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Objective: To study the possible association between invasive fungal sinusitis (mucormycosis) and coronavirus disease. Methods: A prospective observational study was conducted at a tertiary care centre over four months, involving all patients with mucormycosis of the paranasal sinuses suffering from or having a history of coronavirus disease infection. Results: Twenty-three patients presented with mucormycosis, all had an association with coronavirus disease 2019. The ethmoids (100 per cent) were the most common sinuses affected. Intra-orbital extension was seen in 43.47 per cent of cases, while intracranial extension was only seen in 8.69 per cent. Diabetes mellitus was present in 21 of 23 cases, and was uncontrolled in 12 cases. All patients had a history of steroid use during their coronavirus treatment. Conclusion: New manifestations of coronavirus disease 2019 are appearing over time. The association between coronavirus and mucormycosis of the paranasal sinuses must be given serious consideration. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness, and both of these must be properly checked. [ABSTRACT FROM AUTHOR]

Background The association of smokeless tobacco (SLT) with stroke has been dealt with in only a few reviews. The present meta-analysis aims to present the updated comprehensive summary risk of stroke in adult SLT users along with sub group analysis. Methods A systematic literature search for articles evaluating risk of stroke in SLT users was conducted. The study characteristics and risk estimates were extracted independently by two authors (RG and SG). Random-effect model was used to estimate the summary relative risks. Results The overall risk of stroke in SLT users was found to be significantly higher (1.17, 95% CI 1.04–1.30) compared to non-users, especially for users in Southeast Asian region. The results remained unchanged even after strict adjustment for smoking (1.18, 95% CI 1.04–1.32). SLT users had 13.4 times higher risk of fatal stroke, though risk of nonfatal stroke was not enhanced. Significantly higher risk of stroke was seen in users of chewing tobacco (1.35, 95% CI 1.20–1.50) in comparison to non-chewers. Gender-based analysis showed enhanced risk of fatal stroke in both male and female users. SLT-attributable fraction of fatal stroke was highest for India at 14.8%. Conclusion The significant higher risk of stroke with SLT use, even after adjustment for smoking, emphasizes the imperative need to include SLT cessation advice for control and prevention of stroke. [ABSTRACT FROM AUTHOR]

Background: Recent media reports on human studies associating brominated flame retardants (BFRs) in household products in pregnancy with urogenital anomalies in boys and endocrine disruption in both sexes. We sought to explore the perceptions of pregnant women of brominated flame retardant (BFR) exposure, in light of recent media reports on the adverse health effects of BFR exposure prenatally. Methods: Pregnant women were recruited for interviews through posters and pamphlets in prenatal clinics, prenatal fairs and community centres. Interviews were audiotaped and transcribed verbatim for Charmaz-based qualitative analysis supported by NVIVO 10™. Results: Theoretical sufficiency was reached after analyzing the interviews of 23 pregnant women. Themes co-constructed were: I-Lack of Awareness of BFRs; II-Factors Influencing BFR Exposure; III-Responsibility; IV-Informed Choice. Almost all participants felt it was difficult to make informed choices to avoid BFRs, and wanted communication from clinicians and regulation from governments regarding decreasing BFR exposure. Conclusion: Pregnant women in Canada may be unaware of the potential risks of exposure to BFRs. Professional organizations and governments should further study risk associated with BFR exposure in pregnancy and provide educational materials for pregnant women and clinicians regarding BFR exposure. [ABSTRACT FROM AUTHOR]

