13CO2 recovery fraction in expired air of septic patients under mechanical ventilation

The continuous intravenous administration of isotopic bicarbonate (NaH13CO2) has been used for the determination of the retention of the 13CO2 fraction or the 13CO2 recovered in expired air. This determination is important for the calculation of substrate oxidation. The aim of the present study was to evaluate, in critically ill patients with sepsis under mechanical ventilation, the 13CO2 recovery fraction in expired air after continuous intravenous infusion of NaH13CO2 (3.8 µmol/kg diluted in 0.9 percent saline in ddH2O). A prospective study was conducted on 10 patients with septic shock between the second and fifth day of sepsis evolution (APACHE II, 25.9 ± 7.4). Initially, baseline CO2 was collected and indirect calorimetry was also performed. A primer of 5 mL NaH13CO2 was administered followed by continuous infusion of 5 mL/h for 6 h. Six CO2 production (VCO2) measurements (30 min each) were made with a portable metabolic cart connected to a respirator and hourly samples of expired air were obtained using a 750-mL gas collecting bag attached to the outlet of the respirator. 13CO2 enrichment in expired air was determined with a mass spectrometer. The patients presented a mean value of VCO2 of 182 ± 52 mL/min during the steady-state phase. The mean recovery fraction was 0.68 ± 0.06 percent, which is less than that reported in the literature (0.82 ± 0.03 percent). This suggests that the 13CO2 recovery fraction in septic patients following enteral feeding is incomplete, indicating retention of 13CO2 in the organism. The severity of septic shock in terms of the prognostic index APACHE II and the sepsis score was not associated with the 13CO2 recovery fraction in expired air.

L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs

The effects of adding L-carnitine to a whole-body and respiratory training program were determined in moderate-to-severe chronic obstructive pulmonary disease (COPD) patients. Sixteen COPD patients (66 ± 7 years) were randomly assigned to L-carnitine (CG) or placebo group (PG) that received either L-carnitine or saline solution (2 g/day, orally) for 6 weeks (forced expiratory volume on first second was 38 ± 16 and 36 ± 12 percent, respectively). Both groups participated in three weekly 30-min treadmill and threshold inspiratory muscle training sessions, with 3 sets of 10 loaded inspirations (40 percent) at maximal inspiratory pressure. Nutritional status, exercise tolerance on a treadmill and six-minute walking test, blood lactate, heart rate, blood pressure, and respiratory muscle strength were determined as baseline and on day 42. Maximal capacity in the incremental exercise test was significantly improved in both groups (P < 0.05). Blood lactate, blood pressure, oxygen saturation, and heart rate at identical exercise levels were lower in CG after training (P < 0.05). Inspiratory muscle strength and walking test tolerance were significantly improved in both groups, but the gains of CG were significantly higher than those of PG (40 ± 14 vs 14 ± 5 cmH2O, and 87 ± 30 vs 34 ± 29 m, respectively; P < 0.05). Blood lactate concentration was significantly lower in CG than in PG (1.6 ± 0.7 vs 2.3 ± 0.7 mM, P < 0.05). The present data suggest that carnitine can improve exercise tolerance and inspiratory muscle strength in COPD patients, as well as reduce lactate production.

Obese women on a low energy rice and bean diet: effects of leucine, arginine or glycine supplementation on protein turnover

This study examined if leucine, arginine or glycine supplementation in adult obese patients (body mass index of 33 + or - 4 kg/m²) consuming a Brazilian low energy and protein diet (4.2 MJ/day and 0.6 g protein/kg) affects protein and amino acid metabolism. After four weeks adaptation to this diet, each subject received supplements of these amino acids (equivalent to 0.2 g protein kg-1 day-1) in random order. On the seventh day of each amino acid supplementation, a single-dose 15N-glycine study was carried out. There were no significant differences in protein flux, synthesis or breakdown. The protein flux (grams of nitrogen, gN/9 h) was 55 + or - 24 during the nonsupplemented diet intake and 39 + or - 10, 44 + or - 22 and 58 + or - 35 during the leucine-, glycine- and arginine-supplemented diet intake, respectively; protein synthesis (gN/9 h) was 57 + or - 24, 36 + or - 10, 41 + or - 22 and 56 + or - 36, respectively; protein breakdown (gN/9 h) was 51 + or - 24, 34 + or - 10, 32 + or - 28 and 53 + or - 35, respectively; kinetic balance (gN/9 h) was 3.2 + or - 1.8, 4.1 + or - 1.7, 3.4 + or - 2.9 and 3.9 + or - 1.6. There was no difference in amino acid profiles due to leucine, arginine or glycine supplementation. The present results suggest that 0.6 g/kg of dietary protein is enough to maintain protein turnover in obese women consuming a reduced energy diet and that leucine, arginine or glycine supplementation does not change kinetic balance or protein synthesis

