Oral Diet Research Articles

OGC SO23 - Audit on Enhanced Recovery After Surgery (ERAS) in Oesophago-gastric Resections for Cancers

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols, have been designed to guide clinicians in managing patients post-operatively, reducing hospital stay, complications and readmissions. Our trust’s ERAS protocol includes guidance on oral intake initiation, drain, catheter and epidural removal, investigation frequency, medications required on discharge and early mobilization. However, implementation of ERAS protocols in complex oncological surgery can be challenging, due to the multiple factors included and increasing complexity. We aimed to assess the compliance of ERAS implementation in a high volume resectional oesophago-gastric unit, and subsequent impact on morbidity. Method A retrospective review of all patients who underwent oesophago-gastric resections during March-April 2024 was performed. Patients were included if they completed an oesophagectomy, or subtotal/total gastrectomy resection for cancer. Electronic records and medical notes were reviewed and compared to all aspects of the trust’s ERAS protocol. The adherence percentage to the protocol was calculated. Results 20 patients underwent surgery. 85% started their oral diet on time per ERAS protocol. Adherence to ERAS was lowest for epidural (52.6%, 95% within 24-hours of target), catheter (55%, 90% within 24-hours of target), apical (55.6%, 100% within 24-hours of target), basal (53.8%, 85.7% within 24-hours of target), and abdominal drain removals (81.8%, 90.9% within 24-hours of target). All patients mobilized within four days post-op, with 65% achieving daily mobilization. VTE prophylaxis was prescribed for all, and discharge medication adherence ranged from 86.7% to 100%. The mean hospital stay was 9 days post-oesophagectomy, with a 3.2% emergency department return rate. Conclusion Implementation of an ERAS protocol is feasible in complex oesophago-gastric cancer surgery. Effective involvement and training of allied health, specialist pain services and the whole surgical team can decrease morbidity and length of stay in oesophagectomy, while avoiding excess emergency department presentations. Ongoing training and feedback of allied health, pain services, and surgical team at all levels is important to ensure adequate compliance.

EGS SO28 - Management of oesophageal diverticulitis in a 71-year-old female: Case report and review of management approaches

Abstract Background Oesophageal diverticulitis is a rare condition with fewer than ten reports in the literature. We present a case of oesophageal diverticulitis in a 71-year-old female with a history of COPD, TIA, and known oesophageal diverticulum. She was managed conservatively with NBM, total parenteral nutrition and intravenous antibiotics requiring a 16-day inpatient stay. The rarity of this condition poses challenges in its diagnosis and management, necessitating a thorough understanding of both conservative and surgical interventions. This case highlights the complexity involved in treating oesophageal diverticulitis, especially in patients with significant comorbidities. Method Patient presented with a 6-day history of upper abdominal pain and sepsis (elevated inflammatory markers; CRP 320, WCC 11.1, temperature 38.0, pulse 104). Abdomen was soft with upper abdominal tenderness. Imaging was consistent with diverticulitis of a 5.9cm lower oesophageal diverticulum without perforation. Initial management included making the patient nil by mouth, total parenteral nutrition, and intravenous antibiotics (vancomycin and metronidazole). The patient’s condition was closely monitored with serial blood tests and clinical assessments. Opinion was sought from a tertiary upper GI centre. Discharge was planned once the patient safely transitioned to oral diet and was apyrexial for 48 hours. Results Inflammatory markers improved over five days (CRP from 320 to 51, WCC from 11.1 to 9). She remained intermittently pyrexial until day 8 of admission. Clinical improvement allowed transition from intravenous to oral therapy, and she was discharged on day 16 with double dose oral PPI therapy. Patient has been followed up by tertiary upper GI services with plans for consideration of surgical resection of the oesophageal diverticulum. The patient’s successful discharge without surgical intervention during the acute phase underscores the effectiveness of a conservative management approach initially, with a plan for definitive surgical treatment in a stable outpatient setting. Conclusion Oesophageal diverticulitis, though rare, requires a nuanced approach to management, especially in patients with significant comorbidities. This case demonstrates the importance of an awareness of thorough history taking and review of previous examinations to prevent delayed diagnosis of a rare pathology not demonstrated on a CT abdomen and pelvis. This approach highlights the importance of individualised treatment plans and the potential for conservative management to provide stabilisation, followed by elective surgical management. The paucity of cases of oesophageal diverticulitis has prevented development of evidence based guidelines, underscoring the importance of seeking advice from tertiary centers when managing rare presentations.

