Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study.

BACKGROUND: Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS: Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS: Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS: Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.

Chemical composition, pesticidal activities and in-silico investigation of Hedychium spicatum Sm. chloroform extract.

The present study aimed to identify the bioactive constituents in the chloroform extract of H. spicatum rhizomes (HS-RCLE), further evaluated for its in-vitro pesticidal activities validating via molecular docking techniques. GC/MS analysis of HS-RCLE identified 14 compounds contributing 84.1 % of the total composition. The extract was dominated by oxygenated sesquiterpenes (43.1 %) with curcumenone (25.2 %) and coronarin E (14.8 %) as the major compounds. The extract recorded 89.4 % egg hatchability inhibition and 82.6 % immobility of Meloidogyne incognita, 66.7 % insecticidal activity on Spodoptera litura, 100 % phytotoxic activity on Raphanus raphanistrum seeds, and 74.7 % anti-fungal activity on Curvularia lunata at the respective highest dose studied. The biological activities were furthermore validated by using docking studies on certain proteins/enzymes namely acetylcholinesterase (PBD ID: IC2O), carboxylesterase (PDB ID: 1CI8), acetohydroxyacid synthase (PBD ID: 1YHZ) and trihydroxy naphthalene reductase (PBD ID: 3HNR). The bioactivity of the major constituents of the extract was predicted with the help of in silico PASS studies. HS-RCLE was observed to be a viable alternative source of natural pesticidal agents and paves the way for further studies on its mechanistic approaches and field trials to ascertain its pesticidal studies.

Dietary lutein supplementation improves immunity and antioxidant status of captive Indian leopards (Panthera fusca).

Indian leopards kept in zoos are fed solely on carabeef on bone (CBB) diets. Carabeef contains lesser or no carotenoids. Hence, the captive Indian leopard diets are suspected to be deficient in carotenoids while their wild counterparts acquire these pigments from their natural prey. Lutein is a vital carotenoid that plays its role as an antioxidant and immunomodulator. This experiment investigates the effect of lutein supplementation on antioxidant status, immunity, and stress in captive Panthera fusca fed CBB diets. Nine leopards were used based on 3 × 3 replicated Latin square designs in the experiment. Groups CON, LUT20, and LUT40 were supplemented with 0, 20, and 40 ppm of lutein, respectively. Each experiment comprised of 10 days of wash-out period, 11 days of adaptation, and 4 days of collection. Digestibility of crude protein (CP) was higher (p < .01) in groups LUT20 and LUT40. Serum concentration of protein, globulin, urea (p < .05), total carotenoids, total antioxidant capacity (TAC), catalase (CAT) activity, and lymphocyte transformation test (LTT) index were higher (p < .001) in groups LUT20 and LUT40. Activity of superoxide dismutase (SOD) and serum concentration of immunoglobulin were higher (p < .001) in group LUT20. Serum concentration of malonaldehyde (MDA) and fecal concentration of cortisol decreased (p < .001) in groups LUT20 and LUT40. Serum concentration of total immunoglobulin (µg/ml) and LTT were higher in group LUT20. Fecal concentration of cortisol (ng/g) was lower in LUT20 and LUT40. The study concludes that supplementation of lutein at 20 ppm would improve antioxidant status and immunity and alleviate stress in captive Indian leopards.

First principles investigations on the controversy of structural phase transitions in thorium dialuminide under pressure.

We study the high pressure structural aspects of thorium dialuminide, ThAl2, by performing evolutionary crystal structure searches and first principles calculations. We predict a phase transition from the ambient AlB2-type hexagonal structure to a P63/mmc hexagonal structure above 2.4 GPa. We also note that the new structure remains stable up to 50 GPa. This differs from the finding of an earlier study in which three phase transitions were reported close to 5.5, 12 and 25 GPa. An analysis of the electronic structures, Bader charge and electron localization function (ELF) indicates a complex chemical bonding comprising partial metallic, ionic (Th-Al) and covalent (Al-Al) characters in the ambient phase. Comparison of crystal parameters and ELFs for ambient and high pressure phases indicates that a change of Al-Al bonding under pressure is responsible for the structural phase transition. Furthermore, we computed the high P-T phase diagram by including the temperature effects via free energies for the most relevant structures, namely, AlB2-type, MgCu2-type and new hexagonal. We found that a MgCu2-type structure becomes stable only under high P-T conditions. We also provide a plausible explanation for the observed isostructural transition in the ambient AlB2-type structure at 5.5 GPa.

