Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review.

Pancreatic adenocarcinoma (PDAC) is well known for its poor survival time. Clinical symptoms are painless jaundice or abdominal or back pain. Less specific symptoms often appear that make diagnosis difficult, e.g., weight loss, loss of appetite, nausea and vomiting, and general weakness. Only 10-20% of patients are diagnosed at an early stage. A cure is practically only possible with a radical surgical operation. In the case of locally advanced findings, neoadjuvant therapy is administered. Among the therapeutic options offered are chemotherapy, radiotherapy (including stereotactic radiotherapy-SBRT), targeted treatment, or immunotherapy. In the case of metastatic disease, of which more than half are present at diagnosis, the goal is to relieve the patient of problems. Metastatic PDAC can cause problems arising from the localization of distant metastases, but it also locally affects the organs it infiltrates. In our review article, we focus on the largest group of patients, those with locally advanced disease and metastatic disease-symptoms related to the infiltration or destruction of the pancreatic parenchyma and the growth of the tumor into the surrounding. Therefore, we deal with biliary or duodenal obstruction, gastric outlet syndrome, bleeding and thromboembolic diseases, pain, depression, and fatigue, as well as pancreatic exocrine insufficiency and malnutrition. Metastatic spread is most often to the liver, peritoneum, or lungs. The presented overview aims to offer current therapeutic options across disciplines. In accordance with modern oncology, a multidisciplinary approach with a procedure tailored to the specific patient remains the gold standard.

Comparative Analysis of Corneal Parameters Performed with GalileiG6 and OCT Casia 2.

BACKGROUNDS: To compare keratometry (Ks and Kf), astigmatism (Ast.), and the astigmatism axes (Ax.) of the posterior surface of the cornea; the total, central cornea thickness (CCT); and the thinnest corneal thickness (TCT) measured using two different measurement methods. METHODS: Patients qualified for cataract surgery at the Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland, were included in the study and monitored with the following two devices: OCT-CASIA2 and Dual Scheimpflug Analyzer GalileiG6. Our work was a randomized, prospective study in which compliance with the agreement of measurements between the devices was evaluated using the Bland-Altman method. RESULTS: A total of 110 patients (62 females and 48 males) were examined. Overall, 100 eyes of patients that qualified for cataract surgery were enrolled in the study. No statistically significant difference was observed for Total-Ks and Total-Kf. A significant difference was observable for the following parameters: total Ks-ax, total Kf-ax, the total power of astigmatism, and in all parameters of the part of the cornea and corneal thickness (CCT and TCT). CONCLUSIONS: The measurements obtained using Casia2 and the Dual Scheimpflug Analyzer GalileiG6 were significantly different and not interchangeable except for total Ks and Kf.

Social capital and food security in post-conflict rural Lira District, northern Uganda.

While a strong relationship has been established between social capital and food security in the research literature, it is uncertain whether this holds in post-conflict situations. This study examines associations between social capital and food security in post-conflict Lira District, northern Uganda. Since factors affecting food security are complex, we explored the roles of households' characteristics in food security outcomes. Data were collected from March to July 2011 through face-to-face interviews with 221 heads of household in rural Lira. Using multinomial logistic regression, a strong positive association was identified between social capital and household food security. The study also found significant associations of food security with sex, education of household head, amount of cultivated land, and farm and home possessions. The results of this analysis can aid the design of food security programmes that empower poor people while targeting the most vulnerable groups, thereby promoting sustainable development in post-conflict communities.

Comparative analysis of measurements of the anterior segment and the axial length parameters of the eyeball obtained with optical and ultrasound technique.

