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We determined the effects of increasing the dietary inclusion of whole cottonseed (WCS) on nutrient digestibility and the milk production responses of high-producing dairy cows. Twenty-four multiparous Holstein cows (mean ± SD; 52.7 ± 2.63 kg/d milk; 104 ± 23 DIM) were randomly assigned to treatment sequences in a replicated 4 × 4 Latin square design with 21-d periods. Treatments were increasing doses of WCS at 0%, 8%, 16%, and 24% DM, with WCS replacing soybean meal and hulls to maintain similar diet nutrient composition (% DM) of NDF (32%), forage NDF (21%), starch (27%), and CP (17%). Total fatty acid (FA) content of each treatment was 1.70%, 2.96%, 4.20%, and 5.40% DM, respectively. Three preplanned contrasts were used to test the linear, quadratic, and cubic effects of increasing dietary WCS. Increasing dietary WCS from 0% to 24% DM quadratically influenced the intake of DM and NDF, with the highest value being the inclusion of 8% WCS, and intakes of 16- and 18-carbon, and total FA, with maximum values obtained up to 24% WCS. Increasing dietary WCS affected digestibility of DM (cubic) and NDF (quadratic), with the lowest values being the inclusion of 8% WCS. Increasing WCS increased 16-carbon digestibility (quadratic) but decreased digestibility of 18-carbon and total FA (both quadratic), with highest and lowest values for the inclusion of 24% WCS, respectively. Increasing dietary WCS quadratically increased absorbed 16- and 18-carbon, and total FA, with maximum values obtained for 24% WCS. Increasing dietary WCS quadratically increased yields of milk, milk fat, milk protein, milk lactose, 3.5% FCM, and ECM, and linearly increased BW gain. The source of milk FA was affected by dietary WCS, with a quadratic decrease in the yield of de novo and mixed milk FA and a quadratic increase in preformed milk FA. Increasing dietary WCS linearly increased trans-10 C18:1 milk FA content. As dietary WCS increased, plasma insulin linearly decreased, and plasma gossypol levels linearly increased. Despite the decrease in total FA digestibility, increasing dietary WCS from 0% to 24% DM increased FA absorption. Increasing the dietary inclusion of WCS up to 16% DM increased milk production responses and DM intake. Under the current dietary conditions, high-producing dairy cows benefited best from a diet containing an inclusion of 8% to 16% WCS in DM., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Recent research has highlighted the importance of dietary fatty acid profile of fatty acid supplements on production responses of high-producing dairy cows. Conventional soybeans contain ∼15% oleic acid and ∼50% linoleic acid whereas high oleic acid soybeans (HOSB) contain ∼70% oleic acid and ∼7% linoleic acid. We determined the effect of increasing dietary inclusion of roasted and ground HOSB on production responses of high-producing dairy cows. Twenty-four multiparous Holstein cows (mean ± SD; 50.7 ± 4.45 kg/d of milk; 122 ± 57 DIM) were randomly assigned to treatment sequences in a replicated 4 × 4 Latin square design with 21-d periods. Treatments were increasing doses of HOSB at 0%, 8%, 16%, and 24% of DM. The HOSB replaced conventional soybean meal and hulls to maintain similar diet nutrient composition (% of DM) of 27.4% to 29.4% NDF, 20.6% forage NDF, 27.5% starch, and 15.9 to 16.5% CP. Total fatty acid content of treatments was 1.65%, 3.11%, 4.52%, and 5.97% of DM, respectively. Preplanned polynomial orthogonal contrasts included the linear, quadratic, and cubic effects of increasing HOSB. Increasing dietary inclusion of HOSB linearly decreased DMI and MUN and increased yields of milk, 3.5% FCM, ECM, and milk fat, and quadratically increased milk protein. The increased response to milk fat was due to an increase in preformed milk fatty acids. Due to the increase in milk component yields and decrease in DMI, there was an increase in feed efficiency. Increasing HOSB inclusion linearly decreased plasma BUN concentration and tended to decrease plasma insulin. Increasing HOSB had no effect on BW change or BCS change. In summary, increasing dietary inclusion of HOSB up to 24% of DM increased production responses of high-producing dairy