Perception of training and job perspectives among final-year residents in the specialty of Endocrinology and Nutrition

Introduction: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19. Material(s) and Method(s): Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021. Result(s): 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology. Conclusion(s): The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility.Copyright © 2022 SEEN y SED

Inequalities in food perceptions during the Covid-19 pandemic. A comparative study in urban and rural contexts of Tucumán (Argentina)

This work describes food experiences during the Covid-19 pandemic, according to the urban or rural ecological configuration and the socioeconomic level (SES) in households in the province of Tucumán (Argentina). A digital field work was carried out in 1342 households classified as urban (942) or rural (400) according to the criteria of the Instituto Nacional de Estadísticas y Censos. Food experiences were assessed through primary data analysis applying the Latin American and Caribbean Scale for the measurement of Food Security and SES through the Family Affluence Scale. Likewise, secondary information sources were used to characterize the structural living conditions of the urban and rural population. The results showed a higher affectation in the experiences of the home in general, compared to the experiences of adults and children and adolescents, in particular. Rural households were the most affected, as were those with low SES. However, the experiences and practices in both environments had in common the care of feeding children and adolescents. © Editado por D. Demarchi

Metabolic risks and prognosis of COVID-19: are dietary patterns important?

PurposeThis 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/approachThis 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.FindingsIn 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 ındex-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/implicationsThe 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 implicationsFollowing a healthy diet pattern can help reduce the metabolic risks of COVÍD-19 disease.Originality/valueDespite 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.

Improving complementary feeding practices through a comprehensive health systems strengthening approach: experiences from Egypt. (Special section on complementary feeding in emergencies.)

This article describes experiences of improving complementary feeding practices using a systems approach with particular focus on health systems strengthening. Achievements included: the development of national guidelines for optimum complementary feeding for children 6-23 months of age, inclusion of a specific indicator for complementary feeding in the new National Food and Nutrition Strategy, updated training packages to improve health worker counselling skills and strengthened social behaviour change communication activities. A systems approach requires strong coordination between all partners across sectors to ensure communities benefit from the synergistic effects of complementary interventions, while system strengthening was noted to improve the resilience of the Ministry of Health and Population to withstand the shocks of the COVID-19 pandemic and the subsequent Ukraine crisis.

Evaluating the Impact of Nutrition Support on Clinical Outcomes in Critically Ill Patients With COVID-19: A Retrospective Study

Background: Patients with COVID-19 experience prolonged ICU stays. The rate of malnutrition in hospitalized patients remains controversial as well as the appropriate nutrition therapy for these patients. The purpose of the study was to evaluate the impact of nutrition support on clinical outcomes in critically ill patients with COVID-19. Method(s): This was a retrospective chart review involving 48 adults, critically ill patients admitted with confirmed SARS-CoV-2 infection. Data extracted included demographic, anthropometric, medical history, biochemical tests, medications, nutrition support protocol, clinical outcomes, length of stay, and ventilator status. We tested associations between aspects of nutrition support (such as early versus delayed feeding, adequacy, and patient positioning) and clinical outcomes (ICU length of stay, weight status, malnutrition status, refeeding syndrome, and ventilator days) using Chi-square, and t-tests, with significance established at the level of p <= 0.05. Result(s): Thirty-eight percent (18) of the patients met the criteria for malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) tool. Approximately 83% of these patients did not have a documented diagnosis of malnutrition in the electronic medical record. More than half of the patients in the study (58.3%) were placed in prone position as part of their treatment and only 7% of these had documented signs of feeding intolerance. None of the patients were switched to total parenteral nutrition (TPN). Only 37% of the patients received adequate protein within the first week of nutrition support while 98% had adequate or exceeded caloric needs. There was no difference in percent weight loss among patients who received inadequate protein compared to those who had adequate protein. Inadequate protein intake was associated with shorter ICU stays (p = 0.04) and fewer ventilator days (p = 0.01) compared to those with adequate protein. Patients who received inadequate or exceeded their calories needs also had shorter ICU stays and fewer ventilator days (p > 0.05). In the context of this study, shorter ICU stays translated into fewer days of life, as 98% of the studied population died before ICU discharge. There were no associations between early nutrition support and selected biochemical parameters. Conclusion(s): The rate of malnutrition was remarkable and largely undocumented. Most patients did not meet the minimum estimated protein needs. Studies with larger sample sizes are needed to examine appropriate protein needs and the effect of nutrition support in patients with COVID-19. Diagnosing and documenting malnutrition warrants heightened attention.

Was COVID-19 pandemic anxiety reflected on nutritional habits in adults?

