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BACKGROUND/OBJECTIVES To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. SUBJECTS/METHODS This first cross-sectional nationwide "Pediatric Nutrition Day (pNday)" survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. RESULTS At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively. During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. CONCLUSIONS Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Children with biliary atresia, particularly infants, are at high risk for malnutrition due to a multitude of factors including poor oral intake and intolerance of enteral feeding, fat malabsorption, abnormal nutrient metabolism, and increased caloric demand. Malnutrition and sarcopenia negatively impact outcomes in biliary atresia, leading to higher pre- and post-transplant morbidity and mortality. This review summarizes factors contributing to nutritional deficiencies in biliary atresia and offers an organized approach to the assessment and management of malnutrition in this vulnerable population.

Primary hyperoxaluria type 1 is a rare genetic condition characterized by oxalate deposition in the kidneys. We report findings of an 8-month old female presenting with failure to thrive, poor oral intake, and kidney stones resulting in the diagnosis of primary hyperoxaluria type 1. The patient exhibits a unique presentation without renal failure at the time of diagnosis suggesting a previously unreported comorbidity in early stages of disease.

A 78-year-old male, originally from China, was brought to the hospital for weakness, urinary incontinence, confusion, and poor oral intake. He was started on empiric antibiotics, which were narrowed when blood cultures produced gram-negative bacteremia speciating to Klebsiella pneumoniae, sensitive to ceftriaxone. Computed tomography scan of the abdomen and pelvis demonstrated a large cystic region with air-fluid level in the left lobe of the liver. Suspecting this to be the source of the patient’s bacteremia, the lesion was percutaneously drained and the fluid cultured, which also revealed ceftriaxone-sensitive Klebsiella pneumoniae. While a stool ova and parasite examination on the patient was negative, further workup was positive for Entamoeba histolytica antibody in the serum, detected via enzyme-linked immunosorbent assay and indicative of either current or past infection. This suggested possible prolonged subclinical infection with bacterial superinfection, especially given that Klebsiella pneumoniae is one of the most common organisms cultured from these abscesses. In patients with liver abscesses who immigrated from developing and/or endemic regions or have a relevant recent travel history, an underlying amoebic etiology of an abscess should be considered.

This study aimed to elucidate the effects of a liquid polymeric formula containing alginate, a source of water- soluble dietary fiber, on stool form, intestinal microbiota, and the production of short-chain fatty acid production. Participants were 11 elderly patients with malnutrition and poor oral intake, who required enteral feeding. The alginate-containing liquid formula, which characteristically changes state from liquid to semi-solidified depending on pH, was administered for 4 weeks. This variable-viscosity liquid formula significantly improved the values of nutritional indices and stool form. Analysis of fecal specimens revealed significant decreases in pH. The concentrations of short-chain fatty acids did not change significantly in stool samples, but acetic acid and propionic acid were significantly increased in blood samples. The proportion of Clostridium cluster XI in fecal microbiota was also significantly increased. The alginate-containing variable-viscosity liquid formula significantly improved stool form, lowered fecal pH, and short-chain fatty acid concentrations in blood.

Introduction Besides the causes we know including adhesive ileus, it is not uncommon for poor oral intake (POI) in patients after distal pancreatectomy (DP). This study investigated the occurrence of POI and identify the risk factors of POI in patients after DP. Methods In this retrospective study, prospectively collected data of patients who received DP in National Cancer Center, Korea between April 2013 and December 2020 were reviewed. The diet protocol after DP in our institution as follows; sips of water (SOW) on postoperative day (POD) 1, soft blended diet (SBD) on POD 2 or 3, and normal regular diet (NRD) after POD 5, if the patient was tolerable on diet protocol. POI after distal pancreatectomy was defined as the delay of postoperative diet protocol after DP or the reverse of postoperative diet progression sequence. Results A total of 148 patients received open distal pancreatectomy during the study period. Patients who were diagnosed adhesive ileus were excluded (n = 14), and finally 134 patients were enrolled. Including 7 patients with postoperative delayed gastric emptying, 39.2 (52/134)% patients experienced POI after distal pancreatectomy. multi-visceral resection (HR 2.901, 95% CI 1.041-8.085, p = 0.042), celiac axis resection (HR 12.369, 95% CI 1.113-137.451, p = 0.041), operation time > 180 minutes (HR 3.146, 95% CI 1.265-7.822, p = 0.014), and postoperative major complication (HR 3.778, 95% CI 1.205-11.847, p = 0.023), clinically significant POPF (HR 3.642, 95% CI 1.065-12.451, p = 0.039) were independent risk factors for POI after DP. Conclusions Therefore, especially in patients with these risk factors.

