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Objective: To characterize changes in body composition following cytotoxic chemotherapy for germ cell carcinoma of the testis (GCT) and quantify associations between body composition metrics and chemotherapy-associated adverse events (AEs) and post-retroperitoneal lymph node dissection (RPLND) complications., Materials and Methods: This retrospective multi-center study included 216 men with GCT treated with cytotoxic chemotherapy and/or RPLND (2005-2020). We measured body composition including skeletal muscle (SMI), visceral adipose (VAI,), subcutaneous adipose (SAI), and fat mass (FMI) indices on computed tomography. We quantified chemotherapy-associated changes in body composition and evaluated associations between body composition and incidence of grade 3 + AEs and post-RPLND complications on multivariable logistic regression analyses., Results: One hundred and eighty-two men received a median of 3 cycles of cisplatin-based chemotherapy. Following chemotherapy, median change in SMI was -6% (P = <.0001), while VAI, SAI, and FMI increased by +13% (P = <.0001), +11% (P = <.0001), and +6% (P = <.0001), respectively. Seventy-nine patients (43%) experienced at least one grade 3 + AE. A decrease in SMI following chemotherapy was associated with increased risk of grade 3 + AEs (P = .047). One hundred and 3 men with a median age of 28.5 years (IQR 23-35.5) underwent RPLND of whom 22 (21.3%) experienced at least 1 grade 3 + post-RPLND complication. No baseline body composition metrics were associated with post-RPLND complications., Conclusion: In men with GCT of the testis, chemotherapy was associated with 6% loss of lean muscle mass and gains in adiposity. Lower skeletal muscle was associated with a higher incidence of chemotherapy-associated AEs. Body composition was not associated with the incidence of post-RPLND complications., Competing Interests: Declaration of Competing Interest Sarah Psutka serves on an advisory board for Janssen/Johnson & Johnson, Immunity Bio, CG Oncology, Merck; Research funded by the National Institute on Aging, the Bladder Cancer Advocacy Network; Global PI for SunRISE-4; Janssen; Florian Fintelmann receives research support from Pfizer, serves as a consultant and speaker for Boston Scientific, and has a patent for “patient risk stratification based on body composition derived from computed tomography images sing machine learning” (patent number: WO2019051358A1). The remaining authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Pediatric hearing loss can significantly impact speech, language, social, and educational development. Providing access to speech and environmental sounds using amplification devices, such as hearing aids, can help improve developmental outcomes. However, timely rehabilitation and intervention may be delayed due to limited access to resources, further prolonging the adverse effects of childhood hearing loss. The aim of this study was to investigate socioeconomic barriers in time to dispensing hearing aids in a diverse pediatric patient population., Methods: Data from an existing internal database from a tertiary pediatric hospital were analyzed from January 2020 through August 2022 for barriers associated with hearing aid (HA) dispensing delays. Demographic and clinical characteristics were obtained. Multivariate regression and survival analysis statistics were used to identify factors associated with delayed time to dispensing hearing aids., Results: Of the 121 patients who had been appropriately diagnosed and fit, 108 (89.3%) had received hearings aids and 13 (10.7%) had not at the time of the study. Of those who had received HA, time to dispensing was not significantly impacted by sex, race, ethnicity, language, or income level. Insurance was found to be an influencing factor in time to receiving the HA., Conclusion: Factors such as insurance and hearing loss laterality contribute to delays in receiving hearing aids. Identifying these specific barriers and disparities in hearing rehabilitation services will prove vital in facilitating an expedited and equitable pathway to receiving hearing aids., Level of Evidence: 3 Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background and Objective: There are limited data on the prevalence and management of testicular germ cell tumor (TGCT) cases presenting with venous tumor thrombus (VTT). Our objectives were to describe the prevalence of TGCT with VTT, to identify a multicenter retrospective cohort, and to ascertain expert opinion regarding optimal management of this entity., Methods: Using the IBM Marketscan database, we identified men with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND) with concurrent VTT or inferior vena cava (IVC) tumor thrombectomy to estimate the prevalence of VTT in TGCT. To identify a multicenter retrospective cohort of patients, we surveyed surgeons and described the presentation, management, and outcomes for the cohort., Key Findings and Limitations: The prevalence of TGCT with VTT in the IBM Marketscan database was 0.3% (n = 7/2517) when using stringent criteria and 3.1% (n = 79/2517) when using broad criteria. In response to our survey, 16 surgeons from ten centers contributed data for 34 patients. Most patients (n = 29, 85%) presented with nonseminomatous germ cell tumor. Surgical management was used for 93.9% (n = 31), including postchemotherapy tumor thrombectomy with primary cavorrhaphy in 63%. The Marketscan analysis was limited to insured individuals and did not include