Notes

Transition From PCR-Ribotyping to Complete Genome Sequencing Primarily based Inputting involving Clostridioides difficile.
The efficacy of portable monitor (PM) sleep testing in children is not well understood. While most studies have evaluated PM in a lab setting, the utility of PM in the home environment is relatively unknown. We sought to determine whether home PM accurately diagnoses obstructive sleep apnea (OSA) in adolescents and to assess patient satisfaction with home PM sleep testing.

We evaluated adolescents (age 12-18 years) with suspected OSA using a PM device. In addition to in-laboratory PSG, all subjects had PM testing performed twice, once in their home and once concurrent to in-laboratory PSG. PM was compared to PSG using two primary outcomes the apnea hypopnea index (AHI) and oxygen desaturation index (ODI). All subjects were approached for interview to evaluate their experience with PM sleep testing.

Twenty adolescents participated. read more Bland-Altman analysis comparing the AHI and ODI determined by home or in-laboratory PM to in-laboratory PSG, revealed mostly agreement; however, some deviations were observed when either parameter was markedly increased. While PM testing tended to underestimate the AHI, the diagnostic agreement between home PM and PSG was 80% (by the White-Westbrook method). Most preferred PM to PSG and found PM easy to very easy to set up.

In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected OSA. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could help with adolescents receiving sleep apnea therapy more promptly.

Registry ClinicalTrials.gov; Identifier NCT03748771.
Registry ClinicalTrials.gov; Identifier NCT03748771.
The Consensus Sleep Diary (CSD) was developed by experts to promote standardization of sleep diary data across the field, but studies comparing the CSD to other assessments of sleep parameters are scarce. This study compared the CSD with three other methods to assess sleep duration, efficiency and timing.

Participants (N = 80) were community adults (mean age = 32.65 years, 63% female) who completed the time-stamped CSD and used single-channel electroencephalography (EEG) and actigraphy for 7 days at home, then completed a retrospective sleep questionnaire. Total sleep time (TST), sleep efficiency (SE), and sleep midpoint were compared using correlations, Bland-Altman plots and limits of agreement (adjusted for repeated measures).

Correlations between the CSD and all methods on TST were large (rs = .63-.75). Adjusted CSD average TST was 40 minutes greater than EEG and 31 minutes greater than actigraphy. Correlations between CSD, actigraphy, and EEG for SE were small (rs = .18), and correlation with questive/inferred methods. However, sleep timing was rather accurately assessed with the CSD in comparison to objective/inferred measures. Researchers should carefully consider which sleep assessment methods are best aligned with their research question and parameters of interest, as methods do not demonstrate complete agreement.Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune, inflammatory disease. Gastrointestinal (GI) involvement, extensively described in adults, is less characterised in paediatric-onset SLE (pSLE). The aim of the present narrative review was to provide a comprehensive summary and update on GI involvement in pSLE. A literature search on PubMed and EMBASE was conducted to identify original articles, reviews, case series and editorials published in English from 2000 to 31 August 2020. Based on this, we reported the prevalence, pathogenetic mechanisms, clinical issues, diagnostic tools and management of each form of GI involvement in pSLE. Lupus enteritis is the most frequent type of GI involvement in pSLE, followed by intestinal pseudo-obstruction, protein-losing enteropathy, hepatic disease and acute pancreatitis. The most common presenting GI symptoms are non-specific and include abdominal pain, anorexia, nausea, vomiting. In most cases, they are associated with other clinical and laboratory manifestations of SLE. The complications of GI involvement, including perforation and intestinal infarction, can be life-threatening. Laboratory findings and imaging studies can help to rule out non-SLE related causes for GI manifestations and to reveal typical features of the single forms of GI involvement. Early diagnosis and treatment are crucial to improve prognosis and avoid unnecessary surgery. Most SLE GI manifestations respond well to glucocorticoids and immunosuppressants. In conclusion, GI involvement is frequent in pSLE and its diagnosis and management can be a challenge for clinicians. In view of the limited available data, further studies are needed to better explore the prevalence, prognosis and treatment recommendations for GI involvement in pSLE.
To evaluate the performance of two screening tools, respectively Pain Detect Questionnaire (PDQ) and Douleur Neuropathique 4 questions (DN4), and the optimal cut-off point of the sural nerve cross-sectional area (CSA), in identifying the neuropathic pain features suggestive of a small fiber neuropathy (SFN), in patients with fibromyalgia syndrome (FM).

Consecutive adult female FM patients fulfilling the American College of Rheumatology (ACR) 2016 criteria have been enrolled. Patients underwent a clinical assessment and ultrasound examination of the sural nerve CSA. In each patient was established the presence of neuropathic pain features suggestive of the presence of SFN. The performance of PDQ versus DN4 was compared to the clinical judgment of SFN as external criterion analysing the area under the receiver operating characteristic curve (AUCROC). The optimal sural nerve CSA cut-off was established with the ROC curve analysis versus the clinical judgment of SFN.

The study involved 80 patients (mean age 49.5±10.5 years, mean disease duration 5.2±4.9 years, mean revised FIQR score 60.9±19.6). Comparing the AUC-ROCs of the screening tools with clinical judgment of SFN, a better AUC was documented, although not significantly (p=0.715), for DN4 (0.875) compared to PDQ (0.857). A sural nerve CSA of 3 mm2 identifies neuropathic pain features with a sensitivity of 70% and a specificity of 90%.

Screening tools have a good concordance in identifying neuropathic pain features suggestive of SFN in FM patients, although a better performance is provided by DN4. Determining the CSA sural nerve with an ultrasound examination may provide some information about the possible presence of SFN.
Screening tools have a good concordance in identifying neuropathic pain features suggestive of SFN in FM patients, although a better performance is provided by DN4. Determining the CSA sural nerve with an ultrasound examination may provide some information about the possible presence of SFN.
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