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.

Simple Facial Skin Care Tips to Improve Your Skin

The face is of utmost importance in skin care. Facial skin care involves several aspects like care of the general facial skin (the cheek and the forehead), care of the eye-region (puffy eyes) and care of the lips (because lips have specially sensitive skin). A facial skin is generally divided into two broad regions by dermatologists. The first region or the T region encompasses the forehead, the nose bridge, the lips and the chin below the lips. The cheeks and the region beneath the eyes comprise the other main region of the facial skin.The significance of such differentiation in facial skin care regions in most evident in those with a combination skin type. A combination skin type is one of the five classifications of skin types of a face. The other four types are normal skin, dry skin, oily skin and sensitive skin. In a combination skin type, generally the T region is oily and the other region is drier and less oily. The preliminary aspects of a facial care are outlined below.* Cleansing: The skin of the face should be clean. Since face is most exposed to the weather so cleansing is a very necessary part of a facial skin care schedule. Face cleansing is usually done with face packs and cleansing milks. The face packs and the cleansing milks of the facial care can be of both cosmetic and organic origin. The skin being an extremely sensitive canvas, it actually depends upon the person to decide what type of face pack will work best for the skin. Milk is an ideal example of a fulfilling facial care cleansing ingredient. However, while cleansing it is important not to over-cleanse the skin. This is because excess cleansing can even clean away the natural oil secretions that help to naturally moisturize the skin.* Exfoliating and scrubbing: Since the facial skin is always generating a certain amount of dead cells, so exfoliating and scrubbing ensures that the skin is free from the roughness that the dead cells can cause. Face scrubs with tiny grains are more effective as they are more alike the natural grain of the face. Face scrubs with bigger grains can scrub away more than just the top layer of dead cells. Organic options like a half teaspoon of fine grained sugar and flour thrash also act as good scrubbers and are of considerable importance in facial skin care.* Moisturizing and sunscreen: moisturizing the skin is important in facial skin care whether you have normal, oily, dry, combination or sensitive skin. Water is a basic ingredient of causing softness in the skin and moisturizers (cosmetic and herbal) helps to retain this moisture onto the face. Repeated splashing of water on the skin, especially after an exposure to pollution and dirt, ensures that these harmful elements do not get the time of settling down on the facial skin. Sunscreen is an equally important aspect in facial care. Sunscreens help by screening away the harmful UVA and the UVB rays of the direct sunlight.Xtend-Life offers a variety of facial skin care products in both the men’s skincare and women’s skincare categories. The special ingredient Cynergy TK used in all the xtend-life products make the products suitable for all skin types and is especially suitable in fighting the wrinkle lines on the face. Cynergy TK works in synchrony with other active skin care ingredients, like the potent nano-antioxidant Nanobelle Q 10 to make the skin feel younger and fresher.Also, the Xtend-Life anti-wrinkle products has another special organic component called Phytessence Wakame, which is an extract of a specific Japanese Sea kelp. This component inhibits the harmful enzyme hyalurinidase and boosts the generation of hyaluronic acid in the skin to its adequate limits. This assists in making the skin much more younger.The facial skincare products in the women’s category are Age Defense active day cream, Whitening day cream, Restorative night cream, the Eye Contour Serum and the two types of cleansing and moisturizing masks. The deep Active Hydrating Mask and the Deep Active Cleansing masks are available in the men’s category as well. The other two active skincare products for men are Age Defense Active Facial Fluid and the Eye Contour Serum.

Social Networking and Joining the Online Health Community

Building health related social networking sites require much-needed features like online health communities.Many illness sufferers are now participating in online illness specific communities, discussing their experiences. We all have sick friends and family members, and now thanks to e-mail, live health chat, health forums, medical blogs, video sharing and other online resources, we have become much more intimate and the supportive environments are helping those with serious illnesses and diseases.Social networking sites may have such supportive environments, however without an online health community, health related social networking sites simply become another social networking site.There are many challenges faced by most social networking sites and the most common is getting people back onto the site. How do we engage people in health care services and have them coming back to the social networking site on a regular basis that is not for a recreational means? One answer is ensuring the online health communities are active and relevant to the users of the site.The second most common challenge is how to create synergies among the different services offered by the social networking sites and what are the differentiations between these sites to better compete in this niche market. One answer is ensuring the online health communities are offering meaningful information related to the illness sufferers and ensuring that the “big brothers” or advocates of the social networking sites are keeping the health content up to date and relevant for all users of the site, be it illness sufferers or family and friends of illness sufferers.These online global health communities are emerging as a new medical domain and require illness sufferers to join to help keep the online global health communities afloat. These online health communities are open to all: illness sufferers, family, friends, professionals, and researchers. People seen within these communities are a valuable health resource to others suffering from the same illness or disease.People within these health communities are strong advocates, making others aware of what it is they are suffering from and detailing their experiences. These people can be seen as “big brothers or big sisters” to others within their community. They frequently post content designed to help others, and to respond to the questions posted by others.Quality of life improves when the illness sufferers are in control of their illness or disease, and the communities provide illness sufferers this support. The greater the community, the greater the support. All communities require growth, growth by visitors and growth by registered members participating in discussions.