinc, vitamin E and vitamin C exerted no harmful effects on adult prostate but ameliorated effects against aged prostate.

Validated selective spectrophotometric methods for the kinetic determination of desloratidine in tablets and in the presence of its parent drug

Two novel selective validated methods have been developed for analysis of desloratidine [DSL] in its tablets formulation. Both were kinetic spectrophotometric methods, depend on the interaction of the secondary amino group in DSL with acetaldehyde to give N-vinylpiperidyl product. The formed N-vinylpiperidyl compound was reacted with 2,3,5,6-tetrachloro-1,4-benzoquinone [chloranil] to form colored N-vinylpiperidyl-substituted benzoquinone derivatives. The formed blue-colored derivative was measured at 672 nm. The reaction conditions were carefully studied and all factors were optimized. The molar ratio between the reactants was estimated and a suggested reaction mechanism was presented. The analysis was carried out using initial rate and fixed time [at 6 min] methods. The linear concentration ranges were 3 - 50 and 10 - 60 microg mL[-1] with limits of detection of 3.2 and 2.2 microg mL[-1] for the initial rate and fixed time methods, respectively. ICH guidelines were applied for analytical performance validation of the proposed methods. The presence of common excipients in the pharmaceutical formulation did not produce any significant interference, as well as from loratadine, which is the parent compound of DSL. Different commercially available tablets formulations containing were successfully analyzed, with, the percentage recovery ranging from 97.28-100.90 +/- 0.7 2-1.41%. The obtained results were compared statistically with the reported method results. The proposed methods have similar accuracy and precision as the reported as indicated from the F- and t-test data

Human telomerase reverse transcriptase messenger RNA [TERT mRNA] as a tumour marker for early detection of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is the fifth most common malignancy in the world. Although tumour markers such as alpha-foetoprotein [AFP] are widely used and important for HCC detection in clinical scenes, they still do not provide a satisfactory solution to detect HCC at the early stage. The aim of our study was to illustrate the significance of serum human telomerase reverse transcriptase messenger RNA [hTERT mRNA] as a novel biomarker for early detection of HCC. Patients and Thirty-five patients with HCC, 15 patients with liver cirrhosis, and 10 healthy subjects were sex and age matched. History taking, full physical examination, and laboratory investigations including liver function tests, hepatitis markers, AFP, and quantification of serum human telomerase reverse transcriptase mRNA [hTERT mRNA] using real-time reverse transcription polymerase chain reaction [RT-PCR] were conducted. Ultrasonography [US], triphasic computed tomography [CT], and liver biopsy were carried out. The hTERT was above the cutoff point [>144 copies/ml] in 27 HCC patients with a sensitivity of 77.14% and a specificity of 100% and with a positive predictive value [PPV] of 100% and a negative predictive value [NPV] of 65.2%. AFP was above the cutoff point [>50 ng/ml] in 23 HCC patients with a sensitivity of 65.71% and a specificity of 96% and with a PPV of 96.3% and an NPV of 53.8%. Our study also showed a statistically significant relationship between the size of the tumour in HCC patients and both AFP and hTERT, and hTERT appears to be more correlated with the size of the tumour than AFP. There is no direct correlation between hTERT or AFP and the number of focal lesions with p value >0.05. Serum hTERT mRNA is more sensitive and specific than AFP in the early detection of HCC and its level correlates with the size of the tumour

Antioxidant lipoxygenase inhibitors from the leaf extracts of Simmondsia chinensis

OBJECTIVE@#To isolate and identify chemical constituents with antioxidant and lipoxygenase inhibitory effects of the ethanolic extract of Simmondsia chinensis (Jojoba) leaves.@*METHODS@#The alcoholic extract was subjected to successive solvent fractionation. The antioxidant active fractions (chloroform, ethyl acetate and aqueous fractions) were subjected to a combination of different chromatographic techniques guided by the antioxidant assay with DPPH. The structures of the isolated compounds were elucidated on the basis of spectroscopic evidences and correlated with known compounds. The antioxidant activity was assessed quantitively using DPPH and β-carotene methods. The inhibitory potential against enzyme lipoxygenase was assessed on soybean lipoxygenase enzyme.@*RESULTS@#Ten flavonoids and four lignans were isolated. Flavonoid aglycones showed stronger antioxidant and lipoxygenase inhibitory effects than their glycosides. Lignoid glycosides showed moderate to weak antioxidant and lipoxygenase inhibitory effects.@*CONCLUSIONS@#A total of 14 compounds were isolated and identified from Simmondsia chinensis; 12 of them were isolated for the first time. This is the first report that highlights deeply on the phenolic content of jojoba and their potential biological activities and shows the importance of this plant as a good source of phenolics in particular the flavonoid content.