cows and did not affect body reserves., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Processing method of soybeans has the potential to influence dairy cow production performance, therefore we determined the effect feeding raw or roasted, ground high oleic acid soybeans (HOSB) on production responses of high-producing dairy cows. Thirty-six multiparous Holstein cows (45.6 ± 6.22 kg/d of milk; 110 ± 61 DIM) were randomly assigned to treatment sequences in a 4 × 2 Truncated Latin square design with 35-d periods. Treatments were: 1) control diet containing soybean meal and soybean hulls (CON), 2) 16% roasted and ground HOSB (RST), 3) 16% raw and ground HOSB (RAW-D), and 4) 16% raw and ground HOSB + additional rumen by-pass protein (RAW-U). High oleic acid soybeans replaced conventional soybean meal and hulls in the control diet and rumen by-pass protein replaced soybean meal in RAW-U to maintain diet nutrient composition (%DM) of ∼28.0% NDF, 21.3% forage NDF, 27.3% starch, and 17.8% CP. Fatty acid content of CON, RST, RAW-D, and RAW-U was 1.60, 4.30, 4.36, and 4.34%DM, respectively. Pre-planned contrasts included the overall effect of HOSB inclusion {CON vs. HOSOY [1/3 (RST + RAW-D + RAW-U)]}, the effect of soybean processing {RST vs. RAW [1/2 (RAW-D + RAW-U)]}, and the effect of increasing RUP content within the raw HOSB treatments (RAW-D vs RAW-U). For most variables tested, there were significant interactions between treatment and week, as HOSOY increased production variables compared with CON and RST increased production responses compared with RAW, with only the magnitude of difference varying between weeks. Overall, HOSOY increased DMI and yields of milk, 3.5% FCM, ECM, and milk fat, but did not affect milk protein yield. RST did not impact DMI but increased yields of milk, 3.5% FCM, ECM, milk fat, and milk protein. Compared with RAW-D, RAW-U increased yields of milk and milk protein and tended to increase ECM. Overall, HOSB inclusion of 16% DM increased production responses in high-producing dairy cows, but roasted HOSB had a greater impact than raw HOSB, and the addition of rumen-bypass protein positively affected milk protein response., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Introduction: Kimura's disease (KD) is a rare chronic inflammatory disorder characterized by subcutaneous lymphoid hyperplasia with peripheral eosinophilia. Kidney involvement is reported in 15%-18% of adult patients with KD, in many cases as nephrotic syndrome. We present a case of overlapping membranous nephropathy and IgA nephropathy associated with KD., Case Report: A 27-year-old man was admitted with a history of bilateral leg edema for the last 2 months and concomitant progressive increase of cervical mass and fever. Laboratory findings were as follows: peripheral leukocyte count, 10,080/mm³; eosinophils, 3,200/mm³ (31.7%); serum creatinine, 0.83 mg/dL; and eGFR: 140 mL/min per 1.73 m 2 . Urinalysis revealed the presence of hematuria and proteinuria and the following results: 24-h proteinuria, 12.9 g; serum albumin, 1.3 g/dL; and elevated IgE level, 750 kU/L. Serologies for hepatitis B, hepatitis C, HIV, and VDRL were all negative. Complement C3 and C4 levels were normal. No monoclonal protein was detected in blood and urine. Parasite infestation was discarded. A biopsy of the cervical lymph node revealed eosinophilic lymphoid hyperplasia, suggesting KD. A kidney biopsy revealed findings consistent with the overlapping of membranous nephropathy with IgA nephropathy. The patient was treated for KD with prednisone 1 mg/kg/d with progressive dose tapering and posterior association of methotrexate 15 mg/week. A renin-angiotensin system inhibitor was prescribed for nephrotic syndrome. The cervical mass regressed, and proteinuria achieved partial remission, with an increase in serum albumin level and normalization of eosinophils and IgE levels., Conclusion: Although uncommon, kidney involvement must be considered in patients with KD. Glomerular diseases are the most frequent form of kidney injury., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Barbosa, Neves, Mohrbacher, Abdo, Cavalcante, Menezes, Sato, Oliveira, Pereira, Bales, Frediani, Chocair and Cuvello-Neto.)

