Estudo da permeabilidade de fármacos por meio do modelo de saco intestinal de ratos / Study of drug permeability through the rat gut sac model

Os parâmetros de permeabilidade e solubilidade são fundamentais à absorção oral de fármacos e a partir dessas características, foi criado o Sistema de Classificação Biofarmacêutica, através do qual os fármacos são divididos em quatro classes. Atualmente, para a determinação da solubilidade de um fármaco, existem diversos métodos padronizados por agências regulatórias, no entanto, para a determinação da permeabilidade, os ensaios são passíveis de diversas variações em sua execução, diminuindo a confiabilidade dos resultados obtidos e impossibilitando a comparação dos mesmos quando realizados com técnicas diferentes umas das outras. O objetivo do presente trabalho é avaliar as variáveis experimentais do modelo do saco intestinal que podem influenciar nos resultados de permeabilidade aparente de fármacos e na viabilidade do tecido. O presente estudo foi aprovado pelo Comitê de Ética no Uso de Animais da FCF-USP (109.2018-P574). Foram utilizados 33 Rattus norvegicus da linhagem Wistar, machos, jovens adultos, com peso entre 200 g e 300 g. Para realização do procedimento, cada animal permaneceu em jejum por cerca de quatro horas e após adequada anestesia a porção do jejuno do intestino delgado foi retirada e dividida em seis segmentos de aproximadamente 8,5cm cada. Foram realizados experimentos com e sem inversão do saco intestinal, submetidos a diferentes tempos de banho de gelo após sua ressecção, na presença ou ausência de inibidor da glicoproteína-P (verapamil). Os fármacos naproxeno e famotidina foram empregados como marcadores de alta e baixa permeabilidade, respectivamente. A losartana foi utilizada como substrato da glicoproteína P. Cada um dos sacos intestinais foi colocado em um tubo de ensaio contendo tampão Krebs, a 37°C, saturado com gás carbogênio. Para avaliação da integridade e viabilidade dos segmentos intestinais, observou-se a presença de movimentos peristálticos e coletaram-se amostras do meio de incubação nos tempos 0, 30, 45, 60, 90 e 120 minutos para quantificação dos fármacos e de glicose, uma vez que esta é ativamente transportada para a serosa do intestino delgado. Determinou-se a permeabilidade aparente de cada fármaco e as concentrações de glicose nas diferentes condições experimentais, realizou-se planejamento fatorial multinível e os resultados foram analisados por análise variância (ANOVA), seguida de pós-teste de Tukey. Observou-se que as variáveis experimentais interferiram de forma significativa na viabilidade tecidual e na permeabilidade aparente dos fármacos. Não foram observadas diferenças significativas da permeabilidade de fármacos nos diferentes segmentos do jejuno. A glicose mostrou-se um bom marcador de viabilidade tecidual e foi constatado que a presença ou ausência de movimentos peristálticos não está relacionada diretamente com a viabilidade do tecido. Uma vez que foram constatadas tantas interferências nos resultados, é imprescindível que os procedimentos experimentais sejam padronizados, para que os resultados apresentem menor variabilidade e possam ser comparados entre si

The permeability and solubility parameters are fundamental to the oral absorption of drugs and from these characteristics, the Biopharmaceutical Classification System was created, through which drugs are divided into four classes. Currently, for the determination of the solubility of a drug, there are several methods standardized by regulatory agencies, however, for the determination of permeability, the tests are subject to several variations in their execution, reducing the reliability of the results obtained and making it impossible to compare the results obtained. same when performed with different techniques. The aim of this study is to evaluate if different experimental conditions can influence the results of apparent drug permeability and tissue viability on gut sac model. The present study was approved by the Ethics Committee for the Use of Animals of FCF-USP (109.2018-P574). Thirty-three male, young adult Rattus norvegicus were used, weighing between 200 g and 300 g. To perform the procedure, each animal fasted for about four hours and after adequate anesthesia, the portion of the jejunum of the small intestine was removed and divided into six segments of approximately 8.5 cm each. Experiments were performed with and without inversion of the gut sac, submitted to different times of ice bath after its resection, in the presence or absence of a P-glycoprotein inhibitor (verapamil). The drugs naproxen and famotidine were used as markers of high and low permeability, respectively. Losartan was used as a substrate for P-glycoprotein. Each of the gut sacs was placed in a test tube containing Krebs buffer, at 37°C, saturated with carbogen gas. To evaluate the integrity and viability of the intestinal segments, the presence of peristaltic movements was observed and samples of the incubation medium were collected at 0, 30, 45, 60, 90 and 120 minutes for quantification of drugs and glucose, as it is actively transported to the serosa of the small intestine. The apparent permeability of each drug and the glucose concentrations were determined under different experimental conditions, multilevel factorial design was performed and the results were analyzed by analysis of variance (ANOVA), followed by Tukey's post-test. It was observed that the experimental variables significantly interfered in the tissue viability and in the apparent permeability of the drugs. No significant differences in drug permeability were observed in the different segments of the jejunum. Glucose proved to be a good marker of tissue viability and it was found that the presence or absence of peristaltic movements is not directly related to tissue viability. Since so many interferences were found in the results, it is essential that the experimental procedures be standardized, so that the results show less variability and can be compared between different authors

Pós-operatório de paciente oncológico em jejum prolongado: diagnósticos e intervenções de enfermagem / Post-operative oncological patients in prolonged fast: nursing diagnosis and interventions / Postoperatorio del paciente oncológico bajo ayuno prolongado: diagnósticos e intervenciones de enfermería

