ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

The global regulatory framework for the commercialization of nutrient enriched biofortified foods.

Nutrient enriched crops (NECs) were developed through biofortification as a tool to reach the world's most vulnerable. The delivery model developed by HarvestPlus for the scaling of NECs relies on commercial demand from food businesses and consumers, coupled with the ability to promote and market foods that comply with legislation. This review of standards, regulations, and laws across the value chain in 20 countries demonstrates that existing provisions for food labeling are sufficient to carry out sales and marketing of foods made from conventionally bred NECs. The term biofortification is not necessary to create demand and, potentially, is counterproductive. Promoting the natural source of vitamins and minerals and relevant nutrition claims is the most effective and simple way to signpost healthier products to consumers. Until 2021, it was not possible to distinguish NECs at the grain level from the market standard. The development of a globally relevant Publicly Available Specification allows traders to demand grains that offer a substantial increase in zinc, iron, or vitamin A. Addressing this gap at the grain level ensures that standards and regulations are available end-to-end in the food supply chain providing the enabling environment for the rapid scale of NECs.

Developing a definition of biofortification through the synthesis of food biofortification publications: a scoping review protocol.

OBJECTIVE: The objective of this review is to develop a definition of biofortification through the synthesis of food biofortification publications and to document the breadth of the research on this topic. INTRODUCTION: Biofortification of a food source is a human health intervention. Due to the varying definitions of this concept, biofortification can be difficult to describe. Originally, biofortification was defined as the use of plant breeding methods to produce staple foods dense in minerals and vitamins. Research using the term focused on mineral, vitamin, and protein improvement of staple foods. However, the field has expanded to include non-staple foods as well as different methodological approaches to biofortification (eg, transgenic, molecular breeding). Researchers require a broad overview of the evidence and consensus on a definition to ensure effective communication within this scientific community. INCLUSION CRITERIA: Inclusion criteria will be broad to ensure that existing definitions of biofortification are captured across the different areas of study in this field. The review will consider research published in English. Inclusion will not be limited by participant type, date of publication, or context. The concept will be strictly biofortification. METHODS: A broad search strategy will be utilized for AGRICOLA, AGRIS, Web of Science, PubAg, CINAHL, PubMed, Cochrane Library, Epistemonikos, JBI Evidence Synthesis, Google Scholar, and Washington State University Libraries' integrated catalog. A limited search for gray literature will be conducted. The data extracted will include study and author characteristics. Tables and figures will demonstrate the breadth of the evidence.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS). Part 1: Definitions and clinical signs.

OBJECTIVE: To use a systematic, evidence-based consensus process to develop definitions for transfusion reactions in dogs and cats. DESIGN: Evidence evaluation of the literature was carried out for identified transfusion reaction types in dogs and cats. Reaction definitions were generated based on synthesis of human and veterinary literature. Consensus on the definitions was achieved through Delphi-style surveys. Draft recommendations were made available through industry specialty listservs and comments were incorporated. RESULTS: Definitions with imputability criteria were developed for 14 types of transfusion reactions. CONCLUSIONS: The evidence review and consensus process resulted in definitions that can be used to facilitate future veterinary transfusion reaction research.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoring.

OBJECTIVE: To systematically review available evidence to develop guidelines for the prevention of transfusion reactions and monitoring of transfusion administration in dogs and cats. DESIGN: Evidence evaluation of the literature (identified through Medline searches through Pubmed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. Evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. Evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines for prevention and monitoring were generated based on the synthesis of the evidence. Consensus on the final recommendations and a proposed transfusion administration monitoring form was achieved through Delphi-style surveys. Draft recommendations and the monitoring form were made available through veterinary specialty listservs and comments were incorporated. RESULTS: Twenty-nine guidelines and a transfusion administration monitoring form were formulated from the evidence review with a high degree of consensus CONCLUSIONS: This systematic evidence evaluation process yielded recommended prevention and monitoring guidelines and a proposed transfusion administration form. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) transfusion reaction small animal consensus statement (TRACS). Part 3: Diagnosis and treatment.

OBJECTIVE: To systematically review available evidence to develop guidelines for diagnosis and treatment of transfusion-associated reactions in dogs and cats. DESIGN: Standardized and systemic evaluation of the literature (identified through Medline via PubMed and Google Scholar searches) was carried out for identified transfusion reaction types in dogs and cats. The available evidence was evaluated using PICO (Population, Intervention, Comparison, Outcome) questions generated for each reaction type. The evidence was categorized by level of evidence (LOE) and quality (Good, Fair, or Poor). Guidelines, diagnostic, and treatment algorithms were generated based on the evaluation of the evidence. Consensus on the final guidelines was achieved through Delphi-style surveys. Draft recommendations were disseminated through veterinary specialty listservs for review and comments, which were evaluated and integrated prior to final publication. RESULTS: Medline via PubMed and Google Scholar databases were searched. There were 14 Population Intervention Comparison Outcome questions identified and corresponding worksheets were developed focusing on the diagnosis and treatment of transfusion-associated reactions in dogs and cats. Fourteen guidelines and four algorithms were developed with a high degree of consensus. CONCLUSIONS: This systematic evidence evaluation process yielded recommended diagnostic and treatment algorithms for use in practice. However, significant knowledge gaps were identified, demonstrating the need for additional research in veterinary transfusion medicine.

Ready-to-eat cereal and milk for breakfast compared with no breakfast has a positive acute effect on cognitive function and subjective state in 11-13-year-olds: a school-based, randomised, controlled, parallel groups trial.

