Suspected Thiamine Deficiency Secondary to Chronic Gastrointestinal Illness: A Case Report.

Introduction: Thiamine deficiency, also known as beriberi, is a nutritional disorder caused by a lack of thiamine (vitamin B1) in the diet. It can occur in 2 forms: dry beriberi, which affects the nervous system, and wet beriberi, which affects the cardiovascular system. Gastrointestinal beriberi is a subtype that affects the digestive system and can lead to multisystem involvement. In the United States (US), thiamine deficiency often arises from chronic malnutrition secondary to alcoholism, known as Wernicke-Korsakoff Syndrome. Case Presentation: A 45-year-old female with no known past medical history or alcohol use disorder came to the emergency department with an altered mental status and with a history of intractable nausea and vomiting for several months prior to presentation. During intake, the medical team discovered she had bilateral lower extremity weakness and an anion gap metabolic acidosis. Her inpatient workup ruled out meningitis, encephalitis, peritonitis, diabetic ketoacidosis, and cerebrovascular accident. A thiamine deficiency was the most probable cause of her presentation, secondary to her protracted history of vomiting and poor oral medication intake. Refeeding syndrome complicated her hospitalization. After replenishing thiamine, the patient experienced significant improvement in mental status and lower extremity weakness. The healthcare team later discharged her with home physical therapy rehabilitation and nutritional counseling. Conclusion: Thiamine deficiency is not common in the US. However, this case highlights the importance of including this deficiency in the differential when a patient arrives with a history of malnourishment secondary to a gastrointestinal illness with signs of altered mental status and neurological symptoms.

Prevention, Assessment, and Management of Malnutrition in Older Adults with Early Stages of Cognitive Disorders.

Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.

Improved early growth in Danish children with cystic fibrosis from 2000-2022.

BACKGROUND: Improved growth in children with CF may have resulted from advances in treatment for cystic fibrosis (CF) over the past two decades, including the implementation of newborn screening in Denmark in 2016. This observational cohort study focuses on changes in early growth in Danish children with CF born between 2000 and January 2022. METHODS: Age, length/height, and weight data of children 0-5 years old were obtained from the Danish CF Cohort. Data were stratified to four birth cohorts born between 2000 and 2022. Weight-for-age (WAZ), length-for-age (LAZ), height-for-age (HAZ) and body-mass-index (BMZ) z-scores were computed using WHO growth curves. Cubic spline mixed effects models were used to evaluate growth over 5 years between birth cohorts. RESULTS: We included 255 children in the analyses. Cubic spline mixed effects models show that catch-up growth improved in birth cohorts over time, with the 2016-2022 birth cohort achieving growth reference curve values in WAZ, LAZ/HAZ and BMZ the earliest. The proportion of underweight and stunting observations among children born 2000-2004 decreased by the 2016-2022 birth cohort, while the proportion of overweight, low BMZ and high BMZ observations increased. CONCLUSION: Advances in care for young children with CF have led to improvements in growth - with the 2016-2022 birth cohort approaching potential for overweight. Nonetheless, low BMZ remains. Immediate, individualized nutrition care throughout early childhood remain crucial in mitigating malnutrition.

The quality of life impacting factors in malnourished patients with gastric cancer.

Introduction: Malnutrition is prevalent among individuals with gastric cancer and notably decreases their quality of life (QOL). However, the factors impacting QOL are yet to be clearly defined. This study aimed to identify essential factors impacting QOL in malnourished patients suffering from gastric cancer. Methods: By using the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutritional status (≥4 defined malnutrition) of hospitalized cancer patients, 4,586 gastric cancer patients were ultimately defined as malnourished. Spearman method was used to calculate the relationship between clinical features and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Then, univariate and multivariate logistic regression were used to observe which factors affected QOL, and subgroup analysis was performed in young and old population respectively. In addition, we used univariate and multivariate logistic regression to explore whether and how self-reported frequent symptoms in the last 2 weeks of the PG-SGA score affected QOL. Results: In multivariate logistic regression analysis of clinical features of patients with malnourished gastric cancer, women, stage II, stage IV, WL had an independent correlation with a low global QOL scores. However, BMI, secondary education, higher education, surgery, chemotherapy, HGS had an independent correlation with a high global QOL scores. In multivariate logistic regression analysis of symptoms in self-reported PG-SGA scores in patients with malnourished gastric cancer, having no problem eating had an independent correlation with a high global QOL scores. However, they have no appetite, nausea, vomiting, constipation and pain had an independent correlation with a lower global QOL scores. The p values of the above statistical results are both < 0.05. Conclusion: This study demonstrates that QOL in malnourished patients with gastric cancer is determined by female sex, stage II, stage IV, BMI, secondary and higher education or above, surgery, chemotherapy, WL, and HGS. Patients' self-reported symptoms of nearly 2 weeks, obtained by using PG-SGA, are also further predictive of malnourished gastric cancer patients. Detecting preliminary indicators of low QOL could aid in identifying patients who might benefit from an early referral to palliative care and assisted nursing.