PurposeThis 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/approachThe 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.FindingsIn 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/valueDuring 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.

Relationship Between Nutrition and Supplementary Food Use and Fear of COVID-19 in Nurses Who Worked Actively During the Pandemic

Objectives: This research was conducted to determine the effects of nurses' fear of COVID-19 on their dietary habits and use of supplements. Methods: The research, which is descriptive and cross-sectional, was shared as an online survey over the social networking site and social networking with the snowball sampling method. It was carried out between December 2020 and March 2021 with 485 nurses who worked actively during the pandemic and agreed to participate in the study. The data were obtained with the questionnaire in line with the relevant literature and the "COVID -19 Fear Scale". The data were used to evaluate the number, percentage, mean, standard deviation, median, minimum, maximum, t-test, ANOVA test, and chi(2) test. Results: Fear levels were found to be higher in nurses who regularly took food supplements during the pandemic and didn't have adequate or balanced nutrition, who couldn't eat most of the time due to working conditions, who took the food supplements to help in the prevention and treatment of COVID-19 and who recommended them to the individuals around them (p<0.05). Conclusion: It was determined that there was an increase in nurses' use of food supplements before and during the pandemic, and this increase was statistically significant (p<0.001).

Nutrition Modification in the COVID-19 Quarantine Process: Focus on Sleep Alteration, Anxiety and Happiness Factors

Objective: Coronavirus disease-2019 pandemic has made the quarantine process essential to protect public health and prevent the risk. The aim of this study was to evaluate the effect of the quarantine process applied in Turkish speaking population on nutritional changes. Additionally, the relationship between nutritional and sleep pattern changes, anxiety and happiness status was evaluated. Materials and Methods: A questionnaire form was applied via the Google Forms application. General information was questioned with a socio-demographic form. Changes in nutrition and sleep patterns were obtained with closed-ended questions asked using the self-assessment method, and the levels of anxiety and happiness were obtained using the Likert-type question technique. Results: Total of 900 people who completed the questionnaire were included. Almost half of the participants reported that they experienced nutritional changes and 54.1% did not. Also, it was determined that females experienced more than males (p <= 0.001). Participants reported that the quarantine process also caused sleep pattern changes. However, nutritional changes were also found to be significantly higher in participants who experienced sleep pattern changes. It was shown that increased happiness and anxiety levels were associated with nutritional changes (p <= 0.001). Regardless of nutrition, sleep pattern changes were more common who reported high anxiety and better happiness status (p <= 0.001). It was found that females had more sleep problems than males during the quarantine period (p=0.006). Conclusion: People responsible for public health should be aware of crisis processes such as quarantine may cause short and/or longterm health problems in public health and should try increasing social and individual awareness

Nutritional assessment of COVID-19 patients admitted in intensive care units in Pakistan

Coronavirus disease 2019 (COVID-19) can be life threating if untreated. Early diagnosis and effective nutritional management can save life. To assess the nutritional status and predict possible outcomes of critical patients Sequential Organ Failure Assessment (SOFA), nutrition risk in critically ill patients (NUTRIC), and acute physiology and chronic health evaluation (APACHE) score has been used. This retrospective observational study was conducted on confirmed COVID-19 cases in Intensive Care Unit (ICU) of Shifa hospital between November 24, 2020 to May 31, 2021. The demographic, clinical and laboratory information was obtained from hospital records. Risk factors for COVID-19 were identified and compared using multivariate logistic regression analysis. The nutritional risk for each patient was assessed. In this study 162 COVID-19 patients with median age of 64 years (IQR: 56-74) were included. Hypertension (59.2%) was found to be the most common comorbidity and the most prevalent symptoms upon admission were fever (54.9%). The patients in critical condition were supplied nutrients through nasogastric route (61.7%) while 37.7% and 0.6% were assisted through oral and total parenteral nutrition (TPN) route. The Glasgow comma score was found to be mild (72.2%) (GCS>12) with increased creatinine, white blood cell count, C-reactive protein (CRP C), and glycosylated haemoglobin HbA1c level were present. Interestingly based on SOFA, APACHE and NUTRIC score low insignificant malnutrition risk was observed. Our study found different demographic factors and comorbidities have a substantial impact on COVID-19 patients, as evidenced by demographic, laboratory, clinical, and nutritional risk factors.

Initiating Home Parenteral Nutrition Therapy in a Patient at High Risk of Refeeding Syndrome After COVID-19 Infection

Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).

