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Introduction: Enhanced recovery after surgery (ERAS) protocol is a novel method of enhancing patient recovery in post gastrointestinal surgery patients. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach, comprehensively designed to improve postoperative outcome. In 1997, a Dutch professor Henrik Kehlet gave the concept of "multimodal approach to control postoperative pathophysiology and rehabilitation". Colorectal surgery was the first surgical subspecialty where the ERAS pathway was implemented in the year 1999. The term ERAS was given in 2001 by a team of surgeons who met in London to develop guidelines for perioperative care, grounded on evidence. Materials and methods: The study was conducted in Meenakshi Medical College from April 2022 to June 2022. The source of the study was patients in the general surgery department admitted for gastrointestinal surgery. Inclusion and exclusion criteria were established and patients satisfying said criteria were included in the study. The patients and attenders were informed about the study, the workup, nature and complications that could happen. patients who consented alone were included. Patients from my unit were made into the test group and other as control group. The average length of hospital stay for test group patients was 7days. The average length of hospital stay for control group patients was 14days. There is a statistical difference between the studyand the control group regarding length of hospital stay. The length of hospital stay for study group patients was very low compared to the control group. Results:The average age of patients undergoing gastrointestinal surgeries was 49 in the test group and 44 in the control group. The female patients in this study were 35%in the study group and 40% in the control group, the average female patients were 37.5 %. The male patients were 65% in the test group and 62.5 %in the control group. The average male patients were 62.5 % in this study. There is no statistical significance in gender distribution. Conclusion: From this study, ERAS is found beneficial in reducing the length of hospital stay, cost-effective with fewer complications, and better surgical outcomes when compared to conventional management of patients undergoing gastrointestinal surgeries. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal tract surgeries could disrupt the microbiome and simultaneously cause trauma, which may result in psoriasis. Objective: To examine associations between gastrointestinal tract surgeries and newly diagnosed psoriasis. Methods: This nested case‐control study included patients with newly diagnosed psoriasis from 2005 to 2013, retrieved from the Taiwan National Health Insurance Research Database. We retrospectively (5 years from the index date) determined whether the patients had undergone gastrointestinal tract surgery. Results: We identified 16 655 patients with newly diagnosed psoriasis and matched 33 310 individuals as the control group. The population was stratified by age and sex. There was no association between age and psoriasis (<20 years: adjusted odds ratio [aOR] 0.80, 95% confidence interval [CI] 0.52‐1.24; 20‐39 years: aOR 1.09, 95% CI 0.79‐1.51; 40‐59 years: aOR 0.89, 95% CI 0.57‐1.39; ≥60 years: aOR 0.82, 95% CI 0.54‐1.26). Similar findings were obtained by sex, with no differences among men (aOR 0.90, 95% CI 0.69‐1.17) and women (aOR 0.96, 95% CI 0.71‐1.29). Conclusion: Our study indicates that gastrointestinal surgeries have limited age‐ and sex‐related effects on psoriasis. These findings provide new insights into the risk of developing psoriasis. [ABSTRACT FROM AUTHOR]

Background & Objective: This study was conducted to compare the effectiveness between goal-directed fluid therapy guided by Estimated Continuous Cardiac Output (esCCO) monitoring and liberal infusion therapy on the early perioperative and postoperative complications, as well as long-term complications in major gastrointestinal surgeries. Methodology: A randomized controlled trial was conducted at Hanoi Medical University Hospital, Hanoi, Vietnam from October 2020 to October 2021. There were 138 patients enrolled in the study and divided randomly into two groups: Group LIF (liberal infusion therapy) and Group GD (goal-directed fluid therapy using esCCO monitors). The logistic regression (univariate and multivariate) analysis models were performed to evaluate the relationship between the complication (yes or no) and potential predictors. Results: Mortality and length of hospital stay in the esCCO group were not different from those in the liberal infusion therapy group (P > 0.05). Postoperative respiratory complications such as pneumonia and pulmonary edema were lower in the Group GD but not statistically significant compared with the Group LIF (5.7% vs 7.4% with P > 0.05). There was a higher rate of acute kidney injury in the Group GD than in the Group LIF, but the difference was not statistically significant (5.7% vs 1.5% with P > 0.05). Other complications such as bleeding, wound infection, and tissue edema in the Group GD was almost equivalent to those in the Group LIF and the difference was not statistically significant. Conclusion: Goal-directed fluid therapy according to esCCO guidelines reduced the amount of intraoperative fluids while maintaining hemodynamic stability during surgery, but has not shown a real effect in reducing postoperative complications. Further studies with a larger number of patients are needed, in high-risk groups of patients requiring intravenous fluids according to esCCO guidelines to better evaluate the effectiveness of reducing postoperative complications. Abbreviations: esCCO - Estimated Continuous Cardiac Output; esSVI - Estimated Stroke Volume Index; PEEP - Positive End-Expiratory Pressure; MAC - Minimum Alveolar Concentration [ABSTRACT FROM AUTHOR]

