Τρίτη, 28 Ιουνίου 2016

LytM Fusion with SH3b-Like Domain Expands Its Activity to Physiological Conditions

Microbial Drug Resistance , Vol. 0, No. 0.

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MHC-III haplotype regulates chronic arthritis [Genetics]

Genome-wide association studies have revealed many genetic loci associated with complex autoimmune diseases. In rheumatoid arthritis (RA), the MHC gene HLA-DRB1 is the strongest candidate predicting disease development. It has been suggested that other immune-regulating genes in the MHC contribute to the disease risk, but this contribution has been difficult...

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Characteristics of Vancomycin-Resistant Enterococcus Strains in the West Balkans: A First Report

Microbial Drug Resistance , Vol. 0, No. 0.

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Veteran Emergency Medical Technician Support Act: Policy implications

By Allison G. S. Knox, EMT-B, faculty member at American Military University

On May 12, the Veterans Emergency Medical Technician Support Act passed the U.S. House of Representatives. This legislation, H.B. 1818, "assists military medic veterans to efficiently transition their military medical training into a civilian workforce and addresses the shortage of emergency medical technicians in states."

This legislation will help streamline the process for former military medics to join the civilian workforce. Under this bill, it will now be easier for veterans who have completed military EMT training to meet state requirements for EMT certification and licensure.

This bill has the potential to be tremendously beneficial to local governments. First of all, it will save localities money by freeing them from having to retrain military EMTs on skills they've already been performing. In the last few years, many local governments have suffered from slashed budgets, which have reduced funding for the expensive process of training medics. ​

​Full story: Veteran Emergency Medical Technician Support Act: Policy implications

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Neuromuscular Impairments Are Associated With Impaired Head and Trunk Stability During Gait in Parkinson Fallers

Background. The trunk plays a critical role in attenuating movement-related forces that threaten to challenge the body's postural control system. For people with Parkinson's disease (PD), disease progression often leads to dopamine-resistant axial symptoms, which impair trunk control and increase falls risk. Objective. This prospective study aimed to evaluate the relationship between impaired trunk muscle function, segmental coordination, and future falls in people with PD. Methods. Seventy-nine PD patients and 82 age-matched controls completed clinical assessments and questionnaires to establish their medical history, symptom severity, balance confidence, and falls history. Gait characteristics and trunk muscle activity were assessed using 3-dimensional motion analysis and surface electromyography. The incidence, cause, and consequence of any falls experienced over the next 12 months were recorded and indicated that 48 PD and 29 control participants fell at least once during this time. Results. PD fallers had greater peak and baseline lumbar multifidus (LMF) and thoracic erector spinae (TES) activations than control fallers and nonfallers. Analysis of covariance indicated that the higher LMF activity was attributable to the stooped posture adopted by PD fallers, but TES activity was independent of medication use, symptom severity, and trunk orientation. Furthermore, greater LMF and TES baseline activity contributed to increasing lateral head, trunk, and pelvis movements in PD fallers but not nonfallers or controls. Conclusions. The results provide evidence of neuromuscular deficits for PD fallers that are independent of medications, symptom severity, and posture and contribute to impaired head, trunk, and pelvis control associated with falls in this population.

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Dengue in a patient with underlying polycythemia: The first global case report

Beuy Joob, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(4):301-302

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Standardized management of Zika virus infection during pregnancy

Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(4):217-218

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Emphasizing the need to achieve universal health coverage worldwide

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(4):292-293

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Pharmacoepidemiology: Pattern of some commonly reported diseases and drugs utilized in a tertiary health institution

Sylvester Erhunmwonsere Aghahowa, Chukwunonso Ezekwueche, Esiekpaobo Omonokhua, Philip Obarisiagbon

Annals of Tropical Medicine and Public Health 2016 9(4):219-225

Purpose: Due to a wide variation of diseases reported and drugs utilized in different regions, It became necessary to assess the pattern of diseases commonly reported and drugs utilized prior to and after visiting the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. Materials and Methods: Patients who reported with various diseases at the first point of visit were randomly selected after obtaining ethical consent from the health institution. Results: Out of 4253 patients who were assessed, the male to female ratio was 0.92:1. The age range was 56 ± 26.02 [mean ± standard deviation (SD)] years. The diseases reported were classified; the most common was trauma (open wounds: 62.69%) followed by infection (malaria: 62.51%), gastrointestinal disease (upset stomach: 65.06%), respiratory disease (cough: 69.79%), cardiovascular disease (hypertension: 68.51%), central nervous system disease (headache: 63.97%), endocrine disease (diabetes: 81.66%), musculoskeletal disorder (pain: 91.40%), and dermal disease (rash: 63.15%). The commonly utilized classes of drugs prior/post visits were analgesics (acetaminophen 44.87%/diclofenac 24.24%), antiallergic (chlorpheniramine 1.01%/loratadine 0.16%), anti-infective (ampicillin-cloxacilline 12.16%/ciprofloxacine 18.75%), antidiarrhea (oral rehydration salt 0.6%/zinc sulfate 0.25%), antifungal (clotrimazole 1.42%/fluconazole 3.12%), antihypertensive (Moduretic 10.02%/amlodipine 7.02%) antimalarial (artemether-lumefantrine 24.42%/artemether-lumefantrine 41.51%), antiulcer (mist magnesium trisilicate 1.08%/omeprazole 2.40%), anxiolytic (diazepam 0.42%/bromazepam 0.55%), and minerals/vitamins (ascorbic acid 4.00%/ferrous sulfate 1.48%). There was a significant difference in the pattern of disease among the ages (P < 0.05) but the difference was insignificant between the sexes (P > 0.05). Conclusion: Essential drugs were being prescribed and utilized prior to and after hospital visits. It is therefore, recommended that an enhanced adequate stocking and prescribing be encouraged in accordance with the reported diseases.

