ABSTRACT
Over the years, the standard of care for re-alimentation of patients admitted for the treatment of anorexia nervosa (AN) has been a conservative or cautious approach described as "start low and go slow." These traditional refeeding protocols advocate for a low-calorie diet that restricts carbohydrates, with the primary goal of hypothetically lowering the risk of refeeding syndrome (RFS) and its complication. However, no consensus exists for the optimal inpatient approach to refeeding children and adolescents with AN. There is still some disagreement about what constitutes an ideal pace for nutritional rehabilitation. Varying treatment protocols have emerged across the globe, often reflecting the preferences and biases of individual practitioners and contributing to the lack of a universally accepted protocol for refeeding in AN. Although it is widely accepted that low-caloric refeeding (LCR) is safe for inpatient treatment of AN, this strategy has been shown to have several significant drawbacks, leading to increased criticism of the LCR method. Research from the last decade has led to calls for a more aggressive refeeding protocol, one that suggests a higher caloric intake from the offset. As a result, this research aimed to conduct a systematic review of the existing literature on strategies for refeeding hospitalized pediatric/adolescent patients with AN and related eating disorders. We aimed to compare high-caloric refeeding (HCR) and LCR in terms of weight gain, length of stay, and risk of RFS. We conducted a thorough search of medical databases for abstracts published in English, including Google Scholar, PubMed, and MEDLINE, to find relevant studies published between 2010 and February 2023. Our focus was on articles that evaluated high versus low refeeding protocols in children and adolescents hospitalized for treating AN and related eating disorders. Only articles that reported on at least one of the outcome variables of interest, such as hypophosphatemia, weight gain, RFS, or length of hospital stay, were considered. This review included 20 full-text articles published in the last decade on the HCR protocol in children and adolescents, with a total sample size of 2191 participants. In only one of the 20 studies did researchers find evidence of a true clinical case of RFS. We, therefore, found no evidence that HCR increased the risk of RFS in adolescents, even in those with a very low body mass index (BMI). However, evidence suggests a lower BMI at the time of hospital admission is a better predictor of hypophosphatemia than total caloric intake. In conclusion, based on the evidence from this review, a high-caloric diet or rapid refeeding in children/adolescents suffering from AN may be both safe and effective, with serial laboratory investigations and phosphate supplementation as needed. Hence, more research, particularly, randomized controlled trials, is required to help shape an evidence-based refeeding guideline outlining target calorie intakes and rates of advancement to assist clinicians in the treatment of adolescents with AN and related eating disorders.
Subject(s)
Aspergillosis/complications , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Aspergillosis/diagnosis , Bezoars , Diagnostic Imaging/methods , Female , Follow-Up Studies , Humans , Middle Aged , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed , Treatment Outcome , Ureteral Obstruction/diagnosis , Ureteroscopy/methods , Urography/methodsABSTRACT
A six-year-old female victim of sexual assault, with grade IV perineal injury with massive intestinal prolapse out of the perineum, is reported to highlight the severity of injury during sexual assaults.
Subject(s)
Child Abuse, Sexual , Genitalia, Female/injuries , Intestinal Diseases/etiology , Subarachnoid Hemorrhage/etiology , Anal Canal/injuries , Child , Female , Genitalia, Female/surgery , Humans , Intestinal Diseases/surgery , Perineum/injuries , Prolapse , Vagina/injuriesABSTRACT
We report a case of 62-year-old female, who developed port site metastasis one year after undergoing laparoscopic cholecystectomy for calculous cholecystitis. This is only second such report in Indian literature.
ABSTRACT
Endoscopic cystoenterostomy for drainage of pancreatic pseudocyst is a new emerging modality which has rarely been reported in pediatric patients. Only ten successfully performed cases of pediatric endoscopic cystoenterostomy have been reported previously. We report a case of 9 year old male child with post traumatic pseudocyst of pancreas, successfully managed by endoscopic cystogastrostomy. To best of our knowledge, this is the first pediatric case report in Indian literature.
