Moderate-to-severe food insecurity is positively correlated with the risk of eating disorders in the aftermath of the COVID-19 pandemic.

Background: The COVID-19 pandemic may have worsened food insecurity and altered the eating behaviour of young adults. Therefore, this cross-sectional study aims to investigate the correlation between moderate-to-severe food insecurity and the risk of eating disorders among young urbanists in Malaysia after the pandemic-led lockdown. Methods: The food security status and the risk of eating disorders were assessed using the validated Food Insecurity Experience Scale (FIES) and Eating Attitude Test (EAT-26), respectively. Results: Among the 208 young urbanists, approximately one-third (30.8%) were moderate-to-severe food insecure and about one-fifth (18.8%) were at risk of eating disorders after the nationwide lockdown. With the adjustment of gender, the binary logistic regression analysis revealed that moderate-to-severe food insecure individuals were 2.279 times (P = 0.030, 95% CI = 1.084-4.791) more likely to engage in disordered eating in the aftermath of the COVID-19 pandemic. The findings of partial correlation further indicated that moderate-to-severe food insecurity was positively correlated (rpartial = 0.156, P = 0.024) with bulimia and food preoccupation after the outbreak. Conclusions: Governments and non-governmental organizations must work closely to develop effective policies to address food insecurity and disordered eating behaviour among young urbanists - after the pandemic.

Extranodal NK/T-cell lymphoma: a case report of renal insufficiency during PD1 inhibitor treatment.

BACKGROUND: Extranodal NK/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma that accounts for approximately 3-8% of all malignant lymphomas. So far, ENKTL has no standard treatment guidelines, and the current treatment methods pose adverse effects. The combination of programmed death receptors (PD-1) and programmed death receptors' ligands (PD-L1) downregulates effector T cells; hence, it may be an effective treatment for NK/T-cell lymphoma. Here, we report a patient diagnosed with ENKTL whose health was significantly improved after PD-1 immunotherapy. At the same time, the patient suffered from related renal toxic side effects. Immunotherapy is an emerging treatment method for tumors, and the early diagnosis and identification of its side effects are vital for the diagnosis and treatment of tumors. CASE REPORT: Laboratory tests, pathological examinations, and the patient's history were performed to estimate the severity and the cause of renal insufficiency. The patient with ENKTL developed transient renal damage during immunotherapy. During the next treatment and examination, renal insufficiency was irrelevant to PD-1 inhibitors and avoided unnecessary drug withdrawal. CONCLUSIONS: In the present case report, we discuss a patient who developed a severe transient renal impairment during immunotherapy and review published studies regarding immunotherapy and its renal-related side effects. We also outline how to critically distinguish whether a patient's kidney injury is anti-PD-1 treatment. We also provide insights to oncologists to develop an effective follow-up treatment plan for early detection and management of any anti-PD-1 treatment side effects.

Cross-cultural adaptation and psychometric evaluation of the Malay version of the Neck Disability Index.

PURPOSE: Translating the Neck Disability Index (NDI) into the Malay language (NDI-M); evaluation of psychometric properties in patients with neck pain. METHODS: The NDI-M was translated according to established guidelines. In the first visit, 120 participants completed the NDI-M, visual analogue scale (VAS) for pain and demographic details. 98 participants returned to complete similar questionnaires and the Global Rating of Change (GRoC) scale. The NDI-M was evaluated for internal consistency, test-retest reliability, content validity, construct validity and responsiveness. RESULTS: The NDI-M demonstrated excellent internal consistency (Cronbach's α = 0.84) and good test-retest reliability (ICC2,1 = 0.79). Content validity was confirmed with no floor or ceiling effects. Construct validity was established revealing three-factor subscales explaining 68% of the total variance. The NDI-M showed a moderate correlation with VAS (Rp = 0.49, p < 0.001). Regarding responsiveness, a moderate correlation between NDI-M change scores and VAS change scores was found (Rp = 0.40, p < 0.001). However, there was no significant correlation between NDI-M with GRoC (Rs = 0.11, p = 0.27). CONCLUSIONS: The NDI-M is a reliable and valid tool to measure functional outcomes in patients with neck pain. It is responsive in detecting changes in pain intensity during a patient's rehabilitation journey.Implications for rehabilitationThe NDI was translated into the Malay language and culturally adapted for Malay-speaking patients with neck pain.The NDI-M demonstrated an excellent level of internal consistency and good test-retest reliability. It demonstrated content and construct validity, with three-factor subscales, and moderate responsiveness for pain intensity.The NDI-M is a reliable, valid and responsive instrument to measure functional limitations in patients with neck pain for rehabilitation.

