Changes in body composition of burn patients during the phases of response to trauma.

OBJECTIVE: To assess the changes in body composition of burn patients through electrical bioimpedance in the phases of response to trauma. METHODS: a longitudinal observational study, carried out from October 2019 to March 2020. Sociodemographic, clinical, epidemiological, anthropometric and body composition data were collected. Statistical analysis was performed with SPSS, considering a significance of 5%. The comparison between variables was performed using the paired Student's t test. RESULTS: the sample consisted of 58 adult burn patients, with a mean age of 38.2±12.5 years. The mean body surface area (BSA) with burns was 10.8±7.3%. Nutritional assessment demonstrated a depletion of body weight, Body Mass Index, fat-free mass and muscle mass in the phases of response to trauma (p<0.005). CONCLUSION: metabolic alterations in the different phases of the metabolic response to trauma led to a depletion of the nutritional status of burn patients of both sexes during hospitalization.

Changes in body composition of burn patients during the phases of response to trauma / Alterações na composição corporal de pacientes queimados durante as fases de resposta ao trauma / Cambios en la composición corporal de pacientes quemados durante las fases de respuesta al trauma

ABSTRACT Objective: To assess the changes in body composition of burn patients through electrical bioimpedance in the phases of response to trauma. Methods: a longitudinal observational study, carried out from October 2019 to March 2020. Sociodemographic, clinical, epidemiological, anthropometric and body composition data were collected. Statistical analysis was performed with SPSS, considering a significance of 5%. The comparison between variables was performed using the paired Student's t test. Results: the sample consisted of 58 adult burn patients, with a mean age of 38.2±12.5 years. The mean body surface area (BSA) with burns was 10.8±7.3%. Nutritional assessment demonstrated a depletion of body weight, Body Mass Index, fat-free mass and muscle mass in the phases of response to trauma (p<0.005). Conclusion: metabolic alterations in the different phases of the metabolic response to trauma led to a depletion of the nutritional status of burn patients of both sexes during hospitalization.

RESUMO Objetivo: avaliar as alterações na composição corporal de pacientes queimados por meio da bioimpedância elétrica nas fases de resposta ao trauma. Métodos: estudo observacional longitudinal, realizado de outubro de 2019 a março de 2020. Foram coletados dados sociodemográficos, clínicos, epidemiológicos, antropométricos e de composição corporal. A análise estatística foi realizada com o SPSS, considerando significância de 5%. Comparação entre as variáveis foi realizada por meio do teste t de Student pareado. Resultados: a amostra foi composta por 58 pacientes adultos queimados, com média de 38,2±12,5 anos. A média da área de superfície corporal (ASC) com queimaduras foi de 10,8±7,3%. A avaliação nutricional demonstrou depleção do peso corporal, índice de massa corporal, massa magra e massa muscular nas fases de resposta ao trauma (p<0,005). Conclusão: alterações metabólicas nas diferentes fases da resposta metabólica ao trauma levaram a depleção do estado nutricional de pacientes queimados de ambos os sexos durante a internação.

RESUMEN Objetivo: evaluar alteraciones en la composición corporal de pacientes quemados mediante bioimpedancia eléctrica en las fases de respuesta al trauma. Métodos: estudio observacional longitudinal, realizado de octubre de 2019 a marzo de 2020. Se recogieron datos sociodemográficos, clínicos, epidemiológicos, antropométricos y de composición corporal. El análisis estadístico se realizó mediante SPSS, considerando una significancia del 5%. La comparación entre variables se realizó mediante la prueba de la t de Student pareada. Resultados: la muestra estuvo compuesta por 58 pacientes adultos quemados, con una edad media de 38,2±12,5 años. El área de superficie corporal media (ASC) con quemaduras fue de 10,8±7,3%. La evaluación nutricional mostró disminución del peso corporal, índice de masa corporal, masa magra y masa muscular en las fases de respuesta al trauma (p<0,005). Conclusión: los cambios metabólicos en las diferentes fases de la respuesta metabólica al trauma llevaron a la disminución del estado nutricional de los pacientes quemados de ambos sexos durante la hospitalización.

Nutritional assessment of hospitalized patients: Comparison of real and estimated anthropometric measures

ABSTRACT The assessment of the nutritional status of hospitalized patients is fundamental to the establishment of the diagnosis. For bedridden patients, however, it is not possible to determine simple measures, such as weight and height, which are the most widely used variables for nutritional assessments. Objective: Compare real and estimated anthropometric measures in hospitalized patients. Methods: A cross-sectional study was conducted with adult (>18 years of age) and senior patients (>60 years of age) admitted for clinical or surgical treatment in the general surgery infirmary of Governador Paulo Guerra Restauração Hospital. Data (sex, age, clinical diagnosis, real weight, real height, body mass index, knee height and arm circumference) were collected using nutritional follow-up charts and tabulated using Excel 2016. Statistical analyses were performed in SPSS® version 21.0. Results: One hundred and twenty patients participated in the study (median age: 55 years). Most were adults (73.3%) and women (53.3%). The mean differences in weight between the estimated and real measures were statistically significant (p=0.000), with an overestimation of this variable. Regarding height, the estimated values differed significantly from the real values in both men and women (p<0.000) and the difference was larger among the seniors (mean: -0.072). No significant difference was found between the real and estimated body mass index (p= 0.44). Conclusion: In the comparison of methods for estimating weight and height to real measures, a tendency was found to overestimate these body measures.

