Proposed diagnostic criteria for the diagnosis of hypophosphatasia in children and adolescents: results from the HPP International Working Group.

Hypophosphatasia (HPP) is a rare inborn error of metabolism that presents variably in both age of onset and severity. HPP is caused by pathogenic variants in the ALPL gene, resulting in low activity of tissue nonspecific alkaline phosphatase (TNSALP). Patients with HPP tend have a similar pattern of elevation of natural substrates that can be used to aid in diagnosis. No formal diagnostic guidelines currently exist for the diagnosis of this condition in children, adolescents, or adults. The International HPP Working Group is a comprised of a multidisciplinary team of experts from Europe and North America who have expertise in the diagnosis and management of patients with HPP. This group reviewed 93 papers through a Medline, Medline In-Process, and Embase search for the terms "HPP" and "hypophosphatasia" between 2005 and 2020 and that explicitly address either the diagnosis of HPP in children, clinical manifestations of HPP in children, or both. Two reviewers independently evaluated each full-text publication for eligibility and studies were included if they were narrative reviews or case series/reports that concerned diagnosis of pediatric HPP or included clinical aspects of patients diagnosed with HPP. This review focused on 15 initial clinical manifestations that were selected by a group of clinical experts.The highest agreement in included literature was for pathogenic or likely pathogenic ALPL variant, elevation of natural substrates, and early loss of primary teeth. The highest prevalence was similar, including these same three parameters and including decreased bone mineral density. Additional parameters had less agreement and were less prevalent. These were organized into three major and six minor criteria, with diagnosis of HPP being made when two major or one major and two minor criteria are present.

The challenge of hypophosphatasia diagnosis in adults: results from the HPP International Working Group Literature Surveillance.

Hypophosphatasia (HPP) is an inborn error of metabolism caused by reduced or absent activity of the tissue non-specific alkaline phosphatase (TNSALP) enzyme, resulting from pathogenic variants in the ALPL gene. Clinical presentation of HPP is highly variable, including lethal and severe forms in neonates and infants, a benign perinatal form, mild forms manifesting in adulthood, and odonto-HPP. Diagnosis of HPP remains a challenge in adults, as signs and symptoms may be mild and non-specific. Disease presentation varies widely; there are no universal signs or symptoms, and the disease often remains underdiagnosed or misdiagnosed, particularly by clinicians who are not familiar with this rare disorder. The absence of diagnosis or a delayed diagnosis may prevent optimal management for patients with this condition. Formal guidelines for the diagnosis of adults with HPP do not exist, complicating efforts for consistent diagnosis. To address this issue, the HPP International Working Group selected 119 papers that explicitly address the diagnosis of HPP in adults through a Medline, Medline In-Process, and Embase search for the terms "hypophosphatasia" and "HPP," and evaluated the pooled prevalence of 17 diagnostic characteristics, initially selected by a group of HPP clinical experts, in eligible studies and in patients included in these studies. Six diagnostic findings showed a pooled prevalence value over 50% and were considered for inclusion as major diagnostic criteria. Based on these results and according to discussion and consideration among members of the Working Group, we finally defined four major diagnostic criteria and five minor diagnostic criteria for HPP in adults. Authors suggested the integrated use of the identified major and minor diagnostic criteria, which either includes two major criteria, or one major criterion and two minor criteria, for the diagnosis of HPP in adults.

Hypophosphatasia diagnosis: current state of the art and proposed diagnostic criteria for children and adults.

