Difficulty In Ingestion Research Articles

Effect of using Chamomilla Recutita on Management of Radiation Induced Stomatitis in Cancer Patients

Background: Oral Stomatitis is a common inflammatory complication amongst cancer patients enduring radiation therapy. Stomatitis may consequence in discomfort pain and, difficulty in ingestion which may lead to nutritional deficiency. It is a serious side effect, which can consequence in a secondary infection (fungal, viral, or bacterial); it can lead to an interruption in treatment schedule and sometimes even patient drawing from treatment. So, it is important to use chamomilla recutita as preventative measures, and appropriate management measures when stomatitis does occur. This study aimed to determine the effect of using Chamomilla Recutita on the management of radiation-induced stomatitis in cancer patients. Design: A randomized controlled trial research design was utilized. Subjects: 60 adult patients were randomly selected and distributed into two groups equally (Study groups) who received routine care and mouthwash with a liquid extracted from Chamomilla Recutita at 1% and (Control group) who received routine hospital care only. A daily evaluation was done using the measurement scales of oral toxicities defined by the World Health Organization (WHO). Results: A significant difference was found in oral assessments’ scores between the two groups. analysis and comparison of data mean a statistically significant difference between both studied groups as regards the decrease of pain level in the Chamomilla Recutita group faster and better than the other group. There was a statistically significant difference in the change in weight between both studied groups, and that meant that body weight improved much more in the Chamomilla Recutita group than it was in the other one. Recommendation: It is important to enhance the awareness level among the public, patients, and also the health care providers regarding the importance of performing oral hygiene using Chamomilla Recutita especially during receiving radiotherapy. Regular educational programs to continuously update the nurses knowledge with the advanced and effective practice of oral hygiene, early detection of stomatitis, and proper treatment to avoid or decrease oral infection as well as enforcing adequate nutrition rich in proteins, that promote healing and minimize infection.

True Infection by Capillaria hepatica in a Dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepatic disease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of the present report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic. Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds and other wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectal temperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins and a sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patient was treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement. Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed a macrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia. In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP, suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that tested negative. In the ultrasonographic exam it was noticed that the liver had the same alterations and the presence of free fluid in the abdominal cavity. Due to the deterioration of the clinical picture a blood transfusion was necessary, however the patient worsened and presented respiratory difficulty for a bilateral pleural effusion. Then, the fluid was drained and a treatment with S-adenosil metionin, silymarin, ursodesoxicolic acid, doxycycline and prednisolone was started. After 17 days, a hepatic biopsy was performed, but the patient died at the surgery desk. Samples from the liver were collected for histopathologic exam. The diagnosis was confirmed in hepatic capillariosis and periportal chronic hepatitis, with the visualization of numerous parasites structures with bioperculated barrel shape. Discussion: Due to the nonspecific clinical alterations observed in the patient and the low prevalence of C. hepatica in domestic animals, there was a difficulty in the diagnosis which lead to a symptomatic, nonspecific and inefficient treatment that culminate with the death of the patient. The histopathologic exam of the liver is the best manner to find the correct diagnosis of C. hepatica infection, once the parasites eggs remains in the liver parenchyma wrapped by fibrosis and aren´t eliminate in the feces. The eggs elimination in the environment just occur after the death of the animal. Although there didn't exist a consensus about hepatic capillariosis treatment yet, if the diagnosis were done earlier, a specific treatment with better chances of a good result could be performed. We concluded that hepatic capillariosis should be included in differential diagnosis for patients with hepatic syndrome, mainly if the animal had a hunting habit and if it had access to surroundings with high rats’ infestation.

A multinational review: Oesophageal cancer in low to middle-income countries.

Oesophageal cancer (OC) is an aggressive neoplasm that manifests in the gastrointestinal tract and is the result of numerous factors that can contribute to the development of the disease. These may include old age, nutritional deficiencies, oesophageal obstruction and food ingestion difficulties. Environmental factors serve a large role in increasing the risk of developing OC. Two factors that serve an increasing risk of developing OC are the use of tobacco and the consumption of alcohol. Genetic factors also exhibit a large effect on the risk of developing OC, for example, the causative genes in Black Africans differ from other races. OC is 3–4 times more common among men than women. OC has been previously reported in >450 000 individuals worldwide, and its incidence is increasing. The current review compares OC in low to middle-income countries with developed countries. The incidence of OC, particularly squamous cell carcinoma (SCC) is high in low and middle-income countries. In developed countries, the incidence of SCC is low compared with adenocarcinoma. The majority of OC cases are diagnosed in the late stages of the disease, leading to high mortality rates. The current review aimed to discuss factors that contribute to the development of this disease in different geographical areas and genetic mechanisms governing these findings. The current review also aims to discuss the preventative treatment options for the disease, and also discusses the diagnosis and surveillance in five LMICs, including South Africa, China, Tanzania, India and Brazil.

