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da Silva Goncalves dos Santos J, de Farias Meirelles B, de Souza da Costa Brum I, Zanchetta M, Xerem B, Braga L, Haiut M, Lanziani R, Musa TH, Cordovil K. First Clinical Nutrition Outpatient Consultation: A Review of Basic Principles in Nutritional Care of Adults with Hematologic Disease. ScientificWorldJournal 2023; 2023:9303798. [PMID: 37780637 PMCID: PMC10539097 DOI: 10.1155/2023/9303798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Methods A bibliographic survey was carried out between 2020 and 2022 using two databases: PubMed/MEDLINE and Scientific Electronic Library Online (SciELO) and the information source Academic Google, irrespective of language or geography. Results In the first nutrition consultation (FNC), there should be an investigative direction focused on nutritional interventions in the short, medium, and long term. The record in the patient's medical record is relevant for carrying out the consultation, according to the recommendations of the normative councils of medicine and nutrition. The main steps to be followed are the investigation of the presence of food allergies and intolerances; the drugs/nutritional supplements in use; changes in the digestive tract; the presence or absence of picamalacia; and socioeconomic and lifestyle data. In addition, it is necessary to carry out laboratory evaluations, semiological assessment, anthropometric assessment, and assessment of food consumption. In the end, the nutritional approach should be composed of calculation of energy and macronutrient and micronutrient needs, intervention in nutritional status deviations, nutritional guidelines, and nutritional therapeutic planning of return, focusing on adherence to treatment. Conclusion The first nutrition consultation may represent investigative steps that help the clinical nutritionist in the management, allowing a longitudinal and specific nutritional therapeutic planning for patients assisted in large reference centers for hematological disease.
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Affiliation(s)
- Julia da Silva Goncalves dos Santos
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Isabela de Souza da Costa Brum
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mariana Zanchetta
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Bruna Xerem
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Lucas Braga
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Marcia Haiut
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Renata Lanziani
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Taha Hussein Musa
- Biomedical Research Institute, Darfur University College, Nyala, Sudan
| | - Karen Cordovil
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
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Juwairiyyah Fatima S, Nepal N, Ochieta D. Surviving Critical Low Hemoglobin Levels and Pica. Cureus 2023; 15:e38812. [PMID: 37303454 PMCID: PMC10256244 DOI: 10.7759/cureus.38812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Iron deficiency is the most common nutritional deficiency. Pica is commonly associated with iron deficiency anemia (IDA). A case of a 40-year-old female who presented with a critical record of low hemoglobin (Hgb) (1.6 g/dL) with severe iron deficiency and pica with no lasting deficits despite such low hemoglobin is discussed in this article. The patient presented to the emergency room with complaints of weight loss, weakness, palpitation, fatigue, dysphagia, and on-and-off vomiting for about a year and severe menorrhagia for about one and a half years. She also has had pica for the past several years where she eats and chews toilet paper. Several of her female family members also have pica. She was found to have critically low hemoglobin of 1.6 g/dL and serum iron of 8 ug/dL and ferritin of less than 1 ng/mL. The patient was treated with six units of packed red blood cells and IV and oral iron supplementation. She was discharged with a hemoglobin of 7.3 g/dL. She was later found to have a 9.6 cm uterine mass that is consistent with leiomyoma (fibroid) in transvaginal ultrasound and is following up with a gynecologist for the definitive management. She did not have lasting deficits from the critically low hemoglobin and has stopped engaging in pica behavior.
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Affiliation(s)
| | - Nisha Nepal
- Internal Medicine, Danbury Hospital, Danbury, USA
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3
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Yankov I, Tashev V, Kozev P, Shentova R, Mitkovski D, Boyanov N. Gastric trichobezoar in the absence of psychosocial stressors: a report of two cases. Folia Med (Plovdiv) 2022; 64:537-542. [PMID: 35856118 DOI: 10.3897/folmed.64.e62464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/03/2021] [Indexed: 01/19/2023] Open
Abstract
Abstract.
