Comparison of Gas-sensing Capsule With Wireless Motility Capsule in Motility Disorder Patients

Background/Aims@#Motility disorders are prevalent, often leading to disrupted regional or whole gut transit times. In this study, we conducted a comparative analysis between the wireless motility capsule and an innovative gas-sensing capsule to evaluate regional and whole gut transit times in individuals with diagnosed motility disorders. @*Methods@#We prospectively enrolled 48 patients (34 women) diagnosed with functional dyspepsia and/or functional constipation according to Rome IV criteria. Patients ingested the capsules in tandem. We assessed the agreement between transit times recorded by both devices using Spearman correlation and Bland-Altman analysis. Additionally, diagnostic concordance between the capsules were evaluated using confusion matrices. @*Results@#We observed a significant correlation between the wireless motility capsule and the gas-sensing capsule for gastric emptying time (r = 0.79, P 59 hours), the gas-sensing capsule demonstrated a sensitivity of 0.79, specificity of 0.84, and accuracy of 0.82. Importantly, the gas-sensing capsule was well-tolerated, and no serious adverse events were reported during the study. @*Conclusions@#Our findings underscore the gas-sensing capsule’s suitability as a dependable tool for assessing regional and whole gut transit times.It represents a promising alternative to the wireless motility capsule for evaluating patients with suspected motility disorders.

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Objectives@#This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. @*Methods@#A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. @*Results@#The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. @*Conclusions@#This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Sheep as a large animal model for hearing research: comparison to common laboratory animals and humans / 한국실험동물학회지

Sensorineural hearing loss (SNHL), caused by pathology in the cochlea, is the most common type of hearing loss in humans. It is generally irreversible with very few effective pharmacological treatments available to prevent the degenerative changes or minimise the impact. Part of this has been attributed to difficulty of translating “proof-ofconcept” for novel treatments established in small animal models to human therapies. There is an increasing interest in the use of sheep as a large animal model. In this article, we review the small and large animal models used in preclinical hearing research such as mice, rats, chinchilla, guinea pig, rabbit, cat, monkey, dog, pig, and sheep to humans, and compare the physiology, inner ear anatomy, and some of their use as model systems for SNHL, including coch‑ lear implantation surgeries. Sheep have similar cochlear anatomy, auditory threshold, neonatal auditory system development, adult and infant body size, and number of birth as humans. Based on these comparisons, we suggest that sheep are well-suited as a potential translational animal model that bridges the gap between rodent model research to the clinical use in humans. This is especially in areas looking at changes across the life-course or in spe‑ cific areas of experimental investigation such as cochlear implantation and other surgical procedures, biomedical device development and age-related sensorineural hearing loss research. Combined use of small animals for research that require higher throughput and genetic modification and large animals for medical translation could greatly accelerate the overall translation of basic research in the field of auditory neuroscience from bench to clinic.

A Full-Scale Narrative Review On Monkey pox

A developing zoonotic orthopoxvirus with a clinical presentation resembling smallpox is the human monkey pox. A double-stranded DNA virus causes monkey pox (MPX), a viral zoonosis. -For the first time, numerous monkey pox cases and clusters have been recorded simultaneously in endemic and non-endemic nations over a wide range of geographical regions. On 23 July 2022, the World Health Organiza-tion (WHO) declared the monkey pox outbreak as a Public Health Emergency of International Concern (PHEIC). From May to July 2022, a multi-country outbreak of monkey pox was reported. The recurrence of the disease has caused global panic and a rise in public health concerns. we performed a thorough lit-erature search for MPVX infection PubMed, Google scholar and Elsevier search engines, articles pub-lished in the last 3 months and personal collection of the relevant publications were considered in this review. Despite the fact that this condition has been there for more than 50 years, the recent rise in cases and the growing body of knowledge about it have made it necessary for practicing doctors to conduct a focused review. Therefore, in this review we Summarized the previous concepts, exploring the present, and focusing on future prevention of Monkey pox.

