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1.
Clin Nutr ; 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32307194

RESUMO

BACKGROUND & AIMS: Enteral nutrition is controversial in hemodynamically unstable patients. This study aimed to evaluate the association between hemodynamic and skin perfusion parameters and enteral nutrition therapy (NT) outcomes in septic shock patients. METHODS: Ventilated adults with septic shock were evaluated at bedside upon admission (H0), and at 12 h (H1), 24 h (H2) and 48 h (H3) for mean arterial pressure (MAP), heart rate, urine output, lactate levels, mottling score, capillary refill time (CRT), central-to-toe temperature gradient and norepinephrine dose. Two groups were stratified: NT success (NTS) (≥20 kcal/kg or 11 kcal/kg for obese in the first ICU week) or NT failure (NTF). A generalized linear model and generalized estimating equations were performed. RESULTS: Over a 19-month period, 2167 admissions were assessed and 141 patients were analyzed (63.5 ± 15.0 years, SAPS-3 75 ± 12, 102 [72%] in the NTS vs. 39 [28%] in NTF). At 12 h, the failure group showed more severe mottling scores, higher lactate levels, norepinephrine dose and central-to-toe temperature gradient. Mottling score at 12 h was a predictor of NT failure (RR 1.28 95%CI [1.09-1.50], p = .003). Over 48 h, higher mottling scores, lactate levels and norepinephrine dosage, % of patients with central-to-toe temperature gradient and CRT ≥3 s were observed in the failure group and higher urine output and MAP values were observed in the success group. CONCLUSION: Early improvement in hemodynamic and skin perfusion parameters was associated with success in nutrition therapy, and mottling score at 12 h was a risk factor for nutrition therapy failure. This data could support the recommendation to start NT after hemodynamic and perfusion goals are achieved and to proactively evaluate bedside parameters while implementing NT in critical care setting.

2.
Nutr Clin Pract ; 35(2): 205-210, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31642115

RESUMO

This article presents 7 nutrition steps that, if not followed by the clinical staff, may be metaphorically considered as "7 deadly sins" of nutrition therapy. In this review, we suggest approaches that must be avoided or accomplished to increase compliance with the "Ten Commandments" of good nutrition practice in the intensive care setting. Multiple aggressive and simultaneous sets of therapies are implemented in the intensive care setting, which include nutrition and metabolic support as important components in these therapies. "Sins" should be remembered as a mnemonic device for nutrition standard care in the intensive care unit; this incorporates nutrition adequacy and protocol adherence.

4.
Nutr Clin Pract ; 34(1): 137-141, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30101996

RESUMO

BACKGROUND: The Nutritional Risk Screening 2002 (NRS-2002) is a widely recommended nutrition risk indicator. Two cut-offs have been proposed for intensive care unit (ICU) patients to classify nutrition risk: ≥3-<5, at risk and ≥5, high risk. To date, no study has directly compared these cut-offs. The aim of this study is to compare the NRS-2002 ICU nutrition risk cut-offs as predictors of clinical outcomes including infections, ICU and hospital mortality, length of stay (LOS), duration of mechanical ventilation (MVd), weaning failure, tracheotomy for prolonged MVd, and chronic critical illness (CCI). METHODS: Adult patients were screened and stratified according to NRS-2002 ICU criteria. Clinical, epidemiologic, and nutrition data were extracted from medical records. Statistical analysis for independent samples and Poisson regression were performed. RESULTS: A total of 185 patients were screened: 1 (0.54%) no risk; 96 (51.89%) at risk, and 88 (47.56%) high risk. High-risk patients were older, had higher Simplified Acute Physiology Score 3 (62.0 ± 14.1 vs 53.0 ± 12.9, respectively; P < .001) and Sequential Organ Failure Assessment (6.9 ± 3.7 vs 5.1 ± 3.1, respectively; P < .001), and developed more infections (42 [47.8%] vs 27 [28.1%]; P = .010). No differences were found for ICU and hospital LOS, MVd days, weaning failure, tracheotomy, and CCI. ICU and hospital mortality were higher in high-risk patients. The high-risk cut-off was predictor of ICU mortality (relative risk 2.10, 95% confidence interval 1.07-4.14; P = .032). CONCLUSION: Our data suggest that the NRS-2002 high-risk cut-off is associated with worse clinical outcomes and is a predictor for ICU mortality.


