Body mass index and weight loss in patients submitted to orthognathic surgery: a prospective study.

OBJECTIVE: To compare the body mass index (BMI) and the weight loss (WL) in patients with dentofacial deformities who underwent monomaxillary versus bimaxillary orthognathic surgery. MATERIALS AND METHODS: This prospective longitudinal study included 69 patients with dentofacial deformities who underwent surgical orthodontic treatment. Patients were divided into two groups according to the type of orthognathic surgery: monomaxillary or bimaxillary. A preoperative nutritional assessment based on BMI was performed; the percentage of involuntary WL between the preoperative and postoperative periods was also calculated. Data were collected at preoperative and 10, 40, and 90 days postoperative (PO). Statistical analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY, USA), and data are reported with 95% confidence interval. RESULTS: According to BMI, patients who underwent monomaxillary surgery presented: underweight = 2.6%, normal weight = 51.3%, overweight = 35.9%, and obese = 10.3%. The subjects who underwent bimaxillary surgery presented: normal weight = 43.3%, overweight = 36.7%, and obese = 20%. BMI was similar between the groups at all time points (preoperative, p= 0.237; 10 days PO, p= 0.325; 40 days PO, p= 0.430; and 90 days PO, p= 0.609). All patients lost weight postoperatively, and WL was similar among the PO measurements (p= 0.163). CONCLUSIONS: Although both monomaxillary and bimaxillary orthognathic surgeries resulted in WL and lower BMI, there was no statistically significant difference in these metrics between the two types of surgery.

Body mass index and weight loss in patients submitted to orthognathic surgery: a prospective study

ABSTRACT Objective: To compare the body mass index (BMI) and the weight loss (WL) in patients with dentofacial deformities who underwent monomaxillary versus bimaxillary orthognathic surgery. Materials and Methods: This prospective longitudinal study included 69 patients with dentofacial deformities who underwent surgical orthodontic treatment. Patients were divided into two groups according to the type of orthognathic surgery: monomaxillary or bimaxillary. A preoperative nutritional assessment based on BMI was performed; the percentage of involuntary WL between the preoperative and postoperative periods was also calculated. Data were collected at preoperative and 10, 40, and 90 days postoperative (PO). Statistical analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY, USA), and data are reported with 95% confidence interval. Results: According to BMI, patients who underwent monomaxillary surgery presented: underweight = 2.6%, normal weight = 51.3%, overweight = 35.9%, and obese = 10.3%. The subjects who underwent bimaxillary surgery presented: normal weight = 43.3%, overweight = 36.7%, and obese = 20%. BMI was similar between the groups at all time points (preoperative, p= 0.237; 10 days PO, p= 0.325; 40 days PO, p= 0.430; and 90 days PO, p= 0.609). All patients lost weight postoperatively, and WL was similar among the PO measurements (p= 0.163). Conclusions: Although both monomaxillary and bimaxillary orthognathic surgeries resulted in WL and lower BMI, there was no statistically significant difference in these metrics between the two types of surgery.

RESUMO Objetivo: Comparar o Índice de Massa Corporal (IMC) e a perda de peso (PP) de pacientes com deformidades dentofaciais após cirurgia ortognática monomaxilar e bimaxilar. Material e Métodos: Foi realizado um estudo longitudinal prospectivo em 69 pacientes com deformidade dentofacial submetidos a tratamento cirúrgico-ortodôntico. Os pacientes foram divididos em dois grupos: cirurgia ortognática monomaxilar e bimaxilar. Foi realizada avaliação nutricional pré-operatória de acordo com o IMC. Foi calculada a porcentagem de PP involuntária entre o pré e o pós-operatório (PO). A coleta de dados foi realizada no pré-operatório e aos 10, 40 e 90 dias PO. A análise estatística foi realizada no software SPSS v. 17.0, com intervalo de confiança de 95%. Resultados: De acordo com o IMC, os indivíduos submetidos à cirurgia monomaxilar apresentaram: baixo peso = 2,6%, peso normal = 51,3%, sobrepeso = 35,9% e obesidade = 10,3%. Entre os indivíduos submetidos à cirurgia bimaxilar, 43,3% estavam com peso normal, 36,7% estavam com sobrepeso e 20% eram obesos. O IMC foi semelhante em todos os períodos (pré-operatório, p= 0,237; 10 dias PO, p= 0,325; 40 dias PO, p= 0,430; e 90 dias PO, p= 0,609). Todos os pacientes perderam peso no pós-operatório. A PP foi semelhante entre os tempos de PO (p= 0,163). Conclusões: A cirurgia ortognática monomaxilar ou bimaxilar pode causar redução do peso corporal e diminuição no IMC, mas não há diferença estatisticamente significativa entre esses dois tipos de cirurgia em relação à PP e ao IMC.

Acadêmicos de Odontologia no combate à COVID-19: percepção discente sobre um projeto de extensão interprofissional / Dentalstudents in the fight against COVID-19: student's perception of an interprofessional extension project

Esteartigo tem como objetivo relatar a percepção dos discentes de Odontologia quanto sua participação nas ações extensionistas interprofissionais no enfrentamento da pandemia de COVID-19.Para tanto, foi realizado um estudo qualitativo, transversaledescritivo, por meio de roteiro com perguntas abertas e questionário estruturado autoaplicado, enviado para estudantes participantes no Projeto de ExtensãoUniversitária por meio da atenção às divisas rodoviárias do Estado do Paraná e/ou da atuação como atendentes em serviço de telessaúde para enfrentamento da COVID-19 (Central de Informações COVID-19) e/ou na Farmácia Especial do Estado do Paraná. A análise dos relatos foi realizada por meio do Discurso do Sujeito Coletivo. Todos os estudantesde Odontologia que participaram do projetoaceitaram responder a essa pesquisa. Foram identificadas como principais contribuições do Projeto de Extensão para a sua formação a obtenção de novos conhecimentos, a oportunidade de atuação interprofissional, a aplicação prática dos conhecimentos teóricos, o aprendizado técnico-científico, a promoção de acolhimento, da escuta qualificada e de atendimento humanizado. Deste modo, conclui-se que está atendendo às diretrizes para a Extensão na Educação Superior Brasileira, promovendo a formação integral e cidadã dos estudantes, propiciando a vivência dos seus conhecimentos, de modo interprofissional e interdisciplinar (AU).

Thispaper reportsthe perception of Dentistry students concerning their participation in interprofessional extension actions in the management of the COVID-19 pandemic. For that purpose, a qualitative, cross-sectional and descriptive study was performed, using a script with open questions and a self-applied structured questionnaire sent to students participating in the University Extension Project by attention to the road borders of the State of Paraná and/or as attendants in the telehealth service in the management of COVID-19 (COVID-19 Information Center) and/or the Special Pharmacy of the State of Paraná. The reports were analyzed by the Collective SubjectDiscourse. All Dentistry students who participated in the project agreed to respond to this survey. The main contributions of the Extension Project to their training were identified as acquisition of new knowledge, opportunity for interprofessional action, practical application of theoretical knowledge, technical-scientific learning, promotion of reception, qualified listening and humanized care. Thus, it is concluded that the guidelines for Extension in Brazilian Higher Educationare being met, promoting the integral and citizen training of students, providing the experience of their knowledge in an interprofessional and interdisciplinary manner (AU).