PURPOSE: To compare anterior chamber depth (ACD), keratometry (K1, K2), central corneal thickness (CCT), and axial length (AL) measured by four different devices. MATERIAL AND METHODS: 150 eyes qualified for cataract surgery were included in the study. Four devices: IOL Master 500, OCT CASIA2, Dual Scheimpflug Analyzer Galilei G6, and Quantel Compact Touch ultrasound biometer, were compared. The agreement of measurements between the devices was evaluated by the Bland-Altman method. RESULTS: ACD was significantly different for Ultrasound and IOL Master 3 ± 0.33 3.12 ± 0.42 respectively Interclass correlation ecoefficiency (ICC):0.69 (95% confidence interval (CI): 0.62; 0.76) p < 0.001. A significant difference was observed between Casia and IOL while measuring K1, 43.5 ± 1.7 vs. 43.61 ± 1.56 ICC:0.84 (95%CI: 0.79; 0.87) and ACD parameters 2.65 ± 0.45 vs. 3.12 ± 0.42 ICC 0.68 (95%: 0.6; 0.75) and K2 42.51 ± 1.62 vs. 44.57 ± 1.59 ICC; 0.83 (95%CI:0.78; 0.87) p < 0.001. Similarly, measurements obtained by Casia, and Galilei were also different K1 43.5 ± 1.7 ICC:0.7 (95%CI:0.62; 0.76), CCT 546.35 ± 34.75 vs. 566.73 ± 37.92 ICC:0.88 (95%CI:0.84; 0.9) p < 0.001. Differences between Galilei and IOL master were not significant p values from 0.175 to 0.999 ICC 0.8 (95%CI:0.75; 0.85) to ICC 0.94 (95%CI:0.92; 0.95). CONCLUSIONS: The measurements obtained from Casia, and Ultrasound were significantly different and not interchangeable except for IOL master and Galilei.

Repeatability, reproducibility, and comparison of ocular biometry using a new optical coherence tomography-based system and another device.

Precise measurement of axial length before cataract surgery is necessary for the proper lens implantation. We included 100 eyes of 56 patients in the study. The mean age was 41 (15-84 years). Measurements of axial length, anterior chamber depth (ACD) carried out with the new Revo NX were compared with those obtained with the IOLMaster 500. Interoperator testing was performed on 56 eyes of 56 participants. To test repeatability, axial length, ACD, central corneal thickness, and lens thickness were used. Inter-operator reproducibility was also assessed. The results were evaluated using Bland-Altman analyses. The mean ACD measured with the IOLMaster and Revo NX was 3.41 and 3.40 mm p = 0.467, respectively. The interclass correlation was excellent at the level of 0.975. ICC for axial length values was 0.999, and the mean was equal to 23.47 for the new device and 23.48 for IOLMaster. ICC for Inter-operator repeatability was higher than 0.99 in all parameters. Revo NX showed a very high level of repeatability with ICC ranging from 0.9929 for central corneal thickness to 0.9997 for axial length. Both devices showed excellent agreement and differences that are insignificant, which suggests that they can be used interchangeably.

Reproducibility, and repeatability of corneal topography measured by Revo NX, Galilei G6 and Casia 2 in normal eyes.

PURPOSE: To test the repeatability and reproducibility of the topography module in posterior segment spectral domain optical coherence tomography with Revo NX (new device) and to compare keratometry values obtained by a Scheimpflug tomography (Galilei G6) and a swept source OCT (Casia 2). METHODS: In this prospective study, healthy subjects with nonoperated eyes had their central corneal thickness (CCT), anterior and posterior K1/K2 corneal power measured with the new device. Two operators made 6 measurements on the new device to check intraobserver repeatability and reproducibility, and measurement on Casia 2 and Galilei G6. Bland-Altman plots were used to assess the agreement between the devices for each analyzed variable. RESULTS: 94 eyes (94 patients) were studied. All devices produced significantly different mean CCT, the highest for Galilei 569.13±37.58 µm followed by Casia 545.00 ±36.15 µm and Revo 537.39±35.92 µm. The mean anterior K1 was 43.21 ± 1.37 for Casia 2 43.21 ± 1.55 for Revo NX and 43.19 ± 1.39 for Galilei G6, and the differences were insignificant p = 0.617. The posterior K1 for Revo NX was -5.77 ± 0.25 whereas for Casia 2 it was -5.98±0.22 and for Galilei G6-6.09±0.28 D p< 0.0001. The Revo NX showed intraclass correlation coefficient ranging from 0.975 for the posterior K2 surface, and 0.994 for anterior K1 and 0.998 for CCT. CONCLUSIONS: Revo NX is independent of the user and offers a high level of repeatability for the anterior and posterior cornea. The wide range of differences between the devices suggests they should not be used interchangeably.

Social network characteristics and resource access among formerly displaced households in Lira, Uganda.

In rural African communities, the support of extended family, friends, and neighbours is essential in borrowing or leveraging land, labour, food, and money, especially at times of social and financial turmoil. Little is known, though, about the nature of the networks and the conditions under which they may generate greater support in post-conflict communities. This study, conducted in the Lira district of northern Uganda, examined the composition, proximity, and size of the networks that households utilise to gain access to resources during and after resettlement. Network structures with more kin and co-resident ties were found to offer greater resource access to households in post-conflict settings. Furthermore, there was a lack of meaningful linkages outside of a person's own village, especially with regard to households whose head has no or a low level of education. These findings enhance understanding of the specific role of relationships in social support for resource access among households in post-conflict communities.

