Diabetes and the gastrointestinal tract in the pediatric patient.

The child who has diabetes is at increased risk for gastrointestinal disorders. In addition to the typical stigmata of increased weight and round, robust-appearing faces with chemical abnormalities of hypoglycemia, hypocalemia, and hyper-bilirubinemia, the infant of a diabetic mother may have a microcolon which require

Death from colonic disease in epidermolysis bullosa dystrophica

BACKGROUND: Squamous cell carcinomas and renal failure were reported the causes of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). Death from colonic disease in epidermolysis bullosa (EB) is never reported. CASE PRESENTATION: We demonstrate a male patient with RDEB. He suffered megacolon due to fecal impaction and died from sigmoid colon perforation with peritonitis at age 35 years. CONCLUSION: Constipation is a common clinical feature of RDEB, but fetal complications of chronic constipation are rarely reported. To the author's best knowledge, it has not been reported or recognized in the English literature previously. The aggressive assessment of constipation with fecal impaction is recommended in patients with RDEB

Review: Time use as an explanation for the agri-nutrition disconnect? Evidence from rural areas in low and middle income countries

Time is a vital input into nutritional outcomes, as it is necessary for the production, procurement and preparation of food, child feeding and childcare. Thus, agricultural interventions may fail to improve nutritional outcomes if they do not take account of time constraints, particularly of rural women who spend a considerable portion of their time in agriculture. Given the potential trade-offs pertaining to time in productive vs. reproductive activities and its implications for maternal and child nutrition, the goal of this review is to systematically map and assess the available evidence, both qualitative and quantitative studies, agriculture-time use-nutrition pathway. Through an analysis of 89 studies, identified through a systematic search, on rural areas of low and middle-income countries, we observe three findings. First, women play a key role in agriculture, as reflected in their time commitments. Second, evidence from a very limited set of studies suggests that agricultural interventions tend to increase time commitments in agriculture of the household members for whom impact is measured. Third, while changing time use tends to change nutritional outcomes, it does so in a range of complex ways and there is no agreement on the impact. Nutritional impacts are varied because households and household members respond to increased time burden and workload in different ways

Diffuse duodenal nodular lymphoid hyperplasia: a large cohort of patients etiologically related to Helicobacter pylori infection

Abstract Background Nodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. There are no published reports of its association with Helicobacter pylori infection. Methods From March 2005 till February 2010, we prospectively followed all patients with diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Patients underwent esophagogastroduodenoscopy with targeted biopsies, colonoscopy, and small bowel video capsule endoscopy. Duodenal nodular lesions were graded from 0 to 4 based on their size and density. Patients were screened for celiac sprue (IgA endomysial antibody), immunoglobulin abnormalities (immunoglobulin levels & serum protein electrophoresis), small intestine bacterial overgrowth (lactulose hydrogen breath test), and Helicobacter pylori infection (rapid urease test, and histological examination of gastric biopsies). Patients infected with Helicobacter pylori received sequential antibiotic therapy and eradication of infection was evaluated by 14C urea breath test. Follow up duodenoscopies with biopsies were performed to ascertain resolution of nodular lesions. Results Forty patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years) with DDNLH were studied. Patients presented with epigastric pain, vomiting, and weight loss. Esophagogastroduodenoscopy showed diffuse nodular lesions (size varying from 2 to 5 mm or more) of varying grades (mean score ± 1SD 2.70 ± 0.84) involving postbulbar duodenum. Video capsule endoscopies revealed nodular disease exclusively limited to duodenum. None of the patients had immunoglobulin deficiency or small intestine bacterial overgrowth or positive IgA endomysial antibodies. All patients were infected with Helicobacter pylori infection. Sequential antibiotic therapy eradicated Helicobacter pylori infection in 26 patients. Follow up duodenoscopies in these patients showed significant reduction of duodenal nodular lesions score (2.69 ± 0.79 to 1.50 ± 1.10; p Helicobacter pylori infection showed no significant reduction of nodular lesions score (2.71 ± 0.96 to 2.64 ± 1.15; p = 0.58). Nodules partially regressed in score in 2 patients, showed no interval change in 10 patients and progressed in 2 patients. Conclusions We report on a large cohort of patients with DDNLH, etiologically related to Helicobacter pylori infection.</p

Identity in Flux : The Case of Eurasians in Sarawak

The primary objectives of this study were to explore how Eurasians in Sarawak identify ethnically and why they identify as they do. The conceptual framework was comprised of various ideas consistent with symbolic interactionism namely Brunsma and Rockquemore (2001, 2002), Rockquemore (1998, 2002) and Rockquemore and Brunsma's (2002, 2004, 2008) multidimensional model and Strauss and Corbin (1990, 1998) and Corbin and Strauss (2008) on structure and process. In addition, Jenkin's (1994, 2004, 2008) internalexternal dialectic and Blumer's (1969/1986) on self-indication were also used to help address multiple aspects of ethnic identification. Snowball and maximum variation sampling were used to locate informants. They were those who had one parent or grandparent that identified with a local ethnicity and one with a European ethnicity, or one parent that identified as Eurasian. A total of 45 informants, who were residents of Sarawak, contributed to this study. The method of data collection was face-to-face interviews based on an interview guide. Grounded theory methods, including the constant comparative method, axial coding, selective coding, the conditional/consequential matrix and the.oretical sampling, were used for this study. Through these methods categories were created and analyzed based largely on the data. A major finding of the study is that infonnants identify themselves in diverse ways. There could be pressures for individuals to identify in certain ways, however there was also some degree of agency in ethnic identification. While the presentation of identity often remains unchanged during interactions, fluidity was also evident in some situations. Identity-related issues relating to appearance, the Bumiputera and 'Others' categories and belonging/identity crises were also discussed. In light of the findings, this thesis proposed a new model on fluid identities and a more holistic interactionist approach to ethnic identity study which dealt with 11 constraint, agency, interactions both at and within the boundaries, and one which transcended the instrumentalist perspective