BACKGROUND: This manuscript provides a summary of the current evidence to support the criteria for diagnosing a child or adult with hypophosphatasia (HPP). The diagnosis of HPP is made on the basis of integrating clinical features, laboratory profile, radiographic features of the condition, and DNA analysis identifying the presence of a pathogenic variant of the tissue nonspecific alkaline phosphatase gene (ALPL). Often, the diagnosis of HPP is significantly delayed in both adults and children, and updated diagnostic criteria are required to keep pace with our evolving understanding regarding the relationship between ALPL genotype and associated HPP clinical features. METHODS: An International Working Group (IWG) on HPP was formed, comprised of a multidisciplinary team of experts from Europe and North America with expertise in the diagnosis and management of patients with HPP. Methodologists (Romina Brignardello-Petersen and Gordon Guyatt) and their team supported the IWG and conducted systematic reviews following the GRADE methodology, and this provided the basis for the recommendations. RESULTS: The IWG completed systematic reviews of the literature, including case reports and expert opinion papers describing the phenotype of patients with HPP. The published data are largely retrospective and include a relatively small number of patients with this rare condition. It is anticipated that further knowledge will lead to improvement in the quality of genotype-phenotype reporting in this condition. CONCLUSION: Following consensus meetings, agreement was reached regarding the major and minor criteria that can assist in establishing a clinical diagnosis of HPP in adults and children.

Updated practice guideline for dual-energy X-ray absorptiometry (DXA).

The introduction of dual-energy X-ray absorptiometry (DXA) technology in the 1980s revolutionized the diagnosis, management and monitoring of osteoporosis, providing a clinical tool which is now available worldwide. However, DXA measurements are influenced by many technical factors, including the quality control procedures for the instrument, positioning of the patient, and approach to analysis. Reporting of DXA results may be confounded by factors such as selection of reference ranges for T-scores and Z-scores, as well as inadequate knowledge of current standards for interpretation. These points are addressed at length in many international guidelines but are not always easily assimilated by practising clinicians and technicians. Our aim in this report is to identify key elements pertaining to the use of DXA in clinical practice, considering both technical and clinical aspects. Here, we discuss technical aspects of DXA procedures, approaches to interpretation and integration into clinical practice, and the use of non-bone mineral density measurements, such as a vertebral fracture assessment, in clinical risk assessment.

SARS-CoV-2 virus associated angiotensin converting enzyme 2 expression modulation in colorectal cancer: Insights from mRNA and protein analysis COVID-19 associated (ACE2) expression in colorectal cancer.

The SARS-CoV-2 virus gains entry into human cells by exploiting the angiotensin-converting enzyme 2 (ACE2), a key component known as the spike protein (S), as a point of entry. Initially, SARS-CoV-2 suppresses the natural function of ACE2, leading to a gradual decline in cell health. Additionally, individuals with cancer are considered more susceptible to COVID-19. This study investigates the expression patterns of ACE2 in colorectal cancer (CRC) patients with and without a history of COVID-19 infection. RT-PCR was used to analyze samples from both cancerous and adjacent non-affected colorectal tissues of 47 CRC patients, comprising two groups: 24 CRC patients with no history of COVID-19 and 23 CRC patients with a recent history of COVID-19 infection. Epithelial CR cells were isolated from both types of tissues and cultured to evaluate cell adhesion. Immunohistochemistry analyses were conducted to examine ACE2 protein expression using various ACE2 antibodies for both cell types. The study revealed ACE2 mRNA expression in all CRC tissues of patients with and without a history of COVID-19. ACE2 expression was significantly higher in CRC patients without a history of COVID-19. Notably, the non-affected colorectal cancer (NACRC) tissues of patients without a history of COVID-19 also showed ACE2 expression, whereas no ACE2 expression was detected in the biopsies of CRC patients with a positive COVID-19 history. ACE2 antibodies were employed to validate ACE2 protein expression at the mRNA level. COVID-19 appears to downregulate ACE2 expression in both CRC and NACRC tissues of CRC patients with a positive history of COVID-19 infection.

Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators.

INTRODUCTION: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.

Three cases of colon cancer in four generations of the Saudi family, caused by endogamous germline mutations.

