36 research outputs found
Effect of Early Enteral Feeding on Apolipoprotein AI Levels and High-Density Lipoprotein Heterogeneity in Preterm Infants
No full textBackground/Aim: We have previously shown that infants receiving total parenteral nutrition have low apolipoprotein Al levels which are associated with high-density lipoprotein (HDL) class distributions as in lecithin:cholesterol acyltransferase deficiency. This study investigates the influence of early enteral feedings on apolipoprotein Al and HDL subclasses. Methods: Apolipoprotein Al and HDL distributions were determined in 15 total parenterally fed preterm infants (TPN group) receiving early feedings, in 28 enterally fed preterm infants (ENT group), and in 26 term infants at birth and on day 5. The HDL subclasses were determined by gradient gel electrophoresis. Results: In the TPN group, the apolipoprotein Al levels increased significantly postnatally (from 73 +/- 16 to 104 +/- 23 mg/dl) to levels found in the term and ENT groups on day 5 (88 +/- 16 and 96 +/- 19 mg/dl). The HDL subclass distributions at birth and on day 5 were similar in both TPN and ENT groups with more large HDL2b and less small HDL3c than in term infants. Whereas the HDL subclass distribution of term infants remained unchanged, in TPN and ENT infants, a shift from HDL2b to HDL3c was observed, with no difference between term and preterm infants on day 5. Conclusion: In contrast to exclusively parenterally fed infants, infants receiving early enteral feedings exhibited a significant rise of apolipoprotein Al and HDL subclass distributions as fully enterally fed preterm infants. Copyright (C) 2002 S. Karger AG, Basel
Collusion, efficiency, and dominant strategies
No full textAbstractGreen and Laffont proved that no collusion-resilient dominant-strategy mechanism, whose strategies consist of individual valuations, guarantees efficiency in multi-unit auctions. Chen and Micali bypassed this impossibility by slightly enlarging the strategy spaces, yet assuming knowledge of the maximum value a player may have for a copy of the good, and the ability of imposing high fines on the players. For unrestricted combinatorial auctions, efficiency in collusion-resilient dominant strategies has remained open, with or without the above two assumptions. We fully generalize the notion of a collusion-resilient dominant-strategy mechanism by allowing for arbitrary strategy spaces; construct one such mechanism for multi-unit auctions, without relying on the above two assumptions; and prove that no such mechanism exists for unrestricted combinatorial auctions, with or without any additional assumptions. Our results hold when the mechanism does not know who colludes with whom, and players in the same coalition can perfectly coordinate their strategies
Identifying Pediatric Trauma Data Gaps at a Large Urban Trauma Referral Center in Santiago, Chile
No full textABSTRACT
Background
Trauma registries contribute to improving trauma care, but their impact is highly dependent on the quality of the data. A simplified point of care pediatric trauma registry (PTR) was developed at the Centre for Global Surgery from the McGill University Health Centre (MUHC) for implementation in Low-middle income countries (LMICs). Pilot deployment was launched at a large urban trauma center in May 2016 in Santiago, Chile. Prior to deployment, we sought to identify missing data in existing trauma records in order to optimize PTR practicality and user benefit.
Materials and methods
The project was approved by the local Institutional Review Board. Retrospective chart review was conducted on trauma patients below the age of 15 who were evaluated at the emergency room (ER) of Hospital Dr. Sotero del Rio (HSR) between January 1st and June 30th 2015. Data missingness was evaluated for each component of the PTR (demographics, mechanism, injury and outcomes). Potential independent predictors of data missingness were evaluated using multiple linear regression.
Results
A total of 351 patients were included. Demographic data missingness ranged from 0% (age) to 95% (mode of arrival). Mechanism data missingness ranged from 6% (cause of injury) to 42% (site of injury). Injury physiology data missingness ranged from 37% (oxygen saturation) to 99% (respiratory rate). Interestingly, mean injury anatomy data missingness was significantly inferior to physiology data (0.6% vs. 78.6%, p < 0.05). Outcome data missingness reached 54% at 2 weeks.
Conclusion
In resource-limited settings, high quality data is essential to guide responsible resource allocation. We believe implementation of a simplified trauma registry has the potential to reduce data gaps for pediatric trauma patients by streamlining trauma data collection at point of care. This should include streamlined data collection with a short per-patient completion time, and should forego attempts to collect data at 2 weeks, which has proven unsuccessful.
