Perceptions of Continuous Glucose Monitoring Systems in the T1D Exchange Diabetes Registry: Satisfaction, Concerns, and Areas for Future Improvement.

Manufacturers continue to improve performance and usability of continuous glucose monitoring (CGM) systems. As CGM becomes a standard of care, especially for people on insulin therapy, it is important to routinely gauge how satisfied people with diabetes are with this technology. This article describes survey feedback from a large cohort of people with diabetes using older and current CGM systems and highlights areas of current satisfaction, concern, and future system improvement.

Evaluating methods to create protein functionalized catanionic vesicles.

Catanionic surfactant vesicles (SVs) composed of sodium dodecylbenzenesulfonate (SDBS) and cetyltrimethylammonium tosylate (CTAT) have potential applications as targeted drug delivery systems, vaccine platforms, and diagnostic tools. To facilitate these applications, we evaluated various methods to attach proteins to the surface of SDBS/CTAT vesicles. Acid phosphatase from wheat germ was used as a model protein. Acid phosphatase was successfully conjugated to vesicles enriched with a Triton-X 100 derivative containing an unsaturated ester. Enzymatic activity of acid phosphatase attached to vesicles was assessed using an acid phosphatase assay. Results from the acid phosphatase assay indicated that 15 ± 3% of the attached protein remained functional but the presence of vesicles interferes with the assay. DLS and zeta potential results correlated with the protein functionalization studies. Acid phosphatase functionalized vesicles had an average diameter of 175 ± 85 nm and an average zeta potential of -61 ± 5 mV in PBS. As a control, vesicles enriched with Triton-X 100 were prepared and analyzed by DLS and zeta potential measurements. Triton X-100 enriched vesicles had an average diameter of 140 ± 67 nm and an average zeta potential of -49 ± 2 mV in PBS. Functionalizing the surface of SVs with proteins may be a key step in developing vesicle-based technologies. For drug delivery, antibodies could be used as targeting molecules; for vaccine formulation, functionalizing the surface with spike proteins may produce novel vaccine platforms.

Grading system for medullary thyroid carcinoma; an institutional experience.

OBJECTIVE: Medullary thyroid carcinoma (MTC) is a rare type of thyroid malignancy. Recently, a two-tier grading system (GS) for MTC has been suggested. We conducted this study to evaluate the generalizability, as well as application of recently proposed GS to our cohort of Medullary thyroid carcinoma (MTC) cases. METHODS: We assigned grades to MTC cases and divided them into two groups by using morphologic criteria only as suggested by recent studies: low-grade (LG, <5 mitosis per 2 mm2, and no necrosis) and high-grade (HG, ≥5 mitosis per 2mm2 or necrosis). RESULTS: A total of 59 MTC cases were evaluated and of those 52 (88 %) were LG and 7 (12 %) were HG. Vascular invasion (VI) (p = 0.017), distant metastasis (DM) (p < 0.0001), nuclear pleomorphism (NP) (p = 0.017) and prominent nucleoli (p = 0.03) were prominently noted in the HG group. After controlling for demographics using multivariate cox regression, tumor grade and necrosis remained significantly associated with the overall survival (HR = 22.7, p < 0.01 and HR = 11.1, p = 0.008, respectively). Upon comparing the cases with and without nodal disease, we found that nodal disease is more strongly associated with NP (p = 0.029), tumor fibrosis (p = 0.0001), VI (p = 0.001) and DM (p = 0.005). CONCLUSIONS: We applied the two-tier GS for MTC to our cohort of cases and found statistically significant differences in the overall survival among the two groups. Adding the grading to the pathology report communicates additional information regarding risk stratification in MTC.

CONCENTRATED INSULINS: CLINICAL UPDATE OF THERAPEUTIC OPTIONS.

