Dietary practices in propionic acidemia: A European survey

Background

The definitive dietary management of propionic acidaemia (PA) is unknown although natural protein restriction with adequate energy provision is of key importance.

Aim

To describe European dietary practices in the management of patients with PA prior to the publication of the European PA guidelines.

Methods

This was a cross-sectional survey consisting of 27 questions about the dietary practices in PA patients circulated to European IMD dietitians and health professionals in 2014.

Results

Information on protein restricted diets of 186 PA patients from 47 centres, representing 14 European countries was collected. Total protein intake [PA precursor-free L-amino acid supplements (PFAA) and natural protein] met WHO/FAO/UNU (2007) safe protein requirements for age in 36 centres (77%). PFAA were used to supplement natural protein intake in 81% (n = 38) of centres, providing a median of 44% (14–83%) of total protein requirement. Seventy-four per cent of patients were prescribed natural protein intakes below WHO/FAO/UNU (2007) safe levels in one or more of the following age groups: 0–6 m, 7–12 m, 1–10 y, 11–16 y and > 16 y. Sixty-three per cent (n = 117) of patients were tube fed (74% gastrostomy), but only 22% received nocturnal feeds.

Conclusions

There was high use of PFAA with intakes of natural protein commonly below WHO/FAO/UNU (2007) safe levels. Optimal dietary management can only be determined by longitudinal, multi-centre, prospective case controlled studies. The metabolic instability of PA and small patient cohorts in each centre ensure that this is a challenging undertaking.

Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

BACKGROUND

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)-free protein substitute (PS) to help meet non-Phe protein requirements. Semi-solid weaning Phe-free PS have been available for >15 years, although no long-term studies have reported their efficacy.

METHODS

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe-free infant L-amino acid formula; natural protein intake; and issues with administration of PS or food.

RESULTS

Median commencement age for weaning was 17 weeks (range 12-25 weeks) and, for weaning PS, 20 weeks (range 13-37 weeks). Median natural protein was 4 g day^-1 (range 3-11 g day^-1 ) and total protein intake was >2 g kg^-1 day^-1 from weaning to 2 years of age. Children started on 2-4 g day^-1 protein equivalent (5-10 g day^-1 of powder) from weaning PS, increasing by 0.2 g kg^-1 day^-1 (2 g day^-1 ) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

CONCLUSIONS

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

TNFα deficiency results in increased IL-1β in an early onset of spontaneous murine colitis

Inflammatory bowel disease (Crohn's disease (CD) and ulcerative colitis (UC)) is a multifactorial disease resulting from immune dysregulation in the gut. The underlying colitis is characterized by high levels of inflammatory cytokines, including TNFα. Biological intervention for IBD patients using anti-TNFα antibodies is often an effective therapeutic solution. However, TNFα neutralization fails to induce remission in a subgroup of IBD patients, primarily in UC patients. There is a dearth of suitable animal models representing TNFα non-responders. Here we have combined one of the best UC models currently available, namely Winnie and the TNFαKO mouse to generate a TNFα-deficient Winnie to study early onset colitis. The induced TNFα deficiency with underlying colitis does not influence general health (viability and body weight) or clinical parameters (colon weight, colon length and histological colitis) when compared with the Winnie genotype alone. The molecular characterization resulted in identification of Il1β as the major elevated cytokine during early phases of colitis. Further, in vitro functional assay using bone marrow-derived dendritic cells confirmed IL-1β as the major cytokine released in the absence of TNFα. This study has generated a successful model of colitis that remains TNFα non-responsive and has demonstrated that IL-1β expression is a major pathway for the progression of colitis in this system. These data also suggest that IL-1β can be a potential target for clinical intervention of UC patients who fail to respond to TNFα neutralization.

Postextraction computer-guided implant surgery in partially edentate patients with metal restorations: a case report

OBJECTIVES

The aim of the present study was to describe a postextraction, computer-guided protocol for implant-prosthetic rehabilitations in partially edentate patients with metal restorations.

METHODS

A 60-year-old man with a loose FDP (fixed dental prosthesis) in the first quadrant was selected for a postextraction computer guided implantology according with the 2-piece radiographic template protocol. A two components radiographic template was produced, with the teeth setup portion based on the wax-up. CBCT (cone beam computed tomography) scans of the patient, wearing the base portion of the radiographic template and of the assembled radiographic template alone, were accomplished. The CBCT volume were imported in a dedicated software (NobelClinician, Nobel-Biocare, Kloten, Switzerland) and a surgical template was produced from the digital planning. The surgery was performed with a flap approach, as a bone regeneration procedure was carried out. A delayed loading protocol was chosen to allow a healing free of masticatory stress. A mobile partial denture was delivered to the patient to grant function and social life until the delivery of the definitive FDP.

RESULTS

The surgery was performed rapidly and free of obstacles. A good primary stability of the implants was achieved. The patient referred an acceptable postoperative pain and swelling.

