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Bleckwenn M. [Frequent occasions for counselling in the GP practice]. MMW Fortschr Med 2024; 166:5. [PMID: 38581484 DOI: 10.1007/s15006-024-3722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Affiliation(s)
- Markus Bleckwenn
- Institut für Allgemeinmedizin, Universität Leipzig, Medizinische Fakultät, Philipp-Rosenthal-Straße 55, Haus W, 04103, Leipzig, Deutschland.
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Ramachandran R, Grantham T, Isaac-Coss G, Etienne D, Reddy M. Gastroduodenal Involvement in AL Amyloidosis: Case Report and Literature Review. J Investig Med High Impact Case Rep 2024; 12:23247096241237759. [PMID: 38462925 PMCID: PMC10929022 DOI: 10.1177/23247096241237759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/12/2024] Open
Abstract
Gastrointestinal amyloidosis is a rare condition commonly found in the setting of systemic AL amyloidosis. Amyloid can deposit throughout the gastrointestinal tract and the resulting symptoms vary depending on the site of deposition. Gastrointestinal (GI) manifestations can range from weight loss or abdominal pain, to more serious complications like gastrointestinal bleeding, malabsorption, dysmotility, and obstruction. This case describes a patient with known history of IgG lambda AL amyloidosis, presenting with epigastric pain and unintentional weight loss found to have gastroduodenal amyloidosis. The definitive diagnosis of GI amyloidosis requires endoscopic biopsy with Congo red staining and visualization under polarized light microscopy. There are currently no specific guidelines for the management of GI amyloidosis. Generally, the goal is to treat the underlying cause of the amyloidosis along with symptom management. Our patient is being treated with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) and started on hemodialysis due to progression of renal disease.
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Somers A, Perkisas S, Bastijns S, Ariën F, De Cock AM. Clinical approach to the older person with anorexia. Acta Clin Belg 2023; 78:486-496. [PMID: 37345458 DOI: 10.1080/17843286.2023.2228037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Anorexia is a challenging problem among older people. Apart from being the consequence of normal ageing, it can also be a symptom of underlying disease. Despite the high prevalence of anorexia, only few recommendations exist on the evaluation in older people. The objective of this study is to summarize evidence and provide guidance through creating a flowchart. METHODS A systematic literature search was performed through combining following keywords: older people (aged, geriatrics, older adult), anorexia (also loss of appetite, unintentional weight loss) and diagnosis. After removal of duplicates and case-reports, articles were selected based on title and abstract by two reviewers. Guidelines, reviews, studies and relevant publications discussing anorexia or unintentional weight loss were included. Relevant data were extracted and processed into a flowchart. RESULTS Out of 619 hits, 25 articles were included discussing either the evaluation of anorexia or unintentional weight loss. Consensus in the work-up of unintentional weight loss is to start with a detailed history and physical examination followed by full bloodwork, urinalysis, chest x-ray and a faecal occult blood test. In certain cases, ultrasound and upper endoscopy are further recommended. In the work-up of anorexia, medication, social, psychological, logopaedic and neurocognitive aspects need to be taken into consideration. CONCLUSIONS One of the main challenges of the evaluation of anorexia in older people is the lack of guidance in existing literature. Therefore, we investigated what is currently known about the management of anorexia and unintentional weight loss as well and combined best practices to form a flowchart.
