Comparative Analysis between Synthetic Vitamin E and Natural Antioxidant Sources from Tomato, Carrot and Coriander in Diets for Market-Sized Dicentrarchus labrax.

Synthetic vitamin E is commonly used in aquafeeds to prevent oxidative stress in fish and delay feed and flesh oxidation during storage, but consumers' preferences tend towards natural antioxidant sources. The potential of vegetable antioxidants-rich coproducts, dried tomato (TO), carrot (CA) and coriander (CO) was compared to that of synthetic vitamin E included in diets at either a regular (CTRL; 100 mg kg-1) or reinforced dose (VITE; 500 mg kg-1). Natural antioxidants were added at 2% to the CTRL. Mixes were then extruded and dried, generating five experimental diets that were fed to European sea bass juveniles (114 g) over 12 weeks. Vitamin E and carotenoid content of extruded diets showed signs of degradation. The experimental diets had very limited effects on fish growth or body composition, immunomodulatory response, muscle and liver antioxidant potential, organoleptic properties or consumer acceptance. Altogether, experimental findings suggest that neither a heightened inclusion dose of 500 mg kg-1 of vitamin E, nor a 2% inclusion of natural antioxidants provided additional antioxidant protection, compared to fish fed diets including the regular dose of 100 mg kg-1 of vitamin E.

Primary intramedullary spinal-cord lymphoma (PISCL): a rare entity with a challenging diagnosis.

Primary intramedullary spinal-cord lymphoma (PISCL) is a rare cause of myelopathy and constitutes only 1% of central nervous system lymphomas. Delay to diagnosis is common due to its rarity, its similarity to other causes of myelopathy and the difficulties in obtaining pathological diagnosis. We report a case of PISCL and discuss the challenges faced on diagnosis, namely the impact of corticosteroids on histological findings, the usefulness of MRI, positron-emission tomography/CT (PET/CT) and repeated lumbar punctures.

Tumefactive demyelinating lesions spectrum disorders and the potential role of contemporary disease modifying treatments: a case report.

Marburg disease is a fulminant variant of multiple sclerosis (MS), in which the diagnosis may be particularly difficult and with high rates of mortality. We describe the case of a women with a clinical picture, radiographic features, and neuropathological findings consistent with the classical descriptions of Marburg disease. Initially, our patient did not improved with the acute phase treatments but later showed a good response to natalizumab (NTZ) treatment. This report highlights not only the utility of brain biopsy in the accurate diagnosis of this challenging condition but also the potential role of NTZ as an effective therapeutic option.

Authentic leadership, nurse satisfaction at work and hospital accreditation: study in a private hospital network / Liderazgo auténtico, satisfacción del enfermero en el trabajo y acreditación hospitalaria: estudio en una red de hospitales privado / Liderança autêntica, satisfação do enfermeiro no trabalho e acreditação: estudo em uma rede hospitalar privada

ABSTRACT Objectives: to identify the dominant dimensions of the authentic leadership of nurses in a private hospital network and to verify the association with job satisfaction and accreditation. Methods: cross-sectional, analytical study carried out in 11 hospitals with 282 nurses, of which 94 were leaders and 188 were led. Participants answered the Authentic Leardership Questionnaire and the Job Satisfaction Survey. Results: there was a significant difference between the assessment of leaders and followers in all dimensions of the Authentic Leardership Questionnaire. Regarding the association of authentic leadership and job satisfaction, a significant positive moderate correlation was found among the employees. In hospitals accredited by the Joint Commission International, leaders were perceived as more transparent by their subordinates. Conclusions: there was correlation between authentic leadership and job satisfaction and authentic leadership and the accreditation model among the subordinates.

RESUMEN Objetivos: identificar las dimensiones dominantes del liderazgo auténtico de los enfermeros en una red de hospitales privados y su correlación con la satisfacción laboral y con el modelo de acreditación. Métodos: es un estudio transversal, analítico, realizado en 11 hospitales entre 282 enfermeros, de los cuales 94 eran líderes y 188 liderados, que respondieron a los cuestionarios Authentic Leardership Questionnaire y Job Satisfaction Survey. Resultados: se observó una diferencia significativa entre la evaluación de los líderes y de los liderados, en todas las dimensiones del Authentic Leardership Questionnaire. Respecto a la asociación del liderazgo auténtico con la satisfacción laboral, la correlación era significativamente positiva para los liderados, considerándose moderada. En los hospitales, con el modelo Joint Commission International, los liderados percibían a sus líderes con mayor transparencia. Conclusiones: se ha encontrado una correlación entre el liderazgo auténtico y la satisfacción laboral y el modelo de acreditación entre los liderados.

