Antioxidant Therapy in Inflammatory Bowel Disease: A Systematic Review and a Meta-Analysis of Randomized Clinical Trials.

The objective of this study is to assess the effectiveness of treatment for inflammatory bowel diseases in modulating oxidative stress biomarkers and cytokine levels. A systematic review of clinical trials was conducted, searching electronic databases including PubMed, Science Direct, and Scopus. After excluding articles that did not meet the inclusion criteria, 19 studies were included in the systematic review and 8 in the meta-analysis (6 for antioxidant capacity, 6 for superoxide dismutase (SOD), and 5 for lipid peroxidation analyzed through malondialdehyde (MDA) levels). SOD was significantly modulated (RR = 0.3764, 95% CI [0.0262 to 0.7267], p = 0.035) but not antioxidant capacity (RR = 0.3424, 95% CI [0.0334 to 0.7183], p = 0.0742) or MDA (RR = -0.8534, 95% CI [-1.9333 to 0.2265], p = 0.1214). Nonetheless, studies investigating oxidative stress biomarkers and cytokines in the context of alternative therapies for IBD treatment are still scarce. This review highlights the potential of antioxidant supplementation in IBD management and underscores the need for further investigations into its effects on oxidative stress biomarkers and cytokines to improve therapeutic approaches for IBD patients.

Comparison between GLIM and PG-SGA methods in the nutritional assessment of hospitalized oncological patients / Comparação entre os métodos GLIM e ASG-PPP na avaliação nutricional de pacientes oncológicos hospitalizados

ABSTRACT Objective The aim of this study was to compare the Global Leadership Initiative on Malnutrition and Subjective Global Assessment methods produced by the patient in the nutritional assessment of cancer in-patients. Methods Cross-sectional study with a prospective variable, conducted with patients admitted to a public hospital in Pernambuco, Brazil. The application of these tools and the diagnosis of malnutrition were performed within the first 48 hours of admission. Sociodemographic, clinical and laboratory data were obtained from the medical records and weight, height, arm circumference, triceps skinfold and handgrip strength data were collected. Results The 82 patients evaluated included mostly men aged ≥ 60 years with less than 8 years education. Malnutrition frequency was 93.7% according to the Subjective Global Assessment and including 23.2% severe malnutrition while, according to the Global Leadership Initiative on Malnutrition, 50% of the patients were considered severely malnourished. Malnutrition by the Global Leadership Initiative on Malnutrition showed a sensitivity of 82.9% and when associated with handgrip strength sensitivity was 90.8%, considering the Subjective global assessment produced by the patient as a reference; on the other hand, the specificity was 16.7% independently of adding handgrip strength. None of the anthropometric variables was associated with the reference tool. Conclusion The Global Leadership Initiative on Malnutrition proved to be a very sensitive tool for diagnosing malnutrition when compared to the gold standard, particularly for severe malnutrition, but with little specificity. The need for a comprehensive nutritional assessment in the clinical practice was confirmed, using the parameters available and not interpreting them separately.

RESUMO Objetivo O objetivo deste estudo foi comparar os métodos Global Leadership Initiativeon Malnutrition e Avaliação Subjetiva Global Produzida pelo Próprio Paciente na avaliação nutricional de pacientes oncológicos hospitalizados. Métodos Estudo transversal com uma variável prospectiva, realizado com pacientes internados em um hospital público de Pernambuco. A aplicação dessas ferramentas e o diagnóstico de desnutrição foram realizados nas primeiras 48 horas de admissão. Dados sociodemográficos, clínicos e laboratoriais foram obtidos do prontuário, e dados com peso, altura, circunferência do braço, prega cutânea tricipital e força de preensão palmar foram coletados. Resultados Dos 82 pacientes avaliados, a maioria eram homens com idade ≥60 anos com menos de 8 anos de estudo. A frequência de desnutrição foi de 93,7% pela Avaliação Subjetiva Global; destes, 23,2% com desnutrição grave. Já pela Global Leadership Initiative on Malnutrition, 50% dos pacientes foram considerados desnutridos graves. A desnutrição pela Global Leadership Initiative on Malnutrition apresentou uma sensibilidade de 82,9% e de 90,8% quando associada à força de preensão palmar considerando a Avaliação Subjetiva Global Produzida pelo Próprio Paciente como referência. Por sua vez, a especificidade foi de 16,7% independentemente de adicionar a força de preensão palmar. Nenhuma das variáveis antropométricas apresentou associação com a ferramenta de referência. Conclusão A Global Leadership Initiative on Malnutrition mostrou-se uma ferramenta bastante sensível para diagnosticar desnutrição quando comparada ao padrão ouro, principalmente para desnutrição grave, porém pouco específica. Ratificou-se a necessidade de uma avaliação nutricional ampla na prática clínica, utilizando os parâmetros disponíveis e não os interpretando de forma isolada.

