Ángulo de fase para el tamizaje del riesgo nutricional en pacientes cardiacos críticos

Introduction: The phase angle has been listed as a nutritional marker and its useful role in critically ill patients, but its role as a patient-to-patient tool has not yet been tested. This study sought to evaluate the phase angle as a proposal to determine nutritional risk in critically ill patients hospitalized in cardiac intensive care units. Methods: Transversal study, coupled to a prospective analysis variable (hospitalization outcome) and involving adult and elderly male and female patients in cardiac intensive care units. The nutritional risk was determined by using the NUTRICscore, the phase angle was obtained through bioelectrical impedance analysis and other data, through the clinical record. A significance level of p <0.05 was used for all statistical analysis. Results: 79 patients were included and resulted in homogeneous distribution among the sexes and an average age of 67.2 ± 13.7 years. Most of the sample had malnutrition according to the body mass index (BMI) (46.7%; CI: 36.0-57.8) and due to the adequacy of the arm circumference (40.8%; CI: 34.0-52.0). According to the NUTRIC score, 59.5% (CI: 48.5-69.3) had a high nutritional risk, and 68.4% (CI: 57.4-77.6) had a low phase angle (≤5.5 °). Correlation between the phase angle and age (p = 0.010) and BMI (p = 0.023) was verified. A good sensitivity (72%; CI: 55.6-81.9) and specificity (68%; CI: 42.5-77.5) of the low phase angle were obtained to detect nutritional risk by NUTRIC. Conclusions: The PhA had good results of sensitivity and specificity but should be used with caution to determine the nutritional risk in critically ill cardiac patients.Introducción: El ángulo de fase se ha catalogado como un marcador nutricional y su papel útil en pacientes críticos, pero aún no se ha probado su papel como herramienta de paciente a paciente. Este estudio buscó evaluar el ángulo de fase como propuesta para determinar el riesgo nutricional en pacientes críticos hospitalizados en unidades de cuidados intensivos cardíacos. Metodología: Estudio transversal, acoplado a una variable de análisis prospectivo (resultado de hospitalización);participaron pacientes adultos y adultos mayores del sexo masculino y femenino en unidades de cuidados intensivos cardíacos. El riesgo nutricional se determinó mediante el NUTRICscore, el ángulo de fase se obtuvo a través del análisis de impedancia bioeléctrica y otros datos, a través de la historia clínica. Se utilizó un nivel de significación de p <0,05 para todos los análisis estadísticos. Resultados: Se incluyeron 79 pacientes y resultó una distribución homogénea entre los sexos y una edad promedio de 67,2±13,7 años. La mayor parte de la muestra presentaba desnutrición según índice de masa corporal (IMC) (46.7%; CI: 36.0-57.8) y por adecuación del perímetro braquial (40,8%; CI: 34.0-52.0). De acuerdo con el puntaje NUTRIC, el 59,5% (CI: 48.5-69.3) tenía un riesgo nutricional alto y el 68,4% (CI: 57.4-77.6) tenía un ángulo de fase bajo (≤ 5,5°). Se verificó correlación entre el ángulo de fase y la edad (p = 0,010) y el IMC (p = 0,023). Se obtuvo una buena sensibilidad (72%; CI: 55.6-81.9) y especificidad (68%; CI: 42.5-77.5) del ángulo de fase bajo para detectar riesgo nutricional por NUTRIC. Conclusiones: El PhA tuvo buenos resultados de sensibilidad y especificidad, pero debe ser utilizado con precaución para determinar el riesgo nutricional en pacientes cardíacos críticos

JOGOS DIGITAIS, APLICATIVOS, SIMULADORES, GAMIFICAÇÃO E NOTICIABILIDADE

A Revista Observatório apresenta seu quarto número de 2018, com capa produzida pela colega, professora e artista Amanda Leite, trazendo dois  and dossiês especiais! O primeiro, intitulado JOGOS DIGITAIS, APLICATIVOS, SIMULADORES E GAMIFICAÇÃO – DELINEANDO PRÁTICAS PARA EDUCAÇÃO E SAÚDE, foi organizado pelos colegas Dra. Lynn Alves e Dra. Isa Neves, ambas da Universidade Federal da Bahia (UFBA) e tem o objetivo de socializar as pesquisas que vem sendo realizadas nos programas de Pós-Graduação Stricto Sensu, no Brasil e em Portugal. O segundo, intitulado NOTICIABILIDADE, foi organizado pelos colegas Dra. Lia Seixas, da Universidade Federal da Bahia (UFBA) e Dr. Alfredo Vizeu, da Universidade Federal de Pernambuco (UFPE), e mapea as diferentes acepções que a noticiabilidade adquire nos meios acadêmicos brasileiro e anglo-saxão, além de apontar pistas para se problematizar as modalidades de leitura e formulação nativa do conceito. Leia mais