RESUMO Objetivos: identificar as dimensões dominantes da liderança autêntica dos enfermeiros em uma rede hospitalar privada e correlacionar com a satisfação no trabalho e com o modelo de acreditação. Métodos: estudo transversal, analítico, realizado em 11 hospitais, com 282 enfermeiros, sendo 94 líderes e 188 liderados, que responderam aos questionários Authentic Leardership Questionnaire, Questionário de Liderança Autêntica e o Job Satisfaction Survey, Pesquisa de Satisfação no trabalho. Resultados: houve diferença significante entre a avaliação dos líderes e liderados, em todas as dimensões do Authentic Leardership Questionnaire. Em relação à associação da liderança autêntica com a satisfação do trabalho, para os liderados foi encontrada uma correlação significativamente positiva, sendo considerada moderada. Nos hospitais, com o modelo Joint Commission International, os líderes foram percebidos por seus liderados com maior transparência. Conclusões: foi encontrado correlação entre a liderança autêntica com a satisfação no trabalho e o modelo de acreditação entre os liderados.

Effects of a structured education program on glycemic control in type 1 diabetes

ABSTRACT Objective Diabetes mellitus is associated with significant morbidity and mortality, and education is known to play a key role in managing this disease. This study addresses the effects of a structured education program (SEP) on self-care in subjects with type 1 diabetes mellitus (T1DM). The aim was to evaluate the effect of a SEP on glycemic control, knowledge, and skills associated with diabetes care in subjects with T1DM. Subjects and methods A total of 47 adults with T1DM were followed up for 20 months (32 participated in the SEP and 15 served as a control group). The SEP consisted of workshops, individualized care, 24-hour distant support, and a questionnaire assessing knowledge of diabetes care. Glycosylated hemoglobin (HbA1c) levels were measured before and after the SEP implementation. Results Compared with pre-SEP levels, the mean HbA1c levels decreased by approximately 20% (21 mmol/mol) at 1 year, with a further 11% reduction (10 mmol/mol) observed 8 months later (p < 0.001). Knowledge about diabetes care increased by 37% between the pre-SEP and post-SEP questionnaires (p < 0.005). Conclusion Relevant improvements occurred after SEP activities. The sustained decrease in HbA1c levels and the overall increase in knowledge and confidence regarding diabetes care reinforce the importance, necessity, and positive outcomes of a SEP intervention in T1DM.

Comportamiento de la mortalidad por cáncer cervicouterino en el municipio de Rafael Freyre: 1997-2014 / Behavior of Mortality from Cervical Cancer in the Municipality of Rafael Freyre: 1997-2014

Introducción: el cáncer cervicouterino persiste como un problema de salud no resuelto a nivel mundial; después del cáncer de mama, es el más frecuente en el sexo femenino y ocupa el séptimo lugar entre todas las neoplasias malignas que afectan a ambos sexos. Objetivo: describir el comportamiento de la mortalidad por cáncer cervicouterino en el municipio de Rafael Freyre entre 1997 y 2014. Método: se realizó un estudio de mortalidad con las 56 fallecidas reportadas por esa causa en el municipio y períodos referidos. Como fuente de datos se utilizó el reporte mensual computarizado que envía el Departamento de Estadísticas provincial de los fallecidos a cada municipio. Resultados: la tasa media anual de mortalidad en el municipio fue de 12,3 x 100 000 mujeres; los grupos de edades más afectados son los de 70-74 y 80 y más, con tasas de 62,5 y 60,0, respectivamente. Las áreas geográficas de mayor riesgo epidemiológico de fallecer las mujeres por esta causa fueron el Área de Salud de Santa Lucía y los consejos populares de "Carlos Noris", Dagame y Santa Lucía, con tasas de mortalidad de 23,5; 21,5 y 19,5, respectivamente. Conclusiones: este problema de salud tiene una tendencia descendente en el municipio, pero la tasa de mortalidad media anual supera la tasa provincial y la nacional.

