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Saudi Medical Journal Jun 2024To assess the risk variables related to the types of candidemia for each patient, who was admitted into the intensive care unit regardless of the patient with or without...
OBJECTIVES
To assess the risk variables related to the types of candidemia for each patient, who was admitted into the intensive care unit regardless of the patient with or without complete diagnosis of COVID-19, during the period of March 2019 to December 2022.
METHODS
The evaluation comparison of demographic and clinical data of COVID-19 positive and negative patients with candidemia confirmed in blood, 113 cases were assessed. Variables such as gender, age, age of hospitalization, history of hospitalization, concurrently infection, The acute physiology and chronic health evaluation-II scores, comorbidity checking, intubation, central venous catheter use, parenteral nutrition use, steroid use, antibiotic use, lymphopenia, and laboratory variables were evaluated. species distribution, antifungal susceptibility in blood culture were determined.
RESULTS
Coronavirus disease-19 was present in 62.8% of cases confirmed candidemia, and these cases were significantly different from COVID-19 negative cases. Significance was found in more intubation, central venous catheter use, parenteral nutrition, and steroid therapy in Group 2. There was no significance with species distribution and associated infection. In total, COVID-19 positive had higher hemoglobin, aspartate aminotransferase, alanine transaminase, and white blood cell levels, which may be associated with the possibility of revealing and controlling candidemia.
CONCLUSION
and () are the species seen in infected COVID-19 patients, while C. parapsilosis and are found in non-COVID-19 ones. Risk factors were intubation, parenteral nutrition, central venous catheter, and steroid in the COVID-19 group.
Topics: Humans; Candidemia; Risk Factors; Male; Female; Intensive Care Units; COVID-19; Middle Aged; Candida; Aged; Adult; Parenteral Nutrition; Candida albicans; Antifungal Agents; SARS-CoV-2; Candida tropicalis
PubMed: 38830660
DOI: 10.15537/smj.2024.45.6.20240102 -
Journal of Pediatric Gastroenterology... Jun 2024To review recent evaluations of pediatric patients with intestinal failure (IF) for intestinal transplantation (ITx), waiting list decisions, and outcomes of patients...
OBJECTIVES
To review recent evaluations of pediatric patients with intestinal failure (IF) for intestinal transplantation (ITx), waiting list decisions, and outcomes of patients listed and not listed for ITx at our center.
METHODS
Retrospective chart review of 97 patients evaluated for ITx from January 2014 to December 2021 including data from referring institutions and protocol laboratory testing, body imaging, endoscopy, and liver biopsy in selected cases. Survival analysis used Kaplan-Meier estimates and Cox proportional hazards regression.
RESULTS
Patients were referred almost entirely from outside institutions, one-third because of intestinal failure-associated liver disease (IFALD), two-thirds because of repeated infective and non-IFALD complications under minimally successful intestinal rehabilitation, and a single patient because of lost central vein access. The majority had short bowel syndrome (SBS). Waiting list placement was offered to 67 (69%) patients, 40 of whom for IFALD. The IFALD group was generally younger and more likely to have SBS, have received more parenteral nutrition, have demonstrated more evidence of chronic inflammation and have inferior kidney function compared to those offered ITx for non-IFALD complications and those not listed. ITx was performed in 53 patients. Superior postevaluation survival was independently associated with higher serum creatinine (hazard ratio [HR] 15.410, p = 014), whereas inferior postevaluation survival was associated with ITx (HR 0.515, p = 0.035) and higher serum fibrinogen (HR 0.994, p = 0.005).
CONCLUSIONS
Despite recent improvements in IF management, IFALD remains a prominent reason for ITx referral. Complications of IF inherent to ITx candidacy influence postevaluation and post-ITx survival.
PubMed: 38828781
DOI: 10.1002/jpn3.12274 -
Journal of Pediatric Gastroenterology... Jun 2024Long-term outcomes of congenital diarrheas and enteropathies (CODE) are poorly described. We evaluated the morbidity and mortality of children with CODE followed by an...
BACKGROUND
Long-term outcomes of congenital diarrheas and enteropathies (CODE) are poorly described. We evaluated the morbidity and mortality of children with CODE followed by an intestinal rehabilitation program (IRP) compared to children with short bowel syndrome (SBS).
METHODS
Matched case-control study of children with intestinal failure (IF) due to CODE (diagnosed between 2006 and 2020; N = 15) and SBS (N = 42), matched 1:3, based on age at diagnosis and duration of parenteral nutrition (PN). Nutritional status, growth, and IF-related complications were compared. Survival and enteral autonomy were compared to a nonmatched SBS cohort (N = 177).
