Low-Dose Triple-Pill vs Standard-Care Protocols for Hypertension Treatment in Nigeria: A Randomized Clinical Trial.

Importance: With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. Objective: To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Design and Setting: Randomized, parallel-group, open-label, multicenter trial conducted in public hospital-based family medicine clinics in Nigeria. Participants: Black African adults with uncontrolled hypertension (≥140/90 mm Hg) who were untreated or receiving a single blood pressure-lowering drug. Interventions: Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg). Main Outcomes and Measures: The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6. Results: The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151/97 mm Hg; and clinic blood pressure, 156/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, -5.8 mm Hg [95% CI, -8.0 to -3.6]; P < .001]). At month 6, clinic blood pressure control (<140/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, -2% to 20%]) and home blood pressure control (<130/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events. Conclusions and Relevance: Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol. Trial Registration: Pan African Clinical Trials Registry Identifier: PACTR202107579572114.

MORBIDITY PATTERN AND LEVEL OF COMPLIANCE WITH SAFETY MEASURES AMONG QUARRY WORKERS IN GUSAU METROPOLIS, ZAMFARA STATE.

Introduction: Quarrying is a thriving occupation providing widespread employment opportunities to the poor indigenes of Zamfara State. The workers are more susceptible to various morbidities due to numerous hazards in their working environment. This study aims to assess the morbidity pattern, availability, and compliance with safety measures among quarry workers in Gusau metropolis, Zamfara State. Methodology: A cross-sectional study was conducted among 307 quarry workers in Gusau metropolis between July and August 2022. The respondents were selected by multi-stage sampling technique. Data was collected using an interviewer-administered questionnaire (ODK), an observer checklist, and clinical examination. Appropriate descriptive and inferential statistics were done to determine significant association (p<0.05). Results: The common morbidities among the respondents were respiratory (39.4%), ear (6.5%), eye (30.0%), and injuries (39.7%). Working hours per day and duration of work in the quarry were factors associated with respiratory morbidities. Respondents' level of compliance with safety measures were; no compliance (5.2%), low compliance (43.7%), moderate compliance (49.8%), and considerable compliance (1.3%). Conclusions: This study showed high morbidities and low compliance with safety measures among quarry workers in Gusau metropolis, Zamfara State.

Integrated metabolome and transcriptome analyses provide insight into the effect of red and blue LEDs on the quality of sweet potato leaves.

Red and blue light-emitting diodes (LEDs) affect the quality of sweet potato leaves and their nutritional profile. Vines cultivated under blue LEDs had higher soluble protein contents, total phenolic compounds, flavonoids, and total antioxidant activity. Conversely, chlorophyll, soluble sugar, protein, and vitamin C contents were higher in leaves grown under red LEDs. Red and blue light increased the accumulation of 77 and 18 metabolites, respectively. Alpha-linoleic and linolenic acid metabolism were the most significantly enriched pathways based on Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. A total of 615 genes were differentially expressed between sweet potato leaves exposed to red and blue LEDs. Among these, 510 differentially expressed genes were upregulated in leaves grown under blue light compared with those grown under red light, while the remaining 105 genes were expressed at higher levels in the latter than in the former. Among the KEGG enrichment pathways, blue light significantly induced anthocyanin and carotenoid biosynthesis structural genes. This study provides a scientific reference basis for using light to alter metabolites to improve the quality of edible sweet potato leaves.

Weighted Gene Co-Expression Network Analysis to Explore Hub Genes of Resveratrol Biosynthesis in Exocarp and Mesocarp of 'Summer Black' Grape.