The Relationships among Fear of Covid-19, Health Consciousness, Attitude toward Supplements, and Purchase Intention Using a Moderated Mediation Analysis

The purpose of this study is to examine the relationship between fear of Covid-19 (FoC), attitudes toward supplements (AtS), health consciousness (HC), and purchase intention (PI) by using moderated mediation analysis. The data acquired from 308 customers via faceto-face surveys were analyzed using descriptive statistics and structural equation modeling, and the process model produced by Hayes tested the hypotheses. The results show that the variable of AtA partially mediated the association between FoC and purchase intention. Health consciousness moderates the strength of the relationships between FoC and PI mediated by AtS. According to this, the influence of fear of Covid-19 on purchase intention via the attitudes toward food supplements differs according to consumers' health consciousness (low vs. high). The study provides essential cues for researchers, marketers, and advertisers of food supplements during the COVID-19 pandemic.

The Impact of Covid-19 Pandemic on Food and Nutrition Security and Dietary Habits Among Syrian Refugees in Camps: A General Review

With over one billion people experiencing nutritional shortages, food insecurity is expanding as a worldwide problem. There are presently 657,628 Syrian refugees registered in Jordan nine years after the crisis in the Syrian Arab Republic began. The COVID-19 pandemic had a substantial impact on pregnant women, nursing mothers, and most families with small children regarding food and nutrition security. It affected refugees worldwide. This review focuses on Syrian refugees' nutritional intake and the factors influencing their dietary habits, eating habits, and food insecurity. Due to system interdependencies, these impacts have cascaded across different components of the humanitarian aid provision system and led to risks of deterred personal growth and longer-term risks on the future leadership of the refugee community. The methodology followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A structured search of two databases-PubMed and Google Scholar—was carried out, and articles were identified that focused upon the impact of COVID-19 pandemic on food and nutrition security and dietary habits among refugees in camps. From this study, we recommend devising an interdisciplinary framework for assessing the education, protection, food security and household needs of the refugee communities together rather than intervening discreetly, and using the food security and household component of the system as the ladder to achieve effective management of pandemic-borne risks for the community. © 2023 The Author(s). Published by Enviro Research Publishers.

Clinical Nutrition in Covid-19 Patients-A Systematic Review

Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.

The Association Between Nutritional Status and Outcomes in Patients Infected With COVID-19

Background: The COVID-19 pandemic continues to pose challenges for healthcare systems across the world. Many patients infected with the virus, whether mild or severe, have nutritional complications ranging from poor appetite to the need for nutrition support. Limited research has shown that nutritional status plays a significant role in disease outcomes for COVID-19 patients. Although the American Society for Parenteral and Enteral Nutrition set guidelines for the nutritional management of COVID-19 patients, to date there are few major studies investigating the association between nutritional risk and outcomes in these patients. Thus, the purpose of this study is to assess the association between nutritional status and outcomes in hospitalized patients with COVID-19 and to identify the most common feeding practices among these patients. Method(s): A descriptive research design was used. Researchers reviewed the medical records of a random sample of 300 adult patients diagnosed with COVID-19 admitted to an academic metropolitan healthcare system between March 2020 to March 2021. Nutritional status was obtained from the admission screening and assessment documentation by a clinical dietitian (RD). Patients were then stratified based on admission nutritional status as malnourished or not. Differences in hospital length of stay (LOS), ICU LOS, ventilator dependence (in hours), and mortality were compared between groups using Mann-Whitney U, independent t-test, and chi-square tests. Result(s): Malnourished patients had a longer median (IQR) length of stay compared to non-malnourished patients (8 days (3,16) vs 4 days (3,8), p = 0.001). More patients who were malnourished expired (10/43, 23.3%) compared to patients who were not malnourished (17/ 257, 6.6%) (p = 0.002). No significant differences were observed in ICU length of stay or hours on a ventilator between groups. Most patients in the study were fed orally (87.3%), while 12.7% were fed enterally, and none of the patients were fed through use of parenteral nutrition. Conclusion(s): Results suggest that malnourished patients with COVID-19 experienced several worse outcomes compared to patients with COVID-19 who were not malnourished during hospitalization. Other known factors that influence outcomes of patients with COVID-19 were not considered in this descriptive study. Subsequent analysis to account for race, obesity, and other comorbidities is needed.