Background Ketotic Hypoglycaemia (Blood sugar 2.5) is common in children with acute gastroenteritis and other common illnesses with poor oral intake. Untreated hypoglycaemia can lead to serious neurological sequelae. Some metabolic disorders can present with ketotic hypoglycaemia, the presenting illness unmasking the underlying metabolic problem, despite the presence of ketones. We looked specifically at cases of ketotic hypoglycaemia in children with a history of diarrhoea and vomiting or acute illness with inadequate oral intake. Aims To compare screening and management of ketotic hypoglycaemia in association with acute illness with the local guidelines. Methods Patients were identified through HIPE code ‘’E-16-2’’. A retrospective chart review was done on patients presenting with hypoglycaemia from Feb 2016 to May 2017 to compare the screening and management of patients with the local guidelines. As per audit recommendation the local hospital guideline was reviewed and an Algorithm along with ‘’Hypoglycaemia pack’’ was made available in the acute assessment unit. Staff education session was arranged A re-audit was performed on patients presenting with hypoglycaemia from January 2018 to December 2018 to see the adherence to the recommendations. Results The following table shows comparison of initial audit and re-audit results Conclusion Re audit showed marked improvement in lab glucose monitoring ,rechecking blood glucose timing and taking samples for urinary organic acids.However there is still room for improvement in sampling serum Amino acids. All patients got treatment as per guildelines. Recommendations Algorithmic approach,staff education and availability of ‘’Hypoglycaemia Packs’’ did improve the outcome however there is continued need for staff education to adhere to the guidelines

In acute pancreatitis, the most crucial aspect of management falls within the first 48-72 hours, which should be approached in a step-wise order. When steps are skipped or rushed, such as the early use of computed tomography (CT) with contrast in the setting of poor oral intake, the risk of morbidity increases. This is a case when the deleterious effects of contrast worsened the severity of the clinical course, resulting in a higher rate of mortality and longer hospital stay, and escalated the healthcare cost burden.

Wernicke's encephalopathy (WE) is an acute neurological disorder, potentially fatal if untreated, caused by thiamine deficiency. A 15-year-old female patient with choledocholithiasis, cholecystitis and abdominal tuberculosis on antitubercular therapy presented with poor oral intake, bilious vomiting and encephalopathy. A prompt diagnosis of WE was made and confirmed by brain magnetic resonance imaging. The patient recovered completely after the administration of thiamine.

Preoperative malnutrition because of poor oral intake significantly increases the risk of adverse events after surgery and leads to increased length of stay. While immunonutrition has been utilized in the non-ERAS setting, its utility in both minimally invasive surgery and ERAS pathway procedures remain poorly defined. There are at least ten meta-analyses regarding the assessment of immunonutrition, but virtually, all of these were performed in an era prior to minimally invasive surgery, adoption of enhanced recovery protocols, and an understanding of the assessment and physiology of sarcopenia. In terms of immunonutrition within an ERAS pathway, the few studies that have been published have severe flaws in design and sample, bringing their overall conclusion into question. Furthermore, the optimal components of immunonutrition have yet to be adequately determined and may vary for patients based on comorbidities as well as the proposed procedures. Risk stratification based on markers of nutritionally deficient states such as image assessed sarcopenia, Glasgow Prognostic Score, prognostic nutrition index, or assessment of methylarginines are needed prior to the initiation of any such immunotherapy. Lastly, there is a need for properly designed randomized control trials that stratify patients appropriately and determine the optimal timing, composition, and duration of immunotherapy.

The risk of dying from a pulmonary embolism (PE) is estimated to be about 30% if inotropic support is required and no cardiopulmonary arrest occurs. Fibrinolysis in massive PE is regarded as a life-saving intervention, unless there is a high risk of bleeding following the use of the fibrinolytic therapy. Rivaroxaban is an oral factor Xa inhibitor, however its anticoagulation effects before or after administration of fibrinolytics in massive PE are still unknown. Two patents were admitted: 61-year-old woman with repeated syncope, and a 73-year-old woman was admitted with dyspnea and poor oral intake. Systemic arterial hypotension with radiologic confirmation led to a diagnosis of massive PE in both patients. Rivaroxaban was administered before in one, and after firbrinolytic therapy in the other. One showed similar efficacy of rivaroxaban with currently used anticoagulants after successful fibrinolysis, and the other one without antecedent administration of the fibrinolytic agent showed unfavorable efficacy of rivaroxaban.

