Measuring malnutrition and its impact on pediatric surgery outcomes: A NSQIP-P analysis

BackgroundThere is a limited understanding of the impact of pediatric malnutrition indicators on post-operative outcomes.Materials and methodsAll pediatric surgical patients captured in the ACS NSQIP-Pediatric database from 2016 to 2018 were included. Multivariable logistic regression was used to estimate odds of 30-day post-operative infection by malnutrition definition (stunted, wasted, requiring nutritional support, pre-operative hypoalbuminemia).ResultsAmong pediatric surgery patients (n = 282,056), 19% of patients met one definition of malnutrition, 6% met two, 1% met 3, and < 0.1% met all 4. After adjustment, requiring nutritional support (OR 1.47, 95% CI 1.36–1.60), stunting (OR 1.17, 95% CI 1.10–1.25), and hypoalbuminemia (OR 1.17 95% CI 1.04–1.32) were associated with increased odds of post-operative infection while wasting was not. Requiring nutritional support was associated in an increase of 10.17 days (95% CI 9.89–10.44) in time from admission to surgery.ConclusionsThe metric used to define malnutrition changed the association with post-operative outcomes. Nutritional supplementation, stunting, and hypoalbuminemia were associated with poorer postoperative outcomes. These findings have implications for pre-operative patient level counseling, accurate risk stratification, surgical planning, and patient optimization in pediatric surgery.Level of EvidenceIII.     

Combined semi-nested polymerase chain reaction and heteroduplex analysis for detecting monoclonality of IgH rearrangement in patients with follicular lymphoma

A new, sensitive method combining seminested polymerase chain reaction (PCR) and heteroduplex analysis was used to detect follicular lymphoma (FL) cells in peripheral blood. Based on the detection of IgH rearrangement in DNA from peripheral blood leukocytes, the method demonstrated the presence of monoclonal B cells in FL patients with high frequency.     

Subclinical hypothyroidism is associated with coronary artery disease in older persons

BACKGROUND: We report the prevalence of coronary artery disease (CAD) associated with subclinical hypothyroidism in older persons. METHODS: We investigated the prevalence of subclinical hypothyroidism and its association with dyslipidemia and with CAD in 170 women and 110 men, mean age 75 +/- 9 years, in an academic nursing home. RESULTS: Of 280 persons, 18 (6%) had subclinical hypothyroidism, 18 (6%) had treated clinical hypothyroidism, 13 (5%) had subclinical hyperthyroidism, and 231 (83%) were euthyroid. Dyslipidemia occurred in 15 of 18 persons (83%) with subclinical hypothyroidism, in nine of 18 persons (50%) treated for hypothyroidism, in six of 13 persons (46%) with subclinical hyperthyroidism, and in 128 of 231 euthyroid persons (55%) (p <.025 comparing subclinical hypothyroidism with euthyroidism and p <.005 comparing subclinical hypothyroidism with treated hypothyroidism and with subclinical hyperthyroidism). CAD was present in 10 of 18 persons (56%) with subclinical hypothyroidism, in nine of 18 persons (50%) with treated hypothyroidism, in 5 of 13 persons (38%) with subclinical hyperthyroidism, and in 38 of 231 euthyroid persons (16%) (p <.001 comparing subclinical hypothyroidism with euthyroidism; p <.005 comparing treated hypothyroidism with euthyroidism; and p <.05 comparing subclinical hyperthyroidism with euthyroidism). CONCLUSIONS: Subclinical hypothyroidism was associated with a high prevalence of dyslipidemia and a high prevalence of CAD.     

Epidemiology of tuberculosis and HIV coinfections in Singapore, 2000–2014

Cross‐matching of records between Singapore's tuberculosis and HIV registries showed that 3.3% of individuals with tuberculosis (TB) were coinfected with HIV (2000?2014), the TB incidence among individuals with HIV infection was 1.65 per 100 person‐years, and 53% of coinfections were diagnosed within 1 month of each other. The findings supported joint prevention programmes for early diagnosis and treatment.     

