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Sousa-Catita D, Mascarenhas P, Oliveira C, Grunho M, Santos CA, Fonseca J. Nutrition and Outcome of 100 Endoscopic Gastrostomy-Fed Citizens with Severe Dementia. Nutrients 2023; 15:2753. [PMID: 37375659 DOI: 10.3390/nu15122753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Dementia is a rising public health concern. Feeding and nutritional problems increase as the disease progresses, affecting the clinical course and caregiver burden. While some guidelines advise against percutaneous endoscopic gastrostomy (PEG) and tube feeding in advanced dementia, conflicting evidence exists. This study aims to evaluate the nutritional status and influence of PEG feeding on the outcome and evolution of nutritional/prognosis markers of patients with severe dementia (PWSD) who underwent gastrostomy for nutritional support. We conducted a 16-year retrospective study on 100 PEG-fed PWSD with strong familial support. We evaluated the survival PEG-feeding period, safety, and objective nutritional/prognosis data on the gastrostomy day and after 3 months: Body Mass Index (BMI), Mid Upper Arm Circumference, Tricipital Skinfold, Mid-Arm Muscle Circumference, albumin, transferrin, total cholesterol, and hemoglobin. Most patients presented low values in these nutritional/prognosis parameters. No major life-threatening PEG complications were reported. The mean survival time after gastrostomy was 27.9 months (median of 17 months). Female sex, BMI recovery at 3 months, and higher baseline hemoglobin levels were associated with a reduced risk of death and increased survival time. The study concluded that, in carefully selected PWSD with strong familial support, PEG feeding can improve nutritional status and have a positive impact on survival.
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Affiliation(s)
- Diogo Sousa-Catita
- Grupo de Patologia Médica, Nutrição e Estudos Clínicos (PaMNEC) of Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
- Residências Montepio-Serviços de Saúde, SA-Rua Julieta Ferrão N° 10-5°, 1600-131 Lisboa, Portugal
| | - Paulo Mascarenhas
- Grupo de Patologia Médica, Nutrição e Estudos Clínicos (PaMNEC) of Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| | - Cátia Oliveira
- GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Miguel Grunho
- Grupo de Patologia Médica, Nutrição e Estudos Clínicos (PaMNEC) of Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- Neurology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Carla Adriana Santos
- GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Jorge Fonseca
- Grupo de Patologia Médica, Nutrição e Estudos Clínicos (PaMNEC) of Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
- GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal
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Pinheiro RA, Zanuncio JC, Toma R, Isaac Junior JB, Soares MA, Santos CA, Serrão JE, Cabral MJS, Tavares MT. Brachymeria koehleri (Hymenoptera: Chalcididae): first record as hyperparasitoid in Dione juno juno (Lepidoptera: Nymphalidae) pupae. BRAZ J BIOL 2022; 82:e260645. [PMID: 36515296 DOI: 10.1590/1519-6984.260645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- R A Pinheiro
- Universidade Federal de Viçosa - UFV, Departamento de Biologia Geral, Viçosa, MG, Brasil
| | - J C Zanuncio
- Universidade Federal de Viçosa - UFV, Instituto de Biotecnologia Aplicada à Agropecuária - BIOAGRO, Departamento de Entomologia, Viçosa, MG, Brasil
| | - R Toma
- Fiocruz Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - J B Isaac Junior
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Departamento de Ciências Biológicas e da Saúde, Diamantina, MG, Brasil
| | - M A Soares
- Universidade Federal dos Vales do Jequitinhonha e Mucuri -- UFVJM, Departamento de Agronomia, Diamantina, MG, Brasil
| | - C A Santos
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Departamento de Ciências Biológicas e da Saúde, Diamantina, MG, Brasil
| | - J E Serrão
- Universidade Federal de Viçosa - UFV, Departamento de Biologia Geral, Viçosa, MG, Brasil
| | - M J S Cabral
- Universidade Federal dos Vales do Jequitinhonha e Mucuri -- UFVJM, Departamento de Agronomia, Diamantina, MG, Brasil
| | - M T Tavares
- Universidade Federal do Espírito Santo - UFES, Departamento de Ciências Biológicas, Vitória, ES, Brasil
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Lopes S, Tavares V, Mascarenhas P, Lopes M, Cardote C, Godinho C, Oliveira C, Santos CA, Oom M, Grillo-Evangelista J, Fonseca J. Oral Health Status of Adult Dysphagic Patients That Undergo Endoscopic Gastrostomy for Long Term Enteral Feeding. Int J Environ Res Public Health 2022; 19:ijerph19084827. [PMID: 35457695 PMCID: PMC9028949 DOI: 10.3390/ijerph19084827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022]
Abstract
Background: Endoscopic Gastrostomy (PEG) is required to maintain a feeding route when neurological or cancer dysphagia impact oral intake. This study aimed to evaluate the oral health and oral changes of PEG-patients without oral feeding for three months. Methods: Prospective observational study, with a PEG-patients convenience sample. Data were obtained before PEG (T0) and 3 months after gastrostomy (T1). Initial oral hygiene habits were collected through a questionnaire. Intra-oral evaluation was performed using: Plaque Index (IP), Gingival Index (IG), Decayed, Missing and Filled Teeth Index (DMF), Community Periodontal Index (CPI), and Attachment Loss (AL). T0 and T1 were compared to evaluate oral health evolution. Results: Thirty-nine patients aged 65.3 ± 17.4 years were included. Initial (T0) oral health was worse than expectable. Between assessments period, oral indexes suffered a general deterioration with statistical relevance to the DMF. The frequency of deep periodontal pockets and attachment loss remained stable. Conclusions: PEG-patients presented poor oral health and insufficient oral hygiene habits, even before gastrostomy. After three months of PEG feeding, oral health suffered a general deterioration. This outcome was probably associated with the absence of oral feeding activity, which is beneficial to oral homeostasis, and further reduced oral hygiene. Improved oral daily care and dental appointments should become part of the PEG-patients follow-up.
