Controversies regarding management of Helicobacter pylori infections.

PURPOSE OF REVIEW: The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies. RECENT FINDINGS: We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy. SUMMARY: Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.

Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

Transcriptome, proteome, and protein synthesis within the intracellular cytomatrix.

Despite the knowledge that protein translation and various metabolic reactions that create and sustain cellular life occur in the cytoplasm, the structural organization within the cytoplasm remains unclear. Recent models indicate that cytoplasm contains viscous fluid and elastic solid phases. We separated these viscous fluid and solid elastic compartments, which we call the cytosol and cytomatrix, respectively. The distinctive composition of the cytomatrix included structural proteins, ribosomes, and metabolome enzymes. High-throughput analysis revealed unique biosynthetic pathways within the cytomatrix. Enrichment of biosynthetic pathways in the cytomatrix indicated the presence of immobilized biocatalysis. Enzymatic immobilization and segregation can surmount spatial impediments, and the local pathway segregation may form cytoplasmic organelles. Protein translation was reprogrammed within the cytomatrix under the restriction of protein synthesis by drug treatment. The cytosol and cytomatrix are an elaborately interconnected network that promotes operational flexibility in healthy cells and the survival of malignant cells.

Utilization of Current Diagnostic Indicators to Characterize Pediatric Undernutrition among US Children.

The purpose of this study was to estimate the prevalence of pediatric undernutrition in the US general population using the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus statement on identification of pediatric malnutrition (undernutrition). National Health and Nutrition Examination Survey (NHANES) data for years 2005-2014 was analyzed for children ages 1-13 years (n = 13,950) with valid anthropometric data. The prevalence of undernutrition was assessed through z-scores for weight-for-height, body mass index (BMI)-for-age, height-for-age, and mid-upper-arm circumference-for-age generated from the 2000 Centers for Disease Control and Prevention growth charts. Children were stratified into: no undernutrition, mild undernutrition, and moderate or severe undernutrition. Descriptive statistics were used to identify the prevalence of undernutrition. Differences in Z-scores across growth chart metrics were compared across undernutrition categories using analysis of variance. The total prevalence of pediatric undernutrition in this sample was 0.4% (severe undernutrition), 2.0% (moderate undernutrition), and 10.9% (mild undernutrition) for all ages. Z-scores differed significantly across all levels of undernutrition for all anthropometrics, showing poorer mean growth metrics in those with undernutrition. Pediatric undernutrition is a prevalent condition that transcends the prior focus on <5th percentile of growth curves and impacts children across different demographic categories.

Retrospective Analysis of Population Demographic Characteristics, Medical Interventions, and Resource Use at a Medical Student-Run Clinic on the Texas-Mexico Border.

PURPOSE: The study's purpose was to assess population demographics and resource utilization of the Medical Student Run Clinic, which provides primary care services to patients in El Paso, Texas along the Texas-Mexico border. METHODS: A retrospective cross-sectional chart review was performed on 760 patients evaluated at the medical student-run clinic between 2013 and 2016. Data included demographic characteristics, chief complaints, diagnoses, and interventions, which were analyzed with calculations of means, standard deviations, and percentages. RESULTS: Most (79.7%) patients were female; average age was 38.43 years; 91% of patients were Hispanic, and 66.8% spoke Spanish. Average BMI was 30.9 kg/m2. Less than 1% of patients presented with a psychiatric complaint; however, 17.9% screened positive for anxiety, and 16.5% screened positive for depression. CONCLUSIONS: This study shows that diabetes, hypertension, obesity, anxiety, and depression represent avenues for future patient-centered interventions and provide insight into challenges patients face along the border.