Programa de incentivo ao aleitamento materno em creches de Curitiba-PR: percepção de profissionais da educação infantil / Breastfeeding Incentive Program in daycare centers in Curitiba-PR: perception of early childhood education professionals

O objetivo deste estudo foi verificar a percepção de profissionais da educação infantil quanto ao programa de incentivo ao aleitamento materno em creches do município de Curitiba-PR. Estudo transversal, de caráter quantitativo, realizado em 40 centros municipais de educação infantil (CMEI) participantes do Programa Mama Nenê. Ao todo, participaram do estudo 108 profissionais. Para a coleta de dados, foram aplicados questionários estruturados com perguntas fechadas. Foi realizada análise descritiva dos dados. Com base na percepção dos profissionais entrevistados, as creches analisadas incentivam o aleitamento materno por meio do Programa Mama Nenê, utilizando estratégias significativas. Contudo, foi verificada baixa adesão das mães à iniciativa de usar os espaços físicos das creches para amamentar, conhecidos como "cantinhos da amamentação". Para a criação de condições mais favoráveis à continuidade da amamentação nestas instituições, a educação em saúde e a adequação das leis que protegem mulheres trabalhadoras que amamentam são questões fundamentais. (AU)

The aim of this study was to assess the perception of early childhood education professionals about the breastfeeding incentive program at daycare centers in the city of Curitiba, state of Paraná. This is a cross-sectional, quantitative study carried out at 40 daycare centers participating in the Program "Mama Nenê". A total of 108 professionals participated in the study. For data collection, structured questionnaires with closed questions were applied. A descriptive data analysis was performed. According to the perception of the professionals interviewed, the daycare centers analyzed encourage breastfeeding through the Program "Mama Nenê", using significant strategies. However, a low adherence by mothers to the use of the spaces of the institutions for breastfeeding, the so called "breastfeeding corners", was observed. To create more favorable conditions for the continuity of breastfeeding in daycare centers, health education and the adequacy of laws protecting working women who breastfeed are key issues. (AU)

Formulas alimentares: influência no estado nutricional, condição clínica e complicações na terapia nutricional domiciliar / Nutrition formulas: influence on nutritional condition, clinical condition and complications in household nutrition therapy

Introdução: As transições demográfica, epidemiológica e nutricional contribuem para o aumento do nú- mero de indivíduos com necessidade de Terapia Nutricional Enteral Domiciliar (TNED). Objetivo: Analisar a influência da categoria de fórmula nutricional no estado nutricional, nas complica- ções relacionadas à TNED e na necessidade de hospitalização de indivíduos em TNED. Métodos: Estudo clínico transversal observacional analítico realizado em Curitiba, PR, Brasil, com adultos e idosos em TNED. A antropometria, a categoria de fórmula alimentar infundida, a presença de complica- ções relacionadas à TNED e a necessidade de admissão hospitalar foram avaliadas. O estado nutricional foi classificado por meio do Índice de Massa Corporal (IMC). A estatística foi descritiva e as análises dos dados foi realizada por teste de qui-quadrado ou teste exato de Fisher e teste de Kruskal Wallis. O nível de significância adotado foi de 5% (p0,05). Discussão: Estudos sugerem que estado nutricional, complicações relacionadas à TNED e necessidade de hospitalização dependem da categoria de fórmula utilizada. Os resultados do presente estudo demonstraram que a categoria de fórmula não influencia o estado nutricional e admissões hospitalares. Conclusão: A categoria de fórmula não influencia no estado nutricional, presença de complicações e readmissões hospitalares. O estado nutricional comprometido não aumentou a ocorrência de complicações relacionadas à TNED e a necessidade de hospitalização (AU)

