Qualidade de vida de pessoas com estomias intestinais

Ostomy is an open surgical origin, when it is necessary to deviate temporarily or permanently, the normal transit of food and / or deletions. The patient with ostomy disposal is faced with changes in their physiology, also emerging on the need to care collection bag. This study aimed to analyze the quality of life (QOL) of people living with ostomy Intestinal (EI), who attended the Pediatric and Adult Rehabilitation Center of Rio Grande do Norte (CRI / CRA-RN). It is an analytical study with cross-sectional design and quantitative approach, accomplished with 89 people who had EI. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (CEP / UFRN), CAAE: 19866413.3.0000.5537. Held data collection in the period January-March 2015 using two instruments: an adapted general questionnaire covering socio-demographic, clinical and self-care and a specific instrument for assessing QOL of people with stoma titled as City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-Q), validated and adapted to Portuguese in 2010, composed of four areas, namely: Welfare Body (BEF), Welfare Psychological (BEP), Welfare (BES ) and Spiritual Well-Being (BEE). The collected data were entered into a database in Microsoft Excel 2007 spreadsheet application and processed in computerized software for descriptive and inferential analysis. The results showed that 83.1% had a colostomy and ileostomy 16.9%. Sociodemographic characteristics prevailed in males (57.3%), over 50 (57.3%), mulatto (46.1%), with presence of companion / a (57.3%), retired / beneficiaries (50.5%), monthly income above the minimum wage (68.5%) and who have studied up to elementary school (67.4%). Regarding clinical aspects, it was observed that the main cause that led to the making of the stoma was the neoplasm (59.6%) followed by trauma (21.3%). The sample showed people with stoma for more than six months (79.8%) of permanently (57.3%), in use sink equipment piece drainable (68.5%) of flat base (82.0%). With respect to self-care, 93.3% emptied and washed the bag alone (care related to hygiene) and 75.3% fixed the new exchange on the skin during the exchange (care related to the stock). Patients with more than six months of ostomy and had no partner (a) had higher averages of self-care related hygiene and purse. The average of respondents QoL scores was 68.90% for General QOL; 68.03% for the BEF; 68.38% for the BEP; 66.46% for BES and 75.41% for BEE. Among the aspects that influenced QOL included: physical strength, pain, suffering and gases (physical domain); appearance, care of the stoma and adaptation to new condition (psychological domain); isolation, interference in personal relationships and social activities (social domain) and going to church or synagogue, spiritual activities and positive change after ostomy (spiritual realm). Based on these results, it is concluded that this was a predominantly adult sample / elderly (between 50 and 70 years), with low education and the cause motivating the stoma, neoplasms. However, such findings did not pass at low percentage levels on the self-care capacity to deliver even at low QOL scores.

