The diversity of ursodeoxycholic acid precursors from bile waste of commercially available fishes, poultry and livestock in Indonesia

Ursodeoxycholic acid (UDCA), a secondary bile acid (BA), has been used as a drug to treat various liver diseases. UDCA is synthesised from cholic or chenodeoxycholic acid (CA/CDCA), two primary BAs frequently used as the starting materials. Nowadays, swine, cattle, and poultry bile are the main sources of those BAs. However, other commercial animals could be promising sources as well. We identified two livestock, two poultries, and eight fishes that are commercially cultivated in Indonesia. Four free BAs including CA, CDCA, deoxycholic acid (DCA), and lithocholic acid (LA) were identified for their occurrences using thin-layer chromatography and high-performance liquid chromatography. CA was detected in cow, duck, red tilapia, gourami, the common carp, and grouper, whereas CDCA was only detected in two poultries and the common carp. The occurrence of DCA was common and abundant in most tested animals. In contrast, the presence of LA was found to be very low in all samples. The biliary bile of tilapia has been found to contain a high abundance of free CA (43% of the total bile). A simple extraction was able to purify CA from biliary bile of tilapia. This is a new promising and competitive source of CA.

Functional priorities reported by parents of children with cerebral palsy: contribution to the pediatric rehabilitation process / Prioridades funcionais identificadas por pais de crianças com paralisia cerebral:contribuições para o processo de reabilitação infantil

Background: Collaborative actions between family and therapist are essential to the rehabilitation process, and they can be a catalyst mechanism to the positive outcomes in children with cerebral palsy (CP). Objectives: To describe functional priorities established by caregivers of CP children by level of severity and age, and to assess changes on performance and satisfaction on functional priorities reported by caregivers, in 6-month interval. Method: 75 CP children, weekly assisted at Associação Mineira de Reabilitação, on physical and occupational therapy services. The following information was collected: gross motor function (Gross Motor Function Classification System-GMFCS) and functional priorities established by caregivers (Canadian Occupational Performance Measure-COPM). Data were collected in two moments, with a 6-month interval. Results: The main functional demands presented by caregivers were related to self-care activities (48.2%). Parents of children with severe motor impairment (GMFCS V) pointed higher number of demands related to play (p=0.0036), compared to the other severity levels. Parents of younger children reported higher number of demands in mobility (p=0.025) and play (p=0.007), compared to other age groups. After 6 months, there were significant increase on COPM performance (p=0.0001) and satisfaction scores (p=0.0001). Conclusions: Parents of CP children identified functional priorities in similar performance domains, by level of severity and age. Orienting the pediatric rehabilitation process to promote changes in functional priorities indentified by caregivers can contribute to the reinforcement of the parent-therapist collaboration. .

Contextualização: Ações colaborativas entre família e terapeuta são essenciais para o processo de reabilitação, podendo constituir mecanismo catalisador de desfechos funcionais positivos para crianças com paralisia cerebral (PC). Objetivos: Descrever prioridades funcionais identificadas por cuidadores de crianças com PC por nível de gravidade e idade e avaliar mudanças no desempenho e satisfação reportadas pelos cuidadores nas prioridades identificadas no intervalo de seis meses. Método: De 75 crianças com PC, atendidas semanalmente naAssociação Mineira de Reabilitação, nos serviços de fisioterapia e de terapia ocupacional, foram coletadas informações referentes à função motora grossa (Sistema de Classificação da Função Motora Grossa-GMFCS) e às prioridades funcionais estabelecidas pelos cuidadores (Medida Canadense de Desempenho Ocupacional-COPM). Os dados foram coletados em dois períodos, com intervalo de seis meses. Resultados: As principais demandas apontadas pelos cuidadores referiram-se às atividades de cuidados pessoais (48,2%). Pais de crianças com comprometimento motor grave (GMFCS V) apresentaram maior número de demandas relacionadas ao brincar (p=0,036), comparadas com outros níveis de comprometimento. Pais de crianças mais jovens reportaram maior número de demandas em mobilidade (p=0,025) e brincar (p=0,007) em relação aos outros grupos etários. Após seis meses, observou-se aumento significativo dos escores de desempenho (p=0,0001) e de satisfação (p=0,0001) da COPM. Conclusões: Pais de crianças com PC identificaram prioridades funcionais em áreas de desempenho semelhantes por nível de gravidade da função motora grossa e por grupo etário. Direcionar o processo ...

Comunicação não verbal entre enfermeiros e idosos à luz da proxêmica / Nonverbal communication between nurses and the elderly based on the proxemics / Comunicación no verbal entre enfermeros y ancianos a la luz de la proxémica

Objetivou-se analisar a comunicação não verbal entre enfermeiros e idosos na consulta de enfermagem à luz do referencial teórico de Hall. Estudo exploratório descritivo com abordagem quantitativa, realizado por filmagens das consultas de enfermagem com idosos em Unidades Básicas de Saúde do município de João Pessoa-Paraíba, analisadas a cada um minuto, totalizando 1.575 interações não verbais. A análise mostra predomínio de enfermeiros (90,63%) e idosos (65,63%) do sexo feminino e classificação regular para a maioria dos fatores com prevalência da postura sentada (80,09%), cadeiras uma em frente a outra (64,46%), distância pessoal (91,40%), expressão facial tranquila (59,78%), uso do toque apenas ao realizar um procedimento técnico (53,33%), interação visual enquanto manipula objetos (57,69%) e volume de voz inalterado (48,79%). Esses resultados refletem a necessidade de os enfermeiros dominarem conscientemente suas manifestações corporais e faciais a fim de melhor interagirem com o idoso.

