Extracorporeal Life Support Organization Guidelines for the Provision and Assessment of Nutritional Support in the Neonatal and Pediatric ECMO Patient.

DISCLAIMER: This guideline is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians' and other health professionals' judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but Extracorporeal Life Support Organization (ELSO) is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

Un acercamiento desde la ecología social a la lectura de territorio en la intervención del trabajo social / An approach from social ecology to the reading of territory in social work intervention

Este artículo de reflexión desarrolla la siguiente premisa: realizar lectura de territorio para llevar a cabo procesos de gestión ambiental y planificación territorial, como un resultado de la investigación realizada en el 2018, Prácticas y saberes de intervención del Trabajo Social en el escenario ambiental; desde la experiencia de los departamentos de Antioquia y Caldas. El presente artículo pretende entonces abordar el papel que asume el trabajador social en relación con la intervención en el escenario ambiental, partiendo del reconocimiento y la lectura del territorio, entendido este no solo como un espacio geográfico, sino también como un espacio donde convergen diferentes aristas, tales como los ámbitos sociales y culturales inmersos en la cotidianidad del hombre; con ello se espera generar reflexiones y movilizaciones frente al reconocimiento de derechos e incentivar la participación ciudadana. Teniendo en cuenta este panorama, y pensando desde la ecología social, es indispensable que el ser humano comprenda el vínculo que tiene con la naturaleza, no solo desde el enfoque natural, sino también desde el social y el cultural.

This reflection article develops the following premise: to perform territory reading to carry out processes of environmental management and territorial planning, as a result of the research conducted in 2018, Practices and knowledge of Social Work intervention in the environmental scenario; from the experience of the departments of Antioquia and Caldas. This article aims then to address the role assumed by the social worker in relation to the intervention in the environmental scenario, starting from the recognition and reading of the territory, understood not only as a geographical space, but also as a space where different edges converge, such as the social and cultural spheres immersed in the daily life of man; with this, it is expected to generate reflections and mobilizations in front of the recognition of rights and encourage citizen participation. Considering this panorama, and thinking from the perspective of social ecology, it is essential that human beings understand the link they have with nature, not only from the natural approach, but also from the social and cultural ones.

Energy and Protein Delivery in Overweight and Obese Children in the Pediatric Intensive Care Unit.

BACKGROUND: Early and optimal energy and protein delivery have been associated with improved clinical outcomes in the pediatric intensive care unit (PICU). Overweight and obese children in the PICU may be at risk for suboptimal macronutrient delivery; we aimed to describe macronutrient delivery in this cohort. METHODS: We performed a retrospective study of PICU patients ages 2-21 years, with body mass index (BMI) ≥85th percentile and >48 hours stay. Nutrition variables were extracted regarding nutrition screening and assessment, energy and protein prescription, and delivery. RESULTS: Data from 83 patient encounters for 52 eligible patients (52% male; median age 9.6 [5-15] years) were included. The study cohort had a longer median PICU length of stay (8 vs 5 days, P < .0001) and increased mortality rate (6/83 vs 182/5572, P = .045) than concurrent PICU patient encounters. Detailed nutrition assessment was documented for 60% (50/83) of patient encounters. Energy expenditure was estimated primarily by predictive equations. Stress factor >1.0 was applied in 44% (22/50). Median energy delivered as a percentage of estimated requirements by the Schofield equation was 34.6% on day 3. Median protein delivered as a percentage of recommended intake was 22.1% on day 3. CONCLUSIONS: The study cohort had suboptimal nutrition assessments and macronutrient delivery during their PICU course. Mortality and duration of PICU stay were greater when compared with the general PICU population. Nutrition assessment, indirect calorimetry-guided energy prescriptions, and optimizing the delivery of energy and protein must be emphasized in this cohort. The impact of these practices on clinical outcomes must be investigated.

Caracterización en salud oral y hábitos de higiene oral en pacientes con enfermedad renal crónica / Diagnosis of oral health and oral hygiene habits in patients with chronic kidney disease

Objetiv determinar el estado de salud oral de pacientes con enfermedad renal crónica atendidos en un centro de terapia renal y su relación con marcadores nutricionales, inflamatorios y dosis de eritropoyetina. Pacientes: todos los pacientes con enfermedad renal crónica atendidos en RTS sucursal Caldas en programas predialítico, postrasplante renal, hemodiálisis y diálisis peritoneal, con más de tres meses ininterrumpidos de asistencia en uno de esos programas, haber aceptado su participación en el estudio, contar con los paraclínicos necesarios para el estudio y registro de dosis administrada de eritropoyetina. Métodos: trescientos treinta y seis pacientes cumplieron con los criterios de inclusión: 24 (7%) en prediálisis, 164 (49%) en hemodiálisis, 114 (34%) en diálisis peritoneal y 34 (10%) en postrasplante renal. Se establecieron los datos demográficos y se evaluaron los índices de placa (higiene oral), salud periodontal, experiencia en caries COP-D (cariados, obturados, perdidos - diente), y diagnóstico estomatológico. También resultados de exámenes paraclínicos indicadores de estado inflamatorio tales como albúmina, ferritina y porcentaje de saturación de transferrina, además la dosis administrada de eritropoyetina. Resultados: la población de pacientes en prediálisis y postrasplante renal no arrojó datos suficientes para ser incluida en el análisis estadístico. De los pacientes en diálisis 63% presentaban buena higiene oral, 33% regular, y sólo 3% tenían mala higiene oral, a pesar de ello la prevalencia de enfermedad periodontal fue alta afectando a 75% de los pacientes llegándose a presentar gingivitis severa en 35-38% de los pacientes. Por el índice COP-D se observó que la prevalencia en caries fue alta. Por lo disperso de los resultados de laboratorio de marcadores inflamatorios no fue posible determinar correlación alguna entre ellos y salud periodontal o dosis de eritropoyetina. Conclusiones: la higiene oral de los pacientes ...

