Nutritional Deficits Research Articles

Reactive response to predation risk affects foraging time of hares, yet not their phosphorus intake

Antipredator responses could affect nutrient intake, which could lead to nutritional deficits. However, little is known about the antipredator response of small herbivores because most are nocturnal or crepuscular and therefore very difficult to study in the field. Therefore, we experimentally assessed the effect of a reactive response to predation risk on the nutrient (i.e., phosphorous) intake of the European hare (Lepus europaeus) using three different playback sounds. Additionally, we studied the time spent being costly vigilant, the time spent foraging, and the vegetation height in which the hares were present using accelerometers and GPS. Our results showed that elevated predation risk from our playback experiment did not affect the (1) phosphorus intake, (2) time spent being costly vigilant, and (3) time spent in tall vegetation. However, elevated predation risk did increase the time spent foraging. Possibly hares spent more time foraging with an increased predation risk because hares cannot seek refuge from predators. Additionally, the effect on phosphorus intake could be weak because phosphorous intake does not benefit a flight escape, while the reactive response acts late in the predation sequence limiting the effect on hare ecology. Prey anti-predator responses seem strongly related to the escape tactics of prey species that can differ between different habitats and the time of the day. More detailed field studies are necessary to get a better insight into species’ anti-predator-food tactics.

Social Protection and Foundational Cognitive Skills during Adolescence: Evidence from a Large Public Works Program.

Many low- and middle-income countries have introduced public works programs (PWPs) to fight poverty. This paper provides the first evidence that children from families who benefit from PWPs show increased foundational cognitive skills. The results, based on unique tablet-based data collected as part of a long-standing longitudinal survey, show positive associations between participation in the Productive Safety Net Programme (PSNP) in Ethiopia during childhood with long-term memory and implicit learning, and suggestive evidence for working memory. These associations appear to be strongest for children whose households were still PSNP participants in the year of data collection. Evidence suggests that the association with implicit learning may be operating partially through children's time reallocation away from unpaid labor responsibilities, while the association with long-term memory may in part be due to the program's success in remediating nutritional deficits caused by early-life rainfall shocks.

Food insecurity and associated factors among households with under-5 children in slum communities in Ibadan, Nigeria

IntroductionFood insecurity is a leading cause of childhood morbidity and mortality. This study assessed the prevalence of household food insecurity and its associated factors among under-5 children in Ibadan, Nigeria.MethodsThis was a cross-sectional household survey of 1,027 under-5 children and their caregivers in urban and rural slums in Ibadan. We used an electronic interviewer-administered, semi-structured questionnaire adapted from the Nigeria Demographic Health Survey and Household Food Insecurity Access Scale was used to report sociodemo-economic characteristics, food insecurity, and anthropometric measurement. The household food insecurity scale consisted of nine questions graded from 0 (Never) to 3 (Often) computed to determine the presence of food insecurity. Nutrition indices were computed, and the results were classified according to World Health Organization 2006 cut-off points. Chi-square tests were used to assess associations between food insecurity and the independent variables. Binary logistic regression analyses were conducted to identify the predictors of food insecurity (α = 0.05).ResultsThe mean ages of the caregivers and under-5 children were 31.7 ± 7.47 years and 34.49 ± 15.8 months respectively. Overall, 530 (51.7%) children were females, and 765 (74.5%) had normal weight for height. In all, 195 (19.0%) households had food insecurity, while 832 (81.0%) households had food security (Chi-square = 103.364, p = < 0.001). Under-5 children living in urban slums were seven times more likely to experience household food insecurity compared to those in rural slums (AOR = 6.859, 95%CI = 4.524–10.509, p = < 0.001).DiscussionHousehold food insecurity was more prevalent in urban slums. Strengthening of the school health program would help identify children with nutritional deficits, and improve the overall health status of children living in slum communities.

