Correlação entre a Clearance da Creatinina Estimada e a Taxa de Filtração Glomerular Estimada nos Doentes Muito Idosos e Erros de Prescrição dos Antibióticos: Um Estudo de Coorte

Introduction: Determination of renal function is particularly important when prescribing antibiotics to elderly patients. This study aims to determine the correlation between estimated creatinine clearance and the estimated glomerular filtration rate, for a hospitalized population of very elderly patients, and to audit antibiotic prescribing errors. Material and methods: Retrospective cohort study of all patients ≥ 80 years hospitalized with antibiotic. Creatinine clearance was calculated using Cockcroft-Gault equation and estimated glomerular filtration rate by Modification of Diet in Renal Disease Study and Chronic Kidney Disease Epidemiology Collaboration equations. Dosing errors were determined through adjustment of daily define dose to renal function. Results: The study included 589 patients. The correlation of Cockcroft-Gault with Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration was r = 0.98 and 0.96 for the minimum serum creatinine, and 0.97 and 0.93 for the maximum serum creatinine. Based on Cockcroft-Gault, there were errors in the daily defined dose in 45% in the minimum serum creatinine, and 52% in the maximum serum creatinine day. There was a discrepancy in the recording of errors of 14% to 16% when Cockcroft-Gault was compared with Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration. Discussion: There was a good correlation of Cockcroft-Gault with the estimated glomerular filtration rate by Modification of Diet in Renal Disease or Chronic Kidney Disease Epidemiology Collaboration. Regardless of the equation used to estimate renal function there was a high rate of antibiotic dosing errors documented in this population. Conclusion: This study supports the maintenance of the Cockcroft-Gault equation for drug dosing in the very elderly population. Further studies are needed to investigate underlying causes of prescribing errors.Introdução: A determinação da função renal é particularmente importante na prescrição de antibióticos em doentes idosos. O objetivo deste estudo é correlacionar a clearance de creatinina com a taxa de filtração glomerular estimada, numa população hospitalizada de doentes muito idosos, e auditar os erros de prescrição antibiótica. Material e Métodos: Coorte retrospetivo de todos os doentes ≥ 80 anos hospitalizados com antibioterapia prescrita. A clearance de creatinina foi calculada através da equação Cockcroft-Gault, e a filtração glomerular estimada através das equações Modification of Diet in Renal Disease e Chronic Kidney Disease Epidemiology Collaboration. Os erros de prescrição foram determinados pelo ajuste da dose diária definida à função renal. Resultados: Foram incluídos 589 doentes. A correlação da Cockcroft-Gault com Modification of Diet in Renal Disease e Chronic Kidney Disease Epidemiology Collaboration foi r = 0,98 e 0,96 para a creatinina sérica mínima, e 0,97 e 0,93 para a creatinina sérica máxima. Com base na Cockcroft-Gault, a taxa de erro na dose diária definida foi 45% no dia da creatinina sérica mínima e 52% no dia da creatinina sérica máxima. Quando a Cockcroft-Gault foi comparada com a Modification of Diet in Renal Disease e a Chronic Kidney Disease Epidemiology Collaboration houve uma discrepância no registo de erros de 14% a 16%, respetivamente. Discussão: Verificou-se uma boa correlação entre a Cockcroft-Gault e as equações que calculam a filtração glomerular: Modification of Diet in Renal Disease ou Chronic Kidney Disease Epidemiology Collaboration. Independentemente da equação utilizada para estimar a função renal, foi documentada uma taxa elevada de erros na dose de antibióticos prescrita nesta população. Conclusão: Este estudo reforça a manutenção do uso da equação de Cockcroft-Gault para calcular a dose adequada de antibióticos na população muito idosa. Mais estudos são necessários para investigar as causas subjacentes aos erros de prescrição.info:eu-repo/semantics/publishedVersio

