Óleos encapsulados: perfil de ácidos graxos e contaminação por hidrocarbonetos policíclicos aromáticos / Encapsulated oils: fatty acid profile and contamination by polycyclic aromatic hydrocarbons

Os óleos vegetais encapsulados podem ser extraídos a frio e ter como origem fontes não convencionais, reconhecidos por preservarem compostos bioativos característicos e, alguns deles, serem fontes de ácidos graxos essenciais. No entanto, são produtos geralmente onerosos e por este motivo, passíveis de adulteração com óleos de menor qualidade. O objetivo deste trabalho foi avaliar a identidade e a contaminação por hidrocarbonetos policíclicos aromáticos (HPAs) de óleos encapsulados. Foram avaliadas catorze amostras, de diferentes tipos e marcas, comercializadas na cidade de São Paulo. Os ensaios realizados incluíram perfil de ácidos graxos e HPAs [benzo(a)antraceno, criseno, benzo(b)fluoranteno e benzo(a)pireno]. Duas amostras (14%) foram consideradas insatisfatórias quanto aos perfis de ácidos graxos, incluindo óleos de coco e borragem. Quanto aos HPAs, as concentrações parao benzo(a)pireno variaram de

Composition in fatty acids of mature milk of nursing mothers / Composição em ácidos graxos do leite maduro de nutrizes

Abstract Objectives: to determine the fatty acid composition of mature milk of nursing mothers and its distribution according to some maternal variables. Methods: this is a cross-sectional observational epidemiological study based on the eva-luation of the fatty acid profile of mature human milk. Samples of mature breast milk were taken from 106 nursing mothers, by manual milking and who were after the 5th postpartum week. The milk fat extraction was carried out by using the Bligh and Dyer method and methy-lated with 0.25 mol/L sodium methoxide in methanol diethyl ether. The fatty acid of the milk profile was determined by a Gas Chromatograph equipped with a flame ionization detector. Results: among the saturated fatty acids, the highest values were observed for palmitic (C16:0), stearic (C18:0), myristic (C14:0) and lauric (C12:0) fatty acids, respectively. Among the monounsaturated fatty acids, there was a higher contribution of oleic (C18:1) and palmi-toleic (C16:1) fatty acids, respectively. The total essential fatty acids (linoleic and α-linolenic) was 14.94%. Conclusions: a low content of essential fatty acids in the breast milk of the nursing mothers was observed in the present study, which are important for infant growth and deve-lopment. We suggest the need to implement nutrition education strategies aimed for pregnant women and nursing mothers who should be advised to eat healthier foods.

Resumo Objetivos: determinar a composição em ácidos graxos do leite maduro de nutrizes e sua distribuição segundo algumas variáveis maternas. Métodos: trata-se de um estudo epidemiológico observacional, transversal realizado a partir da avaliação do perfil de ácidos graxos do leite humano maduro. Amostras de leite materno maduro foram obtidas de 106 nutrizes, a partir da 5ª semana pós-parto, por meio de ordenha manual. A extração da gordura do leite foi realizada através do método de Bligh e Dyer, e metiladas com metóxido de sódio 0,25 mol/L em metanol dietil - éter. O perfil de ácidos graxos do leite foi determinado por um Cromatógrafo a Gás equipado com detector por ionização de chamas. Resultados: dentre os ácidos graxos saturados, foram observados valores mais elevados para os ácidos graxos palmítico (C16:0), esteárico (C18:0), mirístico (C14:0) e láurico (C12:0), respectivamente. Entre os ácidos graxos mono-insaturados, verificou-se maior contribuição dos ácidos graxos oleico (C18:1) e palmitoleico (C16:1), respectivamente. O total de ácidos graxos essenciais (linoleico e α- linolênico) foi de 14,94%. Conclusões: foi observado baixo teor de ácidos graxos essenciais no leite materno das nutrizes do presente estudo, que são importantes para o crescimento e desenvolvimento do lactente, sugerindo-se a necessidade de implementação de estratégias de educação nutricional direcionadas a gestantes e nutrizes que devem ser orientadas a consumir alimentos mais saudáveis.

Elaboração de cardápio para pacientes adultos de um centro de referência em queimaduras: Relato de experiência / Menu preparation for adult patients from a burn reference center: Experience report / Preparación de cardapio para pacientes adultos de un centro de referencia de quemaduras: Reporte de caso

Objetivo: Descrever o planejamento de um cardápio equilibrado qualitativamente e quantitativamente, para pacientes adultos vítimas de queimaduras do Centro de Tratamento de Queimados em Salvador, Bahia. Trata-se de um relato de caso, para o qual foi feito levantamento de dados baseado em protocolos e nas diretrizes mais atuais em terapia nutricional para queimaduras para revisar o cardápio oferecido aos pacientes hospitalizados no Hospital Geral do Estado da Bahia. Relato do Caso: Foi calculado o cardápio padrão atual das seis refeições oferecidas e dois cardápios propostos através do sistema de avaliação e prescrição Dietwin® com informações acerca do valor energético total, macronutrientes e micronutrientes. Houve ajuste da oferta energética total, de 2810Kcal/dia para uma média de 2546,77Kcal/dia, correspondendo a 36Kcal/Kg/dia, para um adulto referência de 70Kg. Houve aumento na oferta de proteína de 85,88g/dia para média de 111,46g/dia, 1,59 g/Kg/dia. Com o aumento da oferta proteica, a relação de calorias por gramas de nitrogênio foi reduzida de 179,5:1 do cardápio original, para uma média de 118,26:1. A oferta lipídica foi reduzida de 26,66% para em média 21,5%. A relação ômega 6:ômega 3 foi reduzida de 7,39:1 para 1,16:1, nos cardápios propostos. Conclusões: Os cardápios propostos estão de acordo com as evidências científicas mais recentes, com ajustes quantitativos da oferta calórica, proteica e lipídica, além de melhora da composição qualitativa dos carboidratos e ácidos graxos essenciais.

