Desfecho clínico e fatores associados em pacientes comCOVID-19 internados em uma Unidade de Terapia Intensiva / Clinical outcome and associated factors in patients with COVID-19 admittedto an Intensive Care Unit

Introdução: O Corona Virus Disease (COVID-19) é umainfecção de elevada transmissibilidade e está associada commaior suscetibilidade ao desenvolvimento de desnutrição.Desta forma, a terapia nutricional enteral deve estar inte-grada ao tratamento global deste agravo. Objetivo: Analisar os fatores clínicos, nutricionais e bioquí-micos associados ao desfecho clínico de pacientes com COVID-19 internados em uma Unidade de Terapia Intensiva (UTI). Métodos: Trata-se de uma série de casos, realizado no pe-ríodo de março a julho de 2020, com os dados registrados nasfichas de acompanhamento nutricional dos pacientes interna-dos com COVID-19. As variáveis analisadas foram: demográ-ficas (idade e sexo); clínicas (comorbidades, doença de basee desfecho), antropométricas, bioquímicas e de suporte nu-tricional. Resultados: A amostra foi composta por 102 pacientes,65,7% apresentaram síndrome respiratória aguda grave, aprincipal doença de base observada foi as doenças cardíacas(23,5%) e 69,3% dos pacientes evoluíram para a alta da UTI.Com relação às variáveis nutricionais, aproximadamente 50%dos pacientes receberam alimentação por via enteral e 73,3%iniciaram de forma precoce. No que se refere aos marcadores bioquímicos, os pacientes que foram a óbito, apresentarammaiores valores das razões proteína C reativa (PCR) /albu-mina (p=0,024) e das concentrações de PCR (p=0,012)quando comparado com os que evoluíram para alta da UTI.Além disso, observa-se que os idosos (HR ajustada =3,62;IC95% 1,19 – 10,97) e o início precoce da terapia nutricionalenteral (HR ajustada = 10,62; IC95% 2,41 – 46,87) foram fa-tores relacionados com a alta da UTI. Conclusão: O acompanhamento do processo inflamatórioatravés de diferentes marcadores parece ser um bom parâ-metro de evolução clínica desses pacientes. Além disso, osbenefícios da terapia de nutrição enteral precoce podem es-tar associados à melhor evolução clínica e redução de com-plicações durante internamento.(AU)

ntroduction: The Corona Virus Disease (COVID-19) is ahighly transmissible infection and is associated with greatersusceptibility to the development of malnutrition. Thus, en-teral nutritional therapy must be integrated into the globaltreatment of this condition. Objective: To analyze the clinical, nutritional and biochem-ical factors associated with the clinical outcome of patientswith COVID-19 admitted to an Intensive Care Unit (ICU). Methods: This is a case series, carried out from March toJuly 2020, with data recorded in the nutritional monitoringrecords of patients hospitalized with COVID-19. The variablesanalyzed were: demographic (age and sex); clinical (comor-bidities, underlying disease and outcome), anthropometric,biochemical and nutritional support. Results: The sample consisted of 102 patients, 65.7% hadthe severe acute respiratory syndrome, the main underlyingdisease observed was heart disease (23.5%) and 69.3% ofpatients were discharged from the ICU. Regarding nutritionalvariables, approximately 50% of patients received enteralfeeding and 73.3% started early. Concerning biochemicalmarkers, patients who died had higher C-reactive protein(CRP)/albumin ratios (p=0.024) and CRP concentrations(p=0.012) when compared to those who progressed to dis-charge from the ICU. In addition, it is observed that the eld-erly (adjusted HR = 3.62; 95%CI 1.19 – 10.97) and early ini-tiation of enteral nutritional therapy (adjusted HR = 10.62;95%CI 2.41 – 46 .87) were factors related to ICU discharge. Conclusion: Monitoring the inflammatory process usingdifferent markers seems to be a good parameter for theclinical evolution of these patients. In addition, the benefitsof early enteral nutrition therapy may be associated withbetter clinical outcomes and reduced complications duringhospitalization.(AU)

IMMUNE RESPONSE OF SEVERE MALNUTRITION CHILDREN TREATED ACCORDING TO THE PROTOCOL OF THE WORLD HEALTH ORGANIZATION.