Introduction: cervical cancer persists as an unresolved health problem worldwide; after breast cancer, it is the most frequent in females and ranks seventh among all malignant neoplasms affecting both sexes. Objective: to describe the behavior of cervical cancer mortality in the municipality of Rafael Freyre among the years 1997-2014. Methods: a mortality study was carried out, as universe was chosen the 56 deceaseds reported by that cause in the municipality at referred periods, as a source of data was used the monthly report of death on-line that sends the provincial department of health in Holguin. Results: the annual half rate of mortality in the Municipality was 12.3 x 100 000 women, the groups of ages more affected were 70-74 years and 80 and but, with rates of 62.5 and 60.0 respectively. The geographical areas of more epidemic risk of dying the women for this cause were, the Area of Health of "Santa Lucía" and popular Council of "Carlos Noris", "Dagame" and "Santa Lucía" with rates of mortality of 23.5, 21.5 and 19.5 respectively. Conclusions: this problem of health has a descending tendency in the municipality, but the rate half annual of mortality overcomes the provincial and national rate.

Neurological aspects of human parvovirus B19 infection: a systematic review.

Parvovirus B19 has been linked with various clinical syndromes including neurological manifestations. However, its role in the latter remains not completely understood. Although the last 10 years witnessed a surge of case reports on B19-associated neurological aspects, the literature data remains scattered and heterogeneous, and epidemiological information on the incidence of B19-associated neurological aspects cannot be accurately extrapolated. The aim of this review is to identify the characteristics of cases of B19-associated neurological manifestations. A computerized systematic review of existing literature concerning cases of B19-related neurological aspects revealed 89 articles describing 129 patients; 79 (61.2%) were associated with CNS manifestations, 41 (31.8%) were associated with peripheral nervous system manifestations, and 9 (7.0%) were linked with myalgic encephalomyelitis. The majority of the cases (50/129) had encephalitis. Clinical characteristic features of these cases were analyzed, and possible pathological mechanisms were also described. In conclusion, B19 should be included in differential diagnosis of encephalitic syndromes of unknown etiology in all age groups. Diagnosis should rely on investigation of anti-B19 IgM antibodies and detection of B19 DNA in serum or CSF. Treatment of severe cases might benefit from a combined regime of intravenous immunoglobulins and steroids. To confirm these outcomes, goal-targeted studies are recommended to exactly identify epidemiological scenarios and explore potential pathogenic mechanisms of these complications. Performing retrospective and prospective and multicenter studies concerning B19 and neurological aspects in general, and B19 and encephalitic syndromes in particular, are required.

Alimentos diet e light: consumo e conhecimento por frequentadores de supermercados de Florianópolis, SC / Diet and light foods: knowledge by consumers of the supermarkets in Florianópolis, SC

Os objetivos do estudo foram avaliar o consumo e o conhecimento sobre os alimentos diet e light por 299 frequentadores de supermercados de Florianópolis, SC. Foi um estudo descritivo, em que um questionário semiestruturado foi aplicado para cada consumidor. Apenas 33,8% dos entrevistados referiram consumir alimentos diet e 66,2% alimentos light. Observou-se o aumento do conhecimento sobre as características destes alimentos com o aumento da renda. O desconhecimento em relação ao significado dos termos discutidos pode ser indicativo da utilização inadequada destes produtos. Logo, a divulgação de informações corretas sobre a sua definição é crucial para que o cliente possa optar pela versão mais adequada.

Risk-based assessment does not distinguish between recent and chronic HIV-1 infection in Rio de Janeiro, Brazil

This study investigated the risk factors associated with recent and chronic HIV infections among individual attending a voluntary counseling and testing (VCT) site in Rio de Janeiro, Brazil. In a cross-sectional study, recent HIV infections were detected by the sensitive/less-sensitive test, using Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) strategy, and compared to chronic HIV infection and HIV negative individuals. Seroincidence was estimated and risk factors associated with recent and chronic infections were assessed using multinomial logistic regression. Among the 7,379 individuals tested between June 2006 and April 2007, the overall prevalence and incidence of HIV infection were 7.5 percent; and 1.39/100 PY, respectively. In multivariate analysis, having a HIV positive steady partner was a risk factor for recent and for chronic HIV infection for MSM, heterosexual male and women. No differences in risk factors for recent and chronic infections were found between MSM and heterosexual males. Among women, chronic infected individuals were more likely than HIV negatives to be older. Recently HIV infected women were more likely than HIV negatives to be less educated; and more likely than HIV negatives and chronically infected to report having more partners. Routinely used risk-based assessment in testing centers in Brazil lack sensitivity to distinguish between recent and chronic infections, particularly among MSM and heterosexual males. Steady relationships and serosorting may be playing a key role in maintaining the HIV epidemics in Brazil.

