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Objective: The objective of the study is to examine the relationship between weight-control behaviors and self-reported sociodemographic characteristics, weight status, and perception of body weight in a large, representative sample of adolescents in the West Bank and Gaza Strip territories of Palestine. Method: Self-report measures of sociodemographic characteristics, body weight perception, height and weight, and weight-control behaviors were completed by 8,885 male and female students aged 12-18 years from 405 randomly selected schools as part of the 2003/2004 Palestinian Health Behavior in School-aged Children Study (HBSC). Results: In both genders, dieting to lose weight was common among adolescents and significantly higher among overweight than among underweight or normal weight adolescents. Extreme weight-control behaviors (vomiting, diet pills, or laxatives) and smoking were more common among boys than girls, and extreme weight-control behaviors were particularly common among underweight boys. Older adolescents were less likely than younger adolescents to engage in weight-control behaviors. Perception of body weight as too fat was an influential factor in following an unhealthy diet to lose weight. Discussion: Practices to control weight, particularly extreme and unhealthy weight-control behaviors, are common among adolescents in the Palestinian territories. These findings suggest the need to design appropriate prevention and early intervention programs for adolescents in Palestine. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations of daily breakfast consumption (DBC) with demographic and lifestyle factors in 41 countries.Methods: Design: Survey including nationally representative samples of 11-15 year olds (n = 204,534) (HBSC 2005-2006).Statistics: Multilevel logistic regression analyses.Results: DBC varied from 33% (Greek girls) to 75% (Portuguese boys).In most countries, lower DBC was noticed in girls, older adolescents, those with lower family affluence and those living in single-parent families. DBC was positively associated with healthy lifestyle behaviours and negatively with unhealthy lifestyle behaviours.Conclusion: Breakfast skipping deserves attention in preventive programs. It is common among adolescents, especially girls, older adolescents and those from disadvantaged families.The results indicate that DBC can serve as an indicator to identify children at risk for unhealthy lifestyle behaviours. [ABSTRACT FROM AUTHOR]

Objectives: To examine overweight prevalence and its association with demographic and lifestyle factors in 11-15 year olds in the HBSC 2005-2006 survey.Methods: Self-reports of height, weight, eating patterns, physical activity and sedentary behaviours were obtained from nationally representative samples in 41 countries (n=204,534).Results: Overweight prevalence was highest in USA (28.8 %) and lowest in Latvia (7.6 %). In most countries, overweight was more prevalent in boys than girls. Overweight was consistently negatively associated with breakfast consumption and moderate to vigorous physical activity; OR range: 0.48-0.79 and 0.50-0.78, respectively.Conclusion: Overweight prevalence in youth remained high across the countries examined. The primary factors linked to overweight were breakfast consumption and physical activity. These data should contribute to formulating preventive programs and policies. [ABSTRACT FROM AUTHOR]

In the context of a larger study examining the interaction of vitamin A (VA) status and age on immune function, we examined age-related changes in hematologic and iron status variables in male Lewis rats. Animals were fed a nutritionally adequate purified diet containing either 0.35 (marginal), 4.0 (control) or 50 (supplemented) mg retinol equivalents (as retinyl palmitate) per kg of diet from the time of weaning until killing at 8-10 (middle-aged) or 20-22 (old) mo of age. Neither VA nor VA and age interaction effects were significant for most iron variables examined. After controlling for body weight, old rats had significantly lower hemoglobin, hematocrit and plasma iron than middle-aged rats. This decrease in hematologic and transport iron variables was not accompanied by a shift of iron into other storage compartments. Old rats also had significantly lower total iron content and iron concentration in liver, spleen and bone marrow. Hemosiderin iron in marrow smears correlated significantly (r = 0.43-0.76, P: < 0.05) with chemical estimates of iron in storage, transport and functional pools. Old rats also tended to have less stained iron in femur marrow smears. Thus, body iron in functional, transport and storage compartments, namely the liver, spleen and bone marrow, were significantly lower in old than in middle-aged rats. Although iron stores and status are usually considered to increase with advancing age, our data show a consistent pattern of lower hematologic and storage iron variables in old than in middle-aged Lewis rats. Future research is indicated to understand the biology and functional consequences of the observed age-associated decline in body iron. [ABSTRACT FROM AUTHOR]

