Cushing’s disease: does low-dose pasireotide offer a comparable efficacy and safety to high-dose?

Whilst literature is expanding on pasireotide use in the management of Cushing’s disease (CD), there is still currently much unknown about long-term and low-dose pasireotide use in CD. We present a 60-year-old female with residual CD after transphenoidal surgery (TSS), being successfully managed with S.C. pasireotide for over 10 years. For 6 years, her S.C. pasireotide was inadvertently administered at 360 µg twice daily (BID), almost half the recommended dose of 600 µg BID. Despite the low-dose, her urinary free cortisol (UFC) normalised within 6 months and Cushingoid features resolved. She remained in biochemical and clinical remission on the same low-dose for 6 years, before a medication audit discovered her mistaken dose and directed her to take 600 µg BID. With the higher dose 600 µg BID for the next 5 years, her glycaemia worsened without any changes in her UFC and residual tumour volume. Our case showed the continuing effectiveness and safety of treatment with S.C. pasireotide for more than 10 years, and that a low-dose regimen may be considered an option for responders by its safety profile

Primary Adrenal Lymphoma as a Rare Cause of Primary Adrenal Insufficiency: Challenges in Management and a Review of the Literature

Background/Objective: Primary adrenal lymphoma (PAL) is an aggressive form of lymphoma associated with adrenal insufficiency (AI) in most cases. It requires a histologic confirmation unlike other cases of primary AI. Case Report: We report a case of a 66-year-old man who presented with AI with symptomatic hypotension and hypo-osmolar hyponatremia. Ultrasound and computed tomography scans revealed bilateral bulky adrenal masses that were avid on fluorodeoxyglucose positron emission tomography scan. The diagnosis of PAL was confirmed with adrenal biopsy. He was treated with rituximab-based chemotherapy, which was complicated by several endocrine challenges, including worsening diabetes, multiple adrenal crises, prolonged hyponatremia, and refractory hypokalemia requiring spironolactone. He eventually developed central nervous system disease and was treated with palliative intent. Discussion: AI in the setting of PAL can constitute both diagnostic and therapeutic challenges, including significant electrolyte imbalances as discussed in this case report. Conclusion: It is important to have a high suspicion for PAL, especially in the presence of bilateral adrenal masses and AI. Early adrenal biopsy is required for diagnosis. Multidisciplinary care is vital to manage complications that arise during the disease course and treatment

Epigenome targeting by probiotic metabolites

BACKGROUND: The intestinal microbiota plays an important role in immune development and homeostasis. A disturbed microbiota during early infancy is associated with an increased risk of developing inflammatory and allergic diseases later in life. The mechanisms underlying these effects are poorly understood but are likely to involve alterations in microbial production of fermentation-derived metabolites, which have potent immune modulating properties and are required for maintenance of healthy mucosal immune responses. Probiotics are beneficial bacteria that have the capacity to alter the composition of bacterial species in the intestine that can in turn influence the production of fermentation-derived metabolites. Principal among these metabolites are the short-chain fatty acids butyrate and acetate that have potent anti-inflammatory activities important in regulating immune function at the intestinal mucosal surface. Therefore strategies aimed at restoring the microbiota profile may be effective in the prevention or treatment of allergic and inflammatory diseases. PRESENTATION OF THE HYPOTHESIS: Probiotic bacteria have diverse effects including altering microbiota composition, regulating epithelial cell barrier function and modulating of immune responses. The precise molecular mechanisms mediating these probiotic effects are not well understood. Short-chain fatty acids such as butyrate are a class of histone deacetylase inhibitors important in the epigenetic control of host cell responses. It is hypothesized that the biological function of probiotics may be a result of epigenetic modifications that may explain the wide range of effects observed. Studies delineating the effects of probiotics on short-chain fatty acid production and the epigenetic actions of short-chain fatty acids will assist in understanding the association between microbiota and allergic or autoimmune disorders. TESTING THE HYPOTHESIS: We propose that treatment with specific probiotic bacteria under in vivo conditions would offer the ideal conditions to examine the microbiological, immunological and epigenetic mechanisms of action. Advances in epigenetic technology now allow investigators to better understand the complex biological properties of probiotics and their metabolites. IMPLICATIONS OF THE HYPOTHESIS: Determining the precise mechanisms of probiotic action will lead to more specific and efficacious therapeutic strategies in the prevention or treatment of chronic inflammatory conditions

Prognostic significance of early platelet dynamics in Staphylococcus aureus bacteremia

