Symptoms Of Anorexia Research Articles

Concurrent bluetongue and theileria infections in pattanam sheep flocks and their management

Astudy was undertaken to find out the concurrent mixed bluetongue and theileriosis in Pattanam sheep in the Cauvery delta region of Tamil Nadu. During September to October 2018, a total of 42 sheep (aged 3 months to 5 yrs.) from five flocks exhibiting symptoms of anorexia, oral lesions, lameness and lymph node enlargement was studied. On reverse transcriptase polymerase chain reaction (RT-PCR), the presence of bluetongue virus was confirmed in 2 (4.76%) sheep. Giemsa stained peripheral blood smears showed the presence of Theileria spp. in 8 (19.05%) animals. Besides these, 15 (35.71%) sheep had the concurrent infections of both bluetongue and theileria. Blue tongue virus antibodies could not be detected in all the serum samples by ELISA. The morbidity and mortality rates in flocks ranged from 10.0 to 85.7% and 3.1 to 16.0%, respectively. The mixed infections were predominantly seen in males aged between 7 months to 2 yrs. The positive animals were treated with oxytetracycline (10 mg/kg IV), buparvaquone (2.5 mg/kg IM) and meloxicam (0.5 mg/kg IM) along with supportive treatment. After treatment, 95% of animals recovered while 5% succumbed due to advanced stage of disease. Early diagnosis and screening of animals for concurrent/multiple pathogens and implementation of vector control measures are needed to reduce the losses associatedwith these diseases.

Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis.

Background and Aim: Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. Methods: We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman–Tukey’s transforming random effect model. Results: A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16–0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10–0.27) followed by diarrhea at 15% (95%CI, 0.12–0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the “inpatient-only” studies when compared with studies that included outpatients only and those including both inpatients and outpatients. Conclusions: In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.

Scenario of pathogenesis and socioeconomic burden of human brucellosis in Saudi Arabia.

Brucellosis is considered a prevailing endemic infectious disease in the Kingdom of Saudi Arabia and represents a health problem with socio-economic burden. There are two main Brucella species that cause human brucellosis; Brucella abortus, and Brucella melitensis. The clinical features range from asymptomatic to the acute symptoms of fever, joint pain, muscle pain, headache, nausea/vomiting, anorexia and malaise in addition to the subsequent complications that might occur. The endemicity of brucellosis might be explained due to obstacles in controlling the importation of animals for slaughtering during Hajj periods and for several other predisposing factors. The distribution of the disease is all over the country and the most prevalent part is the south followed by north and then the east and central parts. However, in the complexity of brucellosis control measures, there are several activities which have been implemented to tackle the disease such as mass vaccination of animals, regulating importation of slaughter animals, and improving public awareness. This review provides a detailed description of the status of brucellosis in Saudi Arabia, which includes epidemiology, clinical characteristics, virulence and pathophysiology, and prevention of the disease.

Chronic Manganese Toxicity in Indian Mines-An Historical Account of the Contributions of Dr. T.P. Niyogi.

The mining of manganese ore in India started in the year 1899, in Nagpur district of the Central Provinces. Almost six decades later, in 1957, Dr. T. P. Niyogi examined several young men involved in dry drilling of Manganese ore, who had symptoms of muscular pain, weakness, clumsy movements, asthenia, anorexia, insomnia, and gait difficulties. These patients were also emotionally disturbed and prone to falls and accidents. He concluded that these symptoms were due to chronic manganese toxicity with parkinsonian features and psychiatric manifestations which he published in 1958.[1] This lead to the formation of an Enquiry Committee by the Ministry of Labour and Employment, Government of India which instituted corrective measures in mining of manganese in India. Very few reports of chronic toxicity due to inhalation of manganese have been reported subsequently. This paper highlights the contributions of Dr. T.P. Niyogi who was the Civil Surgeon in Chhindwara, MP during that period.

Metagenomics Study Reveals Changes in Gut Microbiota in Centenarians: A Cohort Study of Hainan Centenarians.

