Nutritional Status and GI Symptoms in Pediatric Patients with Cystic Fibrosis

BACKGROUND: Cystic fibrosis (CF) is a genetic disorder that affects many organ systems including the lungs and the gastrointestinal tract. Children with CF often suffer from exocrine pancreatic insufficiency (EPI), causing many issues including poor digestion and poor nutrient absorption. It is imperative that children with CF consume greater amounts of calories, fat, protein, and fat-soluble vitamins to maintain healthy BMI. Studies have shown that adequate nutritional status leads to less severe symptoms and increased ability to fight off infection. OBJECTIVE: The purpose of this study was to evaluate the nutritional intake and frequency of GI symptoms in CF participants compared to their non-CF siblings. METHODS: Participants with CF and their siblings without CF were recruited for this study. Each participant completed a food frequency questionnaire and a GI symptom questionnaire. Data from the food frequency questionnaire was analyzed to determine the approximate composition of each food or drink that was reported. These values were then compared to published dietary reference intakes (DRIs) specific to healthy individuals and children with CF. RESULTS: No significant difference was observed in macronutrient intake between CF and non-CF participants. Our CF participants were deficient in non-fermentable fiber (52%), vitamin A (48%), vitamin E (96%), and vitamin K (100%). CF participants consumed excessive calcium (87%), zinc (87%), sodium (87%), iron (91%), and magnesium (83%). Significant differences were observed between CF and non-CF nutrient intakes of zinc (p=0.05), iron (p=0.04), vitamin A (p=0.03), vitamin E (p=0.003), vitamin C (p=0.05), and vitamin B-12 (p=0.03). CF participants experienced more frequent GI symptoms than non-CF participants. Among CF participants, individuals with the homozygous f508del mutation experienced more frequent GI symptoms than those with the heterozygous f508del mutation. CONCLUSIONS: All participants were eating well and meeting their macronutrient goals. Some dietary deficiencies existed in CF participants, including non-fermentable fiber, and vitamins A, E, and K. Exploring their clinical effects will be a future area of focus. GI symptoms were common in participants with CF, highlighting the need for interventions in this area. Also, GI symptoms in homozygous f508del patients were more frequent than in heterozygous f508del patients. These findings will be used in larger analyses to assess links between dietary intake and composition of the gut microbiome.https://digitalcommons.unmc.edu/surp2021/1009/thumbnail.jp

Diagnosing Capnocytophaga canimorsus Infections

We reviewed clinical and epidemiologic features of 56 human Capnocytophaga canimorsus isolates submitted during a 32-year period to California's Microbial Diseases Laboratory for identification. An increasing number of isolates identified as C. canimorsus have been submitted since 1990. Many laboratories still have difficulty correctly identifying this species

Validation of a 40-Gene Expression Profile Test to Predict Metastatic Risk in Localized High-Risk Cutaneous Squamous Cell Carcinoma

Background: Current staging systems for cutaneous squamous cell carcinoma (cSCC) have limited positive predictive value (PPV) for identifying patients who will experience metastasis. Objective: To develop and validate a gene expression profile (GEP) test for predicting risk for metastasis in localized, high-risk cSCC with the goal of improving risk-directed patient management. Methods: Archival formalin-fixed paraffin-embedded primary cSCC tissue and clinicopathologic data (n=586) were collected from 23 independent centers in a prospectively designed study. A GEP signature was developed using a discovery cohort (n=202) and validated in a separate, non-overlaping, independent cohort (n=324). Results: A prognostic, 40-gene expression profile (40-GEP) test was developed and validated, stratifying high-risk cSCC patients into classes based on metastasis risk: Class 1 (low-risk), Class 2A (high-risk), and Class 2B (highest-risk). For the validation cohort, 3-year metastasis-free survival (MFS) rates were 91.4%, 80.6%, and 44.0%, respectively. A PPV of 60% was achieved for the highest-risk group (Class 2B), an improvement over staging systems; while negative predictive value, sensitivity, and specificity were comparable to staging systems. Limitations: Potential understaging of cases could affect metastasis rate accuracy.Conclusion: The 40-GEP test is an independent predictor of metastatic risk that can complement current staging systems for patients with high-risk cSCC

Second WIN International Conference on “Integrated approaches and innovative tools for combating insecticide resistance in vectors of arboviruses”, October 2018, Singapore

The past 40 years have seen a dramatic emergence of epidemic arboviral diseases transmitted primarily by mosquitoes. The frequency and magnitude of the epidemics, especially those transmitted by urban Aedes species, have progressively increased over time, accelerating in the past 10 years. To reduce the burden and threat of vector-borne diseases, the World Health Organization (WHO) has recently adopted the Global Vector Control Response (GVCR) in order to support countries in implementing effective sustainable vector control. The evidence-base to support vector control is however limited for arboviral diseases which make prioritization difficult. Knowledge gaps in the distribution, mechanisms and impact of insecticide resistance on vector control impedes the implementation of locally tailored Aedes control measures. This report summarizes the main outputs of the second international conference of the Worldwide Insecticide resistance Network (WIN) on “Integrated approaches and innovative tools for combating insecticide resistance in arbovirus vectors” held in Singapore, 1–3 October 2018. The aims of the conference were to review progress and achievements made in insecticide resistance surveillance worldwide, and to discuss the potential of integrated vector management and innovative technologies for efficiently controlling arboviral diseases. The conference brought together 150 participants from 26 countries.</p