Parenteral Nutrition Electrolyte Abnormalities and Associated Factors Before and After Nutrition Support Team Initiation.

BACKGROUND: Studied since the 1940s, refeeding syndrome still has no universal definition, thus making comparison of studies difficult. Negative outcomes (eg, metabolic abnormalities) may occur with the use of specialized nutrition, such as parenteral nutrition (PN). Less than half of medical institutions have a nutrition support team (NST) managing PN. Interdisciplinary team management of PN may reduce negative outcomes of PN. The objective of this study was to show the value of the NST by measuring differences in PN variables, especially electrolyte abnormalities (EAs), before and after NST initiation at a large medical center and to identify factors associated with EAs among adult subjects receiving PN. MATERIALS AND METHODS: During this retrospective study, computerized medical charts (N = 735) from 2007-2010 were reviewed for electrolyte changes (particularly potassium, magnesium, and phosphorus) the first 3 days following PN initiation in hospitalized adults. Changes in EAs with other variables were compared before and after NST implementation. Equivalent samples sizes were collected to better evaluate the impact of the team. RESULTS: Following the implementation of the NST, fewer EAs were seen in PN patients (53%; χ2  = 10.906, P = .004); significantly less potassium, phosphorus, and magnesium intravenous piggyback supplementation (88.8% vs 94%; χ2  = 5.05, P = .026) was used; and mortality within 30 days of PN cessation was significantly less (12.7% vs 10.6%, P = .012). CONCLUSION: Our study complements existing research, finding that an NST was associated with a decreased occurrence of EAs and mortality in the hospitalized adult receiving PN.

Delivered volumes of enteral nutrition exceed prescribed volumes.

BACKGROUND: Enteral nutrition (EN) provisions are typically calculated based on a 24-hour infusion period. However, feedings are often interrupted for daily activities, procedures, or gastrointestinal intolerance. The study's objective was to determine the delivered EN quantities provided to stable hospitalized patients, using cellular time and measured volumes to verify our EN calculation adjustment. METHODS: A supply of consecutively numbered ready-to-hang (RTH) EN product was delivered to the bedside of 26 inpatients with established EN tolerance at goal rates on various types of nursing units. The dietitian weighed the volume remaining in the infusing product and recorded the measurement time. On the following days, the dietitian continued to weigh the infusing RTH product and the empty RTH bottles saved by nursing. The primary outcome was the difference between the prescribed and delivered EN provisions, which was calculated with a paired t test. RESULTS: Patients received significantly more calories in the delivered enteral feeding (mean [SD], 1678 [385] kcal) than prescribed calories in the EN order (1489 [246 kcal]; t = 3.736, P = .001), adjusting for observed time. No significant differences were found between nursing units, product, and rate. CONCLUSION: EN delivered may actually exceed ordered amounts by 5%­21% (mean, 12%) with feeding pump inaccuracy as the primary contributing factor. This differs from what others have found. Our findings support using a volume-based ordering system vs a rate-based ordering system for more accurate EN delivery.

Factores de riesgo para las enfermedades periodontales / Risk factors for periodontal diseases

Introducción: las periodontitis son enfermedades multifactoriales que afectan a individuos susceptibles. El principal factor etiológico de las periodontitis es el biofilm de la placa dentobacteriana, los factores de riesgo pueden estar asociados con ellas pero no necesariamente las causan. Existen numerosos factores de riesgo pero solo unos pocos tienen evidencia científica que muestra una relación causal con las periodontitis. El propósito del presente artículo es hacer una breve revisión de la literatura más relevante sobre los factores de riesgo para las periodontits y analizar el desarrollo de un enfoque de riesgo multifactorial, con miras a adoptar la prevención como plan de trabajo en el campo de la periodoncia. Métodos: se revisaron publicaciones y revisiones sistemáticas de la literatura de la última década. Resultados: basados en estudios longitudinales se han verificado como factores de riesgo: el tabaquismo, la diabetes mellitus mal controlada y la colonización de los tejidos periodontales por alto número de bacterias específicas. Conclusión: los factores de riesgo pueden tener un papel significante en la patogénesis de las periodontitis, para lograr el manejo efectivo de estas lo más lógico es la identificación y el control de estos factores.

Introduction: periodontitis are multi-factorial diseases that affect susceptible individuals. Microbial dental plaquebio-film is the main etiological factor, although several other local and systemic factors have important modifying roles on its pathogenesis. Those risk factors are associated with the disease, but they do not necessarily cause it. Numerous risk factors do exist, but only a few of them have scientific evidence that show a causal relationship with periodontitis. The purpose of this article is to make a brief review on of the most relevant literature related to risk factors in periodontitis and to develop a multi-factorial risk approach that emphasizes on the importance of prevention as a work plan in the area of periodontology. Methods: publications of the last ten years were reviewed. Results: based on controlled longitudinal studies, the risk factors identified were: smoking habit, Diabetes Mellitus with low glycemic control, and colonization of tissue by a high number of specific bacteria. Conclusion: risk factors may have a significant role on the pathogenesis of periodontitis. Effective disease management should include identification and control of risk factors.

Evaluación de los enfoques terapeúticos para las varias formas de enfermedad periodontal: parte III: prevalencia de bacilos entéricos y levaduras / Evaluation of the therapeutic approach of various typesof periodontal disease: part III: enterobacteriaceae entericrods and yeast species

Introducción: (véanse partes I y II) esta publicación se enfoca en la prevalencia de bacilos entéricos y levaduras en muestras de placa subgingival de los 69 pacientes de la investigación. Estudios preliminares sugieren una asociación entre bacilos entéricos y algunos tipos de patógenos periodontales. Se realizó análisis microbiológico y se determinó la susceptibilidad a los siguientes antibióticos: Ciprofloxacina, Metronidazol, Amoxicilina, Tetraciclina y Clindamicina. Métodos: las características socio-demográficas (edad, género, tabaquismo y agrupación familiar) y los parámetros clínicos (profundidad sondeable, nivel de inserción, sangrado superficial y sangrado al sondaje) se evaluaron al comienzo, a los 3, 6, 12 y 24 meses, se tomaron muestras microbiológicas de 6 sitios por paciente al inicio del estudio, a los 12 y 18 meses. Los resultados de este estudio con relación a la presencia de bacilos entéricos y de Candida albicans sólo obedecen al primer cultivo, que es cuando se mide la prevalencia, aunque a todos los pacientes se les hizo seguimiento durante dos años, después de realizarles la terapia periodontal no quirúrgica convencional. Se realizó un análisis descriptivo en el cual se obtuvieron las frecuencias, proporciones y prevalencias de aparición de los bacilos entéricos y levaduras para el grupo total de pacientes, de buenos y malos respondedores mediante tablas de distribución de frecuencias y gráficos de barras compuestas. Resultados: se presentó una prevalencia de bacilos entéricos, entre ellos Escherichia coli, Klebsiella spp, Enterobacter spp y también de levaduras en la microflora subgingival de los pacientes con periodontitis n=69 (36.2%), tanto de buenos n=57 (33.3%) como de malos respondedores n=12 (49.9%). Conclusión: del estudio se puede concluir que E. coli fue el microorganismo que se presentó en mayor porcentaje en ambos grupos de pacientes. De acuerdo al test de...

Introduction (see parts I and II): this publication is focused on the prevalence of enteric rods and yeasts species in samples taken from subgingival plaque of 69 patients included in the investigation. Preliminary studies suggest an association between enteric rods and some types of periodontal pathogens. Microbiological analysis was realized by means of culture, and susceptibility was determined for the following antibiotics: Ciprofloxacin, Metronidazole, Amoxicillin, Tetracycline and Clindamycin. Methods: evaluations of the socio-demographic criteria (age, gender, tobacco use, and family grouping), and clinical parameters (probing depth, clinical attachment, superficial bleeding, and probing bleeding) were made at the beginning, 3, 6, 12, and 24 months. Microbiological samples of each patient were taken from 6 different sites at the beginning of the study, 12 and 18 months. The results corresponding to the presence of enteric rods, and Candida albicans are only part of the first sample, which measured the prevalence, although all the patients had a follow up of two years after conventional non surgical periodontal therapy. A descriptive analysis was made, which determined the frequency, proportion, and prevalence of enteric rods and yeasts in both groups, good and poor responders, shown in frequency distribution tables and compound bar charts. Results: the most prevalent species, found in subgingival microflora in patients with periodontitis n=69(36.2%) including both, good n=57 (33.3%) and poor responders n=12 (49.9%) were enteric rods, mainly Escherichia coli, Klebsiella spp and Enterobacter spp, and yeasts. Conclusion: Escherichia coli had the highest prevalence percentage in both, good and poor responders. According to antimicrobial susceptibility test, Ciprofloxacin would be the antibiotic of choice in subjects with periodontitis and with enteric rods.

Proyecto educativo: maternidad-paternidad como proyecto de vida de los adolescentes / Education projet: the relationship maternity-paternity as a life project of adolescents

Este proyecto analiza los problemas a los que está sometida la población adolescente de Colombia, desde los generales de su edad hasta los específicos de la época que le ha tocado vivir, donde debe enfrentar una sociedad en crisis sociales, económicas y culturales, y con rupturas comunicacionales, que le exige una compleja capacidad de adaptación. Si los adolescentes no logran esta adaptación presentan conflictos consigo mismo, la familia, la escuela, y la comunidad, cuyas consecuencias se reflejan en problemas sociales como la violencia, y la maternidad-paternidad no deseada. En esta última, predominan uniones libres inestables, lo que lleva Para intervenir dichos pcentes, mediante entos de autoestid, integridad yrar como efecto que la decisión de tener un hijo sea un proceso insc rito en su proyecto de vida quea contribuya a su bienestar y utocuidado, que sean favorables para la vida y logmaa su salud reproductiva. Así s, respeto, libertad, voluntad responsable, igualdalae puede influir sobre la incidencia del embarazo no deseado y su s estrategias de promoción de la salud, comportamiroimpacto social.blemas, este proyecto busca promover en los adolesa las adolescentes a asumir la crianza de sus hijos.Este proyecto se sustenta en un marco social, institucional y teórico conceptual.