Current opinion in gastroenterology
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Curr. Opin. Gastroenterol. · Mar 2010
ReviewNear-normal glycemia for critically ill patients receiving nutrition support: fact or folly.
In critically ill patients, nutrition support may be a life-saving intervention, but is not without risk. Adverse metabolic changes, including hypertriglyceridemia and hyperglycemia, are common. Hyperglycemia is associated with adverse outcomes, in particular, infection. Four major studies have addressed whether near-normal glycemia (80-110 mg/dl) in this clinical setting improves outcomes compared with blood sugars of approximately 150 mg/dl. The purpose of this review is to determine whether tight glycemic control is superior to moderate glycemic control (150 mg/dl) in critically ill patients receiving nutrition support. ⋯ Glycemic control to approximately 150 mg/dl is not inferior to near-normal glycemia in critically ill patients requiring nutrition support and is clearly safer. Lipid changes caused by insulin infusion may improve outcomes more than glycemic control itself, and prevention of hypertriglyceridemia should be a major focus of clinical care.
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To discuss new colorectal cancer screening tests and highlight controversies regarding colon screening and surveillance. ⋯ Colorectal cancer screening can reduce both incidence and mortality of colorectal cancer if performed with high quality. New work should focus on improving the quality of all screening programs.
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Rotaviruses cause life-threatening gastroenteritis in children throughout the world. The burden of disease has resulted in the development of two live, attenuated vaccines that are now licensed in many countries. This review summarizes new data on these vaccines, their effectiveness, and remaining challenges including new data on the rotavirus enterotoxin, a potential antiviral target. ⋯ Rotavirus is now a commonly occurring vaccine-preventable disease among children in developed countries and hopefully this also will soon be true for developing countries. Future studies will determine whether other methods of prevention, such as nonreplicating vaccines and antiviral drugs, will be needed to treat disease in immunocompromised children.
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Curr. Opin. Gastroenterol. · Mar 2008
ReviewGlutamine: role in critical illness and ongoing clinical trials.
This review will assess recent clinical and mechanistic data examining glutamine's ability to reduce morbidity and mortality in critical illness. ⋯ Severe glutamine deficiencies occur rapidly in critical illness. The magnitude of glutamine deficiency is correlated with ICU mortality. Further, metaanalysis reveals glutamine reduces morbidity and mortality in critical illness. It is likely that our new understanding of the molecular pathways by which glutamine acts will lead to insight on how best to utilize glutamine as a nutritional therapy. Presently, randomized, multicenter clinical trials utilizing glutamine as both nutritional replacement and pharmacologic intervention, independent of nutritional needs, are ongoing.
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This paper highlights recent studies of interest and provides rationale for why deficiencies with the current scientific paradigm of immunonutrition has produced studies with conflicting results, and why it should be replaced with a new paradigm termed 'pharmaconutrition'. ⋯ This review provides insights into why the current paradigm of immunonutrition has failed to consistently demonstrate a beneficial effect of key immunomodulating nutrients, and offers a timely solution through the new paradigm of pharmaconutrition.