Signs Of Nutritional Deficiencies Research Articles

Nutrition Rehabilitation in Oncopathology: Opportunities and Prospects

Nutritional corrective support is an integral component of rehabilitation programs in the perioperative period for oncological pathology. The aim of this study was to evaluate the effectiveness of including remaxol in the rehabilitation treatment regimen for gastroenterological cancer patients. Material and methods. The treatment results of 42 patients with gastric outlet tumors and small intestine tumors were retrospectively analyzed. Remaxol was included in the adjuvant therapy for patients in the main (I, N=22) group: intravenously 400 ml at a rate of 40–80 drops/min (2–4 ml/min) once a day for 10 days. Patients in the comparison group (II, N= 20) received traditional nutritional therapy. The study used both traditional clinical diagnostic methods and methods for assessing the risks of nutritional deficiency and the rehabilitation potential of the body, its adaptive capabilities, and disease prognosis. Results. All patients showed signs of severe nutritional deficiency, endotoxemia, intoxication, and hepatotoxicity. Liver detoxification parameters were better in patients who received remaxol as an adjuvant therapy than in the comparison group. Conclusions. Cancer patients with a high nutritional risk and moderate to high nutritional deficiency are at a higher risk of developing toxic complications requiring adjuvant therapy. The inclusion of remaxol in adjuvant therapy reduced the severity of hepatotoxic reactions in these patients. The data obtained made it possible to recommend its inclusion in treatment regimens for patients with this pathology.

Development and Validation of a Nomogram for Predicting Nutritional Risk Based on Frailty Scores in Older Stroke Patients

BackgroundIn older stroke patients with frailty, nutritional deficiencies can amplify their susceptibility, delay recovery, and deteriorate prognosis. A precise predictive model is crucial to assess their nutritional risk, enabling targeted interventions for improved clinical outcomes.ObjectiveTo develop and externally validate a nutritional risk prediction model integrating general demographics, physical parameters, psychological indicators, and biochemical markers. The aim is to facilitate the early identification of older stroke patients requiring nutritional intervention.MethodsThis was a multicenter cross-sectional study. A total of 570 stroke patients were included, 434 as the modeling set and 136 as the external validation set. The least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables. Internal validation was performed using Bootstrap resampling (1000 iterations). The nomogram was constructed based on the results of logistic regression. The performance assessment relied on the receiver operating characteristic curve (ROC), Hosmer–-Lemeshow test, calibration curves, Brier score, and decision curve analysis (DCA).ResultsThe predictive nomogram encompassed seven pivotal variables: Activities of Daily Living (ADL), NIHSS score, diabetes, Body Mass Index (BMI), grip strength, serum albumin levels, and depression. Together, these variables comprehensively evaluate the overall health and nutritional status of elderly stroke patients, facilitating accurate assessment of their nutritional risk. The model exhibited excellent accuracy in both the development and external validation sets, evidenced by AUC values of 0.934 and 0.887, respectively. Such performance highlights its efficacy in pinpointing elderly stroke patients who require nutritional intervention. Moreover, the model showed robust goodness of fit and practical applicability, providing essential clinical insights to improve recovery and prognosis for patients prone to malnutrition.ConclusionsElderly individuals recovering from stroke often experience significant nutritional deficiencies. The nomogram we devised accurately assesses this risk by combining physiological, psychological, and biochemical metrics. It equips healthcare providers with the means to actively screen for and manage the nutritional care of these patients. This tool is instrumental in swiftly identifying those in urgent need of targeted nutritional support, which is essential for optimizing their recovery and managing their nutrition more effectively.

Evaluation of anti-Fel d 1 IgY ingredient for pet food on growth performance in kittens.

