scholarly journals Role of Thiamine in Refeeding Syndrome in Children

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Case Report ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Tertiary Care ◽  
Intestinal Resection ◽  
Current Evidence ◽  
Care Hospital ◽  
Refeeding Syndrome ◽  
Wide Range

Purpose, Setting and Subjects: We conducted a case report study of a postoperative pediatric patient on total parenteral nutrition managed by a multidisciplinary team in a tertiary care hospital. In October 2020, data of nutritional status, hypophosphatemia, electrolyte and metabolic imbalance, and the role of thiamine supplement were reviewed. Background: Refeeding Syndrome is usually defined as the possibly lethal maldistribution of fluids and electrolytes that could take place in malnourished patients receiving enteral or parenteral refeeding. This is due to hormonal and metabolic disturbances that may lead to critical clinical deterioration. The biochemical key feature of Refeeding Syndrome is hypophosphatemia. In general, the syndrome is complicated and may also incorporate abnormal electrolytes and fluid balance; changes in serum level of protein, glucose, and the metabolism of fat; thiamine deficiency; hypokalemia; and hypomagnesaemia. Case Report: an ex-preterm 6-year-old boy who underwent major intestinal resection due to necrotizing enterocolitis (NEC) during his stormy neonatal period, presented to ED with constipation for 2 days; the patient was admitted in the pediatric ward under combined care with Pediatric Surgery, as a case of large bowel obstruction for conservative management. He had cachexic appearance, global developmental delay (GDD), and faltering growth. Subsequently and during his PICU stay, he suffered a fluctuating course of electrolytes imbalance a few days after commencing total parenteral nutrition (TPN), and developed altered mental status that responded well to thiamine infusions to resume his baseline sensorium within 48 hours. Conclusions: The role of thiamine in Refeeding Syndrome is extremely underestimated, despite the current evidence of its high efficacy. However, the fussy exclusion mechanism to reach the diagnosis is probably the reason behind the delaying of treatment in most of the cases. A wide range of patients are at risk of developing Refeeding Syndrome, especially malnourished children, as in this case report. Categories: Nutrition, Surgery, Pediatrics, Gastroenterology.

Dosing errors in total parenteral nutrition prescriptions at a specialized cancer care hospital of Lahore: The role of clinical pharmacist

2020 ◽  
pp. 107815522092301
Author(s):  
Zunaira Akbar ◽  
Hamid Saeed ◽  
Zikria Saleem ◽  
Sidra Andleeb
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Enteral Feeding ◽  
Cancer Care ◽  
Inappropriate Prescribing ◽  
Major Complication ◽  
Care Hospital ◽  
Study Objective ◽  
Pharmacy Department

Study objective To determine the role of pharmacist in identifying the frequency of errors in total parenteral nutrition prescriptions in cancer patients for the years 2015 and 2016. Total parenteral nutrition has a high potential for medical errors because of its complex composition, thus leading to severe complications. Pharmacist review of the prescriptions reduces the risk of inappropriate prescribing, preparation, and administration of parenteral nutrition. Methodology An observational study was performed by collecting data of total parenteral nutrition prescriptions of 71 patients for the last two years from Pharmacy Department of specialized cancer care hospital. Results It was found that the frequency of dosing errors and incomplete prescriptions was higher in 2015 compared to 2016. Additionally, the frequency of macro and micronutrients dosing errors were higher in adults (23.4% and 66.2%) compared to pediatrics (14.6% and 46.6%). Furthermore, the frequency of illegible prescriptions was higher (5.03%) in year 2016 as compared to year 2015 (1.64%). Nevertheless, such dose interventions improved patient’s weight (20%) and promoted enteral feeding (42.3%). Major complication was hypophosphatemia (39.4%) followed by hyperglycemia (10%) and catheter-induced infection, i.e. sepsis (4.2%). Conclusion In conclusion, data suggested that pharmacist played instrumental role in identifying and rectifying total parenteral nutrition dosing errors for both micronutrients and macronutrients—with higher frequency in 2015 compared to 2016, leading to improvements in total parenteral nutrition-related complications and switches to enteral feeding.

