Low Appetite Research Articles

Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication

HIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements.

Understanding Cardiac Cachexia among Patients with Heart Failure Using a Mixed-Methods Sequential Explanatory Design

In heart failure, cardiac cachexia often presents in people as weight loss accompanied by muscle wastage, loss of appetite and reduced quality of life. Such people often have a poor prognosis. However, the impact of these symptoms on Thai patients’ quality of life is unknown. Therefore, this study aimed to explore cardiac cachexia, its symptoms, and its effect on quality of life using a mixed-method sequential explanatory design. Data for this study were collected from a specific cardiac failure clinic in a large hospital in Bangkok, Thailand, from August 2022 to January 2023. Forty-two patients with heart failure were screened for cardiac cachexia using cachexia consensus criteria and bioelectrical impedance vector analysis. They also completed the Simplified Nutritional Appetite Questionnaire, the Thirst Distress Scale for Heart Failure and the Kansas City Cardiomyopathy Questionnaire to assess appetite, thirst, and quality of life, respectively. Thirty-eight participants were included for statistical analysis and divided into two groups: those with confirmed or suspected cardiac cachexia (n = 7) and those without (n = 31). The former group reported low appetite scores; however, no significant differences were observed between the two groups’ appetite, thirst, or quality of life. After identifying patients with cardiac cachexia, six semi-structured interviews were conducted using an interview guide and analyzed through thematic analysis. The interviews revealed two common themes: Changes in diet and thirst and a Reduction in physical activity levels. Both themes complement the quantitative results. This study initiates a significant step in the understanding of cardiac cachexia in the Thai population with heart failure. Nurses can play a crucial role in identifying and managing patients with or at risk of cardiac cachexia.

Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish adolescents

BackgroundThis study evaluates the psychometric properties of the Turkish version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a population of Turkish adolescents.MethodThe NIAS, designed to screen for ARFID symptoms, including picky eating, fear-related eating behaviors, and low appetite, was administered to secondary school students between 13 and 18 ages in Muğla, Turkiye.ResultsBased on a sample of 268 adolescents, the NIAS’s reliability and validity in this demographic are supported. The research utilized confirmatory factor analysis to verify its three-factor structure and various reliability tests, including Cronbach’s alpha and test-retest reliability, confirming the scale’s internal consistency and temporal stability. The descriptive analysis highlighted significant differences in NIAS scores across BMI categories, with underweight adolescents scoring higher, suggesting a potential link between ARFID symptoms and lower body weight. Criterion validity was supported by significant correlations between NIAS subscales and measures of anxiety, depression, and eating behaviors, indicating the scale’s effectiveness in reflecting relevant psychopathological features.ConclusionOverall, the study establishes the Turkish NIAS as a useful tool for identifying ARFID in Turkish adolescents, aiding early detection and intervention in this at-risk age group. Further research is recommended to explore the scale’s utility across different clinical settings and refine its diagnostic accuracy, enhancing our understanding of ARFID’s impact on youth mental health and nutritional status.

Prevalence and associated factors of depression among women with advanced pelvic organ prolapse in Northwest Ethiopia: cross-sectional study

BackgroundDepression is a symptom characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. One of the most common mental illnesses in the world and a major contributor to morbidity and mortality is depression. The purpose of this study was to ascertain the prevalence of depression and the risk factors associated with it in women who had advanced pelvic organ prolapse.MethodsA facility-based cross-sectional study was conducted to determine depression among advanced pelvic organ prolapse women at Gondar University Comprehensive Specialized Hospital. All women who have advanced pelvic organ prolapse were consecutively included till it reached a total of 367 participants over four months. A structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics and depression status of the participants. Depression measures were obtained by using the Patient Health Questionnaire tool, which is validated in the Ethiopian local language for chronic illnesses including pelvic organ prolapse using a cut point of five and above, which is considered to indicate depression. Women who screened positive were linked to a psychiatric clinic for further evaluation and treatment. Data was entered into a computer using Epi Info version 3.5.3 and then exported to STATA version 14 for analysis. Multivariable logistic regressions were fitted and odds ratios with 95% confidence intervals with a P value less than 0.05 were used to identify statistically significant factors.ResultsThe prevalence of depression was found to be 47.1% (95% CI: 43-52%). Being rural (AOR = 4.8; CI: 1.11–16.32), having a history of divorce because of pelvic organ prolapse (AOR = 5.5; CI: 1.85–16.32) and having a history of urinary symptoms (AOR = 3.1; CI: 1.12–8.59) were found to be independently associated with depression.ConclusionsThe prevalence of depression among women with advanced pelvic organ prolapse in this study is high as compared to other studies. Depression screening strategies should be designed for the early identification and treatment of depression among women with advanced pelvic organ prolapse.