The relationships among Flory-Huggins specific interaction parameters, maximum amorphous capacity, and solid-state interactions of spray dried amorphous drug dispersions with conventional and novel pharmaceutical polymers / Las relaciones entre los parámetros de interacción específicos de Flry-Huggins, la capacidad amorfa máxima y las interacciones en estado sólido de las dispersiones de fármacos amorfos secados por aspersión con polímeros farmacéuticos convencionales y nuevos

This study evaluated the specific interactions between drug and polymers in amorphous spray dried dispersions (SDDs). Four Biopharmaceutics Classification System (BCS) II class drugs were evaluated. Binary and ternary SDDs were manufactured with conventional polymers and arabinogalactan. Specific interaction parameters between drug and polymer were determined using theoretical calculations and DSC data. Analytical methods were used to evaluate solid and solution state interactions. Maximum amorphous content for each formulation was calculated using DSC. Flory-Huggins Specific Interaction Parameters were calculated. Negative specific parameters were associated with solid-state interactions and improved capacity of drug in the amorphous state. Ternary SDDs containing drug, polymer, and arabinogalactan displayed similar hydrogen bonding as was observed with binary SDDs. Solution-state interactions observed in binary systems may be used in tertiary systems to improve the amorphous drug capacity and improved dissolution compared to the binary. The resultant tertiary systems are an improvement over binary drug polymer systems.

Este estudio evaluó las interacciones específicas entre el fármaco y los polímeros en dispersiones amorfas secadas por pulverización (SDD). Se evaluaron cuatro fármacos de clase II del Sistema de Clasificación Biofarmacéutica (BCS). Los SDD binarios y ternarios se fabricaron con polímeros convencionales y arabinogalactano. Los parámetros de interacción específicos entre el fármaco y el polímero se determinaron utilizando cálculos teóricos y datos de DSC. Se utilizaron métodos analíticos para evaluar las interacciones del estado sólido y de la solución. El contenido amorfo máximo para cada formulación se calculó usando DSC. Se calcularon los parámetros de interacción específicos de Flory-Huggins. Los parámetros específicos negativos se asociaron con interacciones en estado sólido y una capacidad mejorada del fármaco en el estado amorfo. Los SDD ternarios que contienen fármaco, polímero y arabinogalactano mostraron enlaces de hidrógeno similares a los observados con los SDD binarios. Las interacciones de estado de solución observadas en sistemas binarios pueden usarse en sistemas terciarios para mejorar la capacidad del fármaco amorfo y mejorar la disolución en comparación con el binario. Los sistemas terciarios resultantes son una mejora con respecto a los sistemas de polímeros de fármacos binarios.

Determining the incidence and risk factors for short-term complications following distal biceps tendon repair

Distal biceps rupture is a relatively uncommon injury that can significantly affect quality of life. Early complications following biceps tendon repair are not well described in the literature. This study utilizes a national surgical database to determine the incidence of and predictors for short-term complications following distal biceps tendon repair. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017. Patient demographic variables of sex, age, body mass index, American Society of Anesthesiologists class, functional status, and several comorbidities were collected for each patient, along with 30-day postoperative complications. Binary logistic regression was used to calculate risk ratios for these complications using patient predictor variables. Results: Early postoperative surgical complications (0.5%)—which were mostly infections (0.4%)—and medical complications (0.3%) were rare. A readmission risk factor was diabetes (risk ratio [RR], 4.238; 95% confidence interval [CI], 1.180–15.218). Non-home discharge risk factors were smoking (RR, 3.006; 95% CI, 1.123–8.044) and ≥60 years of age (RR, 4.150; 95% CI, 1.611– 10.686). Maleness was protective for medical complications (RR, 0.024; 95% CI, 0.005–0.126). Surgical complication risk factors were obese class II (RR, 4.120; 95% CI, 1.123–15.120), chronic obstructive pulmonary disease (COPD; RR, 21.981; 95% CI, 3.719–129.924), and inpatient surgery (RR, 8.606; 95% CI, 2.266–32.689). Conclusions: Complication rates after distal biceps repair are low. Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications.