scholarly journals Clinical Profile and Role of Septic Screen in Early Onset Sepsis in a Tertiary Care Hospital of Western Nepal - A Prospective Observational Study

2020 ◽  
Vol 8 (1) ◽  
pp. 14-18
Author(s):  
Binod Kumar Gupta ◽  
Raju Kaphle ◽  
Buby Philip Kurian ◽  
Badri Kumar Gupta
Keyword(s):  
Respiratory Distress ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Early Onset Sepsis ◽  
Wide Range

INTRODUCTION: Neonatal sepsis is an important cause of neonatal mortality and morbidity with wide range of clinical manifestations. This study was aimed to study the clinical characteristics of sepsis along with the role of septic screen for early diagnosis of septicemia. MATERIAL AND METHODS: A prospective observational hospital based cross-sectional study was conducted in 113 screen positive newborns over a 12-month period at Universal College of Medical Sciences, Teaching Hospital Bhairahawa, Nepal. RESULTS: Out of 489 cases admitted to the NICU during the study period, 113 babies with screen positive sepsis were included in the study. Poor feeding (46%, n=52), respiratory distress (38.9%, n=44) and lethargy (30.1%, n=34) were top three clinical presentations in neonates with sepsis followed by seizures, jaundice, vomiting, fever and hypothermia respectively. 57.5% (n=65) of clinical sepsis cases enrolled had culture positivity with staphylococcus aureus in 41.5% (n=27) and Coagulase negative Staphylococcus (CONS) in 27.7% (n=18).  Klebsiella was the third common organism isolated in blood culture (23.1%, n=15). The sensitivities and specificities of two-test and three-test combinations in proven sepsis was calculated. Two-test combinations showed sensitivities between 33-100% and specificities between 30-90% whereas three-test combinations showed the sensitivities and specificities between 60-100% and 20-90% respectively. CONCLUSION: Poor feeding, respiratory distress and lethargy were common presentations in early onset neonatal sepsis. Three-test combination of septic screen had no overall advantage over two-test combination in the present study.

scholarly journals Profile of fungal blood stream infection (BSI) in neonate at tertiary care hospital in South India

2018 ◽  
Vol 5 (6) ◽  
pp. 2199
Author(s):  
Shanmuga Sundaram C. ◽  
Kamalarathnam C. N.
Keyword(s):  
Risk Factors ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Broad Spectrum ◽  
Tertiary Care Hospital ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Central Line ◽  
Care Hospital

Background: Advancement in neonatal care has led to remarkable improvement in survival of new-born.  Fungal infections in new born are an important health problem associated with substantial morbidity and mortality. The objective of this study was to assess the prevalence and epidemiology of neonatal fungal blood stream infection and to analyze risk factor associated with mortality due to fungal septicemia.Methods: This is a retrospective study of all neonatal fungal cases admitted from July 2016 to June 2017 to a tertiary care hospital in South India.Results: Isolation rate of fungal blood stream infection was 3.3%. Risk factors observed for candida blood stream infection were Broad spectrum antibiotic usage >7 days (91.18%) followed by central line >7 days (58.9%) and total parenteral nutrition (50.68%). Poor weight gain (71.23%), respiratory distress (68.4%) are common clinical presentation. Mortality among candida blood stream infection was 29 (39.72%). On step-wise logistic regression analysis, prolonged rupture of membrane and endotracheal tube placement for more than 7 days were significant independent predictors of mortality in neonatal candida blood stream infection.Conclusions: Candida blood stream infection is significant problem in our unit. It occurs in 3.3 %of neonates admitted in our unit and accounts for 34% of blood culture positive sepsis. Non-albican candidiasis is the predominant agent causing candida blood stream infection. Fungal prophylaxis may be recommended in neonates with risk factors like birth weight less than 1500 gms, those requiring ventilation for more than 7 days, those on total parenteral nutrition for more than 7 days and those on prolonged broad-spectrum antibiotics. It reemphasizes the need for aseptic insertion, maintenance, early identification of catheter related infection and early removal of central line. 