Several studies based on 16SrDNA analysis have revealed certain unique characteristics of gut microbiome in centenarians. We established a prospective cohort of fecal microbiota and conducted the first metagenomics-based study among centenarians. The objective was to explore the dynamic changes of gut microbiota in healthy centenarians and centenarians approaching end of life and to unravel the characteristics of aging-associated microbiome. Seventy-five healthy centenarians residing in three regions of Hainan participated in follow-up surveys and collection of fecal samples at intervals of 3 months. Data pertaining to dietary status, health status scores, cause of disease and death, and fecal specimens were collected for 15 months. Twenty participants died within 20 months during the follow-up period. The median survival time was 8–9 months (range, 1–17) and the mortality rate was 14.7% per year. The health status scores before death were significantly lower than those at 3 months before the end of the follow-up period [median score: 3 (range, 1–5), P < 0.05]. At this time, the participants mainly exhibited symptoms of anorexia and reduced dietary intake and physical activity. Metagenomics sequencing and analysis were carried out to characterize the gut microbiota changes in the centenarians during their transition from healthy status to death. Anosim analysis showed a significant change in gut microbiota from 7 months prior to death (R = 0.10, P = 0.02). All participants were grouped with 7 months before death as cut-off; no significant difference in α diversity was found between the two groups (P = 0.45). Semi-supervised monitoring and log rank sum analysis revealed significant changes in the abundance of ten bacterial species before death; of these, eight species were significantly reduced (Akkermansia muciniphila, Alistipes finegoldii, Alistipes shahii, Bacteroides faecis, Bacteroides intestinalis, Butyrivibrio crossotus, Bacteroides stercoris, and Prevotella stercorea) while two were significantly increased before death (Bifidobacterium longum and Ruminococcus bromii). Compared to centenarians in northern Italy, Hainan centenarians exhibited unique characteristics of gut microbiome. The abundance of ten bacterial species showed significant changes starting from 7 months before death. We speculate that these changes might occur before the clinical symptoms of deterioration in health status.

Are Gastrointestinal Symptoms Specific for Coronavirus 2019 Infection? A Prospective Case-Control Study From the United States

Are Gastrointestinal Symptoms Specific for Coronavirus 2019 Infection? A Prospective Case-Control Study From the United States

SAT-207 Adrenocortical Carcinoma in Untreated Congenital Adrenal Hyperplasia

Background:Congenital adrenal hyperplasia (CAH) is a group of rare inherited autosomal recessive disorders characterized by a deficiency of various enzymes participating in steroid hormone synthesis. It occurs in 1 in 5000 to 1 in 15000 births. The most common (90-95%) cause of CAH is the absence of the enzyme 21-hydroxylase. We are presenting a case of a 34 year old male with untreated congenital adrenal hyperplasia due 21-hydroxylase deficiency and metastatic adrenocortical carcinoma.Case:A 34 year old male with a history of classic congenital adrenal hyperplasia (CAH) untreated since childhood presented with symptoms of right abdominal pain, anorexia and weight loss. His family history was significant for one brother diagnosed with CAH, father with liver and pancreatic cancer and another brother with colon cancer. After 2 weeks of treatment with NSAIDs for the pain, his abdominal pain worsened and patient also reported dyspnea with minimal exertion and dry cough. The patient was admitted to TUMC and his evaluation revealed a large right adrenal mass (17x11cm) with multiple liver and lung lesions suggestive of metastatic cancer. The adrenal mass was needle biopsied and pathology results were diagnostic of adrenal cortical carcinoma.His baseline morning cortisol level was 22.45 mcg/dL, ACTH 13.2 (n=7.2-63.3), androstenedione 291 ng/dL (n=27-152), 17-hydroxy progesterone 10,850 ng/dL (n=27-199), testosterone 140 mg/dL, renin 1.295 ng/ml/h (n=0.167-5.38), aldosterone unable to assay due to interference and LDH 2011 U/L (n=87-241). He failed an overnight 1mg dexamethasone suppression test with cortisol of 20.17 in the morning. During hospitalization, his clinical condition gradually deteriorated with hypotension, altered mental status, acute respiratory failure and acute liver failure with an AST 2787 units/L (n <39), ALT 399 (n=30-65) and ALP 1013 units/L (n=40-120). Oncology decided that the patient was a poor candidate for antineoplastic treatment therefore he was offered hospice care and eventually expired.Discussion:There have been reports of benign and malignant adrenal tumors in patients with CAH. It has been surmised that ACTH is the driver of adrenal tumor transformation in these patients. Our patient with adrenocortical carcinoma presented at a late stage with widespread metastases resulting in death. His elevated cortisol level occurred in association with low normal ACTH and the failed 1mg overnight dexamethasone suppression test are consistent with tumor production of cortisone. Considering that he had untreated CAH since childhood, we assume elevated ACTH levels were present until tumor transformation occurred.

