Salmonella typhi osteitis can mimic tuberculosis. A report of three cases

We report three cases of Salmonella typhi osteitis. One patient was an immunocompetent woman with a single focus of osteitis, another had heterozygous sickle cell disease with multifocal osteitis, and the remaining patient had acute discitis. Tuberculosis was considered in all three patients, based on origin from an endemic area (sub-Saharan Africa), a chronic course in the first two patients, and granulomas in a biopsy specimen from one patient.     

Nutrition concerns in discharge planning for older adults: a need for multidisciplinary collaboration

This survey of 84 case managers (CMs) (88% response rate) in 11 south Florida hospitals, in one for-profit health care system, sought to identify their discharge planning concerns regarding the food and nutrition needs of older patients, how they addressed these concerns, and the degree to which registered dietitians (RDs) were involved. Most CMs were female (82 of 84, 98%), older than age 40 (59 of 84, 70%), and were registered nurses (51 of 84, 61%). Almost all (82 of 84, 98%) reported job barriers, including excessive patient loads and responsibilities and limited community services. Almost all said that nutrition-related diseases and factors (eg, chewing/swallowing problems, poor appetite, modified diets, poor dentition) strongly influenced discharge planning. Many perceived community nutrition resources (eg, congregate meals, food stamps, shopping assistance, outpatient dietitians) as not readily available. While physicians, nurses, social workers, and physical therapists were identified as very important in discharge planning, RDs were not; almost half of CMs consulted them infrequently, if at all. Strategies for the six nutrition-related case scenarios were inconsistent. Home-health agencies were chosen most often and outpatient RDs least often. Comprehensive discharge planning must include more attention to nutrition with greater input from clinical, outpatient, home health, and community RDs through, for example, attendance at hospital discharge planning rounds, inservices for CMs, and better marketing of RD services. More RDs can and should become CMs to help serve the number of older adults with nutrition-related chronic conditions.     

Loss of tumor suppressive microRNA-31 enhances TRADD/NF-κB signaling in glioblastoma

Glioblastomas (GBMs) are deadly tumors of the central nervous system. Most GBM exhibit homozygous deletions of the CDKN2A and CDKN2B tumor suppressors at 9p21.3, although loss of CDKN2A/B alone is insufficient to drive gliomagenesis. MIR31HG, which encodes microRNA-31 (miR-31), is a novel non-coding tumor suppressor positioned adjacent to CDKN2A/B at 9p21.3. We have determined that miR-31 expression is compromised in >72% of all GBM, and for patients, this predicts significantly shortened survival times independent of CDKN2A/B status. We show that miR-31 inhibits NF-κB signaling by targeting TRADD, its upstream activator. Moreover, upon reintroduction, miR-31 significantly reduces tumor burden and lengthens survival times in animal models. As such, our work identifies loss of miR-31 as a novel non-coding tumor-driving event in GBM.     

Serum free cortisol as an ancillary tool in the interpretation of the low-dose 1-μg ACTH test

Objective Serum free cortisol, rather than serum total cortisol (TC), determines glucocorticoid activity in vivo, but how the considerable inter‐subject variation in ambient serum free cortisol affects the outcome of dynamic hypothalamic–pituitary–adrenal (HPA) assessment in noncritically ill subjects is unknown. Design, patients and measurements We performed the low‐dose 1‐μg ACTH test in 75 subjects referred for HPA evaluation. Serum TC was determined by a chemiluminescence method, and serum free cortisol was measured by the same method following equilibrium dialysis. In a subset of these patients, salivary cortisol was also measured. Results Mean fraction of free cortisol was 5·07 ± 4·08% (±SD; range 1·77–10·1%). Although no correlation was seen between TC and the fraction (%) of free serum cortisol, a positive correlation existed between baseline total and free cortisol (R = 0·539 P = 0·01), as well as between peak ACTH‐stimulated total and free cortisol (R = 0·619; P = 0·01). There was no correlation between baseline salivary cortisol and serum free cortisol and between peak ACTH‐stimulated salivary and serum free cortisol. Using the lowest attained peak serum free cortisol in subjects whose TC response to ACTH was normal (≥500 nm ), the minimal ‘pass’ level for normal serum free cortisol response to 1 μg ACTH was set at 25·0 nm . Five of the 19 subjects showing subnormal TC response to 1 μg ACTH had normal serum free cortisol response. Conclusions Discrepancies between the peak free and TC were noted mostly for subjects whose ACTH‐stimulated TC peaked between 440 and 580 nm . At this range, the measurement of serum free cortisol allows further refinement of the assessment of borderline responses to 1‐μg ACTH.