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1/12. Treatment of cachexia with recombinant growth hormone in a patient before lung transplantation: a case report.

    OBJECTIVES: To describe the effects of recombinant human growth hormone (rhGH) in a severely malnourished patient before lung transplantation. DESIGN: Case study. SETTING: intensive care unit. patients: A 38-yr-old severely malnourished (body mass index, 15.1 kg/m2) woman (receiving prednisone) with bronchiolitis obliterans evolving during 10 yrs presented with end-stage lung disease and required continuous noninvasive mechanical ventilation. INTERVENTIONS: Two courses of 35 days of 16 IU/day (0.42 IU/kg/day) rhGH administered subcutaneously, with an interruption of 5 wks between the two courses of rhGH. MEASUREMENTS AND MAIN RESULTS: weight gain of 14.7% and 12.8% fat-free mass, as measured by 50-kHz bioelectrical impedance analysis, during treatment during a 3.5-month period. nitrogen excretion decreased from 23.7 g/day before treatment to 8.0 g/day while receiving rhGH. Improvement of pulmonary function was also noted and allowed discharge of the patient from the hospital after the second course of rhGH. She underwent successful lung transplantation 2 months later and reached 48.8 kg of body weight 6 months later. CONCLUSIONS: rhGH treatment is a possible strategy that could be used with malnourished patients who are awaiting lung transplantation to improve the nutritional status and respiratory muscle function to prevent recurring respiratory infection and postoperative complications favored by malnutrition and possibly to decrease the length of hospital stay.
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2/12. Torulopsis glabrata pneumonia in a malnourished woman.

    A middle-aged woman developed malabsorption and severe protein-calorie malnutrition after a near-total gastrectomy for a perforated gastric ulcer. A transbronchial lung biopsy showed pulmonary infection with Torulopsis glabrata. Improvement in the patient's nutritional status was followed by clearing of the pneumonia without the need for antifungal chemotherapy.
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3/12. Gastrodiscoides hominis infection in a Nigerian-case report.

    Gastrodiscoides hominis is a large fluke of pig and human and constitutes an important parasite of human in Assam, Indian, the philippines and Southeast asia. This parasite has not been reported in nigeria and possibly other parts of africa. This is a case report of a seven year old Nigerian child who presented with features of malnutrition and anaemia and was found to have Gastrodiscoides hominis and ascaris lumbricoides. Following clearance of the worms there was tremendous improvement of the health status of the child. The detailed epidemiology of this parasite still remains to be studied in this environment.
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4/12. Intradialytic parenteral nutrition as a therapy for malnourished hemodialysis patients.

    B.H. did not consistently meet the expected outcomes related to maintenance of fluid balance and normal blood glucose levels. Interdialytic episodes of hypotension continued intermittently despite efforts of the multidisciplinary team to frequently assess the patient, alter the treatment plan, and avoid complications. Although postdialysis rebound hypoglycemia occurred, it was infrequent. B.H. did, however, meet the expected patient outcome related to nutrition. His nutritional parameters at the end of IDPN therapy correlated with dramatic improvement in his clinical status. Three months after the termination of the IDPN therapy, he showed continued improvement on oral intake only. Ongoing support from all nephrology professionals permitted this patient to obtain and maintain a desirable weight and nutritional status that eventually led to successful renal transplantation.
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keywords = nutritional status, status
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5/12. Malnutrition in the institutionalized elderly: the effects on wound healing.

    Under-nutrition and protein-energy malnutrition are seen at alarmingly high rates in institutionalized elderly and in patients admitted to hospitals. A combination of immobility and loss of lean body mass - which comprises muscle and skin - and immune system challenges increases the risk of pressure ulcers by 74%. The development of pressure ulcers in the hospital affects 10% of admissions, with the elderly at the highest risk. Common causes of malnutrition in the elderly involve: decreased appetite, dependency on help for eating, impaired cognition and/or communication, poor positioning, frequent acute illnesses with gastrointestinal losses, medications that decrease appetite or increase nutrient losses, polypharmacy, decreased thirst response, decreased ability to concentrate urine, intentional fluid restriction because of fear of incontinence or choking if dysphagic, psychosocial factors such as isolation and depression, monotony of diet, and higher nutrient density requirements along with the demands of age, illness, and disease on the body. All have been found to delay healing and increase the risk of pressure ulcer development. In addition, what is ingested should contain nutrients to support health and healing. The financial impact of malnutrition is high and the consequences for patient morbidity and mortality are severe. Practical suggestions to improve the nutritional status of long-term care residents include liberalizing previous diet restrictions where safe and appropriate, addressing impairments to dentition and swallowing, addressing physical and/or cognitive deficits, encouraging family and friends to provide favorite foods, auditing/addressing specific food under-consumption, and providing prudent nutrient supplementation. Clinicians must be aware of the numerous factors in play with regard to nutrition and its impact on not only general well-being but also on wound care. Nutritional intervention in pressure ulcer management is truly "healing from the inside out."
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6/12. Recurrent D-lactic acidosis in a child with short bowel syndrome.