Objective: to establish the oral health condition of patients with chronic kidney disease (CKD) who received care in a center for renal therapy, as well as its relationship with nutritional and inflammatory markers and doses of erythropoietin received. Patients: patients with chronic kidney disease treated at RTS Caldas, in the following programs: predialysis, post-renal transplant, hemodialysis, and peritoneal dialysis. All these patients had attended any of these programs uninterruptedly for at least three months; they agreed to participate in the study and had the necessary laboratory studies, as well as registered doses of erythropoietin. Methods: three hundred thirty-six patients met the inclusion criteria: 24 (7%) in predialysis, 164 (49%) in hemodialysis, 114 (34%) in PD and 34 (10%) in post-renal transplant. The following demographic data were established and assessed: Silness and Loe plaque indices (oral Health) and Loe and Silness gingival indices, caries experience in Decayed-Missing-Filled Teeth Index (DMFT) and stomatologic diagnosis. Additionally, laboratory reports were recorded indicating the infammation state of the patients: albumin, ferritin, transferrin saturation and erythropoietin dosage. Results: pre-dialysis and post-renal transplant populations did not give suffIcient information to be included in the statistical analysis. The following information was obtained from dialysis patients: 63% had good oral hygiene, 33% fair, and only 3% had poor oral hygiene. The prevalence of periodontal disease was high, affecting 75% of patients. Severe gingivitis was present in 35-38% of patients. The DMFT index showed a high prevalence of caries. No relationship was found between laboratory results for infammatory markers, periodontal health, and doses of erythropoietin. Conclusions: the oral hygiene of dialysis patients is satisfactory. However, they have a high prevalence of periodontal disease and tooth decay. This suggests ...

Demografía y ecología de anidación de la iguana verde, Iguana iguana (Squamata: Iguanidae), en dos poblaciones explotadas en la Depresión Momposina, Colombia / Demography and nesting ecology of green iguana, Iguana iguana (Squamata: Iguanidae), in 2 exploited populations in Depresión Momposina, Colombia

We studied the demography and nesting ecology of two populations of Iguana iguana that face heavy exploitation and habitat modification in the Momposina Depression, Colombia. Lineal transect data was analyzed using the Fourier model to provide estimates of social group densities, which was found to differ both within and among populations (1.05-6.0 groups/ha). Mean group size and overall iguana density estimates varied between populations as well (1.5-13.7 iguanas/ha). The density estimates were far lower than those reported from more protected areas in Panama and Venezuela. Iguana densities were consistently higher in sites located along rivers (2.5 iguanas/group) than in sites along the margin of marshes, probably due to vegetational differences (1.5 iguanas/group). There was no correlation between density estimates and estimates of relative abundance (number of iguanas seen/hour/person) due to differing detectabilities of iguana groups among sites. The adult sex ratio (1:2.5 males:females) agreed well with other reports in the literature based upon observation of adult social groups, and probably results from the polygynous mating system in this species rather than a real demographic skew. Nesting in this population occurs from the end of January through March and hatching occurs between April and May. We monitored 34 nests, which suffered little vertebrate predation, perhaps due to the lack of a complete vertebrate fauna in this densely inhabited area, but nests suffered from inundation, cattle trampling, and infestation by phorid fly larvae. Clutch sizes in these populations were lower than all other published reports except for the iguana population on the highly xeric island of Curaçao, implying that adult females in our area are unusually small. We argue that this is more likely the result of the exploitation of these populations rather than an adaptive response to environmentally extreme conditions.

[Demography and nesting ecology of green iguana, Iguana iguana (Squamata: Iguanidae), in 2 exploited populations in Depresión Momposina, Colombia]. / Demografía y ecología de anidación de la iguana verde, Iguana iguana (Squamata: Iguanidae), en dos poblaciones explotadas en la Depresión Momposina, Colombia.

We studied the demography and nesting ecology of two populations of Iguana iguana that face heavy exploitation and habitat modification in the Momposina Depression, Colombia. Lineal transect data was analyzed using the Fourier model to provide estimates of social group densities, which was found to differ both within and among populations (1.05-6.0 groups/ha). Mean group size and overall iguana density estimates varied between populations as well (1.5-13.7 iguanas/ha). The density estimates were far lower than those reported from more protected areas in Panama and Venezuela. Iguana densities were consistently higher in sites located along rivers (2.5 iguanas/group) than in sites along the margin of marshes, probably due to vegetational differences (1.5 iguanas/group). There was no correlation between density estimates and estimates of relative abundance (number of iguanas seen/hour/person) due to differing detectabilities of iguana groups among sites. The adult sex ratio (1:2.5 males:females) agreed well with other reports in the literature based upon observation of adult social groups, and probably results from the polygynous mating system in this species rather than a real demographic skew. Nesting in this population occurs from the end of January through March and hatching occurs between April and May. We monitored 34 nests, which suffered little vertebrate predation, perhaps due to the lack of a complete vertebrate fauna in this densely inhabited area, but nests suffered from inundation, cattle trampling, and infestation by phorid fly larvae. Clutch sizes in these populations were lower than all other published reports except for the iguana population on the highly xeric island of Curaçao, implying that adult females in our area are unusually small. We argue that this is more likely the result of the exploitation of these populations rather than an adaptive response to environmentally extreme conditions.