Terapia nutricional em pacientes com câncer do aparelho digestivo

Nutritional status in patients with cancer is a critical determinant of treatment success and life quality. Therapeutic approaches in cancer, including surgery, chemotherapy and radiation, are associated with malnutrition, and drugs used to treat cancer often result in vomiting, mucositis, diarrhea, and dysphagia. The main objective of this research is to understand the effect of nutritional interventions in GI cancer patients, analyzing several studies. For the accomplishment of this study we performed a systematic review of the literature, searching for scientific articles of the following databases PubMed, Bireme and Google academic. Results showed that neoplastic cachexia is a very common clinical manifestation in patients with GI cancer. Early nutritional therapy provides beneficial results in terms of minimizing weight loss, reducing deterioration of nutritional status, and physical function. The first nutritional choice should be the oral route. When patients are unable to ingest caloric and mainly oral protein supply, they may be candidates for NE or NP. Recent studies have suggested the association of enteral and parenteral therapies in reducing postoperative complications and in decreasing hospital stay

Imaging methods evaluation in osteoarticular and peripheral nerves involvement in leprosy

In leprosy, bone lesions due direct invasion of bacilli are low in incidence and these lesions exhibit radiologic findings of acute and chronic osteomyelitis similar to those of other granulomatous infectious agents. The more common bone lesions are those due to injurious effects of trauma and infection imposed upon denervated tissues. Radiographycally are seen various degrees of reabsorption of the extremities involving hands and feet with the loss of digits and disorganizing arthropathies in small joints. The radiologic appearance are similar to other conditions in which there is sensory impairment like scleroderma, syringomielia and diabetes mellitus. The ultrasonography and magnetic resonance imaging (MRI) can be helpful in evaluation of the involvement of the peripheral nerves helping in the diagnosis of the neuritis, abscess and differential diagnosis in compressive syndromes.Na hanseníase, lesões ósseas por invasão direta do bacilo são de baixa incidência, e os achados radiológicos destas lesões são de osteomielite aguda ou crônica similares aos de outras infecções granulomatosas. As lesões ósseas mais comuns são devidas ao trauma e a infecção secundária nos tecidos denervados. Radiograficamente, são observados vários graus de reabsorção das extremidades distais envolvendo mãos e pés, ocasionando perda dos dígitos e osteoartropatia neuropática de pequenas articulações. Os achados radiológicos são semelhantes às outras condições nas quais há déficit sensorial, como esclerodermia, siringomielia e diabetes mellitus. A ultra-sonografia (US) e a ressonância magnética (RM) podem ser úteis na avaliação do comprometimento dos nervos periféricos auxiliando no diagnóstico das neurites, abscessos e no diagnóstico diferencial das síndromes compressivas.Hospital Universitário Getúlio VargasUniversidade Federal do Amazonas (UFAM)Universidade Federal de São Paulo (UNIFESP)UFAM Departamento de Clínica MédicaUniversidade de São Paulo (USP)UNIFESP Departamento de MedicinaUNIFESP Departamento de Diagnóstico por ImagemUNIFESP, Depto. de MedicinaUNIFESP, Depto. de Diagnóstico por ImagemSciEL

Transplante de microbiota fecal no tratamento da infecção por Clostridium difficile recorrente—uma revisão

Clostridium difficile infection (CDI) has become one of the major complications associated with the use of systemic antibiotics. Antimicrobials disrupt the balance of the colonic intestinal flora, predisposing the individual to infections by opportunistic strains, such as an CDI, that can characteristically cause a course of diarrhea and colitis. The standard treatment for these cases is the use of metronidazole or vancomycin for a period of 10 to 14 days. However, it is estimated that this therapy will fail in ∼ 5 to 35% of the patients, who will present a recurrence of CDI. The treatment options for recurrent CDI remain limited, but with promising therapies being constantly researched. The use of stools obtained from a donor to perform fecal microbiota transplantation (FMT) has been gaining space in several health centers, with reported success rates of 80 to 100%. However, there still is a limited experience in this subject, with the need for studies that allow the creation of a specific protocol for FMT

ESPAÇOS SÓCIO-OCUPACIONAIS NO INSTITUTO FEDERAL DE EDUCAÇÃO, CIÊNCIA E TECNOLOGIA DE GOIÁS: LOCUS DE EFETIVAÇÃO DA DIMENSÃO SOCIOEDUCATIVA DO TRABALHO DOS ASSISTENTES SOCIAIS

This article aims to present the experience report regarding the construction of the Social Service work proposal at the Federal Institute of Education, Science and Technology of Goiás. This proposal, the result of the articulation of the Social Workers of this Institution. This initiative made it possible to map and define the different work fronts, and, above all, to apprehend these spaces as places for carrying out the socio-educational dimension of the Social Workers' Work.O presente artigo tem o intuito de apresentar o relato de experiência referente à construção da proposta de trabalho do Serviço Social no Instituto Federal de Educação, Ciência e Tecnologia de Goiás. Essa proposta, fruto da articulação das/os Assistentes Sociais desta Instituição. Essa iniciativa possibilitou o mapeamento e a definição das diversas frentes de trabalho, e, sobretudo, apreender esses espaços como locais para efetivação da dimensão socioeducativa do Trabalho das/os Assistentes Sociais

Care4Value:measuring value in health in integrated continuous care units

Objective: To develop a digital platform for optimizing data collection processes with medical scales and monitoring data for measuring value in health. Method: Using an investigative intervention methodology, a platform was developed including qualitative and quantitative approaches in three phases: focal groups were conducted by a multidisciplinary team of investigators and healthcare providers at the pilot study site, an Integrated Continuous Care Unit (UCCI); data from a sample of 21 UCCI users was analyzed as a pre-test to classify different levels of complexity; UCCI financial data and operational costs were collected and analyzed during the 21 users stay at the UCCI. The platform’s iteractive and incremental development allowed for the collection of as a form of improvement. Results: The platform includes three modules: a mobile application; a dashboard; and an import module. Data collected on the platform are centralized and shown on the dashboard. Data are collected using a mobile application and/or an import module to input data from existing medical systems. Conclusion: The mobile application is ready to be used by healthcare providers and caregivers. The dashboard shows users’ clinical follow-up and health gain data for monitoring.info:eu-repo/semantics/publishedVersio

Histórias de vida de educadores riograndenses

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Nutritional therapeutic for the critically ill patients

Nutritional Therapeutic has a great impact on the treatment of the critically ill patient. Its choice and conduct, however, has been a matter of doubt and frequent errors. The choice of nutritional therapeutic and its route of administration must consider if the gastrointestinal tract is available. The enteral route will be used if the gastrointestinal tract is available. If it isn’t; like short bowel syndrome, or gastrointestinal haemorrhage, parenteral nutrition is indicated.This review has the objective of answer the most frequent questions and conduct the nutritional therapeutic in critically ill patients.  A Terapia Nutricional tem tido grande impacto na evolução do paciente grave. Sua escolha e manuseio, no entanto, têm sido alvo de dúvidas e erros freqüentes, principalmente no paciente crítico. A escolha da terapia nutricional a ser realizada, bem como sua via de administração deve levar em conta o quadro clínico e as condições gerais do paciente. A via oral/enteral de oferta de nutrientes, mais fisiológica, é a preferível. Portanto, sempre que possível, deve-se utilizar o trato gastrointestinal. Quando este não puder ser utilizado, a via parenteral está indicada, tanto no sentido de suplementar a nutrição enteral, como quando esta não consegue suprir toda a demanda de nutrientes, de que o paciente necessita. Esta revisão tem por objetivo apresentar e difundir a condução da terapia nutricional no paciente crítico, de forma prática e adequada. De maneira geral, a oferta calórica deverá atender às necessidades basais do paciente e a protéica fornecer material plástico para síntese protéica. Minerais, vitaminas e água deverão ser ajustados às necessidades e ao quadro clínico do paciente em questão

HERVs establish a distinct molecular subtype in stage II/III colorectal cancer with poor outcome

© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.Colorectal cancer (CRC) is one of the most lethal malignancies. The extreme heterogeneity in survival rate is driving the need for new prognostic biomarkers. Human endogenous retroviruses (hERVs) have been suggested to influence tumor progression, oncogenesis and elicit an immune response. We examined multiple next-generation sequencing (NGS)-derived biomarkers in 114 CRC patients with paired whole-exome and whole-transcriptome sequencing (WES and WTS, respectively). First, we demonstrate that the median expression of hERVs can serve as a potential biomarker for prognosis, relapse, and resistance to chemotherapy in stage II and III CRC. We show that hERV expression and CD8+ tumor-infiltrating T-lymphocytes (TILs) synergistically stratify overall and relapse-free survival (OS and RFS): the median OS of the CD8-/hERV+ subgroup was 29.8 months compared with 37.5 months for other subgroups (HR = 4.4, log-rank P < 0.001). Combing NGS-based biomarkers (hERV/CD8 status) with clinicopathological factors provided a better prediction of patient survival compared to clinicopathological factors alone. Moreover, we explored the association between genomic and transcriptomic features of tumors with high hERV expression and establish this subtype as distinct from previously described consensus molecular subtypes of CRC. Overall, our results underscore a previously unknown role for hERVs in leading to a more aggressive subtype of CRC.The biobanking of CRC from Hospital Santa Maria, Lisbon, Portugal, was supported by a grant from the Official Portuguese Funding Agency for Science and Technology (FCT: PIC/IC/82821/2007).info:eu-repo/semantics/publishedVersio

Genetic and microenvironmental intra-tumor heterogeneity impacts colorectal cancer evolution and metastatic development

© The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.Colorectal cancer (CRC) is a highly diverse disease, where different genomic instability pathways shape genetic clonal diversity and tumor microenvironment. Although intra-tumor heterogeneity has been characterized in primary tumors, its origin and consequences in CRC outcome is not fully understood. Therefore, we assessed intra- and inter-tumor heterogeneity of a prospective cohort of 136 CRC samples. We demonstrate that CRC diversity is forged by asynchronous forms of molecular alterations, where mutational and chromosomal instability collectively boost CRC genetic and microenvironment intra-tumor heterogeneity. We were able to depict predictor signatures of cancer-related genes that can foresee heterogeneity levels across the different tumor consensus molecular subtypes (CMS) and primary tumor location. Finally, we show that high genetic and microenvironment heterogeneity are associated with lower metastatic potential, whereas late-emerging copy number variations favor metastasis development and polyclonal seeding. This study provides an exhaustive portrait of the interplay between genetic and microenvironment intra-tumor heterogeneity across CMS subtypes, depicting molecular events with predictive value of CRC progression and metastasis development.This work was financed by national funds from FCT - Fundação para a Ciência e a Tecnologia, I.P., in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences - UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy - i4HB. This research was also funded by: PTDC/MED-ONC/28660/2017 from Fundação para a Ciência e Tecnologia (FCT) to A.R.G. A.R.G is recipient of Researcher Grant CEECIND/02699/2017 from FCT. The biobanking of CRC samples from Hospital Santa Maria, Lisbon, Portugal was supported by FCT research grant PIC/IC/82821/2007. This work was produced with the support of INCD funded by FCT and FEDER under the project 22153-01/SAICT/2016.info:eu-repo/semantics/publishedVersio