How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice

Background/Aims@#The 3-phase fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has shown a high level of efficacy in irritable bowel syndrome, largely based on dietitian delivered education. However, access to dietitians can be limited, and challenges exist when applying the diet to a wide range of cultures, such as limited FODMAP analysis of local foods. This review aims to discuss ways to optimally use the FODMAP diet in practice in a wide range of cultures, directed at gastroenterologists from a dietitian’s perspective. @*Methods@#Recent literature was analysed via search databases including Medline, CINAHL, PubMed and Scopus. @*Results@#The dietetic process involves detailed assessment and follow-up through the 3 stages of the FODMAP diet (restriction, re-introduction, and long-term maintenance). Emerging evidence suggests the diet can be delivered by other health professionals such as the gastroenterologist or nurse, but training on how to do so successfully would be needed. Self-guided approaches through use of technology or specialised food delivery services may be an alternative when dietitians are not available, but efficacy data is limited. Regardless of delivery mode, nutritional and psychological risks of the diet must be mitigated. Additionally, culturally appropriate education must be provided, with accommodations necessary when the FODMAP content of local foods are unknown. @*Conclusion@#While the diet has shown improved irritable bowel syndrome outcomes across studies, it is important to acknowledge the essential role of dietitians in implementing, tailoring, and managing the diet to achieve the best outcome for each individual.

Oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So, this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women.Methods: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol.Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 versus 20.3 hours respectively) with significant p-value (<0.001).Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavorable cervix.

Detection of clinically significant prostate cancer with PI-RADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions

ABSTRACT Purpose To determine if PSAD, PSADtz, and ADC values improve the accuracy of PI-RADS v2 and identify men whose concurrent systematic biopsy detects clinically significant cancer on areas without mpMRI visible lesions. Materials and methods Single reference-center, cross-sectional, retrospective study of consecutive men with suspected or known low to intermediate-risk prostate cancer who underwent 3T mpMRI and TRUS-MRI fusion biopsy from 07/15/2014 to 02/17/2018. Cluster-corrected logistic regression analyses were utilized to predict clinically significant prostate cancer (Gleason score ≥3+4) at targeted mpMRI lesions and on systematic biopsy. Results 538 men (median age=66 years, median PSA=7.0ng/mL) with 780mpMRI lesions were included. Clinically significant disease was diagnosed in 371 men. PI-RADS v2 scores of 3, 4, and 5 were clinically significant cancer in 8.0% (16/201), 22.8% (90/395), and 59.2% (109/184). ADC values, PSAD, and PI-RADS v2 scores were independent predictors of clinically significant cancer in targeted lesions (OR 2.25-8.78; P values <0.05; AUROC 0.84, 95% CI 0.81-0.87). Increases in PSAD were also associated with upgrade on systematic biopsy (OR 2.39-2.48; P values <0.05; AUROC 0.69, 95% CI 0.64-0.73). Conclusions ADC values and PSAD improve characterization of PI-RADS v2 score 4 or 5 lesions. Upgraded on systematic biopsy is slightly more likely with PSAD ≥0.15 and multiple small PI-RADS v2 score 3 or 4 lesions.

Orthogonal assays for the identification of inhibitors of the single-stranded nucleic acid binding protein YB-1

We have previously shown that high expression of the nucleic acid binding factor YB-1 is strongly associated with poor prognosis in a variety of cancer types. The 3-dimensional protein structure of YB-1 has yet to be determined and its role in transcriptional regulation remains elusive. Drug targeting of transcription factors is often thought to be difficult and there are very few published high-throughput screening approaches. YB-1 predominantly binds to single-stranded nucleic acids, adding further difficulty to drug discovery. Therefore, we have developed two novel screening assays to detect compounds that interfere with the transcriptional activation properties of YB-1, both of which may be generalizable to screen for inhibitors of other nucleic acid binding molecules. The first approach is a cell-based luciferase reporter gene assay that measures the level of activation of a fragment of the promoter by YB-1. The second approach is a novel application of the AlphaScreen system, to detect interference of YB-1 interaction with a single-stranded DNA binding site. These complementary assays examine YB-1 binding to two discrete nucleic acid sequences using two different luminescent signal outputs and were employed sequentially to screen 7360 small molecule compounds leading to the identification of three putative YB-1 inhibitors.

