Perioperative Management of a Rare Pancreatic Insulinoma Resection: Anaesthetic Challenge!

Insulinoma is a rare, mostly benign and solitary neuroendocrine tumour of the β-cells of islets of langerhans of pancreas. Clinically it presents with a classical ‘Whipple Triad’ encompassing symptomatic hypoglycemia, fasting hypoglycemia (<50 mg/dl) and immediate relief of symptoms after glucose administration. Definitive treatment is laparoscopic or open surgical excision of the tumour. We report and discuss the distinctive anaesthetic considerations and implications during perioperative period. A comprehensive approach including preoperative optimization of blood glucose levels with various drugs and dietary modifications, scrupulous hemodynamic and blood sugar monitoring with prompt initiation of dextrose infusion during surgical handling of tumour and meticulous management of rebound hyperglycemia with insulin infusion in postoperative period remains the essence for better outcome in these subset of patients.

Gyrate Atrophy of the Choroid and Retina: A Review

Gyrate atrophy (GA) of the choroid and retina is a rare autosomal recessive genetic condition characterized by elevation of the plasma level of the amino acid ornithine due to deficiency of the enzyme ornithine ketoacid aminotransferase. Accumulation of ornithine occurs in various body tissues but leads primarily to characteristic ophthalmic manifestations including myopia, cataract, progressive chorioretinal atrophy, and macular changes. Patients usually present with night blindness that starts in the first decade of life followed by visual field constriction and eventually diminution of the central visual acuity and blindness. The condition has been reported worldwide and its differential diagnosis is broad and includes choroideremia and retinitis pigmentosa. Treatment currently depends on life-long dietary modifications including restriction of the amino acid arginine in diet. This article describes in detail the pathogenesis, clinical features, multimodal imaging findings, and treatment options for GA of the choroid and retina and its complications.

Traditional practices in post-partum care among Indonesian and Filipino mothers: a comparative study

This study was conducted to assess the traditional practices in post-partum care among Indonesian and Filipino mothers to propose a program to improve maternal and child health. The study utilized a descriptive research design for Indonesian mother respondents (n=110) and Filipino mother-respondents (n=119) conveniently selected. Traditional practices on post-partum care focused on hygienic care, behavioral precautions, breastfeeding, baby care; dietary modifications; and physical activities. Descriptive statistics (frequency and percentage), weighted mean, and independent t-test were used to describe and analyze quantitative information. Four dimensions, including hygienic care (p-value 0.038); breastfeeding and baby care (p-value 0.000); dietary modifications (p-value 0.000); and physical activities (p-value 0.000), showed a statistically significant difference in the assessment of mother respondents on their traditional practices in post-partum care. Meanwhile, the dimension on behavioral precautions (p-value 0.250) yielded statistically no significant difference on the assessment of mother respondents on their traditional practices in post-partum care. Four dimensions, including hygienic care (p-value 0.038); breastfeeding and baby care (p-value 0.000); dietary modifications (p-value 0.000); and physical activities (p-value 0.000), showed a statistically significant difference in the assessment of mother respondents on their traditional practices in post-partum care. Meanwhile, the dimension on behavioral precautions (p-value 0.250) yielded statistically no significant difference on the assessment of mother respondents on their traditional practices in post-partum care]

Impact of Dietary Modifications on Plasma Sirtuins 1, 3 and 5 in Older Overweight Individuals Undergoing 12-Weeks of Circuit Training