Qualidade de vida de pessoas com estomias intestinais

Ostomy is an open surgical origin, when it is necessary to deviate temporarily or permanently, the normal transit of food and / or deletions. The patient with ostomy disposal is faced with changes in their physiology, also emerging on the need to care collection bag. This study aimed to analyze the quality of life (QOL) of people living with ostomy Intestinal (EI), who attended the Pediatric and Adult Rehabilitation Center of Rio Grande do Norte (CRI / CRA-RN). It is an analytical study with cross-sectional design and quantitative approach, accomplished with 89 people who had EI. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (CEP / UFRN), CAAE: 19866413.3.0000.5537. Held data collection in the period January-March 2015 using two instruments: an adapted general questionnaire covering socio-demographic, clinical and self-care and a specific instrument for assessing QOL of people with stoma titled as City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-Q), validated and adapted to Portuguese in 2010, composed of four areas, namely: Welfare Body (BEF), Welfare Psychological (BEP), Welfare (BES ) and Spiritual Well-Being (BEE). The collected data were entered into a database in Microsoft Excel 2007 spreadsheet application and processed in computerized software for descriptive and inferential analysis. The results showed that 83.1% had a colostomy and ileostomy 16.9%. Sociodemographic characteristics prevailed in males (57.3%), over 50 (57.3%), mulatto (46.1%), with presence of companion / a (57.3%), retired / beneficiaries (50.5%), monthly income above the minimum wage (68.5%) and who have studied up to elementary school (67.4%). Regarding clinical aspects, it was observed that the main cause that led to the making of the stoma was the neoplasm (59.6%) followed by trauma (21.3%). The sample showed people with stoma for more than six months (79.8%) of permanently (57.3%), in use sink equipment piece drainable (68.5%) of flat base (82.0%). With respect to self-care, 93.3% emptied and washed the bag alone (care related to hygiene) and 75.3% fixed the new exchange on the skin during the exchange (care related to the stock). Patients with more than six months of ostomy and had no partner (a) had higher averages of self-care related hygiene and purse. The average of respondents QoL scores was 68.90% for General QOL; 68.03% for the BEF; 68.38% for the BEP; 66.46% for BES and 75.41% for BEE. Among the aspects that influenced QOL included: physical strength, pain, suffering and gases (physical domain); appearance, care of the stoma and adaptation to new condition (psychological domain); isolation, interference in personal relationships and social activities (social domain) and going to church or synagogue, spiritual activities and positive change after ostomy (spiritual realm). Based on these results, it is concluded that this was a predominantly adult sample / elderly (between 50 and 70 years), with low education and the cause motivating the stoma, neoplasms. However, such findings did not pass at low percentage levels on the self-care capacity to deliver even at low QOL scores.

Bacterial translocation in rats nonfunctioning diverted distal colon

To investigate whether the alterations of the diverted colon segment mucosa, evidenced in fecal colitis, would be able to alter Bacterial Translocation (BT). Methods: Sixty-two Wistar male rats ranging from 220 to 320 grams of weight, were divided in two groups: A (Colostomy) and B (Control), with 31 animals each one. In group A, all animals underwent end colostomy, one stoma, in ascending colon; and in the 70th POD was injected in five rats, by rectal route – diverted segment - 2ml of a 0.9% saline solution in animals (A1 subgroup); in eight it was inoculated, by rectal route, 2ml of a solution containing Escherichia coli ATCC 25922 (American Type Culture Collection), in a concentration of 108 Colony Forming Unit for milliliters (CFU/ml) - A2 Subgroup; in ten animals the same solution of E. coli was inoculated, in a concentration of 1011 CFU/ml (A3 Subgroup); and in eight it was collected part of the mucus found in the diverted distal colonic segment for neutral sugars and total proteins dosage (A4 subgroup). The animals from the group B underwent the same procedures of group A, but with differences in the colostomy confection. In rats from subgroups A1, A2, A3, B1, B2, and B3 2ml of blood were aspirated from the heart, and fragments from mesenteric lymphatic nodule, liver, spleen, lung and kidney taken for microbiological analysis, after their death. This analysis consisted of evidencing the presence of E. coli ATCC 25922 CFU. Mann-Whitney and ANOVA Tests were applied as analytic techniques for association of variables. Results: The occurrence of BT was evidenced only in those animals in which inoculated concentration of E. coli ATCC 25922, reached levels of 1011CFU/ml, i.e. in Subgroups A3 and B3, although, being significantly greater (80%) in those animals without colostomy (subgroup B3) when compared to the ones with colostomy (20%) from the subgroup A3 (P <0.05). Lung, liver and mesenteric lymphatic nodules were the tissues with larger percentile of bacterial recovery, so much in subgroup A3, as in B3. Blood culture was considered positive in 60% of the animals from subgroup B3 and in 10% of those from subgroup A3 (p <0.05). There was greater concentration of neutral sugars, in subgroup A4 - mean 27.3mg/ml -, than in subgroup B4 - mean 8.4mg/ml - (P <0.05). Conclusion: The modifications in the architecture of intestinal mucosa in colitis following fecal diversion can cause alterations in the intestinal barrier, but it does not necessarily lead to an increased frequency of BT

Vitamines B, éléments clés de l'efficacité métabolique : Effets de la nature de la diète sur les apports

