Carla Barbosa Nonino-Borges

Desperdício de alimentos intra-hospitalar

OBJETIVO: Verificar a ocorrencia do desperdicio, na forma de resto de alimentos, na Unidade de Alimentacao e Nutricao da Unidade de Emergencia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, da Universidade de Sao Paulo. METODOS: Realizou-se analise descritiva de dados, levantados em um periodo de 14 dias, sobre os restos de alimentos deixados pelos clientes/pacientes, assim como dos custos estimados do total da producao e do resto de alimentos. RESULTADOS: Foram analisadas 650 dietas, totalizando 402kg de alimentos, tendo retornado a Unidade de Alimentacao e Nutricao 123kg (31%) de alimentos. Das dietas distribuidas, 71 (15%) retornaram intactas. Desconsiderando as dietas intactas, o peso total de alimentos produzidos foi de 353kg e o resto de 77kg (22%). O custo total mensal estimado das dietas foi de US

Clinical Predictors of Different Grades of Nonalcoholic Fatty Liver Disease

25,000.00 e o custo estimado dos restos foi de US

Routine abdominal drains after Roux-en-Y gastric bypass: a prospective evaluation of the inflammatory response

7,580.00. CONCLUSAO: Os resultados demonstram uma perda excessiva de alimentos, incompativel com as normas operacionais de uma Unidade de Alimentacao e Nutricao hospitalar, o que nos remete a necessidade de reflexao acerca das possibilidades de ajustes, introduzindo revisoes nas praticas gerenciais e operacionais do servico com enfoque nas acoes interdisciplinares.

Dieta cetogênica no tratamento de epilepsias farmacorresistentes

BackgroundNonalcoholic fatty liver disease (NAFLD) is one of the comorbidities related to obesity. Liver biopsy has been used as the “gold standard” for the diagnosis, grading, and prognosis of obese patients. The objective of the present study was to evaluate clinical predictors of more advanced stages of NAFLD.MethodsIn this retrospective study we assessed several physical and laboratorial factors, including some cytokines, in morbidly obese patients submitted to Roux-en-Y gastric bypass that could be related to the diagnosis and staging of NAFLD. Fragments of the livers were obtained from wedge biopsies during operation.ResultsThe medical records of 259 patients were studied. The patients were divided into four groups: normal hepatic biopsy, steatosis, mild nonalcoholic steatohepatitis (NASH), and moderate and severe NASH. There were no differences in cytokine levels among groups. The triglyceride levels were the only variable that could stratify the grades of NAFLD and also differentiate from normal livers in the female patients. Also in this group, the aminotransferases and GGT levels and fasting glucose were predictors of the more advanced stages of NASH, while BMI and weight were predictors of the more advanced stages of NASH in male patients.ConclusionsThere are no available markers in clinical practice to detect the initial stages of NAFLD. It is very important to perform a liver biopsy in all patients submitted to bariatric surgery and in obese patients with no indication to be operated in the presence of elevated blood levels of aminotransferases, GGT, and fasting glucose.

Evolução da massa corporal magra após 12 meses da cirurgia bariátrica

BACKGROUND Despite the extensive published data regarding the use of drains in surgery, it is still controversial. Most bariatric surgeons use drains as routinely. However, drains have sometimes have been shown to be unhelpful and even to increase the anastomotic leak rates. The purpose of the present study was to evaluate the peritoneal inflammatory response in the presence of a drain left in place until the seventh postoperative day after bariatric surgery. METHODS All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. A 24F Blake drain was left in place for 7 days. The peritoneal effluent from the drain was collected for the determination of cytokine levels and for microbiologic analysis. RESULTS A total of 107 obese patients were studied. A marked increase in the levels of tumor necrosis factor-α and interleukin-1β was observed by the seventh postoperative day, even in patients without any abdominal complications. Bacterial contamination of the peritoneal effluent was also demonstrated. CONCLUSION The results of our study have shown that at 7 days after surgery, a marked peritoneal inflammatory response and bacterial contamination are present. These findings could have resulted from the use of the drain for 7 postoperative days.

Early identification of infectious complications in bariatric surgery by the determination of peritoneal and systemic cytokines.

A epilepsia e uma condicao clinica cronica correspondente a um grupo de doencas que tem em comum crises epilepticas; ela atinge de 0,5% a 1,0% da populacao dos paises desenvolvidos, podendo esta prevalencia ser maior nos paises em desenvolvimento. Aproximadamente um terco dos pacientes evolui com crises epilepticas intrataveis com medicamentos; em alguns casos, e possivel o tratamento cirurgico. Nos pacientes em que cirurgia nao e possivel, a dieta cetogenica passa a ser uma opcao terapeutica, principalmente em criancas. Espera-se que esta terapia seja eficaz para, pelo menos, um terco dos pacientes, resultando em reducao ou controle das crises. No presente trabalho, apresentamos metodos para o preparo e uso a dieta cetogenica. O planejamento da dieta e individualizado, seguindo-se recomendacoes para o consumo energetico e proporcoes de gorduras, proteinas e carboidratos especificos. Sempre que introduzida a dieta, o paciente deve ser monitorizado, devido a possibilidade de efeitos adversos. A orientacao dos pais ou responsaveis sobre a dieta cetogenica, e como ela funciona, proporciona maior aceitacao e aderencia a esta forma de tratamento da epilepsia.

Prospective and randomized comparison of two techniques of staple line reinforcement during open Roux-en-Y gastric bypass: oversewing and bioabsorbable Seamguard®.