[Rotavirus A among hospitalized infants, up to three years of age, with acute gastroenteritis in Campo Grande, State of Mato Grosso do Sul]. / Rotavírus A em crianças de até três anos de idade, hospitalizadas com gastroenterite aguda em Campo Grande, Estado do Mato Grosso do Sul.

Polyacrylamide gel electrophoresis and combined immunoenzyme assay for rotavirus and adenovirus were used to analyze 380 fecal samples from children up to three years of age who were hospitalized with acute diarrhea in Campo Grande, State of Mato Grosso do Sul, between May 2000 and January 2004. Among all the samples, 88 (23.2%) were positive for Rotavirus A. Out of these, 81 (92%) had a defined electrophoretic pattern: 77 (87.5%) with a long pattern and four (4.5%) with a short pattern. Genotype G and P characterization was done by nested RT-PCR for 85 samples, of which 56 (65.9%) were genotyped as type G. Among these, 49 (87.5%) were G1, five (8.9%) were G4, one (1.8%) was G3 and one (1.8%) was G9. The genotype was found to be type P in 37 samples (43.5%) and all of these were P[8]. The G and P association most observed was G1P[8], with 33 samples (89.2%), followed by G4P[8], two samples (5.4%); G3P[8], one sample (2.7%); and G9P[8], one sample (2.7%).

Rotavírus A em crianças de até três anos de idade, hospitalizadas com gastroenterite aguda em Campo Grande, Estado do Mato Grosso do Sul / Rotavirus A among hospitalized infants, up to three years of age, with acute gastroenteritis in Campo Grande, State of Mato Grosso do Sul

Através da eletroforese em gel de poliacrilamida e do ensaio imunenzimático combinado para rotavírus e adenovirus, foram analisadas 380 amostras fecais de crianças com até 3 anos, hospitalizadas com diarréia aguda, entre maio de 2000 e janeiro de 2004, em Campo Grande, MS. Do total de amostras, 88 (23,2 por cento) foram positivas para Rotavirus A. Dentre essas, 81 (92 por cento) tiveram padrão eletroferotípico definido, sendo 77 (87,5 por cento) de padrão longo e quatro (4,5 por cento) de padrão curto. A caracterização genotípica G e P foi feita por RT-Nested-PCR para 85 amostras, sendo 56 (65,9 por cento) genotipáveis para genótipo G. Dentre essas, 49 (87,5 por cento) foram G1, cinco (8,9 por cento) G4, uma (1,8 por cento) G3 e uma (1,8 por cento) G9. Considerando a genotipagem P, 37 (43,5 por cento) foram genotipáveis e todas eram P[8]. A associação G e P mais observada foi G1P[8], 33 (89,2 por cento) amostras; seguida de G4P[8], duas (5,4 por cento) amostras; G3P[8], uma (2,7 por cento) amostra; e G9P[8], uma (2,7 por cento) amostra.

Polyacrylamide gel electrophoresis and combined immunoenzyme assay for rotavirus and adenovirus were used to analyze 380 fecal samples from children up to three years of age who were hospitalized with acute diarrhea in Campo Grande, State of Mato Grosso do Sul, between May 2000 and January 2004. Among all the samples, 88 (23. 2 percent) were positive for Rotavirus A. Out of these, 81 (92 percent) had a defined electrophoretic pattern: 77 (87. 5 percent) with a long pattern and four (4. 5 percent) with a short pattern. Genotype G and P characterization was done by nested RT-PCR for 85 samples, of which 56 (65. 9 percent) were genotyped as type G. Among these, 49 (87. 5 percent) were G1, five (8. 9 percent) were G4, one (1. 8 percent) was G3 and one (1. 8 percent) was G9. The genotype was found to be type P in 37 samples (43. 5 percent) and all of these were P[8]. The G and P association most observed was G1P[8], with 33 samples (89. 2 percent), followed by G4P[8], two samples (5. 4 percent); G3P[8], one sample (2. 7 percent); and G9P[8], one sample (2. 7 percent).