Assuntos
Estado Terminal/mortalidade , Avaliação Nutricional , Estado Nutricional/fisiologia , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Fatores de Risco
6.
Int J Surg Case Rep ; 41: 5-8, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29024841

RESUMO

INTRODUCTION: Appendicitis is a common cause of acute abdomen; however, the classic clinical signs are not often present, and it has unusual presentations. Thus, its diagnosis can be challenging. PRESENTATION OF CASE: We describe the case of an elderly man who presented with right abdominal wall abscess with spontaneous drainage in the emergency department. Since we suspected a subjacent abdominal pathology, we performed surgery, and intraoperatively, we observed that the Appendix tip had invaded the abdominal wall. DISCUSSION: This patient had a challenging diagnostic process and surgical visualization of the appendicular tip invading the abdominal wall was an important characteristic in proving the cause of the abdominal wall abscess. CONCLUSION: The onset of an abdominal wall abscess without a known cause needs to be thoroughly investigated, with consideration of a subjacent abdominal cause and appendicitis necessitatis.

7.
Rev Bras Ter Intensiva ; 29(1): 87-95, 2017.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28444077

RESUMO

The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.


Assuntos
Doença Crônica/epidemiologia , Estado Terminal/epidemiologia , Inflamação/epidemiologia , Cuidadores , Doença Crônica/mortalidade , Estado Terminal/mortalidade , Humanos , Inflamação/mortalidade , Inflamação/fisiopatologia , Tempo de Internação , Alta do Paciente , Prognóstico , Taxa de Sobrevida
8.
Nutr Hosp ; 34(1): 19-29, 2017 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-28244768

RESUMO

INTRODUCTION: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy. OBJECTIVE: To compare the effect of two EN strategies (underfeeding versus full-feeding) on ICU and overall mortality (hospital mortality or 60-day mortality) and length of stay (LOS), duration of mechanical ventilation (MV), infectious complications, and gastrointestional tolerability in ICU patients. METHODS: Random effects meta-analysis of randomized controlled trials (RCT). Our search covered MEDLINE, EMBASE, SCOPUS and CENTRAL databases until May 2015. Underfeeding was assigned into to two different groups according to the level of energy intake achieved (moderate feeding 46-72% and trophic feeding 16-25%) for subgroup analysis. RESULTS: Five RCTs were included among the 904 studies retrieved (n=2432 patients). No difference was found in overall mortality when all five studies were combined. In the subgroup analysis, moderate feeding (three studies) showed lower mortality compared with full-feeding (RR 0.82;95%CI,0.68-0.98;I2 0% p=0.59 for heterogeneity). No differences were found for ICU mortality, ICU and hospital LOS, duration of MV, and infectious complications. Underfeeding showed lower occurrence of GI signs and symptoms except for aspiration and abdominal distention. CONCLUSIONS: This meta-analysis found no differences in ICU and overall mortality, ICU and hospital LOS, duration of MV, and infectious complications between underfeeding and full-feeding. The subgroup analysis showed lower overall mortality among patients receiving moderate underfeeding. This result should be cautiously interpreted due to the limitations of the small number of studies analyzed and their methodology.