Pressure induced multi-centre bonding and metal-insulator transition in PtAl2.

A study on pressure induced metallization or metal-insulator transition (MIT) of materials is of enormous importance in high pressure research not only in view of various possible device applications but also for basic physical insight into their mechanism. Though the former transition (metallization) is quite common, the latter one (MIT) is comparatively rare, and only a few simple metals (Na, Al, etc.) are predicted to be an insulator at megabar pressure. In this work, we have shown that the binary intermetallic compound (PtAl2) exhibits a pressure induced metal-insulator transition comparatively at low pressure, near ∼28 GPa. By means of first principles calculations, we have established that a unique multi-centre bonding is developed under pressure which causes charge-density-ordering in the system and finally leads to MIT and structural phase transition involving unit cell reduction. In search of some exotic properties, we have found that the system has a good thermoelectric figure-of-merit in its insulating phase.

Partial replacement of dietary buffalo meat on the bone with chicken carcass improves serum antioxidant profile of zoo-housed Indian leopards (Panthera pardus fusca).

This experiment was conducted to study the effect of gradual replacement of dietary buffalo meat on the bone (BMB) with chicken carcass (CC) on nutrient utilization, serum cortisol, and total serum antioxidant profile of zoo-housed Indian leopard. Twelve adult leopards were randomly distributed into a replicated Latin square design comprising three treatments, three periods, four animals, and three sequences. Leopards in group T1 were fed normal zoo diet of BMB. On the basis of dry matter, 10% and 20% of BMB was replaced with CC in groups T2 and T3 , respectively. Each experimental period comprised 21 days. During each period, a digestion trial of 4-day collection period was conducted after an adaptation period of 17 days. On Day 21 of each experimental period, blood was collected from all the animals by puncturing the ventral coccygial vein. Intake and apparent digestibility of major nutrients were similar among the groups. Replacement of 20% BMB with addition of CC increased (p < 0.001) the calculated supply of I, niacin, and vitamin A. Carotenoid intake increased (p < 0.01) with increased level of CC in the diet. Serum concentration of cortisol decreased (p < 0.01) whereas serum concentration of total carotenoids increased (p < 0.001) with increased level of CC in the diet. Serum concentration of antioxidant enzymes increased (p < 0.001) with increased level of CC in the diet. It was concluded that replacement of 20% of BMB with CC increased antioxidant profile. This may reduce oxidative stress in zoo-housed Indian leopards without any adverse effect on nutrient utilization.

A unique metallic phase of H3S at high-pressure: sulfur in three different local environments.

We propose a new metallic phase (R3[combining macron]m, Z = 24) for H3S in a large pressure interval (∼108-166 GPa) using an evolutionary crystal structure search algorithm combined with first-principles calculations. This structure consists of SH6, SH3 and S units which are connected through strong SH hydrogen-bonds. It supports four-types of SH hydrogen-bonds that symmetrize at ∼166 GPa. This is the only phase in the H-S family where sulfur exists in three different local environments. Sulfur in SH6 behaves as a cation, like in the SF6 molecule, whereas other sulfurs behave as anions. Hydrogens in SH6 behave like halogens (anions) whereas other hydrogens behave like alkalis (cations). The new structure has a substantially smaller DOS at the Fermi-level in comparison to earlier structures R3m and Im3[combining macron]m. This implies a lower superconducting temperature (TC) for the new phase and thus questions the validity of earlier high-TC explanations. We also find that S-H covalent bonds are different from the B-B bonds of MgB2.

Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India.