Nutritional Problems Among Special Needs Children in a Rural Special Needs Children Home Near Chennai.

Background Special needs children have various health problems, and the most common problems are nutritional deficiency and malnourishment which leads to increased morbidity affecting their quality of life. This study aims to assess the nutritional status and health-seeking behaviour of special needs children. Methods The study was conducted among 46 special needs children at a special needs children's home. After collecting basic sociodemographic details, they were assessed for nutritional status and health-seeking behaviour using a semi-structured questionnaire followed by general and clinical examination. Results Out of these 46 special needs children, 69.6% were male and 30.4% were female. The mean age was 11.69±4.62 years. In this study, 65.22% were underweight; 6.52% were overweight; 10.87% were obese I; 4.35% were obese III; 13.04% were normal. Among them, 37% seek Government healthcare facilities for their healthcare needs. Referral advice was provided to all required children. Conclusion A high proportion of the special needs children were screened positive for nutritional deficiency and malnourishment which needs to be addressed. Interventions should be aimed at correcting the nutritional deficiency and malnourishment by involving the caretakers, mainly mothers of these children.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS).

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Context: Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. Aims: To assess nutritional status and its associated factors among the elderly population. Settings and Design: This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. Materials and Methods: The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Statistical Analysis: Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. Conclusion: This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Financial stress, health and malnourishment among older adults in India.

As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20-40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.

Multiple Early Life Stressors as Risk Factors for Neurodevelopmental Abnormalities in the F1 Wistar Rats.

Cumulative exposure to multiple early life stressors is expected to affect behavioral development, causing increased susceptibility to neuropsychiatric disorders. The present study was designed to mimic such conditions in a rat model to study behavioral impairments during adolescence and adulthood. Female Wistar rats (n = 32; 140-150 gm) were switched to a low protein (LP; 8% protein) or control (20% protein) diet 15 days prior to conception, and then the diet regime was maintained throughout the experimental period. Pups born to control and LP dams were intraperitoneally injected with deltamethrin (DLT-pyrethroid insecticide; 0.7 mg/kg body weight; PND 1 to 7), lipopolysaccharide (LPS-bacterial endotoxin; 0.3 mg/kg body weight; PND 3 and 5), or DLT+LPS, on designated days forming eight experimental groups (Control, LP, Control+LPS, LP+LPS, Control+DLT, LP+DLT, Control+DLT+LPS and LP+DLT+LPS). Neurobehavioral assessments were performed in F1 rats (1, 3, 6 months) by open field, elevated plus maze, light and dark box, and rotarod tests. LP rats were found to be highly susceptible to either singular or cumulative exposure as compared to their age-matched control counterparts, showing significantly severe behavioral abnormalities, such as hyperactivity, attention deficits and low anxiety, the hallmark symptoms of neuropsychiatric disorders like schizophrenia and ADHD, suggesting thereby that early life multi-hit exposure may predispose individuals to developmental disorders.

Evaluation of the nutritional status of patients with liver cirrhosis.