Les travaux sur la nutrition en vitamines B des ruminants montrent des résultats très variés sur les quantités de ces nutriments disponibles pour l’animal selon la nature de la ration. Ces divergences sont dues à des changements des populations microbiennes dans le rumen, causées par les facteurs physico-chimiques de la ration. Une amélioration de la compréhension des effets de la nature de la diète sur la synthèse et l’utilisation des vitamines B dans le rumen pourrait aider à identifier les conditions sous lesquelles une supplémentation en ces vitamines serait bénéfique pour la vache. Le but de ce travail de thèse est donc d’améliorer la compréhension des effets de l’espèce fourragère, de la maturité et de la longueur des particules de fourrage sur les apports en vitamines B chez la vache laitière. Pour évaluer chacune de ces variables, les concentrations de thiamine, riboflavine, niacine, vitamine B6, folates et vitamine B12 ont été mesurées dans les échantillons d’aliments et de digesta duodénal recueillis lors de trois projets réalisés à l’Université du Michigan par l’équipe du Dr. M. Allen. Dans la première étude, l’effet de l’espèce fourragère des ensilages a été évalué au cours de deux expériences similaires durant lesquelles les vaches recevaient une diète à base d’ensilage de luzerne ou de dactyle. Les diètes à base de luzerne ont été associées à une augmentation de la dégradation de la thiamine et de la vitamine B6 dans le rumen par rapport aux diètes à base d’ensilage de dactyle. La deuxième étude visait à évaluer les effets de la maturité des plantes lors de la mise en silo sur les quantités de vitamines B disponibles pour la vache; les deux expériences se différenciaient par l’espèce fourragère étudiée, soit la luzerne ou le dactyle. Une récolte à un stade de maturité plus élevé a augmenté les flux duodénaux de thiamine, de niacine et de folates lorsque les vaches recevaient des diètes à base d’ensilage de luzerne mais n’a diminué que le flux duodénal de riboflavine chez les animaux recevant des diètes à base d’ensilage de dactyle. La troisième étude a comparé les effets de la longueur de coupe (10 vs. 19 mm) d’ensilages de luzerne et de dactyle sur le devenir des vitamines B dans le système digestif de la vache laitière. Cette étude a permis de constater qu’une augmentation du temps de séchage au champ diminuait les concentrations de vitamines B dans les ensilages. Cependant, la taille des particules des ensilages de luzerne et de dactyle n’a pas affecté les quantités des vitamines B arrivant au duodénum des vaches. En général, les résultats de ces études montrent qu’il existe une corrélation négative entre la synthèse de riboflavine, de niacine et de vitamine B6 et leur ingestion, suggérant une possible régulation de la quantité de ces vitamines B par les microorganismes du rumen. De plus, l’ingestion d’amidon et d’azote a été corrélée positivement avec la synthèse de thiamine, de folates et de vitamine B12, et négativement avec la synthèse de niacine. Ces corrélations suggèrent que les microorganismes qui utilisent préférentiellement l’amidon jouent un rôle majeur pour la synthèse ou la dégradation de ces vitamines. De plus, la présence d’une quantité suffisante d’azote semble avoir un impact majeur sur ces processus. La suite de ces travaux devrait viser la modélisation de ces données afin de mieux appréhender la physiologie de la digestion de ces vitamines et permettre la création de modèles mathématiques capables de prédire les quantités de vitamines disponibles pour les vaches. Ces modèles permettront, lorsqu’intégrés aux logiciels de formulation de ration, d’élaborer une diète plus précise, ce qui améliorera la santé du troupeau et la performance laitière et augmentera les profits du producteur.