Internal jugular (IJ) catheter insertion for hemodialysis (HD) is an indispensable procedure in the management of patients with renal failure. The central approach is favored over posterior approach to insert IJ catheters. There are no studies comparing the outcomes between the two approaches. The aim of this study was to compare central approach with posterior approach for IJ HD catheter insertion and to analyze various outcomes like procedure-related complication rates, catheter insertion failure rates, interruptions during dialysis due to blood flow obstruction and catheter infection rates between the two methods among patients receiving HD. All patients requiring IJ HD catheter insertion during a 1-month period were randomly assigned to undergo catheter insertion via either conventional central approach or posterior approach. Patients were followed-up till the removal of the catheter. Among 104 patients included in the study, 54 were assigned to the central approach group and 50 to the posterior approach group. The central approach group had higher rate of procedure-related complications (14.81% vs. 6%, P= 0.04). Catheter insertion failure rates were marginally higher in posterior approach group (20% vs. 12.96%, P= 0.07). One or more instance of interruption during HD due to obstruction in blood flow was more common in posterior approach (46% vs. 9.25%, P< 0.01). Catheter infection rates were similar between the two groups; 16.66% (n = 9) in central group vs. 14% (n = 7) in posterior group. Posterior approach is a reasonable alternative to conventional central approach in IJ cannulation for HD catheter. It is, however, associated with a significantly high rate of interruption in HD blood flow and catheter insertion failure rates. The posterior approach can be used in patients with local exit site infection or in failed attempts to cannulate IJ vein via the conventional central approach. [ABSTRACT FROM AUTHOR]

Background: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%), blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 x 105/mm³ on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student 't' test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84) donors had coagulopathy on second day (mean INR 1.9 ± 0.42). Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5. [ABSTRACT FROM AUTHOR]

The chemical, bioactive, and antioxidant potential of twenty wild culinary mushroom species being consumed by the people of northern Himalayan regions has been evaluated for the first time in the present study. Nutrients analyzed include protein, crude fat, fibres, carbohydrates, and monosaccharides. Besides, preliminary study on the detection of toxic compounds was done on these species. Bioactive compounds evaluated are fatty acids, amino acids, tocopherol content, carotenoids (β-carotene, lycopene), flavonoids, ascorbic acid, and anthocyanidins. Fruitbodies extract of all the species was tested for different types of antioxidant assays. Although differences were observed in the net values of individual species all the species were found to be rich in protein, and carbohydrates and low in fat. Glucose was found to be the major monosaccharide. Predominance of UFA (65–70%) over SFA (30–35%) was observed in all the species with considerable amounts of other bioactive compounds. All the species showed higher effectiveness for antioxidant capacities. [ABSTRACT FROM AUTHOR]

Background Traditionally, the Arctic diet has been derived entirely from locally harvested animal and plant species; however, in recent decades, imported foods purchased from grocery stores have become widely available. The present study aimed to examine Inuvialuit, traditional or nontraditional dietary patterns; nutrient density of the diet; dietary adequacy; and main food sources of energy and selected nutrient intakes. Methods This cross-sectional study used a culturally appropriate quantitative food frequency questionnaire to assess diet. Traditional and nontraditional eaters were classified as those consuming more or less than 300 g of traditional food daily. Nutrient densities per 4184 kJ (1000 kcal) were determined. Dietary adequacy was determined by comparing participants' nutrient intakes with the Dietary Reference Intakes. Results The diet of nontraditional eaters contained, on average, a lower density of protein, niacin, vitamin B12, iron, selenium, zinc, omega-3 fatty acids ( P ≤ 0.0001), vitamin B6, potassium, thiamin, pantothenic acid ( P ≤ 0.001), riboflavin and magnesium ( P ≤ 0.05). Inadequate nutrient intake was more common among nontraditional eaters for calcium, folate, vitamin C, zinc, thiamin, pantothenic acid, vitamin K, magnesium, potassium and sodium. Non-nutrient-dense foods (i.e. high fat and high sugar foods) contributed to energy intake in both groups, more so among nontraditional eaters (45% versus 33%). Traditional foods accounted for 3.3% and 20.7% of total energy intake among nontraditional and traditional eaters, respectively. Conclusions Diet quality and dietary adequacy were better among Inuvialuit who consumed more traditional foods. The promotion of traditional foods should be incorporated in dietary interventions for this population. [ABSTRACT FROM AUTHOR]