The aim is to analyze the nonverbal communication between nurses and the elderly in the nursing consultation based on the theory by Hall. The research concerns a descriptive exploratory study and it has a quantitative approach. It took place through filmings of the nursing consultations which happened in Health Basic Units in João Pessoa, Paraíba, Brazil, observed every minute, a total of 1.575 nonverbal interactions. The analysis has showed the predominance of the female nurses (90.63%) and the elderly (65.63) and a regular classification for most of the factors as a prevalence of a sitting set (80.09), opposite chairs (64.46%), personal distance (91.40%), calm facial expression (59.78%), touch was used for a technical procedure (53.33%), visual interaction for the manipulation of the objects (57.69) and no alteration in the voice volume (48.79%). These results reflect the necessity of the nurses to domain consciously their corporal and facial manifestations in order to improve the interaction with the elderly.

El objetivo es analizar la comunicación no verbal entre enfermeros y ancianos en la consulta de enfermería bajo la teoría de Hall. Estudio exploratório descriptivo con abordaje cuantitativa, realizada a través de filmaciones de consultas con ancioanos en Unidades Básicas de Saúde de João Pessoa - Paraíba, totalizando 1.1575 interacciones no verbales. El análisis muestra predomínio de enfermeros (60,63%) y ancianos (65,63%) de sexo femenino y classificación Regular para la mayoría de factores con predominio de postura sentada (80,09%), sillas una frente a otra (64,46%), distancia personal (91,40%), expresión facial tranquila (59,78%), uso de contacto sólo para realizar procedimientos técnicos (53,33%), interacción visual cuando manipula objetos (57,69%) y volumen de voz inalterado (48,79%). Estos resultados reflejan la necessidad de que los enfermeros dominen conscientemente manifestaciones corporales y faciales a fin de mejorar la interacción con el anciano.

Preoperative bile salt administration versus bile refeeding in obstructive jaundice.

BACKGROUND: Endotoxaemia due to intraluminal bile salt depletion may be a cause of renal failure in patients with obstructive jaundice. Administration of bile salts to these patients has been reported to decrease portal and systemic endotoxaemia during surgery and improve renal function. However, such changes have not been shown with bile refeeding. We compared the effect of preoperative bile salt administration with preoperative bile refeeding on renal function in patients with obstructive jaundice. METHODS: Sixteen patients with obstructive jaundice underwent percutaneous transhepatic biliary drainage--eight received oral bile salts (500 mg of sodium deoxycholate 8-hourly for 48 hours preoperatively) and the other 8 were refed the total bile output for the entire period of biliary drainage (median 13 days). Blood endotoxin levels and renal function were assessed before, during and after the operation. RESULTS: The number of patients with intraoperative portal and postoperative systemic endotoxaemia decreased after both forms of therapy. Renal function also improved in both the groups--all 4 patients with renal failure recovered. There was a significant increase in creatinine clearance postoperatively after bile salt therapy (from 65 ml/minute preoperatively to 87 ml/minute postoperatively). CONCLUSION: Refeeding of bile obtained by percutaneous catheter drainage is an effective, cost-free substitute for oral bile salts in patients with obstructive jaundice.

Pancreatite aguda: etiopatogenia, fisiopatologia e tratamento / Acute pancreatitis: etiopathogeny, pathophysiology and treatment

Com o objetivo de verificar os progressos na etiopatogenia e fisiopatologia da pancreatite aguda e as tendências atuais em seu tratamento, apresentamos uma revisäo de trabalhos publicados recentemente sobre esses temas. Em 60 a 80 por cento dos casos, a pancreatite aguda está associada à litíase biliar ou ao consumo de etanol. Entretanto, a cada dia novos fatores säo associados a essa doença. Os mecanismos fisiopatológicos responsáveis pelo seu desencadeamento näo estäo bem determinados. Várias teorias säo propostas. A mais recente associa as lesöes pancreáticas à liberaçäo de radicais livres de oxigênio provenientes do metabolismo celular. Näo há um tratamento específico para a pancreatite aguda. Nos casos leves, as primeiras medidas terapeuticas säo a suspensäo da ingesta oral, analgesia e, se necessário, hidrataçäo venosa. Nos pacientes mais graves säo necessários cuidados intensivos. O tratamento cirúrgico precoce está indicado apenas em situaçöes de urgência. Tardiamente, a decisäo para tratamento cirúrgico deve ser baseada em dados clínicos, morfológicos e bacteriológicos.

Dissolution of gall-stones in vitro.

An in vitro study on dissolution of 36 gall-stones obtained from 3 patients (12 stones from each patient) was carried out in heparin, bile salt and clofibrate solutions of different strengths. Heparin was found to be a poor solvent while bile salt (sodium desoxycholate) proved better and clofibrate the best solvent in various concentrations used. In addition 3 stones, one from each patient, were placed in normal saline to serve as control.