Effect of diarrhoea on Tacrolimus trough level in a post liver transplant patient.

Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.

Development of an international core outcome set for peripheral vascular malformations: the OVAMA project.

BACKGROUND: An important limitation in vascular malformation research is the heterogeneity in outcome measures used for the evaluation of treatment outcome. OBJECTIVES: To reach international consensus on a core outcome set (COS) for clinical research on peripheral vascular malformations: lymphatic (LM), venous (VM) and arteriovenous malformations (AVM). In this consensus study, we determined what domains should constitute the COS. METHODS: Thirty-six possibly relevant outcome domains were proposed to an international group of physicians, patients and the parents of patients. In a three-round e-Delphi process using online surveys, participants repeatedly rated the importance of these domains on a five-point Likert scale. Participants could also propose other relevant domains. This process was performed for LM, VM and AVM separately. Consensus was predefined as 80% agreement on the importance of a domain among both the physician group and the patient/parent group. Outcomes were then re-evaluated in an online consensus meeting. RESULTS: 167 physicians and 134 patients and parents of patients with LM (n = 50), VM (n = 71) and AVM (n = 29) participated in the study. After three rounds and a consensus meeting, consensus was reached for all three types of vascular malformations on the core domains of radiological assessment, physician-reported location-specific signs, patient-reported severity of symptoms, pain, quality of life, satisfaction and adverse events. Vascular malformation type-specific signs and symptoms were included for LM, VM and AVM, separately. CONCLUSIONS: Our recommendation is that therapeutic-efficacy studies on peripheral vascular malformations should measure at least these core outcome domains.

Changing prevalence and treatment outcomes of patients with p16 human papillomavirus related oropharyngeal squamous cell carcinoma in New Zealand.

There has, to our knowledge, been no previous report of changes in the prevalence and outcomes of treatment of HPV-positive (+) oropharyngeal squamous cell carcinoma (SCC) in New Zealand. We identified all affected patients in the greater Wellington region between 1 January 1994 and 30 November 2014 from the New Zealand Cancer Registry. Their personal details, characteristics of their tumours, treatment, complications, and outcomes were collected retrospectively from their casenotes and the New Zealand Death Registry, followed by p16 immunohistochemical staining. Of the 161 patients included, 131 (81%) were men. p16 immunohistochemical staining was done routinely in 13 patients during investigations, and retrospectively for 135 patients. The proportion of p16+ oropharyngeal SCC increased from 24% during 1994-1999, to 76% during 2009-2014 (p<0.001). Oropharyngeal SCC among Europeans was more likely to be p16+ than in non-Europeans (67% compared with 44%, p=0.036). Patients with p16+ disease were younger (mean (SD) 56 (10) compared with 66 (9) years, p<0.01) with fewer coexisting conditions (mean (SD) Charlson Comorbidity Index: 2.45 (0.82) compared with 2.92 (1.16), p=0.01), and less likely to have smoked (57/81(70%) compared with 38/42 (91%) p=0.035), or misused alcohol (12/81 (15%) compared with 14/42 (31%), p=0.042), or both. They were also more likely to have poorly differentiated tumours (30/52 (58%) compared with 9/34 (26%), p=0.019) with nodal metastases (74/85 (87%) compared with 17/30 (57%), p=0.001). Overall 5-year all-cause survival was more favourable for patients with p16+ disease (65/86 (76%) compared with 15/49 (31%), p=0.000). Interestingly, all-cause age at death was younger in p16+ patients (62 (11.1) compared with 71 (11.2) years, p=0.001). The prevalence of p16+ oropharyngeal SCC had tripled in this population between 1994 and 2014, and affected patients have distinct characteristics and outcomes of treatment.

Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma.