Modi’s low appetite for improving relations with Pakistan

With the inauguration of new governments in both India and Pakistan, there was some hope that the bilateral peace process, on hold since 2013, would resume, but recent events related to the Indian union territory of Jammu and Kashmir and counter-terrorism operations indicate this is unlikely.

#2182 An unexpected life-threatening cause of kidney failure

Abstract Background and Aims Kidney failure can appear in acute clinical conditions and the cause cannot always be determined, as in approximately 40% of cases that require renal replacement therapy (RRT). In addition, there are other cases in which a patient with persistently low estimated glomerular filtration rate (eGFR) for 3 months is treated with RRT without a primary renal diagnosis. Systemic sclerosis (SSc) is a rare condition that can lead to RRT due to renal ”crisis”. Autopsy studies reveal kidney pathology in approximately 60 percent of patients with SSc. In addition, as many as 50 percent of patients with SSc have markers of kidney disease, as manifested by mild proteinuria, elevated serum creatinine concentration, and/or hypertension. The aim of our paper is to describe a case in which hemodialysis was initiated in emergency setting and the diagnosis was established after that. However clinical course was fatal and the final diagnosis was SSc. Method A 65-year-old male patient was admitted to the Nephrology department with a weight loss of 20 kg in 2 years, depression, low appetite and progressive decline of physical strength. He was previously diagnosed with diabetes mellitus (DM) and high blood pressure (HBP), the ponderal loss being attributed to DM. Insulin treatment was initiated together with antihypertensive medication. In the following 3 months, the kidney function deteriorated progressively and hemodialysis was started. Gray scale and CEUS US were performed to assess a possible cause of kidney failure. However, after the commencement of hemodialysis, the clinical condition did not improve and patient died in respiratory failure complicated by continuous pleural effusion. A skin biopsy from the right thigh was performed for the positive diagnosis. Results At clinical evaluation the patient was cachectic, with striking generalized parchment-like skin lesions which were suggestive both for ichthyosis or SSc. Laboratory tests revealed hyperglycemia, anemia, hypoalbuminemia, increased lactate dehydrogenase and creatine kinase (CK), mild proteinuria and glomerular hematuria. On the other side, myositis antibodies (AB) panel, antinuclear AB, tumor markers for pancreas and gastro-intestinal carcinoma, AB for vasculitis and lupus were negative. Ultrasound (US) (grey scale and CEUS) described dilated bile ducts and gallbladder with massive sludge, without evidence of tumoral neovascularization, and shrunk kidneys with hypoechoic medulla. CT scan confirmed the US findings. Dialysis parameters indicated kt/V 1.4 and urea reduction ratio of 79%. Therefore, no metabolic disturbances could explain the severely altered medical status. The clinical condition of the patient made the kidney biopsy unfeasible. Nevertheless, we decided to perform a skin biopsy, which revealed gross collagen bands, absence of sebaceous glands or hair follicles, as well as rare capillaries with lymphocyte inflammatory infiltrate and absence of hypoderma, thus confirming the diagnosis of SSc. Conclusion SSc can present with obscure clinical signs, leading to multiple organ dysfunction and initially unapparent cause of kidney failure. However, clinicians must be aware of potentially suggestive etiological signs such as parchment-like skin lesions and high blood pressure in a patient with multiple comorbidities. One must differentiate a dehydrated skin from a pathognomonic skin lesion as it is in SSc.

