Managing hyperemesis gravidarum: a multimodal challenge

Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect

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

Wernicke's encephalopathy during parenteral nutrition

BACKGROUND: Thiamine deficiency in humans affects the cardiovascular, muscular, nervous, and gastrointestinal systems. Wernicke's encephalopathy is described in alcoholism, in hyperemesis gravidarum, and in prolonged IV feeding without vitamin supplementation. METHODS: We report a case of a 66-year-old man undergoing surgery for acute necrotic-hemorrhagic pancreatitis, who presented a Wernicke's syndrome during parenteral nutrition (PN). After surgery, he was treated with infusion of industrial 3-compartment bags, without vitamin supplementation. On the seventh postoperative day, nausea and vomiting began, and 5 days later the patient showed diplopia, ataxia, general muscular stiffness, reduction of osteotendinous reflexes, confusional state, and thrombocytopenia. The magnetic resonance scan evidenced pathologic changes in the medial thalamus, in the third and fourth ventricular floor, in the cerebellar vermis, and in the periaqueductal gray substance. RESULTS: All neurologic signs and platelet blood count gradually normalized after IV supplementation of thiamine, 100 mg daily. The magnetic resonance scan repeated 40 days after the first one was normal. CONCLUSIONS: Our report points out the risk of incorrect procedures in management of industrial 3-compartment bags. Moreover, we suggest that thrombocytopenia may be related to thiamine deficiency

Nutrient intake and nutritional status in adult patients with inherited metabolic diseases treated with low-protein diets: A review on urea cycle disorders and branched chain organic acidemias

Low-protein diets (LPDs) are the main treatment for urea cycle disorders (UCDs) and organic acidemias (OAs). In most cases, LPDs start in childhood and must be continued into adulthood. The improved life expectancy of patients with UCDs and OAs raises the question of their consequences on nutritional status in adult subjects. As this topic has so far received little attention, we conducted a review of scientific studies that investigated the nutrient intake and nutritional status in adult patients with UCDs and branched chain organic acidemias (BCOAs) on LPD. Methods: The literature search was conducted in PubMed/MEDLINE, Scopus, EMBASE and Google Scholar from 1 January 2000 to 31 May 2020, focusing on nutrient intake and nutritional status in UCD and OA adult patients. Results: Despite protein restriction is recommended as the main treatment for UCDs and OAs, in these patients, protein intake ranges widely, with many patients who do not reach safety levels. When evaluated, micronutrient intake resulted below recommended values in some patients. Lean body mass resulted in most cases lower than normal range while fat body mass (FM) was often found normal or higher than the controls or reference values. Protein intake correlated inversely with FM both in adult and pediatric UCD patients. Conclusions: The clinical management of adult patients with UCDs and BCOAs should include an accurate assessment of the nutritional status and body composition. However, as little data is still available on this topic, further studies are needed to better clarify the effects of LPDs on nutritional status in adult UCD and BCOA patients

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

SARS CoV2 infection in a young subject affected by arginosuccinate synthase deficiency: A case report of epilepsy worsening

We describe a case of a 21 years old woman affected by Citrullinemia type 1- Arginosuccinate Synthase deficiency (ASSD)-who underwent a SARS CoV2 infection during the first phase of pandemic burst in Italy. She had no symptoms of infection nor a metabolic crisis. After recovery from SARS CoV2, she experienced a worsening in their epilepsy despite therapy, with one/two crisis a week