Refractory myasthenia gravis, dysphagia and malnutrition : a case report to suggest disease-specific nutritional issues

Objective: We describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition. Methods: A 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition. Results: The first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic pouss\ue9s. Conclusions: Current guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia

Effect of sugar cane policosanol on lipid profile in primary hypercholesterolemia.

Policosanol, a mixture of long-chain aliphatic primary alcohols, is used as a cholesterol-lowering supplements. The effectiveness of policosanol is still questionable. To determine the lipoprotein-lowering effects of Cuban sugar cane-derived policosanol a double-blind, randomized, placebo controlled trial was performed. Sixtyeight primary hypercholesterolemic subjects were enrolled and randomly assigned to the treatment or to the control group. The first group received sugar cane policosanol 20 mg daily for 8 weeks, while the control group was treated with placebo. All subjects followed a normocaloric diet. The content of policosanol in the supplement tablets was assessed by gas chromatography. A total of 32 subjects in the policosanol group and 31 subjects in the control group completed the study. Body mass index, total cholesterol, HDL-cholesterol, LDLcholesterol and triglyceride plasma levels did not change significantly in either group. In conclusion, sugar cane policosano

Sugar cane policosanol failed to lower plasma cholesterol in primitive, diet-resistant hypercholesterolaemia: A double blind, controlled study

Previous clinical studies have shown that oral administration of sugar cane policosanol (SCP) reduces plasma total cholesterol and low-density lipoprotein cholesterol levels. A double blind, randomized, placebo controlled trial was performed in hypercholesterolaemic, diet-resistant patients. Seventy patients meeting the selection criteria were enrolled. Each subject was treated with policosanol 10 mg/d in addition to a dietetic regimen for 8 weeks. At the start and at the end of the study body weight, body mass index (BMI), total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides (TG) plasma levels were measured. Thirty-three subjects in the policosanol and Thirty-one subjects in the control group completed the study. During the study body mass index, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides plasma levels did not change significantly within and between groups. In conclusion, sugar cane policosanol at a dose of 10 mg/d showed no lipid lowering effects in subjects with primitive, diet-resistant hypercholesterolaemia