Assuntos
Estado Terminal/terapia , Nutrição Enteral/métodos , Insuficiência Respiratória/terapia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Rev. bras. ter. intensiva ; 29(1): 87-95, jan.-mar. 2017. tab, graf
Artigo em Português | LILACS | ID: biblio-844289

RESUMO

RESUMO Os avanços tecnológicos que permitem dar suporte às disfunções de órgãos levaram a um aumento nas taxas de sobrevivência para a maioria dos pacientes críticos. Alguns destes pacientes sobrevivem à condição crítica inicial, porém continuam a sofrer com disfunções de órgãos e permanecem em estado inflamatório por longos períodos. Este grupo de pacientes críticos foi descrito desde os anos 1980 e teve diferentes critérios diagnósticos ao longo dos anos. Sabe-se que estes pacientes têm longas permanências no hospital, sofrem importantes alterações do metabolismo muscular e ósseo, apresentam imunodeficiência, consomem quantias substanciais de recursos de saúde, têm reduzida capacidade funcional e cognitiva após a alta, demandam uma considerável carga de trabalho para seus cuidadores, e apresentam elevadas taxas de mortalidade em longo prazo. O objetivo desta revisão foi apresentar as evidências atuais, em termos de definição, fisiopatologia, manifestações clínicas, tratamento e prognóstico da doença crítica persistente.


ABSTRACT The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.


Assuntos
Humanos , Doença Crônica/epidemiologia , Estado Terminal/epidemiologia , Inflamação/epidemiologia , Alta do Paciente , Prognóstico , Doença Crônica/mortalidade , Taxa de Sobrevida , Estado Terminal/mortalidade , Cuidadores , Inflamação/fisiopatologia , Inflamação/mortalidade , Tempo de Internação
10.
Nutr. hosp ; 34(1): 19-29, ene.-feb. 2017. graf, tab
Artigo em Inglês | IBECS | ID: ibc-161137

RESUMO

Introduction: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient’s needs, prospective studies question this strategy. Objective: To compare the effect of two EN strategies (underfeeding versus full-feeding) on ICU and overall mortality (hospital mortality or 60-day mortality) and length of stay (LOS), duration of mechanical ventilation (MV), infectious complications, and gastrointestinal tolerance in ICU patients. Methods: Random effects meta-analysis of randomized controlled trials (RCT). Our search covered MEDLINE, EMBASE, SCOPUS and CENTRAL databases until May 2015. Underfeeding was assigned into two different groups according to the level of energy intake achieved (moderate feeding 46-72% and trophic feeding 16-25%) for subgroup analysis. Results: Five RCTs were included among the 904 studies retrieved (n = 2,432 patients). No difference was found in overall mortality when all fi ve studies were combined. In the subgroup analysis, moderate feeding (three studies) showed lower mortality compared with full-feeding (RR 0.82; 95% CI, 0.68-0.98; I2 0% p =0.59 for heterogeneity). No differences were found for ICU mortality, ICU and hospital LOS, duration of MV, and infectious complications. Underfeeding showed lower occurrence of GI signs and symptoms except for aspiration and abdominal distention (no difference was found). Conclusions: This meta-analysis found no differences in ICU and overall mortality, ICU and hospital LOS, duration of MV, and infectious complications between underfeeding and full-feeding. The subgroup analysis showed lower overall mortality among patients receiving moderate underfeeding. This result should be cautiously interpreted due to the limitations of the small number of studies analyzed and their methodology (AU)


