The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study / 소아과

BACKGROUND: Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. PURPOSE: We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care. METHODS: Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients. RESULTS: Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery. CONCLUSION: The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.

Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement / Prevalência de miocardite em casos pediátricos na unidade de terapia intensiva, com envolvimento de outros sistemas

OBJECTIVE: To assess children with myocarditis, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis. METHODS: This was an observational study of 63 patients admitted to PICU with non-cardiac diagnosis. Cardiac enzymes, chest-X ray, echocardiography, and electrocardiogram were performed to diagnose myocarditis among those patients. RESULTS: There were 16 cases of definite myocarditis. The age distribution was non-normal, with median of 5.5 months (3.25-21). Of the 16 patients who were diagnosed with myocarditis, 62.5% were originally diagnosed as having respiratory problems, and there were more females than males. Among the present cases, the accuracy of cardiac enzymes (cardiac troponin T [cTn] and creatine phosphokinase MB [CKMB]) in the diagnosis of myocarditis was only 63.5%, while the accuracy of low fractional shortening and of chest-X ray cardiomegaly was 85.7 and 80.9%; respectively. Cardiac troponin folds 2.02 had positive predictive value of 100%, negative predictive value of 88.7%, specificity of 100%, sensitivity of 62.5%, and accuracy of 90.5%. CONCLUSIONS: Children with myocarditis present with symptoms that can be mistaken for other types of illnesses. When clinical suspicion of myocarditis exists, chest-X ray and echocardiography are sufficient as screening tests. Cardiac troponins confirm the diagnosis in screened cases, with specificity of 100%. .

OBJETIVO: Determinar as crianças com miocardite, a frequência de sintomas apresentados e a precisão de investigações no diagnóstico. MÉTODOS: Estudo observacional de 63 pacientes internados na UTIP com diagnóstico de problemas não cardíacos. Os exames de enzimas cardíacas, raios-X do tórax, ecocardiograma e eletrocardiograma (ECG) foram feitos para diagnosticar miocardite entre os pacientes. RESULTADOS: Houve 16 casos de miocardite definida. A distribuição etária não foi normal, com média de 5,5 meses (3,25-21). Dos 16 pacientes, 62,5% foram originalmente diagnosticados com problemas respiratórios e a mulheres estavam em maior número do que os homens. Dentre nossos casos, a precisão das enzimas cardíacas (cTn e CKMB) no diagnóstico da miocardite foi de apenas 63,5%, apesar de a precisão da baixa fração de encurtamento (FS) e dos raios-X de tórax que revelaram cardiomegalia ter sido 85,7% e 80,9%; respectivamente. A troponina cardíaca em 2,02 vezes apresentou valor preditivo positivo = 100%, valor preditivo negativo = 88,7%, especificidade = 100%, sensibilidade = 62,5% e precisão = 90,5%. CONCLUSÕES: As crianças com miocardite apresentam sintomas que podem ser confundidos com outros tipos de doenças. Quando há suspeita clínica de miocardite, raios-X de tórax e ecocardiografia são testes de rastreamento suficientes. As troponinas cardíacas confirmam o diagnóstico em casos examinados, com especificidade de 100%. .

Heart rate variability in normal children and patients with congenital left to right shunt: time domain analysis based study

Three groups of subjects were included in this study. Group I: 50 subjects with no evidence of structural heart disease to study normal heart rate variability indices using time domain analysis in normal children. Group II included 30 patients with congenital left to right shunt with no evidence of heart failure. Group III included 20 patients with congenital left to right shunt and heart failure. All groups are both age and weight matched. Based on analysis of 24 hours ambulatory electrocardiographic monitoring data we noticed no significant difference between group I and group II in all time domain indices while there was significant reduction of all indices in group three compared to other 2 groups [P <0.001 for both SDNN and SDANN and <0.01 for pNN50 and rMSSD] using one way ANOVA]. We concluded that, the presence of heart failure in patients with CHD augments sympathetic nervous system activity in those patients and is responsible for the genesis of arrhythmias in them

