A Systematic Review of Nutritional Lab Correlates with Chemotherapy Induced Peripheral Neuropathy

Chemotherapy induced peripheral neuropathy (CIPN) is a dose-limiting side effect of chemotherapy for which no prevention or cure exists. Cancer and cancer treatments can adversely affect nutritional status. Nutrition may play a role in development of CIPN, yet the relationship between nutrition and CIPN is not well understood. Common laboratory values measuring various aspects of nutrition (hemoglobin/hematocrit, vitamin B12, calcium, and magnesium) may be associated with CIPN. The aim of this systematic review is to evaluate the empirical evidence surrounding the relationship between laboratory measures of nutrition and CIPN among persons with cancer who received neurotoxic chemotherapy drugs. We conducted an extensive review of the literature to identify articles that evaluated relationships between laboratory measures of nutrition and CIPN. A total of eleven articles satisfied the inclusion/exclusion criteria. Participants in the studies had breast or colorectal cancer, lymphoma or multiple myeloma and were receiving a variety of neurotoxic drugs. Hemoglobin/hematocrit, vitamin D, albumin, and magnesium were associated with CIPN. The quality of the studies ranges from fair to good. Evidence suggests that low levels of the above-mentioned tests could be associated with CIPN but additional research is needed.

Diversity of Pyrite-Hosted Solid Inclusions and their Metallogenic Implications—A Case Study from the Myszków Mo–Cu–W Porphyry Deposit (the Kraków–Lubliniec Fault Zone, Poland)

Pyrite from the central part of the Myszków porphyry deposit in Poland was investigated using a combination of reflected and transmitted polarizing microscopy, back-scattered imaging with energy-dispersive X-ray spectroscopy, and Raman micro-spectroscopy. Five generations of pyrite (I–V) found in hydrothermal veins were distinguished, differing in morphology, microtexture, and the types and amounts of solid inclusions. In general, pyrite hosts a diversity of mineral inclusions, including both gangue and ore phases, i.e., chlorite, quartz, monazite, cerianite-(Ce), xenotime, K-feldspars, albite, sericite, barite, magnetite, chalcopyrite, galena, sphalerite, bastnaesite (Ce), bismuthinite, native silver, cassiterite, rutile, anatase, and aikinite-group species. The presence of inclusions is good evidence of various stages of the evolution of the hydrothermal lode system ranging from high- to low-temperature conditions. During the formation of stockworks, some fluctuations in the physicochemical conditions of mineralizing fluids were indicated by the occurrence of cassiterite formed from acidic, reducing solutions, and hematite hosted in xenotime or REE phases found in pyrite, which signal more oxidizing conditions. Periodically, some episodes of boiling in the hydrothermal, porphyry-related system were recorded. They were mainly evidenced by the presence of (1) lattice-bladed calcite found in the close vicinity of pyrite II, (2) irregular grain edges of pyrite I, (3) clustered micropores in pyrite I, and (4) the variety of mineral inclusions hosted in I and II generations of pyrite.

Psychometric Properties of the Oldenburg Burnout Inventory in a Portuguese Sample of Aircraft Maintenance Technicians

From its initial conceptualization as emotional exhaustion, cynicism, and reduced personal efficacy for the help professions, burnout has received increasing attention in modern times, especially after the 2019 WHO’s inclusion of this syndrome in the ICD-11 list. Burnout can be measured using several psychometric instruments that range in dimensionality, number of items, copyrighted, and free use formats. Here, we report the psychometric properties of data gathered with the Oldenburg Burnout Inventory (OLBI) in a sample of Portuguese Aircraft maintenance technicians. As far as we know, this is the first study addressing the burnout syndrome in this occupational group. Data gathered with the OLBI displayed good evidence of validity related to internal structure, to other variables, with good evidence of reliability. We showed that burnout significantly correlated with mental and physical fatigue emphasizing the vital critical role that these variables play with safety in the aviation industry.

Economic inequality in malnutrition: a global systematic review and meta-analysis

ObjectiveTo describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition.MethodsWe conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15–49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses.ResultsFrom 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX −0.15 (95% CI −0.19 to −0.11)) and wasting (−0.03 (95% CI −0.05 to −0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI −0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (−0.02 (95% CI −0.08 to 0.05)) or North America (−0.04 (95% CI −0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)).ConclusionsThere is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed.PROSPERO registration numberCRD42020201572.

When I use a word . . . . No jab, no job? A benefit:harm balance analysis

The current debate about whether individuals should be entitled to work in the healthcare sector if they decline to be vaccinated against SARS-CoV2 has been largely informed by personal opinions and argument by analogy. A benefit:harm balance analysis suggests that while vaccination has a highly favourable benefit:harm balance, the balance in instituting a “no jab, no job” policy is highly uncertain and may be unfavourable. Furthermore, there are practical difficulties and legal uncertainties. The much misunderstood precautionary principle dictates that if the benefit:harm balance of an intervention is unclear and may be unfavourable, the intervention should not be undertaken. Furthermore, the onus is on those who believe that the benefit:harm balance will be favourable to prove that it is so; it is not for the sceptics to prove that it isn’t. In the absence of good evidence in favour, this is an intervention that would be best avoided.

Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale

The gabapentinoids, gabapentin, and pregabalin, target the α2δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric indications, and there is increasing concern about their safety, so it is particularly important to have good evidence to justify this usage. We conducted a systematic review and meta-analysis of the evidence for three of their common psychiatric uses: bipolar disorder, anxiety, and insomnia. Fifty-five double-blind randomised controlled trials (RCTs) and 15 open-label studies were identified. For bipolar disorder, four double-blind RCTs investigating gabapentin, and no double-blind RCTs investigating pregabalin, were identified. A quantitative synthesis could not be performed due to heterogeneity in the study population, design and outcome measures. Across the anxiety spectrum, a consistent but not universal effect in favour of gabapentinoids compared to placebo was seen (standardised mean difference [SMD] ranging between -2.25 and -0.25). Notably, pregabalin (SMD -0.55, 95% CI -0.92 to -0.18) and gabapentin (SMD -0.92, 95% CI -1.32 to -0.52) were more effective than placebo in reducing preoperative anxiety. In insomnia, results were inconclusive. We conclude that there is moderate evidence of the efficacy of gabapentinoids in anxiety states, but minimal evidence in bipolar disorder and insomnia and they should be used for these disorders only with strong justification. This recommendation applies despite the attractive pharmacological and genetic rationale for targeting voltage-gated calcium channels.

The role of Helicobacter pylori in complex human comorbidity

One of the main features of modern medicine is the fact that most somatic diseases lose their mononosological character, acquiring the status of comorbidity. Comorbidity has become a separate research area in various specialties of medicine and is currently being formalized into a system of knowledge about the patterns of combination of diseases. With regard to infectious pathology, the term "comorbidity" is rarely mentioned. In the conventional sense, comorbidity is understood as a combination of two or more diseases in a patient at the same time.In our opinion, the term "comorbidity" can be applied from the standpoint of the simultaneous combination of somatic and infectious diseases, but with a certain addition. In particular, it can be used in relation to somatic pathology with simultaneous combination with both monoinfection and polyetiologic. This is "complex comorbidity", which should be understood as "a complex pathological condition of a person, characterized by a simultaneous or sequential combination of psychosomatic and infectious pathology. It can take place when one or more infectious diseases are combined in combination with psychosomatic nosologies consisting of one or more units. "Over the past decade, a significant number of works have appeared on the role of H. pylori in the etiology and pathogenesis of a large number of somatic diseases. H. pylori plays in the development of many diseases - both associated with the stomach and determining the damage to other organs and systems. The clinical significance of this infection is determined by its leading role in the formation of chronic gastritis, gastric ulcer and duodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. There is good evidence for the association of H. pylori infection with idiopathic iron deficiency anemia and idiopathic thrombocytopenic purpura. The clinical aspects of H. pylori infection are heterogeneous and include a wide range of pathologies, the evidence base for which at both the pathogenetic and clinical levels continues to expand.

Protocol for the RELATE trial: a feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms

Introduction Young people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services. Methods and analysis This protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up. Ethics and dissemination Ethical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries. Trial registration ClinicalTrials.gov, NCT04467320. Registered on 13 July 2020.

Association of Elmiron (pentosanpolysulphate sodium) with pigmented maculopathy: An update for urologists and patients

Introduction: Bladder pain syndrome (BPS) is a difficult disorder to diagnose and manage with a limited number of treatment options that have a good evidence base. Elmiron (pentosanpolysulphate sodium (PPS)) is recognised as a main second-line treatment option in many international guidelines. Recently published retrospective studies suggest that there is an association between Elmiron and pigmented maculopathy, a rare disease associated with visual impairment. Objectives: To review the known literature on Elmiron and pigmented maculopathy and alternative oral pharmacotherapy options for BPS. To promote awareness on this topic and aid urologists in managing Elmiron prescription. Methods: We reviewed the most commonly used oral treatments for BPS, in particular Elmiron, the current evidence to support this association with eye disease and its position in the management pathway of this complex condition. Conclusions: Recent retrospective longitudinal studies have demonstrated an association of Elmiron with pigmented maculopathy. However, as yet the exact nature of this relationship is unknown. Nevertheless, Elmiron remains an important part of the treatment pathway for BPS. We suggest clinicians should fully inform patients of this association, including patients who have been previously comenced on Elmiron. There should be ongoing and continuing reviews of all treatments to review its efficacy in indiviual patients. Level of evidence: Not applicable