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Affiliation(s)
- Sara Lopes
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - Vitor Tavares
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - Paulo Mascarenhas
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (P.M.); (C.G.)
| | - Marta Lopes
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - Carolina Cardote
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (P.M.); (C.G.)
| | - Cátia Oliveira
- Artificial Feeding Team (GENE), Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (C.O.); (C.A.S.)
| | - Carla Adriana Santos
- Artificial Feeding Team (GENE), Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (C.O.); (C.A.S.)
| | - Madalena Oom
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - José Grillo-Evangelista
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal; (S.L.); (V.T.); (M.L.); (C.C.); (M.O.); (J.G.-E.)
| | - Jorge Fonseca
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (P.M.); (C.G.)
- Artificial Feeding Team (GENE), Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal; (C.O.); (C.A.S.)
- Correspondence:
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Brito M, Padinha M, Carlos S, Oliveira C, Santos AP, Nunes G, Santos CA, Fonseca J. Long-Term Intestinal Failure and Home Parenteral Support: A Single Center Experience. GE Port J Gastroenterol 2022; 30:127-133. [PMID: 37008517 PMCID: PMC10050871 DOI: 10.1159/000522161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Home parenteral nutrition (HPN) and/or home parenteral hydration (HPH) are the gold-standard treatment for patients with long-term intestinal failure (IF). The authors aimed to assess the impact of HPN/HPH on nutritional status and survival of long-term IF patients, as well as HPN/HPH-related complications. <b><i>Methods:</i></b> This was a retrospective study including IF patients under HPN/HPH followed in a single large tertiary Portuguese hospital. The data collected included demographics, underlying conditions, anatomical characteristics, type and duration of parenteral support, IF functional, pathophysiological, and clinical classifications, body mass index (BMI) at the beginning and end of follow-up, complications/hospitalizations, current patient status (deceased, alive with HPN/HPH, and alive without HPN/HPH), and cause of death. Survival after HPN/HPH beginning, until death or August 2021, was recorded in months. <b><i>Results:</i></b> Overall 13 patients were included (53.9% female, mean age 63.46 years), and 84.6% of patients presented type III IF and 15.4% type II. Short bowel syndrome caused 76.9% of IF. Nine patients received HPN and 4 HPH. Eight patients (61.5%) were underweight at the beginning of HPN/HPH. At the end of follow-up, 4 patients were alive without HPN/HPH, 4 maintained HPN/HPH, and 5 died. All patients improved their BMI (mean initial BMI 18.9 vs. 23.5 at the end, <i>p</i> < 0.001). Eight patients (61.5%) were hospitalized due to catheter-related complications, mainly infectious (mean hospitalization episodes 2.25, mean hospital stay of 24.5 days). No deaths were related to HPN/HPH. <b><i>Conclusion:</i></b> HPN/HPH significantly improved IF patients’ BMI. HPN/HPH-related hospitalizations were common, however causing no deaths, reinforcing that HPN/HPH is an adequate and safe therapy for long-term IF patients.
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Affiliation(s)
- Mariana Brito
- GENE, Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC − Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
- *Mariana Brito,
| | - Mafalda Padinha
- PaMNEC − Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
- Pharmacy Department, Hospital Garcia de Orta, Almada, Portugal
| | - Sandra Carlos
- Surgery Department, Hospital Garcia de Orta, Almada, Portugal
| | - Cátia Oliveira
- GENE, Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Gonçalo Nunes
- GENE, Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC − Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Carla Adriana Santos
- GENE, Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- GENE, Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC − Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
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Sousa-Catita D, Bernardo MA, Santos CA, Silva ML, Mascarenhas P, Godinho C, Fonseca J. Comparing Assessment Tools as Candidates for Personalized Nutritional Evaluation of Senior Citizens in a Nursing Home. Nutrients 2021; 13:nu13114160. [PMID: 34836415 PMCID: PMC8623379 DOI: 10.3390/nu13114160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 01/10/2023] Open
Abstract
Nutrition is an important health issue for seniors. In nursing homes, simple, inexpensive, fast, and validated tools to assess nutritional risk/status are indispensable. A multisurvey cross-sectional study with a convenient sample was created, comparing five nutritional screening/assessment tools and the time required for each, in order to identify the most useful instrument for a nursing home setting. Nutrition risk/status was evaluated using the following tools: Subjective Global Assessment (SGA), Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS 2002), and calf girth (CG). The time spent completing each tool was recorded. Eighty-three subjects were included. MNA-SF and CG were the screening tools that ranked highest with regards to malnutrition identification. CG failed to identify nutritional risk/malnutrition in seniors with lower limb edema. CG was the fastest tool while SGA was the slowest. This was the first study comparing non-invasive nutritional tools with time expended as a consideration in the implementation. CG is responsive, fast, and reliable in elders without edema. MNA-SF was more efficient at detecting malnutrition cases in the elderly population. Both MNA-SF and CG are considered the most suitable for the nursing home setting.
