Terapia nutricional no traumatismo cranioencefálico grave

O objetivo do presente artigo é revisar a literatura e organizar os principais achados, gerando recomendações baseadas nas melhores evidências encontradas relativas à terapia nutricional nos casos de traumatismo cranioencefálico. O traumatismo cranioencefálico permanece uma patologia altamente letal, apesar dos avanços em seu diagnóstico e tratamento. Poucas intervenções terapêuticas tem se mostrado eficazes em melhorar este quadro. Há múltiplas alterações metabólicas e hidroeletrolíticas decorrentes do traumatismo cranioencefálico, caracterizadas por um estado hipermetabólico associado a um intense catabolismo, que levam a necessidades nutricionais específicas. Na literatura atual não há diretrizes específicas para terapia nutricional em pacientes vítimas de traumatismo cranioencefálico grave, mas há muitos dados interessantes e questões que estão sendo melhores estudadas, possibilitando um melhor direcionamento da terapia nutricional neste cenário. Além de avaliação e acompanhamento por uma equipe multiprofissional qualificada e treinada para estas questões, a introdução precoce do suporte nutricional, a utilização preferencial da via enteral com a infusão adequada de calorias, o uso de formulações adequadas e nutricionalmente equilibradas para cada caso específico, associadas a utilização de imunonutrientes específicos, melhor controle hidroeletrolítico e metabólico, além de melhor entendimento fisiopatológico e das consequências das próprias terapêuticas instituídas, parece modificar os desfechos destes casos.

Parenteral administration of vitamins A, D and E on the oxidative metabolism and function of polymorphonuclear leukocytes in swine

The weaning period of piglets is characterized by physiological alterations, such as decreased weight gain, increased reactive oxygen species (ROS) and increased serum cortisol levels with possible effects on the immune response. The effect of parenteral administration of vitamins A, D and E on production performance, oxidative metabolism, and the function of polymorphonuclear leukocytes (PMNLs) was assessed in piglets during the weaning period. The sample was comprised of 20 male piglets that were given an injectable ADE vitamin combination (135,000 IU vitamin A, 40,000 IU vitamin D and 40mg vitamin E/animal) at 20 and 40 days of age. Weight gain, concentration of reduced glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD) and the microbicidal and phagocytic activity of PMNLs were assessed. No difference was observed in the average piglet weight during the study; however, a greater percentage of weight gain was observed after weaning in the treated group. The concentrations of GSH and SOD did not differ between groups, although lipid peroxidation was greater in the control group at 60 days of age. The investigated variables of oxidative metabolism were correlated as follows: -0.41 for GSH and MDA, -0.54 for GSH and SOD and 0.34 for MDA and SOD. The intensity of intracellular ROS production, the percentage of ROS-producing PMNLs and the intensity of phagocytosis by PMNLs did not differ between treatment groups. Administration of the injectable ADE combination improved the percentage of weight gain between 20 and 40 days of age, decreased oxidative stress at 60 days of age and did not influence the function of PMNLs in piglets.

Relapse of Intravenous Drug Use Triggered by Enfuvirtide, a Parenteral Antiretroviral Medication

Fuzeon (R) (enfuvirtide; Hoffmann-LaRoche, Nutley, NJ) is a parenteral medication prescribed to antiretroviral-experienced HIV patients. Clinicians are frequently concerned when prescribing enfuvirtide to former drug addicts because of the risk of triggering relapse, however, no previous report has described this adverse event. We describe two HIV-infected patients, previously abstinent from injection drug use, who experienced relapse or near-relapse situations after starting treatment with enfuvirtide. Along with the concerns related to adherence and to injection site reactions, clinicians who prescribe enfuvirtide should consider and discuss the risk of triggering relapse among former or recovering drug addicts.

