Effect of the abbreviation of preoperative fasting to 2h with a drink containing carbohydrate in postoperative pulmonary function after Thoracoscopic Sympathectomy: a pilot randomized study: Efeito da abreviação do tempo de jejum pré-operatório para 2h com bebida contendo carboidratos na função pulmonar após a Simpatectomia Toracoscopica: um estudo piloto randomizado

Objective: The organic response to trauma is attenuated by intake of a carbohydrate (CHO)-enriched drink 2 hours before surgery, as opposed to strict preoperative fasting. We investigated whether this approach would improve postoperative respiratory function in patients undergoing bilateral thoracoscopic sympathectomy. Method: Qualifying patients (mean age, 24 years; range, 16-37 year) scheduled for thoracoscopic sympathectomy were randomized to conventional 6- to 8-hour fasting (control group, n=7) or 6-hour fasting for solids, followed by intake of a CHO-rich drink (12% maltodextrin in 200 mL of water) 2 hours before anesthesia (CHO group, n=7). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%) were measured, and cirtometry was performed pre- and postoperatively (Day 1). The visual analog scale (VAS) was used to assess pain and well-being postoperatively. Results: Pain and well-being did not differ between groups by VAS scores. Thoracic expansibility declined postoperatively in both groups at axillary level but significantly decreased at xiphoid level only in the control group (p=0.04). Both groups showed significant declines in FVC and FEV1 on postoperative Day 1. Only the control group displayed significant postoperative FEF 25-75% decline, compared with preoperative baseline (p=0.01). Conclusion: In this pilot study, intake of a CHO-enriched drink 2 hours preoperatively benefitted patients postoperatively, enhancing basilar lung expansion and marginally improving lung function

Pré-habilitação no paciente com sarcopenia candidato a procedimentos cirúrgicos

Aging is a natural process in humans that brings physiological, morphological, biochemical, and psychological changes. As age increases, these modifications translate into increased vulnerability for diseases like sarcopenia, which implies a decrease in functional capacity, loss of muscle mass and strength, and greater fragility.El envejecimiento es un proceso natural en el ser humano que trae consigo cambios fisiológicos, morfológicos, bioquímicos y psicológicos. A medida que van aumentando los años, estas modificaciones se traducen en una mayor vulnerabilidad para el desarrollo de enfermedades como la sarcopenia, que implican una disminución de la capacidad funcional, pérdida de masa y fuerza muscular, y mayor fragilidad.O envelhecimento é um processo natural do ser humano que acarreta mudanças fisiológicas, morfológicas, bioquímicas e psicológicas. Com o passar dos anos, essas modificações se traduzem em maior risco de desenvolver doenças como a sarcopenia, que implica na diminuição da capacidade funcional, perda de massa e força muscular e maior fragilidade

Ingestion of glutamine and maltodextrin two hours preoperatively improves insulin sensitivity after surgery: a randomized, double blind, controlled trial

OBJETIVO: investigar se a abreviação do jejum pré-operatório com uma bebida contendo glutamina e dextrinomaltose melhora a resposta orgânica ao trauma cirúrgico. MÉTODOS: trinta e seis pacientes adultas, (18-62 anos) candidatas à colecistectomia videolaparoscópica eletiva foram aleatoriamente divididas em três grupos: grupo jejum convencional (grupo Jejum), ou em dois grupos para receber duas dietas diferentes, oito horas (400ml) e duas horas antes da indução anestésica (200ml): grupo carboidrato (12,5% de dextrinomaltose) e glutamina (12,5% de dextrinomaltose e, respectivamente, 40 e 10g de glutamina). As amostras de sangue foram coletadas no período pré e pós-operatório. RESULTADOS: vinte e oito pacientes completaram o estudo. Nenhuma complicação pulmonar ocorreu durante o estudo. O volume residual gástrico foi similar entre os grupos (p=0,95). No pós-operatório, todas as pacientes do grupo jejum apresentaram glicemia anormal (>110mg/dl), sendo essa anormalidade 50% para o grupo CHO (p=0,14) e, apenas, 22,2% para o grupo GLN (p=0,01). No pós-operatório, todas as pacientes que abreviaram o jejum (grupo CHO + GLN) apresentaram insulinemia normal, contrastando com 66,7% no grupo jejum (p=0,02). A sensibilidade anormal à insulina subiu no pós-operatório de 32,1% para 46,4% dos casos (p=0,24). A sensibilidade anormal à insulina, no pós-operatório, ocorreu em apenas 11,1% das pacientes do grupo GLN comparado com 55,5% do grupo jejum (p=0,02). CONCLUSÃO: a abreviação do jejum pré-operatório para duas horas com glutamina e dextrinomaltose melhora a sensibilidade à insulina de pacientes submetidas à colecistectomia videolaparoscópica eletiva