BACKGROUND: Most of the cases of PHPT in developing countries present in symptomatic stage, some even in very advanced stage but in recent years the trend seems to be changing. This has been corroborated from few recently published literature from developing countries. The scope of this study is to further carry out an in-depth analysis of various clinical and biochemical parameters of PHPT patients at a tertiary care center of northern India. METHODS: In this retrospective analysis, a total of 333 patients with PHPT from the year 1990 to 2016 were studied. The study population was divided into three subgroups based on the time span; 1990-1999 (n = 34), 2000-2009 (n = 112), 2010-2016 (n = 187), and clinical and biochemical parameters were compared. RESULTS: The clinical presentation has evolved progressively with increase in older age group (35 vs 39 vs 43.85, p < 0.001), less patients with musculoskeletal symptoms (85.3 vs 76.8 vs 61%, p = 0.002) and less patients with severe bone disease (29.4 vs 10.7 vs 10.7%, p = 0.088). Biochemical parameters also showed a changing trend with significant decrease in mean S. Alkaline phosphatase (1393 vs 965 vs 414.8 IU/L, p < 0.001) and S. iPTH (837.52 vs 812.89 vs 635.74 pg/mL, p = 0.02). Vitamin D nutrition status is still suboptimal but shows improvement, and more patients are insufficient as compared to previous deficient state (mean S. Vitamin D-10.31 vs 16.16 vs 25.30 ng/mL, p < 0.001). CONCLUSIONS: Our study reveals a change in trend in PHPT which is similar to evolution of this disease in western population and positively corroborated with observations from China, Hong Kong and Turkey.

Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial.

BACKGROUND: There is a paucity of good quality evidence regarding the best therapeutic option for acute control of blood pressure during acute hypertensive emergency of pregnancy. OBJECTIVE: We sought to compare the efficacy of intravenously administered hydralazine and oral nifedipine for acute blood pressure control in acute hypertensive emergency of pregnancy. STUDY DESIGN: In this double-blind, randomized, controlled trial, pregnant women (≥24 weeks period of gestation) with sustained increase in systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg were randomized to receive intravenous hydralazine injection in doses of 5, 10, 10, and 10 mg and a placebo tablet or oral nifedipine (10 mg tablet up to 4 doses) and intravenous saline injection every 20 minutes until the target blood pressure of 150 mm Hg systolic and ≤100 mm Hg diastolic was achieved. Crossover treatment was administered if the initial treatment failed. The primary outcome of the study was time necessary to achieve target blood pressure. The secondary outcomes were the number of dosages required, adverse maternal and neonatal effects, and perinatal outcome. RESULTS: From December 2014 through September 2015, we enrolled 60 patients. The median time to achieve target blood pressure was 40 minutes in both groups (intravenous hydralazine and oral nifedipine) (interquartile interval 5 and 40 minutes, respectively, P = .809). The median dose requirement in both groups was 2 (intravenous hydralazine and oral nifedipine) (interquartile range 1 and 2 doses, respectively, P = .625). Intravenous hydralazine was associated with statistically significantly higher occurrence of vomiting (9/30 vs 2/30, respectively, P = .042). No serious adverse maternal or perinatal side effects were witnessed in either group. CONCLUSION: Both intravenous hydralazine and oral nifedipine are equally effective in lowering of blood pressure in acute hypertensive emergency of pregnancy.

Structural Phase Transitions in PtIn2 at High Pressure: A Theoretical Investigation.

A study of the bonding and electronic properties of intermetallics under pressure is crucial in the design and development of novel materials for useful applications. These properties are largely controlled by the underlying crystal structures. Here we investigated the high-pressure structural behavior of PtIn2 using crystal structure search calculations, which efficiently combine evolutionary algorithms and state-of-the-art density functional theory. Three new crystal structures, namely, Fe2B-type (I4/mcm, Z = 2), cotunnite-type (Pnma, Z = 4), and monoclinic (C2/m, Z = 2), are proposed at about 9.4, 13.5, and 47.5 GPa, respectively. With pressure, the covalent character of the Pt-In pair interaction is found to increase because of enhancement of spd hybridization, and structural transitions are rationalized in terms of the covalency increase.

Prediction of a novel 10-fold gold coordinated structure in AuIn2 above 10 GPa.

