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.
What Are The Greatest Changes In Shopping In Your Lifetime
What are the greatest changes in shopping in your lifetime? So asked my 9 year old grandson.
As I thought of the question the local Green Grocer came to mind. Because that is what the greatest change in shopping in my lifetime is.
That was the first place to start with the question of what are the greatest changes in shopping in your lifetime.
Our local green grocer was the most important change in shopping in my lifetime. Beside him was our butcher, a hairdresser and a chemist.
Looking back, we were well catered for as we had quite a few in our suburb. And yes, the greatest changes in shopping in my lifetime were with the small family owned businesses.
Entertainment While Shopping Has Changed
Buying butter was an entertainment in itself.
My sister and I often had to go to a favourite family grocer close by. We were always polite as we asked for a pound or two of butter and other small items.
Out came a big block of wet butter wrapped in grease-proof paper. Brought from the back of the shop, placed on a huge counter top and included two grooved pates.
That was a big change in our shopping in my lifetime… you don’t come across butter bashing nowadays.
Our old friendly Mr. Mahon with the moustache, would cut a square of butter. Lift it to another piece of greaseproof paper with his pates. On it went to the weighing scales, a bit sliced off or added here and there.
Our old grocer would then bash it with gusto, turning it over and over. Upside down and sideways it went, so that it had grooves from the pates, splashes going everywhere, including our faces.
My sister and I thought this was great fun and it always cracked us up. We loved it, as we loved Mahon’s, on the corner, our very favourite grocery shop.
Grocery Shopping
Further afield, we often had to go to another of my mother’s favourite, not so local, green grocer’s. Mr. McKessie, ( spelt phonetically) would take our list, gather the groceries and put them all in a big cardboard box.
And because we were good customers he always delivered them to our house free of charge. But he wasn’t nearly as much fun as old Mr. Mahon. Even so, he was a nice man.
All Things Fresh
So there were very many common services such as home deliveries like:
• Farm eggs
• Fresh vegetables
• Cow’s milk
• Freshly baked bread
• Coal for our open fires
Delivery Services
A man used to come to our house a couple of times a week with farm fresh eggs.
Another used to come every day with fresh vegetables, although my father loved growing his own.
Our milk, topped with beautiful cream, was delivered to our doorstep every single morning.
Unbelievably, come think of it now, our bread came to us in a huge van driven by our “bread-man” named Jerry who became a family friend.
My parents always invited Jerry and his wife to their parties, and there were many during the summer months. Kids and adults all thoroughly enjoyed these times. Alcohol was never included, my parents were teetotallers. Lemonade was a treat, with home made sandwiches and cakes.
The coal-man was another who delivered bags of coal for our open fires. I can still see his sooty face under his tweed cap but I can’t remember his name. We knew them all by name but most of them escape me now.
Mr. Higgins, a service man from the Hoover Company always came to our house to replace our old vacuum cleaner with an updated model.
Our insurance company even sent a man to collect the weekly premium.
People then only paid for their shopping with cash. This in itself has been a huge change in shopping in my lifetime.
In some department stores there was a system whereby the money from the cash registers was transported in a small cylinder on a moving wire track to the central office.
Some Of The Bigger Changes
Some of the bigger changes in shopping were the opening of supermarkets.
• Supermarkets replaced many individual smaller grocery shops. Cash and bank cheques have given way to credit and key cards.
• Internet shopping… the latest trend, but in many minds, doing more harm, to book shops.
• Not many written shopping lists, because mobile phones have taken over.
On a more optimistic note, I hear that book shops are popular again after a decline.
Personal Service Has Most Definitely Changed
So, no one really has to leave home, to purchase almost anything, technology makes it so easy to do online.
And we have a much bigger range of products now, to choose from, and credit cards have given us the greatest ease of payment.
We have longer shopping hours, and weekend shopping. But we have lost the personal service that we oldies had taken for granted and also appreciated.
Because of their frenetic lifestyles, I have heard people say they find shopping very stressful, that is grocery shopping. I’m sure it is when you have to dash home and cook dinner after a days work. I often think there has to be a better, less stressful way.
My mother had the best of both worlds, in the services she had at her disposal. With a full time job looking after 9 people, 7 children plus her and my dad, she was very lucky. Lucky too that she did not have 2 jobs.
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.