Comparaçäo da avaliaçäo nutricional subjetiva global X avaliaçäo nutricional objetiva / Comparison of the subjective global nutrition assessment X objective nutrition evaluation

A avaliaçäo nutricional subjectiva global (ANSG), introduzida por Destsky et al. (1987), avalia a perda de peso corpóreo, gordura e massa muscular e mudanças na ingestäi dietética, sendo eficaz para o diagnóstico de desnutriçäo protéico-calórica do adulto hospitalizado. OBJETIVO. Comparar a eficiência do emprego da ANSG em nosso meio, com as medidas tradicionais de avaliaçäo nutricional (antropometria, exames laboratoriais e testes cutâneos de hipersensibilidade tardia). MÉTODO. Realizou-se um estudo prospectivo em 100 pacientes do hospital da Beneficiência Portuguesa de Säo Paulo. Admitidos consecutivamente em 3/91 a 5/91. Comparou-se a aplicaçäo do questionário sistematizado por Destky et al (1987), com as medidas antropométricas (peso e altura corporais, prega cutânea truciptal e circunferência do braço) e bioquímica (albumina sérica, hemoglobina, hematócrito e linfócitos de sangue periférico). A ANSG e avaliaçäo antropométrica foram realizadas pela mesma, observadora (LZC), treinada e capacitada para essa funçäo. RESULTADOS. Dos 100 pacientes avaliados pela ANSG, 83 por cento foram categorizados como normais, 14 por cento desnutridos moderados e 3 por cento desnutridos graves. Observaram-se associaçöes estatisticamente significantes (p<0,05) entre albumina (<3,5), hemoglobina (<13,9g/mL), prega cutânea triciptal (<10mm) e circunferência muscular do braço (<23,3cm) com a presença de desnutriçäo moderada e grave estabelecidas pela ANSG. O diagnóstico de suporte nutricional enteral e parenteral...

[Comparison of the subjective global nutrition assessment x objective nutrition evaluation]. / Comparação da avaliação nutricional subjetiva global x avaliação nutricional objetiva.

OBJECTIVE: Nutritional Assessment methods (ONA) are traditionally employed in hospitalized patients (anthropometry, laboratorial exams and immunological tests). The Subjective Global Assessment (SGA) estimates weight loss and changes in dietetic intake as being allegedly efficient for protein-caloric malnutrition diagnosis of the hospitalized adult. PURPOSE: Compare the efficacy of SGA against the traditional ONA. METHODS: The prospective study was done with 100 hospitalized patients from 3/90-5/90 at the Hospital Beneficência Portuguesa de São Paulo. The Detsky et al. questionnaire was applied besides anthropometric measurements (body weight, triceps skinfold thickness-TSF, mirdam circumference MCA) and laboratorial examinations (serun albumin, hemoglobin, peripheral blood lymphocytes) all of them in the first 3 days of admission. SGA always preceded ONA, and was always done by the same observer. RESULTS: There was a significant reduction on the average values of anthropometric and laboratorial measurements with the progressive worsening of nutritional status assessed by SGA. There were significant associations (p < 0.05) between hypoalbuminemia (< 3.5 g/dL) loss of TSF (< 10 mm) and MAC (< 23.3 cm) in those patients classified as moderately and severely malnourished by SGA (14%). Hypoalbuminemia, low TSF and SGA malnutrition were all significantly associated to mortality (p < 0.05). CONCLUSION: SGA in our hospital is a reliable diagnostic method for the diagnosis of malnutrition of hospitalized adult patients and malnutrition of hospitalized adult patients and keeps prognostic association with mortality.

