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Biomedical subjects

Khursheed N Jeejeebhoy

Publications and source records attributed to Khursheed N Jeejeebhoy.

At least 19 recordsLinked to original sources
PubMed2006

The management of conditioned nutritional requirements in heart failure.

Patients suffering from congestive heart failure exhibit impaired myocardial energy production, myocyte calcium overload and increased oxidative stress. Nutritional factors known to be important for myocardial energy production, calcium homeostasis and the reduction of oxidative stress, such as thiamine, riboflavin, pyridoxine, L-carnitine, coenzyme Q10, creatine and taurine are reduced in this patient population. Furthermore, deficiencies of taurine, carnitine, and thiamine are established primary causes of dilated cardiomyopathy. Studies in animals and limited trials in humans have shown that dietary replacement of some of these compounds in heart failure can significantly restore depleted levels and may result in improvement in myocardial structure and function as well as exercise capacity. Larger scale studies examining micronutrient depletion in heart failure patients, and the benefits of dietary replacement need to be performed. At the present time, it is our belief that these conditioned nutritional requirements, if unsatisfied, contribute to myocyte dysfunction and loss; thus, restoration of nutritional deficiencies should be part of the overall therapeutic strategy for patients with congestive heart failure.

Animals↗
PubMed2006

Short bowel syndrome and intestinal failure: consensus definitions and overview.

Short bowel syndrome (SBS)-associated intestinal failure is a highly disabling condition that impairs quality of life and social integration. Although the condition is not uniformly fatal, it might lead to serious, life-threatening complications. The basic goals of medical treatment are to maintain fluid, electrolyte, and nutrient balances and to make appropriate modifications in disease management to avoid side effects. Various definitions have been proposed for SBS and intestinal failure within the medical literature, but many focus on different aspects of the conditions, leading to confusion. In the past, identifying the cause of intestinal failure was of little consequence, because all patients were managed on total parenteral nutrition at home. However, with the recent development of medical therapies such as recombinant growth hormone, octreotide, and glucagon-like peptide-2 analogues and with improvements in small bowel transplantation, many patients can be made nutritionally autonomous. To evaluate the relative efficacy of these therapies, there is now a need to develop consensus definitions so that patients can be properly categorized before therapy. To this end, a group of experts on the subject was convened to develop the following new definitions: "Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance." "Short-bowel syndrome results from surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet."

Humans↗
PubMed2006

A patient with anemia of obscure origin: Crohn's disease in disguise.

BACKGROUND: A 65-year-old white Mediterranean male with a 10-year history of intermittent anemia, who was otherwise completely asymptomatic, was referred to our hospital in March 2004. He had a medical history of beta thalassemia and fecal occult blood tests had occasionally been positive. INVESTIGATIONS: Fecal occult blood test, laboratory investigations, esophagogastroduodenoscopy, colonoscopy with retrograde ileoscopy, mesenteric angiography, small-bowel series, CT scan of the abdomen and pelvis, Meckel's scan, and capsule endoscopy. Laparoscopic surgery followed by macroscopic and microscopic histopathologic examination of samples obtained during the procedure. DIAGNOSIS: Crohn's disease of the small bowel. MANAGEMENT: Laparoscopic segmental small-bowel resection with end-to-end anastomosis. Postsurgical treatment with Pentasa 4 g a day.

Aged↗
PubMed2005

Taurolidine lock: the key to prevention of recurrent catheter-related bloodstream infections.

The literature shows that repeated courses of antibiotics and catheter removals in a subset of patients suffering from multiple catheter-related bloodstream infections (CRBSI), are unlikely to prevent recurrence. In acceding to preventative strategies, we report our application of the antimicrobial chemotherapeutic Taurolidine used as a daily flush solution in seven home TPN patients suffering from multiple episodes. A pretreatment infection rate of 10.8 infections per 1000 catheter days decreased to 0.8 after treatment.

Adult↗
PubMed2005

Capsule endoscopy findings in patients with established and suspected small-bowel Crohn's disease: correlation with radiologic, endoscopic, and histologic findings.