Introducción: a pesar de las directrices que hacen hincapié en que la cantidad de la Nutrición Enteral (NE) administrada debe estar próxima a las necesidades del paciente, los estudios prospectivos cuestionan esta estrategia. Objetivo: comparar el efecto de dos estrategias de NE (subalimentación vs. alimentación completa) sobre la mortalidad en la UCI y general (mortalidad hospitalaria o la mortalidad en 60 días), el tiempo de internación en la UCI y en el hospital, duración de la ventilación mecánica (VM), complicaciones infecciosas y la tolerancia gastrointestinal en pacientes críticos. Métodos: metaanálisis de efectos aleatorios de ensayos clínicos aleatorizados (ECA). Nuestra búsqueda se basa en MEDLINE, EMBASE, SCOPUS y CENTRAL hasta mayo de 2015. La subalimentación fue asignada a dos grupos diferentes de acuerdo con el nivel de consumo de energía (alimentación moderada 46-72% y la alimentación trófica 16-25%) para el análisis de subgrupos. Resultados: se incluyeron cinco ECA entre los 904 estudios que se encontraron en la búsqueda (n = 2.432 pacientes). No se encontraron diferencias en la mortalidad general cuando se combinaron los cinco estudios. En el análisis de subgrupos, la alimentación moderada (tres estudios) mostró una mortalidad más baja en comparación con la alimentación completa (RR 0,82; IC 95% 0,68-0,98; I2 0% p = 0,59 para la heterogeneidad). No se encontraron diferencias de mortalidad en la UCI ni en el tiempo de internación hospitalaria, la duración de la VM y las complicaciones infecciosas. La subalimentación mostró menor aparición de signos y síntomas gastrointestinales, excepto para aspiración y distensión abdominal (no se encontró ninguna diferencia). Conclusiones: este metaanálisis no encontró diferencias significativas de mortalidad, duración de la estancia, duración de VM ni complicaciones infecciosas en la UCI o hospitalización total entre los grupos de subalimentación y alimentación completa. El análisis de subgrupos mostró menor mortalidad global entre los pacientes que recibieron la subalimentación moderada. Este resultado debe interpretarse con cautela debido a las limitaciones del pequeño número de estudios analizados y su metodología (AU)


Assuntos
Humanos , Desnutrição/epidemiologia , Nutrição Enteral/estatística & dados numéricos , Insuficiência Respiratória/complicações , Apoio Nutricional/métodos , Respiração Artificial , Estado Terminal/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
CuidArte, Enferm ; 11(1): 100-103, jan.2017.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1027736

RESUMO

Introdução: Hemoglobinopatias são doenças genéticas de caráter étnico em que mutações na estrutura molecular das globinas podemacarretar em modifi cações funcionais dessas moléculas. Objetivo: Verifi car a prevalência e os aspectos epidemiológicos de pacientesafetados por hemoglobinopatias atendidos no Ambulatório de Aconselhamento Genético do Hospital Emílio Carlos (HEC) da cidade deCatanduva-SP. Material e Método: Estudo retrospectivo, descritivo, observacional, realizado através da análise dos prontuários médicosdos pacientes atendidos no período compreendido entre setembro/2005 a setembro/2014. A amostra estudada foi composta por 87indivíduos com idade média de 10,8 anos. Resultados: A classifi cação socioeconômica revelou que metade das famílias pertencia àsclasses D e C2. Praticamente 92% dos pais estavam empregados, 67% possuíam ensino fundamental incompleto, 95% residiam emcasa de alvenaria e 100% das moradias dispunham de água encanada e rede de esgoto. A prevalência de traço para anemia hereditáriapor talassemias e hemoglobinas variantes na amostra avaliada foi de aproximadamente 29%: 26,44% de talassemia alfa heterozigota,1,15% de heterozigose para hemoglobina S (HbAS) e 1,15% de heterozigose para hemoglobina C (HbAC). Com uma maior prevalênciana população caucasoide (64%) que entre os negroides (36%). A ocorrência de antecedentes familiares para anemias hereditárias foiverifi cada em 44% da população avaliada. Conclusão: Os resultados obtidos revelam a necessidade de implantação de serviços de saúdepública direcionados à realização de diagnóstico molecular para hemoglobinopatias no HEC.