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Affiliation(s)
- Annelies Somers
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Stany Perkisas
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Sophie Bastijns
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Femke Ariën
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
| | - Anne-Marie De Cock
- University Center for Geriatrics University of Antwerp, Antwerp, Belgium
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Rao G, Ufholz K, Saroufim P, Menegay H, Beno M. Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care. Diagnosis (Berl) 2023; 10:267-274. [PMID: 37080911 DOI: 10.1515/dx-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Identify the incidence, rate of physician recognition, diagnostic practices and cancer outcomes for unintentional weight loss (UWL). METHODS We completed a secondary analysis of structured and unstructured EHR data collected from adult patients between January 1, 2020 and December 31, 2021. We used four common definitions to define UWL, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy. Unstructured physicians' notes were used to identify both intentional weight loss (e.g. dieting) as well as physician recognition of UWL. Cancer outcomes were identified within 12 months of UWL using diagnostic codes. Physician actions (lab tests, etc.) in response to UWL were identified through manual chart review. RESULTS Among 29,494 established primary care patients with a minimum of two weight measurements in 2020 and in 2021, we identified 290 patients who met one or more criteria for UWL (1 %). UWL was recognized by physicians in only 60 (21 %). UWL was more common and more likely to be recognized among older patients. Diagnostic practices were quite variable. A complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the three most common tests ordered in response to UWL. Five patients were diagnosed with cancer within 12 months of UWL (3 in whom UWL was recognized; two in whom it was not.). CONCLUSIONS Unintentional weight loss is poorly recognized across a diverse range of patients. A lack of research-informed guidance may explain both low rates of recognition and variability in diagnostic practices.
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Affiliation(s)
- Goutham Rao
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kelsey Ufholz
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Paola Saroufim
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Harry Menegay
- University Hospitals of Cleveland, Cleveland, OH, USA
| | - Mark Beno
- Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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5
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Batista M, Santos ML, Silva C, Pereira G, Alves G, Cotter J. Whipple's Disease: A Case Report. Cureus 2023; 15:e39963. [PMID: 37415994 PMCID: PMC10320647 DOI: 10.7759/cureus.39963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Whipple's disease (WD) is caused by Tropheryma whipplei, frequently found in lamina propria's macrophages in the small intestine. It is a rare and chronic systemic infection, and the principal clinical manifestations are diarrhea, weight loss, abdominal pain, and arthralgia. The diagnosis is difficult mainly because of its rarity and should be considered in patients with arthralgias, diarrhea, abdominal pain, and weight loss after more common conditions have been excluded. The laboratory diagnosis is established by a duodenal biopsy. The treatment involves 14 days of intravenous antibiotics with good penetration in the cerebrospinal fluid (i.e., ceftriaxone) and one-year treatment with oral co-trimoxazole. Early diagnosis and proper treatment are crucial because it improves the prognosis. We report the case of a 58-year-old female with skin hyperpigmentation, loss of appetite and weight (16% of body weight in three months), nausea, upper abdominal pain, and diarrhea. Esophagogastroduodenoscopy and colonoscopy were performed to obtain biopsy samples, which, together with laboratory tests and microbiological studies, led to a diagnosis of Whipple's disease.
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Affiliation(s)
- Marta Batista
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | | | - Cristina Silva
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Gabriela Pereira
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Glória Alves
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital da Senhora da Oliveira, Guimarães, PRT
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Jancar N, Sousa Gonçalves F, Duro J, Pinto I, Oliveira T, Aguiar P. Kala-Azar: A Case Report. Cureus 2023; 15:e34864. [PMID: 36923201 PMCID: PMC10010315 DOI: 10.7759/cureus.34864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Leishmaniasis is a zoonosis caused by unicellular protozoans Leishmania. The transmission can be zoonotic or anthroponotic, depending on the species, and the main vector is the phlebotomine sandfly. The disease is endemic in the tropics of Asia and Africa but is considered rare in Portugal, especially in immunocompetent hosts. Its main clinical syndromes constitute cutaneous leishmaniasis, mucocutaneous disease, and visceral leishmaniasis. The latter is also known as kala-azar and is caused by the infection of the phagocytes of the reticuloendothelial system, causing the typical symptoms: fever, hepatosplenomegaly, and pancytopenia. The clinical manifestations are non-specific, frequently causing a delay in the diagnosis, especially in nonendemic areas and immunocompetent hosts. Early diagnosis and treatment are essential, given the high mortality rate in untreated patients. The diagnosis is based on the direct visualization of the protozoan and molecular methods, such as polymerase chain reaction tests. Amphotericin B is considered the first-line treatment. We present a case of visceral leishmaniasis in an immunocompetent patient with fever, hepatosplenomegaly, and pancytopenia.
