Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-By-Step Approach.

This tutorial suggests a current strategy toward a multiprofessional therapy based upon a comprehensive step-by-step approach to the course of intensive care unit diarrhea episodes. Evidence published in the last 10 years, obtained through a database search (PubMed), shows that its prevalence is quite variable. Although multicausal, it is often erroneously associated with the supply of enteral nutrition. Several complications affect not only nutrition status but also the development of skin lesions, which can become the focus of infections, and the length of hospital stay. Here, we propose an early, objective, directed, and multimodal approach, aiming at optimizing care for these patients. In a dynamic walkthrough, the reader will find a guide for the general diagnosis and for colitis resulting from Clostridium difficile infections, as well as current instructions and recommendations for drug treatment and supportive therapy for these 2 modalities. We also bring together ways to prevent and treat associated skin lesions in this setting. Because it is neglected in the critical environment, diarrhea is still a poorly addressed disease, and its complications bring about a significant worsening in quality of life and hospital stay.

Isquemia grave de membros inferiores por arterite por HIV / Severe ischemia of lower limbs due to arteritis caused by HIV infection

A isquemia aguda de membros pode se manifestar, embora de forma incomum, como consequência à vasculite associada ao vírus da imunodeficiência humana (HIV). O presente caso descreve a evolução de uma paciente soropositiva para o HIV, que apresentou quadro de isquemia distal bilateral, com diminuição da temperatura de terço distal das pernas e pés, dor intensa, cianose fixa de pododátilos e ausência de pulsos distais. Submetida ao tratamento com terapia trombolítica, apresentou sinais de lesões decorrentes da isquemia e lesão tecidual de reperfusão com perda tecidual em regiões distais dos dedos, porém com melhora dos sinais e sintomas dos membros inferiores. Trata-se de um caso raro na literatura em função da associação da vasculite com o HIV e do acometimento dos vasos distais nos membros inferiores. Entretanto, o conhecimento desta associação é de extrema importância devido à repercussão na vida dos pacientes acometidos.

The acute limb ischemia may manifest itself, albeit unusual, as a consequence of vasculitis associated with human immunodeficiency virus (HIV). This case report described a patient seropositive for HIV who developed bilateral distal ischemia with temperature decrease of distal legs and feet, severe pain, cyanosis of fixed toes, and absence of distal pulses. She underwent treatment with thrombolytic therapy, showed signs of injury resulting from ischemia and reperfusion tissue injury with tissue loss in the distal regions of the fingers, but with improvement of the signs and symptoms of lower limbs. It is a rare case in literature due to the association of vasculitis with HIV and to the torment of distal vases of the lower limbs. Despite of that, the knowledge of the pathology is extremely important because of the repercussion in the patients' lives.

Fasciite necrotisante após vacina influenza: relato de caso / Necrotizing fasciitis after influenza vaccine: case report

Paciente de 30 anos, do sexo masculino, apresentou, após vacinação contra influenza comum, dor intensa, edema e eritema em membro superior esquerdo no local da aplicação e febre contínua não aferida. Foi hospitalizado, porém houve agravamento progressivo do quadro e resistência ao tratamento com anti-inflamatórios e antibióticos, culminando em queda do estado geral, formação de coleção no local e convulsão febril. Optou-se por tratamento cirúrgico, submetendo-se o paciente a procedimentos para fasciotomia, desbridamento, drenagem de coleção e sutura de extenso ferimento em membro superior esquerdo.

A 30-year-old male patient, after being vaccinated against the common influenza, presented severe pain, swelling and erythema at the site of injection on the left upper limb and had continuous fever that was not checked. He was admitted to the hospital,, but his clinical condition got worse, with no response to treatment with anti-inflammatory drugs and antibiotics. He developed an abscess at the site of vaccine injection, and high fever with febrile seizures. Surgical treatment was chosen, and the patient underwent debridement and drainage of the abscess, upper arm fasciotomy and repair of the extensive surgical wounds of the left arm.

The magic sextet of clinical research.

This article approaches some general guidelines for evaluating clinical research (design, execution and reporting), including the initial research 'idea' (or question to be answered), 'hypothesis and objective' which should be aligned with the 'primary variable' to be investigated and the 'conclusions' reached on the basis of the results of the study. One cannot forget that the study 'title' should reflect the 'idea' and relative 'objective' of the study and the 'conclusion', emphasizing the 'Magic Sextet of Research'.

O sexteto mágico da pesquisa clínica / The magic sextet of clinical research

Este artigo aborda orientação geral para a avaliação da pesquisa clínica (planejamento, execução e divulgação) desde a sua "ideia brilhante e a pergunta de pesquisa", "hipótese e objetivo", que precisam estar alinhadas com a "variável primária" a ser determinada e, por sua vez, coincidindo com a "conclusão" do trabalho de pesquisa. Não esquecemos o "título" do trabalho de pesquisa que reflete a "ideia brilhante" que você teve e corresponde ao "objetivo" alcançando, relacionando-se com a "variável primária" e coincidindo com a "conclusão", enfatizando como "O Sexteto Mágico da Pesquisa".

This article approaches some general guidelines for evaluating clinical research (design, execution and reporting), including the initial research "idea" (or question to be answered), "hypothesis and objective" which should be aligned with the "primary variable" to be investigated and the "conclusions" reached on the basis of the results of the study. One cannot forget that the study "title" should reflect the "idea" and relative "objective" of the study and the "conclusion", emphasizing the "Magic Sextet of Research".