Various research pieces of evidence have been published in recent years, establishing the increasing prevalence of early colon cancer among young people. In this background, the current study aimed to analyze the reasons behind colon cancer recurrence among endogamous consanguineous cases in four generations of a single Saud family. For this study, the authors conducted the whole-exome sequencing analysis to screen for germline mutations in DNA samples from consanguineous cases within the family. After collecting the colon samples, it was analyzed histologically and immunohistochemically with the help of Breast Cancer antibodies (BRCA2 and 1 correspondingly) and H&M staining (hematoxylin and eosin). For this study, 26 at-risk consanguineous cases were considered. Three cases were diagnosed with malignant colon cancer, two with breast cancer, and 17 with germline mutations, yet remain unaffected by cancerous tumors. The rest, four consanguineous cases, are healthy and non-carriers of the mutations. However, as per the exome analysis outcomes, 15 cases inherited germline mutations in nine genes. Nine substitution mutations were present in six of the nine inherited genes in these inherited germline mutations. Furthermore, it also presented six insertion and deletion frameshift mutations in five of nine inherited genes. The immunohistochemical staining process achieved positive staining outcomes for BRCA1 and 2. Therefore, germline mutations inherited from the nine genes of endogamous consanguineous cases of mutation carriers remain the primary reason behind colon cancer recurrence in the same family.

Guideline No. 422g: Menopause and Osteoporosis.

OBJECTIVE: Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. TARGET POPULATION: Perimenopausal and postmenopausal women. BENEFITS, HARMS, AND COSTS: Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. EVIDENCE: Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. SUMMARY STATEMENTS: RECOMMENDATIONS.

Directive clinique no 422g : Ménopause et ostéoporose.

OBJECTIF: Proposer des stratégies pour améliorer les soins aux femmes en périménopause ou ménopausées d'après les plus récentes données probantes publiées. POPULATION CIBLE: Femmes en périménopause ou ménopausées. BéNéFICES, RISQUES ET COûTS: La population cible bénéficiera des plus récentes données scientifiques publiées que leur communiqueront les fournisseurs de soins de santé. Aucun coût ni préjudice ne sont associés à cette information, car les femmes seront libres de choisir parmi les différentes options thérapeutiques offertes pour la prise en charge des symptômes et morbidités associés à la ménopause, y compris l'abstention thérapeutique. DONNéES PROBANTES: Les auteurs ont interrogé les bases de données PubMed, Medline et Cochrane Library pour extraire des articles publiés entre 2002 et 2020 en utilisant des termes MeSH spécifiques à chacun des sujets abordés dans les 7 chapitres. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Médecins, y compris gynécologues, obstétriciens, médecins de famille, internistes, urgentologues; infirmières, y compris infirmières autorisées et infirmières praticiennes; pharmaciens; stagiaires, y compris étudiants en médecine, résidents, moniteurs cliniques; et autres fournisseurs de soins auprès de la population cible. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Characteristics associated with the perceived likelihood to become parents among young adults with sickle cell disease or sickle cell trait in the USA.

Individuals with sickle cell disease (SCD) and individuals with sickle cell trait (SCT) have different health trajectories, but it is unknown whether sociodemographic and clinical characteristics are associated with their likelihood to be a parent. The purpose of this study was to examine the sociodemographic and clinical characteristics associated with perceived likelihood-to-parent among a cohort of young adults with SCD or SCT in the USA. The participants were 234 young adults (82 males, 152 females) who had either SCD (n = 138) or SCT (n = 96). The average age was 25.9 years (SD = 4.9), and most participants (87%) were single. Study participants completed the likelihood-to-parent item (0-4 scale) included in the valid and reliable Sickle Cell Reproductive Health Knowledge Parenting Intent and Behavior Questionnaire (SCKnowIQ). The mean likelihood-to-parent score was M = 2.3 (SD = 1.1) and 41% indicated that they were 'very' or 'extremely' likely to be a parent. Bivariate analysis showed that likelihood-to-parent was associated with the participant's sickle cell genotype (p = .03), age (p = .003), educational level (p = .04), income (p = .01), employment (p = .04), number of children (p < .001), health insurance (p = .02), and influenced by others (p < .001). In multiple regression analysis, participants reported higher likelihood-to-parent scores if they had at most 2 children (p = .03), higher income (p = .03), had no insurance (p = .01), and reported higher levels of being influenced by others (p = .001). Additional research is needed to confirm these findings in larger representative samples with more young adult males and to understand the likelihood to become parents over time by implementing longitudinal studies in the SCD and SCT populations. Such research is needed to guide appropriate education and genetic counseling for reproductive decision-making among young adults with SCD or SCT.

