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[PMID]:29465577
[Au] Autor:Peng T; Hu Z; Yang X; Gao Y; Ma C
[Ad] Endereço:Department of Nephrology, Shandong University Qilu Hospital, Jinan City, China.
[Ti] Título:Nitrite-induced acute kidney injury with secondary hyperparathyroidism: Case report and literature review.
[So] Source:Medicine (Baltimore);97(8):e9889, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Acute kidney injury (AKI) with hyperparathyroidism caused by nitrite was rare, and renal function and parathyroid hormone (PTH) decreased to normal range after therapy. PATIENT CONCERNS: Acute kidney injury was diagnosed in a 40-year-old male with hyperparathyroidism and cyanosis of his hands and both forearms. DIAGNOSES: The patient ate some recently pickled vegetables, and he experienced nausea, vomiting and diarrhoea without oliguria or anuria; Additionally, his hands and both forearms had a typical blue ash appearance. After admission, the laboratory findings indicated theincreasing serum creatinine (Scr) and parathyroid hormone (PTH). He was diagnosed as acute kidney injury with hyperparathyroidism caused by nitrite. INTERVENTIONS: The patient stopped eating the pickled vegetables and was given rehydration, added calories and other supportive therapy without any glucocorticoids. OUTCOMES: According to his clinical manifestations, laboratory findings and imaging results, the patient was diagnosed with acute kidney injury with secondary hyperparathyroidism. He was given symptomatic supportive care therapy. After one week, the serum creatinine, parathyroid hormone (PTH), hypercalcemia, hyperphosphatemia, proteinuria, and urine red blood cell values decreased to normal range. LESSONS: Nitrite-induced acute kidney injury with secondary hyperparathyroidism was relatively rare. After therapy, the function of the kidney and parathyroid returned to normal. This case suggests that detailed collection of medical history, physical examination and correct symptomatic treatment is very important.
[Mh] Termos MeSH primário: Lesão Renal Aguda/induzido quimicamente
Hiperparatireoidismo Secundário/induzido quimicamente
Nitritos/envenenamento
[Mh] Termos MeSH secundário: Lesão Renal Aguda/terapia
Adulto
Cianose/induzido quimicamente
Diarreia/induzido quimicamente
Hidratação
Conservação de Alimentos
Seres Humanos
Hiperparatireoidismo Secundário/terapia
Masculino
Náusea/induzido quimicamente
Apoio Nutricional
Vômito/induzido quimicamente
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Nitrites)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009889


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[PMID]:28458120
[Au] Autor:Kempf E; Tournigand C; Rochigneux P; Aubry R; Morin L
[Ad] Endereço:AP-HP, Henri Mondor University Hospital, Medical Oncology Department, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
[Ti] Título:Discrepancies in the use of chemotherapy and artificial nutrition near the end of life for hospitalised patients with metastatic gastric or oesophageal cancer. A countrywide, register-based study.
[So] Source:Eur J Cancer;79:31-40, 2017 07.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To evaluate the frequency and the factors associated with the use of chemotherapy and artificial nutrition near the end of life in hospitalised patients with metastatic oesophageal or gastric cancer. METHODS: Nationwide, register-based study, including all hospitalised adults (≥20 years) who died with metastatic oesophageal or gastric cancer between 2010 and 2013, in France. Chemotherapy and artificial nutrition during the final weeks of life were considered as primary outcomes. RESULTS: A total of 4031 patients with oesophageal cancer and 10,423 patients with gastric cancer were included. While the proportion of patients receiving chemotherapy decreased from 35.9% during the 3rd month before death to 7.9% in the final week (p < 0.001 for trend), the use of artificial nutrition rose from 9.6% to 16.0% of patients. During the last week before death, patients with stomach cancer were more likely to receive chemotherapy (adjusted odds ratio (aOR) = 1.35, 95% CI = 1.17-1.56) but less likely to receive artificial nutrition (aOR = 0.80, 95%CI = 0.73-0.88) than patients with cancer of the oesophagus. The adjusted rates of chemotherapy use during the last week of life varied from 1.6% in rural hospitals to 11.2% in comprehensive cancer centres, while the adjusted probability to receive artificial nutrition varied from 12.1% in private for-profit clinics up to 19.9% in rehabilitation care facilities (p < 0.001). CONCLUSIONS: Our study shows that in hospitalised patients with metastatic oesophageal or gastric cancer, the use of chemotherapy decreases while the use of artificial nutrition increases as death approaches. This raises important questions, as clinical guidelines clearly recommend to limit the use of artificial nutrition in contexts of limited life expectancy.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Neoplasias Esofágicas/terapia
Apoio Nutricional/utilização
Neoplasias Gástricas/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Institutos de Câncer/estatística & dados numéricos
Feminino
França
Hospitalização/estatística & dados numéricos
Hospitais Urbanos/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Metástase Neoplásica
Estado Nutricional
Sistema de Registros
Estudos Retrospectivos
Saúde da População Rural/estatística & dados numéricos
Assistência Terminal/métodos
Assistência Terminal/estatística & dados numéricos
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171230
[Lr] Data última revisão:
171230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:27739314
[Au] Autor:Manásek V; Bezdek K; Foltys A; Klos K; Smitka J; Smehlik D
[Ti] Título:The Impact of High Protein Nutritional Support on Clinical Outcomes and Treatment Costs of Patients with Colorectal Cancer.