Improved glycemic control is associated with a reduced risk of diabetic complications. Optimal management of patients with type 2 diabetes includes nutritional therapy, physical activity, and pharmacotherapy for glycemic control. Most patients with type 2 diabetes are initially managed with oral antidiabetic agents, but as ß-cell function declines and the disease progresses, insulin therapy is frequently needed to maintain glycemic control. Insulin therapy given with multidose insulin injection regimen or by continuous insulin infusion is needed for patients with type 1 diabetes to achieve control. Obesity and its associated insulin resistance contribute to greater insulin requirements in patients with both type 1 and type 2 diabetes to achieve glycemic control, creating a need for concentrated insulin. Concentrated insulin formulations can be prescribed as an alternative to 100 unit/mL insulin and provide the advantage of low injection volume, leading to less pain and possibly fewer insulin injections. This review includes a stepwise analysis of all currently available concentrated insulin products, analyzes the most up-to-date evidence, and presents this in combination with expert guidance and commentary in an effort to provide clinicians with a thorough overview of the characteristics and benefits of concentrated insulins in patients with type 1 and type 2 diabetes-instilling confidence when recommending, prescribing, and adjusting these medications. Abbreviations: A1C = glycated hemoglobin; ß-cell = pancreatic betacell; BG = blood glucose; CI = confidence interval; CSII = continuous subcutaneous insulin infusion; MDI = multiple daily injections; NHANES = National Health and Nutrition Examination Survey; PD = pharmacodynamic; PK = pharmacokinetic; TDD = total daily dose; U100 = 100 units/mL; U200 = 200 units/mL; U300 = 300 units/mL; U500 = 500 units/mL; USD = United States dollars.

Association between provider type and cesarean birth in healthy nulliparous laboring women: A retrospective cohort study.

BACKGROUND: Term nulliparous women have the greatest variation across hospitals and providers in cesarean rates and therefore present an opportunity to improve quality through optimal care. We evaluated associations between provider type and mode of birth, including examination of intrapartum management in healthy, laboring nulliparous women. METHODS: Retrospective cohort study using prospectively collected perinatal data from a United States academic medical center (2005-2012). The sample included healthy nulliparous women with spontaneous labor onset and term, singleton, vertex fetus managed by either obstetricians or certified nurse-midwives. Univariate and multivariate logistic regression was used to compare labor interventions and mode of birth by provider type. RESULTS: A total of 1339 women received care by an obstetrician (n = 749) or nurse-midwife (n = 590). The cesarean rate was 13.4% (179/1339). Adjusting for maternal and pregnancy characteristics, care by obstetricians was associated with an increased risk of unplanned cesarean birth (adjusted odds ratio [aOR] 1.48 [95% confidence interval {CI} 1.04-2.12]) compared with care by midwives. Obstetricians more frequently used oxytocin augmentation (aOR 1.41 [95% CI 1.10-1.80]), neuraxial anesthesia (aOR 1.69 [95% CI 1.29-2.23]), and operative vaginal delivery with forceps or vacuum (aOR 2.79 [95% CI 1.75-4.44]). Adverse maternal or neonatal outcomes were not different by provider type across all modes of birth, but were more frequent in women with cesarean than vaginal births. DISCUSSION: In low-risk nulliparous laboring women, care by obstetricians compared with nurse-midwives was associated with increased risk of labor interventions and operative birth. Changes in labor management or increased use of nurse-midwives could decrease the rate of a first cesarean in low-risk laboring women.

Synthesis and pharmacological evaluation of mono-arylimidamides as antileishmanial agents.

Arylimidamide (AIA) compounds containing two pyridylimidamide terminal groups (bis-AIAs) possess outstanding in vitro antileishmanial activity, and the frontrunner bis-AIA DB766 (2,5-bis[2-(2-isopropoxy)-4-(2-pyridylimino)aminophenyl]furan) is active in visceral leishmaniasis models when given orally. Eighteen compounds containing a single pyridylimidamide terminal group (mono-AIAs) were synthesized and evaluated for their antileishmanial potential. Six of these compounds exhibited sub-micromolar potency against both intracellular Leishmania donovani and Leishmania amazonensis amastigotes, and three of these compounds also displayed selectivity indexes of 25 or greater for the parasites compared to a J774 macrophage cell line. When given orally at a dose of 100mg/kg/day for five days, compound 1b (N-(3-isopropoxy-4-(5-phenylfuran-2-yl)phenyl)picolinimidamide methanesulfonate) reduced liver parasitemia by 46% in L. donovani-infected mice. Mono-AIAs are thus a new class of candidate molecules for antileishmanial drug development.

Individual, housing, and neighborhood correlates of asthma among young urban children.

Using data from a large cohort of urban children, this study identified multilevel correlates of asthma to determine whether neighborhood attributes remain associated with asthma after adjustment for individual level and immediate housing characteristics. A cross-sectional analysis was conducted using data from the Fragile Families and Child Well-being Study and its substudy, the In-Home Longitudinal Study of Pre-Schooled Age Children (n = 1,784). The primary outcome was asthma diagnosis by age 5. Sociodemographic measures were assessed via telephone survey, housing and block conditions recorded via direct observation, and neighborhood characteristics came from geocoded census tract data. After multivariable adjustment, non-Hispanic Black, Puerto Rican, or other Hispanic race, child's lack of insurance coverage, male gender, presence of allergies, the exterior condition of a child's home, mother's educational attainment, and the percent of the neighborhood population with a bachelor's degree remained significantly associated with having received an asthma diagnosis by age 5. The authors identified sociodemographic and economic factors at the individual, household, and neighborhood level which are correlates of childhood asthma in urban areas. After adjustment for more proximal characteristics, the effects of all neighborhood markers were minimal, with the exception of neighborhood education.

