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In low-risk febrile neutropenia (LR-FN), the safety of early discontinuation of empiric antibiotics without marrow recovery is not well established. This study aimed to evaluate the safety of procalcitonin (PCT) guided early discontinuation of antibiotics in LR-FN. In this trial, children with LR-FN with an afebrile period of at least 24 h, sterile blood culture, and negative/normalized PCT were randomized at 72 h of starting antibiotics into two groups: intervention arm and standard arm. The antibiotics were stopped in the intervention arm regardless of absolute neutrophil count (ANC), while in the standard arm, antibiotics were continued for at least 7 days or until recovery of ANC (>500/mm3). The primary objective was to determine the treatment failure rates, and the secondary objective was to compare the duration of antibiotics and all-cause mortality between the two arms. A total of 46 children with LR-FN were randomized to either the intervention arm (n = 23) or the standard arm (n = 23). Treatment failure was observed in 2/23 (8.7%) of patients in the intervention arm compared to 1/23 (4.3%) in the standard arm [RR: 2 (95% CI: 0.19–20.6); p = 0.55]. The median duration of antibiotics in the intervention arm and standard arm were 3 days vs 7 days (P= <0.001). There was no mortality in this study. PCT-guided early discontinuation of empirical antibiotics in LR-FN is feasible. There was no significant difference observed in treatment failure between the early discontinuation of antibiotics vs standard therapy. The total duration of antibiotic exposure was significantly lesser in the discontinuation arm. Further, larger multicenter studies are needed to confirm the finding of this study. [ABSTRACT FROM AUTHOR]

The present study explores the efficacy of 12-week yoga+diet-based lifestyle intervention (YBLI) vs dietary intervention (DI) on health-related quality of life (HRQoL) and identifies the predictors of change in HRQoL in Indians with metabolic syndrome (Met S). Data from the historical randomized controlled trial was used including adults (n=260, 20-45 years) with Met S. Four domains of HRQoL were measured at baseline, 2 and 12 weeks using WHOQOLBREF questionnaire. Generalized estimating equation and chi-square test was used to compare 12-week changes in HRQoL domains and proportion of subjects, respectively. Changes in HRQoL were predicted using regression models concerning changes in body mass index (BMI), physical activity, total calorie intake, adiponectin, and superoxide dismutase (SOD) levels. Exploratory mediation analysis was carried out using Baron & Kenny approach. YBLI resulted in a significantly greater increase in the physical domain score of HRQoL than DI. A significantly greater proportion of subjects in YBLI group (71%) showed an increase in physical domain scores compared to DI (51%). A unit change in BMI negatively predicted a unit change in physical, psychological and environmental health. Whereas, a unit change in adiponectin and SOD levels positively predicted a unit change in physical and environmental health. Partial mediation between YBLI intervention and physical HRQoL domain was observed via adiponectin. In conclusion, a 12-week YBLI has a positive and greater effect on HRQoL physical domain score than following DI alone. Changes in BMI, adiponectin, and SOD levels may predict changes in HRQoL domains after lifestyle intervention. [ABSTRACT FROM AUTHOR]

Objective: To identify the best performing prognostic model using admission characteristics to predict mortality at 30 days and functioning outcome at 6-months post-admission in patients with moderate or severe brain injury. Methods: Using a retrospective database (n = 1466 patients) of a tertiary trauma care centre, three different models were developed using logistic regression methods for predicting mortality and functioning outcome. The performance of the models was assessed in terms of discrimination and calibration. The models were validated using split sample method. For facilitating clinical usefulness, score charts were derived from the regression models. Results: The variables motor score, hypotension, pupillary reactivity, age, creatinine level, limb movement (hemiparesis), and tSAH/IVH were found to be the most predictive independent prognostic factors of both mortality and functioning outcome. For both the outcomes, discriminative ability of the three prognostic models was excellent in the development dataset (AUC = 0.845–-0.905) as well as the validation data set (AUC = 0.836–0.880). Calibration in the validation data set for model-2 was good (H-L test p-value > 0.05); however, for model-1 and model-3, it was poor (H-L test p-value < 0.05). Conclusion: For clinical decision-making, model-2 is recommended on the basis of good performance in predicting outcomes in patients with moderate or severe TBI in India and other similar countries. [ABSTRACT FROM AUTHOR]

Metabolic syndrome, a prediabetic and precardiovascular pathologic condition that begins early in life, tracks into adulthood and magnifies with age. Randomized controlled trials evaluating efficacy of yoga-based lifestyle vs. dietary intervention on metabolic syndrome are lacking. Here, the efficacy of a 12-week yoga-based lifestyle intervention vs. dietary intervention on cardio-metabolic risk factors and metabolic syndrome risk scores have been assessed in Indian adults with metabolic syndrome. In this two-arm, open label, parallel group, randomized controlled trial, 260 adults (20–45 years) diagnosed with metabolic syndrome as per joint interim statement, 2009 were randomized to yoga-based (including diet) lifestyle or dietary intervention alone (n = 130, each) for 12 weeks. Primary endpoints were the 12-week changes in cardio-metabolic risk factors and metabolic risk scores. The secondary endpoints were the 12-week changes in the proportion of subjects recovered from metabolic syndrome, dietary intake, and physical activity. Intent-to-treat analysis was performed including all the subjects with baseline data with imputed missing data. Treatment × time interaction showed yoga-based lifestyle intervention had a greater treatment effect over dietary intervention by significantly reducing waist circumference, continuous metabolic syndrome z-score, and dietary intake/day while significantly increasing physical activity. High-density lipoprotein cholesterol showed a significantly greater reduction following dietary intervention than yoga-based lifestyle intervention. A significantly greater proportion of subjects recovered from metabolic syndrome in yoga-based lifestyle (45.4%) vs. dietary intervention group (32.3%). A 12-week yoga-based lifestyle intervention is more efficacious than usual dietary intervention in improving cardio-metabolic risk factor and metabolic risk score in Indian adults with metabolic syndrome. [ABSTRACT FROM AUTHOR]

The article discusses a study about an introduction of imatinib in patients with chronic myeloid leukemia (CML) which has led to an improvement in their overall survival. It states that differential expression of miRNA or microRNA levels has emerged as potential prognostic biomarkers like miR-505-5p and miR-193b-3p in cancer. It states that these biomarkers have the potential to serve in the assessment of the imatinib therapy response in newly diagnosed CML patients.