BACKGROUND: Little is known about the accuracy of capsule endoscopy (CE) in evaluation of small-bowel Crohn's disease. METHODS: Symptomatic eligible patients had ileocolonoscopy and biopsies from the terminal ileum, followed by small-bowel radiologic studies before CE. Endoscopic, radiologic, CE, and histologic findings were compared. Histology (terminal ileum biopsy specimens or a tissue sample after small-bowel resection) served as a criterion standard. RESULTS: Fifty-four patients were enrolled; 15 of the 54 patients were excluded from data analysis (critical small-bowel strictures, 14, identified on radiology; incomplete CE, 1). Data were analyzed for 39 patients. All patients had histologic evaluation of the small bowel. Final diagnosis of active small-intestine Crohn's disease was made in 29/39 patients (74.4%). When calculated, CE yielded a sensitivity and a specificity of 89.6% and 100.0%, respectively, and a positive predictive value and a negative predictive value of 100.0% and 76.9%, respectively, whereas small-bowel series were 27.6%/100.0% and 100.0%/32.3%. CONCLUSIONS: CE is more accurate in detecting small-bowel inflammatory changes suggestive of Crohn's disease than conventional studies. CE, combined with ileocolonoscopy, may be proposed as a first-line investigation of the small intestine in cases of uncomplicated known or suspected Crohn's disease.

Adult↗
PubMed2005

Enteral feeding.

PURPOSE OF REVIEW: Enteral nutrition is now widely used as the preferred route of nutritional support in malnourished and intensive care unit patients. Studies providing evidence for efficacy, techniques of administration, and outcome are appearing daily in the literature. This review presents evidenced-based studies in this field from December 2002 to the present and critically reviews them for the reader. In this way the reader can rapidly access important publication from the morass being published each year. RECENT FINDINGS: A diverse group of studies are covered in this review: effect of nutritional status on outcome, effect of combining enteral and parenteral nutrition, enteral nutrition in pancreatitis, rehydration of infants, gastric versus intestinal feeding, nutrition in hip fractures and pressure ulcers, systematic reviews and guidelines, immunonutrition and enterocolitis in infant feeding SUMMARY: Enteral nutrition is an established modality of nutritional support that has received wide acceptance. It is not clear, however, for which conditions it improves patient outcome and the best way to optimize its delivery. In this review, articles addressing the outcome of patients and methods to optimize delivery of enteral nutrition are reviewed. Unfortunately, with few exceptions, most studies are based on few patients or do not have a placebo arm. An more important flaw in these studies is the nutritional status of the patient and need for support.

Enteral Nutrition↗
PubMed2005

Given capsule endoscopy in celiac disease: evaluation of diagnostic accuracy and interobserver agreement.

BACKGROUND AND AIMS: Capsule endoscopy (CE) has been increasingly used for diagnosing diseases of the small bowel. It is an attractive technique for assessing celiac disease (CD) because it is noninvasive and provides a close and magnified view of the mucosa of the entire small bowel. In this study, we evaluated the accuracy of CE and interobserver agreement in recognizing villous atrophy (VA) using histopathology as the reference. We also explored the extent of small bowel involvement with CD and the relationship between the length of the affected bowel and the clinical presentation. METHODS: Ten CD patients with histologically proven VA and the same number of controls were subjected to CE. Four, blinded to histology findings, investigators (two with and two without prestudy CE experience) were asked to diagnose VA on CE images. RESULTS: Based on assessment of all four investigators, the overall sensitivity, specificity, PPV, and NPV of CE in diagnosing VA were 70%, 100%, 100%, and 77%, respectively. The sensitivity and the specificity of the test was 100% when the reports of experienced capsule endoscopists only were analyzed. The interobserver agreement was perfect (kappa= 1.0) between investigators with prestudy CE experience and poor (kappa= 0.2) between the investigators who had limited prestudy exposure to CE. Celiac patients with extensive small bowel involvement had typical symptoms of malabsorption (diarrhea, weight loss) as opposed to mild and nonspecific symptoms in patients whose disease was limited to the proximal small bowel. CE was tolerated well by all study participants with 95% reporting absence of any discomfort. CONCLUSIONS: Although based on a small sample size, the study suggests that CE may be useful in assessing patients with CD. Familiarity with CE technology appears to be a critical factor affecting the accuracy of the test. Larger studies are warranted to more precisely define the advantages and limitations of CE in CD.

