Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

<p>Electrochemical synthesis and characterization of self-doped aniline 2-sulfonic acid-modified flexible electrode with high areal capacitance and rate capability for supercapacitors</p>

Polypyrrole and aniline 2-sulfonic acid (CFt/PPy/ASA(0.03) composite was synthesized on carbon felt (CFt) under acid conditions. Here, we report investigated in concentration of ASA on the electropolymerization of the PPy, to improve performance of supercapacitor by a facile and effective one-step electropolymerization method. To form a 3D carbon felt, homogeneous and large grains are grown on the surface with the addition of ASA, which provides high active mass and potential redox materials of pseudocapacitive supercapacitor. The flexible electrode shows a high specific areal capacitance 4000 mF.cm(-2) at the scan rate of 10 mV.s(-1) and excellent rate capability. A symmetric supercapacitor was also assembled with 1 M H2SO4 electrolyte which delivers a maximum energy density of 18.8 Wh.kg(-1) at a power density of 312.5 kW.kg(-1), and a maximum power density of 1875 kWh.kg(-1) can be reached up while delivering a energy density 2.2 Wh.kg(-1). The device displays retention of capacitance performance 82.7% even after 2500 cycles in aqueous electrolyte on the PPy-based materials. Therefore, (CFt/PPy/ASA(0.03) electrode has an important role in practical applications of flexible, wearable and portable electronics

Oxidative stress response to different exercise intensity with an automated assay: thiol/disulphide homeostasis

The aim of this study was to investigate the effect of different intensity treadmill exercises on the thiol disulphide homeostasis which is a new marker of oxidative stress in rats. Male albino Wistar rats were randomly divided into four groups as follows: control (CNT), low (LEx), moderate (MEx) and high-intensity exercise (HEx) group. Exercise was performed for 4 weeks. Following completion of the experimental protocol, serum total thiol, native thiol and disulphide concentrations were determined using a novel automated measurement method. Additionally, dynamic disulphide status, reduced thiol, oxidised thiol and thiol oxidation reduction percentage ratios were compared among the groups. Disulphide levels were significantly lower in MEx group and highest in CNT group (p = .047). The lowest oxidised thiol and the highest reduced thiol were determined in CNT group (p = .086; p = .083). These findings indicate that moderate-intensity exercise is more effective in reducing oxidative stress than low and high-intensity exercise

Temporalis muscle flap for craniofacial reconstruction after tumor resection

Temporalis muscle flap provides a good solution for the reconstruction of craniofacial defects after tumor resection. Nine patients with complicated defects located at the upper two thirds of the face, anterior cranial base, or mastoid region are presented. Five patients had orbital exenteration, two with total maxillectomy and two with anterior craniofacial resection. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and total maxillectomy cavities and coverage of surface defects. Cranial, oral, and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically easy flap can be preferred for the reconstruction of craniofacial defects after ablative tumor surgery, especially in older and debilitated patients

Elective free-tissue transfer in pediatric patients

Twenty-two elective free-tissue transfers for reconstruction of various defects were performed in 20 pediatric patients over a 7-year period. Patient ages ranged from 5 to 17 years (mean: 12.5 years). There were six open wounds, six unstable scars, five tumor resection defects, three facial gunshot wounds, one facial paralysis, and one penis agenesis. Ten free flaps were transferred to the head and neck region, seven to the lower extremity, four to the upper extremity, and one to the genital area. Ten fasciocutaneous flaps, seven muscle or myocutaneous flaps, and five vascularized bone grafts were transferred. All flaps survived, except for one in an electrical burn patient. The success rate was 95 percent. No vessel spasm was observed. Children tolerated long operation periods better than adults. The recovery time after surgery was considerably shorter than in adults. The mean operative time was 6 hr, and the average hospital stay was 12 days. The mean follow-up period was 27 months. Results of this study indicate that microvascular free-tissue transfer is a safe and reliable method for the reconstruction of various defects in children

An unusual long-term complication of burn injury: malignant fibrous histiocytoma developed in chronic burn scar

Development of malignant tumors in chronic burn wounds is a well-known complication. These tumors are almost always squamous cell carcinomas, although other types of malignancies such as basal cell carcinoma, malignant melanoma and sarcomas can be seen rarely. There are only three previously reported cases of malignant fibrous histiocytoma developed in chronic burn scar in the literature. Two cases with malignant fibrous histiocytoma developed in chronic, badly treated burn wounds are presented. One of the tumors was multifocal and overexpression of the p53 gene was present. Both tumors were excised widely and skin grafted. Regional lymph node dissection was performed in one case. One of the patients died due to tumor recurrence and lymphatic metastases. These cases represent a very uncommon complication of burn injury and indicate the importance of the appropriate primary treatment of the burn wound. (C) 2000 Elsevier Science Ltd and ISBI. All rights reserved

Investigation of aclidinium bromide degradation by stability-indicating HPLC methods, characterization of impurities by NMR, and identification of degradation products by LC-MS

Aclidinium bromide (ACL) is a long-acting muscarinic receptor antagonist used for the long-term treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the degradation of aclidinium bromide under stress and stability testing conditions, for which we developed and validated the first stability-indicating, specific, precise, accurate, and robust assay and related substances HPLC methods. Nine of the compounds used as reference standards were synthesized and fully characterized by H-1 and C-13 NMR, MS, and FTIR techniques. Two of these molecules, namely ACL-dimer and ACL-desphenyl, are novel compounds and reported herein for the first time. Hydrolysis of aclidinium resulted in major degradation via the formation of ACL-desDTG and DTGA metabolites. ACL-desphenyl and phenol were observed only under oxidative conditions at very low levels (< 0.10%), while ACL-hydroxy, known as a metabolite of aclidinium and confirmed by LC/QDa and LC/Q-TOF m/z data, formed under oxidative stress-testing conditions, UV light, and daylight. The identification of two impurities formed only when aclidinium bromide was treated with hydrogen peroxide was done by LC/QDa and LC/Q-TOF studies and the novel structures were proposed as ACL-bromophenoxy and ACL-bromothiophenyl formed via bromination of the phenyl and thiophene ring on the aclidinium, respectively. The stress and photostability testing studies showed that the aclidinium bromide drug substance is not sensitive to elevated temperature (105 degrees C, 10 days), slightly sensitive to daylight and UV-radiation, and it showed significant degradation under all hydrolysis and oxidizing conditions. The related substances HPLC method reported herein is also capable to monitor the potential genotoxic impurity 3-bromopropoxybenzene (3-BPB), a class 2 impurity according to ICH M7, and ensures that the impurity remains below the threshold of toxicological concern (TTC) limit, making it safe for patients

Evaluation of crop water stress index (CWSI) for red pepper with drip and furrow irrigation under varying irrigation regimes

An experiment was conducted to determine the effect of water stress on yield and various physiological parameters including crop water stress index for drip and furrow irrigated processing red pepper in the 2010-2011 growing seasons in the Mediterranean region of Turkey. Drip treatments consisted of full irrigation (DFI), deficit irrigation DDI-75 and DDI-50 which received 75 and 50% of DFI, respectively. D-PRD-50 and DF-PRD-50 alternative and fixed partial root drying, received 50% of DFI. Furrow treatments consisted of full irrigation (FFI), fixed alternative furrow (FAF-50) and PRD furrow (FPRD-50). FAF-50 and FPRD-50 received 50% of water applied to FFI. In FAF-50 the same furrows were irrigated while FPRD-50 was irrigated in alternate furrows. The experimental design was randomized blocks with four replications for drip and furrow treatments. Both irrigation methods and levels had a significant effect on the total yield of red pepper. Drip produced higher red pepper yields than furrow. The highest yield was obtained from the DFI treatment followed by DDI-75, DDI-50 and DF-PRD-50 treatments. Although, D-PRD-50, DF-PRD-50 and DDI-50 received the same amount of water, D-PRD-50 had a higher yield. In furrow, FFI resulted in the highest yield followed by FPRD-50 and FAF-50. The lowest water use efficiency (WUE) was obtained from the DFI while the highest WUE was found in DPRD-50 in drip system. The lowest WUE was found in FFI, and the highest WUE was in FPRD-50 treatment under furrow. The threshold crop water stress index (CWSI) was 0.26 for drip and 0.38 for furrow prior to irrigation. There was a significant relation between yield and CWSI. A high correlation was found between CWSI and leaf area index. The results revealed that DFI for the drip and FFI for the furrow were recommended. Under water scarcity conditions, DDI-75 and D-PRD-50 treatments can be recommended. © 2014 Elsevier B.V.TOVAG-109O693The authors would like to thank the Turkish Scientific and Technical Research Council (TUBITAK) for its financial support for the project TOVAG-109O693

An experimental study of skin flap associated with muscle: Is muscle nourishment possible through the musculocutaneous perforators?

An experimental study was planned to examine whether the blood supply of muscle would be maintained by reverse flow from the cutaneous arteriolar microcirculatory system via the musculocutaneous perforators. A flap model containing both muscle and skin based on the inferior superficial epigastric vessels was designed with the blood supplied directly from the cutaneous arteriolar microcirculatory system, A total of 154 male Wistar Albino rats were divided into three groups. Group I included the standard vertical rectus abdominis musculocutaneous flap based on the superior deep epigastric vessels (N = 48), Group II included the acute cutaneous muscle flap (N = 53). Group III contained the delayed cutaneous muscle flap (N = 53). Skin flap survival area, muscle scintigraphy with technetium-99m-methoxy-isobutyl-isonitrile, microangiography, and histopathological examination of the flaps were conducted. The mean percentage of surviving skin paddle area was 96.4 +/- 5.2%, 84.9 +/- 21.6%, and 91.0 +/- 16.8% in groups I, II, and III respectively. There was no significant difference between groups. Microangiography revealed the blood,flow from skin to muscle through the musculocutaneous perforators. The radioisotope uptake of the muscle flap was expressed as A percentage of the intact contralateral muscle. Mean uptake in group I was 90.1 +/- 4.9% immediately after flap elevation, 62.5 +/- 13.5% on day 2, and 88.3 +/- 12.0% on day 7, These values were 53.7 +/- 7.1%, 63.6 +/- 14,1%, and 89.2 +/- 18.1% in group II, and 64 +/- 7.8%, 75.5 +/- 9.8%, and 92.8 +/- 40:1% in group III. Radioisotope uptake in group I was significantly higher than groups II and III immediately after flap elevation (p < 0,05, analysis of variance), whereas there was no significant difference on days 2 and 7. Histopathological examination revealed surviving muscle tissue without marked atrophy. There was no marked difference between groups histopathologically. These results indicate that muscle tissue may survive by reverse how through the musculocutaneous perforators when elevated with an axial skin flap