CONCLUSIONS

The 2-piece radiographic template protocol was evaluated as smooth, complication-free and suitable for patients who want to maintain their teeth until the day of implant surgery. A good command of the computer-guided software as well as a comprehensive learning curve in computer-guided implantology is necessary to obtain predictable results.

Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding

OBJECTIVE

To compare hysterectomy and levonorgestrel intra-uterine system (LNG-IUS) for the treatment of abnormal uterine bleeding (AUB) and iron deficiency anemia.

PATIENTS AND METHODS

Retrospective study evaluating quality of life, sexual function, satisfaction and blood hemoglobin concentration improvement in 60 pre-menopausal women treated with hysterectomy or LNG-IUS. All analysis was performed with statistical software SPSS 21.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

Despite superior control of bleeding and dysmenorrhea observed after hysterectomy, LNG-IUS showed similar impact on blood hemoglobin levels, quality of life, satisfaction and sexual function resulting more cost-effective.

CONCLUSIONS

In the absence of contraindications, LNG-IUS should always be the first therapeutic choice for chronic AUB. Surgical treatment must be considered as an "extrema ratio".

The burden and epidemiology of community-acquired central nervous system infections: a multinational study

Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

Assessing suicide risk with the Clinical Interview for Psychotic Disorders (CIPD): Preliminary reliability and validity of the Suicide Risk Scale for Psychosis (SRS-P)

Background

Suicide risk is an important variable to consider both in assessment and throughout the therapeutic process in psychotic disorders. The SRS-P is an 18-item scale computed from the patient and clinician-rated scores obtained in the CIPD. The scale comprises lifetime assessment of depressed mood, anhedonia and its current interference and severity, current and past feelings of hopelessness, suicidal ideation, ‘voices’ about suicide, and suicide-related behaviors.

Aims

To assess reliability and convergent validity of the SRS-P in a sample of participants with psychosis.

Methods

The sample comprised 22 participants (68.2% male), single (72.7%), between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176), employed (50%). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The mean age of illness onset was 23.57 years (SD = 5.555). The participants were assessed with the CIPD, Depression, Anxiety and Stress Scales-21, Forms of Self-Criticism and Reassurance Scale, Self-Compassion Scale, Other as Shamer Scale and the Empowerment with Psychotic Symptoms Scales.

Results

The SRS-P has shown good reliability (α = .87) and validity in relation to depressive symptoms (r = .67; P = .001), anxiety (r = .74; P < .001), stress (r = .59; P = .004), inadequate self (r = .43; P = .046), hated self (r = .54; P = .009), reassured self (r = –.65; P = .001), self-compassion (r = –.63; P = .002), shame (r = .46; P = .033) and empowerment regarding positive symptoms (r = –.54; P = .015).

Conclusions

The SRS-P presented adequate reliability and convergent-divergent validity. Further studies are planned in order to test the factorial structure of the scale and confirm the presented results in a larger sample.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A giant urinary bladder stone in the mummy of Lebanese Maronite Patriarch Joseph Tyan (1760-1820) and its environmental and nutritional implications

INTRODUCTION

Historical sources and anthropological investigations, with the indispensable support of radiology, bring to light pathological evidence of the past.

CASE PRESENTATION

The purpose of this article is to present the radiological investigation conducted on the mummy of the Maronite Joseph Tyan (1760-1820), a famous patriarch who guided the Lebanese Maronite community during a critical period of its history. The natural mummy of the Patriarch was temporarily removed from its burial site to certify the degree of preservation. Conventional radiography was necessary to determine the state of the internal organs and any physical abnormalities, and to clarify the degree of conservation of the mummy.

DISCUSSION

Radiological analysis uncovered an exceptional case of a large urinary bladder stone. This pathological evidence confirms historical documentary sources that in the last years of his life the Patriarch suffered from abdominal pain and urinary problems. We can suppose that the environment and diet of the Maronite community, limited by restricted agricultural resources, was the possible cause of the urinary bladder stone, as today the epidemiology of these diseases demonstrates links with mainly cereal diets in rural areas.

Dietary practices in isovaleric acidemia: A European survey

Background

In Europe, dietary management of isovaleric acidemia (IVA) may vary widely. There is limited collective information about dietetic management.

Aim

To describe European practice regarding the dietary management of IVA, prior to the availability of the E-IMD IVA guidelines (E-IMD 2014).

Methods

A cross-sectional questionnaire was sent to all European dietitians who were either members of the Society for the Study of Inborn Errors of Metabolism Dietitians Group (SSIEM-DG) or whom had responded to previous questionnaires on dietetic practice (n = 53). The questionnaire comprised 27 questions about the dietary management of IVA.

