Total Parenteral Nutrition (TPN) Support

Parenteral nutrition refers to nutritional support provided by an intravenous route. Access may be a peripheral vein or central vein. Peripheral venous access is usually used for short term support and limits the volume of fluids and nutrients that can be delivered. Whenever possible, enteral nutrition is preferred in order to provide nutrients to the gut and maintain the intestinal barrier.Indications for Parenteral NutritionParenteral nutrition is used in cases of gut failure or severe gastrointestinal disease. Catheter-related sepsis is a significant risk in immunocompromised patients. In HIV/AIDS, TPN will induce weight gain, the composition of which depends on the underlying etiology of the malnutrition. Septic patients tend to gain primarily fat whereas those with malabsorption or inadequate dietary intake gain more body cell mass. It is possible that this modality may not be widely available throughout the Region. However, it is an option that should be pursued when necessary.Components of Parenteral NutritionThe solution for parenteral nutrition consists of nutrients in their simple form,namely dextrose, amino acids, lipids and micronutrients. Dextrose is the monosaccharide that provides the major source of non-protein energy. Each gram of dextrose in parenteral solution provides 3. 4 kilocalories or 14. 2 kilojoules. Carbohydrate should be provided in adequate amounts to spare protein, but not in excess as this may cause hyperglycemia, fatty liver or other complications. The recommended rate of dextrose infusion should not exceed 4 to 5 mg/kg/minute. Amino acids provide protein to maintain nitrogen balance and prevent degradation of somatic proteins. Protein requirements are calculated based on clinical condition and goals of treatment. Amino acid solutions provide 4 kilocalories per gram or 18. 1 kilojoules per gram. Parenteral lipid emulsions provide a concentrated source of energy and essential fatty acids. They may be used in conjunction with carbohydrate and amino acid solutions or alone for caloric enhancement. The energy content of lipid emulsions depends on the formulation. ten percent yields 1. 1 kilocalorie per mL; 20% yields 2. 0 kilocalories per mL; 30% yields 3. 0 kilocalories per mL. There is some evidence that parenteral lipids may have a negative effect on immunity. In patients with HIV infection lipids should not exceed 30% of total energy intake or 1 g/kg/day. Hyperlipidemia may also develop if lipids are not cleared. Thus serum lipids should be monitored at baseline and regular intervals thereafter. Micronutrients and electrolytes are provided as standardized components of parenteral solutions. These may be modified according to the needs of the patient.Anabolic TherapyNutrition support will usually result in weight gain, but for some PLWHA, classified as non-responders, there is evidence of an anabolic block, whereby the regained weight is composed of a disproportionately high amount of body fat with limited accretion of lean tissue. This phenomenon can be identified with body composition analysis. Thus,although re-feeding is always necessary, it is not always sufficient for some individuals. In cases where lean tissue gains are insufficient, an anabolic agent may be required such as testosterone replacement. Other anabolic therapies that have shown favorable results include Oxandrin, Decadurabolan, and Recombinant Growth Hormone.Palliative CareWhen AIDS patients become terminally ill and medical care becomes mainly palliative,not curative, the nutrition care plan should reflect the overall goals of care. Nutritional therapy is directed to alleviating symptoms and providing comfort. Nutrition support should be considered to improve quality of life if the patient, caregivers and medical team agree to this intervention.Common Dietary ProblemsDuring the course of treatment and care, many dietary problems can arise. Strategies to help alleviate common problems are addressed inPregnancy, Lactation and HIVPregnancy, lactation, and HIV disease engender physiologic stress, with increased nutritional needs for energy, protein and micronutrients. It is well recognized that the nutritional health of a pregnant woman influences pregnancy outcome. Nutritionalstatus has even greater implications for the HIV-infected woman who is at higher risk of premature delivery and having a low birth weight infant.Low birth weight infants have an increased incidence of infant mortality as well as medical and developmental complications. Other risk factors, such as pregnancy during adolescence, substance use, opportunistic infection, low pre-pregnancy weight and inadequate gestational weight gain impose further risks of a poor pregnancy outcome. Moreover, vitamin A deficiency has been associated with poor pregnancy outcome and increased risk of perinatal HIV transmission. Pregnant HIV-positive women should be referred early in pregnancy to a dietitian or other suitable health care professional for counselling to optimize nutritional status and improve pregnancy outcome. It is essential to assess complementary therapy use, as mega-doses of vitamins and some herbal preparations are contraindicated in pregnancy.Weight Gain in PregnancyRecommended weight gain based on pre-pregnancy weight:Underweight (BMI 25):Nutritional Requirements12. 5-18. 0 kg11. 5-16. 0 kg7. 0-11. 5 kgAccording to the Recommended Dietary Allowances for use in the Caribbean, the following requirements for pregnancy/lactation are in addition to the requirements for HIV+ women:4? Additional 285 kilocalories per day to support fetal growth and developmentAdditional 6 grams protein per dayPrenatal multivitamin-mineral daily (to include at least 0. 4 mg folic acid)Other micronutrient supplements as needed (e. g. iron, calcium)Lactation: additional 500 kcal per day and 11 grams of protein Vitamin A:Maternal vitamin A deficiency is associated with increased risk of vertical HIV transmission to the infant. However, there is little evidence that vitamin A supplementation of the pregnant woman reduces the risk of HIV infection to the infant. Moreover, high doses of vitamin A can be teratogenic. Should supplementation be necessary, the following WHO guidelines can be used.Iron deficiency anemia is highly prevalent in pregnant women throughout the world. Anemia is associated with increased risk of maternal and fetal morbidity and mortality, as well as intrauterine growth failure. Iron status should be assessed and deficiency should be treated. WHO recommend that women receive 60 mg iron during 6 months of pregnancy and 120 mg per day to treat severe anaemia.Folate deficiency:Folate deficiency causes megaloblastic anemia and is associated with risk of neural tube defects in the infant (e. g. spina bifida). WHO recommends 0. 4 mg folate supplement daily.

