Bone marrow transplant (BMT) recipients often require parenteral nutrition (PN) to meet their nutrient needs. While general guidelines for the provision of PN support by nutrition support teams (NSTs) have been shown to decrease inappropriate PN use, recommendations for nutrition in BMT recipients are lacking. We reviewed the charts of patients status post BMT on PN to determine whether institutional guidelines for PN initiation and continuous supervision of NSTs could be applied in this population. With the Institutional Review Board (IRB) approval, charts of adult BMT recipients on PN between June 14, 2006 and June 30, 2007 were examined. Sixty-nine charts were reviewed. Indications for initiation of PN included severe mucositis, graft versus host disease (GVHD), and other transplant related side effects resulting in poor oral intake. Among 69 patients, 37 (54%) had severe mucositis, 12 (17%) had GVHD, 2 (3%) had both mucositis and GVHD, and 18 (26%) had other side effects. It was determined that all patients met the criteria for initiation of PN support, as outlined in the guidelines form. Comprehensive guidelines for initiating PN support, developed by NSTs can also be used for BMT recipients in order to optimize their nutritional status.
1) The document provides guidance on optimal nutrition therapy for ICU patients, post-ICU patients, and those in long-term recovery.
2) It recommends starting enteral nutrition within 48 hours of ICU admission and gradually increasing calories and proteins to prevent overfeeding and refeeding syndrome.
3) The optimal calorie and protein targets may vary during the different phases of recovery; at least 1.3 g/kg/day of proteins should be targeted after the initial ICU phase.
This document summarizes recent evidence on enteral versus parenteral nutrition in septic shock patients. The largest randomized controlled trial showed no difference in mortality between enteral and parenteral nutrition routes. Enteral nutrition was associated with lower calorie intake and higher rates of hypoglycemia and gastrointestinal complications. Updated guidelines recommend withholding enteral nutrition in hemodynamically unstable shock patients. It remains unclear if parenteral nutrition offers benefits in shock patients, though it may reduce gastrointestinal issues. No guidelines address parenteral nutrition indications in shock patients.
This study assessed compliance to dietary counseling among 72 patients with type 2 diabetes at a hospital in Pakistan. At their first visit, 66.7% had very inadequate diets and 29.2% had poor diets. After 3 months, 19.4% had very inadequate diets and only 1.4% had poor diets, showing improved diet quality for 94.5% of subjects. Compliance rates were determined to be very good for 19.4%, good for 37.5%, and fair for 33.3%. While compliance varied by recommendation, overall rates were sufficiently high to positively change diets and potentially help control diabetes complications.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
This document provides an overview and learning objectives for the 15th Annual Gastroenterology/Hepatology Update meeting. Key presentations will cover new clinical information and treatment updates in gastrointestinal and liver diseases. Recent breakthrough research will be discussed, including updates on colorectal cancer screening guidelines, management of gastroesophageal reflux disease, evaluation and treatment of abnormal liver tests and viral hepatitis, and implications for clinical practice in lower GI diseases and pancreatic disorders.
Adequacy of Enteral Nutritional Therapy Offered to Patients in an Intensive C...asclepiuspdfs
The document summarizes a study that evaluated the nutritional status and adequacy of enteral nutritional therapy (ENT) provided to patients in an intensive care unit (ICU) in Brazil. The study found that most patients were elderly and malnourished or at nutritional risk upon admission. However, the average calorie and protein requirements were not met, with only 40% of calorie and protein needs being adequately provided. The main reasons for inadequate ENT were delays initiating enteral tube feeding and fasting periods for clinical procedures. As a result, over 90 liters of prescribed enteral nutrition were wasted. The study concludes that malnutrition, delays starting ENT, and fasting may increase mortality risk for critically ill ICU patients.
This document provides guidelines for training in pediatric gastroenterology fellowship programs. It summarizes the key changes and considerations in the field that necessitated updating training guidelines, including advances in medical knowledge, emphasis on competencies and outcomes-based education, lifestyle and duty hour changes, and the evolving healthcare system. The document reviews existing guidelines that were consulted in developing the new NASPGHAN guidelines. It describes the unique characteristics of pediatric gastroenterology and outlines the core competencies that fellowship training must address according to accrediting bodies like ACGME and RCPSC.
1) The document provides guidance on optimal nutrition therapy for ICU patients, post-ICU patients, and those in long-term recovery.
2) It recommends starting enteral nutrition within 48 hours of ICU admission and gradually increasing calories and proteins to prevent overfeeding and refeeding syndrome.
3) The optimal calorie and protein targets may vary during the different phases of recovery; at least 1.3 g/kg/day of proteins should be targeted after the initial ICU phase.
This document summarizes recent evidence on enteral versus parenteral nutrition in septic shock patients. The largest randomized controlled trial showed no difference in mortality between enteral and parenteral nutrition routes. Enteral nutrition was associated with lower calorie intake and higher rates of hypoglycemia and gastrointestinal complications. Updated guidelines recommend withholding enteral nutrition in hemodynamically unstable shock patients. It remains unclear if parenteral nutrition offers benefits in shock patients, though it may reduce gastrointestinal issues. No guidelines address parenteral nutrition indications in shock patients.
This study assessed compliance to dietary counseling among 72 patients with type 2 diabetes at a hospital in Pakistan. At their first visit, 66.7% had very inadequate diets and 29.2% had poor diets. After 3 months, 19.4% had very inadequate diets and only 1.4% had poor diets, showing improved diet quality for 94.5% of subjects. Compliance rates were determined to be very good for 19.4%, good for 37.5%, and fair for 33.3%. While compliance varied by recommendation, overall rates were sufficiently high to positively change diets and potentially help control diabetes complications.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
This document provides an overview and learning objectives for the 15th Annual Gastroenterology/Hepatology Update meeting. Key presentations will cover new clinical information and treatment updates in gastrointestinal and liver diseases. Recent breakthrough research will be discussed, including updates on colorectal cancer screening guidelines, management of gastroesophageal reflux disease, evaluation and treatment of abnormal liver tests and viral hepatitis, and implications for clinical practice in lower GI diseases and pancreatic disorders.
Adequacy of Enteral Nutritional Therapy Offered to Patients in an Intensive C...asclepiuspdfs
The document summarizes a study that evaluated the nutritional status and adequacy of enteral nutritional therapy (ENT) provided to patients in an intensive care unit (ICU) in Brazil. The study found that most patients were elderly and malnourished or at nutritional risk upon admission. However, the average calorie and protein requirements were not met, with only 40% of calorie and protein needs being adequately provided. The main reasons for inadequate ENT were delays initiating enteral tube feeding and fasting periods for clinical procedures. As a result, over 90 liters of prescribed enteral nutrition were wasted. The study concludes that malnutrition, delays starting ENT, and fasting may increase mortality risk for critically ill ICU patients.
This document provides guidelines for training in pediatric gastroenterology fellowship programs. It summarizes the key changes and considerations in the field that necessitated updating training guidelines, including advances in medical knowledge, emphasis on competencies and outcomes-based education, lifestyle and duty hour changes, and the evolving healthcare system. The document reviews existing guidelines that were consulted in developing the new NASPGHAN guidelines. It describes the unique characteristics of pediatric gastroenterology and outlines the core competencies that fellowship training must address according to accrediting bodies like ACGME and RCPSC.
Nutritional support is important for surgical patients to prevent complications. Three key aspects of nutritional support discussed are:
1) Enteral nutrition is preferred over parenteral nutrition when possible, with a hierarchy of feeding methods from oral to tube feeding to be followed.
2) Malnutrition increases surgical risk, so nutritional screening and optimization of intake, including supplementation, is important pre-and post-operatively.
3) Close monitoring of caloric and protein intake as well as electrolytes and glucose is needed for patients receiving enteral or parenteral nutrition support.