Seropositivity for hepatitis B virus, vaccination coverage, and vaccine response in dentists from Campo Grande, Mato Grosso do Sul, Brazil

This study investigated the seropositivity for hepatitis B virus (HBV), the vaccination index, and the vaccine response index in dentists from Campo Grande, MS. Blood samples from 474 dentists (63.7 percent women and 36.3 percent men), with a mean age of 38.5 ± 10.5 years were analyzed by enzyme-linked immunosorbent assay to detect the serological markers: HBsAg, anti-HBs, and anti-HBc. The HBsAg positive samples were tested for anti-HBc IgM, HBeAg, and anti-HBe. A total of 51 (10.8 percent) dentists showed seropositivity for HBV. Three (0.6 percent) were HBsAg/anti-HBc/anti-HBe positive, 43 (9.1 percent) were anti-HBc/anti-HBs positive, and 5 (1.1 percent) had only anti-HBc. Viral DNA was detected by polymerase chain reaction in 9 (17.6 percent) out of 51 HBV seropositive samples. A vaccination index of 96.6 percent (458/474) was observed, although 73.1 percent (335/458)completed the three-dose schedule. Excluding 46 HBV seropositive individuals from 458 that reported vaccination, 412 were analyzed for vaccine response index. It was observed that 74.5 percent (307/412) were anti-HBs positive; this percentage increased to 79.1 percent when three doses were administered. The results showed a high vaccination index and a good rate of vaccine response; however, the failure in completing the three-dose schedule and the occurrence of HBV infection reinforce the need for more effective prevention strategies.

Comportamento de risco para infecção pelo HIV entre adolescentes atendidos em un centro de testagem e aconselhamento em DST/Aids no município do Rio de Janeiro / Risk behavior to HIV infection among adolescents attending a STD/AIDS testing and counceling center of teh municipality of Rio de Janeiro, Brazil

O objetivo deste estudo é investigar comportamentos relacionados ao HIV entre 820 adolescentes, idade entre 13 e 19 anos, que realizaram sorologia para o HIV em um Centro de Testagem e Aconselhamento (CTA) da Cidade do Rio de Janeiro, Brasil. Utilizamos dados coletados do Sistema de Informações do CTA (SI-CTA). Observou-se concentração de adolescentes na faixa etária de 17 e 19 anos. Entre as gestantes, encontrou-se proporção mais alta de jovens de 13 a 16 anos, de casadas e de baixa escolaridade quando comparada às não gestantes, aos homens heterossexuais e aos homens que fazem sexo comhomens (HSH). Cerca de metade das adolescentes procurou o serviço para a realização de exames de pré-natal; e entre os adolescentes, 60% buscaram o teste por terem sido expostos à situação de risco. Os adolescentes heterossexuais, os HSH e as não gestantes referiram maior número de parceiros sexuais e utilização mais freqüente do preservativo do que as gestantes. A proporção de testes positivos para o HIV foi de 0,35%, 2,05%, 3,74% e 4,81%, respectivamente, para gestantes, não gestantes,heterossexuais e HSH. Os dados evidenciam vulnerabilidade dos adolescentes atendidos, em relação ao HIV, e apontam para a necessidade entre eles de estratégias específicas que aumentem conhecimentos, oportunidades e opções de prevenção...

Controle do diabetes: o tratamento dietoterápico é eficaz? / Diabetes control: is diet therapy effective?

O tratamento do diabetes baseia-se fundamentalmente em três pontos principais: uso de medicamentos exercício físico e dieta. Considerando as complexas desordens metabólicas, a dieta assume um papel relevante na terapêutica do diabetes. O objetivo deste estudo foi avaliar a adesäo à dieta e sua influência no controle do diabetes. Foram tratados 41 pacientes adultos (28 mulheres e 13 homens portadores) de Diabetes Mellitus tipo II, sendo que sessenta e quatro por cento tinham idade superior a 50 anos, internados na Clínica Médica do Hospital Universitário da Universidade Federalde Santa Catarina. A adesäo à dieta foi avaliada com 3 consultas, com intervalo de 30 dias entre elas, por meio de orientaçäo nutricional, sendo avaliado a perda de peso e o controle glicêmico...