Liver and kidney nitrogen uptake in rats fed beans enriched with 15 nitrogen through (15NH4)2SO4 used as soil fertilizer

This study was conducted to determine the incorporation of 15 nitrogen (15N) into liver and kidney of a group of rats (N = 17) fed a mixture of cooked rice and beans for 4 weeks. The beans (Phaseolus vulgaris), grown in soil cultivated with (15NH4)2sO4, had 1.5% 15N enrichment. Three or four rats were sacrificed weekly and a control group (N = 13) received an isonitrogen and isocaloric reference casein diet. The amount of nitrogen transferred from the beans to the liver at the end of the first, second, third and fourth weeks was 17, 11, 27 and 29% of the total nitrogen, respectively. For the kidney, the respective values were 10, 9, 25 and 27% of the total nitrogen. The total nitrogen content of the liver and kidney of rats receiving the reference casein control diet was similar to that of the rice-beans animals. Weight gain was similar for the two groups, indicating the well-balanced biological value of the experimental diet. The present study shows that its is possible to monitor 15N incorporation into beans and subsequently into rat liver and kidney, in contrast to classical methods for protein metabolism evaluation which measure only total body nitrogen intake and excretion or weight gain

Effect of acute glucose infusion on plasma levels of insulin, glucose and free fatty acids, and on the glucose removal rate in obese women

The objective of the present study was to report the variations in levels of insulin, free fatty acids and glucose occurring in a group of obese and nonobese women after acute intravenous glucose infusion. The difference between glucose and insulin levels in obese and nonobese women in response to glucose infusion was statistically significant. The mean maximum value for glucose detected in the obese group was 256 mg/dl versus 283 mg/dl in the nonobese group (p < 0.05). Insulin content was 147 muU/ml in the obese group versus 36 muU/ml in the nonobese group (p < 0.05). K (fractional removal rate constant for glucose) values were similar in both groups suggesting that the higher glucose and insulin peaks showed by the obese were due to the higher glucose uptake by the blood rather than its removal impairment.

Indicadores das condiçöes nutricionais na regiäo Polonoroeste: V. Desnutriçäo proteíco-energética e parasitoses intestinais em um grupo de crianças de 3 a 72 meses de idade da cidade de Mirassol D'Oeste, Mato Grosso, Brasil / Nutritional conditions indicators in Polonoroeste area: V. Proteic-energetic malnutrition and intestinal parasites in a group of children from 3 to 72 months from Mirassol D'Oeste, Mato Grosso, Brasil

Este trabalho tem por objetivo caracterizar a desnutriçäo protéico-energética associada a parasitose intestinal em grupo de 149 crianças de ambos os sexos, na faixa etária de 3 a 72 meses, da cidade de Mirassol D'Oeste, na regiäo do Projeto Polonoroeste em Mato Grosso. De cada criança foram coletados os seguintes dados: sexo, peso, idade e amostra de fezes para exame parasitológico. Os dados peso/idade obtidos foram analisados pelos critérios de GOMEZ. Utilizou-se como padräo de referência o National Center for Health Statistic (NCHS). Para diagnóstico dos parasitas intestinais executou-se o método de Hoffman, Pons e Janer. O grupo estudado constitui-se em sua maioria de crianças desnutridas, sendo a forma leve de desnutriçäo mais comum que as formas moderada e grave. As enteroparasitoses foram encontradas em 69% das amostras examinadas. A "Giardia lamblia" foi o protozoário mais comum e o "Ancilostomídeo" o helminto mais encontrado. O teste X2 näo mostrou relaçäo de dependência entre o estado nutricional e a freqüência de enteroparasitoses

Efeito de uma dieta rica em fibras sobre o transito intestinal. / Effect of a rich fiber diet on the intestinal transit

