Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review.

Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.

Giant rectus sheath hematoma.

BACKGROUND: Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality. CASE PRESENTATION: An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Surgery was performed, markedly improving his clinical status. CONCLUSIONS: POCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up.

Prescrição de fitoterapia por nutricionistas em farmácias magistrais / Prescription of herbal medicine by nutritionist in drugstores

O emprego da fitoterapia por parte dos profissionais de saúde e o aceite destes fármacos pela população aumenta gradativamente. A prescrição de fitoterápicos por nutricionistas é regulamentada há algum tempo no Brasil, porém existe a necessidade de se avançar nas pesquisas sobre fitoterapia, além de observar quais fitoterápicos têm seu uso mais frequente para entendimento da necessidade atual e para a devida capacitação profissional. O presente estudo tem por finalidade compilar informações sobre a prescrição de fitoterápicos por nutricionistas em farmácias magistrais, observando quais são as formulações prevalentes. Foi realizado um levantamento bibliográfico nas bases de dados e referências clássicas. Há relatos de que o fato de as plantas medicinais, drogas vegetais e fitoterápicos serem de origem vegetal pode levar ao entendimento de que seu uso é irrestrito e sem efeitos adversos. Porém, é necessário entendimento farmacológico e interações. Observa-se a preferência de prescrição por algumas plantas pelo nutricionista, destacando-se a Camellia sinensis, citada pela maioria dos estudos, e com o objetivo principal de controle de peso. Além disso, fitoterápicos com efeito ansiolítico estão dentre as plantas de escolha dos profissionais. Contudo, são escassos os estudos e metodologias que avaliem o perfil atual e as necessidades pontuais dos prescritores.(AU)

The use of herbal medicine by health care professionals and the acceptance of these drugs by the population is increasing gradually. The prescription of herbal medicines by nutritionists has been regulated for some time in Brazil. However, it is necessary to advance in the research on herbal medicine, as well as to identify which herbal medicine are more frequently used in order to understand the current needs and to provide proper professional training. This study aims to compile information on the prescription of herbal medicines by nutritionists in pharmacies, observing which are the prevalent formulations. A bibliographic search was performed in databases and classical references. There are reports that the fact that the plant-based drugs and medicines are of vegetable origin may lead to the understanding that their use is unrestricted and have no adverse effects. But it is necessary pharmacological interactions and understanding. We found that nutritionists are more likely to prescribe some plants, such as Camellia sinensis, which is cited in most of the studies, mainly for weight control. In addition, herbal medicines with anxiolytic effects are among the plants chosen by the professionals. However, there are few studies and methodologies to assess the current profile and the specific needs of the prescribers.(AU)

Associação entre o índice glicêmico e a carga glicêmica da dieta de frequentadores de clínicas estéticas privadas de Porto Alegre - RS e indicadoresde adiposidade corporal / Association between glycemic index and glycemic load in the diet of clients of private esthetics clinics in Porto Alegre and body fat indicators

Objective: To evaluate the possible association between dietary glycemic index (GI) and glycemic load (GL) and anthropometric indicators of adiposity in clients of private esthetics clinics of Porto Alegre, Rio Grande do Sul state, Brazil. Methods:Observational, cross-section study in which all participants underwent anthropometric (measurement of weight, height, BMI, and waist circumference) and dietary (24-hour recall) assessments. The dietary GI and GL were calculated as proposed by the Food and Agriculture Organization ? FAO, considering the values of the International Table of GlycemicIndex (2008). Dietary analysis was performed using DietWin® software and statistical analysis using SPPS 16.0 Package®. Results: One hundred nineteen clients of three private cosmetic clinics of Porto Alegre were Included in the current study. The following data were collected from the study subjects: 39.12 ± 13.55 years old, BMI equals to 26.21 ± 5.10kg/m², and waist circumference equal to 80.5 ± 11.3 cm for women and 99.7 ± 13.7 cm for men. The daily GL was equal to 89.9 ± 38.7 grams and the GI was equal to 54.4 ± 7.5%. The daily GL differed between participants categorized byBMI, considering the cutoff of the World Health Organization (WHO): higher GL was observed among overweight and obese participants in comparison to participants with underweight and normal weight (89.9 ± 38.7 g vs 89.9 ± 38.7 grams, p = 0.02). The GL explained approximately 26% of the variability in waist circumference values (p <0.001). Conclusion: Clients of private cosmetic clinics of Porto Alegre included in the current study presented overweight in a high proportion; it could be related to a high dietary GL. This aspect should be considered in the nutrition counseling ofthis group of patients regarding carbohydrate intake

Objetivo: Avaliar a possível associação entre o índice glicêmico (IG) e a carga glicêmica (CG) da dieta de frequentadores de clínicas estéticas privadas de Porto Alegre/RS e indicadores antropométricos de adiposidade corporal. Métodos: Estudo observacional transversal em que os participantes foram submetidos à avaliação antropométrica [peso, estatura, índice de massa corporal (IMC) e circunferência da cintura (CC)] e do consumo alimentar (recordatório de 24 horas). O IG e a CG das dietas foram calculados conforme padrão proposto pela FAO, a partir dos valores de IG da Tabela internacional (2008). A análise dietética dos dados foi realizada no software DietWin® e as análises estatísticas no Pacote SPPS 16.0®. Resultados: Foram avaliados 119 frequentadores de três clínicas estéticas privadas de Porto Alegre com idade média de 39,12 ± 13,55 anos, IMC de 26,21 ± 5,10Kg/m² e CC de 80,5 ± 11,3cm (para mulheres) e de 99,7 ± 13,7cm (para homens). A CG diária foi igual a 89,9 ± 38,7g e o IG igual a 54,4 ± 7,5%. A CG diária diferiu entre os grupos quando categorizados pelo IMC, considerando-se os pontos de corte da Organização Mundial de Saúde (OMS): maior CG diária entre os participantes com sobrepeso e obesidade em comparação àqueles com baixo peso e eutrofia (89,9 ± 38,7g vs. 89,9 ± 38,7g, P=0,02). A CG da dieta explicou cerca de 26% da variabilidade nos valores de CC dos participantes (P<0.001). Conclusão: Elevada prevalência de excesso de peso corporal foi observada na amostra de frequentadoresde clínicas estéticas privadas avaliada, o que foi relacionado ao consumo de dieta com elevada CG. A orientação nutricional desse grupo específico de indivíduos deve ponderar para esse aspecto quando da escolha de alimentos-fonte de carboidrato.