Atrophy↗
PubMed2004

Effect of feeding malnourished patients for 1 mo on mitochondrial complex I activity and nutritional assessment measurements.

BACKGROUND: We showed previously that the activity of complex I (the first enzyme of the electron transport chain) in peripheral blood mononuclear cells decreases with malnutrition and increases to a subnormal value after 1 wk of refeeding, but the traditional markers of nutritional status do not do so. OBJECTIVE: The aim of this study was to ascertain whether a period of nutritional intervention longer than 1 wk would normalize complex I activity and traditional markers of nutritional status. DESIGN: Fifteen malnourished patients (7 women and 8 men) with > or =10% body weight loss over the previous 6 mo were studied on the day of their admission to hospital and 7, 14 and 30 d after the beginning of nutritional support. Complex I activity in peripheral blood mononuclear cells, weight, height, body composition, body water compartments, dietary intake, and serum albumin concentrations were measured on each occasion. The results before and during nutritional intervention were compared with values obtained in 30 healthy volunteers (17 women and 13 men). RESULTS: Complex I activity increased significantly after the first week of refeeding (P < 0.001) and reached a normal value after 1 mo of nutritional supplementation. Among the classic markers of nutritional status, only the ratio of extracellular water to intracellular water tended to decrease over the refeeding period. CONCLUSION: Complex I activity increases rapidly and is normalized by refeeding at a time when other markers of nutritional status do not change significantly.

Adult↗
PubMed2004

Enteral feeding.

PURPOSE OF REVIEW: Enteral nutrition is now the preferred route of nutritional support in malnourished and ICU patients. Studies providing evidence of its efficacy, techniques of administration, and outcome are appearing daily in the literature. This review presents the most important publications in this area and critically reviews them. In this way, the reader can rapidly access important publications from all those that are being published each year. RECENT FINDINGS: A diverse group of studies is covered in this review. The subjects of these studies include the role of enteral and parenteral nutrition in the perioperative patient; reinfusion of succus to promote increased absorption in patients with a fistula or short bowel; enteral nutrition in patients with head injury, in liver disease, and in pancreatitis; bone marrow transplantation; and delivery of enteral nutrition. SUMMARY: Enteral nutrition is an established modality of nutritional support that has received wide acceptance. However, it is not clear in which conditions it improves patient outcome and how to optimize its delivery. In this review, articles addressing the outcome of patients and methods to optimize delivery of enteral nutrition are reviewed. Unfortunately, with few exceptions, most studies are based on few patients or do not have a placebo arm. The usual comparison is with total parenteral nutrition, and in such comparisons, the studies fail to make the two groups comparable in terms of energy intake and the occurrence of a major risk factor for sepsis, namely, hyperglycemia.

Journal Article↗
PubMed2004

Permissive underfeeding of the critically ill patient.

The rise in the popularity of nutrition support in the 1970s was associated with the concept of "hyperalimentation." This concept was based on the early findings that increased metabolic rates were observed in various disease states such as trauma, sepsis, and burns. The aim was to feed 40% to 100% above the basal metabolic rate to avoid weight loss associated with critical illness. Since that time, several observations have indicated that permissive underfeeding may be beneficial because: (a) the metabolic rate is not markedly increased in most patients with critical illness except burns; (b) weight gain during nutrition support in critical illness is not caused by a gain in nitrogen but fat; (c) energy intake as glucose in excess of needs causes increased carbon dioxide production and a fatty liver; (d) hyperglycemia increases the risk of infective complications; and (e) a controlled trial of preoperative nutrition in which patients received 1000 kcal above the metabolic rate increased infectious complications.