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Working together to accomplish gender equality in health: World Health Organization

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(4):286-287

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Correlates of individual-level stigma and unsafe abortions among women seeking abortion care in Trans Nzoia and Machakos Counties, Kenya

Erick Kiprotich Yegon, Peter Kabanya Mwaniki, Elizabeth Echoka, Joachim Osur

Annals of Tropical Medicine and Public Health 2016 9(4):226-234

Objectives: To compare the levels of abortion stigma in regions with high and low incidence of unsafe abortion in Kenya to explore whether abortion-related stigma is associated with incidence of unsafe abortion. Study Design: A cross-sectional survey of 759 women receiving abortion services in private and public health facilities in two counties located in regions with high and low incidence of unsafe abortion regions of Kenya. Results: Of the total respondents, 424 sought postabortion care (PAC), whereas 335 sought induced abortion. Factor analysis revealed a four-factor model for examining individual-level stigma related to seeking an abortion. The mean of stigma scores for women in a Trans Nzoia was higher than in Machakos. (49.82 compared to 47.58, P< 0.001). In the combined sample, respondents seeking PAC reported higher stigma scores compared to those seeking induced abortion. For the overall scale and subscales, stigma reduced with increases in the age of respondents (b = −7.7, P< 0.001 for 25–34 years and b = −4.6, P< 0.001 for 35–49 years). Regression analysis showed that stigma decreased in the county with low incidence of unsafe abortion on interaction between with type of abortion service. Conclusions: Respondents from a county with higher incidence of unsafe abortion reported higher stigma scores compared to those from a county with lower incidence of unsafe abortion. Age, marital status, type of abortion service, and socioeconomic status of respondents were all significantly associated with stigmatizing attitudes across the stigma scale's subscales. Young unmarried women, women who received PAC low socioeconomic background, and married women reported higher stigma scores.

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Contamination of drinking water collected from water machines in a university in Thailand

Sophorn Vong, Nipasak Kong-ngarm, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(4):297-298

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Predictors and factors related to the uptake of cervical cancer screening test among female secondary school teachers in Sagamu, Ogun State, Nigeria

Tade Adesoji Emmanuel, Sholeye Oluwafolahan, Buari Moyosore Adebukola Sinat

Annals of Tropical Medicine and Public Health 2016 9(4):235-240

Background: Cervical cancer is a cause of significant morbidity and mortality among Nigerian women. Early detection by screening has proved to be an effective preventive measure. Knowing the factors that determine and predict uptake helps to determine where more efforts need to be put to achieve better uptake of the screening test. Aim and Objective: To determine the predictors and factors related to the uptake of cervical cancer screening test among female secondary school teachers in Sagamu. Methods: A cross-sectional descriptive study was carried out among 256 secondary school teachers in Sagamu Local Government Area of Ogun State. Data were collected using semi-structured, self-administered questionnaires and analyzed using SPSS version 21. Chi-square test was used to determine factors related to the uptake of the screening test while logistic regression was done to predict which group was less likely to be screened. Results: Uptake of screening test was 17.6%. One hundred and sixty-nine (66%) respondents were willing to be screened. The most common reason for not willing to be screened was the belief of not been at risk of the disease. About 84% of the respondents had a positive attitude toward cervical cancer screening, with a mean score of 7.8 ± 1.5 while only 23.4% had good knowledge with a mean score of 7.6 ± 3.6. Teachers with lower knowledge and attitude scores who had one sexual partner were less likely to be screened. Conclusion: Adequate knowledge needs to be passed across to teachers to improve uptake of cervical cancer screening.

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Laboratory findings from stool examination in blastocystosis diarrhea: A review of 26 cases

Sora Yasri, Viroj Wiwanitkit

Annals of Tropical Medicine and Public Health 2016 9(4):284-285

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Perception of injections in semi-urban communities in Sokoto, northwest Nigeria

Muhammad Tukur Umar, Shaibu Oricha Bello, Abdulgafar Olayiwola Jimoh, Anas Ahmad Sabeer, Umar M Ango

