Poor Appetite Research Articles

Food appearance affects reward-related brain activity in healthy adults: a functional magnetic resonance imaging study

A good appearance of food increases appetite. A new food product called iEat® resembles the appearance and softness of familiar foods. Previous studies have reported that iEat® foods increase appetite. However, the neuronal substrates underlying the increase in appetite following the observation of iEat® foods remain unknown. In the present study, the brain activity of 20 healthy adults during the visual presentation of iEat® and pureed foods and non-food objects was examined using functional magnetic resonance imaging. Compared with pureed foods and non-food objects, iEat® foods showed significantly greater activation in regions of the brain reward system, such as the amygdala, ventral striatum and orbital frontal cortex. In addition, individual differences in the activity of the left amygdala were positively correlated with subjective appetite ratings. These results suggest that the good appearance of foods, such as iEat® foods, may be useful for stimulating the appetite of patients with poor appetite.

Healthy aging and chronic kidney disease.

The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.

180 DIETITIAN-LED, EARLY IDENTIFICATION OF MALNUTRITION RISK IN THE EMERGENCY DEPARTMENT IMPROVES INTERVENTION RATES

Abstract Background Frailty At The Front Door (FATFD) teams are ideally positioned to facilitate screening for risk of malnutrition in the frail older person. The aim of this quality improvement initiative is to improve malnutrition risk identification and first point of contact intervention, in a frail older Emergency Department (ED) population. Methods Dietetic assessment was initially triggered using a non-standardised screen in a Comprehensive Geriatric Assessment (CGA). Referral to dietetics was triggered if there was a ‘yes’ response to - have you lost weight and/or do you have a poor appetite? Patient demographics were prospectively entered onto Excel. A shorter CGA which included a validated MST screen was developed. All patients at risk of malnutrition were referred for dietetic intervention. Patient demographics, MST and Clinical Frailty Score (CFS) score of referred patients were prospectively entered onto Excel. Results were analysed using descriptive statistics. Results Pre-standardised screen, an average of 7 patients per week received an intervention. The mean(SD) age was 83.8(6.9) years. The male to female ratio was 1:1.5. No information was available on malnutrition risk or CFS. Post standardised screen, The mean(SD) age was 84(7) years. The male to female ratio was 1:1.2. Mean(SD) CFS was 5 (1.5). An average of 10.3 patients received an intervention per week. Conclusion Prioritisation of malnutrition risk screening was successful within a shortened CGA. A 47% increase in dietetic intervention was achieved. This has created an opportunity to further develop specialist pathways for example: Tube Feeding and Oral Nutritional Supplements.

Antidepressant Use During Hospice Patients' Final Months on Routine Home Care.

Background: Antidepressants can be used to manage symptoms at the end of life, but the dying process can impact their use. Objectives: To examine the use of antidepressants during hospice patients' final months of home care. Methods: A retrospective case records review of 227 hospice patients in their last three months of care in a residential setting. Chart reviews were conducted of medication logs, hospice staff notes, and caregiver narratives to examine antidepressant use including types of medications prescribed and factors associated with medication maintenance. Results: Thirty percent of patients were prescribed at least 1 antidepressant for symptoms including depression, anxiety, pain, disturbances in sleep, and poor appetite. The majority (96.1%) of patients were not administered their antidepressant on the day of death, and more than half (61.8%) did not receive their antidepressant during their last 3days of life. A quarter (25.5%) of patients on antidepressants did not receive medication 4-7days prior to death while some (12.7%) went without their antidepressant for 8 or more days. Antidepressant use was discontinued by hospice staff or caregivers due to a variety of reasons including difficulty swallowing, minimal consciousness, confusion, nausea, or patient refusal. Conclusions: Antidepressants are prescribed to manage multiple symptoms at the end of life, but use is often disrupted during patients' final days. Tapering and other prescription adjustments may be warranted to avoid risk of antidepressant discontinuation syndrome (ADS).

Ninjin'yoeito ameliorated PPE-induced pulmonary emphysema and anxiety/depressive-like behavior in aged C57BL/6J mice.

