Improvement in Food Intolerance Symptoms after Pretreatment with Antibiotics Followed by Faecal Microbiota Transplantation: A Case Report

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition characterized by abdominal pain and altered bowel habits. Non-immune food reactions or food intolerances affect up to 20% of the general population and are commonly seen in patients with IBS. Faecal microbiota transplantation (FMT) has been described as an emerging, effective treatment for IBS. To date, there have been no reports on changes in food intolerances in patients with IBS treated with FMT. A 35-year-old female presented with an 18-month history of nausea, abdominal pain, alternating bowel habits, headaches/migraines, brain fog, and fatigue. The patient described severe food intolerances to dairy, gluten, egg, and soy. Extensive investigation identified no pathology, and IBS was diagnosed. The patient underwent treatment with antibiotics followed by treatment with FMT enema infusions decreasing in frequency for 12 months. At 12-week follow-up during FMT infusions, the patient reported an 80–90% improvement in her symptoms with formed bowel motions 1–2/day, occasional abdominal pain, and nausea and improved energy levels. The patient reported progressive improvements in her food tolerance from approximately 2 months into the FMT treatment. At week 24, she was tolerating gluten and dairy foods in her diet. At week 52, she was including gluten and dairy in her diet with no symptoms. This case demonstrates that antibiotics, followed by FMT may be an effective treatment for IBS and food intolerances pointing to the gut microbiome as a potential target for treatment.

Hyponatremia and Acute Kidney Injury as a Consequence of Malnutrition: A Case Report

This case presents how malnutrition due to underlying psychiatric disease can cause severe, chronic hyponatremia and acute kidney injury. A 31-year-old man was admitted due to fatigue. Blood tests displayed hyponatremia of 101 mmol/L and acute kidney injury. The patient had restricted himself to a uniform diet mainly consisting of rice boiled without salt. Isotone and hypertonic sodium chloride were used to secure a controlled rise in the sodium level. Despite fluid therapy, a delayed response in improvement in renal function was seen. After discharge, the patient started a balanced diet and the sodium level was almost normalized. Renal function eventually recovered. Long-term malnutrition may affect the tubular function of the kidney. Severe hyponatremia, other electrolyte disturbances, and protein and vitamin deficiency can be factors that interact in this pathogenesis. Resuming a normal diet may allow the kidney’s function to return to normal despite malnutrition during months.

Moderate Hyperhomocysteinemia along with Increased Levels of Vitamin B12 in a 21-Year-Old Male with the Sanfilippo Syndrome: A Case Report

The Sanfilippo syndrome is an autosomal recessive mucopolysaccharidosis. Homocysteine and B₁₂ status have not been described in this syndrome. A 21-year-old bedridden male with the Sanfilippo syndrome was hospitalized. He was in poor nutritional status according to laboratory and somatometric findings, he had an enlarged liver, moderate aortic valve insufficiency and was under antiepileptic, antipsychotic and anti-cholinergic therapy. The patient had moderate hyperhomocysteinemia (16.9 μmol/L) with co-existing high levels of serum B₁₂ (1,765 pg/mL). In addition, cystathionine, methionine sulphoxide and certain amino acids were measured. It was hypothesized that a “functional” deficiency of vitamin B₁₂ may be due to problematic transcobalamin-vitamin B₁₂ complex dissociation. Moreover, the patient’s cardiovascular background and/or medical treatment may explain the observed hyperhomocysteinemia. B₁₂ and homocysteine status should be assessed in Sanfilippo patients. This report suggests that checking vitamin B₁₂ and homocysteine status may be useful in the Sanfilippo syndrome.

Hypocaloric Peripheral Parenteral Nutrition Administered in Intestinal Reconnection Postoperative Patients with 3–5 Days Oral Fasting Indicated: A Case Report

Postoperative patients of intestinal reconnection in Morelia, Mexico, are usually in for 3–5 days of oral fast, which increases protein catabolism in the patient, thus lengthening their hospital stay and increasing the risk of developing metabolic comorbidities. Hypocaloric peripheral parenteral nutrition (HPPN) reduces proteolysis and improves inflammatory markers in these patients. The aim of this case report is to determine whether or not peripheral parenteral nutrition (PPN) improves inflammation, lessening the postoperative risk. A 62-year-old female patient and her cancer diagnosis and intestinal reconnection surgery are discussed. PPN is not commonly used in this type of patients due to the short duration of the fast, although its use is common before surgery. However, postoperative use can be beneficial as well, and given the delicate postoperative state these patients are in, it is worth it (at least in these cases) to give them all the strength and tools available for a better recovery. PPN in the case discussed herein improved the patient’s inflammatory marker levels in a shorter period.

