Analysis of occurrence of bacteraemia with pathogens from gastrointestinal tract in patients fed parenterally and enterally in the intensive care unit.

INTRODUCTION: Bacterial translocation is a migration of microorganisms and their toxins from the intestinal lumen to the mesenteric lymph nodes, blood, and abdominal organs. It can lead to local inflammatory response and a potential increase in intestinal permeability leading to systemic infections and multiple organ failure. Enteral nutrition stimulates gastrointestinal motility, increases blood flow, and improves the integration of the intestinal barrier. AIM: The impact of enteral (EN) and parenteral (PN) nutrition on occurrence of bacteraemia caused by pathogens from the gastrointestinal tract. MATERIAL AND METHODS: It was a retrospective analysis of medical documentation of 254 patients. Microbiological tests were analysed, assessing the presence of bacteraemia or sepsis pathogens from the gastrointestinal tract. In 52 patients gastrointestinal pathogens in blood were found: 29 patients were fed enterally (I group - EN and EN + PN) and 23 only parenterally (II group - PN). RESULTS: The mean length of stay in hospital until the occurrence of bacteraemia in group I was 14, and in group II it was 13 days. Mean time without EN was 4 days (first group) and 12 days (second group). Time of stay in ICU and mortality in the group of patients fed parenterally was observed: group I - 25 days, mortality 34%; group II - 37 days, mortality 56%. In the analysed group the EN and the length of the absence of this kind of feeding did not affect the occurrence of bacteraemia by gastrointestinal pathogens. CONCLUSIONS: However, patients fed only parenterally who had bacteraemia required a longer stay in the ICU and had a higher rate of mortality than the patients with EN.

[The possibility or coercion treatment? Anorexia nervosa--legal regulations. A case report]. / Mozliwosc czy przymus leczenia? Anoreksja psychiczna--uregulowania prawne. Opis przypadku.

Anorexia nervosa is diagnosed on the basis of well-defined diagnostic criteria and requires treatment, as it is associated with the highest mortality rate of all mental illnesses. In Poland, anorexia nervosa is not considered a mental illness, although the opinion of researchers and clinicians are divided. To reduce the death rate of AN correct and early diagnosis, appropriate treatment starting immediately and the appropriate regulations to allow people to take the AN treatment against their will are necessary. In our work, we presented the treatment of patients with severe mental anorexia with a predominance of restrictive behavior as well as the issue of regulations relating to the compulsory treatment of people with eating disorders.

Occurrence of gastrointestinal side effects associated with early use of commercial diets in ITU patients.

BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ITU patients. METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition. RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1-33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h-1 on day 1, 58 mL h-1 on day 2, and 68 mL h-1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates. CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient's general condition and progression of the underlying disease.

[Is Huntington's disease a neurological or psychiatric disorder? case report]. / Choroba huntingtona zaburzeniem neurologicznym czy psychiatrycznym? Opis przypadku.

Huntington's disease is a rare, although commonly known neurodegenerative disease, caused by dynamic point mutation within the IT-15; it is inherited autosomally dominantly. IT-15 mutation includes multiple (36-250) repetitions of trinucleotide sequence (CAG) encoding a glutamine at the amino end of Huntington (mHtt). It is one of the nine polyglutamine diseases (PolyQ), characterized by a CAG repeat. The pathophysiology of Huntington's disease is associated with dysfunction and loss of neurons and gliosis within the striatum, particularly around the caudate nucleus and frontal lobes. Huntington's disease is characterised by the triad of symptoms: cognitive, motor and psychopathological disturbances. Approximately 80% of patients with HD show some of the mental disorders. The most common are affective disorders, in 30-40% symptoms of depression are present. Depression often precedes the onset of neurological symptoms.