Moderate Malnutrition Research Articles

Prevalence and Risk Factors of Primary Malnutrition in Children Below 5 Years of Age

Objective: To find out the prevalence and risk factors of primary malnutrition among children below 5 years of age visiting outpatient department of a tertiary care hospital. Study Design: A cross-sectional study. Place and duration: Department of Pediatric Medicine, Ibn-e-Siena Hospital, Multan from 1st January 2022 to 30th June 2022. Methodology: A total of 151 children of either gender aged below 5 years visiting outpatient department of pediatrics. At the time of enrollment, socio-demographic as well as anthropometric characteristics were noted. Z-score were calculated to label malnutrition considering weight for height criteria according to “World Health Organization (WHO)” charts as: mild, -1.0 to -1.9, moderate, -2.0 to 2.9, and severe, ≤ -3.0. Results: In a total of 151 children, 78 (51.7%) were girls. The mean age, weight and height were 2.67±1.56 years, 10.18±3.55 kg and 82.99±16.39 cm. The mean birth weight was 2.44±0.21 kg. Exclusive breast-feeding for the first 6 months was reported in 69 (45.7%) children while cow’s mild before 1 year of age was reported by 101 (66.9%). The mean height for weight Z-score was calculated to be -1.40±2.20. Distribution of nutritional status revealed that 61 (40.4%) were normal while mild, moderate and severe malnutrition were observed among 37 (24.5%), 11 (7.3%) and 42 (27.8%) children respectively. Malnutrition status had significant association with increasing age (p<0.001), poor maternal educational status (p=0.034) and use of cow’s milk before 1 year of age (p=0.004). Practical Implications: There is a massive need to identify causes behind factors linked with primary malnutrition among children below 5 years of age so that targeted interventions could be planned. Conclusion: The prevalence of primary malnutrition was very high among children below 5 years of age. Age, poor maternal educational status and use of cow’s milk before 1 year of age had significant association with malnutrition. Keywords: Breastfeeding, maternal education, malnutrition, socio-economic status, Z-score

Serum Magnesium Level in Protein-Energy Malnourished Children

Background: Protein energy malnutrition (PEM) is mainly due to inadequate intake of food both in quantity and quality. Serum magnesium level can be detected to identify magnesium deficiency in malnourished children. Low magnesium level in these children is associated with illness and death. Objective: To determine the serum magnesium level in protein energy malnourished children who are under the age of 5 years. Study Design: Prospective Cross Sectional study. Setting: The Pediatric department, civil hospital, Karachi. Study period: From July to December 2021. Material and Methods: Total 245 patients of both genders with moderate and severe malnutrition were included. Venous samples were sent to laboratory and a centrifuge machine was used to separate the serum, which was maintained at a temperature of 20°C for serum magnesium test. Atomic Absorption Spectrophotometer was used to measure serum magnesium levels. Descriptive statistics were applied. Frequency and percentage was calculated. Stratification was done using chi square test and p-value ≤0.05 was considered as significant. Results: Total 156 male and 89 female patients were included in the study. Mean age was 26.63±15.17 months. Mean duration of malnutrition was 11.74±4.86 months. Mean mid upper arm circumference (MUAC) was 11.66±0.76 cm. Serum magnesium level was 1.78±0.22 mg/dl. Overall 180 (73.5%) have moderate PEM. Conclusion: Study showed low serum concentration of magnesium in children with PEM. Keywords: Serum Magnesium Level, Protein Energy Malnutrition, Children Under 5 Years.

Prevalence and prognostic importance of malnutrition, as assessed by four different scoring systems, in elder patients with heart failure

Background and aimsThe lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems. Methods and resultsConsecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903–1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001). ConclusionMalnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk. Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818.

Helminth Infection among Children Living in an Urban Area in Tropical Countries: A Systematic Review