Factors are not the same for risk of stopping exclusive breast-feeding and introducing different types of liquids and solids in HIV-affected communities in Ghana.

Exclusive breast-feeding (EBF) for 6 months supports optimal infant growth, health and development. This paper examined whether maternal HIV status was associated with EBF and other infant feeding practices. Pregnant women were enrolled after HIV counselling, and their babies were followed up for up to 1 year. Data on household socio-economics and demographics, maternal characteristics and infants' daily diet were available for 482 infants and their mothers (150 HIV-positive (HIV-P), 170 HIV-negative (HIV-N) and 162 HIV-unknown (HIV-U)). Survival analyses estimated median EBF duration and time to introduction of liquids and foods; hazards ratios (HR) used data from 1-365 and 1-183 d, adjusting for covariates. Logistic regression estimated the probability of EBF for 6 months. Being HIV-P was associated with a shorter EBF duration (139 d) compared with HIV-N (163 d) and HIV-U (165 d) (P=0·004). Compared with HIV-N, being HIV-P was associated with about a 40 % higher risk of stopping EBF at any time point (HR 1·39; 95 % CI 1·06, 1·84; P=0·018) and less than half as likely to complete 6 months of EBF (adjusted OR 0·42; 95 % CI 0·22, 0·81; P=0·01). Being HIV-P tended to be or was associated with a higher risk of introducing non-milk liquids (HR 1·34; 95 % CI 0·98, 1·83; P=0·068), animal milks (HR 2·37; 95 % CI 1·32, 4·24; P=0·004) and solids (HR 1·56; 95 % CI 1·10, 2·22; P=0·011) during the first 6 months. Weight-for-age Z-score was associated with EBF and introducing formula. Different factors (ethnicity, food insecurity, HIV testing strategy) were associated with the various feeding behaviours, suggesting that diverse interventions are needed to promote optimal infant feeding.

Socioeconomic factors differentiating healthcare utilization of cyclone survivors in rural Bangladesh: a case study of cyclone Sidr.

BACKGROUND: Although many studies have been carried out to examine healthcare utilizations in rural Bangladesh, yet little is known about the healthcare utilization among survivors of a natural disaster. This study addresses this gap by examining the socioeconomic factors associated with healthcare utilization among Cyclone Sidr survivors. METHODS: A systematic random sample of 384 heads of household was interviewed using a semi-structured questionnaire. This study used multivariate logistic analyses to examine post-cyclone healthcare utilizations. Healthcare utilization is defined as the process of seeking professional healthcare and submitting oneself to the application of available health services, with the purpose to prevent or treat health problems. RESULTS: Over half (58%) of Cyclone Sidr survivors suffered from some type of illness occurring during the 15 days preceding the survey. The most common healthcare choices among survivors to address illnesses were seeking assistance from para-professionals (37%), qualified allopaths (26%) and drug store salespersons (17%). A principal finding was that a household's socioeconomic status, as reflected by wealth quintiles, was a major determinant in healthcare utilization. The household heads in the higher wealth quintile were significantly more likely to seek modern allopathic providers for healthcare than those in the poorest quintile (Odds ratio (OR) = 2.89, Confidence interval (CI): 1.92-5.87). The household heads who listened to health risk communications were 2.55 times more likely to seek any healthcare (CI: 1.35-5.11) and 1.77 times to seek modern allopathic care (CI: 1.62-5.09) than those who did not. Other significant predictors of healthcare utilization were education, listening to radio, distance to healthcare facility and perceived susceptibility to water-borne diseases. CONCLUSIONS: Para-professionals, qualified allopath and drugstore salespeople are the primary vehicles for providing healthcare services to population at risk of cyclone. Therefore, there is a need for more medical training for these primary healthcare providers in rural Bangladesh.

Dynamics of nitrogen transformation depending on different operational strategies in laboratory-scale tidal flow constructed wetlands.

