RESUMO
OBJECTIVES: We aim to characterize the prevalence and impact of anxiety and depression (AD) in hospitalized patients with chronic pancreatitis (CP). Anxiety and depression have been shown to have a significant impact on mortality and length of stay in gastrointestinal diseases, but there are limited studies evaluating its impact on CP. METHODS: We performed a retrospective analysis using the National Inpatient Sample from 2007 to 2014. The outcomes were the prevalence and trend of AD, impact on mortality, length of stay, and cost and independent predictors of AD. RESULTS: A total of 75,744 patients with CP were included in our analysis, of which 23,323 (31%) had anxiety or depression. The prevalence of anxiety increased from 7.33% in 2007 to 20.02% in 2014. Depression increased from 18.49% in 2007 to 23.89% in 2014. Independent predictors of AD were decreasing age, female sex, and multiple comorbidities. Decreased risk was seen in African Americans, Hispanics, and those from the South and West. Anxiety and depression did not impact overall mortality or length of stay. CONCLUSIONS: Anxiety and depression are increasingly recognized diagnosis in patients with CP. Careful management and treatment of psychiatric illnesses and improving quality of life need to be addressed for these patients.
Assuntos
Depressão , Pancreatite Crônica , Ansiedade/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Pancreatite Crônica/epidemiologia , Prevalência , Qualidade de Vida , Estudos RetrospectivosAssuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , United States Food and Drug Administration , Rotulagem de Medicamentos , Gastroenterologia , Humanos , Retirada de Medicamento Baseada em Segurança , Estados UnidosRESUMO
As many as 80% of patients with end-stage liver disease and hepatic encephalopathy have significant protein-calorie malnutrition. Because of the severe hypercatabolic state of cirrhosis, the provision of liberal amounts of carbohydrate (at least 35 to 40 kcal/kg per day), and between 1.2 and 1.6 g/kg of protein is necessary. Protein restriction is not recommended. Branched-chain amino acid supplementation and vegetable protein are associated with improved outcomes. Dietary supplementation with vitamins, minerals (with the notable exception of zinc) and probiotics should be decided on a case-by-case basis.
Assuntos
Proteínas Alimentares/administração & dosagem , Encefalopatia Hepática/dietoterapia , Encefalopatia Hepática/tratamento farmacológico , Aminoácidos Aromáticos/administração & dosagem , Aminoácidos de Cadeia Ramificada/administração & dosagem , Carboidratos da Dieta/administração & dosagem , Gorduras na Dieta/administração & dosagem , Fibras na Dieta/administração & dosagem , Suplementos Nutricionais , Humanos , Cirrose Hepática/complicações , Desnutrição/dietoterapia , Desnutrição/tratamento farmacológico , Desnutrição/etiologia , Proteínas de Vegetais Comestíveis/administração & dosagem , Probióticos/uso terapêutico , Vitaminas/administração & dosagemRESUMO
Upper gastrointestinal (GI) dysmotility, an entity commonly found in the intensive care unit setting, can lead to insufficient nutrient intake while increasing the risk of infection and mortality. Further, overcoming the altered motility with early enteral feeding is associated with a reduced incidence of infectious complications in intensive care unit patients. Upper GI dysmotility in critical care patients is a common occurrence, and there are many causes for this problem, which affects a very heterogenous population with a multitude of underlying medical abnormalities. Therefore, it is of utmost importance to identify this widespread problem and subsequently institute a proper therapy as rapidly as possible. Prokinetic pharmacotherapies are currently the mainstay for the management of disordered upper GI motility. Future therapies, aimed at the underlying pathophysiology of this complex problem, are under investigation. These aim is to reduce the side effects of the currently available options, while improving on nutrition delivery in the critically ill. This review discusses the pathophysiology, clinical manifestations, diagnosis, and treatment of upper GI motility disturbances in the critically ill.
Assuntos
Fármacos Gastrointestinais/uso terapêutico , Gastroenteropatias/terapia , Motilidade Gastrointestinal , Estado Terminal , Fármacos Gastrointestinais/efeitos adversos , Fármacos Gastrointestinais/farmacologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Necessidades Nutricionais , Estado Nutricional , Apoio Nutricional/métodosAssuntos
Clostridioides difficile , Infecções por Clostridium , Infecção Hospitalar , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Humanos , Controle de Infecções/métodos , Recidiva , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Management of radiation-induced nausea and vomiting (RINV) includes both prevention and therapy. Primary prevention involves implementation of measures to modify risk factors. Secondary prevention involves prophylaxis and treatment with 5HT(3) receptor antagonists (5HT(3)RAs) with or without corticosteroids, dopamine antagonists, antihistamines, or anticholinergics. 5HT(3)RAs are also useful in treatment of RINV with significantly better outcomes, compared to other antiemetics or placebo. Agents include ondansetron, granisetron, dolasetron, palonosetron, and tropisitron. These agents may be useful in both the radiotherapy patient and the individual who has been accidentally exposed to ionizing radiation.