Introduction: Demographic, epidemiologic and nutritional transitions have contributed to increase Home Enteral Nutrition (HEN). Objective: To analyze the influence of enteral nutrition type in nutritional status, outcome related with HEN and need of hospital care. Method: Clinical cross-sectional, observational and analytical study in Curitiba, PR, Brazil, with adults and elders in HEN. Anthropometric data, diet enteral nutrition type, outcomes related with HEN and need of hospital care were assessed. Body Mass Index (BMI) classified nutritional status. Data were analyzed in descriptive and statistic way (chi-square, Fischer test and Kruskal Wallis test). Results: The final sample was 42 patients. Most of the participants was older than 60 years (mean age: 65y; minimum: 21y; maximum: 94y), 50% (n=21) of each sex. Undernutrition was observed in 72.7% and 86.2%, to adults and elders, respectively. Hospital care was needed by 72.8% and, industrialized and food blended enteral nutrition used concomitantly was observed to 57.1% of the patients. Gastrointestinal system outcomes were the most frequent (40.5%) and tube obstruction frequency was higher in food blended HEN. There were no association between nutritional status with outcomes and diet enteral nutrition type (p>0.05). Discussion: Studies suggested that nutritional status, outcome related with HEN and need of hospital care depends on HEN formula type, and these results are different from ours. HEN formula type did not influence nutritional status and need of hospital care. Conclusion: HEN formula type did not influence nutritional status, outcomes, and in need of hospital care. Nutritional status did not influence outcomes related with HEN, and in need of hospital care (AU)

Proportion of Brazilian diabetes patients that achieve treatment goals: implications for better quality of care.

BACKGROUND: Diabetes and its complications are substantial causes of morbidity and mortality, and caused approximately 5.1 million deaths worldwide in 2013. Early detection and treatment of diabetes complications can prevent their progression. OBJECT: This study compared the proportions of patients with type 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) who achieved the goals of good clinical control. METHODS: Adults and elderly patients with T1DM and T2DM at a public outpatient endocrinology service in Brazil were retrospectively evaluated between 2012 and 2013. Clinical and socio demographic data were obtained from medical records and evaluated in accordance with the Brazilian Diabetes Society Guidelines. Care process measures, outcomes indicators, and supporting process measures were evaluated. RESULTS: A total of 1031 records were analyzed: 29 and 71 % of patients had T1DM and T2DM, respectively. T2DM patients had significantly higher BMI than T1DM patients (overweight and obesity in 85.1 vs. 47.5 %, p < 0.01). The follow-up periods for diabetes and number of clinical visits to the endocrinology service were significantly greater among T1DM patients than T2DM patients (p < 0.01). However, T2DM patients required significantly more other (i.e., non-endocrinological) healthcare services (p < 0.01). HbA1c was significantly lower in T2DM patients (p < 0.01). Moreover, blood pressure and triglycerides were significantly higher in T2DM patients (p < 0.01), whereas total cholesterol and low-density lipoprotein were significantly lower in T2DM patients (p < 0.01). Only 0.5 % of the patients achieved all targets, and 1.1 % did not achieve any. CONCLUSIONS: The achievement of goals of good clinical practice varies among the parameters evaluated. Almost no patients achieved all targets. Many patients are overweight and do not achieve targets for HbA1c, lipid profile, or blood pressure control.

The reality of the surgical fasting time in the era of the ERAS protocol.

Multimodal protocols to optimize perioperative care and to accelerate postoperative recovery include abbreviated pre-and postoperative fasting. The aim of this study was to investigate the pre and postoperative fasting period and the factors that influence it in patients who underwent elective operations. We included patients who underwent surgery of the digestive tract and abdominal wall. Data were collected from the patients and from their personal health records. We included 135 patients between 19 and 89 years old. Most were adults (75.55%), female (60.74%) and the most common procedures were hernioplasty (42.96%) and cholecystectomy (34.81%). The preoperative fasting periods for solids and liquids were similar, median 16.50 (5.50-56.92) and 15.75 (2.50- 56.92) hours, respectively. The preoperative fasting period was influenced by the instruction received and surgery time. Postoperative fasting period was 15.67 (1.67-90.42) hours and was influenced by type of surgery and lack of synchrony between the clinical meeting and the nutrition and dietetics service schedules.

