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Zagales R, Watts E, Awan MU, Hernandez N, Haddadi M, Smith HG, Elkbuli A. Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes. Am Surg 2024:31348241259042. [PMID: 38830580 DOI: 10.1177/00031348241259042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients. METHODS Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection. RESULTS A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24 hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended. CONCLUSIONS Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24 hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.
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Affiliation(s)
- Ruth Zagales
- Indiana University School of Medicine, Bloomington, IN, USA
| | - Emelia Watts
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Muhammad Usman Awan
- Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Nickolas Hernandez
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Minna Haddadi
- American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
| | - Howard G Smith
- Director of Burn Surgery, Warden Burn Center, Orlando Health, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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2
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Perrais M, Trächsel B, Lenglet S, Pruijm M, Ponte B, Vogt B, Augsburger M, Rousson V, Bochud M, Thomas A. Reference values for plasma and urine trace elements in a Swiss population-based cohort. Clin Chem Lab Med 2024; 0:cclm-2023-1433. [PMID: 38641868 DOI: 10.1515/cclm-2023-1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Trace elements (TEs) are ubiquitous. TE concentrations vary among individuals and countries, depending on factors such as living area, workplaces and diet. Deficit or excessive TEs concentrations have consequences on the proper functioning of human organism so their biomonitoring is important. The aim of this project was to provide reference values for TEs concentrations in the Swiss population. METHODS The 1,078 participants to the SKiPOGH cohort included in this study were aged 18-90 years. Their 24-h urine and/or plasma samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) to determine 24 TEs concentrations: Ag, Al, As, Be, Bi, Cd, Co, Cr, Cu, Hg, I, Li, Mn, Mo, Ni, Pb, Pd, Pt, Sb, Se, Sn, Tl, V and Zn. Statistical tests were performed to evaluate the influence of covariates (sex, age, BMI, smoking) on these results. Reference intervals for the Swiss adult population were also defined. RESULTS TEs concentrations were obtained for respectively 994 and 903 persons in plasma and urine matrices. It was possible to define percentiles of interest (P50 and P95) for almost all the TEs. Differences in TEs distribution between men and women were noticed in both matrices; age was also a cofactor. CONCLUSIONS This first Swiss biomonitoring of a large TEs-panel offers reference values in plasma and in urine for the Swiss population. The results obtained in this study were generally in line with clinical recommendations and comparable to levels reported in other population-based surveys.
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Affiliation(s)
- Maïwenn Perrais
- Unit of Forensic Chemistry and Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Faculty Unit of Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bastien Trächsel
- 569258 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sébastien Lenglet
- Unit of Forensic Chemistry and Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Menno Pruijm
- Service of Nephrology, Lausanne University Hospitals and University of Lausanne, Lausanne, Switzerland
| | - Belen Ponte
- Division of Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Vogt
- 27252 University Department of Nephrology and Hypertension, Inselspital, University Hospital Bern , Bern, Switzerland
| | - Marc Augsburger
- Unit of Forensic Chemistry and Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Valentin Rousson
- 569258 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- 569258 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Aurélien Thomas
- Unit of Forensic Chemistry and Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Faculty Unit of Toxicology, 658784 University Centre of Legal Medicine Lausanne-Geneva , Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Wozniak H, Le Terrier C, Primmaz S, Suh N, Lenglet S, Thomas A, Vuilleumier N, Pagano S, de Watteville A, Stringhini S, Guessous I, Quintard H, Heidegger CP, Pugin J. Association of Trace Element Levels with Outcomes in Critically Ill COVID-19 Patients. Nutrients 2023; 15:3308. [PMID: 37571249 PMCID: PMC10421129 DOI: 10.3390/nu15153308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The primary objective of this study was to compare the plasma levels of copper, selenium, and zinc between critically ill COVID-19 patients and less severe COVID-19 patients. The secondary objective was to investigate the association of these trace element levels with adverse outcomes, including the duration of mechanical ventilation, occurrence of septic shock, and mortality in critically ill COVID-19 patients. All COVID-19 patients admitted to the ICU of the Geneva University Hospitals between 9 March 2020 and 19 May 2020 were included in the study. Plasma levels of copper, selenium and zinc were measured on admission to the ICU and compared with levels measured in COVID-19 patients hospitalized on the ward and in non-hospitalized COVID-19 patients. To analyze the association of trace elements with clinical outcomes, multivariate linear and logistic regressions were performed. Patients in the ICU had significantly lower levels of selenium and zinc and higher levels of copper compared to COVID-19 patients hospitalized on the ward and in non-hospitalized COVID-19 patients. In ICU patients, lower zinc levels tended to be associated with more septic shock and increased mortality compared to those with higher zinc levels (p = 0.07 for both). Having lower copper or selenium levels was associated with a longer time under mechanical ventilation (p = 0.01 and 0.04, respectively). These associations remained significant in multivariate analyses (p = 0.03 for copper and p = 0.04 for selenium). These data support the need for interventional studies to assess the potential benefit of zinc, copper and selenium supplementation in severe COVID-19 patients.
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Affiliation(s)
- Hannah Wozniak
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Christophe Le Terrier
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Steve Primmaz
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Noémie Suh
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Sébastien Lenglet
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, 1205 Geneva, Switzerland (A.T.)
| | - Aurélien Thomas
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University Hospitals, 1205 Geneva, Switzerland (A.T.)
- Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Diagnostics Department, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Sabrina Pagano
- Division of Laboratory Medicine, Diagnostics Department, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Aude de Watteville
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Hervé Quintard
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Claudia Paula Heidegger
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
| | - Jérôme Pugin
- Division of Intensive Care, Geneva University Hospitals, the Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland (A.d.W.); (H.Q.); (C.P.H.)
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Osetrov K, Uspenskaya M, Olekhnovich R. The model pH-controlled delivery system based on gelatin-tannin hydrogels containing ferrous ascorbate: iron release in vitro. Biomed Phys Eng Express 2023; 9. [PMID: 36758228 DOI: 10.1088/2057-1976/acbaa1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/09/2023] [Indexed: 02/11/2023]
Abstract
Hydrogels have become an essential class among all biomaterials. The specialized biomaterials are highly valued in the field of biomedical applications. One of the problems in wound management is local microelement deficiency associated with extensive wound lesions. The significant lack of elemental iron in the human body leads to serious consequences and prolongs treatment. The synthesis of gelatin-tannin hydrogels with ion delivery function is proposed in this study. The ability to release ions in low acid solution is a sphere of great interest. The pH drop in the wound cavity is usually associated with the contamination of some bacterial cultures. pH-controlled delivery of iron in buffer solutions (рН = 5.5/6.4/7.4) was considered for these hydrogels. The kinetics of iron release was determined by visible spectroscopy. Theoretical models were applied to describe the process of ion delivery. The structure of materials was examined by IR-spectroscopy and demonstrated the incorporation of ferrous ascorbate into hydrogel matrix. Thermal analysis was used to point out the key differences in thermal behavior by isoconversional methods (Flynn-Wall-Ozawa/Kissinger-Akahira-Sunose). The mechanical properties of the materials have been studied. The effect of iron ascorbate on polymer network parameters was discussed. The current study demonstrated the possibility of obtaining gelatin-tannin hydrogels for pH-dependent iron delivery. That provides future perspectives to expand the set of releasing microelements for biomedical applications.
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Affiliation(s)
- Konstantin Osetrov
- Center for Chemical Engineering, ITMO University, 197101, Saint-Petersburg, Russia
| | - Mayya Uspenskaya
- Center for Chemical Engineering, ITMO University, 197101, Saint-Petersburg, Russia
| | - Roman Olekhnovich
- Center for Chemical Engineering, ITMO University, 197101, Saint-Petersburg, Russia
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Gutowska I, Żwierełło W, Piorun K, Skórka-Majewicz M, Maciejewska-Markiewicz D, Kupnicka P, Baranowska-Bosiacka I, Dalewski B, Chlubek D. The Extent of Burn Injury Significantly Affects Serum Micro- and Macroelement Concentrations in Patients on the First Day of Hospitalisation. Nutrients 2022; 14:nu14204248. [PMID: 36296932 PMCID: PMC9610650 DOI: 10.3390/nu14204248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Burns exceeding 30% of total body surface area (TBSA) result in considerable hypovolemia coupled with the formation and release of inflammatory mediators, leading to subsequent systemic effects known as burn shock. Because of plasma exudation and the associated losses of large quantities of minerals, severe burns can lead to nutritional deficiencies and consequently disrupt homeostasis and metabolism of the entire body. The study group comprised 62 patients, who were divided into 3 groups according to the severity of burns. Serum samples were tested for concentrations of Ca, Mg, Mn, P, K, Zn, Cu, Fe, Se, Na, Cr, Ni, and Al. The mineral concentrations in serum of patients with burn injuries differ significantly from reference values, but this is not affected by the extent of the body burn. There are statistically significant decreases in serum concentrations of elements important for antioxidant protection (Zn, Cu, Se), and significant increases in the concentrations of toxic elements (Al and Ni), which may aggravate the effects associated with the state of burn shock. The Spearman rank correlation analysis did not reveal any statistically significant relationships between the serum concentrations of Mn, Ni, Al, K, Na, P, Mg, Zn, Se, Cr and the affected body surface area and severity of the burn—the values were at the lower end of the reference range. The obtained results indicate that proper nutrition, including elements replenishment, is extremely important in the recovery process of burn patients and time to nutrition is an important factor affecting patient survival after severe burn.
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Affiliation(s)
- Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 71 Street, 70-111 Szczecin, Poland
- Correspondence:
| | - Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 71 Street, 70-111 Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Surgery, Niechorska 27 Street, 72-300 Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 71 Street, 70-111 Szczecin, Poland
| | - Dominika Maciejewska-Markiewicz
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University, Broniewskiego 24 Street, 71-460 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry, Pomeranian Medical University, Powstańców Wlkp. 72 Street, 70-111 Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry, Pomeranian Medical University, Powstańców Wlkp. 72 Street, 70-111 Szczecin, Poland
| | - Bartosz Dalewski
- Department of Dental Prosthetics, Pomeranian Medical University, Powstańców Wlkp. 72 Street, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry, Pomeranian Medical University, Powstańców Wlkp. 72 Street, 70-111 Szczecin, Poland
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Kostina OV, Zagrekov VI, Presnyakova MV, Pushkin AS, Lebedev MY, Ashkinazi VI. Relationship of zinc level with pathogenetically significant homeostasis disorders in severely burned patients. Klin Lab Diagn 2022; 67:330-333. [PMID: 35749596 DOI: 10.51620/0869-2084-2022-67-6-330-333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of the study was to assess the zinc content and identify the relationship between the concentration of this element and changes in the biochemical status of patients and markers of inflammation during burn shock. We examined 23 patients aged 45.3±16.1 years with burns of I-II-III degree, area of 31-80%. The serum concentrations of zinc, albumin, interleukin-6, C-reactive protein (CRP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined. The majority of patients (21/23) had severe hypocincemia, correlated with burn area (r=-0.53; p=0.008). A decrease in zinc levels during burn shock was associated with the development of hypoalbuminemia (r=0.52, p=0.01). The association of deviations in ALT and AST activity with changes in zinc concentration was revealed (-0.59<γ<-0.61, 0.008<p<0.009), which may indicate the role of hepatic dysfunction in the development of hypocinkemia. The development of a systemic inflammatory response was revealed. The correlation analysis revealed an association between the zinc and interleukin-6 levels (r=-0.63, p=0.03), as well as zinc and CRP (r=-0.41, p=0.04). From the first days after the injury, zinc deficiency is observed in severely burned patients, which is affected by an inflammatory reaction and hypoalbuminemia. Due to the fact that zinc is one of the key factors in maintaining homeostasis in the body, it is necessary to further study the molecular mechanisms of regulating the level of this trace element in burned patients and to develop ways to correct hypocinkemia that contribute to the effective treatment of burn disease.