clinicopathological details, and use of billing codes may have included patients with stromal tumors. In addition, lack of responses to the anonymous survey limited data capture, and the RedCap survey did not address symptoms specific to IVC obstruction or allow central review of the imaging leading to VTT diagnosis., Conclusions and Clinical Implications: VTT among males with TGCT is rare and requires complex multidisciplinary management, including venous tumor thrombectomy at the time of postchemotherapy RPLND., Patient Summary: Using a medical database, we estimated that the frequency of testicular cancer cases in which the tumor extends into a blood vessel (called venous tumor thrombus, VTT) is just 0.3-3.1%. We carried out a survey of surgeons with experience of this condition. Our results indicate that although testicular cancers respond well to chemotherapy, VTT is less responsive and complex surgery is necessary for this rare condition., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To describe national patterns of National Health Service (NHS) analysis of mismatch repair (MMR) genes in England using individual-level data submitted to the National Disease Registration Service (NDRS) by the NHS regional molecular genetics laboratories., Design: Laboratories submitted individual-level patient data to NDRS against a prescribed data model, including (1) patient identifiers, (2) test episode data, (3) per-gene results and (4) detected sequence variants. Individualised per-laboratory algorithms were designed and applied in NDRS to extract and map the data to the common data model. Laboratory-level MMR activity audit data from the Clinical Molecular Genetics Society/Association of Clinical Genomic Science were used to assess early years' missing data., Results: Individual-level data from patients undergoing NHS MMR germline genetic testing were submitted from all 13 English laboratories performing MMR analyses, comprising in total 16 722 patients (9649 full-gene, 7073 targeted), with the earliest submission from 2000. The NDRS dataset is estimated to comprise >60% of NHS MMR analyses performed since inception of NHS MMR analysis, with complete national data for full-gene analyses for 2016 onwards. Out of 9649 full-gene tests, 2724 had an abnormal result, approximately 70% of which were (likely) pathogenic. Data linkage to the National Cancer Registry demonstrated colorectal cancer was the most frequent cancer type in which full-gene analysis was performed., Conclusion: The NDRS MMR dataset is a unique national pan-laboratory amalgamation of individual-level clinical and genomic patient data with pseudonymised identifiers enabling linkage to other national datasets. This growing resource will enable longitudinal research and can form the basis of a live national genomic disease registry., Competing Interests: Competing interests: TPM has received grants in the last 36 months from Roche, Novartis and Hermitage Medical Group for support in educational materials, from MSD/Merck/AstraZeneca, Novartis, Iheed and RCPI for consultation as a subject matter expert, and has taken part in advisory boards for Roche, UK CGG (unpaid), Breast Cancer Now (unpaid), and Ovacare (unpaid). NH declares stock in GSK and AstraZeneca. FL has sat as an Expert Advisor for the NHSE&I Lynch Syndrome task and finish group. DE is chair of the Medical Research Council Clinical Academic Research partnership funding committee, and recipient of the Assessor Research Council of Norway Centres of Excellence Funding awards. CT has received honoraria for educational activities and advisory boards from AstraZeneca and Roche (all proceeds donated to registered charity 11511580)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background and Aims: Eosinophilic esophagitis (EoE) is an antigen-mediated inflammatory esophageal disease that is commonly treated with high-dose proton-pump inhibitors (PPIs), topical corticosteroids, or food elimination diet (FED) monotherapy. Combination treatment has not been well studied in the management of EoE. We aimed to determine if PPI and FED combination therapy was able to induce histologic remission in patients with EoE refractory to monotherapy., Methods: We conducted a retrospective cohort study identifying patients with EoE that was refractory to PPI monotherapy and FED monotherapy but histologically responsive to PPI and FED combination therapy. We also identified symptom changes through chart review., Results: Out of 405 EoE patients, 12 patients were identified with EoE that was refractory to PPI monotherapy and FED monotherapy but histologically responsive to PPI and FED combination therapy. Out of 12 patients, 11 (91.67%) noted resolution of symptoms while on combination therapy. Comparative analysis of peak eosinophil counts showed that patients achieved a median of 4.5 eos/hpf (interquartile range [IQR], 2-6.5), which was significantly decreased compared to baseline (median, 45; IQR, 35.5-50; Wilcoxon signed-rank test, P < .001), PPI monotherapy (median, 41; IQR, 26-50; Wilcoxon signed-rank test, P < .001), and FED monotherapy (median, 45; IQR, 17-67.5; Wilcoxon signed-rank test, P < .001)., Conclusion: Our work shows that patients with EoE refractory to PPI monotherapy and FED monotherapy can successfully achieve histologic remission and symptom benefit with PPI and FED combination therapy. Therefore, combination therapy should be considered a viable option for patients with EoE who fail treatment with first-line monotherapies., (© 2022 The Authors.)