Objectives The risks and benefits of initiating antiretroviral treatment ( ART) at high CD4 cell counts have not been reliably quantified. The Strategic Timing of AntiRetroviral Treatment ( START) study is a randomized international clinical trial that compares immediate with deferred initiation of ART for HIV-positive individuals with CD4 cell counts above 500 cells/μL. We describe the demographics, HIV-specific characteristics and medical history of this cohort. Methods Data collected at baseline include demographics, HIV-specific laboratory values, prior medical diagnoses and concomitant medications. Baseline characteristics were compared by geographical region, gender and age. Results START enrolled 4685 HIV-positive participants from 215 sites in 35 countries. The median age is 36 years [interquartile range ( IQR) 29-44 years], 27% are female, and 45% self-identify as white, 30% as black, 14% as Latino/Hispanic, 8% as Asian and 3% as other. The route of HIV acquisition is reported as men who have sex with men in 55% of participants, heterosexual sex in 38%, injecting drug use in 1% and other/unknown in 5%. Median time since HIV diagnosis is 1.0 year ( IQR 0.4-3.0 years) and the median CD4 cell count and HIV RNA values at study entry are 651 cells/μL ( IQR 584-765 cells/μL) and 12 754 HIV RNA copies/mL ( IQR 3014-43 607 copies/mL), respectively. Conclusions START has enrolled a diverse group of ART-naïve individuals with high CD4 cell counts who are comparable to the HIV-positive population from the regions in which they were enrolled. The information collected with this robust study design will provide a database with which to evaluate the risks and benefits of early ART use for many important outcomes. [ABSTRACT FROM AUTHOR]

Objectives The Strategic Timing of AntiRetroviral Treatment ( START) trial has recruited antiretroviral-naïve individuals with high CD4 cell counts from all regions of the world. We describe the distribution of cardiovascular disease ( CVD) risk factors, overall and by geographical region, at study baseline. Methods The distribution of CVD risk factors was assessed and compared by geographical region among START participants who had a baseline electrocardiogram ( n = 4019; North America, 11%; Europe/ Australia/ Israel, 36%; South America, 26%; Asia, 4%; Africa, 23%; median age 36 years; 26% female). Results About 58.3% ( n = 2344) of the participants had at least one CVD risk factor and 18.9% ( n = 761) had two or more. The most common CVD risk factors were current smoking (32%), hypertension (19.3%) and obesity (16.5%). There were significant differences in the prevalence of CVD risk factors among geographical regions. The prevalence of at least one risk factor across regions was as follows: North America, 70.0%; Europe/ Australia/ Israel, 65.1%; South America, 49.4%; Asia, 37.0%; Africa, 55.8% ( P-value < 0.001). Significant regional differences were also observed when risk factors were used as part of the Framingham and Data Collection on Adverse events of Anti- HIV Drugs ( D: A: D) risk scores or used to define a favourable risk profile. Conclusions CVD risk factors are common among START participants, and their distribution varies by geographical region. Better understanding of how and why CVD risk factors develop in people with HIV infection and their geographical distributions could shed light on appropriate strategies for CVD prevention and may inform the interpretation of the results of START, as CVD is expected to be a major fraction of the primary endpoints observed. [ABSTRACT FROM AUTHOR]

Objectives Efforts are needed to improve informed consent of participants in research. The Strategic Timing of AntiRetroviral Therapy ( START) study provides a unique opportunity to study the effect of length and complexity of informed consent documents on understanding and satisfaction among geographically diverse participants. Methods Interested START sites were randomized to use either the standard consent form or the concise consent form for all of the site's participants. Results A total of 4473 HIV-positive participants at 154 sites world-wide took part in the Informed Consent Substudy, with consent given in 11 primary languages. Most sites sent written information to potential participants in advance of clinic visits, usually including the consent form. At about half the sites, staff reported spending less than an hour per participant in the consent process. The vast majority of sites assessed participant understanding using informal nonspecific questions or clinical judgment. Conclusions These data reflect the interest of START research staff in evaluating the consent process and improving informed consent. The START Informed Consent Substudy is by far the largest study of informed consent intervention ever conducted. Its results have the potential to impact how consent forms are written around the world. [ABSTRACT FROM AUTHOR]

