Serogroup W predominated among persons 45 years of age or older with 110/187 (59%) cases. Serogroup B isolates comprised 11 different clonal complexes, with 103/122 (84%) isolates belonging to 4 clonal complexes cc32, cc41/44, cc269 and cc213. In contrast, serogroup W isolates were genetically similar with 95% belonging to cc11. Of 122 serogroup B isolates, 89 (73%; 95% CI 64-80%) were estimated to be covered by 4CMenB and the degree of coverage varied largely by clonal complex and age. Among the 0-4 year olds, 25 of 43 (58%; 95% CI 43-72%) MenB isolates were estimated to be covered. Since the coverage of the 4CMenB vaccine is dependent on circulating clonal complexes, our findings emphasize the need for surveillance of circulating meningococcal strains. In addition, estimation of age specific coverage is relevant to determine the right target age group for vaccination.
  Epidermal growth factor receptor (EGFR) inhibitors are targeted therapies that frequently induce skin eruptions such as acneiform rash. Due to their increasing use in oncology as well as the expanding number of exposed patients, new adverse events may emerge.
 
  A 54-year-old female patient treated with erlotinib for 8 months for pulmonary adenocarcinoma presented inflammatory alopecia that had been ongoing for 1 month. Her condition did not improve with doxycycline 100mg/day. Diffuse erythema of the scalp was associated with painful keratotic plaques and several oozing lesions. A skin biopsy showed signs of acute suppurative and destructive folliculitis. Histology and dermatoscopy were consistent with a diagnosis of folliculitis decalvans. Marked improvement was observed after discontinuation of erlotinib followed by introduction of amoxicillin+clavulanic acid and application of a topical corticosteroid. Unfortunately, the lesions recurred after reintroduction of the anti-EGFR, despite a dosage reduction, requiring up-titration of doxycycline to 200mg/day.
 
  Scarring alopecia with a folliculitis decalvans-like presentation secondary to anti-EGFR is a rare adverse event. The exact pathophysiology remains poorly understood. Treatment is difficult, and while systemic antibiotics are effective, they must be maintained for a long duration in order to avoid recurrence. Early recognition is important to limit the development of scarring alopecia due to the difficulties of stopping treatment in advanced-stage carcinoma.
 Scarring alopecia with a folliculitis decalvans-like presentation secondary to anti-EGFR is a rare adverse event. The exact pathophysiology remains poorly understood. Treatment is difficult, and while systemic antibiotics are effective, they must be maintained for a long duration in order to avoid recurrence. Early recognition is important to limit the development of scarring alopecia due to the difficulties of stopping treatment in advanced-stage carcinoma.Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed.There are reports of children COVID-19 or COVID-19 like symptoms with hyperinflammatory multisystem syndrome, ARDS, gastrointestinal and atypical Kawasaki disease presenting to PICU worldwide temporally associated with COVID-19, for which there are important nutrition support considerations. As a result, the European Society of Pediatric and Neonatal Intensive Care - Metabolism, Endocrine and Nutrition group (ESPNIC-MEN) and paediatric nutritionists working in PICUs are being consulted regarding nutrition management of critically ill children with COVID-19 or COVID-19 like symptoms. Therefore, the aim of this short report is to provide a summary of nutrition support recommendations for critically ill children with COVID-19. They are based on the ESPNIC-MEN section recommendations published in January 2020 and surviving sepsis recommendations from February 2020.
  Severe Acute Malnutrition (SAM) in children is determined using anthropometry. However, bio-electrical impedance (BI) analysis could improve the estimation of altered body composition linked to edema and/or loss of lean body mass in children with SAM. We aimed to assess 1) the changes in BI parameters during clinical stabilization and 2) whether BI parameters add prognostic value for clinical outcome beyond the use of anthropometry.
 
  This prospective observational study enrolled children, aged 6-60 months, that were admitted at Queen Elizabeth Central Hospital in Blantyre, Malawi, for complicated SAM (i.e., having either severe wasting or edematous SAM with a complicating illness). Height, weight, mid-upper arm circumference (MUAC), and BI were measured on admission and after clinical stabilization. BI measures were derived from height-adjusted indices of resistance (R/H), reactance (Xc/H), and phase angle (PA) and considered to reflect body fluids and soft tissue in BI vector analysis (BIVA).
 
  We studiedo-discharge or time-to-mortality. The variability and heterogeneity in BI measures was high and their overall added predictive value for prognosis of individual children was low.
 
  BIVA did not add prognostic value over using anthropometry alone to predict clinical outcome. Several implementation challenges need to be optimized. Thus, in low-resource settings, the routine use of BI in the management of pediatric malnutrition is questionable without improved implementation.
 BIVA did not add prognostic value over using anthropometry alone to predict clinical outcome.  https://www.selleckchem.com/products/su5402.html  Several implementation challenges need to be optimized. Thus, in low-resource settings, the routine use of BI in the management of pediatric malnutrition is questionable without improved implementation.