The aim of the study was to compare the innate immune system of severely malnourished children admitted to the Instituto de Medicina Integral Professor Fernando Figueira and treated according to the protocol of the World Health Organization (WHO) at admission and discharge. An experimental study was conducted with 20 children under two years of age. Ten of them had severe malnutrition and ten were a control group. The malnourished group consisted of hospitalized infants and it was submitted to WHO's protocol. Children with HIV and re-admitted during the study period were excluded. A blood sample was taken at admission and at discharge. Later, an analysis of blood leukocytes, adherence index, phagocytic capacity, production of free radicals superoxide and nitric oxide was performed. Patients with severe malnutrition at hospital discharge showed improved phagocytic function, release of oxygen radicals and reduction of the number of lymphocytes when compared to the time of admission. When compared to the control group, patients at hospital discharge had lower lymphocyte values and lower production of free radicals. Thus, it can be concluded that the duration of hospitalization was insufficient to restore cell-mediated immunity and microbicide activity.

El objetivo del estudio fue comparar el sistema inmune innato de niños con malnutrición grave ingresados en el Instituto de Medicina Integral Professor Fernando Figueira, tratados de acuerdo con el protocolo de la Organización Mundial de la Salud (OMS), al ingreso y al alta hospitalaria. Se llevó a cabo un estudio experimental con 20 niños menores de dos años de edad, 10 con malnutrición grave y 10 niños del grupo de control. El grupo de malnutridos se compuso de lactantes hospitalizados y sometidos al protocolo de la OMS. Se excluyeron los niños afectados por el HIV y los readmitidos durante el período del estudio. Se recogió una muestra de sangre al ingreso y otra al alta, y posterioriormente se realizó el análisis del perfil leucocitario, y el índice de adherencia, la capacidad fagocítica y la producción de los radicales libres superóxido y óxido nítrico. Los pacientes con malnutrición grave en el alta hospitalaria mostraron mejoría de la función fagocítica, la liberación de radicales oxidantes y la reducción del número de linfocitos en comparación con el ingreso hospitalario. En comparación con el grupo de control, los pacientes en el alta hospitalario presentaron valores más bajos de linfocitos y de producción de radicales libres. Por lo tanto, se puede concluir que el tiempo de hospitalización fue insuficiente para restablecer la inmunidad mediada por células, así como para restaurar la actividad microbicida.

GASTRIC CANCER AND ASSOCIATED FACTORS IN HOSPITALIZED PATIENTS.

BACKGROUND: despite the decline in its incidence and mortality rate, gastric cancer continues to be the 4th most common tumor and the 2nd cause of death in the world. OBJECTIVE(S): to analyze the factors associated with gastric cancer in hospitalized patients. METHOD: Transversal study of case series type made at Recife hospitals. The data were obtained from a questionnaire adapted from a previously validated model, which consists of socioeconomic factors, eating habits, lifestyle, family history of cancer, infection by H. pylori and anthropometric data. RESULTS: among 33 patients, there was a slight prevalence of women aged ≥ 60, from rural areas, with low education and income levels. According to IMC, 57.6% were eutrophics and 69.7% at nutritional risk when used % PP. It was found that 42.4% did not undergo any examination for H. pylori, 48.5% had a genetic predisposition, 75.8% were sedentary, 60.6% smokers and former smokers, 51.5% addicted to alcohol and 36.4% were overweight patients. There was frequent consumption of salty foods, fried foods, and low intake of fruits, foods containing nitrates / nitrites and inadequate food storage. CONCLUSION: low socioeconomic status, physical inactivity and inappropriate diet patterns were prevalent factors for gastric cancer in the treated group.