OBJETIVO: O objetivo da pesquisa foi determinar a perda de massa corporal magra em pacientes apos cirurgia bariatrica. METODOS: O estudo retrospectivo foi conduzido com 17 prontuarios de mulheres obesas submetidas a Derivacao Gastrica em Y de Roux com anel de contencao gastrica, incluindo dados obtidos no periodo pre-operatorio imediato e no 1o, 3o, 6o e 12o meses apos a cirurgia. Os dados obtidos no prontuario incluiram a idade, medidas de peso, de altura e massa corporal magra e gorda, calculados pela impedância bioeletrica. RESULTADOS: A media de idade das pacientes foi de 43,1, DP=7,7 anos e durante o seguimento houve diminuicao significativa do indice de massa corporal [51,2 (40,2-74,1) para 33,7 (24,8-53,4)kg/m2] e da massa corporal gorda [67,5 (51,2-67,4) para 32,1 (16,4-61,9)kg] em 12 meses de seguimento. No primeiro mes apos a cirurgia, houve diminuicao da massa corporal magra (M=65,3, DP=7,6 para M=59,7, DP=8,1kg), que representou 8,5% em relacao aos valores iniciais, sendo que a partir dai, os dados mantiveram-se constantes. CONCLUSAO: A perda de massa corporal magra pode refletir uma alteracao no metabolismo proteico durante o pos-operatorio imediato da cirurgia bariatrica, que pode implicar em evolucao clinica e nutricional desfavoraveis.

Effect of the classic ketogenic diet on the treatment of refractory epileptic seizures

BackgroundObesity has become a global epidemic and bariatric surgery is one of the therapeutic tools to deal with it. Postoperative complications can occur, such as staple line dehiscence and anastomotic leaks, leading to increased patient mortality. The diagnosis of these complications is frequently difficult. The objective of the present study was to determine whether peritoneal and systemic cytokines could early detect those complications.MethodsAll patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. Blood and peritoneal effluent from the drain were collected for the determination of cytokine levels. We also evaluated the clinical signs and the leukograms of the patients.ResultsA total of 107 obese patients were studied. Ninety patients had no complications; 17 had at least one infectious complication which include five cases of staple line dehiscence. Until the third postoperative day, the vital signs and the leukogram did not predict the onset of infectious complications, but the cytokines (interleukin-1β and interleukin-6) were early markers of these complications.ConclusionCytokines are good predictors of poor postoperative evolution in bariatric surgery since peritoneal cytokines diagnose better these infectious complications even before changes in blood count and before the occurrence of clinical manifestations.

Nutritional Course of Patients Submitted to Bariatric Surgery

AIMS Surgical staple line dehiscence usually leads to severe complications. Several techniques and materials have been used to reinforce this stapling and thus reduce the related complications. The objective was to compare safety of two types of anastomotic reinforcement in open gastric bypass. METHODS A prospective, randomized study comparing an extraluminal suture, fibrin glue, and a nonpermanent buttressing material, Seamguard®, for staple line reinforcement. Fibrin glue was excluded from the study and analysis after two leaks, requiring surgical reintervention, antibiotic therapy, and prolonged patient hospitalization. RESULTS Twenty patients were assigned to the suture and Seamguard reinforcement groups. The groups were similar in terms of preoperative characteristics. No staple line dehiscence occurred in the two groups, whereas two cases of dehiscence occurred in the fibrin glue group. No mortality occurred and surgical time was statistically similar for both techniques. Seamguard made the surgery more expensive. CONCLUSION In our service, staple line reinforcement in open bariatric surgery with oversewing or Seamguard was considered to be safe. Seamguard application was considered to be easier than oversewing, but more expensive.

Factors Related to Weight Loss up to 4 Years after Bariatric Surgery

OBJETIVO: A dieta cetogenica e empregada como uma terapia alternativa para o tratamento da epilepsia em pacientes com epilepsia refrataria e simula as alteracoes bioquimicas de jejum. Neste trabalho, verificouse o impacto nutricional da dieta cetogenica em criancas com epilepsia refrataria. METODOS: Os dados sobre o estado nutricional (bioquimica, alimentar e medidas antropometricas), a frequencia de crises e os eventos adversos de criancas acompanhadas durante 36 meses foram coletados de prontuarios medicos e visitas ambulatoriais. RESULTADOS: Vinte e nove criancas iniciaram o tratamento; apos um mes, 75,8% apresentaram reducao das crises. Em seis meses, 48,3% dos pacientes tiveram pelo menos 90,0% de reducao na frequencia de crises, e, desses, 50,0% obtiveram o controle completo das crises. Aos doze meses, oito pacientes continuaram a apresentar Resultados positivos, e, desses, sete permaneceram em dieta cetogenica durante 24 meses. Observouse melhora do estado nutricional aos 24 meses de tratamento, especialmente em termos de peso, o que indica a recuperacao da condicao peso para altura. Nao houve mudancas significativas nos indices bioquimicos analisados (colesterol total e de componentes, triglicerideos, albumina, proteina total, creatinina, glicemia, transaminase glutâmico oxalacetica serica e transaminase glutâmico piruvico serica). Os niveis de colesterol aumentaram significativamente no primeiro mes, mas diminuiram nos seis meses seguintes e, posteriormente, se mantiveram dentro dos valores de referencia. CONCLUSAO: Os pacientes em uso da dieta cetogenica classica por pelo menos 24 meses apresentaram melhora de peso e cerca de um terco dos pacientes conseguiu uma reducao significativa da frequencia de crises, com alguns pacientes completamente livres delas.