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1.
Medicine (Baltimore) ; 100(3): e24318, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546062

RESUMO

RATIONALE: The immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is a rare disorder that most often manifests in the early stages of life. IPEX syndrome with a late onset, presenting with severe gastritis has rarely been reported. PATIENT CONCERNS: Two male adolescents presented with recurrent vomiting, severe malnutrition, and growth retardation due to severe gastritis. DIAGNOSES: Esophagogastroduodenoscopy of the 2 patients revealed rare presentations of severe gastritis with multiple ulcers and stenosis of the pylorus. Next-generation sequencing revealed 2 novel variants in gene FOXP3 in the patients who were diagnosed with the IPEX syndrome. INTERVENTIONS: Both patients were treated with a high calorie formular enteral nutritional therapy. In addition, the pylorus of patient 1 was enlarged by balloon dilation, while patient 2 was treated with mercaptopurine and low dose prednisone. OUTCOMES: Symptoms and nutritional status of the patients improved after treatment. LESSONS: Chronic severe gastritis with stenosis of the pylorus could be an atypical manifestation of the IPEX syndrome. The use of next-generation sequencing is highly suitable for the diagnosis of atypical IPEX syndromes.


Assuntos
Diabetes Mellitus Tipo 1/congênito , Diarreia/complicações , Diarreia/diagnóstico , Gastrite/etiologia , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças do Sistema Imunitário/congênito , Fatores de Tempo , Adolescente , China , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/fisiopatologia , Diarreia/fisiopatologia , Fatores de Transcrição Forkhead/genética , Gastrite/fisiopatologia , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Humanos , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/diagnóstico , Doenças do Sistema Imunitário/fisiopatologia , Masculino , Desnutrição/etiologia
2.
Clin Nutr ESPEN ; 41: 423-428, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33487301

RESUMO

INTRODUCTION: The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. TOOLS AND METHODS: This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). RESULTS: Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17-42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). CONCLUSION: Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.


Assuntos
Cuidados Críticos , Unidades de Terapia Intensiva , Tempo de Internação , Desnutrição/etiologia , Estado Nutricional , Adulto , Idoso , Índice de Massa Corporal , Deficiências Nutricionais/diagnóstico , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/etiologia , Deficiências Nutricionais/terapia , Dieta , Feminino , Humanos , Linfopenia/etiologia , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/terapia , Pessoa de Meia-Idade , Nutrientes/deficiência , Avaliação Nutricional , Sobrepeso/epidemiologia , Pandemias , Alta do Paciente , Prevalência , Perda de Peso
3.
Rev Col Bras Cir ; 48: e20202666, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503141

RESUMO

INTRODUCTION: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. OBJECTIVE: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. METHODS: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. RESULTS: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. CONCLUSION: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Desnutrição/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Feminino , Derivação Gástrica , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(52): e23860, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350779

RESUMO

ABSTRACT: Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.


Assuntos
Desnutrição , Estado Nutricional , Procedimentos Cirúrgicos Bucais/efeitos adversos , Complicações Pós-Operatórias , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/etiologia , Pessoa de Meia-Idade , Neoplasias Bucais/complicações , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Avaliação Nutricional , Procedimentos Cirúrgicos Bucais/métodos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Medição de Risco , Fatores de Risco
5.
Medicine (Baltimore) ; 99(52): e23913, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350793

RESUMO

INTRODUCTION: Lung cancer is the leading cause of cancer-related death worldwide. Anorexia is the most common cause of malnutrition in lung cancer patients as well as an independent prognostic factor for cancer survival. This review will deal with the clinical evidence of herbal medicine use for reducing anorexia in lung cancer patients. METHODS AND ANALYSIS: Fourteen electronic databases will be searched from inception until October 2020. We will include randomized controlled trials (RCTs) assessing herbal medicines for anorexia in lung cancer patients. Interventions of any herbal medicines will be included. The methodological qualities of the included RCTs will be assessed via the Cochrane Collaboration tool for assessing the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument will be used to evaluate the confidence in the cumulative evidence. ETHICS AND DISSEMINATION: This systematic literature review does not require an ethics review. This review will be published in a peer-reviewed journal and disseminated electronically and in print. The review will be updated to inform and guide healthcare practices. REGISTRATION NUMBER: reviewregistry1038.


