Summary Patients with breast cancer treated with MPA often report an improvement in appetite. Similar appetite stimulation is seen in patients treated with some corticosteroids, but MPA has a potential advantage over these drugs in that it does not exert a catabolic effect. MPA (100 mg tds orally) has therefore been compared with placebo in 60 patients with advanced malignant disease. Twenty-one patients in the MPA group and 20 in the placebo group were receiving chemotherapy. Patients were treated for 6 weeks and were assessed at weeks 0, 3 and 6 for appetite, energy, mood and pain using visual analogue scales. Nutritional status was assessed by the measurement of serum proteins and anthropometrics. Karnofsky score was recorded as a measure of performance status.There was a significant improvement in appetite in the MPA group between weeks 0 (pre-study) and 3 (P = 0.0002) and 0 and 6 (P = 0.015). There was no significant improvement in appetite in the placebo group. Supporting this finding was the significant increase in serum thyroid binding pre-albumin and retinol binding protein in the MPA group between weeks 0 and 3 and 0 and 6 (P = 0.023 and P = 0.039 respectively). These two parameters showed no significant change in the placebo group Anorexia is a debilitating symptom commonly experience by cancer patients (Theologides, 1977). It is a component of protein-energy malnutrition which is associated with a poor prognosis, reduced response to anti-neoplastic therapy and a reduced quality of life (Holmes & Dickerson, 1987). In a study of 126 cancer patients receiving chemotherapy or radiotherapy Padilla et al. reported that appetite and the ability to eat were the most important factors in the physical aspects of the patients' quality of life. These factors were more important in determining quality of life than the ability to work, physical strength or sexual satisfaction (Padilla, 1986). The background to this often profound loss of appetite and the weight loss that accompanies cancer is complex and agreement on the underlying mechanism has not been reached (Bernstein & Symundi, 1980). Psychological, emotional or physiological factors due to the disease and treatment may initiate or worsen anorexia, but as the disease progresses it is usually the cancer itself that is the main cause of the anorexia (Theologides, 1977 (Goodinson, 1987a). More recently a number of studies have investigated the use of biochemical testing in nutritional assessment, with particular reference to plasma proteins (Mullen & Torosian, 1981;Inglebleek et al., 1975;Carpentier et al., 1982;Ota et al., 1985;Thean et al., 1988;Weisberg, 1983). Those (Aitken, 1969). As an instrument they allow a measurement of changes in subjective feelings within individual patients over a set time. These scales have been validated for reliability, between subject reliability, test-retest reliability and validity by Silverstone (1982).
This study set out to compare the long‐term palatability of three oral sip‐feed supplements. Sixty patients with various malignancies were randomized to receive one of three products—Build‐Up, Fortimel and Fortisip. Participants were encouraged to take as much of the supplements each day for as long as they could manage. At the initial tasting, palatability and acceptability of the products was recorded and this was repeated throughout the trial period. Patients' reasons for discontinuing the trial were noted. Build‐Up was found to be the best‐tolerated product of the three. It was taken for a significantly longer time than either Fortimel or Fortisip. There was an indication that Build‐Up was more acceptable at the initial tasting than Fortisip but not Fortimel. A smaller proportion of patients stopped taking Build‐Up due to flavour‐related reasons compared to Fortisip but there was no significant difference between Build‐Up and Fortimel. In all, 54% of the patients discontinued the trial for flavour‐related reasons. Thirty‐five per cent found that the sip‐feeds they had been allotted unpalatable at the initial tasting, while 19% stopped the trial due to ‘flavour fatigue’. Only 10% of the sample continued taking their allotted product for 90 days or more.
The acceptability of commercially available oral supplements has a great influence on their long‐term use by cancer patients with a poor nutritional status. This study compares short‐term and long‐term palatability of six oral supplements used widely in hospitals throughout the UK, and their effect on the nutritional intake of the patient.
OBJECTIVES To compare prior hemophagocytic lymphohistiocytosis (HLH) criteria to adult COVID-19-associated hyperinflammatory syndrome (cHIS) criteria for the diagnosis of hyperinflammation in pediatric patients with COVID-19. The secondary objective was to assess treatment response to intravenous (IV) anakinra in these patients. METHODS This case series included children admitted to the pediatric intensive care unit (PICU) for COVID-19 pneumonia with hyperinflammation and treated with IV anakinra between July 2020 to April 2021. Hyperinflammatory criteria were determined for each patient. Clinical course, chest imaging, and inflammatory marker trends were assessed pre- and post-anakinra treatment. RESULTS All patients had a cHIS criteria score of >5. Two patients met 2004-HLH criteria. Only the patient that required extracorporeal membrane oxygenation (ECMO) met the H-Score cut-off value. All but one patient had a decrease in their inflammatory markers and improvement in clinical status with early initiation of adjunctive IV anakinra. CONCLUSIONS In this case series, adult cHIS criteria were successfully used to identify pediatric COVID-19 patients with hyperinflammation. Ferritin levels decreased following early initiation of IV anakinra.
In non-endemic settings, transfusion-transmitted malaria (TTM) is rare but potentially fatal and becoming more common with globalization. We present two pediatric cases that demonstrate donor screening using questionnaires is subject to error and that TTM should be considered with fever following numerous transfusions in children, particularly sickle cell patients.
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