Introduction Several factors influence mortality and survival after hip fracture, including nutritional status, which is associated with both incidence and prognosis. However, there is little evidence on the impact of oral nutritional supplements (ONS) on the survival of these patients, and the available results are mixed. Our aim was to analyze the effect of adherence to ONS treatment on post-hospital mortality, with the hypothesis that this would be lower in an adherent group. Methods Prospective study of patients aged 65 years or older, admitted for fragility hip fracture. Follow-up was carried out at 3, 6 and 12 months to evaluate retrieval of ONS in pharmacies and survival. Adherence was considered if ONS were withdrawn for 3 months or longer. The sample was divided into four groups: (1) well-nourished patients without prescription of ONS, (2) moderately malnourished patients without prescription of ONS, (3) moderate or severely malnourished patients with prescription of ONS but without adherence, and (4) moderately or severely malnourished patients with prescription of ONS and adherence. Mortality between groups was compared by means of a Cox regression, adjusted for confounding variables. Results 300 patients were included (mean age 82.9 years; 79.3% female), with severe malnutrition in 19.7%. Non-adherent malnourished patients showed a significantly higher risk of death than adherent malnourished patients (HR = 3.67; 95% CI: 1.41–9.57; p = 0.008). Non-adherent malnourished patients had a significantly higher risk of death compared to well-nourished patients (HR = 2.95; 95% CI: 1.31–6.65; p = 0.009). Malnourished patients without ONS had a non-significant higher mortality risk than well-nourished patients (HR = 1.66; 95% CI: 0.72–3.84, p = 0.236). Adherent malnourished patients showed a non-significant trend toward lower mortality than well-nourished patients (HR = 0.80; 95% CI: 0.25–2.56; p = 0.712). Conclusion In our study, 3-month adherence to ONS is associated with a reduction in 3, 6 and 12-month mortality in older patients with a hip fracture when compared to non-adherent patients and shows a trend toward an improved survival rate than that of well-nourished patients.

Promising effects of topical sunflower seed oil, rich in linoleic acid, in infants with severe acute malnutrition.

Friedreich's ataxia (FA) is a rare autosomal recessive neurodegenerative disorder. Although FA is frequently associated with cardiomyopathy and diabetes mellitus, its coexistence with solid malignancies is exceptionally rare. To date, only a limited number of gastrointestinal cancers have been reported in patients with FA. This case report presents the first documented occurrence of esophageal squamous cell carcinoma (ESCC) in a genetically confirmed FA patient, highlighting the diagnostic challenges and therapeutic considerations encountered in this unique clinical setting. A 48-year-old Iranian man with a 29-year history of Friedreich's ataxia presented with an 8-month history of progressive dysphagia, recurrent hematemesis, and recent onset of complete aphagia. On examination, he was cachectic and exhibited severe alopecia, kyphoscoliosis, dysarthria, and a non-ambulatory status. Laboratory evaluation demonstrated profound anemia and elevated alkaline phosphatase levels. Upper gastrointestinal endoscopy revealed a circumferential, obstructing mass in the mid-esophagus, and histopathological analysis confirmed moderately differentiated ESCC. Given the patient's advanced frailty, underlying cardiomyopathy, and severe malnutrition, curative chemoradiotherapy was deemed contraindicated. Palliative management included blood transfusion, nasogastric decompression, and placement of an esophageal stent. Despite these supportive interventions, the patient experienced hemodynamic instability and progressive neurological deterioration, ultimately succumbing to disease progression.

