Perfil nutricional e métodos de avaliação do estado nutricional de pacientes infectados pelo HIV / Nutritional profile and methods for assessing the nutritional status of HIV-infected patients

Introdução: Diante da importância do desenvolvimento de protocolos seguros de avaliação nutricional em unidades hospitalares que atendam pacientes infectados pelo HIV, o objetivo deste trabalho é avaliar e comparar o diagnóstico nutricional realizado pela Avaliação Nutricional Subjetiva Global (ANSG), parâmetros antropométricos e laboratoriais, em pacientes com HIV/AIDS. Método: Estudo transversal com 70 pacientes HIV/AIDS admitidos em um hospital público de referência em Goiânia, GO. O estado nutricional foi avaliado por meio da avaliação nutricional subjetiva global, antropometria (índice de massa corporal, circunferência braquial, circunferência muscular do braço e dobra cutânea triciptal) e parâmetros laboratoriais (albumina, colesterol total e contagem de linfócitos T). Resultados: As prevalências de desnutrição verificadas por meio da avaliação nutricional subjetiva global, índice de massa corporal, circunferência braquial, circunferência muscular do braço, dobra cutânea triciptal, albumina, colesterol total e contagem de linfócitos T foram de 74,3%, 25,7%, 75,7%, 62,9%, 74,3%, 85,3%, 72,3% e 62,9%, respectivamente.Verificou-se associação positiva entre a ANSG e o perfil antropométrico e laboratorial. Conclusões: A ANSG associou-se a indicadores antropométricos e laboratoriais em pacientes infectados pelo HIV. Confirmou-se também a sua capacidade preditiva, na medida em que identificou pacientes com maior gravidade clínica conforme os níveis de células TCD4.Estes resultados fomentam os níveis de evidências que apontam a ANSG como um método confiável e adequado para o diagnóstico, acompanhamento e intervenção nutricional nesses pacientes.(AU)

Introduction: In view of the importance of developing safe protocols for nutritional evaluation in hospital units that treat HIV-infected patients, the objective of this study is to evaluate and compare the nutritional diagnosis performed by Nutritional Subjective Global Assessment (NSGA), anthropometric and laboratory parameters, in patients with HIV / AIDS admitted in a public reference hospital in Goiânia, GO. Methods: A cross-sectional study was conducted with 70 HIV / AIDS patients admitted to a public referral hospital in Goiânia, Goiás. Nutritional status was evaluated through global subjective nutritional assessment, anthropometry (body mass index, arm circumference, arm circumference and Triceps skin fold) and laboratory parameters (albumin, total cholesterol and T lymphocyte counts). Results: The prevalence of malnutrition, measured by global subjective nutritional assessment, body mass index, arm circumference, arm circumference, triceps skinfold, albumin, total cholesterol and T lymphocyte counts were 74.3%, 25.7%, 75.7%, 62.9%, 74.3%, 85.3%, 72.3% and 62.9%, respectively. There was a positive association between the NSGA and the anthropometric and laboratory profile. Conclusions: NSGA was associated with anthropometric and laboratory indicators in patients infected with HIV. Its predictive capacity was also confirmed, in that it identified patients with greater clinical severity according to the levels of CD4 T cells. These results promote the levels of evidence that point to ANSG as a reliable and adequate method for diagnosis, follow-up and nutritional intervention in these patients.(AU)

Validação de fotografias de alimentos para estimativa do consumo alimentar / Validation of food's photographs for estimating the consumption food

RESUMO Objetivo Validar fotografias de um guia fotográfico de alimentos para estimativa do consumo alimentar. Métodos As fotografias de 12 alimentos (bolo simples, macarrão ao sugo, mamão formosa, melancia, repolho roxo ralado, quiabo refogado, churrasco em tiras, filé de frango grelhado, pudim de leite condensado, pizza, amendoim cru e queijo tipo minas), retratadas em três tamanhos de porções (pequena, média e grande), foram avaliadas por 90 indivíduos adultos. Foram também investigados o peso, a estatura e o sexo dos participantes. Para análise de concordância entre o tamanho da porção do alimento retratado nas fotos e o tamanho real do alimento, utilizou-se o teste Kappa. Os dados foram analisados no software Stata, considerando-se p <0,05. Resultados A maior prevalência de acerto foi para as preparações pizza (87,8%), churrasco (80,0%), filé de frango e pudim (75,5%). Já os alimentos com menor percentual de acertos foram a melancia (52,2%), o mamão formosa e o bolo (57,8%). A concordância geral entre a percepção do tamanho da porção do alimento e o tamanho real do alimento foi de 0,622 ( p <0,001). A percepção não foi influenciada pelo sexo e pelo estado nutricional dos participantes ( p >0,05). Conclusão As 12 fotografias apresentaram uma boa concordância com as porções dos alimentos e podem ser um instrumento útil para aumentar a acurácia dos relatos do consumo alimentar.