Objective: To describe the planning of a qualitatively and quantitatively balanced dietary for adult burn victims of the Centro de Tratamento de Queimados in Salvador - Bahia. This is a case report, which data were collected based on the most current protocols and guidelines in nutritional therapy for burns to revise the dietary offered to patients hospitalized in Hospital Geral do Estado da Bahia. Case Report: The current standard dietary of the six meals offered and two menus proposed through the Dietwin® prescription and evaluation system with information on total energy value (VET), macronutrients and micronutrients were calculated. There was adjustment of the total energy supply, from 2810 Kcal / day to an average of 2546.77 Kcal / day, corresponding to 36Kcal / Kg / day, for an adult reference of 70Kg. There was an increase in protein supply from 85.88g / day to a mean of 111.46g / day, 1.59g / kg / day. With the increase in protein supply, the ratio of calories per grams of nitrogen was reduced from 179.5:1 of the original menu, to an average of 118.26:1. The lipid supply was reduced from 26.66% to an average of 21.5%. The W6: W3 ratio decreased from 7.39: 1 to 1.16: 1 on the proposed menus. Conclusions: The proposed menus are in accordance with the latest scientific evidence, with quantitative adjustments of the caloric, protein and lipid supply, as well as improvement of the qualitative composition of carbohydrates and essential fatty acids.

Objetivo: Describir la planificación de un menú equilibrado cualitativamente y cuantitativamente, para pacientes adultos víctima de quemaduras del Centro de Tratamento de Queimados en Salvador - Bahia. Se trata de un relato de caso, donde se hizo la recolecta de datos basados en protocolos y pautas más actuales en terapia nutricional para quemaduras para revisar el menú ofrecido a los pacientes hospitalizados em lo Hospital Geral do Estado da Bahia. Reporte de Caso: Se calculó el menú estándar actual y dos menús propuestos a través del sistema de evaluación y prescripción Dietwin® con informaciones a cerca del valor energético total, macronutrientes y micronutrientes. Hubo ajuste de la oferta energética total, de 2810Kcal/día para una media de 2546,77Kcal/día, correspondiendo a 36Kcal/Kg/día, para un adulto referencia de 70Kg. Se observó un aumento en la oferta de proteína de 85,88g/día para un promedio de 111,46g/día, 1,59g/Kg/día. Con el aumento de la oferta proteica, la relación de calorías por gramos de nitrógeno fue reducida de 179,5:1 del menú original, para una media de 118,26:1. La oferta lipídica se redujo del 26,66% para un promedio del 21,5%. La relación W6: W3 disminuyó de 7,39:1 a 1,16:1, en los menús propuestos. Conclusiones: Los menús propuestos están de acuerdo con las evidencias científicas más recientes, con ajustes cuantitativos de la oferta calórica, proteica y lipídica, además de mejora de la composición cualitativa de los carbohidratos y ácidos grasos esenciales.

Cenário ambulatorial de pacientes com sítio cirúrgico infectado após intervenção cardíaca / Escenario ambulatorial de pacientes con sitio cirugía infectado después intervención cardíaca / Ambulatory setting of patients with surgical site infections after a cardiac intervention

Resumo OBJETIVO Verificar o perfil clínico-cirúrgico e os resultados de pacientes acompanhados em um ambulatório de ferida operatória após cirurgia cardíaca. MÉTODOS Coorte histórica com pacientes submetidos à cirurgia cardíaca e acompanhados por um ano em um ambulatório de feridas de um hospital especializado em cardiologia. Foram analisados os micro-organismos predominantes nas infecções, os produtos utilizados nos curativos, tempo de acompanhamento e o tipo de terapêutica instituída nos curativos. RESULTADOS Entre os 150 pacientes, predominaram sexagenários (61,7 ± 11,4 anos), hipertensos (75%), diabéticos (44,7%). Evidenciou-se 12 pacientes com mediastinite (8%) e 44 com infecção de sítio cirúrgico (29,3%). Utilizou-se para realização dos curativos os ácidos graxos (80%) e alginato de cálcio (19%). O tempo de acompanhamento foi de 35 ±71 dias. CONCLUSÃO Pacientes sexagenários, hipertensos, diabéticos e revascularizados constituíram a população acompanhada no ambulatório de feridas. As taxas de ISC e mediastinite encontradas foram aceitáveis e semelhantes às da literatura.