Sirtuins are nicotinamide adenine dinucleotide (NAD+)-dependent deacetylases that regulate numerous pathways such as mitochondrial energy metabolism in the human body. Lower levels of these enzymes were linked to diseases such as diabetes mellitus and were also described as a result of aging. Sirtuins were previously shown to be under the control of exercise and diet, which are modifiable lifestyle factors. In this study, we analyzed SIRT1, SIRT3 and SIRT5 in blood from a subset of healthy elderly participants who took part in a 12-week randomized, controlled trial during which they performed, twice-weekly, resistance and aerobic training only (EX), the exercise routine combined with dietary counseling in accordance with the guidelines of the German Nutrition Society (EXDC), the exercise routine combined with intake of 2 g/day oil from Calanus finmarchicus (EXCO), or received no treatment and served as the control group (CON). In all study groups performing exercise, a significant increase in activities of SIRT1 (EX: +0.15 U/mg (+0.56/−[−0.16]), EXDC: +0.25 U/mg (+0.52/−0.06), EXCO: +0.40 U/mg (+0.88/−[−0.12])) and SIRT3 (EX: +0.80 U/mg (+3.18/−0.05), EXDC: 0.95 U/mg (+3.88/−0.55), EXCO: 1.60 U/mg (+2.85/−0.70)) was detected. Group comparisons revealed that differences in SIRT1 activity in EXCO and EXDC differed significantly from CON (CON vs. EXCO, p = 0.003; CON vs. EXDC, p = 0.010). For SIRT3, increases in all three intervention groups were significantly different from CON (CON vs. EX, p = 0.007; CON vs. EXDC, p < 0.001, CON vs. EXCO, p = 0.004). In contrast, differences in SIRT5-activities were less pronounced. Altogether, the analyses showed that the activity of SIRT1 and SIRT3 increased in response to the exercise intervention and that this increase may potentially be enhanced by additional dietary modifications.

Changes in serum and urinary metabolomic profile after a dietary intervention in patients with irritable bowel syndrome

Background Irritable bowel syndrome (IBS) is a multi-faceted gastrointestinal disorder where food intake often triggers symptoms. Metabolomics may provide mechanistical insights to why responses to dietary modifications are diverse. Objective This study aimed to identify metabolite patterns related to dietary intake in patients with IBS, and to identify metabolites driving the separation between responders and non-responders to treatment. Methods Participants were randomized to a low fermentable oligo-, di-, monosaccharide and polyol (FODMAP) diet (LFD) or traditional IBS diet (TID) for four weeks. Fasting serum and urine samples pre- and post-intervention were analyzed using 1H nuclear magnetic resonance (NMR) metabolomics. Response to treatment was defined as a reduction in IBS severity scoring system (IBS-SSS) ≥50. Results Twenty-five individuals in the LFD (13 responders) and 28 in the TID (14 responders) were included in these post hoc analyses. In endpoint samples, significant decreases in polyols and glucose were seen in the LFD. Post-intervention samples revealed that LFD responders had significantly increased levels of 2-hydroxybuturate and decreased levels of glucose and pantothenic acid compared to non-responders. For the TID, only weak multivariate models were identified and a larger diversity in metabolite response compared to the LFD were noted. Conclusions In this study, metabolite patterns between individuals who responded well to an LFD compared to non-responders could be distinguished. This provides new hypotheses for mechanistic actions related to response to dietary modifications, but the results need to be validated in larger cohorts. Clinical trial registration This trial was registered at www.clinicaltrials.gov, registry number NCT02107625.

Barriers to dietary modifications for people living with type 2 diabetes in a rural indigenous Guatemalan community

In Guatemala, the prevalence of diabetes continues to increase with a disproportionate burden falling on indigenous rural communities. In this study, we assessed barriers to making dietary modifications for people living with type 2 diabetes in a rural indigenous Guatemalan population. Structed interviews (n=32) were conducted with participants selected from a convenience sample of adults with type 2 diabetes living in villages in and around San Lucas Tolimán, Guatemala. Frequencies were calculated for closed-ended questions and content analysis was used to evaluate open-ended questions. Most participants (81%) were women with low-levels of formal education and average daily food expenditure of just over $1 USD. The majority of participants were able to identify foods important in a diabetic diet, however, with significant barriers to making dietary modifications. Commonly cited perceived barriers included high costs of food due to travel and storage, inadequate local access to fresh fruits and vegetables and incompatibility with traditional diet. Several structural and cultural barriers exist to prevent dietary modifications for people living with type 2 diabetes in this rural indigenous population.

Symbiotic bacterial community of Drosophila melanogaster changes with nutritional modifications of the diet but can alleviate negative effects on larval phenotypes

ABSTRACTObesity is an increasing pandemic and is caused by multiple factors including genotype, psychological stress, and gut microbiota. Our project investigated the effects produced by high fat and high sugar dietary modifications on microbiota and metabolic phenotype of Drosophila melanogaster. Larvae raised on the high fat and high sugar diets exhibited bacterial communities that were compositionally and phylogenetically different from bacterial communities of the larvae raised on normal diets, especially if parental microbiota were removed. Several of the dominant bacteria taxa that are commonly associated with high fat and high sugar diets across model organisms and even human populations showed similar pattern in our results. Corynebacteriaceae and Erysipelotrichaceae were connected with high fat food, while Enterobacteriaceae and Lactobacillaceae were associated with high sugar diets. In addition, we observed that presence of symbiotic microbiota often mitigated the effect that harmful dietary modifications produced on larvae, including elevated triglyceride concentrations and was crucial for Drosophila survival, especially on high sugar peach diets.

