Nutritional assessment and preliminary report on early support of the trauma patient.

The high nitrogen demands imposed by severe trauma may quickly render the injured patient malnourished. Nutritional assessment of these patients is confused by tissue damage, shock, blood loss, operation, and anesthesia. Consequently, standard nutritional markers do not correlate well with immunocompetence and postoperative morbidity. For this reason we devised an abdominal trauma index (ATI) based on the anatomical severity of injury. The ATI is calculated by assigning a risk factor (1-5) to each organ injured and then multiplying this by a severity-of-injury estimate (1-5). The sum of the individual organ scores comprises the final ATI. The incidence of postlaparotomy complications is low (5%) with an ATI less than 15, intermediate (15%) with 15-25, and high (50%) with greater than 25. Having identified the high-risk trauma patient, we initiated a prospective randomized study to assess the cost-benefit of early nutritional support. Patients with an ATI greater than 15 were allocated to a control group (no supplemental nutrition during first five postoperative days) or enteral-fed group. The enteral group had a needle catheter jejunostomy (NCJ) placed at laparotomy. The constant infusion of an elemental diet (Vivonex HN) was begun at 18 hours postoperatively and advanced to 3,000 cc/day within 72 hours. To date 26 patients (14 control, 12 enteral) have been entered in this study. At one week, nitrogen balance in the control group (?12.9 to -11.1 g/day) continues to be negative compared to a positive trend (?12.2 to +3.3 g/day) in the fed group. In control patients serum albumin (3.54 +/? 0.16 to 3.19 +/? 0.15 g%) and transferrin (227 +/? 11 to 204 +/? 10 mg%) decrease while in the enteral patients albumin (3.27 +/? 0.11 to 3.34 +/? 0.15 g%) and transferrin (229 +/? 10 to 234 +/? 12 mg%) remain stable. Although the incidence of overall morbidity is similar, septic complications occurred in 29% (4/14) of the control group compared to none in the enteral group. Our experience suggests the following: (1) Anatomical severity of injury is a better predictor of postinjury septic morbidity than standard nutritional markers; (2) immediate postoperative feeding by NCJ is safe and feasible; and (3) early nutritional support decreases the incidence of septic complications in the severely injured patient.     

A note on the value of folic acid in the treatment of macrocytic anaemia in assam tea garden labourers

The results of treatment with folic acid in 20 severe cases of pregnancy or nutritional anaemia are recorded. As judged by European standards, the final results are anything but normal, but they do demonstrate the life-saving properties of folic acid which should be regarded as a specific drug in this difficult and often fatal condition.     

Nutritional rehabilitation of mitochondrial aberrations in aplastic anaemia

Aplastic anaemia (AA) is a disease characterised by bone marrow hypocellularity and peripheral blood pancytopenia. AA is also associated with mitochondrial aberrations. The present study was undertaken primarily to test the hypothesis that a nutrient mixture could affect the nutritional rehabilitation of mitochondrial aberrations in AA mice. BALB/c AA mice were induced by a combination of hypodermic injections of acetylphenylhydrazine (100?mg/kg), X-rays (2·0?Gy) and intraperitoneal injections of cyclophosphamide (80?mg/kg). We treated these mice with nutrient mixture-supplemented diets in a dose-dependent manner (1445·55, 963·7, 674·59?mg/kg per d), and the effects of the nutrient mixture for mitochondrial rehabilitation were analysed in AA mice. Transmission electron microscopy showed that mitochondrial ultrastructural abnormalities in bone marrow cells, splenocytes and hepatocytes of the nutrient mixture groups were restored markedly, compared with the AA group. Mitochondrial membrane potentials of the nutrient mixture groups were increased remarkably. Western blot analysis also revealed that the nutrient mixture significantly inhibited cytochrome c release of mitochondria in the AA group. Furthermore, the mitochondrial DNA content of the nutrient mixture groups was also increased. Our data suggest that the nutrient mixture may promote the rehabilitation of mitochondrial aberrations, and consequently protects against mitochondrial dysfunction in AA mice.     

Infection and the IUD. A preliminary report.

This is a preliminary report to answer the question: “Does the IUD increase the incidence of pelvic infection?” From one hospital, the percentage of young women with a discharge diagnosis of Pelvic Inflammatory Disease (PID) who were wearing an IUD at the time of admission was calculated. With precisely the same definitions, the percentage of young women utilizing an IUD who were discharged from the same hospital as having had appendicitis was determined. Thus far, a statistically significant correlation between IUD usage and P.I.D. could not be demonstrated. A larger study is current.     