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Affiliation(s)
- Diogo Sousa-Catita
- Residências Montepio—Serviços de Saúde, SA, 1600-131 Lisboa, Portugal
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (C.G.); (J.F.)
- GENE—Artificial Feeding Team, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Correspondence: ; Tel.: +351-9-1893-5354
| | - Maria Alexandra Bernardo
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (M.A.B.); (M.L.S.); (P.M.)
| | - Carla Adriana Santos
- GENE—Artificial Feeding Team, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
| | - Maria Leonor Silva
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (M.A.B.); (M.L.S.); (P.M.)
| | - Paulo Mascarenhas
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (M.A.B.); (M.L.S.); (P.M.)
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (C.G.); (J.F.)
| | - Jorge Fonseca
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal; (C.G.); (J.F.)
- GENE—Artificial Feeding Team, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
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Santos I, Mendes L, Mansinho H, Santos CA. Nutritional status and functional status of the pancreatic cancer patients and the impact of adjacent symptoms. Clin Nutr 2021; 40:5486-5493. [PMID: 34656030 DOI: 10.1016/j.clnu.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 01/04/2023]
Abstract
RATIONALE & AIMS Pancreatic cancer (PC) is the third most common type of gastrointestinal tract cancer in Europe and the fourth leading cause of death by cancer. Its initial stage is asymptomatic Therefore, the diagnosis tends to be late leading to locally advanced stages that presuppose late and debilitating symptoms, which consequently makes the Nutritional Status (NS) get worse. The weight loss (WL), malnutrition, and oncologic cachexia, which are quite prevalent in PC patients, reflect a poor prognosis. We aimed to track and evaluate the NS and Functional Status (FS) of PC patients (hospitalized patients - HP and Day Hospital patients - DHP) and associate NS with symptoms with nutritional impact and FS. METHODS Observational cohort study in PC patients from Garcia de Orta Hospital. NS was tracked and evaluated using Nutritional Risk Screening (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA). To assess FS we used the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Scale Index (KPSI) and Handgrip Dynamometer (HGD). RESULTS 41 PC patients (30-HP and 11-DHP). 29 patients in stage IV of the tumor. 24 with a WL >10% in the last 6 months. 37 manifest symptoms with nutritional impact. 30 to 34 malnourished according to the GLIM criteria and PG-SGA, respectively. 11 in ECOG level 2 and corresponding KPSI, 10 in level 3 and 8 in level 4. 28 patients had a value of HGD below the 10th percentile. NRS-2002, PG-SGA and GLIM criteria were positively correlated with the symptoms (p < 0.01), % WL (p < 0.01) and ECOG (p < 0.01) and negatively correlated with HGS (p < 0.05 - NRS-2002; p < 0.01 - PG-SGA and GLIM criteria). CONCLUSIONS PC patients manifest debilitating symptoms with nutritional impact, namely severe WL and anorexia, which in turn lead to deterioration of the NS and FS. It is an oncology population with high nutritional risk and a higher prevalence of malnutrition, associated with severe % WL and symptoms and a sharp decline in FS.
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Affiliation(s)
- I Santos
- Serviço de Nutrição, Hospital Garcia de Orta, Portugal; Dietética e Nutrição, Escola Superior de Tecnologia da Saúde de Lisboa, IPL, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - L Mendes
- Dietética e Nutrição, Escola Superior de Tecnologia da Saúde de Lisboa, IPL, Portugal; Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro de Investigação em Saúde e Tecnologia (H&TRC), Portugal
| | - H Mansinho
- Serviço de Hemato-Oncologia, Hospital Garcia de Orta, Portugal
| | - C A Santos
- Serviço de Nutrição, Hospital Garcia de Orta, Portugal; Dietética e Nutrição, Escola Superior de Tecnologia da Saúde de Lisboa, IPL, Portugal; Centro de Investigação em Saúde e Tecnologia (H&TRC), Portugal
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Santos IM, Mendes L, Carolino E, Santos CA. Nutritional Status, Functional Status, and Quality of Life - What is the Impact and Relationship on Cancer Patients? Nutr Cancer 2020; 73:2554-2567. [PMID: 33121266 DOI: 10.1080/01635581.2020.1839520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE AND AIMS Malnutrition is common and multifactorial in cancer patients (CP), combining the systemic inflammatory process with decreased food intake, loss of muscle and bone mass, and decreased functional status (FS). We aimed to track and evaluate the nutritional status (NS) of CP; associate results between hospitalized patients (HP) and day hospital patients (DHP); associate NS with tumor, symptoms, and FS. METHODS Cross-sectional observational study in HP or DHP from Garcia de Orta Hospital, over 18 years old. NS was monitored and evaluated using Nutritional Risk Screening (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and anthropometric and biochemical parameters. To assess FS we used the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Scale Index (KPSI), and handgrip dynamometer (HGD). RESULTS The 265 CP (114-HP, 151-DHP), of which 34.2%-HP and 17.2%-DHP had low BMI. From NRS-2002, 86.0% and 35.8% were respectively at nutritional risk. Using PG-SGA, 93.0% and 39.7% were respectively malnourished. PG-SGA were positively correlated with ECOG (p < 0.01) and negatively correlated with KPSI (p < 0.01), BMI (p < 0.01), and handgrip strength-HGS (p < 0.01-DHP and p < 0.05-HP). CONCLUSIONS PG-SGA and FS scales are appropriate and validated tools for early identification of malnutrition and FS in CP. HGD can be a useful tool for assessing FS and NS.