Nutrição mineral da cana‑de‑açúcar irrigada com efluente de esgoto tratado, em área com aplicação de fosfogesso

O objetivo deste trabalho foi quantificar o aporte e a remoção de nutrientes em sistemas de cultivo  de cana‑de‑açúcar irrigados, ou não, com efluente de estação de tratamento de esgoto (EETE), com e sem  adição  de fosfogesso,  bem  como  avaliar  os  efeitos  desses sistemas  de  cultivo  no  estado  nutricional  das  plantas. Foram avaliados tratamentos sem irrigação e com irrigação a 100 e 150% da necessidade hídrica da  cultura. Os tratamentos com fosfogesso foram aplicados em área de terceiro corte, irrigada com EETE desde  o plantio. As  avaliações foram realizadas em duas safras. Os tratamentos não afetaram os rendimentos de  colmos. O tratamento com EETE e fosfogesso apresentou efeito sinérgico sobre o conteúdo de nitrogênio e de  enxofre nas plantas. O EETE beneficiou a nutrição das plantas quanto ao fósforo, mas não causou melhorias  na nutrição com potássio e enxofre. A nutrição com ferro, zinco e manganês não foi influenciada pelo aporte  desses micronutrientes pelo EETE. O  fósforo e o nitrogênio aportados na irrigação com EETE devem ser  considerados na recomendação de adubação. Porém, potássio, enxofre, ferro, zinco e manganês do efluente não  são fontes eficientes desses nutrientes para as plantas.

Alimentação hospitalar: proposições para a qualificação do Serviço de Alimentação e Nutrição, avaliadas pela comunidade científica

The scope of this paper is to validate proposals used to qualify hospital food by the Brazilian scientific community. An electronic questionnaire was applied to clinical nutrition professionals registered on the Lattes Platform (Brazilian database of institutions and researchers' curricula in the areas of Science and Technology). The questionnaire incorporated a Likert scale and had spaces for comments. The themes dealt with patient participation, the nutritional and sensory quality of hospital diets, and planning and goals of the Hospital Food and Nutrition Service (HFNS). The questionnaire also asked for the top five priorities for a HFNS. Proposals with total or partial adherence equal to or greater than 70% were considered to be approved. All proposals had total adherence equal to or greater than 70%. The proposal that had minimal adherence (70%) was the one that proposed that nutritional intervention must be arranged by mutual agreement with the patient. The proposal that had maximal adherence (93%) was the one advocating that there must be statistical control on diets prescribed by the HFNS. The most cited priorities referred to infrastructure and training of human resources (40%), the quality of hospital food (27%) and the nutritional status of the patient.

Human Leukocyte Death After a Preoperative Infusion of Medium/Long-Chain Triglyceride and Fish Oil Parenteral Emulsions: A Randomized Study in Gastrointestinal Cancer Patients

Background: Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. Material and Methods: Twenty-five patients from a randomized, double-blind clinical trial (ID: NCT01218841) were randomly included to evaluate leukocyte death after 3 days of preoperative infusion (0.2 g fat/kg/d) of an LE composed equally of medium/long-chain triglycerides and soybean oil (MCTs/LCTs) or pure fish oil (FO). Blood samples were collected before (t0) and after LE infusion (t1) and on the third postoperative day (t2). Results: After LE infusion (t1 vs t0), MCTs/LCTs did not influence cell death; FO slightly increased the proportion of necrotic lymphocytes (5%). At the postoperative period (t2 vs t0), MCTs/LCTs tripled the proportion of apoptotic lymphocytes; FO maintained the slightly increased proportion of necrotic lymphocytes (7%) and reduced the percentage of apoptotic lymphocytes by 74%. In the postoperative period, MCT/LCT emulsion increased the proportion of apoptotic neutrophils, and FO emulsion did not change any parameter of apoptosis in the neutrophil population. There were no differences in lymphocyte or neutrophil death when MCT/LCT and FO treatments were compared during either preoperative or postoperative periods. MCT/LCTs altered the expression of 12 of 108 genes related to cell death, with both pro- and antiapoptotic effects; FO modulated the expression of 7 genes, demonstrating an antiapoptotic effect. Conclusion: In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis. (JPEN J Parenter Enteral Nutr. 2012; 36: 677-684)

Abordagem dos temas alimentação e nutrição no material didático do ensino fundamental: interface com segurança alimentar e nutricional e parâmetros curriculares nacionais