Resumen OBJETIVO Verificar el perfil clínico-quirúrgico y los resultados de pacientes acompañados en un ambulatorio de heridas operatorias después de cirugía cardiaca. MÉTODO Cohorte histórica con pacientes sometidos a la cirugía cardiaca y acompañados por un año en el ambulatorio de heridas de un hospital especializado en cardiología. Fueron analizados los microorganismos predominantes en las infecciones, los productos utilizados en las curaciones, el tiempo de seguimiento, o el tipo de tratamiento utilizado en las curaciones. RESULTADOS Entre los 150 pacientes predominaron el sexo masculino (58%), sexagenarios (61,7 ± 11,4 años), hipertensos (75%), diabéticos (44.7%). Se evidenciaron 12 pacientes con mediastinitis (8%) y 44 con infección en el sitio quirúrgico (29.3%). Se utilizó en las curaciones fueron los ácidos grasos (80%) y el alginato de calcio (19%). El tiempo medio de seguimiento fue de 35 ± 71 días. CONCLUSIÓN Los pacientes sexagenarios, hipertensos, diabéticos y revascularizados constituyeron la población acompañada en el ambulatorio de heridas. Las tasas de ISC y mediastinitis encontradas fueron aceptables y similares a las de la literatura.

Abstract OBJECTIVE Verifying the clinical-surgical profile and the results of patients monitored in an surgical wound ambulatory after a cardiac surgeries. METHODS This is a historical cohort research with patients submitted to cardiac surgery and monitored for a year in an outpatient surgical wound clinic from a hospital specialized in cardiology. The study analyzed the prevalent microorganisms in infections, the products used in the dressings, the time of follow-up, and the type of therapy established in the dressings. RESULTS Among the 150 patients, most were sexagenarians (61.7 ± 11.4 years), hypertensive patients (75%), and diabetic (44.7%). There were 12 patients with mediastinitis (8%) and 44 with surgical site infection (29.3%). Fatty acids (80%) and calcium alginate (19%) were used for wound healing. The mean follow-up time was 35 ± 71 days. CONCLUSION Sexagenary, hypertensive, diabetic and revascularized patients constituted the population monitored in the wounds outpatient clinic. The SSI and mediastinitis rates found were acceptable and similar to those in literature.

Dietary intake of n-3 and n-6 polyunsaturated fatty acids in Korean toddlers 12–24 months of age with comparison to the dietary recommendations

BACKGROUND/OBJECTIVES: Adequate dietary fatty acid intake is important for toddlers between 12–24 months of age, as this is a period of dietary transition in conjunction with rapid growth and development; however, actual fatty acid intake during this period seldom has been explored. This study was conducted to assess the intake status of n-3 and n-6 polyunsaturated fatty acids by toddlers during the 12–24-month period using 2010–2015 Korea National Health and Nutrition Examination Survey data. SUBJECTS/METHODS: Twenty-four-hour dietary recall data of 12–24-month-old toddlers (n = 544) was used to estimate the intakes of α-linolenic acid (ALA; 18:3n-3), eicosapentaenoic acid (EPA; 20:5n-3), docosahexaenoic acid (DHA; 22:6n-3), linoleic acid (LA; 18:2n-6), and arachidonic acid (AA; 20:4n-6), as well as the major dietary sources of each. The results were compared with the expected intake for exclusively breastfed infants in the first 6 months of life and available dietary recommendations. RESULTS: Mean daily intakes of ALA, EPA, DHA, LA, and AA were 529.9, 22.4, 37.0, 3907.6, and 20.0 mg/day, respectively. Dietary intakes of these fatty acids fell below the expected intake for 0–5-month-old exclusively breastfed infants. In particular, DHA and AA intakes were 4 to 5 times lower. The dietary assessment indicated that the mean intake of essential fatty acids ALA and LA was below the European and the FAO/WHO dietary recommendations, particularly for DHA, which was approximately 30% and 14–16% lower, respectively. The key sources of the essential fatty acids, DHA, and AA were soy (28.2%), fish (97.3%), and animals (53.7%), respectively. CONCLUSIONS: Considering the prevailing view of DHA and AA requirements on early brain development, there remains considerable room for improvement in their intakes in the diets of Korean toddlers. Further studies are warranted to explore how increasing dietary intakes of DHA and AA could benefit brain development during infancy and early childhood.

Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments

Oenothera biennis with the common name of “evening primrose” is containing a valuable fixed oil with commercial name of EPO. Evening primrose oil has two types of omega-6-fatty acid including linoleic acid (60%–80%) and γ-linoleic acid (8%–14%). Essential fatty acids are considered as essential compounds for body health, especially among women. The aim of this study was to evaluate the efficacy of evening primrose oil in the management of women ailments. The document was prepared by investigation in scientific articles of electronic resources (Google Scholar, PubMed, Science Direct, Wiley, Scopus, and Springer) by keywords of evening primrose oil and women. The results of our investigations showed that evening primrose oil has been the subject of several clinical studies, including premenstrual syndrome (PMS), hot flash, mastalgia, fibroadenomas, gestational diabetes, cervical ripening, and dilation. The major clinical studies are focused on mastalgia, followed by PMS. The results of studies confirmed the evening primrose oil's efficacy in women health, but the immediate response should not be expected from it, therefore, it should be regularly used up to 4 or 6 months.

