Incidence of Refeeding Syndrome in Pediatric Inpatients at the US-Mexico Border.

OBJECTIVES: Refeeding syndrome is a life-threatening, physiological process that occurs when patients with severe malnutrition are too rapidly rehabilitated, leading to the development of electrolyte abnormalities. Hypophosphatemia, a hallmark of the disease, has most commonly been studied, because it is recognized to result in cardiac arrhythmias, seizures, cardiac failure, respiratory failure, rhabdomyolysis, coma, and even death. Although many studies have found caloric intake to be a main causal factor in refeeding syndrome, few have explored other factors, such as geographic location. Border cities, such as El Paso, Texas, have a unique, diverse population. The purpose of this study was to establish the incidence of refeeding syndrome concentrated within a border city. METHODS: We performed a retrospective chart review that focused on the incidence of refeeding syndrome in pediatric patients with eating disorders, ages 10 to 19 years, admitted to El Paso Children's Hospital, the only tertiary teaching hospital in the area, associated with Texas Tech University Health Science Center, located along the US-Mexico border, in El Paso, Texas. RESULTS: Twenty-six subjects with a diagnosis of eating disorder were admitted to El Paso Children's Hospital for treatment between 2012 and 2019. Five subjects developed refeeding syndrome, recognized in our study as hypokalemia or hypomagnesemia, during their treatment. CONCLUSIONS: Among hospitalized adolescents admitted to El Paso Children's Hospital, 19% developed refeeding syndrome. This incidence was higher in our population than had been previously reported. Further research is needed to better establish a protocol for the treatment of patients with eating disorders.

Comparative Genomic Analysis of Vibrio diabolicus and Six Taxonomic Synonyms: A First Look at the Distribution and Diversity of the Expanded Species.

Vibrio is a diverse genus of Gammaproteobacteria autochthonous to marine environments worldwide. Vibrio diabolicus and V. antiquarius were originally isolated from deep-sea hydrothermal fields in the East Pacific Rise. These species are closely related to members of the Harveyi clade (e.g., V. alginolyticus and V. parahaemolyticus) that are commonly isolated from coastal systems. This study reports the discovery and draft genome sequence of a novel isolate (Vibrio sp. 939) cultured from Pacific oysters (Crassostrea gigas). Questions surrounding the identity of Vibrio sp. 939 motivated a genome-scale taxonomic analysis of the Harveyi clade. A 49-genome phylogeny based on 1,109 conserved coding sequences and a comparison of average nucleotide identity (ANI) values revealed a clear case of synonymy between Vibrio sp. 939, V. diabolicus Art-Gut C1 and CNCM I-1629, V. antiquarius EX25 and four V. alginolyticus strains (E0666, FF273, TS13, and V2). This discovery expands the V. diabolicus species and makes available six additional genomes for comparative genomic analyses. The distribution of the expanded species is thought to be global given the range of isolation sources (horse mackerel, seawater, sediment, dentex, oyster, artemia and polycheate) and origins (China, India, Greece, United States, East Pacific Rise, and Chile). A subsequent comparative genomic analysis of this new eight-genome subclade revealed a high degree of individual genome plasticity and a large repertoire of genes related to virulence and defense. These findings represent a significant revision to the understanding of V. diabolicus and V. antiquarius as both have long been regarded as distinct species. This first look at the expanded V. diabolicus subclade suggests that the distribution and diversity of this species mirrors that of other Harveyi clade species, which are notable for their ubiquity and diversity.