Forest Cover Associated with Improved Child Health and Nutrition: Evidence from the Malawi Demographic and Health Survey and Satellite Data

Healthy forests provide human communities with a host of important ecosystem services, including the provision of food, clean water, fuel, and natural medicines. Yet globally, about 13 million hectares of forests are lost every year, with the biggest losses in Africa and South America. As biodiversity loss and ecosystem degradation due to deforestation continue at unprecedented rates, with concomitant loss of ecosystem services, impacts on human health remain poorly understood. Here, we use data from the 2010 Malawi Demographic and Health Survey, linked with satellite remote sensing data on forest cover, to explore and better understand this relationship. Our analysis finds that forest cover is associated with improved health and nutrition outcomes among children in Malawi. Children living in areas with net forest cover loss between 2000 and 2010 were 19% less likely to have a diverse diet and 29% less likely to consume vitamin A-rich foods than children living in areas with no net change in forest cover. Conversely, children living in communities with higher percentages of forest cover were more likely to consume vitamin A-rich foods and less likely to experience diarrhea. Net gain in forest cover over the 10-year period was associated with a 34% decrease in the odds of children experiencing diarrhea (P5.002). Given that our analysis relied on observational data and that there were potential unknown factors for which we could not account, these preliminary findings demonstrate only associations, not causal relationships, between forest cover and child health and nutrition outcomes. However, the findings raise concerns about the potential short- and long-term impacts of ongoing deforestation and ecosystem degradation on community health in Malawi, and they suggest that preventing forest loss and maintaining the ecosystems services of forests are important factors in improving human health and nutrition outcomes

Forest Conservation: A Potential Nutrition-Sensitive Intervention in Low- and Middle-Income Countries

Rasolofoson, Ricketts, Jacob, Johnson, Pappinen and Fisher. Childhood undernutrition yearly kills 3.1 million children worldwide. For those who survive early life undernutrition, it can cause motor and cognitive development problems that translate into poor educational performance and limited work productivity later in life. It has been suggested that nutrition-specific interventions (e.g., micronutrient supplementation) that directly address the immediate determinants of undernutrition (e.g., nutrient intake) need to be complemented by nutrition-sensitive interventions that more broadly address the underlying determinants of undernutrition (e.g., food insecurity). Here, we argue that forest conservation represents a potentially important but overlooked nutrition-sensitive intervention. Forests can address a number of underlying determinants of undernutrition, including the supply of forest food products, income, habitat for pollinators, women\u27s time allocation, diarrheal disease, and dietary diversity. We examine the effects of forests on stunting—a debilitating outcome of undernutrition—using a database of household surveys and environmental variables across 25 low- and middle-income countries. Our result indicates that exposure to forest significantly reduces child stunting (at least 7.11% points average reduction). The average magnitude of the reduction is at least near the median of the impacts of other known nutrition interventions. Forest conservation interventions typically cover large areas and are often implemented where people are vulnerable, and thus could be used to reach a large number of the world\u27s undernourished communities that may have difficult access to traditional nutrition programs. Forest conservation is therefore a potentially effective nutrition-sensitive intervention. Efforts are needed to integrate specific nutrition goals and actions into forest conservation interventions in order to unleash their potential to deliver nutritional benefits

