Case report: Rare skeletal manifestations in a child with primary hyperparathyroidism

Background: Primary hyperparathyroidism (PHPT) is uncommon among children with an incidence of 1:300,000. This diagnosis is often missed in children in contrast to adults where it is detected at a pre symptomatic stage due to routine blood investigations. Etiology of PHPT can be due to adenoma, hyperplasia or rarely carcinoma. Case presentation: A 12year old Sri Lankan girl presented with progressive difficulty in walking since 1year. On examination she had bilateral genu valgum. Skeletal survey revealed valgus deformity of knee joints, bilateral subluxation of upper femoral epiphysis(SUFE), epiphyseal displacement of bilateral humeri, rugger jersey spine and subperiosteal bone resorptions in lateral aspects of 2nd and 3rd middle phalanges. There were no radiological manifestations of rickets. Metabolic profile revealed hypercalcemia with hypophosphatemia. Intact parathyroid hormone levels were elevated at 790pg/ml. Vitamin D levels were deficient. She had low bone mineral density with Z score of -3.4. Vitamin D supplementation resulted in worsening of hypercalcemia without reduction in PTH levels. Tc 99 Sestamibi uptake scan showed abnormal tracer retention in left inferior pole of thyroid. A large parathyroid gland was removed with histology favoring parathyroid adenoma. Post operatively she developed hypocalcemia. Bilateral osteotomy was done for SUFE and further surgeries for correction of limb deformities planned. Conclusion: PHPT in children is usually diagnosed late when irreversible organ damage has occurred. Children can present with non specific symptoms involving gastrointestinal, musculoskeletal, renal and neurological systems. PHPT can cause disarray in bone and epiphysis in children during pubertal growth spurt. Genu valgum and SUFE are rare skeletal manifestations in PHPT and only 10 cases of genu valgum and 9 cases of SUFE have been reported up to now. So far no cases have been reported on epiphyseal displacement of humeri. Awareness regarding the occurrence of these rare skeletal manifestations especially during puberty is important for early diagnosis to prevent irreversible outcomes

Real-Time Assessment of Health-Care Requirements During the Zika Virus Epidemic in Martinique.

The spread of Zika virus in the Americas has been associated with a surge in Guillain-Barré syndrome (GBS) cases. Given the severity of GBS, territories affected by Zika virus need to plan health-care resources to manage GBS patients. To inform such planning in Martinique, we analyzed Zika virus surveillance and GBS data from Martinique in real time with a modeling framework that captured dynamics of the Zika virus epidemic, the risk of GBS in Zika virus-infected persons, and the clinical management of GBS cases. We compared our estimates with those from the 2013-2014 Zika virus epidemic in French Polynesia. We were able to predict just a few weeks into the epidemic that, due to lower transmission potential and lower probability of developing GBS following infection in Martinique, the total number of GBS cases in Martinique would be substantially lower than suggested by simple extrapolations from French Polynesia. We correctly predicted that 8 intensive-care beds and 7 ventilators would be sufficient to treat GBS cases. This study showcased the contribution of modeling to inform local health-care planning during an outbreak. Timely studies that estimate the proportion of infected persons that seek care are needed to improve the predictive power of such approaches

BEEHOPE: um projeto de conservação das subespécies nativas de abelha da Europa Ocidental (linhagem M) à escala Europeia

O projeto BEEHOPE, com o título original “Honeybee conservation centres in western Europe - an innovative strategy using sustainable beekeeping to reduce honeybee decline”, foi um dos 10 aprovados na área da biodiversidade do 5º concurso transnacional (2013-2014) BiodivErsA/FACCE-JPI (http://www.biodiversa.org/766), subordinado ao tema “Promover sinergias e reduzir o compromisso entre o abastecimento de alimentos, biodiversidade e serviços dos ecossistemas”. A diversidade nativa das populações de abelha melífera (Apis mellifera) da linhagem da Europa ocidental (M) tem vindo a ser crescentemente ameaçada pela introdução massiva de colónias da linhagem da Europa oriental (C, onde se incluem as subespécies A. m. ligustica, A. m. carnica, A. m. macedónica etc.), e também por outros fatores bióticos (Varroa e vírus associados, Nosema etc.) e abióticos (pesticidas, perda e fragmentação de habitat, alterações climáticas etc.). É neste contexto que surge o projeto BEEHOPE, o qual tem por objetivo último contribuir para a conservação da diversidade genética das populações de abelha melífera da linhagem M.info:eu-repo/semantics/publishedVersio