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Affiliation(s)
- O V Kostina
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - V I Zagrekov
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - M V Presnyakova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - A S Pushkin
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - M Yu Lebedev
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
| | - V I Ashkinazi
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation
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7
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Verouti SN, Pujol-Giménez J, Bermudez-Lekerika P, Scherler L, Bhardwaj R, Thomas A, Lenglet S, Siegrist M, Hofstetter W, Fuster DG, Hediger MA, Escher G, Vogt B. The Allelic Variant A391T of Metal Ion Transporter ZIP8 (SLC39A8) Leads to Hypotension and Enhanced Insulin Resistance. Front Physiol 2022; 13:912277. [PMID: 35784893 PMCID: PMC9240775 DOI: 10.3389/fphys.2022.912277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/18/2022] [Indexed: 12/12/2022] Open
Abstract
The metal ion transporter ZIP8 (SLC39A8) mediates cellular uptake of vital divalent metal ions. Genome-wide association studies (GWAS) showed that the single-nucleotide polymorphism (SNP) variant A391T (rs13107325) is associated with numerous human traits, including reduced arterial blood pressure, increased body mass index and hyperlipidemia. We analyzed in vitro the transport properties of mutant ZIP8 A391T and investigated in vivo in mice the physiological effects of this polymorphism. In vitro, the intrinsic transport properties of mutant ZIP8 were similar to those of wild type ZIP8, but cellular uptake of zinc, cadmium and iron was attenuated due to reduced ZIP8 plasma membrane expression. We then generated the ZIP8 A393T mice (ZIP8KI) that carry the corresponding polymorphism and characterized their phenotype. We observed lower protein expression in lung and kidney membrane extracts in ZIP8KI mice. The ZIP8KI mice exhibited striking changes in metal ion composition of the tissues, including cobalt, palladium, mercury and platinum. In agreement with GWAS, ZIP8KI mice showed reduced arterial blood pressure. Body weight and plasma lipid composition remained unchanged, although these features were reported to be increased in GWAS. ZIP8KI mice also exhibited remarkable insulin resistance and were protected from elevated blood glucose when challenged by dietary sucrose supplementation. We showed that increased hepatic insulin receptor expression and decreased ZnT8 (slc30a8) metal ion transporter mRNA expression are associated with this phenotypic change. In conclusion, our data reveal that ZIP8 plays an important role in blood pressure regulation and glucose homeostasis.
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Affiliation(s)
- Sophia N. Verouti
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonai Pujol-Giménez
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paola Bermudez-Lekerika
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laeticia Scherler
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rajesh Bhardwaj
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Signal Transduction Laboratory, National Institute of Environmental Health Sciences, NIH, Durham, NC, United States
| | - Aurélien Thomas
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University, Geneva, Switzerland
- Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Lenglet
- Forensic Toxicology and Chemistry Unit, CURML, Lausanne University Hospital, Geneva University, Geneva, Switzerland
| | - Mark Siegrist
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Willy Hofstetter
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Daniel G. Fuster
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias A. Hediger
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Matthias A. Hediger, ; Geneviève Escher, ; Bruno Vogt,
| | - Geneviève Escher
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Matthias A. Hediger, ; Geneviève Escher, ; Bruno Vogt,
| | - Bruno Vogt
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Matthias A. Hediger, ; Geneviève Escher, ; Bruno Vogt,
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8
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Advances in Trace Element Supplementation for Parenteral Nutrition. Nutrients 2022; 14:nu14091770. [PMID: 35565737 PMCID: PMC9105959 DOI: 10.3390/nu14091770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Parenteral nutrition (PN) provides support for patients lacking sufficient intestinal absorption of nutrients. Historically, the need for trace element (TE) supplementation was poorly appreciated, and multi-TE products were not initially subjected to rigorous oversight by the United States Food and Drug Administration (FDA). Subsequently, the American Society for Parenteral and Enteral Nutrition (ASPEN) issued dosage recommendations for PN, which are updated periodically. The FDA has implemented review and approval processes to ensure access to safer and more effective TE products. The development of a multi-TE product meeting ASPEN recommendations and FDA requirements is the result of a partnership between the FDA, industry, and clinicians with expertise in PN. This article examines the rationale for the development of TRALEMENT® (Trace Elements Injection 4*) and the FDA’s rigorous requirements leading to its review and approval. This combination product contains copper, manganese, selenium, and zinc and is indicated for use in adults and pediatric patients weighing ≥10 kg. Comprehensive management of PN therapy requires consideration of many factors when prescribing, reviewing, preparing, and administering PN, as well as monitoring the nutritional status of patients receiving PN. Understanding patients’ TE requirements and incorporating them into PN is an important part of contemporary PN therapy.