Improved Glycemic Control Using a Bluetooth®-Connected Blood Glucose Meter and a Mobile Diabetes App: Real-World Evidence From Over 144 000 People With Diabetes.

BACKGROUND: The OneTouch Verio Flex® (OTVF) blood glucose (BG) meter features a ColorSure® Range Indicator. Diabetes management is enhanced by connecting the meter to the OneTouch Reveal® (OTR) mobile app. We sought to provide real-world evidence (RWE) that combining both devices improves glycemic control. METHODS: Anonymized glucose and app analytics were extracted from a server from over 144 000 people with diabetes (PWDs). Data from their first 14 days using OTVF and OTR were compared with 14 days prior to 90- and 180-day timepoints using paired within-subject differences. RESULTS: In people with type 1 diabetes (PwT1D) or people with type 2 diabetes (PwT2D), readings in-range (RIR) improved by +6.1 (54.5% to 60.6%) and +11.9 percentage points (68.2% to 80.1%), respectively, over 180 days, and hyperglycemia was reduced by -6.6 (40.5% to 33.9%) and -12.0 (30.3% to 18.3%). In total, 35% of PwT1D and 40% of PwT2D improved RIR by >10 percentage points. People with type 1 diabetes spending two to four sessions or 10 to 20 minutes per week on the app improved RIR by +5.1 and 7.0, respectively. People with type 2 diabetes spending two to four sessions or 10 to 20 minutes per week on the app improved RIR by +11.6 and 12.0, respectively. In PwT1D or PwT2D, mean BG reduced by -11.4 and -19.5 mg/dL, respectively, from baseline to 180 days, with no clinically meaningful changes in percentage of hypoglycemic readings. All glycemic changes were statistically significant (P < .0005 level). CONCLUSION: Real-world data from over 144 000 PWDs demonstrated improved percentage readings in-range and reduced hyperglycemia in PWDs using the OneTouch Verio Flex blood glucose meter and OneTouch Reveal app.

Sustained Improvements in Readings in-Range Using an Advanced Bluetooth® Connected Blood Glucose Meter and a Mobile Diabetes App: Real-World Evidence from more than 55,000 People with Diabetes.

INTRODUCTION: The OneTouch Verio Reflect® (OTVR) Blood Glucose Meter features a color range indicator and provides on-meter guidance, insights, and encouragement. Diabetes management is enhanced by the OneTouch Reveal® (OTR) Mobile App. We sought to provide real-world evidence (RWE) that combining devices improves glycemia. METHODS: Anonymized glucose and app analytics from more than 55,000 people with diabetes (PWDs) were extracted from a server. Data from their first 14 days using OTVR Meter and OTR App was compared with 14 days prior to 90- and 180-day timepoints using paired within-subject differences. RESULTS: In people with type 1 (PwT1D) or type 2 diabetes (PwT2D), readings in-range (RIR 70-180 mg/dL) improved by 7.8 percentage points (57.9-65.7%) and 12.0 percentage points (72.8-84.8%), respectively, over 180 days and hyperglycemia (> 180 mg/dL) was reduced by - 8.4 percentage points (37.9-29.5%) and - 12.2 percentage points (26.2-14.1%). RIR improved by > 10 percentage points in 38% of PwT1D and 39% of PwT2D. PwT1D spending > 2 to 4 sessions or > 10 to 20 min per week on the app improved RIR by 7.0 and 8.2 percentage points, respectively. PwT2D spending > 2 to 4 sessions or > 10 to 20 min per week on the app improved RIR by 12.6 and 12.1 percentage points, respectively. In PwT1D or T2D, mean blood glucose reduced by - 14.3 and - 19.8 mg/dL, respectively, from baseline to 180 days, with no clinically meaningful changes in percentage of hypoglycemic readings (< 70 mg/dL). PwT1D 65 years and older performed the most app sessions (10 per week) and improved RIR by 7.9 percentage points. PwT2D 65 years and older spent more time on the app (45 min per week) than PwT2D of any other age and improved RIR by 7.6 percentage points. All glycemic changes were statistically significant (p < 0.0005). CONCLUSION: Real-world data from more than 55,000 PWDs demonstrates sustained improvements in readings in-range in PWDs using the OneTouch Verio Reflect Blood Glucose Meter and OneTouch Reveal App.

