Improving the competence of pharmacist students through international lecturers
Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty in Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
In addition, the international lecturer created and gave handouts appropriate to the research topic. Compared with the teaching materials from internal lecturers (in the previous year), teaching materials prepared by the international lecturer were more complete. Furthermore, the international lecturer not only mentioned about the standard procedure of aseptic technique, but also provided practical examples from his own country. A very significant additional material was related to the discussion of the definition, scope, sources of contaminant in aseptic process, as well as how to minimize each type of contaminants present. The other materials were related to TPN, and there were additional materials in the form of making parenteral nutrition calculation made of the products made in the pharmaceutical industry. The enrichment related to the parenteral nutrition formulations was very significant, because it discussed the content of not only glucose, amino acids, and lipids but also vitamins, antioxidants, and minerals.
Congenital abdominal wall defects
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
The long-term outcome for patients with gastroschisis is excellent, with an overall survival of more than 90%. The presence of intestinal atresia, which is found in 10% of cases, is the most important prognostic determinant for a poor outcome. Mortality is mainly related to intestinal failure, associated liver disease, and factors associated with small bowel and/or liver transplantation. In full-term infants with gastroschisis necrotising enterocolitis has been encountered at higher than expected frequencies (up to 18.5%). Cryptorchidism is associated with gastroschisis with an incidence of 15%–30%, and gastro-oesophageal reflux in 16% of cases. Most cases of cryptorchidism, even after replacement of herniated testes into the abdominal cavity, will result in normal testicular descent. Most long-term survivors of gastroschisis will lead normal lives. Scenario 3, is suggestive of ‘vanishing gastroschisis’. This condition is associated with a very small abdominal wall defect and is characterised by necrosis and disappearance of some or all of the intestine, resulting in short bowel syndrome. These patients are likely to be on long-term total parenteral nutrition. In scenario 4, one should suspect intestinal atresia in cases that fail to establish on feeds by 4–6 weeks. This can be ruled out with a lower GI contrast study.
Nutrition and Gastrointestinal Disorders
David Heber, Zhaoping Li in Primary Care Nutrition, 2017
The idea of providing all nutrition through enteral supplements rather than foods is called exclusive enteral nutrition, and it is used for active disease. It was first used in 1973 in adults with Crohn’s disease resistant to other therapies (Voitk et al. 1973). Supplemental enteral nutrition may also be used to maintain a disease remission or to achieve adequate weight gain and growth (O’Sullivan and O’Morain 2006). Although research studies have confirmed its effectiveness in therapy, outcomes of this approach, when implemented in patients, are highly variable. Exclusive enteral nutrition is the initial therapy option in active Crohn’s disease. Parenteral nutrition is reserved to only being considered as an alternative method of nutrition for those who cannot tolerate enteral nutrition or during perioperative periods.
Gastrointestinal manifestations of primary immune deficiencies in children
Published in International Reviews of Immunology, 2018
This is a rare X-linked syndrome due to a mutation in transcription factor forkhead box protein (FOXp3) affecting T-regulatory cells which leads to autoimmunity.42 IPEX is characterized by a triad of immune dysregulation, polyendocrinopathy (usually Type 1 diabetes mellitus) and enteropathy. This is an autoimmune disorder that affects males and presents in the first year of life.43 Children are affected by watery diarrhea, eczema, autoimmune hemolytic anemia, thrombocytopenia and neutropenia. Many patients require total parenteral nutrition. Patients usually die in childhood and the only cure is bone marrow transplantation. Histopathology of the small bowel in patients with IPEX syndrome has shown severe villous atrophy and mucosal erosion with lymphocytic infiltrates of the submucosa or lamina propria.44
Peritoneal carcinomatosis, unilateral malignant pleural effusion with bilateral hydronephrosis post-radical gastrectomy in a signet-ring gastric cancer patient: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Yuting Huang, Moemen Eltelbany, R. Dobbin Chow, Aseem Sood
The patient underwent gastric mucosal biopsy and was diagnosed poorly differentiated gastric adenocarcinoma 6 months prior to presentation. She received radical gastrectomy, splenectomy with Roux-en-Y procedure (Figure 1) followed by three courses of hyperthermic intraperitoneal chemotherapy (HIPEC), and two courses of chemotherapy (Course1: Doxorubicin and Paclitaxel; Course2: Doxorubicin, Paclitaxel and oxalic platinum) in her home country. After completing this treatment, she returned to the U.S., where she began to experience nausea and vomiting. She was admitted to an outside hospital on three different occasions, the most recent being one month prior to current hospitalization, for suspected small-bowel obstruction due to an internal hernia. During that hospitalization, total parenteral nutrition was initiated. Tumor marker testing showed CA125 260 U/ml and CA19-9 822 U/ml. At the same time, the PET scan showed post-partial gastrectomy with moderate inflammatory changes in distal esophagus, no evidence of residual/recurrent tumour at the anastomotic sites, moderate right pleural effusion without hypermetabolism, moderate ascites with some peritoneal thickening without hypermetabolism, small-bowel obstruction, moderate bilateral hydronephrosis, mildly active non-enlarged upper right cervical lymph nodes, likely reactive (7 × 10 mm).
The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients – Randomized Clinical Trial
Published in Nutrition and Cancer, 2018
Lucyna Scislo, Radoslaw Pach, Anna Nowak, Elzbieta Walewska, Malgorzata Gadek, Philip Brandt, Grazyna Puto, Antoni M. Szczepanik, Jan Kulig
The study involved a group of gastric cancer patients who had undergone a surgical resection in a single institution. In majority of cases (76 patients), total gastrectomy with Roux-en-Y reconstruction was performed. Circular stapler was used for oesophago-jejunal anastomosis. A total of 22 patients underwent subtotal gastric resection: 7 with Billroth I and 15 with Billroth II reconstruction. In the postoperative period, all the patients in the examined group received only enteral nutrition. Inclusion criteria were the diagnosis of gastric cancer, planned elective gastrectomy, normal nutritional status, or mild to moderate malnutrition. Patients with severe malnutrition who required parenteral nutrition were excluded. The nutritional status was assessed according to national guidelines (14). Patients assessed as mild malnourished had up to 10% weight loss, albumin concentration 30–35 g/l, total lymphocyte count (TLC) 1,200–1,500, and patients moderately malnourished had 11–20% weight loss, albumin concentration 24–29 g/l, TLC 800–1199.
Related Knowledge Centers
- Gastrointestinal Tract
- Glucose
- Amino Acid
- Lipid
- Intravenous Therapy
- Compounding
- Salt
- Vitamin
- Mineral
- Peripherally Inserted Central Catheter