Estudos epidemiologicos tem demonstrado uma diminuicao do tempo de transito intestinal nas populacoes que ingerem alimentacao rica em fibras. Nos paises mais desenvolvidos a industrializacao tem sido apontada como responsavel pela reducao do conteudo de fibras das dietas. A menor ingesta de fibra tambem tem sido correlacionada com diversas doencas como: diverticulose, hemorroidas, varizes de membros inferiores diabetes, obesidade, aterosclerose. O presente trabalho foi realizado com a finalidade de demonstrar o efeito das fibras sobre o transito intestinal. O estudo foi realizado em 9 pacientes internados na Unidade Metabolica da Disciplina de Nutrologia, Departamento de Clinica Medica, Faculdade de Medicina de Ribeirao Preto. Os pacientes receberam uma dieta de alimentos regionais e normalmente usados na nossa alimentacao.As fibras destes alimentos foram calculados como fibra bruta. Foi medido o tempo de transito em 2 periodos separados e cada periodo constava no minimo de 7 dias. Os resultados do transito no periodo com conteudo normal de fibras (4,6 +/- 0,4 gramas) foi de 37,0 +/- 9,6 horas e no periodo com dieta rica em fibras (11,5 +/- 2,1) foi de 23,0 +/- 11,3 horas.O tempo de desaparecimento dos corantes nas fezes nao mostrou associacao significativa em relacao a quantidade de fibra ingerida pelos pacientes

Avaliacao antropometrica e bioquimica do estado nutricional. / Anthropometric and biochemical evaluation of nutritional status

A alteracao do estado nutricional e reconhecida como um dos graves problemas medicos especialmente nos paises em desenvolvimento sendo uma das preocupacoes da Nutrologia e avaliacao destas alteracoes. A presente revisao foi realizada com objetivo de apresentar e comentar alguns aspectos relacionados com a avaliacao antropometrica e bioquimica do estado nutriciona

Alcoolismo, tabagismo e carcinoma epidermoide de terco medio do esofago: estudo tipo caso-controle. / Alcoholism, smoking and epidermoid carcinoma of the middle third of the esophagus: a case-control study

Para verificar uma possivel associacao entre o carcinoma epidermoide de terco medio de esofago e os habitos de beber e fumar, foi realizado um estudo tipo caso-controle no Hospital das Clinicas de Ribeirao Preto no periodo de agosto de 1980 a outubro de 1981. Entre 25.661 pacientes atendidos nesta instituicao, 21 tiveram o diagnostico deste tipo de neoplasia.Eles foram considerados casos e pareados individualmente com 57 controles (razao de pareamento de 1:3) em relacao as variaveis: sexo, idade, cor, procedencia, residencia, profissao, nivel socio-economico e o habito de beber ou fumar. Foi encontrada associacao estatisticamente significativa entre o carcinoma epidermoide de terco medio de esofago e o alcoolismo, com risco relativo de 26,7 Este valor e maior que os encontrados em outras partes do mundo, referentes a associacao com o cancer de esofago em geral.Em relacao ao tabagismo, nao foi encontrada associacao significativa: o risco relativo obtido foi de 1,9

Estudo de lipidogramas em pacientes do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto (USP). / Lipidograms in patients of the Hospital das Clinicas of the Faculdade de Medicina de Ribeirao Preto (USP)

Foram realizados lipidogramas em 1.149 pacientes do Hospital das Clinicas de Ribeirao Preto. Neles foram encontrados 293 pacientes portadores de hiperlipidemias. Os resultados foram associados a diversas patologias, como hipertensao arterial, obesidade, nefropatia, diabetes mellitus, coronariopatia, acidente vascular cerebral e obstrucao arterial periferica. Entre os pacientes com lipidograma normal, 11,9% eram coronariopatas, 9,1% diabeticos e 3,9% eram nefropatas. Entre os pacientes com perfil lipidico alterado, 11,6% eram nefropatas, 13,3% diabeticos e 15,7% coronariopatas. Esses resultados foram semelhantes aos da literatura, considerando as coronariopatias, hipertensao arterial e nefropatias. Para os diabeticos e obesos, os dados do presente estudo diferem ligeiramente de outros trabalhos, mas demonstram mais uma vez a associacao entre essas patologias e alteracao do perfil lipidico