A 47-year-old Malay man who presented with fever, poor oral intake and loss of weight for 1 month duration. Further work-up revealed evidence of disseminated Salmonella infection that was further complicated with pericardial and pleural empyema. Cultures from pericardial and pleural fluids grew Salmonella species with negative serial blood cultures. Contrast enhanced CT thorax showed pleural effusion with large pericardial effusion. The patient was treated with antibiotics and drainage of pericardial and pleural empyema was done and he was discharged well.

Submassteric abscess is a rare head and neck abscess. It may mimic a parotid abscess due to very close anatomical relationship. We present a 14-month-old child presented with fever, poor oral intake, irritability, and left-sided cheek swelling. Contrast-enhanced computed tomography of the neck showed an abscess formation in left submasseteric space. Intraoral drainage of abscess was successfully performed under general anesthesia. Patient recovered well and was discharged on day three post operatively. Subsequent follow up at one-week post operatively showed no recollection of the abscess.International Journal of Human and Health Sciences Vol. 03 No. 02 April’19. Page: 123-125

This is a case report of an 8-month-old girl who presented to the pediatric emergency department with vesicular rash and fever. She was diagnosed with eczema herpeticum (EH). EH is an acute, rapidly progressive rare dermatologic disease, and if it is not treated promptly, it can cause life-threatening complications. It often occurs in a patient with an underlying skin disorder, such as atopic dermatitis or other erosive dermatoses. Diagnosis is mainly made by clinical examination usually presented as many very similar shaped and sized eroded vesicles. It is important for clinicians to recognize the sign and symptoms of EH and have a high suspicion for patients with atopic dermatitis who present with rapidly disseminating blisters. Treatment is with oral or intravenous acyclovir. If the patient has widespread eruptions or systemic symptoms such as fever, malaise, and poor oral intake, the patient should be admitted for intravenous acyclovir.

Purpose: Oral mucositis can be occurred very often in cancer patients w ho are undergoing chemotherapy. It is very troublesome to cancer patients because it causes pai n, gingival bleeding, nutritional imbalance due to poor oral intake, and sometimes leads to longer hospital stay and poor quality of life. However, it can be prevented or ameliorated by active oral care. This study was designed to improve chemotherapy-induced oral mucositis by means of active education and communication activity according to a standardized protocol for self-oral care. Methods: Seventy cancer patients who were admitted to hospital for chem otherapy and had grade I oral mucositis were enrolled. These patients were educated with one to one method for self-oral care including concept of mucositis along with the importance of self-oral care, and the method of brushing teeth and gargling, etc. Communication activity for it was performed by nurses and physician together, giving feedback and reeducation to patients. The effect of education and communicat ion activity was assessed by the survey from patients. Results: The survey showed that the level of awareness for oral mucositis, the method of brushing and gargling were improved significantly after education and communication activity. The rate of oral mucositis was also reduced after these activity. Conclusion: We conclude that education and communication activity enable cancer patients to do more effective self-oral care and to reduce oral mucositis.

Objectives We present a rare case of absolute dysphagia after adenotonsillectomy due to a forgotten gauze pack impacted in the esophagus. Case report A 9 year old girl was presented with absolute dysphagia 15 days after adenotonsillectomy. The parents reported postoperative poor oral intake for semisolids which became absolute for both solids and fluids 4 days after surgery. Clinically, the only positive finding was pooling of saliva in the hypopharynx detected by flexible nasopharyngoscopy. Computerized tomography revealed a retropharyngo-esophageal well defined lesion which was suggested to be localized neck space infection. Rigid esophagoscopy under general anesthesia was done before planned neck exploration to surprisingly reveal an impacted gauze pack surrounded by severe esophageal inflammatory reaction. Conclusion Because dysphagia was attributed to adenotonsillectomy itself in this case, the diagnosis was delayed for about 15 days. A systematic approach for the management of progressive dysphagia should be considered from non-invasive to more invasive maneuvers and foreign body option should always be borne in mind.

Purpose: Intestinal dysfunction is a major problem after gastroschisis repair, and causes poor oral intake and poor body weight gain in infants with gastroschisis. Dai-kenchu-to (DKT) is often used in the treatment of gastrointestinal dysfunction in Japan. The purpose of this study was to analyze the effect of DKT on infants with uncomplicated gastroschisis. Methods: In this retrospective cohort study from 1991 to 2009, we assessed 16 infants with uncomplicated gastroschisis. Eight infants received 0.3 g/kg/day of DKT for 12 months (group 1) and 8 infants did not receive DKT (group 2). We analyzed their body weight as an indicator of the effect of DKT. Results: There were no significant differences in the background characteristics. The body weight of group 1 was significantly increased at the ages of 9 months (p = 0.0348) and 12 months (p = 0.0097), compared with group 2. Multivariate analyses revealed that only DKT administration had a significant impact on body weight gain at the ages of 9 months (p = 0.0201) and 12 months (p = 0.0111). No side effects related to DKT were reported. Conclusion: DKT administration might work safely and effectively for improving the body weight gain in infants with uncomplicated gastroschisis.

