RESUMO
BACKGROUND: Little is known on the clinical relevance of peanut 2S albumin Ara h 7. OBJECTIVE: To investigate the discriminative ability of Ara h 7 in peanut allergy and assess the role of cross-reactivity between Ara h 2, 6 and Ara h 7 isoforms. METHODS: Sensitization to recombinant peanut storage proteins Ara h 1, 2, 3, 6, and 7 was assessed using a line blot in sera from 40 peanut-tolerant and 40 peanut-allergic patients, based on food challenge outcome. A dose-dependent ELISA inhibition experiment was performed with recombinant Ara h 2, 6 and Ara h 7 isoforms. RESULTS: For Ara h 7.0201, an area under the ROC curve was found of 0.83, comparable to Ara h 2 (AUC 0.81) and Ara h 6 (AUC 0.85). Ara h 7 intensity values strongly correlated with those from Ara h 2 and 6 (rs = 0.81). Of all patients sensitized to 2S albumins Ara h 2, 6, or 7, the majority was co-sensitized to all three (n = 24, 68%), although mono-sensitization to either 2S albumin was also observed in selected patients (Ara h 2: n = 6, 17%; Ara h 6: n = 2, 6%; Ara h 7: n = 2, 6%). Binding to Ara h 7.0101 could be strongly inhibited by Ara h 7.0201, but not the other way around. CONCLUSIONS AND CLINICAL RELEVANCE: Specific IgE against Ara h 7.0201 has a predictive ability for peanut allergy similar to Ara h 2 and 6 and possesses unique IgE epitopes as well as epitopes shared between the other Ara h 7 isoform and Ara h 2 and 6. While co-sensitization to all three 2S albumins is most common, mono-sensitization to either Ara h 2, 6, or 7 occurs in selected patients, leading to a risk of misdiagnosis when testing for a single 2S albumin.
Assuntos
Albuminas 2S de Plantas/imunologia , Antígenos de Plantas/imunologia , Epitopos/imunologia , Imunoglobulina E/imunologia , Hipersensibilidade a Amendoim/imunologia , Adolescente , Adulto , Idoso , Reações Cruzadas , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Outcomes related to chronic intestinal failure (CIF) vary significantly within and between countries. While there are extensive European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines on the delivery of optimal care in CIF, there are no international consensus recommendations on the structure or resources required, nor on the process and appropriate outcome measures for delivering such quality care in CIF. AIM: The aim of this position paper is therefore to devise ESPEN-endorsed, internationally agreed quality of care standards, covering the resources, systems and standards that centres should aim for in order to deliver optimal CIF care. METHODS: Members of the Home Artificial Nutrition-CIF Special Interest Group of ESPEN proposed an initial set of quality-of-care standards which was submitted to voting amongst clinicians from international CIF centres using a modified Delphi process, with participants rating each proposed statement as 'essential', 'recommended' or 'not required'. Any statement receiving 80% of more 'not required' responses was excluded. RESULTS: All 30 proposed standards relating to the structure, 18 relating to the process and 16 to the outcome measures of CIF care were deemed to be essential or recommended in more than 80% of respondents. CONCLUSION: This is the first paper to determine and describe internationally-agreed quality of care standards in CIF, which are now aimed at forming the basis for all CIF teams to develop and monitor their service, while also informing policymakers and payers on the infrastructure required for the optimal approach to multi-disciplinary team CIF care delivery. The recording of standardised outcomes should also allow internal and external benchmarking of care delivery within and between CIF centres.
RESUMO
To investigate the effects of the commonly-used immunomodulators l-glutamine, l-alanine, and the combination of both l-alanyl-l-glutamine (Dipeptamin(®)) on intracellular expression of IL-6, IL-8, and TNF-α during endotoxemia, lipopolysaccharide (LPS)-stimulated human monocytes in a whole blood system were investigated by flow cytometry. Whole blood of twenty-seven healthy volunteers was stimulated with LPS and incubated with three different amino acid solutions (1. l-glutamine, 2. l-alanine, 3. l-alanyl-l-glutamine, each concentration 2 mM, 5 mM, incubation time 3 h). CD14(+) monocytes were phenotyped in whole-blood and intracellular expression of cytokines was assessed by flow cytometry. Our investigations showed for the first time in whole blood probes, imitating best physiologically present cellular interactions, that l-glutamine caused a dose-independent inhibitory effect on IL-6 and TNF-α production in human monocytes stimulated with LPS. However, l-alanine had contrary effects on IL-6 expression, significantly upregulating expression of IL-6 in LPS-treated monocytes. The impact of l-alanine on the expression of TNF-α was comparable with glutamine. Neither amino acid was able to affect IL-8 production in LPS-stimulated monocytes. The combination of both did not influence significantly IL-6 and IL-8 expression in monocytes during endotoxemia, however strongly reduced TNF-α production. For the regulation of TNF-α, l-glutamine, l-alanine and the combination of both show a congruent and exponentiated downregulating effect during endotoxemia, for the modulation of IL-6, l-glutamine and l-alanine featured opposite regulation leading to a canceling impact of each other when recombining both amino acids.