The peri-operative implications of sodium-glucose co-transporter 2 inhibitors: a narrative review.

Sodium-glucose co-transporter 2 inhibitors are a novel class of antihyperglycaemic drugs used in the management of type 2 diabetes, that improve glycaemic control, cardiovascular outcomes and promote weight loss. They are also approved for the treatment of heart failure and chronic kidney disease in patients with or without diabetes. This narrative review discusses the peri-operative effects and implications of sodium-glucose co-transporter 2 inhibitors and gives an overview of current evidence and existing peri-operative guidelines. We conducted a literature review to identify peer-reviewed English language articles published since 2000, with further articles identified by reviewing the references of key papers. Peri-operative sodium-glucose cotransporter 2 inhibitor use carries a risk of euglycaemic ketoacidosis. Although clinically significant diabetic ketoacidosis remains a rare event, sodium-glucose co-transporter 2 inhibitors inhibitor-associated diabetic ketoacidosis has been observed across almost all surgical specialities. Ketoacidosis may present with any blood glucose level. Existing guidelines are inconsistent and may be a source of clinical confusion. Based on the half-life of sodium-glucose cotransporter 2 inhibitors, we recommend withholding treatment for 72 h before elective surgery (5 half-lives), with additional multidisciplinary input for specific procedures with dietary alterations and in patients with poorly controlled diabetes of cardiac/renal disease. In the event of emergency surgery or any surgery within 72 h of sodium-glucose cotransporter 2 inhibitor administration, we recommend pre-, intra- and postoperative blood ketone monitoring (6 hourly for 24 h post-surgery and until full oral diet is resumed). Sodium-glucose cotransporter 2 inhibitor treatment should only be resumed after resumption of full oral diet in the absence of ketosis.

Management of inoperable malignant bowel obstruction using the 4-step BOUNCED diet.

Malignant bowel obstruction (MBO) presents with multiple symptoms. The 4-step BOUNCED diet educates patients to self-manage oral intake according to symptoms. It includes clear fluids, thin liquids, purée and soft, sloppy foods, which are low in fibre. This mixed methods single-arm feasibility study aimed to establish if the diet could reduce MBO symptoms in patients with inoperable colorectal and gynaecological malignancies. The secondary objectives were to investigate if it was easily followed, improved quality of life (QOL) and reduced hospital admissions. Patients able to tolerate an oral diet with one or more symptoms (pain, bloating, early satiety, nausea and vomiting) were eligible. Following informed consent, an oncology dietitian took a diet history and determined which step of the diet they needed to follow using a detailed patient information leaflet. Patients remained on the trial for 28 days. Symptom and QOL data were collected on Days 1 and 28 using the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaires. Thirty patients (24 female, 6 male) aged 18-85 years consented from March 2021 to November 2022. Twenty-six participants completed the trial and 25 found the diet very easy or easy to understand. There was a significant reduction in pain from 96% on Day 1 to 63% on Day 28 (p = 0.004). The mean increase of EORTC global health status/QOL was 23.5 points, 95% CI (12.4-32.5) (p ≤ 0.001). There was a significant difference between number of admissions (p = 0.018) and bed days (p = 0.004) in the 28 days prior to consent compared to the trial period. A modified consistency low-fibre diet is easily followed, may reduce symptoms of MBO, admissions to hospital and improve QOL.