A Segurança Alimentar e Nutricional (SAN) deve ser assegurada a todos. A escola é ambiente propício à formação de hábitos saudáveis e à construção de cidadania. Os Parâmetros Curriculares Nacionais (PCNs) orientam a promoção de concepções de saúde de modo transversal no currículo escolar. Este estudo teve como objetivo identificar e analisar a abordagem dos temas alimentação e nutrição no material didático do ensino fundamental e sua interface com o conceito de SAN e com os PCNs. Foi realizada pesquisa documental mediante o material didático de 5ª a 8ª séries do ensino fundamental da rede pública do Estado de São Paulo. A presença difusa do tema alimentação e nutrição na maioria das disciplinas, por todos os bimestres, nas quatro séries, traz à tona a interdisciplinaridade em saúde. Verificou-se que os PCNs estão relacionados ao conceito de SAN nos seus diversos aspectos e que a maioria das disciplinas contém temas que abordam esta relação. Na interface entre os temas, destaca-se a promoção da saúde e a produção dos alimentos. A metodologia utilizada no material didático apresenta o tema, mas não o conteúdo correlato, o que impossibilitou a análise de sua adequação. Conclui-se que existe a abordagem dos temas relacionados à alimentação e nutrição no material didático, alguns de forma inconsistente, e cabe aos educadores a seleção do conteúdo e da estratégia adequada, além de sua constante atualização, o que está sendo proposto pelo Estado, mas não está ao alcance de todos os profissionais e, portanto, ainda depende da iniciativa de cada docente.

Biological and physicochemical stability of ceftazidime and aminophylline on glucose parenteral solution

Ceftazidime is a broad spectrum antibiotic administered mainly by the parenteral route, and it is especially effective against Pseudomonas aeruginosa. The period of time in which serum levels exceed the Minimum Inhibitory Concentration (MIC) is an important pharmacodynamic parameter for its efficacy. One of the forms to extend this period is to administer the antibiotic by continuous infusion, after prior dilution in a Parenteral Solution (PS). The present work assessed the stability of ceftazidime in 5% glucose PS for 24 hours, combined or not with aminophylline, through High Performance Liquid Chromatography (HPLC). The physicochemical evaluation was accompanied by in vitro antimicrobial activity compared MIC test in the 24-hour period. Escherichia coli and Pseudomonas aeruginosa were the microorganisms chosen for the MIC comparison. The HPLC analysis confirmed ceftazidime and aminophylline individual stability on PS, while the MIC values were slightly higher than the mean described in the literature. When both drugs were associated in the same PS, the ceftazidime concentration by HPLC decreased 25% after 24 hours. Not only did the MIC values show high loss of antibiotic activity within the same period, but also altered MIC values immediately after the preparation, which was not detected by HPLC. Our results indicate that this drug combination is not compatible, even if used right away, and that PS might not be the best vehicle for ceftazidime, emphasizing the importance of the MIC evaluation for drug interactions.

Novos desafios da pesquisa em nutrição e produção animal.

Os organizadores autorizam a reprodução total ou parcial deste trabalho, para qualquer meio convencional ou eletrônico, para fins de estudo e pesquisa, desde que citada a fonte.

O reflexo da nutrição na qualidade do sêmen em reprodutores suínos-suplementação com vitamina A e selênio orgânico

Os organizadores autorizam a reprodução total ou parcial deste trabalho, para qualquer meio convencional ou eletrônico, para fins de estudo e pesquisa, desde que citada a fonte.

Biological and physicochemical stability of ceftazidime and aminophylline on glucose parenteral solution

Ceftazidime is a broad spectrum antibiotic administered mainly by the parenteral route, and it is especially effective against Pseudomonas aeruginosa. The period of time in which serum levels exceed the Minimum Inhibitory Concentration (MIC) is an important pharmacodynamic parameter for its efficacy. One of the forms to extend this period is to administer the antibiotic by continuous infusion, after prior dilution in a Parenteral Solution (PS). The present work assessed the stability of ceftazidime in 5% glucose PS for 24 hours, combined or not with aminophylline, through High Performance Liquid Chromatography (HPLC). The physicochemical evaluation was accompanied by in vitro antimicrobial activity compared MIC test in the 24-hour period. Escherichia coli and Pseudomonas aeruginosa were the microorganisms chosen for the MIC comparison. The HPLC analysis confirmed ceftazidime and aminophylline individual stability on PS, while the MIC values were slightly higher than the mean described in the literature. When both drugs were associated in the same PS, the ceftazidime concentration by HPLC decreased 25% after 24 hours. Not only did the MIC values show high loss of antibiotic activity within the same period, but also altered MIC values immediately after the preparation, which was not detected by HPLC. Our results indicate that this drug combination is not compatible, even if used right away, and that PS might not be the best vehicle for ceftazidime, emphasizing the importance of the MIC evaluation for drug interactions.