[Justification of the need to normalize vitamin D status for immunoprophylaxis].

Currently, there is an increase in the resistance of microorganisms to the available arsenal of antimicrobial drugs, which makes it necessary to maintain and stimulate the body's own immune-protective properties. The main extraskeletal effect of vitamin D activity is associated with the homeostasis of the immune system. The role of vitamin D in reducing the risk of infection with infectious agents has been studied for a long time. Literature search on the effective use of vitamin D for immunoprophylaxis was carried out in Scopus, Web of Science, PubMed, clinicaltrials.gov databases over the past 10 years for related keywords: vitamin D, immunoprophylaxis. Vitamin D stimulates the synthesis of antimicrobial peptides, cathelicidins and defensins, which exhibit broad-spectrum activity against viruses, bacteria and fungal infections; reduces the concentration of pro-inflammatory cytokines; increases the concentration of anti-inflammatory cytokines. Vitamin D is also involved in cell differentiation, maturation and proliferation of immune cells. The article presents the literature review in order to justify additional intake of vitamin D in case of diagnosis of its deficiency and insufficiency for the purpose of immunoprophylaxis in children and adults, especially in risk groups (elderly age, pregnant women, patients with chronic diseases of respiratory, endocrine and urinary systems, gastrointestinal tract, and infectious diseases). Inclusion of vitamin D in the diet as a dietary supplement, as well as fortification of products with it, can be an effective measure to reduce the risk of both morbidity and mortality, especially during the period of quarantine measures.

The Effect of a Polysaccharide-Based Multinutrient Dietary Supplementation Regimen on Infections and Immune Functioning in Multiple Sclerosis.

Multiple sclerosis (MS) is a progressive neurodegenerative disease associated with increased infection rates, chronic inflammation, and premature death. Optimization of nutritional status via dietary supplementation may improve immune function in people suffering from MS and lead to decreased rates of infection. Fifteen individuals with a diagnosis of relapsing-remitting MS for an average of 12.4 years (SD =7.4; R = 2, 25) were enrolled in a one-year open-label clinical trial. Participants consumed a broad-spectrum dietary supplement regimen containing polysaccharides, phytochemicals, antioxidants, vitamins, and minerals three times per day. The occurrence of infections and a panel of cytokines, growth factors, and T- and B-cell subsets were assessed at baseline and 12 months. Seven female and 8 male participants with an average age of 51.3 years (SD =7.2; R = 38, 65) completed the study. At the end of the intervention, participants had fewer total infections (M = 7.9, SD =8.1 at baseline and M = 2.5, SD =4.3 at 12-month follow-up). At 12 months, IL-2, TNF-α, EGF, and CD95 + CD34+ significantly increased, while IL-1ß significantly decreased. No major adverse effects were reported; only mild gastrointestinal intolerance was reported in four cases. A decreased occurrence of infection was observed in MS patients treated with 12 months of a polysaccharide-based multinutrient dietary supplement. Significant changes were also noted in several key biomarkers that would be physiologically favorable to the MS population. Thus, the results of this study suggest an immunomodulatory effect of the dietary supplement regimen studied.

Inducible expression of defensins and cathelicidins by nutrients and associated regulatory mechanisms.

Host defense peptides (HDPs) are crucial components of the body's first line of defense that protect organisms from infections and mediate immune responses. Defensins and cathelicidins are the two most important families of HDPs in mammals. In this review, we summarize the nutrients that are involved in inducible expression of endogenous defensins and cathelicidins. In addition, the mitogen-activated protein kinases (MAPK), nuclear factor kappa B (NF-κB) and histone deacetylase (HDAC) signaling pathways that play vital roles in the induction of defensin and cathelicidin expression are highlighted. Endogenous defensins and cathelicidins induced by nutrients may be potential alternatives to antibiotic treatments against infection and diseases. This review mainly focuses on the inducible expression and regulatory mechanisms of defensins and cathelicidins in multiple species by different nutrients and the potential applications of defensin- and cathelicidin-inducing nutrients.