Assuntos
Anorexia , Neoplasias Pulmonares/complicações , Desnutrição , Fitoterapia/métodos , Anorexia/etiologia , Anorexia/terapia , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle , Medicina Tradicional/métodos , Metanálise como Assunto , Plantas Medicinais , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
Medicine (Baltimore) ; 99(50): e23642, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327343

RESUMO

Malnutrition and cachexia affects the majority of cancer patients and significantly worsens their quality of life and prognosis. However, the diagnostic criteria of malnutrition and cachexia remain a topic under constant debate. To overcome this hurdle, diagnostic tools to objectively detect and quantify the loss of muscle and fat mass are needed. Computed tomography (CT)-based measurement is currently considered the golden standard. Bioelectrical impedance analysis (BIA) is an economical, non-invasive tool but it is seen controversial in patients with cancer and malnutrition because of possible estimation errors.BIA and CT-based analysis of body mass compartments were performed 172 times in 118 cancer patients, within the nutrition program of our institution. Prevalence of malnutrition was determined according to the global leadership initiative on malnutrition criteria. Data obtained for muscle and fat mass from both BIA and CT were correlated using Pearson's ρ. All analyses were performed with an explorative significance level of 5%.45.7% of the cohort were classified as "malnourished." No significant differences were observed between the 2 groups regarding demographic data. Median body mass index, Karnofsky performance status, and nutritional risk score were lower in the malnourished group. Values for muscle and fat mass by BIA and CT were significantly lower in malnourished patients. Correlation of the measured parameters were highly significant between CT-based and BIA measurement. In the overall cohort, correlation of measured muscle mass values by CT and BIA was significant with Pearson's ρ = 0.794 (P < .01). Looking at patients without malnutrition only, Pearson's ρ was 0.754 (P < .01). The correlation of measured fat mass values was equally significant, with Pearson's ρ of 0.748 (P < .01) in the overall cohort and 0.771 (P < .01) in patients with malnutrition.To our knowledge, this is the first study comparing BIA to CT-based body mass analysis in a large cohort of cancer patients with malnutrition. The results suggest that BIA is a valid diagnostic tool for the assessment of muscle and fat mass, even in patients with malnutrition, and could be implemented for the early detection and short-term follow-up of malnutrition and cachexia.


Assuntos
Índice de Massa Corporal , Caquexia/diagnóstico , Impedância Elétrica , Desnutrição/diagnóstico , Neoplasias/complicações , Tomografia Computadorizada por Raios X/normas , Adulto , Fatores Etários , Idoso , Composição Corporal/fisiologia , Caquexia/etiologia , Caquexia/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/patologia , Pessoa de Meia-Idade , Estado Nutricional , Índice de Gravidade de Doença , Fatores Sexuais
7.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370932

RESUMO

A 58-year-old woman presented with a 1-week history of lower limb bruising. She had a medical history of recurrent metastatic colon cancer with a sigmoid colectomy and complete pelvic exenteration leading to colostomy and urostomy formation. She had malignant sacral mass encroaching on the spinal cord. This caused a left-sided foot drop for which she used an ankle-foot orthosis. She was on cetuximab and had received radiotherapy to the sacral mass 1 month ago. On examination, there were macular ecchymoses with petechiae on the lower limbs. There was sparing of areas that had been compressed by the ankle-foot orthosis. Bloods showed mild thrombocytopaenia and anaemia with markedly raised inflammatory markers. Coagulation studies consistent with inflammation rather than disseminated intravascular coagulation. She was found to have Klebsiella bacteraemia secondary to urinary source. Skin biopsy showed dermal haemorrhage without vessel inflammation. Vitamin C levels were low confirming the diagnosis of scurvy.


