Carob kibbles as an alternative raw material for production of kvass with probiotic potential.

BACKGROUND: Non-diary beverages with probiotic properties are of great interest nowadays. In this research, we evaluated the suitability of carob kibbles in the manufacture of kvass. Kvass is a low-alcohol drink popular in Central and Eastern Europe and indicated as a potential non-diary beverage with probiotic properties. Therefore, the viability of probiotic strains of Lactobacillus plantarum and Saccharomyces boulardii during 4 weeks' storage in manufactured beverages was tested. RESULTS: Carob kibbles introduced significant amounts of phenolic compounds into kvasses, especially gallic acid (up to 117.45 ± 10.56 mg L-1 ), and improved antiradical activity up to 78% after fermentation. Moreover, fermentation efficiently reduced furfural and hydroxymethylfurfural content in samples up to 12.9% and 29.9%, respectively. Kvasses with rye malt extract possessed coffee-like, chocolate-like, roasted and caramel-like odours and a more bitter taste. Whereas kvass with carob kibbles was characterized by fruit-like odour and sweeter taste. Fermentation contributed to a creation as well as degradation of volatiles. L. plantarum exhibited higher general mortality during storage, whereas, in the case of S. boulardii, the viability was significantly higher regardless of the sample composition. CONCLUSION: This is the first study reporting the use of carob kibbles for kvass production. The obtained results showed that carob kibbles can replace rye malt extract, at least partially, in the production of kvass, giving to the product added health benefits. Moreover, S. boulardii is a better choice for production of kvass with probiotic properties. © 2021 Society of Chemical Industry.

Remarkable Intracranial Response to Sotorasib in a Patient With KRAS G12C-Mutated Lung Adenocarcinoma and Untreated Brain Metastases: A Case Report.

Sotorasib is a KRAS G12C inhibitor that recently received approval for use in locally advanced or metastatic KRAS G12C-mutated NSCLC. CodeBreaK100, the phase 2 clinical trial leading to the approval of sotorasib, excluded patients with untreated brain metastases; there have been no reports describing efficacy of sotorasib on untreated brain metastases. We present a case of a patient with active untreated brain metastases with resulting disorientation and weakness who has radiographic response and complete resolution of neurologic symptoms with sotorasib. Our case illustrates the intracranial activity of sotorasib, but additional studies are needed to characterize the intracranial response rate and duration of response in these patients.

An Evaluation of the SCORE Program: A Novel Research and Mentoring Program for Medical Students in Obstetrics/Gynecology and Otolaryngology.

BACKGROUND: There has been a steady decrease in the number of physician-scientists and a lack of diversity and inclusion of underrepresented minorities (URMs) in medicine. OBJECTIVE: To assess the research productivity, interest, and experience of medical students, including URMs, and resident and faculty mentors of the Kaiser Permanente Oakland Medical Center's 8-week, intensive, mentored Summer Clinical Otolaryngology and Obstetrics/Gynecology Research (SCORE) Program for second-year medical students. METHODS: A database of SCORE Program research projects was generated from 2016, when the program was launched, through 2018. SCORE Program students and faculty completed a brief, mixed-methods, anonymous exit survey that captured respondents' experiences, perceived program strengths, and opportunities for improvement. The number of peer-reviewed manuscripts produced were counted. RESULTS: A total of 16 SCORE Program students (50% female and 38% URMs) between 2016 and 2018 and 8 residents and 8 faculty members in 2018 completed a brief, mixed-methods, anonymous exit survey that captured respondents' experiences, perceived program strengths, and opportunities for improvement. The medical students coauthored 12 published peer-reviewed articles, 25 abstracts or national posters, and 1 opinion editorial. According to the program's annual exit survey, 87% of students reported an increased interest in pursuing research, 93% had an increased interest in their respective specialties, and 93% believed they had positive mentorship experiences. Similarly, faculty and residents enjoyed mentoring students, thought that students positively contributed to their projects, and would support the SCORE Program in the future. CONCLUSION: Structured research and mentoring experiences, such as the SCORE Program, may encourage students, including URMs, to pursue research throughout their careers in addition to adding research to their curriculum vitae to strengthen their residency applications.

Trends in Referrals to a Pediatric Transgender Clinic.

OBJECTIVES: We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group. METHODS: Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics. RESULTS: We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time (P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%). CONCLUSIONS: The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of patients in this large sample varied by age group, underscoring the need for an individualized approach to gender-affirming care.

Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds.

Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole.