[Differences in the selenium supply of cattle across Europe]. / Saisonale und überregionale Unterschiede im Selenversorgungsstatus von Rindern.

OBJECTIVE: Evaluation of differences in the selenium supply of cattle across Europe. MATERIAL AND METHODS: A total of 35,722 serum samples from cattle throughout Europe (unknown clinical status), which had been sent by veterinarians to the IDEXX Vet Med Lab Ludwigsburg, Germany between January 1st, 2006, and June 30th, 2013, were analyzed routinely for the selenium concentration using ICP-analysis. RESULTS: The collective data of the selenium concentration in cattle serum display seasonal variations, with a lower concentration during summer when compared to the winter. In recent years, the selenium supply has decreased. The farm size, husbandry conditions, economic situation, soil selenium concentration and the countries' specific feeding together play a key role in the selenium supply of the herd. Hungary and the Scandinavian countries Sweden and Denmark show the best selenium supply in Europe. A very poor situation exists in France and Luxembourg (> 50% of the cattle samples are undersupplied). CONCLUSION AND CLINICAL RELEVANCE: An optimal selenium supply for cattle is very important; a trace element deficiency can cause negative health effects and impair herd performance. The selenium concentration varies considerably, depending upon feeding and husbandry conditions. Therefore, a serum selenium analysis in cattle is essential and should be performed annually.

Selenium deficiency in pediatric patients with intestinal failure as a consequence of drug shortage.

BACKGROUND: Parenteral nutrition (PN) is a lifesaving therapy for children with intestinal failure and can now be used chronically without the life-threatening complications of the past. Adequate intravenous trace element supplementation is required as part of a complete nutrition prescription. According to the U.S. Food and Drug Administration (FDA), the number of drug shortages, including sterile injectable agents used as PN components, has increased since 2010. Selenious acid as an individual additive was recently unavailable at our institution for 9 months due to a national shortage. MATERIALS AND METHODS: To assess the impact of the selenious acid shortage, we retrospectively compiled data from existing clinical records for eligible patients. We included children with intestinal failure on full PN support who were older than 1 year at the onset of the selenium shortage. Whole-blood selenium concentrations prior to the selenious acid shortage were compared with concentrations drawn during the shortage. RESULTS: Five patients with intestinal failure and complete PN dependence were identified, and all 5 patients had normal serum selenium concentrations prior to the shortage. All 5 patients developed severe biochemical selenium deficiency in direct correlation with the shortage of selenium. No morbidity associated with selenium deficiency was observed. Selenium concentrations recovered after selenium supplementation was reinstituted. CONCLUSION: A national selenious acid shortage was associated with biochemical selenium deficiency in a cohort of children with intestinal failure. Despite very low selenium concentrations, none of our patients exhibited clinical signs of deficiency.

Drug shortages as an impetus to improve parenteral nutrition practices.

PURPOSE: A medical center's implementation of adult and pediatric parenteral nutrition (PN) algorithms and other strategies for managing PN ingredient shortages are described. SUMMARY: In response to nationwide shortages of amino acids and other PN ingredients in 2010, a large Massachusetts teaching hospital undertook a quality-improvement initiative to ensure appropriate patient selection for PN therapy. A clinical pharmacist was designated as a nutrition support leader with responsibility for the management of PN practices. Clinical pharmacists collaborated with clinical dietitians to establish PN eligibility criteria based on established practice guidelines and developed evidence-based adult and pediatric nutrition support algorithms. In addition, (1) physicians were required to obtain a nutrition service consultation before initial prescribing of PN therapy, (2) the initial ordering of PN therapy through the computerized prescriber-order-entry (CPOE) system was restricted to clinical dietitians and clinical pharmacists, (3) the use of premixed PN solutions at the discretion of dietitians was increased, and (4) the practice of adding i.v. multivitamins and trace elements to PN solutions was restricted. During the first year after implementation of the PN algorithms, CPOE restrictions, and other process changes, PN orders were reduced by an average of five orders per day relative to the preceding 11-month period, helping to ensure continued patient access to PN therapy. CONCLUSION: PN ingredient shortages prompted changes in the decision-making process for the prescription of PN. Guidelines for ordering PN were successfully implemented and allowed for the appropriate selection of qualified patients and the management of PN ingredient shortages.

Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine-zinc): a case of decompensated liver cirrhosis in Wilson's disease.

OBJECTIVES: To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. CASE SUMMARY: A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. DISCUSSION: Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20-30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. CONCLUSION: In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs in clinical practice is certainly a subject of serious concern. Systems for better management of patients with rare diseases need to be instituted by all the institutions concerned.

Papel del zinc en la nutrición / Paper of zinc in the nutrition

El conocimiento acerca del metabolismo del zinc y de su participación bioquímica en diversas funciones fisiológicas, han permitido explicar de este nutrimiento; es así como surge la necesidad de proteger a los grupos de población más vulnerables, empleando en la dieta alimentos que contienen este elemento. En el presente informe se abordan estos temas