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Upon getting information about an upcoming school science fair and the need to consider a topic of interest, many students will typically have no idea where to get started. While the science fair is typically a common occurrence in any school at any grade level, there are different types of topics that should be taken a look at depending on the age of the student. After first taking a look at the many different categories of science projects, you will be able to locate a suitable choice of topic to take to the next level.There is a wide variety of categories that fall under the types of science projects that can be chosen for a school science fair. These include biology, chemistry, physics, microbiology, biochemistry, medicine, environmental, mathematics, engineering, and earth science. While you may not have yet learned very much in any of these categories, don’t be afraid to see what each one entails. Taking a good look at your interests will allow you to focus on the right direction to take.Many resources are also available for those who are unsure as to the topic they are wanting to use to create their science projects. If you take a look at the topics that fall under the biology category, you will likely notice that there are topics that deal with plants, animals, and humans. For those who are in 2nd grade or 3rd grade, an interesting topic may be to determine if ants are picky over what type of food they eat. While this topic might not be of interest to an 8th grader, it is certainly something in the biology category that an elementary school student would enjoy.Along with the biology category, a high school student may want to take a look at diffusion and osmosis in animal cells as this would be a more appropriate topic for the grade level. A student in 6th grade would be more advanced than an elementary school student, but not as advanced as a high school student. At this middle school grade level, a topic of how pH levels effect the lifespan of a tadpole may be of interest.Whichever resource is used to locate a topic for science projects, it is always a good idea to consider the grade level of the student prior to making a selection. It is always assumed to be best to have a project at an appropriate level in order to keep the attention of the student and provide a fun and enjoyable learning experience.

US Markets in green on Friday; Dow 30 up over 345 points, Nasdaq Composite, S&P 500 up nearly 1%

US Markets were trading in the green on Friday with Dow 30 trading at 30,678.80, up by 1.14%. While S&P 500 was trading at 3,701.66, up by 0.98% and Nasdaq Composite 10,690.60 was also up by 0.71 per cent

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US Markets in green on Friday; Dow 30 up over 345 points, Nasdaq Composite, S&P 500 up nearly 1%
Earlier today, Indian stock markets ended the week on a winning note. It was the sixth straight gains for equity markets. Source: Reuters
US Markets were trading in the green on Friday with Dow 30 trading at 30,678.80, up by 345.25 points or1.14 per cent. While S&P 500 was trading at 3,701.66, up by 35.88 points or 0.98 per cent and Nasdaq Composite 10,690.60 was also up 75.75 points or 0.71 per cent. A Reuters report said that today’s strength was on the back of a report which said the Federal Reserve will likely debate on signaling plans for a smaller interest rate hike in December, reversing declines set off by social media firms after Snap Inc’s ad warning.

Source: Comex

Nasdaq Top Gainers and Losers

Source: Nasdaq

Earlier today, Indian stock markets ended the week on a winning note. It was the sixth straight gains for equity markets. The BSE Sensex ended at 59,307.15, up by 104.25 points or 0.18 per cent from the Thursday closing level. Meanwhile, the Nifty50 index closed at 17,590.00, higher by 26.05 points or 0.15 per cent. In the 30-share Sensex, 13 stocks gained while the remaining 17 ended on the losing side. In the 50-stock Nifty50, 21 stocks advanced while 29 declined.