RESUMEN La evaluación del estado nutricional de los pacientes hospitalizados es esencial para establecer su diagnóstico. Sin embargo, para los pacientes postrados en cama, no se pueden realizar medidas sencillas como el peso y la altura, que son las más utilizadas para el diagnóstico nutricional. Objetivo: Comparar mediciones antropométricas reales y estimadas en pacientes hospitalizados. Metodología: Estudio transversal, que incluye pacientes adultos (>18 años) y personas mayores de 60 años, ingresados para tratamiento clínico o quirúrgico en la sala de cirugía general del Hospital da Restauração Governador Paulo Guerra. Los datos (sexo, edad, diagnóstico clínico, peso real, altura real, índice de masa corporal, altura de la rodilla y circunferencia del brazo) se recopilaron mediante los formularios de monitoreo nutricional y se tabularon en el software Excel 2016. Los análisis estadísticos se realizaron con SPSS®, versión 21.0. Resultados: 120 pacientes con mediana de 55 años, en su mayoría adultos (73,3%) y mujeres (53,3%). Las diferencias promedio entre las mediciones estimadas y reales fueron estadísticamente significativas, con sobreestimación del peso (p<0,0001). Con respecto a la altura, fue posible identificar que las medidas estimadas diferían significativamente (p<0,0001) de las reales para hombres y mujeres, y que esta variación era aún mayor entre los ancianos (media: -0,072). No hubo diferencias estadísticamente significativas entre el índice de masa corporal real y el estimado (p= 0,44). Conclusión: Al comparar las metodologías para estimar el peso y la altura con las mediciones reales, fue posible observar una tendencia de los métodos a sobreestimar estas mediciones corporales.

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.

Requerimento energético de pacientes queimados pediátricos: comparação de diferentes fórmulas preditivas / Energy requirements of pediatric burn patients: comparison of different predictive equations

INTRODUÇÃO: Crianças são mais vulneráveis a queimaduras devido as habilidades físicas e motoras em desenvolvimento. Na prática clínica são utilizadas equações preditivas para a determinação do gasto energético total. OBJETIVO: Comparar os requerimentos energéticos obtidos por diferentes equações preditivas em pacientes pediátricos queimados de uma Unidade de Referência em Recife-PE. MÉTODOS: Estudo transversal realizado com pacientes divididos em três grupos: 0 a 5 anos, 5 a 10 anos e 10 a 18 anos, internados de março a outubro/2019 na Unidade de Tratamento de Queimados do Hospital da Restauração Governador Paulo Guerra. Foram coletados dados em prontuário e ficha de avaliação nutricional. As necessidades energéticas foram estimadas utilizando diferentes fórmulas preditivas. RESULTADOS: Dos 117 pacientes, 53,8% eram do sexo masculino. A mediana de idade e tempo de internamento foi de 2,6 (1,4-6,7) anos e 7 (5,0-10,5) dias, respectivamente. Todos os pacientes apresentaram lesões de 2º grau com mediana de 6% de superfície corporal queimada. No grupo 1, o valor energético obtido por Schofield utilizando fator estresse mínimo e médio, mostrou-se semelhante ao de Davies & Liljedahl e Mayes, respectivamente. No grupo 2, o valor energético obtido por Schofield utilizando os três fatores de estresse foi diferente das demais. No grupo 3, o valor energético obtido por Schofield utilizando fator estresse mínimo, foi semelhante ao de Harris Benedict modificado por Long e Curreri. DISCUSSÃO: Estudo pioneiro que compara as diferentes fórmulas preditivas com a equação mais recomendada pela literatura. A maioria das equações preditivas estudadas não concordam com a recomendada, talvez por apresentarem apenas o peso corporal como variável comum. CONCLUSÃO: A maioria dos valores energéticos obtidos pelas fórmulas foram diferentes entre si, o que pode ser explicado pelos distintos fatores que compõem essas equações

INTRODUCTION: Children are vulnerable to burns due to the fact that their physical and motor skills are in the process of development. In clinical practice, predictive equations are used for the determination of total energy expenditure. OBJECTIVE: Compare energy requirements obtained from different predictive equations in pediatric burn patients at a reference service of Recife, Brazil. 10 Nutr. clín. diet. hosp. 2020; 40(2):10-16 Nutr. clín. diet. hosp. 2020; 40(2):10-16 DOI: 10.12873/402andressa Artículo Original Requerimento energético de pacientes queimados pediátricos: comparação de diferentes fórmulas preditivas Energy requirements of pediatric burn patients: comparison of different predictive equations. METHODS: A cross-sectional study was conducted with patients divided into groups (0-5 years, 5-10 years and 10- 18 years) hospitalized at the Burn Treatment Unit of the Restauração Hospital. Data were collected from the patient charts and nutritional assessment. Energy requirements were estimated using different equations. RESULTS: Among the 117 patients, 53.8% were males. Median age and hospital stay were 2.6(1.4-6.7) years and seven (5.0-10.5) days, respectively. All patients had seconddegree burns, with a median of 6% of the body surface affected. In Group 1, the energy value obtained using Schofield's formula considering minimum and mean stress factors was similar to that obtained using the Davies & Liljedahl and Mayes equations, respectively. In Group 2, the energy value obtained using Schofield's formula with three stress factors differed from that of the other equations. In Group 3, the energy value obtained using Schofield's factors with a minimum stress factor was similar to that obtained using the Harris-Benedict equation modified by Long and Curreri. DISCUSSION: This is a pioneering study that compared different formulas with the most recommended equation in the literature. CONCLUSION: Most energy values obtained by the equations differed from each other, which may be explained by the different factors that compose these equations

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Nutritional status and evaluation of the perioperative fasting time among patients submitted to elective and emergency surgeries at a reference hospital. / Estado nutricional e avaliação do tempo de jejum perioperatório de pacientes submetidos à cirurgias eletivas e de emergência em um hospital de referência.

