34 research outputs found
The Effect of Glutamine Supplementation on Microbial Invasion in Surgical Infants Requiring Parenteral Nutrition: Results of a Randomized Controlled Trial
No full textBackground: To determine whether parenteral plus enteral glutamine supplementation influences microbial invasion in surgical infants who require parenteral nutrition (PN). Methods: An prospective double-blind randomized controlled trial studying surgical infants receiving PN for at least 5 days for congenital or acquired intestinal anomalies (2009–2012) was used. Infants were randomized to receive either glutamine supplementation (parenteral plus enteral; total 400 mg/kg/d) or isonitrogenous control. The primary end point was microbial invasion evaluated after 5 days of supplementation and defined as: (i) positive conventional blood culture, (ii) evidence of microbial DNA in blood (polymerase chain reaction), (iii) plasma endotoxin level ≥50 pg/mL, or (iv) plasma level of lipopolysaccharide binding protein ≥50 ng/mL. Data are given as median (range) and compared by logistic regression. Results: Sixty infants were randomized and reached the primary end point. Twenty-five patients had intestinal obstruction, 19 had abdominal wall defects, and 13 had necrotizing enterocolitis. Thirty-six infants showed evidence of microbial invasion during the study, and 17 of these were not detected by conventional blood culture. There was no significant difference between the 2 groups in the primary outcome; evidence of microbial invasion after 5 days was found in 9/31 (control group) and 8/29 (glutamine group) (odds ratio 0.83 [0.24–2.86; P = 0.77]). Conclusion: More than half of surgical infants requiring PN showed evidence of microbial invasion. Approximately half of this was not detectable by conventional blood cultures. Parenteral plus enteral glutamine supplementation had no effect on incidence of microbial invasion
ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition:Iron and trace minerals
No full textAlkalinity of Neutrophil Phagocytic Vacuoles Is Modulated by HVCN1 and Has Consequences for Myeloperoxidase Activity.
No full textThe NADPH oxidase of neutrophils, essential for innate immunity, passes electrons across the phagocytic membrane to form superoxide in the phagocytic vacuole. Activity of the oxidase requires that charge movements across the vacuolar membrane are balanced. Using the pH indicator SNARF, we measured changes in pH in the phagocytic vacuole and cytosol of neutrophils. In human cells, the vacuolar pH rose to ~9, and the cytosol acidified slightly. By contrast, in Hvcn1 knock out mouse neutrophils, the vacuolar pH rose above 11, vacuoles swelled, and the cytosol acidified excessively, demonstrating that ordinarily this channel plays an important role in charge compensation. Proton extrusion was not diminished in Hvcn1-/- mouse neutrophils arguing against its role in maintaining pH homeostasis across the plasma membrane. Conditions in the vacuole are optimal for bacterial killing by the neutral proteases, cathepsin G and elastase, and not by myeloperoxidase, activity of which was unphysiologically low at alkaline pH
The Effect of Glutamine Supplementation on Microbial Invasion in Surgical Infants Requiring Parenteral Nutrition – Results of a Randomised Controlled Trial
No full textBackground: To determine whether parenteral plus enteral glutamine supplementation influences microbial invasion in surgical infants requiring parenteral nutrition. //
Methods: An ethically-approved prospective double-blind randomised controlled trial studying surgical infants receiving parenteral nutrition for at least five days for
congenital or acquired intestinal anomalies (July 2009 – March 2012). Infants were randomised to receive either glutamine supplementation (parenteral plus enteral; total
400mg/kg/day) or isonitrogenous control. The primary endpoint was microbial invasion evaluated after five days of supplementation and defined as either: i) positive
conventional blood culture; ii) evidence of microbial DNA in blood (PCR); iii) plasma endotoxin level ≥50 pg/mL; or iv) plasma level of lipopolysaccharide-binding protein (LBP) ≥50 ng/mL. Data are given as median (range) and compared by binary logistic regression. //
Results: Sixty infants were randomised and reached the primary endpoint. 25 patients had congenital/neonatal intestinal obstruction, 19 had anterior abdominal wall defects, 13 had necrotising enterocolitis. Thirty six infants showed some evidence of microbial invasion during the study: 17 of these were not detected by conventional blood culture. There was no significant difference between the two groups in the primary outcome: evidence of microbial invasion after five days was found in 9/31 in the control group and 8/29 in the glutamine group: odds ratio 0.83 (0.24 – 2.86; p=0.77). // Conclusion: More than half of surgical infants requiring parenteral nutrition showed evidence of microbial invasion. Approximately half of this was not detectable by conventional blood cultures. Parenteral plus enteral glutamine supplementation had no effect on the incidence of microbial invasion
Social networks and state grants: sustaining the livelihoods of households affected by HIV and AIDS in KwaZuluNatal, South Africa
No full textThe livelihoods of households in rural South Africa depend largely on formal and informal
paid work. remittances and social security payments. Agricultural production is far less
important than in other parts of sub-Saharan Africa. In addition. a turbulent social and
political history has affected the composition, functioning and definition of rural
households. This thesis explores in this context how illness caused by HIV, access to antiretroviral
therapy (ART) and the death of individuals change the experience of household
members and their livelihoods.