Wait-there’s evidence for that? Integrative medicine treatments for major depressive disorder

Depression is one of the most common mental health disorders and currently affects over 17 million Americans. Up to two-thirds of patients with depression in the United States will seek complementary and alternative or integrative medical treatments and thus medical providers who treat depression should understand that many integrative medical treatments have evidence of efficacy either as monotherapies or as add-on adjuncts to other treatments. This review references guidelines from the Canadian Network for Mood and Anxiety Treatments and Michigan Medicine, along with an updated literature review, to provide a framework for reviewing medications or herbal formulation, as well as other therapies, which have evidence in the treatment of depression. In general, St. John’s Wort, Omega-3 Fatty Acids, S-adenosyl-L-methionine, and crocus sativus (saffron) have the highest levels of evidence in the treatment of mild-to-moderate depression. Acetyl-l-carnitine, l-methylfolate, DHEA, and lavender have a moderate level of evidence in treating depression, whereas Vitamin D, one of the most common supplements in the United States, does not have evidence in treating depression. Of the non-medication-based therapies, exercise, light therapy, yoga, acupuncture, and probiotics have evidence in the treatment of depression, whereas a full review of dietary modifications for depression was out of scope for this article.

A Study on the Effect of Dietary Modifications in decreasing or delaying Radiation Induced Acute Gastrointestinal Adverse Events in patients receiving Pelvic Radiotherapy

Ionizing radiotherapy is a very common treatment modality for various types of cancer. However, its uses are expected to increase drastically with several advances in screening as well as early detection of cancer. Radiation injury due to radiation to the gastrointestinal tract is an imperative factor that works against better utility of this critical treatment modality. Moreover, following radiotherapy there are a higher chances of acute as well as chronic symptoms that would significantly reduce the quality of life of patients and furthermore adding an extra burden to the patients in terms of cost of healthcare. Thus interventions to reduce these adverse events can have long term benefits. Acute radiation induced gastrointestinal adverse events can be managed by modification of diet. Dietary modification of fat, lactose or non-starch polysaccharides (fibre) or combination of these dietary modifications reduces acute gastrointestinal adverse events during radiotherapy. In our study, we observed patients diagnosed with prostate and rectal cancer and those patients receiving neo adjuvant chemo-radiotherapy of rectum. The patients were advised to follow certain dietary modifications which aid in controlling the acute gastrointestinal side effects that developed after exposing to radiation therapy. The patients were followed up on a weekly basis and recorded the severity of the gastro intestinal symptoms after each cycle of radiation therapy and the quality of life was also calculated. Our study demonstrates that the dietary intervention appears to be a promising treatment option to control these adverse events. The dietary restriction of fat, fibre and lactose also helped in reducing the grades of adverse events during the radiotherapy. The Quality of Life of patients, however, after radiotherapy was found to be decreased when compared to the baseline.

Dietary Modifications during Pregnancy through Decades

The present study aimed to explore the modifications in diet during pregnancy over three generations in the Garhwal region of Uttarakhand. For the selection of the sample, the respondents were categorized in 3 age groups: 20 to 34 years; 35 to 55 years; and ≥ 56 years. Structured diet recall interviews were scheduled for the collection of data. The subjects were asked about their dietary habits during pregnancy and food items that they included and excluded during that period. Most food items mentioned included were milk, fruits, and nutritional supplements. The exclusion of fruits like banana and papaya, of rice, and of leafy green vegetables (LGVs) was mainly observed. Among the age group of ≥ 56 years, the respondents with no changes in their diet during pregnancy were more from rural areas (92%) than from urban areas (62.26%), while in the age group of 20 to 34 years, 25% of the respondents with no change in their diet lived in rural areas, and 8.06% lived in urban areas. There has been an increase in the population with dietary modifications through generations; however, the overall changes are still not satisfying. The present study shows that there is a high need for nutritional education during pregnancy, especially in rural areas.