The role of the renin-angiotensin system (RAS) in the biology of infantile haemangioma (IH) and its accelerated involution induced by ß-blockers was first proposed in 2010. This led to the first clinical trial in 2012 using low-dose captopril, an angiotensin-converting enzyme (ACE) inhibitor, demonstrating a similar response in these tumours. This study aimed to compare serial serum levels of the components of the RAS in patients before and after surgical excision, propranolol or captopril treatment for problematic proliferating IH. Patients with problematic proliferating IH underwent measurements of serum levels of plasma renin activity (PRA), ACE and angiotensin II (ATII) before, and 1-2 and 6 months following surgical excision, propranolol or captopril treatment. This study included 27 patients undergoing surgical excision (n = 8), propranolol (n = 11) and captopril (n = 8) treatment. Treatment with either surgical excision or propranolol resulted in significant decrease in the mean levels of PRA. Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. This study demonstrates the effect of surgical excision, propranolol and captopril treatment in lowering the levels of PRA and ATII, but not ACE, supporting a mechanistic role for the RAS in the biology of IH.

Prevalence and predictors of suicidality among medical students in a public university.

BACKGROUND: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others. OBJECTIVE: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university. METHODS: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21). RESULTS: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent's lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9). CONCLUSION: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.

Mouth opening and trismus in patients undergoing curative treatment for head and neck cancer.

This study documents mouth opening and the incidence of and factors contributing to trismus (<35 mm mouth opening), as well as the associated impact on quality of life, following curative treatment for head and neck cancer. Patient demographics, cancer type and location, and treatments were documented. Mouth opening was measured at >6 months after treatment completion. Patients rated the impact of mouth opening on quality of life from 0 (no effect) to 10 (greatest effect). The mean mouth opening in 120 patients was 40.1mm (range 11-65 mm), with trismus occurring in 34 (28.3%) patients. Surgery and radiotherapy, surgery and chemoradiotherapy, and resection and reconstruction were associated with reduced mouth opening. The mean effect of mouth opening on quality of life for those with and without trismus was 3.8 and 1.5, respectively. There was a significant difference between the mean effect on quality of life for patients with and without trismus for those patients who underwent chemoradiotherapy or combined surgery and radiotherapy (4.0 vs. 1.0, and 3.6 vs. 1.6 respectively). Trismus impacts negatively on patient quality of life. Multi-modality treatment is associated with decreased mouth opening, an increased incidence of trismus, and reduced quality of life.

Orbital immunoglobulin IgG4-related inflammatory fibrosclerosing lesion treated with pentoxifylline and α-tocopherol: case report.

Immunoglobulin G4 (IgG4)-related disease is a distinct group of disorders that are characterised by intense infiltration of an organ with IgG4(+) cells, subsequent inflammation, fibrosis, and masses. We report a new treatment of orbital IgG4-related disease with pentoxyphylline and α-tocopherol, both of which are anti-inflammatory and antifibrotic agents.

Treatment of infantile haemangioma with captopril.

BACKGROUND: Infantile haemangioma (IH) has recently been reported as an aberrant proliferation and differentiation of a primitive mesoderm-derived haemogenic endothelium regulated by the renin-angiotensin system (RAS), leading us to propose angiotensin converting enzyme (ACE) as a potential therapeutic target. OBJECTIVES: To present initial results of our open-labelled observational clinical trial using captopril, an ACE inhibitor (ACEi), in the treatment of problematic proliferating IH. METHODS: After initial screening investigations, infants with problematic IH were admitted for initiation of captopril with a 0·1 mg kg(-1) test dose orally, followed by 0·15 8-hourly over 24 h. This was then followed by dose escalation to 0·3 mg kg(-1) 8-hourly for another 24 hours. The dosage was increased to 0·5 mg kg(-1) 8-hourly 1 week later, if a noticeable involution had not already occurred. The response of IH to captopril was documented clinically and photographically before and after treatment and any side-effect was recorded. RESULTS: Two boys and six girls aged 5-22 weeks (mean 12·9) with problematic IH were recruited with the lesions located in nasal tip (n = 1), cervicofacial (n = 3), periorbital (n = 1) and perineal (n = 2) areas, and shoulder (n = 1). Transient mild renal impairment occurred in one subject but resolved spontaneously. No other complication was observed. The IHs in all patients responded to captopril at a dosage of 1·5 mg kg(-1) daily which led to a dramatic response in three, moderate response in two, and slow response in three patients. Continued involution of IHs was observed during the follow-up period of 8-19 months (mean 15·8) in all subjects. Treatment was ceased at 14 months of age in seven patients with no rebound growth. In the remaining patient, rapid healing occurred with ongoing gradual reduction in the size and colour of a large ulcerated retroauricular lesion following 5·5 months of treatment. The lesion was excised to address its persistent distortion of the ear. CONCLUSIONS: The response of IH to an ACEi supports a critical role for the RAS in IH and represents a paradigm shift in the understanding and treatment of this enigmatic condition.