Background&#x0D; &#x0D; Neglected tropical diseases (NTDs) are a group of preventable and treatable diseases, in which soil-transmitted helminth (STH) infections are among the most common infections worldwide. Most affected are the children and this review aims to identify the prevalence, risk factors and impact of STH in an urban area. &#x0D; &#x0D; Methodology&#x0D; &#x0D; This review was guiding using PRISMA review protocol incorporating the research question of “What is the prevalence, risk factors and impact of helminth infection among urban children in tropical countries?". The databases used in this review include SCOPUS, WEB OF SCIENCE, OVID MEDLINE and PUBMED. The articles used include observational and interventional studies conducted among children aged 18 years and less from 2010 to 2020. The main outcome measure was risk factors of STH infection seen in urban children includes social backgrounds, sanitation and policy.&#x0D; &#x0D; &#x0D; Results&#x0D; &#x0D; From the initial 973 articles found in the database searching, only 13 articles selected for qualitative synthesis after exclusion and screening for eligibility done. The overall prevalence of helminth infection among urban children ranges from 4.8-48.9%. The associated factor that influences helminth infection among children living in an urban area are age, male more common than female, low socioeconomic status, low parents’ education level, living in an urban slum or crowded area, low water quality and sanitation practice and poor hygiene practice. The deworming tablets consumption acts as protective factors for helminth infections. The medium haemoglobin value was significantly lower in helminth-infected children compared to uninfected children and the stunting, underweight as well as moderate acute malnutrition were attributable to helminth infections.&#x0D; &#x0D; &#x0D; Conclusion&#x0D; &#x0D; The prevalence and intensity of helminthiasis were heterogeneous among urban areas of developing countries, however, the endemicity is still high. Further efforts including healthy policies, continuous national deworming programmes and multi-sectoral partnership are required to reduce the prevalence of helminthiasis in the urban area.

Doris Howes Calloway

In the 1970s, Doris Howes Calloway turned to the need to better understand mild to moderate malnutrition. She led the Nutrition Collaborative Research Support Program (NCRSP), which was designed to look at possible effects of inadequate food intakes on outcomes such as growth, morbidity, pregnancy, and childhood intellectual development. Although it was known that a severe lack of calories and/or nutrients could result in serious morbidity and death, there was controversy about the effects of moderate malnutrition. Although growth might be stunted, it seemed possible that other health and developmental outcomes might not be affected. The NCRSP selected low-income regions of 3 countries (Egypt, Kenya, and Mexico) where there was moderate malnutrition, to evaluate causes and effects on these outcomes. The study found that child growth was compromised in all 3 sites, primarily due to childhood illnesses in Egypt and to poor diets in Kenya and Mexico. Other negative effects were also seen in lower scores on tests of cognitive abilities. The NCRSP results were further extended by new studies of undernutrition both in the original countries sites and in additional locations. Ultimately, the NCRSP led to a greater acceptance of the negative consequences of even moderate malnutrition.

Rate, risk factors and estimated time to develop attrition after under-five children started moderate acute malnutrition treatment in Gubalafto, North East Ethiopia.

Lost from follow-up, after starting moderate acute malnutrition (MAM) is an ongoing challenge of public health until the admitted children reached the standard weight of a reference child. Thus, the present study aimed to assess the rate and estimated time to attrition after under-five children started treatment for MAM in the Gubalafto district. A facility-based retrospective cohort study was employed among 487 participant children who had been managed targeted therapeutic feeding from 1 June 2018 to 1 May 2021. The overall mean (±sd) age of the participants' children was 22⋅1 (±12⋅6) months. At the end of the study period, 55 (11⋅46 %) under-five children developed attrition from the treatment after starting ready use of therapeutic feeding. After checking all assumptions, a multivariable Cox regression model was used to claim independent predictors for time to attritions. The median time of attrition after starting treatment of MAM was 13 (IQR ±9) weeks, with the overall incidence of attrition rate reported at 6⋅75 children Per Week (95 % CI 5⋅56, 9⋅6). In the final model of multivariable Cox regression, the hazard of attrition was significantly higher for children from rural residence (AHR 1⋅61; 95 % CI 1⋅18, 2⋅18; P = 0⋅001), and caregivers with their dyads did not get nutritional counselling at baseline (AHR 2⋅78; 95 % CI 1⋅34, 5⋅78; P = 0⋅001). The findings of the present study showed that nearly one in every eleven under-five children was attrition (lost to follow-up) in a median time of 13 (IQR ±9) weeks. We strongly recommended for caregivers provisions of diversification of daily nutrition supplementation of their dyads.

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis.

Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

Ischemic Stroke Complicating Neuromeningeal and Pulmonary Tuberculosis in Children: About a Case in Senegal

Tuberculosis is a major public health problem, especially in developing countries. Neuro-meningeal involvement is rare but represents one of the most severe forms with high morbidity and mortality. We report the case of an ischemic stroke complicating neuromeningeal and pulmonary tuberculosis in a four-month-old infant at the National Hospital Center of children Albert Royer (Senegal). The case was a four-month-old, male infant with no history. His vaccination was up to date according to Senegal’s expanded vaccination program. There was no notion of tuberculosis contagion. He was seen for a prolonged fever for more than a month and chronic cough. He had moderate malnutrition. Neurological examination revealed coma, meningeal syndrome, generalized tonic convulsions and hypertonia. The pupils were in bilateral miosis. Osteotendinous reflexes were abolished with a bilateral Babinski sign. He also had severe respiratory distress, bilateral pulmonary condensation syndrome. Brain computed tomography was in favor of an ischemic stroke. The test GeneXpert MTB/RIF was positive on cerebrospinal fluid and gastric tubing fluid. The curative treatment was based on a quadruple therapy based on rifampicin, isoniazid, pirazinamide and ethambutol. The evolution was unfavorable with the death of the patient.

Effectiveness of Enriched Flour in the Recovery of Children Aged 6 to 59 Months with Moderate Acute Malnutrition

Effectiveness of Enriched Flour in the Recovery of Children Aged 6 to 59 Months with Moderate Acute Malnutrition

The use of clinical and biochemical tools of nutritional status assessment in predicting the course of liver cirrhosis

Malnutrition is a common complication of liver cirrhosis (LC) and is associated with a poor prognosis. Optimal tools for monitoring the nutritional status in LC have not been determined. The aim of the work was to evaluate the diagnostic agreement and prognostic value of the Nutritional Risk Index (NRI) and the Controlling Nutritional Status (CONtrolling NUTritional status, CONUT) score in LC patients. Materials and methods. 161 LC patients (mean age 55.2 ± 11.6 years) were included. 23 patients had LC class A, 57 – class B, and 81 – CTP class C. During the follow-up period (median 489 (interquartile range 293–639) days), 50 patients died of LC complications. The nutritional status of patients was assessed according to the CONUT score and the NRI. The results. Moderate and severe malnutrition was found in 95 and 83 % of class C LC patients according to NRI and CONUT, respectively. Diagnostic agreement between NRI and CONUT was weak (k = 0.306, p ˂ 0.001). The numerical CONUT score predicted the long-term mortality of patients (AUC 0.771, p ˂ 0.001) with an optimal cut-off ≥ 7 points. NRI had a worse predictive ability (AUC 0.673, p ˂ 0.001). Conclusion. The Controlling Nutritional Status (CONUT) score is an acceptable tool for diagnosing malnutrition in LC patients and can predict the long-term mortality of patients. The Nutritional Risk Index (NRI) has low diagnostic agreement with CONUT and lower predictive value.

EFFECT OF ACUTE MALNUTRITION MANAGEMENT ON UNDER TWO YEARS CHILDREN IN BANAADIR HOSPITAL

Acute malnutrition in children can take the form of moderate acute malnutrition (MAM), which carries a three times higher risk of infection, or severe acute malnutrition (SAM), which carries the highest risk of death— nine times higher than for a healthy child. If conditions worsen and the infant is not treated, these variables typically combined to cause a quick and considerable loss of weight and, in some cases, death (Mason, 2009).than an adequately fed child. Objectives: The general objective of the study is to determine the consequences of acute malnutrition management on under two years children in Banadir Hospital, Mogadishu, Somalia. Methodology: This study was descriptive in design which means to describe the research problem rather than analyzing and detailing the problem. It was cross sectional in design, which involves looking at people who differ on one key characteristic at one specific point in time. Quantitative research focuses on numeric and unchanging data and detailed, convergent reasoning rather than divergent reasoning. This study was carried out from May 2020 to December, 2020. The total sample size was 68 participants who were available and welling to participate in this study semi-structural questionnaire. Conclusion: The researcher intended to collect primary data using questionnaire as a research instrument. Descriptive and cross sectional designs were used. This study targeted a population 82 and selected 68 respondents as sample. The shape of the questionnaire in the demographic section is looked upon in terms of Gender, Age, marital status, and level of education. Analysis of data in this study was done concurrently with data collection. The findings of the study may be used by Authorities in making priorities in terms of Acute malnutrition Among under five children.