Exploring the Relationship between Obsessive-compulsive Characteristics and Symptoms of Eating Disorders in a Nonclinical Population

Previous research has documented similarities between symptoms of Obsessive-Compulsive Disorder (OCD), Anorexia Nervosa, and Bulimia Nervosa and elevated comorbidity between these conditions in clinical samples, with the relationship between OCD and Anorexia being stronger than between OCD and Bulimia. Researchers adopting a continuum view of psychopathology have also found that individuals with sub-clinical expressions of obsessive-compulsive symptoms resemble their clinical counterparts in several ways. The goal of the current study was to explore whether or not the observed relationship between obsessive-compulsive symptoms and eating disorder symptoms observed in clinical populations would also be observed in a nonclinical population. 264 participants from a college sample completed self-report measures of these symptoms. A positive correlation was found between scores on obsessive-compulsive, anorexia and bulimia instruments, and reflective of their clinical counterparts the relationship between obsessive-compulsive and anorexia symptoms was more significant than the one between obsessive compulsive symptoms and bulimia symptoms. Implications and limitations for research and clinical practice are discussed.

A Meta-Analysis of the Effectiveness of Kanglaite Injection Plus First-Line EGFRTKIs Versus First-Line EGFRTKIs Alone Stage IIIB Lung Adenocarcinoma

Objective: Several systematic reviews for Therapeutic Effect of Kanglaite Injection Plus First-Line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) Versus First-Line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) Alone In Stage IIIB Advanced Lung Adenocarcinoma have recently emerged evidence. However, limited data are available regarding the activity of available EGFR TKIs against uncommon EGFR mutations. This meta-analysis evaluates the efficacy of Kanglaite Injection Plus First-Line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) Versus First-Line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) Alone In Stage IIIB Advanced Lung Adenocarcinoma. So therefore, Lung Adenocarcinoma related diseases have a profound economic impact on health care systems global wide, thus Kanglaite Injection combined with First-Line EGFR –TKIs have been shown to have beneficial effects than treatment with First-Line EGFR Tyrosine Kinase Inhibitors (TKIs) Alone. Methods: We electronically searched the literature of the China National Knowledge Infrastructure (Chinese language, English 2010-2019), Pub Med, Cochrane Central Register of Controlled Trails from database inception, CNKI, web of science Wang Fang, and manually searched Chinese-language oncology journals to identify randomized controlled trials (RCTs) of Kanglaite Injection Plus First Line EGFR-TKIs Versus First Line EGFR- TKIs Alone, regardless of their having been published or not, blinding, duration of treatment, or duration of follow-up. The quality of the included trials was assessed using the method recommended by The Cochrane Collaboration (CC). If heterogeneity existed among subgroups, then overall results (OS) were calculated based on a random-effects model; otherwise, a fixed effects model was used. Results: Electronic database searches yielded 1780 citations with NSCLC. Articles or Records Excluded by screening of the title/abstract level total 510, Records which are not Rcts 430, Study with no EGFR mutation analysis 590, Due to duplicated publication 180. Finally, we identified full text articles retrieved for detailled evaluation 70. The sample size of each trial had calculated by Rev Man 5.3. Pooled analyses performed using both fixed- and random-effects models revealed that compared with First Line of Egfr-Tkis alone, KLT injection plus First Line of Egfr-Tkis improved the response rate (relative risk [RR}, 1.34; 95% CI, 1.19-1.51 and RR, 1.35; 95% CI, 1.2 0-1.51, respectively). KLT injection plus First Line of Egfr-Tkis was associated with improvement in the symptoms of cough, dyspnea, chest pain, fatigue, and anorexia.