Primitive erythropoiesis in infantile haemangioma.

UNLABELLED: BACKGROUND; Infantile haemangioma (IH) is a tumour of the microvasculature composed predominantly of proliferating endothelial cells. It expresses markers associated with endothelial, haematopoietic and mesenchymal lineages. We have previously shown that the cells forming the capillary endothelium of proliferating IH express cell surface markers and transcriptions factors consistent with it being a haemogenic endothelium. OBJECTIVES: We wished to determine whether the expression of transcription factors associated with the erythroid lineage was of physiological relevance and sufficient for IH tissue cultured in vitro to undergo erythropoiesis. METHODS: Immunohistochemical staining of paraffin-embedded sections of proliferating IHs was undertaken and expression of the embryonically associated haemoglobin ζ (HBZ) chain and the erythropoietin receptor (EPO-R) was determined. Relative expression of mRNA encoding these proteins was determined by quantitative reverse transcription-polymerase chain reaction using snap-frozen biopsy samples. Differentiation towards erythrocytes was investigated using freshly resected tissue cultured as explants in Matrigel. RESULTS: The endothelium of the microvessels, but not the pericyte layer, was strongly immunoreactive for the EPO-R and the embryonically associated HBZ chain. Abundant expression of transcripts encoding these proteins was also detected, corroborating the immunohistochemical staining. When tissue was grown in culture the cells emanating from IH explants were able to generate enucleated erythrocytes in vitro. The erythrocytes were immunoreactive for the erythrocyte-specific marker glycophorin A. CONCLUSIONS: The microvessels in IH are a functional haemogenic endothelium that expresses the embryonically associated HBZ chain and is able to form erythrocytes in vitro. IH thus represents a possible extramedullary site for tumour-associated primitive erythropoiesis.

Pretibial injury: key factors and their use in developing laboratory test methods.

Aims were to 1 characterize pretibial injuries and evaluate protection offered by garments/fabrics; and 2 develop a laboratory test to determine the potential protection provided by such fabrics. Most (>85%) of 75 patients treated for pretibial injury at Hutt Hospital, New Zealand sustained injury to one site and required surgery. Injuries were typically grade 3 or 4, 10-250 mm wide 30-350 mm long, and at the mid- to lower third of the tibia. The severity grade was lower when at least one fabric layer covered the site, slightly lower again with more than one layer, and when a knitted fabric/garment was worn, and a trouser type garment. Laboratory test methods and their application reflected these known variables. The force transmitted through multiple fabric layers was less then through one layer: thick pantyhouse and either denim or fabrics used in 'sweat pants' would minimize transmitted force and maximize impulse.

Cerebral oximetry in cardiac surgery.

There is a need for monitoring of cerebral perfusion during cardiac surgery to reduce neurological complications. Cerebral perfusion is a major factor for regional and global imbalance in oxygen supply-demand, which may result in brain injury following cardiac surgery. Cerebral oximetry (near infrared spectroscopy) is a means to monitor regional cerebral perfusion. It was developed as a non-invasive technology, similar to pulse oximetry, for the continuous assessment of cerebral blood flow. Published studies have demonstrated that the use of cerebral oximetry reduces both postoperative cognitive impairment and the length of hospital stay.

Parotid metastasis--an independent prognostic factor for head and neck cutaneous squamous cell carcinoma.