This study assessed satisfaction in 89 women who underwent concurrent pelvic organ prolapse (POP) repair and midurethral sling placement to treat stress urinary incontinence (SUI). At the 1-year follow-up, 72% of patients had complete cure of both POP and SUI, while 17% and 10% had persistent SUI or POP respectively. Overall, 88% reported being satisfied. Patients who achieved complete cure of both conditions had a 95% satisfaction rate, while 40% were dissatisfied if SUI was not cured and 22% if POP was not cured. The only outcome measure correlated with satisfaction was improvement in vaginal bulge symptoms. The study highlights the complex relationship between surgical outcomes and patient
How to achieve deep remission in treatment of inflammatory bowel disease.Younis I Munshi
The document discusses methods for achieving deep remission in treatment of inflammatory bowel disease (IBD). Deep remission means achieving both symptomatic and mucosal remission. Optimization of conventional therapy, early treatment, use of the Lemann score to assess damage, performance of double-balloon endoscopy, treatment using Traditional Chinese Medicine, and good communication between physicians and patients are needed to attain deep remission. Using these methods can help change the course of the disease, improve patient prognoses, and increase quality of life by minimizing complications and bowel damage.
Gastroenterology for the internist. The Clinics 2019Manuel Chumacero
This document summarizes key points about proton pump inhibitors (PPIs):
1) PPIs are among the most commonly prescribed medications but have been associated with potential adverse effects in observational studies.
2) While evidence for adverse effects is weak, there is also insufficient evidence to dismiss the risks.
3) PPIs are often prescribed inappropriately or at higher than recommended doses.
4) Physicians should carefully consider the indication for PPIs and ensure appropriate dosing before prescribing, and regularly review whether continued PPI therapy is needed.
This document discusses Helicobacter pylori (H. pylori), including its epidemiology, complications, diagnosis, and treatment. Some key points:
- H. pylori was first discovered in 1982 and linked to peptic ulcer disease and gastric cancer. It is acquired primarily in childhood and transmitted within families.
- Asia has a high prevalence of around 58%. Risk factors include poor hygiene and high population density.
- Complications include gastric cancer, ulcers, gastric MALT lymphoma, and intestinal metaplasia.
- Diagnosis involves tests like the urea breath test, stool antigen test, and endoscopy. Treatment guidelines recommend testing dyspepsia, ulcer,
Nutrition is essential for surgery patients as surgical procedures and fasting can quickly lead to malnutrition. Patients with severe protein depletion are more likely to experience postoperative complications like pneumonia and infection. Nutritional status should be assessed through history, diet assessment, physical exam, and lab tests. Malnutrition is caused by reduced food intake, malabsorption, altered metabolism, and more. Nutritional requirements vary but are generally 25-30 calories/kg/day and 1.5-2 grams of protein/kg/day. Nutrition can be provided enterally through tubes or parenterally through IVs. Enteral nutrition is preferred over parenteral when possible.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
Helicobacter Pylori Infection: Management in 2020ChernHaoChong
1) Helicobacter pylori infection is common and testing should be done for patients with dyspepsia, peptic ulcer history, or family history of gastric cancer.
2) The urea breath test is the best tool to detect active H. pylori infection.
3) Patients who test positive for H. pylori antibodies should undergo a urea breath test to confirm active infection before treatment.
The document summarizes key points about irritable bowel syndrome (IBS), including that it is characterized by abdominal pain associated with changes in bowel habits and is considered a disorder of interactions between the gut and brain. It discusses diagnosis of IBS using the Rome criteria, approaches to treatment using a biopsychosocial model and multidimensional clinical profile to develop personalized treatment plans, and the importance of an integrated care model using dietary, pharmacological, and behavioral therapies.
This document provides guidelines from the European Association for the Study of the Liver (EASL) on nutrition in chronic liver disease. It finds that malnutrition is frequently a problem for patients with liver cirrhosis and is associated with worse outcomes. All patients with advanced chronic liver disease, especially those with decompensated cirrhosis, should undergo nutritional screening. Those at risk of malnutrition based on the screening should receive a detailed nutritional assessment. The guidelines recommend assessing muscle mass, using global assessment tools, and performing a dietary intake evaluation for those found to be malnourished or at risk. They provide recommendations on nutritional management and screening in specific situations like hepatic encephalopathy or before and after liver transplantation.
The document discusses malnutrition in hospital patients. It describes how malnutrition can occur due to inadequate diet, digestion issues, or medical conditions. Left untreated, malnutrition can lead to complications and death. Studies show patients who eat less in the hospital have higher mortality rates. Reasons elderly patients eat inadequately in the hospital include illness, appetite loss, oral issues, and menu limitations. Dysphagia is another risk factor for malnutrition. Tube feedings and IV nutrition can help supplement intake for those unable to eat. Early nutrition intervention may help prevent malnutrition in hospitals.
Nutrition is important for surgical patients. Malnutrition can compound complications, while well-nourished patients tolerate surgery better. Several factors are used to assess a patient's nutritional status prior to surgery, including weight loss, serum albumin levels, and medical history. For patients who cannot eat adequately after surgery, enteral or parenteral nutrition may be needed to meet nutrient demands and support healing. Enteral nutrition involves feeding through a stomach or intestinal tube, while parenteral nutrition is administered intravenously.
This document discusses nutritional assessment and management in surgical patients. It begins with an outline of the topics to be covered, including nutritional assessment, requirements, interventions, and disease-specific nutrition. Various methods of nutritional assessment are described, such as clinical history, physical exam, laboratory tests, and calculations of energy expenditure. Enteral and parenteral nutrition are presented as interventions, with details on their indications, delivery methods, and complications. The goal of nutritional support is to meet metabolic needs in patients who cannot maintain adequate intake orally.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
This talk discusses GI/liver side effects of commonly used drugs and provides guidance on advising patients and monitoring or preventing adverse effects. It covers factors that may contribute to side effects like drug interactions and underlying diseases. Specific drugs discussed include statins, NSAIDs, aspirin, and ketoconazole. The speaker emphasizes advising patients on medication use and seeking medical help if unwell, considering individual risk factors when prescribing or recommending prophylaxis, and consulting specialists if serious adverse effects occur.
This document discusses irritable bowel syndrome (IBS) and summarizes a case study of a 32-year-old female patient, Ms. Lee, experiencing IBS symptoms. It covers the evolving diagnostic criteria for IBS, potential treatments including lifestyle modifications, medications, probiotics, and the relationship between small intestinal bacterial overgrowth (SIBO) and IBS. Hydrogen breath testing is presented as a non-invasive way to diagnose SIBO, though it has limitations. The antibiotic rifaximin is introduced as a treatment option for patients who test positive for SIBO.
1. The document discusses updated guidelines for screening of GI cancers, including colorectal, stomach, and pancreatic cancers.
2. For colorectal cancer screening, average risk adults aged 50-75 should be screened with stool tests every 2 years or colonoscopy every 10 years. Surveillance intervals for colon polyps have been adjusted to be less frequent in most cases.
3. For stomach cancer screening, guidelines agree routine screening is not recommended but may be considered for high risk populations. If gastric intestinal metaplasia is found, H. pylori testing and treatment is recommended, without routine endoscopic surveillance.
4. For pancreatic cancer, guidelines recommend against routine screening for asymptomatic adults as there is no
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
Association between-stress-and-dietary-behaviours-among-undergraduate-student...Annex Publishers
Background: Studies have shown that a significant proportion of university students globally suffer from stress. Although many studies have reported an association between psychological stress and dietary behaviour, findings remain inconclusive. To date, no research in Kuwait has assessed the prevalence of stress and its relationship with dietary pattern among university students.
Objectives: This study was designed to determine the extent of stress among undergraduate students in Kuwait University and to examine the relationship between dietary behaviours and stress.
Methods: A total of 407 (164 males and 243 females) undergraduate students, aged ≥ 18 years, from 4 colleges of Kuwait University participated in this cross sectional study. Data were collected using a self-administered questionnaire consisting of three sections: socio demographic information, stress measures and a 7-day food frequency questionnaire.