A 10-fold gold coordinated tetragonal structure is predicted for AuIn2 above 10 GPa by employing the first-principles crystal structure search method. This structure remains the lowest enthalpy structure up to the highest pressure of this study. Detailed electronic structure analysis is carried out to figure out the underlying factors responsible for the transition. Pressure induced electronic topological transition is found to be one of the main factors behind this transition. Phonon calculations show the softening of TA mode phonons and destruction of the giant Kohn anomaly in close proximity to the transition. Bader charge analysis shows the charge transfer increase from the In to Au atom under pressure. So this study has solved a long-standing structural puzzle of the AuIn2 above 10 GPa. This study is also expected to play an important role in our understanding of the pressure induced metallization of geophysically relevant oxides such as SiO2 and TiO2.

The synthesis of unconventional stoichiometric compounds in the K-Br system at high pressures.

Recently, the search for and synthesis of unconventional stoichiometric compounds have become one of the most active areas of high pressure research. Here, we report the synthesis of two new stoichiometric compounds, namely KBr3 and KBr5, at high pressures in the K-Br system. Until now, KBr was the only known compound in this system. Two independent experimental techniques, namely Raman spectroscopy and X-ray diffraction measurements, were employed to detect and confirm the formation of the new compounds. A room temperature chemical reaction between KBr and Br2 resulted in the formation of orthorhombic KBr3 at ∼2.0 GPa. Further compression led to the formation of monoclinic KBr5 at ∼6.0 GPa. This was accompanied by an anomalously large pressure (>2 GPa) increase inside the sample chamber and it remained stable up to the highest pressure, 24 GPa, of our study. Upon decompression, KBr5 remained stable down to 5.0 GPa. High-pressure (14-20 GPa) and high-temperature (>1500 K) laser heating experiments showed the decomposition of KBr5 into KBr3 (trigonal) and Br2 with a large volume reduction. First-principles structural searches were carried out to solve the composition and related crystal structures. The proposed structures give good description of the experimental Raman spectra and X-ray diffraction data. The electronic structure calculations reveal semiconducting behaviour for these compounds.

Mifepristone vs balloon catheter for labor induction in previous cesarean: a randomized controlled trial.

OBJECTIVE: To compare oral mifepristone (400 mg) with trans-cervical balloon catheter for induction of labor (IOL) in post date women with previous one cesarean section (CS). METHODS: In this randomized trial, post date pregnant women (gestation 40 weeks 5 days), with previous one low segment CS (no previous vaginal delivery) were induced either with oral mifepristone (400 mg) or balloon catheter [Foley's catheter (16 Fr); bulb filled with 30 ml normal saline]. They were re-assessed 24 and 48 h later. If at any time Bishop Score was >6; amniotomy was done, followed by oxytocin infusion. Primary outcome of the study was labor onset after first manoeuvre. Secondary outcomes were cervical ripening, need of oxytocin, vaginal delivery and CS, in two groups. RESULTS: From June 2012 to September 2015, we enrolled 107 women. Out of these, 57 received oral tablet mifepristone (400 mg) and 50 were inserted with balloon catheter. Labor onset after first manoeuvre was statistically significantly more in mifepristone group (37/57 vs. 13/50, respectively; p value 0.000). Bishop Score after 24 h was better in balloon catheter (p value 0.000). More women with balloon catheter required oxytocin for IOL (37/50 vs. 20/57, respectively; p value 0.000) along with higher dose [840 (320) mU vs 560 (120) mU, respectively, p value 0.000]. Failure of induction was statistically significantly higher in balloon catheter group (8 out of 50 vs. 2 out of 57, respectively, p value 0.043). There was no statistically significant difference in normal delivery or CS in either group (p value 0.242 and 0.331, respectively). CONCLUSION: Oral mifepristone (400 mg) is associated with statistically significantly higher incidence of labor onset in post date pregnant women with previous one CS, as compared to balloon catheter. Both methods are primarily for cervical ripening and oxytocin should not be delayed in the absence of onset of labor. CLINICAL TRIAL REGISTRATION: Clinical Trials Registry-India, www.ctri.nic.in , CTRI/2012/05/003634.

Role of 5f electrons in the structural stability of light actinide (Th-U) mononitrides under pressure.