Glycaemic and insulinaemic impact of a diabetes-specific oral nutritional supplement with Extra-Virgin Olive Oil in patients with type 2 diabetes mellitus at nutritional risk: a randomized, double-blind, crossover, multicentre clinical trial (DIACARE).

there is controversy about the usefulness of specific enteral nutrition formulas in malnourished patients with diabetes. The effects on blood glucose and other aspects of metabolic control are not fully understood in the scientific literature. the aim of the study was to compare the glycaemic and insulinaemic response of patients with type 2 diabetes at risk of malnutrition after oral feed between a diabetes-specific formula with AOVE (DSF) and a standard one (STF). A randomized, double-blind, crossover, multicentre clinical trial was conducted in patients with type 2 diabetes at risk of malnutrition (SGA). The patients were randomized to receive either DSF or STF, a week apart. A glycaemia and insulinaemia curve was made at times 0 minutes, 30 min, 60 min, 90 min, 120 min, and 180 min after the patients drank 200 ml of the oral nutritional supplement (ONS). The principal variables were the area under the curve (AUC0-t) of glucose and insulin. 29 patients (51 % women) were included, who were on average 68.84 (SD 11.37) years old. Regarding the degree of malnutrition, 86.2 % presented moderate malnutrition (B) and 13.8 % severe (C). When the patients received the DSF, they had a lower mean of glucose AUC0-t (-3,325.34 mg/min/dl [95 % CI: -4,3608.34 to -2,290.07]; p = 0.016) and also a lower mean of insulin AUC0-t (-451.14 uU/min/ml [95 % CI: -875,10 to -27.17]; p = 0.038). There were no differences in the degree of malnutrition. compared with STF, DSF with AOVE showed a better glycaemic and insulinaemic response in patients with type 2 diabetes at risk of malnutrition.

Comparative Assessment of Nutritional Status of School Children Aged 6-8 Years in Selected Urban and Rural Schools of Belagavi – A Pilot Study

Background One of the biggest health issues of poor nations is malnutrition. A school survey is beneficial because it is easy to conduct and enables to detect the presence of disease among large number of students of a particular age group.Aim To assess and compare nutritional status of school children in urban and rural schools.Methods In Belagavi district a prospective qualitative study was carried out including 60 children each from urban and rural schools aged 6 to 8 years. The nutritional status of children was determined using the anthropometric parameters such as weight for height weight for age and height for age based on Waterlowrsquos and Gomezs classifications of malnutrition.Results The study included 120 students 60 from rural area and 60 from metropolitan area. Mild wasting was found in 18 urban and 20 rural students moderate wasting was noted in eight urban and 20 rural students while severe wasting was observed in three rural students and normal weight for height was noted in 34 urban and 17 rural students. Mild stunting was observed in 17 urban and 18 rural children moderate stunting in two urban and four rural severe stunting was noted in one child from rural school. Normal height for age according to Waterlowrsquos classification was observed in 41 urban and 37 rural students. According to Gomezs classification mild malnutrition was identified in 17 urban students and 33 rural students moderate malnutrition was found in five urban and six rural students and severe malnutrition was found in one rural student. On comparison of nutritional status of urban and rural children stunting was observed in 19 urban and 23 rural children whereas wasting was identified in 26 urban and 40 rural children. Furthermore malnutrition affected both urban children 22 and rural children 43.Conclusion According to the present study children attending rural schools in Belagavi showed malnutrition more frequently compared to those attending urban schools. The present study will aid in determining the causes of malnutrition and the most effective ways to prevent it in both urban and rural settings.nbsp

Pola Asuh Ibu dan Status Gizi Balita di Kabupaten Jember

Nutritional problems in children under five years old are something that must be considered. One of the factors that affect poor nutrition is styles parenting. Parenting styles are known to have both positive and negative influences on nutritional status of children. So that, further research is needed, especially in Jember. This study aimed to identify correlation between mother’s parenting style and nutritional status among children under five years. This study used cross-sectional approach. A total of 94 mothers and children registered at Posyandu 85, 86, and 87 in Karangrejo village, Jember regency were selected purposively as sample of the study. The nutritional status was measured using weight for age. Mother’s parenting style was measured using Parental Authority Questionnaire. To identify the correlation between variables, Chi Square test was used. The majority of children with severe malnutrition and moderate malnutrition have mothers with permissive and authoritarian parenting style. In contrast, of the 54 mothers with authoritative parenting style, only 4 mothers whose children with severe or moderate malnutrition. This study showed a significant correlation between mother’s parenting style and nutritional status with p-value of 0.023. From this study, authoritative parenting style was identified to have a positive impact on the nutritional status. Therefore, to optimizing the nutritional status in children can be done through implementation of mother’s parenting style which can support the adequacy of nutritional status of children. &#x0D; Keywords : Parenting Style, Nutritional Status, Children under Five Years