OBJECTIVE: to evaluate the clinical, surgical, and nutritional profile of surgical patients admitted to a reference hospital in Recife city, Pernambuco state, Brazil. METHODS: a cross-sectional study carried out in the wards of the General Surgery Service of Hospital da Restauração Governador Paulo Guerra, from June to September 2018. We included adult and elderly patients (both genders) who were submitted to thoracoabdominal procedures and elective or emergency abdominal surgeries, and in which the assessment of nutritional status could be performed within 72 hours of hospital admission. Data on nutritional status and surgical procedures, as well as clinical and biochemical information, were collected. RESULTS: we studied 140 patients with median age of 45 years. Among all, 59.3% were female and 23% malnourished, according to Subjective Global Assessment. The median preoperative fasting time was 15 hours for size I surgeries and 13.5 hours for size II ones. Longer postoperative hospital stay showed a strong correlation with the total length of hospital stay in both surgical sizes. Malnourished patients had a longer period of perioperative fasting and hospital stay when compared to well-nourished patients (p<0.001). CONCLUSION: the perioperative fasting time for elective surgeries was longer than recommended by literature. Patients with longer fasting spent more time in hospital.

OBJETIVO: avaliar o perfil clínico, cirúrgico e nutricional de pacientes cirúrgicos internados em um hospital de referência da cidade de Recife - PE. MÉTODOS: estudo de caráter transversal, realizado nas enfermarias do Serviço de Cirurgia Geral do Hospital da Restauração Governador Paulo Guerra, no período de junho a setembro de 2018. Foram incluídos pacientes adultos e idosos de ambos os sexos, submetidos a procedimentos toracoabdominais e cirurgias abdominais, de caráter eletivo ou de emergência, em que a avaliação do estado nutricional pôde ser realizada em até 72 horas da admissão hospitalar. Foram coletados dados sobre o estado nutricional, sobre os procedimentos cirúrgicos, assim como, informações clínicas e bioquímicas. RESULTADOS: foram estudados 140 pacientes, com mediana de idade de 45 anos, 59,3% do sexo feminino, sendo que 23% apresentavam-se desnutridos, através da Avaliação Subjetiva Global. A mediana do tempo de jejum pré-operatório para as cirurgias de porte I foi de 15 horas e para as de porte II, 13,5 horas. Maior tempo de permanência hospitalar no pós-operatório apresentou forte correlação com o tempo total de internamento em ambos os portes cirúrgicos. Pacientes desnutridos apresentaram maior tempo de jejum perioperatório e de permanência hospitalar quando comparados com os bem nutridos (p<0,001). CONCLUSÃO: o tempo de jejum perioperatório das cirurgias eletivas esteve acima do que é preconizado pela literatura. Pacientes com maior tempo de jejum permaneceram mais tempo internados.

Adiposity, inflammation and fat-soluble vitamins in adolescents / Adiposidade, inflamação e vitaminas lipossolúveis em adolescentes

Abstract Objective: Evaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender. Methods: Cross-sectional study with adolescents aged 12-19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, β-carotene, α-tocopherol, and 25-hydroxy-vitamin D. Results: The levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p = 0.03) and an increased risk of 25-hydroxy-vitamin D and β-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient β-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2-1.5). Conclusion: Abdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.

Resumo: Objetivo: Avaliar a associação entre processo inflamatório, adiposidade e as vitaminas A, D e E em adolescentes, segundo o sexo. Métodos: Estudo transversal com adolescentes de 12 a 19 anos de ambos os sexos de escolas públicas de Recife. Foi utilizado um questionário para coleta de dados socioeconômicos, de estilo de vida e de consumo alimentar dos adolescentes. Em seguida, realizou-se a avalição antropométrica e coleta de sangue para análise das concentrações séricas de α-1-glicoproteína ácida, retinol, β-caroteno, α-tocoferol e 25-hidroxivitamina D. Resultados: Os níveis de α-1-glicoproteína ácida foram maiores na obesidade abdominal de ambos os sexos. Os meninos com níveis séricos insuficientes de α-tocoferol expressaram níveis reduzidos de α-1-glicoproteína ácida (p = 0,03) e apresentaram um maior risco de deficiência de 25-hidroxivitamina D e β-caroteno na adiposidade total e abdominal, enquanto as meninas mostraram maior risco de insuficiência de β-caroteno com a obesidade abdominal (RP 1,33; IC 95% 1,2-1,5). Conclusão: A adiposidade abdominal reflete maior risco de inflamação e causa alterações distintas nas concentrações das vitaminas lipossolúveis, de acordo com o sexo.

Consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren: a cohort study.