The Influence of Early Nutrition on Neurodevelopmental Outcomes in Preterm Infants

Premature infants, given their limited reserves, heightened energy requirements, and susceptibility to nutritional deficits, require specialized care. Aim: To examine the complex interplay between nutrition and neurodevelopment in premature infants, underscoring the critical need for tailored nutritional approaches to support optimal brain growth and function. Data sources: PubMed and MeSH and keywords: preterm, early nutrition, macronutrients, micronutrients, human milk, human milk oligosaccharides, probiotics AND neurodevelopment or neurodevelopment outcomes. Recent articles were selected according to the authors’ judgment of their relevance. Specific nutrients, including macro (amino acids, glucose, and lipids) and micronutrients, play an important role in promoting neurodevelopment. Early and aggressive nutrition has shown promise, as has recognizing glucose as the primary energy source for the developing brain. Long-chain polyunsaturated fatty acids, such as DHA, contribute to brain maturation, while the benefits of human milk, human milk oligosaccharides, and probiotics on neurodevelopment via the gut-brain axis are explored. This intricate interplay between the gut microbiota and the central nervous system highlights human milk oligosaccharides’ role in early brain maturation. Conclusions: Individualized nutritional approaches and comprehensive nutrient strategies are paramount to enhancing neurodevelopment in premature infants, underscoring human milk’s potential as the gold standard of nutrition for preterm infants.

Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer.

Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.

Machine learning algorithms for prediction of double burden of malnutrition among Tunisian adults

Abstract Background Malnutrition, referring to both nutritional deficits and excess adiposity (EA), currently affects one third of the world population. In Tunisia, nutritional deficits are still major challenges in a context of epidemiological and nutritional transition. The objectives of our study were to identify the potential risk factors of DBM and propose a better machine learning (ML) based model for predicting DBM among Tunisian adults. Methods About 7963 respondents aged 20 years and over were taken from Tunisian Health Examination Survey (THES), a cross-sectional national household survey undertaken in 2016. DBM was defined as the association of EA and anemia. EA was defined as a waist-to-height ratio ≥0.6 and /or overweight: BMI ≥25kg/m2. Anemia was defined as hemoglobin (Hb)&amp;lt;13g/L in men and Hb &amp;lt; 12g/L in women. The potential risk factors for malnutrition were extracted using logistic regression (LR). Five ML algorithms including Naïve Bayes, support vector machine (SVM), artificial neural network (ANN), AdaBoost and random forest (RF) were employed for predicting DBM and their performance was evaluated using accuracy, precision, recall, and area under the curve (AUC). Results LR illustrated that age, sex, region, wealth index, educational level and marital status were identified as potential risk factors for DBM. AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 0.851. Conclusions The study demonstrated the efficacy of ML algorithms in predicting DBM in Tunisian adults. AdaBoost and SVM showed the highest accuracy, and could be utilized as an early detection tool to manage DBM and alleviate the burden on the healthcare system. However, larger and more diverse datasets are needed for further validation. Key messages • Double burden of malnutrition, defined as the coexistence of undernutrition and overnutrition, is a significant issue globally and a major challenge in Tunisia. • Machine learning algorithms, particularly AdaBoost and SVM, can be effective tools for predicting and managing double burden of malnutrition in Tunisian adults.

Analysis of reproduction success, growth and milk trajectories and response to nutritional challenge in two Alpine goat lines selected on divergent longevity

This study aims to investigate whether the variation in reproduction success, growth, and milk trajectories is associated with different adaptive strategies in the short term (response to an acute nutritional challenge), using two Alpine goat lines. A total of 382 Alpine goats (179 low longevity (low_LGV) and 203 high longevity (high_LGV)), selected for divergent functional longevity from a commercial population, were monitored for 4 years and recorded for BW, reproduction and milking performance. Every year, an average of fifty primiparous goats were exposed to a 2-d nutritional challenge in early lactation. A polynomial model was used to analyse the lifetime trajectory of lactation and BW. A piecewise model was used to analyse the individual milk yield and responses of milk components to the nutritional challenges. The statistical analysis revealed that the two lines had a similar performance for total milk yield in the first lactation, BW at birth and at first kidding, litter size and weight, kidding interval and interval from the first insemination to conception. BW trajectories revealed that low_LGV goats had a greater BW in pregnancy but then lost more weight in early lactation compared to high_LGV goats, which showed a greater BW after kidding. Milk trajectories showed that the high_LGV goats had a higher initial milk yield, an earlier but less marked lactation peak and more persistency in milk production in late lactation than low_LGV goats. Except for milk protein content, quite similar response and recovery profiles of milk yield and milk fat content were observed during the challenge for both lines. The response to the challenge was positively correlated to the initial level of milk production in early lactation but negatively correlated with milk production decline after the peak. This finding suggests that the low_LGV goats were more adapted to allocate resources to meet an expected physiological change such as gestation and lactation. However, high_LGV goats allocate more than low_LGV goats for structural mass and may better cope with an unexpected environmental change such as nutritional deficit.

