Qualidade de vida na síndrome do intestino curto: em um único centro

Model of the study: This is an exploratory and descriptive study which was executed in sector of Nutrologynursing at University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRPUSP). Objective: The aim of this research was to evaluate the perception of quality of life of individualswith short bowel syndrome (SBS) with the help of the Quality of Life Core - 30 Questionnaire (QLQ - C30).Methods: The instrument used was the EORTC- QLQ-C30 (European Organization for Research andTreatment of Cancer Quality of Life Questionnaire/ Quality of Life Core - 30 Questionnaire) version 3.0 inPortuguese. The study was conducted on six patients with SBS. Results: The applicability of the questionnaire was adequate and the mean score obtained for this sample (70.7) was considered to besatisfactory. Conclusions: The most affected domains were: Emotional Function and Symptoms: pain,insomnia, fatigue, and diarrhea. The application of the QLQ - C30 permitted us to evaluate the perceptionof the patieModelo do estudo: Estudo de corte transversal do tipo descritivo e exploratório realizado na enfermariada Unidade Metabólica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP). Objetivos do estudo: Avaliar a aplicabilidade do Quality of Life Core- 30 Questionnaire (QLQ - C30), não específico para Síndrome do intestino curto (SIC) em portadores dasíndrome. Metodologia: Para a coleta de dados foi utilizado como instrumento o questionário EORTCQLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire/Quality of Life Core - 30 Questionnaire) versão 3.0 em português. O estudo foi realizado com 6 pacientescom SIC. Resultados: A aplicabilidade deste questionário foi adequada; o escore médio obtido nestaamostra foi considerado satisfatório (escore médio = 70,7). Conclusões: Os domínios mais afetadosforam: Função Emocional e sintomas: dor, insônia, fadiga e diarréia. A aplicação do questionário QLQ -C30 possibilitou avaliar a percepção dos pacientes quanto a sua condição de saúde e qualidade devida, revelando pontos importantes que devem ser considerados pela equipe

GASTRIC/ENTERIC TUBE: CARE ON THE INSERTION, ADMINISTRATION OF DIETS AND PREVENTION OF COMPLICATIONS

More and more , the nutritional therapy is recognized as an important fact in the recovery of sick people. The modern tubes make possible the offering of nutrients and improve nutritional conditions in a less uninvasive method, since the digestive system has at least part of its absorptive capacity. This proceeding needs specialized care, because it can have complications. The staff must have knowledge of the installation of the tubes, infusing of diet and practice to prevent, recognizing and take care of the patient during these complications. We show the technique of introduction of tubes, infusion of the diet and the main complications that may come from this therapyCada dia mais, a terapia nutricional é reconhecida como importante fator na recuperação de doentes. As sondas modernas possibilitam a oferta de nutrientes e a melhora do estado nutricional, por meio de métodos pouco invasivos, desde que o aparelho digestivo tenha conservado, pelo menos, parte de sua capacidade de  absorção. O procedimento requer cuidados especializados, posto que não é isento de complicações. A equipe que assiste o paciente que recebe terapia nutricional através de sondas deve ter conhecimento da instalação das mesmas bem como da administração das dietas e treinamento para prevenir, reconhecer e tratar as complicações. Apresentamos, neste artigo, as técnicas de introdução das sondas, infusão das dietas e principais complicações, que podem advir dessa terapia

Low medication adherence in patients with Short Bowel Syndrome dependent on parenteral nutrition

