Tumor Related- and Non-tumor-Related Diarrhea in a Medullary Thyroid Cancer Patient

Medullary thyroid cancer (MTC) is a rare malignancy originating from calcitonin-producing parafollicular C cells of the thyroid. In advanced disease, hormonal secretion by the tumor cells of calcitonin or other active peptides can cause systemic symptoms. Occasionally, MTCs release corticotropin (ACTH) causing ectopic Cushing’s syndrome. Although the pathogenesis is unclear, diarrhea and facial flushing are more common in MTC, and the management of potentially disabling symptoms is essential to improve the quality of life of these patients. Adequate symptomatic control is needed because chronic diarrhea impairs the quality of life and, when severe, may cause volume depletion and acid-base and electrolyte abnormalities. The initial treatment approach is based on the use of antimotility agents, while somatostatin analogs are a cornerstone in the management of carcinoid syndrome-related diarrhea. Multikinase inhibitors used for the treatment of progressive, advanced disease may also cause diarrhea as a drug-associated adverse event. This case report describes the management of a man with MTC who suffered from diarrhea as the main symptom of the disease. Diarrhea was the earliest, misdiagnosed symptom at presentation of MTC as well as an adverse event of systemic treatment (cabozantinib)

Prevalence and community variation in harmful levels of family conflict witnessed by children: implications for prevention

 AbstractChildren’s reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N = 1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N = 8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs