Cardiovascular and bone health outcomes in older people with subclinical hypothyroidism treated with levothyroxine: a systematic review and meta-analysis.

BACKGROUND: Thyroid dysfunction is common in older people, with females at higher risk. Evidence suggests that thyroid-stimulating hormone (TSH) levels naturally increase with age. However, as uniform serum TSH reference ranges are applied across the adult lifespan, subclinical hypothyroidism (SCH) diagnosis is more likely in older people, with some individuals also being commenced treatment with levothyroxine (LT4). It is unclear whether LT4 treatment in older people with SCH is associated with adverse cardiovascular or bone health outcomes. METHODS: A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected. RESULTS: Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible. CONCLUSIONS: This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022308006.

Asymmetry Thresholds for Common Screening Tests and Their Effects on Jump Performance in Professional Soccer Players.

CONTEXT: Arbitrary asymmetry thresholds are regularly used in professional soccer athletes, notwithstanding the sparse literature available to examine their prevalence. OBJECTIVE: To establish normative and positional asymmetry values for commonly used screening tests and investigate their relationships with jumping performance. DESIGN: Cross-sectional study. SETTING: Elite soccer screening. PATIENTS OR OTHER PARTICIPANTS: A total of 203 professional male soccer players. MAIN OUTCOME MEASURE(S): Bilateral and unilateral jumping; range of motion; and hamstrings (HAM), quadriceps (QUAD), and hip-adductor and -abductor strength tests were used to quantify asymmetry. Players were divided into 4 quartiles (Q1-Q4) based on the magnitude of their asymmetry for each test. Single composite scores were also developed to group tests by range of motion and HAM, QUAD, hip-adduction, and hip-abduction strength, and differences in jump performance were examined among players in each quartile. RESULTS: Large variability (range = 5.2%-14.5%) was evident in asymmetry scores across the different tests and physical qualities. Forwards displayed greater asymmetry in concentric quadriceps and eccentric hip-abduction strength (P < .05). The HAM and QUAD composite scores indicated that Q4 players' jumps were shorter than those in other quartiles during a single-legged countermovement jump and 10-second hop (P < .05). No decrements in unilateral jump performance were shown among players in each quartile for range of motion or hip-adduction and -abduction strength, and no composite measures of asymmetry affected bilateral jump performance. CONCLUSIONS: No single asymmetry threshold was present for all tests; the outcomes were task, variable, and population specific. Larger asymmetries in HAM and QUAD strength appeared to be detrimental to unilateral jump performance.

Timing of the decline in physical activity in childhood and adolescence: Gateshead Millennium Cohort Study.

BACKGROUND AND AIM: There is a widely held and influential view that physical activity begins to decline at adolescence. This study aimed to identify the timing of changes in physical activity during childhood and adolescence. METHODS: Longitudinal cohort study (Gateshead Millennium Study) with 8 years of follow-up, from North-East England. Cohort members comprise a socioeconomically representative sample studied at ages 7, 9, 12 and 15 years; 545 individuals provided physical activity data at two or more time points. Habitual total volume of physical activity and moderate-to-vigorous intensity physical activity (MVPA) were quantified objectively using the Actigraph accelerometer over 5-7 days at the four time points. Linear mixed models identified the timing of changes in physical activity across the 8-year period, and trajectory analysis was used to identify subgroups with distinct patterns of age-related changes. RESULTS: Four trajectories of change in total volume of physical activity were identified representing 100% of all participants: all trajectories declined from age 7 years. There was no evidence that physical activity decline began at adolescence, or that adolescent declines in physical activity were substantially greater than the declines during childhood, or greater in girls than boys. One group (19% of boys) had relatively high MVPA which remained stable between ages 7 and15 years. CONCLUSIONS: Future policy and research efforts to promote physical activity should begin well before adolescence, and should include both boys and girls.

Improving cancer patient emergency room utilization: A New Jersey state assessment.

