Interaction between vitamin D level, antiseizure medications (ASM) and seizure control in epilepsy adult patients.

OBJECTIVE: To investigate vitamin D levels and factors associated with seizure control in adult patients with epilepsy (APE). METHOD: Cross-sectional study with APE in routine outpatient follow-up at a neurology clinic. Clinical variables, antiseizure medications (ASM) and vitamin D were investigated. Data were analyzed using the Chi2 or Fisher's exact tests, Mann-Whitney, Spearman's correlation coefficient, ROC curve and univariate and multiple logistic regression analysis. RESULTS: Mean age was 46.5±15.1 years and disease duration was 27.5±17.0 years; 52.7% (n=49) of patients used one ASM and 47.3% (n=44) used≥2 ASM. There was a significant difference in the level of vitamin D according to the number of ASM and it was higher in patients who used a single ASM (26.02±10.22 versus 22.50±8.69; P=0.048). In the logistic regression, when vitamin D level was set at 20ng/mL, the chance of seizure control for patients using a single ASM was 6.99 times greater than for those using≥2 ASM. When vitamin D level was set at 40ng/mL, the number of ASM did not modify seizure control. There was no correlation between vitamin D and disease duration, patient age and age at the time of the first seizure. In the logistic regression, it was observed that satisfactory levels of vitamin D did not modify potential seizure control. CONCLUSION: Thirty-three percent (33%) of patients presented with vitamin D deficiency (values below 20ng/mL) and 80% had vitamin D levels below what is recommended (30ng/mL). The use of ASM, when associated with different levels of vitamin D, modified the probability of seizure control in APE. Vitamin D levels and intrinsic epilepsy factors are associated with failure to effectively control seizures.

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.

Caregiver's education level, not income, as determining factor of dietary intake and nutritional status of individuals cared for at home.

INTRODUCTION: Home care should intervene in the nutritional status of the elderly. OBJECTIVE: To analyze the nutritional status of the elderly assisted by a Home Care Program (PAD) and associate it with income and education level of the caregiver. CASUISTIC AND METHOD: Thirty-four individuals of both genders who received home care from PAD. The MNA (Mini Nutritional Assessment) was used along with arm circumference. Dietary intake assessment was done with three 24-hour recalls in non-consecutive days. We collected data on income, education level of the caregiver and user in years of formal education and autonomy of user. The differences between the proportions of the nominal variables were tested by the chi-square test. The continuous variables were tested for normality and if normal, the Student's t-test or ANOVA was applied. The adopted significance level was P < 0.05. RESULTS: The studied sample represented individuals older than 65 years, assisted by PAD and 100% dependent on the caregiver. MNA revealed that 38.2% of the users were malnourished and 61.8% were at risk for malnourishment. Energy, fiber, vitamin E, calcium and zinc intakes were inadequate. Education level of the caregivers was a determining factor (P=0.01) for the nutritional status of the elderly while no association was found with respect to income. CONCLUSION: These findings allows us to conclude that the nutritional status of this population is worrisome and that it may be associated with low quality of life influenced by the education level of the caregiver, but also by age, economic conditions and limited autonomy of this population.

[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.

[Comparative analysis of nutritional status, food intake and length of hospitalization considering two hospitals: public versus private]. / Comparación del estado nutricional, consumo alimenticio y tiempo de hospitalización de pacientes de dos hospitales, uno público y otro privado.

INTRODUCTION: To assess the nutritional status of hospitalized patients is important for the prevention of hospital malnutrition and planning of nutritional intervention. OBJECTIVE: To comparatively analyze the nutritional status of patients admitted to two hospitals, one public and another private, caring for populations with different socioeconomic profiles. CASE STUDY AND METHODS: This was a prospective study and samples were collected from patients of two hospitals, one public (PUH) and another private (PRH), which respectively represent the underprivileged and the more affluent populations. The analysis considered 51 patients from the PUH, aged between 53.9 +/- 15.6 years and 51 from the PRH, aged between 55.0 +/- 13.9 years, paired and grouped according to the following diseases: neoplasia (n+25), digestive tract disorders (n+11) and others (n+15). The statistical analysis was made by means of the T-Student test to compare PUH and PRH variables with p < 0.05, as well as to compare different variables in the same hospital, with p < 0.05; p < 0.01; p < 0.005 and p < 0.001. RESULTS: There were no statistical differences when the variables evaluated in both hospitals were compared, except for the length of hospitalization of patients with digestive tract disorders, which was longer for HPR. Upon hospitalization, 21.0% and 17.6% presented a body mass index (BMI) indicative of malnutrition. The patients with neoplasias presented current weight (CW) lower than habitual weight (HW). Both the patients with neoplasias and those with digestive tract disorders presented insufficient energy consumption in the period before hospitalization (p < 0.05). A negative correlation was found between the length of hospitalization and the current weight/habitual weight ratio (r = 0.194, 0 < 0.05, n = 102) and BMI (r=-0.186, p < 0.05, n = 102), according to Pearson's coefficient. CONCLUSION: The similarity of nutritional conditions found points to similarity of nutritional status for patients of both institutions and reflects the changes in the nutritional status of the population. The nutritional intervention should consider the nutritional needs of the population assisted.

Evolution of nutritional status of infants infected with the human immunodeficiency virus.

CONTEXT: There are today only a limited number of studies defining growth parameters and nutritional status for HIV children. OBJECTIVE: To study the nutritional status of infants infected with the human immunodeficiency virus. TYPE OF STUDY: Longitudinal study. SETTING: Department of Pediatrics, Faculty of Medical Sciences, UNICAMP, Campinas, Brazil. PARTICIPANTS: One hundred and twenty-four children born to HIV infected mothers were evaluated from birth until the age of two years. They were subdivided into two groups: 71 infected children and 53 non-infected children. MAIN MEASUREMENTS: Growth was evaluated in both groups by comparing Z-scores for weight/age (w/a), length/age (H/a) and weight/length (w/H) (using the NCHS curves as reference). RESULTS: The Z-score analyses showed that there was a significant difference between the two groups for all the variables studied, except for the H/a value at 3 months of age and the W/H value at 21 months of age, which showed P > 0.05. CONCLUSIONS: The growth of infected infants was observed to be severely affected in comparison with that of seroreversed infants in the same age groups. Although clinical manifestations may take time to appear, the onset of growth changes begin soon after birth.