Purpose: The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts., Methods: A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates., Results: Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis., Conclusion: In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

We determined the effects of altering the ratio of palmitic (C16:0) and stearic (C18:0) acids in supplemental fatty acid (FA) blends on production responses of mid-lactation dairy cows. Twenty-four multiparous Holstein cows (mean ± standard deviation; 47.1 ± 5.8 kg of milk yield, 109 ± 23 DIM) were randomly assigned to treatment sequences in a replicated 4 × 4 Latin square design with 21-d periods. Treatments were a control diet not supplemented with FA (CON), and 3 diets incorporating 1.5% of dry matter (DM) FA supplement blends containing 30% C16:0 + 50% C18:0, 50% C16:0 + 30% C18:0, and 80% C16:0 + 10% C18:0. Additionally, the FA blends were balanced to contain 10% of oleic acid (cis-9 C18:1). The FA blends replaced soyhulls in the CON diet. Diets were formulated to contain (% of DM) 31.0% neutral detergent fiber, 27.0% starch, and 16.9% crude protein. The statistical model included the random effect of cow within square and the fixed effects of period, treatment, and their interaction. Preplanned contrasts included CON versus overall effect of FA supplementation and the linear and quadratic effects of increasing C16:0 in FA blends. Overall FA treatment had no effect on dry matter intake (DMI), but increasing C16:0 linearly increased DMI. Compared with CON, overall FA treatment increased yields of milk, 3.5% of fat-corrected milk, energy-corrected milk, and milk fat but did not affect milk protein yield. Increasing C16:0 linearly increased milk fat yield and tended to linearly increase the yields of 3.5% of fat-corrected milk and energy-corrected milk. Fatty acid supplementation decreased the yield of de novo milk FA but increased yields of mixed and preformed milk FA compared with CON. Increasing C16:0 in FA treatments did not affect the yield of de novo milk FA, linearly increased the yield of mixed, and decreased the yield of preformed milk FA. In summary, feeding FA supplements containing C16:0 and C18:0 increased milk production responses with no effect on DMI compared with a control diet. Mid-lactation cows producing ∼40 to 50 kg/d milk yield responded best to increasing supplemental C16:0 in FA supplements, demonstrating that FA supplements higher in C16:0 and limited in C18:0 improves production responses., (© 2024, The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

We evaluated the effects of fatty acid (FA) supplements with different ratios of palmitic acid (C16:0) and oleic acid ( cis -9 C18:1) in low- and high-FA basal diets on production responses of lactating dairy cows. Thirty-six multiparous Holstein cows (50.2 ± 5.8 kg/d of milk; 160 ± 36 d in milk) were used in a split-plot Latin square design balanced for carryover effects. Cows were blocked by milk yield and allocated to a main plot receiving either a low-FA (LF; 1.93% FA content) basal diet (n = 18) containing cottonseed meal and cottonseed hulls or a high-FA (HF; 3.15% FA content) basal diet (n = 18) containing whole cottonseed. Within each plot, a 3 × 3 Latin square arrangement of treatments was used in 3 consecutive 21-d periods. Treatments were (1) control (CON; no FA supplementation), (2) FA supplement containing 80% C16:0 + 10% C18:1 (PA), and (3) FA supplement containing 60% C16:0 + 30% cis -9 C18:1 (PA+OA). The FA supplements were fed at 1.5% of dry matter and replaced soyhulls in CON. Preplanned contrasts were (1) overall effect of FA supplementation {CON vs. the average of the FA treatments [1/2 (PA + PA+OA)]}, and (2) the effect of the PA treatment versus the PA+OA treatment (PA vs. PA+OA). Treatment by basal diet interactions were observed for yields of milk and lactose, where FA treatments increased yields of milk and milk lactose in LF but not in HF. Basal diet had no effect on dry matter intake (DMI) or milk yield. Compared with LF, HF increased milk fat yield and 3.5% fat-corrected milk (FCM) and tended to increase milk fat content and energy-corrected milk (ECM) yield. The FA treatments decreased DMI but increased the yields of milk fat, 3.5% FCM, and ECM, compared with CON, due to increases in mixed and preformed milk FA yields. The PA+OA treatment decreased DMI and milk protein yield compared with PA. In conclusion, a high-fat basal diet increased milk fat production, and the addition of FA supplements to a low-fat basal diet increased milk lactose yield and tended to increase milk yield. Additionally, regardless of basal diet fat level, FA supplements increased production responses compared with the non-FA-supplemented control diet., (© 2023.)

