Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Protein malnutrition occurs in 41%-42% of peritoneal dialysis (PD) patients, indicating that the current intake of protein is inadequate in many patients. With an intake of protein > or = 1 g/kg/day, most continuous ambulatory peritoneal dialysis (CAPD) patients are in positive or neutral nitrogen balance, while with an intake below this there is considerable risk of negative nitrogen balance. Most CAPD patients are prescribed a diet containing 1.2 g/kg/ day protein or higher, yet the majority of patients have an intake lower than this. Several factors are associated with inadequate protein intake including older age, comorbidity, and loss of residual renal function when the dialysis regimen is inadequate. A minimum weekly Kt/V of 2.0 is needed to achieve a protein intake of 0.9-1.0 g/kg/day. Patients with peritonitis and a permeable membrane have increased losses of protein via the dialysate, and so are at risk for protein malnutrition. To prevent and treat protein malnutrition, routine assessment of both nutritional status and dialysis adequacy are needed. Patients with an adequate clearance (weekly Kt/V of 2.0 or higher, creatinine clearance of 60 L/week/1.73 m2), who are eating 1 g/kg/day and have no markers of malnutrition, including a normal serum albumin, require no intervention. Protein supplements can be prescribed to increase the protein ingestion to 1.2 g/kg/day or more, if the serum albumin is low, or if the patient is clinically malnourished with weight loss and decreased muscle mass. Gastro-paresis and esophagitis, common in PD patients, can be treated. If supplements, dietary counseling, and adequate dialysis regimen do not result in improvement of nutritional status, amino acid dialysate may be beneficial. One to two exchanges per day using amino acid dialysate converts the nitrogen balance from neutral to positive in malnourished CAPD patients. To use amino acid dialysate successfully, the physician must be sure that the clearance is adequate as the serum urea nitrogen rises; inadequate dialysis can result in uremia and decreased intake.
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PMID:Recommendations for dietary protein intake in CAPD patients. 886 18

Prognosis of 21 patients with multiple system atrophy (MSA) who deceased or received tracheostomy is described. The percentage of patients with MSA among the cases of spinocerebellar degeneration was 40% in National Tokyo Hospital. There were 12 women and 9 men, and the mean age at onset was 56 years. Seventy-four percent of MSA patients was olivopontocerebellar atrophy (OPCA), 22% was striatonigral degeneration (SND). The mean age of 17 deceased patients (10 women, and 7 men) was 65.5 years. Ten patients did not undergo tracheostomy and deceased, and 11 patients underwent tracheostomy, among whom 4 patients are still alive. Mean duration of illness from onset to death (without tracheostomy) or tracheostomy was 6.8 years. Cause of death of patients who did not undergo tracheostomy was related to paresis of the larynx or pharynx, for example, aspiration pneumonia due to dysphagia, vocal cord paralysis and sudden death. Some of those who underwent tracheostomy deceased for causes which were not directly related to MSA such as cerebral hemorrhage or uremia, but others seem to be related to some problems of respiratory center such as central chronic respiratory failure, or sudden death (sometimes it happened after infection, but the obstruction of the respiratory tract was not always present at autopsy).
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PMID:[Prognosis of multiple system atrophy--survival time with or without tracheostomy]. 1042 39