Internal medicine residents' perceptions and experiences in palliative care: a qualitative study in the United Arab Emirates.

BACKGROUND: Palliative medicine is a newly developing field in the United Arab Emirates (UAE). The purpose of this study was to gain a deeper understanding of the experiences of internal medicine residents providing end-of-life care to patients and their families, and how those experiences shape their learning needs. METHOD: Nine focus groups were conducted with internal medicine residents and recent graduates from two large academic health centers in the UAE between 2019 and 2020. Through an iterative process, data were collected and examined using constant comparison to identify themes and explore their relationships. RESULTS: Fifty-two residents and graduates participated. Residents frequently care for terminally ill patients and their families, but lack confidence in their skills and request more structured education and training. Cultural and system related factors also impact palliative care education and patient care. Five main themes and associated subthemes were identified: (1) clinical management of palliative patients, (2) patient and family communication skills, (3) religion, (4) barriers to end-of-life education, and (5) emotional impact of managing dying patients. CONCLUSION: Our findings can help guide program development and curricular changes for internal medicine residents in the region. Structured education in end-of-life care, with a focus on fostering culturally sensitive communication skills and spirituality, can improve resident education and patient care. Clear and transparent policies at the institution level are necessary. Programs are also needed to assist residents in developing effective coping strategies and emotionally navigating experiences with patient death.

A Retrospective Study of Pediatric Medication Errors in Saudi Arabia.

Background: The peculiarities of medication errors (MEs) among the pediatric population in the Middle East have not been adequately explored. In this study, we describe the MEs reported at the largest tertiary hospital in Saudi Arabia. Methods: This study is a retrospective analysis of MEs reported by health care professionals at a large tertiary hospital in Saudi Arabia between 2015 and 2016. Results: There were a total of 9123 MEs involving 84 different medications. In total, 109 382 drugs were ordered. Thus, 8.3 MEs per 100 prescriptions were reported during the study period. Thirty-nine errors (0.4%) reached the patient, but did not cause any harm. Transcribing errors accounted for more than half of the MEs (n = 4856, 53.2%). Physicians were the least likely to report an ME (n = 159, 1.7%), whereas pharmacists reported more MEs than any other health care professional (n = 4924, 54%). The most common drug causes of MEs were paracetamol, salbutamol, and amoxicillin, which accounted for 21.0%, 16.6%, and 12.4% of MEs, respectively, over the study period. Conclusions: Medication errors are common in pediatric care, especially for drugs such as paracetamol and amoxicillin that are frequently prescribed. Transcription error was common in this study and is more likely to be reported by pharmacists.

Molecular and serological studies of Egyptian strains of rabbit haemorrhagic disease virus and their comparison with vaccine strains.

Vaccination is the major control measure for rabbit haemorrhagic disease virus (RHDV). The co-circulation of different RHDV genotypes in Egypt has led to the need to determine the most effective vaccine strain and the cross-protection between these genotypes. Rabbits seronegative for RHDV were vaccinated with the commercial GI.1a (RHDVa) vaccine strain Giza2006 and the GI.1d (G5) vaccine strain Giza97. The rabbits were challenged three weeks post vaccination with GI.1a (RHDVa) strains Giza2010 and Kal2012 and GI.1d (G5) RHDV Giza97 and RHDV2014 to determine the degree of cross-protection and evaluate immunity and cross-reactivity by haemagglutination inhibition (HI) and indirect enzyme-linked immunosorbent assay (iELISA). Both vaccines were fully protective three weeks post vaccination, with 95% protection for the GI.1a vaccine and 94.7% for the GI.1d vaccine, with no direct relationship between mortality rates and the genotype of the challenge strain. The antibody titres obtained using the HI test were one log higher for the GI.1a compared with the GI.1d vaccine, but post-challenge titres showed increased responses, expressed as 1?3 log2 higher titres, for the GI.1d vaccine. Sequence and phylogenetic analysis of the Egyptian strain RHDV2014 revealed its relatedness to the GI.1d genotype and showed no evidence of the presence of GI.2 in Egypt until 2014. In conclusion, both GI.1d (G5) and GI.1a (RHDVa)-based vaccines are protective against both RHDV genotypes present in Egypt but continuous monitoring of circulating strains is essential because the arrival of GI.2 in Egypt will require new vaccination strategies.