Pressure induced structural sequences and their mechanism for light actinide (Th-U) mononitrides were studied as a function of 5f-electron number using first-principles total energy and electronic structure calculations. Zero pressure lattice constants, bulk module and C11 elastic module vary systematically with 5f-electron number implying its direct role on crystal binding. There is a critical 5f-electron number below which the system makes B1-B2 and above it B1-R3̄m-B2 structural sequence under pressure. Also, the B1-B2 transition pressure increases with increasing 5f-electron number whereas an opposite trend is obtained for the B1-R3̄m transition pressure. The ascending of N p anti-bonding states through the Fermi level at high pressure is responsible for the structural instability of the system. Above the critical 5f-electron number in the system a narrow 5f-band occurs very close to the Fermi level which allows the system to lower its symmetry via band Jahn-Teller type lattice distortion and the system undergoes a B1-R3̄m phase transition. However, below the critical 5f-electron number this mechanism is not favorable due to a lack of sufficient 5f-state occupancy and thus the system undergoes a B1-B2 phase transition like other ionic solids.

Proton transfer aiding phase transitions in oxalic acid dihydrate under pressure.

Oxalic acid dihydrate, an important molecular solid in crystal chemistry, ecology and physiology, has been studied for nearly 100 years now. The most debated issues regarding its proton dynamics have arisen due to an unusually short hydrogen bond between the acid and water molecules. Using combined in situ spectroscopic studies and first-principles simulations at high pressures, we show that the structural modification associated with this hydrogen bond is much more significant than ever assumed. Initially, under pressure, proton migration takes place along this strong hydrogen bond at a very low pressure of 2 GPa. This results in the protonation of water with systematic formation of dianionic oxalate and hydronium ion motifs, thus reversing the hydrogen bond hierarchy in the high pressure phase II. The resulting hydrogen bond between a hydronium ion and a carboxylic group shows remarkable strengthening under pressure, even in the pure ionic phase III. The loss of cooperativity of hydrogen bonds leads to another phase transition at ∼ 9 GPa through reorientation of other hydrogen bonds. The high pressure phase IV is stabilized by a strong hydrogen bond between the dominant CO2 and H2O groups of oxalate and hydronium ions, respectively. These findings suggest that oxalate systems may provide useful insights into proton transfer reactions and assembly of simple molecules under extreme conditions.

Long-Term Outcome of Follicular Thyroid Carcinoma in Patients Undergoing Surgical Intervention for Skeletal Metastases.

BACKGROUND: A large proportion of follicular thyroid carcinoma (FTC) patients in developing countries present with overt skeletal metastases (SM). These patients often require surgical interventions for prevention of morbidity, palliation of symptoms, and facilitation of radioiodine therapy (RAIT). Scarce literature is available about the long-term outcome of such patients. The aim of this study was to evaluate the long-term outcome of FTC patients undergoing surgical intervention for SM. METHODS: We retrospectively reviewed the data of FTC patients with SM (January 1990-December 2011). Out of 91 patients with SM, 32 had surgical interventions for SM. All had total thyroidectomy performed. RESULTS: The mean age of the patients was 48.5 years (M:F = 1:2). Majority (93.7%) had synchronous metastases and 22% had multiple SM. The surgical interventions for SM included: laminectomy (50%), resection of skull metastases (18.8%), resection of manubrium sterni (18.8%), partial clavicle excision (9.4%), and hemimandibulectomy (3.1%). The main intents were palliation (50%) and facilitation of RAIT (37.5%). 84% patients received RAIT. Median follow-up was 52 months (mean = 50 ± 37). Five- (56 vs 63%) and 10-year (28 vs 23%) overall survival (OS) did not differ significantly (p = 0.968) from those not having interventions for SM. On univariate analysis tumor invasion (p = 0.006) and synchronous presentation of SM (p = 0.043) were significant risk factors for OS, whereas on multivariate analysis tumor invasion (p = 0.006) was significant. CONCLUSIONS: Surgical interventions directed at SM in FTC patients with overt multiple SM might not result in improve OS. However, considering reasonable long-term survival, interventions should be considered for desired palliation and preservation of body function.

Molecular Characteristics of Large Parathyroid Adenomas.