RESULTS
Fifteen CODE patients (five males, median age 3.2 years) were followed for a median of 2.9 years. Eleven children were alive at the end of the follow-up, and two achieved enteral autonomy. The CODE group had higher median PN fluid and calorie requirements than their matched SBS controls at the end of the follow-up (83 vs. 45 mL/kg/day, p = 0.01; 54 vs. 30.5 kcal/kg/day, p < 0.01), but had similar rates of growth parameters, intestinal failure associated liver disease (IFALD), central venous catheter (CVC) complications and nephrocalcinosis. Kaplan-Meier (KM) analyses of 10-year survival and enteral autonomy were significantly lower in CODE patients compared to the nonmatched SBS population (60% vs. 89% and 30% vs. 87%, respectively; log-rank p < 0.008).
CONCLUSIONS
Despite higher PN needs in CODE, rates of IF complications were similar to matched children with SBS. Enteral autonomy and survival rates were lower in CODE patients. Treatment by IRP can mitigate IF-related complications and improve CODE patient's outcome.
PubMed: 38828718
DOI: 10.1002/jpn3.12275 -
Clinical Nutrition (Edinburgh, Scotland) May 2024The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article...
Avoiding the use of long-term parenteral support in patients without intestinal failure: A position paper from the European Society of Clinical Nutrition & Metabolism, the European Society of Neurogastroenterology and Motility and the Rome Foundation for Disorders of Gut-Brain Interaction.
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
PubMed: 38824102
DOI: 10.1016/j.clnu.2024.05.027 -
Clinical Nutrition (Edinburgh, Scotland) Jul 2024Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care... (Review)
Review
Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care requires evidence, consensus-based guidelines, audits of practice, and standardized strategies. Several pediatric scientific organizations, expert panels, and authorities have recently recommended that standardized PN should generally be used over individualized PN in the majority of pediatric patients including very low birth weight premature infants. In addition, PN admixtures produced and validated by a suitably qualified institution are recommended over locally produced PN. Licensed multi chamber bags are standardized PN bags that comply with Good Manufacturing Practice and high-quality standards for the finished product in the frame of their full manufacturing license. The purpose of this article is to review the practical aspects of PN and the evidence for using such multi-chamber bags in pediatric patients. It highlights the safety characteristics and the limitations of the different PN practices and provides some guidance for ensuring safe and efficient therapy in pediatric patients.
Topics: Humans; Infant, Newborn; Parenteral Nutrition; Infant; Child; Child, Preschool; Adolescent; Parenteral Nutrition Solutions; Infant, Premature; Practice Guidelines as Topic; Infant, Very Low Birth Weight
PubMed: 38823267
DOI: 10.1016/j.clnu.2024.05.023 -
Clinical & Translational Oncology :... Jun 2024Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight...
Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.
PubMed: 38822976
DOI: 10.1007/s12094-024-03502-8 -
Air Medical Journal 2024This study aimed to describe the type and frequency of enteral and parenteral fluids and medications used during the transport of neonates by a regional pediatric...
OBJECTIVE
This study aimed to describe the type and frequency of enteral and parenteral fluids and medications used during the transport of neonates by a regional pediatric critical care transport team.
METHODS
We performed a retrospective analysis of neonates transported by a regional neonatal transport team affiliated with a level IV neonatal intensive care unit within a large care network between 2020 and 2021. Demographic and clinical data were collected from the electronic medical record. Standard frequency tabulation and summary statistics were used to report demographics, transport characteristics, and fluid and medication use; results were then stratified by preterm (37 weeks) and term births.
RESULTS
In the 628 included transports, more term than preterm infants received at least 1 fluid or medication (53% vs. 43%, respectively). The most commonly administered medications were antibiotics (ampicillin and gentamicin), prostaglandin, and opiates (morphine sulfate and fentanyl). In addition, term infants received more analgesic medications, antimicrobials, and prostaglandin, whereas preterm infants received total parenteral nutrition more often. There were over 38 different medications provided on the transports studied.
CONCLUSION
This study of a single transport team revealed that a wide variety of medications and fluids were used in the transport of neonates, with term infants receiving more medications than preterm infants. These data could be used by transport teams in making or updating their standardized medication lists or in creating simulations.
Topics: Humans; Infant, Newborn; Retrospective Studies; Female; Male; Transportation of Patients; Critical Care; Intensive Care Units, Neonatal; Infant, Premature; Air Ambulances; Fluid Therapy; Anti-Bacterial Agents
PubMed: 38821705
DOI: 10.1016/j.amj.2023.12.009 -
Frontiers in Pediatrics 2024To analyze clinical data related to preterm infants and identify risk factors for metabolic bone disease of prematurity (MBDP).
