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.

Online Business Ideas – The 7 Fundamental Ideas For Online Business

If you spend even a small amount of time surfing the Internet then you are going to find many different online business ideas and before long it can become quite overwhelming. Just like anything new, there is going to be so much information available but the problem is always knowing which information to listen to and which to ignore; this article covers the 7 fundamental online business ideas which you will come across online.The thing to keep in mind is that each of these ideas will manifest itself in many different forms but no matter what type of online business you are looking to set up you will find that it fits into one or more of these online business ideas. They are the fundamental building blocks of any online business and a good understanding of them will give you the start that most people never have.The 7 Fundamental Online Business IdeasEach of the following online business ideas are based around the 7 different ways of actually making money online. Whatever business you decide to start online it will fit into one of more of the following categories:AdvertisingThe first of the online business ideas is advertising and with this idea you will look to setup a website in some kind of niche. You can then put advertisements on this site that are related to the niche content you have based it around. The key to this idea is making sure you get your targeting right otherwise you are simply going to annoy people who come to your site by trying to advertise them something totally unrelated to their needs; this is a fundamental error and something you should be very cautious of before you even start.ServicesWith this idea you will setup a website that offers some kind of service to people who visit. Now this can be varied from an online gambling site that offers the gambling service to people right through to an online presence for your offline business.The main difference with the latter is that you can either simply use it as an online marketing tool for your offline business or you can totally automate it so that you use your offline brand name to create an entirely separate online business.SubscriptionsThis is my favourite of the online business ideas because it is extremely scalable and in essence fairly easy to setup. There are however a few things to consider before starting this type of model. You need to make sure that whatever you are offering a subscription to has very good content otherwise you can get yourself a bad reputation before you’ve even started. Secondly you need to monitor the subscriptions in detail and offer technical support for anyone that may have problems getting access.ProductsThis idea is fairly self explanatory, you setup a website where you sell products online. These products can be your own products or ones you buy in from a supplier, the only real difference will be the margin you make on each one. Also, it will take longer to get traction with your own products whereas others will probably already have brand awareness.CommissionsThe commissions model is similar to the products model but in this case you simply promote other peoples products and direct them to their website. You have your own affiliate code so that when anyone buys their product you get paid a commission. Effectively you are acting in the same way as a normal offline salesman on commission.LicensingOut of all the online business ideas, this one is probably the most confusing and I have certainly seen it explained in a variety of different ways and unfortunately most of them are incorrect. This idea can come in two different forms, you can either be a licensee or a licensor. In the former case you will take someone else’s brand and use it to promote your own products which you will then sell for a premium online. In the latter case you are the one with the brand that other people license off you and you get paid a fee based on this.This is quite an in depth concept and we have really just touched the surface with this article.Being a BankWhen you look at the different online business ideas you will probably struggle to come up with this one. What I mean by being a bank is that you effectively offer people lines of credit through various mediums online. Once again, this idea can be hard to understand at the beginning but becomes clear when you research in depth.You will have most likely seen companies offering checkout facilities online where you can pay for goods and services through some kind of online transaction. When you look into what actually goes on in this process then you will start to see how this model works but essentially you are being paid interest on money you allow people to borrow for varying periods of time.

Why Your Business Needs Digital Marketing Services

Modern world screams technology from every angle, people are well occupied with their busy and demanding schedules, and don’t have time to look out for different brands, products and upcoming projects through the means of offline marketing, such as: paper-based newspapers, books, communication methods and traditional TV and radio broadcasts. In the current scenario internet and mobile phones are the most picked method to share any information, so when the term Digital Marketing is discussed, customers can access the information any time and any place as per their convenience. Internet and globalization have shrunk the world to an axis point, where people from all over the globe can access the information via computers, tablets or mobiles. Digital marketing is indeed a blessing for the business owners, where they can influence the image of their companies via digital marketing and can reach up to a larger chunk of customers globally.You Should Do Digital MarketingIn the era of technology, where Smartphone rules our life, we feel bound to access the product details online only through, mobiles, computers or tablets. A business turns does not mean the huge traffic on the product website, but that traffic converting to leads or boosting the sales. Online Marketing, is a tool which works on your customer’s psychology with the attractive content, ads followed by various other marketing tactics, Digital Marketing tools and techniques provide business owners the best chances for competition, survival and even for the business boost.Asking Price The first and the foremost reason to opt for digital marketing is, but obviously the cost-factor, which is quite economical, being compared to traditional offline marketing methods. To illustrate the fact a TV ad or newspaper advertisement can cost huge and with no guarantee of being noticed by everybody, on the contrary an email or social media campaign, can reach out to a mass population globally. Reliable Customer’s FeedbackAnother benefit, which really suits the need of the business, is the real-time and reliable customer feedback and reviews to upgrade the services with time. With digital marketing pattern business owners don’t need to spend excessively on surveys and customers’ feedback, but the unbiased information can be attained through internet marketing and ultimately win the customer’s trust. The better revenue growth expectancy of either small or medium enterprises can extend to 4 times much better by using digital marketing techniques, since it lets the product available to go larger and farther reaching markets both locally and abroad.Brand RecognitionOnline Marketing proves beneficial for the brand reputation, with satisfied customers and their real-time feedback, business owners can reach to other potential set of customers. This helps the business owners to make the brand reputation go viral as expected, further opening new doors of opportunities for reaching bigger markets and attain business growth.Conversion OptimizationSince the current era is turning more digital, than people do have the access over their gadgets at every time and business owners can remain available with their product, regardless of their time-zone restrictions and ultimately a larger reach to the consumers would lead to conversion, because the consumer would get what they are looking for a per their convenience. Without conversion, all the traffic would mean nothing and all the other marketing efforts would end in despair. This is the sole reason, why business owners put more efforts towards the digital marketing campaigns.Key Digital Marketing ToolsDigital Marketing can be done in various ways, below mentioned are a few of the major keys, although with the upcoming innovative technology methods, more would be added to this list.

Websites and SEO content

Blogs

Internet banner ads

Online video content

Pay-per-click (PPC) advertising

Email marketing

Social media marketing (Facebook, Twitter, LinkedIn, etc.)

Mobile marketing (SMS, MMS, etc.)
When a customer walks into a shop, the first step he/she follows is to inspect the product and then might leave without buying anything. Undeniably a larger number only come and go and very small groups make a buy. Even if the product website receives tons of website visitors daily or weekly, but none of them ever convert, then it’s alarming, because it leads to clear indication that the business will also cease to exist. Digital Marketing helps the business owners to utilize the tried and tested marketing tactics, which not just attract the superfluous traffic, but highly potential target traffic and would ensure the survival of the business.