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de Man AME, Amrein K, Casaer MP, Dizdar OS, van Zanten ARH, Gundogan K, Lepp L, Rezzi S, Shenkin A, Berger MM. LLL 44-4 : Micronutrients in acute disease and critical illness. Clin Nutr ESPEN 2024; 61:437-446. [PMID: 38777466 DOI: 10.1016/j.clnesp.2024.04.011] [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: 03/17/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Micronutrients (MN), i.e. trace elements and vitamins, are essential components of the diet in relatively small amounts in any form of nutrition, with special needs in critically ill patients. Critical illness is characterised by the presence of inflammation and oxidative stress. MNs are tightly involved in antioxidant and immune defences. In addition, some conditions, and treatments result in large losses of biological fluids containing MNs: therefore, acute renal injury requiring renal replacement therapy, acute intestinal failure, and major burns and trauma are at high risk of acute depletion of body stores, and of deficiency. MN requirements are increased above standard DRI. Blood level interpretation is complicated by inflammation: some biomarkers assist the status determination. Due to the acute challenges of critical illness, it of utmost importance to cover the needs to maintain the organism's endogenous immune and antioxidant defences, and capacity to repair tissues. Practical strategies are proposed.
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Affiliation(s)
- Angélique M E de Man
- Amsterdam UMC, Location Vrije Universiteit, Department of Intensive Care, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Oguzhan S Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Arthur R H van Zanten
- Gelderse Vallei Hospital, Ede and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey; North Estonia Regional Hospital, Tallinn, Estonia.
| | - Liis Lepp
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
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Metsu D, Cinq-Frais C, Camare C, Caspar-Bauguil S, Galinier A. Zinc unbound concentration as an anchor to drive individualize repletion. Clin Nutr 2024; 43:1021-1023. [PMID: 38513551 DOI: 10.1016/j.clnu.2024.02.010] [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: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Zinc (Zn) quantification is of particular interest in many clinical condition (e.g. inflammatory disease, critical care). Currently, Zn status is assessed by measuring plasma/serum concentration. This concentration corresponds to the sum of unbound Zn (Zn-Cu) and Zn highly bound to albumin (Zn-Cb). METHODS Using a pharmacokinetic approach to the interpretation of total Zn concentration (Zn-Ct), taking into account Zn-Cu and the influence of hypoalbuminemia on Zn-Cb, it is possible to improve the individualization of Zn repletion. RESULTS Therefore, during pregnancy and in certain inflammatory disease situations, repletion may not be necessary. However, as in critical care, it would be more appropriate to perform Zn-Cu assays to improve Zn repletion. CONCLUSION Coupled total and unbound Zn should be monitored in order to individualize Zn repletion.
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Affiliation(s)
- D Metsu
- Department of Clinical Laboratory, Montauban Hospital, Montauban, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), Equipe MetaDiab, University of Toulouse, INSERM, University of Toulouse III - Paul Sabatier (UPS), Toulouse, France.
| | - C Cinq-Frais
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France
| | - C Camare
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France; Institute for Metabolic and Cardiovascular Diseases (I2MC), UMR 1297, INSERM, University of Toulouse III - Paul Sabatier (UPS), 31432 Toulouse, France
| | - S Caspar-Bauguil
- Institute of Metabolic and Cardiovascular Diseases (I2MC), Equipe MetaDiab, University of Toulouse, INSERM, University of Toulouse III - Paul Sabatier (UPS), Toulouse, France; Department of Biochemistry, Toulouse University Hospital, Toulouse, France
| | - A Galinier
- Department of Biochemistry, Toulouse University Hospital, Toulouse, France; Institut RESTORE, UMR 1301 INSERM, 5070 CNRS, Université Paul Sabatier, Toulouse, France
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Kiani Z, Khorsand N, Beigi F, Askari G, Sharma M, Bagherniya M. Coenzyme Q10 supplementation in burn patients: a double-blind placebo-controlled randomized clinical trial. Trials 2024; 25:160. [PMID: 38431600 PMCID: PMC10908042 DOI: 10.1186/s13063-024-08006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Burn injuries are important medical problems that, aside from skin damage, cause a systemic response including inflammation, oxidative stress, endocrine disorders, immune response, and hypermetabolic and catabolic responses which affect all the organs in the body. The aim of this study was to determine the effect of coenzyme Q10 (CoQ10) supplementation on inflammation, oxidative stress, and clinical outcomes in burn patients. METHODS In a double-blind placebo-controlled randomized clinical trial, 60 burn patients were randomly assigned to receive 100 mg CoQ10 three times a day (total 300 mg/day) or a placebo for 10 days. Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), oxidative stress markers including total antioxidant capacity (TAC), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine, white blood cells (WBC), and body temperature were assessed as primary outcomes and albumin, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), other hematological parameters, blood pressure, O2 saturation, ICU duration, and 28-mortality rate were assessed as secondary outcomes. RESULTS Fifty-two participants completed the trial. CRP and ESR levels were not significantly different between CoQ10 and placebo groups at the end of the study (P = 0.550 and P = 0.306, respectively). No significant differences between groups were observed for TAC (P = 0.865), MDA (P = 0.692), and SOD activity (P = 0.633) as well. Administration of CoQ10 resulted in a significant increase in albumin levels compared to placebo (P = 0.031). There was no statistically significant difference between the two groups in other measured outcomes (P > 0.05). CONCLUSION Results showed that in patients with burn injury, CoQ10 administration had no effect on inflammatory markers and oxidative stress, although serum albumin levels were improved after supplementation. Further studies with albumin as the primary outcome are needed to confirm this finding.
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Affiliation(s)
- Zahra Kiani
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadereh Khorsand
- Department of Internal Medicine, Imam Musa Kazem Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Beigi
- Pharmaceutical Biotechnology Department, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Science, Isfahan, Iran
- Research and Development Unit, Imam Muss Kazim Hospital, Isfahan University of Medical Science, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Berger MM, Shenkin A, Dizdar OS, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Schweinlin A, Cuerda C. ESPEN practical short micronutrient guideline. Clin Nutr 2024; 43:825-857. [PMID: 38350290 DOI: 10.1016/j.clnu.2024.01.030] [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: 01/10/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. The importance of MNs in common pathologies is recognized by recent research, with deficiencies significantly impacting the outcome. OBJECTIVE This short version of the guideline aims to provide practical recommendations for clinical practice. METHODS An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL for the initial guideline. The search focused on physiological data, historical evidence (for papers published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS The limited number of interventional trials prevented meta-analysis and led to a low level of evidence for most recommendations. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90 % of votes. Altogether the guideline proposes 3 general recommendations and specific recommendations for the 26 MNs. Monitoring and management strategies are proposed. CONCLUSION This short version of the MN guideline should facilitate handling of the MNs in at-risk diseases, whilst offering practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Oguzhan Sıtkı Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Pathak PC, Gadgoli CH. Exploring the efficacy of panchavalkal extract and Zinc-Copper Bhasma in promoting wound healing in incision and excision wound models in the rat. JOURNAL OF ETHNOPHARMACOLOGY 2024; 320:117404. [PMID: 37979819 DOI: 10.1016/j.jep.2023.117404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Modified Panchavalkal (MPVKL) and herbomineral Preparations as per the Ayurvedic texts possess various medicinal properties. Although some of its pharmacological benefits have been documented, scientific validation of combined wound-healing properties has not been done. AIM To investigate the effects of the herbomineral combinations of MPVKL extract on wound healing efficacy through the utilization of incision and excision rodent models. METHODS Excision and incision wound models in Albino Wistar rats were used to assess wound healing activity, with ten groups of six animals each. Along with normal control, diseased, vehicle control, and standard group, groups were treated with MPVKL extract (5% and 10%), MPVKL and Yashad bhasma (0.5%, 1%), and MPVKL and Tamra bhasma (0.1%, 0.075%) for 21 days and 14 days in excision and incision model respectively. The assessments were performed using the wound contraction, breaking and tensile strength, biochemical and antioxidant parameters, and histopathology of the granulation tissue. RESULTS All the test groups demonstrated significant wound contraction (p < 0.001). The highest decrease in epithelialization period (16.1 ± 0.98 days) was observed for the MPVKL (10%) and Yashad bhasma (0.5%) group. There was a significant improvement in the antioxidant activity of MPVKL (10%) and Yashad bhasma groups. The biochemical parameters viz hydroxyproline, collagen and hexosamine increased remarkably in MPVKL (5%) and Yashad bhasma (1%) as compared to disease control. Histopathological studies of test groups showed epithelialization, increased collagen deposition, and neovascularization in contrast to the control group. MPVKL and Yashad bhasma-containing groups increased the tensile and breaking strength of the wound in the incision model when compared to disease control. CONCLUSION In both wound models, MPVKL extract and its herbomineral combination with Yashad Bhasma demonstrated significant wound healing activity when compared to the control group.
