A Rare Case of a Patient With a Foreign Body in the Esophagus for Two Years Which Perforated Into the Mediastinum.

A rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum.

Afr Health Sci. 2012 Dec; 12(4): 569-71
Byaruhanga R, Kakande E, Mwambu T

A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child’s parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally. On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum. The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy. The child recovered well and was discharged from hospital on day 55. HubMed – eating

Child food neophobiais heritable, associated with less compliant eating, and moderates familial resemblance for BMI.

Obesity (Silver Spring). 2013 Mar 20;
Faith MS, Heo M, Keller KL, Pietrobelli A

OBJECTIVE: The heritability of foodneophobia, the tendency to avoid new foods, was tested in 4- to 7-year-oldtwins. We also examined whether food neophobia is associated with parent-child feeding relations or child body fat. DESIGN AND METHODS: We studied sixty-six same-sex twin pairs, including 37 monozygotic (MZ) and 29 dizygotic (DZ) pairs. Food neophobia was assessed by parent questionnaire (Child Food Neophobia Scale, CFNS), as were child feeding practices and “division of responsibility” feeding relations. Child anthropometry and percent body fat were directly measured. RESULTS: MZ and DZ twin pair correlations for food neophobia were r=0.71 and r= -0.01, respectively;heritability= 72%. Greater food neophobia was associated with reduced child eating compliance of prompted foods (p< 0.001) reduced eating compliance of initially refused foods (p< 0.001), and - among girls only - fewer parental food demands(p= 0.01). Interestingly, the correlationbetween maternal BMI and child BMI z-score was significantonlyfor children high (p=0.03), but not low (p=0.55), in food neophobia. CONCLUSIONS: Child food neophobia, a highly heritable trait previously linked to emotionality,was associated with less compliant parent-child feeding relations. Strategies to combat food neophobiaand foster more harmonious feeding relationshipsmay have a role in obesity prevention. HubMed – eating

Obesity is associated with white matter atrophy: A combined diffusion tensor imaging and voxel-based morphometric study.

Obesity (Silver Spring). 2013 Mar 20;
Karlsson HK, Tuulari JJ, Hirvonen J, Lepomäki V, Parkkola R, Hiltunen J, Hannukainen JC, Soinio M, Pham T, Salminen P, Nuutila P, Nummenmaa L

OBJECTIVE: Little is known about the mechanisms by which obesity influences brain structure. In this study we examined the obesity-related changes in brain white and gray matter integrity. DESIGN AND METHODS: We studied 23 morbidly obese subjects and 22 non-obese volunteers using voxel-based analysis of diffusion tensor imaging (DTI) and of T1-weighted MRI images. Full-volume statistical parametric mapping (SPM) analysis was used to compare fractional anisotropy (FA) and mean diffusivity (MD) values as well as gray (GM) and white matter (WM) density between these groups. RESULTS: Obese subjects had lower FA and MD values and lower focal and global GM and WM volumes than control subjects did. The focal structural changes were observed in brain regions governing reward seeking, inhibitory control and appetite. Regression analysis showed that FA and MD values as well as GM and WM density were negatively associated with body fat percentage. Moreover, the volume of abdominal subcutaneous fat was negatively associated with GM density in most regions. CONCLUSIONS: These findings imply that changes in GM and WM in obesity may be due to metabolic factors. Atrophy in regions involved in reward processing and appetite control may further promote abnormal reward seeking and eating behavior. HubMed – eating

Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial.

BMJ. 2013; 346: f1191
Butler CC, Simpson SA, Hood K, Cohen D, Pickles T, Spanou C, McCambridge J, Moore L, Randell E, Alam MF, Kinnersley P, Edwards A, Smith C, Rollnick S

To evaluate the effect of training primary care health professionals in behaviour change counselling on the proportion of patients self reporting change in four risk behaviours (smoking, alcohol use, exercise, and healthy eating).Cluster randomised trial with general practices as the unit of randomisation.General practices in Wales.53 general practitioners and practice nurses from 27 general practices (one each at all but one practice) recruited 1827 patients who screened positive for at least one risky behaviour.Behaviour change counselling was developed from motivational interviewing to enable clinicians to enhance patients’ motivation to change health related behaviour. Clinicians were trained using a blended learning programme called Talking Lifestyles. MAIN OUTCOME MEASURES : Proportion of patients who reported making beneficial changes in at least one of the four risky behaviours at three months.1308 patients from 13 intervention and 1496 from 14 control practices were approached: 76% and 72% respectively agreed to participate, with 831 (84%) and 996 (92%) respectively screening eligible for an intervention. There was no effect on the primary outcome (beneficial change in behaviour) at three months (362 (44%) v 404 (41%), odds ratio 1.12 (95% CI 0.90 to 1.39)) or on biochemical or biometric measures at 12 months. More patients who had consulted with trained clinicians recalled consultation discussion about a health behaviour (724/795 (91%) v 531/966 (55%), odds ratio 12.44 (5.85 to 26.46)) and intended to change (599/831 (72%) v 491/996 (49%), odds ratio 2.88 (2.05 to 4.05)). More intervention practice patients reported making an attempt to change (328 (39%) v 317 (32%), odds ratio 1.40 (1.15 to 1.70)), a sustained behaviour change at three months (288 (35%) v 280 (28%), odds ratio 1.36 (1.11 to 1.65)), and reported slightly greater improvements in healthy eating at three and 12 months, plus improved activity at 12 months. Training cost £1597 per practice.Training primary care clinicians in behaviour change counselling using a brief blended learning programme did not increase patients reported beneficial behaviour change at three months or improve biometric and a biochemical measure at 12 months, but it did increase patients’ recollection of discussing behaviour change with their clinicians, intentions to change, attempts to change, and perceptions of having made a lasting change at three months. Enduring behaviour change and improvements in biometric measures are unlikely after a single routine consultation with a clinician trained in behaviour change counselling without additional intervention.ISRCTN 22495456. HubMed – eating

ISSUES – Eating Disorders – Host Kelsey Kruse shares the scary statistics of Eating Disorders in today’s generation.