Nutritional therapeutic for the critically ill patients

Nutritional Therapeutic has a great impact on the treatment of the critically ill patient. Its choice and conduct, however, has been a matter of doubt and frequent errors. The choice of nutritional therapeutic and its route of administration must consider if the gastrointestinal tract is available. The enteral route will be used if the gastrointestinal tract is available. If it isn’t; like short bowel syndrome, or gastrointestinal haemorrhage, parenteral nutrition is indicated.This review has the objective of answer the most frequent questions and conduct the nutritional therapeutic in critically ill patients.  A Terapia Nutricional tem tido grande impacto na evolução do paciente grave. Sua escolha e manuseio, no entanto, têm sido alvo de dúvidas e erros freqüentes, principalmente no paciente crítico. A escolha da terapia nutricional a ser realizada, bem como sua via de administração deve levar em conta o quadro clínico e as condições gerais do paciente. A via oral/enteral de oferta de nutrientes, mais fisiológica, é a preferível. Portanto, sempre que possível, deve-se utilizar o trato gastrointestinal. Quando este não puder ser utilizado, a via parenteral está indicada, tanto no sentido de suplementar a nutrição enteral, como quando esta não consegue suprir toda a demanda de nutrientes, de que o paciente necessita. Esta revisão tem por objetivo apresentar e difundir a condução da terapia nutricional no paciente crítico, de forma prática e adequada. De maneira geral, a oferta calórica deverá atender às necessidades basais do paciente e a protéica fornecer material plástico para síntese protéica. Minerais, vitaminas e água deverão ser ajustados às necessidades e ao quadro clínico do paciente em questão

Engolo and Capoeira. From Ethnic to Diasporic Combat Games in the Southern Atlantic

This article provides a re-examination of the main Afrocentric narrative of capoeira origins, the engolo or ‘Zebra Dance’, in light of historical primary sources and new ethnographic evidence gathered during fieldwork in south-west Angola. By examining engolo’s bodily techniques, its socio-historical context and cultural meanings, the piece emphasises its insertion into a pastoral lifestyle and highlights the relatively narrow ethnic character of the practice in Angola. This analysis and the comparison with capoeira helps us to develop certain hypotheses about the formation, migration, and re-invention of diasporic combat games between southern Angola and coastal Brazil, and more broadly, to increase our understanding of how African cultures spread across the southern Atlantic

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Intoxicação experimental por monofluoroacetato de sódio em bovinos: aspectos clínicos e patológicos

Monofluoracetato de sódio (MF) foi identificado, por cromatografia, em três das doze plantas que causam morte súbita em bovinos no Brasil, incluindo Palicourea marcgravii, a mais importante desse grupo. Uma lesão considerada típica por alguns autores para intoxicação foi¹ a degeneração hidrópico-vacuolar dos túbulos uriníferos contorcidos distais (DHV). O objetivo deste trabalho foi verificar se a ingestão de MF induz sinais clínicos e lesões similares às observadas nos bovinos intoxicados pelas plantas que causam morte súbita. Seis vacas receberam, por via oral, 0,5 e 1,0mg/kg de MF diluídos em 50mL de água destilada. Clinicamente, os animais apresentaram taquicardia, jugular repleta com pulso venoso positivo, respiração abdominal, ligeira perda de equilíbrio, por vezes cambaleavam, deitavam e apoiavam a cabeça no flanco. Na fase final (agônica), todos os animais caíam em decúbito lateral, esticavam os membros, faziam movimentos de pedalagem, apresentavam opistótono, nistagmo, mugidos e a morte ocorria em 2-14 minutos. À necropsia verificaram-se aurículas, jugulares, ázigos e pulmonares moderadamente ingurgitadas. Observaram-se ainda leve a moderado edema da subserosa nos locais de fixação da vesícula biliar no fígado, além de leve edema entre o duodeno e o pâncreas. O exame histopatológico revelou, em todos os animais, desde leve a acentuada DHV das células epiteliais dos túbulos uriníferos contorcidos distais associada à cariopicnose. Com relação à ultraestrutura, observou-se vacuolização do citoplasma devido ao acúmulo de água. Vacuolização e necrose de coagulação individual ou de grupos de hepatócitos e leve congestão hepática secundários à estase venosa também foram observados. DHV tem sido observada em casos de envenenamento por outras substâncias, porém nestes não está restrita aos túbulos distais e não se observa cariopicnose. Este estudo demonstra que a DHV dos túbulos renais de bovinos pode ser causada pelo envenenamento por MF e, por analogia, essa substância deve ser considerada como um dos fatores importantes, senão o mais significativo, implicado na morte dos animais que ingerem plantas que causam morte súbita no Brasil. Isso indica que estudos, que envolvam metabolização de MF por bactérias ruminais, teriam grande aplicabilidade econômica, uma vez que pelo menos 500.000 bovinos morrem anualmente intoxicados por plantas do grupo das que causam morte súbita no Brasil.Sodium monofluoroacetate (MF) was identified, by cromatography, in three of the 12 plants that cause sudden death in cattle in Brazil, including Palicourea marcgravii, the most important plant of this group. A special kind of hydropic-vacuolar degeneration (HVD) of the distal convoluted uriniferous tubules was considered typical for the poisoning by some authors. The objective of this study was to verify if the ingestion of MF causes similar clinical signs and lesion in cattle poisoned by plants that cause sudden death. Six cows received orally 0.5 and 1.0mg/kg of M diluted in 50mL of distilled water. Clinically the animals presented tachycardia, engorgement and positive pulse of the jugular vein, abdominal breathing, swaying gait, subtle unbalance, and recumbency with head placed the on the flank. In the agonal phase all the animals in lateral recumbence presented muscular fasciculation, tonic contraction, peddling movements, opisthotonus, nystagmus, and died between 2 and 14 minutes. At postmortem examination, the heart auricles, jugular and pulmonary veins were moderately distended and engorged with blood. Slight to moderate edema of the subserosa was seen around the gall bladder and the duodenum near to the pancreas. At light microscopy, HVD associated with nuclear picnosis of the epithelial cells of the distal convoluted uriniferous tubules was present in all animals. Ultrastructurally, the cell lesion represents formation of cytosolic vacuoles, likely due to accumulation of water. Coagulation necrosis of individual or groups of hepatocytes and slight hepatic congestion secondary to the venous stasis were also observed. Hydropic-vacuolar degeneration has been observed in cases of poisoning by many substances, which cause acute tubular nephrosis, however not restricted to the distal renal tubules and without nuclear picnosis. This study demonstrates that the HVD in the kidney can be caused by MF and, in analogy, the compound should be considered responsible for the death of cattle that ingest toxic plants which cause sudden death in Brazil. Our results can be supportive to studies that will focus on the degradation of MF by rumen bacteria, what might have economic implications, as at least 500.000 cattle die annually by sudden death causing toxic plants in Brazil