Xylophagia : a meta-synthesis of the literature

Purpose – The purpose of this paper is to provide an insight into xylophagia, its treatment, intervention options, etiological causes and possible relationship with other diseases. Design/methodology/approach – A systematic search was performed across four scientific databases (i.e. Ovid Medline, Embase via Ovid, PubMed and ProQuest). All of the qualitative studies reporting on xylophagia from the inception of databases until August 2019 have been included. The quality of included studies was assessed through a ten-item checklist given by Kmet et al. (2004). Findings – A total of 18 studies were included, and five primary themes emerged after analysis: precipitation/onset of xylophagia, co-morbid psychiatric or medical illnesses, assessment and investigation modes to confirm diagnosis, outcomes of xylophagia and treatment options comprising medical care, psychological care, counseling and duration of recovery. There were 16 females and 9 males in included studies. The mean ages and standard deviations of males and females were 29.25(12.17) years and 32.81(11.92), respectively. The mean duration and standard deviation of paper pica were 4.80(4.27) years. Research limitations/implications – Despite the limitation that this meta-synthesis is based upon findings from case studies, results show that standardized medication regimens for treating xylophagia are still not available or are unknown. There is a dire need for further research in order to better understand the disorder. The healthcare professionals need to use reciprocal, mutually constituent influence of biological and sociocultural factors in order to screen, diagnose and manage complex psychological problems like xylophagia. Originality/value – The findings advance our understanding of the positive effects of patients and family members undergoing counseling or cognitive behavior therapy in reducing stress and enhancing coping skills thus, avoiding self-damaging behaviors

Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study

<p>Abstract</p> <p>Background</p> <p>Quality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.</p> <p>Methods</p> <p>Responses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics.</p> <p>Results</p> <p>The cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age.</p> <p>Conclusion</p> <p>Cancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.</p

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Multiloculated cystic renal tumors of childhood: Has the final word been spoken

Background: Multicystic renal tumors which include cystic nephroma, cystic partially differentiated nephroblastoma (CPDN) and cystic Wilms tumor has been a diagnostic and therapeutic challenge. Histopathological examination has been the only reliable differentiating method. Management of these tumors is still riddled with controversy as a definitive preoperative differentiation between the three has not been possible. Methods: A retrospective evaluation was performed of the treatment strategies employed with nine cases of multicystic renal tumors treated from 2005 to 2015. Results: The median age at presentation was 12 months with all except one being boys. All except two children underwent primary surgery. The median follow-up was 50 months with six children having long-term survival. One child succumbed to the disease process, one died due to an unrelated cause and another was lost to follow-up. Although there was no ambiguity with cases of cystic nephroma (CN) and cystic Wilms tumor, three of the four cases of CPDN had problems. Conclusion: Primary surgery for multicystic renal tumors is safe and should be seriously considered as it prevents overtreatment in cases of CN and early stage CPDN. Further studies are needed to fully understand the biological behavior of CPDN

Evaluation of shear bond strength with different enamel pretreatments: An in vitro study

Context: Bonding procedures are time consuming and debonding of brackets is a common problem encountered in orthodontics. Aims: The purpose of this in vitro study was to evaluate the shear bond strength (SBS) with different enamel pretreatment (acid etching, air abrasion, and bur abrasion) to enhance the bonding performance. Subjects and Methods: A total of 60 extracted premolars for orthodontic purposes were randomly assigned to three groups based on conditioning method: Group I - conventional etching with 37% phosphoric acid; Group II - air abrasion with 50 μm aluminum oxide; and Group III - bur abrasion with diamond fissure (#330, MANI, Dia-Burs, New Jersey, USA). After storing the specimens for 24 h in distilled water at 37°C, SBS was measured with Universal testing machine (Lloyd Universal testing machine-Model No. L.R 100K, UK). The shear force at a crosshead speed of 1 mm/min was transmitted to brackets. The adhesive remnant index (ARIs) scores were recorded after bracket failure. Statistical Analysis Used: Descriptive statistics, multiple comparisons of the SBS of different groups, were performed by analysis of variance. The Tukey′s test was used to evaluate differences in ARI scores between groups. All statistical evaluations were calculated using the Statistical Package for Social Sciences Windows, release 10.0.0 (SPSS Inc., Chicago, Illinois, USA). Results: The analysis of SBS variance (P < 0.01) and Chi-square test of ARIs scores (P < 0.01) revealed significant differences among three groups tested. The SBS in Group I (mean: 8.822 ± 0.92 MPa) and Group III (mean: 6.015 ± 0.87 MPa) was significantly higher than Group II (mean: 3.824 ± 0.57 MPa). The ARI was used to evaluate the residual adhesive on the enamel after bracket removal. The Tukey′s test was used to evaluate differences in the ARI scores among the groups. Conclusions: The current findings indicate that enamel surface preparation using bur abrasion results in a significant higher than air abrasion; within the limitations of this study recommend bur abrasion as a viable alternative to acid etching