The domestic cat (Felis catus) is one of the most common pets. Worldwide, approximately one in five adults are sensitive to cat allergens. The major cat allergen is the secretoglobulin Fel d 1, which is primarily produced in the salivary and sebaceous glands. Chickens produce IgY antibodies, which are similar in structure to mammalian IgG. When chickens are exposed to Fel d 1, anti-Fel d 1-specific IgY (AFD1) is produced and is naturally concentrated in egg yolk. The aim of this study was to evaluate the tolerability, effects on growth and food consumption, and potential adverse effects of a chicken egg product ingredient containing AFD1 in kittens. This was a blinded, controlled study. Twenty-seven (27) eight-week old kittens were randomly assigned to three feeding groups containing 0 ppm AFD1 (Group 0), 8 ppm AFD1 (Group 1), and 16 ppm AFD1 (Group 2) for 84 days. Veterinary exams and bloodwork were performed on Day 42 and Day 84, and body weight and body condition score (BCS) were monitored weekly. Throughout the study, there were no signs of nutritional deficiency or adverse clinical events in any of the subjects. Administration of a chicken egg product ingredient containing AFD1 in the diet (whether in coating or combination of coating and top dress) had no significant effect on body weight nor food consumption, and all subjects maintained a healthy Body Condition Score (BCS) throughout the study. Moreover, there were no biologically significant differences in the mean clinical chemistry and hematology parameters. This study demonstrated that a diet formulated to contain up to 16 ppm AFD1, included in the coating and the top-dress of dry kitten food, was well tolerated, promoted adequate growth, and exhibited no adverse effects.

Clinical case of delayed diagnosis of celiac enteropathy

Clinical case of delayed diagnosis of celiac enteropathy

Peculiarities of treatment of patients with comorbid pathology: chronic pancreatitis and hypothyroidism, taking into account SEPP1 gene polymorphism (RS7579)

Optimization of therapeutic regimens during the treatment of the polymorbid course of chronic pancreatitis combined with hypothyroidism is an important task of modern science.
 Aim: to treat patients with comorbid pathology: chronic pancreatitis and hypothyroidism, taking into account the polymorphism of the SEPP1 gene (RS7579)
 Materials and methods. During the research, we examined 128 people. Patients were divided into 3 groups. The first group included 48 patients with chronic pancreatitis, the second - 50 patients with chronic pancreatitis in combination with hypothyroidism, and the third - 30 practically healthy people.
 Results. Symptoms of maldigestion decreased in 72 % of the examined patients. Signs of nutritional deficiency have significantly decreased, and general well-being has improved. Multicomponent therapy also affected mood, sleep, and reduced irritability and symptoms of depression and anxiety disorders. A multisystemic polysyndromic approach to treatment led to improvements in both pancreatic and thyroid function. The effectiveness of the treatment strategy for patients with chronic pancreatitis was dependent on individual characteristics, such as the severity of chronic pancreatitis, the presence of primary hypothyroidism, the degree of selenium deficiency and concomitant symptoms, taking into account polymorphic variants of the SEPP1 (rs7579) gene. Selenoid deficiency decreased, especially in the group with a combination of chronic pancreatitis and hypothyroidism. The improvement in thyroid hormone activity included a 40.46 % decrease in blood TSH and a 2.5-fold increase in free T4.
 Conclusions. The program of complex therapy led to the normalization of the condition of patients with the G-allele genotype of the SEPP1 gene (rs7579), as evidenced by significant improvements in most of the analyzed indicators. The concentration of fecal elastase 1 and blood selenoprotein P significantly increased, and the level of serum pancreatic α-amylase significantly decreased in carriers of the AA genotype. Under the influence of therapy, there were also changes in the hormonal activity of the thyroid gland, a decrease in the concentration of total metabolites of NO, and an improvement in the health indicators of the cardiovascular system. However, for patients with the AA genotype of the SEPP1 (rs7579) gene, continuation of therapy remains important to achieve an optimal condition, in particular, to manage cholesterol levels and other cardiovascular risk factors

Less, but not gone-gluten-free diet effects on fatigue in celiac disease: a prospective controlled study.

Fatigue is a frequent complaint in patients with celiac disease. A gluten-free diet is the only established treatment for celiac disease, but how this diet influences fatigue is uncertain. We aimed to investigate fatigue prevalence, severity, and associated factors in patients with celiac disease, at diagnosis and at 1 year after commencing a gluten-free diet. 78 patients with serologically and histologically verified celiac disease, 78 age- and sex-matched healthy subjects. Primary endpoints were Fatigue Visual Analog Scale (fVAS), Fatigue Severity Scale (FSS), and inverted Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs). Clinically relevant fatigue was defined as: FSS score ≥ 4, fVAS score ≥ 50 mm, or inverted SF-36vs score ≥ 65. Higher scores represented more fatigue. Fatigue was reduced after a 12-month gluten-free diet. Median scores changed from 3.8 (interquartile range [IQR]: 2.2 to 4.8) to 1.9 (IQR: 1.4 to 3.5) for FSS, from 44.5 (IQR: 18.8 to 66.0) to 15.5 (IQR: 7.8 to 43.3) for fVAS, and from 65 (IQR: 40 to 75) to 35 (IQR: 25 to 55) for inverted SF-36vs (p < 0.001 for all). Fatigue prevalence also declined after treatment. However, scores were significantly higher in patients compared to control subjects. Higher fatigue scores were associated with depression and pain, but not with signs of disease activity or nutritional deficiency. At diagnosis, patients with celiac disease frequently had severe fatigue. Fatigue declined after a gluten-free diet, but it remained higher than that observed in healthy subjects. ClinicalTrials.gov, Identifier NCT01551563.

Nutritional and Metabolomic Changes of Juvenile Farmed Abalone (Haliotis iris) in New Zealand

Seasonal variations play a crucial role in the physiology, immune responses, and nutritional profile of aquatic animals. Unpredictable water temperature fluctuations, especially those caused by climate change, may negatively affect feed consumption and growth of cultured organisms, such as abalone. In addition, metabolic and nutritional changes across different seasons may have significant effects on aquaculture production. This study aimed to investigate biochemical and metabolic alterations in healthy abalone (Haliotis iris) during 1 year of grow out in a land-based farm in New Zealand. Proximate analyses were used to identify nutritional variations in whole animal tissues, and a gas chromatography–mass spectrometry-based metabolomics approach was used to identify metabolic changes in adductor muscle of abalone during different seasons in the 1-year sampling period. Results showed that protein content was higher in warmer months compared with colder months, whereas lipid, ash, and carbohydrate contents remained generally constant throughout the year. Metabolic profile fluctuations indicated higher amounts of glutamic acid, glutathione, methionine, lysine, serine, tyrosine, and glycine in January and March compared with October and July, indicating possible amino acid breakdown and collagen degradation due to warmer temperatures. Although the proximate analyses findings revealed no signs of nutritional deficiencies in abalone among seasons, the metabolic profiles suggested possible thermal stress during summer months. This study provides a foundation for further nutritional studies to optimise seasonal diets for farmed Haliotis iris and highlights the need to monitor thermal stress effects, especially during summer and/or heatwave events.

Clinical Reflections and Treatment Adaptations for Avoidant Restrictive Food Intake Disorder: A Case Study

Avoidant Restrictive Food Intake Disorder (ARFID) is a serious eating disorder, characterised by problematic eating habits that cause significant nutritional deficiencies. Having only been recently acknowledged as a distinct category, there is little research regarding best practice guidelines, especially among the adult population. In addition, ARFID often coexists with autism, and very little is known about how the diagnoses affect each other, further complicating treatment options. This case study reflects on the treatment of a young autistic woman with ARFID within an inpatient eating disorder setting. Using principles of food exposure, food trials were introduced as a way to increase food variety as well as overall nutrition. Results are promising, with the patient reaching a much safer weight and being able to increase her repertoire of food. While results are not generalisable to a wider population, it is hoped that similar approach could be used with other individuals who have ARFID and autism when aiming to increase nutrition and variety.

До актуальності проблеми аліментарних хвороб у дітей

Purpose - to highlight the problem of alimentary diseases in childhood and their connection with the factors of unbalanced nutrition. An analysis of the literature on the role of unbalanced nutrition in the development of alimentary diseases in children and adolescents was carried out. The source of information for the analysis of questionnaires of adolescents (864 children) was the Ukrainian snippet of the international program ELSPAS (Europea Longitudinal Childhood), which made it possible to identify the interrelation of the nutritional characteristics of children with the risk of developing alimentary diseases. According to the data from the literature and our own research, changes in the structure of non-infectious morbidity in both the adult and child population in the 20th-21st centuries due to an increase in the frequency of alimentary diseases are associated with a tendency to nutritional disorders, namely, unbalanced nutrition. Studies, conducted within the department indicate significant nutritional deficiencies of adolescents and young children, which contributes to the development of alimentary diseases in this group of patients. The article shows the importance of the role of food as a risk factor for the development of inflammatory bowel disease due to the imbalance of the diet in terms of energy value, the prevalence of unrefined fats and carbohydrates in the diet, the lack of plant fiber, etc. This makes it possible to scientifically substantiate preventive programs to diagnose nutritional disorders in children and adolescents to prevent complex disabling diseases such as inflammatory bowel disease. No conflict of interests was declared by the authors.

Diagnosing the Consequence of Uncertain Nutrient Deficiency, and its Sectionalization in Oryza Sativa Using Ensemble Learning Strategies

Nutrition is an essential component in agriculture worldwide to assure high and consistent crop yields. The leaves frequently present signs of nutritional deficiencies in rice crops. A nutritional deficiency in the rice plant can also be diagnosed based on the leaf color and form. Image categorization is an effective and rapid method for analyzing such conditions. However, despite significant success in image classification, Ensemble Learning (EL) has remained elusive in paddy nutrition analysis. Ensemble learning is a technique for deliberately constructing and combining numerous classifier models to tackle a specific computational issue. In this work, we investigate the preciseness of several uncertain deep learning algorithms to detect nutritional deficits in rice leaves. Through soil and agricultural studies, around 2000 images of rice plant leaves were collected encompassing complete nutritional and about five divisions of nutrient deficiencies. The image proportion for learning via training, validation via evaluation, and testing phase were split into 4: 2: 2. For this, an EL method is chosen for the diagnosis and classification of nutritional deficits. Here, EL procedures are considered as a hybrid classification model that integrates CapsNET (Capsule network) and GCN (Graph Convolutional Neural) networks to evaluate the classification. The hybrid classification effectiveness was verified through color and lesion features which were compared with standard machine learning techniques. This research shows that EL strategies can effectively detect nutritional deficits in paddy. Furthermore, the suggested hybrid classification model achieved a better accuracy rate, along with sensitivity and specificity rates of 97.13%, 97.22%, and 96.47% correspondingly.

Nutritional Assessment of the Infant Population of the Chirikyacu Indigenous Community of Peru.

Malnutrition is one of the main public health problems affecting early childhood development, compromising the health and quality of life of thousands of Peruvian children. The main contribution of this work is the analysis of the nutritional status of the infant population of the Chirikyacu Indigenous Community of Peru in order to evaluate current and future food policies. It is a cross-sectional study with a sample of 19 children between 6 months and 6 years of age. Sociodemographic, anthropometric, clinical variables and dietary habits were analyzed from 7 January to 4 February 2018. The mean age of the children was 29.74 months (SD = 23.91). We found statistically significant differences between the BMI values of boys and girls (p &lt; 0.05; Mann-Whitney test). According to the z-scores, 35.29% suffer from malnutrition, although in no case is it severe. Hair, nails and skin were in good condition in general, except for some cases showing signs of nutritional deficiency. Dietary patterns are based on legumes, vegetables, dairy products, ice cream, cookies and sweets, and are considered insufficient to cover basic needs; water intake was also insufficient. Breastfeeding lasted an average of 14 months (SD = 2.9). We found a prevalence of malnutrition higher than that established by the WHO in Latin America among the children of Chirikyacu. The dietary pattern is insufficient to cover basic needs, so it is necessary to continue with nutritional educational interventions to improve it.

Twitter Trends for Celiac Disease and the Gluten-Free Diet: Cross-sectional Descriptive Analysis.

Few studies have systematically analyzed information regarding chronic medical conditions and available treatments on social media. Celiac disease (CD) is an exemplar of the need to investigate web-based educational sources. CD is an autoimmune condition wherein the ingestion of gluten causes intestinal damage and, if left untreated by a strict gluten-free diet (GFD), can result in significant nutritional deficiencies leading to cancer, bone disease, and death. Adherence to the GFD can be difficult owing to cost and negative stigma, including misinformation about what gluten is and who should avoid it. Given the significant impact that negative stigma and common misunderstandings have on the treatment of CD, this condition was chosen to systematically investigate the scope and nature of sources and information distributed through social media. To address concerns related to educational social media sources, this study explored trends on the social media platform Twitter about CD and the GFD to identify primary influencers and the type of information disseminated by these influencers. This cross-sectional study used data mining to collect tweets and users who used the hashtags #celiac and #glutenfree from an 8-month time frame. Tweets were then analyzed to describe who is disseminating information via this platform and the content, source, and frequency of such information. More content was posted for #glutenfree (1501.8 tweets per day) than for #celiac (69 tweets per day). A substantial proportion of the content was produced by a small percentage of contributors (ie, "Superuser"), who could be categorized as self-promotors (eg, bloggers, writers, authors; 13.9% of #glutenfree tweets and 22.7% of #celiac tweets), self-identified female family members (eg, mother; 4.3% of #glutenfree tweets and 8% of #celiac tweets), or commercial entities (eg, restaurants and bakeries). On the other hand, relatively few self-identified scientific, nonprofit, and medical provider users made substantial contributions on Twitter related to the GFD or CD (1% of #glutenfree tweets and 3.1% of #celiac tweets, respectively). Most material on Twitter was provided by self-promoters, commercial entities, or self-identified female family members, which may not have been supported by current medical and scientific practices. Researchers and medical providers could potentially benefit from contributing more to this space to enhance the web-based resources for patients and families.

Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal

BackgroundThe COVID-19 pandemic drew hygiene to the center of disease prevention. The provision of adequate water, sanitation, and hygiene (WASH) services is crucial to protect public health during a pandemic. Yet, access to levels of water supply that support adequate hygiene measures are deficient in many areas in Nepal. We examined WASH practices and their impact on child health and nutritional status in two districts before and during the COVID-19 pandemic.MethodsA longitudinal and mixed method study was conducted in March–May 2018 and November–December 2021. In total, 715 children aged 0–10 years were surveyed at baseline. Of these, 490 children were assessed at endline. Data collection methods included observations, a questionnaire, stool analysis, anthropometric measurements, water quality analysis, and an assessment of clinical signs of nutritional deficiencies. We conducted 10 in-depth interviews to understand major problems related to COVID-19.ResultsMost respondents (94.2%) had heard about COVID-19; however, they did not wear face masks or comply with any social distancing protocols. Almost 94.2% of the households self-reported handwashing with soap 5–10 times per day at endline, especially after defecation, compared to 19.6% at baseline. Water quality was better at endline than at baseline with median 12 to 29 CFU Escherichia coli/100 mL (interquartile range at baseline [IQR] = 4–101) at the point of collection and 34 to 51.5 CFU Escherichia coli/100 mL (IQR = 8–194) at the point of consumption. Fever (41.1–16.8%; p = 0.01), respiratory illness (14.3–4.3%; p = 0.002), diarrhea (19.6–9.5%; p = 0.01), and Giardia lamblia infections (34.2–6.5%, p = 0.01) decreased at endline. In contrast, nutritional deficiencies such as bitot’s spots (26.7–40.2%; p = 0.01), pale conjunctiva (47.0–63.3%; p = 0.01), and dermatitis (64.8–81.4%; p = 0.01) increased at endline. The inadequacy of the harvest and the lack of household income to meet households’ nutritional needs increased drastically (35.0–94.2%; p = 0.01).ConclusionWe found that improved water quality and handwashing practices were associated with a decrease in infectious diseases. However, food security also decreased resulting in a high prevalence of nutritional deficiencies. Our findings underline that disaster preparedness should consider access to adequate WASH, nutrition, and health supplies.

Single anastomosis sleeve jejunal (SAS-J) bypass as a treatment for morbid obesity, technique and review of 1986 cases and 6 Years follow-up. Retrospective cohort

BackgroundSantoro's operation is a sleeve gastrectomy with transit bipartition. The operation aims to maintain passage to the duodenum to minimize nutritional deficiency. This procedure is rapidly changed to single anastomosis sleeve ileal (SASI) bypass. SAS-J bypass is a modification of SASI with a short biliary limb. Material and methodsThis study is a retrospective study of prospectively collected data. The study includes a comprehensive review of 1986 patients who underwent SAS-J bypass over 6 years. The total number is used to evaluate the perioperative data. One- and two-year follow-up was used to evaluate weight loss and comorbidities; follow-up of more than 5 years was used to obtain long-term results. ResultsIn this study, 70.4% of patients were female and 29.6% were male. The mean body mass index (BMI) was 44.7. The mean age was 42 years. Regarding comorbidities, 25.8% of the patients had type 2 diabetes, 31% were hypertensive, 14.2% had sleep apnea syndrome, 6.6% had gastroesophageal reflux disease (GERD), and 39.6% had hyperlipidemia. Of the 1294 patients who complete one-year follow up, %EWL reached 87%. Blood glucose levels were normalized in 98.5% of patients, hypertension remitted in 93%, hyperlipidemia improved in 97%, SAS is improved in all cases, and GERD improved in 89% of patients. After 5 years, 94 patients’ BMI decreased from 44.3 to 28.3 without significant nutritional deficiency. ConclusionsLaparoscopic SAS-J bypass is an effective and simple alternative bariatric procedure at short- and long-term follow-up.

Pengetahuan Ibu Hamil tentang Kebutuhan Nutrisi Selama Kehamilan

During pregnancy there will be many changes that will be experienced by the mother starting from the cardiovascular system, hormonal, urogenital to the body's metabolism. Along with changes in the mother's body metabolism, the need for nutrients will increase. This increase is needed for the development and growth of the fetus during pregnancy. The nutritional elements needed by pregnant women are carbohydrates, proteins, fats, vitamins and minerals. Of course the need will be more than when not pregnant. The research design used in this research is descriptive, namely the research design that aims to find a description of the phenomena (including health) that occur in a certain population with the aim of knowing a description of the knowledge of pregnant women about nutritional needs during pregnancy at BPM Nurhasanah Gudang Lelang Teluk Betung Bandar Lampung for the January 2021 period as many as 30 pregnant women. Data collection tools and data collection methods in this study were to provide questionnaires to pregnant women who came to visit the period 1 January to 31 January 2021 to BPM. The content of the Questionnaire consists of questions about the benefits of nutrition in pregnancy, nutritional fulfillment during pregnancy, and about the danger signs of malnutrition in pregnancy. Based on the results of the study, it can be concluded that the knowledge of pregnant women related to the nutritional needs needed during pregnancy is in the poor category. The assessment was carried out by distributing questionnaires with question components which included: the benefits of nutrition during pregnancy, nutritional fulfillment during pregnancy, the respondent's knowledge of the danger signs of nutritional deficiency and nutritional needs during pregnancy. Characteristics of respondents seen from the level of education, employment status and age of pregnant women. Suggestions in this study are the participation of health workers to assist in nutritional needs during pregnancy and the need for improvement of the support system available at BPM such as leaflets to increase knowledge of pregnant women. Keywords: Knowledge, Pregnant Women, Nutrition

Case Series: Pediatric Human T-Lymphotropic Virus Type 1 and Its Clinical Expression

PurposeHuman T-lymphotropic Virus type 1 (HTLV-1) was the first retrovirus to be identified and associated with oncogenic activity. It is estimated that approximately 10–20 million people in the world are infected with it. The clinical manifestations most commonly associated with HTLV-1 infection include T-cell leukemia/lymphoma and myelopathy associated to HTLV-1 infection. The purpose of this study is to describe clinical and demographic characteristics in pediatric patients with HTLV-1 infection.Methodology and PatientsAmbispective case series analysis, with collection of medical records and subsequent description of demographic data (sex, origin, age) and clinical characteristics in 16 patients with HTLV-1 infection were collected. Twelve of these patients were part of an initially reported cohort and four were recruited later in the study. The patients were collected between January 2017 and July 2021 in a pediatric institution in Cali, in a reference hospital in the southwest region of Colombia.ResultsThirteen of a total of sixteen patients came from the Colombian Pacific coast, where nine were with significant nutritional deficiencies. Seven showed dermatological compromise. Eight patients presented images compatible with inflammation and chronic lung injury, and six of the eight patients were with opportunistic infections. Coinfection with other microorganisms was also observed where one case presented with meningeal tuberculosis, another patient presented with simultaneous infections, namely, malaria, leptospirosis and toxoplasmosis, and a third patient presented intestinal parasitosis and soft tissue infection by Streptococcus pyogenes. Three patients had concomitant autoimmune diseases and a fourth patient was highly suspicious of having polymyositis.ConclusionsThe different clinical findings with simultaneous HTLV-1 infection broaden the panorama to suspect infection by this virus. More studies are required to achieve a direct association between structural lung disease, autoimmune diseases, immunodeficiency and HTLV-1 infection. This study aims to raise interest and awareness of an ancient but neglected disease.

