A new integrated assessment framework for climate-smart nutrition security in sub-Saharan Africa : the integrated Future Estimator for Emissions and Diets (iFEED)

Funding statement This work was supported by the Biotechnology and Biological Sciences Research Council through UK Research and Innovation as part of the Global Challenges Research Fund, AFRICAP programme, grant number BB/P027784/1.Peer reviewedPublisher PD

Ectopic ACTH Syndrome Due to MEN-I Associated Metastatic Neuroendocrine Pancreatic Gastrinoma in a 22 Year Old Female without Hyperparathyroidism: Diagnostic and Therapeutic Challenges

Introduction: Ectopic ACTH production due to malignant tumors is a rare cause of Cushing\u27s syndrome (CS). Diagnosis and treatment of such patients can be challenging. Case: 22 year old female with recent onset fatigue, weight gain, polyuria, polydipsia, presented with melena and hypotension. She had cushingoid facies, acne, central obesity, muscle weakness and purple striae. Labs showed: Cortisol 56 µg/dl (5-15), 24 hour UFC \u3e1000 µg/24hr (5-50), Cortisol after 1mg Dexamethasone suppression 54 µg/dl (Learning points: When evaluating patients with suspected ectopic ACTH production, independent review of radiologic imaging should be done to avoid being misled by prior reports. EUS is a superior method for identifying PNET (1). Biochemical confirmation with IPSS helps exclude Cushing\u27s Disease in the setting of a pituitary adenoma. Medical therapy to control hypercortisolism and anticoagulation are necessary to lower morbidity and mortality associated with severe CS (2). Finally, screening for MEN-1 in these patients is recommended, even in the absence of hyperparathyroidism (3)

A 23-Year-Old Female with a Mixed Germ Cell Tumor of the Pituitary Infundibulum: The Challenge of Differentiating Neoplasm from Lymphocytic Infundibuloneurohypophysitis—A Case Report and Literature Review

The pathologic spectrum of diseases that infiltrate the pituitary infundibulum includes a broad variety of clinical entities. There are significant differences in the prevalence of these etiologies depending on the age of presentation. Lymphocytic infundibuloneurohypophysitis (LINH) predominates over other causes of infundibular disease in adults over age 21. Differentiating LINH from other causes of infundibular disease can be difficult because the various etiologies often have similar clinical presentations and radiologic imaging characteristics. We report the first case in an adult of a mixed germ cell tumor comprised of germinoma and embryonal cell carcinoma infiltrating the pituitary infundibulum. In our case, a 23-year-old female was initially misdiagnosed as having LINH. She presented with panhypopituitarism and diabetes insipidus, which is the most common initial presentation in both entities. The two diagnoses are difficult to distinguish based on MRI imaging, CSF findings, and histopathological examination. Our case demonstrates the need for close follow-up of patients with isolated lesions of the pituitary infundibulum and reinforces the need for biopsy of an infundibular lesion when progression of disease is demonstrated. In our case, biopsy with comprehensive immunohistochemical staining was the sole means of making a definitive diagnosis

A 23-Year-Old Female with a Mixed Germ Cell Tumor of the Pituitary Infundibulum: The Challenge of Differentiating Neoplasm from Lymphocytic Infundibuloneurohypophysitis—A Case Report and Literature Review

The pathologic spectrum of diseases that infiltrate the pituitary infundibulum includes a broad variety of clinical entities. There are significant differences in the prevalence of these etiologies depending on the age of presentation. Lymphocytic infundibuloneurohypophysitis (LINH) predominates over other causes of infundibular disease in adults over age 21. Differentiating LINH from other causes of infundibular disease can be difficult because the various etiologies often have similar clinical presentations and radiologic imaging characteristics. We report the first case in an adult of a mixed germ cell tumor comprised of germinoma and embryonal cell carcinoma infiltrating the pituitary infundibulum. In our case, a 23-year-old female was initially misdiagnosed as having LINH. She presented with panhypopituitarism and diabetes insipidus, which is the most common initial presentation in both entities. The two diagnoses are difficult to distinguish based on MRI imaging, CSF findings, and histopathological examination. Our case demonstrates the need for close follow-up of patients with isolated lesions of the pituitary infundibulum and reinforces the need for biopsy of an infundibular lesion when progression of disease is demonstrated. In our case, biopsy with comprehensive immunohistochemical staining was the sole means of making a definitive diagnosis