This study evaluates the relation between consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren from Recife/PE, Brazil. This is a cohort study conducted in 2008-2009 and 2012-2013, with 238 students recruited from the public school system of the city of Recife, Northeast Brazil. Demographic data, stage of sexual maturation, socioeconomic, lifestyle, anthropometric, and lipid profiles were collected. There was a high prevalence of overweight, abdominal obesity, and dyslipidemia in both the time periods. The number of teenagers sufficiently active was higher in 2012-2013. There was a positive correlation between the consumption of ultraprocessed foods and age in 2008-2009. In 2008-2009, high consumption of ultraprocessed foods occurred in the majority of adolescents with normal total serum cholesterol values. In 2012-2013, low maternal schooling proved to be an important factor for a lower consumption of ultraprocessed foods. The consumption of ultraprocessed foods showed no direct relationship with overweight, abdominal obesity, and dyslipidemia in adolescents.

Adiposity, inflammation and fat-soluble vitamins in adolescents.

OBJECTIVE: Evaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender. METHODS: Cross-sectional study with adolescents aged 12-19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, ß-carotene, α-tocopherol, and 25-hydroxy-vitamin D. RESULTS: The levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p=0.03) and an increased risk of 25-hydroxy-vitamin D and ß-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient ß-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2-1.5). CONCLUSION: Abdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.

Estado nutricional e avaliação do tempo de jejum perioperatório de pacientes submetidos à cirurgias eletivas e de emergência em um hospital de referência / Nutritional status and evaluation of the perioperative fasting time among patients submitted to elective and emergency surgeries at a reference hospital

RESUMO Objetivo: avaliar o perfil clínico, cirúrgico e nutricional de pacientes cirúrgicos internados em um hospital de referência da cidade de Recife - PE. Métodos: estudo de caráter transversal, realizado nas enfermarias do Serviço de Cirurgia Geral do Hospital da Restauração Governador Paulo Guerra, no período de junho a setembro de 2018. Foram incluídos pacientes adultos e idosos de ambos os sexos, submetidos a procedimentos toracoabdominais e cirurgias abdominais, de caráter eletivo ou de emergência, em que a avaliação do estado nutricional pôde ser realizada em até 72 horas da admissão hospitalar. Foram coletados dados sobre o estado nutricional, sobre os procedimentos cirúrgicos, assim como, informações clínicas e bioquímicas. Resultados: foram estudados 140 pacientes, com mediana de idade de 45 anos, 59,3% do sexo feminino, sendo que 23% apresentavam-se desnutridos, através da Avaliação Subjetiva Global. A mediana do tempo de jejum pré-operatório para as cirurgias de porte I foi de 15 horas e para as de porte II, 13,5 horas. Maior tempo de permanência hospitalar no pós-operatório apresentou forte correlação com o tempo total de internamento em ambos os portes cirúrgicos. Pacientes desnutridos apresentaram maior tempo de jejum perioperatório e de permanência hospitalar quando comparados com os bem nutridos (p<0,001). Conclusão: o tempo de jejum perioperatório das cirurgias eletivas esteve acima do que é preconizado pela literatura. Pacientes com maior tempo de jejum permaneceram mais tempo internados.

ABSTRACT Objective: to evaluate the clinical, surgical, and nutritional profile of surgical patients admitted to a reference hospital in Recife city, Pernambuco state, Brazil. Methods: a cross-sectional study carried out in the wards of the General Surgery Service of Hospital da Restauração Governador Paulo Guerra, from June to September 2018. We included adult and elderly patients (both genders) who were submitted to thoracoabdominal procedures and elective or emergency abdominal surgeries, and in which the assessment of nutritional status could be performed within 72 hours of hospital admission. Data on nutritional status and surgical procedures, as well as clinical and biochemical information, were collected. Results: we studied 140 patients with median age of 45 years. Among all, 59.3% were female and 23% malnourished, according to Subjective Global Assessment. The median preoperative fasting time was 15 hours for size I surgeries and 13.5 hours for size II ones. Longer postoperative hospital stay showed a strong correlation with the total length of hospital stay in both surgical sizes. Malnourished patients had a longer period of perioperative fasting and hospital stay when compared to well-nourished patients (p<0.001). Conclusion: the perioperative fasting time for elective surgeries was longer than recommended by literature. Patients with longer fasting spent more time in hospital.

Suplementação com imunonutrientes pós tromboembolectomia: um relato de caso / Supplementations with immunonutrients after thromboembolectomy: a case report