Antioxidant lipoxygenase inhibitors from the leaf extracts of Simmondsia chinensis

Objective: To isolate and identify chemical constituents with antioxidant and lipoxygenase inhibitory effects of the ethanolic extract of Simmondsia chinensis (Jojoba) leaves. Methods: The alcoholic extract was subjected to successive solvent fractionation. The antioxidant active fractions (chloroform, ethyl acetate and aqueous fractions) were subjected to a combination of different chromatographic techniques guided by the antioxidant assay with DPPH. The structures of the isolated compounds were elucidated on the basis of spectroscopic evidences and correlated with known compounds. The antioxidant activity was assessed quantitively using DPPH and β-carotene methods. The inhibitory potential against enzyme lipoxygenase was assessed on soybean lipoxygenase enzyme. Results: Ten flavonoids and four lignans were isolated. Flavonoid aglycones showed stronger antioxidant and lipoxygenase inhibitory effects than their glycosides. Lignoid glycosides showed moderate to weak antioxidant and lipoxygenase inhibitory effects. Conclusions: A total of 14 compounds were isolated and identified from Simmondsia chinensis; 12 of them were isolated for the first time. This is the first report that highlights deeply on the phenolic content of jojoba and their potential biological activities and shows the importance of this plant as a good source of phenolics in particular the flavonoid content.

Is there microbial health hazard from plain and flavored UHT milk ?

This study was conducted to answer the question about the probability of incidence of microbial public health hazard that may arise from consumption of UHT milk either plain or flavored types. To answer this question, we examined microbiologically UHT milk samples in 3 lines: aerobically, anaerobically and fungal. Therefore, 100 UHT milk samples were collected randomly from different supermarkets and retails distributed in Assuit city during summer season of 2011. Plain type was represented by 14 samples, while chocolate flavored by 31 samples, strawberry flavored by 30 samples and banana flavored by 25 samples. All samples were examined for the incidence of aerobic, anaerobic and fungal contamination. The revealed results showed that neither anaerobes nor fungi could be detected, while the aerobic microorganisms were detected in 11 samples [11%], in which Staphylococci species were isolated from 7 samples and Gram-negative bacilli werw isolated from 4 samples. It was also noticed that none of the contaminated samples was from the plain type, but they were from flavored types as 8 chocolate and 3 strawberry. Moreover, 6 samples out of the 11 contaminated were of the same production date [29/5/2011], indicating that the line of production in such day may be faced to unhygienic conditions. Latex agglutination test, SDS-PAGE and PCR were used for identification and toxigenicity detection of Staph. aureus strains, in which, 4 samples out of the 7 with Staphylococci species had enterotoxigenic Staph. aureus as 3 samples contaminated with strains harboring classical superantigen genes [2 with SEA + 1 with SED gene] and 4th sample contaminated with strain harboring new superantigen gene [SEG gene]. The Gram-negative bacilli were E. coli, Klebsiella species and Proteus species. Because of the isolated microorganisms were heat-sensitive, their presence in UHT milk means the sterilization temperature was inefficient and/or post-sterilization contamination that are referring to the answer of the present study

Prevalence of hepatitis D in hepatitis B virus carriers in volunteer blood donors at Minia governorate

Background: There are many hundred carries for hepatitis B virus [HBV] and hepatitis D virus [HDV] is a defective virus that requires hepatitis B surface antigen [HBs Ag] for replication and transmission. Coinfection of HBV and HDV are usually acute, self limited infections. In contrast, a super infection causes a generally sever and acute hepatitis that most often results in chronic hepatitis D, with the suppression of HBV replication but persistence of HDV replication

The aim of the work: detection of infection with HDV among HBsAg positive blood donors in Regional Blood Transfusion Center in Minia governorate

Patients and methods: We evaluated ten thousand volunteer blood donors in Minia regional blood transfusion center in the period from October 2009 to May 2010. Blood screening for HBsAg was done using plasma of the blood donors. Any blood sample was seropositive for HBsAg, was subjected to detection of antibodies to hepatitis delta antigen [anti-HD] in plasma samples and confirmed the diagnosis of hepatitis B DNA by doing PCR test to all positive [anti-HD] cases. Also detection of HCV by MEIAs was done

Results: Out of the 10000 samples, 200 samples were reactive to HBsAg. Out of the 200 blood samples, 21[10.5%] were anti-HD positive. 21 positive anti- HD samples were HBV DNA positive [100%] and 2% were positive to HCV while