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Affiliation(s)
- Prachi Chandrashekhar Pathak
- Saraswathi Vidya Bhavan's College of Pharmacy, Dombivli, India; SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle, India.
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Nunez JH, Clark AT. Burn Patient Metabolism and Nutrition. Phys Med Rehabil Clin N Am 2023; 34:717-731. [PMID: 37806693 DOI: 10.1016/j.pmr.2023.06.001] [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] [Indexed: 10/10/2023]
Abstract
Following severe burns, patients have unique metabolic derangements that make adequate nutritional support imperative for their survival and recovery. Patients with burns have persistent and prolonged hypermetabolic states that lead to increased catabolism following injury. During rehabilitation, catabolism leads to increased muscle wasting and cachexia. Failure to adequately meet the patient's increased nutritional requirements can lead to poor wound healing, increased infections, and overall organ dysfunction. Because of these risks, adequate assessment and provision of nutritional needs are imperative to care for these patients.
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Affiliation(s)
- Johanna H Nunez
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern Medical Center, E05514B, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Shahrokhi S, Jeschke MG. Metabolic and Nutritional Support. Surg Clin North Am 2023; 103:473-482. [PMID: 37149383 DOI: 10.1016/j.suc.2023.01.009] [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: 05/08/2023]
Abstract
Hypermetabolism is a hallmark of larger burn injuries. The hypermetabolic response is characterized by marked and sustained increases in catecholamines, glucocorticoids, and glucagon. There is an increasing body of literature for nutrition and metabolic treatment and supplementation to counter the hypermetabolic and catabolic response secondary to burn injury. Early and adequate nutrition is key in addition to adjunctive therapies, such as oxandrolone, insulin, metformin, and propranolol. The duration of administration of anabolic agents should be at minimum for the duration of hospitalization, and possibly up to 2 to 3 years postburn.
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Affiliation(s)
- Shahriar Shahrokhi
- Burn Program at Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marc G Jeschke
- Burn Program at Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; TaAri Institute, Hamilton Health Sciences Research Institute, Hamilton, Ontario, Canada; David Braley Research Institute, C5-104, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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Cruz DM, Mostafavi E, Vernet-Crua A, O’Connell CP, Barabadi H, Mobini S, Cholula-Díaz JL, Guisbiers G, García-Martín JM, Webster TJ. Green nanotechnology and nanoselenium for biomedical applications. Nanomedicine (Lond) 2023. [DOI: 10.1016/b978-0-12-818627-5.00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Chiu YC, Liang CM, Chung CH, Hong ZJ, Chien WC, Hsu SD. The influence of early selenium supplementation on trauma patients: A propensity-matched analysis. Front Nutr 2022; 9:1062667. [PMID: 36570123 PMCID: PMC9773250 DOI: 10.3389/fnut.2022.1062667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Oxidative stress is involved in numerous inflammatory diseases, including trauma. Micronutrients, such as selenium (Se), which contribute to antioxidant defense, exhibit low plasma levels during critical illness. This study aimed to investigate the impact of early Se supplementation on trauma patients. Materials and methods A total of 6,891 trauma patients were registered at a single medical center from January 2018 to December 2021. Twenty trauma patients with Se supplemented according to the protocol were included in the study group. Subsequently, 1:5 propensity score matching (PSM) analysis was introduced. These patients received 100 mcg three times a day for 5 days. The primary outcome was overall survival (OS); the secondary outcomes were hospital/intensive care unit (ICU) length of stay (LOS), serologic change, ventilator dependence days, and ventilation profile. Results The hospital LOS (20.0 ± 10.0 vs. 37.4 ± 42.0 days, p = 0.026) and ICU LOS (6.8 ± 3.6 vs. 13.1 ± 12.6 days, p < 0.006) were significantly shorter in the study group. In terms of serology, improvement in neutrophil, liver function, and C-reactive protein (CRP) level change percentile indicated better outcomes in the study group as well as a better OS rate (100 vs. 83.7%, p = 0.042). Longer ventilator dependence was found to be an independent risk factor for mortality and pulmonary complications in 6,891 trauma patients [odds ratio (OR) = 1.262, 95% confidence interval (CI) = 1.039-1.532, p < 0.019 and OR = 1.178, 95% CI = 1.033-1.344, p = 0.015, respectively]. Conclusion Early Se supplementation after trauma confers positive results in terms of decreasing overall ICU LOS/hospital LOS and mortality. Organ injury, particularly hepatic insults, and inflammatory status, also recovered better.
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Affiliation(s)
- Yu-Cheng Chiu
- Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ming Liang
- Division of Trauma Surgery and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Zhi-Jie Hong
- Division of Trauma Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Der Hsu
- Division of Trauma Surgery and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,*Correspondence: Sheng-Der Hsu,
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Dusapin CJ, Pantet O, Voirol P, Charrière M, Thomann P, Berger MM. Computer customization errors compromised the optimization of trace element repletion dose after major burns. Clin Nutr 2022; 41:2207-2210. [DOI: 10.1016/j.clnu.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
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Dhanasekara CS, Schrader K, Chandrahas S, Aickareth G, Dissanaike S, Griswold JA. Higher baseline copper levels are associated with worse outcome in burn patients with overweight and obesity. Burns 2022; 48:1246-1252. [PMID: 34629187 DOI: 10.1016/j.burns.2021.09.016] [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: 04/08/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We examined the interactive effects of copper (Cu) and overweight (overweight) and obesity on outcomes of burn patients. We posited that higher baseline Cu among burn patients with overweight or obesity will be associated with poor clinical outcomes vs. patients with a normal weight. METHODS A retrospective review was conducted on patients with ≥20% total burn surface area (TBSA) with an initial measurement of Cu. Patients were grouped by body mass index (BMI). The interactions between baseline Cu and BMI groups on multiple burn patient outcomes were examined in a series of multiple regression models. RESULTS One-hundred-and-sixty patients met eligibility (age 43.9 ± 17.5, males 86.3%, normal weight:overweight:obesity = 53:38:69). BMI groups did not differ significantly on demographics, burn severity, or baseline biochemistry. Normal weight patients with higher baseline Cu had shorter ICU stay (ICUS), shorter length of stay (LOS), and had fewer operations (Ps < 0.05). In contrast, overweight and obese patients with higher baseline Cu had longer ICU stay (p = 0.001 and p = 0.034), LOS (p = 0.005 and p = 0.066), and increased operations (p = 0.001 and p = 0.067). CONCLUSIONS Higher baseline Cu seems associated with adverse outcomes in overweight and obese burn patients. Further research is needed to confirm this association and explore the direction of causality.
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Affiliation(s)
| | - Kaylee Schrader
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Sheila Chandrahas
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | | | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - John A Griswold
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA.
