Nutrologia e nutrição em unidade de terapia intensiva: sinergia em busca de excelência

Objective: Nutritional therapy, in spite of current guidelines, does not seem to be perceived yet as an important therapeutic strategy in critical patients. The objective of this study was to assess the joint action of a team composed of a nutrology specialist and a nutritionist in ICU by measuring quality indicators such as fasting time and adequacy of caloric intake. Methods: This is a prospective descriptive study realized in a mixed adult intensive care unit, with patients that remained stayed for longer than 24h. Patients received nutritional therapy according to a protocol based on guidelines and adapted to the unit. Demographic and clinical data were gathered; nutritional route, time of start of therapy, prescribed volume, and received volume of enteral feeding. Results: Out of 89 patients assessed, 48 (53.9%) started with oral feeding, 2 (2.2%) received parenteral feeding, and 39 (43.8%), enteral feeding. The time for enteral therapy to start was 24h and 25 minutes (QI: 7-44h), and 87.2% of patients received enteral feeding in the first 48h of stay. For surgical patients (n=42), the time to start feeding via any route was 20h and 59 minutes (QI: 14h 45 min - 41h 15 min). 87% of the calories prescribed were instilled via enteral feeding throughout the 284 days of assessment. Conclusion: The presence of a team composed of a nutrology specialist and a nutritionist may be capable of meeting the attention and specific knowledge in nutritional therapy needs, bringing high quality and proven excellence through the indicators measured

Prevalence of rheumatoid cachexia in rheumatoid arthritis : a systematic review and meta-analysis

Background: Low muscle mass occurs in patients with rheumatoid arthritis without weight loss; this condition is referred asrheumatoid cachexia. The aim of the current study was to perform a systematic review with meta-analysis to determine therheumatoid cachexia prevalence. Methods: A systematic review with meta-analysis of observational studies published in English, between 1994 and 2016, wasconducted using MEDLINE (via PubMed) and other relevant sources. Search strategies were based on pre-defined keywordsand medical subject headings. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was used to estimate the prevalence, and because studies reported different methods and criteria to estimatebody composition and prevalence of rheumatoid cachexia, subgroup analyses were performed. Meta-regression adjusted forthe 28-joint disease activity score and disease duration (years) was performed (significance level atP≤0.05). Results: Of 136 full articles (one duplicate publication) screened for inclusion in the study, eight were included. The esti-mated overall prevalence of rheumatoid cachexia was 19% [95% confidence interval (CI) 07–33%]. This prevalence was 29%(95% CI 15–46%) when body composition was measured by dual-energy X-ray absorptiometry. When the diagnostic criteriawere fat-free mass index below the 10th percentile and fat mass index above the 25th percentile, rheumatoid cachexia prev-alence was 32% (95% CI 14–52%). The 28-joint disease activity score and disease duration had no influence on the estimatedprevalence of rheumatoid cachexia (P>0.05). Most studies were rated as having moderate methodological quality. Conclusions: Meta-analysis showed a prevalence of rheumatoid cachexia of 15-32%, according to different criteria, demon-strating that this condition is a frequent comorbidity of rheumatoid arthritis. To better understand its clinical impact, more studies using standardized definitions and prospective evaluations are urgently needed

