Juliana Rodrigues

Nutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice

The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis.

A corrida de massa do rio Vieira em Teresópolis, sudeste do Brasil: caracterização da área-fonte dos sedimentos transportados

This work has presents the geology of the bedrock and the sedimentary deposits of the upper course of the Vieira river where a debris flow killed 23 people on January 2011. The upper course of rio Vieira has drawn a straight line and is embedded in a N25E trending fracture and fault system. Over the almost 2 km of exposed bedrock, there is a predominance of gneissic Cordeiro and Serra dos Orgaos suites. The granite of the Nova Friburgo suite occurs only in the river head and in a narrow strip in the middle section of the channel. Three types of sedimentary remnants were observed: a) talus deposit with granite boulders in the river head; b) gneissic rock fall deposits near the the channel walls; c) granite boulders and gneissic blocks in the floodplain. The presence of granite boulders at the head and the scarcity of the granite in the bedrock indicates that the bulk transported solids comes from the erosion of talus deposits in the headwaters of the river. The blocks of gneiss comes from rock-fall deposits along the channel walls.