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Research Article
Outcome of Infants Discharged Home from the Neonatal Unit with Partial Nasogastric Feeds
Shivani Kamal,
Indira Chandrasekar
Issue:
Volume 8, Issue 1, June 2024
Pages:
1-4
Received:
12 January 2024
Accepted:
24 January 2024
Published:
5 February 2024
Abstract: Aim: In our previous publication, we proposed an algorithm for safely discharging infants from the neonatal intensive care unit (NICU) on partial nasogastric feeds (NGF), thus avoiding gastrostomy tube placement (GTP) for infants who were unable to take full oral feeds. This follow up study post intervention, is to determine the number of patients discharged home on partial nasogastric (NG) feeds, the effectiveness of this intervention measured by reaching full oral feeds within 3 months of discharge and parent view on this intervention and outcome. We also investigated the success of this intervention based on the main discharge diagnosis. Study Design: Retrospective single-center study of infants discharged from the NICU from June 2019 to Dec 2020. Chart review was done to determine the rate of follow-up, time of achieve full oral feeds, and discontinuation of NG tube. We calculated NICU days saved by calculating the days from discharge to reaching full oral feeds at home. Results: Patient records were available for chart review regarding their outpatient follow-up in 96%. 82% of patients reached full feeds on an average of 35 days (range 1day to 10 weeks). 10% of patients required GTP due to the need for prolonged gavage feeding. 2 records were unavailable. Infants discharged home with NG tubes saved 587 NICU days. 88% of the parents contacted over phone responded positively in their choice of NG tube instead of GTP. Conclusion: Discharge from NICU on partial NG feeds for select infants is associated with reduced NICU stay without increased post-discharge complications or increased parent satisfaction.
Abstract: Aim: In our previous publication, we proposed an algorithm for safely discharging infants from the neonatal intensive care unit (NICU) on partial nasogastric feeds (NGF), thus avoiding gastrostomy tube placement (GTP) for infants who were unable to take full oral feeds. This follow up study post intervention, is to determine the number of patients ...
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Research Article
Onset of Irritable Bowel Syndrome, Dyspepsia, Diarrhea, Bloating, and Constipation in Deployed Gulf War Veterans
Zachary Thomas Verne,
Jeremy Zachary Fields,
George Nicholas Verne,
Benjamin Buyi Zhang,
Amber Leigh Thacker,
QiQi Zhou*
Issue:
Volume 8, Issue 1, June 2024
Pages:
5-10
Received:
15 January 2024
Accepted:
29 January 2024
Published:
5 February 2024
Abstract: An estimated 694,550 United States service members were actively deployed to the Persian Gulf from 1990-1991. Many veterans who were deployed developed Persian Gulf War Syndrome along with chronic gastrointestinal symptoms after returning from the Persian Gulf. Our objective in this study was to determine the phenotypic expression of gastrointestinal symptom complexes in previously healthy veterans who had been stationed in the Persian Gulf. One hundred and four consecutive veterans (88 males, 16 females) who had previously been deployed in 1990-91 were evaluated for their bowel habits and gastrointestinal symptoms. A workup was completed to find identifiable causes of their symptoms and all veterans were asked to do a modified version of the Bowel Disease Questionnaire symptom survey. None of the veterans reported gastrointestinal symptoms before deployment. During deployment to the Persian Gulf: 22 veterans (21%) developed irritable bowel syndrome; 17 (16%) developed dyspepsia; 50 (48%) developed diarrhea; 11 (11%) developed bloating; and 4 (4%) developed constipation. The results of the current study suggest that the development of irritable bowel syndrome, dyspepsia, diarrhea, bloating, and constipation is frequently seen in deployed Gulf War Veterans and the gastrointestinal symptoms commonly persist upon returning home. These novel findings are very important for currently deployed veterans who are serving in the Middle East and are at a high risk of developing gastrointestinal disorders.
Abstract: An estimated 694,550 United States service members were actively deployed to the Persian Gulf from 1990-1991. Many veterans who were deployed developed Persian Gulf War Syndrome along with chronic gastrointestinal symptoms after returning from the Persian Gulf. Our objective in this study was to determine the phenotypic expression of gastrointestin...