The influence of different flooded/drained (F/D) time ratios and different effluent flow rates on the dynamics of nitrogen transformations in three laboratory-scale tidal flow constructed wetland systems (TFCWs-A, B, and C) under varying NH4(+)-N and COD influent loadings was investigated in this study. Good organic matter removal performance up to 90% was achieved for all experimental TFCWs under inflow concentrations of 300 and 150 mg/L regardless of F/D and effluent flow rate. The ammonium removal efficiency of wetland with F/D=3h:3h (55%) was higher than that of the wetland with F/D=5h:1h (47%) under an ammonium inflow concentration of 60 mg/L, indicating the positive effect of longer drained and shorter flooded time on tidal-operated wetlands under nitrification. In addition, more uniform oxygen distribution and better nitrification capacity within the wetland might be achieved with a relatively slow effluent flow rate of 0.025 L/s. TFCWs were shown to be a robust and reliable option to achieve high TN removal of 70% due to its repeated cycle of "wet" and "dry" periods, particularly for the treatment of wastewater with high organic content. Moreover, F/D and effluent flow rates of tidal flow constructed wetlands exhibited no significant effect on phosphorus removal in this study. Other techniques, such as pretreatment or post treatment, require further investigation.

Maternal HIV is associated with reduced growth in the first year of life among infants in the Eastern region of Ghana: the Research to Improve Infant Nutrition and Growth (RIING) Project.

Children of HIV-infected mothers experience poor growth, but not much is understood about the extent to which such children are affected. The Research to Improve Infant Nutrition and Growth (RIING) Project used a longitudinal study design to investigate the association between maternal HIV status and growth among Ghanaian infants in the first year of life. Pregnant women in their third trimester were enrolled into three groups: HIV-negative (HIV-N, n = 185), HIV-positive (HIV-P, n = 190) and HIV-unknown (HIV-U, n = 177). Socioeconomic data were collected. Infant weight and length were measured at birth and every month until 12 months of age. Weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) z-scores were compared using analysis of covariance. Infant HIV status was not known as most mothers declined to test their children's status at 12 months. Adjusted mean WAZ and LAZ at birth were significantly higher for infants of HIV-N compared with infants of HIV-P mothers. The prevalence of underweight at 12 months in the HIV-N, HIV-P and HIV-U were 6.6%, 27.5% and 9.9% (P < 0.05), respectively. By 12 months, the prevalence of stunting was significantly different (HIV-N = 6.0%, HIV-P = 26.5% and HIV-U = 5.0%, P < 0.05). The adjusted mean ± SE LAZ (0.57 ± 0.11 vs. -0.95 ± 0.12; P < 0.005) was significantly greater for infants of HIV-N mothers than infants of HIV-P mothers. Maternal HIV is associated with reduce infant growth in weight and length throughout the first year of life. Children of HIV-P mothers living in socioeconomically deprived communities need special support to mitigate any negative effect on growth performance.

Persistent household food insecurity, HIV, and maternal stress in peri-urban Ghana.

BACKGROUND: The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress. METHODS: Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen's stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress. RESULTS: The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14). CONCLUSION: In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa.

Postnatal depression symptoms are associated with increased diarrhea among infants of HIV-positive Ghanaian mothers.

HIV infection is linked to increased prevalence of depression which may affect maternal caregiving practices and place infants at increased risk of illness. We examined the incidence and days ill with diarrhea among infants of HIV positive (HIV-P), HIV negative (HIV-N), and unknown HIV status (HIV-U) women, and determined if symptoms of maternal postnatal depression (PND) modulated the risk of diarrhea. Pregnant women (n = 492) were recruited from three antenatal clinics; mothers and infants were followed for 12 months postpartum. Diarrheal incidence was 0.6 episodes/100 days at risk. More HIV-P than HIV-N and HIV-U women tended to report PND symptoms (χ(2) = 4.76; P = 0.09). Reporting symptoms was associated with an increased risk of infantile diarrhea only among HIV-P and HIV-U but not HIV-N women (interaction term, χ(2) = 7.84; P = 0.02). Health care providers should be aware of the increased risk of infantile diarrhea when both maternal HIV and PND symptoms are present and take preventive action.

Effect of a polyamine biosynthesis inhibitor on the quality of grape and red wine.

BACKGROUND: The quality of berries and red wines is influenced by the cultivar. The aim of this study was to determine the effect of a polyamine biosynthesis (PA) inhibitor on some red grapevine cultivars with a genetically lower quality of grapes and wines. O-Phosphoethanolamine was used as a PA inhibitor because of its positive effect on the quality of some small berries. RESULTS: The PA inhibitor at a foliar dose treatment of 7.0 g ha(-1) significantly increased the peroxidation inhibition of berries (1.16- to 1.56-fold), the color density (from 1.66% to 69.14%) and the sensory quality of the wines with a lower genetically programmed color quality (André, Saint Laurent and Zweigeltrebe), but not the higher-quality Alibernet variety. The PA inhibitor predominantly decreased the total phenolic and anthocyanin contents (from 37.0% to 27.5%), and it significantly decreased the contents of free polyamines in all varieties-very dramatically in Saint Laurent grapes (17.16- to 1.58-fold). CONCLUSIONS: Foliar treatment of red grapevine varieties of a low quality, using O-phosphoethanolamine, can help produce higher-quality wines.