Fatty acid profile in erythrocytes associated with serum cytokines in pediatric cystic fibrosis patients / Perfil de ácidos graxos nos eritrócitos associados com citocinas séricas em pacientes pediátricos com Fibrose Cística

ABSTRACT Objective To analyze erythrocyte fatty acid composition and its association with serum cytokine levels in pediatric cystic fibrosis patients. Methods A cross-sectional study was performed at a reference center in Rio de Janeiro, Brazil. We have included all pediatric patients aged 5-19 years with confirmed cystic fibrosis diagnosis. Erythrocyte fatty acid composition and serum cytokine (TNF-α, IL-1β, IL-6 and IL-8) and C-reactive protein levels were measured. The cut-off point to determine essential fatty acids deficiency was the linoleic acid concentration of <21%. Results Twenty-six children (<10 years old) and thirty-one adolescents were studied. Most patients were female and heterozygous for DF508 mutation and suffered from exocrine pancreatic insufficiency. Both children and adolescents had lower linoleic acid concentration (<21%). TNF-α was the only pro-inflammatory marker whose levels were increased; the increase was greater in children. An association between fatty acid composition in erythrocytes and cytokines IL-1β and IL-6 was observed (p<0.05). Conclusion The pediatric cystic fibrosis patients studied presented a deficiency of essential fatty acids, and an association between fatty acid profile in erythrocytes and serum pro-inflammatory cytokines was observed. These findings highlight the importance of this type of assessment that may open new possibilities for studying pathophysiology and treating cystic fibrosis patients, such as the dietary supplementation with n-3 fatty acids (eicosapentaenoic and docosahexaenoic acids). However, further longitudinal studies are needed for better clarification of the imbalance in lipid metabolism and inflammation in cystic fibrosis

RESUMO Objetivo Analisar a composição dos ácidos graxos nos eritrócitos e sua associação com os níveis séricos de citocinas em pacientes pediátricos com fibrose cística. Métodos Estudo transversal, realizado em um centro de referência no Rio de Janeiro/Brasil. Foram incluídos todos os pacientes pediátricos com diagnóstico confirmado de fibrose cística, entre cinco e 19 anos de idade. Foram analisadas a composição de ácidos graxos nos eritrócitos, as citocinas séricas (TNFα, IL-1, IL-6 e IL-8) e a proteína C reativa. O ponto de corte para determinar a deficiência de ácidos graxos essenciais foi a concentração de ácido linoleico <21%. Resultados Foram estudadas 26 crianças (<10 anos) e 31 adolescentes, sendo a maioria do sexo feminino, heterozigoto para a mutação DF508 e com insuficiência pancreática exócrina. Nas crianças e nos adolescentes as concentrações de ácido graxo linoleico eram baixas (<21%). O TNF-α foi o único marcador pró-inflamatório cujas concentrações estavam aumentadas, principalmente nas crianças. Uma associação entre a composição de ácidos graxos nos eritrócitos e as citocinas IL-1β e IL-6 foi observada (p<0,05). Conclusão Os pacientes pediátricos estudados apresentaram deficiência de ácidos graxos essenciais e foi observada associação entre o perfil de ácidos graxos nos eritrócitos com as citocinas pró-inflamatórias séricas. Os achados destacam a importância deste tipo de avaliação sobre a fisiopatologia e o tratamento de pacientes com fibrose cística, como a suplementação com ácidos graxos n-3 (eicosapentaenoico e docosahexaenoico). No entanto são necessários mais estudos longitudinais no esclarecimento entre o desequilíbrio do metabolismo lipídico e a inflamação na fibrose cística.

Efectos del consumo de aceite de pescado sobre indicadores de síndrome metabólico en ratas obesas IIMb/Beta / Effects of fish oil consumption on metabolic syndrome parameters in obese IIMb / Beta rats

Existe consenso científico acerca de la necesidad de cambiar hábitos de alimentación y aumentar la actividad física como estrategias para prevenir y paliar la epidemia de sobrepeso y obesidad. En este estudio se evaluaron los efectos de dietas isocalóricas e isolipídicas, con diferente calidad de lípidos, sobre algunos indicadores de síndrome metabólico en ratas de la línea IIMb/Beta de 70 días de edad. Este modelo murino manifiesta obesidad acompañada de hipertriacilglicerolemia y resistencia insulínica desde la pubertad y desarrolla diabetes tipo 2 en la adultez. Se suministraron durante 90 días tres dietas formuladas según AIN-93 (American Institute of Nutrition-93) ad libitum: Dieta AIN con aceite de girasol como fuente de lípidos; Dieta JB con grasa bovina (remplazando al aceite de girasol) y Dieta JBn-3 con grasa bovina más ácidos grasos poliinsaturados n-3 provenientes de aceite de pescado. Los animales que consumieron la dieta JBn-3 manifestaron disminución (p<0,05) en algunos indicadores de sindrome metabólico como la hiperinsulinemia, la hipertriacilglicerolemia y el depósito de lípidos totales, colesterol y triacilgliceroles hepáticos. Si bien se requieren más estudios, se confirma la validez de las intervenciones dietarias para el abordaje de la obesidad y sus comorbilidades recomendadas por los organismos internacionales(AU)