Objetivo: identificar os principais diagnósticos de enfermagem e suas respectivas intervenções em uma população de pacientes oncológicos submetidos a jejum prolongado no pós-operatório. Método: estudo descritivo, documental e transversal. O cenário do estudo foi um hospital federal de ensino no Rio de Janeiro, caracterizado como UNACON. Os dados foram coletados durante 60 dias em prontuários referentes aos anos de 2016 a 2018. Foram analisados 61 prontuários que atendiam aos critérios de inclusão e 208 complicações foram apresentadas pelos pacientes oncológicos. Resultados: Foram definidos oito diagnósticos de enfermagem, entre os quais os mais evidentes foram: Nutrição desequilibrada: menor que as necessidades corporais e Risco de glicemia instável. Onze intervenções de enfermagem foram definidas em consonância com a Taxonomia de NANDA-I e buscaram ser de fácil aplicação na prática assistencial de enfermagem. Conclusão: foi evidenciada uma ampla gama de diagnósticos e intervenções de enfermagem a qual se recomenda sua adoção no processo de enfermagem.

Objective: to identify the main nursing diagnoses and respective interventions in a population of cancer patients undergoing prolonged postoperative fasting. Method: descriptive, cross-sectional, documentary study. The study scenario was a federal teaching hospital in Rio de Janeiro, characterized as a high-complexity oncological facility. Data were collected for 60 days from medical records for the years 2016 to 2018. In the 61 medical records that met the inclusion criteria and were analyzed, cancer patients presented 208 complications. Results: eight diagnoses were established, the most in evidence being: nutrition imbalance: less than body requirements; and risk of unstable blood glucose level. Eleven nursing interventions, designed to be easily applied in nursing care practice, were specified in line with the NANDA-I Taxonomy. Conclusion: the wide range of nursing diagnoses and interventions evidenced are recommended for adoption in the nursing process.

Objetivo: identificar los principales diagnósticos de enfermería y sus respectivas intervenciones en una población de pacientes oncológicos sometidos a ayuno postoperatorio prolongado. Método: estudio descriptivo, transversal, documental. El escenario de estudio fue un hospital universitario federal en Río de Janeiro, caracterizado como una instalación oncológica de alta complejidad. Se recolectaron datos durante 60 días de las historias clínicas de los años 2016 a 2018. En las 61 historias clínicas que cumplieron con los criterios de inclusión y fueron analizadas, los pacientes con cáncer presentaron 208 complicaciones. Resultados: se establecieron ocho diagnósticos, siendo los más evidentes: desequilibrio nutricional: menor que los requerimientos corporales; y riesgo de niveles inestables de glucosa en sangre. Once intervenciones de enfermería, diseñadas para ser fácilmente aplicadas en la práctica del cuidado de enfermería, fueron especificadas de acuerdo con la Taxonomía NANDA-I. Conclusión: la amplia gama de diagnósticos e intervenciones de enfermería evidenciados se recomiendan para su adopción en el proceso de enfermería.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

ABSTRACT BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Evaluation of the bioequivalence of two formulations containing the combination of 400 mg of acetaminophen (paracetamol), 4 mg of phenylephrine and 4 mg of chlorpheniramine in capsules: open-label, three-way crossover study, partially replicated in healthy volunteers of both sexes

This study was carried out in order to compare the relative bioavailability of two different formulations containing 400 mg of acetaminophen + 4 mg of phenylephrine hydrochloride + 4 mg of chlorpheniramine maleate, Test formulation (Cimegripe®) and Reference formulation (Resfenol®) in 84 healthy volunteers of both sexes under fasting conditions. The study was conducted in a single dose, randomized, open-label, crossover 3-way and partially replicated. The tolerability was evaluated by the monitoring of adverse events and vital signs, results of clinical and laboratory tests. Plasma concentrations were quantified by validated bioanalytical methods using the ultra-performance liquid chromatography coupled to tandem mass spectrometry. The Cmax, Tmax, AUC0-t, AUC0-inf, T1/2 and Kel pharmacokinetic parameters were calculated from these obtained concentrations. The 90% confidence intervals were constructed for the ratio reference/test from the geometric average of the Cmax and AUC parameters which were comprised between 80% and 125%. Only the Cmax parameter of the phenylephrine was applied the scaled average bioequivalence due to the intraindividual coefficient of variation > 30% obtained, thus extending the acceptance limits of the interval. It can be concluded that the two formulations were bioequivalent in terms of rate and absorption extent and thus interchangeable

Efectos de un protocolo de ayuno intermitente sobre la composición corporal y perfil lipídico en estudiantes universitarios / Effects of a protocol of intermittent fasting on body composition and lipids profile in university students

El ayuno intermitente es una estrategia nutricional de creciente interés para el control del peso y mejora de la salud metabólica. El objetivo del presente estudio fue evaluar el efecto de un protocolo de ayuno intermitente sobre la composición corporal, perfil lipídico y los biomarcadores de riesgo cardiovascular en estudiantes universitarios. En este estudio experimental participaron 30 sujetos varones y fueron divididos aleatoriamente en dos grupos, 15 sujetos constituían el grupo experimental (GE) (edad: 20,83±0,98 años) y 15 el grupo control (GC) (edad: 23,71±5,55 años). El GE realizó un protocolo de ayuno 16/8, dieciséis horas de ayuno y ocho horas de ingesta calórica sin limitaciones, dos días consecutivos a la semana durante cinco semanas. Se evaluó la composición corporal, la ingesta calórica, el perfil lipídico y los biomarcadores del riesgo cardiovascular al inicio, mitad y final del protocolo. Se observaron descensos significativos en el GE en pliegues cutáneos, perímetro cintura, porcentaje de grasa, perfil lipídico y biomarcadores del riesgo cardiovascular en comparación con GC (p<0,05). Se encontraron incrementos significativos en la ingesta de colesterol y ácidos grasos poliinsaturados en el GE al final del estudio (p<0,05). Se observaron descensos en el colesterol total, triglicéridos, lipoproteínas de baja densidad y biomarcadores del riesgo cardiovascular a lo largo del protocolo en el GE (p<0,05). Un protocolo de ayuno intermitente 16/8, dos días consecutivos por semana, durante cinco semanas, parece efectivo para mejorar parámetros de composición corporal y perfil lipídico, así como para mejorar los biomarcadores relacionados con el riesgo cardiovascular(AU)