Journal Article↗
PubMed2003

Effect of low-protein diet and protein supplementation on the expressions of TNF-alpha, TNFR-I, and TNFR-II in organs and muscle of LPS-injected rats.

Previous studies had shown that increasing energy intake in anorexic TNF-alpha-treated rats increased morbidity due to stabilization of TNF activity by soluble and membrane TNF receptors (TNFR). Although protein supplementation reduces septic morbidity, its effect on TNF and TNFR is unknown. To determine the effect of low protein intake and supplementation on TNF and TNFR, 30 male Wistar rats weighing 250 g were fed a liquid defined-formula diet for 10 days and randomly allocated to 1) controls (C; n = 6), receiving normal energy and protein energy density of 0.047 MJ/60 ml + normal saline (NS); 2) low protein (LP; n = 6), receiving normal energy but a reduced protein-energy density of 0.012 MJ/60 ml + LPS; 3) refeeding (RF; n = 6), initially depleted on low-protein diet (10 days) and then repleted on normal protein (10 days) while receiving LPS; and 4) pair fed (P-F; n = 12), individual P-F rats being paired with individual LP or RF rats receiving NS. Protein and mRNA expression of TNF-alpha, TNFR-I, and TNFR-II in liver, spleen, and gastrocnemius were measured by Western blot and RT-PCR, respectively. In liver, the changes in TNF-alpha, TNFR-I, and TNFR-II were translational, whereas in spleen the effects were due to a combination of transcription and translation. In gastrocnemius, the effects were transcriptional/translational for TNFRs. In contrast, TNF-alpha mRNA was significantly increased, but TNF-alpha protein expression was reduced in LP rats compared with C and RF groups. In conclusion, protein deficiency in endotoxic rats increases the expression of TNFR-I and TNFR-II in all organs studied and TNF-alpha in selected ones. This increase is suppressed by refeeding protein. A differential pattern between translation and transcription of TNF-alpha and its receptors is present. Our data suggest that protein restriction may be deleterious in sepsis.

Animals↗
PubMed2003

Nutritional effects on NF-kappaB/IkappaB activity in weight-gaining and -losing rats.

BACKGROUND: We had previously reported metabolic abnormalities in TNF-treated weight-gaining (WG) rats, associated with increased soluble and membrane TNF receptors. OBJECTIVE: On the basis of these findings, we hypothesized that stabilization of TNF in circulation in WG animals by these receptors augmented the action of TNF. TNF influences cellular function through the activation of NF-kappaB, by its release from IkappaBalpha and translocation to the nucleus where it regulates gene transcription. This study was designed to determine whether NF-kappaB binding was increased in WG rats in comparison with weight-losing (WL) rats. DESIGN: Twenty two male Wistar rats weighing 200-220 g were fed a liquid-defined formula diet for 10 days and divided as follows: (i) WG rats (n = 11) receiving an energy density of 0.35 MJ per 60 ml and (ii) WL rats (n = 11) receiving an energy density of 0.09 MJ per 60 ml. Nuclear extracts from heart, liver, lung, spleen and gastrocnemius were used for NF-kappaB measurements by electrophoretic mobility shift assay. Tissue lysates from heart and lung were used for IkappaBalpha measurements by Western blot analysis. RESULTS: There was increased NF-kappaB binding in the lung and heart extracts of the WG rats as compared with WL rats. There was no difference in the binding activity between WG and WL rats in the spleen, liver and gastrocnemius extracts. In lung and heart lysates, IkappaBalpha protein expression was decreased in WG rats as compared with the WL rats. We conclude that there is increased organ-specific TNF activity in WG rats because of increased binding of NF-kappaB to the nucleus and reduced IkappaBalpha levels in the lung and heart. CONCLUSIONS: The findings are consistent with increased TNF activity resulting in the release of NF-kappaB from the NF-kappaB/IkappaBalpha complex and translocation to the nucleus. The nuclear translocation of NF-kappaB observed in the heart and lung suggests that nutrition may influence the action of TNF in these vital organs in sepsis. This finding is potentially of great significance, as pulmonary and cardiac failure are the main causes of death in sepsis.

Animals↗