FRI080 Post Bariatric Hypoglycemia And Pregnancy: Successful Utilization Of Remnant Stomach Gastrostomy Tube Placement In Severe Refractory Hypoglycemia After Roux-en-Y Gastric Bypass Surgery

Abstract Disclosure: S.S. Habbsa: None. A. Port: None. Introduction: Post bariatric hypoglycemia (PBH) can occur following Roux-En-Y Gastric Bypass (RYGB). Due to an exaggerated glucagon-like-peptide-1 (GLP-1) response from rapid nutrient transit to the distal bowel, patients with PBH exhibit endogenous hyperinsulinemic hypoglycemia following a carbohydrate load. Severe cases can result in significantly impaired quality of life (QoL), including syncope, seizures, and nutritional deficits from restricted intake. Recently, remnant stomach percutaneous endoscopy gastrostomy (PEG) tube placement has been reported in a handful of cases as a successful long-term strategy for RYGB-PBH refractory to nutritional and medical therapy. However, there are no known outcomes in pregnancy. Case: A 25-year-old female with a history of RYGB presented with increasingly severe and frequent PBH beginning 12 months after surgery. Mixed meal testing was consistent with prandial hypoglycemia (down to 20 mg/dL) with hyperinsulinemia (C-peptide 11 [0.80 - 3.10 ng/mL], Insulin 50 [&amp;lt;23 uIU/mL]). Ultrasound was negative for pancreatic anomalies. Dietary modification and medical therapy with acarbose, diazoxide, and liraglutide were unsuccessful. 3 years after RYGB, she required hospitalization for hypoglycemic seizures, and she underwent remnant stomach PEG tube placement. Oral intake was discontinued (except for protein for comfort) and substituted with 12-hour nocturnal feeds. Her PBH diminished, and she reported significant improvement in QoL. 6 years after PEG placement, the patient became pregnant. Working closely with a dietician, she increased caloric intake by 200-250 kcal/day in the second and third trimesters. Screening for gestational diabetes with oral glucose tolerance testing was deferred given risk of PBH exacerbation, and CGM was used instead for glycemic monitoring. Intolerance to overnight feeds was remedied using concentrated enteral formulas and incorporation of short daytime tube feed boluses. She delivered a healthy baby via elective C-section. During lactation, due to concern for food protein allergy, she was transitioned to a non-dairy non-soy-based feeding regimen. She returned to her pre-pregnancy weight and her sugars remained stable. Conclusion: This is the first case report documenting safe and effective use of remnant stomach enteral feeds for management of severe refractory PBH post RYGB during pregnancy and lactation. Pregnancy presents a unique situation in which increased carbohydrate intake is necessary to support fetal development; however, this can be life-threatening for patients with severe PBH. Remnant stomach PEG feeds utilize the original gut without need for surgical RYGB reversal, preventing rapid nutrient transit. Long-term reversal of PBH, sustained weight loss and customizable feeding regimens support the use of remnant PEG placement for severe RYGB-PBH in the appropriate patient. Presentation: Friday, June 16, 2023

Nutritional status of older adults in India: An exploration of the role of oral health and food insecurity factors

BackgroundIn this study, we attempted to generate insights into the determinants of nutritional status among older adults in India by exploring the role of factors including oral health, food insecurity, socioeconomic, demographic and health-related variables. The study also examined the moderating role of tooth loss with the association between chewing ability and nutritional status. MethodsThe data was obtained from Longitudinal Ageing Study India (LASI) – Wave 1 (2017-18). The sample consisted of 27,411 older adults (Male = 13, 232; Female = 14, 179) aged 60 years and above. In addition to descriptive and bivariate analysis, we employed multinominal logistic regression analysis. ResultThere was a significant association between the ability to chew solid food and tooth loss in the nutritional status of older adults. It was further revealed that tooth loss acted as a moderator (aRRR = 1.50, 95 % CI: 1.08–2.08) between the chewing ability and the risk of being underweight. The weight loss due to food insecurity increased the relative risk ratio of being underweight (aRRR = 1.58, 95 % CI: 1.25–2.00). Further evidence showed that self-rated health (SRH), Instrumental Activities of Daily Living (IADL), morbidity status and socioeconomic factors had a significant role in determining the nutritional status among older adults. ConclusionChewing ability, tooth loss, and food insecurity determine nutritional status among older adults. It is suggested to care for oral and general physical health as these factors increase the risk of nutritional deficits. Also, policy measures should be strengthened to address the specific health and food security needs of older adults from vulnerable socioeconomic circumstances.