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Gasser M, Lenglet S, Bararpour N, Sajic T, Wiskott K, Augsburger M, Fracasso T, Gilardi F, Thomas A. Cadmium acute exposure induces metabolic and transcriptomic perturbations in human mature adipocytes. Toxicology 2022; 470:153153. [PMID: 35301059 DOI: 10.1016/j.tox.2022.153153] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 01/23/2023]
Abstract
Obesity is considered as a major public health concern with strong economic and social burdens. Exposure to pollutants such as heavy metals can contribute to the development of obesity and its associated metabolic disorders, including type 2 diabetes and cardiovascular diseases. Adipose tissue is an endocrine and paracrine organ that plays a key role in the development of these diseases and is one of the main target of heavy metal accumulation. In this study, we determined by inductively coupled plasma mass spectrometry cadmium concentrations in human subcutaneous and visceral adipose tissues, ranging between 2.5nM and 2.5µM. We found a positive correlation between cadmium levels and age, sex and smoking status and a negative correlation between Cd and body mass index. Based on cadmium adipose tissue concentrations found in humans, we investigated the effects of cadmium exposure, at concentrations between 1nM and 10µM, on adipose-derived human mesenchymal stem cells differentiated into mature adipocytes in vitro. Transcriptomic analysis highlighted that such exposure altered the expression of genes involved in trace element homeostasis and heavy metal detoxification, such as Solute Carrier Family transporters and metallothioneins. This effect correlated with zinc level alteration in cells and cellular media. Interestingly, dysregulation of zinc homeostasis and transporters has been particularly associated with the development of obesity and type 2 diabetes. Moreover, we found that cadmium exposure induces the pro-inflammatory state of the adipocytes by enhancing the expression of genes such as IL-6, IL-1B and CCL2, cytokines also induced in obesity. Finally, cadmium modulates various adipocyte functions such as the insulin response signaling pathway and lipid homeostasis. Collectively, our data identified some of the cellular mechanisms by which cadmium alters adipocyte functions, thus highlighting new facets of its potential contribution to the progression of metabolic disorders.
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Affiliation(s)
- Marie Gasser
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Lenglet
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland
| | - Nasim Bararpour
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland; Present address: Department of Genetics, Stanford School of Medicine, Stanford, CA 94305
| | - Tatjana Sajic
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kim Wiskott
- Unit of Forensic Pathology, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland
| | - Marc Augsburger
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland
| | - Tony Fracasso
- Unit of Forensic Pathology, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland
| | - Federica Gilardi
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Aurélien Thomas
- Unit of Forensic Toxicology and Chemistry, CURML, Lausanne and Geneva University Hospitals, Lausanne, Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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10
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Berger MM, Binz PA, Roux C, Charrière M, Scaletta C, Raffoul W, Applegate LA, Pantet O. Exudative glutamine losses contribute to high needs after burn injury. JPEN J Parenter Enteral Nutr 2021; 46:782-788. [PMID: 34288001 PMCID: PMC9292800 DOI: 10.1002/jpen.2227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Burnpatients characteristically have increased energy, glucose, and protein requirements. Glutamine supplementation is strongly recommended during early‐phase treatment and is associated with improved immunity, wound healing, and reduced mortality. This study evaluated if early burn exudative losses might contribute to higher supplementation needs. Methods Patients admitted to the burn intensive care unit (ICU) had exudate collection from tight bandages applied to arms or legs during the first week (exudate aliquot twice daily). Seven amino acids (alanine, arginine, cystEine, glutamine, leucine, lysine, and methionine) were quantified by liquid chromatography–mass spectrometry. Descriptive analysis of all results is provided as median and interquartile range or in value ranges. Results Eleven patients aged 19–77 years, presenting with burns on 18%–70% of the body surface, with a median simplified acute physiology score II of 33 (range, 16–56) were included during the study period. The highest amino acid losses were observed during the first 3 days with an important interpatient and intrapatient variability. Glutamine and alanine losses were highest, followed by leucine and lysine in all patients; amino acid exudate concentrations were in the range of normal plasma concentrations and were stable over time. Total glutamine losses were correlated to the burned surface (r2 = 0.552, P = .012), but not to enteral glutamine supplements. Conclusions The study shows significant exudative losses during early‐stage burn recovery and particularly for glutamine and alanine. Glutamine loss generally decreased with wound closure, the subsequent decline of exudation, and the evolving size of burn surfaces.