Effects of Immunization with Recombinant <i>Schistosoma mansoni</i> Enzymes AK and HGPRT: Murine Infection Control

Schistosomiasis is one of the most important human helminthiases worldwide. Praziquantel is the current treatment, and no vaccine is available until the present. Thus, the presented study aimed to evaluate the immunization effects with recombinant Schistosoma mansoni enzymes: Adenosine Kinase (AK) and Hypoxanthine-Guanine Phosphoribosyltransferase (HGPRT), as well as a MIX of the two enzymes. Female Balb/c mice were immunized in three doses, and 15 days after the last immunization, animals were infected with S. mansoni. Our results showed that the group MIX presented a reduction in the eggs in feces by 30.74% and 29%, respectively, in the adult worms. The groups AK, HGPRT and MIX could produce IgG1 antibodies, and the groups AK and MIX produced IgE antibodies anti-enzymes and anti-S. mansoni total proteins. The groups AK, HGPRT and MIX induced a reduction in the eosinophils in the peritoneal cavity. Besides, the group AK showed a decrease in the number of hepatic granulomas (41.81%) and the eggs present in the liver (42.30%). Therefore, it suggests that immunization with these enzymes can contribute to schistosomiasis control, as well as help to modulate experimental infection inducing a reduction of physiopathology in the disease

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022

Contribuições da Sociologia na América Latina à imaginação sociológica: análise, crítica e compromisso social Sociology's contribution in Latin America to sociological imagination: analysis, critique, and social commitment

O artigo aborda o papel desempenhado pela Sociologia na análise dos processos de transformação das sociedades latino-americanas, no acompanhamento do processo de construção do Estado e da Nação, na problematização das questões sociais na América Latina. São analisados seis períodos na Sociologia na América Latina e no Caribe: I) a herança intelectual da Sociologia ; II) a sociologia da cátedra; III) O período da "Sociologia Científica" e a configuração da "Sociologia Crítica"; IV) a crise institucional, a consolidação da "Sociologia Crítica" e a diversificação da sociologia; V) a sociologia do autoritarismo, da democracia e da exclusão; VI) a consolidação institucional e a mundialização da sociologia da América Latina (desde o ano de 2000), podendo-se afirmar que os traços distintivos do saber sociológico no continente foram: o internacionalismo, o hibridismo, a abordagem crítica dos processos e conflitos das sociedades latino-americanas e o compromisso social do sociólogo.<br>The article focuses on the role played by Sociology in the analysis of processes of change in Latin American societies, in the process of construction of Nation and State, in the debate of social issues in Latin America and the Caribbean. Six periods in Sociology in Latin America and the Caribbean are examined: I) sociology's intellectual legacy; II) sociology as a cathedra; III) the period of "Scientific Sociology"; IV) the institutional crisis, the consolidation of "Critical Sociology", and the diversifying of sociology; V) sociology of authoritarianism, democracy and exclusion; VI) institutional consolidation and globalization of Latin American sociology (since 2000). It may be said that the distinctive features of sociological knowledge in the continent were: internationalism, hybridism, the critical approach to processes and conflicts of Latin American societies, and the sociologist social commitment