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Parenteral nutrition refers to nutritional support provided by an intravenous route. Access may be a peripheral vein or central vein. Peripheral venous access is usually used for short term support and limits the volume of fluids and nutrients that can be delivered. Whenever possible, enteral nutrition is preferred in order to provide nutrients to the gut and maintain the intestinal barrier.Indications for Parenteral NutritionParenteral nutrition is used in cases of gut failure or severe gastrointestinal disease. Catheter-related sepsis is a significant risk in immunocompromised patients. In HIV/AIDS, TPN will induce weight gain, the composition of which depends on the underlying etiology of the malnutrition. Septic patients tend to gain primarily fat whereas those with malabsorption or inadequate dietary intake gain more body cell mass. It is possible that this modality may not be widely available throughout the Region. However, it is an option that should be pursued when necessary.Components of Parenteral NutritionThe solution for parenteral nutrition consists of nutrients in their simple form,namely dextrose, amino acids, lipids and micronutrients. Dextrose is the monosaccharide that provides the major source of non-protein energy. Each gram of dextrose in parenteral solution provides 3. 4 kilocalories or 14. 2 kilojoules. Carbohydrate should be provided in adequate amounts to spare protein, but not in excess as this may cause hyperglycemia, fatty liver or other complications. The recommended rate of dextrose infusion should not exceed 4 to 5 mg/kg/minute. Amino acids provide protein to maintain nitrogen balance and prevent degradation of somatic proteins. Protein requirements are calculated based on clinical condition and goals of treatment. Amino acid solutions provide 4 kilocalories per gram or 18. 1 kilojoules per gram. Parenteral lipid emulsions provide a concentrated source of energy and essential fatty acids. They may be used in conjunction with carbohydrate and amino acid solutions or alone for caloric enhancement. The energy content of lipid emulsions depends on the formulation. ten percent yields 1. 1 kilocalorie per mL; 20% yields 2. 0 kilocalories per mL; 30% yields 3. 0 kilocalories per mL. There is some evidence that parenteral lipids may have a negative effect on immunity. In patients with HIV infection lipids should not exceed 30% of total energy intake or 1 g/kg/day. Hyperlipidemia may also develop if lipids are not cleared. Thus serum lipids should be monitored at baseline and regular intervals thereafter. Micronutrients and electrolytes are provided as standardized components of parenteral solutions. These may be modified according to the needs of the patient.Anabolic TherapyNutrition support will usually result in weight gain, but for some PLWHA, classified as non-responders, there is evidence of an anabolic block, whereby the regained weight is composed of a disproportionately high amount of body fat with limited accretion of lean tissue. This phenomenon can be identified with body composition analysis. Thus,although re-feeding is always necessary, it is not always sufficient for some individuals. In cases where lean tissue gains are insufficient, an anabolic agent may be required such as testosterone replacement. Other anabolic therapies that have shown favorable results include Oxandrin, Decadurabolan, and Recombinant Growth Hormone.Palliative CareWhen AIDS patients become terminally ill and medical care becomes mainly palliative,not curative, the nutrition care plan should reflect the overall goals of care. Nutritional therapy is directed to alleviating symptoms and providing comfort. Nutrition support should be considered to improve quality of life if the patient, caregivers and medical team agree to this intervention.Common Dietary ProblemsDuring the course of treatment and care, many dietary problems can arise. Strategies to help alleviate common problems are addressed inPregnancy, Lactation and HIVPregnancy, lactation, and HIV disease engender physiologic stress, with increased nutritional needs for energy, protein and micronutrients. It is well recognized that the nutritional health of a pregnant woman influences pregnancy outcome. Nutritionalstatus has even greater implications for the HIV-infected woman who is at higher risk of premature delivery and having a low birth weight infant.Low birth weight infants have an increased incidence of infant mortality as well as medical and developmental complications. Other risk factors, such as pregnancy during adolescence, substance use, opportunistic infection, low pre-pregnancy weight and inadequate gestational weight gain impose further risks of a poor pregnancy outcome. Moreover, vitamin A deficiency has been associated with poor pregnancy outcome and increased risk of perinatal HIV transmission. Pregnant HIV-positive women should be referred early in pregnancy to a dietitian or other suitable health care professional for counselling to optimize nutritional status and improve pregnancy outcome. It is essential to assess complementary therapy use, as mega-doses of vitamins and some herbal preparations are contraindicated in pregnancy.Weight Gain in PregnancyRecommended weight gain based on pre-pregnancy weight:Underweight (BMI 25):Nutritional Requirements12. 5-18. 0 kg11. 5-16. 0 kg7. 0-11. 5 kgAccording to the Recommended Dietary Allowances for use in the Caribbean, the following requirements for pregnancy/lactation are in addition to the requirements for HIV+ women:4? Additional 285 kilocalories per day to support fetal growth and developmentAdditional 6 grams protein per dayPrenatal multivitamin-mineral daily (to include at least 0. 4 mg folic acid)Other micronutrient supplements as needed (e. g. iron, calcium)Lactation: additional 500 kcal per day and 11 grams of protein Vitamin A:Maternal vitamin A deficiency is associated with increased risk of vertical HIV transmission to the infant. However, there is little evidence that vitamin A supplementation of the pregnant woman reduces the risk of HIV infection to the infant. Moreover, high doses of vitamin A can be teratogenic. Should supplementation be necessary, the following WHO guidelines can be used.Iron deficiency anemia is highly prevalent in pregnant women throughout the world. Anemia is associated with increased risk of maternal and fetal morbidity and mortality, as well as intrauterine growth failure. Iron status should be assessed and deficiency should be treated. WHO recommend that women receive 60 mg iron during 6 months of pregnancy and 120 mg per day to treat severe anaemia.Folate deficiency:Folate deficiency causes megaloblastic anemia and is associated with risk of neural tube defects in the infant (e. g. spina bifida). WHO recommends 0. 4 mg folate supplement daily.