INTRODUCTION: Due to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs. METHODS: The New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return. RESULTS: A total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR=0.6, p value=0.02 and Hispanic OR=0.5, p value=0.02, respectively), age aged 65 to 75years (SNF/ICF OR 2.35, p value=0.00 and Home Healthcare Service OR 5.15, p value=0.01, respectively), number of diagnoses (OR 1.26, p value=0.00), insurance payer (SNF/ICF OR 2.2, p value=0.02 and Home Healthcare Services OR 2.85, p value=0.07, respectively) and type of cancer (breast OR 0.54, p value=0.01, prostate OR 0.56, p value=0.01, uterine OR 0.37, p value=0.02, and other OR 0.62, p value=0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value=0.00, OR 1.18, p value=0.00, and OR 1.16, p value=0.04, respectively). Readmission is significantly affected by race (American Americans OR 0.41, standard error 0.08, p value=0.001 and Hispanics OR 0.29, standard error 0.11, p value=0.01, respectively), income (Quartile 2 OR 0.98, standard error 0.14, p value 0.01, Quartile 3 OR 1.07, standard error 0.13, p value 0.01, and Quartile 4 OR 0.88, standard error 0.12, p value 0.01, respectively), and type of cancer (prostate OR 0.25, standard error 0.09, p value=0.001). CONCLUSION: Web based symptom questionnaires, patient navigators, end of life nursing and clinical cancer pathways can identify, guide and prompt early initiation of treat before progression of symptoms in cancer patients most likely to visit the ED. Thus, improving cancer patient satisfaction, outcomes and reduce health care costs.

Giant Meckel's diverticulum compressing root of mesentery - A rare cause of ileal gangrene - Case report and review of literature.

INTRODUCTION: Meckel's diverticulum (MD) commonly presents as gastrointestinal bleeding in the pediatric population and intestinal obstruction in adults. There is no consensus for surgical excision of an incidentally diagnosed MD. We present a hitherto unreported vascular cause of intestinal gangrene due to MD. CASE PRESENTATION: A 16year old boy was referred as an acute abdomen for tertiary hospital management. Clinical examination and CT suggested small bowel obstruction and emergency laparotomy was performed. A giant MD compressing the root of mesentery, causing critical occlusion of the ileal vessels and extensive ileal gangrene was found. The gangrenous bowel was resected and a jejuno-ascending colon anastamosis was done. Postoperative recovery was uneventful. DISCUSSION: This case report highlights an unrecognized complication of a giant Meckel's diverticulum. There are no clear guidelines on the management of an incidentally discovered MD though certain studies recommend resection of an incidental MD in males and individuals less than 50 years of age or when the MD is larger than 2cm or contains histologically abnormal tissue. Other meta-analyses do not recommend routine resection. MD has been identified as a high risk region for ileal malignancy and its resection usually has minimal morbidity. A valid consent for opportunistic resection of a Meckel's diverticulum in any laparotomy would be discerning. CONCLUSION: Appropriate opportunistic resection of an incidental Meckel's diverticulum may prevent extensive surgical morbidity later. This case highlights the need to revisit guidelines for management of incidentally identified MD.

A rare case of male pseudohermaphroditism-persistent mullerian duct syndrome with transverse testicular ectopia - Case report and review of literature.

INTRODUCTION: Persistent Mullerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism. Transverse testicular ectopia (TTE) is characterized by one testis moving to the opposite side and both testes traversing the same inguinal canal. CASE PRESENTATION: An 11-month-old boy presented with bilateral cryptorchidism. The left testis was not palpable; the right testis was canalicular with a right inguinal hernia. Ultrasound showed both testes located in the right inguinal canal. Right inguinal exploration revealed two testes with intact spermatic cords. A primitive uterus with fallopian tubes was also identified on opening the processus vaginalis. After herniotomy, bilateral orchidopexy was carried out (left orchidopexy through a trans-septal approach). Karyotyping confirmed a male gender (46XY). One year after the operation, ultrasound showed both testes to be in good condition. DISCUSSION: PMDS is caused by defects in the gene that encodes Antimullerian hormone(AMH). Treatment aims to correct cryptorchidism and ensure appropriate scrotal placement of the testes. Malignant transformation is as likely as the presence of abdominal testes in an otherwise normal man. Failing early surgical correction, gonadectomy must be offered to prevent malignancy. Division of the persistent mullerian duct structures is indicated only in patients where persistence interferes with orchidopexy. CONCLUSION: TTE should be suspected in patients presenting with inguinal hernia on one side and cryptorchidism on the other side. Herniotomy and bilateral orchidopexy is optimal. Removal of mullerian structures may injure the artery to vas deferens and is hence not recommended. Follow-up for fertility assessment in the latter years should be counselled.