La vaccination est un outil majeur de lutte contre le virus de la maladie hémorragique virale du lapin (RHDV). Compte tenu de la circulation concomitante en égypte de plusieurs génotypes différents du RHDV, il a fallu déterminer quelle était la souche vaccinale la plus efficace ainsi que le niveau de protection croisée parmi ces génotypes. Des lapins séronégatifs au RHDV ont été vaccinés, en recevant soit la souche vaccinale commerciale Giza2006 du sous-type GI.1a (RHDVa), soit la souche vaccinale Giza97 du sous-type GI.1d (G5). Trois semaines après la vaccination, les lapins ont été soumis à une épreuve virulente, avec les souches Giza2010 et Kal2012 du sous-type GI.1a (RHDVa) et avec les souches Giza97 et RHDV2014 du sous-type GI.1d (G5) du RHDV. La protection conférée par les deux vaccins trois semaines après la vaccination était complète, avec un taux de protection de 95 % pour le vaccin GI.1a et de 94,7 % pour le vaccin GI.1d, et aucune relation directe n'a pu être établie entre les taux de mortalité et le génotype auquel appartenait la souche utilisée pour l'épreuve virulente. Les titres d'anticorps inhibiteurs de l'hémagglutination (HI) étaient supérieurs de 1 log chez les sujets ayant reçu des souches GI.1a par rapport à ceux ayant reçu des souches GI.1d, mais les titres post-inoculation d'épreuve ont révélé une réponse accrue, exprimée par des titres supérieurs de 1 à 3 log2 chez les sujets vaccinés avec des souches GI.1d. L'analyse des séquences et l'étude phylogénétique de la souche égyptienne RHDV2014 ont révélé sa parenté avec le génotype GI.1d et permis d'établir que le génotype GI.2 n'était pas présent en égypte avant 2014. En conclusion, tant les vaccins basés sur le génotype GI.1d (G5) que ceux basés sur le génotype GI.1a (RHDVa) sont protecteurs vis-à-vis des génotypes du RHDV présents en égypte, mais il conviendra d'exercer une surveillance continue des souches en circulation dans le pays car l'introduction du génotype GI.2 en égypte devra être suivie de nouvelles stratégies de vaccination.

La vacunación es la principal medida de lucha contra el virus de la enfermedad hemorrágica del conejo (RHDV). La circulación simultánea de diferentes genotipos del virus en Egipto ha hecho necesario determinar cuál de esos genotipos constituye la cepa vacunal más eficaz y hasta qué punto hay protección cruzada entre ellos. En primer lugar, a una serie de conejos seronegativos para el RHDV se les administró bien la vacuna comercial GI.1a (RHDVa), con la cepa vacunal Giza2006, o bien la vacuna GI.1d (G5), con la cepa vacunal Giza97. Tres semanas después, los animales fueron infectados con las cepas Giza2010 y Kal2012, del genotipo GI.1a (RHDVa), y con las cepas Giza97 y RHDV2014, del genotipo GI.1d (G5), a fin de determinar el grado de protección cruzada y de evaluar el nivel de inmunidad y reactividad cruzada por inhibición de la hemaglutinación y enzimoinmunoanálisis indirecto (iELISA). Ambas vacunas confirieron plena protección a las tres semanas de la administración, con un porcentaje de protección del 95% en el caso de la vacuna GI.1a y del 94,7% en el de la vacuna GI.1d, sin que se observara relación directa alguna entre las tasas de mortalidad y el genotipo de la cepa de infección utilizada. Los valores de títulos de anticuerpos obtenidos con la prueba de inhibición de la hemaglutinación que indujeron las vacunas GI.1a fueron superiores en una unidad logarítmica a los de las vacunas GI.1d, pero tras la infección, los títulos pusieron de manifiesto una respuesta más intensa, expresada en títulos 1?3 log2 veces más altos, en el caso de la vacuna GI.1d. El análisis filogenético y de secuencias de la cepa RHDV2014 egipcia reveló su parentesco con el genotipo GI.1d, sin indicio alguno de la presencia de GI.2 en Egipto hasta 2014. La conclusión es que tanto las vacunas a base de GI.1d (G5) como las de GI.1a (RHDVa) ofrecen protección contra los dos genotipos del virus presentes en el país, aunque no deja de ser imprescindible una vigilancia continua de las cepas circulantes, pues la llegada a Egipto de la cepa GI.2 hará necesarias nuevas estrategias de vacunación.

