Changes in mucosa laryngopharyngeal vascularization after radiotherapy and concomitant chemotherapy observed with narrow band imaging. Description of two cases

Introducción y objetivo: La imagen de banda estrecha o Narrow Band Imaging (NBI) es un sistema de mejora de imagen utilizado en la detección de anomalías vasculares en la mucosa y submucosa con neoplasia. En 2011 Ni estableció los cinco tipos de patrones de imágenes en la mucosa laríngea relacionándolos con los hallazgos histopatológicos de las lesiones. Sin embargo, estos patrones se ven modificados por tratamientos previos de cirugía láser, radioterapia y quimioterapia. Nuestro objetivo es describir las imágenes tipo con NBI obtenidas en pacientes tratados con el esquema terapéutico de radioterapia y quimioterapia concomitante. Descripción: Imágenes de NBI en paciente de 68 años con carcinoma epidermoide no queratinizante supraglótico estadio III tratado con radioterapia y quimioterapia concomitante a los tres meses y al año posterior al tratamiento. Imágenes de NBI en paciente de 50 años con carcinoma epidermoide no queratinizante de nasofaringe estadio II tratado con radioterapia y quimioterapia concomitante a los tres meses y al año posterior al tratamiento. Resultados: Los patrones obtenidos no se identifican con ninguno de los establecidos previamente por Ni. Las imágenes difieren en función del tiempo transcurrido desde el tratamiento. Conclusiones: Es importante conocer las alteraciones observadas en la mucosa y submucosa de pacientes tratados con radioterapia y quimioterapia concomitante ya que difieren de los patrones característicos descritos por Ni asociados a la presencia de neoplasia.Introduction and objective: Narrow Band Imaging (NBI) is an image enhancement system used to detect vascular anomalies in the mucosa and submucosa of neoplasms. In 2011 Ni established the five types of imaging patterns in the laryngeal mucosa relating them to the histopathological findings of the lesions. However, these patterns are modified by previous treatments of laser surgery, radiotherapy and chemotherapy. Our objective is to describe the NBI type images obtained in patients treated with the therapeutic regimen of radiotherapy and concomitant chemotherapy. Description: NBI images in a 68-yearold patient with stage III supraglottic non-keratinizing squamous cell carcinoma treated with radiotherapy and concomitant chemotherapy at three months and the year after treatment. NBI images in a 50-year-old patient with stage II nasopharynx non-keratinizing squamous cell carcinoma treated with radiotherapy and concomitant chemotherapy at three months and the year after treatment. Results: The obtained patterns are not identified with any of those previously established by Ni. The images differ depending on the time elapsed since the treatment. Conclusions: It is important to know the alterations observed in the mucosa and submucosa of patients treated with radiotherapy and concomitant chemotherapy since they differ from the characteristic patterns described by Ni associated with the presence of neoplasia

Mainstreaming prevention: Prescribing fruit and vegetables as a brief intervention in primary care

This is the author's PDF version of an article published in Public health© 2005.This articles discusses a project at the Castlefields Health Centre in Halton whereby primary care professionals issue a prescription for discounts on fruit and vegetables. The prescription is explicitly linked to the five-a-day message

Management of anterior chamber dislocation of a dexamethasone intravitreal implant: a case report

Background Ozurdex is a 700 mcg dexamethasone intravitreal implant, approved for the management of macular edema secondary to retinal vein occlusion, and other related pathoglogiesAnterior chamber dislocation of Ozurdex represents an uncommon complication of the intravitreal injection, which can be managed by repositioning the implant into the vitreous cavity. We describe the case of a successful repositioning of an Ozurdex implant by mobilization and subsequent balanced saline solution injection in the anterior chamber. Case presentation An 83-year-old white woman presented to our Emergency Unit complaining of pain and vision loss in herright eye lasting a week. Her anamnesis revealed a history of persistent cystoid macular edema after phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation, recently treated with an intravitreal Ozurdex implant. She also took a long-distance flight 2 days after the injection. An anterior segment examination showed corneal edema and the rod implant adherent to corneal endothelium. To avoid corneal decompensation, we opted for a implant repositioning. Under topical anesthesia, a 30-gauge needle was introduced through a limbar incisionto mobilize the dislocated rod. Balanced saline solution was injected, with a successful repositioning of the implant into the vitreous cavity. Topical 5 % hypertonic saline solution and 0.2 % betamethasone associated with 0.5 % chloramphenicol drops were administered four times a day. To prevent redislocation of the Ozurdex implant, she was instructed to avoid prone position, any kind of physical effort, and not to undertake long-distance flights during the first postoperative week. One week after surgery, an anterior segment examination showed an improvement of corneal edema. Funduscopy showed that the Ozurdex implant was settled into the vitreous cavity. Conclusions Anterior chamber dislocation of Ozurdex from the vitreous cavity is rare. In our patient, in addition to the posterior capsule tearing, the long-distance flight could have contributed to implant dislocation. Repositioning of the implant is necessary to avoid endothelial decompensation. It can be carried out by using saline balanced solution with the same efficacy as other surgical procedures reported in the literature. A possible disadvantage of this procedure could be implant migration

Multilevel regression modelling to investigate variation in disease prevalence across locations