Objectives HIV-1 transmitted drug resistance ( TDR) in treatment-naïve individuals is a well-described phenomenon. Baseline genotypic resistance testing is considered standard of care in most developed areas of the world. The aim of this analysis was to characterize HIV-1 TDR and the use of resistance testing in START trial participants. Methods In the Strategic Timing of Anti Retroviral Treatment ( START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based on a modified 2009 World Health Organization definition to reflect newer resistance mutations. Results Baseline resistance testing was available in 1946 study participants. Higher rates of testing occurred in Europe (86.7%), the USA (81.3%) and Australia (89.9%) as compared with Asia (22.2%), South America (1.8%) and Africa (0.1%). The overall prevalence of TDR was 10.1%, more commonly to nonnucleoside reverse transcriptase inhibitors (4.5%) and nucleoside reverse transcriptase inhibitors (4%) compared with protease inhibitors (2.8%). The most frequent TDR mutations observed were M41L, D67 N/ G/ E, T215 F/ Y/ I/ S/ C/ D/ E/ V/ N, 219 Q/ E/ N/ R, K103 N/ S, and G190 A/ S/ E in reverse transcriptase, and M46 I/L and L90 M in protease. By country, the prevalence of TDR was highest in Australia (17.5%), France (16.7%), the USA (12.6%) and Spain (12.6%). No participant characteristics were identified as predictors of the presence of TDR. Conclusions START participants enrolled in resource-rich areas of the world were more likely to have baseline resistance testing. In Europe, the USA and Australia, TDR prevalence rates varied by country. [ABSTRACT FROM AUTHOR]

Background South Africa is experiencing a dietary and lifestyle transition as well as increased rates of noncommunicable chronic diseases. Limited information is available on the diets of rural populations. The present study aimed to characterise the diets of men and women from rural Kwa Zulu- Natal ( KZN) and develop a quantitative food-frequency questionnaire ( QFFQ) specific for this population. Methods A cross-sectional study was carried out by collecting single 24-h dietary recalls from 81 adults and developing a QFFQ in Empangeni, KZN, South Africa. Results The diet of this population was limited in variety, high in plant-based foods (especially cereals and beans), and low in animal products, vegetables and fruits. Amaize meal staple ( Phutu) was consumed by over 80% of subjects and accounted for almost 45% of energy intake, as well as making an important contribution to fat and protein intake. Most of the protein consumed by the study population was plant-based protein, with almost 40% being obtained from the consumption of phutu and beans. A culturally appropriate QFFQ was developed that includes 71 food and drink items, of which 16 are composite dishes unique to this population. Conclusions Once validated, this QFFQ can be used to monitor diet-disease associations, evaluate nutritional interventions and investigate dietary changes in this population. [ABSTRACT FROM AUTHOR]

Aims The Ipswich Touch Test is a novel method to detect subjects with diabetes with loss of foot sensation and is simple, safe, quick, and easy to perform and teach. This study determines whether it can be used by relatives and/or carers to detect reduced foot sensation in the setting of the patient's home. Methods The test involves lightly and briefly (1-2 s) touching the tips of the first, third and fifth toes of both feet with the index finger. Reduced foot sensation was defined as ≥ 2 insensate areas. Patients due to attend clinic over a 4-week period were invited by post. The invitation contained detailed instructions and a sheet for recording the results. The findings were compared with those obtained in clinic using the 10-g monofilament at the same six sites. Results Of 331 patients (174 males), 25.1% ( n = 83) had ≥ 2 insensate areas to 10-g monofilament testing. Compared with this, the Ipswich Touch Test at home had a sensitivity of 78.3% and a specificity of 93.9%. The predictive values of detecting 'at-risk' feet were positive at 81.2% and negative at 92.8%. The likelihood ratios were positive at 12.9 and negative at 0.23. Conclusions With clearly written instructions, this simple test can be used by non-professionals to accurately assess for loss of protective sensation. We believe that the Ipswich Touch Test may also be a useful educational adjunct to improve awareness of diabetes foot disease in patients and relatives alike and empower them to seek appropriate care if sensation was found to be abnormal. [ABSTRACT FROM AUTHOR]

