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[Long-term HRV analysis shows stress reduction by magnesium intake].
Wienecke, E, Nolden, C
MMW Fortschritte der Medizin. 2016;(Suppl 6):12-16
Abstract
BACKGROUND Mental pressure and stress represent an ever-increasing socio-political challenge. The heart rate variability (HRV) measurement, which has its origin in the cardiac function diagnosis, gives information on the neurovegetative activity. A low HRV shows an imbalance of the sympathetic and parasympathetic efferents and thus is an indicator of stress. METHOD A randomized, controlled, two-armed parallel study with 100 participants and a period of 90 days was performed. Main object of investigation was to what extent the mineral magnesium, which is also a high-quality natural calcium antagonist in cardiology, can influence the sympathovagal balance, when given in combination with a strength-endurance training. The effect on intracellular magnesium concentration was investigated as an additional parameter. RESULTS In the group with daily supplementation of 400 mg of magnesium, HRV parameters clearly increased: pNN50 - an indicator of parasympathetic activity - increased. LF-HF ratio as well as stress index - low values for each represent a good balance of the vegetative nervous system - decreased. In the control group no positive changes in HRV parameters could be shown. Vagus activity, and thus the adaptive and regenerative capacity of the body, veritably increased by magnesium supplementation. No effect on the intracellular magnesium concentration could be shown in the study. CONCLUSIONS The results of this study point out that persons with mental and physical stress can benefit from a daily intake of magnesium. This might lead to an improved physiological regulation of the sympathetic and parasympathetic efferents and, furthermore, prevent magnesium deficiency and diseases such as, for example, restlessness, irritability, lack of concentration, sleep disorder or depression.
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2.
Insulin resistance in early vs late nutrition and complications of sirs in neurosurgical intensive care unit (ICU).
Pilika, K, Roshi, E
Medical archives (Sarajevo, Bosnia and Herzegovina). 2015;(1):46-8
Abstract
BACKGROUND Systemic Inflammatory Response Syndrome (SIRS) is a common complication in neurosurgical diseases in Intensive Care Unit (ICU). Because of associated insulin resistance (IR) the ICU is in dilemma in which stage to start the nutrition to patients and what is the amount of Insulin Unit to control the hyperglycemia. AIM: to define the IR and to compare IR and amount of insulin among ICU patients in "Mother Theresa" University Hospital Center (MTUHC) in Tirana Albania. METHODS 154 patients with neurosurgical disease and SIRS complications were randomized in two groups: early nutrition 73 patients (47%) and late nutrition 81 (53%) and compared for a number of variables. RESULTS There was no statistical age and gender difference between the two groups (P>0.05). The amount of insulin units to control the level of glycemia (80-110 mg/dc) was 12.8±7 unit per day in early nutrition and 23.8 ±12.9 units in late nutrition group (p<0.01). No patient in early nutrition group but six (7.4%) patients in late nutrition group developed insulin resistance (p=0.03). CONCLUSIONS the IR due to the infection complications is higher among late than early nutrition group. Therefore, we suggest that in neurosurgical ICU it would be better to start the nutrition within 72 hours.
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3.
The drooling reduction intervention trial (DRI): a single blind trial comparing the efficacy of glycopyrronium and hyoscine on drooling in children with neurodisability.
Parr, JR, Weldon, E, Pennington, L, Steen, N, Williams, J, Fairhurst, C, O'Hare, A, Lodh, R, Colver, A
Trials. 2014;:60
Abstract
BACKGROUND Drooling saliva is a common problem in children with neurodevelopmental disorders. The negative consequences of drooling include skin breakdown, dehydration, and damage to clothing and equipment. Children and families often suffer social embarrassment due to drooling. There is no evidence about the relative effectiveness, side effect profiles or patient acceptability of the two medications most commonly used to reduce drooling - glycopyrronium and hyoscine. Consequently, there is no consensus or guideline to aid clinical decisions about which drug to use, and at what dose. METHODS/DESIGN A multi-centre, randomised trial of treatment with glycopyrronium or hyoscine in children with problematic drooling and non-progressive neurodisability. Ninety children aged between 3 and 15 years who have never received medication for drooling will be stratified by severity of drooling and care centre. Randomisation to receive treatment with glycopyrronium or hyoscine will be computer generated from the trial randomisation website. Dose adjustment and side effect monitoring will occur via telephone consultation. Medication arm will be known to participants and clinicians but not the Trial Outcome Assessor.The primary outcome measure is the Drooling Impact Scale score at four weeks, at which time all children will be on the maximum tolerated dose of their medication. Secondary outcome measures include change in Drooling Impact Scale score between baseline, 4, 12 and 52 weeks, change in Drooling Severity and Frequency Scale score and difference between groups in the Treatment Satisfaction Questionnaire for Medication score. A structured interview with children and young people of sufficient age, cognitive and communication ability will explore their perceptions of drooling and the effectiveness and acceptability of the medications. DISCUSSION The primary objective of the study is to identify whether glycopyrronium or hyoscine is more effective in treating drooling in children with non-progressive neurodisability. The study will also determine which medications at what doses are most acceptable and have fewest side effects. This information will be used to develop evidence based guidance to inform the medical treatment of drooling. DRI TRIAL REGISTRATION Current Controlled Trials: ISRCTN75287237.EUDRACT 2013-000863-94.Medicines and Healthcare products Regulatory Agency (MHRA): 17136/0264/001-0003.