Cost-effectiveness study of early versus late parenteral nutrition in critically ill children (PEPaNIC): preplanned secondary analysis of a multicentre randomised controlled trial.

BACKGROUND: The multicentre randomised controlled PEPaNIC trial showed that withholding parenteral nutrition (PN) during the first week of critical illness in children was clinically superior to providing early PN. This study describes the cost-effectiveness of this new nutritional strategy. METHODS: Direct medical costs were calculated with use of a micro-costing approach. We compared the costs of late versus early initiation of PN (n = 673 versus n = 670 patients) in the Belgian and Dutch study populations from a hospital perspective, using Student's t test with bootstrapping. Main cost drivers were identified and the impact of new infections on the total costs was assessed. RESULTS: Mean direct medical costs for patients receiving late PN (€26.680, IQR €10.090-28.830 per patient) were 21% lower (-€7.180, p = 0.007) than for patients receiving early PN (€33.860, IQR €11.080-34.720). Since late PN was more effective and less costly, this strategy was superior to early PN. The lower costs for PN only contributed 2.1% to the total cost reduction. The main cost driver was intensive care hospitalisation costs (-€4.120, p = 0.003). The patients who acquired a new infection (14%) were responsible for 41% of the total costs. Sensitivity analyses confirmed consistency across both healthcare systems. CONCLUSIONS: Late initiation of PN decreased the direct medical costs for hospitalisation in critically ill children, beyond the expected lower costs for withholding PN. Avoiding new infections by late initiation of PN yielded a large cost reduction. Hence, late initiation of PN was superior to early initiation of PN largely via its effect on new infections. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01536275 . Registered on 16 February 2012.

Starch-based polyurethane/CuO nanocomposite foam: Antibacterial effects for infection control.

In the present study, a new method for the synthesis of the open cell flexible polyurethane foams (PUFs) was developed by using starch powder and the modification of closed cell foam formulation. Starch is the second largest polymeric carbohydrate as a macromolecule on this planet with a large number of glucose units. Copper oxide nanoparticles (CuO NPs) were synthesized by thermal degradation method at different temperatures of 400, 600 and 800 °C as antimicrobial agents. The antimicrobial activity of CuO NPs and commercial CuO powder against the main causes of hospital infections were tested. CuO600 was the most effective antimicrobial agent and enhanced polymer matrix tensile strength with starch powder as new polyurethane foams (PUFs) cell opener with high tensile strength. The effects of parameters on tensile strength were optimized using response surface methodology (RSM). CuO NPs and PUF had optimal conditions and were characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Foam synthesized at the optimal conditions had an open cell structure with high tensile strength and efficient antimicrobial activity that made them suitable to be used as an antimicrobial hospital mattress to control hospital infections.

Potential role of bioactive peptides in prevention and treatment of chronic diseases: a narrative review.

In the past few years, increasing interest has been directed to bioactive peptides of animal and plant origin: in particular, researchers have focused their attention on their mechanisms of action and potential role in the prevention and treatment of cancer, cardiovascular and infective diseases. We have developed a search strategy to identify these studies in PubMed (January 1980 to May 2016); particularly those papers presenting comprehensive reviews or meta-analyses, plus in vitro and in vivo studies and clinical trials on those bioactive peptides that affect cardiovascular diseases, immunity or cancer, or have antioxidant, anti-inflammatory and antimicrobial effects. In this review we have mostly focused on evidence-based healthy properties of bioactive peptides from different sources. Bioactive peptides derived from fish, milk, meat and plants have demonstrated significant antihypertensive and lipid-lowering activity in clinical trials. Many bioactive peptides show selective cytotoxic activity against a wide range of cancer cell lines in vitro and in vivo, whereas others have immunomodulatory and antimicrobial effects. Furthermore, some peptides exert anti-inflammatory and antioxidant activity, which could aid in the prevention of chronic diseases. However, clinical evidence is at an early stage, and there is a need for solid pharmacokinetic data and for standardized extraction procedures. Further studies on animals and randomized clinical trials are required to confirm these effects, and enable these peptides to be used as preventive or therapeutic treatments. LINKED ARTICLES: This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.