Background: Armed conflict creates a biological trap where acute malnutrition and chronic non-communicable diseases (NCDs) coexist and reinforce one another. Sixty-five percent of the world’s acutely food-insecure individuals live in conflict zones, facing dual burdens such as Gaza’s 150% surge in severe acute malnutrition (SAM) and Sudan’s 43% hypertension prevalence among displaced adults. This nexus is mediated through epigenetic reprogramming, microbiome collapse, and accelerated aging. The objective of this study was to evaluate how biologically, culturally, and life-stage-adapted precision nutrition strategies can address malnutrition and related infectious and NCD risks in conflict-affected populations. Methods: We synthesized literature on conflict-related malnutrition–NCD pathways and applied a precision nutrition framework to four case studies (Gaza, Sudan, Yemen, and Ukraine), emphasizing: • Biological tailoring (eg, micronutrient/gene screening); • Cultural adaptation (eg, moringa-based ready-to-use therapeutic foods [RUTF]); • Life-stage targeting (eg, prenatal epigenetic interventions). Results: Precision nutrition interventions demonstrated measurable benefits: • In Gaza, RUTF with water purification reduced diarrhea by 40% (95% confidence interval [CI]: 32%–48%), enhancing SAM recovery. • In Sudan, plant sterol-enriched rations lowered low-density lipoprotein [LDL] cholesterol by 12% (95% CI: 9%–15%) in famine survivors with cardiovascular risk. • In Yemen, FUT2-guided vitamin A supplementation reduced cholera incidence by 45% (95% CI: 37%–52%). • In Ukraine, a tele-nutrition and dietary approaches to stop hypertension [DASH]-diet voucher program reduced hypertension crises by 52% (95% CI: 45%–58%). Conclusion: Available evidence supports the potential role of precision nutrition in helping to alleviate the starvation–disease–trauma cycle in conflict-affected populations.

Impact of oral nutritional support adherence on muscle strength, body composition, and general health status in gastrointestinal cancer patients: ONMUS study.

Diffuse Reticulate Purpura in an Adolescent Female With Anorexia Nervosa: A Case Report.

Background and Clinical Significance: Celiac disease (CD) is a gluten-triggered immune enteropathy that may rarely present as Celiac crisis (CC), a life-threatening condition marked by severe diarrhea, dehydration, metabolic derangements, and acute malnutrition. Pediatric diagnostic criteria are lacking, and despite its reduced incidence in high-income countries, CC remains a critical complication, potentially associated with refeeding syndrome. Case Presentation: We report the case of a 23-month-old girl presenting with chronic diarrhea, weight loss, iron-deficiency anemia, hypoalbuminemia, and coagulation abnormalities. Serology confirmed CD, and a gluten-free diet (GFD) was initiated. However, the patient experienced clinical deterioration consistent with CC. Her course was further complicated by refeeding syndrome, ileo-ileal intussusception, and deep vein thrombosis, requiring corticosteroids, anticoagulation, and multidisciplinary nutritional support. Full clinical recovery was achieved within two months. Conclusions: This case highlights the life-threatening potential of CC and the necessity for early recognition. Timely GFD initiation, correction of metabolic abnormalities, and monitoring for refeeding syndrome are essential. We propose pediatric-adapted diagnostic criteria to facilitate earlier recognition and standardize the management of CC. The proposed framework includes major and minor criteria based on the rapid onset of gastrointestinal symptoms with serological evidence of CD autoimmunity, accompanied by clinical instability requiring hospitalization or intensive support and multiple indicators of systemic compromise.

Surgical site infections (SSIs), including periprosthetic joint infections (PJIs), represent significant complications following total joint arthroplasty (TJA). The geriatric nutritional risk index (GNRI) serves as an objective measure of nutritional status; however, its predictive value for postoperative infections in TJA patients remains ambiguous. To address this issue, a meta-analysis was conducted alongside a systematic search of PubMed, Embase, and Web of Science. Observational studies that assessed the relationship between preoperative GNRI and postoperative SSI or PJI following TJA were included in the analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were synthesized using random-effects models to account for heterogeneity.Seven retrospective cohort studies comprising 221,810 patients were analyzed. The results indicated that a low GNRI, which suggests malnutrition, is significantly associated with an increased risk of SSI after TJA (OR = 1.59; 95% CI 1.21-2.08; I² = 81%; p< 0.001). This association persisted across both primary and revision procedures (OR = 1.52 vs. 1.65; p= 0.76) and within 30-day and 90-day follow-ups (OR = 1.58 vs. 1.56; p= 0.98). A more pronounced correlation was found in patients with severe malnutrition (GNRI < 92) compared to those with moderate risk (GNRI: 92-98; OR = 2.18 vs. 1.25; p< 0.001). Although a similar trend was observed for PJI (OR = 2.37; 95% CI 0.73-7.72; p= 0.15), this finding was based on only two studies (three datasets) and remains uncertain.Evidence regarding shoulder arthroplasty was limited; however, existing data suggested trends similar to those seen in hip and knee arthroplasty. In conclusion, preoperative malnutrition, as indicated by a low GNRI, may be associated with an elevated risk of SSIs following TJA.