Assuntos
Alanina/farmacologia , Glutamina/farmacologia , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Lipopolissacarídeos/farmacologia , Monócitos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Dipeptídeos/farmacologia , Endotoxemia/sangue , Citometria de Fluxo , Humanos , Interleucina-6/sangue , Interleucina-8/sangue , Espaço Intracelular/metabolismo , Monócitos/efeitos dos fármacos , Fator de Necrose Tumoral alfa/sangueRESUMO
OBJECTIVE: This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. METHODS: Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM-IV, questionnaires, and medical records. RESULTS: At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co-morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. CONCLUSION: Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients.
Assuntos
Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/estatística & dados numéricos , Neoplasias/epidemiologia , Classe Social , Desemprego/estatística & dados numéricos , Transtornos de Adaptação/epidemiologia , Transtornos de Adaptação/psicologia , Transtornos de Adaptação/terapia , Adulto , Fatores Etários , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Alcoolismo/terapia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Estudos de Coortes , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Neoplasias/psicologia , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Desemprego/psicologiaRESUMO
The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.
Assuntos
Colectomia , Doença Diverticular do Colo/cirurgia , Abscesso/diagnóstico , Abscesso/cirurgia , Doença Aguda , Algoritmos , Colonoscopia , Doença Diverticular do Colo/diagnóstico , Medicina Baseada em Evidências , Seguimentos , Fidelidade a Diretrizes , Humanos , Enteropatias/diagnóstico , Enteropatias/cirurgia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Fatores de RiscoRESUMO
BACKGROUND: Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany. METHODS: In 2009 German Surgical Society (DGCH) members in leading positions were surveyed with a standardised online questionnaire concerning their perioperative nutritional routines in elective surgery. RESULTS: From the addressed physicians nâ=â156 (6.24â%) answered. Of those, 86.9â% consider the nutritional status of their patients. Only 6â% use standardised nutritional screening tools. Short preoperative fasting for solid and liquid food is practiced by 65â% and 40â%, respectively. After the operation, 65â% allow intake of clear fluids on the day of surgery and 78â% initiate solid food on the day of surgery or the first postoperative day. Oral nutritional supplements are given only "sometimes" or "rarely" by 53.9â% of the respondents. CONCLUSION: The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline-based clinical nutrition in surgical care in Germany.
Assuntos
Atitude do Pessoal de Saúde , Internet , Inquéritos Nutricionais , Terapia Nutricional , Assistência Perioperatória , Procedimentos Cirúrgicos Operatórios , Medicina Baseada em Evidências , Alemanha , Fidelidade a Diretrizes , Humanos , Necessidades Nutricionais , Estado Nutricional , Centro Cirúrgico Hospitalar , Inquéritos e QuestionáriosRESUMO
Combination therapy with antivirals plus hepatitis B immunoglobulin (HBIg) has become the standard treatment for prevention of post-liver transplant hepatitis B virus (HBV) recurrence. However, HBIg therapy is inconvenient and expensive. Alternative therapeutic approaches with modern nucleos(t)ide analogues are limited so far. The present case report describes prevention of HBV recurrence with entecavir and tenofovir. A 48-year-old male patient with hepatitis B-induced decompensated liver cirrhosis initially improved on lamivudine (LAM) until LAM resistance (rtL180M and rtM204V) emerged followed by renewed decompensation. Therefore, tenofovir was added to LAM leading to undetectable HBV DNA (<200 copies/mL). Six months later, low-level viremia (479 copies/mL) was detected. Treatment was escalated to tenofovir plus entecavir. HBV DNA became negative again, and the patient underwent orthotopic liver transplantation. HBIg was administered during transplantation (10,000 IU) and on the second and third postoperative days (total dose 26,000 IU). Subsequently, the anti-hepatitis B surface (HBs) titer rose to 1477 IU/L at day 4 post transplantation. Although HBIg should have been continued, the patient remained on combination therapy with tenofovir plus entecavir only. The anti-HBs titer decreased and became negative 4 months later. However, under continued combination therapy with oral antivirals, HBV DNA and hepatitis B surface antigen remained negative during the entire follow-up of 21 months after liver transplantation. Combination therapy with entecavir plus tenofovir may prevent post-liver transplant hepatitis B recurrence even without HBIg maintenance therapy. This case illustrates that combination oral antiviral therapy might substitute for HBIg as indefinite prophylactic regimen due to profound antiviral efficacy and low risk of viral resistance. Efficacy and safety must be further investigated in randomized controlled trials.