Introducción: a pesar de la disminución de la incidencia y la mortalidad, el cáncer gástrico sigue siendo el cuarto tumor más frecuente y la segunda causa de muerte por cáncer en el mundo. Objetivos: analizar los factores asociados con el cáncer gástrico en pacientes hospitalizados. Método: estudio de corte serie de casos, realizado en hospitales de Recife. Los datos fueron obtenidos a partir de cuestionarios adaptados de un modelo previamente validado, que contenían los problemas socioeconómicos, los hábitos alimentarios, el estilo de vida, los antecedentes familiares de cáncer, la infección por H. pylori y los datos antropométricos. Resultados: de los 33 pacientes, tuvieron un ligero predominio las mujeres con edades ≥ 60 años, de zonas rurales, con bajos niveles de educación e ingresos. De acuerdo con el IMC, el 57,6% fueron normales y el 69,7% en riesgo nutricional cuando se utiliza% PP. Se encontró que el 42,4% no se sometió a examen para H. pylori, el 48,5% tenían una predisposición genética, el 75,8% eran sedentarios, el 60,6% eran fumadores y ex fumadores, el 51,5% eran adictos al alcohol y el 36,4% tenían sobrepeso. Hubo consumo frecuente de alimentos salados, alimentos fritos, baja ingesta de frutas, alimentos que contienen nitratos/ nitritos, así como una inadecuada conservación de los alimentos. Conclusión: el bajo nivel socioeconómico, la inactividad física y los hábitos alimentarios inadecuados fueron factores predominantes para el cáncer gástrico en el grupo analizado.

Efeito da cirurgia bariátrica sobre o perfil lipídico mais aterogênico em curto prazo / Effect of bariatric surgery on in short-term atherogenic lipid profile

Introdução: A obesidade mórbida está relacionada com a alta incidência de dislipidemia, sendo esta considerada fator de risco para doenças cardiovasculares. Objetivo: Avaliar o perfil lipídico no pré e pós-operatório de pacientes submetidos ao bypass gástrico em Y de Roux. Métodos: Estudo retrospectivo com pacientes submetidos ao bypass gástrico em Y de Roux no Hospital das Clínicas da Universidade Federal de Pernambuco. Foram avaliados o peso corporal, índice de massa corporal, circunferência da cintura, razão cintura-quadril, colesterol total (CT), lipoproteína de alta densidade (HDL-c), lipoproteína de baixa densidade (LDL-c) e triacilgliceróis (TG) antes e após 3 meses de cirurgia. A partir dos lipídeos séricos foi avaliado o perfil lipídico mais aterogênico por meio da razão TG/ HDL-c. Resultados: Foram estudados 30 pacientes, sendo 83,3% do sexo feminino. Houve redução das concentrações de todos os parâmetros estudados com exceção da HDL-c, com diminuição na frequência de dislipidemia e do risco cardiovascular após 3 meses. Conclusão: Em apenas 3 meses de pós-operatório, a cirurgia bariátrica mostrouse efetiva em melhorar o perfil lipídico e, consequentemente, de fatores de risco cardiovasculares importantes (AU)

Introduction: Morbid obesity is related to the high incidence of dyslipidemia, which is considered a risk factor for cardiovascular disease. Objective: To evaluate the lipid profile in the pre and post-operative patients undergoing gastric bypass Roux-Y. Methods: A retrospective study on patients undergoing gastric bypass Roux-Y at the Hospital of the Federal University of Pernambuco. Body weight, body mass index, waist circumference, waist-hip ratio, total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and triglycerides (TG) were evaluated before and 3 months after surgery. From the serum lipids was rated the most atherogenic lipid profile through the TG / HDL-c ratio. Results: 30 patients were studied, 83.3% were female. There was reduction of concentrations of all parameters studied except for HDL-c, with decreased frequency of dyslipidemia and cardiovascular risk after 3 months. Conclusion: In just three months after surgery, bariatric surgery was effective in improving lipid profile and therefore, some important cardiovascular risk factors (AU)