Estimation of Population Based Colorectal Cancer Survival Analysis Using Cox Proportional Hazards Model

Colorectal cancer (CRC) is a tumour of the colon and rectum. Most cases of CRC are sporadic; meaning there are no known hereditary (genetic) components, and it develops slowly over several years through adenomatous polyps. Changes in bowel habits, blood in the stool, and anaemia are cardinal symptoms and sings of CRC. In later stages, fatigue, anorexia, weight loss, pain, jaundice, and other signs and symptoms of locally advanced and metastatic disease occur. The aim of this study is to estimate the population based colorectal cancer survival analysis using cox Proportional Hazards model, in order to fits colorectal cancer data in population-based research. This research was a five-year retrospective study on data from a record of colorectal cancer patients that received treatments from 2013 to 2017 in Radiotherapy Department of Usmanu Danfodiyo University Teaching Hospital, Sokoto, being it one of the cancer registries in Nigeria. 9 covariates were selected to fit colorectal cancer data using Cox Regression Models. The 5-year median survival was found to be 121 days. From the results, it was concluded that the predictor variables could significantly predict the survival of colorectal cancer patients using Cox proportional model. Also the results show that the data met Cox Proportional Hazards Assumptions.

Rare presentations of acute appendicitis

Acute appendicitis is the one of the most common emergency conditions that the rural surgeon must deal with. Though the majority of patients present with the typical symptoms of right iliac fossa pain, nausea and anorexia, many patients do present with atypical symptoms and signs. These patients present a challenge to rural surgeons. Acute appendicitis is a great mimic and can present with a variety of symptoms. The eyes don’t see what the mind doesn’t know and it is important to know the various ways in which appendicitis can present and to always keep it as a differential diagnosis while managing a patient with acute abdomen. In this paper we have looked at 4 different presentations of appendicitis. Appendicitis is a great mimic and should always be kept as a differential for acute abdomen.

2388 Peliosis Hepatis Progressing to Acute Liver Failure

INTRODUCTION: Peliosis hepatis is characterized as a vascular condition in which blood-filled cystic cavities are distributed diffusely throughout the liver parenchyma. The condition is rare, with the pathogenesis poorly described in the literature. It is believed that this disease is secondary to an underlying malignancy, immune disorder, infection, or a drug/toxin mediated effect. We present a case of a patient diagnosed with peliosis hepatis complicated by the development of acute liver failure. CASE DESCRIPTION/METHODS: A 71-year-old man with a past medical history of coronary artery disease, hypertension, hyperlipidemia, and prostate cancer treated with radiosurgery was admitted to our hospital with symptoms of fatigue, dysphagia and anorexia. He was in his usual state of health until four weeks prior to admission, when he began experiencing early satiety with poor oral intake, nausea, diarrhea, right upper quadrant abdominal pain, and weight loss. He was evaluated by his primary care provider who prescribed him a five day course of levofloxacin with no resolution of symptoms. Upon admission, labs were notable for leukocytosis and a mild transaminitis. Imaging revealed hepatomegaly with hepatic hemangiomatosis and splenic hemangiomas. A liver MRI was performed which returned consistent with diffuse hepatic peliosis with splenic peliosis. He underwent an intensive hematologic/oncologic, rheumatologic, and infectious workup that was significant for a positive quantiferon TB gold and he was subsequently started on empiric TB therapy. Synthetic liver function continued to worsen consistent with acute liver injury, which progressed to acute liver failure. The patient continued to decline and ultimately passed from multi-organ system failure. DISCUSSION: The majority of patients with peliosis hepatis will present asymptomatically and are found incidentally, while a subset of patients will present with abdominal pain or stigmata of liver disease. A liver biopsy is useful for diagnosis and is used in the context of the clinical picture, laboratory data, and imaging findings. Once the underlying offending etiology is recognized and appropriately treated, symptoms can improve and regression of the hepatic lesions can be seen. Our patient is unique in that his presentation was atypical and rapid, and a true causal etiology was never concretely identified, leading to progression to acute hepatic failure.

