Recuperação acelerada após reparo cirúrgico aberto eletivo do aneurisma da aorta abdominal: revisão sistemática da literatura

Pós-graduação em Anestesiologia - FMB

Efeito da participação e do desligamento de programa de mudança no estilo de vida sobre o nível de atividade e aptidão física, percepção de saúde e presença de síndrome metabólica em adultos da comunidade de Botucatu - SP

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Densidade mineral óssea de adolescentes sobrepesos, obesos e superobesos: o impacto do excesso de gordura corporal sobre a massa óssea

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Efeito da temperatura de incubação e de criação sobre o tecido adiposo e desempenho de frangos de corte

Pós-graduação em Zootecnia - FCAV

Comportamento da composição corporal, contagem elucocitária e adipocinas de adolescentes obesos treinados e não treinados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Gordura corporal total e do tronco e o desempenho da marcha em mulheres na menopausa

OBJETIVO:Verificar a relação entre gordura corporal total e de tronco com o desempenho da marcha em mulheres na menopausa.MÉTODOS:Trinta e nove mulheres na menopausa, com idade de 50 anos ou mais, foram avaliadas. As avaliações foram: peso e estatura para cálculo do índice de massa corporal (IMC), composição corporal pela técnica de Dual-Energy X-ray Absorptiometry (DEXA) e marcha utilizando um baropodômetro. As variáveis de composição corporal utilizadas foram gordura corporal total, percentual de gordura corporal e gordura de tronco, enquanto as variáveis da marcha foram porcentagem de tempo de duplo apoio e de apoio simples e velocidade. As mulheres foram divididas de acordo com a mediana em dois grupos para cada variável da composição corporal: menos e mais gordura corporal, menos e mais percentual de gordura e menos e mais gordura de tronco. Para comparar as variáveis de marcha nesses grupos, foi utilizado o teste de Mann-Whitney. Para avaliar as possíveis relações entre as variáveis de composição corporal e marcha, o teste de correlação de Spearman foi utilizado. Todas as análises foram realizadas com nível de significância de 5%.RESULTADOS:O grupo com mais gordura de tronco, quando comparado com o grupo com menos gordura de tronco, apresentou maiores valores de duplo apoio (p=0,007) e menores valores de apoio simples (0,03). Foram encontradas correlações significativas e positivas entre gordura de tronco e duplo apoio (R=0,40) e negativas entre gordura de tronco e apoio simples (R=-0,32).CONCLUSÃO:Mulheres na menopausa que apresentam maiores quantidade de gordura no tronco tendem a apresentar desempenho prejudicado na marcha.

Effect of concurrent training on risk factors and hepatic steatosis in obese adolescents

OBJETIVOAnalisar os efeitos de 20 semanas de treinamento concorrente sobre as variáveis de composição corporal, perfil lipídico e diagnóstico da esteatose hepática em adolescentes obesos.MÉTODOSRealizou-se um ensaio clínico aberto com 34 adolescentes obesos com idades entre 12 e 15 anos. Foram analisados gordura corporal total e de tronco, colesterol total e suas frações (HDL, LDL e VLDL) e triglicérides, sendo realizado exame de ultrassonografia de abdome superior para diagnosticar esteatose hepática. Os participantes foram submetidos ao treinamento concorrente (associação de treino com pesos e exercício aeróbio) três vezes por semana, com duração de uma hora-aula durante 20 semanas. Para o tratamento estatístico, foram realizados o teste t de Student pareado e a análise de frequência, a fim de verificar as reduções relativa e absoluta do diagnóstico da esteatose hepática, adotando-se p<0,05.RESULTADOSOs adolescentes estudados apresentaram melhoras significativas da composição corporal, com diminuição do percentual de gordura total, da massa gorda total, da gordura de tronco e do aumento da massa magra, além de redução do tamanho dos lóbulos do fígado, dos índices de prevalência da esteatose hepática, do colesterol total e LDL-colesterol.CONCLUSÕESO treinamento concorrente foi efetivo por promover melhorias significativas de variáveis da composição corporal e do perfil lipídico, além de reduzir a prevalência da esteatose hepática.

Alloxan diabetes alters the tensile strength, morphological and morphometric parameters of abdominal wall healing in rats

PURPOSE:To investigate the effects of alloxan diabetes on the abdominal wall healing of rats undergoing laparotomy.METHODS:Ninety-six male Wistar rats weighing between 200 and 300 grams, divided into two groups: non-diabetic group (G1) and another with untreated diabetes (G2). Three months after diabetes induction, the animals underwent a 5cm-long- laparotomy and 5.0 nylon monofilament suture. After the surgery, 12 animals from each group were euthanized on days 4, 14, 21 and 30 corresponding to the moments M1, M2, M3 and M4. In each moment a fragment of the abdominal wall containing the scar was removed for tensile strength measurement, histological and morphometric study. Clinical and biochemical parameters were also analyzed.RESULTS:G2 animals showed parameters compatible with severe diabetes and decreased plasma levels of insulin. The tensile strength in G2 was significantly smaller in M2 and M4, with a tendency to fall in the other two. Through light microscope, diabetic animals showed more difficulty to increase collagen density and contraction. G2 animals showed high cellularity of fibroblasts in later healing moments, with collagen thinning in M2 and M4.CONCLUSION:The abdominal wound healing in untreated diabetic animals was altered and led to a higher incidence of dehiscence and infections.