There is scientific consensus about the importance of changing dietary habits and increasing physical activity for the prevention and treatment of obesity and its co-morbidities. The effects of isocaloric and isolipidic diets with different type of fat on symptoms of the metabolic syndrome in 70 days old IIMb/Beta rats were evaluated. This murine model develops obesity, hypetryacilglycerolemia and insulin resistance since puberty, progressing to type 2 diabetes in adulthood. Three diets formulated according to AIN-93 (American Institute of Nutrition-93) were offered ad libitum during 90 days: Diet AIN with sunflower oil; Diet JB with bovine fat (replacing sunflower oil) and Diet JBn-3 with bovine fat and PUFAn-3 from fish oil. The group fed JBn-3 diet showed diminution (p<0,05) on several of the clinical manifestations of the metabolic syndrome, such as: hyperinsulinemia, hypertriacylglycerolemia and hepatic total lipids, cholesterol and triacylglycerols. Although more research is required, the study supports the beneficial effects of dietary approaches on obesity and its comorbidities(AU)

Comparação dos efeitos do ácido hialurônico 0, 2% e ácidos graxos essenciais em paciente com queimadura por fertilizante: relato de caso / Comparison of the effects of hyaluronic acid 0. 2% and essential fatty acids in burn victim due to fertilizer exposure: case report / Comparación de los efectos del ácido hialurónico 0, 2% y los ácidos grasos esenciales en víctima de quemaduras debido a la exposición a fertilizante: relato de caso

Objetivo: Relatar a experiência no tratamento de queimadura decorrente de exposição a fertilizante, comparando o uso de creme de ácido hialurônico (AH) e ácidos graxos essenciais (AGE), em paciente atendido pelo programa Estratégia Saúde da Família (ESF) de Jaguariúna, SP. Relato de caso: P.C.M., sexo masculino, 46 anos, com queimaduras de 2o grau superficial e pequenas áreas de 2o grau profundo nas duas mãos, decorrentes do uso de fertilizante, sem sinais de infecção ou demais complicações. Foi atendido em Unidade de ESF, onde foi iniciado protocolo de limpeza diária das lesões com soro fisiológico 0,9%. Na mão direita, foi aplicada fina camada de AH 0,2% e, na mão esquerda, AGE, na mesma frequência de uso do AH. Os curativos foram feitos pela enfermeira e técnica da ESF. A evolução da reparação da lesão foi acompanhada e avaliada diariamente por esses profissionais. Resultados: Após 60 dias de uso tópico de creme contendo AH 0,2%, ocorreu a completa cicatrização da mão direita. Na mesma data de avaliação, a mão esquerda ainda apresentava fissuras e descamação, não demonstrando total cicatrização. Com a piora do quadro da mão esquerda, optou-se por suspender o uso do AGE e iniciar o uso de AH uma vez ao dia. Após 39 dias, foi verificado que a lesão estava completamente cicatrizada. Conclusão: Os resultados demonstraram que o uso de AH proporcionou cicatrização de forma mais rápida e efetiva para queimadura decorrente da exposição a fertilizante, em comparação ao AGE.

Objective: To report the experience in treating a burn victim due to fertilizer exposure comparing hyaluronic acid (HA) cream and essential fatty acids (EFA), who was treated by Health Family Strategy (HFS) of Jaguariuna, SP. Case report: P.C.M., male, 46 years old, with superficial second-degree burn injuries and small areas with deep second degree burn on both hands, caused by fertilizer exposure. There were no signs of infection or other complications. He was treated at HFS Unit where a protocol to clean the wound with saline solution 0.9% was initialized. On his right hand was applied HA 0.2% and on his left hand was applied EFA following the same routine in both hands. A nurse and a technical nurse of the HFS Unit did all the dressings and evaluated the wounds daily. Results: The complete reparation of the injury on the right hand was achieved after 60 days applying HA 0.2%. In the same period, the left hand was still not fully recovered and presented fissure and peeling, with this result the nurses decided to suspend the EFA and start using HA on the left hand once a day. After 39 days, the left hand was entirely recovered. Conclusion: These results demonstrate that the use of HA provided healing more quickly and effectively to burn due to exposure to fertilizer, as compared to the EFA.

Objetivo: Presentar la experiencia en el tratamiento de quemaduras debido a la exposición a fertilizante, comparando el uso de la crema de ácido hialurónico(AH) y ácidos grasos esenciales(AGE),en pacientes atendidos por el Estratégia Saúde da Família(ESF) en la ciudad de Jaguariúna, São Paulo. Relato de caso: P.C.M., varón, de 46 años, con quemaduras de segundo grado superficiales y pequeñas áreas de segundo grado profundo en ambas manos, como resultado del uso de fertilizantes, sin signos de infección u otras complicaciones. El paciente fue tratado en la Unidad ESF, donde se inició el protocolo de limpieza diaria de las lesiones con solución salina al 0,9%. En su mano derecha se aplicó una capa fina de AH 0,2% y en la mano izquierda, AGE, en la misma frecuencia del uso de AH. Las curaciones fueron realizadas por la enfermera y la técnica de enfermería de ESF. La evolución del reparo de la lesión fue acompañada y evaluada diariamente por esos profesionales. Resultados: Después de 60 días de utilización de AH 0,2% em crema, se observó completa cicatrización de la mano derecha. En la misma data, la mano izquierda aún presentaba grietas y descamación, no siendo observado cicatrización completa. Con la imagen de la izquierda empeoramiento, se decidió suspender el uso del AGE y comenzar a usar AH una vez al día. Después de 39 días, se encontró que la lesión se curó completamente. Conclusión: Estos resultados demuestran que el uso de HA proporciona una curación más rápida y efectiva para quemaduras debido a la exposición a fertilizantes en comparación con la AGE.