Hearing healthcare outreach in developing countries is ill defined and inundated with sustainability challenges. One method to facilitate sustainable efforts is by training local personnel on certain aspects of hearing healthcare. The purpose of this descriptive study was to identify the challenges and successes of an audio-technician training program conducted in various regions throughout Guatemala. A collaboration was created between Healing the Children, Centro de Audicion, the University of Washington, and Gallaudet University to create a learning environment for Guatemalan audio-technicians and audiology graduate students. Administration of the audio-technician training component of this program began in 2008 and continues today. Challenges and successes were identified around five themes: (1) audio-technician recruitment and skills upon entering training program; (2) practical and logistical components of clinical training; (3) collaboration and resources for ongoing care; (4) funding for travel, time, and accommodation for personnel involved in training sessions; and (5) cultural differences surrounding our approach to hearing healthcare and training. Approaches to overcome the barriers identified and future directions are discussed., Competing Interests: Conflict of Interest None declared., (© Thieme Medical Publishers.)

Pathogenic variants in the Glycyl-tRNA synthetase gene cause the allelic disorders Charcot-Marie-Tooth disease type 2D and distal hereditary motor neuropathy type V. We describe clinical features in 8 unrelated patients found to have Glycyl-tRNA synthetase variants by Next Generation Sequencing. In addition to upper limb predominant symptoms, other presentations included failure to thrive, feeding difficulties and lower limb dominant symptoms. Variability in the age at testing ranged from 14 months to 59 years. The youngest being symptomatic from 3 months and ventilator-dependent. Sequence variants were reported as pathogenic, p.(Glu125Lys), p.(His472Arg); likely pathogenic, p.(His216Arg), p.(Gly327Arg), p.(Lys510Gln), p.(Met555Val); and of uncertain significance, p.(Arg27Pro). Our case series describes novel Glycyl-tRNA synthetase variants and demonstrates the clinical utility of Next Generation Sequencing testing for patients with hereditary neuropathy. Identification of novel variants by Next Generation Sequencing illustrates that there exists a wide spectrum of clinical features and supports the newer simplified classification of neuropathies.

Background: Bohring-Opitz syndrome (BOS) is a rare genetic disorder characterised by a recognisable craniofacial appearance and a typical 'BOS' posture. BOS is caused by sporadic mutations of ASXL1 . However, several typical patients with BOS have no molecular diagnosis, suggesting clinical and genetic heterogeneity., Objectives: To expand the phenotypical spectrum of autosomal recessive variants of KLHL7 , reported as causing Crisponi syndrome/cold-induced sweating syndrome type 1 (CS/CISS1)-like syndrome., Methods: We performed whole-exome sequencing in two families with a suspected recessive mode of inheritance. We used the Matchmaker Exchange initiative to identify additional patients., Results: Here, we report six patients with microcephaly, facial dysmorphism, including exophthalmos, nevus flammeus of the glabella and joint contractures with a suspected BOS posture in five out of six patients. We identified autosomal recessive truncating mutations in the KLHL7 gene. KLHL7 encodes a BTB-kelch protein implicated in the cell cycle and in protein degradation by the ubiquitin-proteasome pathway. Recently, biallelic mutations in the KLHL7 gene were reported in four families and associated with CS/CISS1, characterised by clinical features overlapping with our patients., Conclusion: We have expanded the clinical spectrum of KLHL7 autosomal recessive variants by describing a syndrome with features overlapping CS/CISS1 and BOS., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: There are many single-gene causes of steroid-resistant nephrotic syndrome (SRNS) and the list continues to grow rapidly. Prompt comprehensive diagnostic testing is key to realising the clinical benefits of a genetic diagnosis. This report describes a bespoke-designed, targeted next-generation sequencing (NGS) diagnostic gene panel assay to