Introduction: Hemoglobinopathies are ethnic genetic diseases in which mutations in the molecular structure of globins can causefunctional modifi cations of these molecules. Objective: To evaluate the prevalence and the epidemiological aspects of patients affectedby hemoglobinopathies treated at the Genetic Counseling Outpatient Clinic of Hospital Emilio Carlos (HEC) in the city of Catanduva-SP,Brazil. Materials and Method: It was a retrospective, descriptive, observational study, carried out through the analysis of medical recordsof the patients attended from September 2005 through September 2014. The study sample consisted of 87 individuals with a mean ageof 10.8 years. Results: socioeconomic classifi cation revealed that half of the families belonged to the D and C2 classes. Almost 92% ofthe parents were employed, 67% had incomplete elementary education, 95% lived in masonry houses and 100% of the households hadpiped water and sewage network. In the sample evaluated, the prevalence of trait for hereditary anemia due to thalassemias and varianthemoglobins was approximately 29%: 26.44% of heterozygous alpha thalassemia, 1.15% of heterozygous for hemoglobin S (HbAS) and1.15% of heterozygous for hemoglobin C (HbAC), with a higher prevalence in the Caucasian population (64%) than among the negroids(36%). The occurrence of a family history for hereditary anemia was verifi ed in 44% of the evaluated population. Conclusion: The resultsobtained suggest the need for implementation of public health services aimed at performing a molecular diagnosis of hemoglobinopathiesin ECH.


Introducción: Las hemoglobinopatías son enfermedades genéticas de carácter étnico en las que las mutaciones en la estructura molecularde las globinas pueden acarrear en modifi caciones funcionales de esas moléculas. Objetivos: Verifi car la prevalencia y los aspectosepidemiológicos de pacientes afectados por hemoglobinopatías atendidos en el Ambulatorio de Asesoramiento Genético del HospitalEmilio Carlos (HEC) de la ciudad de Catanduva-SP, a través del análisis de los prontuarios médicos de los pacientes atendidos enel período comprendido entre septiembre/2005 a septiembre/2014. Material y Método: La muestra estudiada fue compuesta por 87individuos con edad media de 10,8 años. Resultados: La clasifi cación socioeconómica, reveló que la mitad de las famílias pertenecíana las clases D y C2. El 92% de los padres estaban empleados, el 67% poseía educación básica incompleta, el 95% residía en casa dealbañilería y el 100% de las vivien das disponían de agua potable y red de alcantarilla. La prevalencia de traza para anemia hereditaria portalas y hemoglobinas variantes en la muestra evaluada fue de aproximadamente 29%: 26,44% de talasemia alfa heterozigota, 1,15% deheterozigose para hemoglobina S (HbAS) y 1,15% de heterozigose para hemoglobina C (HbAC). Con una mayor prevalencia en poblacióncaucasoide (64%) que entre los negros (36%). La ocurrencia de antecedentes familiares para anemias hereditárias fue verifi cada en el44% de la población evaluada. Conclusión: Los resultados obtenidos revelan la necesidad de implantación de servicios de salud públicadirigidos a la realización de diagnóstico molecular para hemoglobinopatías en el HEC.


Assuntos
Humanos , Aconselhamento Genético , Anemia , Epidemiologia , Hemoglobinas Anormais , Hemoglobinopatias , Fatores Socioeconômicos
12.
J Neuroinflammation ; 12: 162, 2015 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-26337974

RESUMO

BACKGROUND: Status epilepticus (SE) is a severe condition that may lead to hippocampal cell loss and epileptogenesis. Some of the mechanisms associated with SE-induced cell death are excitotoxicity, neuroinflammation, and apoptosis. OBJECTIVE: The objective of the present study is to test the hypothesis that DBS has anti-inflammatory and antiapoptotic effects when applied during SE. METHODS: Rats undergoing pilocarpine-induced SE were treated with anterior thalamic nucleus (AN) deep brain stimulation (DBS). Inflammatory changes and caspase 3 activity were measured within 1 week of treatment. RESULTS: In pilocarpine-treated rats, DBS countered the significant increase in hippocampal caspase 3 activity and interleukin-6 (IL-6) levels that follows SE but had no effect on tumor necrosis factor α (TNFα). CONCLUSIONS: DBS has anti-inflammatory and antiapoptotic effects when given to animals undergoing status.


