Decrease In Appetite Research Articles

271P First-in-human, phase I dose escalation and expansion study of anti-HER2 ADC MRG002 in patients with HER2 positive solid tumors

MRG002 is an ADC composed of a humanized anti-HER2 mAb conjugated to MMAE via a vclinker. MRG002 is presently being investigated as monotherapy in an ongoing phase I study for safety, tolerability, PK, and preliminary antitumor activity in patients (pts) with HER2+ advanced or metastatic solid tumors. In phase Ia dose escalation utilizing a “3+3” design, a total of 25 pts with BC (19), SGC (3), GC (2), and CRC (1) were enrolled to identify MTD/RP2D. The median age was 53 (30, 66) years. The median number of prior therapies was 5 (1, 11). The starting dose of MRG002 was 0.3 mg/kg, followed by 0.6, 1.2, 1.8, 2.2, 2.6, and 3.0 mg/kg, all pts with BC and GC had HER2+ per CAP guidelines. For the other cancers, pts had an IHC status of 2+ or 3+, regardless of HER2 FISH results. Each pt received MRG002 Q3W for a maximum of 8 cycles. Commonly observed TRAEs were neutrophil count decrease (56%), AST increase (56%), WBC decrease (56%), lactate dehydrogenase increase (44%), alopecia (44%), CPK increase (40%), ALT increase (36%), triglyceride increase (32%), cholesterol increase (32%), GGT increase (32%), appetite decrease (32%), and hypoaesthesia (32%). Majority of AEs were mild to moderate in severity. The most commonly reported TRAEs ≥ Grade 3 were neutrophil count decrease and triglycerides increase in 3 pts (12%), respectively. The treatment-related SAEs were reported in 6 pts (24%) including GGT increase, AST/ALT increase, neutrophil count decrease, LEVF decrease, fatigue, peripheral neuropathy. There was no death due to AEs. Among 21 pts who had at least one tumor assessment, 9 PR (43%), 8 SD (38%), and 4 PD (19%). The investigator assessed ORR was 43% and the DCR was 81%. Of these 21 pts, 16 pts were HER2+ breast cancer, 8 PR, 5 SD, and ORR was 50% (8/16), DCR was 81%(13/16). There were two DLTs at 3.0 mg/kg including LVEF decrease and CPK elevation. Accordingly, the RP2D determined at 2.6 mg/kg which is currently being evaluated in the phase Ib dose expansion. The dose escalation of MRG002 showed manageable safety profile and encouraging antitumor activity in pts with HER2+ solid tumors including BC, GC and other cancer types, which will be further investigated in phase II studies.

The role of ghrelin and serotonin in the control of eating behavior in patients with obesity and diabetes mellitus type 2

In recent years, the incidence of obesity and type 2 diabetes mellitus (DM) has been increasing steadily; therefore, the search for hormonal and metabolic substances the correction of which can normalize human eating behavior is required. The main system for controlling hunger and appetite — the melanocortin pathway — is located in the hypothalamus. Activation of this signa­ling system by melanocortins leads to appetite decrease and causes a feeling of satiety. Neuropeptide Y and agouti-related protein act antagonistically and enhance hunger. There are different types of eating disorders, such as binge eating and night ­eating syndrome, which are most common among obese patients and those with type 2 DM. They are characterized by excessive intake of food and, consequently, complication of the course of underlying disease due to its negative impact on carbohydrate and lipid metabolism. There are various hormonal and metabolic substances that are responsible for suppressing and stimulating the center of hunger in the hypothalamus. This article examines the effect of ghrelin and serotonin on the mechanism of eating habits formation and the control of eating behavior in patients with obesity and type 2 DM. This article highlights the role of ghrelin and serotonin in eating behavior. Ghrelin is an orexigenic hormone and is capable of activating the center of hunger. The concentration of this hormone in patients with obesity and/or type 2 DM is reduced compared to healthy individuals that indicates the adaptation of the body to positive energy balance and excess calorie intake by humans. In turn, serotonin, whose receptors are also present in the hypothalamus, upon bin­ding to 5-HT2C receptor causes inhibition of neuropeptide Y secretion that leads to feeling of satiety and normalization of appetite and weight, thus exhibiting anorexigenic properties. Lorcaserin is currently the only serotonin receptor agonist approved by the Food and Drug Administration for the treatment of obesity. That is why studies of hormonal and metabolic substances that are involved in the signaling pathways of the hypothalamus hunger center will help find effective ways to treat obesity and type 2 DM.

The Nutritional Status of Oncological Patient Prior to Antitumor Treatment: Single-Center Prospective Observational Study

Background: Malnutrition is a frequent medical problem of cancer patients (pts) that negatively impacts of results of antitumor treatment. Aim: To study the problem of malnutrition in cancer hospital. Materials and methods: The observational study included 80 pts (30 males, age 51.613.6 years) who underwent examination before antitumor treatment (medical/surgical). Body mass index (BMI), weight loss (WL) over last 6 months, decrease in appetite before admission, reasons for decrease in food intake, physical activity, nosology, cancer staging, the time to diagnosis, therapy status, total protein (TP), albumin, absolute lymphocyte count (ALC) were evaluated. The data were analyzed by SPSS13.0 software. The results were expressed as mean SD. Results: The BMI was 25.35.4 kg/m2, WL 9.00.1%. The most common pathology were esophageal/gastric cancer (31%), stage IV (77%). 25% had received treatment within the last 612 months, 60% of the pts had received chemotherapy, of whom 36% had received 1st-line chemotherapy. Only 13% had additionally used enteral nutrition. An unwanted reduction of appetite was observed in 75% of pts. Most of them (34%) could not explain the reason of WL, 31% reported nausea/vomiting, 19% referred to anorexia; 13% showed consequences of chemotherapy toxicity (dysgeusia, stomatitis), 3% could not eat properly due to the pain syndrome. Of 60 patients who lost weight unintentionally, 54 (67.5%) had an average WL 14.19.1%. WL up to 5% was in 5 pts (6.25%), up to 10% in 14 pts (17.5%) and in 35 pts (43.75%) more than 10%. 46% retained their usual daily activity, 80% deemed it useful to include a nutritional program in the treatment. The concentration of TP was 63.58.1 g/l, albumin 34.97.4 g/l, ALC 1.60.6109/l. Conclusions: Cancer patients have direct prerequisites for the development of cachexia, and, according to our study, 6.25% of patients were at the stage of precachexia, and 61.25% already had cachexia at the time of inclusion in the study. Although their compensatory capacity is quite high, the appointment of additional nutritional support is an integral component of the management of these patients. However, according to our data, only one tenth of patients used some kind of nutritional support. Nevertheless, in case of antitumor treatment, nutritional status evaluation must be mandatory in order to address the issue of nutritional support.

Literature Review: The Effectiveness of Giving Ginger (Zingiber Officinale Roscoe) to Pregnant Women Nausea Vomiting 1st Trimester Pregnancy

Nausea and vomiting often occur when you wake up in the morning, which is also called morning sickness. Nausea and vomiting that occur in the first trimester of pregnancy are caused by increased levels of the hormone Estrogen and Human Chorionic Gonadotropine (HCG) in serum from the placenta and can cause a decrease in appetite so that there is a change in electrolyte balance with potassium, calcium and sodium which causes changes in body metabolism. Nausea and vomiting during pregnancy affects about 80-90% of pregnant women. Ginger (Zingiber officinale Roscoe) is the most widely used herbal therapy in the management of nausea and vomiting. The purpose of this study was to determine how effectiveness ginger was in reducing the frequency of nuesea and vomiting in pregnant women in the 1st trimester.This study uses a literature study method obtained through electronic media with keywords. There were 8 selected articles, consisting of 5 international and 3 national articles. This article provides information about the effectiveness of giving ginger to reduce the frequency of nausea and vomiting in pregnant women in the 1st trimester. The conclusions obtained from the analysis are that ginger can reduce nausea and vomiting in pregnant women in the 1st trimester.

Literature Review: The Effectiveness of Giving Ginger (Zingiber Officinale Roscoe) to Pregnant Women Nausea Vomiting 1st Trimester Pregnancy

Nausea and vomiting often occur when you wake up in the morning, which is also called morning sickness. Nausea and vomiting that occur in the first trimester of pregnancy are caused by increased levels of the hormone Estrogen and Human Chorionic Gonadotropine (HCG) in serum from the placenta and can cause a decrease in appetite so that there is a change in electrolyte balance with potassium, calcium and sodium which causes changes in body metabolism. Nausea and vomiting during pregnancy affects about 80-90% of pregnant women. Ginger (Zingiber officinale Roscoe) is the most widely used herbal therapy in the management of nausea and vomiting. The purpose of this study was to determine how effectiveness ginger was in reducing the frequency of nuesea and vomiting in pregnant women in the 1st trimester.This study uses a literature study method obtained through electronic media with keywords. There were 8 selected articles, consisting of 5 international and 3 national articles. This article provides information about the effectiveness of giving ginger to reduce the frequency of nausea and vomiting in pregnant women in the 1st trimester. The conclusions obtained from the analysis are that ginger can reduce nausea and vomiting in pregnant women in the 1st trimester.

A Clinicl Case Report on Black Dog (Depression)

Aim: - The intent of this case report is to define the top practice for a person detected with depressive disorder who has been denoted to a public mental health facility for treatment. To identify the black dog symptoms early to provide treatment and prevent potential complication.
 Presentation of case: A 45-year-old male patient got admitted in psychiatric ward AVBR Hospital Sawangi Meghe Wardha, Maharashtra, with the complaints of insomnia, low mood, social withdrawal, irritable, lack of interaction, lack of interest, sadness, hopelessness, helplessness, decrease appetite and suicide ideation such as hanging. patient was apparently asymptomatic 10 month ago when his younger brother passes away and his started show above clinical features of depression. patient received antidepressant drug citalopram, Imipramine and two-time Somatic therapy (Electroconvulsive Therapy). symptoms were minimized.
 Result: The patient was received psychopharmacological treatment antidepressant drug sertraline, citalopram, fluvoxamine along with somatic therapy (ECT) two times and psychosocial therapy, coping strategies, family therapy, yoga, recreation, meditation and symptoms was minimized.
 Discussion: Millions of people worldwide suffer from depression. it is most common disorder in outpatient clinic. which can result impairment and disability of individual ability to cope up with daily life.
 Conclusion: A positive outcome gets by the patient not only with the help of therapeutic management but also the family coping and support even. later on, due to proper psychopharmacological treatment, patient shown positive feedback and slowly all the aims are achieved which were planned in period. Finally, the patient got discharged from the hospital and now he is continuing his on follow up.

Hubungan Kualitas Hidup Lansia dengan Food Intake di Panti Sosial Tresna Werdha Ina Kaka Ambon

AbstractThe decline in the functioning of the body's systems in the elderly as they get older can change certain nutritional aspects such as the sense of smell and taste, the ability to chew and swallow and the digestive function makes food uncomfortable and the elderly's appetite decreases . The decrease in food intake certainly affects the quality of life of the elderly. Food intake is one of the important factors to meet the needs of good nutritional intake. Elderly with high quality of life can cover all existing domains and also a good food intake for the changes experienced by the elderly. So that it becomes the basis of the importance of improving the quality of life and food intake of the elderly. The study was conducted to explore the relationship between quality of life and food intake at the Tresna Werdha Inakaka Social Home in Ambon. Research using quantitative methods with descriptive correlation design. The respondents involved were the elderly at the Tresna Werdha Ina Kaka Social Home, Ambon. Sampling using purposive sampling technique with respondents as many as 36 elderly. The data were processed using the excel program and then tested using the SPSS program to determine the relationship between variables. Data analysis using SPSS 20 correlation test or correlation using Pearson Product Moment with a significance level of 0.05. The results showed that there was a relationship between variables in quality of life and food intake, with a moderate degree of correlation that led to a positive direction (r = 0.502; p = 0.002; p <0.05). Based on the results of the study, it can be concluded that in the Tresna Werdha Ina Kaka Social Home, the quality of life and food intake have a moderate relationship, the higher the quality of life the better the food intake for the elderly.Keywords: Elderly, Quality of Life, Food Intake

Clinical characteristic of prodromal symptoms between bipolar I and II disorder among Chinese patients: a retrospective study

BackgroundThis study aimed to identify the clinical characteristic of prodromal symptoms in Chinese patients with bipolar disorder (BD), prior to the first affective episode. It further aimed to characterize the prodromal traits between bipolar disorder type I (BD-I) and type II (BD-II).Methods120 individuals with BD-I (n = 92) and BD- II (n = 28) were recruited to the study. Semi-structured interviews were then administered to evaluate prodromal symptoms in patients, within 3 years of BD onset, by using the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R).ResultsIn the prodromal phase of the first depressive episode, patients with BD-II experienced more prodromal symptoms (p = 0.0028) compared to BD-I. Additionally, more frequent predictors were reported in patients with BD-II than BD-I including educational and occupational dysfunction (p = 0.0023), social isolation (p < 0.001), difficulty making decisions (p = 0.0012), oppositionality (p = 0.012), and suspiciousness/persecutory ideas (p = 0.017). There were also differences in the duration of the precursors. The duration of “weight loss or decrease in appetite” (p = 0.016) lasted longer in patients with BD-I, while “obsessions and compulsions” (p = 0.023) started earlier in patients with BD-II and occurred during the pre-depressive period. The prevalence and duration of each reported prodrome, preceding a first (hypo) manic episode, showed no difference between patients with BD-I and BD-II.ConclusionsSpecific affective, general, or psychotic symptoms occurred prior to both affective episodes. The characteristic of prodromal symptoms were key predictors for later episodes of BD including attenuated mania-like symptoms, subthreshold depressed mood, mood swings/lability, and anxiety. In the pre-depressive state, when compared to BD-II, BD-I presented with more prodromal symptoms in nonspecific dimensions, which indicated the substantial burden of BD-II. In conclusion, this study extends the understanding of the characteristics of prodromes of BD-I and BD-II.

Phase 1b/2a study of PLX2853, a small molecule BET inhibitor, in subjects with advanced solid tumors and lymphoma.

3018 Background: PLX2853 is a potent, orally active small molecule BET inhibitor. Its unique pharmacokinetic (PK) profile is associated with less thrombocytopenia and improved tolerability by allowing transient target engagement with a prolonged pharmacodynamic (PD) response and time for recovery after dosing. Methods: We conducted a first-in-human 3+3 Ph1b/2a study of PLX2853 in adults with relapsed or refractory solid tumors and lymphoma to determine the safety, PK and recommended phase II dose (RP2D) (NCT03297424). Secondary endpoints included efficacy and PD. Results: As of 2 February 2021, 44 subjects (median age 65, range 39 - 84) received PLX2853 in escalating doses from 5mg to 120mg QD and 40mg to 60mg BID. Ovarian cancer (n = 11), uveal melanoma, colorectal, and prostate (n = 5 each) were the most represented tumor types. Adverse events (AE) occurring in ≥15% of subjects included nausea (41%), decrease appetite (39%), fatigue (27%), vomiting (25%), diarrhea (25%), dysgeusia (25%), dehydration (23%), anemia (20%), dry mouth (18%), dizziness (16%), abdominal pain (16%), and pyrexia (16%). Thrombocytopenia occurred in 11% of subjects. Most AEs ( &gt; 85%) were grades (G) 1-2. Of all AEs, 40% were related. There were 5 treatment-related serious AEs in 2 subjects (n = 1 G4 thrombocytopenia, G4 ischemic stroke, G3 subarachnoid hemorrhage [SAH], and G3 thromboembolic event; n = 1 G3 vomiting). Dose-limiting toxicities were observed at 120mg QD (G4 thrombocytopenia, G4 ischemic stroke, G3 thromboembolic event, and G3 SAH; asymptomatic G4 thrombocytopenia), 60mg BID (G3 thrombocytopenia with recovery &gt; 7 days), and 40mg BID (dose reduction for transient G3 fatigue). PLX2853 systemic exposure was dose-proportional up to 120mg with a short terminal half-life ( &lt; 3.5 hr). Plasma concentrations were above the IC90 in the MYC-responsive reporter assay for 9 hr at 80mg or higher doses. RNA-seq analyses of peripheral blood mononuclear cells showed a dose-dependent modulation of BET target gene expression. One complete response (ongoing 9+ months) was seen in a patient with DLBCL, two patients had partial responses (1 uveal melanoma, 1 primary peritoneal cancer), and 14 patients had stable disease. The median PFS was 82.5 days (range: 51 – 209 days). Conclusions: PLX2853 shows encouraging signs of clinical activity and is well tolerated at the anticipated RP2D of 80 mg/day. PLX2853 is being evaluated as monotherapy and in combination. Clinical trial information: NCT03297424.

Effects of sodium-glucose cotransporter-2 inhibitors on appetite markers in patients with type 2 diabetes mellitus

Background and aimsGlycosuria induced by sodium-glucose cotransporter 2 (SGLT2) inhibitors leads to weight loss and improved diabetes control, but a significant disparity exists between observed and expected weight loss with these medications, hindering clinical effects. This study investigated whether this discrepancy could be explained by compensatory increases in appetite and associated alterations in appetite-regulating hormones. Methods and resultsThis was a prospective single-center observational pilot study. Adults 18–70 years old newly prescribed an SGLT2 inhibitor through usual care were invited to participate. Fasting and postprandial appetite was assessed immediately before, 1 week after, and 12 weeks after SGLT2 inhibitor initiation. Serum samples were collected at corresponding time points to measure ghrelin, leptin, and peptide tyrosine–tyrosine (PYY). Seven patients were included. At 1 and 12 weeks after SGLT2 inhibitor initiation, self-reported appetite did not change significantly and trended toward a decrease in appetite. There were no significant differences in fasting or postprandial ghrelin, leptin, or PYY. ConclusionResults suggest the discrepancy between expected and observed weight loss with SGLT2 inhibitors cannot be explained by increases in appetite or changes in appetite-regulating hormones. Further studies are needed to investigate alternative metabolic compensatory mechanisms to optimize weight loss with SGLT2 inhibitor use.