#2900 Appetite changes as a predictor of mortality among end-stage renal disease patients (ESRD) on maintenance hemodialysis: one year survival analysis

Abstract Background and Aims End-stage renal disease (ESRD) has become a major health problem worldwide. Appetite loss is a dominant feature of the disease which plays an important role in protein energy wasting and malnutrition, with subsequent higher rates of mortality. The study aimed to examine appetite changes among patients with ESRD on maintenance hemodialysis and its association with one-year mortality. Method This is a prospective observational study that was conducted at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University and Aga Hospital Dialysis Unit over a period of one-year Patients who fulfilled inclusion and exclusion criteria were included. The study was explained to all participants and informed consent was obtained. All demographic, clinical, and laboratory data were collected. Appetite was assessed using the following 4 scores: subjective assessment of appetite, the self-assessment of appetite changes for 30 days, The Visual Analog Scale (VAS), and The Functional Assessment of Anorexia/Cachexia Therapy (FAACT). All patients were followed up for one year to report the mortality events. Results The current study included 162 hemodialysis patients whose age (SD) was 48.72±12.64 years, and males constituted 57.4% of them. Around 44.4% of the cases reported having good appetite using the subjective assessment score, and 13% reported decreased appetite using the self-assessment of appetite score. The median VAS score was 80, and the FAACT score ranged from 7 to 32 with a mean value of 15.85. After one year of observation, death occurred in 24/162 (14.8%). There were statistically significant differences in mean values of three appetite scores among both dead and alive groups with lower values reported in the deceased one [self-assessment of appetite (p=0.019), VAS score (p=0.001), and FACCT (p=<0.001)]. The ROC analysis shows that FACCT & VAS scores were able to determine patients who destinated to mortality with area under curve (AUC) of (0.774 &0.704), at a cut-off point of (14.5%, and 75), with sensitivity of (83.3% &and 66.7%) and specificity of (61.6%, and 53.6%), respectively. Kaplan Meier survival analysis demonstrated that VAS & FACCT scores had a statistically significant effect on median survival time among studied cases. Lower median survival time was detected among cases with decreased appetite by self-assessment tool, VAS score less than 80, and FACCT score less than 15. Kaplan-Meier and hazard curves for the included sample showed lower Median survival time (95% CI) among patients with diminished appetite by the 4 scores: 311.67(265.98-357.36) by self-assessment score (p=0.008), 344.28 (329.57-358.9) days by subjective assessment of appetite (p=0.28), 342.33(330.46-354.19) days by VAS score (p=0.016), and 332.01(314.6-349.43) days by FAACT score (p<0.0001). Cox regression analysis demonstrated that VAS and FACCT scores were statistically significant predictors of median survival time among studied cases (p<0.001, <0.001) and hazard ratio (HR) of (0.968 & 0.734), respectively. Conclusion Diminished appetite is prevalent among hemodialysis patients. Poor appetite is associated with higher mortality. Lower appetite score values can predict mortality among such patients.

Augmented gut hormone response to feeding in older adults exhibiting low appetite.

