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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchiectasis non-cystic fibrosis &#40;referred as bronchiectasis&#41; is a progressive disease characterized by permanent bronchial dilatation&#44; mucus retention and impaired clearance of cilia&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> The prevalence of bronchiectasis is not known with certainty and has historically been neglected&#46; However&#44; international data show an increase in the prevalence of bronchiectasis during the last few years in Europe and United States&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> The prevalence is higher in women and Asian populations&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> The widely known pathogenesis of bronchiectasis is based on the &#8220;Cole&#39;s Vicious Cycle Hypothesis&#8221; in which individuals at risk experience a strong inflammatory response to infection and lung tissue damage resulting in structural damage to the airway leading to mucus stasis&#44; and support for chronic infection to continue as a vicious circle&#46; The inflammatory response here involves neutrophils&#44; lymphocytes&#44; and macrophages&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with chronic airway diseases including bronchiectasis may experience nutritional deficiencies with the consequence of reduced muscle mass and impaired muscle function&#46; Subsequent respiratory muscle dysfunction is associated with increased symptoms of breathlessness&#44; poor response to exercise ventilation and exacerbations&#44; and even lead to severe respiratory failure&#44; and difficulty of weaning in mechanically ventilated patients&#46; Providing nutritional therapy is very important and aims to increase energy intake&#44; protein and amino acids especially branched chain amino acids &#40;BCAA&#41;&#44; foods rich in polyunsaturated fatty acids&#44; vitamins and minerals in order to reduce local and systemic inflammation&#44; replace muscle mass and treat nutrition disorders in patients with chronic airway diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 59-year-old female patient was admitted to Infection Center of Wahidin Sudirohusodo Hospital in August 2019 with a complaint of shortness of breath since 5 days ago&#44; she also has decreased oral intake experienced since 2 weeks ago due to decreased appetite and productive cough with very abundant mucus&#44; yellowish colored&#46; Nausea and vomiting existed 5 days ago&#46; Unintentional weight loss has occurred since the last 2 weeks&#44; approximately 4<span class="elsevierStyleHsp" style=""></span>kg&#46; She has a history of pulmonary tuberculosis with uncompleted anti-tuberculosis drug treatment&#44; and recurrent cough and shortness of breath since 14 years ago&#46; During hospitalization&#44; the patient&#39;s clinical condition worsened due to impending respiratory failure&#46; Her oxygen saturation was below &#60;90&#37; hence she had to receive oxygen support through continuous positive airway pressure &#40;CPAP&#41;&#44; and consequently became more difficult to eat and drink via oral because of chest tightness and dependent on oxygen support by CPAP mask and refused to insert a nasogastric tube&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">At the time of consultation to clinical nutrition department&#44; the patient was compos mentis with vital signs were&#58; blood pressure 135&#47;76<span class="elsevierStyleHsp" style=""></span>mmHg&#44; heart rate 90 beats per minute&#44; respiratory rate 28 times per minute with oxygen supported by CPAP&#44; oxygen saturation 98&#37;&#44; and body temperature 36&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Physical examination showed base crackles on both of pulmonary fields and chest wall muscle retraction&#46; There were muscle wasting at the lower and upper extremities&#46; Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio &#40;NLR&#41; 9&#46;3&#44; moderate depletion of immune system with total lymphocyte count &#40;TLC&#41; 808&#46;4&#47;&#956;l&#44; hypoalbuminemia &#40;3&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41; and elevated in liver transaminase&#58; AST 206<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; ALT 224<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46; Acid-resistant bacillus sputum test was negative&#46; Gene expert&#58; <span class="elsevierStyleItalic">M&#46; tuberculosis</span> was undetected&#46; Chest computed tomography &#40;CT&#41; scan result&#58; active old pulmonary tuberculosis with infected bronchiectasis at the bottom on both lung fields&#44; compensated pulmonary emphysema and cardiomegaly&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical nutrition diagnosis for this patient was severe malnutrition &#40;SGA score C&#41;&#46; Nutritional therapy was given gradually with target calorie of 1400<span class="elsevierStyleHsp" style=""></span>kcal calculated by Rule of thumb with protein 0&#46;8&#8211;1&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day when the patient was in Intensive Care Unit &#40;ICU&#41; through parenteral and oral nutrition&#46; After her condition was stable and transferred to general ward&#44; target calorie increased to 1900<span class="elsevierStyleHsp" style=""></span>kcal based on