phenylephrine-hydrochloride and Malnutrition

This study was conducted with the aim of evaluating a 10-year experience in the Pulmonology Department of a cancer center for percutaneous endoscopic gastrostomy through transnasal route (TN-PEG) in patients with head and neck cancer whose oral access is precluded. This study was a retrospective analysis of 40 consecutive head and neck cancer patients referred for PEG placement, between 2005 and 2014, using a transnasal route because of the impossibility of intubation through the oral cavity. Demographics, outcome of TN-PEG procedure, indications for bronchoscopic approach (prophylactic/palliative), clinical need for bronchoscopy (trismus, oropharyngeal obstruction), location of cancer, complications, and overall survival were reviewed. In 40 TN-PEG procedures, executed by 1 of 3 pulmonologists, 39 were successfully placed and there were no immediate complications. All except 1 complication were minor, but no surgery or PEG removal was required. There was a rapid learning curve among all operators. A combined TN-PEG placement by a gastroenterologist and a pulmonologist is a safe and useful option for these patients; the learning curve for successfully performing the procedure was short.

Topics: Adolescent; Adult; Aged; Bronchoscopes; Child; Female; Gastroenterology; Gastroscopy; Gastrostomy; Head and Neck Neoplasms; Humans; Learning Curve; Male; Malnutrition; Middle Aged; Nose; Nutritional Support; Palliative Care; Patient Care Team; Pulmonary Medicine; Retrospective Studies; Trismus; Young Adult

To explore the predictors and outcome of hypoxaemia in children under 5 years of age who were hospitalized for the management of diarrhoea in Dhaka, where comorbidities are common.. In a prospective cohort study, we enrolled all children <5 years of age admitted to the special care ward (SCW) of the Dhaka Hospital of ICDDR,B from September to December 2007. Those who presented with hypoxaemia (SpO(2) < 90%) constituted the study group, and those without hypoxaemia formed the comparison group.. A total of 258 children were enrolled, all had diarrhoea. Of the total, 198 (77%) had pneumonia and 106 (41%) had severe malnutrition (<-3 Z-score of weight for age of the median of the National Centre for Health Statistics), 119 (46%) had hypoxaemia and 138 children did not have hypoxaemia at the time of admission. Children with hypoxaemia had a higher probability of a fatal outcome (21%vs. 4%; P < 0.001). Using logistic regression analysis, the independent predictors of hypoxaemia at the time of presentation were lower chest wall indrawing [OR 6.91, 95% confidence intervals (CI) 3.66-13.08, P < 0.001], nasal flaring (OR 3.22, 95% CI 1.45-7.17, P = 0.004) and severe sepsis (OR 4.48, 95% CI 1.62-12.42, P = 0.004).. In this seriously ill population of children with diarrhoea and comorbidities, hypoxaemia was associated with high case-fatality rates. Independent clinical predictors of hypoxaemia in this population, identifiable at the time of admission, were lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis.

Topics: Bangladesh; Body Weight; Case-Control Studies; Child, Preschool; Confidence Intervals; Diarrhea; Female; Hospitals, Urban; Humans; Hypoxia; Infant; Logistic Models; Male; Malnutrition; Nose; Odds Ratio; Pneumonia; Prevalence; Sepsis; Thorax

Orthopaedic patients with poor nutritional status are at an increased risk of postoperative complications, such as infection and wound healing. Nasal colonization with Staphylococcus aureus, especially with methicillin-resistant Staphylococcus aureus, has been shown to be a risk factor for surgical-site infections. We examined the incidence of nutritional depletion in our arthroplasty population and its correlation with Staphylococcus aureus colonization. We conducted a retrospective review of prospectively collected data of our arthroplasty patient population. Patients with known Staphylococcus aureus colonization or surgical-site infection were compared with a random cohort of patients. Patient demographics, preoperative nasal culture, and two nutritional screening scores were collected. Six hundred and fifty-two patients underwent arthroplasty and completed preoperative nasal cultures and nutritional assessment. A high percentage (27%) of our patients demonstrated some level of nutritional depletion prior to joint replacement. Overall nutritional scores were not significantly associated with surgery-type, preoperative nasal culture, or surgical- site infection in our patient population.

Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bacteriological Techniques; Chi-Square Distribution; Female; Humans; Logistic Models; Male; Malnutrition; Methicillin-Resistant Staphylococcus aureus; Middle Aged; New York City; Nose; Nutrition Assessment; Nutritional Status; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Two unusual autopsy cases of fatal Ascaris infection have been presented. The first case presents lethal diffuse peritonitis due to duodenal rupture caused by the presence of parasitic Ascaris worm in gastrointestinal tract of 2.5-year-old child. The second one is a case of subacute asphyxia caused by obturation of upper respiratory tract by a large number of adult Ascaris roundworms. General economic crisis and inefficient medical service make possible spreading of almost eradicated disease, thus the possibility of the most serious complications of this helminthiasis must not be forgotten.

Topics: Airway Obstruction; Animals; Ascariasis; Asphyxia; Child, Preschool; Duodenum; Esophagus; Female; Forensic Pathology; Humans; Infant, Newborn; Larynx; Leukocytes; Male; Malnutrition; Nose; Peritoneum; Peritonitis; Rupture, Spontaneous

Topics: Deficiency Diseases; Eye Diseases; Histamine; Humans; Malnutrition; Neck; Nose; Otorhinolaryngologic Diseases; Pharynx; Staining and Labeling

Topics: Child; Disease; Ear, Middle; Humans; Infant; Malnutrition; Nasal Cavity; Nose; Nose Diseases; Otitis Media; Paranasal Sinus Diseases