Results: Of the total participants, 43% were found to suffer from some level of stress, with slightly more females (44%) than males (40.9%). When examined the severity of stress level, 28.4% of the females and 22% of the males had moderate to severe form of stress. Stressed female students were more likely to eat fast foods (OR 1.75; 95% CI: 1.02-3:00), snacks (OR 2.0; 95% CI: 1.16-3:43) and beverages (OR 2.28; 95% CI: 1.30-3.98) than unstressed female students. For male students, none of the food consumption groups were associated with stress.
Conclusions: These results show a clear difference in food selection patterns between stressed male and female students with stress being strongly associated with unhealthy food selection among female students than male students. These findings emphasize the importance for the development of specific intervention programs to decrease stress and improve healthy behaviour especially among female university students and thus reduce the potential negative implications of stress on health.
1) Enteral nutrition involves providing calories, protein, electrolytes, vitamins, and minerals through the gastrointestinal tract and is the preferred method of nutrition for critically ill patients who can tolerate it.
2) Early initiation of enteral nutrition within 48 hours for critically ill patients is recommended to provide clinical benefits over parenteral nutrition or no nutrition support.
3) Factors such as underlying disease state, severity of illness, nutritional status, and ability to be fed enterally must be considered when determining a patient's eligibility for and initiation of enteral nutrition.
How to improve enteral feeding tolerance in chronically critically ill patientsDr Jay Prakash
These interruptions to EN result in significant daily and cumulative calorie deficits, thus contributing to underfeeding and malnutrition. Underfed patients have an increased risk of all-cause mortality, bloodstream infections and longer ICU and hospital stays.
Nutritional support is important for surgical patients to prevent complications. Three key aspects of nutritional support discussed are:
1) Enteral nutrition is preferred over parenteral nutrition when possible, with a hierarchy of feeding methods from oral to tube feeding to be followed.
2) Malnutrition increases surgical risk, so nutritional screening and optimization of intake, including supplementation, is important pre-and post-operatively.
3) Close monitoring of caloric and protein intake as well as electrolytes and glucose is needed for patients receiving enteral or parenteral nutrition support.
This study assessed satisfaction in 89 women who underwent concurrent pelvic organ prolapse (POP) repair and midurethral sling placement to treat stress urinary incontinence (SUI). At the 1-year follow-up, 72% of patients had complete cure of both POP and SUI, while 17% and 10% had persistent SUI or POP respectively. Overall, 88% reported being satisfied. Patients who achieved complete cure of both conditions had a 95% satisfaction rate, while 40% were dissatisfied if SUI was not cured and 22% if POP was not cured. The only outcome measure correlated with satisfaction was improvement in vaginal bulge symptoms. The study highlights the complex relationship between surgical outcomes and patient
How to achieve deep remission in treatment of inflammatory bowel disease.Younis I Munshi
The document discusses methods for achieving deep remission in treatment of inflammatory bowel disease (IBD). Deep remission means achieving both symptomatic and mucosal remission. Optimization of conventional therapy, early treatment, use of the Lemann score to assess damage, performance of double-balloon endoscopy, treatment using Traditional Chinese Medicine, and good communication between physicians and patients are needed to attain deep remission. Using these methods can help change the course of the disease, improve patient prognoses, and increase quality of life by minimizing complications and bowel damage.
Gastroenterology for the internist. The Clinics 2019Manuel Chumacero
This document summarizes key points about proton pump inhibitors (PPIs):
1) PPIs are among the most commonly prescribed medications but have been associated with potential adverse effects in observational studies.
2) While evidence for adverse effects is weak, there is also insufficient evidence to dismiss the risks.
3) PPIs are often prescribed inappropriately or at higher than recommended doses.
4) Physicians should carefully consider the indication for PPIs and ensure appropriate dosing before prescribing, and regularly review whether continued PPI therapy is needed.
This document discusses Helicobacter pylori (H. pylori), including its epidemiology, complications, diagnosis, and treatment. Some key points:
- H. pylori was first discovered in 1982 and linked to peptic ulcer disease and gastric cancer. It is acquired primarily in childhood and transmitted within families.
- Asia has a high prevalence of around 58%. Risk factors include poor hygiene and high population density.
- Complications include gastric cancer, ulcers, gastric MALT lymphoma, and intestinal metaplasia.
- Diagnosis involves tests like the urea breath test, stool antigen test, and endoscopy. Treatment guidelines recommend testing dyspepsia, ulcer,
Nutrition is essential for surgery patients as surgical procedures and fasting can quickly lead to malnutrition. Patients with severe protein depletion are more likely to experience postoperative complications like pneumonia and infection. Nutritional status should be assessed through history, diet assessment, physical exam, and lab tests. Malnutrition is caused by reduced food intake, malabsorption, altered metabolism, and more. Nutritional requirements vary but are generally 25-30 calories/kg/day and 1.5-2 grams of protein/kg/day. Nutrition can be provided enterally through tubes or parenterally through IVs. Enteral nutrition is preferred over parenteral when possible.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
Helicobacter Pylori Infection: Management in 2020ChernHaoChong
1) Helicobacter pylori infection is common and testing should be done for patients with dyspepsia, peptic ulcer history, or family history of gastric cancer.
2) The urea breath test is the best tool to detect active H. pylori infection.
3) Patients who test positive for H. pylori antibodies should undergo a urea breath test to confirm active infection before treatment.
The document summarizes key points about irritable bowel syndrome (IBS), including that it is characterized by abdominal pain associated with changes in bowel habits and is considered a disorder of interactions between the gut and brain. It discusses diagnosis of IBS using the Rome criteria, approaches to treatment using a biopsychosocial model and multidimensional clinical profile to develop personalized treatment plans, and the importance of an integrated care model using dietary, pharmacological, and behavioral therapies.
This document provides guidelines from the European Association for the Study of the Liver (EASL) on nutrition in chronic liver disease. It finds that malnutrition is frequently a problem for patients with liver cirrhosis and is associated with worse outcomes. All patients with advanced chronic liver disease, especially those with decompensated cirrhosis, should undergo nutritional screening. Those at risk of malnutrition based on the screening should receive a detailed nutritional assessment. The guidelines recommend assessing muscle mass, using global assessment tools, and performing a dietary intake evaluation for those found to be malnourished or at risk. They provide recommendations on nutritional management and screening in specific situations like hepatic encephalopathy or before and after liver transplantation.
The document discusses malnutrition in hospital patients. It describes how malnutrition can occur due to inadequate diet, digestion issues, or medical conditions. Left untreated, malnutrition can lead to complications and death. Studies show patients who eat less in the hospital have higher mortality rates. Reasons elderly patients eat inadequately in the hospital include illness, appetite loss, oral issues, and menu limitations. Dysphagia is another risk factor for malnutrition. Tube feedings and IV nutrition can help supplement intake for those unable to eat. Early nutrition intervention may help prevent malnutrition in hospitals.
Nutrition is important for surgical patients. Malnutrition can compound complications, while well-nourished patients tolerate surgery better. Several factors are used to assess a patient's nutritional status prior to surgery, including weight loss, serum albumin levels, and medical history. For patients who cannot eat adequately after surgery, enteral or parenteral nutrition may be needed to meet nutrient demands and support healing. Enteral nutrition involves feeding through a stomach or intestinal tube, while parenteral nutrition is administered intravenously.