Harris Benedict equation&#46; Macronutrient composition was protein 1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day using high protein diet&#44; carbohydrates 45&#8211;50&#37;&#44; and fat 33&#46;3&#8211;38&#46;3&#37;&#46; The patient was given supplementations such as vitamin A 6000<span class="elsevierStyleHsp" style=""></span>IU&#44; vitamin B complex&#44; vitamin C 300<span class="elsevierStyleHsp" style=""></span>mg&#44; vitamin D 600<span class="elsevierStyleHsp" style=""></span>IU&#44; zinc 20<span class="elsevierStyleHsp" style=""></span>mg&#44; curcumin 1200<span class="elsevierStyleHsp" style=""></span>mg and snakehead fish extract with high albumin content&#46; The progression of nutritional support in calorie intake and protein can be achieved by the patient during treatment as shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After 14 days of treatment&#44; we found significant clinical and metabolic improvement&#44; such as NLR 2&#46;5&#44; TLC 2265&#47;&#956;l&#44; plasma albumin 4&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; nitrogen balance &#43;3&#46;2&#44; and normal liver transaminase &#40;AST 19&#44; ALT 29<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&#46; In addition&#44; there were improvements in arterial blood gas analysis test &#40;increased oxygen pressure&#44; decreased carbon dioxide pressure&#41; due to resolved impending of respiratory failure problem and functional capacity &#40;handgrip strength 3&#46;1&#8211;17&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; All biochemical test results and parameters observed during hospitalization can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Inflammation plays important role in IB and for modulating inflammation through nutrition therapy&#44; we gave nutritional intake containing omega 3&#44; BCAA and glutamine&#44; as well as curcumin supplementation&#46; Omega 3 provides a protective effect against pulmonary inflammation by increasing the resolution of inflammation through the production of specialized pro-resolving mediators such as resolvins&#44; protectin and maresins&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> In a meta-analysis&#44; omega-3 PUFAs in enteral diets might be associated with an improvement in early and late PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#44; shortened length of stay in ICU and mechanical ventilation duration in patients with acute respiratory distress syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> BCAA can modulate inflammatory response of skeletal muscle through glutamine synthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> In conditions of catabolic stress such as critical illness and respiratory disease&#44; systemic glutamine depletion occurs because glutamine demand increases beyond the body&#39;s capacity to synthesize it&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Yiming Xu and Ling Liu in their research concluded that the anti-inflammatory effects of curcumin has therapeutic potential for acute lung inflammatory disease&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Previous study showed that NLR values were statistically greater in patients with bronchiectasis exacerbation compared to healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> The higher NLR is associated with more inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> In our case&#44; the patient had a decrease in NLR as an inflammatory biomarker after getting nutritional therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to overcome the depletion of the immune system&#44; we provided supplementation with vitamins A&#44; C&#44; D and mineral which is zinc&#46; Shaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> demonstrated that providing zinc alone or simultaneous zinc and vitamin A supplementation in acute upper respiratory infections patients significantly improved the clinical outcome by enhancing the immune status&#46; Alshami et al&#46; &#40;2018&#41; in his editorial concluded that vitamin C plays role in improving of outcome in many respiratory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> Vitamin D deficiency tends to occur in bronchiectasis&#44; and vitamin D supplementation can modulate immunity and affect the control of inflammation process&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Bartley et al&#46; &#40;2018&#41;&#44; revealed that vitamin D3 supplementation might increase their 25&#40;OH&#41;D levels and improved quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The effect of pro-inflammatory cytokines causes changes in liver protein synthesis&#44; specifically&#44; increased in acute phase protein synthesis while the rate of albumin synthesis is down-regulated&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> Hypoalbuminemia was treated by administering a high protein diet containing BCAAs and snakehead fish extract with high albumin content&#46; BCAAs especially leucine works by enhancing protein synthesis and attenuate proteolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Acute liver injury can result from hypoxic hepatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> In our patient&#44; impending respiratory failure caused the oxygen supply to the tissues consequently to be decreased&#44; resulting acute liver injury