Comparing Ultrasound with Magnetic Resonance Imaging in the Evaluation of Subungual Glomus Tumors and Subungual Myxoid Cysts.

Introduction: Subungual myxoid cysts and subungual glomus tumors demonstrate characteristic features on magnetic resonance imaging (MRI) and ultrasound (US). It is not yet well-established whether US is congruent to MRI in diagnostic evaluation of these subungual lesions. Methods: Participants with clinical suspicion for subungual glomus tumors or subungual myxoid cysts were recruited. After clinical evaluation, participants underwent radiography, MRI, and US plus biopsy, aspiration, or excision where possible. Differential diagnoses were revised after review of imaging, and imaging findings were compared to definitive diagnosis by pathology, aspiration, or clinical course. Results: All lesions were visible on both US and MRI and size estimates agreed between the two modalities. US and MRI findings of subungual glomus tumors and subungual myxoid cysts agreed with their known respective imaging characteristics. Conclusions: Diagnosis of subungual myxoid cysts and subungual glomus tumors agreed between US and MRI. We provide sample MRI and US imaging parameters for optimal evaluation of subungual myxoid cysts and glomus tumors. We demonstrate that subungual MRI evaluation can be performed without special equipment, allowing for evaluation by most radiology departments. Lastly, US is user-dependent and may be non-inferior for a sonographer familiar with subungual US.

The influence of erosion sources on sediment-related water quality attributes.

Suspended fine sediment has a significant impact on freshwater quality variables such as visual clarity (VC). However, freshwater quality is related to the attributes of the catchment sources contributing fine sediment to the stream network. Here, the extent to which an array of sources defined spatially according to erosion process and geological parent material may be discriminated and classified based on sediment-related water quality (SRWQ) attributes that potentially affect VC was examined. Erosion sources were sampled across two New Zealand catchments representing six types of erosion and eight parent materials. Erosion source measurements focused on particle size, organic matter content, and light beam attenuation (which is convertible to VC). The source data were analysed to: 1) evaluate source variability using a combination of Kruskal-Wallis and principal component analysis; 2) reclassify sources using a Random Forest model; and 3) demonstrate how erosion source affects VC for a range of theoretical sediment concentrations (SC) using a simple empirical model. The results indicate that SRWQ attributes show significant variation across erosion sources. The extent to which attributes differed between sources often related to whether there was a strong association between a specific erosion process and parent material. The 19 a priori source classifications were reduced to 5 distinct sources that combined erosion process and parent material (i.e., bank erosion-alluvium; mass movement-ancient volcanics; mass movement-sedimentary; surficial erosion; gully-unconsolidated sandstone). At low SC, the impact of erosion source on VC became most evident ranging from 2.6 to 5.6 m at SC of 5 g m-3. These findings show how catchment sources of sediment, in addition to sediment concentration, influence VC, and highlight the need to consider quality as well as quantity of material supplied to stream networks when planning erosion control.

Thyrotropin-secreting microadenoma and the importance of a prompt diagnosis: A case report.

Background: The prevalence of thyrotropin-secreting pituitary adenomas, most being macroadenomas, is one to two cases per million inhabitants. Their differential diagnosis may be challenging, especially for microadenomas. Case description: We present the case of a 50-year-old male with progressive neck enlargement, hot sudorific hands, anorexia, diarrhea, and weight loss over the preceding three months. Laboratory evaluation revealed high thyroid hormones, predominantly high free triiodothyronine of 7.74 pg/mL (reference range 2.3-4.2), with a non-suppressed thyroid stimulating hormone (TSH) of 1.73 µIU/mL (reference range 0.55-4.78). A high level of suspicion directed additional evaluation that revealed a high total alpha-subunit of glycoprotein hormones (αGS) and αGS/TSH ratio. Magnetic resonance imaging revealed a six mm pituitary lesion. A microthyrotropinoma was diagnosed, and long-acting octreotide was initiated before surgery for symptomatic control. Endoscopic transnasal transsphenoidal tumor resection was performed months later. The patient was in remission one year after surgery with no pituitary deficits. Conclusions: Reaching an accurate diagnosis on time is crucial for deciding the optimal therapeutic approach and preventing and decreasing the frequency of endocrine and neurological complications. HIPPOKRATIA 2022, 26 (4):157-160.

Monitoring the Age of Mosquito Populations Using Near-Infrared Spectroscopy.

Mosquito control with bednets, residual sprays or fumigation remains the most effective tool for preventing vector-borne diseases such as malaria, dengue and Zika, though there are no widely used entomological methods for directly assessing its efficacy. Mosquito age is the most informative metric for evaluating interventions that kill adult mosquitoes but there is no simple or reliable way of measuring it in the field. Near-Infrared Spectroscopy (NIRS) has been shown to be a promising, high-throughput method that can estimate the age of mosquitoes. Currently the ability of NIRS to measure mosquito age is biased, and has relatively high individual mosquito measurement error, though its capacity to rigorously monitor mosquito populations in the field has never been assessed. In this study, we use machine learning methods from the chemometric literature to generate more accurate, unbiased estimates of individual mosquito age. These unbiased estimates produce precise population-level measurements, which are relatively insensitive to further increases in NIRS accuracy when feasible numbers of mosquitoes are sampled. The utility of NIRS to directly measure the impact of pyrethroid resistance on mosquito control is illustrated, showing how the technology has potential as a highly valuable tool for directly assessing the efficacy of mosquito control interventions.