Ariella Kelman,1,2 Caroline O Robinson,1 Elisenda Cochin,3 Nina J Ahluwalia,1 Julia Braverman,3 Emil Chiauzzi,3 Kristina Simacek3 1Genentech, South San Francisco, CA, USA; 2Division of Immunology and Rheumatology, Stanford University Medical School, Stanford, CA, USA; 3PatientsLikeMe, Cambridge, MA, USA Objective: This study aimed to explore patient and physician perspectives on current laboratory test reporting practices and to elicit ideas for improvement. Methods: Two independent studies were conducted. The first solicited members of an online physician community for opinions on current laboratory test reporting practices and possible improvements. The second addressed the same topic, but solicited patient feedback, and included an evaluation of a mock laboratory test report for the rheumatoid factor blood test. Results: Both physicians and patients expressed a desire for patient-friendly information on laboratory reports. Physicians expressed a need for education for patients around false-positive and false-negative results within laboratory reports, while patients sought context around the meaning of results, relevance to other tests, and follow-up steps. Conclusion: Physicians and patients see value in enhancing laboratory test reports to improve communication. While reports should include the context that patients value, they should also contain cautionary interpretation emphasized by physicians. Patient consultation on improving laboratory reports may help improve such patient-focused communication and promote greater patient understanding of health information, thereby increasing patient participation in their own health care and improving outcomes. Practice implications: Laboratory reports are typically designed by experts. Including patients in laboratory report design may facilitate communication and improve outcomes through better patient engagement. Keywords: laboratory test reports, doctor–patient communication, patient-centered, medical records, health records

A quiz concerning the diagnosis of a 46-year-old woman who experiences intermenstrual bleeding is presented.

This article presents a question related to the diagnosis in case of a 79 year old Caucasian male who presented with a two week history of melena. The answer of this question is also given. The patient's past medical history included hypertension, atrial fibrillation, and malignant melanoma. He was on warfarin. Examination demonstrated a palpable irregular liver edge and the presence of melena was confirmed on per-rectal examination. Gastroscopy identified three ulcers with craters in the gastric fundus, the largest being approximately 2.5 cm in size.

Abstract Background The prevalence of overweight in children and adolescents is high and overweight is associated with poor health outcomes over short- and long-term. Lifestyle factors can interact to influence overweight. Comprehensive studies linking overweight concomitantly with several demographic and potentially-modifiable lifestyle factors and health-risk behaviours are limited in adolescents - an age-group characterized by changes in lifestyle behaviours and high prevalence of overweight. Thus, the objective of the current study was to examine the association of overweight with several socio-demographic and lifestyle variables simultaneously in a representative sample of adolescents. Methods A nationally representative sample of 11-15 year-olds (n = 7154) in France participated as part of the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) study. Students reported data on their age, height, weight, socio-demographic variables, lifestyle factors including nutrition practices, physical activity at two levels of intensity (moderate and vigorous), sedentary behaviours, as well as smoking and alcohol consumption patterns using standardized HBSC protocols. Overweight (including obesity) was defined using the IOTF reference. The multivariate association of overweight with several socio-demographic and lifestyle factors was examined with logistic regression models. Results The adjusted odds ratios for the association with overweight were: 1.80 (95% CI: 1.37-2.36) for low family affluence; 0.73 (0.60-0.88) for eating breakfast daily; 0.69 (0.56-0.84) for moderate to vigorous physical activity (MVPA); and 0.71 (0.59-0.86) for vigorous physical activity (VPA). Significant interactions between age and gender as well as television (TV) viewing and gender were noted: for boys, overweight was not associated with age or TV viewing; in contrast, for girls overweight correlated negatively with age and positively with TV viewing. Fruit and vegetable intake, computer and video-games use, smoking and alcohol consumption were not associated with overweight. Conclusions In multivariate model, family affluence, breakfast consumption and moderate to vigorous as well as vigorous physical activity were negatively associated with overweight. These findings extend previous research to a setting where multiple risk and protective factors were simultaneously examined and highlight the importance of multi-faceted approaches promoting physical activity and healthy food choices such as breakfast consumption for overweight prevention in adolescents.

Abstract Background Parents have significant influence on behaviors and perceptions surrounding eating, body image and weight in adolescents. The aim of this study was to examine the prevalence of body weight dissatisfaction, difficulty in communication with the parents and the relationship between communication with parents and adolescents' dissatisfaction with their body weight (dieting or perceived need to diet). Methods Survey data were collected from adolescents in 24 countries and regions in Europe, Canada, and the USA who participated in the cross-sectional 2001/2002 Health Behaviour of School-Aged Children (HBSC) study. The association between communication with parents and body weight dissatisfaction was examined using binary logistic regression analysis. Results Body weight dissatisfaction was highly prevalent and more common among girls than boys, among overweight than non-overweight, and among older adolescents than younger adolescents. Difficulty in talking to father was more common than difficulty in talking to mother in all countries and it was greater among girls than among boys and increased with age. Difficulties in talking to father were associated with weight dissatisfaction among both boys and girls in most countries. Difficulties in talking to mother were rarely associated with body weight dissatisfaction among boys while among girls this association was found in most countries. Conclusion The findings suggest that enhanced parent communication might contribute in most countries to less body dissatisfaction in girls and better communication with the father can help avoiding body weight dissatisfaction in boys. Professionals working with adolescents and their families should help adolescents to have a healthy weight and positive body image and promote effective parent – adolescent communication.

