Tumor-induced osteomalacia: a case report

Background Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. Case presentation We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. Conclusion Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.

The Texas State Donated Skeletal Collection at the Forensic Anthropology Center at Texas State

The Forensic Anthropology Center at Texas State (FACTS) began accepting whole-body donations for scientific research and educational purposes under the Texas Anatomical Gift Act in 2008. Research conducted with donated whole bodies involves studies in taphonomy and human decomposition, including reconstructing the postmortem interval. Following decomposition, the skeletal elements of all donors are collected, cleaned, and permanently curated into the Texas State Donated Skeletal Collection (TXSTDSC), which is used for teaching and research by faculty and students at Texas State but is also open to external researchers. To date, FACTS has received 710 donors. Fifty-eight percent of donors are male and 42% are female. Donor ages range from 21 weeks’ gestation to 103 years old at the time of death, with a mean of 66 years, and a median of 68 years. Based on self-identified or family-identified ancestry, 90% of donors are White, 4.5% are Hispanic, 3% are Black, less than 2% are of mixed ancestry, and less than 1% are Asian or Native American. Information collected about each donor includes geographic/residential history; occupational history; socioeconomic status; anthropometrics; parity status; alcohol, tobacco, and drug use history; mobility status; an overall health questionnaire; cause and manner of death.

'The Bitter Sweetness of the Space Between': Creative Reflections of Pasifika Ethnic Mixedness

<p>This Master of Arts thesis investigates and draws conclusions regarding how creative arts present accommodating spaces for articulating and understanding cultural mixedness amongst Pacific populations in New Zealand. New Zealand is home to an expanding Pacific population; statistics identify a growing number of these Pacific people who are multi-ethnic, and who are claiming their mixedness in official census data. As Pacific populations have grown, Pacific artists have risen to national prominence in visual, literary and performing arts. Many of these artists have themselves been of mixed ancestry. This thesis examines the work of three female New Zealand artists of mixed Samoan-English or Samoan-Indian descent, asking, “How do these artists and their work express their cultural mixedness?” Discussion centres on mixed media visual artist Niki Hastings-McFall, who is of English and Samoan descent; spoken word poet Grace Taylor, also of English and Samoan descent; and musical performer Aaradhna Patel, who is of Indian and Samoan descent. Placing both the creative work and public commentary of these three artists at its centre, this thesis explores how these artists publicly identify with their Samoan heritage as well as their other heritage(s); how they use their art as a platform for identity articulation; and how creative arts provide flexible and important spaces for self-expression. The thesis draws its theoretical underpinnings from Pacific studies, art history, transnational cultural studies and postcolonial studies, and utilizes Samoan and Tongan conceptions of vā as a key analytic tool.</p>

'The Bitter Sweetness of the Space Between': Creative Reflections of Pasifika Ethnic Mixedness

<p>This Master of Arts thesis investigates and draws conclusions regarding how creative arts present accommodating spaces for articulating and understanding cultural mixedness amongst Pacific populations in New Zealand. New Zealand is home to an expanding Pacific population; statistics identify a growing number of these Pacific people who are multi-ethnic, and who are claiming their mixedness in official census data. As Pacific populations have grown, Pacific artists have risen to national prominence in visual, literary and performing arts. Many of these artists have themselves been of mixed ancestry. This thesis examines the work of three female New Zealand artists of mixed Samoan-English or Samoan-Indian descent, asking, “How do these artists and their work express their cultural mixedness?” Discussion centres on mixed media visual artist Niki Hastings-McFall, who is of English and Samoan descent; spoken word poet Grace Taylor, also of English and Samoan descent; and musical performer Aaradhna Patel, who is of Indian and Samoan descent. Placing both the creative work and public commentary of these three artists at its centre, this thesis explores how these artists publicly identify with their Samoan heritage as well as their other heritage(s); how they use their art as a platform for identity articulation; and how creative arts provide flexible and important spaces for self-expression. The thesis draws its theoretical underpinnings from Pacific studies, art history, transnational cultural studies and postcolonial studies, and utilizes Samoan and Tongan conceptions of vā as a key analytic tool.</p>