Gastro-tracheal fistula following esophageal cancer surgery through the retrosternal route: a case report

BackgroundGastro-tracheal fistula is a rare but serious complication after esophageal surgery, often requiring long-term treatment and invasive procedures. Gastro-tracheal fistula usually occurs through the posterior mediastinal route and rarely through the retrosternal route. No previous reports have described gastro-tracheal fistula after retrosternal route reconstruction was cured by conservative treatment.Case presentationA 70-year-old man with lower thoracic esophageal cancer underwent thoracoscopic esophagectomy in the prone position and gastric tube reconstruction through the retrosternal route with neck anastomosis after neoadjuvant chemotherapy. Despite anastomotic leakage on postoperative day 10, his general condition was stable, and he was managed conservatively with antibiotics and gastric tube decompression. On day 29, he presented with high fever and a gastro-tracheal fistula was observed by esophagography. Conservative management was continued because the patient remained stable. On day 48, esophagography showed that the fistula was undetectable. The patient was able to take fluids orally. He progressed well on an oral diet and was transferred to a different hospital.ConclusionsA gastro-tracheal fistula, although rare, can occur after retrosternal route reconstruction. When a patient is stable, gastro-tracheal fistula after retrosternal route reconstruction may be cured by conservative treatment.

Root caries: Prevalence, risk indicators, and clinical characteristics – A cross-sectional study

Objectives: The objectives of this study were to determine the prevalence of root caries (RC) in South Coastal population of India, to identify the risk indicators associated with it and to describe some clinical characteristics of RC lesions. Materials and Methods: A cross-sectional study was conducted with a sample size of 1062 subjects to assess the prevalence of RC. Each subject underwent an oral examination, performed by a single-calibrated examiner. Questionnaires were used to collect the data on oral hygiene habits, diet, smoking, alcohol habits, systemic conditions, and education level. Univariate and multivariable regression analyses were performed to identify the risk indicators associated with RC. Results: The prevalence of RC was found to be 7.5%, with a mean RC Index of 17.66%. The results of multiple logistic regression showed that age (≥40 years), systemic conditions, and exposed root surfaces were statistically significantly associated with RC (P < 0.05). Conclusion: RC is prevalent not only in the older age group but also the younger adults in this cohort. This study suggests an association between RC and the variables age (≥40 years), exposed root surfaces and systemic conditions.

Health Literacy and Health-Related Habits among Conscripts in the Norwegian Armed Forces-A Cross-Sectional Survey.

Although health information is widely available to the Norwegian population a lack of health literacy is still common and considered a public health challenge. However, there is limited information on the health literacy of the adolescent population in Norway. The purpose of this pilot study was to assess health literacy and self-reported health habits among soldiers in basic military training, both in field, camp, and home settings. Furthermore, we aimed to investigate which health habits characterize soldiers with inadequate health literacy. An electronic questionnaire was sent out to conscripts who completed first-time military service in 2022 and was answered by 2,225 conscripts. Descriptive statistics were performed using cross-tabulations, correlations, and chi-squared tests. The survey is part of an internal quality study of the Norwegian Armed Forces routines. It is approved by the Norwegian Armed Forces joint medical services. In the study population, 43% scored inadequate health literacy on the European Health Literacy Survey Questionnaire-Q12 (HLS-Q12), and 57% scored adequate health literacy. We found a significant difference between those having inadequate and adequate HLS-Q12 scores in categories of self-rated health habits of oral health and diet with lower scores in the inadequate score group. The use of tobacco during field exercise in camp and at home was higher in the group of conscripts with adequate health literacy scores. The conscripts generally reported a lower standard of health habits during field exercises with significantly less brushing and flossing, higher use of tobacco products and higher consumption of energy drinks and sugary snacks compared to reported habits in camp and at home. The results from our study suggest that the conscripts in the Norwegian Armed Forces have a lower health literacy than the general population, and this is reflected in reported higher frequency of unhealthy habits in service settings than at home. The Armed Forces have an opportunity to take responsibility to optimize the health skills of their soldiers and to encourage them to make informed decisions about their own health. Improved adaptation to the national recommendations regarding nutrition, tobacco use, and oral health are areas having the potential to greatly improve the overall health habits of conscripts.

Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery

Objective: To evaluate the clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Method: This was a retrospective study. A total of 120 patients with cervical cancer undergoing radical surgery at Tangshan People’s Hospital from June 2021 to June 2023 were randomly divided into two groups (n=60 cases each group). The control group received routine nursing intervention, while the study group was provided with comprehensive nursing intervention. Comparative analysis was conducted on clinical indicators, postoperative complications, bladder and pelvic floor function recovery, and patient satisfaction before and after intervention in both groups. Result: In the study group, ambulation time, gastrointestinal function recovery, duration of postoperative drainage tube placement, oral diet resumption time, duration of postoperative vaginal bleeding, and length of hospital stay were significantly shorter than in the control group (all p< 0.05). Bladder function recovery in the study group was superior to that in the control group (p< 0.05). The study group showed lower scores for anorectal disorders, urogenital disorders, and pelvic organ prolapse than the control group (p< 0.05, respectively). Patient satisfaction was 100% in the study group and 85% in the control group, suggesting a statistically significant difference between the two groups (p< 0.05). Conclusion: Comprehensive nursing intervention deserve to be promoted as it can accelerate postoperative clinical recovery, reduce the incidence of surgical complications, improve pelvic floor and bladder function post-cervical cancer surgery, and enhance patient satisfaction with care. doi: https://doi.org/10.12669/pjms.40.10.9271 How to cite this: Zhao Q. Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Pak J Med Sci. 2024;40(10):2287-2292. doi: https://doi.org/10.12669/pjms.40.10.9271 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

8269 Euglycemic Diabetic Ketoacidosis Secondary to Rapid Weight Loss in a Patient on Dapagliflozin

Abstract Disclosure: A. Sridhar: None. A. Iqbal: None. A. Prabha Kumar: None. F. Haider: None. M. Babic: None. Background: Euglycemic DKA (eDKA) is a potentially life-threatening complication in patients taking SGLT 2 inhibitors (SGLT2i). Common precipitating factors include strenuous exercise, carbohydrate restriction, starvation, and alcohol use. Clinical case: The patient is a 71-year-old female with past medical history of Type 2 diabetes mellitus (DM), gastro-esophageal reflux disease, hypertension, hyperlipidemia, coronary artery disease and chronic pain syndrome. She presented with complaints of nausea, vomiting, reduced appetite and generalized weakness for the past 4 days. She also reported an intentional weight loss of 35 pounds in the last 6 weeks achieved with daily exercise and a carbohydrate restricted diet. She had been taking Dapagliflozin-Metformin 5-1000 mg twice daily and pioglitazone 30 mg once daily for 2 years and Ozempic subcutaneous injection 1 mg weekly for 6 months. Physical examination in the ED showed normal vital signs, dry mucous membranes, and trace bilateral lower extremity edema. Blood work was significant for venous blood gas pH 7.24, bicarbonate 9 mmol/L, anion gap 30 mmol/L, blood glucose 94 mg/dL, HbA1c 5.8 % and WBC 13.2 K/uL. Urinalysis was positive for glucose and ketones. The patient was admitted for management of eDKA and was started on intravenous 10% dextrose infusion and insulin infusion. Endocrinology was consulted and they recommended following DKA protocol and stopping Dapagliflozin at discharge. She was maintained on insulin infusion for 48 hours after which her anion gap normalized, and she was transitioned to subcutaneous insulin with Lantus 8 units and sliding scale insulin. During this time the patient’s symptoms resolved, and she was able to tolerate oral diet. She eventually resumed her home medications with oral Metformin 1000 mg twice daily and pioglitazone 30 mg once daily. Dapagliflozin and Ozempic were discontinued at discharge. Strenuous exercise and carbohydrate restriction which caused rapid weight loss, were likely the triggers for eDKA in our patient. A diabetes educator was involved at discharge and the patient was counseled to avoid possible triggers and identify warning signs and symptoms in the future. The patient was discharged with a follow up appointment with her Endocrinologist. Conclusion: High index of clinical suspicion is important to promptly diagnose eDKA in patients taking SGLT2i. Patient education on avoiding precipitating factors and early recognition of signs and symptoms is necessary to reduce mortality. Presentation: 6/3/2024

Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis.