Study design: Cross-sectional. Aim: We aimed to investigate adherence to oral medications in patients with severe Short Bowel Syndrome (SBS). Casuistic and Methods: Ten patients with severe intestinal failure attending a specialized unit in a university hospital were enrolled in this study. All patients received intermittent parenteral nutrition for at least 4 months. The participants (six men and four women) had 56 ± 13 years and body mass index of 18 ± 3 kg/m2. Information related to the use of medications at home was recorded, and adherence behavior was assessed by using the Morisky Medication Adherence Scale. Results: Four patients (40%) had high medication adherence. Among patients with low medication adherence, unintentional behavior was observed in two patients, intentional behavior was observed in one patient, and an association of unintentional with intentional behavior was identified in three patients. Conclusion: Outside the hospital setting, most patients with SBS have low adherence to oral medications. These results suggest the development and implementation of targeted strategies aimed to promote awareness and adherence to medication treatmentModelo do estudo: Transversal. Objetivo do estudo: Avaliar a adesão de pacientes com Síndrome do Intestino Curto ao tratamento medicamentoso por via oral. Casuística e Métodos: O estudo inclui 10 pacientes com Síndrome do Intestino Curto (SIC) acompanhados em unidade especializada de um hospital universitário. Todos os pacientes recebiam nutrição parenteral por no mínimo quatro meses. A casuística consistia em seis homens e quatro mulheres, com idade de 56 ± 13 anos e Índice de Massa Corporal de 18 ± 3kg/m2. Foram registradas informações sobre o uso de medicamentos no domicílio. A adesão ao tratamento medicamentoso foi avaliada pelo teste de Morisky e foi identificada a natureza do comportamento em relação à não adesão. Resultados Apenas 40% dos pacientes foram classificados como “mais aderentes”. Dentre os “menos aderentes”, a baixa adesão por associação do comportamento intencional e não intencional foi observada em três casos; dois pacientes apresentavam apenas o comportamento intencional e o comportamento não intencional foi documentado em um paciente. Conclusões: A maioria dos pacientes tem baixa adesão ao tratamento medicamentoso por via oral durante o período em que eles permanecem em seus domicílios. Tais resultados sugerem o desenvolvimento e a implementação de estratégias que visem à percepção da relevância do uso correto dos medicamentos e a promoção da adesão ao tratamento medicamentos

Perfil do estado de saúde de mulheres climatéricas

Modelo do estudo: Estudo retrospectivo com análise de dados de prontuário.Objetivo: O presente estudo teve por objetivo verificar a freqüência de obesidade, diabetes mellitus,hipertensão arterial e dislipidemia em um grupo de mulheres climatéricas.Metodologia: Estudo das primeiras pacientes atendidas no Ambulatório do Climatério (ACLI) do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto -USP, no período de1983 a 2007. De fevereiro a abril de 2008 foram coletados dados de peso, estatura, Índice de MassaCorporal (IMC), grupo biológico, diagnóstico de hipertensão, diabetes e dislipidemia.Resultados: De 1983 a 2007, 400 pacientes tiveram seguimento no Ambulatório (ACLI), e 272 apresentavam seus prontuários com os dados do presente estudo devidamente registrados. Dessas 272pacientes, foram selecionadas 628 consultas, sendo que, portanto, em média, cada mulher teve trêsretornos. Estas mulheres tinham idade mínima de 29 e máxima de 80 anos, com IMC mediano acimade 25 kg/m2. O diagnóstico de diabetes, hipertensão e dislipidemia foi detectado em, respectivamente:32%, 68% e 54% dos casos.Conclusão: Mulheres climatéricas atendidas em um hospital de nível de atendimento terciário apresentaram um aumento do IMC e da prevalência de doenças crônicas não transmissíveis com o passar dotempo, o que faz urgir um olhar mais atento dos profissionais de saúde a esse grupo populacional.Study design: Retrospective analysis of medical records.Purpose: This study aimed to determine the prevalence of obesity, diabetes mellitus, hypertension anddyslipidemia in a group of climacteric women.Methods: Study of the first patients treated at the Menopause Clinic (ACLI), Department of Obstetrics andGynecology, School of Medicine of Ribeirão Preto (USP), from 1983 to 2007. Data on weight, height, BMI,biological group, diagnosis of hypertension, diabetes and dyslipidemia was collected from February/2008 until April/2008.Results: From 1983 until 2007, 400 patients were followed up, and 272 had their records registered. Ofthese 272 patients, 628 were selected queries, and therefore, on average, each woman had threereturns. Women over the age of 29 and maximum of 80 years and median BMI above 25kg/m². Theprevalence of diabetes, hypertension and dyslipidemia was respectively 32%, 68% and 54%. The prevalence of NCDs and BMI was higher for the later groups.Conclusion: Climacteric women treated at a hospital level care center showed a worsening of the BMIand the prevalence of noncommunicable chronic diseases over time, which is urging a closer look athealth professionals in this population group

Impact of the AHI1 Gene on the Vulnerability to Schizophrenia: A Case-Control Association Study