Introdução: A cicatrização é um processo de reparação tecidual dinâmico e imediato do organismo, em resposta a uma lesão, com intuito de restituir a característica anatômica, estrutural e funcional do tecido lesado. Para que ocorra a cicatrização, são necessárias uma ingestão adequada de macro e micronutrientes, como proteínas, arginina, glutamina, vitamina C, A, ferro e zinco, bem como a hidratação. Objetivo: Avaliar o efeito da suplementação com imunonutrientes na cicatrização pós tromboembolectomia complicada. Metodologia: Estudo do tipo relato de caso, realizado durante 39 dias (5,6 semanas), na Clínica de Cirurgia Vascular do Hospital da Restauração Governador Paulo Guerra, localizado em Recife - PE. As informações clínicas, cirúrgicas e nutricionais foram coletadas em prontuário médico e na ficha de acompanhamento nutricional do serviço de Nutrição. Resultados: Paciente do sexo feminino, adulta, 30 anos, oclusão arterial aguada e isquemia crítica de membro inferior esquerdo, submetida à tromboembolectomia com fasciotomia de membro. Discussão: A paciente do presente relato de caso apresenta diversos fatores de risco que estão relacionados à incidência de trombose venosa, como o uso de anticoncepcionais, tabagismo, excesso de peso e sedentarismo. Dessa forma, a adoção de hábitos de vida saudáveis, pode contribuir para a prevenção de eventos tromboembólicos. No que se refere à nutrição, destaca-se a importância da utilização da terapia nutricional específica com nutrientes imunomoduladores, visando o favorecimento da modulação da resposta inflamatória e imunológica, bem como a cicatrização de feridas. Conclusão: A utilização de terapia nutricional com nutrientes imunomoduladores específicos para a cicatrização de feridas influencia positivamente no desfecho clínico de paciente em pós-operatório de tromboembolectomia. A imunomodulação auxilia no fechamento de ferida pós-operatória, reduz as indicações de novos procedimentos e as chances de amputação de membro inferior esquerdo em paciente portadora de síndrome compartimental causada por trombose venosa

Introduction: Healing is a process of immediate and dynamic tissue repair in response to an injury, in order to restore the anatomical, structural and functional characteristics of the damaged tissue. In order for healing to occur, adequate intake of macro and micronutrients such as proteins, arginine, glutamine, vitamin C, iron and zinc, as well as hydration is required. Objective: To evaluate the effect of immunonutrient supplementation on healing after complicated thromboembolectomy. Methodology: A case report study, conducted during 39 days (5.6 weeks), at the Vascular Surgery Clinic of the Governador Paulo Guerra Restauração Hospital, located in Recife - PE. The clinical, surgical and nutritional information were collected in medical records and in the nutrition monitoring chart of the Nutrition service. Results: A 30-year-old female patient, watery occlusion and critical ischemia of the left lower limb, submitted to thromboembolectomy with limb fasciotomy. Discussion: The patient of the present case report presents several risk factors that are related to the incidence of venous thrombosis, such as contraceptive use, smoking, overweight and sedentary lifestyle. Thus, the adoption of healthy life habits may contribute to the prevention of thromboembolic events. Regarding nutrition, the importance of the use of specific nutritional therapy with immunomodulatory nutrients is emphasized, favoring the modulation of the inflammatory and immunological response, as well as wound healing. Conclusion: The use of nutritional therapy with specific immunomodulatory parameters for wound healing influences positively the clinical outcome in the postoperative period of thromboembolectomy. An adjuvant immunomodulation at the postoperative wound closure reduces the indications of new procedures and as chances of amputation of the left lower limb in a patient with compartment syndrome through venous thrombosis

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Consumo alimentar de iodo versus neoplasia de tireoide: a utilização de dietas restritivas préiodoterapia / Food consumption of iodine versus tireoid neoplasia: the use of restrictive diets pre-iodotherapy

Introdução: A tireoidectomia total e a radiação ionizante são os principais tipos de tratamento para o câncer de tireoide. A restrição de iodo precedente a radiação, por sete a catorze dias, é indicada para melhor captação do iodo ionizante. Objetivo: Avaliar o consumo alimentar de iodo em pacientes com neoplasia de tireoide submetidos à dietas restritas em iodo pré-iodoterapia. Métodos: Estudo de intervenção, não controlado, randomizado, aberto, realizado em pacientes de ambos os sexos, maiores de 18 anos, com carcinoma diferenciado de tireoide, atendidos no Instituto de Medicina Integral Prof. Fernando Figueira. Foram divididos dois grupos (A e B), os quais receberam orientações de dieta restrita em iodo por sete e catorze dias, respectivamente. O consumo alimentar foi mensurado pela aplicação do recordatório de 24 horas. Os dados foram analisados no Sigma Stat versão 13.0. Resultados: Foram analisados 59 pacientes, com idade média de 49±12,96 anos, sendo 57 (96,6%) mulheres. Ambos os grupos apresentaram ingestão de 30 a 50µg/dia de iodo, havendo boa adesão às orientações independente do tempo de restrição. A ingestão habitual dos grupos estava acima do adequado de acordo com a Estimated Average Requirement para sexo e idade. Discussão: O câncer de tireoide é o mais comum do sistema endócrino, sendo cerca de 70% no sexo feminino. A administração da dose ablativa de 30 a 150 mCi de iodo radiativo é o tratamento complementar de melhor escolha. A redução da ingestão diária promove maior captação do iodo radioativo pelas células malignas. As orientações de restrição da ingestão de iodo por sete ou catorze dias são suficientes para favorecer um melhor prognostico do tratamento ablasivo. Conclusão: Os grupos avaliados seguiram as orientações das dietas restritas em iodo (< 50ug/dia) para pacientes candidatosa terapia com iodo131, independente do tempo de restrição (AU)