Impact of the integration of proton magnetic resonance imaging spectroscopy to PI-RADS 2 for prediction of high grade and high stage prostate cancer / Impacto da incorporação da espectroscopia por ressonância magnética ao PI-RADS 2 para a predição de câncer de próstata de alto grau e de estágio avançado

Abstract Objective: To compare the predictions of dominant Gleason pattern ≥ 4 or non-organ confined disease with Prostate Imaging Reporting and Data System (PI-RADS v2) with or without proton magnetic resonance spectroscopic imaging (1H-MRSI). Materials and Methods: Thirty-nine men underwent 3-tesla endorectal multiparametric MRI including 1H-MRSI and prostatectomy. Two radiologists assigned PI-RADS v2 and 1H-MRSI scores to index lesions. Statistical analyses used logistic regressions, receiver operating characteristic (ROC) curves, and 2x2 tables for diagnostic accuracies. Results: The sensitivity and specificity of 1H-MRSI and PI-RADS v2 for high-grade prostate cancer (PCa) were 85.7% (57.1%) and 92.9% (100%), and 56% (68.0%) and 24.0% (24.0%). The sensitivity and specificity of 1H-MRSI and PI-RADS v2 for extra-prostatic extension (EPE) were 64.0% (40%) and 20.0% (48%), and 50.0% (57.1%) and 71.4% (64.3%). The area under the ROC curves (AUC) for prediction of high-grade prostate cancer were 0.65 and 0.61 for PI-RADS v2 and 0.72 and 0.70 when combined with 1H-MRSI (readers 1 and 2, p = 0.04 and 0.21). For prediction of EPE the AUC were 0.54 and 0.60 for PI-RADS v2 and 0.55 and 0.61 when combined with 1H-MRSI (p > 0.05). Conclusion: 1H-MRSI might improve the discrimination of high-grade prostate cancer when combined to PI-RADS v2, particularly for PI-RADS v2 score 4 lesions, but it does not affect the prediction of EPE.

Resumo Objetivo: Comparar as predições de tumor com padrão 4 de Gleason dominante ou de tumor com extensão extraprostática utilizando o sistema Prostate Imaging Reporting and Data System (PI-RADS v2), combinado ou não a espectroscopia por ressonância magnética (1H-ERM). Materiais e Métodos: Trinta e nove pacientes submeteram-se a RM de 3 tesla com bobina endorretal, incluindo 1H-ERM, e prostatectomia. Dois radiologistas classificaram as principais lesões identificadas em cada caso utilizando PI-RADS v2 e escores de 1H-ERM. As análises estatísticas incluíram regressões logísticas, curvas receiver operating characteristic (ROC) e tabelas 2x2 para acurácia diagnóstica. Resultados: A sensibilidade e a especificidade da 1H-ERM e do PI-RADS v2 para a detecção de câncer de próstata de alto grau foram 85,7% (57,1%) e 92,9% (100%), e 56% (68%) e 24% (24%). A sensibilidade e a especificidade da 1H-ERM e do PI-RADS v2 para a detecção de extensão extraprostática (EEP) foram 64,0% (40%) e 20% (48%), e 50% (57,1%) e 71,4% (64,3%). As áreas das curvas ROC para a predição de câncer de alto grau foram 0,65 e 0,61 para PI-RADS v2 e 0,72 e 0,70 quando combinado com 1H-ERM (radiologistas 1 e 2, p = 0.04 e 0.21). Para a predição de EEP, as áreas das curvas ROC foram 0,54 e 0,60 para PI-RADS v2 e 0,55 e 0,61 quando combinado com 1H-ERM (p > 0.05). Conclusão: É possível que a 1H-ERM melhore a predição de câncer de alto grau quando combinada ao PI-RADS v2, em particular para lesões que recebem um escore PI-RADS v2 4; entretanto, ela não afeta a predição de EEP.

A global, cross cultural study examining the relationship between employee health risk status and work performance metrics

BACKGROUND: Health risk assessments (HRA) are used by many organisations as a basis for developing relevant and targeted employee health and well-being interventions. However, many HRA's have a western-centric focus and therefore it is unclear whether the results can be directly extrapolated to those from non-western countries. More information regarding the differences in the associations between country status and health risks is needed along with a more global perspective of employee health risk factors and well-being overall. Therefore we aimed to i) quantify and compare associations for a number of health risk factors based on country status, and then ii) explore which characteristics can aid better prediction of well-being levels and in turn workplace productivity globally. METHODS: Online employee HRA data collected from 254 multi-national companies, for the years 2013 through 2016 was analysed (n = 117,274). Multiple linear regression models were fitted, adjusting for age and gender, to quantify associations between country status and health risk factors. Separate regression models were used to assess the prediction of well-being measures related to productivity. RESULTS: On average, the developing countries were comprised of younger individuals with lower obesity rates and markedly higher job satisfaction compared to their developed country counterparts. However, they also reported higher levels of anxiety and depression, a greater number of health risks and lower job effectiveness. Assessment of key factors related to productivity found that region of residency was the biggest predictor of presenteeism and poor pain management was the biggest predictor of absenteeism. CONCLUSIONS: Clear differences in health risks exist between employees from developed and developing countries and these should be considered when addressing well-being and productivity in the global workforce. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40557-017-0172-1) contains supplementary material, which is available to authorized users.