Aplicaçäo da técnica de mudanças de comportamento no tratamento de pacientes obesos atendidos no Hospital Universitário/UFSC / Aplication of techinical behaviour changing in tratament of obese patient assisted in Universitary Hospital/UFSC

Estudos têm demonstrado que a mudança de comportamento no paciente obeso apresenta algumas vantagens sobre métodos radicais ou mesmo conservadores, pois busca a mudança de estilo de vida. Estudou-se oito pacientes do sexo feminino, com idade variando entre 33,5 mais ou menos 7,13 anos. Estes pacientes foram atendidos no ambulatório de nutriçäo entre os meses de agosto e novembro de 1997. Durante o período de estudo, notou-se uma grande melhora de comportamento dos pacientes, quanto a sua alimentaçäo e a assiduidade aos exercícios físicos, resultando consequentemente em perda de peso...

Acompanhamento nutricional de pacientes ostomizados / relate of an experience with ostomized patients

Atualmente tem-se observado um aumento crescente no número de ostomias realizadas em pacientes portadores de doenças do trato gastrointestinal. Esta interaçäo altera a estrutura física e psíquica do paciente, uma vez que a via de execuçäo passa a ser uma "Bolsa de Excreçäo", que requer cuidados especiais em relaçäo a sua alimentaçäo, após sua implantaçäo. O ostomizado deve aprender a observar quais os alimentos que seu organismo näo tolera (para que possa aos poucos retornar a uma alimentaçäo normal ou apenas com pequenas restriçöes).Assim foi o objetivo deste estudo, avaliar o hábito alimentar de 15 pacientes ostomizados e o seu estado nutricional...

Prevalência de obesidade em indivíduos portadores de diabetes mellitus não insulini dependente / Obesity prevalence in diabetes mellitus non insulin dependent individuals

O Ministério da Saúde aponta que 33por cento da população brasileira adulta apresenta sobrepeso, problema encontrado em todas as classes sócio-econômicas. A obesidade está diretamente relacionada com o índice de morbidade por hipertensão, diabetes mellitus tipo II (DMNID) e moléstias cardiovasculares. Entre estas, o diabetes mellitus é classificado pela OMS como a terceira causa de morte em todo o mundo. O objetivo deste estudo foi avaliar o estado nutricional da população portadora de DMNID atendida pelo HU-UFSC, bem como sua adesão ao tratamento dietoterápico.Foram avaliados dados antropométricos e bioquímicos de 158 pacientes adultos internados na Clínica Médica do HU-UFSC, 87 por cento deles com idade acima de 58 anos....

Estudo dos hábitos alimentares de diabéticos tipo I / Study of type-I - Diabetic`s alimentary

No tartamento do diabetes mellitus, a dieta exerce um papel primordial, objetivando a manutenção dos níveis de glicose e de lipídeos dentro ou próximos dos valores normais, e a melhoria da sobrevida através de uma nutrição adequada. Sabe-se que existem problemas na terapêutica nutricional dos pacientes diabéticos, tais como a baixa adesão à dieta planejada e a pouca fidedignidade nas informações fornecidas pelos pacientes diabéticos, tais como a baixa adesão à dieta planejada e a pouca fidedignidade nas informações fornecidas pelos pacientes, principalmente na clientela infanto-juvenil. Diante destes fatos, este trabalho propôs-se a estudar os hábitos alimentares dos diabéticos tipo I assistidos pelo Grupo Multiprofissional do HU-UFSC, a fim de buscar melhores formas de incentivá-los e conscientizá-los dos benefícios alcançdos, a curto e longo prazo, através do tratamento dietoterápico adequado....

Experiência de um programa de educaçäo nutricional continuada a pacientes diabéticos atendidos no Hospital Universitário-UFSC / Experience with a continuing educational program in diabetic patients seen at Hospital Universitario Ufsc

O Diabetes Mellitus é uma doença caracterizada pela elevaçäo crônica de glicose no sangue. Visando reduzir a morbilidade e a mortalidade por diabetes, o Ministério da Saúde considera como objetivo principal a educaçäo em saúde. O tratamento baseia-se em medicamentos, exercício físico e dieta. Para se obter um bom ajuste do indivíduo ao tratamento é necessário uma estratégia nutricional...