Effect of nitric oxide, antioxidants and pravastatin on experimental atherosclerosis in male New Zealand white [NZW] rabbits

Atherosclerosis is considered one of the major causes of human morbidity and mortality all over the world. In this work, an attempt was done to investigate the possible role of nitric oxide [NO] on modulation of experimentally-induced atherosclerosis in male New Zealand White [NZW] rabbits. For this purpose, 64 male NZW rabbits were left for 2 weeks to acclimatize to laboratory conditions before being included in this experiment. Rabbits were then randomly classified into 8 equal groups. The first group [control, C] was fed commercial chow and the second group [atherosclerotic, A] was fed an atherogenic diet [containing 1% cholesterol]. The last 6 groups [VCA, AA, NSA, NA, PA and PNA groups] were fed the atherogenic diet in addition to the following respectively [vitamin C, L-arginine, Nigella sativa [NS], N-Nitro- L-arginine methyl ester [L-NAME], pravastatin and L-NAME with pravastatin]. The different feeding regimen and treatments were continued for 2 months. After 2 months, rabbits were killed to evaluate the severity of atherosclerosis and the effect of the different treatments given. The following parameters were assayed [plasma lipid profile, malondialdehydes [MDA], total antioxidant status [TAS] and nitrites; aortic tissue prostaglandin E[2][PGE[2]] and histological examination]. The atherogenic diet induced a significant increase in plasma total cholesterol [TC], triglycerides [TG], low density lipoprotein [LDL], high density lipoprotein [HDL] and MDA compared to C group. The TAS, nitrites and aortic PGE[2] were significantly decreased compared to control values. These atherogenic changes were reflected on the histopathological changes observed in aortic tissues from the A group. Vitamin C [500 mg/kg/day, orally] improved the atherogenic changes when given to atherosclerotic rabbits. There was a significant increase in TAS, nitrites and aortic PGE[2] associated with a significant decrease in MDA associated with improvement in the histopathological picture of aortic tissue of VCA group compared to A group. Administration of NS to atherosclerotic rabbits produced significant decrease in TC, TG, LDL and MDA and significant increase in HDL, TAS, nitrites and PGE[2] in NSA group compared with A group. These effects were associated with improvement in the histopathological picture of aortic tissue of NSA group compared with A group. L-arginine produced significant decrease in MDA and significant increase in TAS nitrites and PGE[2] in AA group compared with A group. In NA group, L-NAME aggravated atherosclerosis as evidenced by a significant increase in MDA, significant decrease in TAS, nitrites and PGE[2] and aggravation of the atherogenic changes in aortic tissue compared with A group. Pravastatin improved all atherogenic changes in PA group compared with A group. There were significant decrease in TC, TG, LDL and MDA with significant increase in HDL, TAS, nitrites and aortic PGE[2]. This protective effect of pravastatin was reflected on the histopathological picture of aortic tissue. In PNA group, L-NAME antagonized the protective effect of pravastatin. It was concluded that atherosclerosis is a multifactorial disease. The increase in free radicals [FR] and lipid peroxidation and the decrease in NO and PGE[2] are the main contributors of atherosclerosis. The antiatherogenic effects of pravastatin depend upon its plasma lipid lowering and antioxidant effects, in addition to increase intimal NO and PGE[2] production. L-NAME antagonized the antiatherogenic effects of pravastatin. The antiatherogenic effects of Nigel/a saliva and vitamin C depend mainly on their antioxidant action. Other mechanisms may contribute such as decrease in lipid profile [Nigella saliva] and increase in NO and PGE[2] production [Nigella saliva and Vitamin C]. These findings suggest that pravastatin is the most effective antiatherosclerotic agent followed by Nigella saliva and high dose of vitamin C. So, it is recommended that addition of Nigella saliva and/or antioxidant vitamins [such as vitamins C] to potentiate the antiatherogenic effects of pravastatin in atherosclerotic patients. This will also reduce the cost of treatment and side effects of drugs