This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN). Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis. Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, p = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% p = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, p = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201-2.706, p = 0.688). The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.

Clinical Outcomes of Peptic Ulcer Bleeding

Despite advancements in endoscopic technology and drug therapy, the high mortality and rebleeding rates associated with hemorrhagic peptic ulcers remain a concern. Although further research is needed to validate contributing factors, I recommend use of the Rockall score to predict the rebleeding risk in patients with peptic ulcers. Greater caution should be exercised, particularly in hospitalized patients, those who have undergone pancreatic surgery, and those with bleeding due to Dieulafoy’s lesions. Delaying resumption of an oral diet for at least 24 hours after endoscopic bleeding control is also advisable.

Achieving The Nutritional Goal Of Burn Patients In A Referral Hospital In The Northern Region Of Brazil

Background: Burns represent a significant health challenge, not only due to the pain and suffering they cause, but also due to metabolic complications. Oral nutritional therapy is a powerful tool in the recovery of these patients, as the burn requires double the energy demands. Therefore, achieving the nutritional goal in burn patients should be considered a priority in clinical management. Materials and Methods: Patients admitted to the Burn Treatment Center at a reference hospital in the North region were evaluated. For nutritional diagnosis, the gold standard tools for nutritional risk analysis were applied, Nutritional Risk Screening (NRS-2002) for adults and Screening Tool for Risk on Nutritional Status and Growth (Strongkids, 2012) for children. These are validated low-cost and non-invasive methods. Monitoring the achievement of VET and protein was carried out through food records and the percentages achieved in accordance with the prescribed calories and proteins were calculated. Results: 22 adult patients were evaluated. Of these, 15 men and 7 women, with an average age of 35.8 years. The assessment revealed 7% malnourished, 67% eutrophic, 33% obese and 13% obese. Adults averaged 2026 cal/day with 112% VET attainment and 90g protein with 125% intake. It is worth highlighting the joint action of nutrition professionals with the prescription of hypercaloric and hyperprotein preparations to adapt to the needs recommended for burn patients, in addition to Oral Nutritional Therapy (ONT), with an increase of 600cal/day and 40g of proteins. The use of hypercaloric and hyperprotein supplementation in burn patients is a strong ally in diet therapy, given the catabolic state and high risk of depletion. Among the children's audience, 7 children were served: 4 boys and 3 girls, an average age of 4.4 years. The nutritional diagnosis showed 85% in eutrophy, and 15% in nutritional risk. The VET of this group was on average 1215 cal and 39g of protein. Children achieved an average of 142% of daily VET and 175% of protein needs. To this end, 85% used TNO, accounting for 300 cal and 7.6 g of additional protein to the oral diet. Conclusion: Achieving the nutritional goals prescribed for burn patients has a significant impact on the meffectiveness of treatment

Clinical outcomes of endoscopic balloon dilation for refractory esophageal strictures after esophageal atresia repair