Annals of Tropical Medicine and Public Health 2016 9(4):241-244

Objective: The hazards associated with injections constitute a serious public health challenge worldwide, especially in the developing countries such as Nigeria. To adequately address this menace, there is a need for a survey to assess the perception of health-care seekers and providers on injections generally to provide a platform upon which targeted intervention can be made. This study aimed at evaluating the semi-urban community perception on injections and awareness of dangers associated with it. Materials and Methods: This was a cross-sectional using validated interviewer administered questionnaires. A total of 102 respondents were recruited using a multi-stage sampling technique from semi-urban area. The questionnaire sought their demographic profiles, awareness of hazards associated with injections use, and perceptions. Results: Out all the respondents, 96.1% had injections in the last 3 months. Only 47.1% seek medical help in government health facilities. Majority considered injections to be more effective than oral drugs [80.4%, odds 4.10 and 95% confidence interval (CI) 2.53-6.65]. Most of the respondents preferred injections (74.5%, odds 2.92 and 95% CI 1.88-4.55). Chloroquine injection was the most cited by injections the respondents (70.6%). And only, 29.4% (odds 0.42 and 95% CI 0.27-0.64) had adverse events following injections. Awareness of hazards associated with injections was not too good as (27.5%, odds 0.38 and 95% CI 0.25-0.58) admitted that injection carries no risks. Conclusion: Awareness on dangers associated with injections was poor with erroneous perception that injections generally were more effective than oral drugs. Chloroquine is still widely used as an anti-malaria drug in private settings despite its ban. Incidence of injection is high in semi-urban communities.

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Implementing universal minimal standards to counter the challenge of gender-based violence in emergencies

Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(4):289-290

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Head lice treatment with two interventions: Pediculosis capitis profile in female schoolchildren of a rural setting in the south of Iran

Mohammad Djaefar Moemenbellah-Fard, Zahra Nasiri, Kourosh Azizi, Mohammad Reza Fakoorziba

Annals of Tropical Medicine and Public Health 2016 9(4):245-250

Background: Previous research suggests that certain communities, including rural residents, exhibit endemic infestations which can be prevented by banned interventions such as the use of certain chlorinated lice-killing chemicals. The aim of this study was to evaluate two different treatments on head lice among primary school girls of Lar, Fars Province, south of Iran. Patients and Methods: Lindane (1%) or permethrin (1%) shampoos were used on two groups who were treated for live head lice after screening with plastic lice detection combs at schools. A questionnaire form on the epidemiologic factors was included. The outcomes were followed up for 2 weeks from the initial treatment on days 2, 6, 9, and 14. Data analyses were performed using analysis of variance (ANOVA) and Kruskal–Wallis tests. A P value <0.05 was considered to be statistically significant. Results: From 2,084 students examined, 82 girls (3.93%) were infested with pediculosis. No significant correlation was found between head lice infestation level and hair length, hair style, itching, family size, education grade, and age. The data on days 2, 6, 9, and 14 from permethrin and lindane treatments were 71.8%, 64.1%, 89.7%, and 89.7% versus 92.5%, 92.5%, 97.5%, and 95%, respectively. On days 2 (P = 0.017) and 6 (P = 0.002) after treatment, significant differences were noted on reexamination of the cases. Only one reinfestation case was identified during the treatment period. The level of insensitivity to permethrin was twice that of lindane at the end of this period. Conclusion: The level of cure in treated students was similar for both shampoos. Lindane swiftly acted to reduce the level of infested cases by the second day.

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Active screening for tuberculosis among slum dwellers in selected urban slums of Puducherry, South India

Palanivel Chinnakali, Pruthu Thekkur, Gomathi Ramaswamy, Kalaiselvi Selvaraj

Annals of Tropical Medicine and Public Health 2016 9(4):295-296

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Affluence and adolescent obesity in a city in south-east Nigerian: A cross-sectional survey

Agozie C Ubesie, Chinyere V Okoli, Samuel N Uwaezuoke, Anthony N Ikefuna

Annals of Tropical Medicine and Public Health 2016 9(4):251-254

Background: Pediatric obesity is becoming a public health challenge in both developed and developing countries. While poverty is a known risk factor for pediatric obesity in developed countries, the role of socioeconomic class in developing countries remains unclear. This study aims to determine the prevalence of adolescent obesity in Enugu, south-east Nigeria, and relate same to socioeconomic class. Materials and Methods: A cross-sectional study of adolescents aged 10-19 years in Enugu metropolis. The participants were enrolled by multistage sampling method. Their weights and heights were measured and body mass index (BMI) was calculated. The participants were classified as obese, overweight, and normal using age- and sex-specific BMI percentiles. Socioeconomic class was determined using parental income and educational level. Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 2,419 participants were included in the study (1,242 males and 1,177 females). Their mean age was 14.80 ± 2.07 years. The prevalence rates of obesity and overweight were 5.7% and 7.2%, respectively. Females were more likely to be overweight and obese [odds ratio (OR) = 2.55, P < 0.001, OR = 2.66, P < 0.001, respectively]. Adolescents from the upper socioeconomic class were more likely to be obese [OR = 2.57, P < 0.001, 95% confidence interval (CI): 1.80–3.67]. Conclusion: Adolescent obesity in Enugu, south-east Nigeria, is more common among children from the upper socioeconomic class.