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Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda C. ESPEN micronutrient guideline. Clin Nutr 2022; 41:1357-1424. [PMID: 35365361 DOI: 10.1016/j.clnu.2022.02.015] [Citation(s) in RCA: 186] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Department of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II, University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation (SNHf), Epalinges, Switzerland.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Gudivada KK, Kumar A, Sriram K, Baby J, Shariff M, Sampath S, Sivakoti S, Krishna B. Antioxidant micronutrient supplements for adult critically ill patients: A bayesian multiple treatment comparisons meta-analysis. Clin Nutr ESPEN 2022; 47:78-88. [PMID: 35063246 DOI: 10.1016/j.clnesp.2021.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/26/2021] [Accepted: 12/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Antioxidant micronutrients (AxMs) have been administered to critically ill adults attempting to counteract the oxidative stress imposed during critical illness. However, results are conflicting and relative effectiveness of AxMs regimens is unknown. We conducted a Bayesian multi-treatment comparison (MTC) meta-analysis to identify the best AxM treatment regimen that will improve clinical outcomes. METHODS PubMed, EMBASE, Web of Science and Cochrane databases were searched from the inception of databases through August 2020. Randomized controlled trials (RCT) comparing AxMs supplementations with placebo among critically ill adults were included. Two authors assessed trial quality using Cochrane risk of bias tool and assessed certainty of evidence (CoE). A random effect model, non-informative priors Bayesian MTC meta-analysis using gemtc package in R version 3.6.2 was performed. AxMs treatment effect on clinical outcomes (mortality, infection rates, intensive care unit (ICU) and hospital stays and ventilator days) were represented by absolute risk differences (ARD) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Prior to final analysis, we repeated the search through January 2021. RESULTS 37 RCT (4905 patients) were included with 16 direct comparisons. With respect to mortality, the ARD for "vitamin E" compared with placebo was centred at -0.19 [95%CrI: -0.54,0.16; very low CoE] and was ranked the best treatment for mortality reduction as per surface under the cumulative ranking curve (SUCRA 0.71, 95%CrI: 0.07,1.00). A combination of "selenium, zinc and copper" was ranked the best for lowest ICU stay [-9.40, 95% CrI: -20.0,1.50; low CoE]. A combination of "selenium, zinc, copper and vitamin E" was ranked the best treatment for infection risk reduction [-0.22, 95% CrI: -0.61,0.17; very low CoE]. Ventilator days were least with a combination of "selenium, zinc and manganese" [2.80, 95% CrI: -6.30,0.89; low CoE]. Hospital stay was the lowest using a combination of "selenium, zinc and copper" [-13.00, 95% CrI: -38.00,13.00; very low CoE]. There is substantial uncertainty present in the rankings due to wide and overlapping 95% CrIs of SUCRA scores for the treatments. CONCLUSIONS Studies on critically ill adult patients have suggested a possible beneficial effects of certain AxM supplementations over and above the recommended dietary allowance. However, evidence does not support their use in clinical practice due to the low confidence in the estimates. Current studies evaluating specific AxMs or their combinations are limited with small sample sizes. REGISTRATION PROSPERO, CRD42020210199. TAKE-HOME MESSAGE Evidence suggesting a potential benefit of AxMs use more than recommended doses in critically ill adults is weak, indicating that there is no justification for this practice.
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Affiliation(s)
- Kiran Kumar Gudivada
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad Metropolitan Region, Telangana, India.
| | - Ashish Kumar
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Krishnan Sriram
- US Veterans Affairs Tele Critical Care West, Minneapolis, MN, USA
| | - Jeswin Baby
- Division of Epidemiology and Biostatistics, St John's Research Institute, Bangalore, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
| | - Sriram Sampath
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
| | - Sumitra Sivakoti
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad Metropolitan Region, Telangana 508126, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, India
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14
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Dixit R, Chaudhary NK, Mishra PK, Srivastava P, Bhartiya SK, Pratap A, Basu S, Shukla VK. Study on Blood Serum Levels of Heavy and Trace Metals in Chronic Non-Healing Wounds. INT J LOW EXTR WOUND 2022:15347346221074161. [PMID: 35037502 DOI: 10.1177/15347346221074161] [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: 11/16/2022]
Abstract
Wound healing is a complex, highly regulated process that is important in sustaining the skin barrier function. The etiologic relation of specific metals is not adequately described for chronic non-healing wounds. The aim of this study was to estimate heavy and trace metals in chronic non-healing wound and their association with wound healing. The levels of zinc, selenium, copper, magnesium, chromium, cadmium, iron, and lead were estimated in serum of chronic non-healing wound patients using atomic absorption spectrophotometry. The tests were carried out in 50 patients with chronic non-healing wound and thirty healthy volunteers as control. The serum levels of elements namely zinc, selenium, copper, magnesium, and chromium were significantly reduced in chronic non-healing wounds (P < .001) as compared to control. Lead and cadmium levels had shown the significantly increasing trend in chronic non-healing wound cases (P < .001). The present study demonstrated a significant decrease in serum, levels of selenium, zinc, copper, magnesium, iron, and chromium levels in patients with chronic non-healing wound indicating an association between these elements and wound healing. To summarize the findings of our research, hence trace elements were decreasing in chronic non-healing wound patients suggesting their role in wound healing.
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Affiliation(s)
- Ruhi Dixit
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
| | - Naveen Kumar Chaudhary
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
| | - Pradeep Kumar Mishra
- Department of Chemical Engineering, Indian Institute of Technology, 30114Banaras Hindu University, Varanasi, India
| | - Pradeep Srivastava
- School of Biochemical Engineering, Indian Institute of Technology, 30114Banaras Hindu University, Varanasi, India
| | - Satyanam Kumar Bhartiya
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
| | - Somprakas Basu
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
| | - Vijay Kumar Shukla
- Department of General Surgery, Institute of Medical Sciences, 30114Banaras Hindu University, Varanasi, India
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Sharifi-Razavi A, Karimi N, Jafarpour H. Evaluation of Selenium Supplementation in Acute Ischemic Stroke Outcome: An Outcome Assessor Blind, Randomized, Placebo-Controlled, Feasibility Study. Neurol India 2022; 70:87-93. [DOI: 10.4103/0028-3886.336328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Coni P, Pichiri G, Lachowicz JI, Ravarino A, Ledda F, Fanni D, Gerosa C, Piras M, Coghe F, Gibo Y, Cau F, Castagnola M, Van Eyken P, Saba L, Piludu M, Faa G. Zinc as a Drug for Wilson's Disease, Non-Alcoholic Liver Disease and COVID-19-Related Liver Injury. Molecules 2021; 26:6614. [PMID: 34771023 PMCID: PMC8587580 DOI: 10.3390/molecules26216614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023] Open
Abstract
Zinc is the second most abundant trace element in the human body, and it plays a fundamental role in human physiology, being an integral component of hundreds of enzymes and transcription factors. The discovery that zinc atoms may compete with copper for their absorption in the gastrointestinal tract let to introduce zinc in the therapy of Wilson's disease, a congenital disorder of copper metabolism characterized by a systemic copper storage. Nowadays, zinc salts are considered one of the best therapeutic approach in patients affected by Wilson's disease. On the basis of the similarities, at histological level, between Wilson's disease and non-alcoholic liver disease, zinc has been successfully introduced in the therapy of non-alcoholic liver disease, with positive effects both on insulin resistance and oxidative stress. Recently, zinc deficiency has been indicated as a possible factor responsible for the susceptibility of elderly patients to undergo infection by SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic. Here, we present the data correlating zinc deficiency with the insurgence and progression of Covid-19 with low zinc levels associated with severe disease states. Finally, the relevance of zinc supplementation in aged people at risk for SARS-CoV-2 is underlined, with the aim that the zinc-based drug, classically used in the treatment of copper overload, might be recorded as one of the tools reducing the mortality of COVID-19, particularly in elderly people.