Nurse-led HIV services and quality of care at health facilities in Kenya

Objective:To develop a novel measure to characterize human immunodeficiency virus (HIV) programme quality at health facilities in Kenya and explore its associations with patient- and facility-level characteristics.Methods:We developed a composite indicator to measure quality of HIV care, comprising: assessment of eligibility for antiretroviral therapy(ART); initiation of ART; and retention on ART or in care, if ineligible for ART, for 12 months. We applied the comprehensive retention indicator to routinely collected clinical data from 13 331 patients enrolled in HIV care and treatment at 63 health facilities in the Eastern and Nyanza regions of Kenya from 1 January 2014 to 31 March 2016. We explored the association between facility- andpatient-level characteristics and the primary outcome: appropriate staging and management of HIV, and retention in care over 12 months.Findings:Of the enrolled patients, 8404 (63%) achieved comprehensive retention 12 months after enrolment in care. In univariate analyses, patients at facilities where nurses delivered HIV treatment services (including eligibility assessment, initiation and follow up of ART) had significantly higher comprehensive retention rates at 12 months. In multivariate analyses, after adjusting for both facility- and patient-level characteristics, patients at facilities where nurses initiated ART had significantly higher comprehensive retention in care at 12 months (relative risk, RR: 1.22; 95% confidence interval, CI: 1.00­1.48).Conclusion:Nurse-led HIV services were significantly associated with quality of care, confirming the central role of nurses in the achievement of global health goals, and the need for further investment in nursing education, training and mentoring

Multidrug resistance mediated by co‑carriage of extended‑spectrum beta‑lactamases, AmpC and New Delhi metallo‑beta‑lactamase‑1 genes among carbapenem‑resistant Enterobacteriaceae at five Indian medical centres.

In this study, we evaluated the coexistence of extended‑spectrum beta‑lactamases (ESBL), AmpC and New Delhi metallo‑beta‑lactamase‑1 (NDM‑1) genes among carbapenem‑resistant Enterobacteriaceae (CRE) recovered prospectively from patients at multiple sites. The study included 285 CRE strains from 2782 Gram‑negative Bacilli collected from multiple centres during 2007–2010, of which 87 were characterised. Standard and reference laboratory methods were used for resistance determination. Detection of blaNDM‑1, blaAmpC, blaTEM, blaSHV and blaCTX‑M was done by polymerase chain reaction. High levels of antimicrobial resistance observed among study isolates. Co‑carriage of ESBLs, AmpC and NDM‑1 was 26.3%. Nosocomial origin among the co‑carriage isolates was 64.3%, with 9.2% associated mortality.

An adequacy evaluation of a maternal health intervention in rural Honduras: the impact of engagement of men and empowerment of women / Evaluación de la suficiencia de una intervención de salud materna en un entorno rural de Honduras: repercusión de la participación de los hombres y el empoderamiento de las mujeres

Objective. To determine the impact that a 6-year maternal and child health project in rural Honduras had on maternal health services and outcomes, and to test the effect of level of father involvement on maternal health. Methods. This was a program evaluation conducted through representative household surveys administered at baseline in 2007 and endline in 2011 using 30 cluster samples randomly-selected from the 229 participating communities. Within each cluster, 10 households having at least one mother-child pair were randomly selected to complete a questionnaire, for a total of about 300 respondents answering close to 100 questions each. Changes in key outcome variables from baseline to endline were tested using logistic regression, controlling for mother's education and father's involvement. Results. There were improvements in most maternal health indicators, including an increase in women attending prenatal checkups (84% to 92%, P = 0.05) and institutional births (44% to 63%, P = 0.002). However, the involvement of the fathers decreased as reflected by the percentage of fathers accompanying mothers to prenatal checkups (48% to 41%, P = 0.01); the fathers' reported interest in prenatal care (74% to 52%, P = 0.0001); and fathers attending the birth (66% to 54%, P = 0.05). There was an interaction between the fathers' scores and the maternal outcomes, with a larger increase in institutional births among mothers with the least-involved fathers. Conclusions. Rather than the father's involvement being key, changes in the mothers may have led to increased institutional births. The project may have empowered women through early identification of pregnancy and stronger social connections encouraged by home visits and pregnancy clubs. This would have enabled even the women with unsupportive fathers to make healthier choices and achieve higher rates of institutional births.