Background: The optimum nutritional support of critically ill neonates is considered an essential aspect of their medical management since they are susceptible to rapid nutritional depletion, loss of fat-free mass, organ failure, delayed wound healing, and diminished immune function in the post-gastrointestinal surgery state. Providing appropriate nutritional support for these high-risk patients is a very complex and critical process accompanied by many potential errors. To the best of our knowledge, this study has been the first attempt investigating the energy and protein adequacy and probable barriers to the achievement of nutritional goals in such patients. Methods: The present study was carried out at Akbar Children’s Hospital in Mashhad, Khorasan Razavi province, Iran, during 8 months in 2019. All the gastrointestinal surgical patients admitted to the neonatal intensive care unit (NICU) for at least 72 h were eligible for enrollment in the study. The information on age, gender, primary surgical diagnosis, route of nutritional support, adequacy of received energy and protein, probable barriers to the achievement of nutritional goals, and clinical outcomes were collected in this study. Results: Totally, 59 eligible neonates were included in the study 59.3% (n=35) of whom were male. Among different methods of nutritional support, enteral nutrition (47.5%) was the most frequently used feeding route. Energy and protein adequacy was observed in 35.5% and 79.7% of the patients, respectively. The fluid restriction was the major barrier to the provision of optimum nutritional support, affecting 38.9% of the patients. Finally, nutritional adequacy was observed to be significantly associated with decreased infection rate and length of hospital stay. Conclusion: While 64.5% of the studied neonates did not receive adequate energy, almost 80% of them had adequate protein intake during their post-gastrointestinal surgery state. The awareness of the fluid restriction and nonavailability of calorie-dense solutions as the most frequent barriers to the achievement of nutritional goals may lead to making reasonable and realistic decisions on the customized protocols of the NICU patients as well as medical management and insurance coverage of required nutritional products. [ABSTRACT FROM AUTHOR]

Introduction: Studies show that more than 25% of patients admitted to the Pediatric Intensive Care Unit (PICU) suffer from acute or chronic malnutrition at the time of admission. Providing the sufficient protein a child needs in the ICU can reduce the risk of mortality, infection, ventilator dependence, and length of stay in the ICU. This study aims to describe the gap between protein prescription and actual intake in children admitted to the ICU due to major gastrointestinal surgery. Methods: This study was prospective. The audit was carried out at the Akbar Children's Hospital, Mashhad, Iran in October 2018. The inclusion criteria were as follows: 1: Ages between 1 month and 10 years old, 2: Admission to the ICU due to being under serious medical conditions, 3: ICU length of stay > 24 h, 4: Admission to the PICU following gastrointestinal surgeries. The audit was performed over four weeks. Results: Thirty children were included in this audit. In terms of gender, 54% were girls. The average height in both of them (boys and girls) was 58 cm. The average weight was 4.8 kg for girls and 5.1 kg for boys. The average prescribed daily protein intake was 1.8 ± 0.5 gr/Kg/d. The average delivered daily protein intake was 1.8 ± 0.4 gr/Kg/d. The results showed that 83.3% of the children in the audit achieved nutritional adequacy during PICU stay. Conclusion: According to the results of this study, it can be stated that the amount of protein intake and administration for children admitted to the PICU was not in the acceptable range. This study can be a model for future studies to improve nutrition services for patients admitted to the intensive care unit. [ABSTRACT FROM AUTHOR]