How to cite this article
St-Louis E, Roizblatt D, Deckelbaum DL, Baird R, Millán CV, Ebensperger A, Razek T. Identifying Pediatric Trauma Data Gaps at a Large Urban Trauma Referral Center in Santiago, Chile. Panam J Trauma Crit Care Emerg Surg 2017;6(3):169-176.
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Effect of liposomal content of lipid emulsions on plasma lipid concentrations in low birth weight infants receiving parenteral nutrition
No full textWe studied the effects of phospholipid liposomes present in intravenously administered lipid emulsions on plasma lipid levels in preterm infants given 10% and 20% lipid emulsions. Twenty premature infants (birth weight 1454 ± 54 gm) on a parenteral nutrition regimen received up to 4 gm triglycerides per kilogram per day in a 20% lipid emulsion for 2 weeks, and then received the 10% emulsion at 2 gm triglycerides per kilogram per day, which delivered the same total phospholipid load but twice the amount of liposomes. Triglyceride, total cholesterol, and phospholipid concentrations increased significantly when the infants were given 2 gm triglycerides per kilogram per day in the 10% emulsion rather than 4 gm/kg per day in the 20% emulsion (44 ± 4 to 57 ± 5 mg/dl, 134 ± 6 to 162 ± 9 mg/dl, and 204 ± 8 to 251 ± 10 mg/dl, respectively. Lipoprotein analysis indicated the presence of lipoprotein X-like particles in the low-density lipoprotein fraction and an increase of the intermediate-density lipoprotein fraction in infants who received the 10% emulsion. The presence of excess phospholipids in the 10% emulsion was associated with greater plasma lipid alterations. Therefore the use of 20% rather than 10% emulsion allows for more efficient triglyceride clearance, even at a higher triglyceride intake. Administration of emulsions that are relatively poor in phospholipid liposomes may allow delivery of >2 gm triglycerides per kilogram per day to low birth weight infants.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Early increases in concentrations of total, LDL, and HDL cholesterol in HIV-infected children following new exposure to antiretroviral therapy.
No full textAntiretroviral therapy (ART) is associated with dyslipidemia and cardiovascular disease in adults infected with HIV. For children perinatally infected with HIV, ART exposure is lifelong and early-onset dyslipidemia could have significant long-term effects. We examined cholesterol levels in children during the first year after exposure to a new ART regimen (initiation or switch). In 52 children, total cholesterol increased by 30.5 and 43 mg/dL at 6 and 12 months, respectively (P \u3c 0.001). Low-density lipoprotein cholesterol made the largest contribution, but high-density lipoprotein cholesterol also increased within months of therapy alteration. Early identification of these children and intervention could mediate potential increased risk for future cardiovascular disease
Blood TG and glucose levels after TG emulsion injections.
No full text<p>A. Total plasma TG concentrations (mg/dL) in non-fasting neonatal mice (p10), acutely injected (i.p.) with saline or n-3 TG emulsion (0.75 g n-3 TG/kg body weight). *<i>p</i><0.05 (n = 3–8 in each group). Each data point represents the mean ± SEM of 3 separate experiments. B. Plasma glucose concentrations (mg/dL) in non-fasting mice (p10) in post-H/I treatment of n-3 TG or n-6 TG or vehicle (saline) comparing to the time between before H/I and after H/I. **<i>p</i><0.001 (n = 5–9 in each group).</p
Plasma lipid and plasma lipoprotein concentrations in low birth weight infants given parenteral nutrition with twenty or ten percent lipid emulsion