Age-related changes in gut hormones may play a role in anorexia of ageing. The aim of this study was to determine concentrations of ghrelin, PYY, and GLP-1 in older adults exhibiting an anorexia of ageing phenotype. Thirteen older adults with healthy appetite (OA-HA; 8f, 75 ± 7 years, 26.0 ± 3.2 kg m−2), fifteen older adults with low appetite (OA-LA; 10f, 72 ± 7 years, 23.6 ± 3.1 kg m−2), and twelve young adults (YA; 6f, 22 ± 2 years, 24.4 ± 2.0 kg m−2) completed the study. Healthy appetite and low appetite were determined based on BMI, habitual energy intake, self-reported appetite, and laboratory-assessed ad libitum lunch intake. Participants provided a fasted measure of subjective appetite and blood sample (0 min) before consuming a standardised breakfast (450 kcal). Appetite was measured and blood samples were drawn throughout a 240-min rest period. At 240 min, an ad libitum lunch meal was consumed. Relative intake at lunch (expressed as percentage of estimated total energy requirement) was lower for OA-LA (19.8 ± 7.7%) than YA (41.5 ± 9.2%, p < 0.001) and OA-HA (37.3 ± 10.0%, p < 0.001). Ghrelin suppression was greater for OA-LA (net AUC, −78719 ± 74788 pg mL−1·240min−1) than both YA (−23899 ± 27733 pg mL−1·240min−1, p = 0.016) and OA-HA (−21144 ± 31161 pg mL−1·240min−1, p = 0.009). There were trends for higher GLP-1 concentrations in OA-LA compared with YA at 90 min (8.85 ± 10.4 pM vs. 1.88 ± 4.63 pM, p = 0.073) and 180 min (5.00 ± 4.71 pM vs. 1.07 ± 2.83 pM, p = 0.065). There was a trend for a greater PYY response for OA-LA compared with OA-HA (net AUC p = 0.062). “Anorexigenic response score” – a composite score of gut hormone responses to feeding – showed greater anorexigenic response in OA-LA, compared with YA and OA-HA. No differences were seen in subjective appetite. These observations suggest augmented anorexigenic responses of gut hormones to feeding may be causal mechanisms of anorexia of ageing.

Assessing the Body Composition of "Picky Eaters" Using Body Impedance Analysis: An Experience From a Tertiary Care Center.

Picky eating might be associated with a higher risk of being underweight and poor growth. This study aimed to investigate if picky eaters aged between three and 12 yearsshowed differences in height, weight, and body composition compared to their non-picky peers using a body impedance analysis (BIA). This cross-sectional study was conducted between March 1, 2022, and July 31, 2022, on children aged three to 12 years who presented to the outpatient pediatric clinics at Al Habib Ar Rayyan in Riyadh, Saudi Arabia. Body composition was measured using BIA after manually inserting the height, gender, and age into the machine, where body mass index (BMI), fat mass, and skeletal muscle mass were recorded. Participants were classified as under/normal/over for each body composition measurement. A total of 2234 children were entered into the final data analysis. Our analysis showed that 1917 (85.8%) were Saudis and 1117 (50%) were males. The mean age of participants was 6.08±2.01 years and 1151 (51.5%) were in the pre-school age. The reported prevalence of picky eaters was 1684 (75.4%), of whom, 606 (27.0%) were selective eaters, 365 (16.2%) were low appetite eaters, and 723 (32.2%) were both selective and low appetite eaters. Being underweight was significantly more common among the picky eaters 487 (28.9%) compared to those non-picky eaters 55 (10.0%) (p<0.001). Significantly, 1280 (76%) picky eaters had below-average skeletal muscle mass compared to 151non-picky eaters (27.5%) (p<0.001). The low appetite picky eater group had more under skeletal muscle mass children 277 (75.9%) compared to the selective picky eater group412 (68.0%) (p=0.009).Additionally, the low appetite group possessed lower muscle ratios (p=0.012) and were more underweight than the selective group (p<0.001). Furthermore, the low appetite group showed a higher percentage of children below the 3rd percentile in the height for age category (p=0.003) compared to the selective group. This study is the first of its kind in Saudi and globallyto evaluate body composition using BIA among children. The study showed that picky eating is more associated with underweight children and low muscular mass. Despite the normal BMI, height, and weightof a picky eater, their skeletal muscle mass might be less than average,which could be associated with an increased risk of morbidity.

High Symptom Burden Predicts Poorer Quality of Life Among Children and Adolescents Receiving Hematopoietic Stem Cell Transplantation or Chimeric Antigen Receptor T-Cell Therapy.