Insulin resistance and body composition in cancer patients.

Cancer cachexia, weight loss with altered body composition, is a multifactorial syndrome propagated by symptoms that impair caloric intake, tumor byproducts, chronic inflammation, altered metabolism, and hormonal abnormalities. Cachexia is associated with reduced performance status, decreased tolerance to chemotherapy, and increased mortality in cancer patients. Insulin resistance as a consequence of tumor byproducts, chronic inflammation, and endocrine dysfunction has been associated with weight loss in cancer patients. Insulin resistance in cancer patients is characterized by increased hepatic glucose production and gluconeogenesis, and unlike type 2 diabetes, normal fasting glucose with high, normal or low levels of insulin. Cancer cachexia results in altered body composition with the loss of lean muscle mass with or without the loss of adipose tissue. Alteration in visceral adiposity, accumulation of intramuscular adipose tissue, and secretion of adipocytokines from adipose cells may play a role in promoting the metabolic derangements associated with cachexia including a proinflammatory environment and insulin resistance. Increased production of ghrelin, testosterone deficiency, and low vitamin D levels may also contribute to altered metabolism of glucose. Cancer cachexia cannot be easily reversed by standard nutritional interventions and identifying and treating cachexia at the earliest stage of development is advocated. Experts advocate for multimodal therapy to address symptoms that impact caloric intake, reduce chronic inflammation, and treat metabolic and endocrine derangements, which propagate the loss of weight. Treatment of insulin resistance may be a critical component of multimodal therapy for cancer cachexia and more research is needed.

Insulin resistance and body composition in cancer patients.

Cancer cachexia, weight loss with altered body composition, is a multifactorial syndrome propagated by symptoms that impair caloric intake, tumor byproducts, chronic inflammation, altered metabolism, and hormonal abnormalities. Cachexia is associated with reduced performance status, decreased tolerance to chemotherapy, and increased mortality in cancer patients. Insulin resistance as a consequence of tumor byproducts, chronic inflammation, and endocrine dysfunction has been associated with weight loss in cancer patients. Insulin resistance in cancer patients is characterized by increased hepatic glucose production and gluconeogenesis, and unlike type 2 diabetes, normal fasting glucose with high, normal or low levels of insulin. Cancer cachexia results in altered body composition with the loss of lean muscle mass with or without the loss of adipose tissue. Alteration in visceral adiposity, accumulation of intramuscular adipose tissue, and secretion of adipocytokines from adipose cells may play a role in promoting the metabolic derangements associated with cachexia including a proinflammatory environment and insulin resistance. Increased production of ghrelin, testosterone deficiency, and low vitamin D levels may also contribute to altered metabolism of glucose. Cancer cachexia cannot be easily reversed by standard nutritional interventions and identifying and treating cachexia at the earliest stage of development is advocated. Experts advocate for multimodal therapy to address symptoms that impact caloric intake, reduce chronic inflammation, and treat metabolic and endocrine derangements, which propagate the loss of weight. Treatment of insulin resistance may be a critical component of multimodal therapy for cancer cachexia and more research is needed.