Headache, Pituitary Apoplexy and Diabetes insipidus: Suspect Necrotizing Hypophysitis

Background: Necrotizing hypophysitis (NH) is an exceedingly rare clinical entity; we found only 5 reported cases in a literature review. CASE: A 34-year-old female with a history of primary hypothyroidism developed a headache, double vision, nausea, vomiting, decrease in appetite, galactorrhea, and weight loss. An MRI of the brain showed a 0.9 cm T2 hyperintense pituitary lesion with features suggestive of cystic degeneration or apoplexy of an adenoma There was effacement of the optic nerve anterior to the optic chiasm. Eye examination revealed optic nerve edema and a cranial nerve VI palsy. Laboratory studies revealed a normal prolactin 20.0 (3.3-26.7 ng/ml), and IGF-1 189 (RR: 66 - 303 ng/ml). The pituitary-adrenal axis and pituitary-gonadal axis appeared intact. After short treatment with dexamethasone, her primary symptom of severe headache improved but she later developed polyuria. The evaluation confirmed diabetes insipidus. Her headache worsened after the completion of the brief course of steroids. After a repeat MRI showed mild interval enlargement of the hypo-enhancing posterior pituitary, she underwent transsphenoidal pituitary tumor surgery. A biopsy showed necrotizing inflammation with foci of acute necrosis accompanied by polymorphonuclear cells. There was no granuloma seen. Special stains were negative for fungal, acid-fast, and bacterial organisms. Laboratory studies revealed negative ANA, negative ANCA, PR-3 Ab, MPO Ab, and anti-TPO Abs. The ACE enzyme was elevated at 85 (RR: 8-53 U/l), but the repeat test was within the normal range. A chest CT was not suggestive of pulmonary sarcoidosis. A post-surgery MRI demonstrated a decrease in pituitary size. Her headache worsened with a reduction in prednisone below 20 mg daily. In order to attempt further reduction in prednisone, azathioprine was started as a steroid-sparing agent. Titration of azathioprine up to 175 mg allowed prednisone to be reduced to the replacement dose of prednisone 5 mg daily. An MRI showed the pituitary mass to be unchanged. DISCUSSION: Hypophysitis is associated with diffuse enlargement and dysfunction of the pituitary gland. This case of NH is of unclear cause. There was no evidence of other inflammatory causes such as sarcoidosis, IgG4-related disease, ANCA-associated vasculitis, or infectious cause. As with typical lymphocytic hypophysitis, NH can present with sudden-onset hypopituitarism, neural compression, diabetes insipidus, and radiologic features of ischemic pituitary apoplexy. Signs and symptoms at diagnosis, as well as pituitary hormone abnormalities, vary on the degree of pituitary involvement. Pituitary adenoma commonly does not cause diabetes Insipidus. Radiologic findings consistent with ischemic pituitary apoplexy coupled with the presence of diabetes insipidus is suggestive of NH. A definitive diagnosis of NH, however, requires histopathology.

A Challenging Diagnosis of Primary Hyperparathyroidism in an Adolescent Female

Background: Hypercalcemia secondary to primary hyperparathyroidism (PHPT) is less common in children than adults. Single parathyroid adenoma is commonly the cause of primary hyperparathyroidism in children. Clinical Case: We present a 15-year-old female with one-week history of abdominal pain despite taking over the counter antacids. Her initial work up by her primary care provider revealed serum calcium of 11.8 mg/dL (9.0–11.5) and creatinine of 0.8 mg/dL (0.4–1.2). A week later, she presented to the emergency department with same complaint. In ED, she was found to have hypercalcemia (12.8 mg/dl) with elevated parathyroid hormone (PTH) at 78.5 pg/mL (15–65). Her random urine calcium creatinine ratio was high at 2.1. Her 25OHD was 25 ng/mL (30–100). She had negative urine pregnancy test but had trace ketones, leukocyte esterase, blood and bacteria. CBC and CMP were otherwise unremarkable. She continued to complain abdominal pain with nausea, decrease appetite, fatigue, and general muscle weakness. There was no known family history of calcium or metabolic bone disorders. Her vital signs and physical exam were normal. Subsequent labs showed mild improvement of calcium between (11–12.3 mg/dL), PTH between 54.5 and 77 pg/mL, normal thyroid function. Ionized calcium was mildly elevated 6.0 mg/dL (4.5–5.3) but her repeat 25OHD was low at18 ng/mL. Serum phosphorus levels were relatively normal with lowest level of 2.5 mg/dL (2.7–4.5). Gliadin Deamidated IgA was detectable 15 U/mL (< 15.0 U/). Ultrasound of abdomen was significant for nonspecific mild hepatomegaly; kidneys were normal in size and appearance. Ultrasound of thyroid was significant for probably intrathyroid parathyroid, measuring 6 x 8 x 8 mm. Tc-Sestamibi scan did not confirm a parathyroid adenoma. Genetic testing for MEN-1 was negative. FHH- related genes (i.e. CASR) was positive for p.R990G variant resulting in a mild gain of function of the calcium-sensing receptor. Although previous Tc-Sestamibi scan was unremarkable, an over read of it raised a concern for questionable uptake in the left superior lobe. SPEC-CT demonstrated possible abnormal parathyroid tissue in the upper pole of the left thyroid. FNA of the left thyroid nodule confirmed likely intrathyroidal parathyroid adenoma. Subsequent follow up and treatment, including parathyroidectomy, was done by another institution. She underwent a left parathyroidectomy with normalization of serum calcium and PTH levels post operatively (10.1 mg/dl and 8 pg/mL, respectively) and has complete resolution of her previous abdominal and gastrointestinal symptoms. Conclusion: PHPT is uncommon in children and adolescents and is typically associated with a single parathyroid adenoma. High index of suspicion is key for early diagnosis of PHPT despite a negative Tc-Sestamibi initially.

