Looking beyond the physical management of patients with head and neck cancer

Cancers of the head and neck region often leave patients with conspicuous defects, as well as limitations in physical and psycho-social functions. Rehabilitation is challenging and can never fully restore the anatomical, physiological, or functional characteristics that have been lost. Ideally newly diagnosed cancer patients should be managed by a multidisciplinary team of specialists from various allied fields who will be able to educate them and help them decide on the most appropriate and suitable treatment options. Patients must understand the processes, be of possible side effects and comprehend the limitations aware of rehabilitation. At the same time, clinicians may need to consider issues of distributive justice when deciding which patients will receive which resources, especially in financially limited institutions and countries. The biggest challenge to us as clinicians as well as community members is to try and treat all patients holistically and to address both their physical and psychosocial needs. This requires a fervent commitment to action, and that we all stand together and help each other through difficult times

Does providing “Compromised treatment” equate to “Compromised care” or could it be considered “Appropriatech”?

Teeth are sensory structures that play a part in many different aspects of a patient’s life, including mastication, speech, smiling and aesthetics. As such they can affect both their functional and psychosocial wellbeing and quality of life. Unfortunately, these vital components can be lost due to caries, periodontal disease, dental trauma or iatrogenic damage. Dental practitioners should aim to provide treatment that will save and/or restore compromised or diseased teeth whenever possible. This may include direct or indirect restorations, endodontics, periodontal therapy and even reimplantation or autotransplantation in specific cases.1 Despite the wide range of treatment possibilities, oral rehabilitation is often not available, accessible or affordable to all patients.2 To try to “provide treatment for the many”, cost-effective procedures may need to be considered. However, this cost-cutting cannot be achieved by “ignoring sound prosthodontic principles” and needs to have some form of quality control.2 This paper will give a brief review of the controversial cervical margin relocation technique. It will then use this as an example for how a clinician can debate whether the provision of “compromised treatment” equates to inferior care, or if it could be considered appropriate for the given situation. They need to also ensure that the chosen treatment is safe, adheres to evidence-based principles and still provides quality of care

Concentric left ventricular remodeling and aortic stiffness: A comparison of obesity and hypertension

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The influence of cabbage cultivars on the fitness of Plutella xylostella (Linnaeus 1758) (Lepidoptera: Plutellidae) and its biological control agent Cotesia vestalis (Haliday 1834) (Hymenoptera: Braconidae)