Rice as one of antioxidant source for farming family in COVID-19 pandemic: a case study from West Nusa Tenggara Indonesia

The main food consumption of farming families is an important concern during the pandemic. Farmers in West Nusa Tenggara (WNT) survive with the availability of rice to support household health and food security during the pandemic. In addition to its nutritional content, rice also contains phenolic compounds and has antioxidant activity. This study aims are to measure the frequency of rice consumption, food variety, varieties of rice consumed daily during the pandemic in WNT, as well as the antioxidant properties of several rice varieties grown in WNT. This study was conducted from September 2020 to June 2021 in East Lombok, Sumbawa and Bima Regencies, WNT Province, Indonesia using a survey approach. The data collection techniques were observation, Focus Group Discussion, recording, interviews with 74 respondents with a semi-structured questionnaire and study literature related to the nutritional content and bioactive compound of the rice. Quantitative data was tabulated to determine the frequency and average then descriptively analyzed, while qualitative data was thematically analysed. The most consumed rice varieties are seen from the production data of seed breeders in the WNT region, the phenolic content was determined using Folin-Ciocalteu, antioxidant activity was examined using DPPH assay. The result showed that the highest portion of food consumed by farmer households in WNT is rice. The most variety of rice produced by breeders is the Inpari 32 variety. There are about 97% of farmers consume rice for 3 times a day, while 3% of the remaining consume 2 times a day of rice. Food variety includes 7.9% vegetable-rice and 92.1% rice-vegetables-meat protein. The results of the analysis of antioxidant properties and phenolic content in rice is depending on the variety. The antioxidant properties of the Jeliteng, Baroma, Pamelen, Nutrizinc and Inpari 32 rice varieties were 44.85+or-0.51%, 9.87+or-1.55%, 9.96+or-1.22%, 9.75+or-1.09%, and 14.305+or-1.24%, respectively, while the phenolic contents were 9.76+or-0.09, 4.23+or-0.03, 4.48+or-0.02, 4.64+or- 0.07, 4.58+or-0.42 mg GAE/g dryrice extract, respectively. The results of this study indicate that rice has been used as one of antioxidants source for farming families during the pandemic.

Vitamin D Levels in Hospitalized COVID-19 Patients

Background: Several studies suggest an association between serum Vitamin D levels and outcomes in patients diagnosed with COVID-19. Prevention measures for COVID-19 continue to be one of the best strategies to combat the virus but identification of individuals at high risk will help clinician's direct preventative care to reduce infections and improve outcomes. This work assesses the vitamin D levels of hospitalized COVID-19 patients at one community hospital in central Pennsylvania. Method(s): This prospective study, conducted on adult, hospitalized patients under the care of clinical nutrition services between April 2021 and April 2022. Inclusion criteria included age >18 years, COVID-19 positive by polymerase chain reaction (PCR) test with associated symptoms, and not receiving vitamin D supplementation prior to or during hospital admission (N = 122). Vitamin D 25 hydroxy laboratory values were obtained, and values were interpreted utilizing the recommended range categories: 25(OH)D level >= 30 ng/ml was representative of adequate vitamin D stores, while values between 21-29 ng/ml signified vitamin D insufficiency. A 25(OH)D value <20 ng/ml is indicative of vitamin D deficiency. Result(s): Over 77% (n = 95) of all patients included in study had vitamin D values below the recommended levels, with one half (n = 61) demonstrating vitamin D deficiency. Only 22.1% (n = 27) were found to have values consistent with a blood level deemed adequate. Conclusion(s): Many hospitalized patients with COVID-19 demonstrate vitamin D levels below acceptable ranges, many with vitamin D deficiencies. Identification of these individuals in the community will allow clinicians an opportunity to treat the vitamin insufficiency or deficiency with the goal of preventing infections and potential morbidity or mortality associated with the disease. (Figure Presented).

Spontaneous Gastro-pancreatic Fistula: A Rare Complication of Acute Pancreatitis

Introduction: Although Gastrointestinal fistula is a well-recognized complication of acute pancreatitis, it has been rarely reported. Here we present a rare case of spontaneous gastro-pancreatic fistula following acute pancreatitis. Case Description/Methods: 42 y/o female with PMH of SLE with a recent prolonged hospitalization for acute drug-induced pancreatitis with pseudocyst came to ED with fever, abdominal pain, nausea, and vomiting. She was tachycardic, had leukocytosis, and was positive for COVID-19. CT Scan A/P showed multiple infected peripancreatic collections with communication of the left upper quadrant collection with the gastric lumen (Figure). The patient was hospitalized, Kept NPO, and started on fluids and antibiotics. IR evaluated and put 2 pigtail catheters for drainage of peripancreatic collections. The tip of the pigtail catheter in the left peripancreatic/retroperitoneal collection was in the gastric lumen. The surgery team recommended continuing with conservative treatment with parenteral nutrition, and IV antibiotics as the patient were nontoxic with no signs of free perforation, and pancreatitis would more likely erode a staple or suture line and would put the patient at further risk of free perforation if repair attempted. IR was successful in pulling the drain out of the gastric lumen on the second attempt to allow gastric perforation to heal. Antibiotics were upgraded as per the culture and sensitivity results of the drain fluid. Repeated multiple bedside leak tests and CT scans with oral contrast continue to be positive for patent gastro-pancreatic fistula. Pigtails catheter continues to drain significant necrotic collection. The patient continues to be hospitalized and is being managed conservatively with Parenteral nutrition, and IV antibiotics. Discussion(s): Fistula of the GI tract following acute pancreatitis can be caused by multiple reasons. Necrosis of the bowel may occur concomitantly with the pancreatic or peripancreatic tissue. Furthermore, enzyme-rich fluid and necrosis can lead to vascular thrombosis, which compromises the blood supply of the segmental GI tract, eventually leading to bowel necrosis. GI fistulas are more common in patients with necrotizing pancreatitis with infected pancreatic necrosis. Despite pharmacologic suppression of pancreatic exocrine secretion and advances in endoscopic and percutaneous therapeutic techniques, pancreatic fistula continues to be a source of morbidity and mortality following pancreatitis and requires multidisciplinary treatment.

