Serum phosphate level in burn patients

Introduction

Despite plasma phosphate imbalance being rare, it is a relatively common finding in certain subsets of burn patients. It may occur due to the burn itself or as a result of the treatment. Severe hypophosphataemia (<1.0 mg dl⁻¹) is associated with a significant morbidity and a fourfold increase in mortality. In this study, the relation between serum phosphate level and the total body surface area (TBSA) of the burn was compared.

Methods

According to the percentage of TBSA of the burn, the patients (n = 155) were divided into three groups: group A with 20–29% TBSA burns, group B with 30–39% and group C with more than 40% TBSA burns (62, 48 and 45 patients, respectively).Analysis of variance (ANOVA)-repeated measure was used to detect any statistically significant difference in the three post-burn time-points of 3rd, 6th and 9th days and the mean score of the serum phosphate level between the three groups.

Results

The incidence of hypophosphataemia at 9th post-burn day in the three groups was 6.1%, 32.4% and 73.5%, respectively. There were significant differences (p < 0.05) between mean serum phosphate levels of groups A and C, B and C and A and B as well. We found significant differences between the three post-burn follow-up time stages.

Discussion

We have shown that hypophosphataemia, defined as mean serum phosphate levels below 3.0 mg dl⁻¹, was very common following burn, based on 75.6% of patients with more than 40% burn at the 3rd post-burn day. As the percentage of TBSA of burn increases, the incidence of hypophosphataemia significantly increases. We suggest that phosphate level be routinely measured after a major burn, especially in patients with a complicated course, so that appropriate replacement therapy may be started in a timely manner.     

Impact of Periconceptional Multi-micronutrient Supplementation on Gestation: A Population-based Study

Objective To examine the effect of periconceptional multi‐micronutrient supplementation on gestation and birth outcomes.Methods A population‐based community intervention program was conducted in 18 counties in China.Participants were divided into an intervention group,who received multi‐micronutrient supplementation from at least 3 months before pregnancy throughout the first trimester,and a control group.Pregnant women were followed up to record information about birth outcomes.Maternal socio‐economic characteristics and main birth outcomes were evaluated.Gestational age was further analyzed using survival analysis,to determine the time distribution of delivery.Results Periconceptional multi‐micronutrient supplementation was associated with higher birth weight,birth length and occipitofrontal head circumference,and with lower incidence rates for stillbirth,low birth weight,and preterm birth.Moreover,periconceptional multi‐micronutrient supplementation changed the time distribution of delivery,making the deliveries more clustered in the period between day 275 and day 295 of gestation.Conclusion Our study shows that periconceptional multi‐micronutrient supplementation is beneficial for fetal development and optimizes all measured aspects of health in neonates in socioeconomically disadvantaged areas in China.The change in time distribution of deliveries caused by multi‐micronutrient supplementation needs further clarification.     

Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children

Objective: To determine the effect of zinc supplementation on behaviour in low-income school aged children.
Design: Double-blind randomized, placebo controlled trial.
Setting: Low-income district primary school in Turkey.
Participants: Third grade students in the school. Among 252 students, 226 participated and 218 completed the study.
Intervention: Children in each class were randomized either to the study group to receive 15 mg/day elemental zinc syrup or to placebo group to receive the syrup without zinc for 10 weeks.
Main Outcome Measures: The change in Conner's Rating Scales for Teachers and Parents scores after supplementation.
Results: The mean Conner's Rating Scale for Parents scores on attention deficit, hyperactivity, oppositional behaviour and conduct disorder decreased significantly in the study and placebo groups after supplementation (p < 0.01). The prevalence of children with clinically significant parent ratings on attention deficit (p = 0.01) and hyperactivity (p = 0.004) decreased in the study group while prevalence of oppositional behaviour (p = 0.007) decreased in the placebo group. In children of mothers with low education all mean Parents' scores decreased significantly (p < 0.01) in the study group while only hyperactivity scores decreased in the placebo group (p < 0.01). In this subgroup the prevalence of children with clinically significant scores for attention deficit, hyperactivity and oppositional behaviour decreased only in the study group (p < 0.05). There was no change in mean Teachers' scores.
Conclusion : In our study zinc supplementation decreased the prevalence of children with clinically significant scores for attention deficit and hyperactivity. The affect on behaviour was more evident in the children of low educated mothers.     

Calcium supplementation for the prevention of pre-eclampsia

OBJECTIVE: To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes. METHOD: A total of 524 healthy primigravidas with a blood pressure less than 140/90 mm Hg were randomly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery. RESULTS: The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group (4.0% vs 12.0%; odds ratio [OR], 0.31; 95% confidence interval [CI], 0.15-0.63); the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group (P=0.007 and P=0.02). The risk for preterm delivery was less in the calcium (7.0%) than in the placebo (12.7%) group (OR, 0.51; 95% CI, 0.28-0.93). The mean baseline calcium intake was 313.83+/-203.25 mg/day (range, 85.71-910.71 mg/day), which is lower than the recommended dietary intake of 1000 mg, and the 24-hour urinary calcium excretion was 130.82+/-67.44 mg/dL (range, 40.5-387 mg/dL). CONCLUSION: Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances.     