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in the elderly. COPD is a chronic respiratory disease characterized by airway remodeling and alveolar emphysema. COPD patients are also at high risk for mental illnesses such as depression and anxiety. Ninjin’yoeito (NYT) is prescribed to patients with conditions such as post-illness and postoperative weakness, fatigue, poor appetite, skin rash, cold hands and feet, and anemia. In addition to traditional uses, NYT is also prescribed as a therapeutic drug for poor functioning of the digestive organs, respiratory organs, and urinary organs. NYT is also known to have an antioxidant effect. The objective of this study was to investigate whether NYT could ameliorate COPD-induced lung injury and anxiety/depression in aged C57BL/6J mice exposed to porcine pancreatic elastase (PPE). While intratracheal administration of PPE induced emphysema in elderly mice, long-term administration of NYT suppressed the pathology. NYT was also found to suppress the apoptosis and oxidative stress caused by PPE. In addition, long-term administration of NYT was found to ameliorate PPE-induced depressive-like behavior in three different behavioral studies. These results suggest that NYT has a therapeutic effect on emphysema and the behavioral abnormalities caused by PPE.

Anticholinergic co-prescribing in nursing home residents using cholinesterase inhibitors: Potential deprescribing cascade.

Polypharmacy may result from inappropriate prescribing of medications to treat adverse drug reactions (ADRs), i.e., "prescribing cascade." A potentially harmful prescribing cascade affecting those with severe dementia can result when anticholinergics are prescribed to manage side effects of cholinesterase inhibitors (ChEIs). We investigated 1) factors associated with co-prescribing of anticholinergics and ChEIs and 2) whether discontinuation of ChEIs was associated with subsequent discontinuation of anticholinergics-a potentially beneficial reversal or "deprescribing cascade." We conducted a retrospective analysis of linked Medicare Part A/B/D claims, Master Beneficiary Summary File, Minimum Data Set, Area Health Resource File, and Nursing Home Compare from 2015 to 2016. Subjects were Medicare beneficiaries residing in nursing homes, ≥65 years old with severe dementia admitted for non-skilled stays, who were prescribed ChEIs. Cross-sectional analysis evaluated factors associated with co-prescribing of anticholinergics with ChEIs. Longitudinal Cox proportional hazards regression examined whether discontinuation of ChEIs was associated with subsequent discontinuation of anticholinergics over a 1-year period. We found 15% of our sample experienced co-prescribing of anticholinergics and ChEIs. Several resident and facility-level factors were associated with co-prescribing anticholinergics. Advancing age, minority race or ethnicity, end-stage renal disease, heart failure, and poor appetite were associated with a decreased likelihood of co-prescribing. Female sex, polypharmacy, and non-geriatric prescriber-type were associated with a higher likelihood of co-prescribing. In longitudinal analyses, we observed that discontinuation of ChEIs was associated with a reduced likelihood (HR 0.58 [95% CI, 0.47-0.71]) of discontinuing any medications with anticholinergic properties, except for bladder antimuscarinics (HR 1.32 [95% CI, 0.83-2.09]). Younger, healthier older adults with dementia were more likely to experience co-prescribing anticholinergics and ChEIs. Discontinuation of anticholinergics was infrequent. Further research is needed to understand prescribers' ability to recognize and reverse potential prescribing cascades through deprescribing.

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

SYSTEMIC EPSTEIN-BARR VIRUS-RELATED T-CELL LYMPHOPROLIFERATIVE DISORDER: A RARE CAUSE OF DYSPNEA AND PULMONARY INFILTRATES IN AN IMMUNOCOMPETENT ADULT