Management of Mukhapaka with Ayurvedic Treatment with special reference to Stomatitis-A Case Report

The mouth is a window to the body’s health. It can show signs of nutritional deficiencies or general infection. Oral health is an integral component of general health and well being for all ages. Mukhapaka is a commonest disease of oral mucosa found in India as well as all over the world. Mukhapaka is nothing but a recurrent mouth ulcer or Stomatitis. Oral ulceration is encountered frequently in our daily practice because of over consumption of extremely pungent and spicy food, chewing of chemical agents like Tobacco-Gutkha and also Vitamin deficiency.Stomatitis is curable &amp; not considered threat to life but these ulcers have significant negative impact on the oral health and affecting the quality of life. It also affects normal activities like eating &amp; swallowing. Sometimes brushing &amp; talking also becomes painful. In present era, world is looking at Ayurveda with the hope that it is going to provide good asset to the treatment of ailing humanity. In Ayurveda various treatment modalities are described for Mukhapaka.. I have selected one of them to establish efficacy of Gandusha and Pratisarana on Mukhapaka in my present case study.

Falling Through the Cracks: UK Health Professionals’ Perspective of Diagnosis and Treatment for Children and Adolescents with Avoidant/Restrictive Food Intake Disorder

ABSTRACT Background Avoidant/restrictive food intake disorder (ARFID) describes an eating disturbance associated with weight loss or faltering growth in children, significant nutritional deficiency, reliance on oral supplements, reliance on enteral feeding and/or a clear interference with psychosocial functioning, in the absence of body image concerns. Seven years on from the introduction of the diagnostic criteria for ARFID anecdotal evidence suggests that health practitioners struggle to identify, diagnose and treat ARFID effectively. This study systematically investigates and categorises the different barriers to effective healthcare for children with ARFID, from the perspective of those who encounter and care for these children in their professional practice. Method A mixed methods online survey containing closed and open questions sought to gather information about paediatric healthcare for ARFID. Forty-five primary and secondary health-care professionals (HCPs) from 7 disciplines took part, providing information regarding their confidence in the identification and diagnosis of ARFID but also their confidence in making appropriate onward referrals and any barriers to effective healthcare for this patient population. Results The findings suggested that participating primary HCPs struggle to identify children with ARFID and if they do, they do not necessarily know who to refer these children to for assessment, diagnosis and support. Participating secondary, or specialist, HCPs felt more confident in their ability to identify a child with ARFID, but were similarly unsure about onward referrals. HCPs identified lack of professionals’ knowledge and training and a lack of clear pathways or specific services as barriers to effective diagnosis and treatment for this clinical group. Conclusion This study highlights the need for education and training for primary HCPs and the need for well-coordinated, multidisciplinary, ARFID-specific care pathways which can appropriately manage assessment, diagnosis and support of this often complex clinical group.

Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management.

We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management. Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records. Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy. Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.

Assessment of the nutritive status in cancer patients of the palliative care department

Introduction. Nutritional status disorders are common among cancer patients. These disorders significantly reduce the quality of life and worsen the prognosis. Objective: to assess the prevalence of trophic insufficiency in palliative care cancer patients.Materials and methods. An observational, analytical, single-stage (crosssectional) study was conducted, which included 106 cancer patients of a palliative profile. The patients underwent laboratory and instrumental examination, a comprehensive assessment of the trophic status. Results. 77 (72.6%) of the examined patients showed signs of nutritional deficiency. Signs of hypotrophy were found in 19 patients. Hypotrophy of the III degree was not detected in any of the cases, of the II degree — in 4 patients, of the I degree — in 15 patients. Normal or elevated body mass index in some cases is associated with a violation of the nutritional status. A detailed study of the trophic status in cancer patients with palliative profile showed a different significance of each criterion studied. The study of the level of total protein (χ²=1.07, p=0.348), albumin (χ² =7.42, p=0.006), the number of peripheral blood lymphocytes (χ²=12.61, p=0.0004) allowed more often to diagnose a violation of the nutritional status in comparison with somatometric indicators (χ² =2.07, p=0.153) and the value of transferin (χ² =1.07, p=0.348). The study of variants of the combination of reduced indicators of nutritional status in the examined group of patients showed that the use of one criterion in isolation from other clinical and laboratory indicators will lead to underdiagnosis and underestimation of the severity of trophic disorders.Conclusion. In cancer patients with a palliative profile, nutritional disorders are detected with a high frequency. Somatometric indicators of nutritional status do not fully reflect the presence of trophic disorders. A decrease in the level of albumin, total protein, and the number of peripheral blood lymphocytes makes it possible to more often diagnose a violation of the nutritional status in the studied group of patients. However, none of the criteria for nutritional insufficiency can be used in isolation.