[Ti] Título:Vliv nutricní podpory s vysokým obsahem bílkovin na výsledky lécby a náklady u pacientu s kolorektálním karcinomem..
[So] Source:Klin Onkol;29(5):351-357, 2016.
[Is] ISSN:0862-495X
[Cp] País de publicação:Czech Republic
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The primary objective of this study was to investigate the impact of high protein oral nutrition support (ONS) on clinical outcomes in patients with colorectal cancer (CRC). The secondary aim was to compare the cost of treatment and length of stay (LoS) for CRC patients taking high protein ONS vs. patients on conventional nutritional support. MATERIALS AND METHODS: The study was conducted on adult patients with CRC undergoing colorectal surgery. Informed consent was obtained before the study. The study group (SG; n = 52) was instructed to take high protein ONS (600 kcal, 40 g protein per day) in addition to a normal diet for at least 10 days before and two weeks after surgery. Data from the comparative group (CG; n = 105) were collected retrospectively. RESULTS: A relative reduction in the frequency of the following complications was observed in SG: wound dehiscence (2.2 times lower), infections (4.3 times lower), anastomosis dehiscence (2.0 times lower), and rehospitalization (1.7 times lower). The mean LoS was shorter in SG (9.4 ± 4.97 vs. CG 12 ± 6.4 days), which resulted in significantly lower treatment costs during hospitalization (SG 479 vs. CG 538 EUR; p = 0.01) and at six months after surgery (SG 4,862 vs. CG 6,456 EUR). CONCLUSION: Pre- and postoperative high protein ONS reduces LoS, treatment costs, postoperative complications, and re-hospitalizations in CRC, regardless of initial nutritional status.Key words: high protein oral nutritional support - colorectal cancer - perioperative care.
[Mh] Termos MeSH primário: Neoplasias Colorretais/dietoterapia
Neoplasias Colorretais/economia
Cirurgia Colorretal/economia
Cirurgia Colorretal/reabilitação
Proteínas na Dieta/administração & dosagem
Hospitalização/economia
[Mh] Termos MeSH secundário: Administração Oral
Adulto
Neoplasias Colorretais/cirurgia
Suplementos Nutricionais
Seres Humanos
Tempo de Internação
Apoio Nutricional
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dietary Proteins)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171205
[Lr] Data última revisão:
171205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161015
[St] Status:MEDLINE


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[PMID]:29091557
[Au] Autor:Mendell JR; Al-Zaidy S; Shell R; Arnold WD; Rodino-Klapac LR; Prior TW; Lowes L; Alfano L; Berry K; Church K; Kissel JT; Nagendran S; L'Italien J; Sproule DM; Wells C; Cardenas JA; Heitzer MD; Kaspar A; Corcoran S; Braun L; Likhite S; Miranda C; Meyer K; Foust KD; Burghes AHM; Kaspar BK
[Ad] Endereço:From the Center for Gene Therapy at the Research Institute at Nationwide Children's Hospital (J.R.M., S.A.-Z., L.R.R.-K., L.L., L.A., K.B., K.C., S.L., C.M., K.M., B.K.K.) and the Departments of Pediatrics (J.R.M., S.A.-Z., R.S., L.L., L.A., K.B., K.C., J.T.K., B.K.K.), Neurology (J.R.M., W.D.A., L.