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Affiliation(s)
- Pierpaolo Coni
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Giuseppina Pichiri
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Joanna Izabela Lachowicz
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Alberto Ravarino
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Francesca Ledda
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Daniela Fanni
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Clara Gerosa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Monica Piras
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Ferdinando Coghe
- Dipartimento Servizi di Diagnosi e Cura, Azienda Ospedaliero-Universitaria di Cagliari (A.O.U.), University of Cagliari, 09024 Cagliari, Italy;
| | - Yukio Gibo
- Hepatology Clinic, 1-34-20 Muraimachiminami, Matsumoto, Nagano 399-0036, Japan;
| | - Flaviana Cau
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
| | - Massimo Castagnola
- Laboratorio di Proteomica e Metabonomica-Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, 00013 Rome, Italy;
| | - Peter Van Eyken
- Department of Pathology, Genk Regional Ziekenhuis, 3600 Genk, Belgium;
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554, 09045 Monserrato, Italy;
| | - Marco Piludu
- Department of Biomedical Sciences, University of Cagliari, 09042 Monserrato, Italy;
| | - Gavino Faa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (P.C.); (A.R.); (F.L.); (D.F.); (C.G.); (M.P.); (F.C.); (G.F.)
- UOC Anatomia Patologica, AOU Cagliari, University of Cagliari, 09124 Cagliari, Italy
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Abstract
Wound healing is a complex and energy-demanding process. The relationship between nutrition and wound healing has been recognized for many centuries. Several studies have indicated that nutritional deficiencies are more prevalent among patients with chronic wounds. Malnutrition may alter the inflammatory response, collagen synthesis, and wound tensile strength, all of which are crucial for wound healing. Although the specific role of nutrition and supplementation in wound care remains uncertain, it is necessary to identify and correct nutritional imbalances to avoid any potential deterioration of the healing process. It is also important to recognize the differences in pathophysiology between acute and chronic wounds. A burn, surgical, or a traumatic wound is different from a diabetic foot ulcer, which is different from a pressure ulcer. Chronic wounds are more prevalent in the aging population, and patients often have underlying comorbidities, such as diabetes mellitus, peripheral vascular disease, connective tissue disease, or other systemic illnesses that may alter energy metabolism and contribute to impaired healing. Management approaches to acute wound care may not apply universally to chronic wounds. In this review, we discuss the available data and possible roles for nutrition in wound healing.
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18
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Serum zinc and copper in people with COVID-19 and zinc supplementation in parenteral nutrition. Nutrition 2021; 91-92:111467. [PMID: 34592694 PMCID: PMC8406548 DOI: 10.1016/j.nut.2021.111467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
Objectives Zinc and copper are important to protect cells from oxidative stress and to enhance immunity. An association between low zinc levels and the severity of acute respiratory distress syndrome has been shown for people with COVID-19. We aimed to study serum zinc and copper concentrations in people with severe COVID-19 and zinc supplementation in parenteral nutrition (PN). Methods Thirty-five people with COVID-19 in need of PN were studied in a retrospective design. Serum samples were collected at three time points: at the start of PN, between 3 and 7 d after, and at the end of PN. Results Participants were on PN for a mean of 14 d, with a mean (± SD) daily supplemental zinc of 14.8 ± 3.7 mg/d. Serum zinc increased during PN administration from 98.8 ± 22.8 to 114.1 ± 23.3 µg/dL (Wilks’ λ = 0.751, F = 5.459, P = 0.009). Conversely, serum copper did not vary from baseline (107.9 ± 34.2 µg/dL) to the end of the study (104.5 ± 37.4 µg/dL, Wilks’ λ = 0.919, F = 1.453, P = 0.248). Serum zinc within the first week after starting PN and at the end of PN inversely correlated with total hospital stay (r = −0.413, P = 0.014, and r = −0.386, P = 0.022, respectively). Participants in critical condition presented lower serum copper (z = 2.615, P = 0.007). Mortality was not associated with supplemental zinc or with serum zinc or copper concentrations at any time of the study (P > 0.1 for all analyses). Conclusions Serum zinc concentrations during PN support were inversely associated with length of hospital stay but not with mortality. Serum copper concentrations were lower in participants in critical condition but not associated with prognosis.
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19
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Suleiman MHA, Brima EI. Phytochemicals, Trace Element Contents, and Antioxidant Activities of Bark of Taleh (Acacia seyal) and Desert Rose (Adenium obesum). Biol Trace Elem Res 2021; 199:3135-3146. [PMID: 33048292 DOI: 10.1007/s12011-020-02428-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
Abstract
Acacia seyal and Adenium obesum are used in traditional medicines by indigenous communities of the Asir region of Saudi Arabia. The present study aimed to acquire the phytochemical profiles, quantify the trace element contents and the total phenolic (TPC) and flavonoid (TFC) contents, and evaluate the antioxidant activity of the two species. Phytochemical screening was conducted to detect the presence of the phytochemical constituents. Bark samples were digested with a microwave, and ICP-MS was used for the elemental analysis. The antioxidant capacities in DPPH, H2O2, and FRAP assays and the TPC and TFC were determined by spectrophotometry, and their correlation with the IC50 of the DPPH and H2O2 and the EC50 of the FRAP capacities were analyzed by Pearson's correlation. Both plant extracts contain a variety of phytochemicals. A. obesum had the highest concentrations of all 11 elements measured. In both plants, manganese was found at the highest concentration, and cadmium exhibited the lowest concentration. The aqueous-methanolic extract of A. seyal showed the highest TPC (309.32 ± 2.15 mg gallic acid equivalent/g), whereas the aqueous-methanolic extract of A. obesum exhibited the highest TFC (32.16 ± 3.16 mg quercetin equivalent/g). Significant differences in the IC50 and EC50 values were observed among the tested plant extracts. The highest antioxidant activity was found in aqueous-methanolic extract of A. obesum. Correlation analysis showed significant correlations between the DPPH and FRAP activities and the TFC. The present findings highlight that these plants are good sources of phenolic compounds and essential elements and support their therapeutic use as antioxidant drugs.
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Affiliation(s)
- Mohamed H A Suleiman
- Department of Chemistry, College of Science, King Khalid University, Abha, Asir, 61413, Saudi Arabia.
- Department of Chemistry, Faculty of Science, University of Kordofan, El Obeid, Sudan.
| | - Eid I Brima
- Department of Chemistry, College of Science, King Khalid University, Abha, Asir, 61413, Saudi Arabia
- School of Allied Health Sciences, Faculty of Health and Life Science, De Montfort University, Leicester, LE1 9BH, UK
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20
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Abstract
BACKGROUND The role of nutritional intervention in wound care has been a topic of controversy. Although the efficacy of macronutrient supplementation has been well described, there is a paucity of evidence and no official recommendation regarding the use of vitamins and minerals to optimize wound healing. This is the first review of vitamin and mineral wound intervention that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence by wound type. METHODS In this comprehensive review, the authors outline the nutrients and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize nutrient effectiveness, and propose evidence-based conclusions to improve wound healing outcomes and enhance the consistency of nutritional intervention in wound care. RESULTS Thirty-six studies with a combined total of 2339 patients investigated the use of oral, topical, or intravenous vitamin and/or mineral supplementation for treatment of the following wound types: burn wounds (n = 3), pressure ulcers (n = 7), diabetic ulcers (n = 4), venous ulcers (n = 7), digital ulcers (n = 1), skin incisions (n = 9), hypertrophic scars (n = 4), and sinonasal wounds (n = 1). Improved outcomes were reported in patients with burn wounds receiving vitamins A, B1, B6, B12, D, and E and zinc, calcium, copper, magnesium, selenium, and zinc; patients with pressure ulcers receiving vitamin C and zinc; patients with diabetic ulcers receiving vitamin A, B9, D, and E; patients with venous ulcers receiving zinc; and patients with hypertrophic scars receiving vitamin E. CONCLUSIONS Based on the high-level data provided in this review, the use of specific nutritional interventions may improve the outcome of certain wound types. Further investigation is warranted to draw definitive conclusions.