Children with cancer and other serious illnesses experience symptom burden during hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy, yet limited research has characterized how these symptoms interact with overall quality of life over time. The aim of this study was to examine the longitudinal relationship between symptoms and quality of life in children receiving hematopoietic stem cell transplantation or chimeric antigen receptor T-cell therapy. A multisite study design was used to collect symptom and quality of life information at pre-cell infusion and days +30, +60, and +90 from children (N = 140) receiving hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy. A longitudinal parallel process model was used to characterize the relationship between symptoms and quality of life. Children (mean age, 8.4 years) received allogeneic transplant (57.9%), autologous transplant (25.7%), or chimeric antigen receptor T-cell therapy (16.4%). Symptom prevalence was highest at baseline (>50%) for pain, fatigue, nausea, vomiting, and low appetite. Quality of life scores were worse at baseline (mean [SD], 69.5 [15.8]) and improved by 10 points by day +90. The longitudinal model indicated high symptom prevalence at baseline predicted worse quality of life at both baseline and day +90. Children felt worse early in the treatment trajectory and improved by day +90. The level of symptom burden predicted the overall quality of life at all time points. Children experiencing high symptom burden should receive frequent assessment and enhanced symptom management throughout the treatment trajectory to mitigate negative impacts on quality of life.

Efficacy of a digital lifestyle intervention on health-related QUAlity of life in non-small cell LUng CAncer survivors following inpatient rehabilitation: protocol of the QUALUCA Swiss multicentre randomised controlled trial

IntroductionNon-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting...

Understanding and addressing the unintended effects of aid localisation

ABSTRACT Aid localisation is a decades-old endeavour recently catalysed by the 2016 Grand Bargain agreement. However, localisation’s unintended effects have yet to be assessed systematically. This study typologises five unintended effects in the context of Cordaid’s partnerships within the Just Future program: competition, administration, value, civic space, and climate effects. Through literature reviews and 15 key informant interviews, it finds most frequently and impactfully that localisation risks perpetuating hierarchies, as international NGOs favour partnerships with larger local NGOs that manage to meet donor requirements at the expense of community-based organisations (competition effect). In addition, it risks disproportionately increasing local administrative burdens due to donors’ low risk appetite and mistrustful perceptions of local capacities (administration effect). Localisation furthermore risks diverging from certain values, such as gender-related and LGBTQ+ rights, which are a priority for many international NGOs (value effect). Recommendations focus on adaptive management and providing technical assistance to smaller local NGOs.

A REVIEW ARTICLE ON ‘AN AYURVEDIC REVIEW OF AGNI AND ITS IMPACT ON THE HUMAN BODY, HEALTH AND DIGESTION.

In Ayurveda it is considered that all the diseases result due to low appetite. For this reason, ‘Kaya Chikitsa’ (body treatment) is also referred to as ‘Agni Chikitsa’. Agni (fire) present in the Jathara (stomach) which digests the food is Bhagavaniswara- almighty god- himself; he receives (substances of) sweet and other tastes (for growth and maintenance of the body), he is being subtle (minute) it is not possible to perceive him. Served by Prana, Apana and Samana (the three divisions of Vata), by blowing increasing, protecting and preserving it. It stimulates other Agni to carry out their respective functions. Food nourishes body Dhatus, Ojas, strength, com-plexion etc. It all depends on the equilibrium state of Agni otherwise Rasa etc. cannot be produced or manufac-tured from undigested food. Almost all diseases arise due to sluggish functions of Agni, especially Udara Roga.

The Efficacy of Egg White Powder on Anthropometric Indices in Malnourished Children

Background: White egg powder provides essential amino acids compounds. This study aims to investigate the theory that a regular consumption of white egg powder would improve weight gain and appetite in children with malnutrition. Methods: The present experimental study was conducted among children aged 3-6 years with mild to severe malnutrition referred to Ghadir Mother and Child Hospital affiliated with Shiraz University of Medical Sciences from April to October 2017. The malnourished children received egg white protein (1 g/kg of their current body weight) for 3 weeks. Weight loss as a primary outcome and weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and BMI-for-age Z-score (BAZ) were measured as secondary outcomes, assessed at baseline and after six weeks of study. Results: Of the 23 children included, 20 finished the study. Weight increased in all children although it was not significant (P = 0.101). A lower appetite was seen at the end of the intervention, but it was not significant (P = 0.575). Malnutrition based on WHZ and BAZ decreased compared to the baseline measurement, while the changes were not significant. Regarding other markers, no statistically significant changes were found compared to the baseline measurement. Conclusion: The addition of white egg powder to complementary nutrition could not improve weight gain and appetite in malnourished children. Further research with a larger study population and longer intervention time is needed to demonstrate the clear effect of egg white on improving malnutrition in children.