Objectives:To analyse the aetiological profile and surgical results of patients with acquired chronic subglottic stenosis, and formulate a surgical scheme based on an audit of various surgical procedures.Methods:Thirty patients were treated by 65 procedures (31 endoscopic and 34 external) between 2004 and 2009.Results:Isolated subglottic stenosis was noted as unusual in the majority (27 cases), demonstrating contiguous tracheal or glottic involvement. The major aetiologies were intubation injury (n = 8) and external injury (n = 21) (i.e. blunt trauma, strangulation or penetrating injury). Vocal fold immobility and cartilage framework involvement were frequent with external injury and infrequent with intubation injury. Luminal restoration was achieved by endoscopic procedures in 2 cases, external procedures in 19 cases, and external plus adjuvant endoscopic procedures in 8 cases. The preferred surgical options were: endoscopic procedures, restricted to short, recent, grade I or II mucosal stenosis cases; and external procedures for all other stenosis situations, including isolated subglottic (anterior cricoid split plus cartilage graft), subglottic and glottic or high subglottic (anterior plus posterior cricoid split with cartilage graft), and subglottic and tracheal (cricotracheal resection with anastomosis).Conclusions:External injury stenosis has a worse profile than intubation injury stenosis. Anatomical categorisation of subglottic stenosis guides surgical procedure selection. Endoscopic procedures have limited indications as primary procedures but are useful adjunctive procedures. [ABSTRACT FROM PUBLISHER]

Background: Pelvic osteosarcoma is a rare and aggressive malignant neoplasm with poor outcomes. It represents only 5% of all osteosarcomas. The authors present our institute's experience in management and outcomes of five successive patients of pelvic osteosarcoma. Materials and Methods: We retrospectively reviewed five patients of pelvis osteosarcoma treated in our institute from September 2008 to December 2010. Clinical characteristics and treatment (CCT) modality in form of surgery and chemotherapy were noted. Statistical analysis was done with regards to progression-free survival (PFS) using Kaplan-Meier survival analysis. Results: The median age of the patients was 16.0 years. The median duration of symptoms was 9 months. One patient had lung metastases at presentation. All patients received systemic chemotherapy. One patient underwent surgery in the form of limb sparing approach. Three patients had partial response to treatment, one had complete response, and one had progressive disease. Median duration of PFS was 7 months only. Conclusions: Pelvic osteosarcomas are rare neoplasms with aggressive growth patterns. Survival results are poor in view of advanced stage of presentation and difficult surgical approaches. The combined modality approach is needed to improve the results. [ABSTRACT FROM AUTHOR]

Background We aimed to develop tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages for African American and Latino children living in inner-city communities. Methods A total of 112 children, aged 8-11 years, identified by a parent as being either African-American or Latino, were recruited and administered questionnaires. Internal consistency, a measure of reliability, was assessed by calculating the Cronbach's alpha of test scores. Results Cronbach's alpha exceeded the threshold of acceptability of 0.70 for the Authors' Vegetables Self-Efficacy Index, and all three Low-Sugar Self-Efficacy Indices, including the Reference Index, the Authors' Low-Sugar Food and Beverage Index, and the Low-Sugar Beverages Index. Conclusions We present internally consistent tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages in 8-11-year-old African-American and Latino children from low socio-economic communities. [ABSTRACT FROM AUTHOR]

