Genetic testing for lynch syndrome, an inherited cancer of the bowel, endometrium, and ovary

Genetic screening for the mismatch repair genes found in patients with Lynch syndrome leads to improvements in health outcomes among carriers and members of their family. Clinicians now have a simple and easily employed means of determining if an individual carries the genetic mutations found with Lynch syndrome. This article reviews the background and incidence of Lynch syndrome and presents screening criteria, including the use of Web-based algorithms to estimate the likelihood of an individual having inherited Lynch mutations. Comprehensive management plans based on individual risk and family history plus appropriate preventive measures are recommended. Primary care providers including obstetrician-gynecologists are encouraged to adopt a proactive, evidence-based approach to address patients and their relatives with Lynch syndrome.     

Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed,Physical Function,Strength and Balance,Body Composition,Energy and Protein,in Injured,Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE)

It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.     

Use of mycophenolate mofetil in inflammatory bowel disease

AIM： To assess the efficacy and safety of mycophenolate mofetil （MMF） prospectively in inflammatory bowel disease （IBD） patients intolerant or refractory to conventional medical therapy.
METHODS： Crohn＇s disease （CD） or ulcerative colitis/ IBD unclassified （UC/IBDU） patients intolerant or refractory to conventional medical therapy received MMF （500-2000 mg bid）. Clinical response was assessed by the Harvey Bradshaw index （HBI） or colitis activity index （CAI） after 2, 6 and 12 mo of therapy, as were steroid usage and adverse effects.
RESULTS： Fourteen patients （9 CD/5 UC/IBDU; 8M/6F; mean age 50.4 years, range 28-67 years） were treated and prospectively assessed for their response to oral MMF. Of the 11 patients who were not in remission on commencing MMF, 7/11 （63.6%） achieved remission by 8 wk. All 3 patients in remission on commencing MMF maintained their remission. Ten patients were still on MMF at 6 mo with 9/14 （64.3%） in remission, while of 12 patients followed for 12 mo, 8 were in remission without dose escalation （66.7%）. Three patients were withdrawn from the MMF due to drug intolerance. There were no serious adverse events attributed due to the medication.
CONCLUSION： MMF demonstrated efficacy in the management of difficult IBD. MMF appeared safe, well tolerated and efficacious for both short and long-term therapy, without the need for dose escalation. Further evaluation of MMF comparing it to conventional immunosuppressants is required.     

Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study

BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation.