Severe Protein-energy Malnutrition Research Articles

Description of Energy, Protein, Iron and Folic Acid Intake in Pregnant Women Protein Energy Malnutrition at Sobo Health Center Banyuwangi City

Protein Energy Malnutrition (PEM) is one of the prevailing nutritional issues in Indonesia. Dietary intake is a crucial factor related to malnutrition in pregnant women, with the common impact being Low Birth Weight (LBW) of babies. This research examines the intake of energy, protein, iron, and folate among pregnant women with PEM in the working area of Sobo Health Center, Banyuwangi City. The study is descriptive in nature and involves 15 pregnant women with PEM from the Sobo Health Center area as respondents. Data collection involved filling out personal sheets, measuring upper arm circumference using a LiLA tape, and conducting 2x24-hour food recall interviews. Descriptive analysis was performed using frequency distribution tables generated by the SPSS program. The research findings indicate that among pregnant women with severe energy deficiency PEM, all 15 individuals (100%) had severe energy deficit, 7 individuals (46.7%) had severe protein deficit, and all 15 individuals (100%) had insufficient dietary intake to meet their nutritional needs during pregnancy.

Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting.

Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases. The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms' severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response. Implementing multidisciplinary therapeutic interventions significantly improved the patient's nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach. This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.

Nutritional support in rehabilitation of victims with severe combined trauma

To evaluate the clinical and rehabilitation effectiveness of the protein module (Fresubin Protein) in therapeutic nutrition in patients with severe combined injury (polytrauma) at the rehabilitation stage in a specialized department (neurosurgery). We examined 43 victims who received a combined injury that required treatment in the intensive care unit with subsequent transfer to a specialized department (neurosurgery). At the stage of treatment and rehabilitation in the specialized department, we assessed the biochemical parameters of carbohydrate, fat and protein metabolism, body composition, as well as energy metabolism using indirect calorimetry, and the functional state of the gastrointestinal tract. In the comparison group, patients received a standard diet at the rate of 30 kcal/kg BW. The main group received a standard diet (30 kcal/kg BW) with the addition of a protein module (0.8 g/kg BW) to the diet as an additional source of protein. In both observation groups, moderate to severe protein-energy malnutrition was diagnosed before the study (decreased total protein level - 50.63±1.3 g/l, albumin - 27.97±0.95 g/l, transferrin - 1.33±0.9 g/l). Anthropometric parameters (BMI=17.1±1.2 kg/m2, BMD=20.15±1.5 cm, OP=22.2±1.1 cm, TKFST=8.4±0.5 cm) indicated a deficiency of the somatic protein pool, lean and fat body mass. No pronounced disorders of carbohydrate and fat metabolism were noted. A correlation was found between the dynamics of protein metabolism and the inflammatory process parameters (CRP, white blood cell count, r=-0.79, p=0.001). Against the background of nutritional support with the inclusion of a protein module in the diet, by the 21st day, patients of the main group showed a reliable (p<0.05) normalization of protein metabolism parameters, an increase in lean body mass. The results of the studies indicate that in victims with severe combined trauma, upon admission to the treatment and rehabilitation stage in a specialized department, despite the intensive care provided in the intensive care unit, moderate to severe protein-energy malnutrition with severe protein metabolism disorders is diagnosed. This is manifested by a decrease in the concentration of total protein, albumin, transferrin, and somatic protein pool. Low lean mass values indicate a deficiency of the protein component of nutritional support, a decrease in lean and muscle mass. The consequence of which is a limitation of the volume of rehabilitation, an increased risk of complications. The identified protein deficiency dictates the need to increase the protein component of therapeutic nutrition. Inclusion of a protein module in the therapeutic nutrition program at the rate of 0.8 g/kg of body weight ensures adequate correction of protein metabolism disorders, overall nutritional status in severe combined injury and creates the prerequisites for increasing the effectiveness of rehabilitation measures.

IBC-Oxford University2023_BJSPoster_14Short-Term Outcomes of Single-Anastomosis Sleeve-Ileal Bypass (SASI)

Abstract Background The SASI bypass, which is a simplified version of sleeve gastrectomy with transit bipartition, is based on the same metabolic principles, particularly the early postprandial ileal brake. Compared to SASI bypass, sleeve gastrectomy offers advantages such as shorter operation time and lower incidence of internal herniation. The aim of this study was to assess the safety and outcomes of SASI bypass over a 3-year follow-up period. Methods A retrospective study was conducted on all patients who underwent SASI bypass between January 2018 and June 2023. The primary endpoints were weight loss and diabetic remission. Results A total of 54 patients, with a mean age of 39,4 ± 15 years and a mean body mass index of 38,5 ± 6,8 kg/m2, underwent SASI bypass. There was no significant early postoperative complications. At the end of the first year, the average percentage of excess weight loss (%EWL) was 82,6 ± 7,4, and the rate of diabetic remission was 96,1 %. After 3 years, the %EWL was 97,4 ± 4,1, and the diabetic remission rate was 98,8%. Severe protein-energy malnutrition occurred in 4 patients(7,4%), and reversal of the bypass were made in 3 of 4 patients. Technical variations did not significantly affect %EWL or diabetic remission. Conclusion SASI bypass demonstrated promising outcomes in terms of 3-year %EWL and diabetic remission. While the double-outlet for gastric content allows access to the duodenum, it may hinder the standardization of postoperative care. Furthermore, the presence of a double-outlet does not guarantee the absence of malnutrition.

PREVALENCE AND DETERMINANTS OF PROTEIN-ENERGY MALNUTRITION (PEM) AMONG CHILDREN UNDER 5 YEARS OF AGE IN A RURAL COMMUNITY OF LAHORE

Malnutrition refers to an inadequate supply of nutrients and energy to the body cells, compared to the body's requirements for maintaining growth and ensuring daily functions. It is a major health burden in developing countries and can be categorized as under-nutrition and over-nutrition. This study aimed to determine the prevalence and determinants of Protein Energy Malnutrition (PEM) among children under 5 years of age in a rural community of Lahore. A quantitative descriptive cross-sectional study was conducted in the Lakhodair community of Lahore. A sample of 150 married females participated in the study, and a purposive sampling was used to collect data. The results revealed that 43% of the participants were male mothers, and 57% were female. PEM was categorized as mild, moderate, and severe. Severe PEM was noted in children under the age of 5 years in this Lakhodair community, with an incidence rate of 4.22%. It was concluded that the prevalence rate of PEM among children under 5 years of age in a rural community of Lahore was 4.22%. Protein Energy Malnutrition (PEM) determinants include protein and carbohydrate intake, housing and environmental status, father and mother's education and occupation, monthly income, socio-economic factors, dietary habits, family size, and anthropometric measures.

A clinical case of late manifestation of celiac disease concurrent with another autoimmune disease

Celiac disease is a genetically determined disease with its onset in childhood. In November 2021, a 51-year-old female patient was admitted to the Gastroenterology Department with complaints with diarrhea 5 times daily and severe protein-energy malnutrition by the type of senile kwashiorkor. Analysis of her history indicated that in March 2021, the patient took amoxicilline 500 mg twice daily, as prescribed by the local therapist, for 2 weeks, whereupon she noted the appearance of diarrhea that lasted for a month. Moreover, antibiotic-associated diarrhea was ruled out. A celiac-disease-specific histological pattern of the small bowel mucosa was revealed (the ratio of villus height to crypt depth was 1:1), as well as the titer of antibodies to recombinant tissue transglutaminase-2 IgA class &gt;210 U/ml. This could establish a diagnosis of symptomatic celiac disease. During the gluten-free diet, the stool returned to normal; the body weight gradually began to increase. The persistent severe condition in the patient, hypokalemia, skin bronze hue, low aldosterone levels could diagnose primary hypoaldosteronism. Liver biopsy could diagnose small duct primary sclerosing cholangitis. Thus, it is important to note that the onset of celiac disease may occur may occur in people over 50 years of age; whereas primary hypoaldosteronism and primary sclerosing cholangitis may be associated with celiac disease and have a common autoimmune origin.

Тяжелое течение целиакии, осложненной стрессовой гипергликемией

This article presents a clinical case of lately diagnosed celiac disease complicated by stress-induced hyperglycemia. A 2-yearold patient was admitted to the intensive care unit of the Republican Specialized Scientific and Practical Medical Center of Pediatrics with severe protein-energy malnutrition, lethargy, abdominal bloating, and constipation. On admission, the child had hypoproteinemia, hypoalbuminemia, blood glucose levels up to 11.7 mmol/L, and anemia. On the third day of illness, blood glucose levels reached 16 mmol/L, which was considered as stress-induced hyperglycemia. Glucose levels were reduced by insulin injections on day 9. Celiac disease was suspected based on complaints, anamnestic, clinical and laboratory findings. Examination revealed elevated levels of IgA antibodies to tissue transglutaminase, exceeding the reference values 15 times. Genetic study confirmed the presence of predisposition to the disease. Catamnestic follow-up demonstrated a positive effect of a gluten-free diet. This is the first description of a typical form of celiac disease with late diagnosis and complications such as stress-induced hyperglycemia, respiratory failure, protein-energy malnutrition, and protein-losing enteropathy. Early diagnosis is very important to prevent long-term complications. Key words: children, malabsorption, celiac disease, stress hyperglycemia, protein-losing enteropathy

Impact of Early Childhood Malnutrition on Adult Brain Function: An Evoked-Related Potentials Study.

More than 200 million children under the age of 5 years are affected by malnutrition worldwide according to the World Health Organization. The Barbados Nutrition Study (BNS) is a 55-year longitudinal study on a Barbadian cohort with histories of moderate to severe protein-energy malnutrition (PEM) limited to the first year of life and a healthy comparison group. Using quantitative electroencephalography (EEG), differences in brain function during childhood (lower alpha1 activity and higher theta, alpha2 and beta activity) have previously been highlighted between participants who suffered from early PEM and controls. In order to determine whether similar differences persisted into adulthood, our current study used recordings obtained during a Go-No-Go task in a subsample of the original BNS cohort [population size (N) = 53] at ages 45–51 years. We found that previously malnourished adults [sample size (n) = 24] had a higher rate of omission errors on the task relative to controls (n = 29). Evoked-Related Potentials (ERP) were significantly different in participants with histories of early PEM, who presented with lower N2 amplitudes. These findings are typically associated with impaired conflict monitoring and/or attention deficits and may therefore be linked to the attentional and executive function deficits that have been previously reported in this cohort in childhood and again in middle adulthood.

Revisional Surgery of One Anastomosis Gastric Bypass for Severe Protein-Energy Malnutrition.

Background: One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein–energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM. Methods: This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015–2021). Perioperative data and outcomes were retrieved. Results: Ten patients underwent revision for severe PEM. Our center’s incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal (n = 5), BPL shortening (n = 3), and conversion to Roux-en-Y gastric bypass (RYGB) (n = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m2 (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m2 and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening. Conclusions: Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option.

Medical Nutrition Therapy in Confirmed Covid-19 With Cervical Carcinoma on Chemotherapy and Severe Protein Energy Malnutrition Marasmus Type: A Case Report

ObjectivesThis report aims to help develop more effective rational treatment strategies for Severe Protein Energy Malnutrition marasmus type, confirmed Covid-19 and Carcinoma Cervical on Chemotherapy. These patients have hyperinflammation characterized by high levels of pro-inflammatory cytokines, particularly Interleukin (IL)-6, and other acute-phase proteins, including creative protein (CRP), fibrinogen, and ferritin that correlate with impaired T-cell response in women, with epithelial cervical carcinoma advanced stage.Methods32-year-old woman with Severe Protein Energy Malnutrition body mass index 12.44 kg/m2 with a history of cervical carcinoma stage III and confirmed with covid 19. Oral food intake decreased due to nausea and stomach fullness. The patient showed loss of subcutaneous fat, wasting in all extremities and edema on the dorsum pedis. Laboratory results found Normochromic Normocytic Anemia 10.4, Leukocytosis 20.200, Severe Depletion of the Immune System (404), moderate hypoalbuminemia 2.5 and moderate hyponatremia 125.9. The patient had undergone chemotherapy in 2 cycles due to cervical carcinoma.ResultsMedical nutrition therapy was given with total energy expenditure of 1600 Kcal and increased gradually to 2100 kcal, Protein 1.5 g/Ideal Body Weight/day 19% using high protein formula, carbohydrates 50% and 31% of fat. To improve the immune system and antioxidants, supplementation was given in the form of Zivit ZincR, Hi-DR 5000 IU, curcuma extract, Vitamin C and PujiminR. After 8 days of treatment, the results of oral food intake reached the target of 1600 kcal (100%) accompanied by clinical and laboratory improvements. In addition, there was an increase in handgrip strength from 8.2 to 9.7 during 8 days of treatment indicating an improvement in the patient's physical function during nutritional treatment and a moderate post Covid-19 diagnosis.ConclusionsCervical cancer patients who are infected with the Sars Cov2 virus will further worsen the patient's condition, both in terms of clinical, metabolic and immune system depletion so that they are vulnerable to death. Adequate nutrition will facilitate the healing process and avoid worsening malnutrition.Funding SourcesInstitution from Department of Nutrition, Faculty of Medicine, Hasanuddin University

Квашиоркор: патофизиологические аспекты и пути решения проблемы

Kwashiorkor is a form of severe protein-energy malnutrition known since 1995. It is observed worldwide in regions with high levels of hunger and poverty, especially where the diet consists primarily of carbohydrate-rich foods. This pathology has been reported among hundreds of thousands of children in the world. The clinical presentation of kwashiorkor resembles the symptoms of essential amino acid deficiency, which suggests that not only protein malnutrition, but also disorders of the methionine cycle take part in the pathogenesis of the disease. The study of capillary ultrastructure has shown that edema is the result of increased permeability of microvessels to protein macromolecules, including albumin. Plasma proteins are usually retained in the intravascular space by the endothelial glycocalyx, damage to which leads to edema. Oxidative stress contributes to lower levels of vitamin E and glutathione. An imbalance between the levels of reactive oxygen species and antioxidants leads to mitochondrial damage, which reduces ATP production and impairs liver function. Mitochondrial dysfunction and ATP depletion together with nutrient deficiency may contribute to the development of multiple organ dysfunction syndrome. Three clinical parameters are used to assess the severity of kwashiorkor: mid-arm muscle circumference, body mass index, and the presence of localized symmetric edema. In the absence of timely treatment in the early stages, children may have serious complications, including shock, coma, physical and mental disorders. Normalization of physiological and metabolic functions in patients with kwashiorkor is a complex task. The three-step approach to treating children with severe protein-energy malnutrition recommended by the World Health Organization includes stabilization, rehabilitation, and recurrence prevention. The prognosis in the absence of treatment is unfavorable. Key words: protein-energy malnutrition, kwashiorkor, children

Glutamine for sepsis in severe protein energy malnutrition: A case report in clinical nutrition perspective

Rationale: Protein energy malnutrition in sepsis leads to increased mortality and complication rate. The vicious cycle between sepsis and malnutrition is linked to unfavorable outcome. Glutamine deficiency was found in malnourished and high inflammation condition such as emergency surgery. Glutamine, an amino acid, becomes essential in hypercatabolic condition and acts as a fuel for immune system; however, its benefit in sepsis is still debatable.

Physical development and individual metabolic parameters in various forms of congenital epidermolysis bullosa depending on supplementation treatment

Congenital epidermolysis bullosa (CEB) is a group of rare genetic diseases of varying severity, which are characterized with the formation of blisters on the skin and/or mucous membranes with minor trauma. In this case, the clinical course of the disease in some cases is aggravated by the development of malnutrition, which further worsens the quality of life of patients.Aim of the study. To assess the physical development and laboratory findings of nutritional status in children with simple (SCEB) and dystrophic forms of CEB (DCEB).Methods and materials. The study included children with SCEB and DCEB at the age of 8 months to 18 years old, treated at the National Medical Research Centre of Children's Health (Moscow, Russia) from January 2018 to January 2019. Anthropometric parameters were assessed in all patients, and a biochemical blood test was performed for total calcium, phosphorus, albumin, and magnesium. Data are presented using the median (Me) and quartiles of 25 % and 75 % [Q25; Q75], as well as the mean (M) and 95 % confidence interval (95 % CI) for variables with a normal distribution.Results. A total of 87 children were included in the study, 70 with DCEB and 17 with SCEB. There were no differences in sex and age between the groups. According to the results of the study, all anthropometric parameters (WAZ, HAZ and BAZ) in children with DCEB were statistically significantly lower (p &lt; 0.001) than in children with SCEB. Although in both forms of CEB the averaged values of WAZ, HAZ and BAZ turned out to be within the normal range, in children with DCEB, a decrease in HAZ less than -2 was noted in 22 children (31%). Moderate protein-energy malnutrition (-3 &lt; BAZ &lt; -2) was detected in 29 patients (41 %), while 20 of them (29%) were diagnosed with severe protein-energy malnutrition (BAZ &lt; -3). Biochemical parameters were within the reference values, however, the levels of albumin and total calcium were statistically significantly reduced in children with DCEB compared with SCEB children (p &lt; 0.001 and p = 0.005, respectively). Hypoalbuminemia was observed in 64 %, and hypocalcemia in 9 % of DCEB children.Conclusion. All anthropometric values in children with DCEB were lower than in children with SCEB. The study of albumin and total calcium level in the blood of children with DCEB can reveal preclinical forms of malnutrition.

The knowledge regarding protein energy malnutrition among urban and rural mothers with under five children

Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below malnutrition is a contributing cause in more than half of the children's deaths. Almost half of the deaths worldwide are due to being under weight. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, and parent’s education, and poverty, sex of the child and incomplete immunization of the child. The lack of food is not the sole cause of malnutrition. Lack of awareness and knowledge about feeding amount, frequency, type of food etc. contributes significantly to poor nutritional status among children. This study was under taken to assess the knowledge of mothers of under five children regarding prevention of protein-energy malnutrition between urban and rural Area.

Особенности трофологического статуса у пострадавших в чрезвычайных ситуациях с длительными нарушениями сознания вследствие черепно-мозговой травмы

The aim of the study was to investigate peculiarities of trophological status, to identify prevalence, severity and types of trophological insufficiency and to analyze the effect of infectious complications on the severity of protein-energy malnutrition in victims of emergency situations with long-term impairment of consciousness due to traumatic brain injury. Materials and research methods. The study involved 126 victims of various age groups, who underwent primary screening using NRS-2002 scale, indicators of trophological status and the effect of infectious complications on the severity of protein-energy malnutrition were assessed. Research results and their analysis. Screening showed a high risk of malnutrition in all patients. Indicators of trophological status were less than the reference values. In all age groups, both men and women, moderate protein-energy malnutrition prevailed (82.5%). For young patients, marasmus (64.6%) and marasmic kwashiorkor (34.3%) were most typical. The trophological status of the victims – regardless of the severity and in more than half of the cases – was represented by marasmus and, less often, by kwashiorkor. Patients with infectious complications had a high risk of moderate and severe protein-energy malnutrition development, p &lt;0.001.

Clinical and genetic characteristics of rare pathogenic variants of the CFTR gene in Russian patients with cystic fibrosis

The variety of clinical manifestations of cystic fibrosis is driven by the diversity of the CFTR gene nucleotide sequence. Descriptions of the clinical manifestations in patients with the newly identified genetic variants are of particular interest.The aim of this study was to describe clinical manifestations of the disease with the newly identified genetic variants.Methods. Data from Registry of patients with cystic fibrosis in the Russian Federation (2018) were used. The data review included three steps — the search for frequent mutations, Sanger sequencing, and the search for extensive rearrangements by MLPA. 38 pathogenic variants were identified that were not previously described in the international CFTR2 database. We selected and analyzed full case histories of 15 patients with 10 of those 38 pathogenic variants: p.Tyr84*, G1047S, 3321delG, c.583delC, CFTRdele13,14del18, CFTRdele19-22, c.2619+1G&gt;A, c.743+2T&gt;A, p.Glu1433Gly, and CFTRdel4-8del10-11.Results. A nonsense variant p.Tyr84* was found in 5 patients (0.08 %). Two missense variants c.3139G&gt;A were found in 2 siblings (0.03 %). The c.4298A&gt;G was found in 1 patient. Other variants were detected in a single patient (0.02 %) each. They included two variants of a deletion with a shift of the reading frame 3321delG and c.583delC, two splicing disorders c.2619+1G&gt;A and c.743+2T&gt;A, three extended rearrangements CFTRdele19-22, CFTRdele13,14del18, and CFTRdel4-8del10-11. The last two variants include 2 rearrangements on one allele, which cause the severe course in two young children. 8 of the 10 variants are accompanied by pancreatic insufficiency (PI). Among patients with p.Tyr84*, one had ABPA, one had liver transplantation, and all had Pseudomonas aeruginosa infection. Nasal polyps were diagnosed in 2 patients with p.Tyr84*, 1 with G1047S, 1 with CFTRdel4-8del10-11, and 1 patient with 3321delG, who also had osteoporosis and cystic fibrosis-related diabetes (CFRD). 2 patients with PI with 3321delG and CFTRdel4-8del10-11 genetic variants, and 1 with PI with p.Glu1433Gly genetic variant had severe protein-energy malnutrition (PEM).Conclusion. Clinical manifestations of previously undescribed CFTR genetic variants were described. 5/10 genetic variants should be attributed to class I, 3/10 – to class 7 of the function classification of pathogenic CFTR gene variants associated with transcription and translation disruptions. Class of the identified missense variants c.3139G&gt;A and c.4298A&gt;G has not been established and requires further functional, cultural, and molecular genetic studies.

CLINICOEPIDEMIOLOGICAL PATTERN AND OUTCOME OF KEROSENE POISONING AMONGST CHILDREN ADMITTED IN A TERTIARY CARE MEDICAL COLLEGE HOSPITAL

Introduction: Accidental kerosene poisoning in pediatric age group is still a common problem in India. It causes considerable morbidity and occasional mortality. The objective of our study is to determine the pattern and severity of kerosene poisoning cases presenting to our emergency department and to discuss the various risk factors heralding adverse outcome. Methodology: Data were collected over a period of three years from 1..3.2017-29.2.2020.Atotal 75 children were studied. A detailed history was taken using the proforma having special reference to age, sex, seasonal inuence and thorough clinical examination was carried out including anthropometry, general and systemic details and data were compiled and subjected to statistical analysis with the help of spss software. Results: Among 75 children with acute kerosene poisoning majority were I the toddler age group accounting to 93.33%. Males outnumbered the females with male female ratio 1.52:1.Seasonal preponderance were noted in the month of March to June followed by second peaking in the month of October and November. The casualties mostly took place in the own domestic premises. Potentially harmful habits of keeping kerosene in water storing bottles within the reach of the children were practiced by most of the householders.The most common clinical presentations were fever(93%), cough(90%) and vomiting (85%).Pneumonitis occurred in 31 patients and CNS involvement could be documented in three only. Mean Hospital stay were of three days. All patients improved except two died. Severe Protein energy Malnutrition, presence of complications and prolonged hospital staywere associated with adverse outcome. Extensive radiological ndngs in CXR 6 hours after the ingestion showed signicant coorelation with prolonged hospital stay

Medical nutrition therapy in hemodynamically unstable patients due to cardiogenic shock with infected bronchiectasis and severe protein-energy malnutrition

ObjectiveCardiogenic shock is defined as tissue hypoperfusion due to cardiac dysfunction. It is associated with hemodynamic unstability and elevated arterial lactate as one indicator for anaerobic metabolism. Hypercatabolic state in this condition leads to increasing nutritional requirement and negative nitrogen balance. Therefore, medical nutrition therapy by considering metabolic tolerance can prevent further metabolic deterioration and loss of lean mass and improve the patient's clinical outcome. MethodsA 44-years-old female patient with severe protein-energy malnutrition (Subjective Global Assessment Score C; MUAC 15cm) suffered from hemodynamic unstability due to cardiogenic shock and infected bronchiectasis at the infection center of Wahidin Sudirohusodo Hospital. Intake was postponed due to mean arterial pressure 56mmHg on vasopressor support and oxygen saturation below 93%. Physical examinations showed loss of subcutaneous fat, lung crackles and wheezing, muscle wasting, and pretibial edema. Laboratory assessments showed elevated arterial lactate (3.2mmol/L), hypoalbuminemia (2.4g/dL), lymphocytopenia (650/μL), elevated liver enzymes (SGOT 780U/L; SGPT 868U/L), and urine urea nitrogen (5g/24h). Nutritional therapy was started after mean arterial pressure ≥65mmHg with a stable dosage of the vasopressor drug and decreased arterial lactate level to 2.2mmol/L then given gradually with a target calorie of 1500kcal and protein 1.5–1.8g/kg ideal body weight/day using high protein diet. Arterial lactate and blood gass analyses were controlled every day to determine the target of nutritional therapy day by the day. Snakehead fish extract, zinc, vitamin B complex, Thiamine, vitamin C, vitamin A, vitamin D3, and Curcumin were supplied. ResultAfter 15 days of nutritional therapy, the patient was discharged from the hospital with stable hemodynamic without vasopressor support, adequate nutritional intake, improvement of anthropometric parameters, and laboratory test results (arterial lactate 1.6mmol/L, albumin 3.1g/dL, lymphocyte 1.871/μL, SGOT 34U/L, SGPT 41U/L, urine urea nitrogen 0.72g/24h). ConclusionAdequate nutritional therapy, which is planned by evaluating hemodynamic tolerance, can improve patient clinical outcomes and positive nitrogen balance in the hemodynamically unstable patient.