Assuntos
Ácido Ascórbico , Colectomia/efeitos adversos , Neoplasias Colorretais , Equimose , Desnutrição , Apoio Nutricional/métodos , Escorbuto , Antineoplásicos Imunológicos/uso terapêutico , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/sangue , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Colectomia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/secundário , Neoplasias Colorretais/terapia , Diagnóstico Diferencial , Equimose/sangue , Equimose/diagnóstico , Equimose/etiologia , Feminino , Humanos , Klebsiella/isolamento & purificação , Extremidade Inferior , Desnutrição/etiologia , Desnutrição/terapia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Escorbuto/sangue , Escorbuto/etiologia , Escorbuto/fisiopatologia , Escorbuto/terapia , Pele/patologia , Resultado do Tratamento , Vitaminas/administração & dosagem
8.
Arq Bras Cir Dig ; 33(3): e1537, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331432

RESUMO

Background: Esophageal atresia is congenital anomaly with high mortality. Surgical complications and changes in nutritional status are common problems after surgical correction. Aim: To evaluate nutritional status, esophageal stenosis, and respiratory complications among children who had repaired esophageal atresia. METHODS: Children aged >2 months old with repaired esophageal atresia were included in the current study. Gender, age, weight, and height were recorded for each case. Height for age and weight for age were calculated for each case. RESULTS: According to weight for length percentile, 41.02% of the cases were underweight. Esophageal stenosis was seen in 54.76% of the obtained esophagograms. CONCLUSION: Underweight was present in 41.02 of the patients according to weight-for-height percentile.


Assuntos
Atresia Esofágica , Estenose Esofágica , Desnutrição , Peso Corporal , Atresia Esofágica/complicações , Atresia Esofágica/cirurgia , Estenose Esofágica/epidemiologia , Estenose Esofágica/etiologia , Humanos , Incidência , Lactente , Desnutrição/epidemiologia , Desnutrição/etiologia
9.
Lancet Gastroenterol Hepatol ; 5(11): 1017-1026, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33065041

RESUMO

Patients with gastroparesis often have signs and symptoms including nausea, vomiting, epigastric discomfort, and early satiety, thus leading to inadequate food intake and a high risk of malnutrition. There is a considerable scarcity of data about nutritional strategies for gastroparesis, and current practices rely on extrapolated evidence. Some approaches include the modification of food composition, food consistency, and food volume in the context of delayed gastric emptying. If the patient is unable to consume adequate calories through a solid food diet, stepwise nutritional interventions could include the use of liquid meals, oral nutrition supplements, enteral nutrition, and parenteral nutrition. This Review discusses the role, rationale, and current evidence of diverse nutritional interventions in the management of gastroparesis.


Assuntos
Dietoterapia/métodos , Gastroparesia , Desnutrição , Apoio Nutricional/métodos , Gastroparesia/complicações , Gastroparesia/dietoterapia , Gastroparesia/fisiopatologia , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle
10.
Br J Community Nurs ; 25(Sup8): S6-S10, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32936703

RESUMO

The impact of nutrition on recovery from various illnesses is well recognised. Malnutrition can affect duration of hospitalisation and impede recovery, and therefore it is important to monitor this condition, especially in at-risk groups, such as older adults and those with chronic disease. Underlying malnutrition impairs the immune system, potentially making people more vulnerable to infections such as COVID-19 and impacting recovery. Patients recovering from severe illness are likely to have muscle wasting or feel weak and may have increased protein needs. In addition individuals who have been discharged from hospital may need ongoing nutritional rehabilitation. This article explores the range of symptoms of COVID-19 that can interfere with dietary intake, such as respiratory issues, loss of taste and smell and fatigue and weakness. It goes on to describe how community nurses can identify risk of malnutrition and dietary issues when working remotely. Additionally, it signposts to a range of resources developed to assist patients and carers in accessing appropriate dietary advice.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Desnutrição/diagnóstico , Desnutrição/prevenção & controle , Pneumonia Viral/complicações , Enfermagem em Saúde Comunitária , Infecções por Coronavirus/terapia , Suplementos Nutricionais , Humanos , Desnutrição/etiologia , Papel do Profissional de Enfermagem , Estado Nutricional , Apoio Nutricional , Pandemias , Pneumonia Viral/terapia
12.
Artigo em Inglês | MEDLINE | ID: mdl-32842493