The article presents a quiz related to a case study of a 40 year old previously healthy man with a ten day history of profuse watery diarrhea up to 10 times per day but no blood in the stools. He also complained of mild headache, myalgia, and fever. He had vomiting and crampy abdominal pain two days prior to admission. An urgent colonoscopy was performed on the patient. The quiz was related to the diagnosis of the patient.

This article focuses on a study related to optimal sites to biopsy for an accurate diagnosis of H pylori infection based on its topographical distribution using CLO test. Accurate diagnosis of H pylori is critical for the optimal management of patients undergoing gastroscopy. Generally only one antral biopsy is taken fore CLO well. The study concludes that Using CLO well technique to diagnose H pylori, taking 2 biopsies from the body appears to be superior to taking 2 biopsies from the antrum of the stomach.

Purpose: Evidence now indicates that Thrombotic Thrombocytopenic Purpurpa (TTP) is an immune mediated disorder. An inhibitor to yon Willebrand Factor (vWF) reducing metalloproteinase has been documented in patients with both acute TTP and those with chronic relapsing and congenital forms. We have earlier shown that plasma exchange with Fresh Frozen Plasma (FFP) results in 78% survival in patients with TTP (Rock et al NEJM 1991; 325:393-397) and pilot studies of cryosupenatant plasma (CSP) have shown further improved survival (Rock et al BJHaem 1996; 94:383-386). Methods: The Canadian Apheresis Group has undertaken a randomized prospective trial comparing the treatment of patients with TTP using FFP vs. CSP. Samples from patients are analyzed for vWF and FVIII, metalloproteinase activity and the inhibitor to the metalloprotease both prior to treatment and after 9 days of therapy. Results: The vWF levels ranged from 1.3 to 3.8 IU/ml. Following treatment, this decreased significantly with the level considerably lower in patients receiving CSP compared to FFP (avg. 0.6 vs. 1.6 IU/ml). At entry most patients showed normal vWF multimer patterns. The plasma metalleprotease levels showed large variation ranging from 10-100% protease activity compared to controls. The majority, 10 out of 15, demonstrated low protease activity with less than 50% of control. After treatment, 10 out of 15 (67%) patients had >80% normal protease activity. However 9 of 15 patients (60°%) showed <10% inhibition of normal plasma protease activity indicating that there was little, if any, protease inhibitor in their plasma. Only 4 of the 15 patients exhibited high levels of protease inhibitors and these resulted in <60% inhibition of NHP protease activity in mixing studies. Conclusions: As the platelet count in these patients ranged from 9-48 × 10[sup 9]/ul, the data suggests that high levels of protease inhibitor do not always correlate with low platelet count. Further characterization of the inhibitors from these patients may lead to significant improvement in therapy. CSP effectively decreases vWF levels. [ABSTRACT FROM AUTHOR]

Reports on a study published in the March 1993 issue of `The American Journal of Clinical Nutrition' which determined the day-to-day variability in biochemical indicators of iron status in well-hydrated, healthy women aged 70 to 79 years. Findings.

Background: Elexacaftor-tezacaftor-ivacaftor is a small-molecule cystic fibrosis transmembrane conductance regulator (CFTR) modulator regimen shown to be efficacious in patients with at least one Phe508del allele, which indicates that this combination can modulate a single Phe508del allele. In patients whose other CFTR allele contains a gating or residual function mutation that is already effectively treated with previous CFTR modulators (ivacaftor or tezacaftor-ivacaftor), the potential for additional benefit from restoring Phe508del CFTR protein function is unclear.Methods: We conducted a phase 3, double-blind, randomized, active-controlled trial involving patients 12 years of age or older with cystic fibrosis and Phe508del-gating or Phe508del-residual function genotypes. After a 4-week run-in period with ivacaftor or tezacaftor-ivacaftor, patients were randomly assigned to receive elexacaftor-tezacaftor-ivacaftor or active control for 8 weeks. The primary end point was the absolute change in the percentage of predicted forced expiratory volume in 1 second (FEV1) from baseline through week 8 in the elexacaftor-tezacaftor-ivacaftor group.Results: After the run-in period, 132 patients received elexacaftor-tezacaftor-ivacaftor and 126 received active control. Elexacaftor-tezacaftor-ivacaftor resulted in a percentage of predicted FEV1 that was higher by 3.7 percentage points (95% confidence interval [CI], 2.8 to 4.6) relative to baseline and higher by 3.5 percentage points (95% CI, 2.2 to 4.7) relative to active control and a sweat chloride concentration that was lower by 22.3 mmol per liter (95% CI, 20.2 to 24.5) relative to baseline and lower by 23.1 mmol per liter (95% CI, 20.1 to 26.1) relative to active control (P<0.001 for all comparisons). The change from baseline in the Cystic Fibrosis Questionnaire-Revised respiratory domain score (range, 0 to 100, with higher scores indicating better quality of life) with elexacaftor-tezacaftor-ivacaftor was 10.3 points (95% CI, 8.0 to 12.7) and with active control was 1.6 points (95% CI, -0.8 to 4.1). The incidence of adverse events was similar in the two groups; adverse events led to treatment discontinuation in one patient (elevated aminotransferase level) in the elexacaftor-tezacaftor-ivacaftor group and in two patients (anxiety or depression and pulmonary exacerbation) in the active control group.Conclusions: Elexacaftor-tezacaftor-ivacaftor was efficacious and safe in patients with Phe508del-gating or Phe508del-residual function genotypes and conferred additional benefit relative to previous CFTR modulators. (Funded by Vertex Pharmaceuticals; VX18-445-104 ClinicalTrials.gov number, NCT04058353.). [ABSTRACT FROM AUTHOR]