Intermittent fasting is a nutritional strategy of high interest in weight control and improvement of metabolic health. The objective of this study was to evaluate the effect of an intermittent fasting protocol on body composition, lipid profile and biomarkers of cardiovascular risk in university students. In this experimental study thirty male subjects participated and were randomly divided into two groups; fifteen subjects constituted the experimental group (GE) (age: 20.83 ± 0.98 years) and fifteen the control group (GC) (age: 23.71 ± 5.55 years). The GE performed a fasting protocol 16/8, sixteen hours of fasting and eight hours of caloric intake without limitations, two consecutive days per week for five weeks. Body composition, calorie intake, lipid profile and biomarkers of cardiovascular risk were evaluated at the beginning, middle and at the end of the protocol. Significant decreases were found in GE in skinfolds, waist perimeter, % fat, lipid profile and biomarkers of cardiovascular risk as compared to GC (p <0.05). There were significant increases in the intake of cholesterol and polyunsaturated fatty acids in the GE at the end of the study (p <0.05). There were decreases in total cholesterol, triglycerides, low-density lipoproteins, and biomarkers of cardiovascular risk throughout the study in GE (p<0.05). An intermittent fasting protocol 16/8, two consecutive days per week, for five weeks, seems effective to improve parameters of body composition and lipid profile, as well as to improving biomarkers related to cardiovascular risk(AU)

Unexpectedly prolonged fasting and its consequences on elderly patients undergoing spinal anesthetics. A prospective observational study

Abstract Purpose: To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia. Methods: This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]. Results: Mean fasting durations were 12±2.8 and 9.5±2.1 hours in AM group and 15.5±3.4 12.7±4.4 hours in PM group for foods and liquids respectively. ECG changes were significantly more frequent in PM group and body temperatures were significantly higher in AM group patients. Conclusion: Our study has shown that fasting times in our population is far longer than recommended and fasting prolonged>15 hours is related to a transiently increased cardiac stress and mild hypothermia.

Metabolism of broilers subjected to different lairage times at the abattoir and its relationship with broiler meat quality / Metabolismo de frangos de corte submetidos a diferentes tempos de espera no abatedouro e sua relação com a qualidade da carne

An investigation was made into the effects of different lairage times and the position of chicken crates during transport to the slaughterhouse on the biochemical and hematological profile and physical parameters of broilers, such as color and pH of their breast meat. The treatments were defined by the animals slaughtered after 0, 2, 4 and 6 hours of lairage time at the slaughterhouse, transported in crates located in the top and bottom layers of the truck. It was found that increasing the lairage time at the slaughterhouse to over two hours reduced the number of lymphocytes and increased the heterophil/lymphocyte (H/L) ratio and the basophil count in the hemogram. In addition, lactate dehydrogenase (LDH) activity and cholesterol levels increased and plasma triglyceride and glucose levels decreased. The position of the crates in the truck altered the creatine kinase (CK) activity, and the highest enzyme activity was found in birds transported in the top layer of crates in the truck. Furthermore, the long lairage time in the slaughterhouse increased the pH and the value of a* (redness value) and decreased the lightness value of breast fillets. The interaction significant between 4 and 6 hours of lairage time and the position of the crate in the top layer of the truck favored the development of dark, firm, dry (DFD) meat.(AU)

Este trabalho objetivou a avaliação dos efeitos dos diferentes tempos de espera e da posição das caixas de transporte no caminhão sobre perfil bioquímico e hematológico, além de parâmetros físicos da carne, como cor e pH do peito, de frangos de corte. Os tratamentos foram definidos pelos animais abatidos com zero, duas, quatro e seis horas de espera no abatedouro, posicionados nas partes superior e inferior do caminhão. Como resultado, verificou-se que o aumento do tempo de espera no abatedouro, acima de duas horas, resultou em redução no número de linfócitos, elevação da razão heterófilos/ linfócitos (H/L) e de basófilos no hemograma. Houve aumento da atividade de lactato desidrogenase (LDH), dos níveis de colesterol e redução de triglicerídeos e glicose no plasma. O posicionamento das caixas na parte superior da carroceria do caminhão elevou a enzima creatina quinase (CK) sanguínea. Além disso, o tempo prolongado na área de espera aumentou o pH final e o valor de a* (teor de vermelho) e diminuiu a luminosidade dos filés. A interação significante dos fatores tempo de espera de quatro e seis horas e a posição superior das caixas de transporte propiciaram o desenvolvimento de carnes duras, firmes e escuras (DFD) em frangos de corte.(AU)

Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries / Avaliação do tempo de jejum entre pacientes submetidos a cirurgias do trato digestório em um hospital oncológico / Tiempo de ayuno perioperatorio entre pacientes con cáncer sometidos a cirugías gastrointestinales

Abstract OBJECTIVE To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. METHOD Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. RESULTS The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). CONCLUSION The length of fasting is associated with complications that affect the quality of the patients’ postoperative recovery and nurses’ work. The nursing team should be alert to this aspect and being responsible for overseeing the patients’ interest, should not permit the unnecessary extension of fasting.

