Pediatric thyroid nodules are more likely to develop a malignancy than adults and carry a greater risk for disease recurrence (Gupta et al., 2013) following near total thyroidectomy and adjunctive treatment. In disease management for all patients, consensus guidelines recommend serial measurement of serum thyroglobulin for surveillance after surgery, as it is a generally reliable tumor marker (Cooper et al., 2009). Literature addresses prevalence of interfering antibodies in the adult population (Spencer & Fatemi, 2013). There are virtually no studies available regarding this issue in the pediatric population. We conducted a retrospective review of medical records to assess the prevalence of anti-thyroglobulin antibodies among patients (N = 101) < 18 years old who have sought care from specialists at our center's multidisciplinary thyroid nodule clinic. Our primary endpoints were 1) presence or absence of confounding antibodies at day of diagnosis 2) clearance or persistence of antibodies over the period of the study. Our analysis showed that 31% of patients who met inclusion criteria tested positive for interfering antibodies at cancer diagnosis. Of these patients, 42% of patients achieved clearance an average of 13.5 months following surgery.

The words of Gowers are as true today as they were nearly a century ago. My interest in muscular dystrophy started in 1957 when, as Senior House Officer at Queen Mary's Hospital for Children, Carshalton, Surrey, I first observed a large number of children suffering from this tragic disease. The frustration of helplessly, watching its inevitable course stimulated the present study.After obtaining an initial impression or' the collection from my clinical observations and a review of the hospital records between 1920 and 1950, I started a more systematic enquiry. The present investigation compromises my personal observations on 65 cases ranging in age from 3 to 16 years. Of these, 57 were seen and followed up at Queen Mary's Hospital for Children, and 8 at the Southern Hospital, Dartford, Kent.

Objective: To explore and describe how healthcare non-governmental organizations provide and evaluate programs and services that result in positive and sustainable health outcomes in children and adolescents living in low-and middle-income countries and to better understand the role of nursing within these organizations. Scoping Review: A scoping review informed by the Arksey & O’Malley framework was completed to explore the research on the delivery of pediatric health services by non-governmental organizations in low-and middle-income countries. Qualitative Study: Semi-structured interviews were conducted to share the voices and experiences of stakeholders working in the field of NGO practice to provide clarity, further insight and depth to the results from the scoping review and broaden the understanding of the role of nursing on this topic. Conclusions: Despite variability in practice and a multitude of competing priorities, outcome evaluation is growing within the field of pediatric NGO practice, and progress is being made towards evaluation of broader health outcomes besides unidimensional health indicators or outputs. Nurses can play a significant role in improving pediatric NGO program development and evaluation practices and are well positioned to be global health leaders who can influence policy and practice for the achievement of positive and sustainable health outcomes in children and adolescents in low-and middle-income countries.

Background: Tocopherols are lipid soluble antioxidants that exist as eight structurally different isoforms. The intake of γ-tocopherol is higher than α-tocopherol in the average US diet. The clinical results of the effects of vitamin E as a cancer preventive agent have been inconsistent. All published clinical trials with vitamin E have used α-tocopherol. Recent epidemiological, experimental and molecular studies suggest that γ-tocopherol may be a more potent chemopreventive form of vitamin E compared to the more-studied α-tocopherol. γ-Tocopherol exhibits differences in its ability to detoxify nitrogen dioxide, growth inhibitory effects on selected cancer cell lines, inhibition of neoplastic transformation in embryonic fibroblasts, and inhibition of cyclooxygenase-2 (COX-2) activity in macrophages and epithelial cells. Peroxisome proliferator activator receptor γ (PPARγ) is a promising molecular target for colon cancer prevention. Upregulation of PPARγ activity is anticarcinogenic through its effects on downstream genes that affect cellular proliferation and apoptosis. The thiazolidine class of drugs are powerful PPARγ ligands. Vitamin E has structural similarity to the thiazolidine, troglitazone. In this investigation, we tested the effects of both α and γ tocopherol on the expression of PPARγ mRNA and protein in SW 480 colon cancer cell lines. We also measured the intracellular concentrations of vitamin E in SW 480 colon cancer cell lines. Results: We have discovered that the α and γ isoforms of vitamin E upregulate PPARγ mRNA and protein expression in the SW480 colon cancer cell lines. γ-Tocopherol is a better modulator of PPARγ expression than α-tocopherol at the concentrations tested. Intracellular concentrations increased as the vitamin E concentration added to the media was increased. Further, γ-tocopherol-treated cells have higher intracellular tocopherol concentrations than those treated with the same concentrations of α -tocopherol. Conclusion: Our data suggest that both α and γ tocopherol can upregulate the expression of PPARγ which is considered an important molecular target for colon cancer chemoprevention. We show that the expression of PPARγ mRNA and protein are increased and these effects are more pronounced with γ -tocopherol. γ-Tocopherol's ability to upregulate PPARγ expression and achieve higher intracellular concentrations in the colonic tissue may be relevant to colon cancer prevention. We also show that the intracellular concentrations of γ-tocopherol are several fold higher than α-tocopherol. Further work on other colon cancer cell lines are required to quantitate differences in the ability of these forms of vitamin E to induce apoptosis, suppress cell proliferation and act as PPAR ligands as well as determine their effects in conjunction with other chemopreventive agents. Upregulation of PPARγ by the tocopherols and in particular by γ-tocopherol may have relevance not only to cancer prevention but also to the management of inflammatory and cardiovascular disorders.

