Dietary Diversity, Food Security, and Body Image among Women and Children on San Cristobal Island, Galapagos

Abstract

Objectives: We conducted a study of the food environment and nutritional status among women and children living on a Galapagos Island. Anthropometric and body silhouette data give insight into body size perceptions for women and their young children. We frame our findings in the context of the nutrition transition. Methods: A convenience sample was recruited via word-of-mouth for in-depth interviews and assessments of household food security, dietary intake, anthropometrics, and body image. Interviews took place in 2011 on San Cristobal Island, one of four inhabited islands in the Galapagos archipelago. Twenty women with children between the ages of one and six participated, all permanent residents of San Cristobal Island. Results: Most women (60%) reported limited availability of fresh produce due to an unreliable food supply shipped from mainland Ecuador. Despite reported food insecurity in our sample (55%), more than half of the children (55%) experienced high dietary diversity measured by 24 h recall. Women tended to report less dietary diversity than their children, which may be linked to a stated desire to be thinner. Eighty percent of children were classified as normal weight, while 75% of women were overweight or obese. Conclusions for Practice: Results provide an initial survey of the food landscape on one Galapagos Island. By combining qualitative interviews with indicators of nutritional status, the narrative data allow an interpretation of issues of food security, dietary intakes, dietary diversity, and body size. This study forms the basis for a larger examination of these issues in the Galapagos islands.

http://bit.ly/2DEk9Xu

Primäre und adjuvante Radio(chemo)therapie bei Kopf-Hals-Tumoren

Zusammenfassung

Hintergrund

Die perkutane definitive bzw. adjuvante Radiotherapie oder Radio(chemo)therapie bildet eine der kurativen Behandlungsoptionen beim Plattenepithelkarzinom der Kopf-Hals-Region.

Ziel

Der Beitrag soll eine Übersicht zu aktuell gültigen Behandlungsansätzen und Ergebnissen der Radio(chemo)therapie im Rahmen der definitiven und postoperativen Therapie sein.

Material und Methoden

Es erfolgte eine Sichtung der aktuellen Leitlinien und Literaturrecherche via PubMed-Datenbank.

Ergebnisse

Plattenepithelkarzinom der Kopf-Hals-Region werden stadienadaptiert behandelt. Frühstadien (cT1–2, cN0–1) mit alleiniger Radiotherapie (RT), lokal fortgeschrittenen Stadien mit Radiochemotherapie (RCT). Intensitätsmodulierte RT (IMRT) führt zu vergleichbaren Ergebnissen bei weniger Nebenwirkungen. Partikeltherapie kann Vorteile haben. Die definitive RCT ist der Goldstandard. Adjuvante RT ist bei ≥pT3, pN+, adjuvante RCT bei positivem Resektionsrand oder extranodulärer Ausbreitung (ENE) indiziert. HPV-positive Oropharynxkarzinome haben die beste Prognose. Klinische Studien zur Deintensivierung und Kombination mit Checkpointinhibitoren laufen.

Schlussfolgerung

Moderne perkutane Radiotherapie ist integraler Bestandteil der Therapie, kann Nebenwirkungen reduzieren und wird stadienabhängig alleine oder in Kombination mit Systemtherapie und/oder Operation angewandt. Die Therapie des HPV-assoziierten Oropharynxkarzinoms und HPV-negativen Kopf-Hals-Tumor unterscheidet sich derzeit nicht. Goldstandard im lokal-fortgeschrittenen Stadium ist die simultane Radiochemotherapie mit Cisplatin.

http://bit.ly/2DBpkr2

A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space

Abstract

Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS–TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET–CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS–TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.

http://bit.ly/2FPe7FG

Complementary and alternative medicine in ADHD treatment: more soundly designed clinical trials needed

http://bit.ly/2FUba6G

Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario

Abstract

Purpose

Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation.

Methods

A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings.

Results

The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately.

Conclusions

Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.

http://bit.ly/2B5J5Wj

Increased 18 F-FDG accumulation in the tonsils after chemotherapy for pediatric lymphoma: a common physiological phenomenon

Abstract

Objective

Increased ¹⁸F-fluorodeoxyglucose (FDG) uptake in the tonsils after the completion of chemotherapy in patients with lymphoma may be misdiagnosed as tumor recurrence. This study aimed to investigate the changes in physiological FDG uptake in the tonsils during and after chemotherapy in pediatric patients with lymphoma.

Methods

A total of 47 FDG-PET/CT scans acquired from 13 pediatric patients with lymphoma (before chemotherapy [preC] = 9; during chemotherapy [durC] = 12; within 1 month after the end of chemotherapy [endC] = 11; and after achieving complete response [postC] = 15) were retrospectively included in this study. FDG uptake in the palatine tonsils was assessed using maximum standardized uptake value (SUV_max). The relative size of the palatine tonsils was calculated as the tonsil-pharyngeal ratio (TPR). Serial changes in the SUV_max and TPR were evaluated.

Results

The mean SUV_max was 3.7 ± 1.7, 2.6 ± 0.7, 2.3 ± 0.8, and 6.2 ± 1.6, at the preC, durC, endC, and postC scans, respectively (p < 0.0001); TPR was 59.0 ± 11.2%, 58.3 ± 9.4%, 54.4 ± 7.9%, and 62.2 ± 12.0% in these groups, respectively, with no significant inter-group differences. TPR and SUV_max showed no correlation.

Conclusions

Increased physiological FDG uptake in the tonsils is commonly observed after the completion of chemotherapy, even in the absence of reactive hypertrophy.

http://bit.ly/2RX9HmV

Myiasis in humans—a global case report evaluation and literature analysis

Abstract

Myiasis refers to the infestation of living humans and vertebrates with fly larvae that feed on necrotic or vital tissue of the host. Since the invasion of new fly species in Europe is currently being observed, which live obligatorily parasitically or are close relatives of such species, the aim of this study is to obtain a global overview of the distribution of myiasis-causing fly species in times of climate change and to assess the possible consequences for Western Europe. A systematic literature search was conducted using Pubmed/Medline for the years 1997 to 2017 and a total of 464 international case reports from 79 countries were evaluated. The described cases were caused by 41 different species. In 99.4% of the cases, it was a colonization by just one species, a maximum of three species were detected in a human. Casuistics from Western Europe mostly describe myiasis as a "holiday souvenir" from tropical regions. Reports of autochthonous cases are rare in comparison to other regions. With regard to rising temperatures and the invasion of new fly species, a noticeable increase in the number of cases in Western Europe is to be assumed, which could be an increasing problem in the clinical area and in care, which is why thorough monitoring for professional identification and treatment seems important in the future.

http://bit.ly/2B9zIET