Introduction: Approximately one third of children in Sri Lanka suffer from undernutrition. Recurrent infections that may lead to reduce dietary intake are thought to be an important cause of undernutrition in children. Objectives: To compare dietary intakes of macro and micronutrients in children with recurrent infections and healthy controls. Methods: 364 children, aged 5-10 years, who were recruited from the Children's hospital, Colombo, Sri Lanka for a study on iron and infection had their dietary intake assessed during a period of 8 weeks. Children with a past history of recurrent upper respiratory tract infections (URTI) with clinical and laboratory evidence of URTI during the observation period were the infection group (n = 180), while children without infections were controls (n = 184). A 24 - hour recall of the preceding day's diet was obtained at baseline, week 4 and week 8 (on 3 days) using a dietary data questionnaire incorporating common foods consumed in Sri Lanka. Food composition tables specially prepared for assessment of Sri Lankan diets were used to calculate nutrient intakes. Results: Children in both groups were of similar low socio-economic status. Analysis of dietary data indicated that children with infection and controls had lower intakes of energy, protein, carotene and ascorbic acid than recommended dietary allowances for their age groups. No significant differences were noted in average intakes of nutrients/day between infection and control groups;energy: infection group; 974 ± 198 kcal, controls; 979 ± 109 kcal (P = 0.80), protein: infection group; 29.6±8.5 g, controls; 28.8 ± 7.4 g (P = 0.37), iron: infection group; 11.0 ± 3.7 mg, controls; 11.2 ± 4.0 mg (P = 0.52), ascorbic acid: infection group; 10.3 ± 12.4 mg, controls; 11.7 ± 12.6 mg (P= 0.32) and vitamin A:infection group; 143.0±118µg retinol activity equivalents (RAE), controls; 149.6± 117 µg RAE. Conclusions: Children with URTI and healthy controls had similar dietary intakes. Recurrent mild infections may not be a cause of undernutrition in 5-10 year old children. Acknowledgements: International Life Sciences Institute, USA. [ABSTRACT FROM AUTHOR]

AIMS: Identification of novel biomarkers of diabetes risk help to understand mechanisms of pathogenesis and improve risk prediction. Our objectives were to examine the relationships between adipokines, biomarkers of inflammation and endothelial function and development of type 2 diabetes; and to assess the relevance of including these biomarkers in type 2 diabetes prediction risk models. METHODS: 1345 subjects from the SU.VI.MAX study, who were free of diabetes at baseline and who completed 13 years of follow-up were included in the present analyses. Odds ratios (OR) with 95% confidence intervals (95% CI) of incident type 2 diabetes associated with a 1-SD increase in adiponectin, leptin, C-reactive protein (CRP), soluble intracellular adhesion modecule-1 (sICAM-1), soluble vascular cell adhesion molecule 1 (sVCAM-1), E-selectin and monocyte chemoattractant protein-1 (MCP-1) were estimated. Predicitive performances of models including biomarkers were assessed with area under the receiver operating curves (AUC) and integrated discrimination improvement (IDI) statistics. RESULTS: 82 subjects developed type 2 diabetes during follow-up. The risk of developing type 2 diabetes increased with increasing concentrations of leptin (2.04 (1.28;3.26)), sICAM-1 (1.39 (1.08;1.78)) and sVCAM-1 (1.29 (1.01;1.64)). Type 2 diabetes associations with leptin remained significant after adjusting for a combination of biomarkers. Models adjusted for novel biomarkers had improved performance compared to models adjusted for classical risk factors as assessed by IDI, but not by AUC. CONCLUSIONS: Adipokines, biomarkers of inflammation and endothelial function were significantly associated to onset of type 2 diabetes. However their inclusion in predictive scores is not supported by the present study. [ABSTRACT FROM AUTHOR]