[Ti] Título:Single-Dose Gene-Replacement Therapy for Spinal Muscular Atrophy.
[So] Source:N Engl J Med;377(18):1713-1722, 2017 11 02.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spinal muscular atrophy type 1 (SMA1) is a progressive, monogenic motor neuron disease with an onset during infancy that results in failure to achieve motor milestones and in death or the need for mechanical ventilation by 2 years of age. We studied functional replacement of the mutated gene encoding survival motor neuron 1 (SMN1) in this disease. METHODS: Fifteen patients with SMA1 received a single dose of intravenous adeno-associated virus serotype 9 carrying SMN complementary DNA encoding the missing SMN protein. Three of the patients received a low dose (6.7×10 vg per kilogram of body weight), and 12 received a high dose (2.0×10 vg per kilogram). The primary outcome was safety. The secondary outcome was the time until death or the need for permanent ventilatory assistance. In exploratory analyses, we compared scores on the CHOP INTEND (Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders) scale of motor function (ranging from 0 to 64, with higher scores indicating better function) in the two cohorts and motor milestones in the high-dose cohort with scores in studies of the natural history of the disease (historical cohorts). RESULTS: As of the data cutoff on August 7, 2017, all 15 patients were alive and event-free at 20 months of age, as compared with a rate of survival of 8% in a historical cohort. In the high-dose cohort, a rapid increase from baseline in the score on the CHOP INTEND scale followed gene delivery, with an increase of 9.8 points at 1 month and 15.4 points at 3 months, as compared with a decline in this score in a historical cohort. Of the 12 patients who had received the high dose, 11 sat unassisted, 9 rolled over, 11 fed orally and could speak, and 2 walked independently. Elevated serum aminotransferase levels occurred in 4 patients and were attenuated by prednisolone. CONCLUSIONS: In patients with SMA1, a single intravenous infusion of adeno-associated viral vector containing DNA coding for SMN resulted in longer survival, superior achievement of motor milestones, and better motor function than in historical cohorts. Further studies are necessary to confirm the safety and efficacy of this gene therapy. (Funded by AveXis and others; ClinicalTrials.gov number, NCT02122952 .).
[Mh] Termos MeSH primário: Terapia Genética
Atrofias Musculares Espinais da Infância/terapia
Proteína 1 de Sobrevivência do Neurônio Motor/genética
[Mh] Termos MeSH secundário: Estudos de Coortes
Dependovirus
Intervalo Livre de Doença
Feminino
Terapia Genética/efeitos adversos
Vetores Genéticos
Estudo Historicamente Controlado
Seres Humanos
Lactente
Recém-Nascido
Infusões Intravenosas
Hepatopatias/etiologia
Masculino
Destreza Motora
Apoio Nutricional
Respiração Artificial
Atrofias Musculares Espinais da Infância/genética
Atrofias Musculares Espinais da Infância/fisiopatologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; CLINICAL TRIAL, PHASE II; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Survival of Motor Neuron 1 Protein)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171102
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1706198


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[PMID]:29023536
[Au] Autor:Haider S; Grabovac I; Winzer E; Kapan A; Schindler KE; Lackinger C; Titze S; Dorner TE
[Ad] Endereço:Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna; Austria.
[Ti] Título:Change in inflammatory parameters in prefrail and frail persons obtaining physical training and nutritional support provided by lay volunteers: A randomized controlled trial.
[So] Source:PLoS One;12(10):e0185879, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of the study was to compare the effects of home visits with physical training and nutritional support on inflammatory parameters to home visits with social support alone within a randomized controlled trial. Prefrail and frail persons received home visits from lay volunteers twice a week for 12 weeks. Participants in the physical training and nutritional intervention group (PTN, n = 35) conducted two sets of six strength exercises and received nutritional support. The social support group (SoSu, n = 23) received visits only. TNF-α, IL-6, CRP, and total leukocyte count were assessed at baseline and after 12 weeks. Changes over time within groups were analyzed with paired t-tests; differences between groups were analyzed with ANCOVA for repeated measurements. In the PTN group, IL-6 and CRP remained stable, whereas in the SoSu group, IL-6 increased significantly from a median value of 2.6 pg/l (min-max = 2.0-10.2) to 3.0 pg/l (min-max = 2.0-20.8), and CRP rose from 0.2 mg/dl (min-max = 0.1-0.9) to 0.3 mg/dl (min-max = 0.1-3.0) after 12 weeks. In CRP, a significant difference between groups was found. TNF-α and total leukocyte count did not change in either the PTN group or the SoSu group. Persons showing an increase in physical performance (OR 4.54; 95% CI = 1.33-15.45) were more likely to have constant or decreased IL-6 values than persons who showed no improvement. In conclusion, in non-robust older adults, a physical training and nutritional support program provided by lay volunteers can delay a further increase in some inflammatory parameters.