Primary intravascular large B-cell lymphoma of pituitary

A 68-year-old retired nurse, who was a known hypertensive on medication, presented with prolonged fever of 2-month duration without any clinical evidence of infection. On examination she had altered mental status. She also had other nonspecific complaints such as sleep disturbances, loss of weight, etc. On investigation, she was found to have anemia, thrombocytopenia, raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) values. She also had electrolyte imbalance. Radiological evaluation of brain showed mass lesion in the sella turcica, suggestive of pituitary adenoma. Biochemical evaluation showed hypopituitarism. Trans-sphenoidal biopsy was done. Based on histopathological and immunohistochemical findings a diagnosis of intravascular large B-cell lymphoma (IVLBCL) of pituitary was made. Our patient′s condition deteriorated rapidly and she succumbed to her illness before therapy could be initiated. We are reporting this case because of the rare subtype of large B-cell lymphoma presenting at an extremely unusual primary site

Prevalence of human papilloma virus in marginal periodontium and its association with periodontitis: A cross sectional study

Context: Bacterial pathogens in dental plaque are necessary for the development of periodontitis but this etiology alone does not explain all its clinicopathologic features. Researchers have proven the role of certain viruses like herpes virus in periodontal disease which implies that other viral agents like human papilloma virus may also be involved. Aims: This cross-sectional study was conducted to determine the proportion of patients with human papilloma virus (HPV-16) in marginal periodontium by analyzing DNA from the gingival tissue sample and to understand its association with periodontitis. Settings and Design: 102 systemically healthy patients between the age group of 15 and 70 years reporting to the Department of Periodontology who required surgical intervention (flap surgery for patients with periodontitis and crown lengthening for healthy patients) with internal bevel gingivectomy were selected. Materials and Methods: After scaling and root planning, gingival tissue was collected during the respective surgical procedure. DNA was isolated and amplified using specific primers for HPV-16 by polymerase chain reaction (PCR). The amplified products were checked by agarose gel electrophoresis. Results: No HPV DNA was detected in the 102 samples analyzed. Conclusion: Marginal periodontium does not contain HPV in this study population and hence there was no association between HPV and periodontitis

Immunohistochemical Glomerular Expression of Phospholipase A2 Receptor in Primary and Secondary Membranous Nephropathy: A Retrospective Study in an Indian Cohort with Clinicopathological Correlations

Background: Limited published literature exists on the utility and standardization of anti-phospholipase A2 receptor (anti-PLA2R) immunohistochemistry (IHC) for the diagnosis of primary membranous nephropathy (MN). The study aimed to validate anti-PLA2R IHC for the diagnosis of primary MN and clinicopathological correlations in an Indian cohort. Methods: Subjects included patients with primary and secondary MN diagnosed between January 2012 and August 2014 with an adequate renal biopsy and at least 1 year of clinical follow-up. Anti-PLA2R IHC was performed in all cases with miscellaneous renal lesions as controls. Electron microscopy was performed in selected cases. Sensitivity and specificity of anti-PLA2R IHC to identify primary MN was evaluated. Histopathological analyses of primary and secondary MN were done with clinicopathological correlations including serum creatinine, eGFR, chronic kidney disease stage, 24-h urine protein, serum cholesterol, serum albumin, and hypertension at presentation and follow-up, using the Kruskal-Wallis test and Spearman rank correlation. A p value of ≤0.05 was considered statistically significant. Results: In 153 MN patients (99 primary, 54 secondary) and 37 miscellaneous controls, anti-PLA2R IHC differentiated primary from secondary MN with a sensitivity of 70.2% and a specificity of 96.6%. Secondary MN had increased mesangial matrix expansion compared to primary MN (p = 0.001). Severe nephrotic syndrome, impaired renal function, and hypertension were all more common in primary than in secondary MN. Conclusion: Anti-PLA2R IHC is a specific marker to distinguish primary MN from secondary MN