Feeding Intolerance in Preterm Neonates in Neonatal Intensive Care Unit, Padma General hospital, Dhaka

Background : Premature infants frequently suffer from feeding intolerance and is highly associated to morbidity and mortality. It is a great challenge which have to face all the neonatologist. Feeding intolerance can be defined by difficulty in ingestion or digestion of the milk that causes a disruption in the enteral feeding plan due to the manifestation of some clinical symptoms. These symptoms include gastric residuals, emesis, abdominal distention, visible bowel loops, and change in the character of stool etc.Objective : To determine the frequency of feeding intolerance in hospitalized preterm neonates.Methods : This prospective study was carried out on preterm neonates admitted at neonatal intensive care unit of Padma General Hospital from 1st January 2016 to 31st December 2016. Inclusion criteria included Preterm infants of both genders from day 0 to day 28 of life and with gestational age (GA) of 28 to 36 weeks (estimated by 1st day of maternal last menstrual period). Diagnosis of feeding intolerance depends on presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm.Results : The incidence of feeding intolerance in hospitalized preterm was 4.2%Conclusion : The percentage of feeding intolerance in our study is 4.2% of the preterm neonate.Northern International Medical College Journal Vol.8(1) July 2016: 178-180

Incidence of feeding intolerance in preterm neonates in neonatal intensive care units, Port Said, Egypt

Introduction: The feeding of preterm neonates is one of the main challenges facing the neonatologist. Feeding intolerance can be defined by difficulty in ingestion or digestion of the milk that causes a disruption in the enteral feeding plan due to the manifestation of clinical symptoms. These symptoms include gastric residuals, emesis, abdominal distention, visible bowel loops, and change in the character of stool. Aim: To determine the incidence of feeding intolerance in preterm neonates. Methods: Study was carried out on 998 preterm neonates admitted at neonatal intensive care units of Port-Said in the period from 1st August 2014 till the 1st of March 2015. Inclusion criteria included Preterm infants of both genders from day 0 to day 28 of life and with gestational age from 28 to below 37 weeks (confirmed by maternal last menstrual period). Diagnosis of feeding intolerance depended on presence of one or more signs that leading to interruption of the enteral feeding regime of the preterm as; increased gastric residuals of the previous feeding, emesis, abdominal distention, bloody stool, diarrhea and visible bowel loops. Results: The incidence of feeding intolerance in preterm was 2.6%. Conclusion: The percentage of feeding intolerance in Port-Said, Egypt is 2.6% of the preterm neonate.

Minimal eating observation form: reliability and validity.

