Plasma levels of amino acids in elderly long term care residents with oropharyngeal dysphagia: comparison of hand-oral with tube-enteral-fed patients.

BACKGROUND: Dysphagia and eating difficulties are highly prevalent in long term care patients. Evaluation of their nutritional status is complicated by comorbidity, frailty and individual patterns of feeding. In previous studies we found vitamin deficiencies (folic acid B6 and B12) in orally fed elderly in early stages of oropharyngeal dysphagia despite satisfactory nutritional parameters (BMI, albumin and hemoglobin). The aim of this study is to evaluate the plasma amino acids levels in these hand-oral fed elderly patients with dysphagia. METHODS: Plasma amino acids were measured in 15 orally fed elderly patients in early functional outcome swallowing scale (FOSS), stage 2, and compared with those of 15 matched nasogastric-tube-fed counterparts. RESULTS: The plasma levels of all measured amino acids, ratio of essential to nonessential, levels of conditionally essential and the immune-enhancing amino acids were similar in both groups and within the normal range of our laboratory. The traditional nutritional parameters were also similar in both groups and within the normal range. CONCLUSIONS: Plasma levels of amino acids in elderly patients in early stage of FOSS are satisfactory, supporting the view that their protein intake is adequate. Further studies should concentrate on patients in advanced stages of FOSS.

Oral contraceptives can cause falsely low vitamin B(12) levels.

Serum vitamin B(12) radioimmunoassays may give falsely low results in patients with folate deficiency, multiple myeloma, megadose of vitamin C and following radioisotope organ scan. We evaluated 10 consecutive healthy women on oral contraceptives (OC) who had falsely low vitamin B(12) levels, as reflected by normal urine methylmalonic acid and plasma homocysteine. After 1-month cessation of OCs, vitamin B(12) returned to the normal range in all women. Transcobalamin I (TCI) blood level was decreased in 60% of patients. OCs may cause temporary low vitamin B(12) blood levels of no clinical significance that can be associated with low TCI levels

[Gyrate atrophy of choroid and retina, and hyperornithinemia].

Gyrate atrophy of the choroid and retina is a rare degenerative disease, characterized biochemically by a marked increase in blood ornithine levels, due to deficiency of ornithine S-amino transferase. 4 men aged 35, 36, 48 and 62 years are described with different stages of myopia, night blindness and loss of peripheral vision, which progressed to tunnel vision and partial blindness. Onset of the disease was at ages 3, 10 and 15 years, respectively, while in the 4th patient there was delayed expression starting at about age 50. Most had posterior subcapsular cataracts, and the ocular fundus exhibited demarcated circular areas of chorioretinal degeneration. So far the only patients described in Israel have been of Iraqui origin. Our fourth patient originated from Istanbul, and he may represent a hitherto undescribed variant with a much delayed expression of the disease.

Aminoaciduria resulting from vigabatrin administration in children with epilepsy.

Vigabatrin (gamma-vinyl gamma aminobutyric acid), a recently developed antiepileptic drug, has been extensively evaluated in the treatment of drug-resistant epilepsy. Several case reports demonstrated that vigabatrin affects urinary excretion of several amino and organic acids. Fourteen children were investigated for the presence of abnormal urinary amino acids before and after treatment with vigabatrin. All demonstrated increased urinary excretion of amino acids, particularly beta-alanine, gamma-aminobutyric acid, and beta-aminoisobutyric acid while on vigabatrin, which were not detected when off medication. These results emphasize the importance of obtaining urine for metabolic evaluation before the administration of vigabatrin.

[D-lactic acidosis in short bowel syndrome].

A boy of 20 months and a girl of 27 months who had previously undergone massive bowel resection due to congenital intestinal obstruction are described. During gradual reduction of total parenteral nutrition and initiation of oral feeding, both developed severe, acute metabolic acidosis, accompanied by encephalopathy and ataxia. After the laboratory identification of massive amounts of the d-isomer of lactic acid in urine and blood, both were successfully treated with i.v. bicarbonate, and metronidazole to suppress the overgrowth of colonic lactobacilli responsible for the metabolic crisis.

[Alpha-amino adipic aciduria: a rare psychomotor syndrome].

A 3.5-year-old boy with developmental motor retardation, hypotonicity, and severe speech disturbance had alpha-amino adipic acid in his blood and very high levels in his urine. In only 20 cases has this catabolite of lysine and hydroxylysine been found in high concentrations in urine, due to enzymatic block. The clinical features associated with alpha-amino adipic aciduria may include mental retardation, developmental and motor delay, learning difficulties, convulsions, speech problems and ataxia. 3 siblings had milder symptoms of psychomotor delay and intermediate degrees of alpha amino-adipic aciduria, suggesting that the described developmental deficits could be related to this metabolite or its derivatives.

Clinical indicators to assess the quality of social work services in nursing homes.

Nursing home social work service providers (n = 209) evaluated a proposed set of clinical indicators developed by an NASW Work Group to use in measuring social work performance in that setting. Practitioners rated all of the indicators highly for clarity, relevance, and meaningfulness to service provision. Problems with feasibility of use were identified for two of the indicators. Perceived difficulties in implementation are identified and addressed. A rationale is presented for the utility for nursing home practice of a uniform, professionally validated set of performance indicators as a component of quality improvement efforts.

Searching for the doable in nursing home social work practice.

Nursing home social workers were asked to provide information about their current practice circumstances, and to rate relative importance of resident and family psychosocial needs and frequency of functions performed or overseen by social workers to meet these needs. Both consultant and full-time staff social workers practiced under severe time constraints. Practitioners viewed psychosocial needs similarly, but staff and consultants met these needs through somewhat different functions. Findings provide a profile of practice that can contribute to care improvement through a definition of realistic service expectations for which social workers can be accountable.

Aspectos do programa estadual contra o fumo. / Aspects of the anti-smoking State program

Descrve-se genericamente os motivos da Campanha Contra o Fumo no Estado do Parana as principais entidades e pessoas envolvidas. Tres trabalhos de pesquisa sao apresentados, sendo que os dois primeiros foram realizados antes da Campanha de Agosto de 1980. O primeiro "Desvio da renda mensal para o tabagismo" evidencia que o maior percentual de gasto em fumo se encontra na populacao de baixa renda, entre um e dois salarios minimos (36,03%). O segundo trabalho revela o fato que entre os jovens fumantes a diferenca entre sexos e minima: 14,14% do sexo masculino e 12,12% do sexo feminino. Comecaram a fumar antes de 14 anos de idade, 56,56% de sexo masculino e 62,23% do sexo feminino. Somente 25,14% dos fumantes reconhecem que o fumo prejudica a saude. A terceira e ultima pesquisa realizada em novembro de 1980 reveja que pelo menos um membro de familia de 11, 3% e 8,5% dos jovens entrevistados deixaram de fumar, apos a campanha