[Mh] Termos MeSH primário: Proteína C-Reativa/metabolismo
Terapia por Exercício
Idoso Fragilizado
Interleucina-6/sangue
Apoio Social
Fator de Necrose Tumoral alfa/sangue
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Inflamação/sangue
Inflamação/fisiopatologia
Inflamação/terapia
Masculino
Apoio Nutricional
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (IL6 protein, human); 0 (Interleukin-6); 0 (Tumor Necrosis Factor-alpha); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171022
[Lr] Data última revisão:
171022
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171013
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185879


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[PMID]:28978695
[Au] Autor:DeVilbiss EA; Magnusson C; Gardner RM; Rai D; Newschaffer CJ; Lyall K; Dalman C; Lee BK
[Ad] Endereço:Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA.
[Ti] Título:Antenatal nutritional supplementation and autism spectrum disorders in the Stockholm youth cohort: population based cohort study.
[So] Source:BMJ;359:j4273, 2017 Oct 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: To determine whether nutritional supplementation during pregnancy is associated with a reduced risk of autism spectrum disorder (ASD) with and without intellectual disability in offspring. Observational prospective cohort study using multivariable logistic regression, sibling controls, and propensity score matching. Stockholm County, Sweden. 273 107 mother-child pairs identified through population registers. The study sample was restricted to children who were aged 4 to 15 years by the end of follow-up on 31 December 2011 and were born between 1996 and 2007. Multivitamin, iron, and folic acid supplement use was reported at the first antenatal visit. Diagnosis of ASD with and without intellectual disability in children determined from register data up to 31 December 2011. Prevalence of ASD with intellectual disability was 0.26% (158 cases in 61 934) in the maternal multivitamin use group and 0.48% (430 cases in 90 480) in the no nutritional supplementation use group. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of ASD with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid (odds ratio 0.69, 95% confidence interval 0.57 to 0.84). Similar estimates were found in propensity score matched (0.68, 0.54 to 0.86) and sibling control (0.77, 0.52 to 1.15) matched analyses, though the confidence interval for the latter association included 1.0 and was therefore not statistically significant. There was no consistent evidence that either iron or folic acid use were inversely associated with ASD prevalence. Maternal multivitamin supplementation during pregnancy may be inversely associated with ASD with intellectual disability in offspring. Further scrutiny of maternal nutrition and its role in the cause of autism is recommended.
[Mh] Termos MeSH primário: Transtorno do Espectro Autista
Ácido Fólico/administração & dosagem
Deficiência Intelectual
Ferro/administração & dosagem
Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia
Vitaminas/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Transtorno do Espectro Autista/epidemiologia
Transtorno do Espectro Autista/etiologia
Transtorno do Espectro Autista/prevenção & controle
Transtorno do Espectro Autista/psicologia
Criança
Pré-Escolar
Suplementos Nutricionais
Feminino
Seres Humanos
Deficiência Intelectual/epidemiologia
Deficiência Intelectual/etiologia
Deficiência Intelectual/fisiopatologia
Masculino
Apoio Nutricional/métodos
Avaliação de Resultados (Cuidados de Saúde)
Gravidez
Resultado da Gravidez
Prevalência
Estatística como Assunto
Suécia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Vitamins); 935E97BOY8 (Folic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171028
[Lr] Data última revisão:
171028
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j4273


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[PMID]:28940219
[Au] Autor:Probst P; Ohmann S; Klaiber U; Hüttner FJ; Billeter AT; Ulrich A; Büchler MW; Diener MK
[Ad] Endereço:Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
[Ti] Título:Meta-analysis of immunonutrition in major abdominal surgery.