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Case Report
A Case of Pemrolizumab-Associated Severe Gastritis Treated with Mycophenolate Mofetil
Emin Bodakçi*
Issue:
Volume 8, Issue 1, June 2024
Pages:
11-13
Received:
12 March 2024
Accepted:
29 March 2024
Published:
11 April 2024
Abstract: Immune checkpoint inhibitors have become a frequently used treatment in oncology practice. Although it has approved indications in many types of cancer, phase studies are ongoing in many types of cancer. Side effects due to the increasing use of immune checkpoint inhibitors have begun to be seen frequently. Cases of colitis, pancreatitis and hepatitis due to immune check point inhibitors have been reported very frequently; However, the number of gastritis cases is limited. Here, we presented a case of severe gastritis due to pembrolizumab in a patient with cholangiocellular carcinoma. When side effects develop due to immune check point inhibitors, infliximab and mycophenolate mofetil (MMF) treatments are used in steroid-refractory patients. In our patient, MMF treatment was started due to possible infectious processes due to a recent attack of cholangitis and the inability to remove the stones in the common bile duct. Response to MMF treatment was obtained after 3 months. We would like to state that MMF treatment is an option in cases that develop due to immune check point inhibitors. MMF treatment was used in a case of severe gastritis due to pembrolizumab, as it did not respond to steroid treatments. The patient responded after MMF treatment. We planned to present this rare side effect of pembrolizumab and the treatment strategies we applied in the development of side effects.
Abstract: Immune checkpoint inhibitors have become a frequently used treatment in oncology practice. Although it has approved indications in many types of cancer, phase studies are ongoing in many types of cancer. Side effects due to the increasing use of immune checkpoint inhibitors have begun to be seen frequently. Cases of colitis, pancreatitis and hepati...
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Review Article
The Role of Lactobacillus Reuteri Probiotic for Preventing Functional Gastrointestinal Disorders in Toddlerhood
Mohammad Basir Uddin*,
Shahab Uddin,
Bishwajit Deb,
Tania Hussain,
Sohel Al Rafi,
Azizul Islam
Issue:
Volume 8, Issue 1, June 2024
Pages:
14-21
Received:
28 February 2024
Accepted:
18 March 2024
Published:
11 April 2024
DOI:
10.11648/j.ijg.20240801.14
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Abstract: Probiotic Lactobacillus reuteri has been shown to be useful for a number of gastrointestinal disorders. Its ability to secrete antimicrobial compounds, prevent pathogenic microorganisms from colonizing the host, and alter the composition of the commensal microbiota in the host are all major contributors to its therapeutic advantages. Not only that, but L. reuteri treatment strengthens the host's defenses against infection and pro-inflammatory cytokine production while enhancing the growth and functionality of regulatory T cells. Numerous pediatric illnesses, particularly those pertaining to the intestinal health of infants, have been found to be well managed by L. reuteri, according to systematic reviews and meta-analyses. According to current research on L. reuteri, it may be useful in the management and avoidance of a number of common clinical disorders, including functional constipation, infantile colic, regurgitation, and diarrhea. Probiotic treatment for pediatric illnesses has had favorable benefits on bowel regularity in individuals with chronic constipation and has been found to successfully reduce screaming and/or fussing time in newborns with colic. Additionally, it quickens the emptying of the stomach and lessens distension. Several research have even come to the conclusion that this probiotic strain reduces the frequency of regurgitation. The potential of this probiotic strain for application in the treatment of several gastrointestinal disorders is evident from all of these findings. Therefore, this study aims to encapsulate and condense the advantages of this probiotic strain in clinical settings, with a particular emphasis on how it supports babies' and toddlers' immune systems and gut health.
Abstract: Probiotic Lactobacillus reuteri has been shown to be useful for a number of gastrointestinal disorders. Its ability to secrete antimicrobial compounds, prevent pathogenic microorganisms from colonizing the host, and alter the composition of the commensal microbiota in the host are all major contributors to its therapeutic advantages. Not only that,...