Background: Permanent pacemaker implantation in pediatric patients with severe malnutrition presents a unique surgical challenge due to the absence of a viable subcutaneous protective envelope. In this population, standard device fixation frequently results in recurrent wound dehiscence and device extrusion, often necessitating lead abandonment or epicardial placement. This study evaluates the efficacy of a dual-modality salvage technique integrating a Polytetrafluoroethylene (PTFE) mesh barrier with vascularized fasciocutaneous tissue coverage. Case presentation: We present the case of a 3-year-old male with congenital complete atrioventricular block and severe acute malnutrition, defined by a Weight-for-Height Z-score of less than -3 SD. The clinical course was complicated by three consecutive implant failures over an 8-month period, including two thoracic and one abdominal extrusion, characterized by aseptic pressure necrosis. To salvage the cardiac hardware, a novel sealed-device technique was employed. The pulse generator was encapsulated in a non-absorbable PTFE mesh to minimize the coefficient of friction and placed in a sub-fascial plane. Simultaneously, a random-pattern fasciocutaneous rotation flap was harvested to provide robust, vascularized coverage. Biochemical analysis revealed severe hypoalbuminemia (2.1 g/dL) and anemia pre-operatively. Conclusion: At the 12-month follow-up, the surgical site demonstrated complete physiological integrity with no recurrence of erosion, seroma, or infection. The combination of PTFE encapsulation to mitigate mechanical shearing forces and a fasciocutaneous flap to restore perfusion offers a durable salvage strategy for refractory device extrusion in cachectic pediatric patients.

Gut microbial diversity impacts carbohydrate fermentation by children with severe acute malnutrition.

Plant-based milk alternatives (PBMA) are increasingly being consumed as a supplement to or replacement for cow's milk, even in infancy and childhood. Their effects on later health and growth have been insufficiently studied. We analyze the available evidence concerning the effects of PBMA consumption on health and growth in infants, children, and adolescents. This review is based on publications retrieved by a structured literature search on health and growth outcomes of PBMA consumption in infancy, childhood, and adolescence. Comparative cross-sectional and [das ist so genau richtig, "or" wäre dagegen nicht idiomatisch; inhaltlich versteht man hier als Leser:in "oder"] cohort studies have shown that the intake of nutrients typically found in cow's milk, such as iodine, is lower with exclusive consumption of PBMA. Even the partial replacement of cow's milk by PBMA is associated with reduced linear growth and a lower body-mass index (BMI). The height-for-age z-score was -0.04 [-0.07; -0.01] and the BMI-for-age z-score was -0.06 [-0.09; -0.03] for each cup of PBMA in five-year-olds, corresponding to reductions of 0.2 cm in height and 0.1 kg in weight. There have been case reports of severe malnutrition and undernutrition from the exclusive or predominant consumption of PBMA, mainly in the first two years of life, but the informational value of these reports is limited. Our search did not retrieve any longitudinal studies on long-term outcomes or any randomized intervention trials comparing the consumption of cow's milk and PBMA. High PBMA consumption in early life may increase the risk of health impairment. The low methodological quality of the available evidence, along with residual confounding, makes the risk hard to quantify [hier haben Sie im Deutschen die Aussage geändert, aber beide müssen sich entsprechen, d.h. hier: "impossible to quantify"?]. Recommendations regarding PBMA consumption must be differentiated by life phase. Age-related special nutritional requirements must be met, and this is particularly important in early life. More research on long-term outcomes is needed.