Behavioral disturbances in porencephaly. Report of a case

IntroductionPorencephaly is a neurological condition that can develop before or after birth, characterized by cysts located in any place inside the brain parenchyma, which generally are covered by plain walls and encircled by an atrophic crust. It generates a very variable clinic appearance, with severe cases of high disability and slight cases with a light neurological involvement, which also can go unnoticed until adulthood. The prevalence is unknow and the inheritance is autosomal dominant Male patient of 45 years diagnosed with porencephaly with cerebral palsy that affects left half and cognitive disability. His father reports an emerging defiant behavior, mutism and decrease of appetite from a week ago. No triggering stress factors are reported.ObjectivesShow the importance of include in the differential diagnose hypoactive confusional syndrome.MethodsOn urgent medical visit, male comes with ataxic gates which wasn’t shown before. Inhibited attitude, semiflexed staring at floor, with sparing and monosyllabic speech answers, verbalizing discomfort and personal concern. Sleep-wake rhythm disruptions.ResultsBlood tests and drug screening shows no abnormalities Cranial CT: Without acute lesion Urinary infection observed.ConclusionsIt is important to make complementary test to exclude organic frames which could justify acute-subacute psychopathology. In this case, diagnosis was acute confusional syndrome, however, most known presentation is the hyperactive one which include motor hyperactivity, inappropriate behavior or disorganization and alterations of sensory perception. Hypoactive must always be considered, which is the concluding diagnosis in this case.DisclosureNo significant relationships.

Disordered eating in a population-based sample of young adults during the COVID-19 outbreak.

ObjectiveThe present study aimed to describe the experience of, and factors associated with, disordered eating in a population‐based sample of emerging adults during the COVID‐19 outbreak.MethodParticipants in the EAT 2010–2018 (Eating and Activity over Time) study were invited to complete the C‐EAT (COVID‐19 EAT) survey in April–May 2020. There were 720 respondents to the survey (age: 24.7 ± 2.0 years). Psychological distress, stress, stress management, financial difficulties, and food insecurity during the COVID‐19 pandemic were examined as cross‐sectional correlates of disordered eating in 2020. Open‐ended questions assessed the perceived impact of the pandemic on eating behaviors.ResultsLow stress management was significantly associated with a higher count of extreme unhealthy weight control behaviors (UWCBs). Food insecurity, higher depressive symptoms, and financial difficulties were significantly associated with a higher count of less extreme UWCBs. Higher stress and depressive symptoms were significantly associated with greater odds of binge eating. Six themes pertaining to disordered eating during the pandemic emerged: (a) mindless eating and snacking; (b) increased food consumption; (c) generalized decrease in appetite or dietary intake; (d) eating to cope; (e) pandemic‐related reductions in dietary intake; and (f) re‐emergence or marked increase in eating disorder symptoms.DiscussionPsychological distress, stress management, financial difficulties, and abrupt schedule changes may have contributed to disordered eating during the COVID‐19 pandemic. Interventions that target stress management, depressive symptoms, and financial strain and provide tools to develop a routine may be particularly effective for emerging adults at risk of developing disordered eating during public health crises.