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Affiliation(s)
- Nina Jancar
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Filipa Sousa Gonçalves
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - José Duro
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Inês Pinto
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Tiago Oliveira
- Pathology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Patrício Aguiar
- Internal Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT.,Medicine Department, Faculty of Medicine, Lisbon University, Lisbon, PRT
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Muacevic A, Adler JR, Dawoud H, Elkot AN. Celiac Artery Compression Syndrome as an Uncommon Cause of Intractable Postprandial Abdominal Pain: A Case Report. Cureus 2022; 14:e32434. [PMID: 36644036 PMCID: PMC9833008 DOI: 10.7759/cureus.32434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Celiac artery compression syndrome (CACS) is an uncommon and poorly understood condition. Compression of the celiac artery by the median arcuate ligament causes intractable postprandial abdominal pain, weight loss, vomiting, and nausea. We present a case of a 68-year-old male who suffered recurrent severe episodes of postprandial abdominal pain associated with occasional nausea, vomiting, and elevated blood pressure. The diagnostic workup was significant for celiac artery compression on computed tomography angiography. Diagnosis of CACS was made after the exclusion of the other possible pathologies, and the patient was referred to the surgical team for further management for median arcuate ligament release on an elective basis.
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Luo CM, Hsieh MY, Cheng CH, Chen CH, Liao MT, Chuang SY, Wu CC. Association of Frailty With Thrombosis of Hemodialysis Vascular Access: A Prospective Taiwanese Cohort Study. Am J Kidney Dis 2022; 80:353-363.e1. [PMID: 35257814 DOI: 10.1053/j.ajkd.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Frailty, a multidimensional construct, has been associated with poor outcomes in patients receiving maintenance dialysis. This study assessed the association of frailty with dialysis vascular access patency. STUDY DESIGN Multicenter prospective cohort study. SETTING & PARTICIPANTS 761 prevalent patients receiving hemodialysis at 9 centers in Taiwan as of January 2018. EXPOSURE Performance-based frailty was defined as 3 of the following: unintentional weight loss, weakness, exhaustion, low physical activity, and slow gait speed. Patients were categorized as prefrail if they had 1 or 2 of these characteristics. OUTCOME Rate of and time to dialysis access thrombosis. Data regarding vascular access events were collected for 30 months after enrollment through December 31, 2020. ANALYTICAL APPROACH Logistic regression analysis was used to estimate the association of clinical characteristics with frailty. Cox proportional hazards regression analysis was used to estimate the association of frailty with vascular access thrombosis adjusted for known clinical risk factors. RESULTS The patients' mean age was 66 years, 46% were female, 18% had synthetic graft accesses, and 82% arteriovenous fistulas. Overall, 31% were frail, 35% were prefrail, and 34% were not frail. The frailty phenotype was associated with age, female sex, low body mass index, diabetes mellitus, and prior stroke. During a median follow-up of 731 days, 161 patients (21%) had access thrombosis events (not frail, 14%; prefrail, 20%; frail, 30%; P < 0.001). Frail patients had a higher risk of vascular access thrombosis than nonfrail patients (HR, 2.31 [95% CI, 1.55-3.39], P < 0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with access thrombosis for both fistulas and grafts. LIMITATIONS Limited generalizability and potential residual confounding. CONCLUSIONS Frailty is associated with an increased risk of vascular access thrombosis. These findings highlight the risks of access failure experienced by frail patients receiving hemodialysis.
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Affiliation(s)
- Chien-Ming Luo
- Cardiovascular Division, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | - Mu-Yang Hsieh
- Cardiology Division, Department of Medicine, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | | | - Chiu-Hui Chen
- Hemodialysis Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu
| | - Min-Tsun Liao
- Cardiology Division, Department of Medicine, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Chih-Cheng Wu
- Quality Control Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei; Institute of Biomedical Engineering, National Tsing-Hua University, Hsin-Chu; Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan.
