A 52-year-old female presented with one week of progressive quadriparesis followed by the development of diplopia, dysphonia and dysphagia over 48 h. Initial impression was of an inflammatory myelitis given mild cerebrospinal fluid pleocytosis and diffuse cervical cord swelling extending to the lower brainstem on MRI. Treatment with intravenous methylprednisolone was commenced. Her condition continued to progress with a brief cardiac arrest secondary to diaphragmatic insufficiency due to brainstem involvement. She survived the cardiac arrest after a period of cardiopulmonary resuscitation and was admitted to the intensive care unit. Subsequent MRI suggested a chronic right sigmoid venous sinus thrombosis with venous congestion in the brainstem and upper cervical cord. Digital subtraction angiogram revealed a right dural arteriovenous fistula (DAVF) between the right transverse venous sinus and perimesecephalic veins. The dural arteriovenous fistula was embolised with subsequent rapid improvement in bulbar function. Limb weakness also improved, and she was transferred to a rehabilitation unit for physiotherapy. Our case highlights the importance of rapid recognition of an intracranial DAVF mimicking an inflammatory myelitis in the setting of an acute brainstem syndrome. Symptoms can progress quickly if untreated with the risk of progression following the administration of corticosteroids.

The global aging population has led to age-related digestive dysfunction, which has become a key driver of malnutrition and declining health. Physiological degeneration in older adults severely reduces nutrient bioavailability, making conventional single nutrient supplementation ineffective. Nutrient delivery systems tailored to the physiological constraints of the elderly show great value in alleviating geriatric malnutrition. Micro/nanoencapsulation, emulsions, and gels are particularly promising platforms for elderly-targeted food innovation due to their tunable structure, controlled targeted release, and good biocompatibility. Moreover, combining delivery systems with 3D printing for personalized nutrition and dysphagia-friendly texture design has emerged as an important trend in age-appropriate food development. This review outlines the digestive physiological constraints of the elderly and the design principles of nutrient delivery systems, highlights the adaptive optimization and recent applications of major delivery technologies in geriatric foods, and discusses intervention strategies, current challenges, and future directions. It aims to provide theoretical support for the research and innovation of functional foods tailored for older adults.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus characterized by dysphagia and food impaction. Although uncommon, spontaneous esophageal perforation may occur, most frequently involving the distal esophagus and the gastroesophageal junction. These perforations are typically managed with surgical or endoscopic interventions. Early diagnosis and prompt initiation of treatment within the first 24 hours significantly reduce morbidity and mortality. The aim of this report is to demonstrate that gastroesophageal junction perforation secondary to eosinophilic esophagitis can be successfully managed conservatively, even in delayed presentations, and to contribute to the understanding of treatment strategies for this rare but potentially life-threatening complication. We report the case of a 35-year-old male with a 12-year history of EoE who presented to the emergency department with retrosternal pain, dyspnea, and hematemesis. Five days prior to presentation, he developed a sore throat and cherry-colored diarrhea after consuming grilled chicken and self-administered ibuprofen for symptom relief. Contrast-enhanced imaging and upper endoscopy revealed a perforation at the gastroesophageal junction. Due to the location of the lesion, endoscopic stenting or clipping was considered inappropriate. In the absence of signs of acute abdomen, mediastinitis, or significant fluid collection, a conservative management strategy was adopted. The patient was admitted to the intensive care unit and initially treated with intravenous ceftriaxone (2 g/day) and metronidazole (1.5 g/day), which were later changed to piperacillin-tazobactam (4.5 g every 6 hours) following infectious disease consultation. The patient remained clinically stable, and oral intake was initiated on day 6. Antibiotic therapy was discontinued on day 10, and the patient was discharged without complications. At the three-month follow-up, the patient reported recurrent and progressively worsening dysphagia. Control endoscopy performed at the previously visited center revealed a distal esophageal stricture preventing passage of the gastroscope; therefore, a 12-cm fully covered self-expandable esophageal stent was placed. The stent was removed 20 days later, and the patient remained asymptomatic during the subsequent six-month follow-up period. Spontaneous esophageal perforation secondary to EoE is a rare but potentially life-threatening complication. This case highlights that conservative management may be a viable alternative to surgical or endoscopic intervention not only in early-detected cases but also in carefully selected delayed presentations managed in a multidisciplinary setting. Long-term follow-up remains essential for the early detection and treatment of late complications, such as stricture formation.

Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disorder characterized by prominent nutritional and gastrointestinal challenges. This study aimed to evaluate the nutritional status, gastrointestinal symptoms and biochemical deficiencies in children with DMD, with a particular focus on the clinical utility of supplementary anthropometric indicators such as mid-upper arm circumference Z-score (MUAC-Z) and triceps skinfold thickness Z-score (TSF-Z). This cross-sectional study included 65 genetically confirmed DMD patients aged 5-18 years. Anthropometric data (BMI-SDS, MUAC-Z, TSF-Z), gastrointestinal complaints, serum vitamin D levels and clinical features were analysed. ROC curve analysis was conducted to determine age thresholds associated with symptom onset. The most frequently reported gastrointestinal complaints were abdominal bloating (50.8%), constipation (32.3%) and regurgitation (30.8%). Swallowing difficulties and prolonged meal times were significantly associated with older age and loss of ambulation. ROC analysis identified > 14.5 years as the age threshold for solid food dysphagia. A moderate, significant positive correlation was observed between MUAC-Z and BMI-SDS (r = 0.520; p < 0.001), whereas no significant association was found between TSF-Z and BMI-SDS. Vitamin D deficiency (< 30 ng/mL) was widespread (86.2%) and more prevalent among non-ambulatory patients (96.6% vs. 77.8%; p = 0.036). Malnutrition was more frequently observed in steroid-naïve children than in those receiving corticosteroid therapy (50% vs. 19%; p = 0.041). Nutritional deficiencies and gastrointestinal symptoms are commonly encountered in paediatric DMD and tend to increase with advancing age and functional decline. MUAC-Z and TSF-Z may offer complementary insights into muscle mass and fat distribution beyond BMI. These simple and non-invasive measurements could be useful additions to routine nutritional surveillance in DMD management.