due to hypoxia&#46; When inflammation started to decline&#44; the immune function was increased and respiratory problems were resolved&#44; hence tissue perfusion was improved and seen in improvement of blood gas analysis&#46; Moreover&#44; liver enzyme levels returned to its normal values&#46; In this case&#44; we also found a progress in functional capacity&#44; monitored by handgrip strength&#46; Nutritional therapy with BCAAs has shown to increase muscle strength&#44; fat free mass and improved quality of life in patients with chronic obstructive pulmonary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">An adequate nutritional therapy with macro and micro-nutrients in IB patient could improve clinical outcome&#44; nutritional status and quality of life&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality&#46; Repeated respiratory infections may lead to infected bronchiectasis &#40;IB&#41; and acute exacerbations which often require hospital admission&#44; increase risk of malnutrition and impact quality of life and eventually leads to death&#46; Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation&#44; overcome malnutrition&#44; as well as to decrease morbidity and mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 59-year-old female patient&#44; diagnosed with IB&#46; The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission&#46; Moreover&#44; she had gradual shortness of breath that caused an impending respiratory failure during hospitalization&#44; supported by continuous positive airway pressure &#40;CPAP&#41;&#46; Nutritional assessment was made based on Subjective Global Assessment &#40;SGA&#41; score C&#46; Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio &#40;NLR&#41; 9&#46;3&#44; moderate depletion of immune system with total lymphocyte count &#40;TLC&#41; 808&#46;4&#47;&#956;l&#44; hypoalbuminemia &#40;3&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41; and increased in liver enzymes&#58; aspartate aminotransferase &#40;AST&#41; 206<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; Alanine aminotransferase &#40;ALT&#41; 224<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46; Nutritional therapy was given gradually with target calorie 1400&#8211;1900<span class="elsevierStyleHsp" style=""></span>kcal&#44; protein 0&#46;8&#8211;1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day&#44; carbohydrates 45&#8211;50&#37;&#44; and fat 33&#46;3&#8211;43&#37; through oral and parenteral nutrition&#46; The patient was given supplementations such as vitamins &#40;A&#44; B complex&#44; C&#44; D&#41;&#44; zinc&#44; curcumin and snakehead fish extract high albumin content&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 14 days of treatment&#44; significant clinical and metabolic improvement in NLR&#44; TLC&#44; plasma albumin&#44; liver enzymes &#40;AST&#47;ALT&#41;&#44; blood gas analysis&#44; and functional capacity &#40;handgrip strength&#41; were found&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An adequate nutritional therapy with macro and micro-nutrients in IB patient can improve clinical outcome&#44; nutritional status and quality of life&#46;</p></span>"
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            "titulo" => "Objective"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Nursing&#44; Health Science Students &#38; Health Care Professionals Conference&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
      ]
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Calorie intake of patient&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Protein intake of patient&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; NLR&#58; neutrophil-to-lymphocyte count&#59; MCV&#58; mean corpuscular volume&#59; MCH&#58; mean corpuscular hemoglobin&#59; MCHC&#58; mean corpuscular hemoglobin concentration&#59; TLC&#58; total lymphocyte count&#59; AST&#58; aspartate aminotransferase&#59; ALT&#58; alanine aminotransferase&#59; PO<span class="elsevierStyleInf">2</span>&#58; oxygen pressure&#59; PCO<span class="elsevierStyleInf">2</span>&#58; carbon monoxide pressure&#59; HCO<span class="elsevierStyleInf">3</span>&#58; bicarbonate&#59; BE&#58; base excess&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory&#47;parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoglobin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;0&#8211;16&#46;0<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Leukocyte</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0&#8211;100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&#8211;75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">NLR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Cut off<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">MCV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;2&nbsp;\t\t\t\t\t\t\n
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Medical nutritional therapy in infected bronchiectasis with impending respiratory failure: A case report
Dian Wahyunia,
Autor para correspondencia
, Nurpudji Taslimb, Nurbaya Syamb, Devintha Viranib
a Clinical Nutrition Specialist Program, Nutrition Department, School of Medicine, Hasanuddin University, Makassar 90245, Indonesia