The diamondback moth, Plutella xylostella (Linnaeus 1758.) (Lepidoptera: Plutellidae), is a major insect pest of Brassica crops in many parts of the world leading to economic losses amounting to an estimated US$ 4-5 billion. Although parasitoids (biological control agents) play a major role in suppressing the pest populations during November – May in South Africa, the pest reaches outbreak status during September and October due to low impact of parasitoids, which has necessitated regular application of insecticides. However, insecticide applications have often resulted in the pest developing resistance, and when coupled with the negative effects of several insecticides on parasitoids, integration of the two pest control strategies for effective management of P. xylostella population density has been difficult to achieve. One approach that has received little attention is integration of host plant resistance (bottom-up effect) and biological control (top-down effect) for effective management of P. xylostella. However, the interaction between host plants, the insect pest, and parasitoids is not simple and straight forward, as strong negative impact of host plants on fitness of the insect pest can be cascaded up the food chain and have a negative impact on a given parasitoid, which in turn may reduce the desired complementary effect between the two pest control strategies. To identify optimal interactions between cabbage (Brassica oleracea L. var. capitata, Brassicaceae), P. xylostella and its larval parasitoid Cotesia vestalis (Haliday 1834) (Hymenoptera: Braconidae), this study investigated (i) the effects of seven cabbage cultivars (Empowa, Hollywood F1, Megaton, Leano, Menzania, Beverley Hills and Karabo) on fitness parameters (survival, developmental time, pupal weights, longevity without food and oviposition rates) of P. xylostella; (ii) the influence of the same host plant cultivars on fitness parameters (developmental time, pupal weights, longevity xi without food, fecundity, emergence rate and sex ratio) of C. vestalis. Furthermore, net reproductive rates and the intrinsic rates of natural increase were calculated for C. vestalis that emerged from hosts fed on each of the cultivars. All experiments were conducted in climate-controlled laboratory rooms maintained at 22 ± 1 ºC (mean ± S.D.), 60 ± 5 % RH and 16L: 8D photoperiod. Under the no choice test, overall survival of P. xylostella immature stages was highest on Karabo (67.26%) and lowest on Megaton (44.92%). The larval and pupal developmental period, and generation time was prolonged on Empowa (18.48 days), Karabo (14.64 days) and Beverly Hills (17.48 days), while developmental period on Hollywood F1 (13.79 days) was shortest. Male and female P. xylostella pupal weights were lighter from larvae that fed on Megaton (4.13 and 4.65 mg), Menzania (4.53 and 4.91 mg), and Hollywood F1 (4.11 and 5.08 mg), whereas pupal weights from Karabo (6.0 and 6.82 mg) were the heaviest. Unfed female moths originally reared on Beverley Hills had the highest longevity (5.05 days), whereas those reared on Leano (3.54 days) and Megaton (3.89 days) had the shortest life span. Under the choice-test, P. xylostella moth laid significantly more eggs on Empowa (48.8%) and Hollywood F1 (45.6%) and least on Menzania (11.8%) and Leano (10.6%). Megaton was more resistant to P. xylostella due to lower survival rates of immature stages, lower pupal weights and moth longevity. The generation time of C. vestalis was shortest on Karabo (10.10 days) and Leano (10.38 days), and longest on Megaton (12.57 days) and Empowa (12.80 days). The highest pupal weight of C. vestalis was obtained from parasitoids reared from P. xylostella fed Menzania (5.4 mg), Megaton (5.25 mg) and Beverly Hills (4.85 mg) and the lightest on Karabo (3.8 mg). Parasitoids reared on larvae that fed on Hollywood F1 lived the longest (2.28 days) followed by Menzania (1.94 days) and Beverly Hills (1.8 days), whereas those whose hosts fed on Leano had shortest life span (0.83 days). Despite the parasitoids from Megaton hosts being heavier, their fecundity and number of female progeny per female (16.87 and 3.60, respectively) were lowest. Cotesia vestalis fecundity and daughters produced per female were highest on hosts fed on Menzania (38.00 and 9.13, respectively) and Beverly Hills (32.87 and 9.07, respectively). As a consequence, the net reproductive rate (R0) and intrinsic rate of increase (r) were higher on Menzania (7.87 and 0.58, respectively) and Beverly Hills (8.29 and 0.62, respectively). As survival and overall fitness of P. xylostella was lower on Megaton, this cultivar can play a major role in restricting population growth of this pest and thus generational number of eggs deposited on it during September and October. However, this strong bottom-up effect of Megaton on P. xylostella was cascaded up the food chain, as overall fitness of C. vestalis was lower on hosts developing on it. In contrast, the overall fitness of C. vestalis was higher on hosts that developed on Menzania and Beverly Hills. As these cultivars showed potential to sustain population density of C. vestalis at higher levels, it is also assumed that the period required for the parasitoid to reach the critical density to suppress the host population at a lower average density will be reached quicker than on other cultivars. Thus, their cultivation may improve biological control of P. xylostella during November–May in South AfricaAgriculture, Animal Health and Human EcologyM. Sc. (Agriculture

Immediately loaded zygomatic implants used for a functional and aesthetic rehabilitation following a combined maxillectomy and rhinectomy

Malignancies of the nasal vestibule are rare, yet may result in massive destruction of the face if left untreated. The position and extent of the resulting defects is not only a rehabilitative challenge but also a major psychological burden for the patient. This paper describes a technique for designing and fabricating an immediate surgical obturator and nasal prosthesis to help minimize the post-surgical impact following a total rhinectomy and partial maxillectomy procedure in a patient diagnosed with a squamous cell carcinoma of the nasal septum. The restoration consisted of bilateral zygomatic implants attached to a resin framework housing a central magnet. The latter was used to retain the nasal prosthesis and help support an interim maxillary obturator. Conventional impressions of the dentition and a moulage of the nasal defect were taken. The master casts were poured and used for design and fabrication of the obturator and nasal wax pattern Colour matching of the nose and facial areas was performed with the aid of a digital spectrophotometer (Quickweigh; Spectromatch Ltd., UK), and a silicone nasal prosthesis was fabricated. This case demonstrated how both a functional rehabilitation and reduced psychological impact was achieved by delivering an immediate surgical obturator and facial prosthesis