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Affiliation(s)
- Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre-Alain Binz
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Clothilde Roux
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mélanie Charrière
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Corinne Scaletta
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Wassim Raffoul
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Lee Ann Applegate
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Pantet
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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11
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Żwierełło W, Styburski D, Maruszewska A, Piorun K, Skórka-Majewicz M, Czerwińska M, Maciejewska D, Baranowska-Bosiacka I, Krajewski A, Gutowska I. Bioelements in the treatment of burn injuries - The complex review of metabolism and supplementation (copper, selenium, zinc, iron, manganese, chromium and magnesium). J Trace Elem Med Biol 2020; 62:126616. [PMID: 32739827 DOI: 10.1016/j.jtemb.2020.126616] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Appropriate nutrition is a key component of burn treatment and should be regarded as an integral part of the therapeutic process in burn patients. A nutritional intervention plan should not only allow for adequate quantities of energy and protein but also carefully consider the supply of macro- and micronutrients. As a result of the severe inflammatory response, oxidative stress, and hypermetabolic state, accompanied by often extensive exudation in burn patients, there is a considerable loss of macro- and micronutrients, including essential trace elements. This leads to certain complications, involving e.g. more frequent infections and impaired wound healing. Our current body of knowledge is still insufficient, and the studies carried out to date focus for the most part on the imbalances in trace elements, such as copper (Cu), selenium (Se), and zinc (Zn). Nevertheless, there are many other trace elements involved in immune functions, regulating gene expression or antioxidant defense, and many of those have not been properly investigated in a clinical setting. Due to the insufficient amount of unambiguous literature data and relatively few, often dated, studies carried out with small patient groups, further evaluation of macro- and microelements in burn patients seems indispensable, e.g. to bring up to date local nutritional protocols.
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Affiliation(s)
- Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Daniel Styburski
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Agnieszka Maruszewska
- Institute of Biology, University of Szczecin, Felczaka 3c St, 71-412, Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Maja Czerwińska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Andrzej Krajewski
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland.
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12
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Damianaki K, Lourenco JM, Braconnier P, Ghobril JP, Devuyst O, Burnier M, Lenglet S, Augsburger M, Thomas A, Pruijm M. Renal handling of zinc in chronic kidney disease patients and the role of circulating zinc levels in renal function decline. Nephrol Dial Transplant 2020; 35:1163-1170. [PMID: 31006015 DOI: 10.1093/ndt/gfz065] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/06/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Zinc deficiency is commonly encountered in chronic kidney disease (CKD). The aims of this study were to assess whether zinc deficiency was related to increased renal excretion of zinc and to the progression of CKD. METHODS Plasma and 24-h urinary zinc levels, urinary electrolytes and uromodulin were measured in 108 CKD patients and 81 individuals without CKD. Serum creatinine values were collected for 3 years to calculate the yearly change in estimated glomerular filtration rate (eGFR). Multivariable regression analysis was performed to assess the association between baseline zinc levels and yearly change in eGFR. RESULTS CKD patients had lower circulating zinc levels and higher 24-h urinary zinc excretion than non-CKD participants (612.4 ± 425.9 versus 479.2 ± 293.0 µg/day; P = 0.02). Fractional excretion (FE) of zinc was higher and it significantly increased at more advanced CKD stages. Zinc FE was correlated negatively with 24-h urinary uromodulin excretion (r=-0.29; P < 0.01). Lower baseline plasma zinc levels were associated with a faster yearly decline of renal function in age, gender, diabetes and hypertension adjusted models, but this relationship was no longer significant when baseline eGFR or proteinuria were included. CONCLUSIONS Zinc levels are lower in CKD, and not compensated by reduced renal zinc excretion. The inverse association between urinary zinc excretion and uromodulin possibly points to an impaired tubular activity, which could partly account for zinc imbalance in CKD. These data suggest that zinc status is associated with renal function decline, but further studies elucidating the underlying mechanisms and the potential role of zinc supplements in CKD are needed.
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Affiliation(s)
- Katerina Damianaki
- Department of Medicine, Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne Lausanne, Switzerland.,Department of Internal Medicine Service of Nephrology, University Hospital of Athens, Hippokration Hospital, Athens, Greece
| | - Joao Miguel Lourenco
- Department of Medicine, Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne Lausanne, Switzerland
| | - Philippe Braconnier
- Department of Medicine, Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne Lausanne, Switzerland.,Service of Nephrology, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Jean-Pierre Ghobril
- Division of Chronic Disease, University Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Olivier Devuyst
- Institute of Physiology, University Hospital of Zürich, Zürich, Switzerland
| | - Michel Burnier
- Department of Medicine, Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne Lausanne, Switzerland
| | - Sebastien Lenglet
- Unit of Toxicology, CURML, Geneva University Hospitals, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Augsburger
- Unit of Toxicology, CURML, Geneva University Hospitals, Lausanne University Hospital, Lausanne, Switzerland
| | - Aurelien Thomas
- Unit of Toxicology, CURML, Geneva University Hospitals, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Department of Medicine, Service of Nephrology and Hypertension, Lausanne University Hospital (CHUV) and University of Lausanne Lausanne, Switzerland
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13
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Berger MM. Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized. JPEN J Parenter Enteral Nutr 2020; 44:1380-1387. [PMID: 32829498 DOI: 10.1002/jpen.2002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
Critically ill (intensive care unit [ICU]) patients are characterized by organ failure, intense inflammatory response, insulin resistance, and altered metabolic response. The sicker the patient, the higher the threat to nutrition and micronutrient status. In addition, many patients start the ICU stay with an altered nutrition status, which requires assessment upon admission. Nutrition needs vary among patients as well as during hospitalization, as the metabolic response changes over time. Shock and acute organ failure result in a metabolic shift toward intense catabolism: endogenous glucose production aiming at ensuring the basal adenosine triphosphate production starts immediately and occurs at the expense of the lean body mass using amino acids for neoglucogenesis. Later, the stabilization and recovery phases are characterized by higher energy and substrate needs. Indirect calorimetry is the only tool enabling determination of the metabolic level. When and how should feeding be started? Recent research shows that the route does not matter much, with equipoise between enteral and parenteral nutrition (PN) as long as overfeeding is avoided. As micronutrients are an integral part of metabolism and antioxidant defenses, their delivery must be ensured: whereas needs are well defined for healthy individuals, needs for illness remain poorly defined. PN that contains only macrosubstrates requires the daily prescription of multimicronutrient complements to qualify as total PN. Achievement of goals requires minimal monitoring, consisting of the daily verification of energy and protein goal delivery achievement and daily follow-up determining blood glucose and phosphate levels and insulin requirements.