Introduction: Total thyroidectomy and ionizing radiation are the main types of treatment for thyroid cancer. The restriction of iodine preceding radiation, for seven to fourteen days, is indicated for better uptake of ionizing iodine. Objective: To evaluate the dietary intake of cancer patients candidates for iodine treatment submitted to different periods of restricted diet in iodine. Methods: Cohort study performed in patients of both sexes, older than 18 years, with differentiated thyroid carcinoma, attended at the Instituto de Medicina Integral Prof. Fernando Figueira. Two groups (A and B) were divided, which received dietary guidelines in iodine for seven and fourteen days, respectively. Food consumption was measured by applying the 24-hour recall. The data were analyzed in Sigma Stat version 13.0. Results: A total of 59 patients were analyzed, with a average age of 49 ± 12.96 years, of which 57 (96.6%) were women. Both groups presented ingestion 30 to 50 g / day of iodine, with good adherence to the guidelines independent of the time of restriction. The usual intake of groups was above adequate according to the Estimated Average Requirement for sex and age. Discussion: Thyroid cancer is the most common endocrine system, with about 70% being female. Administration of the ablative dose 30 to 150 mCi of radioactive iodine is the preferred treatment of choice. The reduction of the daily intake promotes a greater uptake of radioactive iodine by the malignant cells. The restriction guidelines for iodine intake for seven or fourteen days are sufficient to favor a better prognosis of ablative treatment. Conclusion: The evaluated groups followed the guidelines of the restricted diets in iodine ( <50ug / day) for patientscandidates for iodine therapy131, regardless of the restriction time (AU)

Avaliação nutricional de pacientes submetidos à cirurgia do trato gatrointestinal: associação entre avaliação subjetiva global, ferramentas de triagem nutricional e métodos objetivos / Nutritional assessment in surgical patients: association between subjective global assessment, nutritional screening tools and objective methods

Introdução: A presença de desnutrição no período pré-cirúrgico aumenta a frequência de complicações infecciosas e não-infecciosas no pós-operatório. Dessa forma, uma avaliação do estado nutricional criteriosa é necessária para a adoção de estratégias que visem a manutenção ou recuperação da saúde. Objetivo: Verificar a associação entre a Avaliação Subjetiva Global (ASG) e ferramentas de triagem nutricional e métodos objetivos. Métodos: Estudo transversal, realizado no período de fevereiro a julho de 2011, com candidatos a grandes cirurgias do trato gastrointestinal, maiores de 18 anos, de ambos os sexos. Foram coletados os seguintes dados: Nutritional Risk Score (NRS) e Nutritional Risk Index (NRI), ASG, peso e altura para o cálculo do índice de massa corporal (IMC), circunferência braquial, prega cutânea tricipital, circunferência muscular do braço, espessura do músculo adutor do polegar, albumina, contagem total de linfócitos, hematócrito e hemoglobina. Os dados foram tabulados utilizando o Software Excel 2007 e realizadas as análises estatísticas no SPSS versão 13.0 (SPSS® Inc., Chicago, IL, USA). As variáveis contínuas foram testadas quanto à normalidade da distribuição pelo teste de Kolmogorov Smirnov e todas apresentaram distribuição normal, sendo então expressas na forma de média e desvio padrão. Para verificar a existência de associação entre as variáveis categóricas foi utilizado o teste do Qui quadrado de Pearson e o teste exato de Fisher e, para comparação entre dois grupos, utilizou-se o Teste t Student. Foi utilizado o nível de significância de 5% (pquanto o NRI classificou apenas 32,5%. Houve associa- ção significativa entre ASG e percentual de perda de peso, NRS e NRI. Conclusão: O percentual de perda de peso, o NRS e o NRI podem ser utilizados como ferramenta de triagem nutricional desses pacientes, visto que foi observada associação significativa com ASG, ferramenta considerada padrão-ouro na avaliação do estado nutricional de pacientes cirúrgicos (AU)

Introduction: The presence of malnutrition in the preoperative period increases the frequency of infectious and non-infectious complications after surgery. Thus a careful assessment of nutritional status is required for the adoption of strategies to maintain or restore health. Objective: To investigate the association between Subjective Global Assessment (SGA) and nutritional screening tools and classic anthropometry. Methods: Cross-sectional study conducted from February to July 2011, candidates for major surgery of the gastrointestinal tract, 18 years, of both sexes. The following data were collected: Nutritional Risk Score (NRS) and Nutritional Risk Index (NRI), SGA, weight, height and body mass index (BMI), arm circumference, triceps skin fold thickness, arm muscle circumference, adductor pollicis muscle thickness, albumin, total lymphocyte count, hematocrit and hemoglobin. Data were tabulated using the software Excel 2007 and statistical analyzes were performed using SPSS version 13.0 (SPSS® Inc., Chicago, IL, USA). Continuous variables were tested for normal distribution using the Kolmogorov Smirnov test and, once all of them showed normal distribution, they were expressed as mean and standard deviation. To verify the existence of association between categorical variables, the chi square of Pearson and the Fisher exact test were used. For comparison between two groups, the Student t test was applied. The significance level of 5% (p< 0.05) for null hypothesis rejection was used. Results: 46 patients were evaluated, aged 56.24 ± 14.38 years, 67.4% (n = 31) female. Approximately 61% and 21.7% were classified as malnourished by SGA and BMI, respectively. Hypoalbuminemia was present in 41% of patients. The NRS tool has classified 65.2% of patients in moderate to severe nutritional risk while only 32.5% have had this classification according to the NRI. There was a significant association between SGA and weight loss percentage, NRS and NRI. Conclusion: Weight loss percentage, NRS and NRI can be used as nutritional screening tools in surgical patients, since these screening tools have showed significant association with SGA, which is considered the gold standard tool in assessing the nutritional status of these patients (AU)

NUTRITIONAL STATUS AND PERIOPERATIVE FASTING TIME VERSUS COMPLICATIONS AND HOSPITAL STAY OF SURGICAL PATIENTS.