INTRODUCTION: The clinical entity of large parathyroid adenomas (LPTAs) has not been well defined. It is speculated that LPTAs would have biochemical, histological, and molecular characteristics different from small adenomas. Our study aimed to find out occurrence of atypia and carcinomas in large parathyroid lesions and the presence of distinct molecular abnormalities in LPTAs. MATERIALS AND METHODS: We divided the parathyroid lesions into large (>7 g, i.e., LPTAs) and small (<7 g) adenomas. We performed parafibromin, APC (adenomatous polyposis coli), galectin 3, and PGP9.5 (protein gene product 9.5) analysis by immunohistochemistry in adenomas without atypia, atypical adenomas, and carcinomas. RESULTS: Mean serum calcium, alkaline phosphatase, and intact PTH were significantly higher in large parathyroid tumor group. The presence of both atypical adenoma and carcinoma was higher in large parathyroid tumor group. There was higher percentage of atypia in patients with LPTAs >10 g (33%), and 68% of tumors showed at least one marker suggestive of malignancy in this group. Detailed analysis of immunohistochemical features of LPTA >10 g revealed that six patients showed complete loss of parafibromin immunoreactivity (out of these four showed atypia), while seven showed partial loss. In histopathologically proven malignancy (n = 9), six patients showed complete loss of parafibromin staining, 5 (55%) APC negativity, and 45% showed both galectin 3 and PGP9.5 positivity. Three out of these showed all IHC markers s/o malignancy, and all of them had evidence of metastases or recurrence. 32% of atypical adenoma and 13% of atypical adenoma showed complete loss of parafibromin staining, however none developed metastases or recurrence in follow-up (median follow-up 40 months). Loss of parafibromin staining (complete or partial) was higher in LPTA group (56%) than that in small adenoma (39%); however, it was not statistically significant. APC, galectin 3, and PGP9.5 markers suggestive were higher in LPTA group but were not significant. CONCLUSION: LPTAs may show some morphological and immunohistochemical features suggestive of malignancy and can be considered a separate entity. However, the immunohistochemical markers are unable to clearly segregate those LPTAs that may show premalignant potential. Further, we would like to recommend that LPTAs showing complete parafibromin loss together with atypia should be kept under close follow-up.

A Rare Complication of Left Open Adrenalectomy.

Chyle leakage after left open adrenalectomy is a quite rare complication. We encountered a young male patient who was operated for left adrenal pheochromocytoma, left laparoscopic adrenalectomy converted to open due to dense adhesions. Postoperatively patient developed chylous fluid drainage on day 2. He was managed conservatively with high protein and MCT oil diet. This case highlights the unusual complication of left adrenalectomy surgery and how it can be managed.

Arginine:glycine amidinotransferase (AGAT) deficiency: Clinical features and long term outcomes in 16 patients diagnosed worldwide.

BACKGROUND: Arginine:glycine aminotransferase (AGAT) (GATM) deficiency is an autosomal recessive inborn error of creative synthesis. OBJECTIVE: We performed an international survey among physicians known to treat patients with AGAT deficiency, to assess clinical characteristics and long-term outcomes of this ultra-rare condition. RESULTS: 16 patients from 8 families of 8 different ethnic backgrounds were included. 1 patient was asymptomatic when diagnosed at age 3 weeks. 15 patients diagnosed between 16 months and 25 years of life had intellectual disability/developmental delay (IDD). 8 patients also had myopathy/proximal muscle weakness. Common biochemical denominators were low/undetectable guanidinoacetate (GAA) concentrations in urine and plasma, and low/undetectable cerebral creatine levels. 3 families had protein truncation/null mutations. The rest had missense and splice mutations. Treatment with creatine monohydrate (100-800 mg/kg/day) resulted in almost complete restoration of brain creatine levels and significant improvement of myopathy. The 2 patients treated since age 4 and 16 months had normal cognitive and behavioral development at age 10 and 11 years. Late treated patients had limited improvement of cognitive functions. CONCLUSION: AGAT deficiency is a treatable intellectual disability. Early diagnosis may prevent IDD and myopathy. Patients with unexplained IDD with and without myopathy should be assessed for AGAT deficiency by determination of urine/plasma GAA and cerebral creatine levels (via brain MRS), and by GATM gene sequencing.

Discriminatory Performance of the Calcaneal Quantitative Ultrasound and Osteoporosis Self-Assessment Tool to Select Older Women for Dual-Energy X-ray Absorptiometry.

The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff <65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice.