ABSTRACT
Research indicates the COVID-19 epidemic changes people's health and diet, However, this has not yet been well discussed in Taiwan, especially in college students. Therefore, the purpose of this study is to investigate the impact of distance learning on college students' dietary patterns, sleep quality and perception of stress during the COVID-19 epidemic in Taiwan. 265 college students from a university in Taichung were recruited in this study. The self-administered online questionnaire was used to investigate the changes in eating behavior, sleep quality, and perception of stress before and one month after distance learning, and further analyzed the relationship among them. The questionnaire contains demographic information, dietary questionnaires (including six categories of food intake behaviors, convenience food intake frequency), the Pittsburgh Sleep Quality Index (PSQI) and Perceived Stress Scale (Chinese 14-item PSS). The results showed that the proportion of college students to meet the recommended Taiwan Dietary Guidelines amount in vegetables (21.9%), fruits (27.5%), meats and dairy products (15.8%), and nuts and seeds (11.3%) were lower during distance learning. The frequency of convenient food intake was lower during distance learning (13.31 +/- 6.10 points;never to occasionally). During the distance learning period, there was a significant negative correlation between dietary patterns and sleep quality (r = -0.160, p = 0.009), It shows that college students with higher dietary pattern scores have better sleep quality. During the distance learning period, there was a significant positive correlation between sleep quality and perceived stress (r = 0.320, p < 0.001), It shows that college students with higher levels of stress had poorer sleep quality. This study found that the lower the perceived stress of college students, the better their diet and sleep quality;conversely, the higher the perceived stress, the worse their diet and sleep quality. Studies have shown that a healthy, balanced diet can reduce the risk of getting various diseases. Therefore, in the post-epidemic era, it is recommended that schools increase the accessibility and availability of vegetables, fruits, dairy products, nuts and seeds on campus to make it easier for teachers and students to obtain such healthy food in order to achieve the goal of promoting balanced diet.Copyright © 2022 Nutrition Society in Taipei. All rights reserved.
ABSTRACT
The world is becoming a place where the number of emergencies and humanitarian crises is increasing rapidly due to economic inequality and the gap between developed and underdeveloped countries, as well as climate changes leading to disruption of the natural balance and development of natural disasters. The most vulnerable groups of the population including women and children always are affected by disasters. The younger the child, the more vulnerable he/she is, especially if not naturally fed or having a mother or parents. Various humanitarian organizations have been involved in a number of crises, with the World Health Organization and UNICEF and other United Nations-related organizations leading the way. In the care of mothers, infants and young children, most important is to ensure appropriate nutrition because otherwise it can result in life-threatening health conditions. The lack of protection, support and promotion of natural nutrition (breastfeeding) and its disruption and undermining by uncritical and uncontrolled donations and distribution of infant formula are the biggest challenge due to the lack of information of mothers, those who provide support in emergencies from both governmental and non-governmental sector, without cross-sectoral cooperation, thus causing uncoordinated and sometimes harmful interventions. Therefore, it is recommended that governments issue guidelines on infant and young child nutrition prior to the occurrence of an emergency, and crisis management regulations in which the issue of infant and young child nutrition will be given due consideration.Copyright © 2020 Croatian Paediatric Society. All rights reserved.
ABSTRACT
The COVID-19 pandemic is predicted to trigger a global economic and food supply crisis, which further affects children's nutritional status as a vulnerable group. This study aimed to observe alterations in nutritional status before and during the COVID-19 pandemic (during 2019-2021) and determinant factors involved in the improvement of nutritional status (based on the height-for-age Z-score (HAZ) index category) during the COVID-19 pandemic. The findings were intended as evidence-based suggestions for policy formulation concerning the improvement of child nutritional status and stunting reductions. This study was part of a cohort study of children's growth and development conducted by National Institute of Health Research and Development (NIHRD) in Bogor city-Indonesia. The analysis was conducted on 565 children under five in 2019 with height measurement data in 2019 and 2021, environmental conditions, parental education, consumption habits, and social assistance. Children were classified as having an improved nutritional status if the HAZ category increased in 2021 compared to 2019. In addition, multiple logistic regression analyses were performed to predict determinant factors involved in improving the child's nutritional status. In this study, 17.5% of children had improved nutritional status, and 79.3% had a steady nutritional status. However, there were 3.2% of children with decreased nutritional status. Model factors determinant related to improved nutritional status includes consumption more than once per week of red meat (adjusted odds ratio (aOR) = 2.15;95% confidence interval (CI): 1.06-4.35, p=0.034), milk consumption more than once per week (aOR = 1.56;95% CI: 0.89-2.74, p=0.119), and age under 5 years old (aOR = 1.86;95% CI: 1.14-3.15, p=0.016). Children under five years old, the consumption of red meat and milk more than once a week have the opportunity to improve nutritional status (by height-for-age index) in children.
ABSTRACT
Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. All rights reserved.
ABSTRACT
Coronavirus disease is a serious viral infection that is characterized by severe inflammation and lymphopenia. The virus attacks many organs causing acute respiratory distress and malfunctioning of the organs leading to death. Through strengthening of the innate immune system, a balanced diet plays a critical role in defense against bacterial and viral diseases. A healthy diet before, during and after an infection can lessen the severity of the symptoms and speed up the recovery of damaged cells. Due to the Mediterranean diet's high concentration of bioactive polyphenols, which have antioxidant, anti-inflammatory, and antithrombic properties, numerous studies have suggested that it is a preventative dietary strategy against many diseases including coronavirus disease. Nutrition and herbal plants play a key role to enhance the immunity of people to protect and fight against coronavirus. Diet rich in antioxidants and phytochemicals represents perfect barrier to the virus through elevation of the innate immunity of the body. In addition, gut microbiota including prebiotics, probiotics, and synbiotics were found to enhance immunity to reduce the symptoms of the disease during infection. Protein-rich foods and honey bee products reported significant role during and post-coronavirus infection. This review presents updated information from original pre-clinical and clinical researches, and review articles as well to expose the nutritive strategies including breastfeeding benefits to infants pre-infection, during, and post-infection with coronavirus.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.
ABSTRACT
Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
ABSTRACT
Aims: Gestational diabetes has been attributed to maternal obesity and suboptimal maternal diet but the relative contribution of maternal eating behaviour is unknown. We compared eating behaviour in women with gestational diabetes and non-pregnant adults, and assessed which eating behaviour traits were most strongly associated with BMI in women with gestational diabetes. Method(s): Participants (total n = 448) including men (n = 67), non-pregnant women (n = 181) and women with gestational diabetes during a singleton pregnancy (n = 200;29 weeks' gestation;NICE / Covid-19 criteria) were recruited prospectively and completed a three-factor eating questionnaire (TFEQ-R18). Associations between BMI and uncontrolled eating (UE), emotional eating (EE) and cognitive restraint (CR) were assessed using linear regression. Result(s): Women with gestational diabetes had significantly lower UE scores compared to men (53% vs 63%;p < 0.001) and non-pregnant women (53% vs 65%;p < 0.001), and lower EE scores compared to non-pregnant women (60% vs 70%;p < 0.001). In men, BMI showed positive associations with UE (Coeff 25.2;95% CI 10.8-39.6;p = 0.001) and EE scores (Coeff 11.9;95% CI 3.3-20.6;p = 0.007) while CR had no significant association. In non-pregnant women, BMI showed positive associations with UE (Coeff 20.7 95% CI 11.4-30.0), p < 0.001) and EE scores (Coeff 7.7;95% CI 1.8-13.6;p = 0.010) and negative associations with CR (Coef-10.6;95% CI -21.1 to -0.1;p = 0.049). In women with gestational diabetes, only EE scores were significantly associated with BMI (Coeff 7.8;95% CI 3.9-11.7;p < 0.001). Conclusion(s): Women with gestational diabetes have favourable eating behaviour compared to men and non-pregnant women. Addressing EE may provide new translational opportunities to reduce BMI in gestational diabetes.
ABSTRACT
COVID-19 has become of the most fatal pandemics in the century. It has widely spread among different countries in the world. Also, the pandemic has affected different sections of the society. It has psychologically and financially affected the individuals also. In this scenario, it is important to analyze the feeding and income coping strategies of the salaried class employees. For this, a questionnaire was developed using Google Form and was sent across different salaried class employees of Kerala. A total of 100 samples were taken and the analysis was done. The findings of the study indicated that most of them did stock up food during COVID-19, and those who did not preferred home deliveries from supermarkets. When financial strategies are considered, a higher strain and a lower emergency saving was witnessed among those of the lower income group. The palliative measures by the Government were equally welcomed by all the income groups except the medical facility.
ABSTRACT
Ab s t r ac t Aim: The aim of this study was to summarize different types of benefits that have been observed in the baby's development and the mother's psychological health during the postpartum period. Background(s): Breastfeeding is a natural process that plays a vital role in the physical as well as mental health of the mother and child. Breast milk is rich in contents such as proteins, fats, and vitamins, which are responsible for building the immune system of the baby. Lactation helps in decreasing the prevalence of infant mortality rate. It enhances the development of the physical health of the children. Breastfeeding protects the mother from many systemic conditions like endometrial cancer, ovarian cancer, breast cancer, etc. It has been observed that with an increase in healthy breastfeeding practices, there is a decline in the cases of maternal mental health issues reported mainly in the postpartum period. Review result: The authors have explained various types of advantages of breastfeeding on the child's and mother's health, their mechanism of action, effects on the baby, and mother-child relationship. Conclusion(s): The mother's mental health plays a crucial role in a healthy infant, and breastfeeding is key to it. The role of breastfeeding is therefore considered a boon for the mother because if there is a decrease in health issues in the child, the mother's mental condition improves automatically. Therefore, breastfeeding should be promoted at the national level. Clinical significance: Breastfeeding not only helps in reducing maternal stress and postpartum depression but also improves the physical health of the child and mother during the postpartum period. The clinicians should teach mothers about the importance and also the correct positions of breastfeeding. "Breastfeeding week" is celebrated every year from August 1 to August 7, as implemented by the Indian government.Copyright © The Author(s). 2023 Open Access.
ABSTRACT
COVID-19 pandemic has brought a significant change in the lives of all population segments. Irrespective of the country, religion, economic status, and position worldwide, a committed thought is developed on "IMMUNITY" and "IMMUNITY BOOSTERS."The nutrition and health portfolio of many populations worldwide reported severe impacts from changing trends in modern lifestyle, food habits, food consumption, and the environment. Defining health remains a crucial task over several decades. The present study is to understand and evaluate the knowledge and purchasing behaviour of the population during COVID-19 time. A survey is conducted through social media platforms with pre-designed and tested questionnaires. Data were collected from 200 respondents. A rapid assessment survey was conducted using Google Forms. Google Form was distributed through various social media platforms such as WhatsApp, Facebook, and LinkedIn in Indian communities residing across the globe. The above data shows that 64% have consumed Vitamin C supplements almost every day for 15 days, 13% for one month, 10% of the respondents more than one month, and 13% took supplements as supplements per the doctor's advice. The results indicate that nearly 73% of the respondents started consuming supplements, 15% sometimes, and 4% of the respondents expressed their consumption was on and off. When questioned in detail, it is mentioned that they have taken supplements. The results depict buying behaviours, reading and understanding the food labels, purchasing supplements and immune boostersCopyright © 2023, Research Journal of Pharmaceutical, Biological and Chemical Sciences.All Rights Reserved.
ABSTRACT
Purpose: This study aims to identify the dietary patterns of two groups of subjects (with and without COVID-19), and to assess the relationship of findings with the prognosis of COVID-19 and metabolic risk parameters. Design/methodology/approach: This study included 100 individuals in the age range of 19-65 years. The medical history, and data on biochemical, hematological and inflammatory indicators were retrieved from the files. A questionnaire for the 24-h food record and the food intake frequency was administered in face-to-face interviews, and dietary patterns of subjects were assessed. Findings: In individuals with COVID-19, the hip circumference, the waist-hip ratio and the body fat percentage were significantly higher (p < 0.05), and the muscle mass percentage was significantly lower (p < 0.05). Mediterranean diet adherence screener (MEDAS), dietary approaches to stop hypertension (DASH) and healthy eating index-2015 (HEI-2015) scores were low in the two groups. A linear correlation of DASH scores was found with the muscle mass percentage (p = 0.046) and a significant inverse correlation of with the body fat percentage (p = 0.006). HEI-2015 scores were significantly and negatively correlated with body weight, body mass index, waist circumference, hip circumference and neck circumference (p < 0.05). Every one-unit increase in MEDAS, DASH and HEI-2015 scores caused reductions in C-reactive protein levels at different magnitudes. Troponin-I was significantly and negatively correlated with fruit intake (p = 0.044), a component of a Mediterranean diet and with HEI-2015 total scores (p = 0.032). Research limitations/implications: The limitation of this study includes the small sample size and the lack of dietary interventions. Another limitation is the use of the food recall method for the assessment of dietary patterns. This way assessments were performed based on participants' memory and statements. Practical implications: Following a healthy diet pattern can help reduce the metabolic risks of COVID-19 disease. Originality/value: Despite these limitations, this study is valuable because, to the best of the authors' knowledge, it is the first study demonstrating the association of dietary patterns with disease prognosis and metabolic risks concerning COVID-19. This study suggests that dietary patterns during the COVID-19 process may be associated with several metabolic risks and inflammatory biomarkers.
ABSTRACT
Background. The Maternal Mortality Rate (MMR) in Indonesia is still a health problem that must be solved. In 2018 and 2019, the postpartum period still dominates maternal mortality in Surabaya. The postpartum visit method is one of the essential things that can affect postpartum services, so it is necessary to evaluate the implementation of the postpartum visit method and recommend visiting methods to improve maternal health. Objective.The study explores the implementation and recommendation of postpartum visit methods during the COVID-19 Pandemic. Materials and Methods. It used a qualitative research type by assessing the interview and observation dept. The instruments used are questionnaires and observation sheets. Researchers conducted interviews with 14 mothers who had completed the postpartum period, five midwives, a stakeholder in the health office and two experts in the field of maternal health. The data is processed using organizing, reduction, coding, description, linking between themes, and data interpretation. Results. Offline visits to health facilities still dominate the implementation of the postpartum visit method. The recommended postpartum visit method combines visits to health facilities, home visits, and telehealth. Besides that, it is necessary to consider maternal postpartum services up to 3 months after delivery, especially for postpartum mothers who have problems. Conclusion. The postpartum visit method during the COVID-19 pandemic, has not run optimally because there are restrictions on offline visits. However, it has not been supported by online monitoring or home visits.Copyright © the Author(s), 2023.
ABSTRACT
Background:COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population.Objectives:We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor and major), DF, and related AID treatment modifications from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.Methods:Among complete responses from 9201 participants as of June 21, 2022, 6787 (73.8%) were women. Six subgroups were identified upon diagnosis of AID vs healthy controls (HC) and their pregnancy/breastfeeding status at the time of any dose of vaccine (Figure 1).Figure 1.Flowchart of the study. AID: autoimmune diseases;HC: healthy controls;rAID: rheumatic AID;nrAID: non-rheumatic AID.[Figure omitted. See PDF]ResultsForty pregnant and 52 breastfeeding AID patients were identified and their vaccination rates (at least one dose) was 100% and 96.2%, respectively (Table 1). Overall AE, minor AE, and major AE were reported significantly more frequently by pregnant than non-pregnant patients (45% vs. 26%, p=0.01;40% vs. 25.9%, p=0.03;17.5% vs. 4.6%, p<0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients (n=2315). All DF in pregnant/breastfeeding patients were managed with glucocorticoids and a fifth of them required initiation or change in immunosuppressive treatment.Table 1.Characteristics of female subjects according to groups. Percentages in parenthesis. *Pregnancy/breastfeeding status at the time of the survey and/or at the time of at least one dose of COVID-19 vaccine. Chi squared test: ~ p=0.01;° p=0.03;§ p<0.01.Total Women (n=6787)Group A Non-pregnant, non-breastfeeding with AID (n=4862)Group B Pregnant with AID* (n=40)Group C Breastfeeding with AID* (n=52)Group D Non-pregnant, non-breastfeeding HC (n=1749)Group E Pregnant HC* (n=31)Group F Breastfeeding HC* (n=53)Age (median, IQR)47, 35-5850, 38-6134, 31-35.2533, 30-3539, 29-4934, 30-36.533, 30-36Caucasian3225 (47.5)2634 (54.1)12 (30)22 (42.3)538 (30.8)7 (22.6)12 (22.6)No comorbidities3027 (44.6)1815 (37.3)19 (47.5)36 (69.2)1102 (63)17 (54.8)38 (71.7)Number of vaccinated women, n (%)6632 (97.7)4753 (97.8)40 (100)50 (96.2)1710 (97.8)30 (96.8)49 (92.5)≥3 doses4850 (71.5%)3583 (73.7%)26 (65%)33 (63.5%)1155 (66%)23 (74.2%)30 (56.6%)No AE4950 (74.6)3517 (74)~22 (55)~36 (72)1312 (76.7)22 (73.3)36 (73.5)Injection site (arm) pain and soreness630 (9.5)471 (9.9)7 (17.5)7 (14)138 (8.1)2 (6.7)5 (10.2)Minor AE1614 (24.3)1232 (25.9)°16 (40)°12 (24)338 (19.8)7 (23.3)10 (20.4)Major AE285 (4.3)196 (4.6)§7 (17.5)§1 (2)77 (4.5)1 (3.3)3 (6.1)Hospitalization74 (1.1)51 (1.1)2 (5)0 (0)20 (1.2)0 (0)1 (2)ConclusionThis study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with AID. While AEs were more commonly reported by pregnant patients with AID, these were no higher than among pregnant healthy controls without AID. These observations are reassuring, likely to strengthen physician-patient communication and overcome hesitancy as the benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of AE and DF.Reference[1]Fazal ZZ, et al;COVAD Study Group. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int 2022;42:2151-2158.AcknowledgementsThe authors are grateful to all respondents, to all patients support groups, and to all COVAD Study Group collaborators from 106 Countries.Disclosure of InterestsNone Declared.
ABSTRACT
Purpose: This study aims to evaluate the reflection of COVID-19 pandemic anxiety experienced in adults on nutritional habits during the COVID-19 pandemic in Turkey. Design/methodology/approach: The study was conducted with 600 adults aged between 19 and 64 years. The general characteristics of the individuals, nutritional habits, use of dietary supplements and COVID-19 pandemic anxiety before and during the pandemic period were questioned via a Web-based questionnaire. COVID-19-related anxiety was assessed using The COVID-19 Phobia Scale (C19P-S) and The State-Trait Anxiety Inventory (STAI). Data analysis was performed using the Statistical Package for Social Sciences, version 24.0. Findings: In this study, 49.8% of the participants stated that their appetite and food consumption amount increased during the pandemic period. The rate of use of dietary supplements among individuals was found to be 40%. It was observed that the mean body weight and body mass index increased significantly in both genders during the COVID-19 pandemic. It has been determined that anxiety about COVID-19 is higher in individuals and women who start using nutritional support during the pandemic period. The total C19P-S and STAI scores of those who started using a dietary supplement during the pandemic were significantly higher than those who did not use a dietary supplement. Similarly, those whose eating habits changed positively and those who bought more packaged products had higher C19P-S scale mean scores (p < 0.05). Originality/value: During the COVID-19 period, it is important to reduce the anxiety levels of individuals, provide psychological support, raise awareness of adequate and balanced nutrition and the correct use of dietary supplements to adapt to the new lifestyle.
ABSTRACT
This study aims to investigate the correlation between mothers' COVID-19 fears and their attitudes toward feeding their children and using food supplements. The mothers of 312 children aged 3-6 years participated in this study. Data were collected online using the Descriptive Characteristics Form for Children and Their Families, the Questionnaire Form on Food Supplement Use, the Mother's Attitudes Toward the Feeding Process Scale (MAFPS), and the Fear of COVID-19 Scale. During the pandemic, 58.9% of children used food supplements. Of these, 38.7% used vitamins/multivitamins, 39.4% used food supplements to strengthen their immunity against the disease, and 23.8% of mothers stated that the food supplement was effective in preventing COVID-19. As the fear of coronavirus increased, the mothers' attitudes toward feeding their children were negatively affected. The mothers' fears of COVID-19 negatively affected their attitudes toward feeding their children by 24.0%. Therefore, nurses should ask whether mothers use food supplements for their children during the pandemic period and inform those who use them about the effects and possible side effects of using this method.
Subject(s)
COVID-19 , Mothers , Female , Humans , Child , COVID-19/prevention & control , Dietary Supplements , Attitude , Surveys and QuestionnairesABSTRACT
Introduction: Immune mediated necrotizing myopathy (IMNM) is a rare, but progressive disease that accounts for about 19% of all inflammatory myopathies. Dysphagia occurs in 20-30% of IMNM patients. It often follows proximal muscle weakness and ensues in the later stages of the disease. We report a rare case of IMNM, presenting with dysphagia as the initial symptom, followed by proximal muscle weakness. Case Description/Methods: A 74-year-old male with a past medical history of coronary artery disease, hypertension, and hyperlipidemia presented to the ED with 2-3 weeks of intractable nausea, vomiting, and dysphagia for solids and liquids. Vital signs were stable, and initial labs displayed an AST of 188 U/L and ALT of 64 U/L with a normal bilirubin. Computed tomogram of the chest, abdomen, and pelvis were negative. An esophagram showed moderate to severe tertiary contraction, no mass or stricture, and a 13 mm barium tablet passed without difficulty. Esophagogastroduodenoscopy exhibited a spastic lower esophageal sphincter. Botox injections provided no significant relief. He then developed symmetrical proximal motor weakness and repeat labs demonstrated an elevated creatine kinase (CK) level of 6,357 U/L and aldolase of 43.4 U/L. Serology revealed positive PL-7 autoxantibodies, but negative JO-1, PL-12, KU, MI-2, EJ, SRP, anti-smooth muscle, and anti-mitochondrial antibodies. Muscle biopsy did not unveil endomysial inflammation or MHC-1 sarcolemmal upregulation. The diagnosis of IMNM was suspected. A percutaneous endoscopic gastrostomy feeding tube was placed as a mean of an alternative route of nutrition. He was started on steroids and recommended to follow up with outpatient rheumatology. He expired a month later after complications from an unrelated COVID-19 infection. Discussion(s): The typical presentation of IMNM includes painful proximal muscle weakness, elevated CK, presence of myositis-associated autoantibodies, and necrotic muscle fibers without mononuclear cell infiltrates on histology. Dysphagia occurs due to immune-mediated inflammation occurring in the skeletal muscle of the esophagus, resulting in incoordination of swallowing. Immunotherapy and intravenous immunoglobulin are often the mainstay of treatment. Our patient was unique in presentation with dysphagia as an initial presenting symptom of IMNM, as well as elevated enzymes from muscle breakdown. It is critical as clinicians to have a high degree of suspicion for IMNM due to the aggressive nature of the disease and refractoriness to treatment.