Análise microbiológica e físico-química de material proteico comestível derivado do processamento da gordura oriunda do abate de bovinos

Background: The use of all by-products of bovine slaughter is of high economic importance for the industries of products of animal origin. Among these products, fat has an important role, once fat rendering may generate several different products, such as protein material that may be used in the manufacture of meat products. However, in spite of the importance that the use of all by-products has for the economic balance of the industry, there are no reports on their use in Brazil, or studies that supply data on microbiological and physical-chemical local standards for this protein. Thus, the objective of this study was to evaluate microbiological and physical-chemical characteristics of protein material obtained from fat rendering, as well as to provide support for companies to use fat rendering to generate protein material, adding value to industrialized meat products.Materials, Methods & Results: The experimental production of edible protein obtained of fat rendering was conducted in slaughterhouse with supervision of the Brazilian Ministry of Agriculture, Livestock and Food Supply. Protein material was obtained in a continuous, humid heat system at high temperatures. Fat scraps containing protein were ground and cooked at high temperature (85 degrees C), and placed in a three phase decanter centrifuge. After centrifugation, protein material was ground again and packed. Samples were collected from 15 batches of protein material, and the following microbiological analyses were carried out: counts of aerobic mesophilic and psychrotrophic microorganisms, coliforms at 35 degrees C, Escherichia coli, sulfite-reducing Clostridium, and Staphylococcus aureus, besides presence or absence of Salmonella and Listeria monocytogens. The following physical-chemical analyses were also carried out: protein, total lipid, moisture, ash, carbohydrate, and energy content. Mean counts of mesophiles, psychrotrophs, and coliforms at 35 degrees C were 4.17; 3.69 and 1.87 (log CFU/g), respectively. Levels of protein, total lipids, moisture, ashes and carbohydrates were 27.50; 7.83; 63.88%; 0.24%; and 0.55%, respectively, and energy content was 182.63 kcal/100g.Discussion: Results of microbiological analyses demonstrated that, although low, the final product showed to be contaminated. Contamination that occurred during the second grinding procedure may be an explanation for these bacterial counts. Also, the temperature used for fat fusion was not enough to eliminate thermoduric microorganisms. However, even with the presence of indicator microorganisms in the samples, none was contaminated by E. coli, sulfite-reducing Clostridium, S. aureus, Salmonella or L. monocytogenes. Physical-chemical analyses showed that the product had adequate nutritional quality. Based on these results, it was possible to conclude that protein material obtained in fat rendering showed characteristics that enable the use of this product as raw material for processed meat products. Besides, the present study was the first one to present scientific results in relation to edible by-products obtained in fat rendering, supplying important information for slaughterhouses and meat-processing plants. The study also produced relevant data on the innocuousness of the product, which may be used to guide decision-making of health inspectors.

Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.Methods: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.Results: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].Conclusion: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Intra-abdominal pressure as a predictor of acute kidney injury in postoperative abdominal surgery

Objectives: The purpose of this study was to determine if intra-abdominal pressure (IAP) could predict acute renal injury (AKI) in the postoperative period of abdominal surgeries, and which would be its cutoff value. Patients and methods: A prospective observational study was conducted in the period from January 2010 to March 2011 in the Intensive Care Units (ICUs) of the University Hospital of Botucatu Medical School, UNESP. Consecutive patients undergoing abdominal surgery were included in the study. Initial evaluation, at admission in ICU, was performed in order to obtain demographic, clinical surgical and therapeutic data. Evaluation of IAP was obtained by the intravesical method, four times per day, and renal function was evaluated during the patient's stay in the ICU until discharge, death or occurrence of AKI. Results: A total of 60 patients were evaluated, 16 patients developed intra-abdominal hypertension (IAH), 45 developed an abnormal IAP (>7 mmHg) and 26 developed AKI. The first IAP at the time of admission to the ICU was able to predict the occurrence of AKI (area under the receiver-operating characteristic curve was 0.669; p=0.029) with the best cutoff point (by Youden index method) >= 7.68 mmHg, sensitivity of 87%, specificity of 46% at this point. The serial assessment of this parameter did not added prognostic value to initial evaluation. Conclusion: IAH was frequent in patients undergoing abdominal surgeries during ICU stay, and it predicted the occurrence of AKI. Serial assessments of IAP did not provided better discriminatory power than initial evaluation.

Dog with hydronephrosis due to abdominal trauma

Hydronephrosis is a condition that results from complete or partial obstruction of the urinary flow. This paper reports the case of a two-year-old, mixed-breed dog diagnosed with hydronephrosis of the left kidney six months after being kicked in the thoraco-abdominal region. The diagnosis was based on radiographic and ultrasonographic examinations. Percutaneous antegrade pyelography was also performed and allowed the visualization of opacification of the left kidney, which confirmed the diagnosis. Because the exams indicated that the patient had normal renal function, nephrectomy was performed. The patient remained in good health during the postoperative period and in subsequent evaluations. (C) 2013 PVJ. All rights reserved

Dor abdominal crônica, dispepsia não ulcerosa e infecção pelo Helicobacter pylori em crianças e adolescentes

Pós-graduação em Patologia - FMB

Estudo da inflamação e da autoimunidade na doença hepática gordurosa não alcoólica

Pós-graduação em Fisiopatologia em Clínica Médica - FMB