1,270 research outputs found
Terapêutica nutricional no doente crítico: nutrição parentérica: avaliação e protocolo de actuação
Trabalho realizado no contexto do estágio de Cuidados Intensivos do Internato Médico Complementar, sob orientação de Alfredo LeiteA nutrição do doente hospitalizado exige, por parte da equipa de cuidados de
saúde, uma avaliação e prescrição como qualquer outra terapêutica. O suporte
nutricional instituído deverá proporcionar, para cada situação clínica, uma combinação
adequada de nutrientes, de modo a evitar ou compensar as alterações metabólicas
secundárias ao estado patológico.
A situação clínica, as necessidades energéticas e a via de administração
disponível, atendendo essencialmente à capacidade de utilização do tubo digestivo,
são alguns dos aspectos a ter em consideração na altura de escolher o tipo de suporte
nutricional a instituir.
No doente critico, está demonstrado que o suporte nutricional influencia o
prognóstico. Nesta população a nutrição por via oral, encontra-se frequentemente
comprometida, habitualmente de uma forma transitória. O estado critico tende
igualmente a acompanhar-se de anorexia, o que torna esta população especialmente
vulnerável ao desenvolvimento de défices nutricionais graves com repercussão na
composição tecidular e na função de órgãos vitais. Por este motivo a nutrição artificial
constitui uma área importante na terapêutica do doente crítico.
A nutrição artificial apresenta dois grandes pilares, a nutrição entérica e a
nutrição parentérica.
A nutrição parentérica (NP) consiste, na administração simultânea ou exclusiva
por via intravenosa de macro (proteínas, hidratos de carbono e lípidos) e
micronutrientes (oligoelementos e vitaminas), podendo ser administrada por via
periférica ou central, de acordo com os objectos e a preparação escolhida.
As necessidades nutricionais variam consoante a população, o estado
nutricional basal e o nível de stress fisiológico, exigindo que se proceda à prescrição de
NP de uma forma individualizada, com monitorização frequente. Actualmente existem
a nível da indústria farmacêutica, várias formulações de composições variadas que
garantem um aporte nutricional equilibrado de macronutrientes para adultos, algumas
já suplementadas com electrólitos. A administração de fluídos e electrólitos deve contudo ser ajustada de acordo
com a situação clínica, fazendo parte integrante do suporte nutricional a sua
monitorização e correcção diárias, com o objectivo de manutenção da homeostasia.
Diversas guidelines internacionais recomendam a aditivação diária e sistemática
das misturas de macronutrientes e electrólitos com oligoelementos (micronutrientes
inorgânicos essenciais) e vitaminas (micronutrientes orgânicos essenciais)
Primary Total Elbow Arthroplasty in the Treatment of Complex Elbow Fracture: A Case Report
Introduction: Some elbow fractures are very complex with
inadequate bone stock, so it is not possible to perform a stable
fixation. However, loss of basic elbow function can severely affect
daily living activities. There are few alternatives to internal fixation,
but arthroplasty can be a reasonable option. The aim of this case
report is to evaluate the role of primary total elbow arthroplasty in
the treatment of complex elbow fractures.
Case study: A 54-year-old male patient presented at our emergency
department in the sequence of a motorcycle accident, which caused
an open fracture of the left elbow, classified as type IIIB of Gustilo
and Anderson. The X-ray showed comminuted fractures of distal
humerus and proximal ulna with bone loss from both epiphysis.
He started antibiotherapy and was submitted to immediate surgical
debridement, provisional fixation with an external fixator and skin
closure. The external fixator was removed 2 months after, when
the patient presented with great elbow instability. The X-ray and
the Computed Tomography showed signals of malunion and bone
loss, which prevented any kind of fixation. Therefore, 3 months
after, the patient was submitted to elbow joint replacement. A
posterior approach was used, in which the triceps was reflected
and was applied a linked arthroplasty - Coonrad-Morrey total elbow
arthroplasty. On the second week after surgery, passive motion
was started and by the fourth week, progressed to active motion.
Six months after, he presented without significant pain and with a
range of motion of 0° to 135º.
Conclusions: Although rarely used, total elbow arthroplasty may
be the choice in selected patients with elbow fractures with loss of
bone. As shown in this case, this treatment can lead to a satisfactory
functional recovery. Despite having some complications, more
recent studies encourage its use in the future
Dermatological remedies in the traditional pharmacopoeia of Vulture-Alto Bradano, inland southern Italy
Dermatological remedies make up at least one-third of the traditional pharmacopoeia in southern Italy. The identification of folk remedies for the skin is important both for the preservation of traditional medical knowledge and in the search for novel antimicrobial agents in the treatment of skin and soft tissue infection (SSTI). Our goal is to document traditional remedies from botanical, animal, mineral and industrial sources for the topical treatment of skin ailments. In addition to SSTI remedies for humans, we also discuss certain ethnoveterinary applications.
Field research was conducted in ten communities in the Vulture-Alto Bradano area of the Basilicata province, southern Italy. We randomly sampled 112 interviewees, stratified by age and gender. After obtaining prior informed consent, we collected data through semi-structured interviews, participant-observation, and small focus groups techniques. Voucher specimens of all cited botanic species were deposited at FTG and HLUC herbaria located in the US and Italy.
We report the preparation and topical application of 116 remedies derived from 38 plant species. Remedies are used to treat laceration, burn wound, wart, inflammation, rash, dental abscess, furuncle, dermatitis, and other conditions. The pharmacopoeia also includes 49 animal remedies derived from sources such as pigs, slugs, and humans. Ethnoveterinary medicine, which incorporates both animal and plant derived remedies, is addressed. We also examine the recent decline in knowledge regarding the dermatological pharmacopoeia.
The traditional dermatological pharmacopoeia of Vulture-Alto Bradano is based on a dynamic folk medical construct of natural and spiritual illness and healing. Remedies are used to treat more than 45 skin and soft tissue conditions of both humans and animals. Of the total 165 remedies reported, 110 have never before been published in the mainland southern Italian ethnomedical literature
A prática do fonoaudiólogo nos Núcleos de Apoio à Saúde da Família em municípios paraibanos
- …