Uso de fórmula nutricional semielemental con alto contenido de TCM en pacientes con diagnóstico de quilotórax congénito o adquirido / Use of semielemental nutritional formula with high TCM content in patients with congenital or acquired chylothorax diagnosis

INTRODUCCIÓN: Antecedentes: El presente informe expone la evaluación del producto nutricional Fórmula semielemental con alto contecnido de TCM (triglicéridos de cadena media) respecto a su uso en pacientes con diagnóstico de quilotóraz congénito o adquirido. Aspectos Generales: El quilotóraz es la acumulación de quilo o fluído alcalino en la cavidad pleural que resulta de fugas provenientes de los vasos linfáticos por malformaciones o lesiones del conducto torácio. Esta enfermedad puede ocurrir en pacientes de cualquier edad, incluyendo neonatos e infantes.Tecnología Sanitaria de Interés: Las fórmulas con alto contenido de triglicéridos de cadena media (TCM) son fórmulas semielementares, ya que los nutrientes que las componen se encuentran higrolizados en moléculas pequeñas. Estas fórmulas están clasificadas como "fórmulas con modificaciones del cuerpo graso", y están compuestas por RCM (70-90% de los lípidos) y pequeñas cantidades de triglicéridos de cadena larga (TCL), añadidos para cubrir los requerimientos de ácidos grasos de los infantes que las consumen. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una búsqueda de literatura científica en relación al uso de fórmulas semielementales con alto contenido de triglicéridos de cadena media (TCM) en neonatos o lactantes con quilotóraz congénito o adquirido. Se dio preferencia a guías de práctica clínica, revisiones sistemáticas con o sin meta-analísis y ensayos clínicos aleatorizados. RESULTADOS: Se realizó la búsqueda bibliográfica y de evidencia que sustente el uso de una formula semielemental con alto contenido de triglicéridos de cadena media (TCM) en pacientes con diagnóstico de quilotórax congénito o adquirido.Luego de revisar un total de 261 referencias resultados de la búsqueda bibliográfica, logramos filtar 38 estudios relevantes. Sinopsis de la Evidencia: Existe evidencia sobre el uso de dietas con alto contenido de triglicéridos de cadena média (TCM) como tratamiento de quilotórax en infantes, niños, adolescentes y adultos lo cual constituye evidencia indirecta para la evaluación del presente Dictamen. CONCLUSIONES: En la presente evaluación de tecnologia sanitaria se presenta la evidencia recabada sobre el beneficio de las fórmulas semielementales con alto contenido de triglicéridos de cadena media (TCM). La evidencia encontrada que compara el uso de una fórmula con alto contenido de TCM con el uso de nutrición parenteral (NPT) es escaza. Se ha identificado evidencia proveniente de un único estudio observacional que compara el uso de fórmulas con alto contenido de TCM con el uso de NPT en infantes con quilotórax post-quirúrgico. El Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, aprueba el uso de la fórmula semielemental con alto contenido de TCM en neoantos o infantes con diagnóstico de quilotórax congénito o adquirido. El present Dictamen Preliminar tiene una vigencia de dos años a partir de la fecha de publicación.

Eficacia y seguridad de fórmulas semielemental con bajo contenido de grasa y alto contenido de trigliceridos de cadena media para pacientes con defecto de la beta oxidacion de acidos grasos de cadena larga / Efficacy and safety of semielemental formulas with low fat and high content of medium chain triglycerides for patients with beta oxidation defects of long chain fatty acids