Assessing mortality risk in pulmonary tuberculosis and severe malnutrition: development of the IIR marker via artificial intelligence.

Bronchiolitis obliterans (BO) is a rare, chronic obstructive airway disease affecting infants and children, often occurring after severe lower respiratory tract infections. We describe the case of a 5-month-old male who experienced recurrent severe pneumonia, a prolonged stay in the pediatric intensive care unit, and ongoing respiratory distress. His condition was complicated by Stage II hypertension, severe acute malnutrition, moderate anemia, and global developmental delay. Serial high-resolution computed tomography scans revealed progressive bilateral ground-glass opacities, consolidations, and bronchiectatic changes consistent with post-infectious BO. The patient required extended mechanical ventilation, long-term supplemental oxygen, multiple courses of antibiotics, antivirals, corticosteroids, and antihypertensive medications. This case emphasizes the diagnostic challenges and complex multidisciplinary management of BO in infancy.

Child mortality is a critical global health indicator, reflecting a nation's development and healthcare quality. Despite significant progress in reducing child mortality globally, Somalia continues to experience high rates, particularly among infants and young children, due to preventable and treatable conditions. Malnutrition, birth complications and infectious diseases are the leading causes of death. To assess and analyse the trends in pediatric mortality over the past 2 years at a national referral hospital in Mogadishu, Somalia. This retrospective cross-sectional study, conducted in the pediatric Department of Banadir Hospital in Mogadishu, Somalia, reviewed records of 1513 pediatric deaths during the study period, of which 70 were excluded due to incomplete records, leaving 1443 cases that met the inclusion criteria for analysis. The overall pediatric mortality rate during the study period was 5.3%. Male children accounted for 56.5% of deaths, whereas females represented 43.5%. Infants under 1 year were disproportionately affected, contributing to most deaths. The primary causes of death were severe acute malnutrition (29.04%), birth asphyxia (10.33%) and preterm (13.65%). The majority of deaths occurred within the first 24 h after admission and between 2 and 5 days of hospitalisation. Significant associations were found between the age of the child and the cause of death (χ2 = 537.485, p < 0.001). Additionally, there were significant associations between the year of death and the age of the child (χ2 = 17.669, p < 0.001), as well as the number of deaths in children per year (χ2 = 89.057, p < 0.001). The leading cause of pediatric death was SAM, followed by prematurity and birth asphyxia. Most deaths occurred within the first 24 h of hospital admission. Nationwide, multi-centre studies and interventions are highly recommended.

Background: Severe Acute Malnutrition (SAM), characterised by an extremely low weight-for-height or length, represents a significant health challenge in Somalia, where complex crises contribute to elevated mortality rates among children under five years of age. Objective: To estimate the median recovery time and assess treatment outcomes for children aged 6-59 months with SAM admitted to Gardo General Hospital in Gardo, Puntland, Somalia. Methods: An institutional-based retrospective cohort study was conducted from July 2023 to July 2025. The study employed data collected from the children's inquiry data form of a systematically random selected sample of 250 children. Data entry was performed using the KOBO Toolbox and subsequently exported to R Programming version 4.4.0 for analysis. Descriptive statistics were utilised to examine demographic and care-related characteristics, anthropometric and complication-related characteristics. Survival curves, such as Kaplan-Meier curves, were generated to estimate the median recovery time from Severe Acute Malnutrition (SAM). Results: The findings of this study indicated that 239(95.6%) children achieved successful treatment outcomes, 4(1.6%) children were transferred out, 4(1.6%) defaulted on their treatment, and 2 children (0.8%) remained in the program during the study period. Unfortunately, there was one recorded fatality, accounting for 1(0.4%) of the cases. Conclusion: This study found a median recovery time of 9 days and a 95.6% recovery rate for children aged 6 to 59 months with Severe Acute Malnutrition (SAM) at Gardo General Hospital.

Understanding the rates and determinants of severe acute malnutrition (SAM) relapse is crucial for stakeholders in Somalia, where evidence is limited. This study aimed to assess SAM relapse rates and associated risk factors among children discharged from outpatient therapeutic programmes (OTP) in the Bay and Hiran regions of Somalia. We conducted a prospective cohort study of 160 children aged 7-53 months discharged as recovered from OTP SAM treatment between August-September 2023. Children were followed monthly for six time points post-discharge. Anthropometric measurements, morbidity data, and household information were collected. Survival analysis was used to calculate cumulative incidence of SAM relapse, defined by weight-for-height z-score (WHZ)<-3 standard deviation (SD) or mid-upper arm circumference (MUAC)<11.5 cm or oedema. Cox proportional hazard models identified factors associated with relapse. Cumulative incidence of SAM relapse at Time 1 (T1) = 5.2% (95% confidence interval (CI) = 2.5, 10.6%), T2 = 14.3% (95% CI = 9.4, 21.5%) and T6 = 26.0% (95% CI = 19.3, 34.5%) by WHZ and 13.2% (95% CI = 8.8, 19.5%) by MUAC. The relapse rate for combined SAM and moderate acute malnutrition by WHZ at T1 = 26.9% (95% CI = 19.5, 36.3%), T2 = 36.2% (95% CI = 28.0, 46.1%) and T6 = 50.1% (95% CI = 41.0, 60.0%). Weight-for-height z-score (WHZ)-based relapse was higher in rural areas (31.4% vs. 22.7% urban, P = 0.285) and among children with WHZ<-3 SD at admission (37.4% vs. 21.2%, P = 0.029). Mid-upper arm circumference (MUAC)-based relapse was higher in urban areas (20.8% vs. 4.1% rural, P = 0.002), among younger children (19.7% vs. 5.5% > 2 years, P = 0.009), and internally displaced persons (21.8% vs. 5.8% non-internally displaced persons, P = 0.003). Factors significantly associated with increased relapse risk included WHZ<-3 SD at admission (adjusted hazard ratio (HR) = 2.22; 95% CI = 1.04, 4.72) and longer OTP stay (adjusted HR = 1.02 per day; 95% CI = 1.00, 1.04). Participation in a cash assistance programme was protective (adjusted HR = 0.44; 95% CI = 0.22, 0.90). Severe acute malnutrition (SAM) relapse rates in Somalia are considerable, with varying patterns by anthropometric indicator, region, and demographic factors. Cash assistance programme offers a promising complementary intervention. These findings can inform targeted interventions and policy changes to reduce relapse and improve long-term outcomes for children recovering from SAM in Somalia and similar contexts. The cluster-RCT associated with this cohort study is registered at ClinicalTrials.gov, ID: NCT06642012.

To identify symptom clusters (SCs) of nasopharyngeal carcinoma (NPC) patients during radiotherapy and examine the relative importance of specific symptoms in relation to quality of life (QoL). This cross-sectional study recruited non-metastatic NPC patients undergoing radiotherapy at Sun Yat-sen University Cancer Center (August 23-24, 2023). Acute toxicities, malnutrition, and QoL were assessed using the patient-reported outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), modified Patient-Generated Subjective Global Assessment (mPG-SGA), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35 (EORTC QLQ-H&N35), respectively. Exploratory factor analysis and network analysis were used to identify SCs and characterize central and bridge symptoms. Multivariable logistic regression was conducted to explore factors associated with QoL. A total of 437 eligible patients (73.46% male; median [IQR] age, 47 [38-55]) were included. Most patients reported ≥ 5 acute toxicities (88.56%) and severe malnutrition (75.06%). Three SCs (corresponding central symptoms) were identified from 18 prevalent items of PRO-CTCAE: general SC (anxiety), head-neck SC (dysphagia), and gastrointestinal SC (nausea). Malnutrition showed high bridge connectivity across SCs. The network remained relatively stable across early and late radiotherapy phases. Among multiple variables examined, the head-neck SC showed the strongest association with poorer QoL (β = 1.805, P < 0.001). NPC patients experience multiple co-occurring symptoms that organize into distinct clusters associated with QoL throughout radiotherapy. Dysphagia in head-neck SC and malnutrition deserve to be priorities for early management to relieve the global network burdens.