In this article, we show how to investigate the role of individual (personal) risk factors in outcome prevalence in multicentre studies with multilevel modelling. The variation in outcome prevalence is modelled by introducing a random intercept. In the next step, the empty model is compared with the model containing the risk factor(s). Because the outcome is dichotomous, this comparison can only be carried out after having rescaled the models’ parameter values to the variance of an underlying continuous variable. We illustrate this approach with data from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC) and provide a corresponding Stata do-file

Monitoring the impact of desert dust outbreaks for air quality for health studies

We review the major features of desert dust outbreaks that are relevant to the assessment of dust impacts upon human health. Our ultimate goal is to provide scientific guidance for the acquisition of relevant population exposure information for epidemiological studies tackling the short and long term health effects of desert dust. We first describe the source regions and the typical levels of dust particles in regions close and far away from the source areas, along with their size, composition, and bio-aerosol load. We then describe the processes by which dust may become mixed with anthropogenic particulate matter (PM) and/or alter its load in receptor areas. Short term health effects are found during desert dust episodes in different regions of the world, but in a number of cases the results differ when it comes to associate the effects to the bulk PM, the desert dust-PM, or non-desert dust-PM. These differences are likely due to the different monitoring strategies applied in the epidemiological studies, and to the differences on atmospheric and emission (natural and anthropogenic) patterns of desert dust around the world. We finally propose methods to allow the discrimination of health effects by PM fraction during dust outbreaks, and a strategy to implement desert dust alert and monitoring systems for health studies and air quality management.The systematic review was funded by WHO with as part of a Grant Agreement with Ministry of Foreign Affairs, Norway. Thanks are also given to the Spanish Ministry for the Ecological Transition for long term support in the last 2 decades to our projects on African dust effects on air quality over Spain; to the Spanish Ministry of Science, Innovation and Universities and FEDER Funds for the HOUSE project (CGL2016-78594-R), and to the Generalitat de Catalunya (AGAUR 2017 SGR41). Carlos Pérez García-Pando acknowledges long-term support from the AXA Research Fund, as well as the support received through the Ramón y Cajal program (grant RYC-2015-18690) of the Spanish Ministry of Science, Innovation and Universities.Peer ReviewedPostprint (published version

[A cohort study on mortality and morbidity in the area of Taranto, Southern Italy].

Introduction: the area of Taranto has been investigated in several environmental and epidemiological studies due to the presence of many industrial plants and shipyards. Results from many studies showed excesses of mortality and cancer incidence for the entire city of Taranto, but there are no studies for different geographical areas of the city that take into account the important confounding effect of socioeconomic position. Objective: to assess mortality and hospitalization rates of residents in Taranto, Statte and Massafra through a cohort study, with a particular focus on residents in the districts closest to the industrial complex, taking into account the socioeconomic position. Methods: a cohort of residents during the period 1998-2010 was enrolled. Individual follow-up for assessment of vital status at 31.01.2010 was performed using municipality data. The census-tract socioeconomic position level and the district of residence were assigned to each participant, on the basis of the geocoded addresses at the beginning of the follow-up. Standardized cause specific mortality/morbidity rates, adjusted for age, were calculated by gender and districts of residence. Mortality and morbidity Hazard Ratios (HR, CI95%) were calculated by districts and socioeconomic position using Cox models. All models were adjusted for age and calendar period, and were done separately for men and women. Results: 321.356 people were enrolled in the cohort (48.9% males). Mortality/morbidity risks for natural cause, cancers, cardiovascular and respiratory diseases were found to be higher in low socioeconomic position groups compared to high ones. The analyses by districts have shown several excess mortality/morbidity risks for residents in Tamburi (Tamburi, Isola, Porta Napoli and Lido Azzurro), Borgo, Paolo VI and the municipality of Statte. Conclusions: The results of this study showed a significant relationship between socioeconomic position and health status of people resident in Taranto. People living in the districts closest to the industrial zone have higher mortality/morbidity levels compared to the rest of the area also taking into account the socioeconomic position

Valutazioni di impatto sanitario, sorveglianza, epidemiologica e studi di intervento nelle aree a rischio. Health Impact Assessment, surveillance and intervention studies in contaminated areas

xlla fine di agosto 2013 ? stato approvato un provvedimento congiunto dei Ministeri di salute e ambiente che stabilisce i criteri metodologici utili per la redazione del rapporto di valutazione del danno sanitario (VDS). In presenza di uno ?stabilimento [ritenuto - n.d.r.] di interesse strategico nazionale? tale documento dovr? essere predisposto annualmente dagli Enti interessati (ASL, ARPA). Il rapporto di valutazione deve informare dello stato di salute connesso a rischi attribuibili all\u27attivit? dello stabilimento in esame, fornire elementi di valutazione per il riesame dell\u27autorizzazione integrata ambientale per indirizzarla a soluzioni tecniche pi? efficaci nel ridurre i potenziali esiti sanitari indesiderati, valutare l\u27efficacia in ambito sanitario delle prescrizioni. Il decreto di definizione dei criteri di valutazione del danno sanitario era previsto dal Decreto n. 207/2012, varato per garantire la produzione dell\u27ILVA di Taranto e l\u27applicazione dell\u27Autorizzazione integrata ambientale