Medical nutrition therapy is necessary for individuals at risk of impaired wound healing, such as those with malnutrition, poor circulation, or advanced age. During the acute inflammatory response from wounds, the body enters a catabolic state, increasing energy and protein needs. For those with malnutrition or at risk for malnutrition, calories should be provided at 30-35 kcal/kg body weight and protein at 1.25-1.5 g/kg body weight. Along with increased energy needs, the assessment and management of vitamins and minerals such as vitamins A, vitamin C, vitamin K, and zinc enhance the synthesis of fibroblasts needed for tissue formation. Early diagnosis and intervention for malnourished patients with chronic wounds are critical steps in providing effective patient care. Oral intake is monitored to ensure calorie and protein intake is adequate and oral nutrition supplements may be provided if indicated. For those unable to tolerate oral feeds, enteral nutrition is the next preferred method. If enteral nutrition is contraindicated then parenteral nutrition can be initiated to provide adequate calories and protein. This case report analyzes the care of a 74-year-old female with a non-healing surgical wound with a history of bariatric surgery who has been diagnosed with malnutrition.

Essential fatty acid deficiency (EFAD) is a condition that can occur when the body does not have adequate fats from the diet. EFAD can develop in as quick as 10 days and can present with symptoms such as itchy and flaky skin, poor wound healing, elevated liver function tests, and increased susceptibility to infection. EFAD rarely occurs in individuals who eat a balanced diet with a variety of foods and fat sources and is seen most often in patients unable to eat by mouth or tolerate tube feedings. Patients with prolonged poor nutrition are at increased risk of EFAD due to insufficient fat intake. Risk factors of EFAD are inflammatory bowel disease, pancreatic insufficiency, extreme diet restriction, and long-term parenteral nutrition support with limited fat emulsion supplementation. Preventing EFAD through awareness and proactive measures is essential in medical nutrition therapy. Since clinical markers are challenging to assess in the acute care setting, physical signs and symptoms are used for identifying and treating EFAD. For patients on parenteral nutrition support with no fat, supplementing with 500 mL intralipids per week is recommended to prevent EFAD. This case report reviews the current nutritional guidelines related to EFAD and parenteral nutrition and highlights a patient at risk for EFAD due to her poor intake, who was receiving long-term parenteral nutrition with supplemental oral intake.

Necrotizing pancreatitis is a severe acute inflammation of the pancreas that disrupts the release of pancreatic enzymes necessary for digestion and the production of insulin needed to stabilize blood glucose levels. Common complications associated with necrotizing pancreatitis include diet intolerance, abdominal pain, nausea, vomiting, decreased oral intake, and hyperglycemia. If the patient cannot meet their estimated nutritional requirements via an oral diet, supplemental nutrition support, such as enteral nutrition (EN) through a feeding tube or parenteral nutrition intravenously through a peripheral or central line, must be considered to prevent malnutrition. When necessary, early initiation of supplemental nutrition support within 24-48 hours of admission is associated with shorter hospital stays. To improve diet tolerance and reduce symptoms while utilizing EN, patients with necrotizing pancreatitis may be fed elemental or semi-elemental formulas through a feeding tube placed in a post-pyloric position. Additionally, insulin therapy may be utilized in cases where patients experience hyperglycemia due to exocrine pancreatic insufficiency. The target blood glucose range for hospitalized patients is less than 180 mg/dL, or less than 140 mg/dL if there is no significant risk of hypoglycemia. Insulin therapy should be initiated when a patient experiences a blood glucose level greater than or equal to 180 mg/dL at least twice within a 24-hour period. This case report evaluates the management of EN intolerance and hyperglycemia when treating individuals with necrotizing pancreatitis.

Decompensated alcoholic cirrhosis is failure of the liver due to alcohol use, accompanied by complications such as portal hypertension, bleeding varices, ascites, and encephalopathy. Nutrition is vital in managing cirrhosis as the loss of hepatocytes from liver damage impairs gluconeogenesis, causing the body to use amino acids and fatty acids for energy, thereby increasing resting energy expenditure. Malnutrition is often diagnosed in patients with decompensated cirrhosis due to increased nutrition needs and comorbidities like altered mental status and ascites, which cause early satiety and negatively affect oral intake. Therefore, nutrition interventions to treat or prevent malnutrition are essential. Evidence indicates cirrhotic patients are at risk for malnutrition should eat three to five meals plus snacks to shorten fasting periods. If calorie and protein needs cannot be met through oral intake, initiating enteral nutrition may be appropriate. Enteral nutrition is preferred unless it is contraindicated, in which case parenteral nutrition would be utilized. Nocturnal enteral feeds may be permissible to shorten fasting periods if oral intake is tolerated but intake does not meet nutritional needs. Nutrient recommendation ranges for cirrhotic patients are 35 calories per kilogram and 1-2 grams of protein per kilogram, based on actual or estimated body weight. Vitamin and mineral supplementation may be needed for patients with a history of alcohol abuse, specifically thiamin, niacin, folate, magnesium, and zinc. This case report explores the complex nutrition needs and goals of care in a patient with decompensated alcoholic cirrhosis and severe chronic protein-calorie malnutrition.

Ga2O3, an ultrawide-bandgap semiconducting material, sees widespread use in optoelectronic, pharmaceutical, and other industrial applications. Additionally, as antibiotic resistance grows, interest rises in the antibacterial properties of Ga2O3 and other gallium-containing compounds. In many cases, GaOOH is a precursor to synthesis of Ga2O3 with similar physiochemical properties. For microparticles, surface effects become heavily amplified. In particular, the surface effects may significantly influence antibacterial action. We synthesize GaOOH and Ga2O3 microparticles via hydrothermal growth. We employ scanning electron microscopy to image samples and energy dispersive X-ray spectroscopy to characterize the stoichiometry. X-ray diffraction spectroscopy is used by us to monitor bulk structural differences between the GaOOH precursor and Ga2O3. To monitor crystal defects we utilize photoluminescence spectroscopy. For antibacterial assays, we test our materials against Staphylococcus aureus bacteria using optical density measurement at 600 nm.