Nursing Care Of Type Ii Diabetes Mellitus Patients

Background: Type II Diabetes Mellitus is a chronic disease with a high prevalence in Indonesia. As nursing care providers, nurses have an essential role in managing patients with type II Diabetes Mellitus. Purpose: Get an overview of the implementation of nursing care in patients with Type II Diabetes Mellitus. Methodology: A case study was conducted on Mrs. D in Dahlia Room RSUD Ciamis on 27 - 30 June 2022. Results: The results of the nursing evaluation obtained: ineffective peripheral perfusion, acute pain, nutritional deficits, impaired skin integrity, unstable blood glucose levels, impaired physical mobility, and disturbed sleep patterns are partially resolved, and the risk of hypovolemia has been determined. Conclusion: Nursing care carried out can overcome the problems experienced by patients.

Nursing Care for Mrs. S Who Experienced Diabetes Mellitus with Nutrition Deficit Problems in the Bougainville Room of the Dr. Koesnadi Bondowoso General Hospital

Background:Diabetes Mellitus is a chronic disease characterized by the body's inability to metabolize carbohydrates, fats and proteins which causes hyperglycemia (high blood glucose levels). Patients with Diabetes Mellitus will experience changes in appetite and experience weight loss. Method: This study uses a case study research design with clients experiencing diabetes mellitus with nutritional deficit problems in the Bougenvil room of the Dr. H. Koesnadi Bondowoso General Hospital, starting from May 15, 2023 to May 17, 2023, data collection in the form of interviews, observations, physical examinations, documentation studies and questionnaires.&#x0D; Results: The results of this study were obtained from research, namely nutritional deficits in accordance with theory, diagnoses in accordance with the theoretical review. In nursing interventions in accordance with the circumstances experienced by the client, while implementation refers to predetermined interventions and evaluation refers to predetermined outcome criteria in accordance with theory and the final evaluation of calories met is rice (735 kcal) and 1 glass of milk (260 kcal).&#x0D; Conclusion: Nutritional deficits are insufficient nutritional intake to meet metabolic needs. The purpose of writing is to provide nursing care to clients who experience diabetes mellitus with nutritional deficit problems.

Prophylactic vs. Reactive Gastrostomy Tube Placement in Patients Treated with Radiotherapy for Head and Neck Cancer

Radiotherapy (RT) for head and neck cancer (HNC) can cause acute toxicities resulting in weight loss warranting alterative enteral access. Some institutions favor prophylactic gastrostomy tube (GT) placement to prevent malnutrition at the forefront, while others choose to reactively place tubes if nutritional deficits arise. Though prophylactic GT placement may limit on-treatment weight loss, this approach may result in unneeded GT placement and may potentially impact long-term swallowing function. Patients with HNC treated with CRT from 2018-2021 were reviewed. GT placement prior to CRT (prophylactic [ppx] tube) was performed at the discretion of the treating radiation oncologist. The remainder of patients were treated with reactive (rx) GT placement in the event of on-treatment weight loss approaching 10-15%. Patient, disease and treatment factors were abstracted from the medical record. Primary endpoints were placement of GT in the rx group, weight change at the end of RT, and time to tube removal. In total, 278 patients were identified; 35 GT-dependent patients and 22 patients with nasal cavity/paranasal sinus cancers were excluded, yielding 221 for analysis. Baseline factors associated with GT group included age, ECOG, baseline swallowing function, primary site, T and N stage, stage group, and treatment year. Treatment factors associated with GT group were: neck target (bilateral v. unilateral/none), concurrent chemotherapy, and total dose. Of the 118 patients in the rx group, 14 (12%) required rx GT placement during or within 30 days of CRT. RT completion rates were similar between groups (95-96%, p = 1). GT was removed at last follow-up in 57% of patients in both groups (p = 1). Percent on-treatment weight loss was -8.9% (SD 6.7) and -7.2% (SD 6.1) for the ppx and rx groups, respectively (p = 0.04). Median Kaplan-Meier estimate of time to GT removal was 7.7 months (95% CI 6.0-11.3) and did not differ between groups (log-rank p = 0.87). Factors associated with the placement of rx GT include: concurrent chemotherapy (yes 20% vs. No 0%, p.0007) and baseline FOIS (5 or less 40% vs. 6 or more 9%, p = 0.02). T stage, N stage, overall stage, postoperative RT, degree of neck irradiation were not associated. Reactive gastrostomy tube placement in patients treated with chemoradiotherapy for head and neck cancer patients is feasible and results in low rates of gastrostomy tube placement. There are no observed differences in on-treatment weight loss between patients treated using a prophylactic versus reactive approach. No differences in time to gastrostomy tube removal were observed.

