Maria do Rosário Del Lama de Unamuno

Distribuição da gordura corporal em pacientes com e sem doenças crônicas: uso da relação cintura-quadril e do índice de gordura do braço

The objective of this work was to evaluate the distribution of corporal, visceral and not visceral fat, in hospitalized patients, measured by means of the anthropometry. The study evaluated 157 hospitalized patients, distributed in two groups: Group I (95 patients with chronic-degenerative diseases) and Group II (62 patients with liver, lung and kidney diseases, neoplasms, ulcers, gastritis, and hematologic diseases). The following anthropometric measurements were obtained from each patient: weight, height, triceps skinfold thickness and circumferences (waist and hip). The largest values of the parameters waist to hip relationship and arm fat index were found in the Group I and these values were significantly superior when compared to the Group II. The results demonstrated that, in the group of patients studied, there was a differentiated distribution of body fat between patients Group I and Group II. These relationships confirm that the patients with chronic-degenerative diseases (Group I) present values of waist to hip relationship and arm fat index that are differentiating in relation to the patients with liver, lung and kidney diseases, neoplasms, ulcers, gastritis and hematologic diseases (Group II).

Avaliação dos níveis séricos das vitaminas A, E, C e B2, de carotenóides e zinco, em idosos hospitalizados

Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients.Serum levels of carotenoids, zinc and vitamins A, E, C and B2 were measured in al (n = 202) the elderly patients hospitalized in different wards of the hospital studied from February 1986 to October 1988. The study was conducted on 130 men and 72 women with a mean age of 67.8 years (range: 60 to 88 years). The percentage of nutritional deficiency was 59.5% for zinc, 56.5% for vitamin C, 34.5% for vitamin B2, 25.9% for vitamin E, 13.2% for vitamin A, and 6.8% for carotenoids. Elderly patients with leucoses, megaesophagus, chronic obstructive pulmonary disease, and congestive heart failure represent a group with a high prevalence of deficiency both of zinc and of the vitamins under study. These results show the importance of detecting deficiencies of these micronutrients and provide a basis for a more rational approach to the treatment of elderly patients.Foram verificados os niveis sericos de zinco, carotenoides e vitaminas A, E, C, B2 em todos os idosos (n = 202) internados nas diversas enfermarias do hospital estudado, no periodo de fevereiro de 1986 a outubro de 1988. Foram estudados 130 homens e 72 mulheres que apresentaram media de idade de 67,8 anos, com variacao entre 60 a 88. A percentagem de niveis sericos deficitarios foi de 59,5 para o zinco, 56,5% para a vitamina C, 34,5% para a vitamina B2, 26% para a vitamina E, 13,2% para a vitamina A e 6,8% para os carotenoides. Os idosos portadores de leucoses, magaesofogo, doenca pulmonar obstrutiva cronica e insuficiencia cardiaca congestiva constituiram-se no grupo de pacientes com grande prevalencia de estado deficitario de zinco e das vitaminas estudadas, resultados que mostram a importância de se investigar as deficiencias desses micronutrientes e dao subsidios para a abordagem terapeutica mais racional do paciente idoso internado.

Uso de cateteres venosos totalmente implantados para nutrição parenteral: cuidados, tempo de permanência e ocorrência de complicações infecciosas

Cateteres venosos totalmente implantados sao utilizados em pacientes com sindrome do intestino curto, pararealizar o suporte nutricional parenteral, o qual mantem estes pacientes vivos, pois fornece-lhes nutrientesque sao absorvidos pela via digestiva. No entanto, estes cateteres nao sao isentos de complicacoes. Asinfeccoes relacionadas aos cateteres venosos sao as complicacoes mais temidas e sua incidencia varia de 3%a 20%, aumentando em pacientes mais graves. O objetivo do presente estudo e descrever as complicacoesinfecciosas em pacientes recebendo nutricao parenteral por meio de cateteres venosos totalmente implantados.Tais cateteres sao utilizados pela Divisao de Nutricao Clinica do Hospital das Clinicas da Faculdade de Medicinade Ribeirao Preto, Universidade de Sao Paulo, para realizar o suporte nutricional parenteral em pacientessubmetidos a resseccoes extensas de intestino delgado. Foram avaliadas as complicacoes infecciosas ocorridascom 21 cateteres, implantados em 16 pacientes. O tempo de permanencia dos cateteres foi de 768±664,3dias (mediana 529 dias) e a taxa de infeccao foi de 0,029 infeccoes/paciente/ano, resultados que se comparamas taxas de infeccao observadas em paises desenvolvidos. Concluiu-se que os cuidados observados no manuseiodestes cateteres foram de fundamental importância para diminuir a incidencia de infeccao nestes pacientes.

Evolução antropométrica e sintomas gastrointestinais em pacientes que receberam suplementos nutricionais ou nutrição enteral

OBJECTIVE: To compare the evolution of anthropometric variables and the occurrence of adverse effects related to the ingestion of nutritional food supplements and enteral diet administration in hospitalized patients. METHODS: The study was performed in the Clinical Medicine wards of the Hospital of the School of Medicine of Ribeirao Preto, USP, with 10 patients receiving nutrition supplements, and 20 patients under enteral nutrition therapy, paired by gender, age (50 ± 21 vs 49 ± 23 years) and basic afflictions. All were volunteers submitted to anthropometric evaluation at the beginning and end of nutritional therapy, utilizing standard techniques. A semi-structured questionnaire was applied daily referring to gastrointestinal complaints. Statistical differences between onset and final results (t-test for dependent samples) and between-group differences (t-test for independent samples) were estimated. RESULTS: Arm muscle circumference increased in patients receiving enteral nutrition therapy (80 ± 15 vs 85 ± 15% adequacy, p = 0.009) and decreased in those receiving nutritional supplements (96 ± 14 vs 92 ± 14% adequacy, p = 0.04). Nausea and vomiting were more frequent in the latter (60 vs 10%, p = 0.01); complaints about taste of the products were reported by 30% of the cases. CONCLUSION: Patients who received oral nutrition supplements reported gastrointestinal complaints and had a less favorable anthropometric evolution. Study data did not disclose the benefit of routine nutrition supplements for hospitalized patients.

Body surface infrared thermometry in patients with central venous cateter-related infections

Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections. Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject. Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus -0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus -0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus -0.22 - -0.10ºC; p<0.01). Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area.

Breath 13CO2 enrichment in obese women during the fasting and the fed states

Abstract The objective of the present study was to assess by isotope ratio mass spectrometry the breath 13 CO 2 enrichment in obese women during the fasting and the fed states and to correlate it with blood 13 CO 2 enrichment. Eight obese women aged 30 ± 6 years (mean ± SD), body mass index of 40 ± 8 kg/m 2 were submitted to intravenous infusion of 13 NaHCO 3 for eight hours. During the first four hours the subjects fasted and during the subsequent four hours they ingested 1 meal per hour. Breath 13 CO 2 enrichment (XCO 2 ) was 0.72 ± 0.12 during fasting and 0.75 ± 0.14 during feeding ( P > 0.5, non parametric Wilcoxon test). Blood 13 CO 2 enrichment was higher during food ingestion (0.61 ± 0.14 against 0.51 ± 0.14 in the fasted state, P = 0.0078). We conclude that breath 13 CO 2 enrichment was not different under fasting and fed conditions. The greater blood enrichment during feeding was not accompanied by greater breath enrichment, indicating that CO 2 is shifted to other metabolic pathways.