Tobacco cessation in patients with multiple chronic conditions: nutritional strategies as an additional tool in treatment

Abstract Objective To evaluate the impacts of a nutritional education intervention for patients with multiple chronic conditions during smoking cessation. Methods The non-probabilistic sample comprised 18 adults and seniors of both sexes recruited from a smoking cessation treatment group. At the beginning of treatment, smoking history, degree of dependence, and stage of motivation were assessed. Degree of craving was evaluated weekly for the 1st month. Anthropometric and biochemical assessments were conducted at baseline, at 1 month, and at 3 months. Dietary intake was assessed with the "How is your diet?" questionnaire. The nutritional intervention was delivered in three sessions. The themes covered were energy balance and physical activity, healthy eating, and the importance of fruit and vegetables in the diet. Statistical analysis was conducted with the Shapiro Wilk test of normality, the paired t test, and the Wilcoxon or Mann-Whitney U tests (significance ≤ 0.05). Results Most people (55.6%) in the intervention group had a high degree of smoking dependence, while the frequency in the control group was 22.2%. Degree of craving decreased significantly after 1 month of treatment (p = 0.017). After 3 months, both groups had a positive variation in mean body weight, although below 3%. In both groups, the average percentage of weight gain was less than 3%, suggesting that delivery of the nutritional education sessions and the nutritionist's use of the protocol proposed by the Instituto Nacional de Câncer (INCA) helped to control weight gain. Blood glucose and homeostasis model assessment-insulin resistance (HOMA-IR) both increased significantly in the intervention group (p = 0.15 and p = 0.50, respectively). Conclusion Greater proximity and more frequent intervention by a nutritionist assists and encourages healthy eating practices during the smoking cessation process, which can benefit individuals' control of chronic diseases over the long term.

Dosagem do magnésio eritrocitário: Qual é o seu real valor? / Measurement of erythrocyte magnesium: What is its real value?

O magnésio é um cátion de localização predominantemente intracelular e de grande importância em várias funções metabólicas. É possível que tenha uma participação importante em processos álgicos e inflamatórios. Sua dosagem sérica possivelmente não representa a realidade de sua concentração corporal. A mensuração do magnésio eritrocitário talvez possa representar um avanço na sua melhor avaliação

Magnesium is a cation with location predominantly intracellular and of great importance in several metabolic functions. It is possible that it plays an important role in pain and inflammatory processes. It's serum dosage possibly does not represent the reality of it's body concentration. The measurement of erythrocyte magnesium may represent an advance in its better evaluation.

Prevalência e resistência a antibióticos de Stenotrophomonas maltophilia em amostras clínicas: estudo epidemiológico de 10 anos / Epidemiological and physiological characteristics of clinical isolates of Stenotrophomonas maltophilia: 10 years study

Introdução:Stenotrophomonas maltophilia é um patógeno oportunista emergente, associado, principalmente, a infecções nosocomiais. As opções terapêuticas para o tratamento de infecções por S. maltophilia são limitadas, devido a sua resistência a uma grande variedade de antibióticos. Objetivo: Investigar a prevalência e a resistência aos antibióticos de isolados identificados como S. maltophilia, a partir de pacientes hospitalizados, recuperados em um laboratório clínico, localizado em Juiz de Fora ­ Minas Gerais, bem como analisar dados epidemiológicos destes pacientes. Materiais e Métodos: Isolados consecutivos, não duplicados de S. maltophilia (n=58), referentes ao período de 10 anos foram analisados. Todas as amostras foram identificadas utilizando o sistema automatizado Vitek 2® Compact (BioMérieux/França). Os padrões de resistência aos antibióticos foram realizados utilizando o método de disco difusão. Os prontuários dos pacientes foram avaliados e dados como idade, sexo, espécime clínico, bem como índice de óbito intra-hospitalar atribuído à infecção por S. maltophilia foi igualmente analisado. Resultados: De um total de 39.547 (100%) espécimes clínicos analisados, 58 (0,14%) isolados não replicados foram identificados como S. maltophilia. 70,6% dos isolados de S. maltophilia foram isolados de secreção traqueal e 15,5% de sangue.Todas as amostras foram sensíveis, in vitro, aos antibióticos testados. Frequência de óbito intra-hospitalar associado à infecção por S. maltophilia foi de 44,7%. Indivíduos de ampla faixa etária (0-100 anos) foram acometidos por infecção por S. maltophilia, sendo o sexo feminino o mais prevalente (56,9%). Conclusão: Pneumonia e bacteremia foram as síndromes clínicas mais frequentes causadas por S. maltophila. Constatou-se moderada taxa de mortalidade associada a infecções por S. maltophilia, apesar da alta sensibilidade in vitro aos antibióticos testados. Novos trabalhos se fazem necessários, a fim de gerar dados e informações que possam ser úteis no diagnóstico precoce, manejo e tratamento correto de infecções associadas a S. maltophilia, em especial aquelas com perfil de resistência aos antibóticos.