Resveratrol is a polyphenol compound beneficial to human health, and its main source is grapes. In the present study, the molecular regulation of resveratrol biosynthesis in developing grape berries was investigated using weighted gene co-expression network analysis (WGCNA). At the same time, the reason for the resveratrol content difference between grape exocarp (skin) and mesocarp (flesh) was explored. Hub genes (CHS, STS, F3'5'H, PAL, HCT) related to resveratrol biosynthesis were screened with Cytoscape software. The expression level of hub genes in the exocarp was significantly higher than that in the mesocarp, and the expressions of the hub genes and the content of resveratrol in exocarp peaked at the maturity stage. While the expression levels of PAL, CHS and STS in the mesocarp, reached the maximum at the maturity stage, and F3'5'H and HCT decreased. These hub genes likely play a key role in resveratrol biosynthesis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis further indicated that resveratrol biosynthesis was related to flavonoid biosynthesis, phenylalanine metabolism, phenylpropanoid biosynthesis, and stilbene biosynthesis pathways. This study has theoretical significance for exploring genes related to resveratrol biosynthesis in the exocarp and mesocarp of grapes, and provides a theoretical basis for the subsequent function and regulatory mechanism of hub genes.

Definition of occult hypoperfusion in trauma: A systematic literature review.

INTRODUCTION: Occult hypoperfusion (OH) entails inadequate tissue oxygenation in the presence of normal vital signs. Numerous studies have demonstrated that this phenomenon is associated with impaired outcome and increased mortality, however definitions of OH differ between studies. The aim of the current study was to identify and evaluate the published definitions of the term `occult hypoperfusion` in trauma (tOH). MATERIAL & METHODS: A review of literature was performed using the Medline database. The following MeSH terms have been used: occult hypoperfusion, severe trauma, polytrauma, resuscitation. Clinical studies on OH were included and utilized definitions have been compared. A predefined data-interpretation process was applied to create an integrative definition for tOH. RESULTS: A total of 43 publications used the term OH. A definition of OH was provided in 16 manuscripts. A pooled mean number of participants of 729 (SD: 1158) was found per study. The majority of manuscripts combine multiple parameters for inadequate tissue oxygenation and normal vital signs to define OH in trauma. In 12 manuscripts, specific cut-off values for hemodynamic parameters (SBP/PR/UP) and in 11/16 papers exact metabolic thresholds (lactate/B.E) were defined. The following definition best integrates definitions in current literature: Lactate > 2 mmol/l or BE <-3 mmol/l (to define inadequate oxygenation) plus SBP > 90 mmHg and PR < 120 bpm (to define normal macroperfusion). CONCLUSIONS: The current systematic review demonstrates that definitions of occult hypoperfusion in trauma differ in the literature. The following comprehensive definition for (tOH) is proposed: Lactate > 2 mmol/l or BE <-3 mmol/l plus SBP > 90 mmHg and PR < 120 bpm. This recommendation appears to represent current literature on tOH and may improve the identification of trauma patients at risk for OH and related complicated courses. Further validation studies are required to demonstrate the clinical role of tOH and the proposed definition.

COVID-19 Vaccine Hesitancy and Determinants of Acceptance among Healthcare Workers, Academics and Tertiary Students in Nigeria.

The COVID-19 pandemic has resulted in millions of human deaths, prompting the rapid development and regulatory approval of several vaccines. Although Nigeria implemented a COVID-19 vaccination program on 15 March 2021, low vaccine acceptance remains a major challenge. To provide insight on factors associated with COVID-19 vaccine hesitancy (VH), we conducted a national survey among healthcare workers, academics, and tertiary students, between 1 September 2021 and 31 December 2021. We fitted a logistic regression model to the data and examined factors associated with VH to support targeted health awareness campaigns to address public concerns and improve vaccination rates on par with global efforts. A total of 1525 respondents took part in the survey, composed of healthcare-workers (24.5%, 373/1525), academics (26.9%, 410/1525), and students (48.7%, 742/1525). Only 29% (446/1525) of the respondents were vaccinated at the time of this study. Of the 446 vaccinated respondents, 35.7% (159/446), 61.4% (274/446) and 2.9% (13/446) had one, two and three or more doses, respectively. Reasons for VH included: difficulty in the vaccination request/registration protocols (21.3%, 633/1079); bad feelings towards the vaccines due to negative social media reports/rumours (21.3%, 633/1079); personal ideology/religious beliefs against vaccination (16.7%, 495/1079); and poor confidence that preventive measures were enough to protect against COVID-19 (11%, 323/1079). Some health concerns that deterred unvaccinated respondents were: innate immunity issues (27.7%, 345/1079); allergic reaction concerns (24.6%, 307/1079); and blood clot problems in women (21.4%, 266/1079). In the multivariable model, location of respondents/geopolitical zones, level of education, testing for COVID-19, occupation/job description and religion were significantly associated with VH. Findings from this study underscore the need for targeted awareness creation to increase COVID-19 vaccination coverage in Nigeria and elsewhere. Besides professionals, similar studies are recommended in the general population to develop appropriate public health interventions to improve COVID-19 vaccine uptake.

