Evaluation of a refeeding plan employed after 43 days of voluntary fasting

OBJETIVO: Avaliar um esquema de realimentação utilizado em pacientes após jejum prolongado voluntário. MÉTODOS: Foi realizado estudo retrospectivo, com base em levantamento dos prontuários de 7 pacientes (média de idade de 41,6 anos e desvio-padrão=5,3) em jejum voluntário por 43 dias em jejum seguidos de 14 dias de realimentação. As variáveis estudadas foram: antropométricas, clínicas, dietéticas, laboratoriais e avaliação da composição corpórea por bioimpedância. Foram utilizadas as seguintes dietas por via oral na realimentação: oligomérica enriquecida com glutamina, associada à dieta hipogordurosa e isenta de lactose (primeira semana); dieta branda normolipídica com lactose (segunda semana). A análise descritiva dos dados apresentados incluiu média e desvio-padrão. A análise de variância ou o teste não paramétrico de Kruskal-Wallis foram utilizados para comparação dos dados nos períodos de jejum e realimentação. Utilizou-se o programa estatístico SIGMA STAT versão 2,03 sendo considerado o nível de significância de 5%. RESULTADOS: No jejum houve redução significativa do peso corpóreo (18,0% desvio-padrão=2,3), da prega cutânea do tríceps (48,2% desvio-padrão=9,0) e da hemoglobina (15,98g/dL desvio-padrão=0,99 para 12,74g/dL desvio-padrão=0,47). Na segunda semana de realimentação houve aumento significativo na contagem total de linfócitos (954 mil/mm³ desvio-padrão=242 para 1.619 mil/mm³ desvio-padrão=232) e dos distúrbios gastrointestinais, em relação à primeira semana. Não ocorreu Síndrome da Realimentação. CONCLUSÃO: O esquema de realimentação utilizado promoveu resultado global adequado, mas requer redução do aporte energético e definição de momento mais adequado para reintrodução de lactose e da dieta normolipídica.OBJECTIVE: To evaluate a refeeding plan employed in patients after a long period of voluntary fasting. METHODS: A retrospective study was done by reviewing the medical records of 7 male patients (mean age of 42.0 years; standard deviation of 5.3 years) who were refed for 14 days after a 43-day fast. The studied variables were: clinical, anthropometric; biochemical and body composition by bioimpedance analysis. The following diets were used orally in the refeeding program: glutamine-enriched oligomeric diet associated with a low-fat lactose-free diet (first week); normal-fat diet with lactose (second week). Descriptive analysis of the data included mean and standard deviation. Analysis of variance or the non-parametric Kruskal-Wallis test was used to compare data during the fasting and refeeding periods. The SIGMA STAT statistics software package version 2.03 was used to analyze data with the significance level set at 5% (p<0.05). RESULTS: During the fasting period there was a significant reduction in body weight (18.0%; standard deviation=2.3), triceps skinfold (48.2%; standard deviation=9.0) and hemoglobin concentration (from 15.98g/dL; standard deviation=0.99 to 12.74g/dL; standard deviation=0.47). During the second week of refeeding, there was a significant increase in total lymphocyte count (from 954 thousand/mm³; standard deviation=242 to 1.619 thousand/mm³; standard deviation=232); and gastrointestinal problems when compared with the first week. No case of refeeding syndrome was observed. CONCLUSION: The refeeding program used promoted a satisfactory global result but it is necessary to reduce energy intake and define the best moment to reintroduce lactose and a normal-fat diet

O papel do New Trauma and Injury Severity Score (NTRISS) para predição de sobrevida

O objetivo deste estudo foi verificar se a substituição do Injury Severity Score (ISS) pelo New Injury Severity Score (NISS), na fórmula original do Trauma and Injury Severity Score (TRISS), melhora sua estimativa da taxa de sobrevida. Estudo retrospectivo realizado num centro de trauma nível I, durante um ano. A curva ROC foi utilizada para identificar o melhor indicador (TRISS ou NTRISS) para predição da probabilidade de sobrevida. O estudo incluiu 533 traumatizados, com idade média de 38±16 anos. Houve predomínio de acidentes de transporte (61,9%). Lesões externas foram mais frequentes (63,0%), seguidas por trauma craniencefálico/cervical (55,5%). A taxa de sobrevida foi de 76,9%. Houve predomínio dos valores do ISS variando de 9-15 (40,0%) e, do NISS, de 16-24 (25,5%). Probabilidade de sobrevida igual ou superior a 75,0% foi obtida para 83,4% das vítimas de acordo com o TRISS e por 78,4% de acordo com NTRISS. A nova versão apresentou melhor desempenho que o TRISS na predição de sobrevida dos doentes traumatizados estudados.El estudio objetivó verificar si la substitución del Injury Severity Score (ISS) por el New Injury Severity Score (NISS) en la fórmula original del Trauma and Injury Severity Score (TRISS) mejora su estimación de tasa de sobrevida. Estudio retrospectivo realizado en centro de trauma nivel I durante un año. Se usó curva ROC para identificar el mejor indicador (TRISS o NTRISS) para predicción de probabilidad de sobrevida. El estudio incluyó 533 traumatizados, edad media 38±16 años. Predominaron accidentes de transporte (61,9%). Prevalecieron las lesiones externas (63%), seguidas de trauma cráneo-encefálico/cervical (55,5%). Tasa de sobrevida: 76,9%. Predominaron valores de ISS variando de 9-15 (40,0%) y de NISS, de 16-24 (25,5%). Se obtuvo probabilidad de sobrevida igual o mayor a 75% para 83,4% de víctimas según TRISS y para 78,4% según NTRISS. La nueva versión (NTRISS) presentó mejor desempeño que TRISS en predicción de sobrevida en los pacientes traumatizados estudiados.The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients

Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report

CONTEXT: Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare. CASE REPORT: We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter. CONCLUSION: The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case