Pulmonary Carcinoma Metastasis in a Feline Digit

Background: Primary pulmonary neoplasia is rare in domestic cats, with fewer than 1% of all tumors diagnosed in this species. Primary lung tumors have a high percentage of metastases, observed in up to 75% of cases in cats. The lung-digit syndrome is characterized by primary pulmonary neoplasms with metastases to the extremities of the limbs, mainly distal phalanges, possibly involving several digits and more than one limb. This report describes a case of pulmonary carcinoma metastasis in a cat digit.Case: A 16-year-old neutered female cat was showing increased volume of the fourth digit was examined at the University of Caxias do Sul veterinary clinic. The animal also showed signs of progressive weight loss, apathy and limping on the right thoracic limb. After clinical evaluation, the animal was sent for radiographic examination of the right metacarpal/phalangeal region and the thorax. A radiopaque structure was observed with discreet central regions of radiolucency, measuring approximately 3 cm in height, 3.4 cm in length and 2.4 cm in depth in the left caudal lung, suggesting neoplasia or pulmonary abscess. Digit image revealed osteolysis of the right and middle distal phalanx measuring 2 cm in height, 3 cm in breadth and 1 cm in length. In view of these radiographic changes, we performed fine needle aspiration cytology of the digit and a nodule in the region of the skeletal musculature of the right thoracic limb. Cytological evaluation revealed cells had cilia on their surface (compatible with respiratory epithelium). The cytologic findings of the fine-needle biopsy were suggestive of carcinoma. After stabilization, the digit was amputated. The material was sent to the laboratory of the Federal University of Pelotas for histopathological examination. Histological evaluation of a digital pulmonary carcinoma metastasis was confirmed. In view of the prognosis and clinical evolution of the disease, the caretaker chose euthanasia. Necropsy and histopathological evaluation of the lung and other organs were not authorized.Discussion: According to the literature, primary lung tumors have a high percentage of metastases, observed in up to 75% of cases in felines.The size of the tumor mass is associated with its metastatic potential, and lung tumors smaller than 1 cm in diameter usually do not present metastases.In the present case, the mass in the lung was greater than 1 cm in size and the animal already presented metastasis in the digit and in the skeletal musculature. In addition to the thoracic cavity, sites where metastases from lung tumors may occur include regional lymph nodes, skin, eyes, skeletal muscle, multiple abdominal organs, and digits. Cats with pulmonary carcinoma and digital metastasis have a median survival 67 days after diagnosis, with intervals of 6 to 122 days reported. Most patients are euthanized due to persistent symptoms of lameness, lethargy and anorexia or evolution of respiratory signs, in addition to the short survival time associated with poor quality of life. In the case reported here, euthanasia was performed after 40 days of diagnosis due to the worsening of the animal's clinical condition.The combination of radiographic, cytological and histopathological findings suggested a primary lung tumor with digit metastasis, also known as lung-digit syndrome. For felines with claudication or digital inflammation, the lung-digit syndrome should be included in differential diagnosis, even if the animal does not present clinical signs associated with the respiratory system. Primary pulmonary carcinoma should be considered in any middle-aged to elderly cat with digital disease.

SUN-276 REEMERGING PROBLEM OF TUBERCULOSIS IN CHRONIC KIDNEY DISEASE PATIENTS: VIGILANCE NEEDED

Tuberculosis (TB) is an important public health problem in India. There are limited data on TB among chronic kidney disease (CKD) population from Indian subcontinent. The diagnosis of TB in CKD patients is difficult due to suboptimal performance of screening and diagnostic tests. This study investigates the clinical profile and outcome of TB in CKD patients This was a prospective observational study over a period of 5 years (2013- 2018) with 6 months follow up. The diagnosis of tuberculosis was done on the basis of clinical and laboratory data. The anti-Koch’s treatment (AKT) was started and modified as per renal function. TB was diagnosed in twenty-seven CKD patients. The AKT regime, drug related adverse effects and outcome were noted. Mean age of the patients was 47.4 ±16.2 years. The majority of the patients (74%) were male. Most of the patients (74%) were in CKD stage 5D followed by five patients (18.5%) were having CKD stage 4 and only two patients (7.5%) having CKD stage 3 at the time of diagnosis. The modality of renal replacement therapy was hemodialysis in 25 patients (92.5%) and only two patients (7.5%) were on peritoneal dialysis. Seven patients (25.9%) were already having Diabetes Mellitus at the time of TB diagnosis. Mean duration dialysis at the time of diagnosis of TB was 9.2 ± 10.6 months. Most of the patients (66.6%) had an extrapulmonary involvement. Pleuro-pulmonary (33.3%), lymph node (25.9%), peritoneum (18.5%) followed by genitourinary tract (11.1%) were the common sites for TB. About 7.4% patients had joint TB and one patient (3.7%) had disseminated TB. Predominantly common clinical presentation was: fever/ pyrexia of unknown origin (55.5%), constitutional symptoms of anorexia, night sweats and weight loss (18.5%) and abnormal chest radiograph (22.2%). The diagnosis of TB in 59.3% patients was on the basis of microbiological/histological reports and only on clinical grounds in rest of the 40.7% patients. Fourteen patients (40.7%) had adverse effects related to AKT. Particularly, nine patients (33.3%) had accelerated hypertension related to rifampicin induced enzyme induction of anti-hypertensive and three patients (11.1%) had isoniazide induced cerebellitis which required dose modification, and two (7.4%) had hepatitis. About 70.3% of the patients survived, and 29.6% died. The clinical presentations of TB in CKD patients are mostly nonspecific, leading to delay in diagnosis and treatment, which is a major factor for poor outcome. Extrapulmonary TB is more common in CKD patients, which needs high index of suspicion. The adverse effects of AKT complicate the treatment and needs vigilance from physician’s perspectives.