Catheter-Related Vancomycin-ResistantEnterococcus FaeciumBacteremia: Clinical and Molecular Epidemiology

2005 ◽  
Vol 26 (7) ◽  
pp. 658-661 ◽  
Author(s):  
Issam I. Raad ◽  
Hend A. Hanna ◽  
Maha Boktour ◽  
Noel Jabbour ◽  
Ray Y. Hachem ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Parenteral Nutrition ◽  
Molecular Epidemiology ◽  
Total Parenteral Nutrition ◽  
Tertiary Care ◽  
Cancer Center ◽  
Care Hospital ◽  
Patients With Cancer ◽  
Vancomycin Resistant ◽  
Gastrointestinal Colonization

AbstractObjective:To study the clinical and molecular epidemiology of vancomycin-resistantEnterococcus faeciumorganisms causing catheter-related bacteremia in patients with cancer.Design:Retrospective case-control study.Setting:University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.Patients:Case-patients were patients with cancer who had catheter-related vancomycin-resistantE. faeciumbacteremia and control-patients were patients with cancer and vancomycin-resistantE. faeciumgastrointestinal colonization without infection.Results:Ten case-patients with catheter-related vancomycin-resistantE. faeciumbacteremia were compared with 30 control-patients with gastrointestinal colonization by vancomycin-resistantE. faecium. Patients with catheter-related vancomycin-resistantE. faeciumbacteremia were more likely to have required mechanical ventilation (P< .01), received total parenteral nutrition (P< .01), and had polyurethane catheters (P< .01) inserted in the femoral vein (P= .01). With the use of pulsed-fleld gel electrophoresis, 4 of the 10 catheter-related vancomycin-resistantE. faeciumbacteremia isolates were genetically indistinguishable, whereas only 2 of the 30 control vancomycin-resistantE. faeciumisolates displayed this same DNA pattern (P= .03).Conclusion:This study suggests that catheter-related vancomycin-resistantE. faeciumbacteremia occurs more frequently in patients who receive total parenteral nutrition, mechanical ventilation, and femoral catheters. (Infect Control Hosp Epidemiol 2005;26:658-661)

scholarly journals Utilization Of Total Parenteral Nutrition In A South Indian Tertiary Care Hospital

2014 ◽  
Vol 17 (7) ◽  
pp. A370
Author(s):  
N. Sreedharan ◽  
M. Vinitha ◽  
P. John ◽  
T. Girish ◽  
K. Vijayanarayana ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
South Indian

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

2021 ◽  
pp. 107815522110293
Author(s):  
Amanda V Pirolli ◽  
Tatiana Brusamarello ◽  
Stella S Everton ◽  
Vânia M S Andrzejevski
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Structured Interview ◽  
Care Hospital ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancers

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

scholarly journals Duodenal atresia with familial apple peel syndrome: case study with review of literature

2019 ◽  
Vol 12 (8) ◽  
pp. e230160
Author(s):  
Jyotsna M Kirtane ◽  
Snehal A Bhange ◽  
Fazal Nabi ◽  
Varshil Shah
Keyword(s):  
Case Report ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Postoperative Period ◽  
Duodenal Atresia ◽  
Short Length ◽  
Review Of Literature ◽  
Jejunal Atresia ◽  
Apple Peel

This is a case report of a neonate who was antenatally diagnosed with jejunal atresia which turned out to be duodenal atresia with apple peel syndrome. A previous sibling, who also had apple peel but with jejunal atresia, succumbed to sepsis after surgery. The first sibling had jejunal stenosis and had died of sepsis following surgery. Combination of duodenal atresia with apple peel is extremely rare. This coupled with a familial condition is rarer still. This case was challenging due to the short length of the gut and prolonged need for total parenteral nutrition and sepsis in postoperative period.

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