BackgroundManaging refractory esophageal strictures (RES) presents formidable challenges. Although endoscopic balloon dilation (EBD) is the first step for esophageal stricture, the clinical outcomes of EBD for RES after esophageal atresia (EA) repair are not established. MethodsAll EA patients with esophageal balloon strictures (EBS) from October 2016 to October 2022 treated by EBD in our institution were retrospectively reviewed. The primary endpoint was to evaluate the clinical outcomes and the risk factors for poor outcomes of EBD for RES. The secondary endpoint was to evaluate the risk factors for pathological weight in RES patients. Results87 patients with RES were included in our study. After the first session of EBDs, 40.2 % experienced a recurrence of esophageal strictures. The median number (IQR) of the first session of EBD was 13.0 (8.0, 16.0), and the median number (IQR) of total dilations of achieving long-term clinical success was 14.0 (10.0, 19.0) with 81.6 % achieving long-term clinical success with less than 20 EBDs. In follow-up, all patients achieved a total oral diet. On multivariable analysis, the presence of GERD (OR 4.17, 95%Cl 1.29–13.51, p = 0.017), LGEA (long-gap esophageal atresia) (OR 5.19, 95 % Cl 1.15–23.52, p = 0.033), eccentric stricture shape (OR 3.34, 95%Cl 1.06–10.53, p = 0.040), and longer stricture length (OR 10.22, 95%Cl 1.14–92.01, p = 0.038) were statistically significant associated with increased endoscopic dilations. The presence of LGEA (OR 3.25, 95%Cl 1.03–10.20, p = 0.044) was significantly associated with recurrence after short-term clinical success. Additionally, Older age at first dilation after LEAP, stricture level at 1/3 upper (ref = 1/3 middle), and LGEA were identified as risk factors for developing pathological weight. ConclusionEndoscopic balloon dilation is an effective method for treating RES after EA repair. GERD, LGEA, eccentric stricture shape, and longer stricture length are the risk factors for increased dilation times. Older age at first dilation after LEAP, stricture level at 1/3 upper, and LGEA were identified as risk factors for developing pathological weight.

Oral microbial diversity in 18th century African individuals from South Carolina.

As part of the Anson Street African Burial Ground Project, we characterized the oral microbiomes of twelve 18th century African-descended individuals (Ancestors) from Charleston, South Carolina, USA, to study their oral health and diet. We found that their oral microbiome composition resembled that of other historic (18th-19th century) dental calculus samples but differed from that of modern samples,and was not influenced by indicators of oral health and wear observed in the dentition. Phylogenetic analysis of the oral bacteria, Tannerella forsythia and Pseudoramibacter alactolyticus, revealed varied patterns of lineage diversity and replacement in the Americas, with the Ancestors carrying strains similar to historic period Europeans and Africans. Functional profiling of metabolic pathways suggested that the Ancestors consumed a diet low in animal protein. Overall, our study reveals important insights into the oral microbial histories of African-descended individuals, particularly oral health and diet in colonial North American enslavement contexts.

Clinical characteristics, treatment strategy, and clinical outcomes in type 2 intestinal failure

Objective: To evaluate the characteristics, clinical management and clinical outcomes of type 2 intestinal failure (IF). Methods: A descriptive case-control study was carried out. The inclusion criteria were as follows: (1) the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus statement. (2) using a requirement for parenteral nutrition (PN) of 28 days or more as surrogate marker. (3) a multidisciplinary team (MDT) included surgeons, nutritionist, pharmacist, stoma therapists, and critical care physicians. (4) complete laboratory data. Patients with type 1 and type 3 IF and those who do not cooperate with follow-up. All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023. The pathophysiology, clinical management, and outcomes of type II IF were analyzed. Results: A total of 67 type II IF were included. The median age was 54 (15-83) with 43 males and 24 females. The body mass index was (17.5±3.8) kg/m2, the incidence of malnutrition was 67.2% (45/67), the incidence of sarcopenia was 74.6% (50/67), the median number of previous surgeries was 2.0 (1-13), and the median duration time of PN was 2.1 (1-12) months. The underlying disease of type 2 IF included 36 Crohn`s disease, 2 ulcerative colitis, 3 radiation enteritis, 2 intestinal Behcet's disease, 4 mesenteric infarction, 1 aggressive fibromatosis, 5 abdominal cocoon syndrome, 5 gastrointestinal perforation, 1 hernia, 4 intestinal dysmotility, and 4 other reasons (gastrointestinal tumor, trauma, and non-Hodgkin's lymphoma). According to the pathophysiology of IF, there were 33 intestinal fistula, 12 intestinal dysmotility, 6 mechanical obstruction, 13 short bowel syndrome, and 3 extensive small bowel mucosal disease. After treatment with MDT, 67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment, of which 36 patients recovered with oral diet or enteral nutrition, 31 patients underwent reconstructive surgery after intestinal rehabilitation treatment failure. The median duration time of reconstructive surgery was 2.7 (1-9) months. 24 patients recovered intestinal autonomy after surgery, with 7 deaths, including 6 deaths due to abdominal infections and 1 case of intestinal dysmotility with abiotrophy and liver failure. Conclusion: Standardized multidisciplinary treatment plays an important role in type II intestinal failure, and it promotes patients with intestinal failure regain enteral autonomy.

