Prospective Comparison of Geriatric Assessment and Provider's Assessment of Older Adults With Metastatic Breast Cancer in the Community.

BACKGROUND: Geriatric assessment (GA) is recommended for evaluating fitness of an older adult with cancer. Our objective was to prospectively evaluate the gaps that exist in the assessment of older adults with metastatic breast cancer (OA-MBC) in community practices (CP). METHODS: Self-administered GA was compared to provider's assessment (PA) of patients living with MBC aged ≥65 years treated in CP Providers were blinded to the GA results until PA was completed. McNemar's test was used to detect differences between PA and GA. RESULTS: One hundred patients were enrolled across 9 CP (median age 73.9). Geriatric assessment detected a total of 356 abnormalities in 96 patients; of which, 223 required interventions. African American and widowed/single patients were more likely to have abnormalities identified by GA. On average, across 100 patients, PA did not detect 25.5% of GA-detected abnormalities, mostly in functional status, social support, nutrition, and cognition. These differences were less pronounced among providers with more clinical experience. Patients with abnormal Timed Up and Go tests more likely had additional abnormalities in other domains, and more abnormalities that were not identified by PA. Providers were "surprised" by GA results in 33% of cases, mainly with cognitive or social support findings, and reported plans for management change for 39% of patients based on GA findings. CONCLUSIONS: Including a GA in the care of OA-MBC in CP is beneficial for the detection of multiple abnormalities not detected by routine PA.

Old Era Continues in Modern World: A Case Report of Scurvy Induced Myopathy in Patient with Chronic Alcoholism.

We report a case of myopathy in a chronic alcoholic patient with scurvy who presented with generalized weakness, myalgias, and arthralgia. Our case raises awareness regarding rare interaction between vitamin C deficiency and myopathy which is seen more commonly in patients with history of chronic alcoholism and low socioeconomic status. Early treatment with vitamin C replacement is helpful in treatment of the disease and its complications.

Composite Gel Polymer Electrolyte for Improved Cyclability in Lithium-Oxygen Batteries.

Gel polymer electrolytes (GPE) and composite GPE (cGPE) using one-dimensional glass microfillers have been developed for their use in lithium-oxygen batteries. Using glass microfillers, tetraglyme solvent, UV-curable polymer, and lithium salt at various concentrations, the preparation of cGPE yielded free-standing films. These cGPEs, with 1 wt % of microfillers, demonstrated increased ionic conductivity and lithium transference number over GPEs at various concentrations of lithium salt. Improvements as high as 50% and 28% in lithium transference number were observed for 0.1 and 1.0 mol kg-1 salt concentrations, respectively. Lithium-oxygen batteries containing cGPE similarly showed superior charge/discharge cycling for 500 mAh g-1 cycle capacity with as high as 86% and 400% increase in cycles for cGPE with 1.0 and 0.1 mol kg-1 over GPE. Results using electrochemical impedance spectroscopy, Raman spectroscopy, and scanning electron microscopy revealed that the source of the improvement was the reduction of the rate of lithium carbonates formation on the surface of the cathode. This reduction in formation rate afforded by cGPE-containing batteries was possible due to the reduction of the rate of electrolyte decomposition. The increase in solvated to paired Li+ ratio at the cathode, afforded by increased lithium transference number, helped reduce the probability of superoxide radicals reacting with the tetraglyme solvent. This stabilization during cycling helped prolong the cycling life of the batteries.

Neuroretinitis as presenting and the only presentation of Lyme disease: Diagnosis and management.

We present a case of neuroretinitis as presenting and the only presentation of Lyme disease in a 25-year-old female who visited hilly areas in the Himalayas of North India. She presented with right eye sudden and painless blurring of vision. Her vision at presentation was 20/60. She had fundus examination; fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) imaging showed classical features of neuroretinitis. No other organ was involved. Oral steroids were prescribed and relevant investigations sent for noninfective and infective causes. Worsened visual acuity (VA) to hand movement and positive IgM titers for Borrelia burgdorferi led to the diagnosis of Lyme disease-associated neuroretinitis. Treatment with oral doxycycline plus oral steroids for 4 weeks revealed VA of 20/20 and resolution of fundus and OCT changes. Neuroretinitis as presenting and the only presentation of Lyme disease will be discussed with serial fundus, FFA, and OCT pictures.

Strategies for Medical Management of Pediatric Eosinophilic Esophagitis.

OBJECTIVE: Eosinophilic esophagitis (EoE) is associated with significant morbidity in children. Strategies for optimizing its outcomes are hence essential. We aimed to review the strategies for medical management of EoE in children. METHODS: We conducted a systematic review of randomized controlled trials (RCTs) of medical interventions in children with EoE, using the Cochrane methodology. Databases including PubMed, EMBASE, CINAHL, Cochrane Central Library, and Google scholar were searched up to March 2016. Primary outcomes included histological (peak eosinophil count) and symptomatic remission. Secondary outcomes were improvement in endoscopic and other histological parameters and adverse effects. RESULTS: A total of 5 RCTs (N = 448) with low to unclear risk of bias were included. The interventions included topical oral steroids, swallowed enteral steroids and anti- interleukin (IL)5 agent. Pooling of data from all trials was not possible owing to significant heterogeneity in interventions. Meta-analysis of data (N = 141) from 3 RCTs (oral viscous budesonide: 2, fluticasone: 1) showed significant histological remission in the intervention versus control group participants (risk difference: 10.32 [95% confidence interval: 3.04, 35.03]; P = 0.0002), level of evidence-low. Compared with anti-IL5 agent, the trials assessing steroids reported high rates of clinical remission. Clinical remission did not correlate with histological improvement in any trial. Except for systemic corticosteroids, there were no significant adverse effects related to other interventions. CONCLUSIONS: Limited low-quality evidence exists on the effects of various interventions in children with EoE. The beneficial effects of swallowed steroid need to be confirmed in large well-designed RCTs.