Resumo OBJETIVO Identificar o tempo de jejum perioperatório e sua associação a variáveis pós-operatórias entre pacientes submetidos a cirurgias oncológicas do trato digestório. MÉTODO Estudo de coorte retrospectiva, realizado por meio da consulta a 128 prontuários de pacientes adultos, submetidos a cirurgias oncológicas gastrointestinais. RESULTADOS O tempo total de jejum durante a internação foi em média 107,6 horas. O tempo total de jejum foi associado de forma estatisticamente significante ao número de sintomas pré-operatórios (p=0,000) e pós-operatórios (p=0,007), ao período de internação (p=0,000), à transfusão sanguínea (p=0,013), ao uso de cateter nasogástrico (p=0,001) e nasoentérico (p=0,003), à admissão pós-operatória em terapia intensiva (p=0,002), à morte pós-operatória (p=0,000) e à duração do jejum pré-operatório (p=0,000). CONCLUSÃO A duração do jejum é associada a complicações que afetam a qualidade da recuperação do paciente e o trabalho da enfermagem. A equipe de enfermagem deve estar atenta a esse aspecto, uma vez que, como responsável pela vigilância dos interesses dos pacientes, não deve permitir o prolongamento desnecessário do período de jejum.

Resumen OBJETIVO Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. MÉTODO Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. RESULTADOS La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). CONCLUSIÓN La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no permitiendo la extensión innecesaria del ayuno.

Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture / A diminuição do tempo de jejum melhora o conforto e satisfação com anestesia em pacientes idosos com fratura de quadril / La disminución del tiempo de ayuno mejora el bienestar y la satisfacción con la anestesia en pacientes ancianos con fractura de cadera

BACKGROUND AND OBJECTIVES: Patient's satisfaction is a standard indicator of care quality. The aim of this study was to evaluate whether a preoperative oral ingestion of 200 mL of a carbohydrate drink can improve comfort and satisfaction with anesthesia in elderly patients with hip fracture. METHOD: Prospective randomized clinical trial conducted in a Brazilian public hospital, with patients ASA I-III undergoing surgery for hip fracture. The control group (NPO) received nothing by mouth after 9:00 p.m. the night before, while patients in the experimental group (CHO) received 200 mL of a carbohydrate drink 2-4 h before the operation. Patients' characteristics, subjective perceptions, thirst and hunger and satisfaction were determined in four steps. Mann-Whitney U-test and Fisher exact test were used for comparison of control and experimental groups. A p-value <0.05 was considered significant. RESULTS: A total of 100 patients were included in one of the two regimens of preoperative fasting. Fasting time decreased significantly in the study group. Patients drank 200 mL 2:59 h before surgery and showed no hunger (p < 0.00) and thirst on arrival to OR (p < 0.00), resulting in increased satisfaction with the perioperative anesthesia care (p < 0.00). CONCLUSIONS: The satisfaction questionnaire for surgical patient could become a useful tool in assessing the quality of care. In conclusion, CHO significantly reduces preoperative discomfort and increases satisfaction with anesthesia care. .

JUSTIFICATIVA E OBJETIVOS: A satisfação do paciente é indicador padrão da qualidade da assistência prestada. O objetivo deste estudo foi avaliar se a ingestão de 200 mL oral pré-operatória de uma bebida de carboidratos pode melhorar o conforto e a satisfação com a anestesia no paciente idoso com fratura de quadril. MÉTODO: Ensaio clínico prospectivo e randomizado realizado em hospital público de saúde brasileiro, pacientes estado físico ASA I-III submetidos à cirurgia de fratura de quadril. O grupo controle (NPO) não recebeu nada pela boca, após as 21 horas da noite anterior, enquanto que os pacientes no grupo experimental (CHO) recebeu 200 mL de uma bebida de carbohidratos de 2 a 4 horas antes da operação. Características dos pacientes, percepções subjetivas, presença de sede e fome e satisfação dos pacientes foi apurado em quatro etapas. Teste de Mann-Whitney U-test e exato de Fisher foram utilizados entre o grupo controle e o grupo experimental. Valor de p < 0,05 foi considerado significativo. RESULTADOS: Um total de 100 pacientes foram incluídos em um dos dois regimes de jejum pré-operatório. Tempo de jejum diminuiu significativamente no grupo de estudo. Pacientes beberam 200 mL 2:59 h antes da cirurgia e não apresentaram fome (p < 0,00) e sede na chegada à SO (p < 0,00), resultando em aumento da satisfação com o cuidado perioperatório anestesia (p < 0,00). CONCLUSÕES: O questionário de satisfação do paciente cirúrgico poderia tornar-se um instrumento útil na avaliação da qualidade de atendimento. Em conclusão, CHO reduz significativamente o desconforto pré-operatório e satisfação com os cuidados da anestesia. .