INTRODUCCIÓN: Antecedentes: El presente dictamen presenta la evaluación de la eficacia y seguridad de la fórmula con bajo contenido de grasa y alto contenido de trigliceridos de cadena media, para pacientes con defecto de la beta oxidación de acidos grasos de cadena larga. Aspectos Generales: Los trastornos de la oxidación de ácidos grasos (FAO), constituyen un grupo crítico de enfermedades potencilamente fatales que representan un grupo de alteraciones heterogéneas que requieren tratamientos específicos.Los trastornos de oxidación de ácidos grasos son indivudualmente raros, pero colectivamente comunes, debido al gran número de diferentes enzimas afectadas. Tecnología Sanitaria de Interés: La fórmula nutricional baja en grasa de cadena larga y rica en triglicéridos de cadenamedia, en su presentación como fórmula para lactantes viene en diferentes presentaciones comerciales. Monogen se encuentra disponible en Perú, de acuerdo a los especialistas que se encuentran en la redacción del presente dictamen. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una estrategia de búsqueda sistemática de la evidencia cientifica con respecto a la eficacia y seguridad de la fórmula con bajo contenido de grasa y alto contenido de trigliceridos de cadena media, para pacientes con defecto de la beta oxidación de acidos grasos de cadena larga. Para la búsqueda primaria se busó la información disponbiela a través de los metabuscadores: Translating Research into Practice (TRIPDATABASE), National Library of Medicine (Pubmed-Medline), The National Guideline Clearinghouse (NGC), y Health Systems Evidence (HSE). RESULTADOS: Tras la búsqueda bibliográfica se encontraron documentos que evaluaron la eficacia y seguridad de la fórmula con bajo contenido de grasa y alto contenido de triglicéridos de cadena media para pacientes con defecto de la beta oxidación de ácidos grasos de cadena larga. CONCLUSIONES: El presente documento evaluó la evidencia cientifica publicada hasta Julio del 2016 para el uso de la fórmula con bajo contenido de grasa y alto contenido de trigliceridos de cadena media para pacientes con defecto de la beta oxidación de ácidos grasos de cadena larga. Los trastornos de la oxidación de ácidos grasos (FAO), constituyen un grupo de enfermedades potencialmente fatales, con más de 20 trastornos deiferentes identificados que representan un grupo de alteraciones heterogéneas que requieren tratamientos específicos. LCHADD, se encuentra reconocida como una de las enfermedades por alteración de la FAO más severas. Las actuales recomendaciones y consenso de expertos recomiendan en lactantes y en pacientes que tienen defectos e la deglución, una fórmula infantil espeical que contiene triglicéridos de cadena media (MCT) y ácidos grasos esenciales, ya que los efectos tóxicos de la acumulación de hidroxi acilcarnitina tienen consecuencias sobre el estado clínico del paciente. El Instituto de Evaluación de Tenologías en Salud e Investigación (IETSI) aprueba el uso de la fórmula con bajo contenido de grasa y alto contenido de trigliceridos de cadena media para pacientes con defecto de la beta oxidación de ácidos grasos de cadena larga bajo.

Giant condyloma acuminatum: report of surgical treatment and evolution of healing / Condiloma acuminado gigante: relato de tratamento cirúrgico e evolução da cicatrização

O condiloma acuminado gigante, variante rara do condiloma acuminado anogenital, apresenta crescimento rápido associado a estados de imunodeficiência.Relatamos os resultados com os cuidados com a ferida operatória. Trata-se de homem de etnia negra, 55 anos, portador do vírus da imunodeficiência humana com condiloma acuminado acometendo desde as regiões inguinais até o sulco interglúteo, que foi ressecado permanecendo a ferida aberta para posterior enxertia. Os cuidados com essa ferida incluíram solução de polihexametileno biguanida/betaína, solução de ácidos graxos essenciais, hidrofibra/prata e película. Evoluiu com infecção secundária sendo a hidrofibra substituída por espuma de poliuretano/prata/ibuprofeno. Houve melhora da infecção e da dor, contração das bordas e presença de tecido de granulação em toda a lesão. Naquelas condições, o enxerto de pele foi realizado no 41º dia. A despeito dos possíveis vieses de confusão, pode-se inferir que esses cuidados prepararam o leito da ferida para receber o enxerto de pele.

Giant condyloma acuminatum, a rare variant of anogenital condyloma, shows rapid growth associated with immunodeficiency. Wound care after resection andoutcomes were reported. NGS, black, 55 years, HIV positive, with giant condyloma acuminatum affecting from the groin to the intergluteal groove, which wasresected, remaining the wound opened for later skin graft. Topical care included polihexametilene biguanide/betaine solution, essencial fatty acids solution,hydrofiber/silver, and poliuretane film. The wound developed secondary infection, so hidrofiber was replaced by polyurethane foam/silver/ibuprofen. Therewas improvement in infection and pain, contraction of the edges and the presence of granulation tissue across the lesion. In those conditions the skin graft was performed after 41 days. Despite possible confusion bias, it can be inferred that the care adopted prepared the wound bed to receive the skin graft.

The Stimulatory Effect of Essential Fatty Acids on Glucose Uptake Involves Both Akt and AMPK Activation in C2C12 Skeletal Muscle Cells

Essential fatty acid (EFA) is known to be required for the body to function normally and healthily. However, the effect of EFA on glucose uptake in skeletal muscle has not yet been fully investigated. In this study, we examined the effect of two EFAs, linoleic acid (LA) and alpha-linolenic acid (ALA), on glucose uptake of C2C12 skeletal muscle cells and investigated the mechanism underlying the stimulatory effect of polyunsaturated EFAs in comparison with monounsaturated oleic acid (OA). In palmitic acid (PA)-induced insulin resistant cells, the co-treatment of EFAs and OA with PA almost restored the PA-induced decrease in the basal and insulin-stimulated 2-NBDG (fluorescent D-glucose analogue) uptake, respectively. Two EFAs and OA significantly protected PA-induced suppression of insulin signaling, respectively, which was confirmed by the increased levels of Akt phosphorylation and serine/threonine kinases (PKCtheta and JNK) dephosphorylation in the western blot analysis. In PA-untreated, control cells, the treatment of 500 microM EFA significantly stimulated 2-NBDG uptake, whereas OA did not. Phosphorylation of AMP-activated protein kinase (AMPK) and one of its downstream molecules, acetyl-CoA carboxylase (ACC) was markedly induced by EFA, but not OA. In addition, EFA-stimulated 2-NBDG uptake was significantly inhibited by the pre-treatment of a specific AMPK inhibitor, adenine 9-beta-D-arabinofuranoside (araA). These data suggest that the restoration of suppressed insulin signaling at PA-induced insulin resistant condition and AMPK activation are involved at least in the stimulatory effect of EFA on glucose uptake in C2C12 skeletal muscle cells.

