Serum Amino Acid Concentrations in Patients Receiving Total Parenteral Nutrition with an Amino Acid Plus Dextrose Mixture

The results of monitoring the serum amino acid concentrations during three infusion regimens using a 5:4 mixture of 70% glucose and the synthetic L-amino acid solution, Synthamin 17 (Travasol) are reported. Twelve stabilized patients received continuous total parenteral nutrition (TPN), eight of whom were subsequently placed on a second regimen of cyclical feeding. A separate group of five patients was infused with amino acids, both with and without simultaneous glucose. The serum amino acid concentrations indicated that the supply of valine, leucine, isoleucine, lysine, and histidine, and the synthesis of taurine from the infused methionine was suboptimal, particularly if the period of TPN was prolonged. The synthesis of tyrosine from phenylalanine appeared to be inversely proportional to the infusion rate of the TPN mixture, in particular the glucose component, resulting in depressed tyrosine and increased phenylalanine concentrations in serum during continuous iv nutrition. Cyclical infusions, on the other hand, permitted the tyrosine and phenylalanine concentrations to return to normal during the noninfusion stage of the cycle. Amino acid measurements enabled us to design an amino acids additive mixture which normalized the serum concentrations in three long-term home parenteral nutrition patients. As a result of these investigations serum amino acid measurements are used routinely to monitor the efficacy of TPN and accommodate any specific amino acid requirements of individual patients. (Journal of Parenteral and Enteral Nutrition 8: 535–541, 1984)     

Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria

International Journal of Clinical Pharmacy - Background Potentially inappropriate prescribing is increasingly common in older patients with falls. However, published indicators to assess...     

Determinants of iron status in Malaysian adolescents from a rural community

Iron deficiency anaemia is the most common micronutrient deficiency worldwide. The prevalence of anaemia in the developing countries is three to four times higher than that in the developed countries. The iron status was assessed in 199 apparently healthy male and female adolescents aged 12–19 years living in a fishing community in Sabah, Malaysia. Data on socio-economic characteristics, lifestyles, anthropometry measurements, iron status, and dietary intake were gathered. Dietary intake of energy, iron, and most nutrients (with the exception of protein and vitamin C) were below the recommended levels for Malaysian adolescents. Three-quarters of the iron was derived from plant foods. The mean haemoglobin value for the male was 13.9±1.3 g/dl with 9.5% having less than 12 g/dl, while the respective figures for the female were 12.4±1.6 g/dl and 28.6%. The mean serum ferritin concentrations for male and female adolescents were 21.5 and 15.4 μg/l, respectively; with 25.7% of the males and 49.5% of the females having deficient levels of ferritin. Dietary intake of total energy and iron, and gender were found to be independent determinants of serum ferritin and haemoglobin levels, accounting for over 40% of the variations for each of these iron indicators. In males, but not in females, the intake of dietary protein and iron, and physical activity were also found to be significant determinants of serum ferritin. The age of subjects and household size were significant determinants of haemoglobin levels for male subjects, but not for female subjects. The findings indicate the importance of adequate intake of energy and dietary iron for improving the iron status of adolescents.     

MGB1 Poor Adherence to Hypertension Treatment Guidelines: An Analysis of Therapeutic Choices

The recent Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) reiterated long-standing recommendations that Stage 1 hypertension (BP ≥ 140/90 mm Hg) without comorbidity should be treated initially with diuretics (DI) or beta blockers (BB). Yet market research suggests that many physicians prefer to use other drug classes, such as calcium channel blockers and ACE inhibitors.
OBJECTIVES: To explore the determinants of therapeutic choice in hypertension.
METHODS: We surveyed by mail a stratified random sample of 10,000 U.S. cardiologists, internists, and family/general practitioners. Physicians were queried about their practice environment and their knowledge, attitudes, and practices regarding antihypertensive therapy, including their choice of drugs to treat patients with specified clinical profiles. The probability that physicians would follow JNC guidelines Stage 1 hypertension was analyzed using multiple logistic regression with stepwise backward elimination to select variable with p < 0.001.
RESULTS: Completed surveys were received from 1,023 physicians. 86.7% prescribe drug therapy for Stage 1 hypertension, and 19.5% (22.5% of drug prescribers) limit their choices to DI and BB. Guideline conformity was higher among physicians who: practice in academic medical centrers; are older; are general practitioners (versus general internists); have smaller caseloads; have fewer hypertensive patients; have higher proportions of HMO, Medicaid, and uninsured patients; and experience more formulary restrictions. Cardiologists and family practitioners were less likely than internists to follow guidelines.
CONCLUSION: JNC guidelines are better accepted by academic physicians, older physicians who have more expenence using DI and BB, physicians with smaller caseloads and hence more time for follow-up and therapy adjustment, and physicians who face drug reimbursement constraints.     

