Practical applications of nutritional scores.

PURPOSE OF REVIEW: Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. RECENT FINDINGS: Critically ill patient staying for more than 24-48 h in the ICU, if unable to eat, should be considered at risk for malnutrition. Several nutritional tools have been proposed but not all are validated to screening those patients. The limitations of existing screening tools are described. SUMMARY: Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.

Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression.

BACKGROUND: Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence. METHODS: A cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records. Patient groups were compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous variables and the Chi-square test for paired categorical variables (significance level of 0.05). The odds ratio (OR) was calculated to identify independent predictors of non-adherence to medication. RESULTS: The final sample (n = 94) had a mean age of 75.2 years (standard deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low education level (61.7%). Also, 22.3% with cognitive impairment, 16% with depression and 23.4% with anxiety were found. Patients non-adherent to medication had higher depression (P = 0.048) and anxiety (P = 0.010), compared to adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P = 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients who had insulin prescribed presented a higher risk of non-adherence to medication (OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the risk of non-adherence to medication is higher by an increase of one unit in anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014). CONCLUSIONS: Higher anxiety and depression were associated with non-adherence to medication and to PA. Insulin prescribed and high anxiety scores were predictors of medication non-adherence. This study appears to contribute to the knowledge about the influence of cognitive and psychological factors in therapeutic adherence in these older diabetic patients.

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort study.

PURPOSE: Characterize the nutritional risk of critically ill patients with the modified NUTrition Risk in the Critically ill (NUTRIC) score. MATERIALS: National, multicenter, prospective, observational study conducted in 15 polyvalent Portuguese intensive care unit (ICU), during 6 months. Adult patients were eligible. Those transferred from another ICU or readmitted, brain dead at admission, and with length of ICU stay (LOS) of 72 hours or less were excluded. NUTRIC score was calculated at admission; scores ≥5 represent a high nutritional risk. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without mechanical ventilation (days free of MV) were secondary outcomes. RESULTS: From 2061 admissions, 1143 patients were considered, mostly males (n = 744, 64.7%) with median (P25-P75) age of 64 (51-75). Patients at high nutritional risk were 555 (48.6%). High NUTRIC score was associated with longer LOS (P < .001), less days free of MV (P = .002) and higher 28-day mortality (P < .001). The area under the curve of NUTRIC score ≥5 for predicting 28-day mortality was 0.658 (95% CI, 0.620-0.696). NUTRIC score ≥5 had a positive predictive value 32.7% and a negative predictive value 88.8% for 28-day mortality. CONCLUSIONS: Almost half of the patients in Portuguese ICUs are at high nutritional risk. NUTRIC score was strongly associated with main clinical outcomes.

What difference exists in the pancreas of mammals with sanguivorous diet? A morphological, stereological and immunohistochemical study of the pancreatic islets of the hematophagous bat Diphylla ecaudata.

Diphylla ecaudata is a vampire bat that mainly feeds on the blood of birds. This highly specialized diet - hematophagy - is accompanied by a series of morphological changes in the gastro-entero-pancreatic system, since the distribution and relative proportions of different pancreatic endocrine cell types can vary between species due to different physiological conditions and eating habits. The aim of this study was to examine for the first time the pancreas of the vampire bat D. ecaudata using morphological, stereological and immunohistochemical techniques. The pancreas of the D. ecaudata has an exocrine acinar portion in which the highest concentration of pancreatic islets is scattered. These pancreatic islets have irregular size and a mean diameter of 56.94 µm. The total number of islets in the pancreas was 23,900, with a volumetric density of 4.1%. Insulin-immunoreactive (IR) cells were located in the central pancreatic islet region and had the largest density (54.8%). Glucagon-IR cells were located mainly in the peripheral mantle region (16.2%), along with somatostatin-IR (SS) cells (14.3%). Cells immunoreactive to insulin, glucagon and somatostatin were also observed to have spread in isolated places in the exocrine pancreas. In the connective tissue near the pancreatic ducts, a high concentration was identified of insulin-IR cells and a low concentration of glucagon-IR and somatostatin-IR cells. These results indicate that although the pancreas of D. ecaudata has morphological similarities with that of other mammals, it has a differentiated islet structure, because there were a large number of islets and different volumetric densities of α, ß and δ cells.