Assuntos
Apoptose/fisiologia , Estimulação Encefálica Profunda/métodos , Encefalite/etiologia , Encefalite/terapia , Estado Epiléptico/complicações , Análise de Variância , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Eletroencefalografia , Hipocampo/metabolismo , Masculino , Agonistas Muscarínicos , Pilocarpina/toxicidade , Ratos , Ratos Wistar , Estado Epiléptico/induzido quimicamente , Estado Epiléptico/patologia
14.
Neotrop. ichthyol ; 13(2): 317-324, 26/06/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-752458

RESUMO

A total of 312 adults of matrinxã were captured bimonthly, between 2011-2012, in two sites of the rio São Francisco: immediately downstream of the Três Marias Dam (site 1) and in the confluence with the rio Abaeté (site 2). Specimens of Brycon orthotaenia from site 2 presented higher values of total length (32.24 ± 5.70 cm for females and 26.64 ± 3.79 cm for males) and body weight (506.66 ± 332.17 g for females and 267.36 ± 145.84 g for males), when compared with the site 1. In site 2 was registered the highest GSI means (9.97 ± 2.96 for females and 0.93 ± 0.52 for males), compared with the site 1 means. Reproduction period occurred from October to February. Unlike site 2, no spawned females or spent males were captured in site 1. Significant differences were found between females and males in site 2 (χ2 = 26.84, df = 1, P < 0.05). Physical-chemical parameters of the water presented higher values in site 2. The canonical correlation test indicated that the reproduction of males is less susceptible to environmental factors than that of females. These results show that B. orthotaenia finds favourable conditions to reproduction just in site 2.


Um total de 312 adultos de matrinxã foram capturados bimestralmente entre 2011-2012, em dois pontos do rio São Francisco: imediatamente a jusante da barragem de Três Marias (ponto 1) e na confluência com o rio Abaeté (ponto 2). Exemplares de Brycon orthotaenia do ponto 2 apresentaram maiores valores de comprimento total (32,24 ± 5,70 cm para fêmeas e 26,64 ± 3,79 cm para machos) e peso corporal (506,66 ± 332,17 g para fêmeas e 267,36 ± 145,84 g para machos) quando comparado com peixes do ponto 1. No ponto 2, foi registrado as maiores médias de IGS (9,97 ± 2,96 para fêmeas e 0,93 ± 0,52 para machos) em comparação com o ponto 1. O período reprodutivo ocorreu de outubro a fevereiro. Ao contrário do ponto 2, fêmeas desovadas e machos espermiados não foram capturados no ponto 1. Foram encontradas diferenças significativas entre fêmeas e machos no ponto 2 (χ2 = 26,84, gl = 1, P < 0,05). Parâmetros físico-químicos da água apresentaram maiores valores no ponto 2. A análise de correlação canônica indicou que a reprodução de machos é menos susceptível a fatores ambientais do que de fêmeas. Estes resultados mostram que B. orthotaenia encontra condições favoráveis para a reprodução apenas no ponto 2.


Assuntos
Animais , Caraciformes/crescimento & desenvolvimento , Caraciformes/embriologia , Migração Animal , Ecologia
15.
Recent Pat Food Nutr Agric ; 7(1): 35-46, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26013772