Management of Severe Acute Malnutrition in Day Care Settings: Findings from Innovative Public Private Partnership at Devbhumi Dwarka District, Gujarat

Introduction: Severe Acute Malnutrition (SAM) is a major public health concern that is linked to a high mortality rate in children under the age of five. Government of Gujarat has expanded treatment network from government facilities to private institutions and non-governmental organizations through various initiative in an effort to address the issue of SAM. Objective: To assess the treatment outcome among SAM children (0-5 years) admitted at Niramay Bal Poshan Kendra, Jam Khambhalia, Devbhumi Dwarka District of Gujarat. Method: A longitudinal study was conducted among SAM children admitted at The Niramay Bal Poshan Kendra (Public Private Partnership model under Bal Poshan Yojana) which is a day care center providing treatment to SAM children for 14 days according to the protocol of NRC (Nutrition Rehabilitation Centre). Under Bal Poshan Yojana, RBSK medical officers screened children for SAM and referred them for treatment at empanelled NGO/Private institution. Total 1557 under five children were screened by them between 6th September 2021 and 5th February 2022. Out of them 121 SAM children were identified, 95 children could be mobilized at the study site (Niramay Bal Poshan Kendra). Out of 95 children, 76 SAM children completed the treatment along with all three follow up at the study site. The data of these 76 Children was analyzed. Results: Among 76 children, average weight gain was 566 grams at the time of discharge and 1000 grams at the time of third follow-up. An average weight gain for the cohort is 5.2 gram/kg/day. At the end of treatment, 92% children moved out of the SAM category at the completion of three follow-up, 55% moved to Moderate Acute Malnutrition and 37% to normal weight category. Conclusion: An average weight gain among the study population was satisfactory. Day care treatment model provides advantage of improved treatment completion rate and higher follow-up completion. Similar models of SAM treatment can help in effectively tackling menace of malnutrition in Gujarat.

Anthropometric Assessment of Patients on Maintenance Hemodialysis at a Tertiary Care Hospital in Nepal

INTRODUCTION Protein energy wasting is common in hemodialysis patients and is linked to increased morbidity and mortality. Anthropometric measurements such as skin fold thickness, mid arm circumference and mid arm muscle circumference are widely used to assess nutritional status in patients on maintenance hemodialysis. Subjective global assessment dialysis malnutrition score is used to classify patients’ nutritional status. The aim of this study was to assess the nutritional status using anthropometry. MATERIAL AND METHODS This descriptive cross-sectional study was carried out from 1st October 2021 till 30th September 2022 under Nephrology unit, Department of Internal Medicine at Universal college of Medical Sciences, Bhairahawa, Nepal. Ethical clearance was taken. Subjective Global Assessment Dialysis Malnutrition score was calculated. Triceps skin fold thickness, Mid arm circumference and Mid arm muscle circumference was measured. Convenience sampling was used. The data were analyzed using the Statisti- cal Package for the Social Science version 17. RESULTS In this study of 50 patients undergoing MHD for at least 3 months, the Mean age of population was 42.00 ±15.26 years. Nearly half of the study population 21 (42%) was having mild to moderate malnutrition using subjective global assessment dialysis malnutrition score and none had severe malnutrition. CONCLUSION There is mild to moderate malnutrition in patients on maintenance hemodialysis at our center based on anthropometric measure- ment including subjective global assessment dialysis malnutrition score tool.

Ozone therapy in clinical practice of the diabetic necrotizing foot.