Mitigation of Ochratoxin A in the food chain, from prevention to remediation

Mycotoxins are metabolites produced by a few filamentous fungi, that are ubiquitous in Nature, being found in many food crops. Their toxicity to humans demands a very strict control under a properly designed food safety program. Also, food losses due to fungal deterioration raise food security concerns. Mitigation actions to avoid or reduce human exposure to mycotoxins start in the field, where most mycotoxin producing fungi are active and mycotoxin accumulation starts. These actions include strategies to prevent mycotoxin-producing fungi from proliferating in the food or feed, to prevent these same fungi to produce the toxins, and to either remove, segregate or degrade the mycotoxins that have been produced. Using the case of ochratoxin A in our food, different strategies to mitigate contamination, from the screening of mycotoxigenic strains, integrated in a preventive approach, to the use of enzymes, as a remediation approach, will be discussed in this presentation. The screening of mycotoxin-producing strains will be discussed based on a microbiome approach, where the producing fungi may be spotted without their isolation, while the use of enzymes will be discussed along with a molecular modelling approach to elucidate enzymatic activity. The authors are grateful for the PhD support grants from the Portuguese Foundation for Science and Technology (FCT): 2020.05849.BD. (Teresa Vale Dias) and UI/BD/152286/2021 (Joana Santos).The authors are grateful for the PhD support grants from the Portuguese Foundation for Science and Technology (FCT): 2020.05849.BD. (Teresa Vale Dias) and UI/BD/152286/2021 (Joana Santos).info:eu-repo/semantics/publishedVersio

Disfagia no doente com AVC : prevalência e determinantes

Introdução: O acidente vascular cerebral (AVC) assume em Portugal elevadas taxas de morbilidade e reinternamento hospitalar. A disfagia surge como uma complicação frequente deste evento neurológico, com índices de morbilidade elevados pelo risco de desnutrição, desidratação e aspiração broncopulmonar. O diagnóstico e a sua monitorização no processo de reabilitação do doente são ações fundamentais na prevenção de aspirações alimentares, redução do internamento hospitalar e na eficácia da reabilitação do doente. Objetivo: Identificar e avaliar o grau de disfagia na pessoa com AVC e analisar a relação entre esta, e as variáveis socio-demográficas e clínicas no sentido de poder melhorar futuramente os cuidados de enfermagem de reabilitação. Métodos: Trata-se de um estudo não experimental, transversal, descritivo-correlacional de caráter quantitativo, que foi realizado numa amostra não probabilística por conveniência, constituída por 25 doentes com diagnóstico de AVC, internados na Rede Nacional Cuidados Continuados Integrados (RNCCI), em unidades de Convalescença e Reabilitação. O instrumento de colheita de dados integra uma seção de caracterização sócio-demográfica e clínica e duas escalas: Escala Gugging Swallowing Screen (GUSS) e Índice de Barthel, a fim de avaliar a disfagia e a funcionalidade, respetivamente. Resultados: A amostra apresenta uma média de idade de 76,8 anos, sendo 68% do sexo feminino e 32% do sexo masculino. Verificámos que 68% dos participantes apresenta mais de dois antecedentes clínicos e apenas 24% dos participantes não apresenta disfagia. Dos restantes, 12% apresenta disfagia grave, 36% moderada e 28% disfagia ligeira. A área de lesão parece influenciar a deglutição, demonstrando a Artéria Cerebral Média (ACM) e Artéria Cerebral Posterior (ACP) como áreas de maior sensibilidade. Denotou-se que quanto maior o grau de dependência, maior gravidade de disfagia. Conclusão: Doentes com AVC isquémico apresentam disfagia, com gravidade relacionada com a área vascular. A existência de vários antecedentes clínicos pode gerar perturbações na deglutição do doente. De igual modo, quanto maior for a dependência funcional do doente, maior é o grau de disfagia e o risco de aspiração pulmonar. Palavras-chave: AVC; Disfagia; Reabilitação.Abstract Introduction: In Portugal, stroke events present with high morbidity and hospital readmission rates. Dysphagia frequently occurs as a complication of this neurological event, with high morbidity rates associated with malnutrition, dehydration and bronchopulmonary aspiration. The diagnosis and its monitoring in the rehabilitation process are fundamental to prevent aspiration of food, to reduce hospital stay and ultimately to improve the effectiveness of the patient’s rehabilitation. Goal: Identify and assess the degree of dysphagia in patients that suffered from a stroke as well as analyse the relationship between this and other sociodemographic and clinical variables, in order to improve patient care in rehabilitation nursing. Methodology: It is a non-experimental, transversal, descriptive and correlational study of quantitative character, which was conducted in a nonprobabilistic sample by convenience, consisting of 25 stroke patients admitted in convalescence and rehabilitation units. The data collection tool integrates both a sociodemographic and clinical characterization section and two scales: Gugging Swallowing Screen Scale (GUSS) and Barthel Index, to assess dysphagia and functionality, respectively. Results: The sample exhibits a mean age of 76.8 years old, 68% female and 32% male. It was found that 68% of the participants presented with two previous clinical events and only 24% of the participants didn’t develop dysphagia. From the remaining, 12% had severe dysphagia, 36% had moderate dysphagia and 28% had mild dysphagia. The area of injury appears to influence deglutition, with the middle and anterior cerebral arteries being the most sensitive areas. It was observed that the higher the degree of dependence, the greatest the severity of the dysphagia. Conclusion: Patients with history of ischemic stroke present with varying degrees of dysphagia related to the affected vascular area. The presence of several previous clinical events may generate disturbances in the patient’s deglutition. Similarly, the greater the functional dependence of the patient, the greater the degree of dysphagia and the risk of pulmonary aspiration. Keywords: Stroke; Dysphagia; Rehabilitation