detect variants in 37 genes including the ability to identify copy number variants (CNVs)., Methods: This study reports results of 302 patients referred for SRNS diagnostic gene panel analysis. Phenotype and clinical impact data were collected using a standard proforma. Candidate variants detected by NGS were confirmed by Sanger sequencing/Multiplex Ligation-dependent Probe Amplification with subsequent family segregation analysis where possible., Results: Clinical presentation was nephrotic syndrome in 267 patients and suspected Alport syndrome (AS) in 35. NGS panel testing determined a likely genetic cause of disease in 44/220 (20.0%) paediatric and 10/47 (21.3%) adult nephrotic cases, and 17/35 (48.6%) of haematuria/AS patients. Of 71 patients with genetic disease, 32 had novel pathogenic variants without a previous disease association including two with deletions of one or more exons of NPHS1 or NPHS2 ., Conclusion: Gene panel testing provides a genetic diagnosis in a significant number of patients presenting with SRNS or suspected AS. It should be undertaken at an early stage of the care pathway and include the ability to detect CNVs as an emerging mechanism for genes associated with this condition. Use of clinical genetic testing after diagnosis of SRNS has the potential to stratify patients and assist decision-making regarding management., Competing Interests: Competing interests: MAS has external consultancy roles with UCB, Retrophin and Pfizer. All other authors declare no conflicts ofinterest., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Five annual capture-mark-recapture surveys on Jasus edwardsii were used to evaluate the effect of sample size and fishing effort on the precision of estimated survival probability. Datasets of different numbers of individual lobsters (ranging from 200 to 1,000 lobsters) were created by random subsampling from each annual survey. This process of random subsampling was also used to create 12 datasets of different levels of effort based on three levels of the number of traps (15, 30 and 50 traps per day) and four levels of the number of sampling-days (2, 4, 6 and 7 days). The most parsimonious Cormack-Jolly-Seber (CJS) model for estimating survival probability shifted from a constant model towards sex-dependent models with increasing sample size and effort. A sample of 500 lobsters or 50 traps used on four consecutive sampling-days was required for obtaining precise survival estimations for males and females, separately. Reduced sampling effort of 30 traps over four sampling days was sufficient if a survival estimate for both sexes combined was sufficient for management of the fishery.

Background: Inherited peripheral neuropathy (IPN) is a clinically and genetically heterogeneous group of disorders with more than 90 genes associated with the different subtypes. Sequential gene screening is gradually being replaced by next generation sequencing (NGS) applications., Methods: We designed and validated a targeted NGS panel assay including 56 genes associated with known causes of IPN. We report our findings following NGS panel testing of 448 patients with different types of clinically-suspected IPN., Results: Genetic diagnosis was achieved in 137 patients (31%) and involved 195 pathogenic variants in 31 genes. 93 patients had pathogenic variants in genes where a resulting phenotype follows dominant inheritance, 32 in genes where this would follow recessive inheritance, and 12 presented with X-linked disease. Almost half of the diagnosed patients (64) had a pathogenic variant either in genes not previously available for routine diagnostic testing in a UK laboratory (50 patients) or in genes whose primary clinical association was not IPN (14). Seven patients had a pathogenic variant in a gene not hitherto indicated from their phenotype and three patients had more than one pathogenic variant, explaining their complex phenotype and providing information essential for accurate prediction of recurrence risks., Conclusions: Our results demonstrate that targeted gene panel testing is an unbiased approach which overcomes the limitations imposed by limited existing knowledge for rare genes, reveals high heterogeneity, and provides high diagnostic yield. It is therefore a highly efficient and cost effective tool for achieving a genetic diagnosis for IPN.