A 65-year-old female with a history of mitral valve repair with a 30-mm Physio Ring underwent transcatheter valve-in-ring implantation of a 26-mm Sapien XT prosthesis for severe mitral regurgitation. After the procedure, patient complained of recurrent pre-syncopal episodes. She admits to poor oral intake since the …

Objective: Tonsillectomy remains one of the most common surgeries performed in the pediatric population. Factors that are predictive of a prolonged stay after tonsillectomy are useful in planning postop care.Method: A retrospective chart review was completed inclusive of all pediatric patients who had tonsillectomy at a tertiary medical center from March 10, 2010, to January 1, 2011. Preoperative variables were analyzed to determine predictors of extended hospital stay (defined as > 24 hours).Results: A total of 210 patients were reviewed. Thirty-three patients (15.7%) had hospital stays greater than 24 hours. Indications for tonsillectomy included obstructive sleep apnea (69.5%), tonsillitis (9.5%), and asymmetry (1.9%). Twenty-eight (84.8%) patients had extended stays for poor oral intake. Fever and respiratory complications accounted for 0.06% respectively. Patients with extended stays were younger (P < .001), weighed less (P < .001), and had higher apnea-hypopnea indices (P = .043). Patients with a hi...

Objectives: The aim of this study was to review the literature regarding the measures to reduce post tonsillectomy pain. Data sources: They included medical text books, medical journals, and medical websites (PubMed, Medscape, Science Direct and EMF-Portal) and all materials available in the internet from 2000 to 2015. Study selection. The initial search presented 170 articles. The articles studied different tools and techniques in tonsillectomy, pharmacological and non pharmacological methods for reducing post operative pain. Data extraction: Web search was performed on the medical databases and the full text of the relevant paper was critically analyzed and interpreted. Data synthesis: Comparisons were made by a structured review with the results, summarized and incorporated into the review article’s main text. Findings: Pain is the most significant obstacle to the rehabilitation of a patient following tonsillectomy. Inadequate analgesia causes poor oral intake, which leads to lassitude, delayed recovery of strength and well being and occasionally requires overnight hospitalization in day case surgical practice. Conclusion: The advances in new surgical tools and techniques make this surgery a safe procedure with less post operative pain. The pain can be managed also in a more effective manner with the combination of pharmacological and non-pharmacological therapies.

Background: Non Hodgkin Lymphoma (NHL) has about 3-7% of oral manifestation. Most of the lesions are from the palate, gingival, tongue, buccal mucosa, floor of the mouth and lips. These site consist approximately 2% of all extra nodal lymphomas as primary origin. The prognosis of NHL depends to the tumour stage, tumour aggressiveness and their response to treatment. The oral lesions appear to respond quite well to irradiation or chemo radiation.Methods: We present a case of a 68 year-old Malay male presented with symptoms of voice change, poor oral intake and bleeding from oral cavity, which turns out to be NHL of the base of tongue without visceral involvement. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11740 Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12

Neonatal herpes simplex virus (HSV) encephalitis is a rare disease nowadays because of prenatal screening test and management. It shows progressive central nervous system manifestations affecting predominantly temporal and frontal lobes. Early diagnosis of HSV encephalitis is important since even with the early initiation of highdose intravenous acyclovir therapy, it results in serious morbidity among survivors. A 14-day-old neonate with fever and poor oral intake was admitted via emergency department. The next day she had seizures and the brain was damaged with permanent sequelae despite of early administration of intravenous acyclovir on day 2 of admission. We report a serious case of HSV encephalitis diagnosed as type 2 HSV by polymerase chain reaction and culture of a newborn without proper prenatal screening test.