RESUMO

INTRODUCTION: Patients undergoing ileostomy surgery often experience electrolyte disturbances and dehydration, especially during the first post-operative period. Recently, research has also begun on how the newly constructed ileostomy affects the patient's nutritional status. AIM: The aim of the present pilot study was to assess the nutritional status of patients before and after the construction of the ileostomy as well as nutrition-related factors. MATERIAL AND METHOD: This was a pilot study. The sample consisted of 13 adult patients diagnosed with colorectal or colon cancer who underwent scheduled ileostomy surgery. The evaluation tool used was "Original Full Mini Nutritional Assessment (MNA)". Patients underwent nutritional assessment before the surgery (time 0), on the 7th post-operative day (time 1), and on the 20th post-operative day (time 2). The statistical significance level was set at p < 0.05. RESULTS: All patients had a drop in MNA score on the 7th and 20th post-operative days. Factors associated with MNA were weight loss, mobility, body mass index (BMI), number of full meals consumed per day, portions of fruits and vegetables consumed per day, and mid-arm circumference, p < 0.05, respectively. Pre-operatively, 38.5%, of patients had severe weight loss (>3 kg), 23% moderate weight loss and 38.5% minimal weight loss. Pre-operatively, 92.3% of participants were able to move on their own and 69.2% on the 20th post-operatively day. Furthermore, BMI >23 kg/m2 had 84.6% of participants pre-operatively and 30.8% on the 20th post-operative day. In terms of portions of fruits and vegetables consumed per day, 30.8% of patients consumed at least 2 times, pre-operatively and no one (0%) on the 20th post-operative day. Moreover, pre-operatively all participants (100%) had arm circumference >22 cm while on the 20th post-operative day, only 38.5% of participants had arm circumference >22 cm. CONCLUSIONS: In the first 20 days after the construction of an ileostomy, the nutritional status of the patients is significantly affected. Decreased patient nutrition in both quantity and ingredients and reduced fluid intake appear to adversely affect the patient's nutritional status.


Assuntos
Neoplasias Colorretais/cirurgia , Ileostomia/efeitos adversos , Desnutrição/etiologia , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Avaliação Geriátrica/métodos , Humanos , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Projetos Piloto , Medição de Risco , Fatores de Risco , Perda de Peso
14.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Artigo em Espanhol | MEDLINE | ID: mdl-32603180

RESUMO

Introduction: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/dietoterapia , Cuidados Críticos/métodos , Estado Terminal , Desnutrição/dietoterapia , Pandemias , Pneumonia Viral/dietoterapia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Gastroenteropatias/complicações , Humanos , Inflamação/epidemiologia , Inflamação/fisiopatologia , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/prevenção & controle , Metanálise como Assunto , Micronutrientes/administração & dosagem , Avaliação Nutricional , Necessidades Nutricionais , Apoio Nutricional , Obesidade/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Síndrome da Realimentação/prevenção & controle , Respiração Artificial , Sarcopenia/epidemiologia
15.
Ann Hematol ; 99(7): 1655-1665, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524200

RESUMO

Second allogeneic hematopoietic stem cell transplantation (allo-HSCT) has a low survival outcome and a high non-relapse mortality (NRM) rate which is a major obstacle to this treatment. We hypothesized that the status of malnourishment after first allo-HSCT as represented by the geriatric nutritional risk index (GNRI) could be used as a prognostic factor to determine the outcomes of second allo-HSCT. A total of 108 patients with a median age of 42 (range, 17-69) years, who received second allo-HSCT for disease recurrence after first allo-HSCT from our institution, were included in this study. Low GNRI had a significant impact on NRM at 2 years after second allo-HSCT: 56.9% in patients with GNRI ≤ 92 compared with 27.5% in patients with GNRI > 92 (P = 0.002). In multivariate analysis, GNRI of ≤ 92 was the only significant factor for NRM (hazard ratio [HR] 2.29, 95% confidence interval [CI] 1.15-4.56, P = 0.018). High-risk disease status at second allo-HSCT (HR 2.74, 95% CI 1.46-5.14, P = 0.002) and GNRI of ≤ 92 (HR 1.70, 95% CI 1.02-2.82, P = 0.042) were identified as significant factors for overall survival (OS). A score of 1 was assigned to each factor, and the OS rate at 2 years after second allo-HSCT decreased according to the score: 53.0% in patients with score 0, 32.3% with score 1, and 2.5% with score 2 (P < 0.001). In conclusion, GNRI could be a useful predictor for the outcomes of second allo-HSCT. A prospective study in other cohorts is warranted to validate the findings of our study.