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9
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Walsh K, Ojha N, Seth R. Fibrolamellar Variant of Hepatocellular Carcinoma in a Young Female. Cureus 2021; 13:e16486. [PMID: 34430102 PMCID: PMC8372826 DOI: 10.7759/cureus.16486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/05/2022] Open
Abstract
Fibrolamellar variant of hepatocellular carcinoma (FLHCC) is a rare malignancy. Our patient presented to the hospital with increasing weight loss, decreased appetite, and night sweats. Imaging revealed a large liver mass and multiple pulmonary nodules concerning for metastasis. The patient eventually underwent interventional radiology (IR)-guided biopsy of the liver which revealed pathology consistent with FLHCC. The patient was discharged from the hospital and was scheduled for a follow up at an outpatient cancer center close to her family.
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Affiliation(s)
- Kevin Walsh
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Niranjan Ojha
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Rahul Seth
- Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, USA
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10
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Ali H, Kazmi MI, Barajas-Ochoa JA, Ahlawat S. Celiac Artery Compression Syndrome: A Unique Presentation. Cureus 2021; 13:e16175. [PMID: 34262830 PMCID: PMC8260192 DOI: 10.7759/cureus.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Celiac artery compression syndrome (CACS), also known as median arcuate ligament syndrome, celiac axis syndrome, and Dunbar Syndrome, is a rare disorder that results from compression of the celiac artery by the median arcuate ligament. The following is a case that depicts an interesting presentation of a patient diagnosed with this rare condition. A 44-year-old male with a history of mutism was brought in by his family for weight loss of 100 lbs with intermittent abdominal pain, weakness and lethargy over a period of five years. His family reported that he had poor nutritional intake, and could only eat a small amount before he seemed to be in pain, and eventually refused to eat. He had no other prior medical history except for mutism, no family history of malignancy, no history of trauma, surgeries, smoking or substance use, and did not take any medications. Physical exam was largely unremarkable. Mesenteric vascular duplex demonstrated severe grade stenosis of the celiac trunk with post-stenotic velocity of 520 cm/sec. Contrast enhanced computed tomography angiography revealed acute angle J-configuration of the takeoff of the celiac axis, with stenosis at its origin and focal post-stenotic dilatation, confirming the diagnosis of CACS. CACS is an elusive diagnosis that should be considered in patients where other causes of abdominal pain and weight loss have been ruled out. The disease can present with the classic triad of post-prandial abdominal pain, weight loss, and an abdominal bruit. Imaging modalities including mesenteric vascular duplex, computed tomography abdominal angiography, magnetic resonance angiography and celiac artery angiography can help make the diagnosis. Treatment involves surgical decompression via division of the median arcuate ligament, with most patients experiencing significant and long-lasting relief from their symptoms.
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Affiliation(s)
- Hasan Ali
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Maryam I Kazmi
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | | | - Sushil Ahlawat
- Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA
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Mughal MS, Kaur IP, Akbar H, Abbas SH, Angi P. Hard Palate Perforation in an Elderly Man With Dementia. Cureus 2021; 13:e15872. [PMID: 34327097 PMCID: PMC8302451 DOI: 10.7759/cureus.15872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
A 74-year-old male with a history of mild cognitive impairment presented to the emergency department with failure to thrive and generalized weakness. He was having difficulty swallowing leading to 30 pounds of unintentional weight loss in the last three months. His social history was significant for 12.5 pack-year smoking and drinking (two to three glasses of wine/day). The oral cavity examination revealed a large (3 × 2 cm2) defect with the erythematous border that encompassed the mid-palatal structures and emanated from the hard palate into his nasal cavity. Auto-immune work-up was negative. Palatal biopsy showed squamous cell carcinoma (SCC; well-differentiated). A diagnosis of locally advanced (stage IVa) oral cavity squamous cell carcinoma (OSCC) was made based on PET scan findings. A palatal obturator (prosthesis) was placed to improve his eating, prevent regurgitation. The patient opted for palliative care and did not want to pursue further treatment. He was discharged home with a regular follow-up visit.