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Affiliation(s)
- Ivan Yankov
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Vasil Tashev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Pavlin Kozev
- Medical University of Plovdiv, Plovdiv, Bulgaria
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The Neurology and Psychopathology of Pica. Curr Neurol Neurosci Rep 2022; 22:531-536. [PMID: 35674869 DOI: 10.1007/s11910-022-01218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Pica is defined by the American Psychiatric Association's Diagnostic and Statistical Manual, 5th edition (DSM 5) as the ongoing ingestion of materials with no nutritive or food value. More specifically such ingestions must be unremitting for at least 1 month and occur at a developmentally inconsistent age for such behavior. This article reviews the association of pica with pregnancy, micronutrient deficiencies, psychiatric disorders, dementia, and developmental disorders with emphasis on autism spectrum disorders (ASD). RECENT FINDINGS Some variants of non-nutritive consumption are prevalent behavioral norms in non-western cultures, so not all picas should be considered pathological. However, the strong association of pica with iron deficiency anemia (IDA) lends credence to the hypothesis that dopamine transmission may be disrupted in this disorder. Picas associated with ASD are resistant to medications but can be treated with applied behavioral analysis therapy (ABA). Etiological hypotheses for pica are explored with a focus on neurobiological, neuroimaging, and psychiatric correlations. Pharmacological management and behavior modification strategies are also discussed. The possibility that pica is a form of addiction analogous to food cravings is introduced and suggested as an area for further research pursuits.
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5
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Gupta A, Amaducci A, Koons A, Lindmark JD, Beauchamp GA. Syndrome of Inappropriate Antidiuretic Hormone Secretion and Lead Toxicity in a Child With Sickle Cell Disease and Pica. Clin Toxicol (Phila) 2021. [PMID: 34522473 DOI: 10.1080/15563650.2020.1804238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe the presentation and management of a three-year-old child with a history of pica, vitamin D deficiency, and sickle cell disease, who was admitted for pyelonephritis, and found to have elevated blood lead level (BLL) of 103.7 µg/dL, and who subsequently developed altered mental status and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In consultation with Medical Toxicology, the patient was chelated with calcium disodium edetate (EDTA) and British Anti Lewisite (BAL). The patient's hyponatremia was managed with hypertonic saline infusion. The patient's encephalopathy improved throughout her hospital course, and she was discharged on hospital day 8. Following five days of EDTA and three days of BAL injections, her repeat BLL was 15.3 µg/dL. SIADH has been associated with severe lead poisoning and may be more likely to occur in high risk patients such as individuals with sickle cell anemia, particularly where medications are used that may cause iatrogenic hyponatremia.
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Affiliation(s)
- Akshay Gupta
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Alexandra Amaducci
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Andrew Koons
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - John D Lindmark
- Department of Pediatric Critical Care, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Gillian A Beauchamp
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
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Abstract
Pica is the developmentally inappropriate consumption of non-nutritive items for at least one month. Pica can lead to many adverse outcomes, but the exact pathophysiology of pica is unknown or variable across populations. Several studies have evidenced that there is a high prevalence of pica among youth with sickle cell disease (SCD). However, the lack of knowledge regarding the correlates of pica contributes to overlooking the condition, inaccurate diagnoses, and a lack of evidence-based treatments once pica is identified. This review examines the literature to develop a biopsychosocial model of pica in SCD. Elucidating the potential relationships among the proposed biological, psychological, and social factors, and pica will inform our understanding of this phenomenon in pediatric SCD and may guide future research and clinical recommendations.
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Affiliation(s)
- Nikita Rodrigues
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- , Washington, DC, USA.
| | - Sharon Shih
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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7
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Gupta A, Amaducci A, Koons A, Lindmark JD, Beauchamp GA. Syndrome of Inappropriate Antidiuretic Hormone Secretion and Lead Toxicity in a Child With Sickle Cell Disease and Pica. Cureus 2021; 13:e16813. [PMID: 34522473 PMCID: PMC8425150 DOI: 10.7759/cureus.16813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
We describe the presentation and management of a three-year-old child with a history of pica, vitamin D deficiency, and sickle cell disease, who was admitted for pyelonephritis, and found to have elevated blood lead level (BLL) of 103.7 µg/dL, and who subsequently developed altered mental status and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In consultation with Medical Toxicology, the patient was chelated with calcium disodium edetate (EDTA) and British Anti Lewisite (BAL). The patient's hyponatremia was managed with hypertonic saline infusion. The patient's encephalopathy improved throughout her hospital course, and she was discharged on hospital day 8. Following five days of EDTA and three days of BAL injections, her repeat BLL was 15.3 µg/dL. SIADH has been associated with severe lead poisoning and may be more likely to occur in high risk patients such as individuals with sickle cell anemia, particularly where medications are used that may cause iatrogenic hyponatremia.