b Nutrition Department, School of Medicine, Hasanuddin University, Makassar 90245, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bronchiectasis non-cystic fibrosis &#40;referred as bronchiectasis&#41; is a progressive disease characterized by permanent bronchial dilatation&#44; mucus retention and impaired clearance of cilia&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> The prevalence of bronchiectasis is not known with certainty and has historically been neglected&#46; However&#44; international data show an increase in the prevalence of bronchiectasis during the last few years in Europe and United States&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> The prevalence is higher in women and Asian populations&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> The widely known pathogenesis of bronchiectasis is based on the &#8220;Cole&#39;s Vicious Cycle Hypothesis&#8221; in which individuals at risk experience a strong inflammatory response to infection and lung tissue damage resulting in structural damage to the airway leading to mucus stasis&#44; and support for chronic infection to continue as a vicious circle&#46; The inflammatory response here involves neutrophils&#44; lymphocytes&#44; and macrophages&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with chronic airway diseases including bronchiectasis may experience nutritional deficiencies with the consequence of reduced muscle mass and impaired muscle function&#46; Subsequent respiratory muscle dysfunction is associated with increased symptoms of breathlessness&#44; poor response to exercise ventilation and exacerbations&#44; and even lead to severe respiratory failure&#44; and difficulty of weaning in mechanically ventilated patients&#46; Providing nutritional therapy is very important and aims to increase energy intake&#44; protein and amino acids especially branched chain amino acids &#40;BCAA&#41;&#44; foods rich in polyunsaturated fatty acids&#44; vitamins and minerals in order to reduce local and systemic inflammation&#44; replace muscle mass and treat nutrition disorders in patients with chronic airway diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 59-year-old female patient was admitted to Infection Center of Wahidin Sudirohusodo Hospital in August 2019 with a complaint of shortness of breath since 5 days ago&#44; she also has decreased oral intake experienced since 2 weeks ago due to decreased appetite and productive cough with very abundant mucus&#44; yellowish colored&#46; Nausea and vomiting existed 5 days ago&#46; Unintentional weight loss has occurred since the last 2 weeks&#44; approximately 4<span class="elsevierStyleHsp" style=""></span>kg&#46; She has a history of pulmonary tuberculosis with uncompleted anti-tuberculosis drug treatment&#44; and recurrent cough and shortness of breath since 14 years ago&#46; During hospitalization&#44; the patient&#39;s clinical condition worsened due to impending respiratory failure&#46; Her oxygen saturation was below &#60;90&#37; hence she had to receive oxygen support through continuous positive airway pressure &#40;CPAP&#41;&#44; and consequently became more difficult to eat and drink via oral because of chest tightness and dependent on oxygen support by CPAP mask and refused to insert a nasogastric tube&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">At the time of consultation to clinical nutrition department&#44; the patient was compos mentis with vital signs were&#58; blood pressure 135&#47;76<span class="elsevierStyleHsp" style=""></span>mmHg&#44; heart rate 90 beats per minute&#44; respiratory rate 28 times per minute with oxygen supported by CPAP&#44; oxygen saturation 98&#37;&#44; and body temperature 36&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Physical examination showed base crackles on both of pulmonary fields and chest wall muscle retraction&#46; There were muscle wasting at the lower and upper extremities&#46; Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio &#40;NLR&#41; 9&#46;3&#44; moderate depletion of immune system with total lymphocyte count &#40;TLC&#41; 808&#46;4&#47;&#956;l&#44; hypoalbuminemia &#40;3&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41; and elevated in liver transaminase&#58; AST 206<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; ALT 224<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46; Acid-resistant bacillus sputum test was negative&#46; Gene expert&#58; <span class="elsevierStyleItalic">M&#46; tuberculosis</span> was undetected&#46; Chest computed tomography &#40;CT&#41; scan result&#58; active old pulmonary tuberculosis with infected bronchiectasis at the bottom on both lung fields&#44; compensated pulmonary emphysema and cardiomegaly&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0025" class="elsevierStylePara elsevierViewall">The clinical nutrition diagnosis for this patient was severe malnutrition &#40;SGA score C&#41;&#46; Nutritional therapy was given gradually with target calorie of 1400<span class="elsevierStyleHsp" style=""></span>kcal calculated by Rule of thumb with protein 0&#46;8&#8211;1&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day when the patient was in Intensive Care Unit &#40;ICU&#41; through parenteral and oral nutrition&#46; After her condition was stable and transferred to general ward&#44; target calorie increased to 1900<span class="elsevierStyleHsp" style=""></span>kcal based on Harris Benedict equation&#46; Macronutrient