BACKGROUND: Platelets are recognized as key immune effectors, but they are targets of bacterial virulence factors. In the present study, we aimed to examine the relationship between early platelet dynamics and the outcome of Staphylococcus aureus bacteremia (SAB). METHOD: Electronic medical records of adult patients hospitalized for SAB between July 2012 and November 2020 were retrospectively reviewed for relevant demographic, laboratory, and clinical data. The outcome endpoints were mortality and microbial persistence. RESULTS: Among the 811 patients evaluated, 29% experienced thrombocytopenia on Day 1. Platelet count nadir occurred on Days 2-3 following SAB onset, and Day 4 was a determining point of platelet count trajectory and mortality. Mortality risk was 6% or less for those with normal platelet count by Day 4 regardless of whether they experienced thrombocytopenia on Day 1, but the risk increased to 16-21% for those who experienced thrombocytopenia on Day 4 regardless of whether they had normal platelet count on Day 1 or sustained thrombocytopenia. The duration of bacteremia was prolonged by one day (median 3 d vs. 2 d) for those with sustained thrombocytopenia compared to those without. CONCLUSION: Early platelet dynamics during SAB have prognostic significance and represent an early window for potential platelet-directed therapeutic interventions to improve outcome

Smart Data Recognition System For Seven Segment LED Display

The automatic data capturing system provides an alternative and effective way of data collection instead of manual data collection in the laboratory, especially for experiments that need to be carried out for a long period. It can solve common mistakes made by humans, like misreading or mistyping data. Thus, a new smart data recognition system for a seven-segment LED display is developed to sort the whole process of data collection to become more systematic and accurate. An image is captured and saved automatically in an image file, and then it is processed through MATLAB software to identify the digits displayed on the LED display. Once the image is preprocessed, analyzed, and recognized, the final output values obtained are transferred to an existing Excel file for a further process according to the user’s requirement. From the results obtained, it was proven that binary thresholding is the best preprocessing method, and the brightness of the image should be set to ‘0’ for better recognition output

A masked ritual: wedding night virginity test among Sri Lankan muslims

The virginity test in the wedding bed is a widespread custom in many cultures and Sri Lanka is no exception. Wedding night virginity testing among Muslim community is camouflaged and masked but prevails. As a result, this study was created to investigate the significance, explanations, relevance, and reasoning for the Muslim marital virginity test as a marriage custom. This study is wholly qualitative. In order to gather data, nine cases were studied in-depth using the snowball sampling technique. One focus group discussion and five key informant interviews were done. The study has shown that the entire virginity test for the bridal bed is a pointless, damaging, humiliating, and unfair practice. The concept of hymenoplasty is barely understood by respondents. Several terms are used to describe virginity tests, such as potti odakkiya (cracking box), pon kulippaattal (bride bathing), etc. The celebration of the virginity test is marked with a breakfast feast, gifts such as gold jewelry, etc. The wedding bed virginity test has been viewed as a harmful habit, encouraging feelings of inferiority and decreasing self-worthiness. Despite gender inequalities, it was proposed that the community at large be educated about the unreliability of wedding bed virginity tests. This study fills a research gap and contributes much-needed empirical data to the academic world by providing an explanatory review on the wedding bed virginity test among Sri Lankan Muslims

The use of smart phones and their mobile applications among older adults in Hong Kong: An exploratory study

The purpose of this study was to explore social participation using smart phones by the older population in Hong Kong. The present study was conducted from 10-June-2013 to 16-August-2013. It was a cross-sectional survey study, and data were collected from street interviews. Potential participants were approached and invited to respond to a questionnaire. The locations for collecting data were evenly distributed on Hong Kong Island, Kowloon, and the New Territories. The size of the samples for Hong Kong Island, Kowloon, and the New Territories were calculated based on their respective proportion of the Hong Kong population in 2011. The estimated time to complete the questionnaire was approximately 10 minutes. The questionnaire included questions on demographic data and the use of smart phones and their related features. A total of 982 participants were interviewed, 46% of whom were male and 54% female. The participants were divided into the following two groups: the young-old (age 50-69) and the old-old (age 70 or above). The mean age was 67.93±10.386. The findings showed that, in comparison with the young-old group (age 50 to 69), a smaller percentage of the old-old group (70 and over) used smart phones and mobile messaging applications to communicate with others. There were no differences in patterns with regard to the type and frequency of the mobile applications being used. However, a smaller percentage of the old-old group had installed the mobile app by themselves and introduced the mobile app to others. This study reveals the behavioral patterns of the young-old and the old-old groups in the use of mobile devices to communicate. The young-old and old-old groups exhibited the same patterns in terms of the types and frequency of the mobile apps used; however, a smaller percentage of the old-old group used mobile apps to communicate. Different educational programs on the importance of social support should be established, and the promotional strategies for these programs need to be tailored to older adults

