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Oral Nutritional Supplements and Appetite Stimulation Therapy
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The development of dementia often impacts food thinking, food seeking and consumption. The deterioration of memory changes the desire to eat and alters the pleasure associated with eating, as memories associated with certain foods are lost. An alteration in the sense of smell and taste has also been reported, with an obvious impact on consumption (Alves, Petrosyan, and Magalhães 2014). As dementia progresses, abnormal mouth and tongue movements may develop. This condition, referred to as orofacial apraxia, can impact the ability to hold food in the mouth, chew and effectively swallow (Cera et al. 2013).
Hearing Testing
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Electrophysiological techniques include OAE, ABR, and cortical evoked response audiometry (CERA). These methods are used in a child's first 6 months and in any child when behavioural testing has failed to produce reliable results (e.g. a child with learning difficulties). Accurate assessment may require sedation or general anaesthesia.
Hearing Tests in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Electrophysiological techniques including otoacoustic emission (OAE), auditory brainstem response (ABR) and cortical evoked response audiometry (CERA) are discussed in Chapter 8) and diagnostic testing of infants in the first 6 months.1–4 They can also prove of value in children of any age when behavioural testing has failed to produce reliable results, in particular those with severe learning or communication difficulties.5 Accurate assessment may require sedation or general anaesthesia. Electrophysiological techniques are also used to confirm hearing thresholds, for example, prior to cochlear implantation or where non-organic factors are suspected. While electrophysiological testing has the advantage of being objective in terms of the child’s response, behavioural and speech discrimination testing remain the only functional measures for assessing the complete auditory system.
Comparative effectiveness of erythropoietin alpha and beta in hemodialysis patients: a single-center prospective observational study
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Muhammad Nadeem Ahsan, Naila Asif, Shafqat Waqar Khanzada, Muhammad Sohaib Asghar, Farah Yasmin, Faran Khalid, Shameen Fareed, Syeda Ghazala Irshad
Anemia is a prevalent complication endured by patients with chronic renal disease [1,2]. Nephrogenic anemia usually occurs as a consequence of inadequacy and deficiency of erythropoietin synthesis in response to low hemoglobin (Hb) [1,2]. Incidence and progression of anemia are increased in individuals with worsening disease, and it is observed to be two to three times more prevalent among individuals suffering from diabetes mellitus when compared to different populations [2]. Renal anemia also leads to the development of cardio-vascular diseases i.e., left ventricular hypertrophy, heart failure and mortality associated with cardiac issues [3,4]. Erythropoiesis stimulating agents (ESA’s) have been utilized for the treatment of nephrogenic anemia since the 1980s [1–5]. Erythropoietin is a crucial growth factor required for recruitment, proliferation, and survival of erythroid progenitor cells [1]. It is a hematopoietic factor synthesized in peritubular interstitialq cells lining cortex of kidney [2]. Erythropoietin is released mainly as a consequence of hypoxia [1]. In patients suffering from end-stage renal disease, the release of erythropoietin is insufficient with need of oxygen due to erosion of normal renal microvasculature detecting oxygen, increased peritubular oxygen pressure required for release of erythropoietin, conversion of peritubular interstitial cells into matrix generating fibroblasts, aggregation of pro-inflammatory cytokines hindering erythropoietin production and autonomic sympathetic dysregulation [3]. Erythropoietin stimulating agents are categorized in two broad categories i.e., short-acting (epoetin alpha, epoetin beta, epoetin delta, epoetin omega and epoetin theta) and long-acting (Darbepoetin alpha, Continuous erythropoietin receptor activator (CERA), Peginesatide) [1].
An evaluation of roxadustat for the treatment of anemia associated with chronic kidney disease
Published in Expert Opinion on Pharmacotherapy, 2022
Yu Kurata, Tetsuhiro Tanaka, Masaomi Nangaku
With the increase in the number of patients with diabetes and hypertension, the prevalence and burden of chronic kidney disease (CKD) have recently skyrocketed. In 2017, there were 697.5 million patients with CKD and the estimated prevalence of CKD was 9.1% in the world’s population [1]. Anemia is one of the major complications associated with CKD and its prevalence increases as the stages of CKD advance. Erythropoietin (EPO) deficiency due to kidney fibrosis is the main cause of renal anemia [2]. Erythropoiesis-stimulating agents (ESAs) including recombinant EPO and its long-acting analogs (darbepoetin α [DA] and methoxy-polyethylene glycol-epoetin β [CERA]) have been the mainstay of renal anemia treatment for over 30 years, and ESAs have drastically reduced the amount of blood transfusion. However, there are a certain number of patients who respond poorly to ESAs and require high doses of ESAs to correct anemia. This condition is called ESA hyporesponsiveness and may be attributed to various conditions such as inflammation, iron deficiency, or uremia [3–5]. Secondary analyses of large randomized controlled trials (RCTs) have shown that supraphysiological EPO concentrations induced by high ESA doses may contribute to increased cardiovascular disease (CVD) risk and that ESA hyporesponsiveness was associated with poor survival [6–8]. Other disadvantages of ESAs include pain at the injection site and antibody-mediated pure red cell aplasia (PRCA). Therefore, a safer and more effective alternative treatment has been sought. EPO is produced via hypoxia-inducible factor (HIF) signaling, which coordinates cellular hypoxic responses. HIF prolyl hydroxylase inhibitors (HIF-PHIs) have been developed as a novel orally active therapeutic agent for renal anemia [9–12]. HIF-PHIs stimulate endogenous EPO production and optimize iron utilization via HIF signaling. Seven HIF-PHIs (daprodustat, desidustat, enarodustat, molidustat, roxadustat, and vadadustat, and DS-1093) have been developed, and some of which have completed phase 3 clinical trials. Roxadustat is a first-in-class HIF-PH. In clinical trials, roxadustat demonstrated non-inferior anemia improvement over conventional ESAs and has been already approved in China, Japan, South Korea, and Chile. Now that the results of clinical trials are available, some safety concerns that should be heeded have been identified. In this review, we summarize pharmacological properties, results of clinical trials, and safety concerns of roxadustat.