Background Lipids of TPN can cause liver toxicity in premature infants, so it is important to evaluate the introduction of new emulsions Purpose To describe the safety of two lipid emulsions used in the compounding of total parenteral nutrition (TPN) for premature infants. Materials and methods A retrospective study of two time periods, 2009 and 2010, of preterm infants population whit TPN. The analysis excluded those cases of death, sepsis and those who had a liver disease. 20 children received parenteral nutrition with lipid emulsion derived from soybean oil (Intralipid ®), from August to December 2009. In the second group were evaluated 19 children, whose lipid emulsion was derived from olive oil (ClinOleic ®) in the period from August to December 2010. The authors evaluated the following criteria: levels of bilirubin and liver enzymes (ALT/AST) and maximum insulin requirements (IU/kg/h). Results 39 infants within 72 h of life completed the study. The group that received parenteral nutrition with soybean oil derived (n=20) showed a mean gestational age of 31.4 weeks (27-34) and an average weight of 1.64 kg (0.76-2.8), the second group with lipids olive oil derived (n=19) 30.4 weeks (28-32) of age and weighing 1.82 kg (0.6-.2.28). Bilirubin levels were similar in both groups: soybean 8.4 mg / dl (2.4-20.02) and olive 9.1 mg / dl (2,52-16.9). There were no significant differences in levels of liver enzymes AST of 43.6 U/L (17-235.3) and ALT of 5.21 U/L (4.1-9.2) and oil olive group AST 43.1 U/L (19.2-170.3) and 13.7 U/L (5.2-37.3) ALT. In the study population also did not show higher insulin requirements in any of the two groups referred to maximum needs, 0.034 UI/kg/h (0.02-0.03) versus 0.036 IU/kg/day (0.02-0.035). Conclusions Both lipid emulsions were well tolerated, showing no difference in hepatic damage. The results suggest that both lipid preparations have similar safety profile in preterm parenteral nutrition.
BackgroundOne activity of the Hospital Pharmacist is the monitoring and adjustment of nutritional support in hospitalised patients.PurposeTo describe the interventions of the Pharmacy Service in the adjustment of Parenteral Nutrition (PN) in patients hospitalised in a postoperative intensive care unit.Material and methodsRetrospective six-month study. All pharmaceutical care for patients being treated with TPN were recorded in the electronic patient medical record and in an Excel database.ResultsPN was initiated in 40 patients. 29 cases of postsurgical paralytic ileus, 6 peritonitis and 5 gastrointestinal bleeding.All patients were interviewed and were screened to estimate the prior nutritional status. We also considered the presence of stress factors and based on all these factors, we estimated our patients’ caloric and protein requirements.During this period 442 interventions were performed. A median of 11 interventions per patient was described:Detect food allergy (n = 4, 1%)Prevent refeeding syndrome: start nutritional support with 25% of caloric requirements and 100% of micronutrients and electrolytes in patients with moderate to severe malnutrition (n = 48, 11%).Adjust the ratio of non-protein kilocalories/gram of nitrogen to be 80–100 to achieve protein anabolism (n = 80, 18%).Skew caloric intake in favour of lipids in patients with respiratory distress (n = 30, 7%).Restrict lipids in hypertriglyceridemia (n = 14, 3%).Prevent and treat hepatobiliary complications (lipid restriction, nutrition cycling). (n = 22, 5%).Restrict carbohydrates in hyperglycaemia (n = 18, 4%).Administer glutamine and Omega 3 fatty acids according to hospital protocol (n = 60, 14%).Correct electrolyte imbalances. (n = 136, 31%).Restrict fluids and electrolytes in nephropathy and heart disease (n = 26, 6%).ConclusionThese results show a high demand for pharmaceutical attention in patients with TPN.Incorporation of the pharmacist in this unit makes it possible to monitor patient nutrition during hospitalisation.References and/or AcknowledgementsNo conflict of interest.
BackgroundThe clinical pharmacist’s main functions in parenteral nutrition (PN) are to ensure the appropriate assessment and monitoring of nutritional support according to the type of illness and the patient’s condition and to verify the quality and safety of the solutions prepared.PurposeTo describe the pharmaceutical interventions (PIs) made in patients hospitalised in a postsurgical intensive care unit.To find the degree of acceptance of the PIs and their relevance to patient care.Material and methodsRetrospective six-month study (January–June 2014).All PIs were recorded in each patient’s electronic medical record and in a special data sheet which included the indication for PN, laboratory data, type of nutrition, type of intervention and acceptance.ResultsNutritional monitoring was performed in 40 patients. 442 PIs were carried out during the study period, with a mean of 11 PIs/patient.The PIs were categorised as the following:Nutrition assessment (n = 158; 36%)Intravenous fluids needs (n = 26; 6%)Electrolyte imbalances (n = 136; 30%)Prevention of liver disease caused by PN (n = 34; 8%)Others (food allergies, glucose management, laboratory monitoring, administration of glutamine and omega 3 fatty acids) (n = 88; 20%)The overall degree of acceptance of the interventions was 99%.ConclusionThe high number and variety of types of PI performed by the pharmacist contributed to improving nutritional support and reducing complications, ensuring a more effective and safer use of PN.References and/or AcknowledgementsESPEN Guidelines for adult parenteral nutritionClin Nutr 2009;28:359–479No conflict of interest.
In this paper we refer to the concept of new addiction as to a phenomenon where there exists a risk of non-substances dependence. After defining and analysing the concept of new addiction itself, the paper will deal with the Internet addiction disorder, an increasingly relevant and widespread social phenomenon, and the changes occurred to the relationship between the individuals and the new technologies in the era of the web society. It is well acknowledged that the web plays a significant matching role (electronic social processes), mediation, composition, re-composition and exchange of social meanings among individuals.\ud Furthermore, several studies point out that there are significant correlation between social factors, cultural (gender) preferences and the use of the web. The analysis cast in this paper aims at verifying if and how the electronic interaction (seen as a peculiar social interaction) may sometime yield internet addiction and which relevance and social meaning is played by some cultural variables in the electronic communication. It is clearly arising a real phenomenon of IAD which will shortly make clear there is a need of several preventive actions aiming at spreading and promoting the awareness and discussion of that phenomenon itself. A possible answer to this new phenomenon (the IAD) could come - paradoxicaly - from the web
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