In the enchanting setting of Ponza, as every year, neuroradiologists and neurologists gather to talk about topics of fundamental importance.
To Dr. Gniuli again this year the task of a clinical framing focused on the physio-pathological mechanisms (those that induce pathology) related to toxic-metabolic diseases.
Rare pathologies, those genetically determined, but in constant increase those related to toxic factors such as alcohol and drugs, with important impact on the survival of the patient, his autonomy, his lifestyle and that of his whole family.
Because cellular metabolism affects the nervous system conspicuously and dramatically, and often the physician helplessly witnesses a set of symptoms he never wanted to see.
Therefore, in genetically determined metabolic disorders, the main elements involved are alterations in the metabolism of the digestive and respiratory organelles. The pathology consists of accumulation of substances (mainly lipids) or demyelination.
In contrast, in toxic pathologies, the damage is’ often direct toxic, in many cases (as in opiates) also mediated by an ischemic process, is conditioned by systemic pathologies (renal or hepatic failure), and very often the toxic substance “replaces” the metabolic support elements (Oxygen, glucose, water), inducing damage.
In Italy in 2023, about 3,000,000 people suffer from Eating Disorders.
We are talking about 5% of the Italian population, and unfortunately 30% of adolescents after COVID, of which 6% are under 12 years old (1).
Such an incidence is comparable to that of Diabetes (5.9%, 3,500,000 people) (1) and is higher than that of cancer in Italy (about 4% of the entire population) (2).
This figure is also alarming because it is growing and growing especially in the adolescent population, which is our future.
In DCA, pain makes its way into the body image, which is the first aspect evident on the outside of each of us, because one’s body becomes an impenetrable peel (in obesity), or transparent (in anorexia), and food becomes a cure (in bulimia) to the pain itself, and suffering , frustration vent in compensatory behaviors (the purging mechanisms), and obsession with the body,with food catalyze attention on a daily basis. Sunsets, the sea, the rays of the sun, the laughter of friends, the caresses of loved ones become pale and faint glimmers in daily life characterized only by a profound distortion of one’s body.
Early diagnosis allows the establishment of a course of treatment and care not only for the patient but also for the familiar surroundings. Therapy should focus on identifying vital risk factors, nutritional framing with cognitive-behavioral techniques, and individual psychotherapy (sometimes combined with group psychotherapy) and helping the family environment. Therapists all need to work together and for the patient by supporting the family and educating them, and must be able to have emergency referral points available to stabilize the patient where necessary (3).
1) Istat data 2023
2) Epicenter.iss.it; cancer registry in Italy
3) clinical Practice Guideline for Eating disorders. Ministry of Healthcare and Consumer affairs.
www.sisdca.it
In recent decades, the prevalence of obesity and overweight has increased worldwide, in both men and women. According to the latest evaluation carried out by the Cancer Research Association of the University of Verona in 2017, overweight and obesity are proven risk factors for 13 tumor sites, with risk estimates that vary widely depending on the tumor site . Obesity is also related to a worse prognosis for some cancers, particularly breast and colon cancers. Childhood and adolescent obesity, also on the rise in many countries, has been associated with an increased risk of cancer in adulthood. One of the main causes of obesity is the imbalance in energy balance favored by a diet rich in processed foods, red meat, trans and saturated fatty acids, sugary foods and drinks and low in fruit and vegetables, legumes and whole grains. The main national and international recommendations to reduce the prevalence of obesity include a balanced diet and regular physical activity.
The change in eating habits and lifestyle (we are therefore talking about a sedentary lifestyle and an increase in simple sugars and unsaturated fats in the diet) is now a global phenomenon. Even in rural populations in Southern Africa* there has been an increase in the risk of cancer.
Therefore, nutrition is no longer just a risk factor for cerebral and cardiovascular diseases, being among the leading causes of hospitalization in industrialized countries. It becomes one of the most important and most avoidable risks of cancer which is the health emergency of these decades.
Learning to eat, learning to live to live better and also to prevent Cancer.
The report, which was very technical and difficult to use for dissemination purposes, focused on the complex interaction in the diagnostic and follow-up (post medical or surgical therapy) phases.
The endocrine pathologies that involve the neuroradiologist (a highly specialized figure on brain diagnostics, which should not be entrusted to the general radiologist, precisely because it is very specific) are predominantly pituitary-secreting ones. In non-secreting forms, the endocrinologist is usually contacted AFTER surgery or for diagnostic completeness, by another specialist, and the neuroradiologist has certainly already intervened.
The most frequent pituitary pathology is Hyperprolactinemia (pituitary adenoma, a pathology ALWAYS benign, accounts for 44% of pituitary tumors) with a prevalence around 60-100/million and an incidence of 6-10/million per year. As if to say that in a city like Rome, about 36-60 people a year get pituitary adenoma. the role of the neuroradiologist is crucial to distinguish a stress hyperprolactinemia or adenoma, and to evaluate the effectiveness of therapy (usually medical).