BACKGROUND: Progressive malnutrition coexists with liver diseases, particularly in patients with cirrhosis. Early diagnosis of malnutrition in patients with advanced stages of chronic liver disease and the implementation of appropriate nutritional treatment for malnourished patients should be an integral part of the therapeutic process. AIM: To evaluate the nutritional status of patients with various severities of advanced liver fibrosis, using various nutritional status parameters. METHODS: This study involved 118 patients with liver cirrhosis who were classified into three groups according to their Child-Pugh score. The nutritional status of the patients in each group was assessed using different methods. The average values obtained from the measurements were calculated for each research group. The influence of disease stage on the examined parameters of nutritional status was determined using one-way analysis of variance. To investigate the relationship between the parameters determining nutritional status and the stage of disease advancement, a correlation analysis was performed. RESULTS: The Child-Pugh A group had the highest mean body weight (76.42 kg), highest mean body mass index (BMI) (26.72 kg/m²), and largest mean arm circumference (27.64 cm). In the Child-Pugh B group, the mean scores of all examined variables were lower than those of the Child-Pugh A group, whereas the mean body weight and BMI of the Child-Pugh C group were higher than those of the Child-Pugh B group. There was a very strong correlation between the Child-Pugh classification and subjective global assessment score; a very strong correlation between the Child-Pugh classification and arm circumference; a strong correlation between the Child-Pugh classification and body weight, albumin concentration, fat-free mass index, muscle mass index, phase angle, and BMI; and an average correlation between Child-Pugh classification and fat mass index. Notably, these indicators deteriorated with disease progression. CONCLUSION: Advanced liver fibrosis leads to the deterioration of many nutritional status parameters. The extent of malnutrition increases with the progression of liver fibrosis. The Child-Pugh score reflects the nutritional status.

Phase Angle in Head and Neck Cancer: A Sex-Differential Analysis from Biological and Clinical Behavior to Health-Related Quality of Life.

Head and neck cancer (H&NC) is a diverse category of tumors related to malignancies in the common aerodigestive pathway, with high metabolic rate, poor nutritional and treatment outcomes, and elevated mortality despite the best standard treatment. Herein, we focus on determining how the phase angle (PA) differs across sex as a predictor of poor prognosis, low quality-of-life (QoL) scores, and mortality in patients with head and neck cancer. This follow-up study presents a sex-differential analysis in a prospective cohort of 139 head and neck cancer patients categorized by sex as male (n = 107) and female (n = 32). Patients were compared in terms of nutritional, biochemical, and quality-of-life indicators between low and normal PA in women (<3.9° (n = 14, 43.75%) and ≥3.9°) and men (<4.5° (n = 62, 57.9%) and ≥4.5°). Our results show that most patients were in locally advanced clinical stages (women: n = 21 (65.7%); men: n = 67 (62.6%)) and that patients with low PA had a lower punctuation in parameters such as handgrip strength, four-meter walking speed, albumin, C-reactive protein (CRP), and CRP/albumin ratio (CAR), as well as the worst QoL scores in functional and symptomatic scales in both the male and female groups. A comparison between sexes revealed significant disparities; malnourishment and tumor cachexia related to an inflammatory state was more evident in the women's group.

Double-Blind Parallel Treatment Randomized Controlled Trial of Prebiotics' Efficacy for Children Experiencing Severe Acute Malnutrition in Southern Punjab, Pakistan.

The prevalence of malnutrition among children under five is alarmingly high in Pakistan. However, there are ready-to-use therapeutic foods (RUTF) available which may be used to treat children with severe acute malnutrition (SAM). This study aims to assess the efficacy of prebiotics as a synergistic additive to RUTF to enhance blood parameters and anthropometric measurements in children with uncomplicated SAM living in Southern Punjab, Pakistan. A double-blind parallel treatment randomized controlled trial was conducted on 204 children aged 6-59 months. Participants were randomized and allocated to the placebo (n = 102) or experimental arms (n = 102) in a 1:1 ratio. One group of children was provided with RUTF and 4 g prebiotics, while the other group was given RUTF and starch as a placebo. Participants recruited for both arms were given treatment for eight weeks, and then their biochemical and anthropometric outcomes were evaluated. A substantial difference between the mean weight, mid-upper-arm circumference, haemoglobin, haematocrit, platelet count, mean corpuscular volume, mean corpuscular haemoglobin, and albumin was revealed. During the two-month follow-up phase of the trial, children who were enrolled in the treatment group gained about 20% of their initial weight (pre-study mean weight = 5.44 ± 1.35 kg; post-study mean weight = 6.53 ± 1.45 kg). The analysis showed a significant difference (p < 0.005) between the control and treatment groups for MUAC and complete blood counts. Conclusively, supplementation with RUTF and prebiotics has proven to be an efficient, effective, and safe therapy for children suffering from SAM to improve their growth and development indicators and reduce the dangers of malnutrition in comparison to RUTF alone.

Multi-Etiological Hyponatremia in Association With Suspected Beer Potomania.