The revolving door: antibiotic allergy labelling in a tertiary care centre.

BACKGROUND: Patients frequently report antibiotic allergies; however, only 10% of labelled patients have a true allergy. AIM: We investigated the documentation of antibiotic 'allergy' labels (AAL) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. METHODS: Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys was carried out. Data were collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission and readmissions. RESULTS: Of the 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AAL were recorded in 122 (18%) patients and the majority were penicillin labels (n = 87; 71%). Details of AAL were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (P = 0.0002) and more aminoglycosides (P = 0.043) and metronidazole (P = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AAL had significantly more hospital readmissions within 4 weeks (P = 0.001) and 6 months (P = 0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections. CONCLUSIONS: AAL are common, but poorly documented in hospital records. Patients with AAL are significantly more likely to require alternative antibiotics and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels.

Impact of a school-based intervention to promote fruit intake: a cluster randomized controlled trial.

OBJECTIVE: There is evidence that fruit consumption among school children is below the recommended levels. This study aims to examine the effects of a dietary education intervention program me, held by teachers previously trained in nutrition, on the consumption of fruit as a dessert at lunch and dinner, among children 6-12 years old. STUDY DESIGN: This is a randomized trial with the schools as the unit of randomisation. METHODS: A total of 464 children (239 female, 6-12years) from seven elementary schools participated in this cluster randomized controlled trial. Three schools were allocated to the intervention and four to the control group. For the intervention schools, we delivered professional development training to school teachers (12 sessions of 3 h each). The training provided information about nutrition, healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop classroom activities focused on the learned topics. Sociodemographic was assessed at baseline and anthropometric, dietary intake and physical activity assessments were performed at baseline and at the end of the intervention. Dietary intake was evaluated by a 24-h dietary recall and fruit consumption as a dessert was gathered at lunch and dinner. RESULTS: Intervened children reported a significant higher intake in the consumption of fruit compared to the controlled children at lunch (P = 0.001) and at dinner (P = 0.012), after adjusting for confounders. CONCLUSIONS: Our study provides further support for the success of intervention programmes aimed at improving the consumption of fruit as a dessert in children.

Characterization and quantification of suspended sediment sources to the Manawatu River, New Zealand.

Knowledge of sediment movement throughout a catchment environment is essential due to its influence on the character and form of our landscape relating to agricultural productivity and ecological health. Sediment fingerprinting is a well-used tool for evaluating sediment sources within a fluvial catchment but still faces areas of uncertainty for applications to large catchments that have a complex arrangement of sources. Sediment fingerprinting was applied to the Manawatu River Catchment to differentiate 8 geological and geomorphological sources. The source categories were Mudstone, Hill Subsurface, Hill Surface, Channel Bank, Mountain Range, Gravel Terrace, Loess and Limestone. Geochemical analysis was conducted using XRF and LA-ICP-MS. Geochemical concentrations were analysed using Discriminant Function Analysis and sediment un-mixing models. Two mixing models were used in conjunction with GRG non-linear and Evolutionary optimization methods for comparison. Discriminant Function Analysis required 16 variables to correctly classify 92.6% of sediment sources. Geological explanations were achieved for some of the variables selected, although there is a need for mineralogical information to confirm causes for the geochemical signatures. Consistent source estimates were achieved between models with optimization techniques providing globally optimal solutions for sediment quantification. Sediment sources was attributed primarily to Mudstone, ≈38-46%; followed by the Mountain Range, ≈15-18%; Hill Surface, ≈12-16%; Hill Subsurface, ≈9-11%; Loess, ≈9-15%; Gravel Terrace, ≈0-4%; Channel Bank, ≈0-5%; and Limestone, ≈0%. Sediment source apportionment fits with the conceptual understanding of the catchment which has recognized soft sedimentary mudstone to be highly susceptible to erosion. Inference of the processes responsible for sediment generation can be made for processes where there is a clear relationship with the geomorphology, but is problematic for processes which occur within multiple terrains.

Influence of different behavioural factors and obesity status on systolic blood pressure among pre-school children.

