A Framework for Adapted Nutritional Therapy for Children With Cancer in Low‐ and Middle‐Income Countries: A Report From the SIOP PODC Nutrition Working Group

The utilization of adapted regimens for the treatment of pediatric malignancies has greatly improved clinical outcomes for children receiving treatment in low‐ and middle‐income countries (LMIC). Nutritional depletion has been associated with poorer outcomes, increased abandonment of therapy, and treatment‐related toxicities. Surveys have found that nutritional intervention is not incorporated routinely into supportive care regimens. Establishing nutritional programs based upon institutional resources may facilitate the incorporation of nutritional therapy into clinical care in a way that is feasible in all settings. We present a framework for establishing and monitoring of nutritional care based on the infrastructure of institutions in LMIC.     

Effects of carbohydrate type on postprandial blood pressure,neuroendocrine and gastrointestinal hormone changes in the elderly

Previous studies have demonstrated that blood pressure falls postprandially in fit elderly subjects, the greatest changes occurring after meals with a high carbohydrate content. To evaluate the influence of the type of carbohydrate on postprandial blood pressure, the effects of equivalent energy content (2.4 MJ) high complex (starch) and high simple (monosaccharide) carbohydrate meals were studied in seven healthy elderly subjects. Blood pressure, heart rate, autonomic function, plasma catecholamines, insulin and neurotensin levels were measured pre- and postprandially. Greater falls in supine and erect systolic blood pressure occurred after the high simple than the high complex carbohydrate meal (p < 0.05). No differences were found in supine or erect diastolic blood pressure, heart rate or in any of the biochemical parameters measured between the meal types. It is concluded that a simple carbohydrate meal results in a greater postprandial fall in blood pressure than an equivalent energy complex carbohydrate meal in the elderly, although the mechanisms for these changes are unknown.     

Value of non-invasive continuous blood pressure monitoring in the detection of carotid sinus hypersensitivity

A patient with recurrent episodes of dizziness and blackouts is described. Detailed cardiac and neurological investigations were normal. Autonomic assessment excluded postural hypotension and confirmed normal sympathetic vasoconstrictor function. Cardiac parasympathetic function in response to deep breathing, hyperventilation and ocular pressure was normal. Left carotid sinus massage only reproducibly lowered blood pressure with minimal change in heart rate. This occurred mainly during head-up tilt. The fall in blood pressure was not affected by the muscarinic blocker atropine, or the peptide release inhibitor, octreotide. A diagnosis of left carotid sinus hypersensitivity of the vasodepressor variety was made. Left carotid sinus denervation was performed. This successfully prevented further episodes of dizziness and blackouts. The ability to measure beat-to-beat blood pressure non-invasively was of particular importance in diagnosis, and in the assessment of management options in this patient.