RESUMO
BACKGROUND AND AIM: Achalasia cardia, a primary motility disorder of the esophagus, poses significant malnutrition risks. This study aims at comprehensively assessing the nutritional status in untreated achalasia patients, contrasting it with functional gastrointestinal disorders (FGIDs) cases and impact of per-oral endoscopic myotomy (POEM) on nutrition at one-year. METHODS: We conducted a prospective study, including consecutive achalasia cases, from December 2021 to April 2022 at a tertiary care centre. Biochemical parameters, anthropometry, subjective global assessment (SGA) and malnutrition universal screening tool were used for nutritional assessment. Cases diagnosed with FGIDs served as controls. RESULTS: As many as 118 cases (41.2 ± 13.9 years, 61% males) with achalasia and 200 controls (43.4 ± 11.9 years, 69% males) were included in the study. Sub-types of achalasia included type I (16.9%), II (76.3%) and III (6.8%). Overall, 38.1% and 6.8% cases were moderately and severely malnourished, respectively. As compared to controls, cases with achalasia had lower pre-albumin (19.4 vs. 25.2; p = 0.001), serum calcium (p = 0.012), vitamin D (p = 0.001), serum iron (p = 0.001), triceps fold thickness (p = 0.002) and hand-grip strength (p = 0.001). On univariate analysis, type-I achalasia, body mass index, % weight loss, lower esophageal sphincter pressures and Eckardt scores were predictors of malnourishment (SGA). On multivariate analysis, type of achalasia, mid arm circumference and low body mass index were significant predictors of malnourishment in cases with achalasia. There was significant improvement in the nutritional status after POEM at one-year follow-up. CONCLUSION: Achalasia patients demonstrate a notably higher risk of malnutrition compared to individuals with FGIDs. Nutritional status significantly improves after POEM. (NCT05161923).
RESUMO
BACKGROUND AND OBJECTIVE: The override rate of Drug-Drug Interaction Alerts (DDIA) in Intensive Care Units (ICUs) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in a system of ICUs and measure the override rate of this system. METHODS: This is a cross-sectional study that details the design, development, implementation, and evaluation of a DDIAS for severe interactions into a Computerized Provider Order Entry (CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAS, acceptance and overridden of DDIAS, and usability of DDIAS have been collected. The study was approved by the local Institutional Review Board (IRB) and; the ethics committee of Shiraz University of Medical Science on date: 2019-11-23 (Approval ID: IR.SUMS.REC.1398.1046). RESULTS: The knowledge base of the DDIAS contains 9,809 severe potential drug-drug interactions (pDDIs). A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for the DDIAS were 81 % and 97.5 %, respectively. The override rate was 2.5 %. The mean System Usability Scale (SUS) score of the DDIAS was 75. CONCLUSION: This study demonstrates that implementing high-risk DDIAS at the point of prescribing in ICUs improves adherence to alerts. In addition, the usability of the DDIAS was reasonable. Further studies are needed to investigate the establishment of severe DDIAS and measure the prescribers' response to DDIAS on a larger scale.