The overall quality of evidence of recommendations surrounding nutrition and diet in inflammatory bowel disease.

BACKGROUND AND AIM: Recently, there has been an increased focus on the role nutrition and diet play in maintaining health in inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on nutrition/diet in IBD. METHODS: A systematic search was performed on multiple databases from inception until January 1, 2021, to identify guidelines pertaining to nutrition or diet in IBD. All guidelines were reviewed for disclosure of conflicts of interest (COI) and funding, recommendation quality and strength, external document review, patient representation, and plans for update-as per Institute of Medicine (IOM) standards. In addition, recommendations and their quality were compared between guidelines/societies.​ RESULTS: Seventeen distinct societies and a total of 228 recommendations were included. Not all guidelines provided recommendations on key aspects of diet-such as the role of supplements or the appropriate micro/macro nutrition in IBD. Fifty-nine percent of guidelines reported on COI, 24% underwent external review, and 41% included patient representation. 18.4%, 25.9%, and 55.7% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 10.5%, 24.6%, and 64.9% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence (p = 0.12) and strong recommendations (p = 0.83) did not significantly differ across societies. CONCLUSIONS: Many guidelines do not provide recommendations on key aspects of diet/nutrition in IBD. As over 50% of recommendations are based on low-quality evidence, further studies on nutrition/diet in IBD are warranted to improve the overall quality of evidence.

Management of breast lesions by breast physicians in a heavily populated South asian developing country.

BACKGROUND: In Asia, from 1998 to 2002, the highest annual-age standardized incidence rates of breast cancer per 100,000 women were recorded as follows: in the Karachi South district of Pakistan 69.0 and in the Israeli Jews 96.8. At Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, in 15-years from Dec. 1995-Dec. 2009, among adult females, approximately 46% (8,915) of malignancies were recorded as breast tumors. Further, according to Pakistan's population estimates (2009), the total population of the country is 177 million; females 85 million (40-69 years: 13.6 million). DISCUSSION: Screening of asymptomatic women: Basing the recommendations on biennial mammograhic screening for average-risk women in the 40-69 year age-band, about 6.8 million women will have to be screened every year. In a resource-constrained country like Pakistan, early detection by this method is not possible. As most symptomatic women present with advanced disease, clinicians skilled in breast diseases are required. The Australasian Society of Breast Physicians has developed a formal three year training model for General Practitioners to qualify as breast physicians by: i) developing their skills in the areas of clinical breast-examination, interpretation of mammography and breast ultrasound; performance of image-guided interventional procedures; counseling of and planning/coordinating treatment of females with breast cancer and assessment/monitoring of women at potentially 'high-risk' of cancer; and ii) working in consultation with surgeons, radiologists, pathologists, oncologists, and other members of the multidisciplinary team. SUMMARY: Easily accessible one-stop breast clinics staffed by trained breast physicians can help reduce morbidity/mortality from breast cancer in developing countries, and improve the quality of life and survival.

Molecular and morphological adaptations in compressed articular cartilage by polarized light microscopy and Fourier-transform infrared imaging.

Fifteen articular cartilage-bone specimens from one canine humeral joint were compressed in the strain range of 0-50%. The deformation of the extracellular matrices in cartilage was preserved and the same tissue sections were studied using polarized light microscopy (PLM) and Fourier-transform infrared imaging (FTIRI). The PLM results show that the most significant changes in the apparent zone thickness due to 'reorganization' of the collagen fibrils based on the birefringence occur between 0% and 20% strain values, where the increase in the superficial zone and decrease in the radial zone thicknesses are approximately linear with the applied strain. The FTIRI anisotropy results show that the two amide components with bond direction perpendicular to the external compression retain anisotropy (amide II in the superficial zone and amide I in the radial zone). In contrast, the measured anisotropy from the two amide components with bond direction parallel to the external compression changes their anisotropy significantly (amide I in the superficial zone and amide II in the radial zone). Statistical analysis shows that there is an excellent correlation (r=0.98) between the relative depth of the minimum retardance in PLM and the relative depth of the amide II anisotropic cross-over. The changes in amide anisotropies in different histological zones are explained by the strain-dependent tipping angle of the amide bonds. These depth-dependent adaptations to static loading in cartilage's morphological structure and chemical distribution could be useful in the future studies of the early diseased cartilage.