Frass from yellow mealworm (Tenebrio molitor) as plant fertilizer and defense priming agent

World population growth requires the development of a sustainable agriculture that allows feeding all the inhabitants of the planet, while reducing the use of agrochemicals. Currently, the insect farming industry for food and feed production is developing exponentially throughout the world; also producing insect frass with a potential utilization within agriculture and greenhouse industry. In the case of the yellow mealworm (Tenebrio molitor), few studies have been developed so far on the use of frass as a fertilizer, and there are none on its ability to activate plant defenses. By applying 2% sterilized mealworm frass to tomato we found a significant increase in its growth, demonstrating that the microbiota might not play a key role in its fertilizing capacity. In addition, the application of frass to sunflowers under different situations of nutritional deficit allowed us to determine what specific nutrients this fertilizer may be providing to the plant, finding a possible deficiency in the supply of N, but with sufficient amounts of P, K, Ca, and S. With respect to the induction of defenses, mealworm insect frass did not induce local root defenses in a root callose deposition assay in Arabidopsis thaliana under our experimental conditions. However, it activated systemic defenses in Arabidopsis thaliana by inducing defense genes in the absence of pathogen, further enhanced by infection with the necrotrophic fungus Botrytis cinerea. Therefore, mealworm frass could be a good fertilizer resource and plant defense inducer to support development of sustainable agriculture.

Usability and feasibility of a tablet-based e-coach for older adults in rehabilitation units to improve nutrition and physical activity: a prospective pilot study

BackgroundFor older adults (≥ 70 years), it is often challenging to maintain new nutrition and physical activity behaviours learned in rehabilitation. To minimize the risk of negative health consequences when returning home, an e-coach can be helpful. Aligning the program with an established concept such as the Transtheoretical Model of Behaviour Change (TTM) and guidance from healthcare professionals can optimize behaviour change.ObjectiveThis prospective single-arm pilot study aimed to assess the usability and feasibility of a nutrition and mobility e-coach for older adults during and after rehabilitation for a period of 9 weeks. In addition, we examined the change in the TTM phase as an indicator of the participant’s readiness to change or the changes made.MethodsOlder adults (≥ 70 years) with nutrition deficits and/ or mobility limitations were recruited in a rehabilitation centre. Participants’ phases of behaviour change in the TTM were identified by comparing current nutrition and physical activity habits via self-report with age-specific nutrition and physical activity recommendations. They received a tablet with the e-coach containing educational and interactive elements on the topics of nutrition and physical activity in older age. Participants used the e-coach and received support from healthcare professionals. The TTM phases were assessed at five times; the e-coach content was adjusted accordingly. Usability was assessed using the System Usability Scale (SUS, Score range: 0-100). Timestamps were used to evaluate how frequently participants used the e-coach: high (≥ 67% of the days), medium (66 − 33% of the days), and low (< 33% of the days).ResultsApproximately 140 patients were approached and n = 30 recruited. Complete data sets of n = 21 persons were analysed (38% female, mean age 79.0 ± 6.0 years). The SUS was 78.6 points, 11 participants (42%) were classified as high users, 6 (39%) as medium users and 4 (19%) as low users. After nine weeks, 15 participants (71%) achieved the physical activity recommendations (baseline: 33%, n = 7). Nutrition recommendations were achieved by 14 participants (66%) after nine weeks (baseline: 24%, n = 5).ConclusionThe e-coach seems to be usable and feasible for older adults. We identified some optimization potentials for our application that can be transferred to the development of comparable e-health interventions for vulnerable older adults.

Nutritional Composition and Anti-Type 2 Diabetes Mellitus Potential of Femur Bone Extracts from Bovine, Chicken, Sheep, and Goat: Phytochemical and In Vivo Studies.