OBJECTIVE
To analyze clinical data related to preterm infants and identify risk factors for metabolic bone disease of prematurity (MBDP).
METHODS
This study involved 856 newborns with a gestational age of less than 37 weeks or a weight of less than 1,500g at the Second Hospital of Jilin University. Multifactorial analysis was performed using logistic regression models to explore the risk factors for MBDP. Linear regression was used to investigate the factors affecting the time of alkaline phosphatase (ALP) exceedance and the peak value of ALP in the MBDP group.
RESULTS
In the MBDP group, ALP excesses occurred in preterm infants at an average of 39.33 days after birth, and the mean value of peak ALP was 691.41 IU/L. Parenteral nutrition and the application of assisted ventilation were independent risk factors for MBDP, with ORs of 1.02 and 1.03 respectively. Gestational age was found to be a protective factor for earlier time of onset of ALP exceedance ( = 2.24,) and the increase in the peak value of ALP ( = -16.30).
CONCLUSION
Parenteral nutrition and the application of assisted ventilation are independent risk factors for MBDP. Gestational age is a major factor influencing the time of onset of ALP exceedance and the peak value of ALP in infants with MBDP.
PubMed: 38818348
DOI: 10.3389/fped.2024.1345878 -
Cureus Apr 2024Introduction Enteroatmospheric fistulas (EAF) present significant challenges in surgical management due to their complex nature and high mortality rate. Traditional...
Introduction Enteroatmospheric fistulas (EAF) present significant challenges in surgical management due to their complex nature and high mortality rate. Traditional approaches often rely on prolonged parenteral nutrition, but emerging evidence suggests the potential benefits of enteral nutrition via fistuloclysis, an underappreciated enteral nutrition route. This study aims to evaluate the effectiveness of nutritional therapy, specifically fistuloclysis, in patients with EAF managed at the Trauma Unit of Santo Tomás Hospital, Panama. Methods A retrospective analysis was conducted on nine male patients diagnosed with EAF between January 2016 and December 2020. Data on demographics, fistula characteristics, and nutritional management were collected through chart review. Descriptive statistics were used for analysis. Results We analyzed nine patients, all of whom received enteral nutrition (EN) via fistuloclysis in a median of 5.5 days from the diagnosis of EAF. Seven patients required parenteral nutrition (PN) at the beginning. The use of specialized enteral formulas, supplemented with hydrolyzed proteins and medium-chain triglycerides, facilitated discontinuation of PN once 80% of nutritional requirements were met via the enteral route, and EN was continued until definitive surgery. The median duration of PN was 34 days. No adverse effects related to EN were observed, whereas complications such as central venous catheter infections were reported in all cases requiring PN. Conclusion Fistuloclysis is a viable and effective alternative to traditional PN in patients with EAF. Specialized nutritional strategies, including the use of semi-elemental formulas, contribute to improved outcomes and reduced complications. Early initiation and gradual increase in enteral nutrition via fistuloclysis demonstrate safety and efficacy, underscoring the importance of tailored nutritional approaches in optimizing patient care for complex surgical conditions.
PubMed: 38817490
DOI: 10.7759/cureus.59403 -
World Journal of Gastrointestinal... May 2024Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment.
BACKGROUND
Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment.
AIM
To analyze the clinical features and risk factors of IFD.
METHODS
Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching (PSM) methods. Based on the occurrence of IFD, patients were categorized into IFD and non-IFD groups. The clinical characteristics and treatment approaches for patients with IFD were analyzed. Multivariate regression analysis was performed to identify the risk factors of IFD.
RESULTS
The IFD incidence after laparoscopic surgery was 9.0% (97 of 1073 patients). After PSM, 97 and 194 patients were identified in the IFD and non-IFD groups, respectively. The most common symptoms of IFD were diarrhea and abdominal, typically occurring on post-operative days 3 and 4. All patients were managed conservatively, including modulation of the intestinal flora (90.7%), oral/intravenous application of vancomycin (74.2%), and insertion of a gastric/ileus tube for decompression (23.7%). Multivariate regression analysis identified that pre-operative intestinal obstruction [odds ratio (OR) = 2.79, 95%CI: 1.04-7.47, = 0.041] and post-operative antibiotics (OR = 8.57, 95%CI: 3.31-23.49, < 0.001) were independent risk factors for IFD, whereas pre-operative parenteral nutrition (OR = 0.12, 95%CI: 0.06-0.26, < 0.001) emerged as a protective factor.
CONCLUSION
A stepwise approach of probiotics, vancomycin, and decompression could be an alternative treatment for IFD. Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics.
PubMed: 38817289
DOI: 10.4240/wjgs.v16.i5.1259