Beer potomania is a unique condition characterized by hyponatremia secondary to excessive beer drinking and low daily solute intake. We report a case of a 41-year-old African American female with multiple comorbidities, notably alcohol use disorder, who was initially treated for hypertensive emergency and was subsequently found to be hyponatremic during the same visit. Beer potomania was suspected as a leading etiology of hyponatremia. This report emphasizes the importance of the proper diagnosis and appropriate management of beer potomania in the setting of concomitant comorbidities. Clinician awareness is crucial in implementing immediate treatment and in the prevention of potentially fatal sequelae such as severe malnutrition and osmotic demyelination syndrome.

Effects of Oral Lipid-Based nutritional supplements on appetite, energy intake, and lipid profile of moderately underweight children.

Oral lipid-based nutritional supplements (LNS) are designed to ensure dietary adequacy and to improve malnourishment in children. Therefore, this study investigated the effects of 4 weeks of LNS on appetite, energy intake, and lipid profile of moderately underweight children (5-10 years old) with BMI-Z score between -2 and - 3 SDS, recruited in a single-blind randomized control trial. In addition to the regular dietary intake, fasting blood samples, anthropometric measurements, energy intake, and appetite responses were obtained before and after 4 weeks of LNS (535 kcal) or PLACEBO (92 kcal). After 4 weeks of supplementation mean energy intake (kcal) (p < .001), body weight (kg) (p < .001), BMI (kg/m2) (p < .01), mid-upper arm circumference (cm) (p < .01), total cholesterol (mg/dl) (p < .01) and fasting glucose (mg/dl) (p < .01) were raised significantly in the LNS group as compared to the PLACEBO group. No significant changes were detected in appetite responses (p > 0.05). In conclusion, LNS increases the overall energy intake, but does not affect the appetite but may induce hyperglycemia and hyperlipidemia.

Four-Year Nutritional Outcomes in Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Patients: an Australian Experience.

Nutritional deficiencies following malabsorptive surgeries are a major concern. PURPOSE: To present clinical-based, mid-term nutritional outcomes in single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) patients using a nutritional supplement based on the American Society for Metabolic & Bariatric Surgery (ASMBS) guidelines. SETTING: Single private institute, Australia. MATERIALS AND METHODS: Data from 196 patients who underwent a primary SADI-S by a single surgeon from January 2017 through March 2022 were retrospectively analysed. All patients received either original or altered formulated nutritional supplementation throughout the study. In total, three formulae, slightly different from each other, were used at three different time points to formulate the supplement. RESULTS: In total, 196 patients were included. The average age and preoperative body mass index were 44.9 ± 6.7 years and 43.6 ± 22.5 kg/m2, respectively. Nutritional follow-up was available on 77.5%, 73.2%, 73.4%, and 59.7% of patients at 12, 24, 36, and 48 months, respectively. At baseline, 48.3%, 30%, 14.9%, 13.3%, 12.4%, 3.8%, 2.3%, and 0.5% of the patients had vitamin D, calcium, folic acid, total protein, iron, vitamin B12, copper, and vitamin A deficiencies, respectively. Postoperatively, mild to moderate vitamin deficiencies were noted in 14.2% of the patients in the first 18 months; however, at 4 years, the cohort had zero nutritional deficiencies. There were no long-term complications, revisions/conversions, or mortalities related to nutritional deficiencies. CONCLUSION: Factors, like preoperative and postoperative early, aggressive correction of nutritional deficiencies, regular laboratory monitoring and follow-ups with the multidisciplinary team, and adherence to our formulated nutritional supplement, have contributed to favourable nutritional outcomes at 4 years.

Elevated Liver Enzymes in an Adult Male With Anorexia Nervosa: A Case Report.

Anorexia nervosa is a prevalent eating disorder often accompanied by various medical complications, along with increased liver serum enzymes, especially transaminases. Here, we describe the case of an adult male patient admitted to a general hospital. The patient presented with malnourishment arising from AN and severely affected liver function tests.

Malnourishment affects gene expression along the length of the small intestine.