As frequency it follows Cushing’s disease (incidence 5-25/million/year), which consists of increased cortisol levels due to ACTH-secreting pituitary adenoma. The endocrinologist usually has the laboratory and clinical diagnostic tools to detect increased cortisol levels, but the role of the neuroradiologist is critical to localize the pathology and to define whether cortisol secretion is autonomous or dependent on pituitary adenoma, and to decide whether to refer to the neurosurgeon or proceed with medical therapy.
The neuroradiologist can participate directly with interventional procedures such as petrous sinus catheterization, which measures ACTH levels directly in the pituitary circulation, and correlates with peripheral circulating ACTH levels.
Acromegaly and gigantism are an additional cause for referral to the neuroradiologist by the endocrinologist. These are rare disorders with an incidence of 3/million, but known to the general public because patients have distinctive physiognomic features, and some patients with acromegaly have been well known in the past (such as Primo Carnera, the great boxer of the twentieth century).
Rare but existing, TSH-oma, a cause of hyperthyroidism of pituitary origin (accounts for less than 1% of functioning pituitary tumors and is the cause of 0.1% of cases of hyperthyroidism).
The extra-hypophyseal pathology that involves the neuroradiologist is definitely Basedowian ophthalmopathy, which is the typical ocular involvement of Basedow’s disease hyperthyroidism, that from the presence of TSH receptor antibody. Evaluation of the level of involvement of the retrobulbar fat or the extrinsic muscles of the eye allows early decisions on the most appropriate therapeutic choice.
Desserts at Christmas have always been part of the tradition of any Western country. Christmas parties without lights and sweets are not holidays, for everyone, whether they are diabetics, people with weight problems or people who have no disorders whatsoever. The important thing, however, is that this joy does not then turn into pain.
Therefore, a number of behavioral strategies should be adopted to properly manage this particular period but to enjoy it to the fullest.
Food has always represented a compensatory element of emotions and a gratification; the infant to calm himself down attaches to the mother’s breast and in this way often becomes pacified.
It is important, however, that the affective value of food does not conflict with our health, and indeed food helps us to live better.
Therefore, behavioral psychologists together with endocrinologists have compiled a series of tips to better manage social events and desserts.
1.) We enjoy the sight of sweets, enjoy window displays in which they are arranged, beautiful, colorful and gratifying even just to be seen. At most we buy a small portion to be eaten later in the day at the end of the meal.
2.) Instead, let us limit “the purchase of sweets” that will be used during the recurrence days 24, 25, 31, New Year’s Day and the Epiphany.
3.) Whenever we wish to eat a dessert always do so at the end of a meal : never eat it as a substitute for a meal, but always at the end of the meal itself by reducing the carbohydrates of that meal or eliminating them completely in the case of diabetic and obese patients, increasing protein and including at least three side dishes.
4.) Use a small dessert plate or even a bread plate in the case of the most important occasions by putting all the desserts you want to eat but all together without taking a second course.
These strategies will allow us to fully enjoy what we are experiencing but keep in check what is harmful to our health.
Merry Christmas to all of you and your loved ones!
Vacations are over. Heat is over. Work is coming full circle again. First colds are back, and Italian health care is preparing to support the new flu wave, and with it the new Sars-19 spike that is likely to be in winter, like all flu spikes.
Recent studies by Italian groups have shown a relationship between low vitamin D levels and COVID onset, especially in populations in northern Italy. Could this be a possible contributing cause (along with particulate pollution that acted as a vehicle for the virus) of why Northern Italy was so plagued by COVID in the first and second waves? In fact, the last 30 years in Italy have seen a real global decline in vitamin D levels. The cause of this phenomenon is, as always, multifactorial.
1)The change in the tilt of the Earth’s axis is related to the change in the rotation of the two poles (instead of north to south currently to the east) which is in turn influenced by the ongoing climate change (the Earth’s axis is responsible for the seasons) and which is responsible for the reduced ability of the sun in our latitudes to fix Vitamin D.
2)The insufficient use of the foods available in the Italian territory of vitamin supplementation.
3) Fish from our seas, being very lean, have lower levels of vitamin D than those found in fish from the northern seas.
4) Vitamin D plays an important role in modulating the immune system, and so its deficiency may be associated with an improperly adapted immune system.
Vitamin D deficiency is also often found in young adolescents, students, complicit in the closing of recent years.
Therefore, a proper assessment of vitamin D level is definitely indicated not only in post-menopausal women, but in general also in a population poorly exposed to the sun and sedentary, in order to improve our body’s ability to respond to infections that we will have to live with for a long time.