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Affiliation(s)
- Mette M Berger
- Department of Adult Intensive Care Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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14
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Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2020; 43 Suppl 1:S5-S23. [PMID: 30812055 DOI: 10.1002/jpen.1525] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krishnan Sriram
- US Department of Veterans Affairs, Regional Tele-ICU System (VISN 23), Hines, Illinois, USA
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Lingtak-Neander Chan
- Department of Pharmacy School of Pharmacy, and Graduate Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Brian Jurewitsch
- Specialized Complex Care Program, St. Michael's Hospital, Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kathleen Logan Coughlin
- Center for Human Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Manzanares
- Department of Critical Care, Faculty of Medicine. Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Rina Mutiara
- Pharmacy Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ricardo Rosenfeld
- Nutrition Support Department, Casa de Saude Sao Jose, Associacao Congregacao de Santa Catarina, Rio de Janeiro, Brazil
| | - Marianna Sioson
- Section of Nutrition, Department of Medicine, The Medical City Hospital, Pasig City, Metro Manila, Philippines
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mette M Berger
- Faculty of Biology and Medicine, Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland
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15
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Lotfi M, Mirza Aghazadeh A, Davami B, Khajehgoodari M, Aziz karkan H, Khalilzad MA. Development of nursing care guideline for burned hands. Nurs Open 2020; 7:907-927. [PMID: 32587709 PMCID: PMC7308693 DOI: 10.1002/nop2.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 11/26/2022] Open
Abstract
Aim To develop an evidence-based guideline to care for hand-burned patients. Design An integrative review. Method The search was conducted of EMBASE, PubMed, Web of Science, SCOPUS, Clinical Key, Iranmedex, Magiran, Scientific Information Database (SID), Cochran, CINAHL and Google Scholar databases from January 2000-August 2019. Following the formation of the research team, two researchers independently selected the eligible studies. The initial search resulted in 2,230 records; ultimately, 40 articles were identified to be the review after screening the records based on the study's inclusion and exclusion criteria. Quality of selected studies was evaluated with the MMAT method. Results Data syntheses of selected studies, coded by highlighting the relevant parts of the text, and assigning code words to these areas were done. Following this, a constant comparison was used to develop categories by combining codes. Finally, hand burns nursing care guideline was developed by categorizing descriptive themes in two main phases. Conclusion This review results have shown that evidence-based guidelines present high-quality recommendations for the healthcare team, which improves the quality of clinical care. Due to a lack of established guidelines in our context, it seems to be helpful to use evidence-based guidelines in managing burned hands.
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Affiliation(s)
- Mojgan Lotfi
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferySina HospitalTabriz University of Medical SciencesTabrizIran
| | - Ahmad Mirza Aghazadeh
- Department of Basic sciencesParamedical FacultyTabriz University of Medical SciencesTabrizIran
| | - Babak Davami
- Faculty of MedicineSina HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Khajehgoodari
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
| | - Hanieh Aziz karkan
- Department of Medical Surgical NursingFaculty of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
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16
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Zhang ZY, Carmeli C, Ponte B, Pruijm M, Ackermann D, Ehret G, Guessous I, Petrović D, Pechère-Bertschi A, Vogt B, Martin PY, Burnier M, Lenglet S, Augsburger M, Thomas A, Bochud M. Ambulatory Blood Pressure in Relation to Plasma and Urinary Manganese. Hypertension 2020; 75:1133-1139. [PMID: 32114854 DOI: 10.1161/hypertensionaha.119.13649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The association of blood pressure (BP) with manganese-an essential trace element required for human health-remains poorly studied. In 734 randomly recruited Swiss participants (mean age, 47.5 years; 51.4% women), we related ambulatory BP to 2 biomarkers, plasma manganese (pMn) and the urinary manganese (uMn) excretion. To allow for diurnal variation, we assessed BP and uMn over 24 hours and during wakefulness and sleep, using split urine samples. Twenty-four-hour, daytime, and nighttime systolic/diastolic BPs averaged 119.8/78.1, 123.8/81.2, and 107.0/68.3 mm Hg; the corresponding median uMn were 199.5, 83.0, and 51.5 μmol and median pMn, 0.52 μg/L. In analyses dichotomized by the median of the biomarkers, greater pMn was associated with higher 24-hour systolic/diastolic BP (+4.1/+2.3 mm Hg; P≤0.0003), greater daytime uMn with lower daytime BP (-3.5/-1.9 mm Hg; P≤0.0067), and greater nighttime uMn with higher nighttime BP (+2.9/+1.2 mm Hg; P≤0.046). In multivariable-adjusted analyses, significance (P≤0.030) was retained for the positive association of 24-hour and daytime diastolic BP with pMn and for systolic BP in relation to uMn at night. The association sizes for a 2-fold increment in the biomarkers amounting to 0.77 mm Hg (95% CI, 0.08-1.47 mm Hg), 0.97 (CI, 0.20-1.76) and 1.33 (CI, 0.20-2.50 mm Hg), respectively. In conclusion, there were positive associations between diastolic BP and pMn over 24 hours and during daytime and between systolic BP and uMn at night.