[So] Source:Br J Surg;104(12):1594-1608, 2017 Nov.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The objective of this study was to evaluate the potential benefits of immunonutrition in major abdominal surgery with special regard to subgroups and influence of bias. METHODS: A systematic literature search from January 1985 to July 2015 was performed in MEDLINE, Embase and CENTRAL. Only RCTs investigating immunonutrition in major abdominal surgery were included. Outcomes evaluated were mortality, overall complications, infectious complications and length of hospital stay. The influence of different domains of bias was evaluated in sensitivity analyses. Evidence was rated according to the GRADE Working Group grading of evidence. RESULTS: A total of 83 RCTs with 7116 patients were included. Mortality was not altered by immunonutrition. Taking all trials into account, immunonutrition reduced overall complications (odds ratio (OR) 0·79, 95 per cent c.i. 0·66 to 0·94; P = 0·01), infectious complications (OR 0·58, 0·51 to 0·66; P < 0·001) and shortened hospital stay (mean difference -1·79 (95 per cent c.i. -2·39 to -1·19) days; P < 0·001) compared with control groups. However, these effects vanished after excluding trials at high and unclear risk of bias. Publication bias seemed to be present for infectious complications (P = 0·002). Non-industry-funded trials reported no positive effects for overall complications (OR 1·13, 0·88 to 1·46; P = 0·34), whereas those funded by industry reported large effects (OR 0·66, 0·48 to 0·91; P = 0·01). CONCLUSION: Immunonutrition after major abdominal surgery did not seem to alter mortality (GRADE: high quality of evidence). Immunonutrition reduced overall complications, infectious complications and shortened hospital stay (GRADE: low to moderate). The existence of bias lowers confidence in the evidence (GRADE approach).
[Mh] Termos MeSH primário: Abdome/cirurgia
Apoio Nutricional/métodos
Complicações Pós-Operatórias/prevenção & controle
[Mh] Termos MeSH secundário: Seres Humanos
Infecção/mortalidade
Controle de Infecções
Tempo de Internação
Complicações Pós-Operatórias/mortalidade
Viés de Publicação
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170924
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10659


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[PMID]:28822398
[Au] Autor:Douglas MJ; Ciraulo D
[Ti] Título:Variability in Perioperative Fasting Practices Negatively Impacts Nutritional Support of Critically Ill Intubated Patients.
[So] Source:Am Surg;83(8):895-900, 2017 Aug 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of the study was to quantify nutritional losses related to pre- and postoperative fasts in critically ill intubated patients and to explore whether shorter fasts are safe and appropriate in this population. A retrospective review of mechanically ventilated adults undergoing surgery more than 24 hours after admission to a Level I trauma center over 15 months was done, which yielded 132 procedures and 81 unique patients. Ninety per cent of preoperative periods and 43 per cent of postoperative periods were affected by nonmedical barriers to feeding. Eighty-two per cent of gastrically fed nonemergent cases were fasted for longer than the 6-hour American Society of Anesthesiologists guideline, whereas 91 per cent of emergent cases had shorter fasts. There were no anesthetic complications, placing an upper limit of 6 per cent on the rate of aspiration for fasts shorter than six hours (95% confidence). Forty-three per cent of cases did not resume tube feeds within 90 minutes postoperatively, and only 37 per cent had a documented justification for delay. Intubated patients were frequently fasted preoperatively for longer than recommended and postoperatively for longer than medically indicated. No complications were observed with shorter-than-guideline fasts. This strengthens the evidence that "standard" preoperative fasting is unnecessary and deleterious in many critically ill intubated patients. New protocols and national guidelines are needed to ensure adequate nutrition.
[Mh] Termos MeSH primário: Jejum/efeitos adversos
Intubação Gastrointestinal
Apoio Nutricional
Cuidados Pós-Operatórios
Cuidados Pré-Operatórios
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Estado Terminal
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170821
[St] Status:MEDLINE


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[PMID]:28814218
[Au] Autor:Nikfarjam M; Wilson JS; Smith RC; Australasian Pancreatic Club Pancreatic Enzyme Replacement Therapy Guidelines Working Group
[Ad] Endereço:Austin Health, Melbourne, VIC mehrdad.nikfarjam@gmail.com.
[Ti] Título:Diagnosis and management of pancreatic exocrine insufficiency.
[So] Source:Med J Aust;207(4):161-165, 2017 Aug 21.