Without gains in nutritional outcomes, it is unlikely that school feeding programmes (SFP) could improve cognition and academic performance of schoolchildren despite the improvements in school enrolment. We compared the nutrient intake adequacy and Fe and nutritional status of SFP and non-SFP participants in a cross-sectional survey involving 383 schoolchildren (aged 5-13 years). Quantitative 24 h recalls and weighed food records, repeated in 20% subsample, were used to estimate energy and nutrient intakes adjusted for day-to-day variations. The probability of adequacy (PA) was calculated for selected micronutrients and the mean of all PA (MPA) was calculated. The concentrations of Hb, serum ferritin, and soluble transferrin receptor (sTfR) and anthropometric measurements were used to determine Fe and nutritional status. Energy and nutrient intakes and their adequacies were significantly higher among SFP participants (P<0·001). The MPA of micronutrients was significantly higher among SFP participants (0·61 v. 0·18; P<0·001), and the multiple-micronutrient-fortified corn soya blend was a key contributor to micronutrient adequacy. In SFP participants, 6 g/l higher Hb concentrations (P<0·001) and about 10% points lower anaemia prevalence (P=0·06) were observed. The concentration of sTfR was significantly lower among SFP participants (11·2 v. 124 mg/l; P=0·04); however, there was no difference in the prevalence of Fe deficiency and Fe-deficiency anaemia between SFP and non-SFP participants. There was also no significant difference in the prevalence of thinness, underweight and stunting. In conclusion, the present results indicate that school feeding is associated with higher intakes and adequacies of energy and nutrients, but not with the prevalence of Fe and nutritional status indicators. The results also indicate an important role for micronutrient-dense foods in the achievement of micronutrient adequacy within SFP.

Objectives: Universal newborn hearing screening has significantly improved the ability to identify patients with congenital sensorineural hearing loss (SNHL), which results in earlier treatment and better hearing and development outcomes. It is recommended that patients born with SNHL who meet criteria receive cochlear implants (CIs) by a target age of 12 months, however many children are being implanted at an older age. This study aims to describe populations of pre-lingual patients with SNHL that are at risk for delayed implantation and to identify and analyze barriers that cause this delay., Methods: Charts of patients receiving a CI between January 2008 and June 2012 at a tertiary care cochlear implant center were reviewed retrospectively. We looked at patient demographics, age at hearing loss diagnosis, age at implantation, and etiology of hearing loss. Barriers to implantation were identified through surveys completed by team members., Results: Fifty-seven CI recipients were identified of which 42 were in patients with pre-lingual SNHL. SNHL etiology included: cochlear dysplasia (18%), GJB2/GJB6 (17%), acquired (10%) extreme prematurity (9%), and idiopathic (46%). The median age of SNHL diagnosis for pre-lingual patients was 15 months. Compared to private insurance, public insurance status was associated with SNHL diagnosis at a significantly later median age (20.0 vs. 4.0 months, p=0.024), and with a significantly longer median interval from diagnosis to implantation (25.5 vs. 11.0 months, p=0.029). While cochlear implant team members identified delayed insurance approval and medical comorbidities as reasons for delayed implantation, the most significant factor identified was parental, with delayed/missed appointments or reluctance for evaluations or surgery., Conclusion: 52% of patients with pre-lingual SNHL that met criteria for CI were implanted more than 12 months after diagnosis. Having public or no insurance was significantly associated with delayed implantation. Parental barriers were most common factors cited for delays in implantation. Overcoming these delays necessitates appropriate identification of at risk patients and creating a system to educate families and chaperone them through the process., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

This article presents findings of a study which assessed the nutritional knowledge levels of nursing students as nurses are in a better position to serve as nutrition educators and counselors by engaging their clients in discussions that would increase their knowledge about disease prevention and management through nutrition. This was a descriptive cross-sectional study, where a selfadministered questionnaire was completed by 166 undergraduate consenting third (3rd) and final (4th) year nursing students in a public university in Ghana who answered 20 multiple choice general nutrition questions. An average score of 8.95 ± 2.01 corresponding to 44.8%, below average, was obtained by the respondents. It was determined that the nutrition knowledge of 3.6%, 62.7% and 33.7% of the study participants was good, adequate and inadequate respectively. It was found that the differences with respect to the nutrition knowledge levels between the age groups, gender, work experience and educational background of respondents were not statistically significant at p < 0.05. The findings of this study support other reports that nurses need more training in nutrition and therefore have important implications for professionals planning curricula for nursing education at the undergraduate level in the university., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The genus Hansenium is revised and a new diagnosis presented. A neotype is designated for the type species Hansenium hanseni (Müller, 1991), and the genus is restricted to the type species and Hansenium remocarpus Kensley and Schotte, 2002. Machatrium gen. nov. and the following species are described: Machatrium falcensis sp. nov. (type species), Machatrium thungku sp. nov. from Lizard Island, Great Barrier Reef; Machatrium wongat sp. nov. from Madang, Papua New Guinea, Machatrium tropex (Bolstad and Kensley, 1999), comb. nov. also from Madang, Papua New Guinea; a further five species are transferred from Hansenium to Machatrium gen. nov. The remaining species of Hansenium are retained as incertae sedis in their existing combination (11 species), reallocated to other genera (1 species) or regarded as species inquirenda (3 species). The principal differentiating characters of Hansenium, Machatrium gen. nov. and Stene triumn Haswell, 1881, are the pseudorostrum being short and trapezoid or long and anteriorly narrowed, morphology of the male pereopod 1, notably the shape of the propodus inferior margin, presence or absence of a process on the inferodistal margin of the merus and carpus; and the apex of the appendix masculina being acute or blunt, with or without a concavity and with or without terminal setae.