Background Healthy Foods North ( HFN) is a community-based intervention designed to promote a healthy diet and lifestyle of Inuit and Inuvialuit populations in Arctic Canada. The objective of the present study was to determine the effects of HFN on the nutrient intake of women of childbearing age. Methods Six communities in Nunavut ( n = 3) and the Northwest Territories ( n = 3) were selected for programme implementation; four received a 12-month intervention and two served as controls. Quantitative food frequency questionnaires were used to assess dietary intake at baseline and 1 year post-intervention. Among women participants aged 19-44 years ( n = 136), 79 were exposed to the intervention and 57 were not. Mean daily energy and nutrient intake and density were determined. Dietary adequacy was assessed by comparing the women's daily nutrient intakes with dietary reference intakes ( DRI). Results Main outcomes were the pre- to post-intervention changes between intervention and control groups for energy and selected nutrient intakes, nutrient density and dietary adequacy. Among the participants, the intervention had a beneficial effect on vitamin A and D intake. The percentage of individuals with nutrient intakes below the DRI increased from pre- to post-intervention for vitamin A and D in the control group but only for vitamin A in the intervention group. The programme did not have a significant impact on calorie, sugar, or fat consumption. Conclusions The HFN programme is effective in mitigating some of the negative impacts of the nutrition transition on dietary adequacy among Inuit and Inuvialuit women of childbearing age. [ABSTRACT FROM AUTHOR]

Background Inuit in Nunavut, Canada, are currently undergoing a nutritional transition that may contribute to an increased prevalence of chronic disease. Information is lacking about the extent to which contemporary Inuit diets are meeting current dietary recommendations. Methods A culturally appropriate quantitative food frequency questionnaire ( QFFQ) developed and validated for Inuit in Nunavut, Canada, was used to assess food and nutrient intake in a cross-sectional sample of adults. Results Participants included 175 women and 36 men with mean (SD) ages of 42.4 (13.2) and 42.1 (15.0) years, respectively. The response rate for those who completed the study was 79% with 208 QFFQs included for analysis. Reported mean daily energy intakes were: men 15 171 kJ (3626 kcal); women 11 593 kJ (2771 kcal). Dietary inadequacy was expressed as the percentage of participants reporting intakes below the sex- and age-specific estimated average requirements ( EARs). For nutrients without EARs, adequate intakes were used. Energy and sodium intakes exceeded the recommendations. Less than 10% of participants met recommendations for dietary fibre intake. Vitamin E intakes were below EARs for ≥97% of participants, whereas >20% reported inadequate vitamin A, folate and magnesium intakes. Among women, >50% reported inadequate calcium and vitamin D intakes. Non-nutrient-dense foods contributed 30% of energy, 73% of sugars and 22% of fat. Traditional foods contributed 56% of protein and 49% of iron. Conclusions The present study demonstrates a relatively high prevalence of inadequate nutrient intakes among Inuit. The results may be used to monitor the nutrition transition among Inuit, evaluate nutritional interventions, and inform public health policy decision-making. [ABSTRACT FROM AUTHOR]

Background Previous studies highlight a possible association between alcohol-drinking patterns and dietary inadequacies, which may have negative implications, particularly for women of child-bearing age. The present study aimed to compare dietary adequacy among alcohol drinkers versus nondrinkers in Inuvialuit women of child-bearing age. Methods A cross-sectional survey of 92 randomly selected women of childbearing age (19-44 years) was conducted in three communities in the Northwest Territories of Arctic Canada, using a validated quantitative food frequency questionnaire. Data were analysed to compare mean daily energy and nutrient intakes, dietary adequacy and nutrient densities (per 4184 kJ) between alcohol drinkers and nondrinkers, as well as heavy drinkers and nonheavy drinkers, using the nonparametric Wilcoxen rank sum test. Results The response rate was between 65% and 85% depending on the community sampled. Of the study participants, 54% ( n = 49) were drinkers and 46% ( n = 42) were nondrinkers. Of the drinkers, 45% ( n = 22) were heavy drinkers. Mean energy intakes were high among all women, although they were significantly higher among drinkers [17 179 kJ (4106 kcal)] compared to nondrinkers [13 317 kJ (3183 kcal)]. There were no significant differences in nutrient intake between the two groups; however, drinkers had a lower nutrient density for most nutrients. Heavy drinkers had a significantly lower nutrient density for all nutrients, except protein, iron, and vitamins B6, C and D, compared to nonheavy drinkers. Conclusions The findings of the present study provide evidence of inadequate dietary intake among Inuvialuit of child-bearing age, regardless of alcohol-drinking behaviour. [ABSTRACT FROM AUTHOR]

