Latest Updates

OVERVIEW OF ENTERAL NUTRITION

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.

Nutritional Management of Celiac Disease

Ciarán P Kelly, MD, Satya Kurada, MD, Mariana Urquiaga, MD
    • Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
    • Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
    • IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Kevin K. Chang, MD, Sam S. Yoon, MD
    • The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
    • A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
    • Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.

Pathologic Evaluation of Soft Tissue Sarcoma

Narasimhan P. Agaram, MBBS
    • Concepts of pathologic examination and grading
    • Important diagnostic criteria for each soft tissue sarcoma
    • Latest molecular diagnostic methods used in the diagnosis of sarcomas

Child Abuse and Nonaccidental Trauma

S Terez Malka, MD
    • Abusive injuries account for over 1% of pediatric emergency department visits.
    • Skeletal survey should now be obtained in any child under age 3 with concern for abusive injury.
    • Cardiopulmonary resuscitation does not lead to significant rib fractures or retinal hemorrhages, and these conditions should be considered highly concerning for abusive injury.

ENDOSCOPIC TECHNIQUES FOR OBTAINING ENTERAL ACCESS

Marvin Ryou, MD, Sanjay Salgado, MD
    • DPEJ tubes should be considered when percutaneous endoscopic gastrostomy (PEG) tubes are not feasible or are contraindicated.
    • Postpyloric feeding (percutaneous gastrostomy with a jejunal extension or direct percutaneous jejunostomy should be considered in severely ill patients (especially those with an APACHE II score over 20).
    • In patients with dementia, PEG tube placement does not enhance mortality, prevent aspiration pneumonia, improve nutritional status, or improve quality of life.

Nephrology: Drug Dosing in Acute Kidney Injury

Jamil Azzi, MD, Steven Gabardi, PharmD, BCPS, FAST, FCCP, Marjan Sadegh, PharmD, BCPS, Craig A Stevens, PharmD, BCPS
    • Full review of all available literature on the impact of acute kidney injury (AKI) on drug pharmacokinetic parameters
    • Recommendations for drug dosing strategies in patients with AKI, including loading doses, maintenance therapy, and therapeutic drug monitoring
    • Evaluation of specific medications that require special attention in patients with AKI

Nephrology: Hypertensive Disorders in Pregnancy

Susan Hou, MD, Kavitha Vellanki, MD
    • New diagnostic criteria for preeclampsia
    • Pathophysiology of preeclampsia
    • Role of serologic biomarkers for diagnosis of preeclampsia
    • Guidelines for target blood pressure in pregnancy
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