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4.
[The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients].
Acosta-Escribano, J, Almanza López, S, Plumed Martín, L, García Martinez, MA, Tajadura Manjarín, N
Nutricion hospitalaria. 2014;(6):1345-51
Abstract
INTRODUCTION The use of procinéticos in the critical patient with nutrition enteral, they have as aim reduce the increase of the gastric residue (RG). We evaluate his efficiency in the improvement of the intake enteral and on the reduction in the incident gastrointestinal complications (CGI) and pneumonia, in critical patients, with neurological injury Aims: To evaluate the effects in the administration metoclopramide (MCG), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM), in neuro-critically patients (NC) of traumatic and vascular aetiology. Prospective, closed-label, randomized study performed in an intensive Care Unit. Methords: 150 adult neuro-critical patients (NC) were admitted of consecutive form and 109 were randomly and two groups 58 MCG y 51 GC. The primary outcomes was the nutritional: the volume of administered diet (VAD); mean efficacious volume (MEV) measured in three consecutive periods of time; the gastrointestinal complications (GIC), and the rate of partial and definitive suspension of the diet. Infecction: incidence of ventilator associated pneumonia NAVM; and of secondary outcomes were: the duration of mechanical ventilation, length of ICU and hospital stay, and incidence the serious sequelae, and 30 days mortality. RESULTS Differences were not observed in the severity variables between groups on admission. A significant increase was observed in the global values and in the first five days of (p < 0.03) of the VEM in the group of MCG. The values of the global VDA and during three phases of study, the number CGI, the rate of partial and definitive suspensions of the diet, and number of NAVM, were similar in both not significant groups. Neither differences were observed in the overall analysis secondary variables. CONCLUSIONS The metoclopramida in the NC, it is not effective in the decrease of the CGI, in the doses and time of treatment reflected in the study.
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Aluminium exposure from parenteral nutrition in preterm infants and later health outcomes during childhood and adolescence.
Fewtrell, MS, Edmonds, CJ, Isaacs, E, Bishop, NJ, Lucas, A
The Proceedings of the Nutrition Society. 2011;(3):299-304
Abstract
Aluminium is the most common metallic element, but has no known biological role. It accumulates in the body when protective gastrointestinal mechanisms are bypassed, renal function is impaired, or exposure is high - all of which apply frequently to preterm infants. Recognised clinical manifestations of aluminium toxicity include dementia, anaemia and bone disease. Parenteral nutrition (PN) solutions are liable to contamination with aluminium, particularly from acidic solutions in glass vials, notably calcium gluconate. When fed parenterally, infants retain >75% of the aluminium, with high serum, urine and tissue levels. Later health effects of neonatal intravenous aluminium exposure were investigated in a randomised trial comparing standard PN solutions with solutions specially sourced for low aluminium content. Preterm infants exposed for >10 d to standard solutions had impaired neurologic development at 18 months. At 13-15 years, subjects randomised to standard PN had lower lumbar spine bone mass; and, in non-randomised analyses, those with neonatal aluminium intake above the median had lower hip bone mass. Given the sizeable number of infants undergoing intensive care and still exposed to aluminium via PN, these findings have contemporary relevance. Until recently, little progress had been made on reducing aluminium exposure, and meeting Food and Drug Administration recommendations (<5 μg/kg per d) has been impossible in patients <50 kg using available products. Recent advice from the UK Medicines and Healthcare regulatory Authority that calcium gluconate in small volume glass containers should not be used for repeated treatment in children <18 years, including preparation of PN, is an important step towards addressing this problem.