No full textBecause 10% and 20% intravenously administered lipid emulsions (Intralipid preparations) differ in their phospholipid/triglyceride ratio (0.12 and 0.06, respectively), 28 low birth weight infants requiring parenteral nutrition for at least 1 week were selected at random to receive either emulsion to determine the effects on plasma lipids and lipoproteins. Triglyceride intake was progressively increased to reach 2 gm/kg per day between days 4 and 7. During that period, all plasma lipids in samples taken 6 hours after infusion were higher in the 10% intrallpid group. In comparison with day 0 values, triglyceride concentrations decreased (63±7 to 45±4 mg/dl; p<0.05) in the 20% group. Cholesterol levels increased in both groups, but the rise was more than twofold higher in the 10% group. Phospholipid increase was approximately 25% in the 20% group but more than 125% in patients receiving the 10% emulsion (p<0.005). The changes in plasma cholesterol and phospholipid levels were almost entirely in low-density lipoproteins. After 7 days, eight infants from each group were given the alternate emulsion, which resulted in a reversal of lipid patterns in each patient. We conclude that the higher phospholipid intake in 10% than in 20% intralipid is associated with higher plasma triglyceride concentrations and leads to accumulation of cholesterol and phospholipids in low-density lipoproteins. Emulsions with lower phospholipid content may be preferable for low birth weight infants and perhaps other patient populations with impaired removal of parenteral fat emulsions. © 1989 The C. V. Mosby Company.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Neonatologie/Pädiatrie – Leitlinie Parenterale Ernährung, Kapitel 13
No full textThere are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.Eine besondere Herausforderung bei der Durchführung parenteraler Ernährung (PE) bei pädiatrischen Patienten ergibt sich aus der großen Spannbreite zwischen den Patienten, die von extrem unreifen Frühgeborenen bis hin zu Jugendlichen mit einem Körpergewicht von mehr als 100 kg reicht, und ihrem unterschiedlichen Substratbedarf. Dabei sind alters- und reifeabhängige Veränderungen des Stoffwechsels sowie des Flüssigkeits- und Nährstoffbedarfs zu berücksichtigen sowie auch die klinische Situation, in der eine PE eingesetzt wird. Das Vorgehen unterscheidet sich deshalb ganz erheblich von der PE-Praxis bei erwachsenen Patienten, z.B. ist der Flüssigkeits-, Nährstoff- und Energiebedarf von Früh- und Neugeborenen pro kg Körpergewicht höher als bei älteren pädiatrischen und bei erwachsenen Patienten. In der Regel benötigen alle Frühgeborenen <35. SSW und alle kranken Reifgeborenen während der Phase des allmählichen Aufbaus der enteralen Nahrungszufuhr eine vollständige oder partielle PE. Die Zufuhrmengen der PE bei Neonaten müssen berechnet (nicht geschätzt) werden. Der Anteil der PE sollte zur Minimierung von Nebenwirkungen sobald wie möglich durch Einführung einer enteralen Ernährung vermindert (teilparenterale Ernährung) und schließlich komplett durch enterale Ernährung abgelöst werden. Eine unangemessene Substratzufuhr im frühen Säuglingsalter kann langfristig nachteilige Auswirkungen im Sinne einer metabolischen Programmierung des Krankheitsrisikos im späteren Lebensalter haben. Wenn bei älteren Kindern und Jugendlichen dagegen der Energie- und Nährstoffbedarf eines Patienten im Vorschul- oder Schulalter durch eine enterale Nährstoffzufuhr nicht gedeckt werden kann, ist abhängig von Ernährungszustand und klinischen Umständen spätestens innerhalb von 7 Tagen eine partielle oder totale PE zu erwägen
Lipid emulsions - Guidelines on Parenteral Nutrition, Chapter 6
No full textThe infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within 400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.Die Infusion von Lipidemulsionen erlaubt die Zufuhr einer hohen Energiedichte, ermöglicht die Vermeidung hoher Glukoseinfusionsraten und ist unverzichtbar für die Bedarfsdeckung mit essentiellen Fettsäuren. Zur Vermeidung eines Mangels an essentiellen Fettsäuren ist die Gabe von Lipidemulsionen innerhalb 400 mg/dl (>4,6 mmol/l) und eine Unterbrechung der Lipidinfusion bei >1000 mg/dl (>11,4 mmol/l) vornehmen zu können. Auswirkungen der Auswahl aus den verschiedenen verfügbaren Lipidemulsionen sind derzeit nicht eindeutig belegt
Trauma care in Malawi: A call to action
No full textInjuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care. Studies in other low- and middle-income countries (LMICs) have demonstrated cost-effective methods for enhancing prehospital, in-hospital, and postdischarge care of trauma patients. We encourage health sectors leaders from across Malawi to take action to improve trauma care and reduce the burden from injury in this country