Nutritional deficits in one's diet have been established as the key risk factor for T2DM in recent years. Nutritional therapy has been demonstrated to be useful in treating T2DM. The current study was carried out to assess the nutritional composition of bovine (12 months), chicken (4 months), sheep (13 months), and goat (9 months) femur bone extracts, as well as their potential therapeutic effects on T2DM regression in a Wistar albino rat model (500 mg/kg b.wt.). The proximate composition of the different extracts, their fatty acid composition, their amino acids, and their mineral contents were identified. In vivo data indicated considerably improved T2DM rats, as seen by lower serum levels of TL, TG, TC, ALT, AST, ALP, bilirubin, creatinine, urea, IL-6, TNF-α, sICAM-1, sVCAM-1, and MDA. Low levels of HDL-C, GSH, and total proteins were restored during this study. Histological investigations of liver and pancreatic tissue revealed that the distribution of collagen fibers was nearly normal. The bovine extract, on the other hand, was the most active, followed by the sheep, goat, and finally chicken extract. This research could result in the creation of a simple, noninvasive, low-cost, and reliable method for T2DM control, paving the way for potential early therapeutic applications in T2DM control.

Treatment variability and its relationships to outcomes among patients with Wernicke's encephalopathy: A multicenter retrospective study

BackgroundDespite guidelines and recommendations, Wernicke's encephalopathy (WE) treatment lacks evidence, leading to clinical practice variability. AimsGiven the overall lack of information on thiamine use for WE treatment, we analyzed data from a large, well-characterized multicenter sample of patients with WE, examining thiamine dosages; factors associated with the use of different doses, frequencies, and routes; and the influence of differences in thiamine treatment on the outcome. MethodsThis retrospective study was conducted with data from 443 patients from 21 centers obtained from a nationwide registry of the Spanish Society of Internal Medicine (from 2000 to 2012). Discharge codes and Caine criteria were applied for WE diagnosis, and treatment-related (thiamine dosage, frequency, and route of administration) demographic, clinical, and outcome variables were analyzed. ResultsWe found marked variability in WE treatment and a low rate of high-dose intravenous thiamine administration. Seventy-eight patients out of 373 (20.9%) received > 300mg/day of thiamine as initial dose. Patients fulfilling the Caine criteria or presenting with the classic WE triad more frequently received parenteral treatment. Delayed diagnosis (after 24h hospitalization), the fulfillment of more than two Caine criteria at diagnosis, mental status alterations, and folic acid deficiency were associated significantly with the lack of complete recovery. Malnutrition, reduced consciousness, folic acid deficiency, and the lack of timely thiamine treatment were risk factors for mortality. ConclusionsOur results clearly show extreme variability in thiamine dosages and routes used in the management of WE. Measures should be implemented to ensure adherence to current guidelines and to correct potential nutritional deficits in patients with alcohol use disorders or other risk factors for WE.

Prolonged Ileus after Colorectal Surgery, a Systematic Review.

The development of prolonged post-operative ileus (POI) remains a significant problem in the general surgical patient population. The aetiology of ileus is poorly understood and management options/preventative measures are currently extremely limited. The pathophysiology leading to a post-operative ileus is relatively poorly understood, and there is no validated method to estimate ileus occurrence or duration. Ileus in the post-operative period commonly occurs following major colorectal surgery and leads to painful abdominal distension, vomiting, nutritional deficit, pneumonia, prolonged hospital stays and susceptibility to hospital-acquired infection. An increased hospital stay, the burden of treatment costs and the burden on the health system highlight the importance of future research on finding definitions, preventions and predictions of ileus. A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing the rate of ileus on various treatments for prolonged post-operative ileus following colorectal surgery. A confidence evaluation in a meta-analysis were performed using CINeMA. Direct and indirect comparisons of all interventions were simultaneously carried out using a network meta-analysis. The level of certainty was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The method of assessing the risk of bias, the quality assessment, used the Cochrane Risk of Bias 2 tool (RoB2). Among the seven included studies, the majority suffered from considerable within-study bias, affecting the confidence rates of study findings. Heterogeneity and incoherence made the pairwise meta-analysis and ranking of interventions unfeasible. Indirect comparisons were considered unreliable due to this incoherence. This systematic review, with a confidence evaluation in the network meta-analysis, determined that there is a knowledge gap in the field of study on prolonged ileus following digestive surgery. The current evidence suffers from heterogeneity and incoherence more than imprecision. There is a gap in the data on ileus occurrence in interventional trials for digestive surgery. This could inform clinicians and trialists to better appraise the current literature and plan future trials.

