Clinical nutrition and metabolism

Adequate nutritional support for critically ill patients has always been (and still remains) one of the main, complex and not fully resolved problems of modern intensive care, which, unfortunately, often remains without due attention. In everyday practice, in order to adequately correct nutritional deficiency, the resuscitator must, first of all, correctly assess the trophological status of the patient. Currently, there exists a large selection of nutrients and different methods for assessing metabolic status. The paper presents a critical analysis of existing methods for assessing the nutritional status and algorithms for the personalized choice of each of them in a specific clinical situation in critically ill patients.

BACKGROUND: Currently it is known that there exists the need for complex medical rehabilitation at the stage of adjuvant radiation treatment of breast cancer. However, data on the combined use of nutritional support and physical factors at this stage of oncological treatment are not available.

AIM: Evaluation of the effectiveness of specialized therapeutic and preventive nutrition in patients with malignant breast diseases and a history of polychemotherapy at the stage of adjuvant radiation therapy in complex medical rehabilitation using low-temperature plasma and general magnetic therapy.

MATERIALS AND METHODS: A prospective simple randomized study was conducted, which involved 60 patients at the stage of adjuvant radiation therapy for breast cancer. The main group (n=30) received a course of medical rehabilitation with the inclusion of nutritional support using specialized therapeutic and preventive nutrition LEOVIT ONCO®, as well as exposure to low-temperature plasma and general magnetotherapy. In the comparison group (n=30), the rehabilitation course included general magnetic therapy without therapeutic and preventive nutrition. All patients underwent individual physiotherapy exercises, and sessions with a medical psychologist. The results obtained were recorded using clinical and functional, laboratory, instrumental studies.

RESULTS: It has been established that the use of specialized dietary products LEOVIT ONCO and physical factors is an effective method of rehabilitation. The use of nutritional support demonstrates the maintenance of the patient’s protein status, reduces intoxication, and reduces the negative impact of oxidative stress factors in the body at the stage of adjuvant radiation treatment. The inclusion of low-temperature plasma and general magnetic therapy in the rehabilitation program has a beneficial effect on hemomicrocirculation in the area of ionizing radiation exposure.

CONCLUSION: The use of nutritional support and physical factors, as a component of complex medical rehabilitation, helps to maintain the optimal nutritional status of the patient, reduces the manifestations of skin radiation reactions, improves the psycho-emotional state of patients and the quality of life of patient.

In order to study modern principles of diagnosis, treatment and prevention of clostridial infection, an analysis of publications on the topic in the medical databases eLibrary, PubMed, Medline (2004–2023) was carried out. Based on the data obtained, a modern concept of etiology, pathogenesis, and methods of treating the disease using specialized principles of diet therapy and nutritional support is presented. It has been shown that today clostridial infection is one of the most dangerous nosocomial infections, the diagnosis of which is quite difficult. Timely testing and a clear diagnostic algorithm make it possible to identify the disease in the early stages of its development. Vancomycin and metronidazole remain the main therapeutic agents, but the effectiveness of the latter has been questioned by recent studies. It is clear that further clinical studies are needed to study the target population of bezlotoxumab and regulate the use of fecal microbiota transplantation, which appears to be promising. A specialized enteral mixture enriched with the natural anti-inflammatory growth factor TGF-β2 has a pathogenetic effect, accelerating the healing of the colon mucosa and improving nutritional status for a long time. Prevention of clostridial infection is largely ensured by hygiene measures, as well as the rational use of antibiotics.

Neurogenic oropharyngeal dysphagia remains a widespread complication of neurological diseases. Its prevalence in stroke patients reaches 50%, among patients with multiple sclerosis — 44%, with amyotrophic lateral sclerosis — 60%, after brain injury — 50%, with Parkinson’s disease — 84%. Neurogenic oropharyngeal dysphagia can lead to a decrease in food intake, development of malnutrition and dehydration, and can also be complicated by the development of aspiration pneumonia, followed by death. Currently, the detection of dysphagia in hospitalized patients is often carried out late or outside the algorithm, which significantly increases the risk of nutritional deficiency, decreased quality of life, and other complications when eating. A clinical study of the swallowing function at the earliest possible time of hospitalization avoids delays in diagnosis and timely determines the feeding tactics of a patient with neurogenic dysphagia. The assessment of the swallowing function should be carried out in the first hours of the patient’s hospitalization, and the main conclusion to be drawn from the results of a clinical study of the swallowing function is whether the patient can receive food through the mouth to satisfy nutritional needs.

Despite the urgency of the problem of the development of nutritional deficiency in patients with dysphagia, there are few specific recommendations in the Russian literature on the stages of diagnosis, medical rehabilitation and nutritional support for this category of patients. This review is devoted to the analysis of the need for correct diagnosis and rehabilitation of patients with dysphagia and the impact of dysphagia on the quality of life and nutritional status of the patients.

As part of the XXVII Russian Oncology Congress, a section “Nutritional support — an underestimated tool in the hands of an oncologist. How to ensure successful continuous antitumor therapy?” was held. The presented message outlines the abstracts of the reports of the section participants.

Report by A.R. Gevorkov concerned the relevance of nutritional support in oncology, the negative impact of nutritional deficiency on the results of surgical, drug and radiation treatment of cancer patients at all stages. Report by O.A. Obukhova was devoted to the effectiveness of nutritional support during surgical treatment of cancer patients, based on the results of well-planned and executed clinical studies, including the first domestic prospective multicenter randomized trial of perioperative high-protein enteral nutrition NUTRILUNC. Report by M.Yu. Kukosh reflected the role of rehabilitation in the continuity of antitumor treatment and the place of nutritional support in the corresponding rehabilitation program.

The authors concluded that nutritional support at all stages of antitumor treatment is relevant, effective and safe, and called on oncologists to widely introduce artificial nutrition into clinical practice.