Obese Subjects Show Sex-Specific Differences in Right Ventricular Hypertrophy

As right ventricular (RV) remodeling in obesity remains underinvestigated, and the impact of left ventricular (LV) diastolic dysfunction on RV hypertrophy is unknown, we aimed to investigate whether (1) sex-specific patterns of RV remodeling exist in obesity and (2) LV diastolic dysfunction in obesity is related to RV hypertrophy.Seven hundred thirty-nine subjects (women, n=345; men, n=394) without identifiable cardiovascular risk factors (body mass index [BMI], 15.3-59.2 kg/m2) underwent cardiovascular magnetic resonance (1.5 T) to measure RV mass (g), RV end-diastolic volume (mL), RV mass/volume ratio, and LV diastolic peak filling rate (mL/s). All subjects were normotensive (average, 119±11/73±8 mm Hg), normoglycaemic (4.8±0.5 mmol/L), and normocholesterolaemic (4.8±0.9 mmol/L) at the time of scanning. Across both sexes, there was a moderately strong positive correlation between BMI and RV mass (men, +0.8 g per BMI point increase; women, +1.0 g per BMI point increase; both P<0.001). Whereas women exhibited RV cavity dilatation (RV end-diastolic volume, +1.0 mL per BMI point increase; P<0.001), BMI was not correlated with RV end-diastolic volume in men (R=0.04; P=0.51). Concentric RV remodeling was present in both sexes, with RV mass/volume ratio being positively correlated to BMI (men, R=0.41; women, R=0.51; both P<0.001). Irrespective of sex, the LV peak filling rate was negatively correlated with both RV mass (men, R=-0.43; women, R=-0.44; both P<0.001) and RV mass/volume ratio (men, R=-0.37; women, R=-0.35; both P<0.001).A sex difference in RV remodeling exists in obesity. Whereas men exhibit concentric RV remodeling, women exhibit a mixed pattern of eccentric and concentric remodeling. Regardless of sex, reduced LV diastolic function is associated with concentric RV remodeling

Development, survival, body weight and oviposition rates of Plutella xylostella (Linnaeus) (Lepidoptera: Plutellidae) when reared on seven cabbage cultivars

Plant cultivars that negatively influence fitness of target phytophagous insects can be an important component of integrated pest management when they substantially restrict population growth of the target pest. In this study, the effects of seven cabbage (Brassica oleracea var. capitata L.) cultivars on survival and development of immature stages, pupal weights, moth longevity and oviposition rates of the diamondback moth, Plutella xylostella (L.) (Lepidoptera: Plutellidae), were evaluated in the laboratory. Under the no choice test, overall survival of P. xylostella immature stages was highest on Karabo (67.26 %) and lowest on Megaton (44.92 %). The larval and pupal developmental period, and thus generation time took longer on Empowa (18.48 d), Karabo (14.64 d) and Beverly Hills (17.48 d), while development on Hollywood F1 (13.79 d) was the fastest. Male and female P. xylostella pupal weights were lower in larvae that fed on Megaton (4.13 and 4.65 mg), Menzania (4.53 and 4.91 mg), and Hollywood F1 (4.11 and 5.08 mg), whereas pupal weights from Karabo (6.0 and 6.82 mg) were the heaviest. Unfed female moths reared on Beverly Hills lived the longest (5.05 d), whereas those reared on Leano (3.54 d) and Megaton (3.89 d) lived for a shortest period. Under the choice-test, P. xylostella laid significantly more eggs on Empowa (48.8 %) and Hollywood F1 (45.6 %) and least on Menzania (11.8 %) and Leano (10.6 %). Although these results show differential impact of the cultivars on the fitness parameters studied, low survival rate of offspring on a crop is the primary target for using plant resistance as a pest management tactic. As survival rates of immature P. xylostella were lower on Megaton together with lower pupal weights and moth longevity, which together negatively impacts fecundity, and thus overall fitness of the pest was lower when developing on it. Megaton was more resistant to P. xylostella. The results of this study show that Megaton can play a major role in restricting population growth of this pest and generational number of eggs deposited on it.Agriculture, Animal Health and Human Ecolog

Looking beyond the physical management of patients with head and neck cancer

Cancers of the head and neck region often leave patients with conspicuous defects, as well as limitations in physical and psycho-social functions. Rehabilitation is challenging and can never fully restore the anatomical, physiological, or functional characteristics that have been lost. Ideally newly diagnosed cancer patients should be managed by a multidisciplinary team of specialists from various allied fields who will be able to educate them and help them decide on the most appropriate and suitable treatment options. Patients must understand the processes, be of possible side effects and comprehend the limitations aware of rehabilitation. At the same time, clinicians may need to consider issues of distributive justice when deciding which patients will receive which resources, especially in financially limited institutions and countries. The biggest challenge to us as clinicians as well as community members is to try and treat all patients holistically and to address both their physical and psychosocial needs. This requires a fervent commitment to action, and that we all stand together and help each other through difficult times.https://www.sada.co.za/the-sadjam2022Prosthodontic