An Outbreak of Arboviral Infection in a Region with Background Malaria Endemicity from Northwestern Nigeria: An Investigation Report.

INTRODUCTION: Arboviruses are a group of infectious agents transmitted by blood-sucking arthropods from one vertebrate host to another. The agents include Dengue fever and West Nile Virus, amongst others. However, Dengue fever is now the world's fastest-spreading tropical disease, with the annual number of cases increasing 30-fold in the last 50 years. Cases of an unknown febrile illness were reported in Sokoto, northwestern Nigeria, in the last quarter of 2016. We investigated to verify the existence of the outbreak and described the socio-demographic characteristics and management outcome of the cases seen. METHODS: We conducted a descriptive, cross-sectional study and an analytical case control study. For the descriptive study, we defined suspected and confirmed cases of outbreak using established protocol. Cases were identified using stimulated passive and active surveillance. For each suspected case, we collected information on age, sex, residence and time of onset. We described the outbreak by time, place and person. Blood specimens were collected and submitted to the reference laboratory for detection of viral agents. We conducted a case-control study with 185 cases and 370 controls. Information on the socio-demographics and risk factors for arboviral infection and malaria among the cases and controls was collected. RESULTS: The outbreak of febrile illness in Sokoto started on the 3rd of October, 2016. A total 1477 cases were line listed (3rd Oct-11th November 2016) and 16 deaths (case fatality rate: 1.1% reported). The most affected areas were urban slums in two urban Local Government Areas (LGA) - Sokoto North and Sokoto South. Laboratory analysis revealed Dengue, West Nile and Malaria in increasing order from the representative samples. There were 57 (43.2%) respondents in the age-group 21-30 among the cases, while 99 (53.5%) of them were males. Cases living in a bushy neighborhood (OR=1.6, 95% CI=1.1-2.4), keeping waste bins in their houses (OR=1.5, 95% CI=1.0-2.1), having uncovered well or uncovered water containers (OR=3.6, 95% CI=2.1- 6.0) were more likely to develop arboviral infection or malaria compared to controls. Having window nets (OR=0.3, 95% CI=0.2-0.5) was found to be a protective factor against arboviral infection or malaria among the cases. CONCLUSIONS: The outbreak of febrile illness in Sokoto was linked to arboviral agents (Dengue virus and West Nile virus) in a malaria-endemic zone. We draw attention to the fact that arboviral infections can coexist with malaria in our region especially in an outbreak setting.