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Research Article
D-dimer Level Is Non-Specifically Elevated Post-Living-Related Liver Transplantation in Children
Hadil Samir Darwish*,
Nermin Mohamed Adawy,
Magdy Anwar Saber,
Noha Mohamed Radwan
Issue:
Volume 8, Issue 1, June 2024
Pages:
22-31
Received:
18 April 2024
Accepted:
3 May 2024
Published:
17 May 2024
Abstract: Background/Objective: D-dimer, a soluble fibrin degradation product, is used to be a marker of vascular thrombosis. However, it has been reported to be elevated in different pathological conditions other than thrombosis. Moreover, its pattern post-liver transplantation (LT) in children is not known. So, we aimed to report its pattern within the first-month post-LT in children and its level in different early post-LT complications. Methods: It is a retrospective observational cohort study in which 52 children who underwent living-related liver transplantation (LRLT) were included. All the available clinical, imaging, and laboratory data including D-dimer level were collected from the patients' files. Those who developed complications within the first post-LT month were assigned to the complication group (n=41), and others were assigned to the non-complication group (n=11). Results: D-dimer level pre-LT ranged from 0.12-16.41 mg/l, with no significant difference between the complication and non-complication groups. Postoperatively, the D-dimer levels were elevated and did not normalize till the postoperative day (POD) 30. The minimum reported level was 1.2 mg/l on POD0 while the maximum one was 33.12 mg/l on POD12. There were no significant differences between the complication and non-complication groups about the D-dimer level from the pre-LT day till the POD30 (p>0.05). The D-dimer level at the onset of the different complications showed no significant difference among the thrombotic, ACR, and the other complication subgroups (p=0.748). Moreover, the vascular thrombosis subgroup didn’t show a significant difference between the D-dimer level before- and at the onset of thrombosis (p=0.480). Conclusion: D-dimer is non-specifically elevated within the 1st-month post-LRLT in children with no clear trend. Moreover, it doesn’t normalize till the end of the 1st post-LT month. Being high early postoperatively doesn't necessarily indicate vascular thrombosis or other complications but rather the nature of the transplantation circumstances.
Abstract: Background/Objective: D-dimer, a soluble fibrin degradation product, is used to be a marker of vascular thrombosis. However, it has been reported to be elevated in different pathological conditions other than thrombosis. Moreover, its pattern post-liver transplantation (LT) in children is not known. So, we aimed to report its pattern within the fir...
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Case Report
Rare Clinically Significant Idiosyncratic Drug Induced Liver Injury Caused by Low Dose Atorvastatin: Time for a New Approach to Surveillance and Risk Identification
Adebola Adetiloye*,
Olurotimi Badero
Issue:
Volume 8, Issue 1, June 2024
Pages:
32-41
Received:
28 February 2024
Accepted:
5 June 2024
Published:
6 June 2024
Abstract: Background: Atorvastatin is a member of the class of cholesterol lowering drugs called statins, which works by inhibiting HMG-CoA reductase, an enzyme involved in cholesterol synthesis in the liver. Statins are used to reduce the risk of cardiovascular events in individuals who have risk factors or a history of cardiovascular disease. While atorvastatin is generally well-tolerated, like all statins, it can have some adverse effects, including Drug induced liver injury (DILI) which is rare and often dose related. However, there is scarcity of reports on symptomatic DILI occurring in patients on low dose statin and normal baseline liver function test. This case adds to the growing body of literature on the potential idiosyncratic, non-dose related adverse effects associated with atorvastatin therapy. Case report: A 69-year-old woman with history of Hypertension, Hyperlipidemia, Prediabetes, Non-Alcoholic Fatty Liver Disease (NAFLD) presented to her Primary care Physician (PCP) for regular follow up. Her Lipid panel in the last 1 year has been suboptimal with her Atherosclerotic Cardiovascular disease (ASCVD) risk score between 12.0-15.1% despite lifestyle modification. Patient was started on 10 mg of Atorvastatin daily after documenting normal baseline liver function test. Fifty-six days later, patient presented to the PCP’s office with symptoms of fatigue, nausea and, right upper abdominal pain for 3 days. She had right upper abdominal tenderness and was mildly icteric. Based on her PCPs suspicion for DILI, she was advised to discontinue atorvastatin and transferred to the emergency room for further evaluation. In the Emergency room her vitals remained stable. Liver Ultrasound showed normal sized liver with features of hepatic steatosis. Laboratory analysis showed elevated alanine aminotransferase (ALT) greater than 16 times Upper limit of normal (ULN), aspartate aminotransferase (AST) greater than 9 times ULN, while alkaline phosphatase (ALP) elevation was less than 2 times ULN suggesting hepatocellular pattern. She was seen by a hepatologist 1 week later and other etiologies of acute hepatitis were ruled out. Over the course of 4 weeks, her symptoms completely resolved and liver function tests continued to improve. Forty-six days after Atorvastatin was discontinued, her aminotransaminases returned to normal levels. Conclusion: Although DILI is usually dose dependent, this case emphasizes the need for constant monitoring of liver function test of patients on low dose statins including patients with normal baseline liver function test. Personalized medical approach involving validated predictive score for DILI may become increasingly important in tailoring statin therapy to minimize the risk of adverse effects.
Abstract: Background: Atorvastatin is a member of the class of cholesterol lowering drugs called statins, which works by inhibiting HMG-CoA reductase, an enzyme involved in cholesterol synthesis in the liver. Statins are used to reduce the risk of cardiovascular events in individuals who have risk factors or a history of cardiovascular disease. While atorvas...
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