[STEPPED DIET THERAPY OF ACUTE ENTERIC INFECTIONS IN CHILDREN].

The article describes the main principles of stepped diet therapy of acute intestinal infections in children developed on the basis of nutritive support staging, depending on patients' age, stage and severity of disease. Significance of functional food products for diet therapy tactics in patients with mild and moderately severe forms of infection is demonstrated.

Updated cost-effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive-care patients.

BACKGROUND/OBJECTIVES: Intravenous (i.v.) glutamine supplementation of parenteral nutrition (PN) can improve clinical outcomes, reduce mortality and infection rates and shorten the length of hospital and/or intensive care unit (ICU) stays compared with standard PN. This study is a pharmacoeconomic analysis to determine whether i.v. glutamine supplementation of PN remains both a highly favourable and cost-effective option for Italian ICU patients. SUBJECTS/METHODS: A previously published discrete event simulation model was updated by incorporating the most up-to-date and clinically relevant efficacy data (a clinically realistic subgroup analysis from a published meta-analysis), recent cost data from the Italian health-care system and the latest epidemiology data from a large Italian ICU database (covering 230 Italian ICUs and more than 77,000 patients). Sensitivity analyses were performed to test the robustness of the results. RESULTS: Parenteral glutamine supplementation can significantly improve ICU efficiency in Italy, as the additional cost of supplemented treatment is more than completely offset by cost savings in hospital care. Supplementation was more cost-effective (cost-effectiveness ratio (CER)=[euro ]35,165 per patient discharged alive) than standard, non-supplemented PN (CER=[euro ]40,156 per patient discharged alive), and it resulted in mean cost savings of [euro ]4991 per patient discharged alive or [euro ]1047 per patient admitted to the hospital. Sensitivity analyses confirmed the robustness of these results. CONCLUSIONS: Alanyl-glutamine supplementation of PN is a clinically and economically attractive strategy for ICU patients in Italy and may be applicable to selected ICU patient populations in other countries.

Monitoring immune modulation by nutrition in the general population: identifying and substantiating effects on human health.

Optimal functioning of the immune system is crucial to human health, and nutrition is one of the major exogenous factors modulating different aspects of immune function. Currently, no single marker is available to predict the effect of a dietary intervention on different aspects of immune function. To provide further guidance on the assessment and interpretation of the modulation of immune functions due to nutrition in the general population, International Life Sciences Institute Europe commissioned a group of experts from academia, government and the food industry to prepare a guidance document. A draft of this paper was refined at a workshop involving additional experts. First, the expert group defined criteria to evaluate the usefulness of immune function markers. Over seventy-five markers were scored within the context of three distinct immune system functions: defence against pathogens; avoidance or mitigation of allergy; control of low-grade (metabolic) inflammation. The most useful markers were subsequently classified depending on whether they by themselves signify clinical relevance and/or involvement of immune function. Next, five theoretical scenarios were drafted describing potential changes in the values of markers compared with a relevant reference range. Finally, all elements were combined, providing a framework to aid the design and interpretation of studies assessing the effects of nutrition on immune function. This stepwise approach offers a clear rationale for selecting markers for future trials and provides a framework for the interpretation of outcomes. A similar stepwise approach may also be useful to rationalise the selection and interpretation of markers for other physiological processes critical to the maintenance of health and well-being.

Effectiveness of immunonutrient-enriched diets in the decrease of infections and mortality in the critically ill.