composition was protein 1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day using high protein diet&#44; carbohydrates 45&#8211;50&#37;&#44; and fat 33&#46;3&#8211;38&#46;3&#37;&#46; The patient was given supplementations such as vitamin A 6000<span class="elsevierStyleHsp" style=""></span>IU&#44; vitamin B complex&#44; vitamin C 300<span class="elsevierStyleHsp" style=""></span>mg&#44; vitamin D 600<span class="elsevierStyleHsp" style=""></span>IU&#44; zinc 20<span class="elsevierStyleHsp" style=""></span>mg&#44; curcumin 1200<span class="elsevierStyleHsp" style=""></span>mg and snakehead fish extract with high albumin content&#46; The progression of nutritional support in calorie intake and protein can be achieved by the patient during treatment as shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After 14 days of treatment&#44; we found significant clinical and metabolic improvement&#44; such as NLR 2&#46;5&#44; TLC 2265&#47;&#956;l&#44; plasma albumin 4&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; nitrogen balance &#43;3&#46;2&#44; and normal liver transaminase &#40;AST 19&#44; ALT 29<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&#46; In addition&#44; there were improvements in arterial blood gas analysis test &#40;increased oxygen pressure&#44; decreased carbon dioxide pressure&#41; due to resolved impending of respiratory failure problem and functional capacity &#40;handgrip strength 3&#46;1&#8211;17&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; All biochemical test results and parameters observed during hospitalization can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Inflammation plays important role in IB and for modulating inflammation through nutrition therapy&#44; we gave nutritional intake containing omega 3&#44; BCAA and glutamine&#44; as well as curcumin supplementation&#46; Omega 3 provides a protective effect against pulmonary inflammation by increasing the resolution of inflammation through the production of specialized pro-resolving mediators such as resolvins&#44; protectin and maresins&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> In a meta-analysis&#44; omega-3 PUFAs in enteral diets might be associated with an improvement in early and late PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#44; shortened length of stay in ICU and mechanical ventilation duration in patients with acute respiratory distress syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> BCAA can modulate inflammatory response of skeletal muscle through glutamine synthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> In conditions of catabolic stress such as critical illness and respiratory disease&#44; systemic glutamine depletion occurs because glutamine demand increases beyond the body&#39;s capacity to synthesize it&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Yiming Xu and Ling Liu in their research concluded that the anti-inflammatory effects of curcumin has therapeutic potential for acute lung inflammatory disease&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Previous study showed that NLR values were statistically greater in patients with bronchiectasis exacerbation compared to healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> The higher NLR is associated with more inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> In our case&#44; the patient had a decrease in NLR as an inflammatory biomarker after getting nutritional therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to overcome the depletion of the immune system&#44; we provided supplementation with vitamins A&#44; C&#44; D and mineral which is zinc&#46; Shaker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> demonstrated that providing zinc alone or simultaneous zinc and vitamin A supplementation in acute upper respiratory infections patients significantly improved the clinical outcome by enhancing the immune status&#46; Alshami et al&#46; &#40;2018&#41; in his editorial concluded that vitamin C plays role in improving of outcome in many respiratory diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> Vitamin D deficiency tends to occur in bronchiectasis&#44; and vitamin D supplementation can modulate immunity and affect the control of inflammation process&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Bartley et al&#46; &#40;2018&#41;&#44; revealed that vitamin D3 supplementation might increase their 25&#40;OH&#41;D levels and improved quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The effect of pro-inflammatory cytokines causes changes in liver protein synthesis&#44; specifically&#44; increased in acute phase protein synthesis while the rate of albumin synthesis is down-regulated&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> Hypoalbuminemia was treated by administering a high protein diet containing BCAAs and snakehead fish extract with high albumin content&#46; BCAAs especially leucine works by enhancing protein synthesis and attenuate proteolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Acute liver injury can result from hypoxic hepatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> In our patient&#44; impending respiratory failure caused the oxygen supply to the tissues consequently to be decreased&#44; resulting acute liver injury due to hypoxia&#46; When