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Affiliation(s)
- Zhen-Yu Zhang
- From the Department of Epidemiology and Health Systems, Center for Primary Care and Public Health-Unisanté (Z.-Y.Z., C.C., B.P., D.P., M. Bochud), University of Lausanne, Switzerland.,Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z.)
| | - Cristian Carmeli
- From the Department of Epidemiology and Health Systems, Center for Primary Care and Public Health-Unisanté (Z.-Y.Z., C.C., B.P., D.P., M. Bochud), University of Lausanne, Switzerland
| | - Belen Ponte
- From the Department of Epidemiology and Health Systems, Center for Primary Care and Public Health-Unisanté (Z.-Y.Z., C.C., B.P., D.P., M. Bochud), University of Lausanne, Switzerland.,Division of Nephrology (B.P., P.-Y.M.), Geneva University Hospitals, Switzerland
| | - Menno Pruijm
- Division of Nephrology and Hypertension, Lausanne University Hospital (M.P., M. Burnier), University of Lausanne, Switzerland
| | - Daniel Ackermann
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland (D.A., B.V.)
| | - Georg Ehret
- Division of Cardiology (G.E.), Geneva University Hospitals, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Department of Primary Care Medicine (I.G.), Geneva University Hospitals, Switzerland
| | - Dušan Petrović
- From the Department of Epidemiology and Health Systems, Center for Primary Care and Public Health-Unisanté (Z.-Y.Z., C.C., B.P., D.P., M. Bochud), University of Lausanne, Switzerland
| | | | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland (D.A., B.V.)
| | - Pierre-Yves Martin
- Division of Nephrology (B.P., P.-Y.M.), Geneva University Hospitals, Switzerland
| | - Michel Burnier
- Division of Nephrology and Hypertension, Lausanne University Hospital (M.P., M. Burnier), University of Lausanne, Switzerland
| | - Sébastien Lenglet
- Faculty Unit of Toxicology, CURML, Lausanne University Hospital, Faculty of Biology and Medicine (S.L., M.A., A.T.), University of Lausanne, Switzerland
| | - Marc Augsburger
- Faculty Unit of Toxicology, CURML, Lausanne University Hospital, Faculty of Biology and Medicine (S.L., M.A., A.T.), University of Lausanne, Switzerland
| | - Aurelien Thomas
- Faculty Unit of Toxicology, CURML, Lausanne University Hospital, Faculty of Biology and Medicine (S.L., M.A., A.T.), University of Lausanne, Switzerland
| | - Murielle Bochud
- From the Department of Epidemiology and Health Systems, Center for Primary Care and Public Health-Unisanté (Z.-Y.Z., C.C., B.P., D.P., M. Bochud), University of Lausanne, Switzerland
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Abstract
PURPOSE OF REVIEW Trace elements are vital components involved in major body functions. Cases of trace elements deficiencies are increasingly encountered in clinical practice, although often underrecognized. This review gives a thorough insight into the newest findings on clinical situations associated with trace elements deficiencies in children and adults, their recognition and management. RECENT FINDINGS Trace elements deficiencies are frequently found in various conditions, most commonly in burns, bariatric surgery, intestinal failure, renal replacement therapy, oncology, critical illness and cardiac surgery. The main trace elements involved are selenium, zinc, copper and iron. Trace elements deficiencies are associated with increased risk of morbidity and mortality. Recognition of clinical signs of trace elements deficiencies can be challenging. Although trace elements supplementation is indisputable in many circumstances, it is still debatable in other situations such as sepsis and cardiac surgery. SUMMARY Recent findings on trace elements deficiencies could have important implications on health outcomes. Trace elements delivery is a core component of nutritional care. Front-line clinicians should be aware of at-risk clinical situations to provide correct and timely intervention. Future research should be directed towards investigating the potential benefits of antioxidant trace elements supplementation in children in whom studies are scarce, especially in critical conditions such as burns, sepsis and cardiac surgery.
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18
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Abdel-Sayed P, Hirt-Burri N, de Buys Roessingh A, Raffoul W, Applegate LA. Evolution of Biological Bandages as First Cover for Burn Patients. Adv Wound Care (New Rochelle) 2019; 8:555-564. [PMID: 31637102 PMCID: PMC6798807 DOI: 10.1089/wound.2019.1037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/12/2019] [Indexed: 01/07/2023] Open
Abstract
Significance: Cutaneous wound regeneration is vital to keep skin functions and for large wounds, to maintain human survival. In a deep burn, the ability of the skin to heal is compromised due to the damage of vasculature and resident cells, hindering a coordinated response in the regeneration process. Temporal skin substitutes used as first cover can play a major role in skin regeneration as they allow a rapid wound covering that, in turn, can significantly reduce infection risk, rate of secondary corrective surgeries, and indirectly hospitalization time and costs. Recent Advances: Skin was one of the first tissues to be bioengineered providing thus a skin equivalent; however, what is the current status subsequent to 40 years of tissue engineering? We review the classic paradigms of biological skin substitutes used as first cover and evaluate recent discoveries and clinical approaches adapted for burn injuries cover, with an emphasis on innovative cell-based approaches. Critical Issues: Cell-based first covers offer promising perspectives as they can have an active function in wound healing, such as faster healing minimizing scar formation and prepared wound bed for subsequent grafting. However, cell-based therapies encounter some limitations due to regulatory hurdles, as they are considered as "Advanced Therapy Medicinal Products," which imposes the same industry-destined good manufacturing practices as for pharmaceutical products and biological drug development. Future Directions: Further improvements in clinical outcome can be expected principally with the use of cell-based therapies; however, hospital exemptions are necessary to assure accessibility to the patient and safety without hindering advances in therapies.