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Affiliation(s)
- Inês Miranda Santos
- Dietetics and Nutrition, Lisbon School of Health Technology, Lisbon, Portugal
| | - Lino Mendes
- Dietetics and Nutrition, Lisbon School of Health Technology, Lisbon, Portugal.,H&TRC (Health and Technology Research Center), Lisbon, Portugal
| | - Elisabete Carolino
- Department of Natural and Exact Sciences - Mathematical Science Area, Lisbon School of Health Technology, Lisbon, Portugal
| | - Carla Adriana Santos
- H&TRC (Health and Technology Research Center), Lisbon, Portugal.,Nutrition Department & GENE (Enteral Feeding Team), Garcia de Orta Hospital, Lisbon, Portugal
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Tavares LCB, Cunha MPV, de Vasconcellos FM, Bertani AMDJ, de Barcellos TAF, Bueno MS, Santos CA, Sant'Ana DA, Ferreira AM, Mondelli AL, Montelli AC, Sadatsune T, Sacchi CT, Gonçalves CR, Tiba-Casas MR, Camargo CH. Genomic and Clinical Characterization of IMP-1-Producing Multidrug-Resistant Acinetobacter bereziniae Isolates from Bloodstream Infections in a Brazilian Tertiary Hospital. Microb Drug Resist 2020; 26:1399-1404. [PMID: 32155381 DOI: 10.1089/mdr.2019.0210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Acinetobacter baumannii is the main species of the Acinetobacter genus; however, non-baumannii Acinetobacter (NBA) species causing infections have been described for the past years, as well as antimicrobial resistance. In this study, we describe the occurrence of two multidrug-resistant (MDR) IMP-1-producing Acinetobacter bereziniae isolates recovered from bloodstream infections in different patients but in the same intensive care unit among 134 carbapenem-resistant Acinetobacter screened. Antimicrobial susceptibility testing revealed resistance to carbapenems, extended spectrum, and antipseudomonad cephalosporins, amikacin, and trimethoprim-sulfamethoxazole. Both A. bereziniae isolates shared the same ApaI-pulsed-field gel electrophoresis (PFGE) pattern. Whole-genome sequencing of both isolates revealed that blaIMP-1 was embedded into an In86 Class I integron carrying also sul1, aac(6')-31, and aadA genes. A new sequence type (ST1309 Pasteur) was deposited. The virulence genes lpxC and ompA, seen in A. baumannii, were detected in the A. bereziniae strains. Recognition of A. bereziniae causing invasive MDR infection underscores the role of NBA species as human pathogens especially in at-risk patients.
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Affiliation(s)
- Lais Calissi Brisolla Tavares
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Thays Almeida Franco de Barcellos
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Sardinha Bueno
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Terue Sadatsune
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
| | | | | | | | - Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil.,Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Santos CA, Avelino JL, Souza GM, Winkelstroter LK. Qualidade higiênico-sanitária de suco de laranja in natura e estabelecimentos comerciais. SaudPesq 2020. [DOI: 10.17765/2176-9206.2020v13n1p205-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
O objetivo deste estudo foi analisar a qualidade microbiológica de suco de laranja in natura em Presidente Prudente (SP) e estabelecimentos comerciais. Foi avaliada a qualidade higiêncio-sanitária do ambiente de trabalho mediante um check-list e a qualidade do suco de laranja por contagem em placa. Os resultados foram submetidos à análise de variância (ANOVA) para dados não paramétricos (Kruskal-Wallis) com p
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Nunes G, Barosa R, Santos CA, Fonseca J. GASTRIC SLEEVE SURGERY AS A NEW CLINICAL INDICATION FOR SURGICAL GASTROSTOMY AFTER FAILURE OF ENDOSCOPIC APPROACH IN PATIENTS WHO NEED LONG-TERM ENTERAL NUTRITION. Arq Bras Cir Dig 2019; 30:229. [PMID: 29019568 PMCID: PMC5630220 DOI: 10.1590/0102-6720201700030015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 06/20/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Gonçalo Nunes
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Rita Barosa
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Carla Adriana Santos
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Jorge Fonseca
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
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Nunes G, Paiva de Oliveira G, Cruz J, Santos CA, Fonseca J. Long-Term Gastrocolocutaneous Fistula after Endoscopic Gastrostomy: How Concerned Should We Be? GE Port J Gastroenterol 2019; 26:441-447. [PMID: 31832501 DOI: 10.1159/000497248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/21/2019] [Indexed: 01/25/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a safe technique for long-term enteral feeding. The most common PEG-associated adverse events are minor. Gastrocolocutaneous fistula (GCCF) results from misplacement of the PEG tube through the colon. The importance of this complication is not currently defined, and there is no clearly established therapeutic algorithm. The authors report a series of 3 cases of GCCF diagnosed and treated in a tertiary center. Case 1 An 88-year-old man underwent PEG due to head and neck cancer. The procedure was uneventful, and the patient remained asymptomatic. After the first PEG tube substitution performed at 6 months, stool drainage through the stoma was observed. Computed tomography (CT) showed a GCCF. After tube removal, the fistula spontaneously closed, and the patient remained under nasogastric feeding until death. Case 2 A 31-year-old man with hereditary spastic paraplegia was submitted to PEG without early complications. The patient remained asymptomatic, and 7 months later, replacement of the PEG tube was planned. Under endoscopic control, the primary tube was removed, but the balloon replacement tube, introduced through the skin, was not observed in the gastric lumen. CT displayed a GCCF that spontaneously closed after a few days. A combined laparoscopic and endoscopic approach was used to resect the fistula tracts and perform a new gastrostomy. Case 3 A 45-year-old man with cerebral palsy was referred to PEG. Skin transillumination was only observed transiently, and the abdominal puncture was performed obliquely. The patient remained asymptomatic until the 7th month, when the primary PEG tube replacement was performed. The percutaneously placed substitution tube did not reach the stomach. GCCF was evident on CT. The fistula spontaneously closed, and the patient was referred to elective surgery for laparoscopic gastrostomy. GCCF is an uncommon complication of PEG. Its clinical course seems to be benign with patients remaining asymptomatic under ambulatory enteral feeding for long periods until PEG tube replacement. Spontaneous fistula closure is the rule in this setting. Laparoscopic gastrostomy should be considered when a new PEG is advised and cannot be safely performed due to colon interposition.