Современное состояние диагностики целиакии в Узбекистане: проблемы и решения

Objective. To study the state of diagnosis, clinical manifestation and laboratory changes in children with celiac disease in the Republic of Uzbekistan. Patients and methods. The article presents a description of 64 newly diagnosed cases of celiac disease registered in the Republican Specialized Scientific and Practical Medical Center of Pediatrics. Celiac disease was diagnosed according to the ESPGHAN criteria. Results. Out of 64 patients, celiac disease was more frequently diagnosed among girls (69.6%), the median age at diagnosis was 5.3 ± 0.6 years. Classic symptoms were observed in 46 (71.9%) patients, the number of patients with extraintestinal manifestations was 18 (28.1%). In classical celiac disease, the most common intestinal symptoms were bloating, diarrhea, and severe protein-energy malnutrition (p ≤ 0.05; p ≤ 0.0001). Among the patients with extraintestinal manifestations, there were more often children with subnanism (p ≤ 0.05). Hemoglobin and calcium levels decreased with the same frequency in atypical and typical forms of celiac disease; there was an increase in the level of alkaline phosphatase in both groups, but higher amounts were found in typical forms of the disease. The majority of patients had a histological study of the intestinal mucosa according to Marsh III, most commonly – IIIc (total villous atrophy). Conclusion. The diagnosis of celiac disease in children living in Uzbekistan is established with a considerable delay. Most patients have classic symptoms accompanied by intestinal manifestations. It is essential to be alert to the diagnosis of celiac disease in patients with extraintestinal manifestations in the absence of diarrhea. In this regard, it is necessary to raise doctors’ awareness of the diagnosis of atypical forms of the disease, as well as to improve their knowledge about different manifestations of celiac disease. Key words: celiac disease, extraintestinal manifestations, children, diagnosis

Epidemiologic Health Survey of a Rural Peasant Association in Southwestern Ethiopia

&#x0D; &#x0D; &#x0D; &#x0D; In many developing countries, health care is either severely inadequate or ineffective. This is especially true in Ethiopia where the rates of infant mortality, child mortality, and maternal mortality are approximately 10-100 times higher than those found in developed countries. However, reliable and comprehensive data on the incidence and prevalence of endemic diseases in many regions of the country are scarce. In the present study, we performed a cross-sectional census survey of a rural peasant association in the Jimma region in southwestern Ethiopia to (i) gather demographic and socioeconomic characteristics of the community and (ii) assess the primary health problems facing the children and women of childbearing age. Our data demonstrate that there was a significant lack of proper sanitation and personal hygiene: 90% of households shared living space with domestic animals, less than 10% of households were equipped with a latrine, and nearly 40% of all water was obtained from unprotected springs and rivers. Of the 166 women of childbearing age (15-49 years), only 13.8% had any knowledge of methods of contraception, and almost 90% had experienced a teenage pregnancy. Less than 2% of all deliveries were aided by trained traditional birth attendants or health professionals. The two-week period prevalence of acute childhood diarrhea was 26.3% and less than 10% of all diarrheal cases were treated with oral rehydration solution. Regarding the nutritional status of children under five years of age, 56.3% were suffering from moderate to severe protein-energy malnutrition based on weight for age, and 57% were moderately to severely stunted based on height for age measurements. Finally, over 90% of randomly chosen individuals were found to be positive for an intestinal parasitic infection. The results demonstrate that there is a great need for improvement in several basic health areas, including the environmental sanitary conditions of the community, as well as the fundamental health status of women and children. Our findings suggest that specific intervention programs must be initiated in order to address the basic health problems facing this rural community.&#x0D; &#x0D; &#x0D; &#x0D;