Today, more and more people seem to be talking about psychology, therapy and mental health.This year the media has been extra generous in its portrayal of mental health issues. We’ve had multiple soap opera plot lines and docudramas detailing the life of the rich and bipolar as well as a vast array of celebrity ‘meltdowns’. The lay man is enjoying an informed tour of mental health issues, from the comfort of his front room. Or is he?Everyone can experience mental ill health- from the famed, to the less than famed; and if it’s on the TV it must be ok. As the adverts would have us believe, that elephant in the room has been well and truly exposed, with famous faces around the world admitting to a mental health issue or confessing to using medication for said difficulty.With all this in hand, one might guess that a girl about town of today’s world would be more comfortable than ever before in sharing her own challenges. After all, Ms Wax does it, and makes many thousands at the West End doing so. So what does the research say on this?As you reflect on these changes in media coverage over the last 18 months, you may find yourself not so pleasantly surprised to learn that according to research from campaigners at platform 51; A 3rd of women take anti-depressants in their life. Of those, a quarter take them for 10 years or more. And most worrying, 18% keep it a secret from their families. 1 in ten wouldn’t even tell a partner.Alternatively, I noticed that niche holistic approaches to mental health were increasing viewed as more acceptable. Twining’s are even using the wellbeing concept as a marketing tool- to sell teabags! *After all it does seem more du jour to see an executive coach as opposed to a psychologist. And once you’re in in the healthcare system, it’s more acceptable to have a psychologist, than a psychiatrist. What is the perceived difference in this varying terminology, and why do treatments involving medications still have this stigma attached despite being so routinely prescribed?Why is it that young women are reluctant to discuss the use of such medication for mental health difficulties? After all, sales of anti-depressants went up 45% over the last 4 years. That’s 23 million prescriptions for anti-depressants a year.Today’s culture is increasingly driven by ambition and achievement; admitting to feeling low, stressed or anxious is just not a desirable option. One might be forgiven for concluding that it is socially acceptable for a celebrity to have a public breakdown or an overdose; But for the average woman of the world, to admit your finding life a bit stressful or god forbid admit that you just aren’t coping-is just too much social pressure to bear.A recent survey polled by the depression alliance suggests that women often report feeling ashamed to discuss mental health concerns with friends and family for fear of being judged, misunderstood or Labelled. It has been reported that young people in today’s achievement oriented society can often feel a sense of failure, upon receiving anti-depressants; almost a last resort scenario when one cannot think of another way. And sometimes it is. But a last resort is still a choice and that in turn requires that one exercise initiative also.People don’t like to appear weak or inadequate. Seeking help and admitting that they are not feeling good can often be a real struggle as it interferes with one of our deepest fears – of taking up residence in… The out group! Accompanying this fear, is the common misconception that once you’ve moved into the ‘out group’, and experienced a mental health difficulty, you will have it/live there forever. This is a massive misconception that many mental health organisations have been campaigning to change.Over the last ten years, I have been involved in a community project With Leading Mental Health Organisation Mind, and their talking therapies programme. We explore and promote the idea of mental wellbeing as belonging on a continuum. Where one might find themselves high or low or anywhere in-between. We have peaks and troughs, and the key here is-this is normal!Our places on this scale can move up and down and round and round as often as you change your socks. After bereavement you may find yourself at a low ebb, near the lower end. Will you live there, at the lower end of wellbeing forever? No. probably not!You may experience a great achievement and find yourself glowing at the highest heights- elated even. Will you be in a state of elation forever- probably not? The same concept applies to mental health issues. Diagnosis or no diagnosis.Despite all the support and campaigning from organisations like MIND, RETHINK and TIME TO CHANGE It is surprisingly hard to be open about these things. Mental health disclosure takes on a more serious consequence when one explores the workplace: Medical records, insurance and selection criteria. But that kettle can wait for another day.While some research suggests that women may hide their use of antidepressants in an effort to maintain positive self-concept and appearance both to themselves and to others. It is this very seeking of help that is an adaptive and indeed resilient behaviour. A courage which can only denote a strength of character present in one who is unwilling to settle for feeling less great- then they know they can feel, and deserve to feel.So, let’s each consider our own beliefs around mental health issues and the social stigma surrounding it! Mental health in our own personal real lives, the lives of our clients, the lives of our nearest and dearest and the lives of celebrities and those portrayed in the media – where is the heart of this stigma lying? Are collective attitudes towards ill mental health changing in line with their media presentation? – I’m not so sure, but every little helps right!I recently watched an old black and white movie in which the leading lady flashed a little ankle and promptly pecked her dashing date on the cheek. A total shocker! She ran away bashful and shy with all those who saw tutting at her promiscuous and socially unkempt dallying.Our attitudes and acceptance of new ways of behaving do and have changed with the passing of time. What was once a Rare, Risque1920′s ankle flash has now become a plethora of raunchy music videos.I think there may be hope for the subject of Ill Mental health yet.