Assuntos
Avaliação Geriátrica/métodos , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Desnutrição/diagnóstico , Estado Nutricional , Adolescente , Adulto , Idoso , Feminino , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/mortalidade , Indicadores Básicos de Saúde , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/mortalidade , Desnutrição/patologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Recidiva , Retratamento/efeitos adversos , Retratamento/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Adulto Jovem
16.
Medicine (Baltimore) ; 99(25): e20112, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569158

RESUMO

INTRODUCTION: Crohn's disease (CD) is a chronic systemic inflammatory disease with indefinite remission and relapse cycles, which can result in a high incidence rate of malnutrition. There has been increasing clinical interest in enteral nutrition (EN) as an adjunct treatment for CD. This report aims to present a case of a severely malnourished CD patient given EN support in combination with conventional infliximab (IFX) treatment. PATIENT CONCERNS: A 42-year-old CD patient with severe malnutrition. She once weighted 27.5 kg (BMI 11.4 kg/m) with hyponatremia, which may cause sudden death at any time. DIAGNOSIS: In this study, the diagnosis of CD made by our gastroenterologist was based on integrating patient symptoms, radiologic findings, and biopsy results. The patient had no differential diagnosis. INTERVENTIONS: The patient received EN support and actively followed up for more than 2 years. The patient also received IFX treatment and four surgeries on an as-needed basis to manage her symptoms. OUTCOMES: The patient's inflammation and symptoms were finally improved by a combination of enteral nutrition and IFX, and her body weight increased to 44 kg. CONCLUSION: The jejunal feeding tube was the starting point of her weight gain and inflammation reduction, which allowed her adequate energy. EN may be a potential complementary therapeutic strategy to manage clinical symptoms of CD and improve severe malnutrition.


Assuntos
Doença de Crohn/complicações , Nutrição Enteral/métodos , Fármacos Gastrointestinais/uso terapêutico , Infliximab/uso terapêutico , Desnutrição/terapia , Adulto , Doença de Crohn/terapia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Desnutrição/etiologia
17.
Medicina (Kaunas) ; 56(6)2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32545556

RESUMO

The epidemic that broke out in Chinese Wuhan at the beginning of 2020 presented how important the rapid diagnosis of malnutrition (elevating during intensive care unit stay) and the immediate implementation of caloric and protein-balanced nutrition care are. According to specialists from the Chinese Medical Association for Parenteral and Enteral Nutrition (CSPEN), these activities are crucial for both the therapy success and reduction of mortality rates. The Chinese have published their recommendations including principles for the diagnosis of nutritional status along with the optimal method for nutrition supply including guidelines when to introduce education approach, oral nutritional supplement, tube feeding, and parenteral nutrition. They also calculated energy demand and gave their opinion on proper monitoring and supplementation of immuno-nutrients, fluids and macronutrients intake. The present review summarizes Chinese observations and compares these with the latest European Society for Clinical Nutrition and Metabolism guidelines. Nutritional approach should be an inseparable element of therapy in patients with COVID-19.


Assuntos
Infecções por Coronavirus , Desnutrição , Estado Nutricional , Apoio Nutricional , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/dietoterapia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Humanos , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/prevenção & controle , Apoio Nutricional/métodos , Apoio Nutricional/normas , Pneumonia Viral/complicações , Pneumonia Viral/dietoterapia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto
20.
Cochrane Database Syst Rev ; 5: CD012616, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32390133