OBJECTIVE: Pharmaconutrients have been shown in clinical and laboratory studies to modulate human and animal immune responses and thus to have potential benefits for the critically ill. However, reviews and meta-analyses continue to reflect controversy in the published research and a lack of agreement regarding these benefits. The objective of this study was to contribute to the resolution of such controversy by evaluating the effectiveness of immunonutrient-enriched diets in decreasing complications and mortality in patients with different critical illnesses. METHODS: The present study is a meta-analysis of randomized clinical trials that evaluated the use of immunomodulating nutrients in critically ill adults. The PubMed and CINAHL datasets were searched. RESULTS: Two hundred sixteen articles were initially found, but only 39 met the established inclusion criteria. In the general population, mortality did not show a statistically significant relative risk (RR) decrease (0.92, confidence interval [CI] 0.80-1.05); infection complications were decreased, with a general RR of 0.57 (CI 0.44-0.74) and an RR of 0.56 (CI 0.46-0.68) in surgical patients; and the sepsis incidence was decreased (RR 0.48, CI 0.27-0.83). CONCLUSIONS: The administration of immunomodulating nutrient-enriched diets did not change the mortality of critically ill or surgical patients, but infection complications in critically ill patients, in particular the surgical population, were decreased. Explanatory clinical trials using isolated immunomodulating nutrients in different populations of critically ill patients followed by pragmatic trials based on clinical trial results should be considered in future research.

Perioperative immunonutrition for gastrointestinal cancer: a systematic review of randomized controlled trials.

BACKGROUND: To improve the clinical outcome, immunonutrition (IN) was usually used in the patients undergoing elective gastrointestinal caner surgery. However, its effectiveness remains uncertain. METHODS: Randomized controlled trials (RCTs) published between 1995 and 2011 were identified and extracted by two reviewers independently from electronic databases, including PubMed, EMBASE, and Cochrane Library. The quality of included trials was assessed according to the handbook for Cochrane reviewer (V5.0.1). Statistical analysis was carried out with RevMan software. RESULTS: Nineteen RCTs involving a total of 2331 patients were included in our meta-analysis. The results showed perioperative IN significantly reduced length of hospital stay (WMD, -2.62; 95% CI, -3.26 to -1.97; P < 0.01) and morbidity of postoperative infectious complication (RR, 0.44; 95% CI, 0.32 to 0.60; P < 0.01) compared with standard diet. Moreover, perioperative IN also significantly decreased morbidity of postoperative non-infectious complication in comparison with standard diet (RR, 0.72; 95% CI, 0.54 to 0.97; P = 0.03). CONCLUSION: Perioperative IN is effective and safe to reduce postoperative infection, non-infection complication and length of hospital stay.

Eficacia, coste-efectividad y efectos sobre la calidad de vida de la suplementación nutricional / Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation

El presente artículo resume los resultados y conclusiones presentados en el Simposio “Suplementación nutricional: evidencias y experiencias” celebrado en el XXIII Congreso Nacional de la SENPE (2008).La malnutrición calórico-proteica, que puede afectar al 30-50% de los pacientes hospitalizados, aumenta el tiempo de hospitalización y el coste de la atención médica en aquellos que la padecen. Un importante volumen de evidencias científicas avala que la administración de suplementos nutricionales (SN) mejora el estado nutricional o previene la aparición de malnutrición en pacientes que no cubren sus necesidades nutricionales con la dieta convencional o con la dieta adaptada, sin que, por ello, se produzca desplazamiento de la ingesta. Todo ello viene reforzado por los resultados que evidencian el papel de los SN en la mejora de parámetros tanto nutricionales como funcionales. La revisión de la literatura existente en determinados contextos clínicos (geriatría uoncología), evidencia que los SN reducen la aparición de complicaciones propias, tanto de la patología de base como del estado de desnutrición, así como que favorecen la reducción de la estancia hospitalaria y de la mortalidad. A pesar de ello, son necesarios más estudios sobre la eficacia de los SN orales en los que se realice un seguimiento más prolongado de lo que ofrecen las publicaciones disponibles actualmente. Más allá de su eficacia, los SN constituyen una intervención terapéutica segura y sin efectos adversos clínicos relevantes que, según la literatura, mejoran la funcionalidad del paciente y su calidad de vida. Cabe añadir que los SN pueden ser coste-efectivos en ciertos perfiles de paciente (ancianos malnutridos o en riesgo de desnutrición y en pacientes quirúrgicos hospitalizados). La revisión de la literatura evidencia la necesidad de realizar más estudios, con la metodología (..) (AU)

