Postgastrectomy diarrhea is often attributed to dumping syndrome or functional changes; however, exocrine pancreatic insufficiency (EPI) from anatomical and physiological alterations may be an underrecognized cause of malabsorption and nutritional decline. Because EPI symptoms are often nonspecific, it may remain undiagnosed and lead to progressive malnutrition if untreated. This case report describes severe EPI identified via nutrition-focused assessment in a patient with persistent diarrhea after Billroth II gastrectomy, and the clinical response to pancreatic enzyme replacement therapy (PERT). A patient with a history of subtotal gastrectomy with Billroth II reconstruction for gastric cancer presented with chronic diarrhea, steatorrhea, weight loss, and hypoalbuminemia. Repeated endoscopic and radiologic evaluations identified no structural cause of diarrhea. Comprehensive nutrition-focused assessment indicated fat malabsorption, and fecal pancreatic elastase was markedly reduced (23.8 µg/g), confirming severe EPI. PERT with pancreatin containing 25,000 units of lipase (Norzyme) was initiated with meals. Posttreatment, steatorrhea resolved and bowel movements normalized without dietary fat restriction. Serum albumin levels subsequently normalized, and body weight returned to the normal range, indicating improved nutritional status. This case emphasizes the clinical value of nutrition-focused assessment in identifying treatable causes of malabsorption, such as EPI, in patients with persistent postgastrectomy diarrhea.

The incidence of supraventricular tachycardia (SVT) is approximately 35 cases per 100,000 patients with a prevalence of 2.25 cases per 1,000. This dysrhythmia originates at or above the atrioventricular node and is defined by a narrow complex QRS (<120 msec) at a rate of >100 beats/min. The effects of vitamin B12 deficiency on sympathetic and parasympathetic systems may cause heart rate variability and autonomic dysfunction. In patients with SVT, the underlying mechanism may be further exacerbated by vitamin B12 deficiency or induced by the deficiency. We describe a case series of three patients with no known comorbidity who presented to our department with SVT. Their SVTs were terminated using the modified Valsalva maneuver. All three patients were incidentally found to be severely deficient in vitamin B12 and had hyperhomocysteinemia. They were discharged on medications and dietary advice to increase vitamin B12 levels. Correcting vitamin B12 deficiency and hyperhomocysteinemia could play a preventive role in patients at risk for SVT. Our case series demonstrates a plausible association between vitamin B12 deficiency and SVT occurrence in previously healthy individuals with no known comorbid conditions.

This case report describes the nutritional management and long-term outcomes of an adolescent undergoing bariatric surgery. A 13-year-old female patient with morbid obesity complicated by nonalcoholic steatohepatitis (NASH), impaired glucose tolerance (IGT), and polycystic ovary syndrome (PCOS) underwent sleeve gastrectomy in July 2021. The patient achieved significant weight loss, with a total weight loss of 43.3% and a body mass index reduction of 16.6 kg/m2 at 3 years post-surgery, which further increased to 18.6 kg/m2 by the fourth year. Remission of NASH, IGT, and PCOS was observed after 1 year. Postoperatively, vitamin D deficiency developed, whereas other biochemical parameters remained within normal reference ranges. Adherence to recommended nutritional supplementation was suboptimal; however, with continuous nutritional education and regular follow-up, the patient ultimately established and maintained a balanced dietary pattern. The case highlights the effectiveness of bariatric surgery in achieving sustained weight loss and improving obesity-related comorbidities in adolescents, while underscoring the critical role of continuous nutritional management, patient education, and individualized multidisciplinary care in supporting long-term postoperative success.

Diabetes has been well established as one of the deadliest chronic diseases globally. Currently, India is known as the diabetes capital of the world although this disease had been documented in the country for centuries. Current treatment strategies center around oral hypoglycemic drugs, insulin, and the standard ‘diabetic diet.’ Nonetheless, millions continued to suffer from this chronic disease and its multiple complications. We herein present a case involving a male patient suffering from diabetes for 20 years despite being on medications and a diabetic diet who finally achieved remission of diabetes and hypertension by removing carbohydrates and following a carnivore diet.