Zinc supplementation at the time of ethanol exposure ameliorates teratogenicity in mice

BACKGROUND: We have previously demonstrated that ethanol teratogenicity in mice is related to the maternal expression of metallothionein (MT), a zinc (Zn)-binding protein. Ethanol induces maternal liver MT, which causes plasma Zn concentrations to decrease as Zn moves into the liver. During pregnancy it is suggested that this change decreases fetal Zn supply and contributes to abnormal development. Here we investigated whether maternal Zn supplementation at the time of ethanol exposure reduces teratogenicity. METHODS: Mice were injected with 25% ethanol (0.015 ml/g intraperitoneally at 0 and 4 hr) and ZnSO4 (2.5 microg Zn/g subcutaneously at 0 hr) and were killed over 16 hr to ascertain changes in plasma Zn. Plasma Zn concentrations peaked at 2 hr, where levels were 5-fold normal and then returned toward normal over 14 hr. Pregnant mice were treated in a similar manner on gestation day 8 with saline, saline + Zn, ethanol + Zn, or ethanol alone, and fetal abnormalities were assessed on gestation day 18. RESULTS: External abnormalities were most prevalent in offspring from dams treated with ethanol. Zn treatment at the time of ethanol exposure reduced the incidence of fetal abnormalities to basal levels. Litters from dams treated with ethanol + Zn contained more fetuses and fewer fetal resorption sites compared with those from ethanol-treated dams. CONCLUSIONS: These findings demonstrate that Zn supplementation at the time of ethanol exposure significantly negates the deleterious effects of ethanol on the fetus.     

Effect of selenium supplementation on the distribution of selenium among plasma proteins of a patient with maple syrup urine disease

Selenium (Se) status was studied in a patient with classical maple syrup urine disease (MSUD) receiving Se supplement. The basal plasma Se concentration was 0.06 mol/l increasing to 2.1 mol/l after 40 days of supplementation. When the plasma Se distribution was analysed by gel filtration, a major peak was seen close to the high molecular weight proteins with a second peak in the albumin region. When the Se dose was decreased in a stepwise manner from 50 g/day to 25 g/day and then to 17 g/day plasma Se decreased, but the proportion of plasma Se in the two protein peaks did not change. In a healthy girl not supplemented with Se, the proportion of plasma Se in the albumin region was somewhat lower. In the MSUD patient glutathione peroxidase activity was initially low, and increased ten-fold during Se supplementation. The study indicates that the Se requirement for plasma glutathione peroxidase activity was fulfilled at the lowest dose of Se used and that Se is incorporated into several plasma proteins after supplementation.Abbreviations MSUD maple syrup urine disease - Se selenium     

Immunoreactivity and activity of mitochondrial superoxide dismutase following training and exercise

Superoxide dismutases (SOD) are physiological antioxidant proteins which scavenge superoxides, a reactive oxygen species capable of producing diverse pathophysiological consequences. Mangano-SOD (Mn-SOD) is a mitochondrial enzyme. Our study presents the first evidence that a single bout of exhaustive exercise (EE) is associated with an increase in plasma Mn-SOD immunoreactivity (IR). Compared to untrained controls, the increase was less in endurance-trained rats supplemented with exogenous glutathione. EE-associated changes in the activity and IR of Mn-SOD were studied in the plasma, liver, skeletal muscles, heart, kidney and lung of trained and control rats.     

增智胶囊治疗小儿智力低下的研究

１９８７年７月至１９９２年６月间，应用新研制的具有健脑、补肾、强身作用的营养性治疗药物增智胶囊治疗小儿智力低下３８１例，一般用药１至２个疗程，以智商（ＩＱ）提高观察疗效。增智胶囊治疗组３８１例，总有效率为８７．６７％，无效１２．３３％，脑复康治疗对照组３６例，总有效率１９．４４％，无效８０．５６％。经另外四家医院二期临床验证２３３例，总有效率８２．８３％，脑复康对照组７８例，总有效率２５．６４％。结果表明增智胶囊是治疗小儿智力低下的有效药物。该研究为小儿智力低下治疗的可能性提供了新的理论和实践依据。     

The effect of nutritional support on weight gain of HIV-infected children with prolonged diarrhoea

AIM: To examine the effect on growth and immunity of enhanced calorie and protein provision to HIV-infected children presenting with prolonged diarrhoea. METHODS: A total of 169 HIV-infected children aged 6-36 months with diarrhoea for 7 days or more were randomly assigned to either standard nutrition support for children with prolonged diarrhoea or an enhanced diet started during hospitalisation and continued after discharge. The change in weight between enrolment and 8, 14 and 26 weeks and changes in plasma HIV-RNA and CD4 cell count at 8 and 26 weeks were estimated. RESULTS: Children receiving enhanced nutrition achieved significantly more weight gain (p < 0.001) between enrolment and 8 weeks than children on the standard diet (median increase in weight-for-age standard deviation score +1.02 vs. +0.01). After 8 weeks median weight velocity was normal and similar in both groups. The change in median CD4 count was similar in both groups. The 26-week mortality rate was high in both groups (standard support: 22%, enhanced support: 29%). CONCLUSIONS: Nutrition support of children with advanced HIV infection and prolonged diarrhoea resulted in significant and sustained weight gain, but did not improve CD4 counts or survival. These results support integrated nutrition interventions for HIV-infected children.