This document discusses nutritional assessment and management in surgical patients. It begins with an outline of the topics to be covered, including nutritional assessment, requirements, interventions, and disease-specific nutrition. Various methods of nutritional assessment are described, such as clinical history, physical exam, laboratory tests, and calculations of energy expenditure. Enteral and parenteral nutrition are presented as interventions, with details on their indications, delivery methods, and complications. The goal of nutritional support is to meet metabolic needs in patients who cannot maintain adequate intake orally.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
This talk discusses GI/liver side effects of commonly used drugs and provides guidance on advising patients and monitoring or preventing adverse effects. It covers factors that may contribute to side effects like drug interactions and underlying diseases. Specific drugs discussed include statins, NSAIDs, aspirin, and ketoconazole. The speaker emphasizes advising patients on medication use and seeking medical help if unwell, considering individual risk factors when prescribing or recommending prophylaxis, and consulting specialists if serious adverse effects occur.
This document discusses irritable bowel syndrome (IBS) and summarizes a case study of a 32-year-old female patient, Ms. Lee, experiencing IBS symptoms. It covers the evolving diagnostic criteria for IBS, potential treatments including lifestyle modifications, medications, probiotics, and the relationship between small intestinal bacterial overgrowth (SIBO) and IBS. Hydrogen breath testing is presented as a non-invasive way to diagnose SIBO, though it has limitations. The antibiotic rifaximin is introduced as a treatment option for patients who test positive for SIBO.
1. The document discusses updated guidelines for screening of GI cancers, including colorectal, stomach, and pancreatic cancers.
2. For colorectal cancer screening, average risk adults aged 50-75 should be screened with stool tests every 2 years or colonoscopy every 10 years. Surveillance intervals for colon polyps have been adjusted to be less frequent in most cases.
3. For stomach cancer screening, guidelines agree routine screening is not recommended but may be considered for high risk populations. If gastric intestinal metaplasia is found, H. pylori testing and treatment is recommended, without routine endoscopic surveillance.
4. For pancreatic cancer, guidelines recommend against routine screening for asymptomatic adults as there is no
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
Association between-stress-and-dietary-behaviours-among-undergraduate-student...Annex Publishers
Background: Studies have shown that a significant proportion of university students globally suffer from stress. Although many studies have reported an association between psychological stress and dietary behaviour, findings remain inconclusive. To date, no research in Kuwait has assessed the prevalence of stress and its relationship with dietary pattern among university students.
Objectives: This study was designed to determine the extent of stress among undergraduate students in Kuwait University and to examine the relationship between dietary behaviours and stress.
Methods: A total of 407 (164 males and 243 females) undergraduate students, aged ≥ 18 years, from 4 colleges of Kuwait University participated in this cross sectional study. Data were collected using a self-administered questionnaire consisting of three sections: socio demographic information, stress measures and a 7-day food frequency questionnaire.
Results: Of the total participants, 43% were found to suffer from some level of stress, with slightly more females (44%) than males (40.9%). When examined the severity of stress level, 28.4% of the females and 22% of the males had moderate to severe form of stress. Stressed female students were more likely to eat fast foods (OR 1.75; 95% CI: 1.02-3:00), snacks (OR 2.0; 95% CI: 1.16-3:43) and beverages (OR 2.28; 95% CI: 1.30-3.98) than unstressed female students. For male students, none of the food consumption groups were associated with stress.
Conclusions: These results show a clear difference in food selection patterns between stressed male and female students with stress being strongly associated with unhealthy food selection among female students than male students. These findings emphasize the importance for the development of specific intervention programs to decrease stress and improve healthy behaviour especially among female university students and thus reduce the potential negative implications of stress on health.
1) Enteral nutrition involves providing calories, protein, electrolytes, vitamins, and minerals through the gastrointestinal tract and is the preferred method of nutrition for critically ill patients who can tolerate it.
2) Early initiation of enteral nutrition within 48 hours for critically ill patients is recommended to provide clinical benefits over parenteral nutrition or no nutrition support.
3) Factors such as underlying disease state, severity of illness, nutritional status, and ability to be fed enterally must be considered when determining a patient's eligibility for and initiation of enteral nutrition.
How to improve enteral feeding tolerance in chronically critically ill patientsDr Jay Prakash
These interruptions to EN result in significant daily and cumulative calorie deficits, thus contributing to underfeeding and malnutrition. Underfed patients have an increased risk of all-cause mortality, bloodstream infections and longer ICU and hospital stays.
Perspectives 29 Treating a Patient with an Intestinal Obstructiontourtt
Intestinal obstructions account for 20% of all acute surgical admissions. Mortality and morbidity are dependent on the early recognition and correct diagnosis of obstruction. If untreated, strangulated obstructions cause death in 100% of patients; however, the mortality rate decreases to 8% with prompt surgical intervention. Intestinal obstruction is caused by a variety of pathologic processes including postoperative adhesions, malignancy, Crohn's disease, and hernias. Dr. Kent outlines the diagnosis and perioperative treatment of patients with intestinal obstruction. Ms. Lau discusses the advantages of closed enteral feeding systems over open systems, including less bacterial contamination and safer increased hang times, which have the potential to improve patient outcomes and safety.
The Journal of the Academy of Nutritionand Dietetics, Journa.docxrhetttrevannion
The Journal of the Academy of Nutrition
and Dietetics, Journal of Parenteral and
Enteral Nutrition, and MEDSURG Nursing
Journal have arranged to publish this
article simultaneously in their publica-
tions. Minor differences in style may
appear in each publication, but the article
is substantially the same in each journal.
Copyright ª 2013 by the Academy of
Nutrition and Dietetics, American Society
for Parenteral and Enteral Nutrition, and
Academy of Medical-Surgical Nurses.
2212-2672/$36.00
doi:10.1016/j.jand.2013.05.015
Available online 17 July 2013
JO
FROM THE ACADEMY
Critical Role of Nutrition in Improving Quality of Care:
An Interdisciplinary Call to Action to Address Adult
Hospital Malnutrition
Kelly A. Tappenden, PhD, RD, FASPEN; Beth Quatrara, DNP, RN, CMSRN; Melissa L. Parkhurst, MD; Ainsley M. Malone, MS, RD;
Gary Fanjiang, MD; Thomas R. Ziegler, MD
ABSTRACT
The current era of health care delivery, with its focus on providing high-quality, affordable care, presents many challenges to hospital-
based health professionals. The prevention and treatment of hospital malnutrition offers a tremendous opportunity to optimize the
overall quality of patient care, improve clinical outcomes, and reduce costs. Unfortunately, malnutrition continues to go unrecognized
and untreated in many hospitalized patients. This article represents a call to action from the interdisciplinary Alliance to Advance Patient
Nutrition to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and
treat malnourished patients and those at risk for malnutrition. We underscore the importance of an interdisciplinary approach to
addressing malnutrition both in the hospital and in the acute post-hospital phase. It is well recognized that malnutrition is associated
with adverse clinical outcomes. Although data vary across studies, available evidence shows that early nutrition intervention can reduce
complication rates, length of hospital stay, readmission rates, mortality, and cost of care. The key is to systematically identify patients
who are malnourished or at risk and to promptly intervene. We present a novel care model to drive improvement, emphasizing the
following six principles: (1) create an institutional culture where all stakeholders value nutrition; (2) redefine clinicians’ roles to include
nutrition care; (3) recognize and diagnose all malnourished patients and those at risk; (4) rapidly implement comprehensive nutrition
interventions and continued monitoring; (5) communicate nutrition care plans; and (6) develop a comprehensive discharge nutrition
care and education plan.
J Acad Nutr Diet. 2013;113:1219-1237.
T
HE UNITED STATES IS
entering a new era of health
care delivery in which changes
in health care policy are driving
an increased focus on costs, quality,
and transparency of care. This new
focus on improving the quality and ef-
ficiency of hospital care highlights an
urgent need to revis.
Malnutrition is common in cancer patients, affecting 40-80% during their disease course. It negatively impacts treatment outcomes, mortality, and quality of life. Early screening and nutritional interventions can help prevent weight loss and treatment interruptions. A multidisciplinary team approach is needed to address nutritional status from diagnosis onward through cancer treatment. Screening tools help identify at-risk patients who need comprehensive assessment and individualized nutritional support through diet, oral supplements, enteral feeding, or parenteral nutrition as needed. Exercise should also be encouraged to preserve muscle mass. Prioritizing nutritional care represents good clinical practice that can optimize cancer treatment.