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21
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Glucose Metabolism in Burns-What Happens? Int J Mol Sci 2021; 22:ijms22105159. [PMID: 34068151 PMCID: PMC8153015 DOI: 10.3390/ijms22105159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Severe burns represent an important challenge for patients and medical teams. They lead to profound metabolic alterations, trigger a systemic inflammatory response, crush the immune defense, impair the function of the heart, lungs, kidneys, liver, etc. The metabolism is shifted towards a hypermetabolic state, and this situation might persist for years after the burn, having deleterious consequences for the patient's health. Severely burned patients lack energy substrates and react in order to produce and maintain augmented levels of glucose, which is the fuel "ready to use" by cells. In this paper, we discuss biological substances that induce a hyperglycemic response, concur to insulin resistance, and determine cell disturbance after a severe burn. We also focus on the most effective agents that provide pharmacological modulations of the changes in glucose metabolism.
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22
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Chinni V, El-Khoury J, Perera M, Bellomo R, Jones D, Bolton D, Ischia J, Patel O. Zinc supplementation as an adjunct therapy for COVID-19: Challenges and opportunities. Br J Clin Pharmacol 2021; 87:3737-3746. [PMID: 33742473 PMCID: PMC8250380 DOI: 10.1111/bcp.14826] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 01/19/2023] Open
Abstract
An outbreak of a novel coronavirus (COVID‐19 or 2019‐CoV) infection has posed significant threats to international health and the economy. Patients with COVID‐19 are at risk of cytokine storm, acute respiratory distress syndrome (ARDS), reduced blood oxygenation, mechanical ventilation, and a high death rate. Although recent studies have shown remdesivir and dexamethasone as treatment options, there is an urgent need to find a treatment to inhibit virus replication and to control the progression of the disease. Essential biometal zinc has generated a lot of excitement as one of the promising candidates to reduce the severity of COVID‐19 infection. Several published observations outlined in the review are the reasons why there is a global enthusiasm that zinc therapy could be a possible therapeutic option. However, the biggest challenge in realising the therapeutic value of zinc is lack of optimal treatment modalities such as dose, duration of zinc supplementation and the mode of delivery. In this review, we discuss the regulatory mechanism that hinges upon the bioavailability of zinc. Finally, we propose that intravenous zinc could circumvent the confounding factors affecting the bioavailability of zinc and allow zinc to achieve its therapeutic potential. If successful, due to advantages such as lack of toxicity, low cost and ease of availability, intravenous zinc could be rapidly implemented clinically.
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Affiliation(s)
- Vidyasagar Chinni
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - John El-Khoury
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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23
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Doostmohammadi M, Forootanfar H, Shakibaie M, Torkzadeh-Mahani M, Rahimi HR, Jafari E, Ameri A, Amirheidari B. Bioactive anti-oxidative polycaprolactone/gelatin electrospun nanofibers containing selenium nanoparticles/vitamin E for wound dressing applications. J Biomater Appl 2021; 36:193-209. [PMID: 33722085 DOI: 10.1177/08853282211001359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this study, polycaprolactone/gelatin (PCL/GEL) electrospun nanofibers containing biogenic selenium nanoparticles (Se NPs) and Se NPs/vitamin E (VE) with average diameters of 397.8 nm and 279.5 nm, respectively (as determined by SEM inspection) were prepared and their effect on wound healing was evaluated using in-vivo studies. The energy dispersive X-ray (EDX) mapping, TEM micrograph, and FTIR spectra of the prepared nanofibers strongly demonstrated well entrapment of Se NPs and VE into scaffolds. An amount of 57% Se NPs and 43% VE were gradually released from PCL/GEL/Se NPs/VE scaffold after 4 days immersion in PBS solution (pH 7.4). The both PCL/GEL/Se NPs and PCL/GEL/Se NPs/VE scaffolds supported 3T3 cell proliferation and attachment as confirmed by MTT assay and SEM imaging. Complete re-epithelialization, low level of edema and inflammatory cells in coordination with high level of oriented collagens demonstrated the wound healing activity of PCL/GEL/Se NPs/VE. Besides, significant antioxidant efficacy of PCL/GEL/Se NPs and PCL/GEL/Se NPs/VE scaffolds was demonstrated according to GSH and MDA assays. To sum up, the prepared PCL/GEL/Se NPs/VE scaffold in the present study represented suitable healing effect on animal model which candidate it for further studies.
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Affiliation(s)
- Mohsen Doostmohammadi
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Forootanfar
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojtaba Shakibaie
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.,Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Torkzadeh-Mahani
- Department of Biotechnology, Institute of Science, High Technology and Environmental Sciences, Graduate University of Advanced Technology, Kerman, Iran
| | - Hamid-Reza Rahimi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Jafari
- Pathology and Stem Cells Research Center, Department of Pathology, Kerman University of Medical Science, Kerman, Iran
| | - Alieh Ameri
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Bagher Amirheidari
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
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25
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Perera M, El Khoury J, Chinni V, Bolton D, Qu L, Johnson P, Trubiano J, McDonald CF, Jones D, Bellomo R, Patel O, Ischia J. Randomised controlled trial for high-dose intravenous zinc as adjunctive therapy in SARS-CoV-2 (COVID-19) positive critically ill patients: trial protocol. BMJ Open 2020; 10:e040580. [PMID: 33268419 PMCID: PMC7712927 DOI: 10.1136/bmjopen-2020-040580] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION SARS-CoV-2 (COVID-19) has caused an international pandemic of respiratory illness, resulting in significant healthcare and economic turmoil. To date, no robust vaccine or treatment has been identified. Elemental zinc has previously been demonstrated to have beneficial effects on coronaviruses and other viral respiratory infections due to its effect on RNA polymerase. Additionally, zinc has well-demonstrated protective effects against hypoxic injury-a clear mechanism of end-organ injury in respiratory distress syndrome. We aimed to assess the effect of high-dose intravenous zinc (HDIVZn) on SARS-CoV-2 infection. The end of study analyses will evaluate the reduction of impact of oxygen saturations or requirement of oxygen supplementation. METHODS AND ANALYSIS We designed a double-blind randomised controlled trial of daily HDIVZn (0.5 mg/kg) versus placebo. Primary outcome measures are lowest oxygen saturation (or greatest level of supplemental oxygenation) for non-ventilated patients and worst PaO2/FiO2 for ventilated patients. Following power calculations, 60 hospitalised patients and 100 ventilated patients will be recruited to demonstrate a 20% difference. The duration of follow-up is up to the point of discharge. ETHICS AND DISSEMINATION Ethical approval was obtained through the independent Human Research Ethics Committee. Participant recruitment will commence in May 2020. Results will be published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER ACTRN126200000454976.