JUSTIFICACIÓN Y OBJETIVOS: La satisfacción del paciente es un indicador estándar de la calidad de la asistencia prestada. El objetivo de este estudio fue evaluar si la ingestión oral preoperatoria de 200 ml de una bebida de hidratos de carbono puede mejorar el bienestar y la satisfacción con la anestesia en el paciente anciano con fractura de cadera. MÉTODO: Ensayo clínico prospectivo y aleatorizado realizado en un hospital público brasileño, en pacientes estado físico ASA I-III sometidos a cirugía de fractura de cadera. El grupo control no recibió nada por la boca, después de las 21 h de la noche anterior, mientras que los pacientes en el grupo experimental recibieron 200 ml de una bebida de hidratos de carbono 2-4 h antes de la operación. Se investigaron características de los pacientes, percepciones subjetivas, presencia de sed y hambre, y satisfacción de los pacientes en 4 etapas. El test U de Mann-Whitney y el exacto de Fisher fueron utilizados en el grupo control y el grupo experimental. Un valor de p < 0,05 fue considerado significativo. RESULTADOS: Un total de 100 pacientes fueron incluidos en uno de los 2 regímenes de ayuno preoperatorio. El tiempo de ayuno disminuyó significativamente en el grupo de estudio. Los pacientes bebieron 200 ml 2:59 h antes de la cirugía y no sintieron hambre (p < 0,00) ni sed a su llegada al quirófano (p < 0,00), lo que trajo un aumento de la satisfacción con el cuidado perioperatorio anestésico (p < 0,00). CONCLUSIONES: El cuestionario de satisfacción del paciente quirúrgico podría convertirse en un instrumento útil para la evaluación de la calidad de la atención. Como conclusión, podemos decir que los hidratos de carbono reducen significativamente el malestar preoperatorio y aumentan la satisfacción con los cuidados de la anestesia. .

Effects of Ramadan on Forensic Cases Presenting to Emergency Service

"The term ""forensic case"" is defined as disruption of physical and/or mental health of an individual due to external factors. Forensic cases are most frequently encountered in emergency services. Ramadan; the ninth month of Islamic calendar; is a month of fasting throughout which Muslims from all around the world worship by observing fasting. There are many studies focusing on the effects of fasting on health. The purpose of this study is to examine the effects of Ramadan on forensic cases presenting to emergency service. "

Menor tempo de jejum pré-operatório e alimentação precoce no pós-operatório são seguros? / Lesser time of preoperative fasting and early postoperative feeding are safe?

INTRODUÇÃO: O jejum noturno praticado antes de operações eletivas foi instituído para prevenir complicações pulmonares, vômitos, regurgitação e aspiração do conteúdo gástrico. No ano de 2005 foi desenvolvido o projeto de Aceleração da Recuperação Total Pós-operatória, denominado ACERTO. O projeto é composto por uma equipe multidisciplinar que visa à recuperação do paciente cirúrgico administrando de duas a seis horas antes da operação uma bebida rica em carboidratos (12,5% de dextrinomaltose). A equipe multidisciplinar é composta por anestesistas, cirurgiões, nutricionistas, enfermeiros e fisioterapeutas. OBJETIVO: Frente aos novos métodos de controle no pré-operatório verificar a qual a necessidade de jejum antes de procedimentos cirúrgicos. MÉTODOS: Revisão sobre jejum pré-operatório realizada nos meses de setembro e outubro de 2011, nos sites de busca Scielo e PubMed. Foram selecionados 24 artigos. CONCLUSÃO: Reduzir o tempo de jejum pré-operatório com solução rica em carboidratos até duas horas antes da operação, tal como alimentação precoce no pós-operatório, trazem inúmeros benefícios ao paciente. O projeto ACERTO tem demonstrado bons resultados e estas novas condutas devem ser encorajadas, diminuindo assim o tempo de recuperação do paciente cirúrgico.

INTRODUCTION: Fasting in the night before elective surgery has been established to prevent pulmonary complications, vomiting, regurgitation and aspiration of gastric contents. The year of 2005 was developed the project ACERTO. It consists in a multidisciplinary team that aims to recover the surgical patient by administering two our six hours before surgery, a carbohydrate-rich beverage (12.5% dextrinomaltose). The multidisciplinary team consists of anesthesiologists, surgeons, nutritionists, nurses and physiotherapists. METHODS: Literature review of preoperative fasting conducted during September and October of 2011 in Scielo and PubMed. CONCLUSION: Reducing the time of preoperative fasting with high carbohydrate solution until two hours before the operation as early feeding postoperatively, bring numerous benefits to the patient. The ACERTO project has shown good results and these new behaviors should be encouraged, thereby reducing the recovery time of the surgical patient.

Influência do jejum transitório no estado nutricional de pacientes no pós-operatório cardíaco / Transitory fasting influence on nutritional status in postoperative cardiac surgery patients

Introdução: A desnutrição hospitalar tem sido associada ao prognóstico clínico desfavorável. Porém pouco se sabe sobre a evolução do estado nutricional, no pós-operatório, mediante a interrupção frequente da oferta de nutrientes. Objetivo: Identificar a influência do jejum transitório no estado nutricional de pacientes no pós-operatório cardíaco com terapia nutricional oral e enteral associadas ou enteral exclusiva. Métodos: Estudo retrospectivo com pacientes submetidos a jejum transitório (período de jejum para procedimentos ou intercorrências clínicas) no pós-operatório cardíaco com terapia nutricional oral e enteral associada ou enteral exclusiva. Verificou-se o estado nutricional, procedimento cirúrgico realizado, as causas do jejum e a inadequação calórico-proteica. Resultados: Foram avaliados sete indivíduos com faixa etária entre 32 e 71 anos, com média de idade de 58,4+-4,7 anos e estado nutricional dentro da normalidade, em sua maioria (71%). A média de período de internação foi de 27,43%+-0,57 dias e a duração total do jejum transitório de 54,43+-18,94 horas. A maioria das cirurgia realizadas foi a de valvas (37%) e revascularização do miocárdio (27%). As principais causas do jejum foram intercorrências com a sonda enteral (71%) e eventos gastrointestinais (57%). A inadequação calórico-proteica da dieta variou de 13% a 82%. Verificou-se redução significativa da classificação do estado nutricional durante o período do estudo. Conclusões: Houve alteração no estado nutricional de indivíduos pós-cirúrgicos, submetidos a período de jejum transitório. Há necessidade da realização de outros estudos deste assunto, pela importância da adequada oferta nutricional aos pacientes submetidos a procedimentos cirúrgicos cardíacos.