Introduction: Optimum nutritional support of critically ill neonates is a major challenging issue in neonatal intensive care unit (NICU). Malnourished neonates are prone to rapid nutritional depletion, which leading to muscle wasting, vital organ dysfunction, delayed wound healing, and decreased immune function. We studied energy and protein delivery and adequacy during post gastrointestinal surgery period in this study. METHODS: This cross-sectional study was carried out in Akbar Children's Hospital, Mashhad, Iran. All post gastrointestinal surgical critically ill neonates with NICU length of stay >72 hours were enrolled. Anthropometric indices, nutritional support route, energy and protein intake were gathered from the third day of hospitalization till discharge time. SPSS software (version 20) was used for data analysis. Results: A total of 59 eligible neonates (59% male) with a mean age of 6±8.3 days were studied. The patients with mean weight= 2.9 kg (SD=0.49) and mean height= 49.9 cm (SD=2.3) were enrolled. Enteral nutrition (47.5%) was the most frequent used feeding route among different methods of nutritional support. Adequacy of delivering energy and protein were 35.5% and 79.7%), respectively. Conclusion: While almost 80% of neonates received adequate protein, only 35.5% of them had adequate energy intake. This study provides evidence for realistic customized decision making on nutritional support protocols in our NICU. [ABSTRACT FROM AUTHOR]

Introduction: Nutritional support is essential for children admitted to the Pediatric Intensive Care Unit (PICU), and lack of attention to the amount of energy prescribed and received by the patient can lead to increased complications such as malnutrition and overfeeding. Both of these complications have negative effects on patients. In this study, we examined the amount of energy prescribed and received in children admitted to the ICU due to major gastrointestinal surgery. Methods: This study was prospective. The audit was performed over four weeks in October 2018. The audit was carried out at the Akbar Children's Hospital, Mashhad, Iran. The inclusion criteria were as follows: 1-Ages between 1 month and 10 years old, 2- Admission to the PICU following gastrointestinal surgeries, 3- Admission to the ICU due to being under critical medical conditions, 4- ICU length of stay > 24 h. Results: In this study, 30 children were included. In terms of gender, 46% were boys. The average weight was 5.1 kg for boys and 4.8 kg for girls. The average height in both sexes was 58 cm. The average prescribed goal for daily energy intake was 67 ± 12 Kcal/Kg/d and the average delivered daily energy intake was 47 ±11 Kcal/Kg/d. So, 56.7 % of the subjects in the study achieved nutritional adequacy during PICU stay. Conclusion: This study demonstrates that the amounts of received and prescribed energy were not in the acceptable range and the results of the present study should be considered for future decision-making steps in our PICU to improve nutrition support services. [ABSTRACT FROM AUTHOR]

Introduction: Optimum nutritional support of critically ill neonates is a major challenging issue in a neonatal intensive care unit (NICU) because they are recognized as a high-risk group. Therefore, providing proper nutritional support is an intricate and critical process. For this reason, nutritional support barriers in these patients were a challenge and so investigated in this study. METHODS: The files of critically ill (59 eligible neonates) after post gastrointestinal surgical with NICU length of stay >72 hours in 2019 at Akbar Children's Hospital, Mashhad, Iran were retrospectively studied. Nutritional support barriers were gathered from the third day of hospitalization till discharge time. SPSS software (version 20) was used for data analysis. Results: The files of 59 critically ill, post-surgical neonates were retrospectively studied. Among all potential barriers of optimum nutrition support were gathered, the fluid restriction was the major barrier, affecting 38.9% of the patients. Other barriers were the non-availability of calorie-dense solutions and prolonged pre-and post-operative fasting, affecting 27.1% and 17% of the patients, respectively. Among the gastrointestinal problems leading to a shortstop feeding, distention was the most major gastrointestinal problem, affecting 10.2% of the patients, after that vomiting (8.5%), large gastric residual volume (6.7%), and diarrhea (5.1%). Conclusion: According to the results of our study, realistic decisions are needed to improve outcomes, and further studies are needed to follow up and monitor the effect of our decisions. [ABSTRACT FROM AUTHOR]