Assessment of Household Food Insecurity During a Medical Mission to Chincha, Peru.

Introduction Food insecurity directly influences health outcomes and is an important consideration for medical missions seeking to address chronic disease, particularly those serving disaster-prone communities. The region of Peru in which we held an inaugural mission is vulnerable to developing food insecurity following natural disasters. We, therefore, sought to evaluate food insecurity to understand the community's needs and inform future public health efforts. Methods In this cross-sectional pilot study, a convenience sample representing the households of patients attending a student-run health fair at the community medical center in Chincha, Peru was assessed for food insecurity. An adult female (n = 30) of each randomly selected family attending the fair was asked to complete the Household Food Security Survey (HFSS) developed by the US Department of Agriculture. The survey items were aggregated into a single, continuous food security scale reflecting the severity of hunger within a household. Results Two-thirds of respondents (n = 20) acknowledged anxiety about having enough food at home over the past 12 months, making it the most common concern. Nearly three in five respondents were concerned about their ability to provide a balanced diet. We found that 16.7% of all households were food insecure with severe hunger, 26.7% were food insecure with moderate hunger, 30% were food insecure without hunger, and 26.7% were food secure. Conclusion Nearly three-quarters of families attending our clinic experience some degree of food insecurity. Families with children were disproportionately affected. The high levels of food insecurity many years after a natural disaster support the development of future social programs such as food pantries. We intend to continue our partnership in Chincha and perform the HFSS survey on a periodic basis to monitor hunger.

Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening.

OBJECTIVE: Assess the prevalence of nonalcoholic fatty liver disease (NAFLD) and of liver fibrosis associated with nonalcoholic steatohepatitis in unselected patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: A total of 561 patients with T2DM (age: 60 ± 11 years; BMI: 33.4 ± 6.2 kg/m2; and HbA1c: 7.5 ± 1.8%) attending primary care or endocrinology outpatient clinics and unaware of having NAFLD were recruited. At the visit, volunteers were invited to be screened by elastography for steatosis and fibrosis by controlled attenuation parameter (≥274 dB/m) and liver stiffness measurement (LSM; ≥7.0 kPa), respectively. Secondary causes of liver disease were ruled out. Diagnostic panels for prediction of advanced fibrosis, such as AST-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) index, were also measured. A liver biopsy was performed if results were suggestive of fibrosis. RESULTS: The prevalence of steatosis was 70% and of fibrosis 21% (LSM ≥7.0 kPa). Moderate fibrosis (F2: LSM ≥8.2 kPa) was present in 6% and severe fibrosis or cirrhosis (F3-4: LSM ≥9.7 kPa) in 9%, similar to that estimated by FIB-4 and APRI panels. Noninvasive testing was consistent with liver biopsy results. Elevated AST or ALT ≥40 units/L was present in a minority of patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that AST/ALT alone are insufficient as initial screening. However, performance may be enhanced by imaging (e.g., transient elastography) and plasma diagnostic panels (e.g., FIB-4 and APRI). CONCLUSIONS: Moderate-to-advanced fibrosis (F2 or higher), an established risk factor for cirrhosis and overall mortality, affects at least one out of six (15%) patients with T2DM. These results support the American Diabetes Association guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT.

Ultrasound Detection of Human Botfly Myiasis of the Scalp: A Case Report.

Dermatobia hominis, also known as the human botfly, is an insect native to Central and South America that is known to parasitize both human and animal hosts through cutaneous infestation by its developing larvae. While human botfly myiasis has been commonly diagnosed through dermatologic findings, the presenting lesions and associated symptoms can be non-specific and often misconstrued as other more common cutaneous diagnoses. Here, we present a case of botfly myiasis of the scalp in which ultrasound was utilized to visualize the larvae and confirm the diagnosis prior to larval removal. In this report, we discuss our patient's presentation, ultrasound imaging, and clinical course/treatment in order to convey how ultrasound imaging, when available, is a valuable tool in establishing the diagnosis of human botfly myiasis.