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Trails of History and Nature Developing ecological & cultural materials for an ecotourism network on the Aegean Island of Naxos

The Cycladic Islands of Greece are a world-premier ecotourism destination that is, unfortunately, experiencing the unfettered impacts of mass tourism, and yet could be an ideal site for more sustainable ecotourism. Specifically, the island of Naxos is located within a major global biodiversity hotspot. It offers a beautiful, topographically diverse landscape, numerous endemic species, various cultural and historical resources, and opportunities for hiking ecotourism along ancient trails across the island. Despite these rich resources, hiking tourism and its potential benefits for the local communities still need to be developed on Naxos, mainly because little information is publicly available to entice, inform, and guide visitors. Thus, to increase hiking ecotourism, this project created effective educational materials that not only allow for improved navigation of the trails but also feature the ecological, cultural, and tourism resources along the trail - from characteristic flora and fauna to Byzantine churches to restaurants and lodging along the way. Increased trail use then supports local vendors, allowing for more sustainable land use than livelihoods based on destructive coastal tourism or overgrazing by sheep, both typical on different parts of the island. The ten trail maps, descriptions, and supporting material we produced will be used in an existing mobile device application supported by the Hellenic Society for the Environment and Cultural Heritage and will contribute to producing a guidebook that visitors can purchase for self-guided hikes. This project provides a model for other ecotourism efforts in the Mediterranean and worldwide, where sustainable hiking activities can protect the rich cultural and ecological diversity that they feature while benefiting the people who offer services and goods to visiting hikers.Master of ScienceSchool for Environment and SustainabilityUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/176157/1/Trails of History and Culture Naxos.pd

Correction to Enhanced Catalytic Performance of Indenediide Palladium Pincer Complexes for Cycloisomerization: Efficient Synthesis of Alkylidene Lactams

Correction to Enhanced Catalytic Performance of Indenediide Palladium Pincer Complexes for Cycloisomerization: Efficient Synthesis of Alkylidene Lactam

Few-wall carbon nanotubes covalently functionalized by ferrocene groups for bioelectrochemical devices.

International audienc

Oral health and microbiota status in professional rugby players: A case-control study

International audienceObjective: Elite athletes are prone to develop oral diseases, which could increase the risk for injuries. The aim of this study was to evaluate the oral health and the composition of oral microbiota of elite rugby players compared to the general population. Methods: We set up a case-control study by screening 24 professional rugby players (PRG) and 22 control patients (CG) for dental and gingival examinations and performed a taxonomic analysis and a predicted functional analysis of oral microbiota. Results: The Decay, Missing and Filled (DMF) teeth index (5.54 ± 6.18 versus 2.14 ± 3.01; p=0.01) and the frequency of gingivitis (58,33% versus 13.63%) were significantly increased in PRG compared to CG. PRG were characterized by a dysbiotic oral microbiota (Shannon Index: 3.32 ± 0.62 in PRG versus 3.79 ± 0.68 in CG; p=0.03) with an increase of Streptococcus (58.43 ± 16.84 versus 42.60 ± 17.45; p=0.005), the main genus implicated in caries. Predicted metagenomics of oral microbiota in rugby players was suggestive of a cariogenic metagenome favourable to the development of caries. Conclusions: Our study shows that the oral health of PRG was poorer than the general population. PRG are characterized by a dysbiotic oral microbiota with an increase of the relative abundance of Streptococcus genus, positively correlated to the weight and negatively correlated to the diversity of oral microbiota. Clinical significance: Dental screening should be included in the medical follow-up of professional rugby players as a part of their health management. New strategies such as using probiotics like Lactobacillus could help to control the dysbiosis of oral microbiota