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The Groningen LCPUFA study: no effect of postnatal long-chain polyunsaturated fatty acids in healthy term infants on neurological condition at 9 years.
de Jong, C, Kikkert, HK, Fidler, V, Hadders-Algra, M
The British journal of nutrition. 2010;(4):566-72
Abstract
Long-chain PUFA (LCPUFA) supplementation of formula can have beneficial effects on neurodevelopmental outcome in early infancy, but uncertainty exists regarding effects after 6 months. The present study is the first to investigate whether consumption by term infants of formula containing LCPUFA for the first 2 months after birth improves neurological condition of these children at 9 years of age. A prospective, double-blind, randomised control study was performed in two groups of healthy term infants: a control group with standard formula (n 169) and a LCPUFA-supplemented group (LF; n 146). A breast-fed group (BF; n 159) served as a reference. At age 9 years, children were neurologically assessed according to Touwen, resulting in a Neurological Optimality Score and information on severity and type of minor neurological dysfunction (MND). Information on potential confounders was collected at enrollment and follow-up. Multivariate analyses were carried out to evaluate the effect of nutrition while adjusting for confounders. Attrition (28 %) was selective: drop-outs in the LF group were more often boys and had a significantly lower mental developmental index at 18 months. Neurological optimality and severity and type of MND at 9 years did not differ between the two formula groups. Children in the BF group showed significantly less often fine manipulative dysfunction than formula-fed children. In conclusion, LCPUFA supplementation of formula during the first 2 postnatal months in healthy term infants does not alter neurological function at school age. The study confirmed that breast-fed infants have a slightly better neurodevelopmental outcome than formula-fed infants.
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7.
Improving head growth in very preterm infants--a randomised controlled trial I: neonatal outcomes.
Tan, MJ, Cooke, RW
Archives of disease in childhood. Fetal and neonatal edition. 2008;(5):F337-41
Abstract
BACKGROUND Infants born very preterm are at an increased risk of poor growth in the post-natal period. Poor brain growth in this critical period may result from inadequate nutrition, and has long-term effects on neurodevelopmental outcome. AIMS To examine the feasibility of providing macronutrients at amounts above current recommendations (hyperalimentation) to improve nutrition and head growth in preterm infants. METHODS 142 infants <29 weeks' gestation were randomised to hyperalimented or standard parenteral and enteral nutrition. Growth was monitored from birth to 36 weeks' postmenstrual age (PMA). The primary outcome measure was occipitofrontal circumference (OFC) at 36 weeks' PMA. RESULTS 55 infants in the intervention group and 59 infants in the control group survived to 36 weeks' PMA. 11 (16%) infants in the intervention group and 13 (18%) infants in the control group were small for gestational age (SGA). There was no statistically significant difference between the two groups in the primary outcome measure or other growth variables. Babies in the intervention group received significantly more energy and protein, but 80% were still in a cumulative protein/energy deficit at the end of 4 weeks. 20 (24%, p = 0.008) of those in deficit at 4 weeks had an OFC of more than 2 SD below the mean at 36 weeks' PMA, as opposed to none of those not in deficit. CONCLUSION Cumulative energy/protein deficit is predictive of poor head growth, but the delivery of adequate intakes remains a challenge in the preterm.
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8.
Analgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol.
Cafiero, T, Burrelli, R, Latina, P, Mastronardi, P
Minerva anestesiologica. 2004;(1-2):45-52
Abstract
AIM: Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia. EXPERIMENTAL DESIGN perspective, randomized, single blinded and comparative study. Institution: neurosurgical operating theatre at University. PATIENTS 96 patients, aging from 25 to 67 years, ASA class I-III, undergoing neurosurgical operations, were studied. INTERVENTIONS AND MEASUREMENTS the anesthetic management was: premedication: atropine 0.01 microg kg(-1) + remifentanil 0.20 microg kg(-1) min(-1); induction: propofol 2.0 microg kg(-1) + cisatracurium 0.15 microg kg(-1); maintenance: sevoflurane 0.8% + remifentanil (titrated infusion) cisatracurium. All patients received ketorolac 30 mg i.v. 1 hour before the end of surgery and ketorolac (60-90 mg) + tramadol (200-300 mg) by elastomeric pump; patients were divided into 2 groups: group T receiving tramadol 100 mg and group S receiving a bolus dose of sufentanil 0.10 microg kg(-1), 30 and 15 minutes before the end of surgery respectively. Recovery time, postoperative analgesia evaluated by VAS, cardiocirculatory parameters and side effects like nausea, vomiting, shivering, muscle rigidity, sedation and respiratory depression were recorded. RESULTS VAS was significantly lower in Group S. Recovery time was shorter in Group T than in Group S (8.8 +/- 3.6 vs 11.6 +/- 4.6 min), no statistically significant differences between groups as regards nausea, vomiting and shivering. Short-lasting respiratory depression was detected in 3 cases in Group S. CONCLUSION At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.