Adequacy of Lipid Emulsion Administration Prescription Rate in a Single Center

PURPOSE: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. METHODS: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. RESULTS: The median prescription rate of total lipid emulsion was 0.134 (0.012~1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P<0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P<0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P<0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P<0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). CONCLUSION: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.

Current Practice Pattern for Dry Eye Patients in South Korea: A Multicenter Study

PURPOSE: To assess current practice patterns for dry eye patients in South Korea and to evaluate the preference according to the ages and clinic types of physicians. METHODS: Dry eye patients (n = 1,612) were enrolled in this multicenter cross-sectional, observational study. The severity level of dry eye patients was classified based on the Korean guidelines for dry eye treatment. The medical records of the enrolled dry eye patients were evaluated, and the practice styles and the preferences were analyzed according to the ages and clinic types of physicians. RESULTS: Of all patients, dry eye level 1 was most common (47.5%), followed by level 2 (33.5%), level 3 (9.1%), and level 4 (1.1%). Topical anti-inflammatory agents were used in 70.7% of patients with dry eye level 2 and in 80.6% of patients at levels 3 and 4. Topical anti-inflammatory agents were also used in 48.7% of patients with dry eye level 1. Preservative-free artificial tears were preferred at all dry eye levels. The use of topical anti-inflammatory agents did not differ with investigator ages, but older physicians preferred preserved artificial tears more than younger ones. Physicians at referral hospitals also tended to use topical anti-inflammatory agents and preservative-free artificial tears earlier, beginning at dry eye level 1, than those who worked at private eye clinics. CONCLUSIONS: Topical anti-inflammatory agents were commonly prescribed for the treatment of dry eye patients in South Korea, even from dry eye level 1. Preservative-free artificial tears were preferred at all dry eye levels. Practice styles differed somewhat depending on the ages and clinic types of physicians.

Systematic review of the effect of omega-3 fatty acids on improvement of blood flow while focused on evaluation of claims for health functional food / 한국영양학회지

Omega-3 polyunsaturated fatty acids are essential fatty acids because humans cannot synthesize them de novo and must obtain them in their diet. Fish and fish oil are rich sources of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Significant evidence of the beneficial role of dietary intake of omega-3 fatty acids in blood flow has been reported and putative mechanisms for improvement of blood flow include anti-thrombotic effects, lowered blood pressure, improved endothelial function, and anti-atherogenic effects. Edible oils containing omega-3 fatty acids were registered as functional ingredients in the Korea Health Functional Food Code. Although omega-3 fatty acids have been evaluated by the Korea Food and Drug Administration (KFDA) based on scientific evidence, periodic re-evaluation may be needed because emerging data related to omega-3 fatty acids have accumulated. Therefore, in this study, we re-evaluated scientific evidence for the effect of omega-3 fatty acids as a functional ingredient in health functional food on improvement of blood flow. A comprehensive literature search was conducted for collection of relevant human studies using the Medline and Cochrane, KISS, and IBIDS databases for the years 1955-2012. Search keywords were used by combination of terms related to omega-3 fatty acids and blood flow. The search was limited to human studies published in Korean, English, and Japanese. Using the KFDA's evidence based evaluation system for scientific evaluation of health claims, 112 human studies were identified and reviewed in order to evaluate the strength of the evidence supporting a relation between omega-3 fatty acids and blood flow. Among 112 studies, significant effects on improvement of blood flow were reported in 84 studies and the daily intake amount was ranged from 0.1 to 15 g. According to this methodology of systematic review, we concluded that there was possible evidence to support a relation between omega-3 fatty acid intake and blood flow. However, because inconsistent results have recently been reported, future studies should be monitored.

Polyunsaturated Fatty Acids in Children / 대한소아소화기영양학회지

Polyunsaturated fatty acids (PUFAs) are the major components of brain and retina, and are the essential fatty acids with important physiologically active functions. Thus, PUFAs should be provided to children, and are very important in the brain growth and development for fetuses, newborn infants, and children. Omega-3 fatty acids decrease coronary artery disease and improve blood flow. PUFAs have been known to have anti-inflammatory action and improved the chronic inflammation such as auto-immune diseases or degenerative neurologic diseases. PUFAs are used for metabolic syndrome related with obesity or diabetes. However, there are several considerations related with intake of PUFAs. Obsession with the intake of unsaturated fatty acids could bring about the shortage of essential fatty acids that are crucial for our body, weaken the immune system, and increase the risk of heart disease, arrhythmia, and stroke. In this review, we discuss types, physiologic mechanism of action of PUFAs, intake of PUFAs for children, recommended intake of PUFAs, and considerations for the intake of PUFAs.