Probiotics enhance the recovery of gut atrophy in experimental malnutrition

ABSTRACT: AIM: The aim of this study was to evaluate the effect of probiotics on the recovery of the bowel atrophy induced by malnutrition in rats. METHODS: Twenty-and-six Wistar rats (200-250g) were fed with either a normoproteic (sham group, n=6) or a free-protein diet (n=20) during 12 days. Twelve malnourished rats were randomized to recover during 15 days with either a hydrolyzed diet (control group, n=6) or the same diet enriched with probiotics (Streptococcus thermophilus and Lactobacillus helveticus; probiotic group, n=6). RESULTS: Probiotic group showed similar gain of body, liver and bowel weight than controls. At the jejunum, both the villus height (383±49 vs. 321±46mm; p=0.04) and crypt depth (157±31 vs. 125±10mm; p=0.04) were greater in probiotic group than in controls. The crypt depth at the cecum (214±22 vs. 169±43 mm; p=0.05) and the wall width at both the cecum (410±18 vs. 340±61 mm; p=0.02) and sigmoid (479±130 vs. 330±62 mm; p=0.03) were higher in probiotic than in control group. CONCLUSION: Streptococcus thermophilus and Lactobacillus helveticus enhance the recovery of gut atrophy induced by malnutrition. Probiotics can be useful as oral adjuvants during the recovery of malnutrition

Estado nutricional e mortalidade entre pacientes idosos transferidos para unidade de cuidados intensivos: uma coorte retrospectiva: Nutritional status and mortality among elderly patients transferred to the intensive care unit: a retrospective cohort

Introdução Muitos pacientes precisam ser transferidos para a realização de procedimentos, ou por necessitarem de cuidados de maior complexidade. Entretanto, a transferência pode cursar com piores desfechos. Objetivo: comparar o estado nutricional e a mortalidade de pacientes idosos transferidos para a UTI com os admitidos na UTI proveniente da sua residencia. Método: Coorte retrospectiva realizada em um hospital privado na cidade de Cuiabá-MT. Estudo realizado com pacientes idosos, admitidos em duas UTIs. Foi determinado a frequencia de pacientes transferidos para a UTI e em seguida, comparado o estado nutricional e a mortalidade entre os pacientes transferidos versus os admitidos diretamente na UTI.  Foi considerado transferência hospitalar o paciente encaminhado de qualquer unidade do próprio hospital (intra-hospitalar) ou quando encaminhado da enfermaria de outro hospital (inter-hospitalar) para a UTI. Resultados: Entre 2190 pacientes internados, 60,0% (n=1315) eram idosos que participaram do estudo (media=73 anos, 53,1% feminino). A taxa de transferência correspondeu a 26,8% dos casos. Os idosos transferidos mostraram 2,5 vezes mais chance de óbito que os admitidos diretamente na UTI (OR=2,55 IC95%1,91-3,39, p<0,001) e apresentaram maior chance de estarem gravemente desnutridos que os provenientes de casa (OR=2,5 IC95% 1,82-3,4), p<0,001). A chance de óbito aumentou apenas entre os idosos transferidos que já estavam desnutridos (OR= 2,9; p<0,001) ou desnutridos graves (OR= 3,2; p<0,001) no momento da admissão na UTI. O mesmo não ocorreu para os admitidos diretamente (p>0,05). Conclusão: Cerca de 30% dos pacientes admitidos na UTI são provenientes de transferência hospitalar.  Os idosos transferidos são mais desnutridos que os admitidos diretamente na UTI. Idosos transferidos e os transferidos com desnutrição, apresentam mais de 2,5 vezes chance de óbito que os admitidos diretamente com ou sem desnutrição

Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial

<p>Abstract</p> <p>Background</p> <p>Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.</p> <p>Methods</p> <p>Seventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.</p> <p>Results</p> <p>There were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).</p> <p>Conclusions</p> <p>Shortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.</p> <p>Trial registration</p> <p>ClinicalTrail.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01354249">NCT01354249</a></p

Probiotic supplementation influences the diversity of the intestinal microbiota during early stages of farmed Senegalese sole (Solea senegalensis, Kaup, 1858)

Ingestion of bacteria at early stages results in establishment of a primary intestinal microbiota which likely undergoes several stages along fish life. The role of this intestinal microbiota regulating body functions is crucial for larval development. Probiotics have been proved to modulate this microbiota and exert antagonistic effects against fish pathogens. In the present study, we aimed to determine bacterial diversity along different developmental stages of farmed Senegalese sole (Solea senegalensis) after feeding probiotic (Shewanella putrefaciens Pdp11) supplemented diet for a short period (10–30 days after hatching, DAH). Intestinal lumen contents of sole larvae fed control and probiotic diets were collected at 23, 56, 87, and 119 DAH and DNA was amplified using 16S rDNA bacterial domain-specific primers. Amplicons obtained were separated by denaturing gradient gel electrophoresis (DGGE), cloned, and resulting sequences compared to sequences in GenBank. Results suggest that Shewanella putrefaciens Pdp11 induces a modulation of the dominant bacterial taxa of the intestinal microbiota from 23 DAH. DGGE patterns of larvae fed the probiotic diet showed a core of bands related to Lactobacillus helveticus, Pseudomonas acephalitica, Vibrio parahaemolyticus,and Shewanella genus, together with increased Vibri o genus presence. In addition, decreased number of clones related to Photobacterium damselae subsp piscicida at 23 and 56 DAH was observed in probiotic-fed larvae. A band corresponding to Shewanella putrefaciens Pdp11 was sequenced as predominant from 23 to 119 DAH samples, confirming the colonization by the probiotics. Microbiota modulation obtained via probiotics addition emerges as an effective tool to improve Solea senegalensis larviculture.En prens