COVID 19 and nutrition: coronavirus and 5 immune boosting nutrients

The COVID-19 outbreak which started in 2019 in China, turned out to be a deadly, infectious worldwide pandemic, caused by the SARS-CoV-2. COVID-19 affects the respiratory system, symptoms including cough, fever and shortness of breath. Upon infection, there is an uncontrolled release of pro-inflammatory cytokines, leading to acute respiratory distress syndrome, and even death. The shutdown of economies during the outbreak made acquisition of nutritious foods difficult, exposing the world to malnutrition. This was worse in underdeveloped countries where there is poor hygiene and poor healthcare systems. A good and balanced nutrition strengthens the immune system, with fruits and vegetables enhancing the anti-inflammatory responses and regulating chronic diseases which are risk factors for COVID-19. In Cameroon, decoctions against COVID-19 made from medicinal plants and foods were widely used. This included 'star yellow', a sauce formulated and used for its role in the control of the transmission of SARSCOV-2. Star yellow contains a combination of palm oil and limestone, which exposes viral RNA to zinc attacks. It also possesses anti-viral and antioxidant properties which inactivates the viral particles in the gut thus stopping the possible transmission of the SARSCOV-2 virus via faeces.

Clinical Nutrition and Food Services

Nutrition and food services provide a clinical support for quality nutritional care and treatment for a patient's overall nutritional health and recovery. In response to the crisis of the COVID-19 pandemic initial surge at SBH Health System in Spring 2020, the clinical nutrition team immediately began setting up strategic plans to cope with the unprecedented challenges and the arising logistical and staffing needs as greater demand was put on acute care hospitals worldwide. This chapter highlights those plans and describes how they were implemented during this COVID-19 crisis to ensure the continuity of quality nutrition care provision for all patients in the hospital as well as in the community. A primary challenge throughout the rapidly evolving COVID-19 crisis was rapidly expanding the capacity of the Nutrition Services Department. With proper strategic planning within the team and across the hospital departments, substantial preparations were made to overcome these difficulties and obstacles, despite the many unforeseen circumstances that often evolved unexpectedly. With great teamwork and collaboration, the clinical nutrition team realized there were actually many pathways to negate and minimize the impact of the crisis on nutrition provision allowing continuity of service through the pandemic crisis. © SBH Health System 2022.

Lung Aspergillus niger infection after SARS-CoV2

A 64-year-old never-smoker man, with professional exposure, presented to Marius Nasta Pneumophtisiology Institute for fatigability to effort, in the context of severe SARS-COV2 infection one month previously. His medical history includes pulmonary tuberculosis (55 years ago) and newly diagnosed type II diabetes (261 mg/dL glycemia). The thoracic tomography computer in the immediate post-COVID period (Fig. 1A) revealed the presence of glass ground lesions and a 3 cm nodule with cystic degeneration in the upper left lobe. A gross examination of the specimen identified a condensation area of 2.5 cm diameter, brown-grey colored, with necrosis and central ulceration. Microscopic examination showed the presence of bronchiectasis with squamous metaplasia of the epithelium, which appears ulcerated;numerous calcium oxalate crystals with adjacent foreign body granulomatous reaction;endobronchial are present fibrinous and inflammatory debris, brown-black pigment, and septate, dichotomous branching hyphae, suggestive of Aspergillus spp. A periodic acid-Schiff stain was performed, identifying the fungal hyphae. The histopathological diagnosis was bronchiectasis supra-infected and colonized with fungal filaments (Aspergillus niger).