Food insecurity and perceived stress but not HIV infection are independently associated with lower energy intakes among lactating Ghanaian women.

Human immunodeficiency virus (HIV) seropositive women living in low-income communities may have difficulty meeting the increased energy requirements that are associated with both lactation and HIV infection. Data on household food security and maternal socio-demographic characteristics, perceived stress, anthropometry, reported illness, dietary intakes and preferences, and exposure to nutrition education were collected from 70 lactating women [16 seropositive (HP), 27 seronegative (HN), and 27 who refused to be tested and had unknown HIV status (HU)]. Diet was assessed with three 24-h recalls (one market day, one weekend day, and one non-market weekday). Data were collected at 8.4 (SD = 4.7) months postpartum. Most women (74.3%) reported being in good health at the time of study. Three-day mean energy intakes did not differ by HIV status [HP: 12,000 kJ (SD = 3600), HN: 12,600 kJ (SD = 5100), and HU: 12,300 kJ (SD = 4800); P = 0.94]. Protein, fat, vitamin A, thiamin, riboflavin, niacin, vitamin C, calcium, iron, and zinc intakes also did not differ by group (P > 0.10). There was a higher proportion of women with high stress levels in food insecure households compared with food secure households (55.6% vs. 26.5%; P = 0.01). Energy intake was independently negatively associated with food insecurity [high: 11,300 kJ (SD = 3500) vs. low: 13,400 kJ (SD = 5400), respectively; P = 0.050] and stress [high: 10,800 kJ (SD = 2800) vs. low: 13,400 kJ (SD = 5300), P = 0.021]. These results suggest the need to integrate multi-dimensional interventions that address economic and mental health constraints which may limit some women's ability to meet their dietary needs.

Diet and food insufficiency among Hispanic youths: acculturation and socioeconomic factors in the third National Health and Nutrition Examination Survey.

BACKGROUND: Low socioeconomic status is associated with poor diet, food insufficiency, and poor child health. Hispanic households have disproportionately low incomes. Acculturation-related changes may augment the effects of poverty on children's diet and health. OBJECTIVE: The goal was to determine the associations that acculturation, measured by parents' language use, and income have with dietary intakes and food insufficiency among Hispanic youths. DESIGN: Data on 2985 Hispanic youths aged 4-16 y were from the third National Health and Nutrition Examination Survey (1988-1994). Nutrient intake data were from one 24-h dietary recall. The analysis was controlled for demographic, socioeconomic, and program variables. RESULTS: Parents' exclusive use of Spanish was associated in bivariate analyses with differences in intakes of energy, protein, sodium, and folate and in percentages of energy from fat and saturated fat. When other factors were controlled for, less acculturation was associated with differences in intakes of energy and sodium and in percentages of energy from fat and saturated fat. Individuals in poorer households had higher intakes of energy, protein, sodium, and some micronutrients. Although not significant for all indicators of food insufficiency, consistent patterns showed that household food insufficiency decreased with less acculturation (odds ratio: 0.4; 95% CI: 0.2, 0.7 for adult meal size reduced) and increased with low income [odds ratio: 5.9 (3.0, 11.7) for not enough food and 5.4 (2.2, 13.4) for child meal size reduced]. CONCLUSIONS: Both acculturation and poverty have roles in children's diets and in household food insufficiency. Culturally specific public health and nutrition education should complement efforts to improve the financial security of low-income households.

Regional program for bone allograft harvesting following multiorgan procurement in Pomeranian Academy of Medicine in Szczecin.

In Poland, up to 1999, the bones for allograft preparations had been procured only in mortuaries of forensic medicine departments. The increasing demand for bone transplantations greatly exceeds the supply resulting in a long waiting time for bone allografts. In November 1999, for the first time in Poland, the group of orthopedic surgeons from the Pomeranian Academy of Medicine started the regional program for bone harvesting following vascularized organ procurements. The aim of this paper is to present the technical details and limitations of bone harvesting that occurred in 10 out of 25 multiorgan procurements.