ABSTRACT Objective Validate photographs of a photographic guide of foods to estimate food consumption. Methods The photos of 12 foods (simple cake, pasta to suck, papaya, watermelon, grated purple cabbage, okra stew, barbecue into strips, grilled chicken, condensed milk pudding, pizza, raw peanuts and cheese type mines), pictured in three portion sizes (small, medium and large), were evaluated for 90 adult subjects. The weight, height and gender of the participants also were investigated. For analysis of agreement between the size of the food portion pictured in the photos and the actual size of the food used the Kappa test. Data were analyzed using Stata software, considering p<0.05. Results The highest prevalence was hit for pizza preparations (87.8%), barbecue (80.0%) chicken fillet and pudding (75.5%), while foods with a lower percentage of correct answers were watermelon (52.2%), the papaya and cake (57.8%). The overall agreement between the perception of the size of the food portion and the actual size of the food was 0.622 (p<0.001). The perception was not influenced by sex and nutritional status of participants (p>0,05). Conclusion We conclude that the 12 photographs showed a good agreement with the portions of food and can be a useful instrument to increase the accuracy of dietary intake reports.

Is energy intake underreported in hemodialysis patients?

INTRODUCTION: Underreporting of energy intake is not much studied in hemodialysis population. OBJECTIVE: To evaluate the underreporting of energy intake and associated factors in hemodialysis patients. METHODS: A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied. RESULTS: The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40). CONCLUSION: The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

A ingestão energética de pacientes em hemodiálise é subrelatada? / Is energy intake underreported in hemodialysis patients?

ResumoIntrodução:O sub-relato da ingestão energética é pouco estudado na população em hemodiálise.Objetivo:Avaliar o sub-relato da ingestão energética e os fatores associados em pacientes em hemodiálise.Métodos:Estudo transversal, com 344 pacientes adultos estáveis, de dez centros de hemodiálise de Goiânia-GO. A ingestão energética foi avaliada por seis recordatórios de 24 horas e a taxa de metabolismo basal (TMB) foi calculada pela equação de Harris Benedict. Foi considerado como sub-relato quando a razão entre a ingestão energética média e a TMB foi menor que 1,27. Para análise dos fatores associados ao sub-relato, foi utilizada a regressão de Poisson com estimativa robusta da variância.Resultados:A prevalência de sub-relato foi de 65,7%, sendo mais expressiva em indivíduos com excesso de peso e nos dias sem diálise. O resultado final da análise multivariada identificou quatro fatores independentemente associados ao sub-relato: sexo feminino (RP = 1,27; IC = 1,10-1,46), índice de massa corporal ≥ 25 kg/m2 (RP = 1,29; IC = 1,12-1,48), três ou menos refeições/dia (RP = 1,31; IC = 1,14-1,51) e tempo de hemodiálise inferior a cinco anos (RP = 1,19; IC = 1,01-1,40).Conclusão:A população avaliada demonstrou elevada prevalência de sub-relato da ingestão energética. Pertencer ao sexo feminino, apresentar excesso de peso, fazer um menor número de refeições diárias e ter menos tempo de hemodiálise foram fatores associados ao sub-relato.

AbstractIntroduction:Underreporting of energy intake is not much studied in hemodialysis population.Objective:To evaluate the underreporting of energy intake and associated factors in hemodialysis patients.Methods:A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied.Results:The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40).Conclusion:The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

Food intake in patients on hemodialysis / Ingestão alimentar de pacientes em hemodiálise

Objective: To evaluate the intake of energy and nutrients by individuals on hemodialysis, following especific recommendations for this population and according to Food Guide for the Brazilian Population. Methods: A cross-sectional study, 118 adult patients, considered stable from, ten dialysis centers in Goiânia, Goiás. Dietary intake was estimated by six 24-hour recalls, and classified as adequate or inadequate, according to specific recommendations for individuals undergoing dialysis and that recommended for a healthy diet. A descriptive analysis was performed. Results: Average dietary intake of 2022.40 ± 283.70 kcal/day; 31.18 kcal/kg/day; 55.03 ± 4.20% carbohydrate; 30.23 ± 3.71% lipid, 1.18 ± 0.23 g protein/kg/day. Important prevalences of inadequacy were observed for the intake of calories (39.0%), protein (39.0%) and other nutrients such as retinol (94.9%), saturated fat (87.3%), cholesterol (61,9%), iron (61.0%), potassium (60.2%) and zinc (45.0%). Patients had a low intake of fruit food group (1.22 ± 0.89 servings) and vegetables (1.76 ± 1.01 servings), dairy products (0.57 ± 0.43 servings) and high intake of food group of oils and fats (3.45 ± 0.95 servings), sugars and sweets (1.55 ± 0.77 servings). Conclusion: Observed food consumption imbalance, characterized by excess of oils and fats, especially saturated oils and cholesterol, sugars and sweets, parallel to low intake of fruits and vegetables and dairy products. A considerable percentage of patients did not intake the minimum recommended of calories, protein, retinol, iron, zinc and potassium. .