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Affiliation(s)
- Gonçalo Nunes
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - João Cruz
- Radiology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Jorge Fonseca
- CiiEM - Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
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Santos CA, Matos SMA, Pitanga FJG, Maia HF. Handgrip strength as discriminator of sarcopenia and sarcopenia obesity in adults of the ELSA-Brasil. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- CA Santos
- Department of Biological Sciences, State University of Southwestern Bahia (UESB), Jequié, Bahia, Brazil
| | - SMA Matos
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - FJG Pitanga
- Department of Physical Education, School of Education, Federal University of Bahia, Salvador, Bahia, Brazil
| | - HF Maia
- Department of Life Sciences I, University of the State of Bahia (UNB), Salvador, Bahia, Brazil
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Barosa R, Roque Ramos L, Santos CA, Pereira M, Fonseca J. Mid upper arm circumference and Powell-Tuck and Hennessy's equation correlate with body mass index and can be used sequentially in gastrostomy fed patients. Clin Nutr 2018; 37:1584-1588. [DOI: 10.1016/j.clnu.2017.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 01/07/2023]
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Vieira J, Nunes G, Santos CA, Fonseca J. SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY. Arq Gastroenterol 2018; 55:41-45. [PMID: 29561975 DOI: 10.1590/s0004-2803.201800000-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. OBJECTIVE This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. METHODS Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus) were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. RESULTS We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%), magnesium in 21 (20.8%), chlorine in 21 (20.8%), potassium in 14 (13.8%), calcium in 11 (10.9 %) and phosphorus in 11 (10.9%). The survival of patients with low sodium (<135 mmol/L) was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007). CONCLUSION Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.
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Affiliation(s)
- Joana Vieira
- Departamento de Gastroenterologia, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Gonçalo Nunes
- Departamento de Gastroenterologia, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Carla Adriana Santos
- Departamento de Gastroenterologia, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- Departamento de Gastroenterologia, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal.,CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
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Nunes G, Barata AT, Santos CA, Patita M, Fonseca J. Nutritional deficiency during colonoscopy preparation: the forgotten iatrogeny. Rev Esp Enferm Dig 2018; 110:285-291. [PMID: 29332407 DOI: 10.17235/reed.2018.5140/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS bowel preparation for colonoscopy induces a semi-fasting state, with a potential negative impact on fragile patients. The present study aims to quantify nutritional deficiency during colonoscopy preparation. METHODS this was an observational and cross-sectional study. A convenience sample was obtained that included adults that underwent colonoscopy after bowel preparation with Klean-Prep® according to the center protocol. Anthropometric evaluation was performed and nutritional deficiency was calculated via the quantification of energy and protein intake during the 48 hours prior to the examination which was compared with the individuals' needs. The association between nutritional deficiency with the quality of bowel preparation, age and status (hospitalized/ambulatory) was evaluated. RESULTS the study included 131 patients aged 21-91 years (mean 63.6 ± 13.2 years); 73 cases were male. Malnutrition reached 67.2% using specific anthropometric tools. A median preparation quality of six points was found when the Boston Bowel Preparation Scale was considered. The mean intake 48 hours prior to the procedure was 1,795 kcal and 100 g of protein. A daily energy intake of less than 50% of the individual needs was observed in 88 patients and less than 25% in 29 cases. The mean energy and protein deficiency were 59% (p < 0.01) and 45% (p < 0.01), and there was no correlation with preparation quality (p > 0.05). Nutritional defiency is similar in hospitalized and ambulatory patients (p > 0.05), but higher in older individuals (p = 0.04). CONCLUSIONS nutritional deficiency during colonoscopy preparation was significant, more so in older patients, and there was no correlation with the quality of bowel preparation. We conclude that bowel preparation regimens should be reformulated with an improved nutritional intake and the inclusion of nutritional supplements without residues.
