Calcium Blood Level Elevation After Atorvastatin Initiation in a Patient With Hyperparathyroidism.

Atorvastatin is a very common medication used for lowering blood cholesterol levels. The drug has known adverse effects, but an elevation in calcium levels is not listed as one of them. We report a 52-year-old man with hyperparathyroidism and hypercholesterolemia, who, under treatment with atorvastatin, developed an additional rise in calcium levels. He was asymptomatic, and during the investigation of his hypercalcemia, a drug adverse effect was suspected. Therefore, atorvastatin therapy was stopped, and calcium levels dropped as a result. Subsequent readministration of atorvastatin and its cessation produced similar results. While hypercalcemia is not listed as a common adverse effect of atorvastatin, we introduce such a phenomenon along with possible underlying mechanisms. Although our patient was asymptomatic, hypercalcemia can be a dangerous condition, especially in a population where the initial calcium levels are already elevated.

Exploring primary care physician feedback following an integrative oncology consultation.

OBJECTIVE: To explore responses from primary care physicians (PCPs) from an integrative physician (IP) consultation and recommended integrative oncology (IO) treatment program. METHODS: Chemotherapy-treated patients were referred by their oncology healthcare professional to an IP, a physician dually trained in complementary medicine and supportive cancer care. The consultation summary and patient-centered IO treatment program was then sent to the patient's PCP, with PCP-to-IP responses analyzed qualitatively using ATLAS.Ti software for systematic coding and content analysis. Trial Registration Number NCT01860365 published May 22, 2013. RESULTS: Of the 597 IP consultations conducted, 470 (78.7%) summaries were sent to patients' PCPs, with only 69 (14.7%) PCP-to-IP responses returned. PCPs were more likely to respond if the patient was Hebrew-speaking (78.3% vs. 65.1%, P = 0.032). Systematic coding identified four predominant themes among PCP narratives: addressing the patient's medical condition and leading QoL-related concerns; patient-centered reflections; available resources providing support and promoting resilience; and PCP attitudes to the IO treatment program. CONCLUSION: PCP-IP communication can provide valuable insight into the patient's bio-psycho-social care, addressing the patient's health-belief model, emotional concerns, caregiver-related factors, preferences, and barriers to adherence to IO care. PRACTICE IMPLICATIONS: Healthcare services should consider promoting IP-PCP communication in order to facilitate better patient outcomes from an IO treatment program.

Prenatal and postnatal exposure to NO2 and rapid infant weight gain - A population-based cohort study.

BACKGROUND: Childhood overweight and obesity is a global public health problem. Rapid infant weight gain is predictive of childhood overweight. Studies found that exposure to ambient air pollution is associated with childhood overweight, and have linked prenatal exposure to air pollution with rapid infant weight gain. OBJECTIVES: To examine the association between prenatal and postnatal ambient NO2 exposure, a traffic-related marker, with rapid weight gain in infants. METHODS: We carried out a population-based historical cohort study using data from the Israeli national network of maternal and child health clinics. The study included 474,136 infants born at term with birthweight ≥2500 g in 2011-2019 in central Israel. Weekly averages of NO2 concentration throughout pregnancy (prenatal) and the first 4 weeks of life (postnatal) were assessed using an optimized dispersion model and were linked to geocoded home addresses. We modelled weight gain velocity throughout infancy using the SuperImposition by Translation and Rotation (SITAR) method, a mixed-effects nonlinear model specialized for modelling growth curves, and defined rapid weight gain as the highest velocity tertile. Distributed-lag models were used to assess critical periods of risk and to measure relative risks for rapid weight gain. Adjustments were made for socioeconomic status, population group, subdistrict, month and year of birth, and the alternate exposure period - prenatal or postnatal. RESULTS: The cumulative adjusted relative risk for rapid weight gain of NO2 exposure was 1.02 (95% confidence intereval [CI] 1.00, 1.04) for exposure throughout pregnancy and 1.02 (95% CI 1.01, 1.04) for exposure during the first four postnatal weeks per NO2 interquartile range increase (7.3 ppb). An examination of weekly associations revealed that the critical period of risk for the prenatal exposure was from mid-pregnancy to birth. CONCLUSIONS: Prenatal and postnatal exposures to higher concentrations of traffic-related air pollution are each independently associated with rapid infant weight gain, a risk factor for childhood overweight and obesity.

Postnatal exposure to ambient temperature and rapid weight gain among infants delivered at term gestations: a population-based cohort study.