Objetivo. Determinar la repercusión de un proyecto de salud maternoinfantil de 6 años de duración, en un entorno rural en Honduras, sobre los servicios de salud materna y los resultados asistenciales, y estudiar el efecto del grado de participación del padre en la salud materna. Métodos. El programa se evaluó mediante una serie de encuestas a los hogares representativos administradas al inicio de la intervención, en el 2007, y al concluir en el 2011, con 30 muestras de agrupaciones de familias elegidas al azar entre las 229 comunidades participantes. Dentro de cada agrupación, se seleccionaron aleatoriamente 10 familias compuestas al menos por una madre y un hijo para que contestasen un cuestionario, con lo cual se reunieron en total cerca de 300 personas encuestadas que respondieron casi 100 preguntas cada una. Se analizaron las variaciones en los criterios principales de valoración, entre el inicio y el final de la intervención, mediante técnicas de regresión logística, controlando el nivel educativo de la madre y la participación del padre. Resultados. Se observaron mejoras en la mayoría de los indicadores de salud materna, incluido un aumento de la cantidad de mujeres que acudieron a los controles prenatales (variación de 84% a 92%, P = 0,05) y de los partos atendidos en centros sanitarios (variación de 44% a 63%, P = 0,002). Sin embargo, se redujo la participación del padre, tal como refleja el porcentaje de padres que acompañan a la madre a los controles prenatales (variación de 48% a 41%, P = 0,01), el interés comunicado por el padre en la asistencia prenatal (variación de 74% a 52%, P = 0,0001) y el porcentaje de padres que estuvieron presentes en el parto (variación de 66% a 54%, P = 0,05). Se constató una interacción entre las puntuaciones paternas y los resultados asistenciales maternos, así como un aumento mayor de los partos en centros sanitarios en los casos en que el padre se involucraba menos. Conclusiones. Más que la participación del padre como factor clave, el aumento de los partos asistidos en centros sanitarios puede haberse debido a los cambios en las madres. Es posible que el proyecto empoderase a las mujeres y les permitiese percatarse antes de su embarazo y reforzar sus conexiones sociales con visitas domiciliarias y grupos de embarazadas. Esto habría facilitado, aun en los casos en los que el padre no se involucraba, que las mujeres tomasen decisiones más saludables, y que aumentasen las tasas de partos atendidos en centros sanitarios.

The Low FODMAP Diet and Its Application in East and Southeast Asia

There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food commonly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.

A systematic review of the nutritional adequacy of the diet in the Central Andes / Revisión sistemática de la adecuación nutricional del régimen alimentario en los Andes centrales

OBJECTIVE:To examine dietary adequacy in the Andean area, including macro- and micronutrient intakes, with a particular focus on rural communities; to highlight nutrition priorities in the Andes; and to identify opportunities for improvement. METHODS: A comprehensive literature search was conducted, identifying published and grey literature in English and Spanish related to diet in the central Andean countries of Bolivia, Colombia, Ecuador, and Peru. Articles reporting data from dietary surveys or nutrition interventions were included. Thirty-four papers or reports published in 1969-2011 were included in the final review. The mean and variation in intakes by sex and age group of all presented nutrients were collated and the mean of means were calculated. RESULTS: Thiamin, niacin, and vitamin C intakes were usually adequate. Intakes of most other micronutrients, including iron, zinc, vitamin A, riboflavin, vitamin B12, folate, and zinc were low, likely resulting in high levels of inadequacy. Energy intakes were lower than requirements, but it is unlikely to be a common problem, rather, this result was probably due to the known tendency of most dietary survey tools to underreport intake. However, energy from fat intakes was very low, usually less than 20% of the total, and in some settings, less than 10%. CONCLUSIONS: The inadequate intake of some micronutrients is common in many developing countries, but the extremely low intake of dietary fat found in the central Andes is not. Increased consumption of animal-source foods would increase fat intakes, while addressing micronutrient deficiencies; however, the impact on the fragile ecosystem of the Andes needs considering. Indigenous crops, such as lupine bean, quinoa, and amaranth are also rich in fat or micronutrients.