1. Malnutrition is common in head and neck cancer patients due to mechanical obstruction, sensory impairment, pain with swallowing, and the effects of cancer treatments like surgery, radiation and chemotherapy.
2. Factors contributing to malnutrition include reduced oral intake, anorexia, nausea, inadequate chewing and swallowing difficulties. Cancer cachexia, where the body breaks down muscle and fat stores, further worsens malnutrition.
3. Malnutrition is associated with increased complications, longer hospital stays, decreased survival, and poorer outcomes for head and neck cancer patients. Early nutritional intervention is important.
Closed or ready-to-hang enteral nutrition systems have several benefits over open systems including reduced risk of contamination, easier administration requiring less nursing time, and improved delivery of nutrients. Major guidelines recommend the use of ready-to-hang liquid nutrition as the preferred method where possible. Using closed systems can improve patient outcomes and reduce healthcare costs.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining energy needs, choosing the route of nutrition (enteral vs parenteral), and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps in knowledge to guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide best practices for nutritional therapy and identify gaps in knowledge to help guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps requiring further research.
This document provides guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) on clinical nutrition for patients in the intensive care unit (ICU). It defines who is at nutritional risk, how to assess a patient's nutritional status, how to determine energy needs, and the appropriate route (enteral vs parenteral) and progression of nutrition support. Recommendations are given for the amount and composition of macronutrients (carbohydrates, fat, protein) to provide. Special clinical situations like dysphagia, trauma, sepsis, and obesity are also addressed. The guidelines aim to guide practitioners in providing optimal evidence-based medical nutrition therapy to critically ill patients.
Nutrition in icu closed system nutrition benefitsSubha Deep
This document discusses the importance of ready-to-hang enteral feeding systems for critically ill patients. It notes that gastrointestinal dysfunction is common in ICU patients and can lead to malnutrition if adequate nutrition is not provided. Ready-to-hang systems have advantages over open systems like less risk of contamination, better maintenance of nutritional adequacy, and reduced nursing time. Guidelines recommend ready-to-hang formulations for critically ill patients. Clinical evidence shows benefits of ready-to-hang systems like lower rates of infection, better nutritional outcomes, and more cost-effective care.
Postpartum Meningitis by Enterococcus Faecalis Secondary to Neuraxial AnesthesiaAnonIshanvi
This study evaluated the efficacy and safety of fecal microbiota transplantation (FMT) for 12 patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Baseline symptoms and scores were assessed using IBS severity scores, Birmingham IBS symptom scores, and quality of life questionnaires. Patients underwent FMT and were followed up at 1, 3, and 6 months. Scores showed significant improvement from baseline to 3 months after FMT, including reduced IBS severity scores and Birmingham scores. FMT was found to provide significant symptom relief for IBS-D over 6 months with no serious adverse events reported.
80.Dr. Manesh kumar. Efficacy Of Oil-Based Nutrition In Polytrauma Patients: An Original Research. Nat. Volatiles & Essent. Oils, 2021; 8(4): 15597-15601Dr. Ambika Hegde. Oral Microflora In Different Trimesters Of Pregnancy- An Original Research. Nat. Volatiles & Essent. Oils, 2021; 8(6): 1472-1476
1. Nutrition is now recognized as an important subspecialty, as proper nutrition can improve patient outcomes like muscle strength, immune function, and wound healing.
2. Malnutrition is common in hospitalized patients, with 1/3 at risk, and even small amounts of weight loss are associated with worse outcomes. Nutritional support teams provide care for complex cases requiring enteral or parenteral nutrition.
3. Indications for nutritional support include a BMI <19, unintentional weight loss, and inability to meet nutritional needs enterally. Tube feeding is used when oral intake is inadequate, and parenteral nutrition is for intestinal failure when the gut cannot be used.
This document discusses the role of medical nutrition therapy in wound healing, specifically for pressure ulcers. It identifies key nutrients needed to support wound repair like protein, calories, vitamins, and minerals. The goals of nutrition intervention for wound healing are to provide adequate nutrients and prevent or promote healing of pressure ulcers. Medical nutrition therapy for wound healing should include increasing energy and protein intake and fluid intake. It also discusses the role of registered dietitian nutritionists in assessing nutritional status, identifying risks, developing nutrition care plans, and monitoring progress.
1) Gastric cancer surgery can lead to nutritional deficiencies due to loss of stomach and changes to small bowel anatomy. Timely nutritional intervention is important to prevent issues like weight loss and micronutrient deficiencies.
2) Screening patients preoperatively for malnutrition is crucial, as up to 65% of patients may be at nutritional risk. Various screening tools evaluate factors like albumin, weight loss, and muscle mass. Nutritional support for 7-14 days preoperatively can reduce complications.
3) Postoperative nutritional goals include early oral feeding, adequate protein intake, and preventing deficiencies like anemia. Monitoring for deficiencies is important long-term, as nutritional recovery may take up to a year after surgery.
Surgical Nutrition Insights - Dr Valeria Simone MDMeghaSingh194
Surgical nutrition plays a crucial role in optimizing patient outcomes and promoting the healing process. As advancements in surgical techniques continue to evolve, so does the understanding of the impact of nutrition on postoperative recovery. Let's explore more: https://www.southlakegeneralsurgery.com/surgical-nutrition-insights/
Intermittent bolus feeding versus continuous enteral feedingDr. Prashant Kumar
Early enteral nutrition is recommended in critically ill adult patients. The optimal method of administering enteral nutrition remains unknown. Continuous enteral nutrition administration in critically ill patients remains the most common practice worldwide; however, its practice has recently been called into question in favour of intermittent enteral nutrition administration, where volume is infused multiple times per day.
This presentation will outline the key differences between continuous and intermittent enteral nutrition, describe the metabolic responses to continuous and intermittent enteral nutrition administration and outline recent studies comparing continuous with intermittent enteral nutrition administration on outcomes in critically ill adults.
Journal of Nutrition and Health Sciences is an open access journal that publishes peer reviewed research articles and short communications in all aspects of nutrition. This Journal encompasses the full spectrum of nutritional science including nutritional requirements, public health nutrition, epidemiology, dietary surveys, body composition, energetics, appetite, obesity, ageing and metabolic studies.
Journal of Proteomics & Geneomics (JPG) is an instructional journal providing a chance to researchers and scientists to explore the advanced and latest research developments within the field of Proteomics and Geneomics. Journal of Proteomics & Geneomics publishes the best quality scientific articles amalgamating broad vary of fields together with the fields associated with Proteomics & Geneomics.
Journal of Obesity and Overweight (JOO) is a peer reviewed open access journal. It is dedicated to increase knowledge, fostering research, and promoting better treatment for people with obesity. It includes subjects like nutrition medicine, clinical nutrition medicine, genetics and nutrition, biophysics and lipid metabolism, etc. It aims to publish advanced research works related to public health and medical developments.
Journal of Computational Systems Biology (JCSB) is an open access online journal which aims to publish peer reviewed research articles and short communications in all aspects of computational biology and bioinformatics. JCSB comprehend the broad spectrum of computational bioscience including biological databases and bioalgorithms.
Journal of Biometrics and Its Applications (JBIA) is peer reviewed open access journal which addresses the fundamental areas in computer science that deal with biological measurements. It covers both the theoretical and practical aspects of human identification and verification. Biometrics based authentication, an integral component of identity science, is now being utilized in several applications playing a central role in personal, national and global security. Biometric refers to the field of development of statistical and mathematical methods applicable to data analysis problems in the biological sciences.