S3020 Hepatitis From a Sexually Transmitted Bacterial Infection

Introduction: Syphilis is a multisystemic, sexually transmitted infection (STI) that is caused by the spirochete Treponema pallidum. Hepatic involvement is rare. We present a patient who was diagnosed with syphilitic hepatitis (SH). Case Description/Methods: A 54-year-old male presented to the hospital with one week of sharp upper abdominal pain, jaundice, poor appetite, and a 25-lb. weight loss. He also reported multiple sexual partners and a rash that developed 2 months ago. Vital signs were within normal range. Physical examination revealed scleral icterus, a soft, non-tender abdomen, a plaque-like penile lesion and small, circular lesions on his palms and soles of feet. Laboratory studies revealed aspartate aminotransferase (AST) 164 U/L, alanine aminotransferase (ALT) 207 U/L, alkaline phosphatase (ALP) 1395 U/L, total bilirubin 5.6 mg/dL, gamma-glutamyl transferase 782 U/L. Hepatitis panel, acetaminophen and alcohol levels were negative. Chronic liver disease work-up was unremarkable. Treponemal antibody and rapid plasma reagin test were both positive. HIV test and cerebrospinal fluid venereal disease research laboratory (VDRL) test were negative. Abdominal ultrasound and CT scan of the abdomen were unremarkable. Magnetic resonance cholangiopancreatography was notable for hepatomegaly and hepatitis. Patient received 1 dose of penicillin G 2.4 million units intramuscularly with remarkable improvement in his symptoms and liver function tests. He was discharged home with close follow-up with gastroenterology and infectious disease. Discussion: SH occurs in 0.2-9.7% of patients with syphilis and is most commonly seen in the primary and secondary disease stages. Clinical manifestations include a maculopapular rash (involving the trunk, palms and/or soles of feet), fatigue, poor appetite, hepatomegaly and icterus. Liver function tests (LFTs) may reveal a marked increase in ALP and GGT in comparison to ALT and AST. SH is diagnosed with abnormal LFTs, serological evidence of syphilis, exclusion of other liver diseases and LFTs returning to normal after antibiotic therapy as in our patient. The histological features of SH include inflammatory infiltration of the bile duct and hepatic granulomas. Spirochetes are often difficult to identify in liver tissue. Penicillin is the mainstay of treatment. Clinicians should consider syphilitic hepatitis in a patient with abnormal LFTs (especially ALP) and a rash involving the palms and soles of feet in the appropriate clinical context.

A CASE OF MICROSCOPIC POLYANGIITIS (MPA) FOLLOWING SARS-COV-2 INFECTION

A CASE OF MICROSCOPIC POLYANGIITIS (MPA) FOLLOWING SARS-COV-2 INFECTION

STOP GOES MY HEART: PERMANENT PACEMAKER IMPLANTATION FOR BRASH SYNDROME-RELATED COMPLETE HEART BLOCK

STOP GOES MY HEART: PERMANENT PACEMAKER IMPLANTATION FOR BRASH SYNDROME-RELATED COMPLETE HEART BLOCK

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

S2072 Microscopic Colitis Induced by KRAS Targeted Therapy, Sotorasib

Introduction: Microscopic colitis is a chronic inflammatory condition in the colon where the patients usually present with chronic non-bloody, watery diarrhea. Colonoscopy usually shows normal mucosa and the diagnosis is established by colon biopsies that show the characteristic submucosal histologic changes. Microscopic colitis has been associated with smoking and different medications such as NSAIDs, PPIs, and SSRIs. We present a case of microscopic colitis that was found to be associated with the KRAS inhibitor, Sotorasib. Case Description/Methods: A 52-year-old non-smoker male with a history of stage IV poorly differentiated lung adenocarcinoma status post radiation and chemotherapy 6 months ago, clostridium difficile diarrhea 6 months ago, and pulmonary embolism on Rivaroxaban. The patient was then started on KRAS targeted therapy with Sotorasrib 960 mg daily given the progression of his carcinoma. One month later, he developed watery diarrhea. PCR stool, including clostridium difficile, was unremarkable. Sotorasib dose was decreased to 480 mg daily and then to 240 mg daily, however; he continued to have severe diarrhea and then was admitted to the hospital. He stated that he had been having 6-8 episodes of loose watery non-bloody stools associated with poor appetite and decreased oral intake. He denied any nausea or vomiting. The patient was started on IV fluids and Imodium while Sotorasib was held. CT abdomen with oral and IV contrast showed stable metastatic right iliopsoas mass and mild colonic wall thickening. Colonoscopy was done and showed grossly normal colonic and rectal mucosa. The cecum, ascending, and sigmoid colon biopsies showed inflammatory granulation tissues consistent with microscopic colitis. Diarrhea significantly improved after discontinuation of Sotorasib. The patient was discharged once his diarrhea resolved which did not recur afterward. Discussion: Sotorasib is an antineoplastic, KRAS inhibitor, which is typically used in advanced non-small-cell lung cancer. Diarrhea has been established as a common side effect (47%) of this medication that can limit its use in the indicated cases. This is the first case report in the literature, up to our knowledge, that shows an association between microscopic colitis and Sotorasib. Understanding the underlying pathophysiology of diarrhea as a limiting side effect of Sotorasib may help the patients to tolerate such medication.