The treatment of chronic anemia in heart failure: a global approach.

Chronic anemia is an independent risk factor for mortality in patients with heart failure (HF). Restoring physiological hemoglobin (Hb) levels is essential to increase oxygen transport capacity to tissues and improve cell metabolism as well as physical and cardiac performance. Nutritional deficits and iron deficiency are the major causes of chronic anemia, but other etiologies include chronic kidney disease, inflammatory processes, and unexplained anemia. Hormonal therapy, including erythropoietin (EPO) and anabolic treatment in chronic anemia HF patients, may contribute to improving Hb levels and clinical outcomes. Although preliminary studies showed a beneficial effect of EPO therapy on cardiac efficiency and in HF, more recent studies have not confirmed this positive impact of EPO, alluding to its side effect profile. Physical exercise significantly increases Hb levels and the response of anemia to treatment. In malnourished patients and chronic inflammatory processes, low levels of anabolic hormones, such as testosterone and insulin-like growth factor-1, contribute to the development of chronic anemia. This paper aims to review the effect of nutrition, EPO, anabolic hormones, standard HF treatments, and exercise as regulatory mechanisms of chronic anemia and their cardiovascular consequences in patients with HF.

Nursing Implementation of Nutritional Management in Diarrhoea Children with Nutritional Deficit Problems

Based on medical record data from Siti Fatimah Hospital Palembang, children aged 6-12 years who suffered from diarrhoeal diseases in 2019 to 2021 were 28 patients. Diarrhoea in children must be treated immediately because diarrhoea that is too frequent in children can cause disruption of the gastrointestinal system such as malabsorption which can cause children to enter less nutrients into the body and can cause nutritional deficits in children with diarrhoea. Methods: This type of research design uses a descriptive design in the form of a case study. The approach used is a nursing care approach which includes assessment, nursing diagnosis, planning, implementation, evaluation and documentation. The case study subjects were 2 pediatric patients suffering from diarrhoea, patient 1 aged 6 years and patient 2 aged 7 years who had nutritional deficit nursing problems. This research was conducted at Siti Fatimah Hospital Palembang in 2022. Results: Implementation of nutrition management nursing is effective to overcome the problem of nutritional deficits that occur in children with diarrhoea by showing the results of weight gain in children every day during the nursing process. Discussion: It is hoped that the patient's parents can recognise the signs of diarrhoea in children so that nutritional deficiencies do not occur and it is hoped that parents can apply the nutritional management that the author has taught.

UAV hyperspectral remote sensor images for mango plant disease and pest identification using MD-FCM and XCS-RBFNN.

To diminish disease transmission together with promoting effective management techniques, it is crucial to monitor plant health and detect pathogens earlier. The initial part in reducing losses sourced from plant diseases is to make an accurate and earlier identification. Thus, the usage of unmanned aerial vehicle (UAV) hyperspectral imaging (HSI) sensors for surveying and assessing crops, orchards, and forests has rapidly elevated over the last decade, particularly for the stress management like water, diseases, nutrition deficits, and pests. Using Minkowski Distance-based Fuzzy C Means (MD-FCM) clustering and Xavier initialization-adapted Cosine Similarity-induced Radial Bias Function Neural Network (XCS-RBFNN) techniques, a UAV HS imaging remote sensor for Spatial and Temporal Resolution (STR) of mango plant disease and pest identification is proposed in this scheme. Collecting the input UAV source (image or video) is eventuated initially along with the Region of Interest (ROI) calculated which is followed by preprocessing. Leaf segmentation is eventuated using Logistic U-net after preprocessing. Next, MD-FCM performs clustering to cluster the diseased leaves and pests individually. The disease and pest characteristics are then retrieved separately and classified further. The requisite features are then chosen from the retrieved features utilizing the Levy Flight Distribution-produced Butterfly Optimization Algorithm (LFD-BOA). Finally, the XCS-RBFNN classifier is utilized to categorize the various diseases together with pests found in the UAV input source using the chosen features. The proposed framework's experimental findings are then compared to some prevailing schemes, with the results revealing that the proposed work outperforms other benchmark techniques.