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Affiliation(s)
- Akshay Gupta
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Alexandra Amaducci
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Andrew Koons
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - John D Lindmark
- Department of Pediatric Critical Care, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Gillian A Beauchamp
- Division of Medical Toxicology, Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
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Hood AM, Reife I, King AA, White DA. Brief Screening Measures Identify Risk for Psychological Difficulties Among Children with Sickle Cell Disease. J Clin Psychol Med Settings 2020; 27:651-661. [PMID: 31463865 PMCID: PMC7047601 DOI: 10.1007/s10880-019-09654-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Children with sickle cell disease (SCD) experience disproportionately high rates of psychological problems. Our goal was to examine the clinical utility of psychological screening measures to identify children with such problems in medical settings. Caregivers completed screening measures assessing social-emotional problems, ADHD symptoms, executive dysfunction, and health-related quality of life for children with SCD (receiving either chronic blood transfusion or hydroxyurea) and their siblings. Our findings demonstrated that screening measures identified clinically elevated symptoms in children with SCD that had not been previously reported. Scores for siblings were for the most part in the normal range. The number of days hospitalized (but not cerebral infarct status) predicted higher scores, emphasizing the challenges associated with SCD complications. Overall, our findings support the notion that screening measures reduce the need for reliance on medical provider judgment for psychological referrals and increase equitability in access to services. Early identification resulting in early intervention has contributed substantially to improved psychological functioning in many contexts, and it is thus likely that such improvements would also be achieved in this uniquely vulnerable population.
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Affiliation(s)
- Anna M Hood
- Department of Psychological & Brain Sciences, Washington University, Campus Box 1125, St. Louis, MO, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7039, Cincinnati, OH, 45229, USA.
| | - Ilana Reife
- Children's Neuropsychological Services, Andover, MA, USA
| | - Allison A King
- Program in Occupational Therapy and Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Desiree A White
- Department of Psychological & Brain Sciences, Washington University, Campus Box 1125, St. Louis, MO, USA
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9
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Hematologic Manifestations of Childhood Illness. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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10
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Abstract
Lead toxicity is the result of lead ingestion, one of the most common ingestions in the pediatric population. Nationwide and statewide efforts to recognize and curtail this epidemic have led to declining rates of toxicity. In patients with sickle cell disease (SCD), lead toxicity can be an elusive diagnosis due to overlapping symptom profiles, and inconsistent follow-up with a primary care physician can make the diagnosis even more difficult. In this article, two illustrative cases of lead toxicity in patients with SCD are described. The discussion reviews the current risk factors, screening, and inpatient management of lead toxicity, as well as describing the unique and sometimes confounding presentations of lead toxicity versus sickle cell crisis. [Pediatr Ann. 2018;47(1):e36-e40.].
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11
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Abstract
Pantoea agglomerans has been classically associated with cellulitis or synovitis secondary to penetrating trauma by vegetation. It is an infrequent cause of systemic infections. We describe the case of a 5-year-old girl with sickle cell disease with P. agglomerans bacteremia and review its potential causes.
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12
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Santos AM, Benute GRG, Nomura RMY, Santos NO, De Lucia MCS, Francisco RPV. Pica and Eating Attitudes: A Study of High-Risk Pregnancies. Matern Child Health J 2015; 20:577-82. [PMID: 26558792 DOI: 10.1007/s10995-015-1856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. METHODS A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. RESULTS Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: "to be considered too thin by others" (p < 0.02), and "to spend too much time thinking about food" (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. CONCLUSIONS The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals.
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Affiliation(s)
- Amanda M Santos
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil.
| | - Gláucia R G Benute
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil.,Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli M Y Nomura
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil
| | - Niraldo O Santos
- Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mara C S De Lucia
- Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rossana P V Francisco
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil
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Aloni MN, Lecerf P, Lê PQ, Heijmans C, Huybrechts S, Devalck C, Azzi N, Ngalula-Mujinga M, Ferster A. Is Pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort. ACTA ACUST UNITED AC 2014; 20:429-32. [PMID: 25494639 DOI: 10.1179/1607845414y.0000000219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND For centuries, writers have recorded their observations on pica. Nevertheless the association of pica with sickle cell disease (SCD) was poorly documented. METHODS Cross-sectional evaluation performed on SCD children and caregivers attending the outpatient clinic who were invited to complete questionnaires assessing behavior of pica. RESULTS Out of 55 sickle cell children, 31(56.4%) reported practicing pica regularly. Substances ingested by patients covered a broad spectrum. Compared with the non-pica group, subjects who reported pica were younger and had lower hemoglobin (8.3 g/dl (7.6-9.7) vs. 9.1 g/dl (7.9-10.5): P < 0.01). The level of ferritin, zinc, copper, and lead was similar between the pica and non-pica groups (P > 0.05). Discussion In this series, there are many substances consumed by SCD children and adolescents, and we did not find an occurrence of similar substances among this select group. Pica children were younger and more anemic than non-pica patients. CONCLUSION This study suggests that pica remains an unknown and under-reported clinical problem in children with SCD and seems to be related to the severity of anemia. The next step of this project aims to clarify causal mechanisms for pica and its association with SCD in a larger population.