Sub-Saharan Africa bears the highest burden of diarrhea, often complicated by comorbidities that delay diagnosis, hinder treatment, and worsen outcomes. As the epidemiology of diarrheal disease evolves, understanding comorbidity patterns is critical for effective public health responses. We examined the temporal patterns and risk factors of diarrheal comorbidity in Kenyan children aged < 5. We conducted secondary pooled analysis with a retrospective cohort design leveraging data from the Global Enteric Multicenter Study (GEMS, 2008-2012), the Vaccine Impact on Diarrhea in Africa (VIDA, 2015-2018), the Enteric for Global Health (EFGH) Shigella surveillance study (2022-2024). The outcome was comorbidity count, defined by Integrated Management of Childhood Illnesses case definitions and clinician diagnoses of ten conditions: malaria, bacterial infection, pneumonia, severe acute malnutrition (SAM), meningitis, acute febrile illness (AFI), respiratory Illness (non-pneumonia), anemia, stunting and wasting. Temporal trends were assessed using descriptive statistics and the Cochran-Armitage trend test. Risk factors were identified using generalized estimating equations with a Poisson distribution, adjusting for clustering. We analyzed data from 4,148 children with moderate-to-severe diarrhea; 90.3% had ≥ one comorbidity, with a declining trend across studies: GEMS (92.9%), VIDA (89.3%), and EFGH (86.6%). Pneumonia (49.5%), malaria (48.3%), and stunting (24.7%) were most common comorbidities. The proportion of children with only one comorbidity increased (28.9% [2008] to 49.7% [2024]), while multiple comorbidities declined. Traditional comorbidities (malaria, pneumonia, wasting, SAM) significantly decreased, while AFI, anemia, and non-pneumonia respiratory illness increased. Multivariable analysis identified older age, lower caregiver education, dehydration, vomiting, 3-month lagged rainfall and temperature, and high respiratory rate as drivers of higher comorbidity counts, while female sex was associated with fewer comorbidities. Despite the high prevalence, we observed a 20-23% decline in comorbidity burden and a fundamental shift in disease profiles. Our findings support the need for a shift from single-disease control to integrated disease management.

Factors associated with treatment outcomes of severe acute malnutrition among under five children admitted at Queen Elizabeth Central Hospital (QECH) nutrition unit: a retrospective cross-sectional study.

Infantile Tremor Syndrome (ITS) is a rare neuro-nutritional disorder observed in young children, characterized by tremors, malnutrition, and developmental regression. This case report details a 4-year-old female patient weighing 5.2 kg, who was admitted due to recurrent vomiting, refusal to consume solid food, and progressive skin peeling. A physical examination revealed hyperpigmented patches, exfoliation, and erosions on the scalp, trunk, and extremities, along with mucosal lesions indicative of zinc deficiency. Developmental assessment indicated delayed milestones, such as poor neck control and an inability to stand or walk, suggesting the presence of coexisting cerebral palsy. The patient was diagnosed with ITS complicated by severe malnutrition and dermatological symptoms resembling acrodermatitis enteropathica. Management strategies included nutritional rehabilitation utilizing an F-75 diet, supplementation with zinc and multivitamins, antifungal treatment (fluconazole syrup), topical mupirocin for skin protection, and ophthalmic intervention for corneal opacity. Significant clinical improvement was noted following supplementation and supportive care. This case underscores the necessity of early identification, thorough nutritional evaluation, and multidisciplinary management-including pharmacological, dietary, and counseling interventions—for children with ITS. Pharmacists are crucial in ensuring the appropriateness of drug therapy, preventing drug-nutrient interactions, and educating caregivers for long-term disease prevention and nutritional recovery. Early detection and integrated management are vital for enhancing outcomes in ITS and preventing recurrence.