Background: Insulin resistance and/or hyperinsulinemia are closely linked to adiposity, metabolic syndrome (MetS) and prolonged inflammatory processes., Methods: We retrospectively analyzed 1,018 adult individuals with a mean age of 46 years (74% male) and classified them as: Metabolically normal: without any of the five criteria of the International Diabetes Federation (IDF) used for the diagnosis of MetS, plus normal fasting insulin (Men < 8 mU/L, Women < 10 mU/L); Level 1 MetS: with one or two IDF criteria, plus hyperinsulinemia (Men: ≥ 8 mU/L), and Women: ≥ 10 mU/L); Level 2 MetS: with three or more IDF criteria, plus hyperinsulinemia., Results: The mean values for fasting insulinemia in metabolically normal individuals was 4.6 ± 1.8 mU/L and 5.6 ± 2.3 mU/L, while their means for the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were 1.0 and 1.2 for men and women, respectively. In addition, the mean values for insulin (and HOMA-IR) for individuals with two normal anthropometric parameters (body mass index and waist girth), or two normal anthropometric parameters plus no IDF criteria, were similar to the metabolically normal group. Based on the obtained mean + 2 SD, we established the following insulin (and HOMA-IR) values as diagnostic cut-offs for hyperinsulinemia: Men: ≥ 8 mU/L (≥ 1.5), and Women: ≥ 10 mU/L (≥ 2.0). The mean serum insulin was significantly higher for individuals with Level 1 MetS (approx. 9 mU/L for both genders) compared with metabolically normal individuals, as was the prevalence of hepatic steatosis, which was more evident in men. Thus, the presence of one or two abnormal IDF criteria, combined with hyperinsulinemia and/or raised HOMA-IR, suggests the presence of MetS and insulin resistance. Patients of both genders with Level 2 MetS had higher serum insulin and/or HOMA-IR values than Level 1, as well as a higher prevalence of hypertension and hepatic steatosis, being more pronounced among men. The process was progressive and proportional to the degree of hyperinsulinemia., Conclusion: It is proposed that intervention against MetS progression should be started in individuals with Level 1 MetS, rather than waiting for more criteria for diagnostic confirmation, which this should help to reduce the occurrence of known complications such as type 2 diabetes, atherosclerosis, hypertension, and chronic kidney disease, among others., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chocair, de Menezes Neves, Sato, Mohrbacher, Oliveira, Pereira, Bales, da Silva, Duley and Cuvello-Neto.)

Introduction: The kidney may be affected by coronavirus (COVID-19) in the setting of acute kidney injury (AKI). Data about AKI in intensive care unit (ICU) patients in Latin America are scarce. We aimed to evaluate the risk of AKI, dialysis (HD), and death in ICU COVID-19 patients in a Brazilian center. Methods: Analysis from medical records of COVID-19 patients in a Brazilian center. Results: A total of 95 patients were analyzed. There was male predominance (64.2%), median age: 64.9 years, and previous history of hypertension and diabetes in 51.6 and 27.4%, respectively. AKI was diagnosed in 54 (56.8%) patients, and 32 (59.2%) of them required HD. Mortality rate was 17.9%. AKI patients when compared with no-AKI were more frequently hypertensive/diabetic and more often needed organ support therapies. Workups depicted more anemia, lymphopenia, and higher levels of inflammatory markers and higher mortality. Comparing patients who had undergone death to survivors, they were older, more frequently diabetic, and had worse SAPS3 and SOFA scores and need for organ support therapies, AKI, and HD. Multinomial logistic regression revealed that hypertension ( p = 0.018) and mechanical ventilation ( p = 0.002) were associated with AKI; hypertension ( p = 0.002), mechanical ventilation ( p = 0.008), and use of vasopressor ( p = 0.027) to HD patients; and age >65 years ( p = 0.03) and AKI ( p = 0.04) were risk factors for death. Conclusions: AKI was a common complication of ICU COVID-19 patients, and it was more frequent in patients with hypertension and need of organ support therapies. As well as age >65 years, AKI was an independent risk factor for death., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Neves, Sato, Mohrbacher, Ferreira, Oliveira, Pereira, Bales, Nardotto, Ferreira, Machado, Bassi, Silva-Júnior, Chocair and Cuvello-Neto.)