Desnutrição de peso normal em pacientes Cardiopatas hospitalizados / Malnutrition of normal weight in hospitalized Cardiopathy patients

Introdução: A desnutrição é frequente em pacientes cardiopatas hospitalizados e sua identificação precoce é crucial para instituir o tratamento nutricional adequado e prevenir seu agravo. A desnutrição é associada ao aumento da taxa de hospitalizações, maior prevalência de complicações, infecções e mortalidade. O índice de massa corporal é comumente utilizado para avaliação nutricional, porém, não é capaz de identificar a depleção de massa magra. Objetivos: Avaliar a prevalência de desnutrição de peso normal em pacientes cardiopatas internados em um hospital de referência cardiológica. Métodos: Estudo transversal e analítico, realizado com pacientes de ambos os sexos e idade maior ou igual a 20 anos. A avaliação do estado nutricional foi determinada pelo índice de massa corporal e bioimpedância elétrica. Classificou-se como desnutrição de peso normal os pacientes portadores de eutrofia pelo índice de massa corporal, associado a um baixo índice de massa muscular apendicular esquelética. Foi adotado um nível de significância de p<0,05. Resultados: A amostra foi constituída por 77 pacientes, com média de idade de 61,7 ± 13,8 anos, maior proporção do sexo feminino (55%) e idosos (62%). A prevalência de desnutrição de peso normal foi de 64%, apresentando associação significativa com a faixa etária (p=0,011) e tempo de escolaridade (p=0,021). Conclusão: A desnutrição de peso normal mostrou ser uma realidade entre pacientes cardiopatas, destacando-se a necessidade de adotar métodos de diagnóstico nutricional mais completos que auxiliem na avaliação da composição corporal e estado nutricional destes pacientes

Acanthamoeba keratitis in patients wearing scleral contact lenses

Purpose: To report a series of cases of Acanthamoeba keratitis (AK) in scleral lens wearers with keratoconus to determine whether this type of contact lens presents a greater risk for development of infection. Methods: This study reports three patients who wore scleral contact lenses to correct keratoconus and developed AK. The diagnoses of AK were established based on cultures of the cornea, scleral contact lenses, and contact lens paraphernalia. This study investigated the risk factors for infections. Results: The possible risks for AK in scleral contact lens wearers are hypoxic changes in the corneal epithelium because of the large diameter and minimal tear exchange, use of large amounts of saline solution necessary for scleral lens fitting, storing the scleral lens overnight in saline solution rather than contact lens multipurpose solutions, not rubbing the contact lens during cleaning, and the space between the cornea and the back surface of the scleral lens that might serve as a fluid reservoir and environment for Acanthamoeba multiplication. Two patients responded well to medical treatment of AKone is still being treated. Conclusions: The recommendations for use and care of scleral contact lenses should be emphasized, especially regarding use of sterile saline (preferably single use), attention to rubbing the lens during cleaning, cleaning of the plunger, and overnight storage in fresh contact lens multipurpose solutions without topping off the lens solution in the case.Univ Fed Sao Paulo, Sao Paulo Hosp, Paulista Sch Med, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Hosp, Paulista Sch Med, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilWeb of Scienc

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations

Predictive models for estimating visceral fat: The contribution from anthropometric parameters

<div><p>Background</p><p>Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters.</p><p>Objective</p><p>Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters.</p><p>Methods</p><p>A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography–CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI).</p><p>Results</p><p>109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R² adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R² adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001).</p><p>Conclusions</p><p>A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.</p></div

Simple linear regression between adipose visceral tissue (AVT) volume determined by the predictive equation and AVT volume obtained using computed tomography (CT) in adult overweight women (p<0.001).

<p>Simple linear regression between adipose visceral tissue (AVT) volume determined by the predictive equation and AVT volume obtained using computed tomography (CT) in adult overweight women (p<0.001).</p

Multiple linear regression coefficients of predicative equations (eq.) for estimating adipose visceral tissue (AVT) in overweight individuals.

<p>Multiple linear regression coefficients of predicative equations (eq.) for estimating adipose visceral tissue (AVT) in overweight individuals.</p

Comparability of the characteristics of the patients included in the study in accordance with sex.

<p>Comparability of the characteristics of the patients included in the study in accordance with sex.</p

Distribution of anthropometric parameters (Mean/Standard Deviation) in accordance with sex.

<p>Distribution of anthropometric parameters (Mean/Standard Deviation) in accordance with sex.</p