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Affiliation(s)
- Marlon Perera
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - John El Khoury
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Vidyasagar Chinni
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Liang Qu
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Johnson
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jason Trubiano
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | | | - Daryl Jones
- Intensive Care Unit Austin Hospital, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit Austin Hospital, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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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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27
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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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28
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Gudivada KK, Kumar A, Shariff M, Sampath S, Varma MM, Sivakoti S, Krishna B. Antioxidant micronutrient supplementation in critically ill adults: A systematic review with meta-analysis and trial sequential analysis. Clin Nutr 2020; 40:740-750. [PMID: 32723509 DOI: 10.1016/j.clnu.2020.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of antioxidant micronutrient (AxM) supplementation in the critically ill patients has been controversial, and recent trials have suggested a tendency to harm. Therefore, we performed a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized controlled trials (RCT) to examine the effect of AxM supplementation on clinical outcomes among critically ill adults. METHODS PubMed, EMBASE, Cochrane, CINAHL, LILACS, DARE, SCOPUS, and Web of sciences databases were searched from inception to March 2019. RCTs that compared AxM supplements with placebo in adult critically ill patients and reporting mortality as an outcomes were included. Trial quality was assessed using updated cochrane risk of bias (RoB-II) tool. Primary outcome was all-cause mortality. Secondary outcomes were 28-day mortality, intensive care unit (ICU) and hospital length of stay (LOS), ventilator days and infection between the two groups. Outcomes were summarised using random-effects estimators. Quality of evidence (QOE) was rated using Grading of Recommendations, Assessment, Development and Evaluation. Prior to final analysis, we repeated the search through September 2019. R version 3.6.2 and STATA version 13 were used for all statistical analyses. RESULTS Pooled analysis of 34 trials with 4678 patients revealed that AxM supplementation was associated with possible reduction in all-cause mortality (relative risk [RR], 0.89 [95%CI 0.79 to 0.99], TSA adjusted CI 0.77 to 1.03; Low QOE). Fragility index and number needed to treat were 1 and 41, respectively. Eight studies with low RoB (RR, 1.08; 95%CI 0.95 to 1.23; TSA CI, 0.64 to 1.82; moderate QOE) did not show mortality reduction with AxM supplementation. SECONDARY OUTCOMES ICU LOS (weighted mean difference [WMD], -0.84; 95%CI -1.50 to -0.18; moderate QOE), hospitalization days (WMD, -2.83; 95%CI -3.91to -1.75; low QOE) and ventilator days (WMD, -1.87; 95%CI -3.60 to -0.14; very low QOE) showed a statistically significant benefit with AxM supplementation. In meta-regression analysis, neither the duration of AxM therapy nor the dosage of selenium, which was the most widely studied AxM, reported an association with mortality. CONCLUSION Although AxM supplementation was associated with possible reduction in all-cause mortality, results from the TSA and studies with low RoB showing null effect suggest that the evidence of benefit is questionable. Secondary outcomes attained statistically significant benefit with AxM supplements, but the certainity of evidence was low. To summarize, current evidence does not justify administration of AxM in critically ill patients. REGISTRATION PROSPERO, CRD42019125898.
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Affiliation(s)
- Kiran Kumar Gudivada
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India.
| | - Ashish Kumar
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India
| | - Sriram Sampath
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India
| | - Manu Mk Varma
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India
| | - Sumitra Sivakoti
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India; Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Telangana, 508126, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Medical College, Bangalore, 560034, India
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Sommerhalder C, Blears E, Murton AJ, Porter C, Finnerty C, Herndon DN. Current problems in burn hypermetabolism. Curr Probl Surg 2019; 57:100709. [PMID: 32033707 DOI: 10.1016/j.cpsurg.2019.100709] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/08/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | - Craig Porter
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
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Antioxidant and Trace Element Supplementation Reduce the Inflammatory Response in Critically Ill Burn Patients. J Burn Care Res 2019; 39:1-9. [PMID: 28877128 DOI: 10.1097/bcr.0000000000000607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
Oxidative stress after burn injury induces inflammatory and hypermetabolic responses associated with adverse outcomes. We propose that antioxidant and trace element supplementation may reduce oxidative stress and subsequently alleviate inflammation and hypermetabolism, thus improving clinical outcomes. We conducted a cohort study of adult patients with an acute burn injury admitted to our provincial burn center. Patients in the antioxidant group received an intravenous infusion of multivitamins and trace elements for the first 14 days after admission. The inflammatory profile was assessed at early time points, < 14 days postburn, and later time points, ≥ 15 days postburn, and included interleukin (IL)-1β, interferon-γ, IL-1 receptor antagonist, IL-6, granulocyte-macrophage colony-stimulating factor, and FMS-like tyrosine kinase 3 ligand. Hypermetabolism was assessed by resting energy expenditure. Clinical outcomes included mortality, morbidities, hospital length of stay, and infections including days to the last positive culture after injury. We studied 172 patients, mean age 49 ± 17 years and 33 ± 13% TBSA burned, with 91 controls and 81 patients in the antioxidant group. Patients in the antioxidant group had significantly lower levels of inflammatory markers at both early and late time points, P < .05. Antioxidant treatment was associated with decreased measure of hypermetabolism, P < .05. Morbidity and mortality were not significantly different between groups. Length of hospital stay was significantly shorter in the antioxidant group when adjusted for patient demographics and injury characteristics (risk ratio (RR), 0.78; 95% confidence interval (CI), 0.66-0.92). In the antioxidant group, while infections were not different, the last positive culture post-injury was documented at median 19 days (Interquartile range (IQR), 11-43 days) compared with controls at 35 days (IQR, 15-59 days), P = .012. Patients receiving antioxidant and trace element supplementation had reduced markers of burn stress-induced inflammation; they were also associated with a decreased hypermetabolic response, shorter length of stay, and improved bacterial clearance.
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Abstract
AbstractWhen readymade parenteral nutrition in multi-chamber bags is supplied without vitamins and minerals, these have to be added or given separately. Separate rapid infusion has logistical advantages but has been claimed to saturate tissue mechanisms, potentially increasing urine micronutrient losses. The present study compared urinary losses after fast (1 h) v. slow (10 h) trace elements infusion. The study enrolled thirty-nine consecutive patients who were starting parenteral nutrition postoperatively. One day’s dose of a complete intravenous micronutrient product was infused over 1 h and over 10 h, in random order, with a washout day after each infusion day. Urinary Zn, Mn, Se, Cr, Cu and Fe losses were measured by 24-h urine collection, recorded for each infusion day and subsequent washout day. For Zn, a dose of 100 μmol was given, and total urinary loss over the next 2 d was mean 40·6 (sd 23·8) μmol after the fast (1 h) infusion v. 33·4 (sd 25·4) μmol after the slow (10 h) infusion, that is, 7 % more of the 1-d dose was lost after fast infusion (P = 0·01). For Mn, after a dose of 1000 nmol, losses were 9·8 (sd 23·9) nmol after the fast infusion v. 22·1 (sd 47·2) nmol after the slow infusion, that is, 1 % more of the 1-d dose was lost after slow infusion (P = 0·04). There were no other significant differences: after 1 μmol Se, the losses were 1·5 (sd 0·6) μmol fast v. 1·3 (sd 0·5) μmol slow; after 200 nmol Cr, 257 (sd 92) μmol fast v. 246 (sd 107) nmol slow; after 8 μmol Cu, 1·6 (sd 1·4) μmol fast v. 1·5 (sd 1·3) μmol slow; and after 20 μmol Fe, 0·6 (sd 1·1) μmol fast v. 0·8 (sd 1·6) μmol slow (P > 0·05 for all). Overall, trace element retention appears to be minimally affected by infusion time.
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32
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Monitoring nutrition in the ICU. Clin Nutr 2019; 38:584-593. [DOI: 10.1016/j.clnu.2018.07.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022]
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33
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Jafari P, Thomas A, Haselbach D, Watfa W, Pantet O, Michetti M, Raffoul W, Applegate LA, Augsburger M, Berger MM. Trace element intakes should be revisited in burn nutrition protocols: A cohort study. Clin Nutr 2018; 37:958-964. [DOI: 10.1016/j.clnu.2017.03.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/12/2017] [Accepted: 03/27/2017] [Indexed: 12/13/2022]
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34
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Klimant E, Wright H, Rubin D, Seely D, Markman M. Intravenous vitamin C in the supportive care of cancer patients: a review and rational approach. ACTA ACUST UNITED AC 2018; 25:139-148. [PMID: 29719430 DOI: 10.3747/co.25.3790] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article reviews intravenous vitamin C (IV C) in cancer care and offers a rational approach to enable medical oncologists and integrative practitioners to safely provide IV C combined with oral vitamin C to patients. The use of IV C is a safe supportive intervention to decrease inflammation in the patient and to improve symptoms related to antioxidant deficiency, disease processes, and side effects of standard cancer treatments. A proposed rationale, together with relevant clinical safety considerations for the application of IV C in oncologic supportive care, is provided.