A Study of Success Rate of Miniscrew Implants as Temporary Anchorage Devices in Singapore

Objective. To find out the success rate of miniscrew implants in the National Dental Centre of Singapore (NDCS) and the impact of patient-related, location-related, and miniscrew implant-related factors. Materials and Methods. Two hundred and eighty-five orthodontic miniscrew implants were examined from NDCS patient records. Eleven variables were analysed to see if there is any association with success. Outcome was measured twice, immediately after surgery prior to orthodontic loading (T1) and 12 months after surgery (T2). The outcome at T2 was assessed 12 months after the miniscrew’s insertion date or after its use as a temporary anchorage device has ceased. Results. Overall success rate was 94.7% at T1 and 83.3% at T2. Multivariate analysis revealed only the length of miniscrew implant to be significantly associated with success at both T1 (P=0.002) and T2 (P=0.030). Miniscrew implants with lengths of 10–12 mm had the highest success rate (98.0%) compared to other lengths, and this is statistically significant (P=0.035). At T2, lengths of 10–12 mm had significantly (P=0.013) higher success rates (93.5%) compared to 6-7 mm (76.7%) and 8 mm (82.1%) miniscrew implants. Conclusion. Multivariate statistical analyses of 11 variables demonstrate that length of miniscrew implant is significant in determining success

A Study of Success Rate of Miniscrew Implants as Temporary Anchorage Devices in Singapore

Objective. To find out the success rate of miniscrew implants in the National Dental Centre of Singapore (NDCS) and the impact of patient-related, location-related, and miniscrew implant-related factors. Materials and Methods. Two hundred and eighty-five orthodontic miniscrew implants were examined from NDCS patient records. Eleven variables were analysed to see if there is any association with success. Outcome was measured twice, immediately after surgery prior to orthodontic loading (T1) and 12 months after surgery (T2). The outcome at T2 was assessed 12 months after the miniscrew's insertion date or after its use as a temporary anchorage device has ceased. Results. Overall success rate was 94.7% at T1 and 83.3% at T2. Multivariate analysis revealed only the length of miniscrew implant to be significantly associated with success at both T1 ( = 0.002) and T2 ( = 0.030). Miniscrew implants with lengths of 10-12 mm had the highest success rate (98.0%) compared to other lengths, and this is statistically significant ( = 0.035). At T2, lengths of 10-12 mm had significantly ( = 0.013) higher success rates (93.5%) compared to 6-7 mm (76.7%) and 8 mm (82.1%) miniscrew implants. Conclusion. Multivariate statistical analyses of 11 variables demonstrate that length of miniscrew implant is significant in determining success

Study protocol of a phase 2, dual-centre, randomised, controlled trial evaluating the effectiveness of probiotic and egg oral immunotherapy at inducing desensitisation or sustained unresponsiveness (remission) in participants with egg allergy compared with placebo (probiotic egg allergen oral immunotherapy for treatment of egg allergy: PEAT study)

Introduction Egg allergy is the most common food allergy in children but recent studies have shown persistence or delayed resolution into adolescence. As there is currently no effective long-term treatment, definitive treatments that improve quality of life and prevent fatalities for food allergies are required. We have previously shown that a novel treatment comprising a combination of the probiotic Lactobacillus rhamnosus CGMCC 1.3724 with peanut oral immunotherapy (OIT) is highly effective at inducing sustained unresponsiveness, with benefit persisting to 4 years after treatment cessation in the majority of initial treatment responders. In this study, we plan to extend the probiotic food OIT platform to another allergen, namely egg. We describe the protocol for a phase 2, dual-centre, randomised, controlled trial evaluating the effectiveness of probiotic and egg OIT at inducing desensitisation or sustained unresponsiveness (remission) in participants with egg allergy compared with placebo. Methods and analysis 80 participants aged 5-30 years of age with current egg allergy confirmed by double-blind placebo-controlled food challenge at study screening will be recruited from Australia and Singapore. There are two intervention arms - probiotic and egg OIT (active) or placebo. Interventions are administered once daily for 18 months. The primary outcome is the proportion of participants who attain 8-week sustained unresponsiveness in the active group versus placebo group. Ethics and dissemination This study has been approved by the Human Research Ethics Committees at the Royal Children's Hospital (HREC 2019.082) and the National Healthcare Group Domain Specific Review Board (2019/00029). Results will be published in peer-reviewed journals and disseminated via presentations at international conferences. Trial registration number ACTRN12619000480189