Impact of brewery wastewater inhibitors in pure and mixed cultures of the yeast Rhodosporidium toruloides NCYC 921 and the microalga Tetradesmus obliquus ACOI 204/07

ABSTRACT: Brewery wastewater (BWW) is an appealing low-cost substrate for the production of single cell oils by oleaginous microorganisms. However, it may contain inhibitor compounds that may affect the microbial metabolism. This work investigated, for the first time, the presence of potential inhibitor compounds in primary brewery wastewater (PBWW) and secondary brewery wastewater (SBWW) for the pure and mixed cultivation of the yeast Rhodosporidium toruloides NCYC 921 and the microalga Tetradesmus obliquus ACOI 204/07. Three organic acids (OrgAc) were identified in the brewery effluents (acetic, propionic and butyric acids). Yeast and microalga pure and mixed cultivations were performed in PBWW and SBWW in order to understand the behaviour of the microorganisms, individually and together. Flow cytometry (FC) was used to monitor each microbial population during the mixed cultivations, and to study the yeast and microalga cell viability throughout all cultivations. The yeast cells in pure cultures grown in both effluents were severely affected by the OrgAc presence confirmed by the cell stress results obtained by FC. However, in the mixed cultures, the yeast cells were able to develop, and the levels of stress conditions were considerably lower. Only in microalga pure and mixed cultures efficient OrgAc removal was observed.info:eu-repo/semantics/publishedVersio

Effect of brewery effluent inhibitors on Rhodotorula toruloides NCYC 921 cells grown in pure and mixed cultures at pH 4 and 6

ABSTRACT: The presence of inhibitor compounds in the culture medium can cause severe effects on the microorganisms cells. Brewery wastewaters present organic acids (acetic, propionic and butyric acids) which can severely affect yeast cells metabolism, when grown in pure cultures, although in mixed cultures they are able to develop. To understand the physiological changes on Rhodotorula toruloides (formerly Rhodosporidium toruloides) cells when fermenting in the presence of the organic acids present in brewery wastewater, pure and mixed cultures with the microalga Tetradesmus obliquus were performed in a synthetic medium containing the same organic acids concentrations that are present in brewery wastewater at pH 4 and 6. It was concluded that, at pH 4, the organic acids effects in the yeast cells were much more toxic than at pH 6. Moreover, mixed cultures can be an advantage over heterotrophic pure cultures as the microalga is able to contribute for the consumption of potential inhibitors for the yeast.info:eu-repo/semantics/publishedVersio

Concomitant wastewater treatment with lipid and carotenoid production by the oleaginous yeast Rhodosporidium toruloides grown on brewery effluent enriched with sugarcane molasses and urea

ABSTRACT: In this study, secondary brewery wastewater (SBWW) supplemented with sugarcane molasses (SCM) was used for SBWW treatment with concomitant lipid and carotenoid production by the yeast Rhodosporidium toruloides NCYC 921. In order to improve the biomass production, ammonium sulfate, yeast extract and urea were tested as nitrogen sources. Urea was chosen as the best low-cost nitrogen source. A fed-batch cultivation was carried out with SBWW supplemented with 10 g L−1 of sugarcane molasses as carbon source, and 2 g L−1 of urea as nitrogen source. A maximum biomass concentration of 42.5 g L−1 was obtained at t=126.5 h and the maximum biomass productivity was 0.55 g L−1 h−1 at t=48.25 h. The maximum lipid content was 29.9 % w/w (DCW) at t=94 h of cultivation and the maximum carotenoid content was 0.23 mg g−1 at 120 h of cultivation. Relatively to the SBWW treatment, after the batch phase, 45.8 % of total Kjeldahl nitrogen removal, 81.7 % of COD removal and 100 % of sugar consumption were observed. Flow cytometry analysis revealed that 27.27 % of the cells had injured membrane after the inoculation. This proportion was reduced to 10.37 % at the end of the cultivation, indicating that cells adapted to the growth conditions.info:eu-repo/semantics/publishedVersio