Eating difficulties are common for patients in hospitals (82% have one or more). Eating difficulties predict undernourishment, need for assistance when eating, length of hospital stay and level of care after hospital stay. Eating difficulties have through factor analysis (FA) been found to belong to three dimensions (ingestion, deglutition and energy). The present study investigates inter-observer reliability. Other questions at issue are if the findings from the previous FA can be confirmed, if adjustments need to be done and if the Minimal Eating Form (MEOF) can serve as an assessment model for identification of eating difficulties. Previously found associations between eating difficulties and outcomes as well as measures taken to improve oral intake were also investigated. Inter-observer study and cross-sectional observational study. Hospitals and special accommodations (SAs). Inter-observer study: Observers made standardized assessments of eating, independently and at the same time, on a sample of 50 patients with stroke. Survey study: 2600 (88%) out of 2945 persons agreed to participate in a survey of eating and nutrition. All SAs within six municipalities and six hospitals were involved. Nursing students, clinical tutors and staff performed the assessments, supported by the researchers. The average agreement between observers of eating difficulties was 89% (Kappa coefficient 0.70). In the survey study, the mean age of persons (n=1726) living in SAs was 85 years (SD 8) and 69% were women, while the corresponding figures for patients (n=874) in hospitals were 69 years (SD 18) and 53% women. Low Body Mass Index (BMI) was found in 27%, unintentional weight loss in 23% and need of eating assistance in 38% of the persons. Protein- and energy- (PE-) enriched food was given to 4%, adapted consistency of food to 23% and food supplements to 16% of the persons. The new FA confirmed the previous one and minor adjustments of the model were made. Having ingestion difficulties was the strongest predictor of need for eating assistance (OR 14.5). Deglutition difficulties strongly predicted serving of adapted consistency of food (OR 7.3). Poor energy levels and reduced appetite predicted weight loss (OR 6.0), BMI below limits (OR 2.5), supplements (OR 5.3) and PE-enriched food (OR 3.4). The MEOF has satisfying validity and reliability. The earlier model of eating difficulties was confirmed (MEOF-I), and the model was slightly adjusted to a new model, MEOF-II. Providing eating assistance seems effective in preventing malnutrition (weight loss and BMI below limits), and is mainly provided to persons with ingestion difficulties. Difficulties with energy intake and appetite are not associated with eating assistance; indicating that those persons might need support of some other kind. This support can include providing PE-enriched food and supplements, but seems however insufficiently or inadequately delivered, as low energy and appetite problems are also associated with both weight loss and low BMI. Findings from other studies are confirmed.

Eating difficulties, assisted eating and nutritional status in elderly (⩾65 years) patients in hospital rehabilitation

This study describes frequencies and associations between eating difficulties, assisted eating and nutritional status in 520 elderly patients in hospital rehabilitation. Eating difficulties were observed during a meal and nutritional status was assessed with Subjective Global Assessment form. Eighty-two percent of patients had one or more eating difficulties, 36% had assisted eating and 46% malnutrition. Three components of eating were focused upon ingestion, deglutition, and energy (eating and intake). Deglutition and ingestion difficulties and low energy were associated with assisted eating, and low energy associated with malnutrition. Underestimation of low energy puts patients at risk of having or developing malnutrition.

Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation

Purpose : To describe and compare eating difficulties from admission to discharge, with regard to length of stay (LOS) and discharge to institutional care, as well as in relation to gender. Method : Patients, aged 65 or above, admitted for stroke rehabilitation, having at least one eating difficulty were observed ( n =108) as regards to eating on admission and at discharge. Analysis followed earlier findings in which eating difficulties had been found to have three components, i.e. ingestion, deglutition and energy. Results : Of the components, ingestion difficulties were the most common, followed by low energy. The most common single difficulties were low food consumption, difficulties in manipulating food on the plate and transporting it to the mouth. Ingestion difficulties especially decreased during the rehabilitation period. Women were older and ate less on admission and at discharge than men, improved less than men, and also a higher proportion had a low food intake at the time of discharge if having longer LOS and/or being discharged to institutional care. Patients with longer LOS and those discharged to institutional care had more eating difficulties on admission and were more dependent in activities of daily living (ADL) than those with shorter LOS and those who returned home. LOS was mainly explained by ingestion difficulties on admission and low age. Discharge to institutional care was explained by living alone before admission, ingestion difficulties at discharge, male gender and high age. Conclusions : Ingestion difficulties on admission indicate a longer in-hospital stay and decrease to a greater extent than other types of eating difficulties. If these difficulties persist at the time of discharge the patients are more likely to need institutional care. It is important to assess and take systematic measures for each of the three variants of eating difficulties, i.e. ingestion, deglutition, and energy, to improve eating abilities. Women in particular need attention with regard to low food intake.

頭頚部末期癌に対する緩和医療

In this study we clinically reviewed the hospice in-patient records of 55 patients with terminal head and neck cancer. We focused on the dying process and strategies used for pain control, because the prediction of various events occurring during the dying process is crucial for the acceptance of death in patients and their families and relief from cancer pain is a central issue in the palliation of terminal head and neck cancer patients. The findings in this study indicated that the clinical course of 70% of patients with terminal head and neck cancer deteriorated gradually, but that death due to sudden change occurred in 30%, mainly due to hemorrhage. The mean duration of cancer pain was 14 weeks, and in the last 3 weeks patients had difficulty in ingestion. Pain management required administration of strong opioids by continuous subcutaneous infusion. Based on these findings, we suggest that it is important to pay particular attention to the high risk of sudden death and to pain management in terminal head and neck cancer patients.