INTRODUCTION: Les arbovirus sont un groupe d'agents infectieux transmis par des arthropodes hématophages d'un hôte vertébré à un autre. Ces agents comprennent, entre autres, la fièvre de la Dengue et le virus du Nil occidental. Cependant, la dengue est aujourd'hui la maladie tropicale qui se propage le plus rapidement dans le monde, le nombre annuel de cas ayant été multiplié par 30 au cours des 50 dernières années. Des cas d'une maladie fébrile inconnue ont été signalés à Sokoto, dans le nord-ouest du Nigeria, au cours du dernier trimestre 2016. Nous avons enquêté pour vérifier l'existence de cette épidémie et décrit les caractéristiques sociodémographiques et le résultat de la prise en charge des cas vus. MÉTHODES: Nous avons mené une étude descriptive, transversale et une étude analytique cas-témoins. Pour l'étude descriptive, nous avons défini les cas suspects et confirmés d'épidémie en utilisant le protocole établi. Les cas ont été identifiés en utilisant une surveillance passive et active stimulée. Pour chaque cas suspect, nous avons recueilli des informations sur l'âge, le sexe, le lieu de résidence et le moment de l'apparition des symptômes. Nous avons décrit l'épidémie par temps, lieu et personne. Des échantillons de sang ont été prélevés et soumis au laboratoire de référence pour la détection des agents viraux. Nous avons mené une étude cas-témoins avec 185 cas et 370 témoins. Des informations sur les données sociodémographiques et les facteurs de risque d'infection par les arbovirus et le paludisme ont été recueillies parmi les cas et les témoins. RÉSULTATS: L'épidémie de maladie fébrile à Sokoto a commencé le 3 octobre 2016. Au total, 1477 cas ont été répertoriés (du 3 octobre au 11 novembre 2016) et 16 décès (taux de létalité : 1,1% rapporté). Les zones les plus touchées étaient les bidonvilles urbains dans deux zones urbaines de gouvernement local (LGA) - Sokoto Nord et Sokoto Sud. Les analyses de laboratoire ont révélé la présence de la dengue, du virus du Nil occidental et du paludisme par ordre croissant dans les échantillons représentatifs. Parmi les cas, 57 (43,2 %) étaient âgés de 21 à 30 ans, tandis que 99 (53,5 %) d'entre eux étaient des hommes. Les cas vivant dans un quartier broussailleux (OR=1,6, IC 95%=1,1-2,4), gardant des poubelles dans leurs maisons (OR=1,5, IC 95%=1,0-2,1), ayant un puits non couvert ou des récipients d'eau non couverts (OR=3,6, IC 95%=2,1- 6,0) étaient plus susceptibles de développer une infection arbovirale ou le paludisme par rapport aux témoins. Le fait de posséder des moustiquaires de fenêtre (OR=0,3, IC 95 %=0,2-0,5) s'est avéré être un facteur de protection contre l'infection à arbovirus ou le paludisme chez les cas. CONCLUSIONS: L'épidémie de maladie fébrile à Sokoto a été liée à des agents arboviraux (virus de la dengue et virus du Nil occidental) dans une zone où le paludisme est endémique. Nous attirons l'attention sur le fait que les infections arbovirales peuvent coexister avec le paludisme dans notre région, en particulier dans le cadre d'une épidémie. MOTS-CLÉS: Fièvre, Paludisme, Arbovirus, Epidémie.

Neuropathological lesions in the brains of goats in North-Western Nigeria: possible impact of artisanal mining.

Indiscriminate small-scale artisanal gold mining activities were reported to have caused anthropogenic heavy metal environmental pollution in Zamfara State, north-western Nigeria. There is little or no information on the neurotoxic effects and related neuropathological lesions due to environmental pollution in the animal population. Therefore, this work investigated the concentration of heavy metal and associated lesions in the brain of goats around an artisanal mining site in Zamfara. Brain samples were collected from 40 goats at slaughter slabs in Bagega (Zamfara State) while 15 goats with the same demography but without a history of environmental exposure at the time of this study served as controls. The concentration of lead and cadmium in brain tissue and histopathologic changes were assessed using atomic absorption spectrophotometry, histology and immunohistochemistry. The metal concentrations were significantly higher in exposed goats than in the unexposed animals. Cresyl violet staining and glial fibrillary acidic protein (GFAP) immunohistochemistry indicated chromatolysis and increased astrocytic activity respectively in the exposed goats. This study is of epidemiological importance as it shows a generalised increase of the metal concentrations in the brain of goats exposed to artisanal mining in Zamfara, north-western Nigeria. This could have health effects on the animals associated with nervous co-ordination, growth and development and as a good sentinel for pathogenesis of the heavy metal exposure.

Probabilistically Perfect Cloning of Two Pure States: Geometric Approach.

We solve the long-standing problem of making n perfect clones from m copies of one of two known pure states with minimum failure probability in the general case where the known states have arbitrary a priori probabilities. The solution emerges from a geometric formulation of the problem. This formulation reveals that cloning converges to state discrimination followed by state preparation as the number of clones goes to infinity. The convergence exhibits a phenomenon analogous to a second-order symmetry-breaking phase transition.