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Affiliation(s)
| | | | | | - Marta Patita
- Gastroenterology Department, Hospital Garcia de Orta. Portugal
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Nunes G, Rodrigues Alves T, Luz C, Vieira I, Carmona L, Santos CA, Fonseca J. False transfixation of the liver using an endoscopic gastrostomy tube: Do not always believe in radiologic images. Turk J Gastroenterol 2017; 28:526-527. [PMID: 29086723 DOI: 10.5152/tjg.2017.17258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gonçalo Nunes
- Department of Gastroenterology, Hospital Garcia de Orta, GENE-Artificial Feeding Team, Almada, Portugal.
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Santos CA, Fonseca J, Carolino E, Guerreiro AS. LOW SERUM CHROMIUM IS RARE IN PATIENTS THAT UNDERWENT ENDOSCOPIC GASTROSTOMY FOR LONG TERM ENTERAL FEEDING. Arq Gastroenterol 2017; 54:211-216. [PMID: 28538943 DOI: 10.1590/s0004-2803.201700000-25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients that underwent Percutaneous Endoscopic Gastrostomy (PEG) present with protein-energy malnutrition. Trace elements are required in small quantities and Chromium (Cr) displays a major role in the metabolism. OBJECTIVE This study aims to evaluate Cr levels and its relationship with serum proteins, BMI and underlying diseases during the first 3 months of PEG feeding. METHODS Prospective observational study during 3-months, when PEG was performed (T0), after 4 (T1), and 12 weeks (T3). Initial evaluation included: age, gender, underlying disease, NRS-2002, BMI, serum albumin, transferrin and Cr concentration. At T1 and T3 a blood sample was collected for Cr, albumin and transferrin. A Graphite Furnace Atomic Absorption Spectroscopy was used to assess Cr. According with the underlying disease, patients were divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). All patients were fed with homemade meals. RESULTS A one hundred and twenty-nine patients (80 males), 26-95 years old were studied: HNC-52; ND-77. The observed data included low mean values of BMI from 71 patients; low Cr-8, low albumin-70, low transferrin-85 and 57 with both proteins low. Albumin was associated with survival time ( P =0.024) and there was a significant correlation between albumin and Cr (r=0.217, P =0.012). A good evolution of Cr and proteins values was observed, with no low Cr levels at T3. CONCLUSION Low serum Cr is rare in PEG-patients, with no relationship to other studied parameters. For the minority of patients displaying low Cr before gastrostomy, homemade PEG meals seem to be effective.
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Affiliation(s)
| | - Jorge Fonseca
- GENE - Enteral Feeding Team. Hospital Garcia de Orta, Portugal.,Center for Interdisciplinary Research Egas Moniz (CiiEM), Almada, Portugal
| | - Elisabete Carolino
- Departamento das Ciências Naturais e Exatas, Escola Superior de Tecnologias da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - António Sousa Guerreiro
- Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.,Serviço de Medicina 4 / Hospital Santa Marta / Centro Hospitalar de Lisboa Central, Portugal
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Santos CA, Fonseca J, Lopes MTM, Carolino E, Guerreiro AS. Serum zinc evolution in dysphagic patients that underwent endoscopic gastrostomy for long term enteral feeding. Asia Pac J Clin Nutr 2017; 26:227-233. [PMID: 28244699 DOI: 10.6133/apjcn.022016.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing endoscopic gastrostomy (PEG) present with protein-energy malnutrition (PEM) but little is known about zinc status. Our aim was to evaluate serum zinc, its relationship with serum proteins and with the nature of the underlying disorder, during the first 3 months of PEG feeding. METHODS AND STUDY DESIGN Prospective observational study during a 3-month period after gastrostomy. Data was collected at initial PEG procedure (T0), after 4 (T1) and 12 weeks (T3). Initial evaluation included: age, gender, disorder causing dysphagia, Neurological Dysphagia (ND) or Head and Neck Cancer (HNC), NRS-2002, BMI, albumin, transferrin, zinc. At T1 and T3, a blood sample was collected for zinc, albumin, transferrin. Serum zinc evaluation was performed with ICP-AES - Inductively Coupled Plasma-Atomic Emission Spectroscopy. Patients were fed with homemade meals. RESULTS A total of 146 patients (89 males), 21-95 years were studied: HNC-56, ND-90 and low BMI in 78. Initial low zinc in 122; low albumin in 77, low transferrin in 94; low values for both proteins in 66. Regarding the serum protein evolution, their levels increase T0-T3, most patients reaching normal values. zinc has a slower evolution, most patients still displaying low zinc at T3. Significant differences between the 3 moments for zinc (p=0.011), albumin (p<0.0001) and transferrin (p=0.014). CONCLUSION PEG patients are prone to PEM and zinc deficiency. Most patients present decreased zinc, suggesting that zinc deficiency is common in PEG candidates and is not corrected during 3 months of enteral feeding. Zinc deficiency should be expected and teams taking care of PEG patients should use zinc supplementation.