Assuntos
Antivirais/farmacologia , Antivirais/uso terapêutico , Farmacorresistência Viral , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/prevenção & controle , Imunoglobulinas/uso terapêutico , Lamivudina/farmacologia , Transplante de Fígado/efeitos adversos , Adenina/análogos & derivados , Adenina/uso terapêutico , Terapia Combinada , Guanina/análogos & derivados , Guanina/uso terapêutico , Hepatite B/tratamento farmacológico , Hepatite B/virologia , Humanos , Imunização Passiva , Masculino , Pessoa de Meia-Idade , Organofosfonatos/uso terapêutico , Assistência Perioperatória , Prevenção Secundária , Tenofovir , Resultado do TratamentoRESUMO
This article analyzes emotional and behavioral problems in children and adolescents with chronic somatic disorders. Within the German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey, KIGGS), chronic somatic conditions and obesity were assessed in 11,529 children and adolescents aged 7-17 years old. Special health care needs (CSHCN), emotional and behavioral problems (SDQ), as well as personal, familial, and social resources were surveyed. About 10.8% of the respondents displayed special health care needs and declared a chronic somatic disorder. Of these cases, 20.6% were classified as abnormal in the SDQ (non-somatic conditions: 6.4%). In a logistic regression analysis, male gender (OR=2.0), low socioeconomic status (Winkler index; OR=2.6), family structure (OR>1), and deficits in familial (OR=2.4) and personal (OR=2.1) resources were found to be significantly associated with psychological comorbidity in chronic somatic conditions. The results confirmed previous findings. Especially socioeconomic, structural, and functional aspects of a family have to be considered in the development and prevention of psychological comorbidity in chronic somatic conditions in childhood and adolescence.
Assuntos
Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Adolescente , Sintomas Afetivos/psicologia , Criança , Pré-Escolar , Doença Crônica , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Transtornos Mentais/psicologia , Medição de Risco , Fatores de Risco , Transtornos Somatoformes/psicologia , Adulto JovemAssuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Gastroenterologia/normas , Alemanha , Humanos , Oncologia/normas , Guias de Prática Clínica como AssuntoRESUMO
The 1st revision of the S2k guideline on the prevention and follow-up care of sepsis, provided by the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information on the effective and appropriate medical care of critically ill patients with severe sepsis or septic shock. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.
Assuntos
Cuidados Críticos/normas , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Sepse/diagnóstico , Sepse/prevenção & controle , Alemanha , HumanosRESUMO
BACKGROUND: Gastrointestinal cancer is a frequent diagnosis in older patients. A curative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents a high risk for perioperative complications and a longer stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way. OBJECTIVE: This retrospective analysis was carried out to find out whether preoperative cognitive impairment is a prognostic factor for the postoperative outcome. METHODS: In patients over the age of 75 years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay. RESULTS: Low MMSE values were significantly associated with the complication rate and the development of a severe complication (Clavien-Dindo gradeâ¯≥ 3a). A cut-off value of 24 points in the MMSE was predictive for the development of complications and a longer hospital stay. The age of the patients was not associated with the MMSE. CONCLUSION: Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, a preoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.
Assuntos
Transtornos Cognitivos/diagnóstico , Cognição , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Moraxella catarrhalis is a major cause of infectious exacerbations of chronic obstructive lung disease. In pulmonary epithelial cells, M. catarrhalis induces release of the pro-inflammatory cytokine interleukin (IL)-8, which plays a pivotal role in orchestrating airway inflammation. The present study demonstrated that protein kinase (PK)C was activated by Moraxella infection and positively regulated M. catarrhalis-triggered nuclear factor (NF)-kappaB activation and subsequent IL-8 release. Activation of the PKC/NF-kappaB signalling pathway was found to be dependent on expression of the Moraxella-specific ubiquitous surface protein A2. In addition, it was shown that specific isoforms of PKC play differential roles in the fine-tuning of the M. catarrhalis-induced NF-kappaB-dependent gene expression through controlling il8 promoter activity. Inhibition of PKCalpha and epsilon with chemical inhibitors or using short interfering RNA-mediated gene silencing significantly suppressed, whereas inhibition of PKCtheta increased, the M. catarrhalis-induced IL-8 transcription and cytokine release. In conclusion, it was shown that Moraxella catarrhalis infection activates protein kinase C and its isoforms alpha, epsilon and theta, which differentially regulate interleukin-8 transcription in human pulmonary epithelial cells.