RESUMO

Melanoidins are colored products that can be found in food and drinks, formed by Maillard reactions. Sometimes these compounds are considered undesirable in certain food products, because they impart a brownish color and must be removed. An overview of recent patents related to melanoidin removal indicates that it can be performed by chemical/biological degradation or by adsorption processes. Therefore, in the present study, the adsorption mechanism for synthetic melanoidin removal from aqueous solutions was studied using different Raphanus sativus press-cake sorbents, with the precursor material being carbonized in a microwave oven, either with direct heating or after a chemical activation process with phosphoric acid, nitric acid or potassium hydroxide. Physical and chemical modifications were evaluated by FTIR, pHPZC, thermogravimetry and BET. The adsorption kinetics was better described by a pseudo-second order model for all activated carbons (ACs). Evaluation of the diffusion process showed dependence on the initial melanoidin concentration due to the wide range of sizes of the adsorbed molecules. The equilibrium data were best fitted by the Langmuir model for the acid-treated AC and by the Freundlich model for the base-treated and non-chemically treated ACs. Melanoidin adsorption was characterized as a spontaneous, favorable and endothermic process involving hydrogen bonds and π-π interactions between the adsorbents surfaces and the adsorbed molecules.


Assuntos
Contaminação de Alimentos/prevenção & controle , Reação de Maillard , Patentes como Assunto , Polímeros/química , Ácidos , Adsorção , Carbono/química , Humanos , Ligação de Hidrogênio , Cinética , Modelos Químicos , Raphanus , Termodinâmica , Água
17.
Environ Technol ; 32(9-10): 1073-83, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21882560

RESUMO

The objective of this study was to evaluate the performance of an adsorbent, based on a solid residue arising from biodiesel production, for the removal of cationic dyes from wastewaters. The adsorbent was produced by microwave thermal activation. The Freundlich model provided the best fit for equilibrium data, indicating heterogeneous adsorption. The adsorption capacity increased in comparison to the adsorbent obtained by thermal processing of the same residue in a conventional oven, showing that microwave processing is an attractive alternative for adsorbent production, given the significant reduction in processing time (decreased from 60 min to 3 min). Both the removal efficiency and the removal capacity decreased with an increase in temperature, pointing towards the exothermic nature of the removal process.


Assuntos
Biocombustíveis , Corantes/isolamento & purificação , Extratos Vegetais/química , Raphanus/química , Poluentes Químicos da Água/isolamento & purificação , Purificação da Água/métodos , Adsorção , Cátions/isolamento & purificação , Micro-Ondas , Poluentes Químicos da Água/química
18.
RBM rev. bras. med ; 67(7)jul. 2010.
Artigo em Português | LILACS-Express | LILACS | ID: lil-553882

RESUMO

Objetivo: Aplicação de um modelo alternativo, com três drogas (subcitrato de bismuto 480 mg/d + tetraciclina 2 g/d + tinidazol 1 g/d por sete dias) escolhidas pelo menor custo, menos efeitos colaterais e menos reações alérgicas. Método: Os resultados deste tratamento foram obtidos dos pacientes do Ambulatório de Gastroenterologia e Hepatologia do Hospital Cruzeiro do Sul, entre agosto de 2003 e dezembro de 2007. Resultados: Foram tratados 81 pacientes, 37 homens e 44 mulheres, com idade média de 54 anos (26 a 85 anos). As indicações foram resistência ao tratamento clássico (47), cardiopatia (10), recidiva do H. pylori (7), preço (6), efeitos colaterais aos medicamentos previamente utilizados (5) e alergia (3). Dos pacientes estudados, 33 apresentavam comorbidades, sendo mais prevalentes HAS (11), DM (6), dislipidemia (4) e insuficiência cardíaca obstrutiva (5). Completaram o tratamento 64 pacientes, 15 ainda não retornaram e 2 realizaram tratamento incompleto. Dos que realizaram tratamento completo ou incompleto (66), 56,1% negativaram para H. pylori (teste da urease e/ou biópsia gástrica) e 30,3% permaneceram positivos 13,6% não realizaram o teste. Dos que retornaram após o tratamento, 59 não apresentaram efeitos colaterais. Foram relatados apenas diarreia (1), vômitos (1), enterorragia (1), herpes e prurido vaginal (1), infecção urinária (1), sonolência (1) e mal-estar (1), sendo alguns destes apresentados pelo mesmo paciente. Conclusão: O tratamento com bismuto, tetraciclina e tinidazol se mostrou eficaz em 64,9% dos pacientes, com baixa incidência de efeitos colaterais e menor preço, mostrando-se mais uma alternativa em pacientes com resistência ou alergia aos antibióticos do esquema clássico.