THU653 Subacute Thyroiditis Following Covid19 Infection

Abstract Disclosure: E. Fanous: None. J.G. Karam: None. Background: Subacute thyroiditis is a self-limiting inflammatory condition of the thyroid gland which usually occurs as a post-viral reaction, leading to the destruction of thyroid follicular cells due to infiltration of lymphocytes. During the first outbreak of COVID-19 virus, subacute thyroiditis had been reported as a complication that may occur in patients without any previous thyroid disorder [1]. Clinical Case: A 62-year-old female patient presented with few weeks history of generalized weakness, fatigue, chills, malaise, low appetite, and unintentional weight loss of around 10lbs. She stated that she feels "internal tremors" and palpitations with heart rate increasing from baseline 60 bpm to 90bpm. She had one episode of near syncope at work prompting her presentation. She reports no change in bowel movements, no heat intolerance, no fever or night sweat, no shortness of breath, no visual changes or eyes problems. Five weeks prior to presentation, the patient was diagnosed with COVID-19 infection by PCR, with a mild disease pattern that consisted of upper respiratory symptoms lasting for few days, however she continued to feel fatigue and low appetite since then, attributing her symptoms to long-term sequelae of Coivd-19. Her past medical history is remarkable for obesity, hypercholesterolemia, and two prior Covid 19 infections: in 2020, treated with monoclonal antibodies, and early 2022. The physical exam was significant for slightly tender thyroid and heart rate of 94 bpm. Thyroid function tests were consistent with hyperthyroidism; TSH&amp;lt;0.01mIU/ml, FT4=2.55ng/dl (0.58-1.64), T4=19.6 mcg/dl (4.4-9.5), T3=1.45ng/ml (0.72-1.35), with negative TSI, TPO AB, and TG AB. ESR was 44mm/hr, RAI uptake and scan showed very low uptake which is indicative for subacute thyroiditis. The patient was given supportive therapy. She developed mild and transient hypothyroidism at 6 weeks follow-up with TSH of 8.59 IU/ml and FT4=0.62 ng/dl (0.89-1.76) before her thyroid tests return to normal at 9 weeks with complete resolution of her symptoms. Conclusion: Prolonged diverse symptoms following Covid19 infection are often attributed to long term Covid symptoms. Health Care providers should be aware of the possibility of subacute thyroiditis following Covid 19 infection and should obtain thyroid function tests in patients who present with malaise, decreased appetite, weight loss and palpitations in the weeks following Covid 19 infection. Reference:1. Mattar SAM, Koh SJQ, Rama Chandran S, Cherng BPZ. Subacute thyroiditis associated with COVID-19. BMJ Case Rep. doi: 10.1136/bcr-2020-237336 Presentation: Thursday, June 15, 2023

THU110 Wrong Tissue At Wrong Place—Rare Case Of Hypopituitarism Secondary To Metastatic Renal Cell Carcinoma