Antimicrobial prophylaxis in neutropenic patients has been practised in one form or another for t several decades but the goal is no longer clear. From being initially solely an attempt at decontamination, drugs such as co-trimoxazole and later the fluoro­ quinolones were preferred to non-absorbable regi­ m ens because they achieve reliable protection against bacteraem ia due to Gram-negative bacilli. Neverthe­ less, fever still invariably occurs during neutropenia leading to the initiation of traditional empirical therapy. Not only is this approach illogical but it also ignores the flexibility afforded the oral and parenteral formulations of the fluoroquinolones, Instead, it m ig h t be as effective and less costly if these agents w ere given orally until the end of neutropenia unless th ere was evidence of malabsorption or poor oral intake, in which case treatm ent would be continued parenterally. Should patients develop fever, an attempt would be made to complement treatment with another anti-microbial agent for microbiologi- cally or clinically defined infection. This would be car­ ried out at diagnosis, before any changes in the prophylactic regimen could be made. Otherwise, treatm ent with the prophylactic regimen would con­ tinue without modification. There is a less compelling need for prophylaxis against candidosis, herpes sim­ plex and cytomegalovirus disease as these would be better managed pre-emptively when there is evidence of yeast carriage or re-activation of viral infection. Similarly, prophylaxis of aspergillosis is a forlorn hope and again a pre-emptive approach might serve us better once there is a screening test available and a safe and effective drug.

A 70-year-old man with a history of diabetes mellitus presented with weakness and poor oral intake for 1 month. On physical examination, he was febrile and had mild right upper quadrant tenderness. The patient's white cell count was 14,900/mm3, with 79.0% neutrophils. A chest radiograph showed an air-fluid level in the right-upper abdomen (Fig. 1). Computed tomography (CT) revealed a huge gas-forming liver abscess (Fig. 2). The patient underwent sonography-guided drainage, and was given intravenous antibiotics and insulin to control his diabetes. The culture of the pus grew Klebsiella pneumoniae. He recovered and was discharged. Figure 1 The chest radiograph showed an air-fluid level in the right-upper abdomen. Figure 2 Computed tomography revealed a huge gas-forming liver abscess (arrows). The diagnostic tools for gas-forming pyogenic liver abscess (GPLA) are sonography and CT. On plain films, an air-fluid level or mottled gas pattern is the most common finding. Gas within the liver parenchyma is reported to be visible in up to 36% of patients with GPLA. Unless suspected, this may be mistaken for bowel gas. In our case, we saw an air-fluid level in the right upper abdomen in the plain X-ray, which enabled us to detect GPLA early.

A 5-year-old male presented with a 1-day history of vomiting, epigastric pain, loose stools and poor oral intake. The child had intermittent symptoms of abdominal pain and vomiting for the past 2 years and there was a strong family history of chronic hereditary pancreatitis. A random serum amylase was elevated at 2320 IU/l. Abdominal ultrasound scan revealed no abnormalities. On the basis of the family history, positive symptoms and elevated amylase, a diagnosis of hereditary pancreatitis was made. The child received symptomatic management and treatment for his acute illness. He is currently awaiting results from molecular testing.

Neurofibromatosis type 1 (NF1; also known as von Recklinghausen’s neurofibromatosis) is inherited in an autosomal dominant fashion, although it can also arise due to spontaneous mutation. Gastrointestinal involvement of NF1 is seen in 10% to 25% and causes symptoms in fewer than 5%. Histologically, the gastro intestinal (GI) manifestation of NF1 occurs in three forms: hyperplasia of the gut neural tissue, stromal tumors, and duodenal or periampullary endocrine tumors. A 31-year-old female, diagnosed with NF1, presented with poor oral intake and vomiting for 10 days prior to admission. Preoperative gastrofiberscopic finding was gastric outlet obstructing polypoid duodenal bulb lesion. The patient underwent hemigastrectomy with antecolic gastrojejunostomy due to gastric outlet obstruction. The final pathologic report was submucosal neurofibromatous proliferation with Brunner’s gland hyperplasia located at the duodenal bulb in the NF1 patient. We report this case with a review of literatures. (J Korean Surg Soc 2010;79:S31-36)

A 29-year-old male patient was admitted due to his general weak ness and poor oral intake for several months. He was diagnosed as having Crohn disease 16 years ago and total colect omy was performed 10 years ago. On the 3rd day after admission, gross hematuria and sudden hemoptysis combined with diffuse infiltration were noted on chest X-ray. His symptoms and the diffusely increased lung opacities improved wi th administering high-dose steroid therapy. Later, anti-GBM antibody was found to be positive on the laboratory fi ndings. We report here on a rare case of Goodpsture syndrome combined with prolonged Crohn disease along with a review of literature. (Tuberc Respir Dis 2006; 61: 384-388)Key word: Goodpsture syndrome, Crohn disease, anti-GBM antibody Address for correspondence : Soo-taek Uh, M.D. Department of Internal Medicine, Soonchunhyang University, School of Medicine, 657, Hannam-Dong, Yougsan-Ku, Seoul 140-743, KoreaPhone: +82-2-709-9482, Fax: +82-2-709-9554E-mail: uhs@hosp.sch.ac.krReceived : May. 18. 2006Accepted : Aug. 14. 2006