Responses to various protein and energy supplements by steers fed low-quality tropical hay. 1. Comparison of response surfaces for young steers

Response curves were established for different supplements, offered at intakes ranging from 0 to 20 g/kg liveweight (W).day to young Bos indicus crossbred steers fed low-quality Rhodes grass (Chloris gayana) hay ad libitum in two pen experiments. Supplements included protein meals of varying rumen-degradability (cottonseed meal (CSM) or fishmeal), as well as ‘energy sources’ comprising grains of high and low ruminal starch degradability (barley and sorghum) and a highly fermentable sugar source (molasses), with all diets adjusted for rumen-degradable nitrogen and mineral content. Unsupplemented steers gained 0.08 and 0.15 kg/day, in Experiments 1 and 2, respectively. Growth of steers increased linearly with intake of ‘energy source’ supplements in increasing order of molasses, sorghum and barley (all differences P < 0.05). Steer growth rate also increased linearly with fishmeal, albeit over a narrow intake range (0–4.1 g/kg W.day), whereas the response with CSM was asymptotic, showing a steep response at low intake before levelling at ~1.2 kg/day. All supplement types were associated with a linear reduction in hay intake by the steers (energy substitution) where the reduction was greater (P < 0.05) for barley and molasses (not different) than for sorghum (P < 0.05), and for fishmeal compared with CSM (P < 0.05). In concurrent metabolism studies with the same rations, organic matter digestibility of the total ration (561–578 g/kg DM, unsupplemented) was increased linearly by barley and molasses (both P < 0.05) but was unaffected by CSM and sorghum supplements. The efficiency of microbial protein synthesis in steers increased linearly, from 91 g microbial crude protein/kg digestible organic matter (unsupplemented), in both molasses and CSM-supplemented steers, with the trend for a higher response to molasses (P = 0.05), and appeared most closely related to digestible organic matter intake. The response curves from these studies provide the practical framework upon which to formulate rations for cattle grazing low-quality forages.

Bacterial translocation in rats nonfunctioning diverted distal colon

To investigate whether the alterations of the diverted colon segment mucosa, evidenced in fecal colitis, would be able to alter Bacterial Translocation (BT). Methods: Sixty-two Wistar male rats ranging from 220 to 320 grams of weight, were divided in two groups: A (Colostomy) and B (Control), with 31 animals each one. In group A, all animals underwent end colostomy, one stoma, in ascending colon; and in the 70th POD was injected in five rats, by rectal route – diverted segment - 2ml of a 0.9% saline solution in animals (A1 subgroup); in eight it was inoculated, by rectal route, 2ml of a solution containing Escherichia coli ATCC 25922 (American Type Culture Collection), in a concentration of 108 Colony Forming Unit for milliliters (CFU/ml) - A2 Subgroup; in ten animals the same solution of E. coli was inoculated, in a concentration of 1011 CFU/ml (A3 Subgroup); and in eight it was collected part of the mucus found in the diverted distal colonic segment for neutral sugars and total proteins dosage (A4 subgroup). The animals from the group B underwent the same procedures of group A, but with differences in the colostomy confection. In rats from subgroups A1, A2, A3, B1, B2, and B3 2ml of blood were aspirated from the heart, and fragments from mesenteric lymphatic nodule, liver, spleen, lung and kidney taken for microbiological analysis, after their death. This analysis consisted of evidencing the presence of E. coli ATCC 25922 CFU. Mann-Whitney and ANOVA Tests were applied as analytic techniques for association of variables. Results: The occurrence of BT was evidenced only in those animals in which inoculated concentration of E. coli ATCC 25922, reached levels of 1011CFU/ml, i.e. in Subgroups A3 and B3, although, being significantly greater (80%) in those animals without colostomy (subgroup B3) when compared to the ones with colostomy (20%) from the subgroup A3 (P <0.05). Lung, liver and mesenteric lymphatic nodules were the tissues with larger percentile of bacterial recovery, so much in subgroup A3, as in B3. Blood culture was considered positive in 60% of the animals from subgroup B3 and in 10% of those from subgroup A3 (p <0.05). There was greater concentration of neutral sugars, in subgroup A4 - mean 27.3mg/ml -, than in subgroup B4 - mean 8.4mg/ml - (P <0.05). Conclusion: The modifications in the architecture of intestinal mucosa in colitis following fecal diversion can cause alterations in the intestinal barrier, but it does not necessarily lead to an increased frequency of BT

Aditivos químicos e biológicos na ensilagem de cana-de-açúcar: 1. composição química das silagens, ingestão, digestibilidade e comportamento ingestivo