Subject(s)
Abdominal Injuries/surgery , Gastrostomy/methods , Jejunum/surgery , Pancreatic Pseudocyst/surgery , Abdominal Injuries/diagnosis , Accidents, Traffic , Child , Drainage/methods , Endoscopy/methods , Follow-Up Studies , Humans , Injury Severity Score , Jejunum/injuries , Laparotomy/methods , Male , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Pancreatic Pseudocyst/diagnostic imaging , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Colon, Sigmoid/microbiology , Enterocolitis, Necrotizing/microbiology , Intestinal Perforation/microbiology , Mucormycosis/diagnosis , Colon, Sigmoid/surgery , Enterocolitis, Necrotizing/surgery , Humans , Infant, Newborn , Intestinal Perforation/surgery , Male , Mucormycosis/surgery , Treatment OutcomeABSTRACT
Hepatogastric fistula secondary to amebic liver abscess is extremely rare. Only three pediatric cases have been reported in the English literature. Percutaneous drainage of abscess along with parenteral metronidazole can prevent the need for extensive surgical intervention. Timely intervention is usually followed by complete recovery.
Subject(s)
Gastric Fistula/diagnosis , Liver Diseases/diagnosis , Animals , Antibodies, Protozoan/immunology , Child, Preschool , Diagnosis, Differential , Endoscopy, Gastrointestinal , Entamoeba histolytica/immunology , Gastric Fistula/etiology , Gastric Fistula/surgery , Humans , Liver Abscess, Amebic/complications , Liver Abscess, Amebic/parasitology , Liver Diseases/etiology , Liver Diseases/surgery , MaleABSTRACT
An unusual case of segmental defect of ileal musculature with terminal ileal atresia and ventricular septal defect is reported. Clinically the patient was diagnosed as ileal atresia. On exploration, there was type I atresia at ileocaecal junction with attendant ileal dilatation and an adjoining 5 cm x 4 cm segment resembling segmental dilatation of ileum, about 15 cm proximal to ileocaecal junction. Pathological examination of segmentally dilated ileum revealed focal absence of circular and longitudinal muscle coat without any evidence of necrosis or inflammation. The possible etiology and its relationship with congenital segmental dilatation of intestine is discussed.
Subject(s)
Ileum/abnormalities , Intestinal Atresia/diagnosis , Muscle, Smooth/abnormalities , Female , Humans , Infant, Newborn , Intestinal Atresia/surgeryABSTRACT
Twelve cases of xanthogranulomatous cholecystitis are reported. The clinical presentation was similar to chronic cholecystitis. All patients had associated gallstones. The diagnosis was achieved at histopathological examination of the resected gall bladders and none had any focus of malignancy. Cholecystectomy was curative.
Subject(s)
Cholecystitis/pathology , Granuloma/pathology , Xanthomatosis/pathology , Adult , Aged , Cholecystitis/complications , Cholecystitis/surgery , Female , Gallstones/complications , Gallstones/pathology , Gallstones/surgery , Granuloma/complications , Granuloma/surgery , Humans , Male , Middle Aged , Retrospective Studies , Xanthomatosis/complications , Xanthomatosis/surgerySubject(s)
Colostomy/methods , Hirschsprung Disease/surgery , Child , Constriction, Pathologic/surgery , Humans , India , Treatment OutcomeABSTRACT
An unusual case of scrotal trauma along with loss of the right testis due to a bite by a stray dog in an infant is reported in view of its extreme rarity.
Subject(s)
Bites and Stings/surgery , Dogs , Scrotum/injuries , Testis/injuries , Animals , Coprophagia , Humans , Infant , Male , Scrotum/surgeryABSTRACT
Despite the strong association between twinning and neural-tube defects (NTD), concordance of twins with NTDs is very rare. A case of concordant NTDs in dizygotic twins is reported in view of its extreme rarity.
