Several Factors Associated With Nitrogen Balance In Elderly Patients

BackgroundNitrogen balance is the method used to assess the protein adequacy. A negative nitrogen balance means that the body suffers from protein energy malnutrition.ObjectiveTo determine the risk factors that associated with nitrogen balance in the elderly patients who were inpatient in IRNA Internal Medicine Dr.Soetomo Hospital.MethodsThe experimental design of the research used was analytic observational with the cross-sectional design. The study was conducted of 50 elderly patients. Risk factors measured were protein intake using food recall and nitrogen excretion that expressed in Urea Nitrogen Urine (gr / 24 h). The nitrogen balance was derived from the difference between nitrogen intake and nitrogen excretion in 24 hours. Bivariate data analysis using Chi square or exact fisher test, while multivariate data analysis using logistic regression test.ResultsIn bivariate analysis, risk factors significantly associated with negative nitrogen balance were decreased renal function (LFG <90 ml / min / 1.73 m2), prolonged bed rest> 7 days and malnutrition. Other risk factors not significantly associated with negative nitrogen balance were diabetes mellitus, random blood sugar> 180 mg / dl, hypoalbumin and CRP> 6 mg / dl. In multivariate analysis showed the decrease of renal function and duration of bed rest > 7 days was significant.ConclusionThe decreased renal function and bed rest for more than 7 days was a risk factor for protein malnutrition in elderly patients.

Optimizing nitrogen balance is associated with better outcomes in neurocritically ill patients

Background Marked protein catabolism is common in patients with critical illness. We hypothesized that optimal protein supplementation using nitrogen balance might be associated with better clinical outcomes in patients in the neurointensive care unit (NICU).Methods A retrospective observational analysis was performed among patients admitted to the NICU between July 2017 and December 2018. Nitrogen balance was measured within 72 hours after NICU admission and measurements were repeated after 10 days in those who stayed in the NICU for more than 7 days. Nitrogen balance was calculated using a standard formula: total protein intake (grams)/6.25 – (urine urea nitrogen + 4 grams). Included patients were categorized into two groups (positive or negative) based on the initial nitrogen balance results. The rate of neurological worsening, defined by a worsening of ≥2 in the Glasgow Coma Scale (GCS) score, and in-hospital mortality were compared between patients who achieved the improvement of nitrogen balance on a follow-up measurement and those who failed to.Results A total of 175 patients were included, and 140 (80.0%) had a negative nitrogen balance on the initial assessment. The negative nitrogen balance group had a lower GCS, longer NICU stay, more events of neurological worsening, and higher in-hospital mortality. Among the 77 patients (44.0%) who underwent a follow-up measurement of nitrogen balance (on a median day of 10), 39 (50.6%) showed an improvement in nitrogen balance and thus received a higher amount of protein (1.94 g/kg/day) than those who did not show this improvement (1.28 g/kg/day) ( P < 0.001). The improvement group had fewer events of neurological worsening (15.4% vs. 36.8%, P = 0.032) and lower in-hospital mortality (12.8% vs. 31.6%, P = 0.047). However, there were no significant differences in baseline nitrogen balance, GCS, and the development of acute kidney injury between the two groups.Conclusions This study demonstrated that a significant proportion of patients in NICU were under protein hypercatabolism. An adequate provision of protein was associated with improved outcomes, suggesting the importance of protein supplementation in neurocritically ill patients.

Estimates for digestible threonine: lysine for 21 - 35-day-old female meat-type quails

ABSTRACT Two assays were performed to estimate digestible threonine-lysine (Threo-Lys) ratio for female meat-type quails between 21 and 28 days old and between 28 and 35 days old. Experimental design was totally randomized. The first assay comprised 440 quails distributed into 5 treatments, 8 replications and 11 fowls per cage. The second assay comprised 280 quails distributed into 5 treatments, 8 replications and 7 fowls per cage. Five digestible Threo: Lys ratios were evaluated (0.66, 0.71, 0.76, 0.81 and 0.86). Performance, carcass and cut yield, chemical composition of carcass and nitrogen balance were evaluated. There was an improvement (P<0.05) in feed conversion and increase in feed intake due to ratios of digestible Threo: Lys between 21 and 28 and between 29 and 35 days olds, respectively. At 35 days old, there was a better (P<0.05) carcass yield and a negative nitrogen balance for Threo: Lys analyzed. A ratio of 0.86 may be recommended for digestible Threo: Lys as the best for feed conversion and carcass yield for female meat-type quails between 21 and 28 and between 28 and 35 days.

Experimental determination of the efective dose (ed50) values of IRIS HUNGARICA leaf and rhizome dry extracts with potential anabolic properties

Keywords: effective dose, anabolic activity, extract, hungarian iris. Acknowledging the importance of plants in the correction of negative nitrogen balance and mild to moderate muscular atrophy, the following advantages of herbal medicinal products over synthetic drugs were taken into account: optimal bioavailability at the systemic, organ and cellular levels; biochemical digestibility of intermediate and end products of metabolism, which decreases the probability of accumulation significantly; organotropic, allergenic and toxic action. The study objective was to determine ED50 values of Iris hungarica leaf and rhizome dry extracts by application of the least square method to the anabolic activity in the intact animals. The study was conducted in 72 white outbred male rats, weighing 230 to 240 g. The anabolic activity of the extracts is estimated by the following indicators: body weight gain of animals; relative weight of internal organs – heart, gastrocnemius muscle, testes; total protein in blood serum, gastrocnemius and cardiac muscles. The experimental animals were administered extracts in doses of 50 mg/kg, 100 mg/kg, 150 mg/kg, 200 mg/kg, 250 mg/kg, and 300 mg/kg. The mean effective dose was 148.81±23.91 mg/kg for Iris hungarica dry leafextract, and 147.27±26.11 mg/kg for Iris hungarica dry rhizome extract as determined by signs of the anabolic effect in the intact animals. Thus, the presence of anabolic effect in dry extracts of leaves and rhizomes of Hungarian iris shows the potential of herbal medicinal products, and the need for more pharmacological studies in order to create a new medicinal product for the correction of negative nitrogen balance and mild to moderate muscular atrophy.

New Progress in Nursing for Early Enteral Nutrition after Esophageal Carcinoma Surgery

<p>Esophageal carcinoma drains the body, and its surgery causes dramatic trauma. After operation, patients must abstain from food. The body experiences negative nitrogen balance for a long time after operation due to fever, stress and loss of body fluids as well as digestive juices. Hence, nutritional support appears to be extremely important. Nurses needed to pay more attention in solving the problem of post-operative malnutrition. </p>