Patient and Healthcare Professional Satisfaction with the OneTouch Verio Reflect® Blood Glucose Monitoring System in the UAE.

AIMS: The goal of this study was to collect the opinions of patients and HCPs who used OneTouch Verio Reflect® in the United Arab Emirates (UAE). BACKGROUND: Blood glucose monitoring devices are essential tools that aid healthcare professionals (HCPs) in improving outcomes in people with diabetes. OBJECTIVES: To assess the satisfaction of patients and HCPs with the new functionalities of the OneTouch Verio Reflect® Blood Glucose Meter (BGM). METHODS: We conducted a multicenter cross-sectional study that recruited eight HCPs and 100 patients with diabetes who had used OneTouch Verio Reflect® with OneTouch Verio® test strips for four weeks in four hospitals in the UAE. RESULTS: Around 98% of patients and HCPs declared their satisfaction with the new features in the OneTouch Verio Reflect® BGM. Participants' responses were not associated with the duration of diabetes (p-values >0.05) except for the Results Log feature (p-value=0.016). Patients rated Blood Sugar Mentor® messages, which include mentor tips, pattern messages, and awards, as the most important features, while HCPs rated ColorSure® Dynamic Range Indicator as the most helpful feature. Patients and HCPs stated that the "pattern found (high glucose)," which was the most frequently seen message, was the most useful message. All HCPs strongly agreed that the ColorSure® Dynamic Range Indicator helped them understand results and 98% of patients agreed that automated meter messages helped them to be more confident in following HCP recommendations. CONCLUSION: Patients and HCPs indicated high levels of satisfaction with the features within the OneTouch Verio Reflect® meter.

Clinical Practice Experiences Using a Professional Diabetes Management Ecosystem During COVID.

BACKGROUND: Challenges of patient care in diabetes were exacerbated by COVID, undermining the ability of patients to engage in-person with health care professionals (HCPs). To combat this, there has been accelerated adoption of telemedicine to support patient and provider connectivity. METHODS: We collated survey information regarding telemedicine from 21 European clinical institutions. Health care professionals joined virtual meetings focusing on the OneTouch Reveal (OTR) ecosystem and its utility for conducting telemedicine. Selected HCPs provided clinical case studies to explain how the OTR ecosystem supported patient care. RESULTS: Remote consultations increased by nearly 50% in 21 European clinics during the pandemic (Belgium [24%], Iberia [65%], Germany [34%], Italy [54%]). In all, 52% of people with diabetes using OTR app to connect remotely with HCPs had type 1 diabetes and 48% had type 2 diabetes. Remote connection methods included telephone (60%), email (19%), video chat (10%), text only (3%), or a mix of these methods (8%). Health care professionals usually reviewed patient data during consultations (45%) rather than before consultations (25%). Fifty-five percent of HCPs indicated digital ecosystems like OTR ecosystem would become their standard of care for diabetes management. In-depth conversations with HCPs provided a deeper understanding of how a digital ecosystem integrated into clinical practice and population management. In addition, five patient case studies using OTR ecosystem were provided by a selection of our HCPs. CONCLUSION: Diabetes management solutions, such as OTR ecosystem, supported telemedicine during the pandemic and will continue to play a valuable role in patient care beyond the pandemic.

The Global Otolaryngology-Head and Neck Surgery Workforce.

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults.

The authors examined the association between life events and antihypertensive medication adherence in older adults and the moderating role of coping. A cross-sectional analysis was conducted by using data (n = 1,817) from the Cohort Study of Medication Adherence among Older Adults (recruitment conducted from August 2006 through September 2007). Life events occurring in the 12 months preceding the study interview were assessed via the Holmes Rahe Social Readjustment Rating Scale (SRRS), and coping levels were assessed via an adapted version of the John Henry Active Coping Scale. Low adherence to antihypertensive medication was defined as scores less than 6 on the 8-item Morisky Medication Adherence Scale (known as "MMAS-8"). Of study participants, 13.2% had low adherence, and 27.2% and 5.0% had medium (150-299) and high (≥300) SRRS scores, respectively. After multivariable adjustment, the odds ratios for low adherence associated with medium and high, versus low, SRRS were 1.50 (95% confidence interval: 1.11, 2.02) and 2.11 (95% confidence interval: 1.24, 3.58), respectively. When multivariable models were stratified by coping level, the association between life events and adherence was evident only among participants with low coping levels.