Percutaneous Endoscopic Colostomy to Relieve Malignant Bowel Obstruction.

Malignant bowel obstruction due to peritoneal carcinomatosis is a common problem. When surgery is not feasible in the context of a high intraperitoneal tumour burden, other techniques are required. We report the case of a 67-year-old female with malignant obstruction of the ascending colon. Following an unsuccessful surgical attempt, decompression was successfully achieved via percutaneous endoscopic colostomy using a lumen-apposing metal stent. The patient was able to resume a full oral diet within 2 days. However, local inflammatory complications arose due to faecal contamination of the sutures. Once the sutures were removed, no further interventions were required. Percutaneous endoscopic colostomy is a safe and viable alternative for decompression in malignant bowel obstruction when surgery is not feasible. However, limitations include the risk of local infection due to sutures and its applicability only in cases with distal stenosis. Malignant bowel obstruction is a frequent challenge in palliative care.Percutaneous colostomy with a lumen-apposing metal stent (LAMS) is a safe and effective option to relieve bowel obstruction.Percutaneous colostomy with a LAMS remains patent in the long term.

Prevalence of dentine hypersensitivity, erosive tooth wear, gingival recession and periodontal health in seven European countries

ObjectivesTo determine the prevalence and associated risk indicators for dentine hypersensitivity (DH), erosive tooth wear (ETW), gingival recession (GR), and gingival inflammation (bleeding on probing, BOP), with clinical and questionnaire data from seven European countries. MethodsA cross-sectional, observational, seven-European country, epidemiological study in systemically healthy adults. Participants completed a questionnaire regarding oral hygiene, diet and lifestyle factors. A clinical examination, by calibrated examiners, measured DH (Schiff; participant yes/no), ETW (basic erosive tooth wear examination, BEWE), GR (mm), and BOP (yes/no). Results3551 participants completed the study, mean age 44 ± 17.4, 43.6 % male, 26.1 % rural dwellers. DH (Schiff ≥ 1) was seen in 75.9 % of participants, ETW (BEWE ≥ 1) in 97.6 %, GR (≥1 mm) in 87.9 %. 65.7 % participants had BOP ≥ 10 % sites, 34.3 % BOP<10 % with probing depths ≤3 mm. DH, ETW, GR and BOP increased markedly during young adult life. Thereafter, GR and ETW continued to increase, DH declined after around age 38–47, and BOP plateaued after age 48. DH was significantly associated with ETW (p < 0.001) and GR (p < 0.01); GR was significantly associated with BOP on lingual surfaces (p = 0.017). There were significant associations between increased full mouth BOP ≥ 10 % and reduced brushing duration and exercise frequency (p < 0.001); increased DH and heartburn (p < 0.001); decreased DH (p < 0.001), ETW (p < 0.001) and BOP ≥ 10 % (p = 0.002) with powered toothbrush use. ConclusionsPrevalence of oral conditions assessed was high, greater than in the majority of the GR, DH and ETW literature. Periodontal health was seen in a third of sampled individuals. All these conditions varied markedly by country and age. Clinical significanceOral diseases and conditions were highly prevalent throughout the seven European countries investigated. For the majority, these conditions are eminently preventable and treatable by changing behaviours. Upstream policy changes are needed to address these health challenges, to raise awareness and to empower individuals with oral health education and support.

