Case Study: Nutrition in the ICU and multi-organ failure

The following case study was discussed at the recent SASPEN Congress held at Spier Estate, Stellenbosch, South Africa. The case study was adapted from the original and used with the kind permission of Fresenius Kabi, Germany. Herewith follows a summarised discussion of the case. It is a reflection of the general opinion of the audienc

Darbepoetin alfa: A new therapeutic agent for renal anemia

Darbepoetin alfa: A new therapeutic agent for renal anemia. Darbepoetin alfa is a super-sialylated analog of human erythropoietin that has a longer circulating half-life in vivo compared to both native and recombinant hormone. It has the same mechanism of action as erythropoietin, stimulating the same surface membrane receptor and triggering the same intracellular chain of events. An extra two N-linked carbohydrate chains, however, gives darbepoetin alfa greater metabolic stability in vivo, and its terminal half-life after intravenous administration is approximately three times longer than for intravenous erythropoietin. This in turn allows injections of the drug to be given less frequently, and studies have shown that once-weekly and once-every-other-week dosing can maintain the hemoglobin concentration in patients with renal anemia. The recommended starting dose for darbepoetin alfa is 0.45 μg/kg once weekly for both IV and SC administration, with subsequent titration based on the hemoglobin concentration. The adverse event profile is very similar to that seen with rHuEPO, and no antibodies have been detected in several thousand patients exposed to the drug, some of whom have been treated for up to five years now. Following a clinical research program that began in November 1996, darbepoetin alfa was finally approved by the European Commission in June 201, and by the FDA in September 201

Signature Strengths: A Positive Psychology Intervention with Informal Caregivers

The adverse effects of caregiving on informal caregivers’ physical and mental health are well documented (Pinquart & Sorensen, 2003; Vitaliano, Zhang, & Scanlan, 2003). Many evidence-based treatments exist to address caregiver distress and burden (Gallagher-Thompson & Coon, 2007). Positive aspects of caregiving, however, have received considerably less attention in the literature. At present, there are relatively few interventions that have a primary focus on improving positive aspects of caregiving. The current study tested an established positive psychology intervention with informal caregivers of older adults. This internet-based study employed a three group randomized controlled design. One hundred and fifty-five women caring for an older adult were randomly assigned to one of three conditions: a standard version of the “using signature strengths in new ways” exercise (Seligman, Steen, Park, & Peterson, 2005), a modified version of the exercise adapted for the caregiving domain, and a survey only control group. Participants across all conditions reported significant increases in happiness, F (2, 174) = 3.54, p = .04, ηp2 = .04, 90% CI [.002, .089] and greater satisfaction with life F (2, 170) = 9.38, p p2= .10, 90% CI [.03, .17] over their time in the study. Participants who received the “using signature strengths” intervention showed a significant decrease in depressive symptoms compared to the control group at one-month follow-up, F (1, 88) = 4.44, p = .04, ηp2= .05, 90% CI [.00, .14]. The modified version of the exercise did not out perform the other conditions on positive caregiving measures, although, secondary analyses did reveal significant increases in positive aspects of caregiving for the modified condition at one-month follow-up compared to baseline, t (29)= -2.34, p = .03, d = -.36, 95% CI [.06, .79]. Results were mixed with regard to clear intervention effects for the “using signature strengths in new ways” exercise. However, caregivers in this study did experience improved well-being, which points to a potential role for positive psychology interventions to augment existing caregiver interventions

Nutrition, anaemia and erythropoietin therapy

This article has no abstract

Oliver Messiaen: Structural aspects of the pianoforte music

Not availabl

Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation

<p><b>Background and Purpose:</b> Mechanisms of early neurologic deterioration after treatment with intravenous, recombinant, tissue-type plasminogen activator (IV rt-PA) include symptomatic intracerebral hemorrhage (SICH) and early recurrent ischemic stroke. We observed a number of cases of acute deterioration due to recurrent ischemic events.</p> <p><b>Methods:</b> We undertook a single-center, retrospective analysis of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008 to define the incidence of early neurologic deterioration (>= 4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism. Deterioration was attributed to SICH when associated with a PH1 or PH2 hemorrhage on postdeterioration computed tomography scans, to recurrent ischemic stroke when there was clinical and radiologic evidence of a new territorial infarction or new vessel occlusion, and otherwise to evolution of the incident stroke.</p> <p><b>Results:</b> Of 228 consecutive IV rt-PA-treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischemic events, which were significantly associated with atrial fibrillation (present in 5 of 6 patients; 4 paroxysmal, 1 permanent). In 4 patients, sudden clinical deterioration developed during or shortly after IV rt-PA infusion, and in 2, deterioration developed 3 days later. All died 2 days to 2 weeks later. The single case without atrial fibrillation had a recurrent, contralateral, middle cerebral artery stroke during IV rt-PA infusion and multiple high-signal emboli detected by transcranial Doppler. Early recurrent ischemic stroke accounted for 5 of 12 (42%) cases of early neurologic deterioration in patients with atrial fibrillation.</p> <p><b>Conclusion:</b> In this single-center series, the incidence of early recurrent ischemic stroke after IV rt-PA was 2.6% and was associated with previous atrial fibrillation.</p&gt

High Rates of Exposure to Simulated Winter Storm Cues Negatively Affect White-Throated Sparrow (Zonotrichia albicollis) Energy Reserves

Birds are often able to cope with, and respond to, inclement weather with physiological and behavioral responses. As storms become more severe or frequent as a result of climate change, the adaptive coping responses of many species may be pushed beyond current tolerance limits. We investigated the effects of experimental recurrent inclement winter weather cues on body composition, glucocorticoid hormones, and behavior of white-throated sparrows (Zonotrichia albicollis). We used a hypobaric climatic wind tunnel to simulate storms by transiently decreasing barometric pressure and temperature, and measured behavioral responses, body composition, and baseline corticosterone levels in birds exposed, or not exposed (control), to different frequencies of simulated storms. In study 1, experimental birds were exposed to one storm per week over 9 weeks. In study 2, experimental birds were exposed to two storms per week over 12 weeks. Birds exposed to one simulated storm per week had higher fat and lean masses than control birds, with no differences in the amount of time groups spent feeding. This change in body composition suggests that birds were coping by increasing energy stores. In contrast, birds exposed to two simulated storms per week had lower fat masses compared to control birds, even though they spent more time feeding. Experimental birds in study 2 also had lower baseline corticosterone levels than controls. These changes suggest that the coping response observed in study 1 was not possible in study 2. These findings provide novel experimental evidence that birds detect and respond to changes in temperature and barometric pressure independent of other storm-related cues. One simulated storm per week resulted in potentially adaptive responses of increased mass. However, increasing the frequency of storm exposure to twice per week exceeded the birds’ capacity to maintain these energy reserves. These results also experimentally demonstrate that repeated exposure to inclement weather cues can directly affect birds’ energy reserves, even in the absence of a storm itself, with strong implications for survival as severe weather events continue to become more prevalent