BackgroundThe Abelson helper integration-1 (AHI1) gene is required for both cerebellar and cortical development in humans. While the accelerated evolution of AHI1 in the human lineage indicates a role in cognitive (dys)function, a linkage scan in large pedigrees identified AHI1 as a positional candidate for schizophrenia. To further investigate the contribution of AHI1 to the susceptibility of schizophrenia, we evaluated the effect of AHI1 variation on the vulnerability to psychosis in two samples from Spain and Germany.Methodology/Principal Findings29 single-nucleotide polymorphisms (SNPs) located in a genomic region including the AHI1 gene were genotyped in two samples from Spain (280 patients with psychotic disorders; 348 controls) and Germany (247 patients with schizophrenic disorders; 360 controls). Allelic, genotypic and haplotype frequencies were compared between cases and controls in both samples separately, as well as in the combined sample. The effect of genotype on several psychopathological measures (BPRS, KGV, PANSS) assessed in a Spanish subsample was also evaluated. We found several significant associations in the Spanish sample. Particularly, rs7750586 and rs911507, both located upstream of the AHI1 coding region, were found to be associated with schizophrenia in the analysis of genotypic (p = 0.0033, and 0.031, respectively) and allelic frequencies (p = 0.001 in both cases). Moreover, several other risk and protective haplotypes were detected (0.006<p<0.036). Joint analysis also supported the association of rs7750586 and rs911507 with the risk for schizophrenia. The analysis of clinical measures also revealed an effect on symptom severity (minimum P value = 0.0037).Conclusions/SignificanceOur data support, in agreement with previous reports, an effect of AHI1 variation on the susceptibility to schizophrenia in central and southern European populations

Low Educational Status, Smoking, and Multidisciplinary Team Experience Predict Hospital Length of Stay after Bariatric Surgery

Objective The objective of the present study was to identify new risk factors associated with longer hospitalization following bariatric surgery. Methods Patient clinical, social, and biochemical data in addition to multidisciplinary team experience were analyzed in a cohort that included all patients undergoing bariatric surgery at our hospital. The primary outcome was length of hospital stay (LOS). Mortality was recorded to validate the obesity surgery mortality risk score (OS-MRS). Results This study included 299 sequential patients, 41 ± 10 years of age, and BMI of 50 ± 8 kg/m 2 who underwent bariatric surgery. Two thirds (196) of patients were hypertensive, a third (86) were diabetic and a third (91) were current or former smokers. Overall, LOS was 8 ± 5 days. The predictors of a longer LOS were smoking ( P < 0.05) and less multidisciplinary team experience ( P < 0.05). Looking at only the last three years of data, LOS was 6 ± 5 days, and the predictors of a longer LOS were low educational attainment ( P < 0.02) and smoking ( P < 0.01) but not team experience. The global mortality was 2.6%, with the OS-MRS identifying a high-risk group. Conclusion Excluding the initial learning phase, longer LOS independent predictors were patient low educational attainment and smoking. These predictors can help guide care to reduce complications

Glutamine supplementation does not improve protein synthesis rate by the jejunal mucosa of the malnourished rat

It has been demonstrated that glutamine, a conditionally essential amino acid, improves nitrogen balance, acts as a stimulant of protein synthesis, and decreases proteolysis in myopathic children. In contrast, other studies have shown no beneficial effect of glutamine supplementation on burn victims or critically ill patients. Nonetheless, we hypothesized that glutamine supplementation would increase the fractional protein synthesis rate (FSR) in the jejunal mucosa of malnourished male Wistar rats. Thus, the objective of the present study was to test the effect of daily oral glutamine supplementation (0.42 g kg(-1) d(-1) for 14 days) on the FSR of the jejunal mucosa of healthy and malnourished rats. A 4-hour kinetic study with L-[1-(13)C]leucine was subsequently performed, and jejunal biopsies were obtained 1.5 cm from the Treitz angle and analyzed. Malnourished rats showed a 25% weight loss and increased urinary nitrogen excretion. Plasma amino acid concentration did not differ between groups. (13)C enrichment in plasma and jejunal cells was higher in the malnourished groups than in the healthy group. The FSR (percent per hour) was similar for the control and experimental groups (P > .05), with a mean range of 220%/h to 27%/h. Oral glutamine supplementation alone did not induce higher protein incorporation by the jejunal mucosa in malnourished rats, regardless of total food intake or the presence or absence of glutamine supplementation. (C) 2009 Elsevier Inc. All rights reserved.FAPESP[01/12736-4]CNPq[306824

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries. Copyright (C) 2010 John Wiley & Sons, Ltd