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Affiliation(s)
- Mohsin S Mughal
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | - Hafsa Akbar
- Department of Internal Medicine, Abington Jefferson Hospital, Abington, USA
| | - Syed H Abbas
- Pathology, Saint Barnabas Medical Center, Livingston, USA.,Pathology, Monmouth Medical Center, Long Branch, USA
| | - Priya Angi
- Geriatrics, Monmouth Medical Center, Leon Hess Cancer Center, Long Branch, USA
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Kostecka M, Bojanowska M. An evaluation of the nutritional status of elderly with the use of the MNA questionnaire and determination of factors contributing to malnutrition. A pilot study. Rocz Panstw Zakl Hig 2021; 72:175-183. [PMID: 34114774 DOI: 10.32394/rpzh.2021.0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In the elderly, nutrition significantly influences biological aging and physiological and pathological changes in the body. A balanced diet and physical activity are the key to good physical and mental health. Objective The aim of this study was: (1) to perform nutritional screening tests in senior citizens residing in eastern Poland and (2) to evaluate the risk of malnutrition in elderly people who live with their families, seniors who live independently, and residents of nursing homes. Material and method The Mini Nutritional Assessment (MNA) screening tool comprising a questionnaire with 22 questions and an abbreviated and survey-adapted version of the questionnaire (KomPAN) were used to investigate eating habits and self-perception of health and nutrition. A total of 398 correctly filled out questionnaires were selected and the resulting data were subjected to statistical analyses in the Statistica 10 program. Results The BMI values of most respondents were indicative or malnutrition or risk of malnutrition, regardless of gender (mean BMI 23.88 kg/m2 ±5.08). Most overweight and obese respondents were female (p=0.0001). The observed decreased BMI values was significantly (p=0.0012, rs= 0.6714) correlated with lower food intake. Unintentional weight loss greater than 3 kg was most frequently noted in respondents living in nursing homes and living independently (p=0.0021). Eating difficulties also considerably influenced the respondents' nutritional status. The respondents' BMI values were significantly correlated (p<0.0001) with their MNA scores, the average MNA score was 21.0±4.4, (rs = 0.7293). Overweight and obese respondents were more likely to consume at least three meals daily (OR=1.87; 95% CI: 1.32-2.06; p<0.001). Conclusions The BMI values and MNA scores of the tested subjects indicate that the majority of the surveyed respondents were malnourished or at risk of malnutrition, regardless of gender. In the present study, the residential environment significantly influenced the patients' nutritional status, in particular in respondents with impaired motor abilities and eating difficulties.
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Affiliation(s)
- Małgorzata Kostecka
- University of Life Science, Faculty of Food Science and Biotechnology, Department of Chemistry, Akademicka street 15, 20-950, Lublin, Poland
| | - Monika Bojanowska
- University of Life Science, Faculty of Food Science and Biotechnology, Department of Chemistry, Akademicka street 15, 20-950, Lublin, Poland
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Abstract
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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14
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Cui Z, Cai J, Lewis CE, Stevens J. Changes in Cardiovascular Disease Risk Factors with Unintentional Versus Intentional Weight Loss: The Coronary Artery Risk Development in Young Adults Study. Metab Syndr Relat Disord 2019; 17:143-148. [PMID: 30730245 PMCID: PMC6939580 DOI: 10.1089/met.2018.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is well known that total and intentional weight loss (IWL) are associated with reductions in cardiovascular disease (CVD) risk factors, however, associations with unintentional weight loss (UWL) have not been studied. METHODS We examined annual changes in blood pressure and lipids associated with UWL versus IWL in 576 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study who had lost weight over one of two time intervals (i.e., study years 5-7 or 7-10) and reported whether the weight loss was intentional at the end of the interval. RESULTS After adjusting for age, sex, race, and field center, an annual weight loss smaller than 6% resulted in small improvements in lipids that were similar regardless of intentionality. When annual weight loss was ≥6%, UWL was associated with less reduction in total cholesterol (-0.2 vs. -10.4 mg/dL), low-density lipoprotein cholesterol (-3.2 vs. -9.4 mg/dL), and triglycerides (-0.5 vs. -19.0 mg/dL) compared with IWL. Intentionality was not associated with the size of changes in blood pressure (systolic blood pressure: -2.7 vs. -2.0 mmHg; diastolic blood pressure: -2.2 vs. -1.3 mmHg) and high-density lipoprotein cholesterol (3.2 vs. 2.7 mg/dL). CONCLUSIONS Substantial UWL may be accompanied or preceded by other biological changes in this young adult population that alter changes in CVD risk factors that are associated with IWL.