闭合性输尿管损伤的早期诊断

０　引言　腹部钝性伤所致闭合性输尿管损伤罕见,且早期缺乏典型症状,往往延误诊断［１］,造成严重后果．我们采用电视屏幕动态观察下大剂量静脉肾盂造影或逆行造影的方法,早期诊断闭合性输尿管损伤,取得较满意效果．１　临床资料　本组男性５例,女性１例,年龄３岁～３６岁,右侧４例,左侧２例．２例合并肾损伤,１例合并骨盆骨折,右骶髂关节分离,尿道损伤．４例为撞伤、压伤,２例坠落伤．６例均无典型输尿管损伤症状．４例在电视屏幕动态观察下行大剂量静脉肾盂造影,其中１例同时在电视屏幕动态观察下行逆行造影．本组６例,早…     

Type 2 diabetes in the sultanate of Oman

During the past four decades, Oman has undergone a rapid socioe-conomic and epidemiological transition leading to a substantial reduction in the prevalence of various communicable diseases, including vaccine-preventable diseases. Health care planning together with the commitment of policy makers has been a critical factor in this reduction. However, with rapid social and economic growth, lifestyle-related non communicable diseases have emerged as new health challenges to the country. Diabetes and obesity are leading risks posed by the chronic diseases. The burden of diabetes has increased sharply in Oman over the last decade, rising from 8.3% in 1991 to 11.6% in 2000 among adults aged 20 years and older. The World Health Organization (WHO) predicted an increase of 190% in the number of subjects living with diabetes in Oman over the next 20 years, rising from 75,000 in 2000 to 217,000 in 2025. There is a lack of awareness of the major risk factors for diabetes mellitus in the Omani population generally. As education is often the most significant predictor of knowledge regarding risk factors, complications and the prevention of diabetes, health promotion in Oman is deemed critical, along with other prevention and control measures. Suitable prevention strategies for reducing the prevalence of diabetes in Oman are discussed. Recommendations are made for reforms in the current health care system; otherwise, diabetes will constitute a major drain on Oman's human and financial resources, threatening the advances in health and longevity achieved over the past decades.     

Tooth autotransplantation with 3D-printed replicas as part of interdisciplinary management of children and adolescents: Two case reports

The management of missing teeth as a result of dental trauma or associated with hypodontia in children and adolescents presents as a clinical challenge for the dental team. One of the options that is regaining popularity is dental autotransplantation. To improve autotransplantation outcomes, careful interdisciplinary planning, surgical simulation using cone beam computed tomography images and three-dimensional-printed teeth replicas should be undertaken for presurgical preparation. This case report showcases two applications of autotransplantation, with emphasis on interdisciplinary management, presurgical preparation and postsurgical orthodontic and aesthetic management to deliver a good long-term, sustainable, biological outcome, as a part of a comprehensive rehabilitation treatment plan in children.     

Simultaneous determination of retinol and α-tocopherol by high pressure liquid chromatography in micro-volumes of serum

The lack of biochemical data to indicate the prevalence of marginal vitamin A deficiency (VAD) in the country is largely because of the difficulty of obtaining enough serum for analysis, especially from malnourished children. Efforts were therefore made to establish a high-pressure liquid chromatography system (HPLC) for the determination of retinol in micro-volumes of serum. Since our previous studies showed that tocopherol could be simultaneously determined in the same system, studies have been carried out for the determination of both vitamins using retinol acetate and -tocopherol acetate as internal standards. Trials were carried out to determine the most suitable sample treatment procedures and chromatographic system including composition of the mobile phase for handling 20 ml of serum. The HPLC system proposed enables successful separation and quantitation of retinol and α-tocopherol and their respective internal standards, retinol acetate and -tocopherol in less than 14 minutes. Reproducibility studies carried out with pooled sera showed a within day and between day variation of less than 8% and 13% respectively for retinol, whilst variations for α-tocopherol were higher, ranging from 8-16%. The proposed method is currently being applied to the determination of retinol and α-tocopherol in a group of malnourished children under six years of age.