Terapia nutricional precoce no trauma: após o A, B, C, D, E, a importância do F (FEED)

Um número significativo de mortes no trauma ocorre dias a semanas após a injúria inicial, sendo causado por infecções e insuficiência orgânica, relacionadas a hipercatabolismo e consequente desnutrição proteica aguda. A terapia nutricional deve ser planejada e incluída com as demais condutas de reanimação para pacientes politraumatizados e grandes queimados. A rápida aquisição de uma via para suporte nutricional é importante para inicio da terapia nutricional precoce em até 48 horas do atendimento. A via enteral é a opção preferencial no pós-operatório de pacientes traumatizado mas a via parenteral deve ser prescrita quando a enteral está contraindicada ou insuficiente. Após as medidas iniciais ditadas pelo ATLS, sintetizadas em A (air), B (breath), C (circulation), D (disability) e E (exposure), nós incluímos a letra F (feed) para enfatizar a importância do atendimento nutricional precoce no trauma.

Luettelo lihan säännöstelystä 21 päivänä elokuuta 1941 annetun valtioneuvoston päätöksen 9 §:n edellyttämistä keskusliikkeistä (A) ja 10 §:n, sellaisena kuin se on 12 päivänä helmikuuta 1942 annetussa valtioneuvoston päätöksessä, edellyttämistä hankintaliikkeistä (B) ja ostoasiamiehistä (C)

14 x 20 cm

Luettelo lihan säännöstelystä 21 päivänä elokuuta 1941 annetun valtioneuvoston päätöksen 9 §:n edellyttämistä keskusliikkeistä (A) ja 10 §:n, sellaisena kuin se on 12 päivänä helmikuuta 1942 annetussa valtioneuvoston päätöksessä, edellyttämistä hankintaliikkeistä (B) ja ostoasiamiehistä (C)

14 x 20 cm

Förteckning över de i 9 § i statsrådets beslut om reglementering av kött utfärdat den 21 augusti 1941 förutsatta centralaffärerna (A) och 10 §, sådan den lyder i statsrådets beslut utfärdat den 12 februari 1942, beträffande uppköparaffärer (B) och uppköparombud (C)

14 x 20 cm

Förteckning över de i 9 § i statsrådets beslut om reglementering av kött utfärdat den 21 augusti 1941 förutsatta centralaffärerna (A) och 10 §, sådan den lyder i statsrådets beslut utfärdat den 12 februari 1942, beträffande uppköparaffärer (B) och uppköparombud (C)

14 x 20 cm

Absence of hepatitis B virus DNA in patients with hepatitis C and non-A-E hepatitis in the State of São Paulo, Brazil

Occult hepatitis B virus (HBV) infection has been reported as cases in which HBV DNA was detected despite the absence of any HBV serological markers or in cases in which anti-HBc antibody was the sole marker. The aim of the present study was to determine, using the polymerase chain reaction (PCR), whether HBV infection occurs in hepatitis C and non-A-E hepatitis patients without serological evidence of hepatitis B infection in São Paulo State. Two different populations were analyzed: 1) non-A-E hepatitis patients, including 12 patients with acute and 50 patients with chronic hepatic disorders without serological evidence of infection with known hepatitis viruses; 2) 43 patients previously diagnosed as hepatitis C with positive results for anti-HCV and HCV RNA. Among hepatitis C patients, anti-HBc was detected in 18.6% of the subjects. Three different sets of primers were employed for HBV DNA detection by nested PCR, covering different HBV genes: C, S and X. HBV-DNA was not detected in any sample, whereas the positive controls did produce signals. The lack of HBV DNA detection with these pairs of primers could be due to a very low viral load or to the presence of mutations in their annealing sites. The latter is unlikely as these primers were screened against an extensive dataset of HBV sequences. The development of more sensitive methods, such as real time PCR, to detect circular covalent closed DNA is necessary in order to evaluate this question since previous studies have shown that cryptic hepatitis B might occur.

Low occurrence of occult hepatitis B virus infection and high frequency of hepatitis C virus genotype 3 in hepatocellular carcinoma in Brazil

Occult hepatitis B virus (HBV) infection has been reported among patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). Our aim was to evaluate the presence of occult HBV infection in patients with HCV-related liver cirrhosis (LC) with or without HCC in São Paulo, Brazil. Serum and liver tissue samples from 50 hepatitis B surface antigen-negative patients with HCV-related LC who underwent liver transplantation at the University of São Paulo School of Medicine Hospital from 1993 to 2004 were divided into groups with LC only (N = 33) and with LC plus HCC (N = 17). HBV DNA was assayed for serum and paraffin-embedded liver tissue (tumoral and non-tumoral) using real time PCR and only 1 case with HCC had HBV DNA-positive serum. All liver samples were negative. HCV genotype 3 was detected in 17/39 (43.7%) cases. In conclusion, using a sensitive real time PCR directed to detect HBV variants circulating in Brazil, occult hepatitis B infection was not found among HCV-positive cirrhotic patients and was rarely found among HCV-positive HCC patients. These results are probably related to the low prevalence of HBV infection in our population. Furthermore, we have also shown that HCV genotype 3 is frequently found in Brazilian cirrhotic patients, particularly when they also have HCC. More studies involving a large number of cases should be carried out to confirm these data and to further characterize Brazilian HCV genotype isolates to elucidate genetic features that might be related to its carcinogenic potential.

A A a b c d e f ff g h i k l m n o p q r [r] ..

Painopaikka ja painovuosi kolofonista.

A A a b c d e f ff g h i k l m ..

Arkit: A8.

Swenske och lappeske ABC book. A A a b c d e f ff g h i k ..

Julkaisutiedot kolofonista.

A A a b c d e f ff g h i k l m n o p q r [r] ..

Painopaikka ja painovuosi kolofonista.

Ensimmäiset pookstawit Jumalan sanasta, eli kysymyxet lapsille edespandawat, se on: ne ensimmäiset ja yxikertaisimmat kysymyxet christillisesä opisa, joitten tygö pannut wastauxet lasten ymmärryxeen ja muistohon painettaman pitää, hamasta sijtä, kuin he rupewat puhumaan, nijn ikää myöden sijhen asti, kuin he a.b.c. kirjan ja catechismuxen, sisäldä ja ulkoo lukemaan selkiästi oppineet owat. Edesannetut yxikertaisille; waan erinomattain nijlle awuxi, jotka yhteisen-kansan seasa lapsia kirjaa lukemaan opettawat, kuinga heidän opettamisen siwusa, myös opetus-lastensa ymmärryxet, sijhen kuin he lukewat, johdattaman pitää, sitä oikein ymmärtämään. Daniel Godeniuxelda. Mutta nytt suomalaisille suosioxi, ruotzin kielestä suomen kielexi käätyt ja wälimitten paratut

Arkit: A-B8.

A A a b c d e f ff g h i k l m ..

Arkit: A8.