S3246 Streptococcus Anginosus Causing Simultaneous Infections in an Elderly Male: Empyema and Infrahepatic Abscess: Case Report and Literature Review

Introduction: Streptococcus Anginosus is a gram-positive bacterium of the Streptococcus Viridians group. Usually presents as normal flora in the oral cavity and the gastrointestinal tract, S. Anginosus can cause pyogenic infections in multiple organs in the body especially in the immunocompromised host. We present a case of S. Anginosus multiple sites infection in an immunocompetent host that was successfully treated. Case Description/Methods: A 75-year-old male with history of diabetes, coronary artery disease, and heart failure with reduced ejection fraction presented to ER with worsening lower abdominal pain associated with poor appetite and decreased oral intake over 3 weeks. He had cholecystectomy about a year prior to presentation. He was clinically stable on examination with mild right upper quadrant tenderness without rebound. CT abdomen with intravenous contrast showed 10*7 cm low-density fluid collection with mild rim enhancement inferior to the right hepatic lobe. He underwent CT-guided drainage of the infrahepatic collection with removal of 50 cc of purulent material and placement of an intraabdominal drain. Also, a loculated right pleural effusion was noted on CT, and 350 cc of purulent pleural fluid was drained, with analysis compatible with empyema. Both fluid cultures grew S. anginosus. Empirical antibiotics were changed to ceftriaxone, but patient had recurrence of right pleural effusion and required repeat thoracentesis. He gradually improved and completed 6 weeks of Ceftriaxone. Discussion: S. anginosus is a normal flora that can cause infection in any organ. Most of the patients reported to have S. anginosus infection were immunosuppressed by cancer, long term steroid use, diabetes or splenectomy. It is less common for this organism to cause concurrent multiple organs infections. Published cases of simultaneous S. anginosus infection of multiple organs were limited and usually ended in poor prognosis like death or turned out to be the same infection with an anatomic connection between the organs. Our patient had the infrahepatic collection diagnosed first before the right sided pleural effusion enlarged. When the infrahepatic collection was drained, the pleural effusion size did not go down, suggesting lack of connection between both collections. S. anginosus is commonly sensitive to antibiotics. Thus, it is commonly treated with Ceftriaxone. Penicillin-intermediate or resistant S. anginosus is rare comprising < 2% of infections and does not usually lead to treatment failure.

Nutritional Status of Under-Five Children and The Relationship with Household Food Wastage and Food Security in Samarahan, Malaysia

Introduction: Malnutrition is prevalent among children in developing countries. The cause of malnutrition, although complex, can be attributed to demographic factors, household food wastage, and food insecurity. This study aims to determine the under-five nutritional status of children and its association with household food wastage and food security in the Samarahan division in Sarawak, Malaysia. Materials and Methods: This is a cross-sectional study involving 304 children from rural areas of Asajaya and Samarahan District using a random sampling technique. An interviewer-administered questionnaire was used to collect data from the parents. The nutritional status of the children was assessed by anthropometry. IBM SPSS Version 27.0 and WHO Anthro version 3.2.2 were used for data analysis. A p-value &lt; 0.05 was considered statistically significant. Results: Analysis revealed that 9.5% of the children were moderately wasted, followed by 5.9% who were severely wasted; 20.4% were moderately stunted and 8.9% were severely stunted. Hierarchical regression analysis indicated that male gender (AOR = 1.931, 95% CI: 1.139, 3.274; p&lt;0.05), low birth weight (AOR =2.645, 95% CI: 1.245, 5.618, p&lt;0.05), poor appetite (AOR = 2.547; 95% CI: 1.298, 4.995, p&lt;0.05), and preventive attitude (AOR = 0.460, 95% CI: 0.227, 0.929, p &lt; 0.05) of household food wastage appeared to be significant predictors of nutritional status. However, household food insecurity had a negative correlation but did not significantly impact the nutritional status. Conclusion: Under-five malnutrition was prevalent in the study area and still a public health concern. Although the study did not find any significant association between household food wastage and food security towards the nutritional status of children, addressing the nutritional problem warranted an appropriate Public Health approach for the specific group, especially the modifiable risk factors such as birth weights, appetite, and attitude.