ABSTRACT
Background: Institutions across the country are experiencing delays in receipt of essential infant formula and feeding supplies due to a supply chain crisis. The supply chain crisis commenced during the COVID-19 pandemic and has continued into present day, late 2022. The supply chain crisis led to an unstable supply of ready to feed (RTF) infant formulas for a children's hospital within a medical center containing a neonatal ICU, pediatric ICU, pediatric floor and newborn nursery. RTF formulas are the recommended inpatient infant feeding due to their sterility. Method(s): To address these RTF formula supply challenges, interprofessional leadership from Clinical Nutrition, Nursing and Supply Chain developed a local infant formula committee. The committee convened based on the needs of the institution, ranging from daily to weekly beginning October 2021 to present day. A shared, live spreadsheet allowed for real time inventory of RTF formula on the Nursing units and amount of product pending receipt in supply chain. Upon identification of low RTF supply, increased usage or RTF outage, the committee implemented a three-tiered action plan for each unit. For the first tier, the formula roomdiluted a higher calorie RTF liquid with water to the desired calorie density (example RTF 24 to RTF 20 calorie/oz). The medical team had an infant formula substitution list to guide feeding alternatives for specialty preparations. In the second tier, the formula room prepared stock formula for each unit daily, with a 24-hour expiration time, to accommodate potential for rapid census changes outside of the formula room operation. As a third layer of safety, powder emergency stock was pre-measured and sent with instructions for Nursing to reconstitute with sterile water, in a dedicated space, if all stock RTF formula was used. The powder emergency stock expired in 30 days, which allowed for a longer shelf life than the stock RTF formula. Result(s): It is practical for institutions without a formula room to implement similar processes using dedicated infant formula preparation space and storage. It also worth mentioning during this time there was a national shortage of powdered infant formulas due to a recall issued in May of 2022 by a major formula manufacturer. The national shortage included elemental powdered formulas for which there is no RTF alternative. Management of elemental formula outages were managed on a case-by-case basis by the Clinical Nutrition department. The Committee also convened to discuss allocations and identify substitutions for other neonatal and pediatric specialty items including sterile water, feeding preparation bottles, ENFit syringes and syringe caps, breastmilk collection containers and infant feeding nipples. Conclusion(s): Using this three-tiered process, the medical center provided sterile RTF formula to infants when available, remained consistent with best practices, predicted inventory needs consistent with usage and prevented waste of powdered infant formula in a time of scarcity. Technology and the anticipatory interprofessional leadership using a three-tiered action plan equipped the medical center for this most extraordinary infant formula crisis nationally.
ABSTRACT
Introduction: Enteral feeding is a physiologic process of providing adequate nutrition and has been shown to improve both mortality and quality of life in patients with inadequate oral intake. Improved critical care medicine and recent wave of Coronavirus Disease 2019 (COVID-19) has left us with a large proportion of patients needing alternative enteral nutrition. Although rare, intussusception is an important differential for patients presenting with acute abdominal pain post makeshift percutaneous endoscopic gastrostomy (PEG) tube placement. Case Description/Methods: A 58-year-old male was admitted to the hospital for coffee ground emesis over three days accompanied with epigastric pain. He had right sided hemiparesis secondary to cerebrovascular accident with PEG tube for enteral nutrition. Examination was significant for epigastric tenderness with normal bowel sounds. PEG tube aspiration revealed bile-tinged fluid. Significant labs included white blood cell count of 11,600 /mm3, hemoglobin 10.2 g/dL, and lactic acid of 2.3 mmol/L. A computerized tomography of the abdomen with IV contrast showed a small segment duodeno-duodenal intussusception at the horizontal segment around the distal end of the tube was noted (Figure A). An urgent esophagogastroduodenoscopy (EGD) revealed a Foley catheter acting as a makeshift PEG tube extending across the pylorus into the duodenum. The distal tip of the Foley catheter was visualized with an inflated balloon seen in the third portion of the duodenum (Figure B) The inflated catheter balloon acted as a lead point causing intussusception in a ball-valve effect. The balloon was deflated, and the catheter was replaced (Figure C) with a 20 Fr PEG tube. Discussion(s): Gastric outlet obstruction is an uncommon complication reported in few cases caused by migration of the gastrostomy tube. Rarely this migrating gastrostomy tube can invaginate the duodenum or the jejunum causing intussusception. Only handful of cases have been reported in the literature. Patients usually present with epigastric pain, vomiting or rarely hematemesis. CT scan of the abdomen is the investigation of choice. Amidst the pandemic and supply shortage, Foley catheters have been deemed as a viable alternative to gastrostomy tubes and are being used more often. It is important to recognize this rare complication and use of balloon catheter should raise further suspicion. Timely endoscopic intervention can help avoid bowel necrosis and surgical intervention.