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Affiliation(s)
- Philippe Abdel-Sayed
- Regenerative Therapy Unit (UTR), Department of Musculoskeletal Medicine DAL, Lausanne University Hospital, Lausanne, Switzerland
- Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit (UTR), Department of Musculoskeletal Medicine DAL, Lausanne University Hospital, Lausanne, Switzerland
- Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Wassim Raffoul
- Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit (UTR), Department of Musculoskeletal Medicine DAL, Lausanne University Hospital, Lausanne, Switzerland
- Service of Plastic, Reconstructive & Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland
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Altarelli M, Ben-Hamouda N, Schneider A, Berger MM. Copper Deficiency: Causes, Manifestations, and Treatment. Nutr Clin Pract 2019; 34:504-513. [PMID: 31209935 DOI: 10.1002/ncp.10328] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The metabolism of the essential trace element copper remains incompletely understood and, until recently, nearly ignored in acute medicine. Menkes disease was for long the only known copper deficiency condition, but several case reports and investigations conducted over the last 2 decades have shown that deficiency is more frequent than previously suspected, with devastating individual consequences and potential public health consequences. The copper needs in healthy individuals are 0.9 mg/d, which translates to 0.3 mg/d intravenously in parenteral nutrition; the present review aims at gathering actual knowledge. METHOD AND RESULTS A review of literature was conducted in PubMed and Cochrane systematic reviews to identify the most recent information about copper deficiency and generate a narrative review. Copper deficiency has hereditary and acquired origins, the latter being the most frequent. Clinical manifestations are nonspecific but affect all organs and systems, particularly the hematologic (anemia) and the neurologic (myeloneuropathy) systems. Deficiency also affects the cardiovascular, cutaneous, and immune systems. Severe copper deficiency due to reduced absorption after bariatric bypass surgery has become frequent. CONCLUSION Deficiency is more frequent than previously recognized, probably because of changing nutrition patterns but also because of some treatments that have become very common such as bypass bariatric surgery and, in acute medicine, prolonged continuous renal replacement therapy. The patients may present with severe hematologic and neurologic complications that go untreated because copper deficiency was not considered in the differential diagnosis: These complications often need active intravenous repletion with doses 4-8 times the usual nutrition recommendations.
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Affiliation(s)
- Marco Altarelli
- Adult Intensive Care and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nawfel Ben-Hamouda
- Adult Intensive Care and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mette M Berger
- Adult Intensive Care and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Pantet O, Stoecklin P, Charrière M, Voirol P, Vernay A, Berger MM. Trace element repletion following severe burn injury: A dose-finding cohort study. Clin Nutr 2018; 38:246-251. [PMID: 29428787 DOI: 10.1016/j.clnu.2018.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/04/2018] [Accepted: 01/22/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Major burn patients are characterized by large exudative losses of Cu, Se and Zn. Trace element (TE) repletion has been shown to improve clinical outcome. Having increased the TE doses over time, the study aimed at analysing if our repletion protocol corrected TE plasma concentrations and if the necessity for continuous renal replacement therapy (CRRT) might increase the TE needs. METHODS Retrospective analysis of prospectively collected data in burn patients requiring intensive care (ICU) between 1999 and 2015. INCLUSION CRITERIA Admission on day 1, full treatment, burned surface area (TBSA) ≥20% and ≥1 TE plasma determination during the stay. Four groups were constituted according to protocol changes. Period 1 (P1): 1999-2000, P2: 2001-2005, P3: 2006-2010, P4: 2011-2015. Changes consisted in increasing TE repletion doses and duration. Demographic data, daily TE intakes and weekly plasma concentrations were retrieved for the first 21 ICU-days. Data as median (IQR). RESULTS 139 patients completed the criteria, aged 37 (28) years, burned on 35 (25) % TBSA. As a result of prescription, Cu, Se and Zn intakes increased significantly between P1 and P4, resulting in normalization of plasma Cu (16 μmol/l) since P3 and Zn (13.5 μmol/l) since P2. Median plasma Se were above reference range (1400 nmol/l) during P3 and P4. CRRT patients required higher doses of Cu for maintenance within normal ranges. CONCLUSION This dose finding study shows that the latest repletion protocol is safe and normalizes Cu and Zn concentrations. Se doses result in supra-normal Se concentrations, suggesting prescription reduction. CRRT patients are at high risk of Cu depletion and require specific monitoring.
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Affiliation(s)
- Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland.
| | - Patricia Stoecklin
- Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| | - Mélanie Charrière
- Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland
| | - Pierre Voirol
- Service of Pharmacy, University Hospital, Lausanne, Switzerland
| | - Arnaud Vernay
- Department of Computer Sciences, University Hospital, Lausanne, Switzerland
| | - Mette M Berger
- Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland
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What's new in trace elements? Intensive Care Med 2017; 44:643-645. [PMID: 29022061 DOI: 10.1007/s00134-017-4955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
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