[Is] ISSN:1326-5377
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food. Main recommendations: The guidelines provide advice on diagnosis and management of PEI, noting the following: A high prevalence of PEI is seen in certain diseases and conditions, such as cystic fibrosis, acute and chronic pancreatitis, pancreatic cancer and pancreatic surgery. The main symptoms of PEI are steatorrhoea or diarrhoea, abdominal pain, bloating and weight loss. These symptoms are non-specific and often go undetected and untreated. PEI diagnosis is predominantly based on clinical findings and the presence of underlying disease. The likelihood of PEI in suspected patients has been categorised into three groups: definite, possible and unlikely. If left untreated, PEI may lead to complications related to fat malabsorption and malnutrition, and have an impact on quality of life. Pancreatic enzyme replacement therapy (PERT) remains the mainstay of PEI treatment with the recommended adult initial enzyme dose being 25 000-40 000 units of lipase per meal, titrating up to a maximum of 75 000-80 000 units of lipase per meal. Adjunct acid-suppressing therapy may be useful when patients still experience symptoms of PEI on high dose PERT. Nutritional management by an experienced dietitian is essential. Changes in management as a result of these guidelines: These are the first guidelines to classify PEI as being definite, possible or unlikely, and provide a diagnostic algorithm to facilitate the early diagnosis of PEI and appropriate use of PERT.
[Mh] Termos MeSH primário: Gerenciamento Clínico
Terapia de Reposição de Enzimas
Insuficiência Pancreática Exócrina/diagnóstico
Insuficiência Pancreática Exócrina/terapia
[Mh] Termos MeSH secundário: Austrália
Seres Humanos
Apoio Nutricional
Guias de Prática Clínica como Assunto
Qualidade de Vida
Sociedades Médicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE


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[PMID]:28813529
[Au] Autor:Abecia L; Jiménez E; Martínez-Fernandez G; Martín-García AI; Ramos-Morales E; Pinloche E; Denman SE; Newbold CJ; Yáñez-Ruiz DR
[Ad] Endereço:Estación Experimental del Zaidín (CSIC), Granada, Spain.
[Ti] Título:Natural and artificial feeding management before weaning promote different rumen microbial colonization but not differences in gene expression levels at the rumen epithelium of newborn goats.
[So] Source:PLoS One;12(8):e0182235, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this work was to evaluate the effect of feeding management during the first month of life (natural with the mother, NAT, or artificial with milk replacer, ART) on the rumen microbial colonization and the host innate immune response. Thirty pregnant goats carrying two fetuses were used. At birth one kid was taken immediately away from the doe and fed milk replacer (ART) while the other remained with the mother (NAT). Kids from groups received colostrum during first 2 days of life. Groups of four kids (from ART and NAT experimental groups) were slaughtered at 1, 3, 7, 14, 21 and 28 days of life. On the sampling day, after slaughtering, the rumen content was sampled and epithelial rumen tissue was collected. Pyrosequencing analyses of the bacterial community structure on samples collected at 3, 7, 14 and 28 days showed that both systems promoted significantly different colonization patterns (P = 0.001). Diversity indices increased with age and were higher in NAT feeding system. Lower mRNA abundance was detected in TLR2, TLR8 and TLR10 in days 3 and 5 compared to the other days (7, 14, 21 and 28). Only TLR5 showed a significantly different level of expression according to the feeding system, presenting higher mRNA abundances in ART kids. PGLYRP1 showed significantly higher abundance levels in days 3, 5 and 7, and then experienced a decline independently of the feeding system. These observations confirmed a highly diverse microbial colonisation from the first day of life in the undeveloped rumen, and show that the colonization pattern substantially differs between pre-ruminants reared under natural or artificial milk feeding systems. However, the rumen epithelial immune development does not differentially respond to distinct microbial colonization patterns.
[Mh] Termos MeSH primário: Ração Animal
Mucosa Gástrica/metabolismo
Mucosa Gástrica/microbiologia
Microbioma Gastrointestinal
Expressão Gênica
Apoio Nutricional
Rúmen/microbiologia
Desmame
[Mh] Termos MeSH secundário: Animais
Biodiversidade
Biomarcadores
Código de Barras de DNA Taxonômico
Feminino
Mucosa Gástrica/imunologia
Cabras
Imunoglobulina A/sangue
Imunoglobulina A/imunologia
Imunoglobulina G/sangue
Imunoglobulina G/imunologia
Metagenoma
Metagenômica/métodos
Gravidez
Rúmen/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Immunoglobulin A); 0 (Immunoglobulin G)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170817
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182235



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