Los protocolos multimodales para optimizar la atención perioperatoria y acelerar la recuperación postoperatoria incluyen abreviatura del ayuno pre y postoperatorio. El objetivo de este estudio fue investigar el período de ayuno antes y después de la operación y los factores que lo influyen en los pacientes sometidos a cirugía electiva. Se incluyeron pacientes sometidos a cirugía del tracto digestivo y de la pared abdominal. Los datos fueron obtenidos con el paciente y su prontuario médico. Se incluyeron 135 pacientes entre 19 y 89 años. La mayoría eran adultos (75,55%), mujeres (60,74%) y fueron sometidos a hernioplastia (42,96%) o colecistectomía (34,81%). El ayuno preoperatorio de sólidos y líquidos fue similar: 16,50 (5,50 a 56,92) y 15,75 (2,50 a 56,92) horas, respectivamente. El ayuno preoperatorio fue influenciado por la orientación recibida y la hora de la cirugía. El ayuno postoperatorio fue 15,67 (1,67 a 90,42) horas y fue influenciado por el tipo de cirugía y la falta de sincronía entre el tiempo de la reunión clínica y del servicio de alimentación y nutrición.

The reality of the surgical fasting time in the era of the ERAS protocol / La realidad del tiempo de ayuno quirúrgico en la era del protocolo ERAS

Multimodal protocols to optimize perioperative care and to accelerate postoperative recovery include abbreviatedpre-and postoperative fasting. The aim of this study was to investigate the pre and postoperative fasting period and the factors that influence it in patients who underwent elective operations. We included patients who underwent surgery of the digestive tract and abdominal wall. Data were collected from the patients and from their personal health records. We included 135 patients between 19 and 89 years old. Most were adults (75.55%),female (60.74%) and the most common procedures were hernioplasty (42.96%) and cholecystectomy (34.81%).The preoperative fasting periods for solids and liquids were similar, median 16.50 (5.50-56.92) and 15.75 (2.50-56.92) hours, respectively. The preoperative fasting period was influenced by the instruction received and surgery time. Postoperative fasting period was 15.67(1.67-90.42) hours and was influenced by type of surgery and lack of synchrony between the clinical meeting and the nutrition and dietetics service schedules (AU)

Los protocolos multimodales para optimizar la atención perioperatoria y acelerar la recuperación postoperatoria incluyen abreviatura del ayuno pre y postoperatorio. El objetivo de este estudio fue investigar el período de ayuno antes y después de la operación y los factores que lo influyen en los pacientes sometidos a cirugía electiva. Se incluyeron pacientes sometidos a cirugía del tracto digestivo y de la pared abdominal. Los datos fueron obtenidos con el paciente y su prontuario médico. Se incluyeron 135 pacientes entre 19 y 89 años. La mayoría eran adultos (75,55%), mujeres (60,74%) y fueron sometidos a hernioplastia (42,96%) o colecistectomía (34,81%). El ayuno preoperatorio de sólidos y líquidos fue similar: 16,50 (5,50 a 56,92) y 15,75 (2,50 a 56,92) horas, respectivamente. El ayuno preoperatorio fue influenciado por la orientación recibida y la hora de la cirugía. El ayuno postoperatorio fue 15,67 (1,67 a 90,42) horas y fue influenciado por el tipo de cirugía y la falta de sincronía entre el tiempo de la reunión clínica y del servicio de alimentación y nutrición (AU)

O índice de risco nutricional (nutritional risk index) é preditor de complicação pós-operatória em operações do aparelho digestivo ou parede abdominal? / Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall?