A Comparison of Clinical, Electro-Diagnostic, Laboratory, and Treatment Outcome Differences in a Cohort of HIV-Infected and HIV-Uninfected Patients With Myasthenia Gravis

There is limited literature comparing the clinical parameters and treatment outcomes in HIV-infected and HIV-uninfected myasthenia gravis (MG) patients. The aim of the study was to investigate the clinical differences and treatment outcomes in the two categories of patients, particularly the safe use of immunosuppressive therapy in immunocompromised patients. The study was a retrospective analysis of medical records of MG patients from the neuromuscular unit at Inkosi Albert Luthuli Central Hospital in Kwa-Zulu Natal between 2003 and 2019. One hundred and seventy-eight (178) patients fulfilled the clinical criteria for MG. Twenty-four (13.4%) were HIV-infected and 154 (86.5%) were HIV-uninfected. There were 116 (65%) females, median 45 years, (IQR 40–62), 90 (50.5%) black African, 66 (37%) Indian, 20 (11.2%) white, and 2 (1.1%) of mixed ancestry. In the HIV-infected cohort, 20 (87%) had generalized MG, 12 (50%) bulbar, and 14 (60.9%) respiratory onset MG, 12 (50%) presented with MG Foundation of America (MGFA) class five diseases at diagnosis, six (25%) presented with MG crisis during the 5-year follow-up. Thirteen (54%) of the HIV-infected group required rescue therapy using (plasma exchange or IV immunoglobulin) combined with pulse cyclophosphamide compared with 17 (11%) in the HIV-uninfected cohort, respectively. At 5 years, 8 (33%) of the HIV-infected group remained refractory to treatment compared with 10 (6.5%) HIV-uninfected cohort, respectively. No adverse events were documented in HIV-infected patients receiving combination rescue therapy (PLEX or IVIG combined with IV cyclophosphamide). In conclusion HIV-infected MG patients are more likely to require combination rescue therapy with PE/IVIG and IV cyclophosphamide compared with those who were HIV-uninfected. No side effects were documented in the HIV-infected group receiving the above therapy.

HPV vaccination and factors influencing vaccine uptake among people of Indian ancestry living in the United States.

126 Background: Despite HPV vaccine availability, approximately one-third of annual global cervical cancer deaths occur in India. This may be related to cultural norms that lead to vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) who move to the US continue to have disproportionately lower HPV vaccination rates than the rest of the US population and factors that influence HPV vaccine uptake in this group. Methods: The National Health Interview Survey (NHIS) is the largest source of health information for Americans and is designed to be representative of the entire civilian non-institutionalized US population. We utilized the 2018 NHIS to compare HPV vaccine initiation and completion rates between POIA and the general US population and factors correlating with HPV vaccine uptake in this group. Results: There were 17,004 people, representing 185,065,802 in the population, who were between the ages of 18-64 and who responded to questions regarding racial ancestry and HPV vaccination. Of this cohort, 1.69% identified themselves as being of Indian ancestry. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07%, and 12.41%, in White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.003). However, of those who received one HPV shot there was no difference in vaccine series completion between racial groups (3.17% vs. 4.27%, 3.51%, 4.31%, and 5.04% for POIA vs. White, Black, Other Asian, and those of other/mixed ancestry, respectively, p = 0.465). Among POIA, younger individuals and those who were single were more likely to obtain HPV vaccination (vaccination rates of 38.12%, 6.45% and 1.79% for ages 18-25, 26-45, and 46-64, respectively, p = 0.018, and 29.53% vs. 3.11% for single vs. married, respectively, p = 0.006). All individuals who were vaccinated had some form of health insurance (p = 0.020). Those born in the US had a higher rate of vaccination than those who were not (p = 0.019); however, duration of residence in the US did not influence vaccination rates among POIA (p = 0.502). While high levels of English proficiency were associated with a higher vaccination rate (p = 0.029), education status was not correlated (p = 0.231). Interestingly, both male and female POIA had equivalent rates of vaccination (3.12% and 2.81%, respectively, p = 0.949). Conclusions: POIA are significantly less likely to receive HPV vaccination than the general US population but are equally likely to complete the vaccine series if initiated. Age, insurance status, being born in the US, English speaking proficiency, and marital status significantly influence HPV vaccine initiation among POIA. These data suggest that public health measures promoting HPV vaccination among POIA immigrants may significantly improve vaccination rates among this population.