This article summarizes the main results and conclusions presented in the Symposium “Nutritional supplementation: evidences and experiences” that took place in the XXIIIrd SENPE Congress (2008).Protein energy malnutrition, that can affect 30-50%of hospitalized patients, increases both time of hospitalization and costs of medical care of this kind of patients. There is a lot of scientific evidences demonstrating that the use of nutritional supplementation improves nutritional status or prevents malnutrition in those patients who do not meet their nutritional needs with a conventional diet or an adapted one with no replacing intake from normal food. This is strengthened by the results that demonstrate the rol of nutritional supplements improving nutritional and functional parameters. Current bibliographic reviews focused on certain clinical frameworks (i.g. geriatrics, oncology),prove that nutritional supplements reduce complications related to pathology and to nutritional status, and also reduce length of hospitalization and mortality. More studies regarding to efficacy of oral nutritional supplements are needed. These studies should be carried out with a period of follow-up longer than the current published studies have. As well as effective, nutritional supplements become a save therapeutic intervention with no important adverse events that, according to bibliography, improve patient’s functionality and quality of life. It is worth mentioning that nutritional supplements can be effective on certain kind of patients, for instance, malnourished elderly or elderly in risk of malnourishment, and hospitalized surgical patients. Scientific literature refers that it is necessary to carry out more studies, with an accurate methodology, which assess the effect of nutritional supplements on quality of life and its cost-effectiveness on malnourished patients regarding specific clinical situations (..) (AU)

Vitamin D and host resistance to infection? Putting the cart in front of the horse.

Vitamin D is being touted as an anti-infective agent and it has even been suggested that vitamin D supplementation could be effective against the H1N1 influenza virus. The claims are largely based on the ability of vitamin D to induce antibacterial peptides and evidence that the immune system produces active vitamin D (1,25(OH)(2)D(3)) in situ. While there are many examples of immune production of 1,25(OH)(2)D(3) in vitro, there is little in vivo evidence. In addition, it is not clear what role immune production of 1,25(OH)(2)D(3) has on the course of disease. Vitamin D and 1,25(OH)(2)D(3) inhibit T helper type 1 (Th1)/Th17-mediated immune responses and autoimmune diseases by acting on the innate and acquired immune system to inhibit the function of Th1 and Th17 cells. Th1 and Th17 cells are important in host resistance to many infections including tuberculosis (TB) caused by Mycobacterium tuberculosis. Paradoxically the innate immune system is induced to produce antibacterial peptides that are effective against TB in vitro. Data from several models of infection have so far not supported a role for vitamin D in affecting the course of disease. There is also very little evidence that vitamin D affects the course of human TB infection. Experiments have not been done in cells, mice or humans to evaluate the effect of vitamin D on influenza virus. At this time it would be premature to claim that vitamin D has an effect on TB, influenza or any other infection.

Análisis comparativo de dos cohortes de pacientes pediátricos con diarrea aguda y respuesta a la solución de rehidratación oral (SRO) frente a SRO + tanato de gelatina / A comparative analysis of response to ORS (oral rehydration solution) vs. ORS + gelatin tannate in two cohorts of pediatric patients with acute diarrhea