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Ayurveda practice in Hindu mandirs in Bangkok, Thailand

Viroj Wiwanitkit, Wasana Kaewla, Salingkarn Kulubrahm Kalasribharadwaj

Annals of Tropical Medicine and Public Health 2016 9(4):300-301

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Rapid multiplex polymerase chain reaction for simultaneous detection of Vibrio harveyi, V. parahaemolyticus, and V. vulnificus in pacific white shrimp (Litopenaeus vannamei)

Kanittada Thongkao, Yuttana Sudjaroen, Parin Chaivisuthangkura

Annals of Tropical Medicine and Public Health 2016 9(4):255-262

Context: A comparatively small number of species, e.g., Vibrio parahaemolyticus and V. vulnificus, cause disease in both aquatic animals and humans. V. harveyi is marine animal pathogen and rarely causes infections in humans; however, it might become a reservoir of antibiotic-resistant bacteria forms and virulence genes. Aims: 1) to develop rapid multiplex polymerase chain reaction (PCR) assay for the simultaneous detection of V. harveyi, V. parahaemolyticus, and V. vulnificus by using vhhP2, tl, and rpoS genes as the respective target genes and 2) to evaluate specificity and determined detection of multiplex PCR technique. Materials and Methods: The multiplex PCR assay was developed and evaluated for specificity on 36 isolates of V. harveyi, 30 isolates of V. parahaemolyticus, and 14 isolates of V. vulnificus, along with other species of Vibrio and non-Vibrio bacterial isolates. Sensitivity of test was described as detection limit of pathogens in lowest amount of sample (CFU/mL or CFU/g) was determined by diluted DNA extracts of the pure cultures and spiked pacific white shrimp (Litopenaeus vannamei) samples Results: This developed multiplex PCR was proved as an accurate method, which was specific for three Vibrio species. The detection limits of V. harveyi, V. parahaemolyticus, and V. vulnificus in pure cultures and spiked shrimp samples ranged 1.05-4.8 × 103 CFU/mL and 1.9-7 × 104 CFU/g, respectively. Conclusions: This rapid multiplex PCR assay can decrease amount and process of sample preparation, which was time-consuming, and had preferable accuracy. This developed technique will be suitable and useful for food-borne pathogen detection in shrimp and horizontal gene transfer study among different Vibrio species in aquatic animals.

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Standardizing the assessment and management protocol of critically ill under-five children: World Health Organization

Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy

Annals of Tropical Medicine and Public Health 2016 9(4):215-216

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Intramuscular calcifications after quinine injections

Anna M.C Koop, Jos P.A.M Vroemen, Jennifer M.J Schreinemakers

Annals of Tropical Medicine and Public Health 2016 9(4):263-265

A 45-year-old woman presented with a painful swelling of the right leg. Twenty years previously, she suffered from malaria and was treated with intramuscular injections of pure quinine. Over the years, she noticed two solid tumors at the site of the quinine injections. Because of the pain and discomfort, we decided to excise the tumor. No evidence exists indicating how to treat dystrophic calcifications after intramuscular injections. Our advice is to consider resection if the calcifications are present for many years and cause complaints.

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Postdoctoral degree in humanistic medical science: The first development from a public health curriculum unit

Viroj Wiwanitkit, Wasana Kaewla

Annals of Tropical Medicine and Public Health 2016 9(4):285-286

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Q-fever in a refugee after exposure to a central New York State livestock farm

Mustafa Qazi, Anita C Weimer, Brenden A Bedard, Byron S Kennedy

Annals of Tropical Medicine and Public Health 2016 9(4):266-270

Q-fever is a zoonotic disease caused by Coxiella burnetii that can create an acute or chronic form of the illness. In March 2014, Q-fever was identified by serology and Real-time Polymerase Chain Reaction (RT-PCR), in a 62 year-old male that was a Nepalese refugee. The male visited a livestock farm with a slaughterhouse in rural Central New York State, twenty-two days prior to onset of symptoms. He had direct handling of goats on this farm prior to slaughter. We describe the case presentation of his illness and the public health epidemiological investigation.

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Very-low-calorie ketogenic diet with aminoacid supplement versus very low restricted-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study

OBJECTIVE: Obesity plays a relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional and metabolic factors. We conducted a dietary intervention case-control randomized trial, to compare the effectiveness on body composition of two nutritional protocols: a very-low-carbohydrate ketogenic diet (VLCKD), integrated by an aminoacid supplement with whey protein, and very low restricted-calorie diet (VLCD).

PATIENTS AND METHODS: The clinical study was conducted with a randomized case-control in which twenty-five healthy subjects gave informed consent to participate in the interventional study and were evaluated for their health and nutritional status, by anthropometric, and body composition evaluation.

RESULTS: The results of this pilot study show that a diet low in carbohydrates, associated with a decreased caloric intake, is effective in weight loss. After VLCKD, versus VLCD, no significant differences in body lean of the trunk, body lean distribution (android and gynoid), total body lean were observed (p > 0.05). After VLCKD, no increasing of sarcopenia frequency, according ASSMI, was observed.

DISCUSSION: Many studies have shown the effectiveness of the ketogenic diet on weight loss; even if not know how to work effectively, as some researchers believe that the weight loss is due to reduced calorie intake, satiety could also be induced by the effect of the proteins, rather than the low-carbohydrates.

