Independent effects of residual renal function and dialysis adequacy on dietary micronutrient intakes in patients receiving continuous ambulatory peritoneal dialysis

BACKGROUND: Dialysis patients are at risk of vitamin and mineral deficiencies, not only because of losses during chronic hemodialysis or peritoneal dialysis but also because of low intakes. OBJECTIVE: The objective was to determine the importance of urea clearance (calculated as K(t)/V) and residual renal function (RRF) in predicting micronutrient intakes in a large cohort of patients receiving continuous ambulatory peritoneal dialysis (CAPD). DESIGN: We conducted a survey of dietary intakes in 242 CAPD patients and divided them into 3 groups according to their weekly urea clearance and RRF: WD group (n = 84), a urea clearance >/= 1.7 and a glomerular filtration rate (GFR) >/= 1 mL x min(-1) x 1.73 m(-2); DD group (n = 71), a urea clearance >/= 1.7 and a GFR < 1 mL x min(-1) x 1.73 m(-2); and ID group (n = 87), a urea clearance < 1.7. RESULTS: Most of the patients had intakes of water-soluble vitamins and minerals that were lower than the recommended dietary allowance; most intakes were significantly higher in the WD group than in the DD and ID groups, except those of niacin and calcium. After age, sex, body weight, and the presence of diabetes were controlled for, total weekly urea clearance and the GFR (but not peritoneal dialysis urea clearance) were significantly associated with intakes of vitamins A and C, the B vitamins, and minerals (calcium, phosphate, iron, and zinc). Low intakes of vitamins and minerals with low RRF and urea clearance were the result of reduced overall food intakes, except for thiamine, vitamin B-6, and folic acid, which were deficient in the diet. CONCLUSIONS: Supplementation with most water-soluble vitamins and minerals, including iron and zinc, should be considered in CAPD patients, especially those with low RRF and low urea clearance. The optimal dose needs to be determined.     

Management of hip dislocation with postural management

BACKGROUND: Hip dislocation in children with cerebral palsy has a well-documented history and morbidity. OBJECTIVE: This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants' postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment. METHODS: The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers' hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed. RESULTS: Children using 'All CAPS' before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05). CONCLUSIONS: Postural management interventions have an important role in the prevention of hip dysplasia.     

Quantitative evolutionary design of nutrient processing: glucose

Quantitative evolutionary design involves the numerical relationships, evolved through natural selection, of biological capacities to each other and to natural loads. Here we study the relation of nutrient-processing capacities of the intestine and of organs beyond it (such as liver and kidneys) to each other and to natural loads of nutrients normally consumed. To control experimentally the rate of nutrient delivery to organs beyond the intestine, we administered nutrients directly into the veins of rats by the method of total parenteral nutrition (TPN). Control rats consuming the TPN solution by mouth ingested glucose at 42 mmol/day and processed it completely, as gauged by negligible appearance of glucose in urine and feces. Experimental rats receiving TPN were able to process infused glucose completely at rates up to 92 mmol/day. At higher infusion rates, they were unable to process further glucose, as gauged by rises in serum and urinary glucose levels and serum osmolality. At the highest infusion rates, they exhibited diuresis, dehydration, and both decreased weight gain and survival. These symptoms closely resemble the human diabetic condition known as nonketotic hypertonicity. Thus, a rat's body has a safety factor of 2.2 (=92/42) for glucose processing: it can process glucose at a rate 2.2 times its voluntary intake. This safety factor represents apparent excess capacity that may have evolved to process other nutrients converted into glucose, to minimize the risk of loads swamping capacities, to handle suddenly increased nutrient requirements, or to effect rapid mobilization of glucose.     

Establishing patient preferences for gastroenterology clinic reorganization using conjoint analysis

OBJECTIVE: The Department of Health states that patients with suspected cancer should be seen within 2 weeks, and the Patients' Charter suggests that patients should not wait for more than 30 min in outpatients. Decisions such as these are often made with little assessment of patient preferences. We have elicited patient preferences for the optimal use of time in the outpatient clinic. DESIGN: Questionnaire survey eliciting preference between different clinic scenarios evaluated using discrete choice conjoint analysis. SETTING AND PARTICIPANTS: Patients attending a teaching hospital gastroenterology outpatient clinic. MAIN OUTCOME MEASURES: The relative importance of time spent on the waiting list, time waiting in the clinic, time spent with the specialist, and time waiting for investigation was assessed using a logit model. RESULTS: Patients placed a similar value on waiting for investigation and time spent on the waiting list. A clinic that had a 2-month waiting list but offered immediate investigations would therefore be more popular than a clinic that had a 2-week waiting list but whose investigations were deferred for 3 months. Patients would be prepared to spend an extra 30 min in the waiting room if they spent 1 month less on the waiting list or waiting for investigation. Time spent with a specialist is valued, and patients would be prepared to spend an extra 3 min waiting in the clinic for every extra minute spent with the doctor. CONCLUSIONS: The present Department of Health recommendations and the Patients' Charter are too simplistic and do not take into account patient preferences.     

Drug induced hypothermia in adult and senescent rats

Temperature regulation was evaluated in senescent (34-40 month old) and adult (8-9 month old) female Iva:WIWU and Emd:Wi-AF/Han rats. Injection of 1.5 mg/kg BW apomorphine HCl or 1.0 mg/kg BW oxotremorine sesquifumarate produced comparable maximal hypothermic responses in adult and senescent rats. However, the latency to reach maximal hypothermia after oxotremorine (but not apomorphine) was longer in senescent than in adult rats of both strains.