Resection and reconstruction following recurrent malignant phyllodes-Case report and review of literature.

INTRODUCTION: Phyllodes tumors are uncommon biphasic fibroepithelial neoplasms of the breast of varying malignant potential occurring in middle aged women. They exhibit diverse biological behavior. Margin free excision is the mainstay of treatment. CASE PRESENTATION: A 27 year-old lady was referred with a painless ulceroproliferative right breast lesion which had rapidly progressed over six months. Three years back, she had been diagnosed with a borderline phyllodes tumor and underwent a wide local excision followed by a right mastectomy for recurrence. The resection margins were positive hence she underwent postoperative radiation. We performed a radical resection of the chest wall and reconstruction using a composite mesh (inner PTFE and outer vypro), pedicled latissimus dorsi flap and a split skin graft for the recurrent malignant tumor. She recovered uneventfully thereafter. DISCUSSION: Malignant phyllodes tumor is uncommon and treatment principles are from case reports and retrospective studies. Aggressive resection of the lesion and reconstruction of the chest wall with bone cement and two meshes-a composite mesh (inner layer -polytetrafluroethylene and outer layer of polypropylene) and a Vypro mesh is a possibility. This case highlights the challenges encountered in managing these patients and presents a radical solution. CONCLUSION: Treatment of phyllodes tumor necessitates adequate excision of the tumor and adjacent tissues to ensure tumor free margins. Pathological evolution from intermediate to malignant histology may be exhibited. A full-thickness chest wall resection and reconstruction although radical is a feasible option as these tumors rarely respond to other modalities of cancer management.

Assessing the Reliability of Digitalized Cephalometric Analysis in Comparison with Manual Cephalometric Analysis.

INTRODUCTION: For more than seven decades orthodontist used cephalometric analysis as one of the main diagnostic tools which can be performed manually or by software. The use of computers in treatment planning is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility. AIM: This study was done to evaluate and compare the accuracy and reliability of cephalometric measurements between computerized method of direct digital radiographs and conventional tracing. MATERIALS AND METHODS: Digital and conventional hand tracing cephalometric analysis of 50 patients were done. Thirty anatomical landmarks were defined on each radiograph by a single investi-gator, 5 skeletal analysis (Steiner, Wits, Tweeds, McNamara, Rakosi Jarabaks) and 28 variables were calculated. RESULTS: The variables showed consistency between the two methods except for 1-NA, Y-axis and interincisal angle measurements which were higher in manual tracing and higher facial axis angle in digital tracing. CONCLUSION: Most of the commonly used measurements were accurate except some measurements between the digital tracing with FACAD® and manual methods. The advantages of digital imaging such as enhancement, transmission, archiving and low radiation dosages makes it to be preferred over conventional method in daily use.

Marinococcus salis sp., nov., a moderately halophilic bacterium isolated from a salt marsh.

A novel Gram-stain-positive, coccoid-shaped, facultative anaerobic, motile and halophilic bacterium strain 5MT was isolated from Surajbari in India. Based on the 16S rRNA gene sequence analysis, it was identified as belonging to the genus Marinococcus and was most closely related to Marinococcus luteus KCTC 13214T (99.3 %, sequence similarity), Marinococcus halotolerans KCTC 19045T (99.0 %), Marinococcus halophilus LMG 17439T (98.8 %) and Marinococcus tarijensis LMG 26930T (98.7 %). However, the DNA-DNA relatedness of strain 5MT with M. luteus KCTC 13214T, M. halotolerans KCTC 19045T, M. halophilus LMG 17439T and M. tarijensis LMG 26930T was 42.6 ± 0.8, 48.6 ± 0.8, 40.9 ± 0.8 and 39.8 ± 0.9 %, respectively. Strain 5MT grows optimally at 5 % (w/v) NaCl, pH 7.5-8.5 and 37 °C. The cell-wall peptidoglycan of strain 5MT contains meso-diaminopimelic acid. Polar lipids of the strain 5MT include diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, a phospholipid and two unknown lipids. The predominant isoprenoid quinone was MK-7. DNA G+C content was 48.9 mol%, and anteiso-C15:0 (40.9 %) was the predominant fatty acid. The results of phylogenetic, biochemical tests and chemotaxonomic allowed a clear differentiation of strain 5MT from all of its nearest phylogenetic neighbours, which represents a novel member of the genus Marinococcus, for which the name Marinococcus salis sp., nov., is proposed. The type strain is 5MT (=KCTC 33743T = LMG 29101T = CGMCC 1.15385T).