Estatura e maturac¸ão sexual em meninas com artrite idiopática juvenil

Objective: To evaluate height, sexual maturation, and the difference between final and expected height in girls with juvenile idiopathic arthritis and no glucocorticoid treatment for at least six months, as compared to a group of healthy girls. Methods: This cross-sectional study involved 44 girls with juvenile idiopathic arthritis, diagnosed according to the International League of Associations for Rheumatology criteria, and 59 healthy controls aged between 8 and 18 (incomplete) years with no comorbid chronic diseases. Demographic data were collected from all participants, and disease and treatment variables were compiled for the patient group. Anthropometric measurements were converted into Z-scores based on World Health Organization standards. Sexual maturation was classified according to Tanner stages. Results: Body mass index and height Z-scores were lower in girls with juvenile idiopathic arthritis as compared to control participants. These values differed significantly in Tanner stage II. Three (6.8%) girls with juvenile idiopathic arthritis had height-for-age Z-scores <−2 (short stature). Girls with polyarticular juvenile idiopathic arthritis and higher cumulative glucocorticoid doses were significantly more likely to present with short stature. The percentage of prepubertal girls in the juvenile idiopathic arthritis group was significantly higher than that observed in the control group, (p = 0.012). Age of menarche, adult height, and the difference between actual and expected height did not differ between groups. Conclusion: These findings suggest that even six months after the suspension of glucocorticoid treatment, children with polyarticular/systemic juvenile idiopathic arthritis subtypes are still susceptible to low height and delayed puberty.Objetivo: Avaliar a estatura, maturac¸ão sexual e a diferenc¸a entre a estatura final e a esperada em meninas com artrite idiopática juvenil (AIJ) sem tratamento com glicocorticoides por pelo menos seis meses, em comparac¸ão com um grupo de meninas saudáveis. Métodos: Este estudo transversal avaliou 44 meninas com artrite idiopática juvenil, diagnosticadas de acordo com os critérios da International League of Associations for Rheumatology e 59 controles saudáveis, entre oito e 18 anos (incompletos) sem comorbidades por doenc¸as crônicas. Os dados demográficos foram coletados de todos os participantes e as variáveis de doenc¸a e tratamento foram compiladas para o grupo de pacientes. As medidas antropométricas foram convertidas em escores-z com base nos padrões da Organizac¸ão Mundial da Saúde. A maturac¸ão sexual foi classificada de acordo com os estágios de Tanner. Resultados: Índice de massa corporal e escores-z de estatura foram menores em meninas com artrite idiopática juvenil em comparac¸ão com os participantes-controle. Esses valores diferiram significativamente no estágio II de Tanner. Três (6,8%) meninas com artrite idiopática juvenil tinham escores-z de estatura para idade < -2 (baixa estatura). Meninas com artrite idiopática juvenil poliarticular e doses cumulativas de glicocorticoides foram significativamente mais propensas a apresentar baixa estatura. A porcentagem de meninas pré-púberes no grupo artrite idiopática juvenil foi significativamente maior do que a observada no grupo controle (p = 0,012). A idade da menarca, a estatura adulta e a diferenc¸a entre a estatura real e a esperada não diferiram entre os grupos. Conclusão: Esses achados sugerem que, mesmo após seis meses da suspensão do tratamento com glicocorticoides, as crianc¸as com os subtipos poliarticular/sistêmico de AIJ ainda são suscetíveis a baixa estatura e atraso na puberdade

Temporal development of muscle atrophy in murine model of arthritis is related to disease severity

Results The clinical parameters of arthritis progressively increased in CIA in all experimental times, demonstrating the greatest difference from other groups at 45 days after induction (clinical score: CO, 00±00; SA, 1.00±0.14; CIA, 3.28±0.41 p>0.05). The CIA animals had lower weights during all the experimentation periods with a difference of 6 % from CO at 45 days (p>0.05). CIA animals also demonstrated progressive decrease in distance walked, with a reduction of 54 % in 35 and 74 % at 45 days. Cytokine analysis identified significant increase in IL-6 serum levels in CIA than CO and SA in all experimental times. CSA of the myofiber of GA and TAwas decreased 26 and 31 % (p> 0.05) in CIA in 45 days after the induction of disease, respectively. There was significant and inverse correlation between the disease clinical score and myofiber CSA in 45 days (GA: r=−0.71; p=0.021). Conclusion Our results point to a progressive development of muscle wasting, with premature onset arthritis. These observations are relevant to understand the development of muscle loss, as well as for the design of future studies trying to understand the mechanisms involved in muscle wasting. As far as we are concerned, this is the first study to evaluate the relation between disease score and muscle atrophy in a model of arthritis

Diminished Expression of Complement Regulatory Proteins on Peripheral Blood Cells from Systemic Lupus Erythematosus Patients

CD55, CD59, CD46, and CD35 are proteins with complement regulatory (Creg) properties that ensure cell and tissue integrity when this system is activated. The aim of this study was to evaluate the Creg expression on peripheral blood cells from SLE patients and its association with cytopenia and disease activity. Flow cytometric analyses were performed on blood cells from 100 SLE patients and 61 healthy controls. Compared with healthy controls, we observed in SLE patients with lymphopenia and neutropenia decreased expression of CD55, CD59, and CD46 (P < 0.05). In SLE patients with anemia, CD59 and CD35 were decreased on red blood cells. Furthermore, there was a negative correlation between CD55 and CD59 on neutrophils and the disease activity. The results suggest there is an altered pattern of Creg expression on the peripheral blood cells of SLE patients, and the expression is correlated with disease activity and/or with activation of the complement system

Adolescent and youth health policies in the Portuguese-Brazilian context: specificities and approximations

Objective: To characterize the scientific production on adolescent health policies and programs in Brazil and Portugal in the period 2010-2017. Method: This is a literature review based on the Scoping Review method. The research guidingquestion was: “How is the scientific production on adolescent health policies and programs in Brazil and Portugal characterized?”Search was carried out in October 2017 on the BVS, EBSCO and Google Scholar platforms. Results: Twenty-two studies were selected, namely, 17 Brazilian and 5 Portuguese. Seven cross-cutting thematic categories were identified, as follows: policy and program evaluation; health promotion and education; mental health; sexual and reproductive health; violence; oral health and nutritional health. We canconclude that, albeit in different social contexts, the themes reflect traditional areas of intervention of policies and programs, except for those arising from the phenomenon of structural violence, markedly present in the Brazilian reality. Also, the lack of emerging issues such as gender identities, migratory flows, and morbimortality from external causes reveal a possible care gap in policies and programs and a necessary field to be explored.info:eu-repo/semantics/publishedVersio