Avaliou-se o efeito da inclusão de aditivos na ensilagem de cana-de-açúcar (Saccharum officinarum L.) sobre a composição químico-bromatológica das silagens, o comportamento ingestivo, o consumo voluntário e a digestibilidade em bovinos de corte. Utilizaram-se cinco novilhos da raça Nelore providos de cânula ruminal, alocados em delineamento quadrado latino 5 ´ 5 e alimentados com dietas com 65% de volumoso na MS. Foram avaliadas cinco silagens (base úmida): controle - cana-de-açúcar sem aditivos; uréia - cana-de-açúcar + 0,5% uréia; benzoato - cana-de-açúcar + 0,1% de benzoato de sódio; LP - cana-de-açúcar inoculada com Lactobacillus plantarum (1 ´ 10(6) ufc/g MV); LB - cana-de-açúcar inoculada com L. buchneri (3,6 ´ 10(5) ufc/g forragem). A forragem foi armazenada em silos do tipo poço por 90 dias antes do fornecimento aos animais. A composição químico-bromatológica da cana-de-açúcar foi alterada após a ensilagem, em relação à cana-de-açúcar original, com redução no teor de carboidratos solúveis e na digestibilidade in vitro e elevação relativa nos teores de FDN e FDA. Os teores de etanol (0,30% da MS) e ácidos orgânicos (0,99% de ácido lático e 2,31% de acético) foram baixos e semelhantes entre as silagens. Os aditivos aplicados na ensilagem não promoveram alterações no consumo e na digestibilidade aparente da MS (7,2 kg/dia e 63,6%, respectivamente). O comportamento ingestivo dos animais também não foi alterado, com tempos médios de 230,6; 519,6 e 672,8 minutos/dia despendidos com ingestão de ração, ruminação e ócio, respectivamente. Os aditivos acrescidos à cana-de-açúcar promoveram pequenas alterações na maioria das variáveis avaliadas.

Aditivos químicos ou biológicos na ensilagem de cana-de-açúcar: 2. parâmetros ruminais e degradabilidade da matéria seca e das frações fibrosas

Objetivou-se avaliar o efeito da inclusão de aditivos na ensilagem de cana-de-açúcar (Saccharum officinarum L.) sobre a degradação de MS e de componentes da parede celular e sobre os parâmetros de fermentação ruminal em bovinos alimentados com dietas contendo essas silagens. Utilizaram-se cinco novilhos da raça Nelore providos de cânula ruminal, alocados em delineamento quadrado latino 5 ´ 5 e alimentados com dietas com 65% de volumoso (%) MS. Foram avaliadas cinco silagens (base úmida): controle - cana-de-açúcar, sem aditivos; uréia - cana-de-açúcar + 0,5% ureia; benzoato - cana-de-açúcar + 0,1% de benzoato de sódio; LP - cana-de-açúcar inoculada com Lactobacillus plantarum (1 ´ 10(6) ufc/g MV); LB - cana-de-açúcar inoculada com L. buchneri (3,6 ´ 10(5) ufc/g forragem). A forragem foi armazenada em silos do tipo poço por 90 dias antes do fornecimento aos animais. Os parâmetros ruminais foram afetados de forma moderada pelas silagens e tiveram forte efeito do horário de coleta de amostras. As concentrações molares médias dos ácidos acético, propiônico e butírico foram de 60,9; 19,3 e 10,2 mM, respectivamente. O ambiente ruminal proporcionado por dietas formuladas com silagens de cana-de-açúcar foi satisfatório e similar ao tradicionalmente observado em dietas contendo cana. O uso de aditivos na ensilagem influenciou, de forma não-significativa, a degradabilidade ruminal da MS e da MO, mas não alterou a degradabilidade ruminal da fração fibrosa. Os aditivos aplicados à cana-de-açúcar resultaram em pequenas alterações na maior parte das variáveis avaliadas. Apesar de a degradabilidade ruminal das silagens ter sido pouco afetada pelo uso de aditivos, os valores observados foram próximos aos observados para a cana-de-açúcar in natura.