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Affiliation(s)
- E Klimant
- Salish Cancer Center, Fife, WA, U.S.A
| | - H Wright
- Naturopathic Specialists, Scottsdale, AZ, U.S.A
| | - D Rubin
- Naturopathic Specialists, Scottsdale, AZ, U.S.A
| | - D Seely
- Department of Research and Clinical Epidemiology, Ottawa Integrative Cancer Centre, Ottawa, ON
| | - M Markman
- Department of Medical Oncology, Cancer Treatment Centers of America, Philadelphia, PA, U.S.A
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35
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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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Lin PH, Sermersheim M, Li H, Lee PHU, Steinberg SM, Ma J. Zinc in Wound Healing Modulation. Nutrients 2017; 10:E16. [PMID: 29295546 PMCID: PMC5793244 DOI: 10.3390/nu10010016] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/17/2017] [Accepted: 12/21/2017] [Indexed: 02/07/2023] Open
Abstract
Wound care is a major healthcare expenditure. Treatment of burns, surgical and trauma wounds, diabetic lower limb ulcers and skin wounds is a major medical challenge with current therapies largely focused on supportive care measures. Successful wound repair requires a series of tightly coordinated steps including coagulation, inflammation, angiogenesis, new tissue formation and extracellular matrix remodelling. Zinc is an essential trace element (micronutrient) which plays important roles in human physiology. Zinc is a cofactor for many metalloenzymes required for cell membrane repair, cell proliferation, growth and immune system function. The pathological effects of zinc deficiency include the occurrence of skin lesions, growth retardation, impaired immune function and compromised would healing. Here, we discuss investigations on the cellular and molecular mechanisms of zinc in modulating the wound healing process. Knowledge gained from this body of research will help to translate these findings into future clinical management of wound healing.
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Affiliation(s)
- Pei-Hui Lin
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Matthew Sermersheim
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Haichang Li
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Peter H U Lee
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Steven M Steinberg
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Jianjie Ma
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Mahmoodpoor A, Hamishehkar H, Sanaie S, Behruzizad N, Iranpour A, Koleini E, Nader ND. Antioxidant reserve of the lungs and ventilator-associated pneumonia: A clinical trial of high dose selenium in critically ill patients. J Crit Care 2017; 44:357-362. [PMID: 29288963 DOI: 10.1016/j.jcrc.2017.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/09/2017] [Accepted: 12/22/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the effect of supplemental selenium administration on the incidence of ventilator-associated pneumonia (VAP) in critically ill patients. METHODS Ninety-nine mechanically ventilated patients were randomized to receive either selenium or isotonic saline infusion for 10days. The primary endpoint was serum glutathione peroxidase-3 (GPX-3) activity and secondary endpoints were development of VAP or death, ICU stay and vasopressor requirement. Serum concentrations of selenium and GPX-3 were measured on Day-1, Day-4 and Day-10. Chi Square and log-rank analyses were used for statistical analyses and odds ratios were calculated. RESULTS Serum selenium and GPX-3 activity levels increased steadily in the treatment group within 10days (P<0.025), while they remained unchanged in the placebo group. The incidence of VAP was 19.4/1000days of mechanical ventilation in the placebo group while it was 15.8/1000 ventilated days in the treatment group (P=0.250). The risk of VAP or death was similar between the treatments and placebo groups. CONCLUSION Despite increasing the antioxidant activity, selenium supplementation did not affect the incidence of VAP in critically ill patients. The risk of developing VAP or death within 30days of ICU admission remained the same in the treatment and the controls.
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Affiliation(s)
- Ata Mahmoodpoor
- Department of Anesthesiology, Tabriz University of Medical Sciences, Iran
| | - Hadi Hamishehkar
- Department of Clinical Pharmacy, Tabriz University of Medical Sciences, Iran
| | - Sarvin Sanaie
- Tuberculosis and lung Disease Research Center, Tabriz University of Medical Sciences, Iran
| | - Nazila Behruzizad
- Department of Anesthesiology, Tabriz University of Medical Sciences, Iran
| | - Afshin Iranpour
- Department of Anesthesiology, Al-Garhoud Hospital, Dubai, United Arab Emirates
| | - Evin Koleini
- Department of Anesthesiology, VA Western NY Healthcare System, Buffalo, NY, United States
| | - Nader D Nader
- Department of Anesthesiology, SUNY-Buffalo, Buffalo, NY, United States.
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Moreira E, Burghi G, Manzanares W. Update on metabolism and nutrition therapy in critically ill burn patients. Med Intensiva 2017; 42:306-316. [PMID: 28951113 DOI: 10.1016/j.medin.2017.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.
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Affiliation(s)
- E Moreira
- Centro de Tratamiento Intensivo del Hospital Maciel, ASSE, Montevideo, Uruguay
| | - G Burghi
- Centro Nacional de Quemados, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - W Manzanares
- Cátedra de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay.
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Broman M, Bryland A, Carlsson O. Trace elements in patients on continuous renal replacement therapy. Acta Anaesthesiol Scand 2017; 61:650-659. [PMID: 28573653 DOI: 10.1111/aas.12909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Intensive care patients with acute kidney injury (AKI), treated with continuous renal replacement therapy (CRRT) are at great risk for disturbances in plasma levels of trace elements due to the underlying illness, AKI, and dialysis. This study was performed to increase our knowledge regarding eight different trace elements during CRRT. METHODS Thirty one stable patients with AKI, treated with CRRT, were included in the study. Blood, plasma and effluent samples were taken at the start of the study and 36 ± 12 h later. A group of 48 healthy volunteers were included as controls and exposed to one fasting blood sample. Samples were analysed for trace elements (Cr, Cu, Mn, Co, Zn, Rb, Mo, Se) and standard blood chemistry. RESULTS Blood and plasma levels of selenium and rubidium were significantly reduced while the levels of chromium, cobalt, and molybdenum were significantly increased in the study group vs. healthy volunteers. There was an uptake of chromium, manganese, and zinc. Molybdenum mass balance was around zero. For selenium, copper, and rubidium there were a marked loss. CONCLUSIONS The low levels of selenium and rubidium in blood and plasma from CRRT patients, together with the loss via CRRT effluent, raises the possibility of the need for selenium supplementation in this group of patients, despite the unchanged levels during the short study period. Further investigations on the effect of additional administration of trace elements to CRRT patients would be of interest.
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Affiliation(s)
- M. Broman
- Department of Perioperative and Intensive Care; Skåne University Hospital; Lund Sweden
| | | | - O. Carlsson
- Gambro Lundia AB; Lund Sweden
- Department of Nephrology; Lund University; Lund Sweden
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Berger MM, Roussel AM. Complémentation ou supplémentation en oligo-éléments : qui, pourquoi, comment ? NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Clark A, Imran J, Madni T, Wolf SE. Nutrition and metabolism in burn patients. BURNS & TRAUMA 2017; 5:11. [PMID: 28428966 PMCID: PMC5393025 DOI: 10.1186/s41038-017-0076-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
Severe burn causes significant metabolic derangements that make nutritional support uniquely important and challenging for burned patients. Burn injury causes a persistent and prolonged hypermetabolic state and increased catabolism that results in increased muscle wasting and cachexia. Metabolic rates of burn patients can surpass twice normal, and failure to fulfill these energy requirements causes impaired wound healing, organ dysfunction, and susceptibility to infection. Adequate assessment and provision of nutritional needs is imperative to care for these patients. There is no consensus regarding the optimal timing, route, amount, and composition of nutritional support for burn patients, but most clinicians advocate for early enteral nutrition with high-carbohydrate formulas. Nutritional support must be individualized, monitored, and adjusted throughout recovery. Further investigation is needed regarding optimal nutritional support and accurate nutritional endpoints and goals.