Introduction:Stenotrophomonas maltophilia is an emerging opportunistic pathogen, mainly associated with nosocomial infections. Therapeutic options for the treatment of S. maltophilia infections are limited because of their resistance to a wide variety of antibiotics. Objective: To investigate the prevalence and antibiotic resistance of isolates identified as S. maltophilia from hospitalized patients recovered from a clinical laboratory located in Juiz de Fora - Minas Gerais, as well as to analyze epidemiological data of these patients. Materials and Methods: Consecutive, non duplicate isolates of S. maltophilia (n=58) for the 10-year period were analyzed. All samples were identified using the automated Vitek 2® Compact system (BioMérieux/France). Antibiotic resistance standards were performed using the disk diffusion method. Patient records were evaluated and data such as age, gender, clinical specimen, and in-hospital death rate attributed to S. maltophilia infection were also analyzed. Results: From a total of 39,547 (100%) clinical specimens analyzed, 58 (0,14%) unreplicated isolates were identified as S. maltophilia. 70,6% of S. maltophilia isolates were isolated from tracheal secretion and 15,5% from blood. All samples were sensitive in vitro to the antibiotics tested. In-hospital death frequency associated with S. maltophilia infection was 44,7%. Individuals from a wide age range (0-100 years) were affected by S. maltophilia infection, with females being the most prevalent (56,9%). Conclusion: Pneumonia and bacteremia were the most frequent clinical syndromes caused by S. maltophila. A moderate mortality rate associated with S. maltophila infections was observed, despite the high sensitivity in vitro to the antibiotics tested. New studies are necessary in order to generate data and information that may be useful in early diagnosis, management and correct treatment of infections associated with S. maltophila, especially those with a profile of antibiotic resistance.

Hipovitaminose D em idosos institucionalizados tratados com anticonvulsivantes, uma associação frequente / Hypovitaminosis D in institutionalized elders treated with anticonvulsants, a common association

CONTEXTO: A população idosa apresenta alta prevalência de hipovitaminose D, sendo provável que, exposta ao uso de anticonvulsivantes, ocorra agravamento dessa condição.OBJETIVO: Avaliar a interferência do uso crônico de fármacos anticonvulsivantes nos níveis séricos de vitamina D em idosos institucionalizados com idade acima de 65 anos.MÉTODOS: Foram estudados 18 idosos institucionalizados tratados com anticonvulsivantes, por no mínimo 12 meses, comparados a 16 idosos não tratados.RESULTADOS: O estudo demonstrou que os dois grupos cursaram com deficiência de vitamina D, sendo mais pronunciada no grupo tratado com anticonvulsivantes. Embora não houvesse diferença estatisticamente significativa nos valores de paratormônio, nos idosos tratados foi observada uma tendência de níveis mais elevados, 53,44 ± 28,92 pg/ml em comparação aos idosos não tratados, 38,5 ± 10,08 pg/ml (P = 0,42). Foi observada diferença estatisticamente significativa entre os níveis séricos de 25-hidroxivitamina D nas pacientes do sexo feminino tratadas de 9,22 ± 3,80 ng/ml versus não tratadas, 18,78 ± 7,62 ng/ml (P = 0,03).CONCLUSÃO: Nossos achados sugerem que idosos institucionalizados apresentam menores níveis séricos de 25-hidroxivitamina D, configurando um estado de deficiência, e diferença significativa foi detectada nas mulheres tratadas com fármacos anticonvulsivantes.

BACKGROUND: Elderly people have a high prevalence of hypovitaminosis D, especially when they are exposed to anticonvulsants.OBJECTIVE: The present study evaluated the influence of chronic use of anticonvulsants on serum levels of vitamin D in institutionalized elders aged above 65 years.METHODS: Eighteen elderly subjects treated with anticonvulsants were studied for at least 12 months and compared to 16 untreated elders.RESULTS: Vitamin D deficiency was observed in both groups, but the group treated with anticonvulsants showed a more remarkable deficiency. Although there was no statistically significant difference in serum parathyroid hormone levels, elderly patients in treatment had a higher value (53.44 ± 28.92 pg/ml) compared to untreated elders (38.5 ± 10.8 pg/ml: p = 0.42). Statistically significant difference was observed between serum 25-hydroxyvitamin D in treated female patients (9.22 ± 3.80 ng/ml) compared to untreated female patients (18.78 ± 7.62 ng/ml: p = 0.03).DISCUSSION: The observed deficiency in both groups suggests that elderly subjects have lower serum 25-hydroxyvitamin D. Compared to untreated elderly women, elderly women treated with anticonvulsants showed a significantly lower serum level of vitamin D.

