Clinical and nutritional predictors of hospital readmission within 30 days.

BACKGROUND/OBJECTIVES: Identify clinical, sociodemographic, and nutritional predictors of hospital readmission within 30 days. SUBJECTS/METHODS: A longitudinal study was conducted with patients hospitalised at a public institution in Recife, Brazil. Sociodemographic (age, sex, race, and place of residence), clinical (diagnosis, comorbidities, medications, polypharmacy, hospital outcome, hospital stay, and occurrence of readmission within 30 days), and nutritional (% of weight loss, body mass index, arm circumference [AC], and calf circumference [CC]) characteristics were collected from the nutritional assessment files and patient charts. Nutritional risk was determined using the 2002 Nutritional Risk Screening tool and the diagnosis of malnutrition was based on the GLIM criteria. RESULTS: The sample was composed of 252 patients, 58 (23.0%; CI95%: 17.2-28.8%) of whom were readmitted within 30 days after discharge from hospital, 135 (53.5%; CI95%: 46.7-60.5%) were at nutritional risk and 107 (42.4%; CI95%: 35.6-49.3%) were malnourished. In the bivariate analysis, polypharmacy, nutritional risk, malnutrition, low AC, and low CC were associated with readmission. In the multivariate analysis, low CC was considered an independent risk factor, increasing the likelihood of hospital readmission nearly fourfold. In contrast, the absence of polypharmacy was a protective favour, reducing the likelihood of readmission by 81%. CONCLUSIONS: The use of six medications or more and low calf circumference are risk factors for hospital readmission within 30 days after discharge.

Blockade of Opiodergic System During Early Weaning Reverts Feeding Behavior Altered Patterns.

Adverse experiences that occur during the early stages of life can have permanent repercussions in adulthood. Among these experiences, early weaning is one that can alter the molecular, cellular, and behavior patterns in later life. Centered on this fact, the objective of the current study was to evaluate the effect of early weaning at 15 days of life of Wistar rats on their feeding behavior and if the opioidergic system blockade would cause a reversal of these outcomes. Experimental groups were formed based on the weaning period of each litter. On postnatal day 15, the group D15 was weaned and, on postnatal day 30 (natural weaning), the group D30 was weaned. The rats weaned on postnatal day 15, and administered subcutaneous Naltrexone (3 mg/kg) were from group D15 + NTX. Those weaned at 15 days of age exhibited higher depressive-like behavior, lesser reactivity time to sucrose, and higher intake of palatable food than the control group. The Naltrexone administration was observed to reverse some outcomes, such as increasing the reactivity time to sucrose and decreasing the quantity of palatable food consumed, to levels similar to those of the control group. Together, the findings of the present study are indicative of the vital role played by the opioidergic system in inducing the changes noted in the eating behavior patterns during adulthood, post early weaning.

Imunomodulação em paciente queimado fasciotomizado: Relato de caso / Immunomodulation in a burned fasciotomized patient: A case report

OBJETIVO: Descrever a evolução clínica e nutricional de paciente queimado fasciotomizado com uso de terapia nutricional imunomoduladora. RELATO DO CASO: Estudo do tipo relato de caso, realizado durante 52 dias na Unidade de Tratamento de Queimados do Hospital da Restauração Governador Paulo Guerra, em Recife-PE. Paciente do sexo masculino, adulto, 27 anos, proveniente do interior de Pernambuco, sem comorbidades, queimado por eletricidade de alta voltagem após acidente de trabalho, evoluindo com síndrome compartimental do membro superior esquerdo e submetido a fasciotomia. Prescrita dieta por via oral associada à suplementação imunomoduladora de característica hipercalórica, hiperproteica, contendo arginina e alto teor de oligoelementos e micronutrientes. Durante o internamento, o paciente apresentou manutenção do estado nutricional, com adesão de novos hábitos alimentares que contribuíram para a cicatrização do membro afetado. CONCLUSÃO: A terapia nutricional imunomoduladora individualizada beneficiou a reparação tecidual, cicatrização e redução do risco de amputação em paciente queimado fasciotomizado.

OBJECTIVE: To describe the clinical and nutritional evolution of a burn patient submitted to fasciotomy and immunomodulating nutritional therapy. CASE REPORT: A case-report study was conducted over a 52-day period at the Burn Treatment Unit of Governador Paulo Guerra Restauração Hospital in the city of Recife, Brazil. A 27-year-old male patient, brown skin color, from the instate region of the state of Pernambuco, without comorbidities, suffered a high-voltage electrical burn after a work accident, developing compartment syndrome of the left upper limb, and was submitted to fasciotomy. An orally diet was prescribed associated with immunomodulatory supplementation with a hypercaloric, hyper protein character, with arginine and high content of trace elements and micronutrients. During hospitalization, the patient's nutritional status was maintained with the adherence to new dietary habits, which contributed to the healing of the affected limb. CONCLUSIONS: Individualized immunomodulating nutritional therapy benefits the tissue repair and healing processes, reducing the risk of amputation in burn patients submitted to fasciotomy.

Undernutrition during pregnancy and lactation increases the number of fos-cells in the reward system in response to a 5-HT6 receptor agonist in male adolescent rats.

Undernutrition promotes morphofunctional adaptations in neuroanatomical circuits, leading to behavioural changes. Adolescence is a period of vulnerability for these adaptations, such as the control of food intake and the serotonergic system. The serotonergic system is capable of promoting satiety. However, its role in hedonic control has not been fully elucidated. The involvement of the 5-HT6 receptor in motivational feeding behaviours was recently observed. Therefore, we aimed to evaluate the effect of a 5-HT6 receptor agonist on food intake and neuronal activation in areas of the reward system in adolescent rats subjected to perinatal protein undernutrition. Wistar rats were divided into two groups according to nutritional manipulation during gestation and lactation. It has been observed that undernourished animals present greater neuronal activation in response to the 5HT-6 receptor agonist in areas of the food reward system.