Introduction: Hospital malnutrition has been linked to poor clinical prognosis. However, little is know about the evolution of nutritional status in the postoperative period through frequente interruption of nutriente supply. Objective: To identify the influence of transitory fastibg on postoperative nutritional status of patients undergoing cardiac surery with both oral and enteral nutrition therapy, and enteral feeding alone. Methods: A retrospective study with patients experiencing transitory fasting (fasting period due to procedures or clinical complications) in cardiac surgery postoperative, receiving na association of oral and enteral nutrition therapy, or enteral feeding exclusively. Nutritional status, surgical procedure, causes of fasting and calorie-protein inadequacy were verified. Results: Seven individual aged between 32 and 71 years, with a mean age of 58,4+-4.7 year, were assessed. Most of them (71%) had na adequate nutritional status. The average length of hospital stay was 54.43+-18.94 hours. The marjority of surgeries performed were valve surgery (37%) and myocardial revascularion (27%). Complications with the enteral nutrition tube (71%) and gastrointestinal events (57%) represented the main causes for fasting. The calorie-protein inadequacy of the diet varied from 13% to 82%. There was a significant reduction in the nutritional status classification during the study period. Conclusion: A change in the postoperative nutritional status of individuals experiencing transitory periods of fasting was verified. It is necessary to conduct further studies on the subject, given the importance of adequate nutritional support to patients undergoing cardiac surgery.

Efeitos de jejum de curta duração na evolução de peritonite fecal em camundongos / Effects of short term fasting on the evolution of fecal peritonitis in mice

PURPOSE: To investigate the effect of 72 hours food suppression on the evolution of fecal peritonitis in mice evaluating the mortality and measuring the number and size of abscesses formed into the peritoneal cavity. METHODS: Mice receiving commercial diet and water ad libitum (control group, N=35) and mice fasted during 72 h (N=35), receiving only water ad libitum, were inoculated by i.p. route, with 4uL/g body weight of a fecal suspension diluted 1:6 or 1:9 in 0.15M NaCl solution (1:6 dilution, 22 controls and 18 fasted; 1:9 dilution, 13 controls and 17 fasted). Animals were followed up until two weeks after fecal inoculation, when the survivors were euthanized for evaluation of the number and size of intra-peritoneal abscesses. Mortality was evaluated by Kaplan Meyer curves. RESULTS: Mortality was significantly higher in fasted groups than in controls. However the number and size of abscesses were significantly less in fasted groups than in controls. CONCLUSION: Seventy two hours food suppression increased the susceptibility to endotoxic shock (high mortality after peritonitis induction) and the resistance to infection with fecal microorganisms (less number and size of intra-peritoneal abscesses).

OBJETIVO: Investigar o efeito de jejum de 72 horas na evolução de peritonite fecal em camundongos, avaliando a mortalidade e o número e tamanho dos abscessos formados na cavidade peritoneal. MÉTODOS: Camundongos recebendo dieta ad libitum (grupo controle, N=35) e camundongos submetidos a jejum durante 72h (N=35) foram inoculados, por via intraperitoenal, com 4uL/g de peso corporal de uma suspensão de fezes diluída a 1:6 ou 1:9 em NaCl 15M (diluição 1:6, 22 controles e 18 jejum; diluição 1:9, 13 controles e 17 jejum). Os animais foram acompanhados até duas semanas após a inoculação das fezes quando eram eutanaziados para avaliação do número e tamanho dos abscessos intraperitoneais. A mortalidade foi avaliada através das curvas de Kaplan Meyer. RESULTADOS: A mortalidade foi significativamente maior nos animais submetidos ao jejum. No entanto o número e tamanho dos abscessos foram significativamente menores neste grupo. CONCLUSÃO: O jejum de 72 horas aumentou a susceptibilidade ao choque endotóxico (maior mortalidade nas primeiras 48 horas) e aumento da resistência aos microorganismos fecais (menor número e tamanho dos abscessos intraperitoneais).

Effect of ramadan fasting on muslim patients with chronic liver diseases

The study evaluated the efficacy of fasting in Ramadan on the clinical, laboratory and ultrasonographic parameters of chronic liver disease patients. A total of 202 patients were selected from the departments of Tropical medicine and outpatient clinics of Al-Azhar University hospitals, Cairo, Egypt from the 26[th] of July till the 30[th] of September 2010. Patients submitted to complete clinical, laboratory, ultrasonographic and endoscopic evaluation pre, during, and post Ramadan. The fasting group was 103 [51%] and the non-fasting group was 99 [49%] patients. The non-fasting group showed significantly a good adherence to therapy [43.4%] compared to [27.2%] the fasting group [p=0.0l6]. Dyspeptic symptoms was higher in the fasting [53.4%] compared to [38.4%] the non-fasting group [p=0.032]. G.I. bleeding during Ramadan was higher in the fasting group [17.5%] compared to non-fasting [14.1%], but the bleeding due to o.v. was significantly higher in the non-fasting group [9.1%] compared to [1%] in the fasting group [p=0.004]. Chronic hepatitis in the fasting group showed non significant changes pre, during and post-Ramadan regarding liver function. Fasting cirrhotic group patients child class C was developed to [13%] during and [32.6%] after Ramadan compared to [0%] before [p=0.001]