Background Accurate nutrient composition data for composite dishes unique to a population is essential for the development of a nutrient database and the calculation of dietary intake. The present study aimed to provide the nutritional composition of composite dishes frequently consumed in rural Kwa Zulu- Natal, South Africa. Methods Commonly consumed composite dishes were identified using 24-h recalls collected from 79 randomly selected community members. Multiple recipes were collected for each reported dish. The mean nutritional composition of each dish was calculated per 100 g using the nutribase clinical nutrition manager (Cybersoft Inc., Phoenix, AZ, USA). Results A total of 79 recipes were collected for 16 commonly consumed dishes (seven meat-based, five starch-based and four legume/vegetable-based). 'Fried chicken' contained the most energy [1469 kJ (351 kcal)], protein (29.7 g), fat (23.7 g), cholesterol (123 mg) and niacin (8.4 mg). 'Fried beef' contained the most potassium (495 mg) and zinc (6.4 mg), whereas 'fish stew' had the most vitamin D (4.2 μg) and calcium (215 mg). 'Fried cabbage' and 'fried spinach' contained the largest percent energies from fat, at 79% and 76%, respectively. A traditional sweet bread, 'jeqe', made with fortified flour contributed significantly to iron (4.6 mg), niacin (4.5 μg) and folate (129 μg). The sodium content of dishes ranged from 88 to 679 mg per 100 g. Conclusions The nutritional composition data for commonly consumed dishes in rural Kwa Zulu- Natal is presented. Although the dishes are good sources of protein, vitamins and minerals, they also contain substantial amounts of fat. This culturally appropriate information will enable the calculation of dietary intake and can be used to encourage the consumption of recipes rich in key nutrients. [ABSTRACT FROM AUTHOR]

Background Inuvialuit of Arctic Canada are at high risk for inadequate vitamin D status as a result of rapid dietary transitions and a lack of solar ultraviolet B exposure. This may have implications for the development of adverse skeletal diseases, cardiovascular diseases and cancers. Data are limited regarding supplement use in Arctic Aboriginal populations. The present study aimed to describe the type and extent of supplement use, emphasising vitamin D, and to identify differences between supplement users and non-users. Methods Supplement information was collected from a population-specific quantitative food frequency questionnaire in three communities in the Northwest Territories, Canada, as part of a cross-sectional study. Data were analysed for frequency of supplementation and types of supplements. Users and non-users were compared in terms of age, sex, body mass index, education, marital status, income support, employment and chronic disease diagnosis using nonparametric tests and the chi-squared test. Results Response rates ranged from 65% to 85%. Included in the analysis were 192 Inuvialuit (45 males, 147 females) with a mean (SD) age of 43.6 (13.9) years. Twenty-three percent reported using a supplement, with multivitamins being the most common. Three percent indicated taking a vitamin D-containing supplement. No significant differences between supplement users and non-users were found. Conclusions Despite limited sun exposure for many months of the year, a small proportion of Inuvialuit adults were using supplements, and specifically vitamin D-containing supplements. Future population-based intervention strategies should promote consumption of vitamin D rich foods and encourage the use of vitamin D supplements if diet alone is unable to meet recommendations. [ABSTRACT FROM AUTHOR]