Abstract Disclosure: S. Avula: None. A. Ahmed: None. M. Salim: None. H. Alameddine: None. Introduction: Metastasis to pituitary is very rare occurrence, accounting for 1-4%. Most common primary cancer that metastasis to pituitary are Breast cancer in females and Lung cancer in males. Most of the pituitary metastasis are asymptomatic with symptomatic patient account for around 7 %. Most common symptoms reported are anterior pituitary dysfunction, visual field defects, headache, diabetes insipidus. Metastasis from Renal cell carcinoma (RCC) is very rare with only 25 cases reported so far. Metastases to the pituitary from RCC cause more severe hypopituitarism and visual dysfunction in comparison to those from other primaries. We present a rare case of hypopituitarism due to metastatic RCC presenting after Clinical Case: A 59-year-old male who initially presented in 2010 with complains of abdominal pain, underwent abdominal imaging and was found to have 7 cm solid mass in the right kidney. He underwent right nephrectomy in France and pathology confirmed RCC with no lymph node involvement. Patient didn’t have any adjuvant therapy. He had 5 years of follow up surveillance scans in Palestine which didn’t show any recurrence. In 2021 patient started to notice vision changes with loss of peripheral vision loss on right side but he didn’t seek any medical attention. In 9/2022 he noticed to have excessive fatigue, low libido, low appetite, excessive thirst and worsening of his vision. He had hormonal evaluation done in Palestine which showed low testosterone, cortisol, thyroid levels and was diagnosed with panhypopituitarism and was started on Hydrocortisone, Levothyroxine, Testosterone and Desmopressin. In 9/2022 had MRI brain in Palestine and showed 2cms suprasellar enhancing mass arising in the suprasellar cistern and appears inseparable from the pituitary stalk infundibulum. In 11/2022 he came to USA for further evaluation and management. In November 2022 patient complained of hallucinations, memory loss, personality changes and bitemporal vision loss. MRI brain showed sellar and suprasellar mass, 2.1 x 2.3 x 3.8 cm, extending to the suprasellar cistern and elevates the optic chiasm with possible third ventricle involvement and had increased in size compared to previous scan. On 11/29/22 patient underwent Endoscopic Endonasal Transplanum, Transtuberculum approach for tumor removal, biopsy of sellar and suprasellar tumor which returned as metastatic RCC. Patient was discussed in tumor board and is scheduled for gamma knife. Conclusion: Metastatic RCC to pituitary is very rare and most of them are asymptomatic leading to delay in diagnosis. Treatment of pituitary metastases is not standardized and should be tailored to patients’ clinical conditions, histology, and presence of extra-pituitary metastases. We need more prospective studies to formulate guidelines for management of pituitary metastases. Presentation: Thursday, June 15, 2023

Network Analysis of Health-related Behaviors, Insomnia, and Depression Among Urban Left-behind Adolescents in China.

Mental health of urban left-behind adolescents (LBA) is a public issue of growing concern. This study aims to examine the symptom level associations among multiple health-related behaviors, insomnia, and depression in urban LBA. Data on a sample of urban LBA aged 11-19 (N = 3,601) from the Adolescent Mental Health Survey in Shenzhen, China, were used. Health-related behaviors (i.e., Internet use, physical inactivity, social jetlag, smoking, and alcohol consumption), insomnia, and depressive symptoms were assessed using a self-administered questionnaire. Graphical Gaussian Model (GGM) was used to describe key bridging nodes in an undirected network. Directed Acyclic Graph (DAG) was used to construct a directed network and estimate the most likely causal associations among behaviors/symptoms. In the undirected network, Internet use was identified as the key bridging node most strongly associated with insomnia and depression. Two other key bridging nodes include difficulty initiating sleep and appetite change. In the directed network, anhedonia emerged as the most pivotal symptom, which could cause insomnia symptoms and behavioral changes, either directly, or through triggering other depressive symptoms, such as low energy and appetite change. These findings have implications for understanding the occurrence and maintenance process of health-related behaviors, insomnia, and depression in urban LBA. In practice, Internet use should be considered a priority in targeting multiple health behavior interventions. Meanwhile, early screening and treatment for anhedonia are of great significance as well.