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Affiliation(s)
| | - Jorge Fonseca
- GENE-Enteral Feeding Team, Hospital Garcia de Orta, Almada, Portugal.,CiiEM-Center for Interdisciplinary Research Egas Moniz, Almada, Portugal
| | - Maria Teresa Martins Lopes
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elisabete Carolino
- Departamento das Ciências Naturais e Exatas, Escola Superior de Tecnologias da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - António Sousa Guerreiro
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Serviço de Medicina 4/Hospital Santa Marta/Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Nunes G, Santos CA, Fonseca J. Giant esophageal diverticulum as a new clinical indication for endoscopic gastrostomy. Rev Esp Enferm Dig 2017; 109:314. [PMID: 28229617 DOI: 10.17235/reed.2017.4528/2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persistent mechanical or functional dysphagia is the most common clinical indication for endoscopic gastrostomy (PEG), however less common conditions may justify prolonged enteral feeding to avoid malnutrition and prevent aspiration. The authors report the case of a 76 year old man referred to the artificial feeding outpatient clinic presenting dysphagia, malnutrition and several episodes of aspiration pneumonia. Upper endoscopy showed a giant esophageal diverticulum, ineffective peristalsis and transient lumen narrowing. X-ray and CT scan confirmed a 9cm long diverticulum. Due to a high surgical risk and unsuitability of endoscopic therapy, the patient underwent PEG, which solved aspiration and improved nutritional status. Dysphagia and aspiration due to giant esophageal diverticula emerges as a new clinical indication for PEG in malnourished patients with respiratory aspiration, not previously reported in the literature.
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Fonseca J, Nunes G, Fonseca C, Canhoto M, Barata AT, Santos CA. Comment to: "EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease". J Hepatol 2017; 66:465-466. [PMID: 27856218 DOI: 10.1016/j.jhep.2016.10.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 12/04/2022]
Affiliation(s)
- Jorge Fonseca
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal; CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Gonçalo Nunes
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal.
| | - Cristina Fonseca
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Manuela Canhoto
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Ana Teresa Barata
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
| | - Carla Adriana Santos
- Hospital Garcia de Orta, Gastroenterology Department, GENE - Artificial Feeding Team, Almada, Portugal
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Oliveira GPD, Santos CA, Fonseca J. The role of surgical gastrostomy in the age of endoscopic gastrostomy: a 13 years and 543 patients retrospective study. Rev Esp Enferm Dig 2016; 108:776-779. [PMID: 27822950 DOI: 10.17235/reed.2016.4060/2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) became the gold standard for enteral feeding. Currently, surgical gastrostomy is seldom used. OBJECTIVE Evaluating the role of surgical gastrostomy in a center with a large experience in PEG. METHODS A retrospective study ranged 13 years, collecting from clinical records: age, gender, underlying disease, date of procedure, technique, primary surgery, complications, 30-day mortality. Patients were divided according to indication for gastrostomy: a) neurological; b) head and neck cancer; c) other diseases; and d) drainage. PEG, open surgical and laparoscopic gastrostomies were compared concerning evolution of the number of procedures, characteristics of patients, complications and mortality. RESULTS We identified 509 PEG, 26 open and 8 laparoscopic surgical gastrostomies. An increasing number of the percutaneous approach over the years was observed, while the number of surgical gastrostomies remains steady (mean: 2.6/year). All percutaneous endoscopic gastrostomies but three were feeding procedures, mostly in neurological patients. All laparoscopic gastrostomies were feeding procedures in head and neck cancer. Most open surgical gastrostomies were secondary procedures, part of more complex surgeries, and frequently for drainage purposes. The open surgical approach displayed more morbidity and mortality, reflecting the severity of underlying diseases. CONCLUSIONS In our institution, open surgical gastrostomy is seldom used, and mostly as part of complex procedures, frequently for drainage purposes. PEG is the choice to most dysphagic patients needing an enteral feeding access. When not feasible, laparoscopic gastrostomy is a suitable alternative.
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Affiliation(s)
| | | | - Jorge Fonseca
- Gastroenterology Department, Hospital Garcia de Orta
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Fonseca J, Santos CA, Brito J. Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy. Nutr Cancer 2016; 68:589-97. [PMID: 27144413 DOI: 10.1080/01635581.2016.1158297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Head and neck cancer (HNC) patients who underwent percutaneous endoscopic gastrostomy (PEG) present malnutrition risk and speech impairments. Their assessment relies on objective anthropometric/laboratory data. Focusing on HNC PEG patients, our aims were to evaluate: 1) outcome; 2) nutritional status when the patients underwent PEG; and 3) association of nutritional status/outcome, creating a survival predictive model. We evaluated the outcome based on NRS 2002, dietary assessment, body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), albumin, transferrin, and cholesterol on the day of gastrostomy. Using BMI, TSF, MAMC, and laboratory data, a survival predictive model was created. Of the 234 patients (cancer stages III-IV), 149 died, 33 were still PEG-fed, and 36 resumed oral intake (NRS-2002≥3, caloric needs <50% in all). BMI was 12.7-43. 189, 197, and 168 patients displayed, respectively, low MUAC, TSF, and MAMC. 91, 155, and 119 patients displayed low albumin, transferrin, and cholesterol. Albumin, cholesterol, and transferrin were strongly associated with the outcome. A predictive model was created, discriminating between short-term survivors (<4 months) and long-term survivors. HNC patients were malnourished. Using anthropometric/laboratory parameters, a predictive model provides discrimination between patients surviving PEG for <4 months and long-term survivors. Teams taking care of PEG patients may provide special support to potential short-term survivors.