Real-World Evidence of Improved Glycemic Control in People with Diabetes Using a Bluetooth-Connected Blood Glucose Meter with a Mobile Diabetes Management App.

Background: The OneTouch Verio Reflect (OTVR) meter provides ColorSure Dynamic Range Indicator (DCRI) and Blood Sugar Mentor (BSM) features that are complemented by the OneTouch Reveal (OTR) mobile app. We sought to provide real-world evidence that these products support improved glycemic control. Methods: Anonymised glucose and app analytics were extracted from the LifeScan server for 4154 people with type 1 diabetes (PwT1D) and 13,623 people with type 2 diabetes (PwT2D). Data from their first 14 days were compared with the 14 days before the 90-day time point using paired within-subject differences. Results: Percentage glucose readings in range (RIR) 70-180 mg/dL improved by +8.1% (from 58% to 66.1%) in PwT1D and by +11.2% (from 72.4% to 83.6%) in PwT2D. Hyperglycemic readings (>180 mg/dL) reduced by -8.5% (from 37.1% to 28.6%) in PwT1D and by -11.3% (from 26.4% to 15.1%) in PwT2D. Mean glucose reduced on average by -14.5 mg/dL (from 174.8 to 160.2 mg/dL) in PwT1D and -18.2 mg/dL (from 157.8 to 139.6 mg/dL) in PwT2D. Glycemic improvement was strongly associated with OTR app engagement. Two to three sessions or 11 to 20 min/week in the app improved readings in range in PwT1D by +7.0% or +8.4%, respectively. Similar engagement trends for glycemic improvement were observed in PwT2D. Proportions of subjects achieving a 5% or 10% improvement in RIR were 46.9%/36.6% for PwT1D and 48.7%/37.7% for PwT2D. Conclusions: Real-world data from over 17,000 people with diabetes (PWDs) demonstrated significantly improved readings in range and reduced the burden of hyperglycemia in PWDs using the OTVR meter and OTR app.

Telephone triage does not improve attendance rates in a paediatric audiology outpatient service.

AIMS: To investigate the impact of clinician-led telephone consultation during the New Zealand COVID-19 lockdown on subsequent appointment attendance in a paediatric audiology service, particularly for Maori and Pacific families. METHODS: A retrospective clinical audit at Counties Manukau Health of all children (>3 years old) on the audiology waiting list. Binary logistic regression analysis tested for association of appointment attendance following attempted audiologist-led telephone consultation, with ethnicity, waiting times, socio-economic deprivation levels and telephone consultation contact. RESULTS: Of 349 eligible children, 208 families participated in telephone consultations (59%). Ten percent of those contacted were able to be discharged as no longer requiring care. There were no differences in attendance rates between those who had participated in telephone consultation and those who had not (77.5% versus 77.8%). Pacific and Maori children were 68% and 64% less likely to attend appointments after adjusting for socio-economic deprivation level, waiting time and telephone consultation compared to NZ European children. Longer waiting times were significantly associated with decreased attendance rates. CONCLUSIONS: Attendance was found to be associated with ethnicity and waiting times. Telephone consultation did not improve attendance rates overall nor for ethnicity subgroups. It is therefore concluded that telephone consultation was found to be of only limited benefit in paediatric audiology services.

Ear and hearing health in Niue: a qualitative study on the worldviews, knowledge, beliefs and use of health care.

Introduction Hearing is a primary sense that facilitates the development of spoken language, social connection and an appreciation of sounds within the natural world. Hearing loss has multiple adverse effects across the life course. Understanding the worldviews of ear and hearing health in Pacific peoples is crucial to inform responsive and appropriate hearing health and primary healthcare services. Aim To understand the worldviews, knowledge and beliefs held by the Niuean community in Niue towards ear and hearing health, and the use of healthcare methods to contribute to service development. Methods Twenty semi-structured interviews were conducted with Niuean community members. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis methods. Results Niuean people value hearing health as an important way to communicate and connect with each other. They are proactive health seekers, have good knowledge about ear disease and hearing health and use mainstream medicines alongside spiritual practices and traditional remedies to maintain good ear and hearing health. The hospital system is responsive and accessible to the community's needs, contrasting with Pacific people's access to hearing health services in New Zealand. Discussion There is a high level of awareness of the importance of hearing health amongst the Niuean community and good accessibility and utilisation of healthcare services. There is potential to implement locally focused ear and hearing health strategies in Niue and conduct hearing health research among the New Zealand-based Niuean community to improve primary healthcare services delivery.