Aims: Dosimeteric and radiobiological comparison of two radiation schedules in localized carcinoma prostate: Standard Three- Dimensional Conformal Radiotherapy (3DCRT) followed by Intensity Modulated Radiotherapy (IMRT) boost (sequential-IMRT) with Simultaneous Integrated Boost IMRT (SIB-IMRT). Material and Methods: Thirty patients were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum and small bowel. All patients were treated with sequential-IMRT plan, but for dosimetric comparison, SIB-IMRT plan was also created. The prescription dose to PTV P + SV was 74 Gy in both strategies but with different dose per fraction, however, the dose to PTV LN was 50 Gy delivered in 25 fractions over 5 weeks for sequential-IMRT and 54 Gy delivered in 27 fractions over 5.5 weeks for SIB-IMRT. The treatment plans were compared in terms of dose--volume histograms. Also, Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) obtained with the two plans were compared. Results: The volume of rectum receiving 70 Gy or more (V > 70 Gy) was reduced to 18.23% with SIB-IMRT from 22.81% with sequential-IMRT. SIB-IMRT reduced the mean doses to both bladder and rectum by 13% and 17%, respectively, as compared to sequential-IMRT. NTCP of 0.86 ± 0.75% and 0.01 ± 0.02% for the bladder, 5.87 ± 2.58% and 4.31 ± 2.61% for the rectum and 8.83 ± 7.08% and 8.25 ± 7.98% for the bowel was seen with sequential-IMRT and SIB-IMRT plans respectively. Conclusions: For equal PTV coverage, SIB-IMRT markedly reduced doses to critical structures, therefore should be considered as the strategy for dose escalation. SIB-IMRT achieves lesser NTCP than sequential-IMRT. [ABSTRACT FROM AUTHOR]

Introduction:The aggressiveness of cholesteatoma in children compared with adults is well known. However, the factors influencing the poorer prognosis of paediatric cholesteatoma are not well understood. This study compared the proliferative potential of paediatric cholesteatoma with that of adult cholesteatoma, using Ki-67 as a proliferation marker.Methods:A prospective study of 67 patients with aural cholesteatoma was performed. Thirty-eight adult and 29 paediatric cases were evaluated using clinical parameters including bone erosion, complications and extent of disease. A surgical specimen underwent histological evaluation and measurement of the proliferation index using Ki-67 labelling. Normal epithelium from a control group was also examined.Results:Cholesteatoma epithelium has a greater rate of proliferation than normal skin. There were however no statistical differences between the paediatric and adult cholesteatoma groups in terms of clinical behaviour or proliferation potential. Paediatric cholesteatoma was similar to adult cholesteatoma in terms of complications, bone erosion and disease spread.Conclusion:Cholesteatoma is a disorder of epithelial proliferation. Although postulated to be more aggressive in children than adults, this study found no clinicopathological differences between paediatric and adult cases. [ABSTRACT FROM PUBLISHER]

Objectives: To characterise the diet of First Nations in north-western Ontario, highlight foods for a lifestyle intervention and develop a quantitative food-frequency questionnaire (QFFQ).Design: Cross-sectional survey using single 24 h dietary recalls.Setting: Eight remote and semi-remote First Nations reserves in north-western Ontario.Subjects: 129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80 years.Results: The greatest contributors to energy were breads, pasta dishes and chips (contributing over 20 % to total energy intake). 'Added fats' such as butter and margarine added to breads and vegetables made up the single largest source of total fat intake (8.4 %). The largest contributors to sugar were sugar itself, soda and other sweetened beverages (contributing over 45 % combined). The mean number of servings consumed of fruits, vegetables and dairy products were much lower than recommended. The mean daily meat intake was more than twice that recommended. A 119-item QFFQ was developed including seven bread items, five soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes, nine fruits and 14 vegetables. Frequency of consumption was assessed by eight categories ranging from 'Never or less than one time in one month' to 'two or more times a day'.Conclusion: We were able to highlight foods for intervention to improve dietary intake based on the major sources of energy, fat and sugar and the low consumption of fruit and vegetable items. The QFFQ is being used to evaluate a diet and lifestyle intervention in First Nations in north-western Ontario. [ABSTRACT FROM AUTHOR]