S3590 Emphysematous Gastritis

Introduction: Emphysematous gastritis is a rare and severe condition characterized by the presence of air and bacteria in the gastric wall. It usually presents with severe abdominal pain and diagnosed by presence of gas within the gastric wall on imaging. It has a high mortality rate of about 60-80%. Conservative management is the mainstay of treatment. Case Description/Methods: A 36-year-old male with a past medical history of alcohol use disorder and major depressive disorder presented with severe diffuse abdominal pain with post-prandial worsening, intractable nausea, and vomiting. This was preceded by binge drinking of alcohol. He reported poor appetite over one month associated with 17lb weight loss and early satiety. No history of liver disease, peptic ulcer disease, excessive NSAID or aspirin use. He was tachycardic and normotensive. No signs or symptoms of overt GI bleeds. Physical exam was negative for guarding or tenderness. Labs were remarkable for lactic acidosis of 3.6 mmol/L with an anion gap of 21. Lipase and LFTs were normal. CT abdomen showed gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis. General surgery was consulted but recommended no acute surgical intervention. He was started on a clear liquid diet, pantoprazole drip, empiric IV Piperacillin-Tazobactam, pain medications, and IV fluids. EGD showed moderate gastritis, no necrosis, mild duodenitis. Biopsy showed mild chronic gastritis. Patient improved clinically and repeat CT abdomen in 2 days showed improvement in gastric emphysema. He was discharged with a 7-day course of oral Amoxicillin-Clavulanate and indefinite pantoprazole 40mg BID (Figure). Discussion: Emphysematous gastritis starts with disruption of the integrity of gastric mucosa with secondary infection. Isolated organisms include Streptococci, S. Aureus Enterococci, Clostridium, Klebsiella, Pseudomonas, E.Coli, Enterobacter. Ischemia is an inciting event as seen in volvulus, SMA occlusion, acute gastric dilation. Mechanical causes include forceful emesis, gastric outlet obstruction, malignancy, and iatrogenic causes like gastrostomy or NG tube insertion, myotomy and biliary stents. Risk factors are alcohol use, NSAID and steroid use, cytotoxins, diabetes, abdominal surgery, and burns. Optimal conservative management with diet management, IV fluids, antibiotics has good outcomes as demonstrated by the above case and additional recent cases in literature.Figure 1.: A- Gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis B- Significantly decreased air locules along the periphery of the proximal gastric mucosa.

S3633 Metastatic Gastric Adenocarcinoma in 23-Year-Old Female

Introduction: Gastric cancer is the fourth most common malignancy in the USA. Since there are no screening recommendations in place, most gastric cancers are detected at a later stage in the USA. The average age of occurrence of gastric cancer is >40 years. Some of the most common risk factors include Helicobacter pylori infection, atrophic gastritis, ethnicity, and dietary factors. Case Description/Methods: A 23-year-old female with a past medical history of attention deficit hyperactivity disorder presented with complaints of worsening cough and exertional dyspnea for 2 months. The patient also reported experiencing poor appetite, occasional nausea, vomiting, and unintentional weight loss of 10 pounds in 2 months with low back pain. The patient does not smoke cigarettes and drinks alcohol socially. No significant family history. Physical examination was unremarkable. Labs were normal except for mildly elevated ALP. Chest x-ray showed bilateral infiltrates. CT chest showed a miliary pattern of the lung parenchyma with multifocal patchy infiltrates and mediastinal and hilar lymphadenopathy. CT abdomen and pelvis (Figure) showed a calcified mass at the lesser curvature measuring up to 36.4 mm, with mixed attenuation lesion in the left hepatic lobe along with portal, celiac, and retroperitoneal lymphadenopathy; metastatic lesion within the L2 vertebral body with mild superior endplate compression and soft tissue extension to epidural space along with left portal venous thrombosis. Upper GI endoscopy (Figure) showed a large, infiltrative, ulcerated, noncircumferential mass on the lower curvature of the gastric body. Biopsy of the gastric mass revealed infiltrative adenocarcinoma, poorly differentiated with mucous and signet-ring features. Tumor cells were negative for E-cadherin expression and HER-2 immunohistochemical staining and positive for PD-L1 and MYC amplification. The plan was to perform palliative chemotherapy because of the advanced nature of the disease. Discussion: Significant progress has been made in understanding gastric adenocarcinomas, but the pathways leading to the development of gastric cancer are still unclear. As gastric cancer exhibits heterogeneity and molecular expressions, it makes it more difficult to understand. Improvements in micro-array-based gene expression profiling can help us to better delineate the tumor behavior and help us with treatment.Figure 1.: a. CT abdomen - partially calcified gastric mass; b. EGD - A large infiltrative and ulcerated, noncircumferential mass on the lesser curvature of the gastric body; c. & d. Histopathology - H&E stain (20 x): gastric mucosa infiltrated by carcinoma cells with a signet-ring morphology.

