Adverse events related to the use of enteral nutritional therapy / Eventos adversos en relación con el uso de la nutrición terapia enteral / Eventos adversos relacionados ao uso de terapia nutricional enteral

Aimed at verifying the occurrence of adverse events related to enteral nutrition use in patients of a public hospital in the countryside of Rio Grande do Sul. A quantitative, longitudinal and descriptive study, conducted in January-May 2012, that accompanied 46 patients admitted to the Intensive Care Unit and Medical Clinic. For evaluating the adverse events, we used quality indicators: inadvertent exit, tube obstruction and volume of infused diet. For analysis, we used descriptive statistics. The results showed that inadvertent exit of the tube and obstruction presented incidence rates of 4.6% and 2.1%, respectively. The volume of diet infused was less than that prescribed, due to pauses for body hygiene, tests and procedures, nausea / vomiting and delay in the availability of installation of the bottle in the unit. We conclude that the use of quality indicators in the assessment of care can help reduce damage to the patient.

Este estudio evaluó el acontecimiento de eventos adversos relacionados con el uso de la nutrición enteral en pacientes de un hospital público en Rio Grande do Sul. Método: Cuantitativo, longitudinal y descriptivo, llevado a cabo de enero a mayo 2012, con 46 pacientes ingresados en la Unidad de Cuidados Intensivos y Medicina Clínica. Para la evaluación de los eventos adversos utilizado los indicadores de calidad de salida: obstrucción inadvertida de la sonda y el volumen infundido dieta. Para el análisis, se utilizó estadística descriptiva. Ya en los resultados se hizo evidente que la salida de la sonda y la obstrucción inadvertida mostró tasas de incidencia del 4,6% y 2,1%, respectivamente. El volumen de la dieta fue menor que el prescrito infundido (mediana 81,4 ml) y la pausa para la higiene corporal, pruebas y procedimientos, náuseas/vómitos y retardo en la disponibilidad de la instalación de la botella en la unidad. Llegamos a la conclusión de que el uso de indicadores de calidad en la evaluación de la atención puede ayudar a reducir el daño al paciente.

Objetivou-se verificar a ocorrência de eventos adversos relacionados ao uso de nutrição enteral em pacientes de um hospital público do interior do Rio Grande do Sul. Estudo quantitativo, longitudinal e descritivo, realizado de janeiro a maio de 2012, com acompanhamento de 46 pacientes internados nas unidades de Terapia Intensiva e Clínica Médica. Para avaliação dos eventos adversos, utilizaram-se os indicadores de qualidade: saída inadvertida, obstrução da sonda e volume de dieta infundido. Para as análises, utilizou-se a estatística descritiva. Como resultados, a saída inadvertida da sonda e a obstrução apresentaram taxas de incidência de 4,6% e 2,1%, respectivamente. O volume de dieta infundido foi inferior ao prescrito, por pausa para higiene corporal, exames e procedimentos, náusea/vômito e demora na instalação do frasco por indisponibilidade na unidade. Conclui-se que a utilização de indicadores de qualidade na avaliação da assistência pode auxiliar na redução de danos ao paciente.

HLA-Bw4-B*57 and Cw*18 alleles are associated with plasma viral load modulation in HIV-1 infected individuals in Salvador, Brazil

Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia > 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4 percent (87/129) of individuals with viremia > 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95 percent CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95 percent CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population.