Background: Globally, young adults and college athletes are primary targets of the marketing campaigns of energy drink companies. Consequently, it is reported that young adults and college athletes consume energy drinks frequently. The purpose of this study was to determine the prevalence of energy drink consumption among student-athletes selected from seven public universities in Ghana. The study assessed the energy drink consumption patterns, types usually consumed, frequency of consumption and reasons why athletes consumed energy drinks., Methods: A total number of 180 student-athletes gave their consent to participate in the study and completed a questionnaire which was administered during an inter-university sports competition., Results: Most of the participants (62.2%) reported consuming at least one can of energy drink in a week. A high proportion (53.6%) of the respondents who drink energy drinks indicated that they did so to replenish lost energy after training or a competition. Other reasons given as to why energy drinks were consumed by the study participants included to provide energy and fluids to the body (25.9%), to improve performance (9.8%) and to reduce fatigue (5.4%)., Conclusion: These results suggest the need to plan health education programmes to particularly correct some wrong perceptions that athletes have regarding the benefits of energy drinks and also create awareness among student-athletes about the side effects of excessive intake of energy drinks.

Background: Despite numerous educational programmes to create awareness about iodized salt and iodine deficiency disorders (IDD), a survey conducted in the Western Region of Ghana in 2007 revealed that the goitre rate stood at 18.8%; and 78.1% of households consumed iodized salt, which is below the goal of the IDD programme in Ghana which aimed at 90% household consumption of iodized salt by the end of 2005 and sustaining the gains by 2011. It was therefore, considered timely to investigate the knowledge levels and the extent of utilization of iodized salt among the people living in Bia District, the District with the lowest intake (77.4%) of iodized salt based on findings of the 2007 survey., Methods: This was a descriptive cross-sectional study. It was conducted among a total of 280 household members, mainly in charge of meal preparation, who were interviewed using a structured interview guide. A combination of cluster and simple random sampling techniques was used to select the respondents from all the seven sub- districts in Bia District., Results: The study revealed that 75.6% of households in the district consumed iodized salt (including households described as occasional users of iodized salt), and knowledge of iodized salt was quite high, as 72% of the respondents knew that not every salt contained iodine. In addition, 69.3% indicated that an inadequate intake of iodized salt can lead to the development of goitre. Despite the high awareness level, only 64.6% of respondents indicated that they exclusively used iodized salt for cooking. The main reason given by exclusive users of common salt was that the price of iodized salt is a little higher than that of common salt., Conclusions: Although majority of the respondents are aware of the importance of iodized salt and iodine deficiency disorders, only 64.6% exclusively used iodized salt, suggesting that respondents' high knowledge levels did not necessarily translate into an increase in the number of households who used iodized salt. Existing laws and policies on universal salt iodization and quality assurance of iodized salt from the production stage to the distribution/selling stage should be enforced.

Helicobacter pylori infection of the stomach is associated with gastritis and peptic ulceration and may be causative. A noninvasive test for this organism might be useful in managing some patients with dyspepsia without the need for further investigation. We have evaluated a new commercially available serological test (Helico-G ELISA, Porton Cambridge, UK) for this infection to assess its diagnostic accuracy in a retrospective study of 115 patients with non-ulcer dyspepsia. Sixty-three of these patients (55%) were found to have H. pylori infection and gastritis on histology. A sensitivity of 81% and specificity of 90% were obtained. No significant fall in the antibody titres was found in a subgroup of 15 patients who were selected to complete a course of triple therapy despite significant improvement in their dyspepsia score and confirmed eradication of H. pylori organism in 80% of these patients. We conclude that the test has limited value in aiding clinical decision of managing patients with dyspepsia.