BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity...BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.展开更多
BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To a...BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.展开更多
BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high tempe...BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature.AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature.METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques.Five specimens of each formula were administered at 25℃and 32℃.Simulated administration was done in an incubator.The samples were collected at 0,2,4,6 h and aerobic culture was performed.Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination.RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25℃and at 2 h at 32℃.As for the reconstituted powdered formula,there was no bacterial growth in all specimens up to 6 h at both temperatures.CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature,while a reconstituted powdered formula may hang up to 6 h at both temperatures.展开更多
Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional e...Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GEexpert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology(HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other(inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.展开更多
Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-...Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.展开更多
文摘BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.
基金Supported by Universiti Sains Malaysia,Short-Term Grant,No.R501-LR-RND002-0000000342-0000.
文摘BACKGROUND Current guidelines recommend providing malnourished individuals immunonutrition before major gastrointestinal surgery.Nonetheless,the advantages of preoperative immunonutrition remain controversial.AIM To analyses the effects of preoperative immunonutrition and standard oral nutrition supplements on colorectal surgery outcomes.METHODS This study employed a prospective single-center randomized double-blinded comparative approach and was conducted at Hospital Universiti Sains Malaysia between September 2023 and September 2024.In this study,the participants in the experimental group were supplied with a specialized oral supplement enriched with immune-modulating nutrients.Meanwhile,a conventional oral nutrition supplement was provided to the control group.The time to first flatus and the time to first bowel evacuation were the primary outcomes recorded.Incidence of nosocomial infections,surgical site infections,and the total length of hospital stay were considered secondary data.RESULTS This study involved 58 patients who were allocated into two groups.No dropouts were documented.The mean age of the participants was 61.20±12.96,and most were males(63.38%).All participants’baseline and surgical characteristics in both arms were also generally comparable.The participants in this study underwent colorectal surgery,where most had laparoscopic surgery(58%).Based on the results,no significant statistical differences were observed regarding the duration from the first flatus to the first bowel evacuation,the onset of a normal diet,and hospital stay between the experimental and control groups.Both groups also recorded 10(17.24%)infectious complications.CONCLUSION The findings indicated no notable variations in the primary and secondary endpoints despite the theoretical benefits of immune-modulating nutrients.Conclusively,routine preoperative immunonutrition may not provide additional advantages over standard nutrition in this demographic.
文摘BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature.AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature.METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques.Five specimens of each formula were administered at 25℃and 32℃.Simulated administration was done in an incubator.The samples were collected at 0,2,4,6 h and aerobic culture was performed.Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination.RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25℃and at 2 h at 32℃.As for the reconstituted powdered formula,there was no bacterial growth in all specimens up to 6 h at both temperatures.CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature,while a reconstituted powdered formula may hang up to 6 h at both temperatures.
文摘Gastroenterology(GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GEexpert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology(HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other(inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.
文摘Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.