INTRODUCTION: many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. OBJECTIVE: to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. METHODS: cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. RESULTS: nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6 ± 2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p = 0.017),while a positive correlation was observed between weight loss and the length of hospital stay (p = 0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p = 0.021). CONCLUSION: the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay.

Introducción: muchos factores pueden influir negativamente en los resultados quirúrgicos, tales como el estado nutricional deteriorado y la extensión del tiempo de ayuno perioperatorio. Objetivo: evaluar la influencia del estado nutricional y el tiempo de ayuno perioperatorio en la aparición de complicaciones quirúrgicas y la duración de la estancia hospitalaria en pacientes sometidos a cirugía del tracto gastrointestinal y/o la pared abdominal, que fueron sometidos a protocolo de atención nutricional. Métodos: estudio de cohorte, realizado con 84 pacientes, de junio a noviembre de 2014. La recolección de datos se realizó mediante la aplicación de un cuestionario estructurado, búsqueda en los registros y prescripción médica y/o nutricional. Para el análisis estadístico se utilizó el programa STATA/SE 12.0 y se adoptó el nivel de significación del 5%. Resultados: el riesgo nutricional estuvo presente en el 26,2% de los casos, y de estos el 45,4% realizaron terapia nutricional preoperatoria, con una media de 6,6 ± 2,79 días. El ayuno preoperatorio fue de 4,5 (3,66; 5,50) horas y el ayuno postoperatorio fue de 5,1 (2,5; 20,5) horas. No se encontraron asociaciones entre los parámetros para evaluar la composición corporal y la presencia de complicaciones. Se observó una correlación negativa entre la duración de la estancia y el IMC (p = 0,017), y una correlación positiva entre la pérdida de peso y el tiempo de estancia hospitalaria (p = 0,036). Los pacientes con mayor tiempo de ayuno postoperatorio tuvieron una mayor incidencia de complicaciones (p = 0,021). Conclusión: el mal estado nutricional y la extensión del tiempo de ayuno perioperatorio están asociados a la aparición de complicaciones quirúrgicas y a una mayor duración de la estancia hospitalaria.

Nutritional status and perioperative fasting time versus complications and hospital stay of surgical patients / Estado nutricional y tiempo de ayuno perioperatorio versus complicaciones y tiempo de internamiento de pacientes quirúrgicos

Introduction: many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. Objective: to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. Methods: cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. Results: nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6±2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p=0.017), while a positive correlation was observed between weight loss and the length of hospital stay (p=0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p=0.021). Conclusion: the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay (AU)

Introducción: muchos factores pueden influir negativamente en los resultados quirúrgicos, tales como el estado nutricional deteriorado y la extensión del tiempo de ayuno perioperatorio. Objetivo: evaluar la influencia del estado nutricional y el tiempo de ayuno perioperatorio en la aparición de complicaciones quirúrgicas y la duración de la estancia hospitalaria en pacientes sometidos a cirugía del tracto gastrointestinal y/o la pared abdominal, que fueron sometidos a protocolo de atención nutricional. Métodos: estudio de cohorte, realizado con 84 pacientes, de junio a noviembre de 2014. La recolección de datos se realizó mediante la aplicación de un cuestionario estructurado, búsqueda en los registros y prescripción médica y/o nutricional. Para el análisis estadístico se utilizó el programa STATA/SE 12.0 y se adoptó el nivel de significación del 5%. Resultados: el riesgo nutricional estuvo presente en el 26,2% de los casos, y de estos el 45,4% realizaron terapia nutricional preoperatoria, con una media de 6,6±2,79 días. El ayuno preoperatorio fue de 4,5 (3,66; 5,50) horas y el ayuno postoperatorio fue de 5,1 (2,5; 20,5) horas. No se encontraron asociaciones entre los parámetros para evaluar la composición corporal y la presencia de complicaciones. Se observó una correlación negativa entre la duración de la estancia y el IMC (p=0,017), y una correlación positiva entre la pérdida de peso y el tiempo de estancia hospitalaria (p=0,036). Los pacientes con mayor tiempo de ayuno postoperatorio tuvieron una mayor incidencia de complicaciones (p=0,021). Conclusión: el mal estado nutricional y la extensión del tiempo de ayuno perioperatorio están asociados a la aparición de complicaciones quirúrgicas y a una mayor duración de la estancia hospitalaria (AU)

Tempo de jejum perioperatório versus tempo de permanência hospitalar e complicações pós operatórias em pacientes submetidos a cirurgias do trato gastrointestinal e de parede abdominal / Fasting time perioperative versus time hospital permanence and complications after surgical patients submitted to surgery of the gastrointestinal tract and abdominal wall