A case of episodic angioedema with eosinophilia in an elderly woman with primary biliary cholangitis

We present the case of a 56-year-old woman diagnosed with primary biliary cholangitis (PBC). She has continuously taken 600mg/day of ursodeoxycholic acid. Edema of the lower limbs manifested on July 20, 20XX; after 2weeks, she manifested rapid weight gain and nettle rash on the limbs and trunk. She was admitted to our hospital on August 22. She had marked eosinophilia, hypoalbuminemia, anemia, non-pitting lower limbs edema, and nettle rash of the limbs and the trunk. We ruled out other diseases that may have caused the edema and suspected her with episodic angioedema with eosinophilia (EAE). The peripheral blood eosinophil count rapidly decreased after the administration of 30mg prednisolone. The edema and nettle rash improved on the 7th day of admission, and the hypoalbuminemia and anemia improved on the 14th day. Prednisolone was tapered and discontinued, and there was no relapse of edema. We revised our diagnosis to non-recurrent EAE. She was diagnosed with asymptomatic PBC; therefore, anemia and hypoalbuminemia were considered not PBC but chronic inflammation and decrease in appetite. In this case, elevation of serum IgG4 was observed at onset and at remission. This suggests that IgG4 may be involved in the development of EAE in patients with chronic liver disease.

DETECTION OF METABOLIC DISORDERS IN HIGH PRODUCTIVE COWS

ANNOTATION The productivity of cows is closely related to the level of metabolism in animals. At different stages of animal development, the intensity of metabolic processes varies significantly. The study of the mechanisms of such changes can significantly help in the regulation of metabolic processes, increase the productivity and quality of milk. In the course of research, the causes of metabolic disorders in highly productive Simmental cows were studied. Using clinical indicators of urine, milk, dispensary examination of cows and statistical analysis made by us, the frequency of occurrence of clinical signs characterizing metabolic disorders in animals was established. Of the 40 animals studied, 11 heads (28 %) showed a healthy state of the body, 9 heads (22 %) showed weak rumination, in turn, 10 heads (25 %) showed a decrease in appetite, 2 heads (5 %) showed udder edema, and 8 heads (20 %) showed general depression of the body. During the veterinary and sanitary evaluation of milk according to the main indicators, changes were detected in animals with metabolic disorders, which leads to a decrease in the quality of milk and dairy products. The most important condition for obtaining milk with a normal composition and properties is a balanced feeding of cows in all elements. Incomplete provision of animals with the necessary nutrients and energy contributes to a decrease not only in milk yield, but also to a change in the amount and ratio of milk components, which reduces biological characteristics and technological indicators.

Poor Taste and Smell Are Associated with Poor Appetite, Macronutrient Intake, and Dietary Quality but Not with Undernutrition in Older Adults

BackgroundAge-related declines in taste and smell function are widely assumed to contribute to the decrease in appetite and the development of undernutrition in older adults. ObjectivesHere we aim to assess the associations of both taste and smell function with several nutrition-related outcomes in a single study, with poor appetite and undernutrition as primary outcomes. MethodsThis is a cross-sectional cohort study of 359 community-dwelling Dutch older adults, aged 65–93 y. Taste function was measured for all 5 basic tastes. Smell function was assessed with 3 tests: for odor identification, discrimination, and threshold. Self-reported taste and smell, appetite, energy (kcal/d) and macronutrient (% energy) intake, and covariates were assessed with extensive questionnaires. Dietary quality was calculated using the Dutch Healthy Diet index 2015, Alternative Healthy Eating Index 2010, and Mediterranean Diet Score. Body measurements included body weight (current and 2 y prior), height, and body impedance analysis. Data were analyzed via multiple logistic and linear regression. ResultsOf our sample, 9.2% had poor taste and 17.0% poor smell, 6.1% had poor appetite, and 21.4% were undernourished. Self-reported poor taste (OR: 8.44; 95% CI: 1.56, 45.56; P = 0.013) was associated with poor appetite, but no other taste or smell score was associated with either poor appetite or undernutrition. Some associations were found of individual taste and smell scores with macronutrient intake and dietary quality. Self-reported poor taste and smell were both consistently associated with poorer dietary quality. ConclusionsIn community-dwelling older adults, specific taste and smell impairments may have diverse consequences for appetite, food intake, or dietary quality. However, this does not necessarily result in undernutrition. The consistent associations of self-reported poor taste and smell with poor dietary quality do underline the usefulness of this information when screening for nutritional risk.