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Affiliation(s)
- Audra Clark
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
| | - Jonathan Imran
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
| | - Tarik Madni
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
| | - Steven E Wolf
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
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Raposio E, Grieco MP, Caleffi E. Evaluation of plasma oxidative stress, with or without antioxidant supplementation, in superficial partial thickness burn patients: a pilot study. J Plast Surg Hand Surg 2017; 51:393-398. [PMID: 28152319 DOI: 10.1080/2000656x.2017.1281821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oxidative stress is one of the main causes of pathophysiological alterations observed during burn injury. The present pilot study aimed to determine whether a specific oral antioxidant supplementation could in any way influence free radical blood values in patients affected by superficial partial thickness burns. MATERIALS AND METHODS Plasma oxidants and plasma antioxidant capacity were analysed in 20 superficial partial thickness burn patients for a 2-week period; patients were randomly divided into two groups, one of which was supported with a specifically designed oral antioxidant formula (Squalene 100 mg, Vitamin C 30 mg, Coenzyme Q10 10 mg, Zinc 5 mg, Beta Carotene 3.6 mg, Bioflavonoids 30 mg, Selenium 55 mcg) administered daily, starting from the day of admission, for the whole study period. RESULTS No significant differences were found in plasma oxidants and plasma antioxidant capacity between the two groups of patients. CONCLUSIONS These results did not reflect any significant benefits of an antioxidant oral supplementation at usual dosages when considering oxidative plasmatic values of superficial partial thickness burn patients.
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Affiliation(s)
- Edoardo Raposio
- a The Plastic Surgery Clinic, Department of Surgical Sciences , University of Parma , Parma , Italy
| | - Michele P Grieco
- a The Plastic Surgery Clinic, Department of Surgical Sciences , University of Parma , Parma , Italy
| | - Edoardo Caleffi
- b The Plastic Surgery and Burns Centre , University Hospital , Parma , Italy
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Ben-Hamouda N, Charrière M, Voirol P, Berger MM. Massive copper and selenium losses cause life-threatening deficiencies during prolonged continuous renal replacement. Nutrition 2017; 34:71-75. [DOI: 10.1016/j.nut.2016.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/13/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
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Abstract
Hypermetabolism is the ubiquitous response to a severe burn injury, which was first described in the nineteenth century. Despite identification of important components of this complex response, hypermetabolism is still not well understood in its entirety. This article describes this incredibly fascinating response and the understanding we have gained over the past 100 years. Additionally, this article describes novel insights and delineates treatment options to modulate postburn hypermetabolism with the goal to improve outcomes of burn patients.
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High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care 2016; 20:356. [PMID: 27788688 PMCID: PMC5084353 DOI: 10.1186/s13054-016-1529-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Selenium (Se) is an essential trace element with antioxidant, anti-inflammatory, and immunomodulatory effects. So far, several randomized clinical trials (RCTs) have demonstrated that parenteral Se may improve clinical outcomes in intensive care unit (ICU) patients. Since publication of our previous systematic review and meta-analysis on antioxidants in the ICU, reports of several trials have been published, including the largest RCT on Se therapy. The purpose of the present systematic review was to update our previous data on intravenous (IV) Se in the critically ill. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included RCTs with parallel groups comparing parenteral Se as single or combined therapy with placebo. Potential trials were evaluated according to specific eligibility criteria, and two reviewers abstracted data from original trials in duplicate independently. Overall mortality was the primary outcome; secondary outcomes were infections, ICU length of stay (LOS), hospital LOS, ventilator days, and new renal dysfunction. Results A total of 21 RCTs met our inclusion criteria. When the data from these trials were aggregated, IV Se had no effect on mortality (risk ratio [RR] 0.98, 95 % CI 0.90–1.08, P = 0.72, heterogeneity I2 = 0 %). In addition, when the results of ten trials in which researchers reported on infections were statistically aggregated, there was no significant treatment effect of parenteral Se (RR 0.95, 95 % CI 0.88–1.02, P = 0.15, I2 = 0 %). There was no positive or negative effect of Se therapy on ICU and hospital LOS, renal function, or ventilator days. Conclusions In critically ill patients, IV Se as monotherapy does not improve clinical outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1529-5) contains supplementary material, which is available to authorized users.
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46
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Livingstone C. Review of Copper Provision in the Parenteral Nutrition of Adults. Nutr Clin Pract 2016; 32:153-165. [DOI: 10.1177/0884533616673190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Callum Livingstone
- Clinical Biochemistry Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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Adjepong M, Agbenorku P, Brown P, Oduro I. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review. BURNS & TRAUMA 2016; 4:18. [PMID: 27574687 PMCID: PMC4971700 DOI: 10.1186/s41038-016-0044-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 04/27/2016] [Indexed: 11/10/2022]
Abstract
Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations.
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Affiliation(s)
- Mary Adjepong
- Department of Biochemistry, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pius Agbenorku
- Department of Surgery, Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Patricia Brown
- Department of Biochemistry, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ibok Oduro
- Department of Biochemistry, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Effect of Human Burn Wound Exudate on Pseudomonas aeruginosa Virulence. mSphere 2016; 1:mSphere00111-15. [PMID: 27303724 PMCID: PMC4894682 DOI: 10.1128/msphere.00111-15] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/03/2016] [Indexed: 11/20/2022] Open
Abstract
Burn wound sepsis is currently the main cause of morbidity and mortality after burn trauma. Infections by notorious pathogens such as Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii impair patient recovery and can even lead to fatality. In this study, we investigated the effect of burn wound exudates (BWEs) on the virulence of those pathogens. BWEs were collected within 7 days after burn trauma from 5 burn patients. We first monitored their effect on pathogen growth. In contrast to A. baumannii and S. aureus, P. aeruginosa was the only pathogen able to grow within these human fluids. Expression of typical virulence factors such as pyocyanin and pyoverdine was even enhanced compared the levels seen with standard laboratory medium. A detailed chemical composition analysis of BWE was performed, which enabled us to determine the major components of BWE and underline the metabolic modifications induced by burn trauma. These data are essential for the development of an artificial medium mimicking the burn wound environment and the establishment of an in vitro system to analyze the initial steps of burn wound infections. IMPORTANCE Microbial infection of severe burn wounds is currently a major medical challenge. Of the infections by bacteria able to colonize such injuries, those by Pseudomonas aeruginosa are among the most severe, causing major delays in burn patient recovery or leading to fatal issues. In this study, we investigated the growth properties of several burn wound pathogens in biological fluids secreted from human burn wounds. We found that P. aeruginosa strains were able to proliferate but not those of the other pathogens tested. In addition, burn wound exudates (BWEs) stimulate the expression of virulence factors in P. aeruginosa. The chemical composition analysis of BWEs enabled us to determine the major components of these fluids. These data are essential for the development of an artificial medium mimicking the burn wound environment and for in vitro analysis of the initial step in the development of burn wound infections.
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50
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Kumar MH, Kumar MS, Kumar SH, Kumar KS. A neoteric multidrug combination: novel approach to limited cutaneous systemic scleroderma involving the face. BMJ Case Rep 2016; 2016:bcr-2015-212787. [PMID: 27033280 DOI: 10.1136/bcr-2015-212787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Limited cutaneous scleroderma is a subtype of scleroderma limited to the skin of the face, hands, feet and forearms. We present a case of a 45-year-old woman affected by limited cutaneous systemic scleroderma involving the orofacial region and causing restricted mouth opening. The patient showed noteworthy improvement of the skin lesion by use of a combination of intralesional corticosteroid with hyaluronidase and various multiantioxidants, resulting in amelioration of her mouth opening problem. The patient gave her full informed written consent to this report being published.
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Affiliation(s)
- M Hari Kumar
- Dental Department, Jeba Dental Clinic, Nagercoil, Tamilnadu, India
| | - M Siva Kumar
- Department of Maxillo Facial, Doctor Kamalkanadasan Dental Clinic, Chennai, Tamilnadu, India
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