Objetivo: el estudio tiene como objetivo observar la respuestaal tratamiento con SRO o SRO + tanato de gelatina en dos cohortesde pacientes pediátricos que presentan diarrea aguda, siendoel número de deposiciones a las 12 horas desde el tratamientoinicial el criterio principal de valoración de la eficacia.Métodos: en el estudio se incluyeron niños de entre 3 meses y12 años de edad. Únicamente se incluyeron niños con diarreaaguda, con más de 3 deposiciones líquidas y menos de 72 horasde evolución. Se registró la variable principal del número de deposicionesy de análisis como número absoluto, categorizado como<= 3 y >= 4 deposiciones en 12 horas y como un índice de disminuciónde deposiciones (IDD). Se registraron otras variables clínicascomo peso, fiebre, vómitos, características de las deposiciones ysignos de peritonitis/sepsis.Resultados: las características principales para las dos poblacionesfueron una edad media de 2,3 años en el grupo de SRO yde 2,6 años en el grupo de SRO + tanato de gelatina. Los niñosmenores de 2 años representaban el 59,8% de los integrantes delgrupo de SRO y el 54,3% de los del grupo de SRO + tanato degelatina. Se registraron variables clínicas como vómitos, deshidratación,peso, fiebre, vómitos, características de las deposiciones ysignos de peritonitis/sepsis. Se creó un índice de disminución delas deposiciones (IDD = final [12 h] - deposiciones iniciales/deposicióninicial) para comparar los dos grupos. Encontramos una diferenciaestadísticamente significativa entre los dos grupos (p <0,0001), el SDI del grupo de SRO fue de -0,1894 y el del grupode SRO + tanato de gelatina fue -0,6023.Conclusiones: observamos una disminución significativa enel número de deposiciones y una mejora en la consistencia de lasdeposiciones en el grupo de SRO + tanato de gelatina...(AU)

Aim: the study aims to observe the response to treatment with ORS only or ORS + gelatin tannate in two cohorts of pediatric patients with acute diarrhea, with the primary efficacy endpoint being the number of stools at 12 hours from baseline. Methods: children aged 3 months to 12 years were included in the study. Only children with acute diarrhea, more than 3 liquid stools, and duration inferior to 72 h were included. Number of stools was recorded as absolute number, categorized as <= 3 and >= 4 stools over 12 hours, and as a stool decrease index (SDI). Other clinical variables were recorded, including weight, fever, vomiting, stool characteristics, and signs of peritonitis/sepsis. Results: baseline characteristics for the two populations included a mean age of 2.3 years in the ORS group and 2.6 years in the ORS + gelatin tannate group. Children younger than 2 years represented 59.8 and 54.3% in the ORS and ORS + gelatin tannate groups, respectively. Clinical variables such as vomiting, dehydration, weigth, and stool decrease index were used to compare the two groups. We found a statistical significant difference between the two groups (p < 0.0001) -- SDI for the ORS group was -0.1894; for the ORS + gelatin tannate group was -0.6023. Conclusions: we observed a significant decrease in the number of stools and an improvement in the consistency of stools in the ORS + gelatin tannate group. Other clinical variables such as vomiting, dehydration, weight, bloody stools, and peritonitis/sepsis signs showed no statistical differences between the two groups, but did show a general trend toward improvement. The Stool Decrease Index (SDI) showed a 18% decrease in the number of stools for the ORS group and 60% for the ORS + gelatin tannate group. The use of ORS + gelatin tannate was associated with a greater decrease in SDI. Gelatin tannate decreased the number of stools at twelve hours in children(AU)

Avaliação da resistência de larvas de Contracaecum sp. (nematoda: anisakidae) à ação da citronela, Cymbopogon sp., in natura, administrada como tratamento da anisakiose em coelhos infectados experimentalmente / Evaluation of the resistence of the Contracaecum sp. larvae, (nematoda: anisakidae), to the action of the citronella, Cymbopogon sp., in natura, administered as treatment of anisakiosis in experimentally infected rabbits