Background: McArdle disease is a myopathy caused by mutations in PYGM gene that is characterized by reduced or absent activity of myophosphorylase. Reports of patients with concomitant McArdle disease and diabetes are scarce. We report a case of a patient with a late diagnosis of McArdle disease and we postulate that symptoms may be related to hypoinsulinemia., Case Presentation: This report describes the evolution of an elderly diabetic patient with confirmed diagnosis of McArdle's disease based on the absence of myophosphorylase activity in the analysis of muscle biopsy, and a homozygous mutation in the PYGM gene. The variant - Chr11: 64.525 (p. Asn168*fs) has not been previously described. The diagnosis of McArdle disease was confirmed after two episodes of rhabdomyolysis, at 77 and 81 years of age, as the symptoms were, until then, discrete. The "second-wind phenomenon" was not spontaneously reported, but it was confirmed when directly questioned. We postulate that the later episodes of rhabdomyolysis occurred because of a progressive decrease in insulin production with a consequent reduction in the uptake of blood glucose by muscle cells, thus compromising the cellular energy balance. To our knowledge, this is the first report of recurrent rhabdomyolysis in an elderly diabetic patient with genetically proven McArdle disease. Our initial attempt to reduce insulin resistance with metformin and pioglitazone was not effective, possibly because of inadequate insulinemia. However, an improvement was evident after the administration of low doses of intermediate-acting insulin., Conclusions: In view of the patient's clinical evolution, we suggest the use of medication that reduces insulin resistance for patients with McArdle disease and type 2 diabetes, pre-diabetes or even normoglycemic metabolic syndrome.

COVID-19 is a severe disease that has reached pandemic status. To the best of our knowledge, we describe the first case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient. We discuss the challenge of establishing the diagnosis as well as the management of tissue-invasive gastrointestinal CMV infection (TI-GI CMV) simulating vascular involvement and intestinal obstruction in a critically ill patient., Learning Points: We describe a case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient.Clinical symptoms simulated mesenteric vascular involvement and intestinal obstruction.The successful management of invasive CMV colitis in a patient with COVID-19 with atypical symptoms is described., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2020.)

Road traffic injuries are a neglected global public health problem. Over 1.25 million people are killed each year, and middle-income countries, which are motorising rapidly, are the hardest hit. Sri Lanka is dealing with an injury-related healthcare crisis, with a recent 85% increase in road traffic fatality rates. Road traffic crashes now account for 25 000 injuries annually and 10 deaths daily. Development of a trauma registry is the foundation for injury control, care and prevention. Five northern Sri Lankan provinces collaborated with Jaffna Teaching Hospital to develop a local electronic registry. The Centre for Clinical Excellence and Research was established to provide organisational leadership, hardware and software were purchased, and data collectors trained. Initial data collection was modified after implementation challenges were resolved. Between 1 June 2017 and 30 September 2017, 1708 injured patients were entered into the registry. Among these patients, 62% were male, 76% were aged 21-50, 71.3% were motorcyclists and 34% were in a collision with another motorcyclist. There were frequent collisions with uncontrolled livestock (12%) and with fixed objects (14%), and most patients were transported by private vehicles without prehospital care. Head (n=315) and lower extremity (n=497) injuries predominated. Establishment of a trauma registry in low-income and middle-income countries is a significant challenge and requires invested local leadership; the most challenging issue is ongoing funding. However, this pilot registry provides a valuable foundation, identifying unique injury mechanisms, establishing priorities for prevention and patient care, and introducing the concept of an organised system to this region., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Luke Commission, a provider of comprehensive mobile health outreach in rural Swaziland, focuses on human immunodeficiency virus testing and prevention, including the performance of over 100 circumcisions weekly. Educational objectives for medical student global health electives are essential. Learning research methodology while engaging in clinical activities reinforces curriculum goals. Medical care databases can produce clinically significant findings affecting international health policy. Engaging in academic research exponentially increased the educational value of student experiences during an international medical elective., Methods: Staff of the Luke Commission, a nongovernmental organization, collected and deidentified information from 1500 Swazi male patients undergoing circumcision from January through June of 2014. Medical students designed studies and analyzed these data to produce research projects on adverse event rates, pain perception, and penile malformations. Institutional review board approval was obtained from the home institution and accompanying senior surgical faculty provided mentorship., Results: First-year medical students enrolled in an international medical elective to explore resource availability, cultural awareness, health care provision, and developing world endemic diseases. While in country, students learned research methodology, collected data, and engaged in research projects. Following the trip, students presented posters at over 10 regional and national meetings. All 4 articles are accepted or under consideration for publication by major journals., Conclusions: During international medical electives the combination of clinical experiences and access to databases from health aid organizations provides the foundation for productive medical student research. All participants benefit from the relationships formed by aid organizations, medical students, and patient populations. Global health research has many complexities, but through careful planning and cultural awareness, medical students can increase their research skills and contribute to the medical literature, bringing attention to and improving health care policies around the world. In sum, the educational experience of medical students is enhanced through the interaction of delivering patient care and completing clinical research studies., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: Hyperleptinemia and metabolic acidosis (MA) are frequently observed in patients on hemodialysis (HD). While the role of leptin in patients on HD is not completely understood, HD only partially corrects MA. Both leptin and acidosis have effect on bone disease. The goal of the present study was to evaluate the effects of MA correction on chronic kidney disease-mineral and bone disorder laboratory parameters and leptin levels., Methods: Forty-eight patients on HD, aged 43±19 years, were prospectively studied. Individual adjustments in the bicarbonate dialysate concentration were made to maintain pre-dialysis concentration≥22 mEq/l. Blood gas analysis was done monthly for 4 months (M1-M4)., Results: From M0 to M4, serum albumin increased (from 3.5 ±0.3 to 4.0±0.3 g/l, p<0.0001) while β2 microglobulin decreased (from 27.6±8.3 to 25.8±6.8 µg/ml, p=0.025). Serum leptin decreased in all but three patients, as well as leptin/adiponectin ratio (p<0.0001). There was a decrease in ionized serum calcium (from 5.0±0.5 to 4.7±0.5 mg/dl, p =0.002) and an increase in parathyroid hormone (PTH) [from 191 (85, 459) to 446 pg/ml (212, 983), p<0.0001] and in serum phosphate (from 5.4±1.4 to 5.8±1.1 mg/dl, p=0.048)., Conclusion: MA correction in HD patients can decrease leptin, an atherogenic marker. The impact of such treatment extends to uremic bone disease, as decrease in serum calcium and increase in PTH. However, this could be an undesirable effect because it may aggravate a secondary hyperparathyroidism. Whether the reduction in leptin levels has impact on outcomes in patients on hemodialysis deserves further investigation.

