Revisiting the association between candidal infection and carcinoma, particularly oral squamous cell carcinoma

Background: Tobacco and alcohol are risk factors associated with cancer of the upper aerodigestive tract, but increasingly the role of infection and chronic inflammation is recognized as being significant in cancer development. Bacteria, particularly Helicobacter pylori, and viruses such as members of the human papilloma virus family and hepatitis B and C are strongly implicated as etiological factors in certain cancers. There is less evidence for an association between fungi and cancer, although it has been recognized for many years that white patches on the oral mucosa, which are infected with Candida, have a greater likelihood of undergoing malignant transformation than those that are not infected. Objective: This article reviews the association between the development of oral squamous cell carcinoma in potentially malignant oral lesions with chronic candidal infection and describes mechanisms that may be involved in Candida-associated malignant transformation

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

“We Used to go Asking for the Rains”: Local Interpretations of Environmental Changes and Implications for Natural Resource Management in Hwange District, Zimbabwe

In Hwange District, Zimbabwe, people living in the vicinity of the largest protected area of the country are facing rapid climate and environmental changes. Adopting an ethnoecological perspective, we sought to understand the way changes are understood locally in an area where people have interacted with their environment for centuries. In this chapter, we examine local people’s knowledge, expertise, and interpretative diagnoses about the environmental and climate changes they perceive around them. Qualitative fieldwork, including participant observation, semi-structured interviews, and structured free-listing interviews, was carried out over a three-month period in the communal lands of the district. Among changes related to wildlife interactions and landscape transformations, people mainly mobilize knowledge of trees and birds to predict rainfall and explain climate variability (related to seasons, precipitation, and temperatures). The most important findings of this research lie in people’s descriptions of ecological changes and their interpretations and explanations for these changes, which focus on arguments that are cultural (abandonment of ritual practices, access to ancestral sites), demographic (population growth), and political (wildlife management). For example, the disturbances in precipitation patterns are understood as a manifestation of the anger of ancestral spirits. We argue that these interpretive frameworks reflect the strong marginalization of the communities of the district from the national program of community-based natural resource management, CAMPFIRE, and that these discourses allow silenced voices to express themselves about sociopolitical concerns in an authoritarian context

Kuluttajabarometri maakunnittain 2000, 2. neljännes

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