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Affiliation(s)
- Zhaohui Cui
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cora E. Lewis
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Objective: This study aimed to identify the impacts of weight change and weight change intention on health-related quality of life (HRQL) among community-dwelling Korean elderly individuals. Method: Data on those aged 75 years and above from the Korean National Health and Nutrition Examination Survey were analyzed using multiple regression analysis. Results: Compared with no weight change, unintentional weight loss was associated with significantly lower adjusted overall HRQL and lower scores in the subdimensions of mobility, pain/discomfort, usual activities, and self-care (in order), whereas intentional weight loss was associated with significantly poorer scores for anxiety/depression. Weight gain showed no statistically significant differences in comparison with no weight change. Discussion: These findings suggest that weight maintenance or weight gain should be recommended rather than weight loss, whether unintentional or intentional, regardless of weight status, to improve HRQL among the elderly.
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Affiliation(s)
- Eun Sun So
- 1 Chonbuk National University, Jeonju-si, Republic of Korea
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16
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Simmons SF, Hollingsworth EK, Long EA, Liu X, Shotwell MS, Keeler E, An R, Silver HJ. Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis. J Am Geriatr Soc 2016; 65:313-322. [PMID: 28198565 DOI: 10.1111/jgs.14488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. DESIGN Randomized, controlled trial. SETTING Five community NHs. PARTICIPANTS Long-stay NH residents with an order for caloric supplementation (N = 122). INTERVENTION Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. MEASUREMENTS Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. RESULTS Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. CONCLUSION It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake.
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Affiliation(s)
- Sandra F Simmons
- Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Emily K Hollingsworth
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee
| | - Emily A Long
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee
| | - Xulei Liu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | | | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Heidi J Silver
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee
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17
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Simmons SF, Keeler E, An R, Liu X, Shotwell MS, Kuertz B, Silver HJ, Schnelle JF. Cost-Effectiveness of Nutrition Intervention in Long-Term Care. J Am Geriatr Soc 2015; 63:2308-16. [PMID: 26503137 DOI: 10.1111/jgs.13709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN Randomized, controlled trial. SETTING Five skilled nursing home facilities. PARTICIPANTS Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.
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Affiliation(s)
- Sandra F Simmons
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Nashville, Tennessee
| | - Emmett Keeler
- Rand Corporation, Santa Monica, California.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Xulei Liu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Brittany Kuertz
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee
| | - Heidi J Silver
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Nashville, Tennessee
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18
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Bennett K, Rettew A, Shaikh B, Supplee S, Alweis R. An easily overlooked cause of abdominal pain. J Community Hosp Intern Med Perspect 2014; 4:25083. [PMID: 25432644 PMCID: PMC4246151 DOI: 10.3402/jchimp.v4.25083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/06/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
A 63 year old female presented to the emergency department with a several month history of intermittent right upper quadrant abdominal pain, early satiety with loss of appetite, and an unintentional weight loss of 8. She underwent a battery of tests that returned negative and subsequently sent for Computed tomographic angiography (CTA) of the abdomen revealing luminal stenosis of the proximal 1 cm of the celiac axis estimating 90% occlusion and a patent SMA and IMA with, typical for median arcuate ligament syndrome. The symptoms, diagnosis, and treatment options are discussed.
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Affiliation(s)
- Kyle Bennett
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA;
| | - Andrew Rettew
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Bilal Shaikh
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Suzanne Supplee
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Richard Alweis
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
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