RESUMO

BACKGROUND: Malnutrition is common in patients with chronic kidney disease (CKD) on dialysis. Oral protein-based nutritional supplements are often provided to patients whose oral intake is otherwise insufficient to meet their energy and protein needs. Evidence for the effectiveness of oral protein-based nutritional supplements in this population is limited. OBJECTIVES: The aims of this review were to determine the benefits and harms of using oral protein-based nutritional supplements to improve the nutritional state of patients with CKD requiring dialysis. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 12 December 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) of patients with CKD requiring dialysis that compared oral protein-based nutritional supplements to no oral protein-based nutritional supplements or placebo. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for eligibility, risk of bias, and extracted data from individual studies. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference and 95% CI for continuous outcomes. MAIN RESULTS: Twenty-two studies (1278 participants) were included in this review. All participants were adults on maintenance dialysis of whom 79% were on haemodialysis (HD) and 21% peritoneal dialysis. The follow-up period ranged from one to 12 months. The majority of studies were at unclear risk of selection, performance, and reporting bias. The detection bias was high for self-reported outcomes. Oral protein-based nutritional supplements probably lead to a higher mean change in serum albumin compared to the control group (16 studies, 790 participants: MD 0.19 g/dL, 95% CI 0.05 to 0.33; moderate certainty evidence), although there was considerable heterogeneity in the combined analysis (I2 = 84%). The increase was more evident in HD participants (10 studies, 526 participants: MD 0.28 g/dL, 95% CI 0.11 to 0.46; P = 0.001 for overall effect) and malnourished participants (8 studies, 405 participants: MD 0.31 g/dL, 95% CI 0.10 to 0.52, P = 0.003 for overall effect). Oral protein-based nutritional supplements also probably leads to a higher mean serum albumin at the end of the intervention (14 studies, 715 participants: MD 0.14 g/dL, 95% CI 0 to 0.27; moderate certainty evidence), however heterogeneity was again high (I2 = 80%). Again the increase was more evident in HD participants (9 studies, 498 participants: MD 0.21 g/dL, 95% CI 0.03 to 0.38; P = 0.02 for overall effect) and malnourished participants (7 studies, 377 participants: MD 0.25 g/dL, 95% CI 0.02 to 0.47; P = 0.03 for overall effect). Compared to placebo or no supplement, low certainty evidence showed oral protein-based nutritional supplements may result in a higher serum prealbumin (4 studies, 225 participants: MD 2.81 mg/dL, 95% CI 2.19 to 3.43), and mid-arm muscle circumference (4 studies, 216 participants: MD 1.33 cm, 95% CI 0.24 to 2.43) at the end of the intervention. Compared to placebo or no supplement, oral protein-based nutritional supplements may make little or no difference to weight (8 studies, 365 participants: MD 2.83 kg, 95% CI -0.43 to 6.09; low certainty evidence), body mass index (9 studies, 368 participants: MD -0.04 kg/m2, 95% CI -0.74 to 0.66; moderate certainty evidence) and lean mass (5 studies, 189 participants: MD 1.27 kg, 95% CI -1.61 to 4.51; low certainty evidence). Due to very low quality of evidence, it is uncertain whether oral protein-based nutritional supplements affect triceps skinfold thickness, mid-arm circumference, C-reactive protein, Interleukin 6, serum potassium, or serum phosphate. There may be little or no difference in the risk of developing gastrointestinal intolerance between participants who received oral protein-based nutritional supplements compared with placebo or no supplement (6 studies, 426 participants: RR 2.81, 95% CI 0.58 to 13.65, low certainty evidence). It was not possible to draw conclusions about cost or quality of life, and deaths were not reported as a study outcome in any of the included studies. AUTHORS' CONCLUSIONS: Overall, it is likely that oral protein-based nutritional supplements increase both mean change in serum albumin and serum albumin at end of intervention and may improve serum prealbumin and mid-arm muscle circumference. The improvement in serum albumin was more evident in haemodialysis and malnourished participants. However, it remains uncertain whether these results translate to improvement in nutritional status and clinically relevant outcomes such as death. Large well-designed RCTs in this population are required.


Assuntos
Proteínas na Dieta/administração & dosagem , Desnutrição/terapia , Diálise Renal , Insuficiência Renal Crônica/terapia , Albumina Sérica/metabolismo , Administração Oral , Braço/anatomia & histologia , Viés , Biomarcadores/sangue , Proteínas na Dieta/efeitos adversos , Humanos , Desnutrição/sangue , Desnutrição/etiologia , Diálise Peritoneal/estatística & dados numéricos , Placebos/administração & dosagem , Pré-Albumina/metabolismo , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Pregas Cutâneas
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