OBJETIVO: Analizar la adecuación del régimen alimentario en la zona andina, incluidas las ingestas de macro y micronutrientes, prestando especial atención a las comunidades rurales; señalar las prioridades nutricionales en los Andes; y establecer las oportunidades de mejora. MÉTODOS: Se llevó a cabo una exhaustiva búsqueda bibliográfica, en la que se seleccionaron documentos publicados y procedentes de la literatura gris, en inglés y español, relacionados con el régimen alimentario en los países andinos centrales de Bolivia, Colombia, Ecuador y Perú. Se incluyeron artículos que aportaran datos de encuestas alimentarias o intervenciones nutricionales. En el análisis final, se incluyeron 34 artículos o informes publicados desde 1969 a 2011. Se recopilaron las medias y las variaciones de las ingestas de todos los nutrientes presentados según el sexo y el grupo de edad, y se calculó la correspondiente media de las medias. RESULTADOS: Las ingestas de tiamina, niacina y vitamina C eran generalmente adecuadas. Las ingestas de la mayor parte de los restantes micronutrientes, incluidos el hierro, el cinc, la vitamina A, la riboflavina, la vitamina B12 y el folato, eran bajas, lo que probablemente ocasionaba altos niveles de inadecuación. Los aportes energéticos eran inferiores a los requeridos, aunque es poco probable que ello constituya un problema frecuente; más bien, este resultado podría deberse a la tendencia conocida de notificar insuficientemente la ingesta en la mayor parte de las encuestas alimentarias. Sin embargo, el aporte energético procedente del consumo de grasas era muy reducido, generalmente por debajo del 20% del total, y en algunos lugares, por debajo del 10%. CONCLUSIONES: La ingesta inadecuada de algunos micronutrientes es frecuente en muchos países en desarrollo, aunque no es tan frecuente la ingesta extremadamente baja de grasa alimentaria observada en los Andes centrales. Un mayor consumo de alimentos de origen animal aumentaría la ingesta de grasas, al tiempo que abordaría las carencias en micronutrientes; sin embargo, debe tenerse en cuenta su posible repercusión sobre el frágil ecosistema de los Andes. Los cultivos autóctonos, como el frijol de altramuz, la quinoa y el amaranto, son también ricos en grasas o micronutrientes.

Disclosure and Experienced Social Support are not Related to Anxiety or Depression in a German HIV Patient Cohort / 감염과화학요법

BACKGROUND: It is unclear to which extent the rate of disclosure of the diagnosis "HIV" to the social environment and the nature of experienced responses are correlated with the current mental health status of HIV-infected patients living in Germany. MATERIALS AND METHODS: Eighty consecutive patients of two German HIV outpatient clinics were enrolled. Patients performed the Hospital Anxiety and Depression Scale (HADS) in its German version. Disclosure behaviour and the experienced responses after disclosing as perceived by the participants were assessed using a questionnaire. In addition, patients were asked to state whether they felt guilty for the infection on a 1-4 point Likert scale. RESULTS: Pathological results on the anxiety scale were reached by 40% of male and 73% of female patients, and on the depression scale by 30% of male and 47% of female patients, thus significantly exceeding recently assessed values in the German general population, except for depression in males. None of the HADS scale results was interrelated either with the rate of disclosure or the experienced responses. 36% of patients reported to feel guilty for the infection, which was positively correlated with results from the HADS. Limitation: The time since the single disclosure events was not assessed, and the subgroup of women was comparably small. CONCLUSIONS: Despite substantial improvement in treatment, HIV-infected patients in Germany still suffer from an elevated level of anxiety and, in part, depression. However, mental health status was neither related with disclosure behaviour nor with experienced responses. We hypothesize that internal beliefs may play a more important role.