Constipation as an Atypical Sign of ARC Syndrome - Case Report.

BACKGROUND: Arthrogryposis- renal tubular dysfunction - cholestasis (ARC) syndrome is a rare multisystem disorder originally described in 1973 and recently ascribed to mutation in VPS33 B whose product acts in intracellular trafficking. It exhibits wide clinical variability but the constipation isn't a characteristic clinical sign. CASE: This girl presented after birth severe contractures of legs. She was admitted at 30 days of age with poor feeding, cholestatic jaundice with normal GGT and failure to thrive . Also we have noted a severe acidosis (pH=7.2) associated with aminoaciduria and glucosuria. At second month of age the girl presented a severe ichtyosis, recurrent fever and constipation. Apart from treatment the constipation has persisted. The baby died of sepsis at 12 weeks of age. CONCLUSION: ARC syndrome exhibits notable clinical variability. Constipation has not been reported previously on the contrary diarrhea is a frequent clinical sign. Knowledge of this rare condition can benefit the practitioner as well as the patient.

Prevalence of microalbuminuria and risk factor analysis in type 2 diabetes patients in Albania: the need for accurate and early diagnosis of diabetic nephropathy.

BACKGROUND: Microalbuminuria is often the first sign of renal dysfunction in diabetes. This study aimed to investigate the prevalence of microalbuminuria in Albanian type 2 diabetes patients and its association with other cardiovascular risk factors. METHODS: Three hundred and twenty-one patients with type 2 diabetes attending, diabetes centers in Albania were enrolled in this cross-sectional, multicenter study. The subjects, aged 40-70 years, had no known proteinuria or other kidney disease. Pregnant women and patients with acute infections were excluded. Data including waist circumference, duration of diabetes and history of hypertension were obtained by questionnaire. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. RESULTS: The prevalence of normoalbuminuria was 56.3%, microalbuminuria 40.8% and macroalbuminuria 2.8%. Systolic and diastolic blood pressure (p<0.01), HbA1c (p<0.01) and fasting plasma glucose (p<0.001) were significantly higher in microalbuminuric than in normoalbuminuric subjects. Independent risk factors for microalbuminuria were duration of diabetes (OR: 2.785, 95% CI: 1.156-3.759), systolic blood pressure (OR: 2.88, 95% CI: 1.85-6.85) and waist circumference (OR: 2.15, 95% CI: 1.01-5.45) in males and poor glycemic control (OR: 4.51, 95% CI: 1.45-13.98), duration of diabetes (OR: 2.568, 95% CI: 1.702-3.778) and waist circumference (OR: 4.87, 95% CI: 1.80-13.11) in females. CONCLUSIONS: The high proportion of type 2 diabetes patients with microalbuminuria raises implications for health policy in Albania. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.

Two-dimensional charge transport in disordered organic semiconductors.

We analyze the effect of carrier confinement on the charge-transport properties of organic field-effect transistors. Confinement is achieved experimentally by the use of semiconductors of which the active layer is only one molecule thick. The two-dimensional confinement of charge carriers provides access to a previously unexplored charge-transport regime and is reflected by a reduced temperature dependence of the transfer curves of organic monolayer transistors.

Prolactin activation of the long form of its cognate receptor causes increased visceral fat and obesity in males as shown in transgenic mice expressing only this receptor subtype.

To date the best defined function of prolactin (PRL) is its action on the ovary and mammary gland, although it has also been shown to have an effect on lipid metabolism. Using mice engineered to express only the long form of the prolactin receptor (PRL-RL), we demonstrate that PRL acting through PRL-RL alone causes severe adipose accumulation in visceral fat of males at 6 months of age. The increase in visceral fat accumulation is attributed to loss of adipose-derived leptin, which results in diminished lipolysis. The reduction in leptin also corresponds to decreased activation of AMP-activated protein kinase (AMPK), which further results in diminished fatty acid oxidation and increased fatty acid synthesis. Interestingly, the blunted AMPK response was only observed in adipose tissue and not in liver suggesting that this PRL mediated effect is tissue specific. A glucose tolerance study inferred that PRL-RL mice may suffer from insulin resistance or a reduction in insulin production that is not due to aberrant expression of glucose transporter 4 (Glut4). Collectively, our findings demonstrate that PRL signaling through the long form receptor causes reduced fatty acid oxidation, increased lipid storage, glucose intolerance, and obesity. These findings are of great importance towards understanding the etiology of obesity associated with hyperprolactinemia in humans as well as the role of PRL as a metabolic regulator in adipose tissue.