Assuntos
Brônquios/imunologia , Células Epiteliais/imunologia , Interleucina-8/metabolismo , Isoenzimas/imunologia , Infecções por Moraxellaceae/imunologia , Proteína Quinase C-alfa/imunologia , Proteína Quinase C-épsilon/imunologia , Proteína Quinase C/imunologia , Brônquios/citologia , Linhagem Celular , Regulação da Expressão Gênica/imunologia , Humanos , Moraxella catarrhalis/patogenicidade , Regiões Promotoras Genéticas , Proteína Quinase C-theta , Transdução de Sinais/imunologiaRESUMO
OBJECTIVE: Multiply traumatised patients often suffer from blood loss and from subsequent therapy-resistant anaemia, possibly mediated by apoptosis, necrosis, or humoral factors. Therefore, the underlying mechanisms were investigated in bone marrow (BM) and peripheral blood in a murine resuscitated haemorrhagic shock (HS) model. METHODS: In healthy male mice, pressure-controlled HS was induced for 60 min. The BM was analysed for Annexin-V, 7-amino-actinomycin D, apoptotic enzymes (caspases-3/7, -8, and -9), expression of death receptors (CD120a, CD95), mitochondrial proteins (Bax, Bcl-2, Bcl-x), as well as erythropoietin (EPO) receptor (EPO-R). Blood cell count, peripheral EPO, and tumour necrosis factor-alpha response were additionally monitored. RESULTS: Twenty-four and 72 h after HS, EPO and EPO-R were strongly up-regulated in peripheral blood and BM, respectively. Decreasing numbers of erythroid progenitors in BM after HS correlated with significant apoptotic changes confirmed by increased caspases-3/7, -8, -9 activity in total BM, death receptor CD95 and CD120a expression on erythroid progenitors, and down-regulated mitochondrial Bcl-2 expression in total BM. Erythroid progenitors in peripheral blood were found to be increased after 72 h. CONCLUSION: Despite the massive EPO response and up-regulation of EPO-R, BM erythroblasts (EBs) decreased. This could be due to deficient maturation of erythroid progenitors. Furthermore, the increased intrinsic and extrinsic apoptosis activation suggests programmed death of erythroid progenitors. We propose that both apoptosis and negatively regulated erythropoiesis contribute to BM dysfunction, while erythroid progenitor egress plays an additional role.
Assuntos
Apoptose/fisiologia , Células Precursoras Eritroides/metabolismo , Eritropoetina/metabolismo , Receptores da Eritropoetina/metabolismo , Choque Hemorrágico/metabolismo , Análise de Variância , Animais , Anexina A5/análise , Apoptose/genética , Inibidores de Caspase , Caspases/metabolismo , Proliferação de Células , Modelos Animais de Doenças , Células Precursoras Eritroides/citologia , Eritropoese/genética , Eritropoese/fisiologia , Eritropoetina/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Choque Hemorrágico/fisiopatologia , Fatores de Tempo , Fator de Necrose Tumoral alfa/fisiologiaRESUMO
BACKGROUND: Prehabilitation prior to complex visceral oncological surgery is playing an increasingly important role. OBJECTIVE: The aim of this review article is to present special situations of preconditioning in visceral oncological patient cohorts. The following conditions were defined as special situations with subsequently increased risk profile: cardiopulmonary comorbidities, geriatric patients, neoadjuvant therapy and simultaneous fatigue. MATERIAL AND METHODS: A selective literature review based on a search in the electronic databases MEDLINE, PubMed, Cochrane Library and the International Standard Randomization Controlled Trial Number (ISRCTN) was performed. RESULTS: The identification of high-risk patients is an essential part of the preoperative evaluation conducted by the anesthesiologist prior to surgery. The cardiovascular and the pulmonary risk profile are determined by means of prediction indices evaluating patient-specific and surgery-related risk factors. The increased use of new oral anticoagulants and dual platelet aggregation inhibition requires individualized treatment strategies. Numerous studies have shown clinically relevant effects of exercise therapy interventions throughout all phases of oncological treatment. In addition to positive effects on therapy-associated side effects, sport can also counteract the effects of sedentary behavior in cancer patients and improve the health-related quality of life. The effectiveness of sport and exercise therapies as well as psychological interventions in oncological patients with fatigue (CRF) is broad, with important components being motivation and compliance. DISCUSSION: In high-risk patients an interdisciplinary approach to planning and conduction of prehabilitation is essential for the early detection and optimization of perioperative risk factors and potential complications. The aim is faster recovery, reduced morbidity and mortality and the possibility to improve long-term survival and quality of life.