Introdução: Pacientes cirúrgicos são expostos a jejum perioperatório prolongado podendo agravar a resposta metabólica ao trauma. Objetivo: identificar o tempo de jejum pré e pósoperatório e associar à incidência de complicações pós-operatórias e tempo de internamento em pacientes submetidos a cirurgias do trato gastrointestinal e de parede abdominal. Métodos: Trata-se de um estudo prospectivo observacional realizado com pacientes cirúrgicos internados no período de abril a outubro de 2013. Considerou-se o tempo de jejum pré-operatório a diferença (em horas) da última refeição realizada até o início do procedimento cirúrgico. O jejum pós-operatório foi contabilizado a partir da diferença (em horas) entre o final do procedimento cirúrgico e o reinício da dieta. As operações foram divididas em porte I (operações envolvendo parede abdominal e laparotomias sem abertura de alças e/ou manipulação de vias biliares) e porte II (operações envolvendo laparotomias com abertura de alças e/ou manipulação de vias biliares). As complicações pós-operatórias avaliadas por um período de até 30 dias após o procedimento cirúrgico. O tempo (em dias) de interna- ção pós-operatória foi calculado pela diferença entre a data da alta e a data da cirurgia. Para análise dos resultados utilizou-se o programa estatístico Sigma Stat 13.0, empregando-se o nível de confiança de 95%. Resultados: Não houve diferença nas medianas do tempo de jejum pré-operatório entre as cirurgias do porte I e II. Os pacientes que realizaram cirurgia do porte II permaneceram mais tempo em jejum pós-operatório ( p<0,001) e por mais tempo internados (p<0,001). Houve maior percentual de complicações nas cirurgias do porte II ( p= 0,001). Discussão: A nutrição tanto no pré como no pósoperatório tem papel relevante, diminuindo a resposta orgânica ao estresse e interferindo de maneira significativa na evolução dos pacientes. Conclusão: O tempo de jejum pré-operatório foi superior ao preconizado pelos protocolos multimodais de abreviação do jejum, independente do porte cirúrgico. O tempo de jejum perioperatório alargado pode favorecer ao aumento do tempo de permanência hospitalar (AU)

Introduction: Surgical patients are exposed to prolonged perioperative fasting can aggravate the metabolic response to trauma. Objective: To identify the pre fasting period and after surgery and associate the incidence of postoperative complications and length of hospital stay in patients undergoing surgery of the gastrointestinal tract and abdominal wall. Methods: This is a prospective observational study of hospitalized surgical patients from April to October 2013. It was considered the preoperative fasting time difference (in hours) of the last meal accomplished at the beginning of the surgical procedure. Postoperative fasting was recorded from the difference (in hours) between the end of the surgical procedure and the diet restart. Operations were divided into size I (operations involving abdominal wall and laparotomy without opening handles and/or manipulation of the bile ducts) and size II (operations involving laparotomy with open handles and/or manipulation of the bile ducts). Postoperative complications assessed for a period of 30 days after surgery. The time (in days) of postoperative hospital stay was calculated as the difference between the date of discharge and the date of surgery. For data analysis we used the statistical software Sigma Stat 13.0, using the confidence level of 95%. Results: There was no difference in median preoperative fasting time between the size of the surgeries I and II. Patients who underwent surgery sized II stayed longer in postoperative fasting (p< 0.001) and in hospital longer (p<0.001). There was a higher percentage of complications in the size surgeries II (p = 0.001). Discussion: Nutrition both pre and post-operative has an important role, reducing organic response to stress and interfering significantly to patient outcomes. Conclusion: Preoperative fasting time was higher than the one from multimodal protocols of fasting abbreviation, regardless of surgical size. The extended perioperative fasting time may favor the increased length of hospital stay (AU)

Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery / Estado nutricional y su impacto en el tiempo de la reubicación y en las complicaciones postoperatorias en pacientes sometidos a cirugía abdominal

Introduction: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. Objective: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. Methods: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. Results: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). Conclusion: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence (AU)

Introducción: El estado nutricional es el factor independiente que más influye en los resultados post-operacionales en las cirugías electivas. Objetivo: evaluar la influencia del estado nutricional en el periodo de hospitalización y en las complicaciones post-operatorias de los pacientes sometidos a cirugía abdominal. Métodos: Estudio prospectivo de 99 pacientes quirúrgicos mayores de 18 años de edad, sometidos a cirugía abdominal en el período de abril a octubre de 2013, en el Instituto de Medicina Integral Professor Fernando Figueira (IMIP). Todos los pacientes fueron sometidos a evaluaciones nutricionales antropométricos a través del índice de masa corporal (IMC), la circunferencia del brazo (CB) y el espesor del pliegue cutáneo tricipital (PCT). La evaluación bioquímica se llevó a cabo a partir de los resultados leucograma y albú- mina sérica. La identificación de los pacientes candidatos a la terapia nutricional (TN) se llevó a cabo a través de la evaluación del riesgo nutricional (RN) utilizando el IMC, la pérdida de peso y la hipoalbuminemia. La información sobre las complicaciones postoperatorias, tiempo de hospitalización y diagnóstico clínico se recogió de los registros médicos. Programa SPSS versión 13.0 y nivel de significancia de 5 % se utilizaron para el análisis estadístico. Resultados: La malnutrición diagnosticada por el CB mostraron asociación positiva significativa con la presencia de complicaciones postoperatorias (p = 0,02) y con el período de hospitalización (p = 0,02). La presencia de RN fue mayor cuando se evaluó por la hipoalbuminemia (28,9 %), sin embargo, sólo el 4 % de la muestra llevó a cabo el TN en el período pre-operacional. El período de hospitalización fue mayor para los pacientes con neoplasia maligna (p < 0,01). Conclusión: El diagnóstico desnutrición de los pacientes sometidos a cirugía abdominal se asocia a un mayor riesgo de complicaciones post-operativas y más tiempo de permanencia de hospitalización (AU)