BACKGROUND: The global prevalence of childhood obesity has risen dramatically recently. Previous studies found an association between rapid infant weight gain and childhood overweight. Evidence suggests that exposure to high ambient air temperatures during prenatal life and during adulthood is associated with birthweight and obesity respectively. OBJECTIVE: The objective of this study was to examine whether exposure to high ambient temperatures during infancy is associated with rapid infant weight gain in Israel. METHODS: This is a population-based historical cohort study using data from the Israeli national public network of maternal and child health clinics between 2008 and 2013. We assessed exposure to ambient temperature in the first year of life using a high-resolution hybrid spatio-temporal model and calculated annual mean and minimum temperatures for each infant based on daily mean and minimum temperatures at the community clinic location. We defined rapid infant weight gain as a World Health Organization weight z-score difference >0.67 between birthweight and weight at age one year. We estimated these associations using log-linear and general additive models and adjusted for population group, district, maternal age, parental education, parity, sex, gestational age, birthweight, calendar year and calendar month of birth. RESULTS: The study population included 217,310 singleton-term infants. Adjusted models demonstrated a positive association between ambient temperature exposure and rapid infant weight gain. Compared to the third quintile of minimum temperature, infants exposed to the first and second quintile had an adjusted relative risk of 0.98 (95% CI 0.96, 1.00) and 0.97 (95% CI 0.95, 0.98), respectively, while those exposed to the fourth and fifth quintiles had an adjusted relative risk of 1.06 (95% CI 1.04, 1.07) and 1.02 (95% CI 1.00, 1.04) respectively. The associations with mean temperature were similar but slightly weaker. CONCLUSIONS: Exposure to higher ambient temperatures, of emerging importance in the climate change era, is associated with rapid infant weight gain in Israel. Future studies should use additional exposure, covariate, and outcome data to analyse the nature and the source of this association in more detail.

An efficient and eco-friendly workflow for dual fingermark processing and STR profiling.

Since its discovery in 1997, DNA retrieved from touched or handled items (touch DNA) has been increasingly used in criminal casework. Depending on the nature of the substrate examined, numerous techniques are being used for fingermark (FM) collection and development, however, it has been shown that FM processing may impede or even prevent the dual analysis of FMs and DNA. In search for a possible solution, we have recently established a novel workflow for a non-destructive collection and eco-friendly visualization of latent FMs using white BVDA gel-lifters and black Wetwop® solution. In the present study, the scope and limitations of the proposed protocol were thoroughly examined for DNA recovery and genotyping in relation to substrate type (porous and non-porous), time elapsed after the deposition (1, 7 and 14 days) and donor's gender. The study included 120 developed FMs of 20 donors (10 males and 10 females, aged 25-50 years), from which 240 DNA samples were recovered and quantified. The independent analysis of two DNA samples recovered from each FM, one - from the adhesive surface of the gel-lifter and the other - from its imprint on the protecting acetate cover, allowed us not only to increase the total number of the identified donors, but also to achieve a higher level of confidence per FM. Though this approach appeared to be more efficient on non-porous substrates (up to 65% on car tin), it is noteworthy that forensically useful DNA profiles (with at least 8 full STR loci) were generated from poor-quality FMs on the porous substrate, drywall (25% and 15% in males and females, respectively). Finally, the integration of the results of touch DNA analysis and that of FM visual inspection allowed us to increase by more than half the number of personal identifications and to strengthen the chain of forensic evidence.

The prevalence and clinical significance of microcolonies when tested according to contemporary interpretive breakpoints for fluconazole against Candida species using E-test.

Changes in the interpretive-breakpoints for antifungals against various Candida species have raised the need to examine the significance of the phenomenon of the growth of microcolonies in agar diffusion inhibition zones, which has generally been considered negligible. The objective was to determine the incidence of cases in which microcolonies demonstrate fluconazole resistance according to current interpretive-breakpoints and whether their growth is associated with therapeutic failure. The fluconazole minimum inhibitory concentrations (MICs) of 100 blood culture isolates of Candida were performed by E-test on Roswell Park Memorial Institute (RPMI) agar and examined for the appearance of microcolonies. Fluconazole MICs of microcolonies were then determined over three generations. The significance of the phenomenon of microcolonies was determined according to clinical data retrieved from electronic files. Microcolonies were a common phenomenon among Candida isolates following incubation on RPMI agar, with a higher frequency among C. albicans isolates as compared to non-albicans Candida across generations (57-93% vs 31-93%, respectively) and a similar fluconazole susceptibility rate over three generations. The rate of microcolonies was similar in both patients with successful and unsuccessful outcome (41% vs 42%, respectively). Microcolonies are a common phenomenon. No increase in MIC was demonstrated throughout three generations of microcolony inoculation on RPMI, and no difference in clinical outcome was observed.