Determining the influence of oral hygiene practices and diet on dental caries among 15-year-old adolescents of Loni block, Ghaziabad- A cross-sectional study

Dental caries is a prevalent chronic disease globally, affecting millions and posing significant public health challenges. Adolescents are particularly vulnerable due to various factors including oral hygiene practices and dietary habits. This cross-sectional study aimed to determine the influence of oral hygiene practices and diet on dental caries among 15-year-old adolescents in Loni Block, Ghaziabad. A total of 140 adolescents from private and public schools were included in the study. Data on oral hygiene practices, dietary habits, and dental caries were collected using structured questionnaires and clinical examinations. Statistical analysis was performed using SPSS version 23. The majority of participants were female (56.4%) and had never received dental care (73%). Most participants brushed their teeth once a day (48.6%) and used fluoridated toothpaste (84.0%). Fresh fruit consumption was reported several times a week by 45.0% of participants, while sweet consumption varied. Dental caries prevalence was high, with 59.3% of participants affected. The present study underscores the importance of addressing oral hygiene practices and dietary habits to combat dental caries among adolescents. Targeted interventions focusing on education and promoting healthy behaviors are crucial for improving oral health outcomes in this population.

Pain Related Secondary Outcomes Associated with Cold Tonsillectomy and Role of Topical Sucralfate in Mitigating Their Severity: A Comparative Observational Study

The aim of the study was to assess the pain related secondary outcomes associated with cold tonsillectomy and role of topical sucralfate to reduce their intensity. Material and Methods: This comparative observational study was conducted in the ENT department of the Pakistan Institute of Medical Sciences (P.I.M.S.), affiliated with the Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, spanned from December 2016 to August 2017, following institutional ethical approval. The study comprised 112 patients with recurrent tonsillitis, evenly assigned to group A (subjects) and group B (control). Tonsillectomy, employing the cold steel dissection method, was administered to all patients. Group A received 10ml of topical sucralfate every 8 hours on the zero and first postoperative days, while group B received a placebo. Comparative analysis between the groups focused on pain-related secondary outcomes, including referred otalgia and the ability to initiate a regular oral diet on the morning of the first postoperative day. SPSS version 21 facilitated data analysis, with significance set at p &lt; 0.005. Results: In group A, the mean age was 12.14±5.17, and in group B, it was 11.53±3.95, resulting in an overall mean age of 11.83±4.59 for both groups. Among 112 patients, 55.4% (n=62) were male, and 44.6% (n=50) were female. The frequency of referred earache was significantly lower in group A (15, 26.8%) compared to group B (25, 54.6%) [n1=n2=56, p=0.049]. Intolerance to start a normal diet was significantly lower in group A (17, 30.4%) compared to group B (39, 69.6%) at the first post-op day [n1=n2=56, p=0.034].Conclusion: Utilizing topical sucralfate alongside other pain management strategies proves to be an effective approach in reducing the intensity of pain related secondary complication i.e. referred otalgia and intolerance to oral intake among patients undergoing tonsillectomy using the cold steel dissection technique.

Successful weaning from parenteral nutrition in a short bowel syndrome patient with high-output stoma through restricted oral diet: a case report.

A restricted oral diet plays a significant role in the nutritional management of patients with Short Bowel Syndrome (SBS). SBS patients often experience increased intestinal output, especially if they are classified as net "secretors" (typically having less than 100 cm of residual jejunum). This means they lose more water and sodium from their stoma than they take in by mouth. In this report, we present the case of an SBS patient with 80 cm of remaining bowel, no colon in continuity, and a high-output stoma. The patient was managed with a restrictive oral diet in combination with parenteral nutrition, pharmacological treatment, and high patient compliance. Following this regimen, the patient's condition improved significantly, leading to a reduction in stoma output and an improvement in nutritional status, including stabilization and weight gain. Upon discharge from the hospital, the patient was maintaining an oral diet with specific nutritional recommendations and receiving parenteral saline. This case report suggests that the combined use of restricted oral intake and parenteral nutrition (PN), alongside appropriate pharmacological management and high patient compliance, can effectively manage high-output stomas and improve nutritional status, even in cases where the small bowel is less than 100 cm in length.