Dravet-Syndrom – auf dem Weg zu einer optimalen und krankheitsspezifischen Behandlung

Dravet syndrome is a severe developmental and epileptic encephalopathy associated with SCN1A mutations. Drug-resistant epilepsy is common despite polypharmacy, but new therapeutic options will soon be available. Cannabidiol was added to the therapeutic armamentarium in 2019 after demonstrating a significant reduction in seizure frequency in two phase III studies. Results appear somewhat less convincing compared with stiripentol or fenfluramine, and there does not seem to be a disease-specific action (yet). In 2020, fenfluramine, previously used for the treatment of obesity, achieved FDA (Food and Drug Administration) and EMA (European Medicines Agency) approval for the treatment of convulsions in Dravet syndrome. Fenfluramine was found to be highly efficacious in two randomized, placebo-controlled phase III studies (one without stiripentol, one with stiripentol). It was generally well tolerated with a mild decrease in appetite as the most common side effect. To date, no cardiovascular side effects have been seen. Although not yet fully elucidated, the anticonvulsive mechanism seems to be mainly serotonergic. Preclinical studies indicate a disease-specific action and possible modification of the disease in Dravet syndrome. The latter would support the use of fenfluramine over and above its anticonvulsive effect and needs to be further elaborated. Clinical trials with other serotonergic products (clemizole and lorcaserin) have started. Current therapies unfortunately do not address the underlying genetic cause of Dravet syndrome and therefore do not have a major impact on patient cognition and other comorbidities. Therapies focusing on amplification of the Nav1.1 channel, based on the TANGO (targeted augmentation of nuclear gene output) technology (antisense oligonucleotides), will start soon (phase I and II studies). This technology seems promising and will probably be the start of an exciting period in the management of patients with a Dravet syndrome.

Gastric Bezoar: Retrieve it, Leave it, or Disbelieve it?

To determine the demographics, potential risk factors, endoscopic interventions and outcomes relating to gastric bezoars in pediatric patients; and comparing results with previously published literature. Retrospective series by chart review of patients identified by International Classification of Diseases-9 codes 938 and 935, using the following Medical Subject Headings: 1, term bezoar; 2, Keywords gastric bezoar∗ or gastric foreign body∗. Thirty pediatric patients between ages of 2 to 18 years were found with gastric bezoars, with a female predominance. Majority had a phytobezoar. Six patients were diagnosed with dysautonomia, implying possible role of autonomic dysfunction contributing to abnormal gastric retention. Frequent symptoms included abdominal pain, nausea and vomiting, a decrease in appetite, and unintentional weight loss. A higher prevalence of underlying gastrointestinal disorders was found in those with bezoars. Nuclear medicine gastric emptying scan performed in 13 children was significantly abnormal in only 4 of these children. Most patients were treated with endoscopic removal of the bezoar. Endoscopic removal was accomplished by Roth net, generally requiring multiple passes. At follow-up, most of the children had improvement of symptoms, with bezoar recurrence in 1 patient. This is to our knowledge the largest series of gastric bezoars in pediatrics. On the basis of our review, phytobezoars may be under-reported in pediatrics. Bezoars should be considered in children presenting with chronic abdominal pain, nausea, and vomiting; even in developmentally normal children and those with normal gastric emptying. We suggest that dysautonomia and underlying gastrointestinal disorders may be potential risk factors.

The effect of acute consumption of resistant starch on appetite in healthy adults; a systematic review and meta-analysis of the controlled clinical trials.

Although several clinical trials have assessed the effect of Resistant Starch (RS) supplementation on appetite, the results have been inconsistent. Therefore, this study aimed to assess the effect of RS on the healthy adults' rating of appetite. To this end, Pubmed, CENTRAL, Web of science, Scopus, Medline, and Proquest were systematically searched to find the relevant randomized, and placebo-controlled human trials up to June 2019. As a result, the area under curve (AUC) and standard deviations of the participants' rating appetite were extracted from four eligible studies. Meta-analysis showed a lower appetite in RS group compared to the controls (weighted mean difference [WMD]=-1.375mmmin, 95% confidence interval [95%CI]:-1.673,-1.076). Since high heterogeneity was observed among the included studies (I2=94.5%, P<0.001), subgroup analysis was carried out by RS dose, RS type, duration of supplementation, and time of AUC measuring. In studies that used RS dose of ≥25 gr, heterogeneity disappeared (P=0.560, I2=0%). In such studies, a significant reduction was observed in rating of appetite (WMD=-4.513mmmin, 95%CI:-5.270,-3.755; P<0.001) than studies with RS dose of <25 gr (WMD=-0.799mmmin, 95%CI:-1.123,-0.474; P<0.001). Additionally, subgroup analysis based on the type of RS showed a significant decrease of appetite in studies that used RS2 (WMD=-4.808mmmin, 95%CI:-5.834,-3.782; P<0.001) than RS1 (WMD=-0.128mmmin, 95%CI:-0.457, 0.202; P=0.448). To decrease the rate of appetite more effectively, we suggest other researchers to identify RS dose and type.