effect of ramadan fasting on duedenal ulcer perforation

Fasting during the month of Ramadan is one of the five holy pillars in the Islamic faith and is an important annual ritual practiced by all Muslims. This involves fasting from dawn to dusk, followed by a break of fast at designated times. The length of fasting varies from ten to 19 hours, depending on the season in which the fasting month of Ramadan falls and the geographical locations. 1st to evaluate the relation between Ramadan fasting and duodenal ulcer perforations and 2nd to asses the risk factors of this complications. This is a prospective study in Baghdad Teaching Hospital - Medical City . Data from 231 consecutive patients with perforated duodenal ulcer from the period of October 2007 to December 2010 were collected and analyzed and all the patients were managed surgically after resuscitation in emergency unit. [96/231, 41.6%] of patients with perforated duodenal ulcer during Ramadan vs. [135/231, 58.4%] during the rest of the years. [96/490, 19.5%] of patients with perforated duodenal ulcer from the total number of all patients with acute abdomeninal surgeries during Ramadan. 43% of patients smoking and 47% of patients had a previous history of acid peptic disease in Ramadan. 54% of patients were in between [20 to 40] years age group and the male to female ratio was 6 :1 . 15% patients of perforated duodenal ulcer had history of regular use of non steroidal anti inflammatory drugs.. Erect chest x-ray demonstrated gas under the diaphragm in 86% . Only 2 patients had a previous surgery of duodenal ulcer perforation. This study suggests that the incidence of duodenal ulcer perforation is relatively high in Ramadan among the people, who are fasting and have predisposing factors [smoking, history of acid peptic disease, non steroidal anti-inflammatory drugs] and need special precaution during this month

Efectos en el tracto reproductivo, digestivo y pérdida de pesocorporal del ave semipesada sometida a descanso ovárico / Efeitos no trato reprodutivo, digestivo e perda do peso de aves semi-pesadossubmetidas a descanso ovárico / The effects on the reproductive and digestive tract and loss of body weight of the Brown egg layers submitted to ovarian rest

Esta investigación evaluó la aplicación del descanso ovárico (DO) en aves semipesadas y el efecto quetienen la edad y la duración del ayuno sobre el tracto reproductivo y gastrointestinal. Se utilizaron 840ponedoras de la línea Hy-Line Brown® con 64 semanas de edad, se evaluaron tres edades de inducciónal DO (65, 70 y 75 semanas) y tres períodos de ayuno (cinco, diez y quince días), en un modelo estadísticocompletamente aleatorizado, anidado, efecto fijo y balanceado. Se sacrificaron aves para evaluar el pesocorporal, peso del tracto digestivo, peso del tracto reproductivo (ovario y oviducto), porcentaje de folículoscon diámetro igual o superior a diez mm (LYF) y el porcentaje de pérdida de peso del ave. El modelo fuesignificativo (p<0.05) para todas las variables evaluadas; la edad presentó efecto significativo (p<0.05) enel peso del ovario y el porcentaje de folículos (LYF), mientras que la duración del ayuno anidado en laedad presentó efecto significativo (p<0.05) en todas las variables, lo que indica un mayor efecto del períodode ayuno en contraste con la edad de aplicación del DO sobre las variables evaluadas. El peso del ovario(edad 65:15.87 ±15.11; edad 70: 7.92 ± 5.46; y edad 75: 7.54 ± 4.96) y porcentaje de folículos (LYF) (edad65: 43.75 ± 21.54; la edad 70 18.05 ± 8.72 y edad 75: 8.33 ± 6.85), mostraron tendencia en la disminucióna medida que aumenta la edad, comportamiento que está asociado con la disminución gradual del númerode folículos y la ampliación del tiempo entre la maduración de una onda folicular y la siguiente normaldel ave a medida que envejece (Kim y Donalson, 2000; North y Bell, 1990). Los porcentajes de pérdida de peso (edad 65: 24.24 ± 8.53%; edad 70: 20.91 ± 5.50% y edad 75: 20.88 ± 7.15%), fueron menores encomparación con los reportes en líneas livianas, posiblemente debido al contenido de reservas lipídicas,lo que ofrece al ave semipesada la capacidad de tolerar el ayuno.

The effects on the reproductive and digestive tract and loss of body weight of the Brown egg layerssubmitted to ovarian rest. This research evaluated the application of the ovarian rest (OR) on brown egglayers and the effect the age and duration of feed withdrawal have over the reproductive and gastrointestinaltract. 840 Hy-Line Brown ® layers were used at 64 weeks of age in which three ages of induction to theOR (65.70 and 75 weeks) and three feed withdrawal periods (five, ten and fifteen days) in a completelyrandomized statistical model, nested, of balanced and fixed effect. Sacrifices were carried out in order toevaluate body weight, weight of the digestive and reproductive tract (ovary and oviduct), follicle percentagewith a diameter equal to or higher than ten mm (LYF) and the percentage of the bird’s weight loss. Themodel was significant (p<0.05) for all the variables evaluated; the age presented a significant effect(p<0.05) over the ovary weight and the follicle percentage (LYF), while the duration of the feed withdrawalrelated to the age had a significant effect (p<0.05) on all the variables, which indicates a greater effect ofthe feed withdrawal period contrasted to the age of the application of the OR upon the variables evaluated.The ovary’s weight (age 65:15.87 to ± 15.11; age 70: 7.92b ± 5.46; and age 75: 7.54b ± 4.96) and thefollicle percentage (65: 43.75 to ± 21.54; age 70 18.05b ± 8.72 and age 75: 8.33b ± 6.85) showed a loweringtendency as the age increased. This type of behavior is associated with the gradual decrease in the numberof follicles and the extended time between the maturation of one follicular wave and the next as the layerages (Kim, Donalson, 2006; North, Bell, 1990). The weight loss percentages (age 65: 24.24 ± 8.53%; age70: 20.91 ± 5.50% and age 75: 20.88 ± 7.15%) were low compared to the reports on white egg layers,possibly due to the content of lipidic reserves which offers the brown egg...