Lactancia materna, alimentación complementaria y malnutrición infantil en los Andes de Bolivia / Breastfeeding, complimentary feeding practices and childhood malnutrition in the Bolivian Andes

El Norte de Potosí es una de las partes más pobres de Bolivia, contiene los indicadores más altos de pobreza rural desnutrición e inseguridad alimentaria de los Andes bolivianos. El propósito fue caracterizar los niveles de desnutrición y las prácticas de alimentación de infantes para desarrollar un programa de intervenciones efectivas, sensibles al género y culturalmente relevantes, fomentando las buenas prácticas de alimentación infantil. Para la toma de los datos antropométricos se usó métodos estándares. Se tomaron el peso y la talla de 400 niños/as menores de cinco años de 30 comunidades. En seis de estas comunidades, se usaron entrevistas y discusiones con grupos focales con 33 madres y otros familiares, además de observaciones en los hogares para describir las prácticas de alimentación de los infantes. Casi el 20 por ciento de los niños/as son de bajo peso; además los niños/as tienen altos niveles de retraso en la talla. El 38 por ciento de las mamás empezaron la lactancia materna después de 12 horas. El 39 por ciento inició la alimentación complementaria, en los primeros tres meses. El tipo de alimento complementario que se da al infante en general fue inadecuado. Con este estudio se pudo ver que las deficiencias nutricionales a menudo empiezan cuando la madre inicia la lactancia materna y cuando introduce por primera vez la alimentación complementaria. Para las intervenciones que estén destinadas a mejorar la nutrición materno-infantil se requerirá cambios en el comportamiento personal, un mayor reconocimiento y apoyo comunitario; estrategias para llegar a la gente joven, hacer participar a los hombres y una mayor disponibilidad de servicios de calidad.

Northern Potosí is one of the poorest parts of Bolivia with the highest indicators of rural poverty, malnutrition and food insecurity in the Bolivian Andes. The objective of this research was to characterize the levels of malnutrition and describe infant feeding practices in Potosi, Bolivia and use this information to develop an effective, gender sensitive and culturally relevant intervention encouraging good infant feeding practices. Standard methods were used to collect anthropometric data. Weight and height data were collected for 400 children under five years of age from 30 communities. In six of these communities, interviews and focus group discussions were conducted with 33 mothers and other families in addition to household observational data that were collected to describe infant feeding practices. Nearly 20 percent of children were underweight; stunting was widespread as well. 38 percent of mothers initiated breastfeeding 12 hours or more after birth. 39 percent of mothers initiated complementary feeding in the first three months following birth. The type of complementary food given to children was usually inadequate. With this research we could see that nutritional deficiencies often begin when the mother starts breastfeeding and when first introduced complementary feeding. Interventions aimed at improving maternal and child nutrition will require changes in parents’ behavior, greater recognition and community support of the importance of child feeding, and the inclusion of strategies to reach young people, involve men, and make high quality nutrition promotion more widely available in the communities.

Urovysion™ testing can lead to early identification of intravesical therapy failure in patients with high risk non-muscle invasive bladder cancer

Purpose: In this study, we investigated the ability of UroVysion™ to assess response to intravesical therapy in patients with high risk superficial bladder tumors. Materials and methods: We performed a retrospective review of patients undergoing intravesical therapy for high risk superficial bladder tumors. Urine specimens were collected for UroVysion™ analysis before and immediately after a course of intravesical therapy. Cytology and cystoscopy were performed six weeks after treatment, using either a positive cytology or visible abnormality on cystoscopy as a prompt for biopsy. The operating characteristics of the UroVysion™ test were then determined. Results: 41 patients were identified in whom 47 cycles of induction and 41 cycles of maintenance intravesical therapy were given during the study period. This yielded a total of 88 treatment and evaluation cycles. Median follow-up was 9 months per induction (range 1-21 months) and 13 months per patient (range 1-25 months). A total of 133 urine samples were collected for UroVysion™ of which 40 were positive. Based upon standard clinical evaluation, 41 biopsies were performed which detected 20 recurrences. UroVysion™ testing performed immediately upon completion of therapy for the 41 patients undergoing biopsy yielded a sensitivity, specificity, and accuracy of 85 percent, 61 percent, and 71 percent. Conclusions: The use of UroVysion™ following intravesical therapy for high-risk superficial bladder tumors helps to identify patients at high risk of refractory or recurrent disease who should undergo immediate biopsy under anesthesia.