Journal of Gynecology Research (JGR) publishes original articles and research studies on, scientific advances, new medical and surgical techniques, obstetric management, and clinical evaluation of drugs and instruments and all aspects of gynecology including gynecological endoscopy, infertility, oncology contraception, urogynecology, fertility, and clinical practice and ultrasonography. It aims to publish the highest quality medical research in women's health, worldwide.
CLINICAL AND EXPERIMENTAL RESEARCH IN CARDIOLOGYAnnex Publishers
Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
Journal of Genetic Mutations and Disorders (JGMD) is an open access, peer reviewed journal which provides advanced researches including Genetics of Infectious Diseases, Genealogical Tracing, Stem Cell Research, Gene mapping with three-point crosses, Genetic linkage and genetic maps. JGMD publishes original research, review articles in all aspects of genetic mutations and disorders
CLINICAL AND EXPERIMENTAL RESEARCH IN CARDIOLOGYAnnex Publishers
Journal of Clinical and Experimental Research in Cardiology (JCERC) is an international open access, scholarly peer-reviewed journal publishing high quality articles in all areas of cardiology related fields, especially current research, new concepts, novel methods, new therapeutic agents, and approaches for early detection and prevention of cardiac disorders and reporting new methods on basic and advanced clinical aspects of cardiology research.
Journal of Bioequivalence Studies (JBS) is an open access, peer reviewed journal that publishes the most relevant and reliable researches with respect to the subject of Bioequivalence studies which includes pharmacokinetic and pharmcodynamic properties of a drug. JBS publishes original articles, review articles, case reports, short communications, etc.
Journal of Forensic Science & Criminology (JFSC) is an open access, significant and reliable source of contemporary knowledge on advancements in the field of forensic science. JFSC publishes peer reviewed research articles, critical reviews and short communications focused on forensic science and criminology. JFSC encompasses the full spectrum of forensic science including forensic biology, forensic chemistry, cyber forensics and crime scene investigation
Annex Publishers, as an Open Access publication model allows the dissemination of research articles to the worldwide community. We offer you the advantage of interaction with the most effective minds from the scientific community. All articles printed under open access will be accessed by anyone.
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JOURNAL OF VETERINARY SCIENCE & ANIMAL HUSBANDRYAnnex Publishers
Journal of Veterinary Science and Animal Husbandry (JVSAH) is a scientific journal which has topics associated with fundamental and aspects of veterinary science and animal husbandry. JVSAH has a special feature of publishing special issues in experimental clinical research, veterinary medicine and current research. At Annex Publishers, we tend to publish quality articles and try our best to provide the most effective analysis journal to the scientific community.
Anti arthritic-efficacy-and-safety-of-crominex-3+(trivalent-chromium-phyllant...Annex Publishers
Abstract
The present investigation was undertaken to evaluate the therapeutic efficacy and safety of Crominex® 3+ (a complex of trivalent chromium, Phyllanthus emblica (Amla) extract and purified Shilajit) in moderately arthritic dogs. Eleven client-owned moderately arthritic dogs in a randomized double-blinded study received placebo or Crominex® 3+ twice daily for a period of 150 days. On a monthly basis, each dog was evaluated for arthritis associated pain (overall pain, pain upon limb manipulation and pain after physical exertion) and a full physical exam (body weight, body temperature and heart rate). At the same time intervals, dogs serum samples were examined for biomarkers of kidney (BUN and creatinine), liver (bilirubin, ALT and AST) and heart and skeletal muscle (CK) functions. Findings of this investigation revealed that dogs receiving Crominex® 3+ (1000 μg chromium, 15 mg Amla extract and 15 mg purified Shilajit per day in two divided doses) exhibited a significant (P< 0.05) reduction in arthritic pain noted as early as after 90 days with a maximum reduction after 150 days of treatment. Pain level remained the same or slightly increased in the dogs receiving placebo. No significant change occurred in physical parameters or serum biomarkers in dogs on placebo or Crominex® 3+, which suggested that Crominex® 3+ was well tolerated by arthritic dogs. In conclusion, Crominex® 3+ significantly (P< 0.05) ameliorated arthritic pain and improved quality of life without causing any untoward effects in moderately arthritic dogs.
This study evaluated the outcomes of three surgical techniques used to correct abomasal displacement in dairy cattle: right flank omentopexy, right flank omentoabomasopexy, and left flank abomasopexy. The study found that cattle corrected with right flank omentopexy or left flank abomasopexy were more likely to return to normal milk production than those corrected with right flank omentoabomasopexy. Concurrent diseases did not significantly affect the likelihood of returning to normal milk production. Reported post-operative complications were infrequent.
Abstract
The objectives of this retrospective study were 1. To determine the effect of three surgical techniques (right flank omentopexy, right flank omentoabomasopexy, and left flank abomasopexy), and 2. To determine the effect of concurrent disease on return to normal milk production. Return to normal milk production occurred in 86.3% of cows diagnosed with LDA. Results suggested that cattle diagnosed with LDA corrected via right flank omentopexy or left flank abomasopexy were significantly more likely to return to normal milk production as compared to those corrected via right flank omentoabomasopexy (p< 0.02). No significant difference in return to normal milk production was noted between surgical techniques for correction of RDA (p=1.000) and right abomasal volvulus (p=0.596). Concurrent disease diagnoses did not affect return to milk production. Reported complications were infrequent (n=11).
List of abbreviations: LDA- Left displaced abomasum; RDA- Right displaced abomasum; RAV- Right abomasal volvulus; RAOV- Right abomasal-omasal volvulus; RFO- Right flank omentopexy; RFOA- Right flank omentoabomasopexy; LFA- Left flank abomasopexy; DA – Displaced Abomasum
Abstract
Three surgical case reports are presented to demonstrate the clinical efficacy of using an improved aqueous solution of chlorine dioxide complex (160 ppm) as a topical antiseptic in the post operative management of serious wounds in dogs. In vitro studies are included to demonstrate the antiseptic properties of this new chlorine dioxide complex.
Keywords: Chlorine dioxide; Antiseptic; Antimicrobial; Wound management
Abbreviations: ClO2-Chlorine dioxide; Cl2-Chlorine; PPM-Parts Per Million; SPP-Species; TEM-Transmission Electron Micrograph
This document discusses Salmonella serovars and their host specificity. It begins by introducing Salmonella as a pathogen that infects many hosts. It then discusses 3 phases in the evolution of Salmonella that led to divergence and adaptation to different hosts. Key points are made about factors determining host specificity, including genetic determinants and physiological differences. The roles of virulence factors, horizontal gene transfer, and host stress are described in relation to pathogenicity and host adaptation of different Salmonella serovars.
Anti inflammatory-and-anti-arthritic-efficacy-and-safety-of-purified-shilajit...Annex Publishers
Abstract
The objective of this investigation was to evaluate the efficacy and safety of purified Shilajit in moderately arthritic dogs. Ten client-owned dogs in a randomized double-blinded study received either a placebo or Shilajit (500 mg) twice daily for a period of five months. Dogs were evaluated each month for physical condition (body weight, body temperature, heart rate, and respiration rate) and pain associated with arthritis (overall pain, pain from limb manipulation, and pain after physical exertion). Serum samples collected from these dogs were examined each month for biomarkers of liver (bilirubin, ALT, and AST), kidney (BUN and creatinine) heart and muscle (creatine kinase) functions. The findings of this study revealed that dogs receiving Shilajit (Group-II) showed a significant (P< 0.05) reduction in pain from limb manipulation by day 60, and overall pain and pain after physical exertion by day 120. Maximum pain reduction, using all three criteria, was observed on day 150. Pain level remained significantly unchanged in dogs receiving the placebo. Dogs in either group showed no significant change (P>0.05) in physical parameters or serum markers, suggesting that Shilajit was well tolerated by moderately arthritic dogs. It was concluded that Shilajit significantly (P< 0.05) reduced pain in osteoarthritic dogs and markedly improved their daily life without any side effects.
