Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice

Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.

Anaesthetic management of an obstetric patient with variegate porphyria

Porphyria is an uncommon disease that can produce life-threatening attacks with a mortality rate of up to 10%, specifically as the result of administration of porphyrinogenic medications. In obstetric anaesthesia there are many situations where drugs are given in an emergency and it is therefore important to be prepared for complications to avoid inadvertently inducing an iatrogenic porphyric crisis. We discuss the case of a 20-year-old nulliparous woman with variegate porphyria who required an emergency caesarean section in labour, and the drugs that are commonly used in obstetric practice.

Effects of clenbuterol on horses

Clenbuterol was intended as a treatment for respiratory diseases in horses, but has been used in multiple species, including humans, for its repartitioning of fat to lean effects (free fatty acids are released from adipose tissue to be used by tissues of higher priority). In the horse industry clenbuterol application is restricted to the treatment of chronic obstructive pulmonary disease and reactive airway disease (heaves). Negative effects of clenbuterol exposure include a decrease in maximum oxygen intake and increased muscle fatigue upon exercise. As a result of these and other negative effects, clenbuterol remains strictly controlled by the US Food and Drug Administration.

Synergism between the hbx gene and aflatoxin B-1 in the development of murine liver-cancer

Infection by hepatitis B virus (HBV) and exposure to dietary aflatoxin B-1 (AFB(1)) have both been implicated by epidemiological studies to be important risk factors in the development of hepatocellular carcinoma (HCC). Our ability to derive transgenic mice which develop liver cancer as a consequence of the expression of a single gene from HBV, the HBx gene, provides an opportunity to use this animal model to test whether AFB(1) can induce p53 mutations, particularly at codon 249, which are frequently detected in HCC and, as a result, act synergistically with HBV to accelerate the manifestation of disease. While AFB(1) significantly shortened the latency of tumor development in the HBx transgenic mice, the tumors did not have p53 mutations. As in tumors from the untreated transgenic mice, the p53 tumor suppressor protein is found bound to the HBx protein and sequestered in the cytoplasmic compartment of the tumor cell. Despite the frequent involvement of ras mutations in mouse tumors, we also have not detected activation of the ms p21 protein in the tumors from the AFB(1)-treated mice. We conclude that although AFB(1) can act as a co-factor with HBx to induce HCC in mice, its mode of action in vivo remains obscure.

A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder

BACKGROUND

One in 110 children in the US have autism spectrum disorder (ASD), a debilitating and life-long disorder that affects the health, relationships, and learning of affected children. Existing research on the etiology, contributing factors, and treatment for ASD is limited and controversial. Studies suggest that GI symptoms are related to behavior issues in children with ASD, which may be improved by a gluten-free, casein-free (GFCF) diet.

OBJECTIVES

To evaluate the relationship between a GFCF diet and gastrointestinal symptoms and behavior patterns in children with ASD.

DESIGN AND SETTING

Cross-sectional design in which parents completed an online survey regarding general health, diet (adapted food-frequency questionnaire (FFQ)), gastrointestinal symptoms, and behavior patterns of their children with ASD.

MAIN OUTCOME MEASURES

Scores on the Gastrointestinal Symptoms Rating Scale (GSRS) and Childhood Autism Rating Scale (CARS).

RESULTS

Seven of thirteen children (median age 9years) were on a GFCF diet, consuming significantly fewer gluten- and casein-containing foods than those not on a GFCF diet. GSRS and CARS scores did not differ significantly according to diet. Parents of all the children on a GFCF diet reported improved GI symptoms and behavior patterns.

CONCLUSIONS

This study provides evidence that the adapted FFQ is an effective tool for evaluating adherence to a GFCF diet. Continued well-controlled research is necessary to elucidate the gut-brain relationship in ASD.

Baby-led weaning and the family diet. A pilot study

Baby-led weaning (BLW) is a style of solid food introduction that emphasizes self-feeding rather than spoon-feeding. The purpose of this cross-sectional study was to determine whether parents using BLW change their dietary intake during weaning, and if their babies are offered family foods. Participants kept diet diaries at baseline and three months later, post-BLW implementation. Wilcoxon tests revealed no significant changes in dietary intake during the first three months of weaning, however, parents offered their children 57% of the same foods they were consuming. Results suggest that BLW does not lead to dietary changes among parents during the weaning process.