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El-Mekkawy M, Hosam A, Rabah A, Mosaad M. Trichobezoar in a patient with sickle cell anemia: A pain crisis is not always to blame. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Pica in children with sickle cell disease: two case reports. J Pediatr Nurs 2012; 27:e65-70. [PMID: 22917881 DOI: 10.1016/j.pedn.2012.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 07/10/2012] [Accepted: 07/18/2012] [Indexed: 11/20/2022]
Abstract
Children with sickle cell disease (SCD) are at greater risk for developing pica compared to other children. This comorbidity can result in harmful medical and nutritional, and neurodevelopmental consequences. This article will describe the medical, nutritional, and psychosocial functioning in two children with SCD and pica in order to illustrate the potential complications and correlates of this co-morbidity. In addition, the clinical implications of pica in children with SCD will be discussed.
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Altepeter T, Annes J, Meller J. Foam bezoar: resection of perforated terminal ileum in a 17-year-old with sickle β+ thalassemia and pica. J Pediatr Surg 2011; 46:E31-2. [PMID: 21763823 DOI: 10.1016/j.jpedsurg.2011.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
Children and adolescents with sickle cell disease demonstrate an increased incidence of pica. Pica involving polyurethane foam has been previously reported, but effective management of such cases remains unclear. We present the case of a 17-year-old African American adolescent girl with sickle β+ thalassemia who presented with a long history of foam rubber pica resulting in intestinal obstruction. Conservative management was unsuccessful, and the patient ultimately required operative intervention. We advocate for a low threshold for early operation in cases of foam rubber bezoar.
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Affiliation(s)
- Tara Altepeter
- Hope Children's Hospital/Advocate Christ Medical Center, Oak Lawn, IL 60043, USA.
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18
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Abstract
Pica, the purposive consumption of nonfood substances, is a millennia-old nutritional enigma. Its worldwide ubiquity, prevalence among pregnant women and children, and association with both positive and negative health outcomes, especially micronutrient deficiencies, underscore the importance of understanding this behavior. Multiple proposed etiologies of pica are reviewed, including cultural expectations, psychological stress, hunger, dyspepsia, micronutrient deficiencies (Fe, Zn, and Ca), and protection against toxins and pathogens. Currently available data, although limited, best support the protection hypothesis as a cause of most types of pica, although some evidence suggests that pagophagy (ice consumption) may occur during iron deficiency. It is possible that the binding capacity of pica substances explains the association with micronutrient deficiencies; earth, starch, etc. may render micronutrients in ingesta unavailable for absorption. Increased research efforts are warranted and must be hypothesis driven, interdisciplinary, and permit the testing of multiple causal inferences.
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Affiliation(s)
- Sera L Young
- Department of Pediatrics, University of California, Davis, California 95817, USA.
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19
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Cardboard bezoar complicating laparoscopic gastric bypass. Surg Obes Relat Dis 2010; 6:313-5. [DOI: 10.1016/j.soard.2009.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/18/2009] [Indexed: 11/16/2022]
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Pica in an eating disordered woman with multiple sclerosis: impulse dys-control, compulsive symptom or self-medication attempt? Eat Weight Disord 2010; 15:e116-8. [PMID: 20571315 DOI: 10.1007/bf03325290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating disorder. Pica is classified among the feeding and eating disorders of infancy and early childhood, but there is a debate in the literature about the psychopathology and classification of this behavior. Some authors emphasize the similarities with the obsessive-compulsive spectrum disorders, whereas others propose an interpretation of pica as an addiction or as an impulsive behavior. The clinical case that we describe provides a picture of impulsive and compulsive features that are very difficult to disentangle. It is noteworthy that hypercalcemia is reported to have a protective/therapeutic effect against multiple sclerosis and seems to increase the plasmatic levels of beta-endorphins. The nature, diagnostic classification, and functions of pica are a topic worthy of future investigation.