S2168 The Use of Rituximab for IgG4–Related Sclerosing Mesenteritis

Introduction: Sclerosing mesenteritis (SM) is an uncommon fibro-inflammatory disease affecting the abdominal mesentery. Although some patients are asymptomatic or have minimal symptoms, SM can present with complications such as bowel obstruction, chylous ascites, and mesenteric ischemia. First-line therapy includes glucocorticoids in combination with tamoxifen in those who are symptomatic. Case Description/Methods: An 82-year-old man with a history of prostate cancer and melanoma in remission and lymphocytic colitis presented with 4-months of poor appetite and 40-pound unintentional weight loss. Computed tomography (CT) abdomen showed an irregular 8.6 cm mesenteric mass with surrounding misty mesentery (Figure, Panel 1). CT-guided biopsy demonstrated fibro-adipose tissue with increased IgG4-positive plasma cells, supporting a diagnosis of IgG4-related SM. Follow-up CT abdomen 6 months later demonstrated enlargement of the mass with new encasement of the jejunal and ileal branches of the superior mesenteric artery and vein. Given impending mesenteric ischemia, he was treated with rituximab, a monoclonal anti-CD20 antibody, with 2 infusions 2 weeks apart without side-effects. He had contraindications to first-line therapy with glucocorticoids given prior suicidal ideation while on budesonide for microscopic colitis. Three months following treatment, his erythrocyte sedimentation rate improved from 52 to 25 (reference range, 3-28 mm/h) and IgG4 level from 851 to 267 (2.4-121 mg/dL). CT abdomen demonstrated a 50% decrease in the volume of the mesenteric mass without significant vascular involvement (Figure, Panel 2) and he had regained 30 pounds. Discussion: Although rituximab has been studied for IgG4-related disease in general, the use of rituximab specifically for IgG4-related SM is not well-known. We report a case of a patient with IgG4-related SM treated effectively with rituximab, suggesting this may be a suitable medication for those who have contraindications or do not respond to current first-line therapy, especially if IgG4-related. Whether this drug would also work in patients with SM not related to IgG4 disease is unknown. Patients treated with rituximab should be closely monitored for infections, as well as allergic and infusion-related reactions.Figure 1.: CT abdomen pelvis of sclerosing mesenteritis before (1) and after (2) rituximab treatment.

Diet variety sup the relationship between appetite and micronutrient intake in patients with heart failure.

Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease the desire to eat a varied diet leading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrient intake have not been investigated in patients with heart failure (HF). The purpose of the study was to determine whether the relationship between appetite and micronutrient insufficiency was mediated through diet variety. A total of 238 patients with HF, mean age 61 ± 12.1; 68% male, and 45% NYHA class III/IV were included in this secondary analysis. Data collection consisted of a 4-day food diary and self-reported appetite on a 10-point visual analogue scale. Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for covariates age, gender, NYHA class, and body mass index showed that diet variety mediated the relationship between appetite and micronutrient insufficiencies [indirect effect = -0.0828, 95% confidence interval (CI): -0.1585 to -0.0150]. There was no direct effect of appetite on micronutrient insufficiency (c´ = -0.1802; 95% CI = -0.3715 to.0111). Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake in patients with HF. More research is needed to validate these associations in patients with HF.