Associations between Chest CT Abnormalities and Clinical Features in Patients with the Severe Fever with Thrombocytopenia Syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus. It involves multiple organ systems, including the lungs. However, the significance of the lung involvement in SFTS remains unclear. In the present study, we aimed to investigate the relationship between the clinical findings and abnormalities noted in the chest computed tomography (CT) of patients with SFTS. The medical records of 22 confirmed SFTS patients hospitalized in five hospitals in Nagasaki, Japan, between April 2013 and September 2019, were reviewed retrospectively. Interstitial septal thickening and ground-glass opacity (GGO) were the most common findings in 15 (68.1%) and 12 (54.5%) patients, respectively, and lung GGOs were associated with fatalities. The SFTS patients with a GGO pattern were elderly, had a disturbance of the conscious and tachycardia, and had higher c-reactive protein levels at admission (p = 0.009, 0.006, 0.002, and 0.038, respectively). These results suggested that the GGO pattern in patients with SFTS displayed disseminated inflammation in multiple organs and that cardiac stress was linked to higher mortality. Chest CT evaluations may be useful for hospitalized patients with SFTS to predict their severity and as early triage for the need of intensive care.     

Beta-melanocyte-stimulating hormone potently reduces appetite via the hypothalamus in chicks

The melanocortin system together with other appetite-related systems plays a significant role in appetite regulation. The appetite-related effects of one such melanocortin, β-melanocyte-stimulating hormone (MSH), are well documented in rodents; however, its effects in the avian class are not thoroughly understood. Thus, we designed a study to determine the effects of i.c.v. β-MSH injection on food and water intake, plasma corticosterone concentration, ingestive and non-ingestive behaviours, and hypothalamic neuronal activation using Cobb-500 chicks. Chicks responded to β-MSH-treatment with a reduction in food and water intake; however when water intake was measured independently of food intake, it was not affected. β-MSH-treated chicks also had increased plasma corticosterone concentrations and increased c-Fos reactivity in the periventricular, paraventricular and infundibular nuclei, and the ventromedial hypothalamus; however, the lateral hypothalamus was not affected. The effect on food intake is primary because behaviours that may be competitive with food intake were not increased in β-MSH-treated chicks. Based on these results, we conclude that β-MSH causes anorexigenic effects that are likely primarily mediated via stimulation of satiety-related hypothalamic nuclei in broiler-type chicks.     

Reliability of sport fish consumption in the New York State Angler cohort study

This paper examines the reliability of sport fish consumption data from the New York State Angler Cohort Study (NYSACS). NYSACS is a prospective cohort study conducted among New York State registered sportsmen and fishermen. Sport fish consumption information for New York State waters including the Great Lakes between June 1990 and June 1991 were collected through self-administered questionnaires, Spouses of male anglers were asked to provide their husbands' fish consumption during the same time period. A short telephone interview after the cohort was ascertained was also conducted among about 100 study participants for the purpose of quality control. Percentage agreement, kappa, and weighted kappa were calculated to evaluate the reliability of the interview using spousal data and reinterview data. Overall, for the total fish consumption between June 1990 and June 1991, percentage agreement, kappa, and weighted kappa between spousal data and primary response were 67.28%, 0.5087, and 0.6157, respectively. For reinterview data, weighted kappa ranged from 0.4510 to 0.5285 for season-specific analysis and kappa ranged from 0.4615 to 0.7006 for fish species-specific analysis. Spouses may be a good source of proxy data for fish consumption. The reliability of sport fish consumption data for the NYSACS study is acceptable, suggesting that the food frequency measuring methods employed are a viable approach to obtain retrospective sport fish consumption data from sportsmen and subsistence anglers.     

Well-breeding Anopheles dirus and their role in malaria transmission in Myanmar

Mosquitos were collected with human and animal baits from March 1996 to January 1998 in four villages located along the Yadana gas pipe line in Yepyu township, Dawae district, Tanintharyi Division, southern Myanmar. A total of 23 anopheline species were collected. Anopheles dirus were abundant in pre-monsoon (May/June) an post-monsoon (October) months. All An. dirus caught both humans and cattle were assayed with specific, sporozoite enzyme-linked immunosorbent assays (ELISAs). A total of 5/250 (2%) caught with human bait was found positive with Plasmodium vivax from Eindayaza, Ohnbinkwin and Thaechaung during rainy and cool-dry months. Larval surveys also showed An. dirus larvae/pupae were caught from domestic wells (6 to 46% found positive). Clinical surveys indicated that transmission is hyperendemic and occur all year round in all four villages.