Objetivo: Avaliar o consumo de energia e nutrientes de indivíduos em hemodiálise, segundo recomendações específicas para essa população, e de acordo com o Guia Alimentar para a População Brasileira. Métodos: Trata-se de estudo transversal, com 118 pacientes adultos considerados estáveis, tratados em 10 centros de diálise em Goiânia, Estado de Goiás. A ingestão alimentar foi estimada por meio de seis recordatórios de 24 horas, sendo classificada em adequada ou inadequada, conforme recomendações específicas para indivíduos em hemodiálise, é recomendado para uma alimentação saudável. Foi realizada análise descritiva dos dados. Resultados: Observou-se ingestão alimentar média de 2022,40 ± 283,70 kcal/dia; 31,18 kcal/kg/dia; 55,03 ± 4,20% de carboidrato; 30,23 ± 3,71% de lipídeo; e 1,18 ± 0,23 g de proteína/kg/dia. Importantes prevalências de inadequação foram observadas para a ingestão de calorias (39,0%), proteínas (39,0%) e outros nutrientes, como retinol (94,9%), gordura saturada (87,3%), colesterol (61,9%), ferro (61,0%), potássio (60,2%) e zinco (45,0%). Os pacientes apresentaram baixa ingestão de alimentos do grupo das frutas (1,22 ± 0,89 porções), legumes e verduras (1,76 ± 1,01 porções), leite e derivados (0,57 ± 0,43 porções), bem como ingestão elevada de alimentos do grupo dos óleos e gorduras (3,45 ± 0,95 porções) e açúcares e doces (1,55 ± 0,77 porções). Conclusão: Foi observado um consumo alimentar em desequilíbrio, caracterizado ...

Vital signs remote monitoring through multipoint videoconferencing.

A system for remote monitoring of patients' vital signs using multipoint videoconferencing is proposed. A multiparametric module and a videoconference server were developed to set up a proof-of-concept where a text was streamed live as data was captured, while a third party monitored it.

A multipoint videoconference-based telemedicine system for electrocardiogram monitoring.

In this work, a system to transfer electrocardiogram image signal through videoconference is described. The approach proposed was tested in order to evaluate its performance and the quality of the signal received back from the videoconference. The performance presented good results as the system react rapidly and no losses of data were observed.

Separating the helix from the antihelix: a new concept in prominent ear correction.

BACKGROUND: For over a century, various otoplasty techniques for correction of the prominent ear have been attempted. Nevertheless, cartilage memory strength, mainly in the thick cartilage (and consequently the recurrence of the prominence), still remains a problem. An additional difficulty relates to the antihelix irregularities caused by attempts to weaken the cartilage spring, which are time-consuming and in some cases lead to an unnatural-looking result. OBJECTIVE: The technique reported in this article represents a new approach to otoplasty that deconstructs the auricular pavilion with a single full incision in the antihelix. This approach makes it easier to rebuild the antihelical fold with dissolving sutures and allows repositioning of the helix and earlobe with a posterior bielliptical incision and a narrow bridge skin resection. METHODS: Between 1999 and 2009, the author performed otoplasty for correction of the prominent ear in 60 patients, including 32 men (53.3%) and 28 women (46.7%). A single incision was made in the superior and lateral borders of the antihelix from the triangular fossa down to the tail of the helix, to completely separate the antihelix from the helix. Three postauricular sutures were applied with nonpermanent side-to-side mattress sutures, with a fourth suture placed to reposition the tail of the helix. A posterior bielliptical incision with a narrow bridge skin resection was performed. RESULTS: Complications occurred in six of the 60 patients (10%) who underwent bilateral otoplasty. A discrete recurrence occurred in the superior pole in six patients (10%) and was unilateral in all cases. Follow-up ranged from three months to 10 years. There were no major recurrences in this series. The satisfaction rate was 98.3%. The antihelix looked smooth, without marks or irregularities; the helix seemed straight and well placed. The posterior scar was inconspicuous. CONCLUSIONS: The present technique introduces a new concept in otoplasty that avoids handling the antihelix cartilage. A single incision of the antihelix breaks the cartilage spring memory completely and allows rebuilding of the antihelical fold without resorting to techniques such as rasping, drilling, excision, or complete incision, all of which are time-consuming and may result in irregularities. Sutures are placed to create the new antihelix in the desired shape easily and without tension. The helix and earlobe are repositioned with a specific posterior skin resection and with the tail of the helix's replacement.

Sífilis gástrica: relato de um caso / Gastric syphilis: report of a case

Os autores descrevem o caso de um paciente do sexo masculino, de 30 anos, que apresentou epigastralgia constante, plenitude pós-prandial, anorexia e emagrecimento. No decorrer de sua evoluçäo houve piora de sua quadro clínico e aparecimento de vômitos alimentares pós-prandiais. O estudo radiológico mostrando processo infiltrativo de antro, associado à endoscopia digestiva com biopsia excluindo a possibilidade diagnóstica de noeplasia malígna, foram pontos importantes na orientaçäo para um quadro de sífilis gástrica. Complementou-se o diagnóstico, estudo laboratorial qualitativo e quantitativo para Lues. O tratamento foi efetuado com penicilina benzatínica