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Issaivanan M, Ahmed R, Shekher M, Esernio-Jenssen D, Manwani D. Sickle cell disease and plumbism in children. Pediatr Blood Cancer 2009; 52:653-6. [PMID: 19127571 DOI: 10.1002/pbc.21919] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Childhood lead poisoning is common, affects multiple organs and is preventable. Co-existence of plumbism and sickle cell disease (SCD) is uncommon, with major overlap in signs and symptoms. We describe a patient with SCD and plumbism. Dysfunctional eating patterns may cause ingestion and increased absorption of lead in these patients. Routine screening for pica and other dysfunctional eating habits with appropriate behavioral interventions is emphasized. Annual screening for lead in patients with SCD of all ages (1-21years) and supplementation of micronutrients like zinc and iron in deficient cases may help prevent plumbism in these patients.
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Affiliation(s)
- Magimairajan Issaivanan
- Division of Hematology-Oncology, and Stem cell transplantation, Schneider Children's Hospital, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
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McCallum IJD, Van zanten C, Inam IZ, Craig W, Mahdi G, Thompson RJ. Trichobezoar in a child with undiagnosed coeliac disease. J Paediatr Child Health 2008; 44:524-5. [PMID: 18928474 DOI: 10.1111/j.1440-1754.2008.01363.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
This report concerns the interesting clinical phenomenology of a 17-year-old Ethiopian female student with a long-standing history of ingesting nonnutritive materials. She was initially non-selective, but later began more exclusively consuming mud obtained from a wall in front of her house. She suffered from a feeding and eating disorder known as pica. Currently, there is no clearly established etiology for pica. This patient's particular psychopathology—recurrent, unwanted, intrusive images and thoughts of the mud wall and of eating the mud; feelings of distress and anxiousness that were not relieved unless she consumed mud; and significant effects on her daily life from her uncontrollable need to return home to eat mud from her wall—suggests an ego-dystonic, obsessive thought-distress-consumption-relief pattern that is consistent with obsessive-compulsive disorder. This case may contribute to the etiological understanding that some forms of pica may be part of the obsessive-compulsive spectrum disorders.
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Affiliation(s)
- Nicholas M Allen
- Department of Pediatrics, Galway University Hospital, Newcastle, Galway, Ireland
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Corbett RW, Ryan C, Weinrich SP. Pica in pregnancy: does it affect pregnancy outcomes? MCN Am J Matern Child Nurs 2003; 28:183-9; quiz 190-1. [PMID: 12771697 DOI: 10.1097/00005721-200305000-00009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To discover the prevalence of pica, the documentation of pica on medical records, and any relationship of pica to pregnancy outcomes in rural socioeconomically disadvantaged pregnant women. STUDY DESIGN AND METHODS Prospective, descriptive, correlational investigation with 128 women who sought prenatal care from two rural community health agencies. Demographic and sociocultural variables, pica practices, pica substances ingested, and pregnancy outcomes were collected. RESULTS Thirty-eight percent of these pregnant women practiced pica. African-American women reported practicing pica more often than other ethnicities. Substances ingested included ice (>1 cup/day), freezer frost, laundry starch, cornstarch, clay dirt, and baked clay dirt. Polypica (ingestion of more than one substance) was practiced by 11 women. Women practicing pica were more likely to have been underweight prior to pregnancy, and smoked fewer cigarettes. Women reporting daily pica practice were significantly more likely to have lower prenatal hematocrits than women who did not practice pica, or who practiced pica less frequently than daily. No specific pregnancy complication was associated with the practice of pica. CLINICAL IMPLICATIONS Pica exists, and might be more common than healthcare providers assume. Although this study did not show specific pregnancy complications associated with pica, other studies have shown anemia and lead poisoning among women who practice pica. It is not clear that patients volunteer information about pica, so it would be helpful if nurses queried patients at each prenatal visit regarding pica practice. Discussion of pica practices should be based on a nonjudgmental model, for pica may have strong cultural implications, and may be practiced for cultural reasons unknown to the nurse.
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Affiliation(s)
- Robin Webb Corbett
- School of Nursing, East Carolina University, Rivers Building, Greenville, NC 27858, USA.
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Derossi SS, Raghavendra S. Anemia. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:131-41. [PMID: 12582350 DOI: 10.1067/moe.2003.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Scott S Derossi
- University of Pennsylvania School of Dental Medicine, Pennsylvania, USA
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