Purpose To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi.Methods This case-control study was performed with 227 patients. Data on clinicopathological characteristics and risk factors were collected using a questionnaire developed for this study speci cally. Ninety-eight blood samples were collected and the prevalence of antibodies against human immunode ciency virus (HIV), herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), and Helicobacter pylori were determined serologically. Fisher's exact test was used for nominal variables and the Mann-Whitney U test was used for continuous variables. Binary linear regression was performed with variables that were signi cant in the Fisher and Mann-Whitney tests.Results The tumor and control groups comprised 157 and 70 patients, respectively. Patients with tumors were signi cantly older than controls (P < 0.001). EC was associated with smoking (P < 0.001) and alcohol consumption (P = 0.020), but 43% of patients with tumors did not smoke or drink. EC was associated with the consumption of hot food and tea (P = 0.003) and smoked sh (P = 0.011). EC was not associated with any serologically investigated infectious agent. In logistic regression analysis, age [odds ratio (OR), 1.042; 95% con dence interval (CI), 1.019-1.066; P < 0.001] and hot food and tea consumption (OR, 2.331; 95% CI, 1.167-4.656; P = 0.016) were signi cant.Conclusions Apart from alcohol consumption and smoking, the consumption of hot food or tea and smoked sh are associated with EC in Malawi.

INTRODUCTIONThe Departments of Surgery at the University of North Carolina (UNC) and Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, formed a partnership of service, training, and research in 2008. We report a case of recurrent pancreatitis leading to pancreatic necrosis treated at KCH.PRESENTATION OF CASEA 42 year-old male presented to KCH with his fourth episode of abdominal pain, nausea and vomiting. He had tachycardia, guarding, rebound tenderness, and free fluid on abdominal ultrasonography. He underwent laparotomy and had fat saponification with pancreatic necrosis. A large drain was placed, he was given antibiotics, and he recovered. He had normal lipids, no gallstones, and did not consume alcohol. He was encouraged to seek further evaluation with endoscopic retrograde cholangiopancreatography or computed tomography in South Africa, however this was prohibitively expensive.DISCUSSIONThis case illustrates the limitations that are often faced by surgeons visiting developing countries. What we consider standard resources and treatment algorithms in managing necrotizing pancreatitis in developed countries (such as serum lipase and percutaneous interventions) were not available.CONCLUSIONVisiting surgeons and trainees must be both familiar with local resource limitations and aware of the implications of such limitations on patient care. To support training and promote advances in health care, local surgeons and trainees should understand optimal treatment strategies regardless of their particular resource limitations. North–South partnerships are an excellent means to uphold our professional obligation to humanity, promote health care as a right, and shape the future of health care in developing countries.

Purpose To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi.Methods This case–control study was performed with 227 patients. Data on clinicopathological characteristics and risk factors were collected using a questionnaire developed for this study specifically. Ninety-eight blood samples were collected and the prevalence of antibodies against human immunodeficiency virus (HIV), herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), varicella-zoster virus (VZV), and Helicobacter pylori were determined serologically. Fisher’s exact test was used for nominal variables and the Mann–Whitney U test was used for continuous variables. Binary linear regression was performed with variables that were significant in the Fisher and Mann–Whitney tests.Results The tumor and control groups comprised 157 and 70 patients, respectively. Patients with tumors were significantly older than controls (P < 0.001). EC was associated with smoking (P < 0.001) and alcohol consumption (P = 0.020), but 43% of patients with tumors did not smoke or drink. EC was associated with the consumption of hot food and tea (P = 0.003) and smoked fish (P = 0.011). EC was not associated with any serologically investigated infectious agent. In logistic regression analysis, age [odds ratio (OR), 1.042; 95% confidence interval (CI), 1.019–1.066; P < 0.001] and hot food and tea consumption (OR, 2.331; 95% CI, 1.167–4.656; P = 0.016) were significant.Conclusions Apart from alcohol consumption and smoking, the consumption of hot food or tea and smoked fish are associated with EC in Malawi.