Lack of Concordance among Nutritional Diagnostic Methods in Newly Diagnosed Colorectal Cancer Patients.

This study aimed to investigate the concordance of different nutritional assessment methods and the prevalence of inadequate nutritional status in newly diagnosed Colorectal cancer (CRC) patients. Cross sectional study was conducted in a public hospital in Alagoas, Brazil. Clinical, nutritional (patient-generated subjective global assessment [PG-SGA], body mass index [BMI], arm circumference [AC], triceps skinfold [TSF], arm muscle circumference [AMC]) and functional (handgrip strength [HGS]) data were collected from July 2017-January 2019. Of the 31 CRC patients with a mean age of 58.97 ± 14.96 years, 48.4% were elderly and 51.6% were female. TSF adequacy (80.8%) and PG-SGA (80.0%) revealed the highest prevalence of malnutrition. BMI identified the same prevalence of malnutrition and excess weight (30.0%). The concordance between PG-SGA and BMI (kappa = 0.086; p = 0.426) was slight, with fair HGS (kappa = 0.268; p = 0.124). PG-SGA and AC (kappa = 0.015; p = 0.99), TSF (kappa = 0.195; p = 0.558) and AMC adequacy (kappa = 0.142; p = 0.380) were poor. PG-SGA can diagnose malnutrition, even in those who are eutrophic/overweight, by other methods. Various methods do not show concordance with PG-SGA, confirming the need for both objective and subjective methods for better diagnosis of CRC patients.

Interleukin-6 and triceps skinfold are associated with severity/cancer stage in newly-diagnosed colorectal cancer patients / La interleucina-6 y el pliegue cutáneo del tríceps están relacionados con el estadio de gravedad del cáncer en los pacientes con cáncer colorrectal recién diagnosticados

Introduction: colorectal cancer (CRC) has an important impact on morbidity and mortality globally, and nitroxidative stress, inflammation, and nutritional status are linked with its progression. Aim: to analyze the association of inflammatory, anthropometric, functional, and oxidative markers with tumor stage in newly-diagnosed CRC patients at a public reference center in Maceió, Alagoas, Brazil. Methods: patient-generated subjective global assessment was applied, and weight, height, arm circumference, triceps skinfold (TSF), arm muscle circumference, and handgrip strength were obtained. A fasting blood sample was collected, centrifuged, and the serum was stored at -80 °C until the analysis. Malonaldehyde levels were quantified by HPLC (high-performance liquid chromatography) and cytokines, namely tumor necrosis factor-alpha, and interleukins IL-6, IL-8, and IL-17 were analyzed by ELISA. Patients were grouped according to cancer stage into group 1 (stage 0-III) and group 2 (stage IV). A binary logistic regression analysis was performed, adjusted for sex and age, to assess the relationships between the variables studied and cancer stage. Significance was considered when p < 0.05. Results: twenty-eight CRC patients were included, twenty (71.4 %) from group 1 and eight (28.6 %) from group 2. The binary logistic regression revealed that lower TSF adequacy (OR = 0.929; CI 95 % = 0.870-0.993; p = 0.029) and higher IL-6 levels (OR = 1.001; CI 95 % = 1.000-1.002; p = 0.012) increased the chance of patients having tumor stage IV. (AU)

