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1.
A team approach to supporting the nutritional needs of patients living with multiple sclerosis.
Bell, N, Brammer, L
British journal of community nursing. 2017;(3):124-128
Abstract
Multiple sclerosis is the most common cause of non-traumatic disability in young adults, with most diagnoses occurring between the ages of 25-49 years. Nutrition must be managed effectively and holistically to improve health and quality of life. Dysphagia management is collaborative and can enhance nutrition and hydration goals as well as reduce the risk of aspiration pneumonia. A case study demonstrates the specialist clinical skills and frameworks used to achieve nutrition, hydration, safety and patient focused outcomes.
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2.
Refeeding syndrome: treatment considerations based on collective analysis of literature case reports.
Boateng, AA, Sriram, K, Meguid, MM, Crook, M
Nutrition (Burbank, Los Angeles County, Calif.). 2010;(2):156-67
Abstract
Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. Cardiac arrhythmias, multisystem organ dysfunction, and death are the most severe symptoms observed. As the cachectic body attempts to reverse its adaptation to the starved state in response to the nutritional load, symptoms result from fluid and electrolyte imbalances, with hypophosphatemia playing a central role. Because guidelines for feeding the malnourished patient at risk for refeeding syndrome is scarce, we have provided management recommendations based on the knowledge derived from a collection of reported English literature cases of the RFS. A MEDLINE search using keywords including "refeeding syndrome," "RFS," and "refeeding hypophosphatemia" was performed. References from initial cases were utilized for more literature on the subject. We have emphasized the continued importance of managing patients at risk for RFS, compared how management of the severely malnourished patients have evolved over time, and provided comprehensive clinical guidelines based on the sum of experience documented in the case reports for the purpose of supplementing the guidelines available. Based on our review, the most effective means of preventing or treating RFS were the following: recognizing the patients at risk; providing adequate electrolyte, vitamin, and micronutrient supplementation; careful fluid resuscitation; cautious and gradual energy restoration; and monitoring of critical laboratory indices.
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3.
Necrolytic acral erythema as a cutaneous marker of hepatitis C: report of two cases and review.
Tabibian, JH, Gerstenblith, MR, Tedford, RJ, Junkins-Hopkins, JM, Abuav, R
Digestive diseases and sciences. 2010;(10):2735-43
Abstract
Necrolytic acral erythema (NAE) is a member of the necrolytic erythemas, which include necrolytic migratory erythema (NME), acrodermatitis enteropathica, and various dermopathies secondary to nutritional deficiencies. NAE is distinct from the other necrolytic erythemas by virtue of its consistent association with hepatitis C (HCV) together with the acral distribution of its lesions, in particular, dorsal hands and feet. Although its etiology is unknown, NAE has been reported to respond to zinc replacement, suggesting a causal relationship. Two patients with HCV infection presented with scaly acral plaques and histopathologic features consistent with NAE while also demonstrating atypical palmoplantar accentuation of lesions. Both patients were found to have zinc deficiency, and their lesions responded to zinc supplementation. Awareness of NAE as a unique cutaneous marker for HCV infection is important not only for accurate dermatologic diagnosis but also for appropriate management of associated morbidity and prompt detection of potentially undiagnosed underlying HCV.
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4.
Double percutaneous endoscopic gastrojejunostomy tubes for decompression and refeeding together with enteral nutrients: three case reports and a review of the literature.
Li, Y, Wang, Z, Ni, X, Jiang, Z, Li, Y, Ding, K, Li, N, Li, J
Surgical laparoscopy, endoscopy & percutaneous techniques. 2009;(5):e167-70
Abstract
Percutaneous endoscopic gastrostomy had become a general technique for placement of indwelling feeding and decompressive tubes. There have been few reports that double percutaneous endoscopic gastrojejunostomy (PEGJ) tubes for decompression and refeeding together with enteral nutrients. We herein present 3 cases, characterized by chronic malnutrition and requiring long-term digestive decompression and enteral nutritional support, which were placed in double PEGJ tubes under endoscopic or fluoroscopic guidance. The procedures were successfully completed for all the patients. Two patients resumed oral intake and PEGJ tubes were removed. The second patient was provided home enteral nutrition while waiting for surgery. Three unusual cases were successfully treated by double PEGJ tubes for digestive decompression and refeeding together with enteral nutrients.
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5.
Bilateral parotid enlargement due to malnutrition under the influence of the media in an adolescent in Lithuania.
Mieliauskaite, D, Venalis, A, Graziene, V, Kirdaite, G
Appetite. 2007;(1):260-2
Abstract
The elimination of censorship for the media in post-communist countries in transition has contributed to increases in the prevalence of several medical problems. Children and adolescents are particularly vulnerable to the messages conveyed through the media, which influence their perceptions and behaviour. We describe a case of bilateral parotid enlargement due to malnutrition under the influence of self-prescribed diet in an adolescent. A 15-year-old girl reported to our institution under suspicion of Sjögren's syndrome for medical advice. Two months ago she developed persistent bilateral parotid enlargement and a dry mouth. Her medical history revealed a weight loss due to "self-prescribed" reduce diet. Social questioning clarified high use of the media and influence on the body concept and self image. On extra oral examination, a diffuse parotid enlargement was seen bilaterally. The examination of the mouth showed a low moisture level of the intraoral mucosa. The unstimulated whole salivary flow rate was 2 ml in 15 min. Laboratory findings evidenced anemia (107 g/l). The serum albumin concentration indicated a reduced level (28 g/l). Search for antinuclear antibodies, anti-SSA antibodies, anti-SSB, -Sm, -RNP and anti-double-stranded DNA antibodies was negative. Evaluation for antibodies against hepatitis C, cytomegalovirus and Epstein-Barr virus infection and HIV rendered negative results. A histopathologic examination of labial salivary gland biopsy revealed a picture of sialoadenosis. From the above investigations, a diagnosis of sialoadenosis due to malnutrition was made.