Post-exercise dietary macronutrient composition modulates components of energy balance in young, physically active adults

The effectiveness of exercise to reduce body mass is typically modest, partially due to energy compensation responses which may be linked to energy substrate availability around exercise. The present study aimed to investigate the effect of manipulating post-exercise energy substrate availability (high carbohydrate/low fat [HCLF] or low carbohydrate/high fat [LCHF] energy replacement) on energy balance components in the short-term (i.e., appetite, energy intake (EI) and energy expenditure (EE)). MethodsAppetite, EI, activity- and total- EE were measured in twelve healthy, young (21.0 ± 2.3 years) physically active participants (10 men, 2 women) on two occasions across 4 days after a 75-min run and an isocaloric energy replacement drink (HCLF and LCHF). Appetite was measured daily by visual analogue scales, EI was calculated by subtracting the energy content of food leftovers from a provided food package, activity- and total- EE determined by heart-rate accelerometery. ResultsComposite appetite ratings between days were lower in HCLF (62.4 ± 12) compared to LCHF (68.3 ± 8.9 mm; p = 0.048). No differences between conditions were detected for EI. Cumulative activity-EE (HCLF= 20.9 ± 3.7, LCHF= 16.9 ± 3.1 MJ; p = 0.037), but not total-EE (HCLF= 44.6 ± 7.7, LCHF= 39.9 ± 4.7 MJ; p = 0.060), was higher for the HCLF condition than the LCHF across the measurement period. ConclusionCompared with low carbohydrate/high fat, immediate post-exercise energy replacement with a high carbohydrate/low fat drink resulted in higher short-term activity energy expenditure and lower appetite ratings.

THE EFFECT OF HYPNOPARENTING AS AN EFFORT TO IMPROVE THE APPETITE OF PRESCHOOL-AGED CHILDREN WITH PICKY EATER

Picky eater is a child eating problem that is often complained of by parents which causes a low appetite at mealtimes, usually occurring in preschool-aged 3-5 years. Picky eaters accompanied by a decrease in appetite if left unchecked for a long time can cause children to lack nutritional intake which results in a low nutritional status of children. Parents' efforts are needed to fix children's eating problems, which is hypnoparenting. Hypnoparenting is applied as coaching children with the principle of hypnosis through suggestions given by parents to the child's subconscious mind. To determine the effect of hypnoparenting as an effort to improve the appetite of preschoolers with picky eaters. The research design uses pre-experimental with one group pretest posttest. The research respondents were 26 children aged 3-5 years. Data collection was carried out by filling out questionnaires (Child Eating Behavior Questionnaire and picky eater questionnaires) which were analyzed using the Wilcoxon test. Obtained from the results of the Wilcoxon analysis test, the significance value of appetite was p value 0.005 ≤ 0.05 and the picky eater's significance value was p value 0.000 ≤ 0.05, then Ha was accepted and H0 was rejected which means there is an influence of hypnoparenting as an effort to improve the appetite of preschool-aged children with picky eaters. 26 preschool-aged children (100%) have poor appetites with picky eaters before hypnoparenting, and 19 preschool-aged children (73.1%) have good appetites without being picky eaters so there are an influence on the appetite of preschool-aged children before and after hypnoparenting.

Oxytocin response to food intake in avoidant/restrictive food intake disorder.

To investigate the response of anorexigenic oxytocin to food intake among adolescents and young adults with avoidant/restrictive food intake disorder (ARFID), a restrictive eating disorder characterized by lack of interest in food or eating, sensory sensitivity to food, and/or fear of aversive consequences of eating, compared with healthy controls (HC). Cross-sectional. A total of 109 participants (54 with ARFID spectrum and 55 HC) were instructed to eat a ∼400-kcal standardized mixed meal. We sampled serum oxytocin at fasting and at 30-, 60-, and 120-min postmeal. We tested the hypothesis that ARFID would show higher mean oxytocin levels across time points compared with HC using a mixed model ANOVA. We then used multivariate regression analysis to identify the impact of clinical characteristics (sex, age, and body mass index [BMI] percentile) on oxytocin levels in individuals with ARFID. Participants with ARFID exhibited greater mean oxytocin levels at all time points compared with HC, and these differences remained significant even after controlling for sex and BMI percentile (P = .004). Clinical variables (sex, age, and BMI percentile) did not show any impact on fasting and postprandial oxytocin levels among individuals with ARFID. Consistently high oxytocin levels might be involved in low appetite and sensory aversions to food, contributing to food avoidance in individuals with ARFID.