Introducción: el cáncer colorrectal (CCR) tiene un impacto importante en la morbilidad y mortalidad a nivel mundial, y el estrés nitroxidativo, la inflamación y el estado nutricional están relacionados con su progresión. Objetivos: analizar la asociación de los marcadores inflamatorios, antropométricos, funcionales y oxidativos con el estadio tumoral de pacientes con CCR recién diagnosticados en un centro público de referencia de Maceió, Alagoas, Brasil. Métodos: se aplicó la valoración global subjetiva generada por el paciente y se obtuvieron el peso, la altura, la circunferencia del brazo, el pliegue cutáneo del tríceps (PCT), la circunferencia del músculo del brazo y la fuerza de prensión. Se tomó una muestra de sangre en ayunas, se centrifugó y el suero se almacenó a -80 °C hasta el momento del análisis. Los niveles de malonaldehído se cuantificaron por CLAR (cromatografía líquida de alta resolución) y las citocinas, representadas por el factor de necrosis tumoral alfa y las interleucinas IL-6, IL-8 e IL-17, se analizaron mediante ELISA. Los pacientes se agruparon según el estadio del cáncer en grupo 1 (estadio 0-III) y grupo 2 (estadio IV). Se realizó una regresión logística binaria, ajustada por sexo y edad, para evaluar las relaciones entre las variables estudiadas y el estadio del cáncer. Se consideró la significancia cuando p < 0,05. Resultados: se incluyeron veintiocho pacientes con CCR, de los cuales veinte (71,4 %) eran del grupo 1 y ocho (28,6 %) del grupo 2. La regresión logística binaria reveló que una menor adecuación de PCT (OR = 0,929; IC 95 % = 0,870-0,993; p = 0,029) y los niveles más altos de IL-6 (OR = 1,001; IC 95 % = 1,000-1,002; p = 0,012) aumentaban la probabilidad de que los pacientes tuvieran un tumor en estadio IV. (AU)

PRE-OPERATIVE FASTING: WHY ABBREVIATE?

INTRODUCTION: Considering the practice of preoperative fasting based on observations on the gastric emptying delay after induction and the time of this fast is closely linked to organic response to trauma, arise the question about preoperative fasting period necessary to minimize such response and support the professional with clinical and scientific evidence. AIM: To review the aspects related to the abbreviation of preoperative fasting from the metabolic point of view, physiology of gastric emptying, its clinical benefits and the currently recommendations. METHOD: Literature review was based on articles and guidelines published in English and Portuguese, without restriction of time until January 2017, in PubMed, SciELO and Cochrane with the descriptors: surgery, preoperative fasting, carbohydrate. From the universe consulted, 31 articles were selected. RESULTS: The literature suggests that the abbreviation of fasting with beverage added carbohydrates until 2 h before surgery, can bring benefits on glycemic and functional parameters, reduces hospitalization, and does not present aspiration risk of healthy patients undergoing elective surgery. Another nutrient that has been added to the carbohydrate solution and has shown promising results is glutamine. CONCLUSION: The abbreviation of preoperative fasting with enriched beverage with carbohydrates or carbohydrate and glutamine seems to be effective in the care of the surgical patient, optimizing the recovery from of postoperative period.

Pre-operative fasting: why abbreviate? / Jejum pré-operatório: por que abreviar?

ABSTRACT Introduction : Considering the practice of preoperative fasting based on observations on the gastric emptying delay after induction and the time of this fast is closely linked to organic response to trauma, arise the question about preoperative fasting period necessary to minimize such response and support the professional with clinical and scientific evidence. Aim : To review the aspects related to the abbreviation of preoperative fasting from the metabolic point of view, physiology of gastric emptying, its clinical benefits and the currently recommendations. Method : Literature review was based on articles and guidelines published in English and Portuguese, without restriction of time until January 2017, in PubMed, SciELO and Cochrane with the descriptors: surgery, preoperative fasting, carbohydrate. From the universe consulted, 31 articles were selected. Results : The literature suggests that the abbreviation of fasting with beverage added carbohydrates until 2 h before surgery, can bring benefits on glycemic and functional parameters, reduces hospitalization, and does not present aspiration risk of healthy patients undergoing elective surgery. Another nutrient that has been added to the carbohydrate solution and has shown promising results is glutamine. Conclusion : The abbreviation of preoperative fasting with enriched beverage with carbohydrates or carbohydrate and glutamine seems to be effective in the care of the surgical patient, optimizing the recovery from of postoperative period.