Qualidade de vida da pessoa portadora de ostomia na unidade local de saúde nordeste

Uma ostomia de eliminação intestinal resulta de um procedimento cirúrgico que consiste na ligação de uma parte do intestino delgado ou grosso, a um orifício externo na cavidade abdominal designado de estoma. O utente portador de uma ostomia de eliminação intestinal, devido à sua situação clínica, manifesta um misto de emoções resultante do enorme impacto físico e emocional devido à doença e ao tratamento. A sua própria vida vai desencadear alterações profundas no seu EU, nos estilos de vida, nas relações familiares e sociais, na sua imagem corporal e na autoestima (Pinto, 2012). Foi objetivo deste estudo analisar a perceção que a pessoa portadora de ostomia de eliminação intestinal, seguida na Unidade Local de Saúde Nordeste (ULSNE), tem sobre a sua qualidade de vida (QV). A investigação enquadra-se no domínio da investigação observacional, optando-se pela realização de um estudo descritivo, analítico e transversal, de abordagem quantitativa. Como instrumento de colheita de dados foi utilizado um formulário com questões relativas às características sociodemográficas, a escala de Graffar e a escala de avaliação da qualidade de vida do utente ostomizado. Aceitaram participar no estudo 105 utentes portadores de eliminação intestinal. O sexo predominante é o masculino (50,5%). A classe etária mais representativa é a dos 65 aos 92 anos (78,1%) e o estado civil predominante antes (67,6%) e depois (55,2%) da cirurgia é o de casado. Quanto à atividade laboral, o abandono do trabalho a tempo inteiro, devido à nova situação clínica, foi referido por 94,3% dos inquiridos. Em relação às habilitações académicas, 46,7% sabe ler e escrever, enquadrando-se na classe social média (57,1%). A consulta de estomaterapia na ULSNE ainda não está implementada, mas os inquiridos consideram que a sua implementação seria pertinente (93,3%), facilitando principalmente a adaptação à nova realidade (40%), a ultrapassar dificuldades (28,6%), a evitar complicações/resolver os problemas (9,5%). A média da QV dos participantes neste estudo é de 279,92, superior à média teórica da escala (215), indicando os inquiridos evidenciam um bom nível de qualidade de vida. O enfermeiro estomaterapeuta é o profissional que melhor pode proporcionar toda a informação e suportes necessários, que permitam ultrapassar os problemas e as limitações sentidas pelo ostomizado e pelas pessoas significativas na sua vida.

Usefulness of clinical observations and blood chemistry values for predicting clinical outcomes in dairy goats with pregnancy toxaemia

Background Pregnancy toxaemia (PT) is a disease that affects pregnant goats during their last month of gestation and is characterized by a high case fatality rate. This study involved 32 does maintained on a commercial dairy goat farm that were diagnosed with PT. A physical examination was performed on and haematology parameters obtained from each doe, at the time of diagnosis. The data from the 24 PT goats that died was compared with the corresponding data from the 8 PT goats that survived. Results Polypnea, swollen limbs, anorexia with absence of ruminal motility, recumbency, nervous signs and drooping ears were the most frequently observed clinical manifestations. Nineteen out of 21 recumbent goats died. Sixteen out of 17 goats with anorexia and absence of ruminal motility died. Mean beta-hydroxybutyric acid (BHBA) values in the goats that died were not significantly different from those in goats that survived. The blood values for pH and pCO2 (p < 0.005) as well as for HCO3 −, BE and K+ (p < 0.001) were significantly lower in the goats that died than in those that survived. Conclusions The clinical signs most indicative of a poor prognosis are anorexia with absence of ruminal motility and recumbency. Among the blood parameters to be considered, hypokalaemia and metabolic acidosis are the most relevant. Goats with PT have a high mortality and their condition can deteriorate very fast. Based on the authors’s experience, a good strategy to minimize the economic losses caused by PT is to focus on the offspring survival rate since an early decision (induction of kidding or caesarian surgery) can increase the number of alive kids.

Avaliação histopatológica do fígado de bovinos mantidos em pastagens de Brachiaria spp. provenientes de abatedouros no Brasil

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, Programa de Pós-Graduação em Saúde Animal, 2016.