925Ethnic differences and determinants of vitamin D deficiency in the UK Biobank

Background While controversy remains regarding optimal vitamin D status, the public health relevance of true vitamin D deficiency is undisputed. There are few contemporary cross-ethnic studies investigating the prevalence and determinants of very low 25-hydroxyvitamin D [25(OH)D] concentrations. Methods We used data from 440,581 UK Biobank participants, of which 415,903 identified as white European, 7,880 Asian, 7,602 black African, 1,383 Chinese, and 6,473 of mixed ancestry. 25(OH)D concentrations were measured by DiaSorin Liaison XL and deficiency defined as ≤ 25 nmol/L 25(OH)D. Results The prevalence of 25(OH)D deficiency was highest among participants of Asian ancestry (57.2% in winter/spring and 50.8% in summer/autumn; followed by black African [38.47%/30.78%], mixed ancestry [36.53%/22.48%], Chinese [33.12%/20.68%] and white European [17.45%/5.90%], P &lt; 1.0E-300). Participants with higher socioeconomic deprivation were more likely to have 25(OH)D deficiency compared to less deprived (P &lt; 1.0E-300 for all comparisons), with the pattern being more apparent among those of white European ancestry and in summer (Pinteraction&lt;6.4E-5 for both). In fully-adjusted analyses, regular consumption of oily fish was effective in mitigating ≤25 nmol/L 25(OH)D deficiency across all ethnicities, whilst outdoor-summer time was less effective for black Africans than white Europeans (OR: 0.89; 95% CI: 0.70, 1.12 and OR: 0.40; 95% CI: 0.38, 0.42, respectively). Conclusions Vitamin D deficiency remains an issue throughout the UK, particularly in lower socioeconomic areas and the UK Asian population, half of whom have vitamin D deficiency across seasons. Key messages The prevalence of 25(OH)D deficiency in the UK is alarming, with certain ethnic and socioeconomic groups considered particularly vulnerable.

Mixed ancestry analysis of whole-genome sequencing reveals common, rare, and structural variants associated with posterior urethral valves

Posterior urethral valves (PUV) are the commonest cause of end-stage renal disease in children, but the genetic architecture of this disorder remains largely unknown. To address this, we analyzed whole-genome sequencing (WGS) data from 132 unrelated PUV cases and 23,727 controls of mixed ancestry. We observed enrichment of rare structural variation intersecting with candidate cis-regulatory elements, particularly inversions predicted to affect chromatin looping (P=3.1x10-5). We also identified statistically significant associations with common variants at 12q24.21 (P=7.8x10-12; OR 0.4) and uncommon variants at 6p21.1 (P=2x10-8; OR 7.2), that were replicated in an independent European cohort. Bayesian fine mapping and functional annotation mapped these loci to the transcription factor TBX5 and planar cell polarity gene PTK7, respectively, providing insights into the biological pathways underlying PUV. These findings demonstrate that a well-controlled diverse ancestry WGS approach can reveal the genetic architecture of a complex disorder by increasing power for disease locus discovery and facilitating fine-mapping of causal variants.

Dynamics of indigenous identification and performance in the early twentieth century: The life and performances of Chief Caupolican as Mapuche and immigrant (1876–1968)

Chief Caupolican is Emile Barrangon, an early 20th-century performer in the US who was born in Chile to an indigenous Mapuche father and a French mother. Despite his fame, he has not yet been included in studies on indigenous agency in Native American representations, likely because of his immigrant origins. We situate his indigenous self-identification and media success within the broader context of ongoing pan-indigenous activism in the country and Native Americans’ efforts to engage indigenous representations in the media. The pan-indigenous movement that sought to unify indigenous political claims, regardless of tribal affiliation, enabled and encouraged foreign-born aborigines and persons of mixed ancestry to identify with indigeneity in ways that transcend nation-state borders. By presenting and examining his multi-faceted life, performance, and political views, this article contributes to better understanding the complex dynamics of the indigenous performance landscape in the early 20th century.