22q11 deletion syndrome (22qDS) has recently been proposed for addition to the newborn screening panel in Wisconsin and it seems likely that it may soon be considered in other states as well. Input from patients with 22qDS and their family was gathered from 21 phone interviews. Cardiac, palate, hypocalcemia, and multiple anomalies were common reasons for involved patients to be diagnosed, though age at diagnosis ranged from birth to adulthood. Many commented on their struggles with 22qDS, including worries about the future and the patient's independence. In general, respondents favored newborn screening for 22qDS because it would help prevent some medical problems, increase access to services, explain existing problems, and identify mild cases. However, a minority expressed reservations, including concerns that it would disrupt bonding, could be too costly, and would not be useful for mild cases.

The highly variable 22q11 deletion syndrome has been proposed for addition to newborn screening panels. A literature review investigated the incidence and prevalence, clinical features, and prognosis of 22q11 deletion syndrome and other issues related to newborn screening. Severe complications that could potentially be helped by screening include cardiac defects in 80% (with 20% having no outward signs to aid detection), hypocalcemia that can lead to seizures in 20% (though hypocalcemia is routinely investigated in sick newborns), and severe immune deficiency in <1% (which would be identified by some states' severe combined immunodeficiency screens). Other benefits that do not fit traditional goals of newborn screening include treatment for complications such as failure to thrive and developmental delay or preventing a "diagnostic odyssey." Although universal screening may prove the incidence to be >1:5000, undetected life-threatening effects occur in a minority of 22q11 deletion syndrome patients. Concerns include an untested screening technique, difficulty obtaining results in time for cardiac intervention, the chance of "vulnerable child syndrome" in mild cases, and possibly detecting congenital heart disease more efficiently by other means. Because addition of tests for highly variable conditions such as 22q11 deletion syndrome is likely to set a precedent for other syndromes, reevaluation of newborn screening criteria should be considered.

Dementia is a progressive and debilitating disease affecting an increasing number of people worldwide. Despite its importance, only a few studies have examined public awareness of dementia. We present a study of the public awareness of dementia in Botucatu, São Paulo, Brazil., Methods: A sample of 73 individuals answered a questionnaire approved by the Medical Ethics Research Committee inquiring about the characteristics of healthy old-aged and demented individuals., Results: Those interviewed believed that dementia is characterized by prevalent memory impairment (41%) and behavioral changes (32.9%) with onset in the 60's or older (42.5%) and upon suspecting dementia, only a few would seek specialized medical help., Discussion: Better understanding of public awareness of dementia provides the clue to more effective health and social policies in order to achieve a higher rate of early diagnosis and thereby possibly decreasing patient, family and caregiver distress.