Results

Information on 140 patients with IVA from 39 centres was reported. 133 patients (38 centres) were given a protein restricted diet. Leucine-free amino acid supplements (LFAA) were routinely used to supplement protein intake in 58% of centres. The median total protein intake prescribed achieved the WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Centres that prescribed LFAA had lower natural protein intakes in most age groups except 1 to 10 y. In contrast, when centres were not using LFAA, the median natural protein intake met WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Enteral tube feeding was rarely prescribed.

Conclusions

This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.

Nociceptin reduces the inflammatory immune microenvironment in a conventional murine model of airway hyperresponsiveness

BACKGROUND

Nociceptin/orphanin FQ (N/OFQ) and its receptor (NOP) are involved in airway hyperresponsiveness (AHR) and inflammation. However, the role of nociceptin at modulating the inflammatory immune microenvironment in asthma is still unclear.

OBJECTIVE

To understand the role of N/OFQ in the regulation of a Th2-like environment, we used a conventional murine model of AHR.

METHODS

Balb/c and CD1 mice were sensitized to ovalbumin (OVA) and treated with saline solution or N/OFQ, at days 0 and 7. A group of Balb/c mice were killed at 7 and 14 days from the first sensitization for the inflammatory profile evaluation while a group of Balb/c and CD1 mice were aerosol-challenged from day 21 to 23 with OVA and killed 24 h later for functional evaluations.

RESULTS

In OVA-sensitized mice, N/OFQ significantly reduced IL-4+ CD4+ T cells in lymph nodes (LN) and IL-13 in the lungs, while it induced IFN-γ increase in the lung. The efflux of dendritic cells (DCs) to the mediastinic LN and into the lung of OVA-sensitized mice was reduced in N/OFQ-treated and sensitized mice. N/OFQ reduced the expression of CD80 on DCs, indicating its ability to modulate the activation of DCs. In a less prone Th2-like environment mice strain, such as CD1 mice, N/OFQ did not modify lung resistances as observed in BALB/c mice. Finally, spectroscopic data showed the N/OFQ was able to interact onto the membrane of DCs obtained from Balb/c rather than CD1 mice, indicating its ability to modulate AHR in a Th2-like environment with a direct activity on DCs.

CONCLUSIONS AND CLINICAL RELEVANCE

Our data confirmed the capability of N/OFQ to modulate the immune microenvironment in the lung of Th2-biased, OVA-sensitized Balb/c mice, suggesting N/OFQ-NOP axis as a novel pharmacological tool to modulate the inflammatory immune microenvironment in asthma.

In vitro evaluation of the post-space depth reading with an intraoral scanner (IOS) compared to a traditional silicon impression

Objectives

The aim of the study was to assess the depth and quality of the post-space reading, using an IOS without scan-post, compared to a traditional silicon technique.

Methods

Six extracted bicuspids were decoronated and endodontically treated. After having prepared the space for the posts, a structure in pink acrylic resin was created with two resin elements. At the center of the structure one sample was put at a time. Digital and traditional impressions were taken for each sample.Digital impressions were developed through the Computer-aided design (CAD) software in order to integrate the scanner results into a three-dimensional grid to make the measurements. A K-file was used to measure the length of the post-space of each sample obtained through the traditional silicon impression and subsequently the measurement results were reported on a millimeter gauge. Furthermore, an assessment of the width of the entrances of the post-spaces was carried out.

Results

The mean reading depth discrepancy expressed in percentages (19.58%) indicates that the digital impression with current technologies fails to impress clearly the post-space. Standard deviation of the data expressed in percentage is 13.89, suggesting that the values were not similar to each other. In two cases the digital technique has achieved less than 10% difference compared to the traditional technique, but there have been also cases in which the variation in depth has reached almost 40%.The samples that showed the minor discrepancy between the two techniques expressed the widest post-space entrance.

Conclusions

In this in vitro study, the application of the IOS for the post-space reading in order to deliver an anatomic post has been proven to be still not reliable, as there are still depth reading limitations for the narrow root channels. In fact, in this type of channels it is difficult to reach with the light beam of the IOS the deepest areas of the post-space, with a consequent incomplete post-space reading.

SEOM clinical guidelines for the management of germ cell testicular cancer (2016)

Testicular cancer represents the most common malignancy in males aged 15-34 years and is considered a model of curable neoplasm. Maintaining success, reducing treatment burden, and focusing on survivorship are then key objectives. Inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims. Most patients are diagnosed with stage I disease (confined to the testicle). Close surveillance and selective, short-course adjuvant chemotherapy are accepted alternatives for these cases. In patients with more advanced disease (stages II and III), 3-4 courses of cisplatin-based chemotherapy (according to IGCCCG risk classification) followed by the judicious surgical removal of residual masses represent the cornerstone of therapy. Poor-risk patients and those failing a first-line therapy should be referred to specialized tertiary centers. Paclitaxel-based conventional chemotherapy and high-dose chemotherapy plus autologous hematopoietic support can cure a proportion of patients with relapsing or refractory disease.