inflammation started to decline&#44; the immune function was increased and respiratory problems were resolved&#44; hence tissue perfusion was improved and seen in improvement of blood gas analysis&#46; Moreover&#44; liver enzyme levels returned to its normal values&#46; In this case&#44; we also found a progress in functional capacity&#44; monitored by handgrip strength&#46; Nutritional therapy with BCAAs has shown to increase muscle strength&#44; fat free mass and improved quality of life in patients with chronic obstructive pulmonary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">An adequate nutritional therapy with macro and micro-nutrients in IB patient could improve clinical outcome&#44; nutritional status and quality of life&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaAceptado" => "2021-06-30"
    "PalabrasClave" => array:1 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1456688"
          "palabras" => array:4 [
            0 => "Infected bronchiectasis"
            1 => "Malnutrition"
            2 => "Nutritional therapy"
            3 => "Respiratory failure"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bronchiectasis is a chronic infective and inflammatory respiratory disease that causes significant morbidity and mortality&#46; Repeated respiratory infections may lead to infected bronchiectasis &#40;IB&#41; and acute exacerbations which often require hospital admission&#44; increase risk of malnutrition and impact quality of life and eventually leads to death&#46; Nutritional therapy is needed to modulate inflammation and enhance immunity to reduce severity of exacerbation&#44; overcome malnutrition&#44; as well as to decrease morbidity and mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 59-year-old female patient&#44; diagnosed with IB&#46; The patient had low oral intake due to productive cough and anorexia since 2 weeks before admission&#46; Moreover&#44; she had gradual shortness of breath that caused an impending respiratory failure during hospitalization&#44; supported by continuous positive airway pressure &#40;CPAP&#41;&#46; Nutritional assessment was made based on Subjective Global Assessment &#40;SGA&#41; score C&#46; Abnormal laboratory findings seen were increased in neutrophil-to-lymphocyte ratio &#40;NLR&#41; 9&#46;3&#44; moderate depletion of immune system with total lymphocyte count &#40;TLC&#41; 808&#46;4&#47;&#956;l&#44; hypoalbuminemia &#40;3&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41; and increased in liver enzymes&#58; aspartate aminotransferase &#40;AST&#41; 206<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; Alanine aminotransferase &#40;ALT&#41; 224<span class="elsevierStyleHsp" style=""></span>U&#47;l&#46; Nutritional therapy was given gradually with target calorie 1400&#8211;1900<span class="elsevierStyleHsp" style=""></span>kcal&#44; protein 0&#46;8&#8211;1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;kg IBW&#47;day&#44; carbohydrates 45&#8211;50&#37;&#44; and fat 33&#46;3&#8211;43&#37; through oral and parenteral nutrition&#46; The patient was given supplementations such as vitamins &#40;A&#44; B complex&#44; C&#44; D&#41;&#44; zinc&#44; curcumin and snakehead fish extract high albumin content&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 14 days of treatment&#44; significant clinical and metabolic improvement in NLR&#44; TLC&#44; plasma albumin&#44; liver enzymes &#40;AST&#47;ALT&#41;&#44; blood gas analysis&#44; and functional capacity &#40;handgrip strength&#41; were found&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An adequate nutritional therapy with macro and micro-nutrients in IB patient can improve clinical outcome&#44; nutritional status and quality of life&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Nursing&#44; Health Science Students &#38; Health Care Professionals Conference&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Calorie intake of patient&#46;</p>"
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        "etiqueta" => "Fig&#46; 2"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; NLR&#58; neutrophil-to-lymphocyte count&#59; MCV&#58; mean corpuscular volume&#59; MCH&#58; mean corpuscular hemoglobin&#59; MCHC&#58; mean corpuscular hemoglobin concentration&#59; TLC&#58; total lymphocyte count&#59; AST&#58; aspartate aminotransferase&#59; ALT&#58; alanine aminotransferase&#59; PO<span class="elsevierStyleInf">2</span>&#58; oxygen pressure&#59; PCO<span class="elsevierStyleInf">2</span>&#58; carbon monoxide pressure&#59; HCO<span class="elsevierStyleInf">3</span>&#58; bicarbonate&#59; BE&#58; base excess&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory&#47;parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hemoglobin</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;0&#8211;16&#46;0<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Leukocyte</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;0&#8211;100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&#8211;75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">NLR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;&#8722;2&#41;&#8211;&#40;&#43;2&#41; <span class="elsevierStyleHsp" style=""></span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02139111
Idioma original: Inglés
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