19.
Sao Paulo Med J ; 126(5): 252-6, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19099157

RESUMO

CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 +/- 15.4 years, 48% were men and 76% were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (beta-0.16; 95% confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (beta-0.06; 95% CI: -0.09 to -0.02) and lower Khan comorbidity-age index (beta 5.16; 95% CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (beta 8.4; 95% CI: 1.7-15.1), being married or having a marriage-like relationship (beta 4.56; 95% CI: 0.9-8.2), being on peritoneal dialysis (beta 4.9; 95% CI: 0.9-8.8) and not having high blood pressure (beta 3.9; 95% CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.


Assuntos
Nível de Saúde , Falência Renal Crônica/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal , Fatores Socioeconômicos , Inquéritos e Questionários
20.
Säo Paulo med. j ; 126(5): 252-256, Sept. 2008. tab
Artigo em Inglês | LILACS | ID: lil-500334

RESUMO

CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 ± 15.4 years, 48 percent were men and 76 percent were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (β-0.16; 95 percent confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (β-0.06; 95 percent CI: -0.09 to -0.02) and lower Khan comorbidity-age index (β 5.16; 95 percent CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (β 8.4; 95 percent CI: 1.7-15.1), being married or having a marriage-like relationship (β 4.56; 95 percent CI: 0.9-8.2), being on peritoneal dialysis (β 4.9; 95 percent CI: 0.9-8.8) and not having high blood pressure (β 3.9; 95 percent CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.


CONTEXTO E OBJETIVO: A qualidade de vida (QoL) é considerada uma importante medida de desfecho, especialmente no manejo de doenças de longa evolução, como a doença renal crônica. O presente estudo avaliou os preditores de QoL em uma amostra de pacientes tratados por diálise. TIPO DE ESTUDO E LOCAL: Estudo transversal com coleta de dados em três centros de diálise do sul do Brasil. MÉTODOS: Avaliação de pacientes tratados por diálise, com aplicação do questionário genérico SF-36 (Short Form-36) e correlação com variáveis demográficas, socioeconômicas, clínicas e laboratoriais. A análise foi ajustada por regressão linear múltipla. RESULTADOS: Foram avaliados 140 pacientes, 94 tratados por hemodiálise e 46 por diálise peritoneal, com idade 54.2 ± 15,4 anos, 48 por cento homens e 76 por cento brancos. A dimensão física do SF-36 esteve associada à idade (β -0,17 intervalo de confiança, IC 95 por cento -0,27-0,58), ao tempo em diálise (β-0,05 IC 95 por cento -0,08-0,01) e ao índice de idade-comorbidade de Khan mais elevado (β 5,52 IC 95 por cento 2,1-8,9). A dimensão mental esteve associada a ocupação remunerada (β 8,4 IC 95 por cento 1,7-15,1), união estável (β 4,56 IC 95 por cento 0,9-8,2), tratamento por diálise peritoneal (β 4,9 IC 95 por cento 0,9-8,8) e ao fato de não ser hipertenso (β 3,9 IC 95 por cento 0,3-7,6). CONCLUSÕES: Os pacientes mais jovens, tratados por diálise há menos tempo e com um menor número de comorbidades apresentaram melhor QoL do ponto de vista físico. A QoL mental foi melhor em pacientes que desempenham atividade remunerada, são casados, tratados por diálise peritoneal e não-hipertensos.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nível de Saúde , Falência Renal Crônica/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Brasil , Estudos Transversais , Falência Renal Crônica/terapia , Modelos Lineares , Diálise Peritoneal , Fatores Socioeconômicos , Inquéritos e Questionários
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