No description available.

This chapter reviews the current literature linking vitamin E to prostate cancer with the overall goal of providing a rationale for the design of potential future large-scale clinical chemoprevention studies. Vitamin E is not a single organic compound and refers to at least four tocopherols (alpha, beta, gamma, and delta) and four corresponding tocotrienols. Much of the literature linking vitamin E with cancer does not distinguish between these various isoforms and has primarily focused on alpha-tocopherol which is the primary vitamin E isoform found in plasma from fasting individuals and in most dietary supplements. Considerable evidence now supports the view that the various isoforms of vitamin E (and their chemical derivatives) have distinct biochemical properties and distinct abilities to modulate oxidative stress, signal transduction pathways, and pathophysiological processes important in carcinogenesis (e.g., apoptosis and angiogenesis). This chapter reviews the recent clinical trials as well as the in vitro and in vivo evidence connecting the various isoforms of vitamin E with prostate cancer. Particular emphasis is placed on gamma-tocopherol, the primary dietary isoform of vitamin E. A major conclusion is that some non-alpha-tocopherol forms of vitamin E hold considerable promise for both the chemoprevention and chemotherapy of prostate cancer.

Veterans have a profound degree of vitamin D deficiency that may contribute to adverse health outcomes. Some veterans, especially African Americans at high risk of vitamin D deficiency, may not be receiving appropriate attention. We hypothesized variations in vitamin D status and monitoring across six different VAMCs and that these differences are associated with health care costs. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (Southeastern United States) was performed, yielding a sample of 15,340 veterans. Monitoring of vitamin D, vitamin D levels, and medical costs and services in all categories varied greatly by site. Memphis tested vitamin D levels less often despite the increased minority presence and high levels of deficiency. Vitamin D deficiency and lack of monitoring predicted increased inpatient health care costs at all sites, but did not fully account for site-cost variations in controlled analyses. Vitamin D deficiency remains a significant problem among veterans in the Southeastern United States and is closely linked to increased health care costs. We recommend protocols that recognize site differences and facilitate testing and monitoring of vitamin D levels, especially in high-risk groups of veterans.

No description available.

Methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (P. aeruginosa) infections are frequently associated with hospitalization and increased healthcare costs. Vitamin D deficiency may contribute to increased costs for patients with these infections and there is evidence that vitamin D may have an antimicrobial role. To evaluate the role of vitamin D deficiency in the costs incurred with these infections, we studied the relationship of serum 25(OH)D levels to healthcare costs in veterans in the southeastern United States. Patients with both infections were vitamin D deficient to a similar extent and so were combined for further analysis. Vitamin D deficient patients had higher costs and service utilization than those who were not vitamin D deficient. Those with vitamin D deficiency had higher inpatient costs compared to the non-deficient group, and this difference was across most categories except for the number of inpatient hospitalizations or total number of days as an inpatient. Vitamin D deficiency was not significantly related to outpatient cost or service utilization parameters. We conclude that vitamin D deficiency is intimately linked to adverse healthcare costs in veterans with MRSA and P. aeruginosa infections. Vitamin D status should be assayed in patients with these infections.

Vitamin D deficiency is a global pandemic associated with increased health care costs and could play a role in the pathogenesis and management of inflammatory bowel disease. This study examined vitamin D status in veterans with ulcerative colitis (UC) and Crohn's disease (CD) and assessed its relationship to health care costs and service utilization. Veteran patients (n = 125) with UC or CD and with an available 25-hydroxyvitamin D level were studied. CD patients were more likely to be vitamin D insufficient than the UC group. Despite the higher vitamin D levels among UC patients, they were significantly more likely to utilize laboratory and pharmacy services compared with CD patients, whereas patients with CD had significantly higher radiology and pharmacy costs. Thus, it is likely that disease-specific characteristics rather than vitamin D status determine the costs of health care services in veterans with established inflammatory bowel disease.