Malnourishment is a risk factor for childhood mortality, jeopardizing the health of children by aggravating pneumonia/acute respiratory infections and diarrheal diseases. Malnourishment causes morphophysiological changes resulting in stunting and wasting that have long-lasting consequences such as cognitive deficit and metabolic dysfunction. Using a pig model of malnutrition, the interplay between the phenotypic data displayed by the malnourished animals, the gene expression pattern along the intestinal tract, microbiota composition of the intestinal contents, and hepatic metabolite concentrations from the same animals were correlated using a multi-omics approach. Samples from the duodenum, jejunum, and ileum of malnourished (protein and calorie-restricted diet) and full-fed (no dietary restrictions) piglets were subjected to RNA-seq. Gene co-expression analysis and phenotypic correlations were made with WGCNA, while the integration of transcriptome with microbiota composition and the hepatic metabolite profile was done using mixOmics. Malnourishment caused changes in tissue gene expression that influenced energetic balance, cell proliferation, nutrient absorption, and response to stress. Repression of antioxidant genes, including glutathione peroxidase, in coordination with induction of metal ion transporters corresponded to the hepatic metabolite changes. These data indicate oxidative stress in the intestine of malnourished animals. Furthermore, several of the phenotypes displayed by these animals could be explained by changes in gene expression.

Prospective Study Investigating the Prevalence and Evolution of Malnourishment in the Acute Orthopaedic Trauma Patient.

Background: Orthopaedic trauma surgeons believe that nutritional status is important. The primary aim of this study was to prospectively investigate the prevalence and progression of malnourishment in orthopaedic trauma patients and determine when and what labs should be ordered. The secondary aim was to determine if malnourished patients had increased complications. Methods: Prospective cohort study of orthopaedic trauma patients at a Level I trauma center. Assessment of nutritional status over the hospital course was performed using the Rainey MacDonald nutritional index (RMNI) and nutritional laboratory markers on admission, day 3, day 7, and 6 weeks post-op. Results: 98 patients were enrolled and included. On admission, 60%, 41%, and 38% of patients were malnourished based on albumin, prealbumin, and RMNI values, respectively, with 31% in severe acute-phase response (APR) as determined by CRP. By day 3, a significant increase in the percent of malnourished patients was noted based on the laboratory markers, 85%, 90%, and 80%, respectively, with 70% in severe APR. On day 7, values stabilized at 74%, 89%, 69%, with 56% in severe APR. At six weeks, malnourishment persisted in 13%, 19%, and 12% of patients, with 4% in severe APR. Older patients demonstrated a greater depression of nutritional markers throughout the hospital stay. Conclusion: The prevalence of malnourishment, based on serum nutritional markers, in the presence of acute orthopaedic injury is substantial, and it continues to rise during the acute hospital stay. Recommend obtaining prealbumin or albumin levels on hospital day 3 to assess nutritional status.

Can helminth and malaria infections affect sex ratio at birth in sub-Saharan Africa? Ideas and hypothesis.

The sex ratio (ratio of boys to girls) at birth (SRB) is about 1.05 (about 105 males to 100 females) under normal conditions and could be an indicator for monitoring demographic changes. Generally, in comparison with female fetuses, the male fetus is biologically weaker and more vulnerable to prenatal events. SRB is influenced by various factors, such as maternal malnourishment. Remarkably, maternal malnourishment and less energy intake are pivotal factors for declining SRB in humans. As estimates, the SRB is below the normal range in sub-Saharan Africa (1.03) than the normal range (1.05). On the other hand, both malaria and helminth infections are hyperendemic in sub-Saharan Africa and both diseases are associated with maternal malnourishment. Hence, an important question arises, could declining SRB in sub-Saharan Africa be influenced by malaria and helminth infections? Cumulative evidence suggests that malaria and helminth infections could influence SRB by induction of maternal malnourishment. This hypothesis provides new ideas about the variation of SRB in some regions of the world where helminths and malaria are endemic.

The effect of child malnourishment on measles spread amidst the COVID-19 pandemic in Afghanistan.

Child malnourishment is a long-lasting concern that Afghanistan has been facing for many years now. This major factor amongst countless others like growing socioeconomic disparity, ineffective healthcare due to lack of funding and political instability has caused increase in nutritional instability through Afghanistan. This has increased the likelihood of numerous malnourished children contracting deadly infectious diseases like measles. Despite receiving nutritional aid, vaccines (reduce measles spread) and funding from international organizations much of these efforts have fell short due to the political instability and lack of sustained support. Emergence of COVID-19 has further intensified the already existing challenges faced by vulnerable Afghan children. The pandemic has impeded with the eradication of measles and vaccine coverage as much of the funding and attention has shifted to containing COVID-19 spread posing a greater threat for malnourished children. The combined effect of both infections has exacerbated and increased mortality in malnourished children as rate of measle spread increases. Afghan healthcare systems are now struggling more as much of their efforts are ineffectual due to lack of facilities and resources.