    D-lactic acidosis is a rare complication in children with short bowel syndrome. It results from fermentation of dietary carbohydrate by luminal bacteria in the small bowel caused by bacterial overgrowth. We present the case of a 14-year-old boy who had been diagnosed with short bowel syndrome from surgical treatment of midgut volvulus five years previously. His nutritional status was maintained by total parenteral nutrition and enteral feeding as tolerated. During hospitalization, episodic confusion and hyperpnea developed. The investigation showed severe metabolic acidosis with serum bicarbonate of 9 mmol/L and a wide anion gap. The serum D-lactic acid was 11.21 mmol/L. There was no evidence of renal or hepatic failure. Therefore, D-lactic acidosis from enteral carbohydrate overload was diagnosed. The treatment was correction of metabolic acidosis by sodium bicarbonate infusion and carbohydrate restriction. The results of the therapy were satisfactory. Early detection and appropriate treatment is necessary to avoid morbidity and mortality following this complication of short bowel syndrome.
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7/12. The use of parenteral nutrition in a severely malnourished hemodialysis patient with hypercalcemia.

    There is a high prevalence of protein-energy malnutrition (PEM) in chronic dialysis patients. Causes of PEM include the catabolic effects of hemodialysis treatments, acidemia associated with end-stage renal disease, common comorbid conditions, and uremia-induced anorexia. morbidity and mortality increase with PEM. Before considering parenteral nutrition (PN) as a nutrition intervention in a maintenance dialysis patient, all other efforts to promote optimal nutrition need to be exhausted. The first step is careful evaluation of protein-energy status, followed by intensive nutrition counseling. If necessary, this is followed by oral nutrition supplementation, appetite stimulation, enteral tube feedings, and finally PN. Short-term parenteral nutrition (PN) became a crucial component of the management of a 38-year-old hemodialysis (HD) patient who endured serious complications after kidney transplant rejection. A profound and prolonged malnourished state followed her treatment for necrotizing pancreatitis. She had developed persistent hypercalcemia believed secondary to tertiary hyperparathyroidism (HPT) and immobilization. Later, she developed hungry bone syndrome (HBS) after parathyroidectomy (PTX). She also developed refeeding syndrome after initiation of PN. The patient's persistent, poorly understood hypercalcemia did not resolve even after PTX and removal of all other sources of vitamin d and calcium from her feedings, medications, and dialysis bath. The close communication of the inpatient and outpatient dialysis multidisciplinary teams became a key component to the successful outcome in this complex patient.
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ranking = 3.0954372422689E-5
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8/12. Malnutrition in the elderly.

    Malnutrition is known to be very common in hospitalized and institutionalized elderly. Various studies report an incidence ranging from 33% to 67% of all patients. Recent evidence also suggests that the presence of nutritional deficiencies is associated with increased morbidity, mortality, and greater use of health care resources. The problem is compounded by the lack of resources in most acute care hospitals and nursing homes to obtain an adequate nutritional assessment or to monitor nutritional status over time. This report will present an overview of nutritional problems in the elderly, and provide an approach aimed at identifying patients at high risk of being malnourished in order to develop rational strategies for management. The role of nutritional factors in the development of pressure sores will also be discussed.
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ranking = 1
keywords = nutritional status, status
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9/12. Laboratory measurements of nutritional status as correlates of atrophic glossitis.

    OBJECTIVE: To perform a comprehensive laboratory assessment of nutritional status in two elderly patients selected for the presence of atrophic glossitis, a classic physical sign of malnutrition. DESIGN: Case report. SETTING: Inpatient internal medicine ward at the William S. Middleton Memorial veterans Medical Center, Madison, wisconsin. MEASUREMENTS AND MAIN RESULTS: Blood specimens were analyzed by the Nutrition Evaluation Laboratory at the USDA Human Nutrition research Center on aging at Tufts University. Both subjects had biochemical evidence of protein-calorie malnutrition and were deficient or marginally deficient in several vitamins and trace minerals. CONCLUSIONS: Much work needs to be done to determine the sensitivity and positive predictive value of the classic physical signs of malnutrition as predictors of low biochemical levels and adverse clinical outcomes. The presence of atrophic glossitis should prompt the clinician to consider a basic nutritional assessment.
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keywords = nutritional status, status
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10/12. protein deficiency and treatment of xerophthalmia.

    In a controlled clinical trial of massive-dose vitamin a therapy for xerophthalmia, holo-retinol-binding protein (holo-RBP) response was related to baseline protein status. Corneal healing was more commonly delayed or transient in children with protein-energy malnutrition (PEM), despite the vast majority achieving holo-RBP levels incompatible with severe corneal destruction. Correction of PEM is essential to ensuring a sustained clinical cure, and repeated massive vitamin a therapy is advisable until that occurs.
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keywords = status
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