Anthropometric parameters of nutritional assessment as predictive factors of the Mini Nutritional Assessment (MNA) of hospitalized elderly patients.

OBJECTIVE: The objective of this study was to identify nutritional indicators that predict MNA (mini nutritional assessment) classification in hospitalized elderly patients. METHOD: This cross-sectional study assessed the nutritional status of 109 elderly patients at the beginning of their hospital stay with anthropometric and laboratory indicators and the MNA. Habitual energy intake (HEI) was also determined. The assessed nutritional indicators were investigated by univariate and multivariate logistic regression analysis to verify if they can predict MNA classification. The odds ratio (OR) and its respective confidence interval (CI) of 95% were also calculated, and the significance level was set at 5% (p < 0.05). RESULTS: The nutritional status of most patients (61.47%) was appropriate but 30.28% were at risk of malnourishment and 8.26% were malnourished. Statistical differences were found for those aged more than 70 years and for arm circumference, body mass index, calf circumference, triceps skinfold thickness and mid-arm muscle circumference. Initially, the predictive factors identified by univariate logistic regression were body mass index (BMI) (p=0.0001; OR=0.825), calf circumference (CC) (p=0.0026; OR=0.832), arm circumference (AC) (p < 0.0001; OR=0.787), triceps skinfold thickness (TST) (p=0.0014; OR=0.920) and mid-arm muscle circumference (MAMC) (p=0.0003; OR=0.975); later, multiple logistic regression analyses revealed that first AC (p=0.0025; OR=0.731 (0.597 - 0.895)), then BMI (p= < 0.0001; OR=10.909 (3.298 - 36.085)) and finally TST (p=0.0040; OR=0.924 (0.876 - 0.975)) and MAMC (p=0.0010; OR=0.976 (0.962 - 0.990)) were factors that predict MNA classification. CONCLUSION: In the conditions of this study, first AC, then BMI and finally TST and MAMC together were capable of predicting MNA classification.

Treatment of achalasia: lessons learned with Chagas' disease.

Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.

[Conventional nutritional support (CNS) in hospitalized surgical patients]. / Atención nutricional convencional (ANC) en pacientes quirúirgicos hospitalizados.

OBJECTIVE: To compare nutritional status assessment methods on hospital admission and discharge in surgical patients receiving conventional nutritional support (CNS). METHODS: One hundred eighty-three patients hospitalized in the surgical ward of the Hospital of PUC-Campinas and aging from 30 to 60 years were assessed; of these, 54.6% were females and 45.4% were males. A nutritional support protocol was used to collect the data with identification and diagnosis data obtained from medical records, antecedents, anthropometry, eating history during hospitalization, total energy intake in the usual diet (UD), energy requirement (ER) and nutritional status. The Wilcoxon test was used for the statistical analysis and the Kappa (k) Coefficient was used to verify the agreement between the nutritional status on hospital admission and discharge. The adopted significance level was 5% (0.05). RESULTS: The analysis of the values on hospital admission and discharge showed that the nutritional status remained constant on admission and discharge when analyzed by groups of diseases. The relationship between nutritional status on hospital admission and discharge in patients with benign biliary tract diseases and vascular diseases presented an excellent agreement between the two moments (k = 1000). It was verified that, discounting the effect of randomness, the nutritional status on admission and discharge agreed in 71.43% and 50% respectively in these two clinical conditions regarding the nutritional diagnosis of being well nourished. In benign diseases of the digestive tract and neoplasias, a good agreement was also observed (k = 0,887 and k = 0,820 respectively). In the total sample, the agreement analysis was high (k = 0,918) showing that the nutritional status remained constant during hospitalization. CONCLUSION: These findings may be attributed to the routine monitoring of nutritional status which allowed an adequate support during hospitalization even when the energy requirement and intake differed.

Manifestaçöes respiratórias na malária por Plasmodium falciparum e vivax / Respiratory manifestations in malaria due to Plasmodium falciparum and vivax

Foram selecionados 110 pacientes que procuraram a SUCAM/CUIABA para diagnóstico e tratamento de malária, com queixa de febre e procedentes de área malarígena. Nestes pacientes foram realizados: gota espessa para a pesquisa de Plasmodium; aplicaçäo de questionário padronizado para detectar sintomas respiratórios presentes no momento da entrevista; gasometria arterial e espirometria para avaliar a funçäo pulmonar. Desta amostra, 62 pacientes foram positivos para malária sendo 41 P. vivax, 20 P. falciparum e 01 forma mista (grupo Malárico); 48 mostraram-se negativos à pesquisa de hematozoários através da gota espessa (grupo Näo Malárico). As manifestaçöes respiratórias encontradas nesta populaçäo quando comparadas os grupos Malárico e Näo Malárico, foram respectivamente: 1§) Sintomáticos Respiratórios de 46,8% para 22,9% (p<0,05); 2§) Alteraçöes Espirométricas de 53,2% para 20,8% (p<0,05); 3§) Alteraçöes Gasométricas de 62,9% para 25,0% (p<0,05). Com estes resultados concluímos que há nítida associaçäo entre a Malária produzida pelo P. vivax e P. falciparum e as manifestaçöes respiratórias apresentadas, nesta populaçäo de estudo

Estudo analitico de um novo fio sintetico em sutura gastrintestinal. / Analytic study of a new sinthetic kind in gastrointestinal suture

Com o intuito de observar um novo fio sintetico de sutura, considerado de absorcao lenta, os AA realizaram cirurgias gastrintestinais em 20 caes, divididos em lotes iguais de cinco animais cada um. Os animais de cada lote respectivamente, foram sacrificados 48 horas, cinco dias, 10 dias e 15 dias apos a cirurgia. As zonas de anastomoses foram estudadas do ponto de vista macro e microscopico, observando-se fundamentalmente a coaptacao das bordas anastomosadas, a espessura das paredes na zona de anastomose, a cicatrizacao na linha de sutura e as alteracoes histopatologicas atribuidas ao fio de sutura. A analise dos resultados obtidos permite concluir que o fio desperta minima reacao granulomatosa tipo corpo estranho, nao interferindo no processo de cicatrizacao nem produzindo reacao alergica local. Em animal algum houve ruptura das bordas anastomosadas ou ulceracao de mucosa provocada pelo fio