University student perceptions of health and disease during remote learning in the COVID-19 pandemic.

OBJECTIVES: Assess student perceptions of health and disease during remote learning in the COVID-19 pandemic. PARTICIPANTS: Convenience sample of undergraduate students at a liberal arts university (n = 67). METHODS: Survey administered across multiple sections of a required general education course in Spring 2020. Measures included Fear of COVID-19 Scale, Multidimensional Health Locus of Control, Perceived Health Competence, and COVID-19 perceived impact on students' communities and wellbeing. RESULTS: Students reported relatively low levels of fear about COVID-19, not differing by number or severity of known cases or community impact (p = 0.67, 0.55, 0.11, respectively). Stress and mental health were priority concerns over infectious diseases. Students reported negatively affected emotional (70%) and interpersonal (67%) wellbeing; unexpectedly, over half of students reported positive impacts in ≥ one wellness dimension. CONCLUSIONS: Student-identified concerns emphasized psychosocial wellbeing, suggesting additional need for mental health resources. Low perceived threat of infectious diseases may present barriers to COVID-19-related prevention behaviors.

Performing Calcitonin Immunocytochemistry on an Additional ThinPrep Slide in Fine-Needle Aspiration Diagnosis of Medullary Thyroid Carcinoma.

OBJECTIVES: This study reviewed the institutional experience of performing calcitonin immunostain on an additional ThinPrep slide in fine-needle aspiration (FNA) diagnosis of medullary thyroid carcinoma (MTC). METHODS: Thyroid FNA cases with MTC suspected or included in the differential diagnosis during cytologic evaluation and calcitonin immunostain performed were retrieved and reviewed. RESULTS: Calcitonin immunostain was performed in 132 cases with 41 positive, 81 negative, and 10 indeterminate results. All calcitonin-positive cases had a cytologic diagnosis of MTC while all calcitonin-negative cases were cytologically classified as non-MTCs except for two cases suspicious for MTC. In 10 cases with an indeterminate calcitonin result, diagnoses of non-MTC and suspicious for MTC were rendered in 6 and 4 cases, respectively. Histopathologic follow-up was available in 85 (64%) cases. All cytologically diagnosed MTC cases were confirmed on histopathology. In 3 MTC cases with an indeterminate calcitonin result, 1 case was misclassified cytologically as follicular neoplasm. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of calcitonin immunostain were all 100% for diagnosing MTC. CONCLUSIONS: Our study demonstrates the feasibility of performing calcitonin immunostain on an additional ThinPrep slide. Calcitonin immunocytochemistry is a valuable adjunct test for FNA diagnosis and differential diagnosis of MTC.

Cockroach exposure independent of sensitization status and association with hospitalizations for asthma in inner-city children.

BACKGROUND: Children with asthma living in urban environments experience disproportionately high asthma hospitalization rates. Excessive exposure to perennial allergens, including cockroach and house dust mite (HDM), have been implicated, but data are limited. OBJECTIVE: To examine the relation between cockroach and HDM exposure and measures of asthma morbidity and health care utilization. METHODS: Participants included 86 atopic asthmatic children living in New Orleans, Louisiana. Sensitization status was determined by means of serum specific IgE testing, and vacuum dust samples were collected for allergen analysis. Logistic regression analysis was used to assess the odds of persistent wheezing, emergency department visits, and asthma hospitalization in those with high vs low levels of allergen exposure. RESULTS: Approximately 44% and 40% of children were exposed to Bla g 1 levels greater than 2 U/g and HDM levels greater than 2 µg/g, respectively, and 24% reported at least 1 hospitalization in the previous 4 months. The median Bla g 1 level was significantly higher in the homes of children hospitalized compared with those with no hospital admissions (7.2 vs 0.8 U/g). In multivariable models, the odds of hospitalization were significantly higher in children exposed to Bla g 1 levels greater than 2 U/g (adjusted odds ratio, 4.2; 95% confidence interval, 1.24-14.17), independent of sensitization status. Exposure to HDMs was not associated with any measure of morbidity. CONCLUSIONS: Exposure to cockroach allergen was strongly associated with increased hospitalization in children with asthma. This effect cannot be explained entirely by IgE-mediated inflammation. Controlled interventional trials are needed to determine whether isolated cockroach abatement improves asthma control.