Potential of essential fatty acid deficiency with extremely low fat diet in lipoprotein lipase deficiency during pregnancy: A case report

BACKGROUND: Pregnancy in patients with lipoprotein lipase deficiency is associated with high risk of maternal pancreatitis and fetal death. A very low fat diet (< 10% of calories) is the primary treatment modality for the prevention of acute pancreatitis, a rare but potentially serious complication of severe hypertriglyceridemia. Since pregnancy can exacerbate hypertriglyceridemia in the genetic absence of lipoprotein lipase, a further reduction of dietary fat intake to < 1–2% of total caloric intake may be required during the pregnancy, along with the administration of a fibrate. It is uncertain if essential fatty acid deficiency will develop in the mother and fetus with this extremely low fat diet, or whether fibrates will cross the placenta and concentrate in the fetus. CASE PRESENTATION: A 23 year-old gravida 1 woman with primary lipoprotein lipase deficiency was seen at 7 weeks of gestation in the Lipid Clinic for management of severe hypertriglyceridemia that had worsened with pregnancy. While on her habitual fat intake of 10% of total calories, her pregnancy resulted in an exacerbation of the hypertriglyceridemia, which prompted further restriction of fat intake to < 2% of total calories, as well as administration of gemfibrozil at a lower than average dose. The level of gemfibrozil, as the active metabolite, in the venous and arterial fetal cord blood was within the expected therapeutic range for adults. The clinical signs and a biomarker of essential fatty acid deficiency, namely the ratio of 20:3 [n-9] to 20:4 [n-6] fatty acids, were closely monitored throughout her pregnancy. Despite her extremely low fat diet, the levels of essential fatty acids measured in the mother and in the fetal blood immediately postpartum were normal. Normal essential fatty acid levels may have been achieved by the topical application of sunflower oil. CONCLUSIONS: An extremely low fat diet in combination with topical sunflower oil and gemfibrozil administration was safely implemented in pregnancy associated with the severe hypertriglyceridemia of lipoprotein lipase deficiency

Identification of Resource Use and Associated Costs for Viral Meningitis

ABSTRACT Purpose: This study involved identifying resource use and assigning monetary value to the diagnostic work-up and management of viral meningitis. Methodology: Using a previously established decision analytic framework, various resources were identified as part of routine management of viral meningitis. Secondary database analyses were used to quantify resources and assign a monetary value as a part of routine management of viral meningitis requiring use of the resource units identified in the decision analytic framework. Discharge data sources from the states of California, Florida, and Illinois, and Medicaid data sources from the state of Pennsylvania, were used for the purpose of analysis. Principal Findings: Physician visits, emergency room visits, hospital admissions, procedures, and medications were identified as the major resources used. Lumbar punctures, CT scans, and antibiotics were identified as the major procedures and medications utilized. No significant difference was found in the major resources used between the states&apos; discharge data and the Medicaid data sources. The mean total charges for patient admissions with CT scans were significantly higher than for patient admissions without CT scans ($11,531.80 vs.$7,841.30, P&lt;0.05). The mean lengths of stay for patients with CT scan were significantly higher than for patient admissions without CT scans (4.71 days vs. 3.88 days, P&lt;0.05). The patient readmission rate was 10.7 percent, while the readmission rate for episodes with more than one hospitalization was 11.1 percent. The mean charge associated with readmission was $12,200

Attitudes Towards Computers

Attitude to use of computers and perceived effects of use of computers on the American economy as well as on the individual. Topics: Judgement on occupational and private experiences with computers; intensity of contacts with computers; image of occupations in the computer area and image of the computer (scales); assessment of the importance of computers in various areas; expected innovations from use of computers; attitude to an extensive use of computers by government and management; attitude to storage of personal data in databases; problems of data protection and increasing surveillance of the individual. Demography: age (classified); sex; school education; occupation; income; political orientation; state.Einstellung zum Gebrauch von Computern und perzipierte Auswirkungen des Computereinsatzes auf die amerikanische Wirtschaft sowie auf das Individuum. Themen: Beurteilung der beruflichen und privaten Erfahrungen mit Computern; Intensität des Umgangs mit Rechnern; Image von Berufen im Computerbereich und Image der Computer (Skalen); Einschätzung der Wichtigkeit der Computer in verschiedenen Bereichen; erwartet Innovationen durch Computereinsatz; Einstellung zu einem umfangreicheren Computereinsatz durch die Regierung und Verwaltung; Einstellung zur Speicherung persönlicher Daten in Datenbanken; Probleme des Datenschutzes und der zunehmenden Überwachung des einzelnen. Demographie: Alter (klassiert); Geschlecht; Schulbildung; Beruf; Einkommen; politische Orientierung; Bundesland