RACIONAL: Pode-se considerar a desnutrição como doença mais comum no ambiente hospitalar, devido à sua alta prevalência. OBJETIVO: Verificar os indicadores de estado nutricional que melhor se correlacionam com as complicações pós-operatórias e o tempo de permanência hospitalar de pacientes submetidos à operações do aparelho digestivo ou parede abdominal de médio e grande porte. MÉTODO: Estudo retrospectivo, com análise de 215 fichas de avaliação nutricional de pacientes cirúrgicos que foram submetidos à avaliação nutricional por meio de dados antropométricos (peso, altura, IMC, circunferência do braço, prega cutânea triciptal, circunferência muscular do braço), avaliação subjetiva global e dados bioquímicos (contagem total de linfócitos e albumina sérica). Em adição, posteriormente foi calculado o índice de risco nutricional. RESULTADOS: Foram incluídos 125 indivíduos. Diagnóstico de desnutrição de acordo com circunferência muscular do braço, índice de risco nutricional e avaliação subjetiva global foi de 46%, 88% e 66%, respectivamente. A classificação como gravemente desnutridos foi de 17,6% dos pacientes de acordo com a avaliação subjetiva global, enquanto que com o índice de risco nutricional foi de 42%. Os pacientes com câncer são mais desnutridos (5,42 unidades do índice de risco nutricional a menos). Houve correlação significativa entre ocorrência de complicações pós-operatórias não infecciosas quando analisado o índice de risco nutricional, considerando que seus menores complicaram mais (p=0,0016). O mesmo resultado foi obtido para albumina sérica (p=0,0015). Os pacientes sem complicações permaneceram, em média, 14,24 dias internados a menos do que os pacientes com complicações não infecciosas (p<0,05). CONCLUSÃO: O índice de risco nutricional e a albumina sérica são os parâmetros com melhor capacidade em predizer ocorrência de complicações pós-operatórias não infecciosas.

BACKGROUND: Malnutrition can be considered the most common disease in hospitals due to its high prevalence. AIM: To investigate the methods of evaluation of the nutritional status that better correlate with postoperative complications and the length of hospital stay in patients submitted to gastrointestinal or abdominal wall surgeries. METHODS: This is a retrospective evaluation of 215 nutritional assessment records. All were submitted to traditional anthropometry (weight, height, BMI, arm circumference, triceps skinfold thickness and mid-arm muscle circumference), subjective global assessment, serum albumin and lymphocyte count. Nutritional risk index was also calculated. RESULTS: A total of 125 patients were included. Malnutrition was diagnosed by mid-arm muscle circumference, nutritional risk index and subjective global assessment in 46%, 88% and 66%, respectively. Severe malnutrition was found in 17,6% if considered subjective global assessment and in 42% by the nutritional risk index. Oncologic patients had a worst nutritional status according to this index (5,42 less units). There was a negative correlation between occurrence the noninfectious postoperative complications with the nutritional risk index (p=0,0016). Similarly, lower serum albumin levels were associated with higher non infectious complications (p=0,0015). The length of hospital stay was, in average, 14,24 days less in patients without complications as compared with non infectious postoperative complications (p<0,05). CONCLUSION: Nutritional risk index and serum albumin are the parameters with the best capacity to predict the occurrence of non infectious postoperative complications and the length of hospital stay was higher to this patients.

Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall?

BACKGROUND: Malnutrition can be considered the most common disease in hospitals due to its high prevalence. AIM: To investigate the methods of evaluation of the nutritional status that better correlate with postoperative complications and the length of hospital stay in patients submitted to gastrointestinal or abdominal wall surgeries. METHODS: This is a retrospective evaluation of 215 nutritional assessment records. All were submitted to traditional anthropometry (weight, height, BMI, arm circumference, triceps skinfold thickness and mid-arm muscle circumference), subjective global assessment, serum albumin and lymphocyte count. Nutritional risk index was also calculated. RESULTS: A total of 125 patients were included. Malnutrition was diagnosed by mid-arm muscle circumference, nutritional risk index and subjective global assessment in 46%, 88% and 66%, respectively. Severe malnutrition was found in 17,6% if considered subjective global assessment and in 42% by the nutritional risk index. Oncologic patients had a worst nutritional status according to this index (5,42 less units). There was a negative correlation between occurrence the noninfectious postoperative complications with the nutritional risk index (p=0,0016). Similarly, lower serum albumin levels were associated with higher non infectious complications (p=0,0015). The length of hospital stay was, in average, 14,24 days less in patients without complications as compared with non infectious postoperative complications (p<0,05). CONCLUSION: Nutritional risk index and serum albumin are the parameters with the best capacity to predict the occurrence of non infectious postoperative complications and the length of hospital stay was higher to this patients.