The present paper is the most extensive approach of the effect of ozone therapy on the diabetic foot. Out of all the 45 cases that have been studied in the timeline 2020-2022, some of them who were incredibly severe with little hope for improvement, had a tremendous impact on me and I will try to describe them in a few words and raise your awareness about this not yet explored field that has real potential in aiding those who suffer. A female patient of 49 years old had diabetes mellitus, multiple necrotic lesions, post peritoneal dialysis with skin calcifications of both legs, chronic kidney disease, renal osteodystrophy, calciphylaxis with secondary cutaneous necrosis in remission, renal lithiasis, secondary arterial hypertension, ischemic cardiac disease, paroxistic atrial fibrillation, polycystic kidney disease, hyperuricemia, calcium metabolism alterations, hyperphosphatemia, moderate proteic malnutrition. The first ozone therapy session was done according to ozone therapy protocol for the diabetic foot, after debridement, disinfection of the wounds and disposal of the necrotizing tissue. Drainage from the wound was examined and revealed an E. coli infection. After 30 sessions, the result was spectacular. A 51-year-old patient presented to the clinic with an open wound after amputation of his left leg. A year after, he came back to the clinic with an infected wet gangrene of his right leg, who also caught the first 3 toes. His medical history included type II diabetes mellitus, end stage renal disease with a double kidney transplant until the age of 28. In both cases debridement of the wound was done, exposing healthy tissue, antibiotics were administered according to antibiogram and the entire procedure of ozone therapy was done as follows: washing the wound with oxygenated water, disinfection of the wound, local infiltrations with ozone, major autohemotherapy and ozonized bag. The result: the left leg had a rapid favorable outcome, and after only 20 ozone sessions, the wound closed. The right leg had a total of 45 ozone therapy sessions done, with a 100% improvement. After 5 months, the patient came to the clinic with a postblockage necrotizing fistula on his right second finger, which healed after 6 ozone therapy sessions. Among those 45 patients included in the study, 10 of those who had major amputations presented to the clinic for a primary intervention and only 2 of them for a reintervention. Nevertheless, most of the minor amputations were done as a primary intervention. In many cases though, to obtain the healing of the patients, reinterventions were necessary. Analyzing these data, the necessity of applying a new method of correctly assessing the severity of the lesions to avoid an undervaluation of it, which would unnecessarily prolong the hospitalization and more importantly their suffering. I have encountered 4 cases of extensive wet gangrene associated with severe sepsis. The mortality in this category of patients was 50%. Studies and research in this field have a special and decisive con tribution in treating and recognizing the effects of ozone therapy in curing the diabetic foot. Through their results, studies will allow the free circulation of information in this field, because if we don’t communicate efficiently, we will not be able to present publicly the results we obtained from the studies and research regarding ozone therapy. Free circulation of information, of innovating ideas – can and has to surpass all frontiers, to allow all specialists in this field to contribute in solving the major problem that is the diabetic foot, this ailment of mankind. The most spectacular effects of ozone therapy in the case of diabetics can only be seen in well informed patients, who come to the doctor with impressive ulcerations of the calf. The clinical specter of the diabetic foot is very large, from the simple presence of neuropathy and/or arteriopathy of the legs, without any existing characteristic lesions, to the necessity of an amputation; ozone therapy can cure without an amputation.

Exploration of phase angle used to construct PG-SGA nutritional assessment and prediction model for malignant tumor patients

Objective: To explore the value of phase angle (PA) in constructing a predictive model of nutrition evaluation for tumor patients. Methods: A retrospective analysis was performed on 1 129 patients with malignant tumors hospitalized in the Cancer Center of Changzhi People's Hospital from June 2020 to February 2021. PA values of six parts of the body were measured by the body composition analyzer, including: left arm (LA), right arm (RA), left leg (LL), right leg (RL), the trunk (TR), and the whole body (WB). Patients' body mass index (BMI) was calculated and patient-generated subjective global assessment (PG-SGA) was assessed. The differences of PA values of six parts were compared and their correlations with BMI and PG-SGA in combination with age, gender and tumor disease types were analyzed, binary classification regression on BMI and PG-SGA was performed, and the functions of the best prediction model was fitted. Decision tree, random forest, Akaike information criterion in a Stepwise Algorithm (stepAIC) and generalized likelihood ratio test were used to select appropriate variables, and the logit logistic regression model was used to fit the data. Results: Comparing the PA values of six parts in pairs, it was found that the PA values of LA and RA, LL and RL, and TR and WB were linearly correlated and the coefficient was close to 1 (P<0.001). Binary classification regression was performed for BMI and PG-SGA, respectively. In order to make the data have clinical significance, 18.5 kg/m(2) was used as the classification point for BMI, 4 and 9 were used as the classification points for PG-SGA score, and the models of A, B and C were obtained. Suitable variables including PA-LA, PA-TR and tumor disease types were used as variables to fit BMI classification; BMI, PA-LA and age were used as variables to fit the PG-SGA model with 9 as the classification point. PA-LA, PA-TR, BMI, age and tumor disease types were used as variables to fit the PG-SGA model with 4 as the classification point. In this study, the predicted values of models A, B and C obtained by R-studio were imported into SPSS 26.0 software, and the cut-off values of classification were obtained by the receiver operating characteristic (ROC) curve. The ROC analytic results showed that the best cut-off values of Model A, B and C were 0.155, 0.793 and 0.295. Model A recommended when the probability is >0.155, a patient's nutritiond tatus should be classified as BMI < 18.5 kg/m(2) group. Model B recommended that PG-SGA<9 group be classified as the probability is >0.793. Model C recommended that PG-SGA < 4 group should be classified when probability is >0.295. Conclusions: The PG-SGA classification prediction model is simple to operate, and the nutritional status of patients can be roughly divided into three groups: normal or suspected malnutrition group (PG-SGA<4), moderate malnutrition group (4≤PG-SGA<9), and severe malnutrition group (PG-SGA≥9). This model can more efficiently predict the nutritional status of cancer patients, greatly simplify the nutritional assessment process, and better guide the standardized treatment of clinical malnutrition.