AIM: The aim of this study was to examine the association between sleeping time (SLT), time spent using screen (ST) and weight status with Systolic Blood Pressure (SBP) among pre-school children. SUBJECTS AND METHODS: The sample comprised 628 pre-school children (50% female), aged 3-6 years-old. SLT and ST were reported by parents. BMI values were categorized according to IOTF. SBP cut points were based on SBP percentiles for age, sex and height. ST was dichotomized according to the following criteria: ≤1 hour vs >1 hour and SLT: ≤10.5 hours vs >10.5 hours. Participants were then categorized into one of four category profiles: Low ST/High SLT; High ST/Low SLT; Low ST/Low SLT and High ST/High SLT. RESULTS: Children assigned to the High ST/Low SLT group were 2-times more likely to have high SBP values compared to those who were assigned to the Low ST/High SLT group (OR = 2.4; 95% CI = 1.1-5.1). Furthermore, those who were assigned as overweight and obese were more likely to be classified as having elevated BP (OR = 1.8; 95% CI = 1.1-3.2 for overweight and OR = 3.1; 95% CI = 1.6-5.8 for obese, respectively). CONCLUSION: The data showed that high ST exposure time and low SLT are associated with enhanced blood pressure in children at pre-school.

Relationship of milk intake and physical activity to abdominal obesity among adolescents.

UNLABELLED: What is already known about this subject Diet and physical activity (PA) are recognized as important factors to prevent abdominal obesity (AO). Studies have found an inverse relationship between milk intake or milk products and body weight and/or body fat in children and adolescents. Evidence suggests that low levels of PA are associated with AO in youth. What this study adds Our study explored the combined association of milk intake and PA on AO in adolescents, which are most often studied in isolation. Our findings suggested that adolescents with high milk intakes, regardless of whether they were active or low active, were less likely to have AO. Our findings could have a great epidemiological interest and bring important evidence in the field of AO management among adolescents. BACKGROUND: Diet and physical activity (PA) are recognized as important factors to prevent abdominal obesity (AO), which is strongly associated with chronic diseases. Some studies have reported an inverse association between milk consumption and AO. OBJECTIVE: This study examined the association between milk intake, PA and AO in adolescents. METHODS: A cross-sectional study was conducted with 1209 adolescents, aged 15-18 from the Azorean Archipelago, Portugal in 2008. AO was defined by a waist circumference at or above the 90th percentile. Adolescent food intake was measured using a semi-quantitative food frequency questionnaire, and milk intake was categorized as 'low milk intake' (<2 servings per day) or 'high milk intake' (≥2 servings per day). PA was assessed via a self-report questionnaire, and participants were divided into active (>10 points) and low-active groups (≤10 points) on the basis of their reported PA. They were then divided into four smaller groups, according to milk intake and PA: (i) low milk intake/low active; (ii) low milk intake/active; (iii) high milk intake/low active and (iv) high milk intake/active. The association between milk intake, PA and AO was evaluated using logistic regression analysis, and the results were adjusted for demographic, body mass index, pubertal stage and dietary confounders. RESULTS: In this study, the majority of adolescents consumed semi-skimmed or skimmed milk (92.3%). The group of adolescents with high level of milk intake and active had a lower proportion of AO than did other groups (low milk intake/low active: 34.2%; low milk intake/active: 26.9%; high milk intake/low active: 25.7%; high milk intake/active: 21.9%, P = 0.008). After adjusting for confounders, low-active and active adolescents with high levels of milk intake were less likely to have AO, compared with low-active adolescents with low milk intake (high milk intake/low active, odds ratio [OR] = 0.412, 95% confidence intervals [CI]: 0.201-0.845; high milk intake/active adolescents, OR = 0.445, 95% CI: 0.235-0.845). CONCLUSION: High milk intake seems to have a protective effect on AO, regardless of PA level.

Zinc pharmacokinetic parameters in the determination of body zinc status in children.

BACKGROUND/OBJECTIVES: Serum or tissue zinc concentrations are often used to assess body zinc status. However, all of these methods are relatively inaccurate. Thus, we investigated three different kinetic methods for the determination of zinc clearance to establish which of these could detect small changes in the body zinc status of children. SUBJECTS/METHODS: Forty apparently healthy children were studied. Renal handling of zinc was investigated during intravenous zinc administration (0.06537 mg Zn/kg of body weight), both before and after oral zinc supplementation (5 mg Zn/day for 3 months). Three kinetic methods were used to determine zinc clearance: CZn-Formula A and CZn-Formula B were both used to calculate systemic clearance; the first is a general formula and the second is used for the specific analysis of a single-compartment model; CZn-Formula C is widely used in medical practices to analyze kinetic routine. RESULTS: Basal serum zinc values, which were within the reference range for healthy children, increased significantly after oral zinc supplementation. The three formulas used gave different results for zinc clearance both before and after oral zinc supplementation. CZn-Formula B showed a positive correlation with basal serum zinc concentration after oral supplementation (R2=0.1172, P=0.0306). In addition, CZn-Formula B (P=0.0002) was more effective than CZn-Formula A (P=0.6028) and CZn-Formula C (P=0.0732) in detecting small variations in body zinc status. CONCLUSIONS: All three of the formulas used are suitable for studying zinc kinetics; however, CZn-Formula B is particularly effective at detecting small changes in body zinc status in healthy children.