Prognostic significance of sarcopenia in metastatic esophageal squamous cell carcinoma.

4068 Background: Sarcopenia is defined as low skeletal muscle mass and represents a quantifiable marker of frailty. Disease related symptoms of anorexia, nausea and dysphagia, in addition to reduced physical activity contribute to muscle wasting in metastatic esophageal squamous cell cancer (MESCC) patients. This study set out to evaluate the prognostic utility of sarcopenia and its association with nutritional indices. Methods: MESCC patients (pts) with available abdominal CT imaging, attending Princess Margaret Cancer Centre between 2011 and 2016, were identified from the institutional database. Skeletal muscle index (SMI), normalized by height, was calculated at the third lumbar (L3) vertebra using SliceOMatic software. SMI cutoffs for sarcopenia were 34.4cm2/m2 in females and 45.4cm2/m2 in males based on previously established consensus. Nutritional risk index (NRI) was calculated using weight and albumin with malnutrition defined as &lt; 97.5. Results: Of the 58 pts analyzed, 26 presented with de novo MESCC, median age was 64 (range 48-85), 30 pts were ECOG PS ≤1 and 45% received systemic therapy. 93% of pts experienced weight loss &gt; 5% in the 3 months preceding diagnosis and median BMI was 20.4 (range 16.3-34.9). Twenty-four (41%) pts were sarcopenic (SP) with differences in BMI and NRI (p &lt; 0.05) compared to non-sarcopenic (NSP) pts. Median BMI in SP pts was 18.9 (16.3-25.6), 46% had a BMI &lt; 18.5 and none were obese (BMI ≥ 30). By NRI, 58% of SP pts were malnourished. Males comprised 71% of SP pts (p = 0.03) but no difference from NSP MESCC pts was identified with age, race, ECOG PS or smoking status with univariate analysis. Median overall survival (OS) was 6 months; 4.2 in SP pts and 6.2 in NSP pts. Significant difference was identified with NRI (p = .0.009) but not sarcopenia (p = 0.247) or BMI (p = 0.393). With a multi-variate Cox model for NRI and sarcopenia, including age, sex, race, and ECOG PS, only ECOG PS was a significant predictor of mortality, HR for 2-3 vs 0-1 of 5.4 (2.5-11.9) p &lt; 0.001. Conclusions: Sarcopenia at diagnosis was not associated with OS. NRI was superior to BMI alone with respect to discriminating pt outcomes, however ECOG PS was the only measure significantly associated with survival.

SAT-LB084 Persistent Cushing Disease in a Prepubertal Pediatric Patient after Gross Total Resection: What to Expect