Keywords: Purified Shilajit; Osteoarthritis in canine; Shilajit safety; Anti-arthritic nutraceutical
The updated-international-veterinary-anatomical-and-embryological-nomenclaturesAnnex Publishers
The international nomenclature of the anatomical, histological and embryological terms is known as Nomina Anatomica Veterinaria (N.A.V.), Nomina Histologica Veterinaria (N.H.V.) and Nomina Embryologica Veterinaria (N.E.V.).
This is the tripod of terms for the morphological sciences in our profession, a dictionary of terms used by all specialists in the basic and in the clinical sciences.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxgoluk9330
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
TOPIC OF DISCUSSION: CENTRIFUGATION SLIDESHARE.pptxshubhijain836
Centrifugation is a powerful technique used in laboratories to separate components of a heterogeneous mixture based on their density. This process utilizes centrifugal force to rapidly spin samples, causing denser particles to migrate outward more quickly than lighter ones. As a result, distinct layers form within the sample tube, allowing for easy isolation and purification of target substances.
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Signatures of wave erosion in Titan’s coastsSérgio Sacani
The shorelines of Titan’s hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it isunclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theo-retical models suggest that wind may cause waves to form on Titan’s seas, potentially driving coastal erosion,but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titanremain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively dis-cern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combinelandscape evolution models with measurements of shoreline shape on Earth to characterize how differentcoastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that theshorelines of Titan’s seas are most consistent with flooded landscapes that subsequently have been eroded bywaves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates atfetch lengths of tens of kilometers.
The cost of acquiring information by natural selectionCarl Bergstrom
This is a short talk that I gave at the Banff International Research Station workshop on Modeling and Theory in Population Biology. The idea is to try to understand how the burden of natural selection relates to the amount of information that selection puts into the genome.
It's based on the first part of this research paper:
The cost of information acquisition by natural selection
Ryan Seamus McGee, Olivia Kosterlitz, Artem Kaznatcheev, Benjamin Kerr, Carl T. Bergstrom
bioRxiv 2022.07.02.498577; doi: https://doi.org/10.1101/2022.07.02.498577
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
PPT on Sustainable Land Management presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
1. Annex Publishers | www.annexpublishers.com
Volume 1 | Issue 1Abstract
Bone marrow transplant (BMT) recipients often require parenteral nutrition (PN) to meet their nutrient needs. While general guidelines for the provision of PN support by nutrition support teams (NSTs) have been shown to decrease inappropriate PN use, recommendations for nutrition in BMT recipients are lacking. We reviewed the charts of patients status post BMT on PN to determine whether institutional guidelines for PN initiation and continuous supervision of NSTs could be applied in this population. With the Institutional Review Board (IRB) approval, charts of adult BMT recipients on PN between June 14, 2006 and June 30, 2007 were examined. Sixty-nine charts were reviewed. Indications for initiation of PN included severe mucositis, graft versus host disease (GVHD), and other transplant related side effects resulting in poor oral intake. Among 69 patients, 37 (54%) had severe mucositis, 12 (17%) had GVHD, 2 (3%) had both mucositis and GVHD, and 18 (26%) had other side effects. It was determined that all patients met the criteria for initiation of PN support, as outlined in the guidelines form. Comprehensive guidelines for initiating PN support, developed by NSTs can also be used for BMT recipients in order to optimize their nutritional status. Introduction
Parenteral Nutrition Utilization in Bone Marrow Transplant Recipients
Wilson S*, Kohli-Seth R, Aldeguer Y, Pek M, Dharshan A, Oropello J, Manasia A, Bassily-Marcus A and Benjamin E
Department of Surgery, Division of Surgical Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
*Corresponding author: Wilson S, Department of Surgery, Division of Surgical Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1264, New York, NY 10029, USA E-mail: sara.wilson@mountsinai.org
Citation: Wilson S, Kohli-Seth R, Aldeguer Y, Pek M, Dharshan A, et al. (2014) Parenteral Nutrition Utilization in Bone Marrow Transplant Recipients. J Nutr Health Sci 1(1): 102. doi: 10.15744/2393-9060.1.102
Research Article
Open AccessKeywords: Total parenteral nutrition (TPN); Bone marrow transplant (BMT); Nutrition support; GVHD; Mucositis
Parenteral nutrition (PN) is a specialized form of intravenous nutrition consisting of macro and micronutrients designed to meet the needs of patients who are unable to tolerate adequate enteral intake. When used appropriately PN can be a lifesaving therapy [1]. Bone marrow transplant is a well-established treatment modality for many diseases, including solid tumors, hematologic malignancies, and autoimmune disorders. Presently, there are two types of BMT that can be performed, autologous (a-BMT) and allogenic (allo-BMT) bone marrow transplantation. In patients who have undergone allo-BMT, 18-70% develop acute graft versus host disease (GVHD) [2].This occurs when transplanted or grafted cells recognize the host as foreign, thereby initiating an immune response that causes diseases in the transplant recipient. Of those patients diagnosed with acute GVHD, 50% progress to chronic GVHD, further increasing the risk for malnutrition and other related complications [3]. Intestinal GVHD characterized by diarrhea with or without nausea, vomiting, abdominal pain and occasionally ileus, contributes to the development of malnutrition, elucidating the need for PN use in these patients to meet their nutrient requirements [4].
Malnutrition is a negative prognostic factor for outcome after BMT. In patients undergoing BMT, impaired nutritional status can lead to longer engraftment time and greater probability of developing infection. Higher transplant-related mortality has also been observed in underweight patients (BMI <20) who undergo BMT [5,6].The use of conditioning regimens has tremendous and deleterious consequences on the anatomical and functional integrity of the gastrointestinal tract. Likewise, the presence of infection and the drugs used for treatment and prophylaxis during the peri-transplant period can result in the development of mouth sores, nausea, vomiting and diarrhea. A common indication for PN use in BMT recipients is the occurrence of severe mucositis of the GI tract. It can affect up to 75% of BMT recipients and combined with other gastrointestinal toxicities such as GVHD, and severe nausea and vomiting, it can significantly affect food intake and absorption resulting in dehydration and malnutrition [7].
The routine use of PN in BMT recipients, either as a supportive care or adjunctive therapy, minimizes the nutritional consequences of transplantation [8]. Despite overall favoring of enteral nutrition over PN, the presence of nausea, vomiting, and GI mucositis, make enteral nutrition support poorly tolerated by BMT patients. That coupled with the increased risk of bleeding associated with enteral tube placement in patients with thrombocytopenia, may justify the need for an alternative to enteral nutrition support.
Received Date: February 15, 2014 Accepted Date: May 15, 2014 Published Date: May 20, 2014
Volume 1 | Issue 1
Journal of Nutrition and Health Sciences
ISSN: 2393-9060
2. Annex Publishers | www.annexpublishers.com
Volume 1 | Issue 1
Journal of Nutrition and Health Sciences
2
Providing prophylactic TPN during cytoreductive therapy to patients following transplantation has previously been shown to improve disease free and overall survival rates, as well as improve time to relapse [9]. Currently the data is limited and has not validated the benefits of either feeding route (PN vs EN) in these patients. Parenteral nutrition may be preferred in patients with severe GI complications that result in failed trials of enteral feeding [10]. Despite these practices, clear and established recommendations for when to appropriately initiate nutrition support are still lacking.
Guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) published in 2009, report PN is ineffective in non-surgical oncology patients with a functional gastrointestinal tract, but recommend its use in patients with severe mucositis or severe radiation enteritis. For patients receiving hematopoietic stem cell transplant, PN should be reserved for patients with severe mucositis, ileus or intractable vomiting. Precise recommendations on the timing of initiation are unclear. They recommend discontinuing PN support when 50% of requirements are met enterally [11].