Assuntos
Neoplasias Abdominais , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Neoplasias Abdominais/reabilitação , Neoplasias Abdominais/cirurgia , Idoso , Fadiga , Humanos , Terapia Neoadjuvante , Complicações Pós-Operatórias/prevenção & controle , Qualidade de VidaRESUMO
BACKGROUND: Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment. OBJECTIVE: The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery. MATERIAL AND METHODS: Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided. RESULTS: This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate. DISCUSSION: In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.
Assuntos
Neoplasias Abdominais , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Neoplasias Abdominais/cirurgia , Exercício Físico , Humanos , Estado Nutricional , Complicações Pós-Operatórias/prevenção & controle , Qualidade de VidaRESUMO
BACKGROUND: Early detection of an acute rejection episode is an important problem in monitoring transplant patients. Erythropoietin (EPO) production is diminished in patients suffering from chronic renal insufficiency or acute rejection. Therefore, a decrease of reticulocyte counts and of young reticulocytes might indicate the emergence of an acute rejection episode. This pilot study examined the value of reticulocyte parameters as indicators of acute rejection episodes. PATIENTS AND METHODS: Reticulocyte parameters were examined in 25 renal transplant patients. Initial immunosuppressants therapy was based on a combination of methylprednisolone, mycophenolatmofetil, cyclosporine and antithymocyte globulin or basiliximab, CellCept, cyclosporine, and ATG or Simulect. During the first 3 weeks after the procedure, blood samples were collected three times per week. Complete blood counts were performed on XE-2100 analyzers (Sysmex). Acute rejection was biopsy-proven. RESULTS: Acute rejection episodes were not accompanied by significantly altered reticulocyte parameters. During the first weeks, the reticulocyte count or the immature fraction, respectively, did not differ between patients with delayed versus immediate onset of renal function: reticulocyte count 1.70 +/- 1.06% vs 1.58 +/- 1.10% and ratio of immature (high fluorescent) reticulocytes 22.8 +/- 7.9% vs 17.6 +/- 9.4%). CONCLUSION: Reticulocyte counts and determination of the immature reticulocyte fraction were not significantly altered by an acute rejection episode. Various influences modulate the release of EPO and reaction of erythropoiesis upon an EPO stimulus.
Assuntos
Rejeição de Enxerto/diagnóstico , Transplante de Rim/efeitos adversos , Contagem de Reticulócitos , Adulto , Idoso , Creatinina/sangue , Eritropoetina/sangue , Feminino , Rejeição de Enxerto/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Ureia/sangueRESUMO
Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
Assuntos
Desnutrição/diagnóstico , Desnutrição/terapia , Neoplasias/terapia , Composição Corporal , Índice de Massa Corporal , Dieta , Exercício Físico , Custos de Cuidados de Saúde , Humanos , Avaliação Nutricional , Necessidades Nutricionais , Estado Nutricional , Apoio Nutricional , Prevalência , Terminologia como AssuntoRESUMO
Enhanced recovery of patients after surgery ("ERAS") has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference. EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10-15% within 6 months, BMI<18.5 kg/m(2), Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction). Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
Assuntos
Nutrição Enteral/normas , Cirurgia Geral/normas , Transplante de Órgãos , Padrões de Prática Médica/normas , Nutrição Enteral/métodos , Europa (Continente) , Humanos , Assistência Perioperatória/normasRESUMO
Taking into account new data and recent clinical controversies regarding nutritional support within the first 7 days of critical illness, early enteral nutrition is recommended. A normocaloric goal of 25 kcal/kg body weight/day should be achieved. In case of inadequate enteral tolerance, parenteral supplementation starting between day 3 and 5 should be selectively restricted to primarily malnourished patients and those with high risk for complications and prolonged stay in the intensive care unit. This can be summarized in a clinical algorithm.