Contraceptive knowledge, attitudes and practice among married women in Samaru community, Zaria, Nigeria.

Contraceptive use and fertility rates vary substantially among developing countries. In some sub-Saharan African countries, fewer than 10% of married women use contraception. Despite all efforts by governments to ensure availability of the products, prevalence has remained low. We conducted a community-based study to examine contraceptive knowledge, attitude and practice of family planning among married women in Samaru, Zaria, Nigeria. Multi-stage random sampling technique was used to study 200 women in Samaru community of Zaria, Nigeria. Mean age of the respondents was 30.6 +/- 1.5 years. In this study contraceptive prevalence was 12.5% and respondents had a positive attitude towards family planning. Thirty years after Alma Ata of which one of the components is to ensure maternal and child health (MCH) and family planning, contraceptive use in most of the communities in Northern Nigeria is low. There is urgent need to step-up public awareness campaigns on family planning to ensure wide spread acceptability and utilization among women within reproductive age group.

Marijuana smoking among secondary school students in Zaria, Nigeria: factors responsible and effects on academic performance.

BACKGROUND: The use of Marijuana is on the increase worldwide especially among adolescents and youths. Marijuana smoking has gained a foothold in our environment because of peer group influence, accessibility and availability. Its medico-social effects could ruin the life and future of our youths. This study was undertaken to determine the prevalence and the factors that influence secondary school students in Zaria LGA to smoke and the effects on academic performance. METHODS: A cross-sectional descriptive study was employed to generate data among secondary school students. A multi-stage sampling technique was used. Data was collected with the use of a structured, pre tested self-administered questionnaire. F2 test was used to test for significance of association between categorical variables. RESULTS: Of the 350 respondents, 262 (74.9%) were males, while 88 (25.1%) were females. The study shows that 33 of the students smoke marijuana giving a prevalence of 9.4%. There were more smokers in the age group 15-19 years (54.6%). Other factors that influence marijuana smoking include family background, peer pressure and attendance of social functions. There was better academic performance (51.1%) among non smokers as compared to smokers (27.2%), and this was found to be statistically significant (chi2 = 11.73, df = 5, P < .05) There was also statistically significant association between age and marijuana smoking (chi2 = 24, df = 2, P < .05). CONCLUSION: The prevalence of marijuana smoking is high. Age, family background, peer pressure and attendance of social function influence marijuana smoking. A comprehensive school health education program should be instituted to curtail this menace.

Superficial siderosis of the meninges and its otolaryngologic connection: a series of five patients.

OBJECTIVE: To study the otolaryngologic disorders in patients with superficial siderosis of the meninges. BACKGROUND: Superficial siderosis of the central nervous system is a rare disorder characterized by progressive bilateral hearing loss and ataxia caused by recurrent bleeding into the subarachnoid space. The cerebellum, eighth cranial nerve, and olfactory nerve are particularly susceptible to the deposition of hemosiderin, which is responsible for the symptoms. The diagnosis is confirmed by magnetic resonance imaging. METHODS: The clinical notes of five patients with superficial siderosis of the meninges were reviewed with the intent of reporting the otolaryngologic symptoms and signs, the clinical investigations, and treatments. RESULTS: Four of the five patients had sensorineural deafness, two had smell disturbances, and three had gait abnormalities. Magnetic resonance imaging was the most important investigation used to identify the condition. CONCLUSIONS: Superficial siderosis of the meninges is an important differential diagnosis in patients with progressive sensorineural deafness.