CONCLUSIONS: Our pilot study showed that a VLCKD was highly effective in terms of body weight reduction without to induce lean body mass loss, preventing the risk of sarcopenia. Further clinical trials are needed on a larger population and long-term body weight maintenance and risk factors management effects of VLCKD. There is no doubt, however, that a proper dietary approach would impact significantly on the reduction of public expenditure costs, in view of prospective data on increasing the percentage of obese people in our nation.

L'articolo Very-low-calorie ketogenic diet with aminoacid supplement versus very low restricted-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study sembra essere il primo su European Review.

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Does diazinon-sprayed market melon alter cholinesterase activity in healthy consumers? A randomized control trial

OBJECTIVE: Food contributes in measurable body burden of the widely used organophosphate pesticides. We designed a randomized controlled open label trial in Mashhad University Hospital in Iran, to study the possible alterations in cholinesterase activity resulting from consuming market melon known to be exposed to diazinon.

PATIENTS AND METHODS: Fifty-three young healthy volunteers were recruited. Participants were randomized to consume 250 g per day of organic (N = 22) vs. market melon (N = 31) during fifteen days. The primary outcome was the variation of red blood-cell (RBC) cholinesterase activity between day 15 (after) and day 0 (prior the intervention). The secondary outcome was a variation of the plasma cholinesterase activity between both dates.

RESULTS: Baseline RBC [5.21 ± 0.93 vs. 5.53 ± 0.99 IU/mL, mean ± SD] and plasma cholinesterase activities [54.0 ± 8.1 vs. 57.4 ± 8.6%] did not significantly differ between organic and market melon-exposed participants, respectively. RBC [5.86 ± 1.27 vs. 5.11 ± 1.2 IU/mL] and plasma cholinesterase activities [58.7 ± 10.0 vs. 50.5 ± 13.0%] significantly increased in organic melon-exposed vs. market melon-exposed participants (p = 0.002 and p = 0.001, respectively).

CONCLUSIONS: RBC and plasma cholinesterase activities significantly improved after eating organic instead of market melon during fifteen days. However, the consequences on the health of the observed cholinesterase alterations attributed to diazinon dietary intake remain to be determined.

L'articolo Does diazinon-sprayed market melon alter cholinesterase activity in healthy consumers? A randomized control trial sembra essere il primo su European Review.

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Police Support Manager - Dispatch - City of Fairfield, California

City of Fairfield, California Police Support Manager - Dispatch Annual salary range: $79,940 to $97,169 DOQ The City provides an attractive benefit package. Application deadline: Monday, August 1, 2016 The City of Fairfield Police Department is seeking an experienced public communications professional to lead the Department's Communications Center team as its new Dispatch Manager (newly-created ...

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Optimization of codon usage of the envelope protein E2 gene from various genotypes of hepatitis C virus to predict the expression level in Pichia pastoris


Hepatitis C virus infection (HCV) alarmingly increases worldwide; it causes chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, so there is urgent need of developing effective and sufficient quantity of vaccine. HCV envelope protein E2 is the main target for developing as a vaccine candidate. Presently recombinant proteins can successfully be used as a vaccine for many diseases. This concern, it is challenging to produce sufficient quantities of many recombinant proteins from their expression hosts. One of the main factors affecting the success of expression of foreign genes in heterologous hosts is the divergence of codon usage of the target gene from that used in the expression system. In this study, we optimized the various genotypes of HCV envelope protein E2 gene according to the codon usage of Pichia pastoris and predicted the expression level. Synonymous codon usage of E2 adapted to that used by P. pastoris was estimated using the relative synonymous codon usage value (RSCU), codon adaptation index (CAI) and effective number of codon (ENC). The CAI of optimized HCV E2 sequences was enhanced from 0.638 to 0.833 and %GC was decreased from 56.05 to 44.05; this was significantly (p < 0.01) different from the native sequences. Codon with RSCU value less than one was replaced with most preferred synonymous codons. The ENC values of optimized HCV E2 sequences varied from 47.00 to 47.50, with a mean value of 47.15 and an SD of 0.14. Our study suggested that, from the measured values of predicted expression level, the codon optimized HCV E2 protein could be produced in sufficient quantity in the expression host; knowledge of the codon usage patterns of E2 of various genotypes facilitate the production of a promising unique vaccine candidate for HCV.

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Efficacy of palonosetron in postoperative nausea and vomiting (PONV)—a meta-analysis


Palonosetron is a second-generation 5-HT3 receptor antagonist with proposed higher efficacy and sustained action for prophylaxis of postoperative nausea and vomiting (PONV).

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The risk of transient postprandial oxyhypoglycemia in nonalcoholic fatty liver disease



Nonalcoholic fatty liver disease (NAFLD) is frequently associated with insulin resistance (IR) and abnormalities in glucose metabolism. Prevalent postprandial hyperinsulinemia along with insulin resistance in NAFLD may lead to hypoglycemia. This study investigated the prevalence of postprandial oxyhypoglycemia in patients with NAFLD.


The oral glucose tolerance test (OGTT) with 75 g glucose was performed in 375 biopsy-proven NAFLD patients with prior unknown type 2 diabetes mellitus (DM). Serum glucose and insulin levels were measured for 3 h after glucose loading and the clinical parameters were compared.


Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and DM were observed in 36, 36, and 28 %, respectively. Hypoglycemia (≤70 mg/dL) after 3 h was observed in 14.4 % of all patients. The rate of hypoglycemia was significantly higher in NGT (63 % of NGT) than in IGT (30 % of IGT) and DM (7 % of DM) (P < 0.05). In patients with hypoglycemia, the levels of insulin were significantly higher at 30 and 60 min than those without hypoglycemia (P < 0.05). By multivariate analysis, high-LDL cholesterolemia (P < 0.05), low-HDL cholesterolemia (P < 0.05), and fibrosis (P < 0.05) were significant factors that contributed to hypoglycemia after 3 h on 75 g OGTT.


A relatively higher proportion of NAFLD cases exhibited transient postprandial hypoglycemia after 3 h on OGTT, especially in NAFLD patients with early-stage fibrosis. By performing 75 g OGTT for 3 h, hypoglycemia would be diagnosed earlier and the treatment intervention would decrease the progression of NAFLD and deterioration of glucose metabolism.

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Controversies in the temperature management of critically ill patients


Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down. A recent upsurge in clinical evidence in the perioperative and critical care field resulted in many clinical trials in temperature management. The results of these clinical trials suggest that aggressive body temperature modifications in comatose survivors after resuscitation from shockable rhythm, and permissive fever in critically ill patients, are carried out in critical care settings to improve patient outcomes; however, its efficacy remains to be elucidated. A recent, large multicenter randomized controlled trial demonstrated contradictory results, which may disrupt the trends in clinical practice. Thus, updated information concerning thermoregulatory interventions is essential for anesthesiologists and intensivists. Here, recent controversies in therapeutic hypothermia and fever management are summarized, and their relevance to the physiology of human thermoregulation is discussed.

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Impact of rare variants in ARHGAP29 to the etiology of oral clefts: Role of loss-of-function versus missense variants


Non-syndromic cleft lip with or without cleft palate (NSCL/P) is a prevalent, complex congenital malformation. Genome-wide association studies (GWAS) on NSCL/P have consistently identified association for the 1p22 region, in which ARHGAP29 has emerged as the main candidate gene. ARHGAP29 re-sequencing studies in NSCL/P patients have identified rare variants; however their clinical impact is still unclear. In this study we identified ten rare variants in ARHGAP29, including five missense, one in-frame deletion, and four loss-of-function (LoF) variants, in a cohort of 188 familial NSCL/P cases. A significant mutational burden was found for LoF (Sequence Kernel Association Test, P = 0.0005) but not for missense variants in ARHGAP29, suggesting that only LoF variants contribute to the etiology of NSCL/P. Penetrance was estimated as 59%, indicating that heterozygous LoF variants in ARHGAP29 confer a moderate risk to NSCL/P. The GWAS hits in IRF6 (rs642961) and 1p22 (rs560426 and rs4147811) do not seem to contribute to the penetrance of the phenotype, based on co-segregation analysis. Our data demonstrate that rare variants leading to haploinsufficiency of ARHGAP29 represent an important etiological clefting mechanism, and genetic testing for this gene might be taken into consideration in genetic counseling of familial cases.

Thumbnail image of graphical abstract

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Pivotal role of α2 Na+ pumps and their high affinity ouabain binding site in cardiovascular health and disease


Reduced smooth muscle (SM-) specific α2 Na+ pump expression elevates basal blood pressure (BP) and increases BP sensitivity to angiotensin II (Ang II) and dietary NaCl, whilst SM-α2 overexpression lowers basal BP and decreases Ang II/salt sensitivity. Prolonged ouabain infusion induces hypertension in rodents, and ouabain-resistant mutation of the α2 ouabain binding site (α2R/R mice) confers resistance to several forms of hypertension. Pressure overload-induced heart hypertrophy and failure are attenuated in cardio-specific α2 knockout, cardio-specific α2 overexpression and α2R/R mice. We propose a unifying hypothesis that reconciles these apparently disparate findings (Abstract Figure): brain mechanisms, activated by Ang II and high NaCl, regulate sympathetic drive and a novel neurohumoral pathway mediated by both brain and circulating endogenous ouabain (EO). Circulating EO modulates ouabain-sensitive α2 Na+ pump activity and Ca2+ transporter expression and, via Na+/Ca2+ exchange, Ca2+ homeostasis. This regulates sensitivity to sympathetic activity, Ca2+ signalling and arterial and cardiac contraction.

This article is protected by copyright. All rights reserved

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Inhibitory masking controls the threshold sensitivity of retinal ganglion cells

The responses of rod photoreceptors, which subserve dim light vision, are carried through the retina by three independent pathways. These pathways carry signals with largely different sensitivities. Retinal ganglion cells (RGCs), the output neurons of the retina, show a wide range of sensitivities under the same dark-adapted conditions, suggesting a divergence of the rod pathways. However, this organization is not supported by the known synaptic morphology of the retina. Here, we tested an alternative idea that the rod pathways converge onto single RGCs, but inhibitory circuits selectively mask signals so that one pathway predominates. Indeed, we found that application of GABA receptor blockers increased the sensitivity of most RGCs by unmasking rod signals, which were suppressed. Our results indicate that inhibition controls the threshold responses of RGCs under dim ambient light. This mechanism can ensure that appropriate signals cross the bottleneck of the optic nerve under changing stimulus conditions.