A avaliação da ação larvicida da citronela, Cymbopogon sp., in natura foi feita através da administração da planta ad libitum a coelhos, Oryctolagus cuniculi, experimentalmente infectados com larvas de Contracaecum sp. Com intervalos regulares de 24 horas após o início da administração da planta, foram realizadas eutanásias e necropsias dos animais infectados, analisando-se a eficácia através de parâmetros como número e viabilidade de larvas recuperadas. A citronela in natura apresentou baixa ação larvicida sobre Contracaecum sp Federal

The evaluation of the larvicide action of the citronella, Cymbopogon sp., in natura was done through the feeding of the citronella grass ad libitum to rabbits, Oryctolagus cuniculi, experimentally infected by Contracaecum sp. larvae. By regular intervals of 24 hours after the beginning of the experiment, the infected animals went submitted to eutanasy and necropsy exams to analyse the action of the plant, using parameters as the number and viability of the recovered larvae. The citronella in natura produced low larvicide action over Contracaecum sp. experimentally.

Prevention of postoperative microbial infection by synbiotics.

Prevention of infectious complications after major surgeries including those for cancer has been a major concern in the clinical field. To overcome this problem, probiotics and synbiotics (combination of probiotics and prebiotics have recently been introduced for post-operative treatment. Clinical application of synbiotics in severe cases, such as severe pediatric surgical cases, acute pancreatitis, liver transplantation, and biliary cancer, has been reported. The present article deals with the clinical effect of such synbiotic therapies for the patients under emergency medical care, and discusses the possible mechanism of action and prospect of synbiotic therapy.

Zinc supplementation for the treatment or prevention of disease: current status and future perspectives.

Zinc is a nutritionally essential trace element, and thus zinc deficiency may severely affect human health. Many studies were published in which the effect of nutritional zinc supplementation on the incidence or severity of a certain disease was investigated. This review summarizes the main observations and aims to evaluate the use of nutritional zinc supplementation for prevention and treatment of human disease.

[Dietary treatment in acute pancreatitis]. / Leczenie iywieniowe w ostrym zapaleniu trzustki.

Proper nourishment is one of the basic elements in treatment patients suffering from acute pancreatitis and that's why it should be introduced in early phase of the disease. Patients suffering from light pancreatitis don't need dietary treatment because regular nourishment being.introduced a few days after the disease has developed itself. The proper supply of nourishing elements is crucial to patients with acute or chronic pancreatities. In this group of patient intravenous feeding or enteral nutrition methods are being used. They work as self sufficient and independent methods or they complete one another. The most recommended is the oligomeric diet with glutamine. Despite constant controversy over nourishment, early enternal nutrition is said to be better than intravenous feeding. Due to protection of intestinal barrier the enternal nutrition decrease the translocation of bacteria and endotoxin and as a result decrease the possibility of pancreaties parenchyma. The analysis of randomized clinical studies shows the improvement of clinical treatment and the improvement of prognosis in the group of patients using enternal nutrition. The number of complications and mortality rate has also decreased in this group. It allows also to shorten the hospitalization and cut the treatment costs. The patients, which do not tolerate internal nutrition or which cannot put up with intestinal entrance are to be fed with intravenous feeding. Presented above positive results of acute panctreatitis treatment, which were achieved after using internal nutrition, are the best basis for introducing this method in clinical practice.

Starting artificial nutrition and hydration in patients with dementia in The Netherlands: frequencies, patient characteristics and decision-making process.

BACKGROUND AND AIMS: In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in The Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision- making process. METHODS: In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in The Netherlands. The response rate was 77%. RESULTS: Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in The Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient's physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease. CONCLUSIONS: Compared with the USA literature, ANH is practised less in The Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken.

[Use of new synbiotics in treatment of the intestinal infections among children].

The article deals with the findings of the complex estimate of the new synbiotic product "Life Harmony" to treat acute intestinal infection among children. The authors show that application of this product, containing B. bifidum, B. longum and L. casei strains, in the diet therapy of the acute intestinal infections of "the watery" type among children contributes to the reduction of the duration of anorexia, flabbiness and diarrhea syndrome, as well as provides a complete recovery of the intestinal microflora balance.