Alcoholic Cirrhosis with Zinc and Copper Co-Deficiency

A 54-year-old Thai female with known alcoholic cirrhosis presented with chronic scaly eczematous patches and plaque for over 1 month. Initially, she was treated with oral antibiotics, but the lesions did not improve. The dermatologic examination and history of alcoholic cirrhosis were compatible with zinc deficiency. Moreover, copper deficiency was found together with zinc deficiency. Excessive alcohol consumption can cause zinc and copper co-deficiency. To avoid aggravated copper deficiency after zinc supplementation, copper and zinc were supplemented together in appropriate proportions. On the 2-week follow-up examination, her clinical outcome improved.

Wernicke’s Encephalopathy after Pancreaticoduodenectomy: A Case Report

Background: Wernicke’s encephalopathy (WE) is caused by thiamine deficiency and classically appears as changes in mental status, oculomotor manifestations, and gait ataxia. WE is mostly found in patients with chronic alcoholism and malnutrition, and has rarely been reported following pancreaticoduodenectomy. Case Presentation: A 77-year-old woman was admitted to our hospital complaining of loss of appetite and weakness of the lower extremities. No abnormalities were found on blood examination. One year earlier, she had undergone pancreaticoduodenectomy for bile duct cancer, and pancreatic fistula developed as a postoperative complication. On hospital day 8, her level of consciousness deteriorated, and she experienced difficulty bending the lower limbs and walking. Computed tomography and upper gastrointestinal series showed dilatation of the residual stomach and stenosis of the gastrojejunostomy. Laboratory test results were normal except for blood gas analysis, which revealed severe lactic acidosis. A diagnosis of WE was suspected due to lactic acidosis secondary to thiamine deficiency. Definitive diagnosis was confirmed by magnetic resonance imaging of the brain. Intravenous infusion of high-dose thiamine (1,200 mg/day) was commenced, leading to improvement of her neurological condition. Conclusions: Physicians should recognize that pancreaticoduodenectomy, when complicated by gastrojejunostomy stenosis resulting in pancreatic fistula, can lead to WE. In this case, blood gas analysis was helpful in arriving at the correct diagnosis. A high degree of suspicion should be maintained if any of the classical features of WE are observed following pancreaticoduodenectomy.

Phase Angle and Dry Weight Benefit Nutritional Management of a Patient with Primary Myelofibrosis Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Background: Progressive, involuntary weight loss (WL) is common in patients with primary myelofibrosis (PMF), and the etiology of this manifestation is multifactorial. A triad of ascites, edema, and splenomegaly is common; therefore, the body weight may be overestimated due to fluid overload. A comprehensive nutritional assessment, including measurement of dry weight, is necessary for monitoring disease progression and to allow the effective planning of nutritional interventions. Also, the phase angle (PA) has been suggested as an important prognostic and muscle mass marker in patients with cancer. To date, there have been no reports of bioimpedance analysis (BIA) of patients with PMF. Case Presentation: A 56-year-old man with PMF underwent allogeneic hematopoietic stem cell transplantation (HSCT) with fatigue and postprandial abdominal fullness, exhibiting splenomegaly (> 10 cm) and bilateral lower-extremity edema. On day –13, a BIA was performed. The patient had a body weight of 73.5 kg, with a fluid balance of +9.2 L and a PA at 50 kHz of 3.15°. A nutritional intervention was administered for 26 days, and on day +13 of HSCT, a repeat BIA revealed an estimated body weight of 69.7 kg with a fluid balance of +5.8 L and a PA at 50 kHz of 3.17°, as well as nonsignificant WL (3.1% in 1 month). Conclusions: This case report is an important addition to the nutritional assessment of PFM patients, since we could provide a better nutritional intervention due to our understanding of the estimated dry weight and assess the PA to investigate a new element of prognosis. Additional studies are needed to demonstrate the effectiveness of BIA in these patients.

The Use of an Arginine-Enriched Oral Nutrition Supplement to Enhance Wound Healing from a Cesarean Section

Background: Surgical wounds can directly hinder daily activities and leave scars that can have long-term impacts on a patient. Cesarean sections account for over one-third of all baby deliveries, resulting in women faced with a wound needing rapid healing to take care of their baby. Case Presentation: The patient received an arginine-enriched oral nutrition supplement twice daily for 14 days as a therapeutic intervention to aid in wound healing and recovery. At the 2-week postpartum visit, validated scar assessment scales were completed to determine how the surgical wound was healing. It was shown that this therapeutic intervention improved wound healing as indicated by low scar assessments. Conclusion: This woman showed that consuming an arginine-enriched oral nutrition supplement could optimize healing following a cesarean section. Future research needs to be conducted on a larger sample size to determine whether these results can be generalized to the broader population.