PURPOSE: We tested the acute effect of breakfast (ready-to-eat-cereal [RTEC] and milk) versus (vs.) no breakfast on cognitive function and subjective state in adolescents. METHODS: Healthy adolescents (n = 234) aged 11-13 years were recruited to take part in this school-based, acute, randomised, controlled, parallel groups trial with two interventions; Breakfast or No Breakfast. The breakfast intervention consisted of ad libitum intake of RTEC (up to 70 g) with milk (up to 300 ml) administered in a naturalistic school breakfast programme environment. Cognitive function was assessed at baseline and + 70 and + 215 min post-intervention in a group-testing situation, similar to a school classroom context. The CANTAB test battery included: Simple Reaction Time (SRT), 5-Choice Reaction Time (5-CRT), Rapid Visual Information Processing (RVIP), and Paired Associates Learning (PAL; primary outcome). Data collection commenced January 2011 and ended May 2011. This trial was retrospectively registered at www.clinicaltrials.gov as NCT03979027 on 07/06/2019. RESULTS: A significant effect of the intervention (CMH[1] = 7.29, p < 0.01) was found for the number of levels achieved on the PAL task. A significant difference between interventions was found when baseline performance reached level 2 (JT, z = 2.58, p < 0.01), such that 100% of participants in the breakfast intervention reached the maximum level 4 but only 41.7% of those in the no breakfast intervention reached level 4. A significant baseline*intervention interaction (F[1,202] = 6.95, p < 0.01) was found for total errors made on the PAL task, indicating that participants who made above-average errors at baseline reduced the total number of errors made at subsequent test sessions following breakfast consumption whilst those in the no breakfast intervention did not. There was a positive effect of breakfast on reaction time and visual-sustained attention. The results also demonstrated interactions of intervention with baseline cognitive performance, such that breakfast conferred a greater advantage for performance when baseline performance was poorer. CONCLUSION: Consuming breakfast has a positive acute effect on cognition in adolescents.

A web-based weight loss programme including breakfast cereals results in greater loss of body mass than a standardised web-based programme in a randomised controlled trial.

OBJECTIVE: To test the hypothesis that promoting breakfast cereal consumption, as part of a web-based programme, results in loss of body mass. METHODS: Single centre, single blind, randomised parallel study. Test group followed a fully interactive website (B) with 'prescribed' breakfast cereals. Control group followed website (A) giving standard advice on weight loss.Study site visits at 0, 4, 12 and 24 weeks for measurements of height, weight, skinfolds, body fat, waist and hip circumference. 180 subjects were randomly allocated to two equal groups.Subjects were in good health and aged 19­50 years, with a BMI ranging from 25­40 kg/m 2 .At baseline there was no difference in mean age or BMI between the two groups. RESULTS: The percentage change in body mass loss was greater when following website B than website A (n = 90; ITT repeated measures p = 0.013). For completers (website A: n = 62, website B: n= 64), the percentage change in body mass loss was also greater for website B than website A (repeated measures p = 0.023). CONCLUSION: The advice and motivation offered by an interactive website, including provision and consumption of breakfast cereals, results in significantly greater loss of body mass compared to the use of a standard website. It is not possible to discern which of the three factors is responsible.

Fungal malignant otitis externa with facial nerve palsy: tissue biopsy AIDS diagnosis.

Fungal malignant otitis externa (FMOE) is a serious and potentially life-threatening condition that is challenging to manage. Diagnosis is often delayed due to the low sensitivity of aural swabs and many antifungal drugs have significant side effects. We present a case of FMOE, where formal tissue sampling revealed the diagnosis and the patient was successfully treated with voriconazole, in addition to an up to date review of the current literature. We would recommend tissue biopsy of the external auditory canal in all patients with suspected FMOE in addition to routine microbiology swabs.

Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner.

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

Wheat bran: its composition and benefits to health, a European perspective.

Wheat bran is a concentrated source of insoluble fibre. Fibre intakes are generally lower than recommendations. This paper reviews the physiological effects of wheat bran and the health benefits it may provide in terms of the prevention of diseases such as colon and breast cancers, cardiovascular disease, obesity and gastrointestinal diseases. In recognition of the weight of evidence, the European Food Safety Authority has recently approved two health claims for wheat bran and gastrointestinal health.

Regular consumption of a cereal breakfast. Effects on mood and body image satisfaction in adult non-obese women.

Breakfast has psychological and nutritional benefits due to physiological mechanisms and expectations about health impact. Beliefs people hold about calories in food can adversely affect mood and body-image satisfaction and such adverse reactions can be predicted by body mass index. The objectives were to test the effect of consuming isocaloric breakfasts, appearing different in calorie content, on appetite, mood and body-image satisfaction, and to assess impact on daily nutrient intake. One-hundred-and-twenty-three women were randomly assigned to eat a cereal or muffin breakfast which "appeared" different in calorie content while unaware they were isocaloric. Participants estimated calories of breakfast, appetite, mood, and body-image satisfaction on a daily basis for seven-days. The cereal breakfast was perceived to be lower in calories, made participants fuller, happier, relaxed, and more satisfied about weight and body compared to the muffin breakfast. Differences in estimated daily fibre and micronutrient intake were compatible with the design. Breakfasts were isocaloric yet the cereal breakfast was rated lower in calories and produced more positive psychological reactions. This evidence indicates the power of perceptions of foods to influence important attributes of health and well-being which could be valuable in dietary interventions where mood and body image satisfaction affect outcome.