Bacillus caseinilyticus sp. nov., an alkali- and thermotolerant bacterium isolated from a soda lake.

A novel Gram-stain-positive, rod-shaped, motile, endospore-forming and proteolytic bacterial strain, SPT, was isolated from Lonar soda lake, in India. On the basis of 16S rRNA gene sequence analysis it was identified as belonging to the class Firmibacteria and was most closely related to Bacillus cellulosilyticus DSM 2522T (96.7%) and other members of the genus Bacillus ( < 95.9%). Strain SPT was catalase- and oxidase-positive. The cell-wall peptidoglycan of strain SPT contained meso-diaminopimelic acid. Polar lipids included diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, three phospholipids, two aminolipids and two unknown lipids. The predominant isoprenoid quinone was MK-7. Anteiso-C15 : 0 (26.8%) was the predominant fatty acid and significant proportions (>5%) of iso-C15 : 0 (20.9%), C16 : 1ω7c alcohol (6.3%), iso-C16 : 0 (6.3%) and anteiso-C17 : 0 (5.3  %) were also detected in strain SPT. The DNA G+C content of strain SPT was 38.9 mol%. The results of phylogenetic, chemotaxonomic and biochemical tests allowed a clear differentiation of strain SPT from all other members of the genus Bacillus. Strain SPT represents a novel member of the genus Bacillus, for which the name Bacilluscaseinilyticus sp. nov. is proposed. The type strain is SPT ( = MCC 2612T = JCM 30246T).

Bacillus lonarensis sp. nov., an alkalitolerant bacterium isolated from a soda lake.

A novel Gram-stain-positive, rod-shaped, motile and endospore-forming novel bacterial strain 25nlg(T) was isolated from Lonar soda lake, in India. Based on the 16S rRNA gene sequence analysis, it was identified as a member of Firmicutes, being most closely related to Bacillus patagoniensis PAT 05(T) (96.6 %) and other members in the genus Bacillus (<96.0 %). Strain 25nlg(T) was catalase and oxidase-positive. The strain grows optimally at a pH of 9.5 with 4-6 % (w/v) NaCl and temperature of 35-37 °C. The cell wall of the strain 25nlg(T) contains meso-diaminopimelic acid as the diagnostic amino acid. Polar lipids include diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, an unknown phospholipid (PL2), an aminophospholipid (APL2) and three unknown lipids (L2-4). The predominant isoprenoid quinone was MK-7. iso-C15:0 (41.7 %) was the predominant fatty acid, and significant proportions of anteiso-C15:0 (20.8 %), C12:0 (5.5 %), anteiso-C17:0 (4.9 %), iso-C17:0 (4.5 %) were also detected in the strain 25nlg(T). The DNA G+C content of the strain 25nlg(T) was 40.5 mol%. The results of molecular, physiological and biochemical tests allowed a clear phenotypic differentiation of strain 25nlg(T) from all other members of the genus Bacillus. Strain 25nlg(T) represents a novel member of the genus Bacillus, for which the name Bacillus lonarensis sp. nov. is proposed. The type strain is 25nlg(T) (=KCTC 33413(T) = LMG 27974(T) = CGMCC = 1.12817(T)).

GluA2 AMPA glutamate receptor subunit exhibits codon 607 Q/R RNA editing in the lens.

Regulated GluA2 AMPA receptor subunit expression, RNA editing, and membrane localization are fundamental determinants of neuronal Ca(2+) influx, and underlie basic functions such as memory and the primary brain disorder epilepsy. Consistent with this, AMPARs, and specifically GluA2, are targets of common antiepileptic drugs (AEDs) and antidepressants. Recently, epidemiological associations between epilepsy and increased cataract prevalence were found comparable to cataract links with diabetes and smoking. Similarly, use of AEDs and several antidepressants also showed links with increased cataract. Here, we demonstrated GluA2 in lenses, consistent with REST/NRSF and REST4 we described previously in lenses, as well as GluA1 and ADAR2 in the lens. Surprisingly, we found predominant neuron-like Q/R editing of GluA2 RNAs also occurs in the lens and evidence of lens GluA2 phosphorylation and STEP phosphatases linked with GluA2 membrane localization in neurons. This study is among the first to show GluA2 expression and predominant Q/R RNA editing in a non-neural cell. Our results suggest GluA2 AMPARs have related roles in lens physiology and disease processes, and provide evidence these anticonvulsant and antidepressant drug targets also occur in the lens.