This article is protected by copyright. All rights reserved

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Polymorphisms in HLA-DQ genes, together with age, sex, and Helicobacter pylori infection, as potential biomarkers for the early diagnosis of gastric cancer


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Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy

Colorectal Disease

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Microbiota affect the rate of transplant acceptance and rejection

The University of Chicago Medical Center News

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Network meta-analysis of Chinese herb injections combined with FOLFOX chemotherapy in the treatment of advanced colorectal cancer

Journal of Clinical Pharmacy and Therapeutics

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Exenatide in obese or overweight patients without diabetes: A systematic review and meta-analyses of randomized controlled trials

International Journal of Cardiology

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Effects of acotiamide on the esophageal motility function in patients with esophageal motility disorders: A pilot study


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Epidural analgesia combined with a comprehensive physiotherapy program after Cytoreductive Surgery and HIPEC is associated with enhanced post-operative recovery and reduces intensive care unit stay: A retrospective study of 124 patients

European Journal of Surgical Oncology

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Hepatitis C viral dynamics during ribavirin priming differ according to prior treatment response and HCV type

Journal of Viral Hepatitis

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Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach

Journal of General Internal Medicine

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Benefit of mechanical bowel preparation prior to elective colorectal surgery: Current insights

Langenbeck's Archives of Surgery

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Alterations of gut microbiota in patients with irritable bowel syndrome: A systematic review and meta-analysis

Journal of Gastroenterology and Hepatology

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Obesity and psychotropic medication: A prospective register linkage study among midlife women and men

BMC Psychiatry

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Iodine-125 implantation plus transarterial chemoembolization for the treatment of hepatocellular carcinoma of 3-5cm: A propensity score matching study

Digestive and Liver Diseases

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Prevalence and burden of HCV co-infection in people living with HIV: A global systematic review and meta-analysis

The Lancet Infectious Diseases

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Risk factors for bleeding after gastric endoscopic submucosal dissection: A systematic review and meta-analysis

Gastrointestinal Endoscopy

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Genomic change in hepatitis B virus associated with development of hepatocellular carcinoma

World Journal of Gastroenterology

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Impact of elemental diet on early recovery after laparoscopic colectomy: Findings of a randomized controlled trial

Surgery Today

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Open versus laparoscopic surgery for rectal cancer: Single-center results of 587 cases

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Pancreatic cysts: What imaging characteristics are associated with development of pancreatic ductal adenocarcinoma

European Journal of Radiology

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Real world treatment patterns and clinical outcomes of HCV treatment-naive patients in China: An interim analysis from the CCgenos study

Journal of Gastroenterology and Hepatology

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HLA-Cw6 allele, NFkB1 and NFkBIA polymorphisms play no role in predicting response to etanercept in psoriatic patients.

Objective: This retrospective study aimed to evaluate the role of NFKB1-94 insertion/deletion ATTG (rs28362491) and NFkBIA 2758 A>G (rs696) polymorphisms and HLA-Cw6 allele in predicting the response to etanercept, a TNF-[alpha] blocker, in a population of psoriatic patients naive to biologics. Methods: Genomic DNA was extracted from whole blood in a series of 96 psoriatic patients who received etanercept for at least 3 months. Patients were classified as responders if they achieved a Psoriasis Area and Severity Index improvement of at least 75% after 12 weeks of etanercept treatment and as nonresponders if Psoriasis Area and Severity Index improvement was less than 75%. Genotyping was performed using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. Results: We did not find any significant role of NFKB1-94 insertion/deletion ATTG (rs28362491) and NFkBIA 2758 A>G (rs696) polymorphisms and the HLA-Cw6 allele in predicting the response to etanercept. Conclusion: Our findings suggest that NFKB1 and NFkBIA polymorphisms are not related to the response to etanercept. They also indicate that the therapeutic response to etanercept is not influenced by the presence of the HLA-Cw6 allele, in contrast with previous evidence on ustekinumab, suggesting that such an association is related more to drug than to disease characteristics. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Transumbilical laparoscopic appendectomy performed by residents is safe and feasible



The aim of this study was to compare the clinical outcomes of single-incision transumbilical laparoscopy-assisted appendectomy performed by surgical residents and attending surgeons.


We reviewed the clinical outcomes of 131 transumbilical laparoscopy-assisted appendectomies performed from January 2011 to June 2014. During the study period, 13 residents and 6 board-certified attending surgeons performed the procedures. For all operations performed by residents and attending surgeons, we reviewed and compared gender, age, BMI, body temperature, white blood cell count, C-reactive protein serum level, and the presence of a fecalith or abscess. Clinical outcomes including operative time, estimated blood loss, need for additional ports, conversion to open surgery, intraoperative complications, postoperative complications, and postoperative hospital stay were compared between the two groups.


The mean preoperative white blood cell count in the resident-operated group was significantly higher than in the attending-operated group (14.0 vs 10.8 ×103/mm3, P = 0.007). There were no other significant differences in clinical variables between the two groups. Outcomes show that estimated blood loss was significantly higher (23.4 vs 9.8 mL, P = 0.031) and operative time tended to be longer (86.0 vs 72.0 min, P = 0.056) in the resident-operated group. No other significant differences were observed.