Nutritional assessment and preliminary report on early support of the trauma patient

The high nitrogen demands imposed by severe trauma may quickly render the injured patient malnourished. Nutritional assessment of these patients is confused by tissue damage, shock, blood loss, operation, and anesthesia. Consequently, standard nutritional markers do not correlate well with immunocompetence and postoperative morbidity. For this reason we devised an abdominal trauma index (ATI) based on the anatomical severity of injury. The ATI is calculated by assigning a risk factor (1-5) to each organ injured and then multiplying this by a severity-of-injury estimate (1-5). The sum of the individual organ scores comprises the final ATI. The incidence of postlaparotomy complications is low (5%) with an ATI less than 15, intermediate (15%) with 15-25, and high (50%) with greater than 25. Having identified the high-risk trauma patient, we initiated a prospective randomized study to assess the cost-benefit of early nutritional support. Patients with an ATI greater than 15 were allocated to a control group (no supplemental nutrition during first five postoperative days) or enteral-fed group. The enteral group had a needle catheter jejunostomy (NCJ) placed at laparotomy. The constant infusion of an elemental diet (Vivonex HN) was begun at 18 hours postoperatively and advanced to 3,000 cc/day within 72 hours. To date 26 patients (14 control, 12 enteral) have been entered in this study. At one week, nitrogen balance in the control group (-12.9 to -11.1 g/day) continues to be negative compared to a positive trend (-12.2 to +3.3 g/day) in the fed group. In control patients serum albumin (3.54 +/- 0.16 to 3.19 +/- 0.15 g%) and transferrin (227 +/- 11 to 204 +/- 10 mg%) decrease while in the enteral patients albumin (3.27 +/- 0.11 to 3.34 +/- 0.15 g%) and transferrin (229 +/- 10 to 234 +/- 12 mg%) remain stable. Although the incidence of overall morbidity is similar, septic complications occurred in 29% (4/14) of the control group compared to none in the enteral group. Our experience suggests the following: (1) Anatomical severity of injury is a better predictor of postinjury septic morbidity than standard nutritional markers; (2) immediate postoperative feeding by NCJ is safe and feasible; and (3) early nutritional support decreases the incidence of septic complications in the severely injured patient.     

Selective dysacusis--a preliminary report.

The symptom of poor speech discrimination in the presence of background noise is a well-recognized feature of elevated hearing thresholds due to cochlear damage. Similar symptoms occasionally occur in patients with no detectable audiological abnormality. In a study to evaluate the frequency selectivity of such patients consistent abnormalities were found using an electrophysiological technique based on extratympanic electrocochleography. These findings indicated that frequency specific responsiveness of the cochlea may be affected before conventional behavioural tests reveal abnormalities. This syndrome has been described as selective dysacusis.     

Nutritional anaemia dysregulates endocrine control of fetal growth

Severe anaemia is associated with increased low birth weight and Barker's hypothesis of 'fetal origins' proposes that a nutritional insult during critical periods of development results in adaptations that predispose individuals to adult onset diseases. We hypothesize that endocrine alterations may occur in the maternal-fetal milieu as a consequence of nutritional anaemia during pregnancy. We examined the quantitative variations in hormonal profiles in paired maternal and cord blood samples obtained from mothers and their neonates who were classified based on maternal anaemia status. Our results show that: (1) 74.6 % of the mothers enrolled in the study were anaemic, of which 85.2 % had moderate anaemia and 14.7 % had severe anaemia; (2) anthropometric parameters measured in the mothers indicate that severely anaemic mothers had a significantly low pre- and post-pregnancy weight, a significantly decreased maternal fundal height and abdominal circumference; (3) anthropometric measures in the neonates born to severely anaemic mothers show a significant reduction in ponderal index, birth weight and placental weight; (4) significant increase in both maternal, fetal insulin-like growth factor 1, ferritin levels and increased maternal erythropoietin levels were observed with an increase in severity of anaemia; (5) decreased T3 and increased prolactin levels were observed in the maternal blood of severely anaemic mothers as compared with the control group. An insight into the endocrine modulation to overcome a growth disadvantage due to nutritional anaemia in pregnancy may lead to a better understanding of fetal adaptations invoked when the maternal-placental nutrient supply fails to meet the fetal nutrient demand.     

Nutritional status and growth parameters of school-age Roma children in the Republic of Macedonia

Main objective of the study was to assess the nutritional status of school age Roma children in Macedonia in order to detect precursors of possible health risks at an early age. The study was designed as a comparative case control study. Study group consisted of 229 Roma school children from the 1st and 272 from the 5th grade residing in different towns in Macedonia. The control group was recruited from other than Roma ethnic background and consisted of 283 children attending 1st and 356 children attending 5th grade. Every participant was measured for his/hers body height and weight. The t-test and Chi square (Chi2) were applied to test statistical significance of variables. The WHO's AnthroPlus software was applied to assess growth parameters and population at risk. There were significant differences in values of the body weight (p = 0.001) and height (p = 0.001) between Roma and non-Roma children attending the 1st grade of primary school. Weight-for-age, height-for-age and BMI-for-age indexes of the 1st grade children significantly differred in in the same intervals of SD (> or = -2SD and < -1SD; > or = -1SD and median; > +1SD and < or = +2SD; between Roma and non-Roma 5th graders. Anthropometric parameters of nutritional status of Roma children in Macedonia are significantly different than those of their non-Roma peers. Their health risks are predominantly related to underweight. The parameters related to health risks of overweight or obesity are lower in Roma than in non-Roma children.     

Screening for risks of cardiovascular disease in children. A preliminary report.

1. The results obtained for 236 Viennese schoolchildren between 11 and 12 years of age indicated that 38% of children had an increased concentration of cholesterol in their serum and 3% had an increased serum triglyceride concentration. 2. The results of the preliminary study suggested that, by extending the dimensions of the screening, further problems, for example the correlation between different 'risk' factors and the significance of nutritional habits, might be studied.