O passado e o presente das hipospádias com sugestão de rotina de conduta a ser adotada / Hypospadias: past, present and approach suggestion

Revisando as recentes publicações de técnicas reconstrutivas de cirurgia de hipospádia e analisando seus devidos resultados foi possível correlacioná-los às diversas apresentações clínicas existentes. Foi feito um levantamento bibliográfico, utilizando os sistemas LILACS, MEDLINE e PUBMED, buscando, preferencialmente, os recentes avanços nos tratamentos para hipospádias. Nas publicações avaliadas foram demonstradas variantes como: topografia do meato; presença do "chordee"; idade à cirurgia; presença de cirurgia prévia; uso pré-operatório de testosterona; e presença de derivações urinária. Fatores que influenciaram a escolha da técnica a ser empregada bem como seus devidos resultados. O tratamento cirúrgico das hipospádias deve ser individualizado, considerando os seguintes achados: presença de "chordee", topografia do meato uretral, presença de placa uretral e tecidos adjacentes adequados para a reconstrução, primo-cirurgia ou reintervenção, apresentação clínica com transposição peno-escrotal. Os recentes avanços em cirurgias de hipospádia permitem reforçar a indicação da técnica cirúrgica de Snodgrass, para formas distais e virgens de tratamento; a mucosa bucal ventral "onlay", para formas complexas multioperadas; e a mucosa bucal dorsal no procedimento 3x1, para reconstrução da placa uretral em formas escrotais e perineais primárias associadas à intensa curvatura ventral.

We reviewed the recent publications about hypospadia surgical reconstructive techniques, and made a correlation of the results with the several clinical presentations. We searched LILACS, MEDLINE and PUBMED, especially for recent advances in hypospadia treatment. The following factors were identified to influence the choice of technique to be used and the results obtained: meatus topography; presence of the penile chordee; age at surgery; previous surgery; preoperative testosterone use; and the presence of urinary diversion. Surgical treatment of hypospadia should be individualized according to the following findings: presence of penile chordee; urethral meatus topography; urethral plate and surrounding tissues adequacy for reconstruction; primary or secondary intervention; and clinical presentation with penoscrotal transposition. Recent advances in hypospadia surgery point to the indication of the following techniques: Snodgrass tubularized incised plateurethroplasty for the untreated distal forms; ventral buccal mucosa onlay procedure for complex forms with multiple interventions; and the dorsal buccal mucosa in the 3X1 procedure for urethral plate reconstruction inprimary scrotal and penile forms associated with intense ventral curvature.

The publication rate of abstracts presented at the 2003 urological brazilian meeting

OBJECTIVE: To determine the publication rate of orally-presented abstracts from the 2003 Urological Brazilian Meeting, as well as the factors determining this publication rate. MATERIALS AND METHODS: The publication rate of the 313 orally-presented abstracts at the 2003 Urological Brazilian Meeting was evaluated by scanning the Lilacs, Scielo and Medline databases. The time between presentation and publication, the state and country of the abstract, the research methodology (cross-sectional, case-control, retrospective case series, prospective case series or clinical trial), whether drugs were utilized and the topic of the study were all characterized. RESULTS: Thirty-nine percent of the abstracts were published after a median time of 14 months (range: 1 to 51 months). There were high publication rates for cross-sectional abstracts (75 percent), drug utilization studies (51.3 percent), clinical trials (50 percent) and prospective case series' (48.1 percent). However, there was only a moderate statistical trend towards a higher publication rate in the prospective case series (p=0.07), while the retrospective case series' showed statistically lower publication rates than the other groups (33.7 percent, p=0.04). Abstracts on laparoscopic surgery had the highest publication rate (61.9 percent, p=0.03) compared to others topics. In 57 percent of the unpublished abstracts, there was no interest in or attempt to publish, and rejection was responsible for the lack of publication of only 4 percent of the abstracts. CONCLUSION: The publication rate of the orally-presented abstracts from the 2003 Urological Brazilian Meeting was comparable to that of international congresses. The subsequent publication of presented abstracts and the selection of prospective studies with stronger evidence should be encouraged and may improve the scientific quality of the meeting.