Nutritional Status and Its Determinants among Adult Cancer Patients Undergoing Chemotherapy Treatment at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia.

Background Malnutrition is a common problem in cancer patients. It has an impact on all aspects of the patient's life such as increasing the risk of infection, treatment toxicity, hospital stay, and health-care costs. Factors influencing the nutritional status of adult cancer patients undertaking chemotherapy treatment in Ethiopia have not been thoroughly investigated. As a result, the purpose of this study is to assess the nutritional status and its determinants among adult cancer patients undergoing chemotherapy treatment at Hawassa University Comprehensive Specialized Hospital. Objectives The objective of this study is to determine the nutritional status and its determinants among adult cancer patients undergoing chemotherapy treatment at Hawassa University Comprehensive Specialized Hospital. Methods A cross-sectional study was conducted among adult cancer patients undergoing chemotherapy treatment at Hawassa University Comprehensive Specialized Hospital Oncology Treatment Center, from January to May 2021. The data were gathered through a face-to-face interview and chart review method. Epi Data 4.6 was used to enter the data, which was then exported to SPSS version 25 for statistical analysis. Multivariable logistic regression analysis was used to determine the association between nutritional status and potential risk factors. A P value less than 0.05 was used to determine statistical significance. Result This study revealed that 48.1% of participants have some level of malnutrition. Lowest wealth index AOR 0.06 (0.016–0.2), food insecurity AOR 0.1 (0.05–0.24), vomiting AOR 0.2 (0.110–.444), poor appetite AOR 0.2 (0.11–0.44), no diarrhea AOR 2.6 (1.34–5.00), and poor functioning AOR 0.3 (0.2–0.54) were significantly associated with good nutritional status. Conclusion and Recommendation. The prevalence of malnutrition among adult cancer patients undergoing chemotherapy treatment at HUCSH was high. Wealth index, food security, poor appetite, diarrhea, and performance status were significantly correlated with the nutritional status of the patients. To improve the patient's nutritional status, economic support, early nutritional screening, and assessment, management of chemotherapy-induced symptoms should be considered.

Update from the Clificol Project: Omicron in Hong-Kong and worldwide overview of the pandemic

Background: The Clificol® COVID-19 Support Project is an innovative international data collection project aimed at documenting the presenting symptoms, use of homeopathy through the pandemic and tackling some of the core questions in homeopathy.&#x0D; Aims: The Covid-19 pandemic raised many questions and mobilised many resources. In order to make good use of resources, sound knowledge of the presenting complaints and demographics are required. In particular, we aimed to characterise the recent Omicron wave in Hong-Kong and to get an overall picture of the global pandemic as experienced by the homeopathic community.&#x0D; Methodology: This online multi-national data-collection project is supported by the ECH, ECCH, ICH, HRI, LMHI, and other professional associations. The collected data includes demographic information, severity, conventional diagnosis and treatment, presenting symptoms as well as the remedies prescribed. The outcome of treatment was tracked using the ORIDL scale. More recently a 23-items prospective questionnaire was added to the input in order to gather targeted data about the presenting complaints.&#x0D; Results and discussion: The recent wave of the Omicron variant in Hong-Kong, was analysed (N=372 cases) in terms of the symptomatology of this variant. The data from the 23-items questionnaire is compared to the longer questionnaire (150 items) used by the Hong-Kong team (21 practitioners). The most frequently reported common Clinical symptoms were extreme tiredness (60%), sore throat (46%), headache during fever (45%), dryness of mouth (37%), poor appetite (37%), runny nose (34%) and unusual muscle pains (31%).&#x0D; Also, the cases collected from around the world over the course of the pandemic (N=1300) were analysed, providing an overall picture of the pandemic and its specificities per country and over time.&#x0D; Conclusions: Clificol has shown and continues to show the value of data collection for the homeopathy community, providing important information for the management of future pandemics and opening new avenues for research in homeopathy.