BACKGROUND: Metastatic parotid cutaneous squamous cell carcinoma (SCC) is the most common parotid gland malignancy in New Zealand and Australia. The current AJCC TNM staging system does not account for the extent of nodal metastasis. A staging system that separates parotid (P stage) from neck disease (N stage) has been proposed recently. AIM: To review the outcome of patients with metastatic head and neck cutaneous SCC treated at our multidisciplinary Head and Neck Service using the proposed staging system. METHOD: Consecutive patients were culled from our Head and Neck/Skull Base Database, 1990-2004. These patients were restaged according to the proposed staging system: P stage: P0 = no disease in the parotid (i.e., neck disease only); P1 = metastatic node < or = 3 cm; P2=metastatic node > 3 cm and < or =6 cm, or multiple nodes; and P3 = metastatic node > 6 cm, or disease involving the facial nerve or skull base. N stage: N0=no disease in the neck (i.e., parotid disease only); N1 = single ipsilateral metastatic node < or = 3 cm; and N2 = multiple metastatic nodes, or any node > 3 cm, or contralateral neck involvement. Loco-regional recurrence and disease-specific survival were calculated using the Kaplan-Meier method and comparison of graphs made with the log-rank test. Multivariate analysis using the Cox regression model was carried out to assess the impact of various parameters. RESULTS: Sixty-seven patients with metastatic head and neck cutaneous SCC were identified. Thirty-seven patients had parotid metastasis (of whom 13 also had neck disease) while 21 had neck metastasis alone. Nine patients had dermal or soft tissue metastasis. These nine patients were excluded from this series, and data analysis was carried out on the remaining 58 (46 men, 12 women, mean age 71 years) patients. Sixty-seven percent of the patients underwent post-operative adjuvant radiotherapy. The five-year disease-specific survival rate was 54%. Among 56 patients followed up to disease recurrence or for a minimum period of 18 months, the loco-regional recurrence rate was 52%. The presence of parotid disease was an independent prognostic factor on survival (p < 0.01), and P3 fared significantly worse than P1 and P2. Those patients who had both parotid and neck disease fared worse than those who had parotid or neck disease alone (p = 0.01). N2 had a significantly poorer outcome compared with N1 (p < 0.01). Immunosuppression (p = 0.01) and a positive surgical margin (p < 0.01) were significant adverse prognostic factors for survival. Adjuvant radiotherapy, extracapsular spread, and perineural and vascular invasion did not influence survival. Our study demonstrates that the extent of parotid disease is an independent prognostic factor for metastatic head and neck cutaneous SCC.

Malignant peripheral nerve sheath tumour of the cervical vagus nerve in a neurofibromatosis type 1 patient.

One serious complication of neurofibromatosis type 1 (NF1) is the development of malignant peripheral nerve sheath tumours (MPNSTs). These malignancies often develop within pre-existing plexiform neurofibromas and their development is now thought to be associated with both tumour suppressor gene mutations and dysregulated growth factor signalling. Recent work demonstrates that the lifetime risk of malignant transformation is significantly greater than previously thought. Ionising radiation, a long-standing disease, particularly the presence of a large number of plexiform neurofibromas from an early age, are suggested risk factors. We present an NF1 patient who developed an MPNST of the cervical vagus nerve which was successfully treated with surgery. Close monitoring of patients with NF and a high level of suspicion towards rapidly enlarging and painful swellings is merited as these features may signify malignant transformation. Whether a positive history of MPNST in other affected family members predisposes the individual to a higher risk of malignant transformation is unclear.

The clinical implication of the vocal cords-carina distance in anaesthetized Chinese adults during orotracheal intubation.

BACKGROUND: Previous studies have identified no strong correlation between patients' height and tracheal length in anaesthetized patients. We have attempted to compare vocal cords-carina distance (VCD) in Chinese patients with the dimensions of five commonly used tracheal tubes. In addition, we attempted to find a surface anatomy measurement that would identify patients with 'short tracheas'. METHODS: We measured VCD in 130 anaesthetized Chinese patients with a fibreoptic bronchoscope. Also measurements were obtained of the distal ends of five commonly used tracheal tubes. We undertook various surface anatomy measurements on the patients' chest and neck region to predict those patients with short tracheas. RESULTS: VCD averaged 12.6 (SD 1.4) cm. In seven patients (5%) this distance was particularly short (between 8.8 and 10.4 cm). Many of the commonly used tracheal tubes would be placed close to or beyond the carina when the black intubation guide mark(s) is (are) at the level of the vocal cords. The VCD of