Foi avaliado o descanso ovárico (DO) em galinhas semipesadas e o efeito da idade e a duração do jejumsobre o trato reprodutivo e gastrointestinal. Foram utilizadas 840 galinhas poedoras da linha Hy-LineBrown® com 64 semanas de idade, foram avaliadas três idades de indução ao DO (65, 70 e 75 semanas) etrês períodos de jejum (cinco, dez e quinze dias), utilizando um modelo desenho completamente aleatório,aninhado , efeito fixo e balanceado. As aves foram sacrificadas para avaliar o peso corporal, peso do tratodigestivo, peso do trato reprodutivo (ovário e oviduto), porcentagem de folículos com diâmetro igual ousuperior a dez mm (LYF) e a porcentagem da perdida de peso da ave. O modelo foi significativo (p<0.05)para todas as variáveis avaliadas; a idade foi significativa (p<0.05) no peso do ovário e a LYF e a duraçãodo jejum aninhado na idade apresentou efeito significativo (p<0.05) em todas as variáveis, o que indicouum maior efeito do período de jejum do que a idade sobre as variáveis avaliadas. O peso do ovário (idade65:15.87 ±15.11; idade 70: 7.92 ± 5.46; e idade 75: 7.54 ± 4.96) e percentagem de folículos (idade 65: 43.75± 21.54; idade: 70: 18.05 ± 8.72 e idade 75: 8.33 ± 6.85), mostraram tendência na diminuição à medidaque aumenta a idade. As percentagens de perda de peso (idade 65: 24.24 ± 8.53%; idade 70: 20.91 ± 5.50%e idade 75: 20.88 ± 7.15%) e as três idades apresentaram uma relação direta entre a duração dos períodosde jejum e o efeito na atrofia reprodutiva e perda de peso, permitindo determinar que não é necessáriosubmeter a jejuns superiores a dez dias.

long-term hunger [Ramadan model] a risk factor for acute appendicitis?

To investigate whether long-term hunger and the changes in nutritional routines during Ramadan constitute risk factors in acute appendicitis on the model of Ramadan fasting in this study. This retrospective study was carried out in 2 different hospitals [Istanbul Haydarpasa Numune Training and Research Hospital and Kars State Hospital, Kars, Turkey] between January 2004 and December 2007. The data obtained from the patients were classified according to age, gender, age group, and pathological characteristics of the appendix. The data obtained during the Ramadan fasting period was compared with the periods before and after. Nine hundred and ninety-two of the 4288 patients who received a diagnosis of acute appendicitis during the 4 years received their diagnosis during the 3 periods. Three hundred sixty-eight [37.1%] patients underwent surgery before Ramadan, 318 [32.1%] during, and 306 [30.8%] after. No significant difference was observed in terms of perforated and non-perforated AA frequency, age, age group, and gender [p>0.05]. There are changes in the nutritional routines during the Ramadan fasting period due to long-term hunger; and limitations were seen in the fluid and food intake. We detected that these changes did not constitute risk factors for acute appendicitis formation as a result of our study

Jejum pré-operatório de 8 horas ou de 2 horas: o que revela a evidência? / Preoperative fasting of 8 hours or 2 hours: what does evidence reveal?

Insulin resistance is a transitory phenomenon of the metabolic response to trauma. In uncomplicated operations it lasts for 2-4 weeks postoperatively, and is directly related to the magnitude of the injury. The fasting status caused by conventional fasting protocols aggravates this resistance and may induce hyperglycemia. Conventional preoperative fasting time may aggravate this resistance and increment the elevation of glycemia especially because it is frequently longer than the expected 6-8h and may reach 10-16 hs. Additionally, overnight fasting may cause variable degrees of dehydration depending on the extension of the fasting period. Recently, various societies of anesthesia and nutrition have changed their guidelines to propose a reduction of preoperative fasting to 2h with clear fluids containing carbohydrates. These new protocols (ACERTO, ERAS) are based on the safety of this routine as consistently demonstrated by various randomized trials and a meta-analysis.

Incidence of diabetic ketoacidosis during Ramadan fasting in Benghazi-Libya

Ramadan is the ninth month on the lunar calendar and it is a holy month for Muslims during which all healthy adults must fast from dawn to sunset. The risk of diabetic ketoacidosis is thought to be higher during Ramadan fasting due to insulin and glucagon alterations. A descriptive retrospective analysis of the records of all patients admitted with diabetic ketoacidosis to all Benghazi hospitals during the lunar year 1428 Hijri [2007-2008]. Fifteen episodes occurred during Ramadan compared to a mean of 19.45 episodes/months during the other lunar months [p<0.001], and there was no significant difference in the mean age [37.6 +/- 10 vs. 38.3 +/- 19, p= 0.8], mortality rate [13.3% vs. 14.4%, p=0.9] or in the length of hospitalization during Ramadan. The commonest precipitating factor for diabetic ketoacidosis during Ramadan was infection [46.6%] followed by miss dosing. There was no increase in the incidence and mortality from DKA during Ramadan which might indicate that Ramadan fasting is not a significant risk factor for diabetic ketoacidosis