Role of dietary supplementation of methionine and folic acid in early atherosclerotic changes in adult male mice

Homocysteine is an important intermediate product in normal metabolism of methionine. Elevation of homocysteine is known as an independent risk factor for atherosclerosis. On the other hand, several studies have reported beneficial effects of folates on endothelial dysfunction. However, the exact mechanism remains to be elucidated. Thus, the objectives of this study were to assess the relationship between total plasma homocysteine and early atherosclerosis, b] to determine whether homocysteine exerts its effects through the adhesion molecule VCAM-]1 or not, c] To estimate the role of folic acid as a prophylactic and or treatment of early atherosclerotic changes. Adult male mice [n=40,] were randomly divided into 4 groups. Group I received the control diet. Group II received control diet plus methionine dissolved in drinking water, adjusted to deliver a total of 4.4%methionine/L drinking water for 8 weeks and the doses were calculated assuming an average water intake of 3 to 4 mL/d and an average body weight of 25 g. Group III received methionine in the same previous dose and duration concomitant with folic acid in a dose of 1mg/kg. Group IV received methionine in the same previous dose and duration followed by folic acid in the same previous dose for another 8 weeks. Blood samples were taken for estimation of homocysteine, Cholesterol, triglycerides, LDL, HDL, nitric oxide, superoxide dismutase. Specimens from aorta were taken and processed for histopathological and immunohistochemical examination. The high expression of VC'AM4 in group II might be responsible for the observed histological changes; adherent inflammatory cells to the irregular endothelial lining in addition to increased intima-media thickness, formation of intimal foam cells, hyperplastic changes, migration of the smooth muscle cells of the media, increase collagen and disturbed elastic fibers architecture. The plasma homocysteine and cholesterol levels were significantly higher in group II than in group I. It was reduced in group III and IV. Although, there was no significant dfference between their levels in group I and III, there was significant difference between group I and IV LDL, HDL, and triglycerides plasma levels did not differ statistically between different groups. Nitric oxide and superoxide were markedly reduced in group II with improvement in groups III and IV. However, the nitric oxide level in group I was significantly higher than that in group Ill and IV While no significant differences between group I, III and IV in superoxide dismutase levels. As regard the endothelial 'VCAM-1 expression, marked increase in the expression in group II, low expression in group III [similar to control] and moderate expression in group IV were observed. Elevated plasma homocysteine is a risk factor for early atherosclerosis which was confirmed by the endothelial expression of VCAM-1. Prophylactic administration of folic acid has a beneficial effect more than its role as a treatment

Auditory function evaluation in high risk neonates

Hearing impairment can be considered as the most common benign defect. Early detection of hearing loss at, or shortly after, birth and appropriate intervention are critical to speech, language and cognitive development. Seventy-four neonates were included in this study [40 males and 34 females]. Twenty-two patients had neonatal hyper-bilirubinemia [total bilirubin >/= 18 mg/dL] [group A], 24 patients had hypoxic ischemic encephalopathy [group and 28 were premature low birth weigh [>37 weeks, >/= 2500 gm respectively] [group C]. Twenty apparently healthy full term infants of matching age and sex were also enrolled in the study as controls. Beside complete history and clinical examination, all patients and controls evaluated by automated auditory brainstem responses [A-ABR] and transient evoked otoacoustic emissions [TEOAEs]. Neonates who had auditory dysfunction [from either the studied cases or controls] were followed up 3 months later by the same tests. Hearing dysfunctions were detected in 45%, 29% and 53.5% in group A, B and C of patients respectively. There were statistically significant higher serum bilirubin level in cases with abnormal hearing [28.5 +/- 3.73] than in those without [20.42 +/- 3.95] P < 0.001, in group A of patients. In group B of patients there was statistically significant lower Apgar score at 5 minutes in cases with abnormal hearing [4.5 +/- 2.39] than in those without [8.3 +/- 3.4] P < 0.025. In group C of patients there were statistically significant lower gestational age and birth weight in cases with abnormal hearing [30.86 +/- 1.76 and 1653.33 +/- 393.91 respectively] than in those without [34.85 +/- 1.5, and 2380.76 +/- 165.25 respectively] P < 0.001 for both

Conclusion: Since most of the neonates admitted to the NICU have one or more identified risk factors, their hearing evaluation by A-ABR and TEOAE at the time of discharge is mandatory for early detection and Prompt treatment of hearing impairment, as normal hearing is very important for speech, language. intellectual and emotional development. Also we recommended universal neonatal hearing screening as some apparently healthy neonates who have hearing problems can be discovered and treated