Synthetic fiber from a teddy bear causing keratitis and conjunctival granuloma: case report.

BACKGROUND: To report a case of keratitis and a case of conjunctivitis caused by synthetic fibers from toy teddy bears. CASE PRESENTATION: Case stories with histopathological analysis. 1) A two-year-old girl developed a severe case of keratitis and corneal ulceration. The initial treatment with various antibiotics gave no improvement and eventually the patient developed spontaneous perforation of the cornea. The corneal swabs contained no bacteria or fungi. Corneal grafting was performed and the corneal button was sent for histopathological examination. 2) A five-year-old girl presented with ocular irritation in her left eye. Examination revealed a conjunctival granuloma in the inferior fornix. The lesion was excised and histopathologically examined. RESULTS: Microscopy revealed synthetic fibers embedded in the cornea and in the conjunctival granuloma. The diagnosis was confirmed by demonstration of marked birefringence of the synthetic fibers. Microscopical examination of synthetic fibers from two different types of fur (whiskers and face hairs) from the two-year-old girl's teddy bear was performed. Hairs from the face of the teddy bear were morphologically and microscopically identical with the fibers causing the severe corneal ulceration in the two-year-old girl. CONCLUSIONS: Doctors should especially in small children be aware of the risk of ocular consequences of close exposure of synthetic fibers from stuffed toy animals. Corneal ulceration, clinically presenting as corneal infection with negative culturing and staining, should lead to a different clinical strategy and treatment. The treatment of conjunctival synthetic fiber granuloma is excision and antibiotic eye drops.

Impact of storm water on groundwater quality below retention/detention basins.

Groundwater from 33 monitoring of peripheral wells of Karachi, Pakistan were evaluated in terms of pre- and post-monsoon seasons to find out the impact of storm water infiltration, as storm water infiltration by retention basin receives urban runoff water from the nearby areas. This may increase the risk of groundwater contamination for heavy metals, where the soil is sandy and water table is shallow. Concentration of dissolved oxygen is significantly low in groundwater beneath detention basin during pre-monsoon season, which effected the concentration of zinc and iron. The models of trace metals shown in basin groundwater reflect the land use served by the basins, while it differed from background concentration as storm water releases high concentration of certain trace metals such as copper and cadmium. Recharge by storm water infiltration decreases the concentration and detection frequency of iron, lead, and zinc in background groundwater; however, the study does not point a considerable risk for groundwater contamination due to storm water infiltration.

Muscular tenderness in the anterior chest wall in patients with stable angina pectoris is associated with normal myocardial perfusion.

OBJECTIVE: This study examines the relationship between the existence of chest wall tenderness evoked by palpation and the absence of ischemic heart disease defined by myocardial perfusion imaging in patients with known or suspected stable angina pectoris. METHODS: Two hundred seventy-five patients were recruited. Myocardial perfusion imaging was performed on 273 of the subjects. Chest pain was classified according to type by criteria given by the Danish Society of Cardiology and severity by the Canadian Cardiovascular Society. Pectoralis major and pectoralis minor were palpated for tenderness using a standardized procedure. RESULTS: The association between tenderness and myocardial perfusion imaging (normal vs abnormal) produced an odds ratio (OR) of 2.24 (confidence interval, 1.26-3.99; P = .009). The OR was the same magnitude and significance when stratified by sex, age, type of pain, or class. When adjusting simultaneously for sex, age, type of pain, and class, the association between tenderness and myocardial perfusion imaging (normal vs abnormal) was still present (OR = 2.57; confidence interval, 1.342-4.902; P = .004). CONCLUSION: Presence of tenderness in the anterior chest wall is associated with a higher prevalence of normal myocardial perfusion imaging in patients with known or suspected angina pectoris, and this association cannot be explained by a common association to age, sex, or pain.