Development of an electrochemical surface-enhanced Raman spectroscopy (EC-SERS) fabric-based plasmonic sensor for point-of-care diagnostics.

Early disease diagnosis is crucial for timely and effective healthcare monitoring and treatment. Demand for modern point-of-care (POC) technologies has increased during the past decade. Continuous monitoring of patient health status can be achieved through wearable sensors which can be incorporated into clothing and other wearables. While electronic textiles that monitor physical parameters (heart rate, blood pressure, etc.) are increasingly commonplace, smart textiles capable of monitoring chemical biomarkers are much less common. In this work, a conductive plasmonic electrochemical sensor was developed from a cotton blend fabric modified with silver nanoparticles and conductive inks. para-Aminothiophenol (pATP) was used as an initial probe molecule to evaluate the performance of the fabric-based electrode for electrochemical surface-enhanced Raman spectroscopic (EC-SERS) measurements. Further investigation was then carried out to detect levofloxacin, a commonly prescribed antibiotic, in both 0.1 M NaF and synthetic urine as supporting electrolyte. It was found that the fabric-based electrode provided excellent EC-SERS signals, comparable to commercial screen-printed electrodes, allowing for rapid detection of levofloxacin at clinically relevant concentrations. To the best of our knowledge, this is the first time a fabric-based electrode has been reported for EC-SERS investigations, highlighting a promising platform for wearable point-of-care sensors.

Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India.

BACKGROUND & OBJECTIVES: Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India. METHODS: A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI. RESULTS: Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05). INTERPRETATION & CONCLUSIONS: HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Musculoskeletal injuries in British Army recruits: a prospective study of incidence in different Infantry Regiments.

BACKGROUND: Musculoskeletal injuries and attrition incurred during basic military training are a significant socioeconomic burden across many Defence Forces. In order to plan an injury prevention strategy, the purpose of this study was to quantify the regiment-specific musculoskeletal injury patterns and training outcomes. METHODS: This was a prospective observational study of the Parachute (n=734), Guards (n=1044), Line (n=3472) and Gurkha (n=458) Regiments of the British Army recruits during a 26-week basic military training programme over a 2-year period. The participant demographic characteristics were: age 18.9 years (SD±2.3), height 176.5 cm (SD±7.80), mass 69 kg (SD±9.7) and body mass index 22.14 kg/m2 (SD±2.5). RESULTS: The incidence of injuries (86%, 46%, 48% and 10%) was significantly different (p<0.001) as were the first time pass out rates (p=0.02) of 38%, 51%, 56% and 98% for Parachute, Guards, Line and Gurkha, respectively. Overuse injuries were more frequently reported than both acute and recurrent injuries in all regiments (X2=688.01, p<0.01). CONCLUSIONS: The disparity in injury incidence and training outcome between Infantry Regiments suggests that the demands of training be taken into account when devising injury prevention strategies.

Emotional and behavioral disturbances in school going HIV positive children attending HIV clinic.

BACKGROUND: To study the emotional and behavioral disturbances (EBD) in school going HIV positive children attending HIV center in a tertiary care hospital. METHOD: This cross-sectional study was conducted on 258 HIV infected children between 6 and 16 years of age, 200 were on Anti-retroviral therapy (ART) and 58 were not on ART. They were evaluated for EBD by using Pictorial Pediatric Symptom Checklist (PPSC) screening tool. A cut-off score of 28 was taken as significant for detecting early EBD. RESULTS: The prevalence of EBD in our study is 11.2%. Demographic and disease related profile were assessed for correlation with EBD. Type of family (p = 0.023), school attendance (p = 0.034), school performance (p = 0.045), and CD4 count (p = 0.015) were detected to have significant association with early manifestation of EBD in the study group. CONCLUSIONS: HIV positive children who have low CD4 count, poor school attendance, and performance are at a higher risk of being detected with EBD. Screening with PPSC to identify EBD in HIV positive children attending HIV clinic in a hospital setting could help in early diagnosis and management.