Cushing disease (CD), which is ACTH-dependent hypercortisolism is an exceedingly rare condition in pediatrics. The exact annual incidence is unknown but estimated to be approximately 0.7-2.4 cases per million people, with approximately 10% occurring in children, making the incidence in pediatrics <0.5 per million.(Lodish, et al. 2018; Sharma, et al. 2015) Of the pediatric cases, few are prepubertal. Of the pituitary tumors, microadenomas are most common. Pituitary macroadenomas accounts for 5-10% of all cases Cushing disease. The first line therapy is surgical resection of the adenoma. Remission rates are better with microadenomas (~75%) compared with macroadenomas (~43%).(Nieman et al. 2015) If a surgical resection is not curative, defined by the persistent elevation of morning serum cortisol > 5 μg/dl, then second-line therapies are required. We describe a 9-year-old African American female who initially presented with symptoms of significant weight gain, lower extremity edema and hypertension. Initial random (late-morning) serum cortisol level was 38.3 μg/dl and ACTH 99 pg/ml. Ultrasound of adrenal glands did not show any distinct masses. MRI brain showed 1.9 cm macroadenoma in the sella. She underwent transsphenoidal resection. Histology confirmed an ACTH-secreting tumor without atypical features: Ki67 <3%, P53 negative. Postoperatively, serum cortisol levels remained elevated to as high as 23.1 μg/dl. In the subsequent weeks following surgery, cortisol levels at different times of day demonstrated loss of normal diurnal rhythm. She also developed symptoms of headaches, anorexia and vomiting. Interestingly, repeat MRI brain was performed but did not show any residual tumor despite persistent biochemical CD. Persistent CD is defined as a sustained elevation in post-surgical cortisol levels. It may be secondary to residual tumor hidden within the gland, or invasion into the cavernous sinus or other neighboring spaces.(Nieman et al. 2015) The family should be included in the medical decision making regarding second line therapies given the long-term health related quality of life issues surrounding patients with CD. Second line therapies include repeat transsphenoidal surgery, radiotherapy, medical therapy, or bilateral adrenalectomy.(Nieman et al. 2015) Multiple comorbidities need to be addressed in the treatment of CD, on the one hand with persistent disease, hypertension, hyperglycemia, obesity and on the other hand with curative resection, possible panhypopituitarism and/or adrenal insufficiency. Patients may also suffer from “glucocorticoid withdrawal syndrome” secondary to relative deficiency of cortisol with symptoms of anorexia, nausea and fatigue and may require psychosocial support. (Nieman et al. 2015) Regardless of if the initial therapy was curative or not, patients with CD require long-term monitoring of secondary comorbidity outcomes. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Comprehensive validation of the functional assessment of anorexia/cachexia therapy (FAACT) anorexia/cachexia subscale (A/CS) in lung cancer patients with involuntary weight loss.

Comprehensive (qualitative and quantitative) assessments of the 12-item functional assessment of anorexia/cachexia therapy (FAACT) anorexia/cachexia subscale (A/CS) and relevant subscales were undertaken for use in constructing potential endpoints in clinical trials of non-small cell lung cancer (NSCLC) with involuntary weight loss. Eleven participants (≥ 18years) from six clinical sites with a diagnosis of stage III unresectable or stage IV NSCLC and involuntary weight loss (either ≥ 5% body weight loss within six months prior to screening or screening BMI < 20kg/m2) were interviewed to evaluate the content validity of the A/CS domain. A psychometric evaluation was conducted on the A/CS domain, and symptoms and concerns subscales, using data from previously completed phase III clinical trials (ROMANA1 [N = 474] and ROMANA2 [N = 488]). Anorexia-related symptoms were highly relevant to participants and had important impacts on their lives including energy levels, and physical, social, and psychological functioning. The majority of participants endorsed the A/CS domain items and found them to be easily understood, relevant, and comprehensive. Confirmatory factor analyses established that the A/CS symptoms and concerns subscales provided an acceptable fit as single factor models in ROMANA1 and ROMANA2. Reliability, validity, and responsiveness were established for the 12item A/CS domain, 5item anorexia symptoms subscale, and 4-item anorexia concerns subscale. These scales have good content validity, favorable psychometric properties, and can be used for characterizing the effect of treatment on anorexia symptoms and/or anorexia-related concerns in patients with NSCLC.

The death of Charlotte Brontë from hyperemesis gravidarum and refeeding syndrome: A new perspective

Many theories have been advanced concerning the cause of Charlotte Brontë's death, none of which fully explain all the symptoms she experienced in the course of her final illness. Her death certificate records the cause of death as phthisis (tuberculosis), but there is no evidence, other than circumstantial, to support this diagnosis. A diagnosis of Addison's disease, caused by tuberculosis of the adrenals, has been proposed, but this is unlikely, since it does not fit well with two and a half months of severe anorexia, nausea and vomiting, followed by remission of these symptoms and eventual death. We agree, as suggested by some authors, that the most likely diagnosis was hyperemesis gravidarum, but suggest that this was complicated by the refeeding syndrome consequent on recovery of her appetite after resolution of hyperemesis gravidarum and that this was the cause of her death. These two diagnoses are compatible with the remission in her symptoms of anorexia, nausea and vomiting in the third week of March 1855, followed by further decline and death.

Clinical profile of tuberculosis in patients with chronic kidney disease: A report from an endemic Country.