Prognostic implications of the global leadership initiative on malnutrition criteria as a routine assessment modality for malnutrition in hospitalized patients at a university hospital

Few studies have examined the association between mortality and malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria for routine nutritional assessment; thus, this association is not well known. We aimed to clarify the association between GLIM-defined malnutrition and mortality in a large population of hospitalized patients. In this retrospective cohort study, we enrolled adult patients admitted to Aichi Medical University Hospital between April 2019 and March 2021, who underwent nutritional assessment using the GLIM criteria. In November 2021, we collected the following data from electronic medical records: demographic, clinical, and laboratory data upon admission; nutritional data assessed using GLIM criteria; and data on final patient outcomes. In this study, we included 9372 hospitalized patients who were identified to be at risk by the validated nutritional screening tools (50.6% men, median age 75.0 [67.0-82.0] years, 69.2% patients aged ≥70 years). The number of patients with no, moderate, and severe GLIM-defined malnutrition was 4145 (44.2%), 2799 (29.9%), and 2428 (25.9%), respectively. Kaplan-Meier survival curve analysis showed a significant increase in mortality with worsening nutritional status (log-rank test, P<0.001). After adjusting for age and sex, multivariable Cox regression analysis revealed that both moderate (Hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.79-2.23, P<0.001) and severe malnutrition (HR 3.06, 95% CI 2.74-3.40, P<0.001) were independent risk factors for mortality. Moreover, multivariable analysis showed that four of the five GLIM sub-criteria (except low body mass index) were independently associated with prognosis. Malnutrition and its severity, routinely assessed using the GLIM criteria, are associated with high mortality in hospitalized patients at nutritional risk. Further research is needed to evaluate the usefulness of the GLIM sub-criteria, including low body mass index, in these patients.

Application of STRONGkids method on assessing the risk of malnutrition among hospitalised children in Universitas Sebelas Maret Hospital

Introduction: Hospital malnutrition (HM) in children augments morbidity and mortality, thus early detection is a preventive measure that may improve a patient’s condition. This study identified the risk factors of HM among children hospitalised in Universitas Sebelas Maret (UNS) Hospital using the STRONGkids method. Methods: This observational analytical cross-sectional study was performed in children hospitalised at the paediatric ward of UNS Hospital between February and August 2021. The samples were taken by consecutive sampling technique. Subjects meeting the inclusion criteria were assessed for their underlying disease, nutritional status based on World Health Organization Anthro software, and STRONGkids score. Chi-square test and logistic regression analysis were used, with a p-value of &lt;0.05 considered as statistical significance. Results: A total of 173 children were included in the study, 56% were males, mean age was 62.5 months, 45% had an underlying chronic disease, and 17.9% experienced moderate malnutrition. Based on the STRONGkids score, 39.3% children were at high risk of malnutrition and 60.7% were at moderate risk of malnutrition. Logistic regression analysis showed that high risk of HM was significantly associated with age (OR 2.58, 95% CI 1.38-4.84, p=0.003), chronic disease (OR 7.23, 95% CI 3.3-15.86, p=0.018), and moderate malnutrition (OR 13.5, 95% CI 3.96-45.98, p&lt;0.001). Conclusion: Children hospitalised in UNS Hospital were at risk of malnutrition. Toddlerhood, chronic disease, and moderate malnutrition significantly increased the risk of HM. Thus, these children need optimal nutritional support to improve their clinical condition. STRONGkids is a convenient and easy method to identify malnutrition risk during hospitalisation.