RESUMO Introdução : Considerando que a prática do jejum pré-operatório é baseada nas observações do retardo do esvaziamento gástrico após a indução anestésica e que o tempo deste jejum está intimamente ligado à resposta orgânica ao trauma, surge o questionamento acerca do período de jejum necessário para minimizar tal resposta e respaldar a atuação profissional em evidências clinicocientíficas. Objetivo : Revisar a abreviação do jejum pré-operatório, sob o ponto de vista metabólico, da fisiologia do esvaziamento gástrico, seus benefícios clínicos e recomendações atualmente vigentes. Método : A revisão foi baseada em artigos e guidelines publicados em inglês e português, sem restrição de tempo até janeiro de 2017, no PubMed, SciELO e Cochrane com os descritores: cirurgia, jejum pré-operatório, carboidrato. Do universo consultado 31 artigos foram selecionados. Resultados : A literatura aponta que a abreviação do jejum com bebida enriquecida com carboidratos até 2 h antes do procedimento cirúrgico pode trazer benefícios sobre parâmetros glicêmicos, funcionais, redução da hospitalização, além de não oferecer risco de broncoaspiração em indivíduos saudáveis submetidos à operações eletivas. Outro nutriente frequentemente adicionado a esta solução de carboidratos, com resultados promissores, é a glutamina. Conclusão : A abreviação do jejum pré-operatório com bebida enriquecida com carboidratos ou carboidratos e glutamina parece mostrar-se eficaz no cuidado ao paciente cirúrgico otimizando a recuperação do período pós-operatório.

Short stature in children of karapotó ethnic background, são sebastião, alagoas, Brazil / Déficit estatural em crianças do povo karapotó, são sebastião, alagoas, Brasil

Objective: To describe the prevalence of short stature among children of Karapotó ethnic background. Methods: Cross-sectional, population-based study that included children between 6 and 59 months of age from the Plak-Ô native village and the Terra Nova settlement, São Sebastião, Alagoas, carried out between 2008 and 2009. Short stature was evaluated by the Height/Ageindex, using as cutoff z score≤−2. The prevalence of short stature was determined by compa-ring simple and relative frequencies. The population growth curves were compared to the WHO reference curves. Data analysis included the outcome variable: Height/Age and the predictor variables: place of residence, gender, age, anemia, birth weight, family income, maternal literacy. The chi-square test was used to compare the categorical variables, where as the chi-square test with Yates correction was used for dichotomous variables, considering as statistically significant p-values≤0.05. Results: The prevalence of short stature was 15.6% for children from the Terra Nova settlement and 9.1% for those from Plak-Ô native village. The prevalence of short stature among the Karapotó ethnicity was 13.4%. The variables: maternal literacy, family income and low birth weight were statistically associated with short stature. Conclusions: The observed short stature prevalence rates are significant, being characterized as a public health problem. Among the associated factors, the following are noteworthy: unfavorable conditions of maternal literacy, family income and low birth weight. The planning of strategies to reverse the situation must take such factors into consideration.

Objetivo: Descrever a prevalência do déficit estatural entre crianças da povo karapotó.Métodos:Estudo transversal, de base populacional, incluiu crianças entre seis e 59 meses da aldeia Plak-Ô e do povoado Terra Nova, São Sebastião (AL), feito entre 2008 e 2009. O déficit estatural foi avaliado pelo índice estatura/idade, adotou-se como ponto de corte escore z≤−2. A prevalência de déficit estatural foi determinada pela comparação das frequências simples e relativas. As curvas de crescimento da população foram comparadas com as curvas de referência da OMS. A análise dos dados contemplou a variável de desfecho estatura/idade e as variáveis preditoras local de moradia, sexo, idade, anemia, peso ao nascer, renda familiar, alfabetização materna. Para comparação das variáveis categóricas dos grupos foi usado o teste do qui-quadrado e o teste do qui-quadrado com correção de Yates para as variáveis dicotômicas, consideraram-se como significância estatística p-valores≤0,05.Resultados:A prevalência de déficit estatural foi de 15,6% para as crianças do povoado Terra-Nova e 9,1% para as da aldeia Plak-Ô. A prevalência de déficit estatural da povo karapotó foi de 13,4%. As variáveis: alfabetização materna, renda familiar e baixo peso ao nascer se relacionaram estatisticamente com o déficit estatural.Conclusões:As prevalências de déficit estatural verificadas são expressivas, são caracterizadas como problema de saúde pública. Destacam-se, entre os fatores associados, condições desfavoráveis de alfabetização materna, renda familiar e baixo peso ao nascer. O planejamento de estratégias para mudar a situação precisa levar tais fatores em consideração.