An immunocytochemical study of the endocrine cells in the stomach and duodenum of Zonotrichia capensis subtorquata (Passeriformes, Emberizidae).

The main purpose of this study was to evaluate the regional distribution pattern and relative frequency of some endocrine cells in the three portions of the gastrointestinal tract (GIT)--the proventriculus, gizzard and duodenum- of the rufous-collared sparrow (Zonotrichia capensis subtorquata), by immunohistochemical methods using six types of polyclonal antisera, specific for serotonin (5-HT), somatostatin (D cells), glucagon, motilin, polypeptide YY (PYY) and insulin. In the proventriculus, endocrine cells immunoreactive for all of these markers were observed. The somatostatin-immunoreactive cells were found with greater frequency, with the presence of cytoplasmic processes. In the gizzard, endocrine cells secreting somatostatin, 5-HT and PYY were detected, while those secreting glucagon and insulin were not. In the final part of the gizzard, endocrine cells secreting 5-HT were more frequent, and cells secreting somatostatin and insulin were not detected. All of the cell types studied were observed in the duodenum in different frequencies, except for cells immunoreactive for glucagon and insulin. The somatostatin-positive (D cells) were the most numerous, being more prevalent in the intestinal glands. The other endocrine cells were identified in smaller numbers, some of them located in the intestinal villi and Lieberkuhn glands. The finding of these cell types in the duodenum confirms their preferential location in the final portions of the principal segments of the digestive system and suggests control by feedback of its functions. In conclusion, some interesting distributional patterns of gastrointestinal endocrine cells were found in this species of sparrow.

Histology and ultrastructure of Aedes albopictus larval midgut infected with Bacillus thuringiensis var. israelensis.

Histological and ultrastrucutural alterations in the midgut of Aedes albopictus larvae infected with Bacillus thuringiensis var. israelensis (Bti) were observed by light and transmission electron microscopy (TEM). Two formulations of Bti were used: granulated and powder, with 0.2% active ingredient in 90 larvae of Ae. albopictus distributed in three containers containing 30 larvae each (one control group and two test groups). The midgut epithelium of the control group presented flattened and elongated cells with mace-shape with a narrow base. Midgut epithelium cells' surface was convex and had a large circular nucleus located in the median-apical portion of the cell. These cells also presented a basal lamina with a small accumulation of extracellular fibrous matrix, thus characterizing a basal membrane, with a muscle layer and a peritoneal membrane more externally. After Bti ingestion, the larvae stopped/slowed their natural movements down in 5 min. After 30 min approximately, the swimming movements stopped completely. Internally, the intestinal cells showed a disorganization of the basal processes, dilatation and fragmentation of the rough endoplasmic reticulum, with intense cytoplasmic vacuolization. There were concentric dense laminas accumulated in the cytoplasm, and these residual membranous bodies were seen greatly increased in size after 60 min. Mitochondria, fragments of rough endoplasmic reticulum and other remainder organelles were surrounded and segregated from the cytoplasm by exocytosis. This article reports the histopathological alterations in the midgut of Ae. albopictus after infection with Bti and contributes to a better understanding of the mode of action of this bacterial strain used as bioinsecticide against mosquito larvae.

[Information and communication technologies in health institutions: the inevitable encounter]. / Tecnologias de Informação e de Comunicação nas Instituições de Saúde: Encontro Inevitável.

It is widely known that the health sector is a complex area within the socio-political context of a country, and we all, as citizens, have something to say about this topic. In a way, our health depends partly on the correct use of Information and Communication Technologies. This work seeks to introduce and promote the impact of information technologies on health organisations, leading them to feel the need to update their procedures, equipment and applications. This scientific article should allow the reader to understand the importance of technological innovations and the provision of technical support in improving the quality of health.