Transumbilical laparoscopy-assisted appendectomy performed by residents is feasible and safe. It is an acceptable as a part of routine surgical training.

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Sternotomy versus video-assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients: A meta-analysis



The purpose of this study was to compare thymectomy by video-assisted thoracoscopic surgery (VATS) and trans-sternal thymectomy (TS) for myasthenia gravis patients.


A meta-analysis was conducted to compare thoracoscopic surgery and sternotomy for myasthenia gravis patients with regard to long-term effect and short-term safety.


A total of 23 trials were included in our research. No significant differences were detected with regard to myasthenic crisis, wound infection, and muscle weakness improvement. VATS led to less blood loss than TS (standardized mean difference, −1.233; 95% confidence interval, −1.425–−1.041; P < 0.001), less risk of pulmonary infection (relative risk, 1.035; 95% confidence interval, 1.001–1.070; P = 0.043), and a shorter hospital stay. TS had a shorter operative time than VATS (standardized mean difference, 0.239; 95% confidence interval, 0.113–0.365; P < 0.001). VATS and TS achieved similar mean specimen weights and complete stable remission rates.


Based on the results of this meta-analysis of retrospective cohort studies, VATS increases surgical safety and achieves an equal surgical efficacy to TS, but TS has a shorter operative time.

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Paramedic - Baker Emergency Medical Services INC.

Seeking Full-Time and Part-Time Paramedic's to work in Baker and Needles CA.

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Etiology of Diarrhea, Nutritional Outcomes and Novel Intestinal Biomarkers in Tanzanian Infants: A Preliminary Study.

Objective: Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relationship to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants, and to assess the association with anthropometrics and novel intestinal biomarkers. Methods: A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and followed for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, PCR-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured. Results: 123 subjects with diarrhea were enrolled. The mean +/- SD age at stool sample collection was 12.4 +/- 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni / coli, 3 ST-enterotoxigenic E. coli and 2 enteropathogenic E. coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (-0.55 +/- 1.10 vs. 0.03 +/- 1.30, p = 0.03) at the final clinic visit, compared to those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to LPS and flagellin. Subjects with any identified enteropathogen had lower IgA antibodies to LPS (0.75 +/- 0.27 vs. 1.13 +/- 0.77, p = 0.01) and flagellin (0.52 +/- 0.16 vs. 0.73 +/- 0.47, p = 0.02), compared to those without an identified pathogen. Conclusion: This quantitative PCR method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Protein Malnutrition During Juvenile Age Increases Ileal and Colonic Permeability in the Rat.

Protein malnutrition can lead to morphological and functional changes in jejunum and ileum, affecting permeability to luminal contents. Regarding the large intestine, data is scarce, especially at juvenile age. We investigated whether low-protein (LP) diet could modify ileal and colonic permeability and epithelial morphology in young rats. Isocaloric diets containing 26% (control diet) or 4% protein were given to male rats between postnatal days 40-60. LP-diet animals failed to gain weight and displayed decreased plasma Zinc levels (a marker of micronutrient deficiency). Additionally, transepithelial electrical resistance and Occludin expression was reduced in their ileum and colon, indicating increased gut permeability. Macromolecule transit was not modified. Finally, LP-diet induced shortening of colonic crypts without affecting muscle thickness. These data show that protein malnutrition increases not only ileum but also colon permeability in juvenile rats. Enhanced exposure to colonic luminal entities may be an additional component in the pathophysiology of protein malnutrition. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Environmental Enteric Dysfunction is Associated with Poor Linear Growth and Can be Identified by Host Fecal mRNAs.

Background and Objective: Environmental enteric dysfunction (EED) can be assessed by the lactulose:mannitol (L:M) test. Our objective was to determine if selected host fecal transcripts were correlated with EED, and whether transcripts and clinical characteristics could be used to predict EED in rural African children. Methods: Demographic and sanitation characteristics, along with L:M testing and host fecal transcript analyses from 798 asymptomatic Malawian children aged 12-61 months were compared to linear growth over the subsequent 3 months. Fecal host mRNA analysis included quantification of expression of 18 transcripts associated with L:M. Permeability was categorized as normal (L:M = 0.45), and random forest predictive models were created. Results: L:M was inversely correlated with linear growth over the subsequent 3 months (r = -0.32, P

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A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community Based Cohort Study.

Objectives: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multi-site, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), two previously published scores (Clark and CODA), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. Methods: Scores were built using maternally-reported symptoms or fieldworker-reported clinical signs obtained during the first seven days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. Results: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% CI: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with poorer weight gain, etiology, and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. Conclusions: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the impact of disease control interventions, and in triaging children for referral in low and middle countries where the rates of morbidity and mortality following diarrhea remain high. This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://ift.tt/1eRPUFd (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Fetal Magnetic Resonance Imaging Detection of Liver Iron Deposition in Neonatal Hemochromatosis During Prenatal Therapy.

No abstract available

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The Prevalence of Duodenitis in Children.

No abstract available

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