The objective is to study the clinical profile of tuberculosis (TB) in chronic kidney disease (CKD). This is retrospective study of CKD patients who were diagnosed to have TB over a period of seven years at a tertiary care hospital. TB was diagnosed in 115 patients with an incidence of 4200/100,000. Mean age of the patients was 46.9 ± 16 years. Sixty-two patients (53.9%) were male. Causes of CKD were diabetic nephropathy and hypertension in 11.3% each, chronic glomerulonephritis in 31.3%, chronic tubulointerstitial nephritis in 39.1%, autosomal dominant polycystic kidney disease, and post-renal transplant CKD in 3.5% each. About 68.7% of patients with TB had advanced CKD stage of 4-5D, whereas 31.3% of patients had early CKD stage 1-3. Twenty percent of patients were on dialysis. Three-fourths of the patients had extrapulmonary TB. Pleuropulmonary (41.8%), kidney and urinary tract (20%), and abdomen and lymph node (13% each) were the most common sites for TB. The main clinical presentation of TB was: fever/pyrexia of unknown origin in 24.3%, constitutional symptoms of anorexia, fever, night sweats, and weight loss in 27.8%, abnormal chest radiograph in 31.2%, ascites/peritonitis in 13.9%, pleural effusion in 25.2%, lymphadenopathy in 20%, and sterile pyuria/hematuria/chronic pyelonephritis in 13%. Microbiological and/or histopathological diagnoses were made in 45.2% and in the other 54.8%, diagnosis of TB was made on clinical grounds. Adverse effects of anti-TB drugs were seen in 9.6% of patients. Ninety-three percent completed the treatment and survived. Eight patients (7%), all in CKD stage 5D, died. The incidence of TB was high among CKD stages 4 and 5 and in those receiving dialysis. Extrapulmonary disease such as pleuropulmonary, renal, peritoneal, and lymph node were the common forms of TB.

Blast-Induced Traumatic Brain Injury Triggered by Moderate Intensity Shock Wave Using a Modified Experimental Model of Injury in Mice.

Background:The increasing frequency of explosive injuries has increased interest in blast-induced traumatic brain injury (bTBI). Various shock tube models have been used to study bTBI. Mild-to-moderate explosions are often overlooked because of the slow onset or mildness of the symptoms. However, heavy gas cylinders and large volume chambers in the model may increase the complexity and danger. This study sought to design a modified model to explore the effect of moderate explosion on brain injury in mice.Methods:Pathology scoring system (PSS) was used to distinguish the graded intensity by the modified model. A total of 160 mice were randomly divided into control, sham, and bTBI groups with different time points. The clinical features, imaging features, neurobehavior, and neuropathology were detected after moderate explosion. One-way analysis of variance followed by Fisher's least significant difference posttest or Dunnett's t 3-test was performed for data analyses.Results:PSS of mild, moderate, and severe explosion was 13.4 ± 2.2, 32.6 ± 2.7 (t = 13.92, P < 0.001; vs. mild group), and 56.6 ± 2.8 (t = 31.37, P < 0.001; vs. mild group), respectively. After moderate explosion, mice showed varied symptoms of malaise, anorexia, incontinence, apnea, or seizure. After bTBI, brain edema reached the highest peak at day 3 (82.5% ± 2.1% vs. 73.8% ± 0.6%, t = 7.76, P < 0.001), while the most serious neurological outcomes occurred at day 1 (Y-maze: 8.25 ± 2.36 vs. 20.00 ± 4.55, t = −4.59, P = 0.048; 29.58% ± 2.84% vs. 49.09% ± 11.63%, t = −3.08, P = 0.008; neurologic severity score: 2.50 ± 0.58 vs. 0.00 ± 0.00, t = 8.65, P = 0.016). We also found that apoptotic neurons (52.76% ± 1.99% vs. 1.30% ± 0.11%, t = 57.20, P < 0.001) and gliosis (2.98 ± 0.24 vs. 1.00 ± 0.00, t = 14.42, P = 0.021) in the frontal were significantly higher at day 3 post-bTBI than sham bTBI.Conclusions:We provide a reliable, reproducible bTBI model in mice that can produce a graded explosive waveform similar to the free-field shock wave in a controlled laboratory environment. Moderate explosion can trigger mild-to-moderate blast damage of the brain.