The study is based on case studies of ten households and adopted a livelihoods conceptual
framework. Data were collected both prospectively and retrospectively in a series of indepth
interviews supplemented by direct observation.
Social capital and state grants were particularly important in mitigating the effects of HIV
and AIDS in affected households. Resident and non-resident members of the household
provided each other with both valuable financial and material support and physical care.
Access to this resource was underpinned by strong norms of obligation to family and
generalised reciprocity within households. These findings highlight the importance of
family or household-focussed interventions in alleviating the burden of HIV and AIDS.
Norms of reciprocity also enabled affected households and individuals with sufficient social
capital to secure support from kin outside the household and the wider community.
Although many affected households encountered difficulties accessing them. social grants
were a major component of their livelihoods. A synergistic relationship existed between
receipt of a disability grant and successful ART outcomes. This finding highlights the
importance of providing social grants for those who become ill and have no other source of
income. Unemployed people on ART should remain entitled to grant support even if they
no longer qualify as disabled in order to assist them to continue treatment
Cost-consequences analysis of increased utilization of triple-chamber-bag parenteral nutrition in preterm neonates in seven European countries
No full textpeer reviewedThe safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK. The cost-consequence analysis estimated the impact on compounding error harm and bloodstream infection (BSI) rates, staff time, and annual hospital budget. Of 265,000 (52%) preterm neonates, 133,000 (52%) were estimated to require PN. Baseline compounding methods were estimated as 43% pharmacy manual, 16% pharmacy automated, 22% ward, 9% outsourced, 3% industry provided non-3CBs, and 7% 3CBs. A modeled increased 3CB use would change these values to 39%, 15%, 18%, 9%, 3%, and 17%, respectively. Modeled consequences included −11.6% for harm due to compounding errors and −2.7% for BSIs. Labor time saved would equate to 41 specialized nurses, 29 senior pharmacists, 26 pharmacy assistants, and 22 senior pediatricians working full time. Budget impact would be a €8,960,601 (3.4%) fall from €260,329,814 to €251,369,212. Even a small increase in the use of 3CBs in preterm neonates could substantially improve neonatal clinical outcomes, and provide notable resource and cost savings to hospitals. © 2020 by the authors. Licensee MDPI, Basel, Switzerland
ESPGHAN/ESPEN/ESPR guidelines on pediatric parenteral nutrition: Iron and trace minerals.
No full textInternational audienc
ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals
No full textAn investigation of the lived reality of the disjuncture between policy and practice in the implementation of South Africa's disability grant
No full textIncludes bibliographical references.The South African constitution emphasises the right of all citizens to income security if they are unable to support themselves and their dependents. Within the current context of high unemployment and poverty, this right is even more pertinent. The Disability Grant, being the only grant available to people in their working years has been widely discussed in its role as a method of poverty alleviation as well as functioning as a de facto Chronic Illness Grant and an Unemployment Grant. Although the DG has been well researched and analysed at a policy level, it is still seen to be functioning in its de facto roles and is accepted as being a mistargeted grant. A qualitative research study was conducted and a sample (composed of Policy Informants, South African Social Security Agency staff and Disability Grant Recipients) were interviewed. The Disability Grant was analysed at both a policy and implementation level. The findings revealed flaws in both the Disability Grant Policy as well as its practical implementation. These highlight the need for transformation and a reimagining of social policy