Aminoacidos escenciales y no escenciales en la insuficiencia renal aguda

Existen controversias acerca de la eficiencia del uso exclusivo de aminoácidos esenciales en nutrición parenteral (NPT) para pacientes con insuficiencia renal aguda. Para estudiar el impacto sobre la insuficiencia renal, en pacientes post cirugía cardíaca, fueron randomizados los pacientes en la unidad de terapia intensiva divididos en dos grupos. Grupo AE con 17 pacientes en NPT con solo aminoácidos esensiales y el grupo AT con 17 pacientes en NPT con aminoácidos esenciales y no esenciales. La NPT fue dada en promedio por 10 días. Los pacientes dializados tuvieron menor recuperación de la función renal y mortalidad mas alta (p<0.05). En conclusión la NPT con AE en insuficiencia renal aguda no modificó los niveles de urea y creatina y tasa de mortalidad, cuando se comparó con la NPT con mezcla completa de aminoácidos.(AU)

Aminoacidos escenciales y no escenciales en la insuficiencia renal aguda

Existen controversias acerca de la eficiencia del uso exclusivo de aminoácidos esenciales en nutrición parenteral (NPT) para pacientes con insuficiencia renal aguda. Para estudiar el impacto sobre la insuficiencia renal, en pacientes post cirugía cardíaca, fueron randomizados los pacientes en la unidad de terapia intensiva divididos en dos grupos. Grupo AE con 17 pacientes en NPT con solo aminoácidos esensiales y el grupo AT con 17 pacientes en NPT con aminoácidos esenciales y no esenciales. La NPT fue dada en promedio por 10 días. Los pacientes dializados tuvieron menor recuperación de la función renal y mortalidad mas alta (p<0.05). En conclusión la NPT con AE en insuficiencia renal aguda no modificó los niveles de urea y creatina y tasa de mortalidad, cuando se comparó con la NPT con mezcla completa de aminoácidos.

[Effect of nutritional support on survival of AIDS-IV C patients]. / Efeito do suporte nutricional na sobrevida dos pacientes com AIDS-IV C.

Fifty-two patients with AIDS-IV C (opportunistic infections) received nutritional supplementation, (enteral diets or total parenteral nutrition) in 60 admission episodes. Most patients had lost more than 10% of their ideal weight; albumin serum level was inferior or equal to 3.0 g/dl at admission in 33.3% of cases, and low serum albumin had a positive correlation with mortality (p less than 0.05%). Lean body mass, indirectly evaluated by 24 hour urinary creatinine excretion was less than 30% of the ideal in 44.7% of cases, and had a positive correlation with death rate. Enteral nutrition was given in 16.7% of episodes, total parenteral nutrition in 35% and in the remaining episodes the patient received only oral supplements. Patients that received TPN spent more time in hospital than patients with enteral nutrition (23.1 more or less 21.3 days against 7.2 more or less 4.8 days). Patients with AIDS IV C are usually undernourished, have low serum albumin and important deficit of lean body mass. Weight loss and low lean body mass are associated positively with mortality. Nutritional support had no influence on mortality rate.

Sodium-dependent release of exogenous glycine from preloaded rat hippocampal synaptosomes.

The effect of high potassium, veratridine, and ouabain stimulation upon the release of exogenously-loaded [3H]glycine was evaluated in crude synaptosomal preparations from rat hippocampi by means of a superfusion technique in the presence of media with different ionic compositions and of tetrodotoxin (TTX). Four minute superfusion of synaptosomes with 30 mM KCl, 10 microM veratridine or 0.4 mM ouabain caused a significant increase in the [3H]glycine efflux which averaged 6.6 +/- 0.2, 25.5 +/- 1.0, and 8.9 +/- 1.0% of the total radioactivity present in the synaptosomes, respectively. The omission of Ca2+ ions in the superfusion medium markedly decreased K(+)-evoked [3H]glycine efflux (2.5 +/- 0.5%), did not appreciably modify that evoked by veratridine (24.2 +/- 2.0%) and significantly increased that evoked by ouabain (18.5 +/- 0.5%). The superfusion of synaptosomes with Na(+)-free media always resulted in a drastic decrease of the depolarization-stimulated [3H]glycine efflux, whereas the omission of Cl- generally resulted in a moderate increase of [3H]glycine efflux. TTX (0.8 microM) markedly affected the stimulatory effect of veratridine (2.5 +/- 0.9%) and ouabain (2.2 +/- 0.5%), but failed to modify significantly that evoked by high potassium (6.5 +/- 0.7%). Finally, [3H]glycine was seen readily to exchange in a partially sodium-dependent way with unlabelled glycine present in the medium. On the whole these findings appear to be consistent with the neurotransmitter character of the glycine release from hippocampal synaptosomes.