Guidelines for the Use of Parenteral and Enteral Nutrition published by The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) in 2002 and The Society of Critical Care Medicine (SCCM) and A.S.P.E.N. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill published in 2009, also fail to provide specific recommendations for when BMT recipients should be provided with enteral and parenteral nutrition support. The 2002 A.S.P.E.N. guidelines acknowledged that peri-transplant patients often suffer transplant related side effects, which can alter their ability to meet nutrient needs enterally. The establishment of enteral access following ablative preparation regimens can be challenging. In patients who require PN support, A.S.P.E.N recommended transitioning to enteral nutrition as soon as side effects abate [12].
In May 2006, the Mount Sinai Hospital Medical Board initiated a quality assurance project whereby all parenteral nutrition consultations were reviewed for appropriateness. A PN review committee was formed and more than 600 charts were reviewed over the course of one year to evaluate whether a review committee coupled with the development of a guidelines form (Table 1) would lead to a decrease in the overall provision of inappropriate PN use in the hospital. With IRB approval, the charts of all adult patients who received PN from June 14, 2006 through June 30, 2007 were reviewed. Results showed that even with an already low rate, inappropriate PN use was further decreased by discussing inappropriate orders with the consulting team, educating staff and emphasizing use of the guidelines form. At that time, BMT patients were excluded from the review due to the lack of specific recommendations for the appropriate delivery of nutrition support in this population [13]. With the emergence of new literature that support appropriate PN use in BMT patients, these charts that were originally excluded were reviewed to determine whether PN administration would have been deemed appropriate using the criteria as outlined in the PN guidelines form.
At least one of the following criteria should be present for administration of parenteral nutrition:
• Short bowel syndrome defined as < 150cm without an intact and functional colon, or < 100cm with an intact and functional colon, malabsorptive syndromes, moderate to severe small bowel transplant rejection
• Pancreatitis
o Severe acute necrotizing pancreatitis
o Failed trial of enteral feedings
• Enteric Fistula
o High output: > 500ml in 24 hours
o Enteral intake must be restricted
• Inability to meet nutritional needs via the GI tract
o Severe malnutrition or catabolism defined as nutritional risk index (NRI) ≤ 83.5 where NRI = (15 x albumin) + (0.4 x % usual body weight)
o Not expected to enterally feed, despite attempt to place post-pyloric tube > 5 days
o Unable to enterally feed at least 50% of nutritional needs for > 7 days
o Unable to obtain / maintain enteral feeding access for > 5 days
• Hemodynamic Instability
o Systolic blood pressure < 70mmHg
o Need for accelerated doses of pressor agents
o Increasing ventilatory support
o Worsening signs of gastrointestinal intolerance
• Diffuse peritonitis/suspected or defined uncontrolled bowel leak or any chylous leak
• Intestinal obstruction, pseudoobstruction and dysmotility syndromes
• Intractable vomiting, diarrhea or high output ostomy
o Diarrhea (≥ 500ml rectal tube output or ≥ 3 bowel movements per day for 2 days)
o High-output ostomy (≥ 1000ml/day)
• Ischemic bowel
• Massive gastrointestinal bleed
• Perioperative upper gastrointestinal cancer
• Bone marrow transplant with severe nausea/vomiting or mucositis
• Graft versus host disease
• Continuation of PN which patient received immediately prior to admission.
Note: Parenteral Nutrition is not indicated in the following disease states alone, unless one or more criteria listed above is met: non-severe pancreatitis, acute and chronic renal failure, inflammatory bowel disease, severe malnutrition, cancer and related therapy, liver diseases, AIDS, hyperemesis gravidarum, critical illness, trauma or mechanical ventilation
Table 1: Parenteral Nutrition Guidelines Form for Adults
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Mount Sinai Hospital is a tertiary care teaching hospital where PN is frequently administered. The majority of patients on PN are followed either by the surgical or medical nutrition support team (NST). Patients who undergo a BMT and require PN support are followed by an endocrinologist, who specializes in the provision of PN in this population, and a registered dietitian, who assesses the patient’s nutritional status and ability to take in adequate calories and protein, enterally. The endocrinologist completes an assessment, determines whether PN is indicated, writes orders, and follows the patient for the duration of therapy.
With the IRB approval, we reviewed the 69 medical records of adult BMT recipients who received PN support between June 14, 2006 and June 30, 2007. Data on each patient was recorded by a registered dietitian and included, age, diagnosis, indication for PN, start date, duration of therapy and type of BMT. Duration of therapy was further classified as being short term, less than or equal to five days, or long term, greater than five days.
Our goal was to determine whether the same guidelines established by our original review committee could be applied to BMT patients despite a lack of definitive recommendations for providing PN support in this population.
A total of 69 charts for patients status post BMT who received PN were reviewed. All patients were admitted by the Oncology service and placed on the BMT unit in the hospital. Thirty-seven patients were male (54%). Mean patient age was 49 years (range 23-70). Thirty patients (43%) underwent an autologous transplant and 39 (57%) underwent an allogenic transplant. Twenty patients (29%) were diagnosed with Non-Hodgkin’s lymphoma (NHL), 13 (19%) with multiple myeloma (MM), 12 (17%) with acute myeloid leukemia (AML), 7 (10%) with Hodgkin’s lymphoma (HL), 6 (9%) with acute lymphoblastic leukemia (ALL), 6 (9%) with myelodysplastic syndromes, one with aplastic anemia, one with acute promyelocytic leukemia (APML), one with chronic lymphocytic leukemia (CLL), one with germ cell tumor, and one with desmoplastic small round cell tumor (Figure 1). Results
Indications for initiation of PN included severe mucositis, GVHD, and other transplant related side effects, including nausea, vomiting, and diarrhea that resulted in poor oral intake. Among the 69 patients, 37 (54%) had documented severe mucositis with an inability to meet nutritional needs, 15 of which received an allogenic transplant and 22 an autologous transplant. Twelve patients (17%) had documented GVHD and 2 (3%) had both mucositis and GVHD. Of these 14 patients, all had received an allogenic transplant. The remaining 18 (26%) had other transplant related side effects, which prevented the sufficient intake of nutrition. Among those patients 10 were allogenic transplant recipients and eight were autologous recipients. After reviewing the charts, 100% of PN starts were deemed appropriate based on the guidelines.
Figure 1: The distribution of patients by condition
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A total of 105 patients underwent bone marrow transplantation in Mount Sinai Hospital between June 14, 2006 and June 30, 2007. During that same time period 69 patients were started on PN support for side effects following BMT that prevented them from taking sufficient calories to meet their nutrient requirements. Discussion
After thorough review of patient charts, it was determined that all initiations of PN support met the criteria outlined in the guidelines form and newer guidelines set forth by ESPEN. This study confirms that our guidelines form was a comprehensive document that could be applied to all patient populations, including those where definitive guidelines have traditionally been lacking. These findings further support the development of criteria for PN initiation by NSTs. Involving multidisciplinary NST members that include ICU physicians, endocrinologists, registered dietitians, and pharmacists, integrates the principles of a diverse group of practitioners in order to develop standards that are not only useful as general guidelines, but also a valuable tool for a specialized group like BMT recipients, where explicit guidelines are lacking.
Complications related to PN were not assessed in this study. Many of our patients were critically ill and we found it difficult to definitively implicate PN as a cause for such complications as catheter-related sepsis and metabolic and electrolyte abnormalities in this group. Moreover, at our hospital, a central venous access team inserts all central catheters and monitors all mechanical and infectious complications related to their placement, and this team reported no complications during our study period. Our hospital also has a very low incidence of catheter-related sepsis and well-established glucose control protocols to maintain euglycemia [12].
In summary, BMT recipients routinely require PN support to meet their nutrient needs. While it is clear that multidisciplinary NSTs continue to play an important role in the management of PN support, written guidelines on when to initiate therapy in BMT patients are lacking. In a population where mortality is high, every effort should be made to optimize these patients. Establishing comprehensive guidelines developed by multidisciplinary NSTs that identify appropriate use of PN is critical. References
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