The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia

Mild iodine deficiency during pregnancy can have significant effects on fetal development and future cognitive function. The purpose of this study was to characterise the iodine status of South Australian women during pregnancy and relate it to the use of iodine-containing multivitamins. The impact of fortification of bread with iodized salt was also assessed. Women (n = 196) were recruited prospectively at the beginning of pregnancy and urine collected at 12, 18, 30, 36 weeks gestation and 6 months postpartum. The use of a multivitamin supplement was recorded at each visit. Spot urinary iodine concentrations (UIC) were assessed. Median UICs were within the mildly deficient range in women not taking supplements (<90 μg/L). Among the women taking iodine-containing multivitamins UICs were within WHO recommendations (150–249 μg/L) for sufficiency and showed an increasing trend through gestation. The fortification of bread with iodized salt increased the median UIC from 68 μg/L to 84 μg/L (p = .011) which was still in the deficient range. Pregnant women in this region of Australia were unlikely to reach recommended iodine levels without an iodine supplement, even after the mandatory iodine supplementation of bread was instituted in October 2009.Vicki L Clifton, Nicolette A Hodyl, Paul A Fogarty, David J Torpy, Rachel Roberts, Ted Nettelbeck, Gary Ma and Basil Hetze

Robot-assisted gastrectomy and oesophagectomy for cancer

Background: Robot-assisted surgery is a technically feasible alternative to open and laparoscopic surgery, which is being more frequently used in general surgery. We undertook this review to investigate whether robotic assistance provides a significant benefit for oesophagogastric cancer surgery. Methods: Electronic databases were searched for original English-language publications for robotic-assisted gastrectomy and oesophagectomy between January 1990 and October 2013. Results: Sixty-one publications were included. Thirty-five included gastrectomy, 31 included oesophagectomy and five included both operations. Several publications suggest that robot-assisted subtotal gastrectomy can be as safe and effective as an open or laparoscopic procedure, with equal outcomes with regard to the number of lymph nodes resected, overall morbidity and perioperative mortality, and length of hospital stay. Robotic assistance is associated with longer operation times but also with less blood loss in some reports. A significant benefit for robotic assistance has not been shown for the more extensive operations of oesophagectomy or total gastrectomy with D2-lymphadenectomy. There are very few oncologic data regarding local recurrence or long-term survival for any of the robotic operations. Conclusions: No significant differences in morbidity, mortality or number of lymph node harvested have been shown between robot-assisted and laparoscopic gastrectomy or oesophagectomy. Robotic surgery, with its relatively short learning curve, may facilitate reproducible minimally invasive surgery in this field but operation times are reportedly longer and cost differences remain unclear. Randomized trials with oncologic outcomes and cost comparisons are needed

Fatty acid profile of pregnant women with asthma

Background & aims: One of the most prevalent complications of pregnancy is asthma which is associated with an increased incidence of intrauterine growth restriction. The mechanisms that affect fetal development in pregnancies complicated by asthma are not clearly defined. Dietary fatty acids (FA) especially polyunsaturated fatty acids (PUFA) are particularly important during pregnancy due to their role in fetal growth and development. Dietary PUFAs also have a role in clinical outcomes for non-pregnant asthmatics. The current study was designed to characterize the fatty acid profile in pregnant women with asthma to determine whether asthma severity or reduced fetal growth were associated with an altered FA profile.: Methods: Maternal dietary intake and plasma fatty acid profile were examined in women with and without asthma at 18, 30 and 36 weeks gestation. Maternal fatty acids levels were related to measures of fetal growth using Doppler ultrasound and birth outcomes.: Results: The data found that pregnant women with moderate/severe asthma had increased circulating plasma fatty acid levels at 36 weeks gestation but reduced dietary intake of fats compared to those women with mild asthma and healthy pregnant controls. In addition, women with moderate/severe asthma had increased circulating n-3PUFA levels at 36 weeks gestation which was associated with reduced fetal and neonatal head circumference.: Conclusion: These observations suggest moderate/severe asthma may disrupt lipid metabolism, transport or cellular uptake during pregnancy which subsequently contributes to reduced fetal growth.Penelope McLernon, Lisa Wood, Vanessa E. Murphy, Nicolette A. Hodyl, Vicki L. Clifto