A new integrated assessment framework for climate-smart nutrition security in sub-Saharan Africa: the integrated Future Estimator for Emissions and Diets (iFEED)

Climate change will put millions more people in Africa at risk of food and nutrition insecurity by 2050. Integrated assessments of food systems tend to be limited by either heavy reliance on models or a lack of information on food and nutrition security. Accordingly, we developed a novel integrated assessment framework that combines models with in-country knowledge and expert academic judgement to explore climate-smart and nutrition-secure food system futures: the integrated Future Estimator for Emissions and Diets (iFEED). Here, we describe iFEED and present its application in Malawi, South Africa, Tanzania and Zambia. The iFEED process begins with a participatory scenario workshop. In-country stakeholders identify two key drivers of food system change, and from these, four possible scenarios are defined. These scenarios provide the underlying narratives of change to the food system. Integrated modeling of climate change, food production and greenhouse gas emissions is then used to explore nutrition security and climate-smart agriculture outcomes for each scenario. Model results are summarized using calibrated statements—quantitative statements of model outcomes and our confidence in them. These include statements about the way in which different trade futures interact with climate change and domestic production in determining nutrition security at the national level. To understand what the model results mean for food systems, the calibrated statements are expanded upon using implication statements. The implications rely on input from a wide range of academic experts—including agro-ecologists and social scientists. A series of workshops are used to incorporate in-country expertise, identifying any gaps in knowledge and summarizing information for country-level recommendations. iFEED stakeholder champions help throughout by providing in-country expertise and disseminating knowledge to policy makers. iFEED has numerous novel aspects that can be used and developed in future work. It provides information to support evidence-based decisions for a climate-smart and nutrition-secure future. In particular, iFEED: (i) employs novel and inclusive reporting of model results and associated in-country food system activities, with comprehensive reporting of uncertainty; (ii) includes climate change mitigation alongside adaptation measures; and (iii) quantifies future population-level nutrition security, as opposed to simply assessing future production and food security implication

A new integrated assessment framework for climate-smart nutrition security in sub-Saharan Africa: the integrated Future Estimator for Emissions and Diets (iFEED)

Climate change will put millions more people in Africa at risk of food and nutrition insecurity by 2050. Integrated assessments of food systems tend to be limited by either heavy reliance on models or a lack of information on food and nutrition security. Accordingly, we developed a novel integrated assessment framework that combines models with in-country knowledge and expert academic judgement to explore climate-smart and nutrition-secure food system futures: the integrated Future Estimator for Emissions and Diets (iFEED). Here, we describe iFEED and present its application in Malawi, South Africa, Tanzania and Zambia. The iFEED process begins with a participatory scenario workshop. In-country stakeholders identify two key drivers of food system change, and from these, four possible scenarios are defined. These scenarios provide the underlying narratives of change to the food system. Integrated modelling of climate change, food production and greenhouse gas emissions is then used to explore nutrition security and climate-smart agriculture outcomes for each scenario. Model results are summarised using calibrated statements - quantitative statements of model outcomes and our confidence in them. These include statements about the way in which different trade futures interact with climate change and domestic production in determining nutrition security at the national level. To understand what the model results mean for food systems, the calibrated statements are expanded upon using implication statements. The implications rely on input from a wide range of academic experts – including agro-ecologists and social scientists. A series of workshops are used to incorporate in-country expertise, identifying any gaps in knowledge and summarising information for country-level recommendations. iFEED stakeholder champions help throughout by providing in-country expertise and disseminating knowledge to policy makers. iFEED has numerous novel aspects that can be used and developed in future work. It provides information to support evidence-based decisions for a climate-smart and nutrition-secure future. In particular, iFEED: i. employs novel and inclusive reporting of model results and associated in-country food system activities, with comprehensive reporting of uncertainty; ii. includes climate change mitigation alongside adaptation measures; and iii. quantifies future population-level nutrition security, as opposed to simply assessing future production and food security implications