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Affiliation(s)
- Jorge Fonseca
- a GENE - Hospital Garcia de Orta , Almada , Portugal.,b CiiEM - Center for Interdisciplinary Research Egas Moniz , Monte de Caparica , Portugal
| | | | - José Brito
- b CiiEM - Center for Interdisciplinary Research Egas Moniz , Monte de Caparica , Portugal
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Santos CA, Fonseca J, Carolino E, Lopes T, Guerreiro AS. SELENIUM IN DYSPHAGIC PATIENTS WHO UNDERWENT ENDOSCOPIC GASTROSTOMY FOR LONG TERM ENTERAL FEEDING. NUTR HOSP 2015; 32:2725-33. [PMID: 26667727 DOI: 10.3305/nh.2015.32.6.9756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIMS endoscopic gastrostomy (PEG) patients usually present protein-energy malnutrition, but little is known about selenium deficiency. We aimed to assess serum selenium evolution when patients underwent PEG, after 4 and 12 weeks. We also evaluated the evolution of albumin, transferrin and Body Mass Index and the influence of the nature of the underlying disease. METHODS a blood sample was obtained before PEG (T0), after 4 (T1) and 12 (T3) weeks. Selenium was assayed using GFAAS (Furnace Atomic Absorption Spectroscopy). The PEG patients were fed through homemade meals. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). RESULTS we assessed 146 patients (89 males), between 21-95 years old: HNC-56; ND-90. Normal values of selenium in 79% (n=115); low albumin in 77, low transferrin in 94, low values for both serum proteins in 66. Low BMI in 78. Selenium has slow evolution, with most patients still displaying normal Selenium at T3 (82%). Serum protein levels increase from T0 to T3, most patients reaching normal values. The nature of the underlying disease is associated with serum proteins but not with selenium. CONCLUSIONS low serum selenium is uncommon when PEG is performed, after 4 and 12 weeks of enteral feeding and cannot be related with serum proteins levels or dysphagia cause. Enteral nutrition using customized homemade kitchen meals is satisfactory to prevent or correct Selenium deficiency in the majority of PEG patients.
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Affiliation(s)
| | - Jorge Fonseca
- GENE - Enteral Feeding Team. Hospital García de Orta, Almada. CiiEM - Center for Interdisciplinary Research Egas Moniz, Almada..
| | - Elisabete Carolino
- Departamento das Ciências Naturais e Exatas, Área Científica de Matemática. Escola Superior de Tecnologias da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa..
| | - Teresa Lopes
- CEDOC, NOVA Medical School. Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa..
| | - António Sousa Guerreiro
- CEDOC, NOVA Medical School. Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa. Unidade Funcional de Med 4. Hospital Santa Marta. Centro Hospitalar de Lisboa Central, Lisboa, Portugal..
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Santos CA, Pereira M, Martins VS, Fonseca J. TRAQUEOESOPHAGEAL FISTULA PATIENTS FED THROUGH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY/GASTROJEJUNOSTOMY: NUTRITIONAL STATUS AND CLINICAL OUTCOME. NUTR HOSP 2015; 32:691-5. [PMID: 26268100 DOI: 10.3305/nh.2015.32.2.9078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND tracheoesophageal fistula (TEF) may result from cancer or mechanical ventilation. Endoscopic Gastrostomy or Gastrojejunostomy (PEG/PEG-J) is used for nutritional support. OBJECTIVE in TEF-patients, evaluating nutritional status when PEG is performed, safety of PEG/PEG-J and clinical outcome. METHODS from the files of PEG/PEG-J feed TEF-patients we collected: clinical data, Body Mass Index, albumin, transferrin and cholesterol when gastrostomy was performed, and clinical outcome globally and according with the TEF cause: Group 1: complication of mechanical ventilation, Group 2: cancer. RESULTS twelve patients, 18-91 years (median: 53), 11 PEG, one PEG-J: six complications of ventilation (neurological diseases), 6 cancers. Mean period from TEF diagnosis until gastrostomy: 2 months in Group 1, 10 months in Group 2. In the day of the gastrostomy, patients presented with malnutrition parameters, most strikingly in the cancer group. Group 1: died a single patient, 3 closed the TEF, resuming oral intake, 2 are still PEG-feed. All cancer patients died (7 months after gastrostomy). One needed a jejunal extension to create a PEG-J. No more complications. CONCLUSION PEG/PEG-J was safe in TEF-patients, but cancer patients underwent gastrostomy too late. In TEF-patients, PEG/PEG-J should be considered in a regular basis, earlier in the disease evolution, before established malnutrition.
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Affiliation(s)
- Carla Adriana Santos
- GENE - Grupo de Estudo de Nutrição Entérica (Enteral Feeding Team), Bloco de Exames Especias, Piso 3, Hospital Garcia de Orta, Avenida Torrado da Silva, 2800 Almada..
| | - Marta Pereira
- GENE - Grupo de Estudo de Nutrição Entérica (Enteral Feeding Team), Bloco de Exames Especias, Piso 3, Hospital Garcia de Orta, Avenida Torrado da Silva, 2800 Almada..
| | - Vera Santos Martins
- Department of Respiratory Disorders, Hospital Garcia de Orta, Avenida Torrado da Silva, 2800 Almada..
| | - Jorge Fonseca
- GENE - Grupo de Estudo de Nutrição Entérica (Enteral Feeding Team), Bloco de Exames Especias, Piso 3, Hospital Garcia de Orta, Avenida Torrado da Silva, 2800 Almada. CiiEM - Centro de Investigação Interdisciplinar Egas Moniz, Almada (Portugal)..
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Fonseca J, Santos CA. Percutaneous endoscopic gastrostomy with jejunal extension plus percutaneous endoscopic gastrostomy (PEG-j plus PEG) in patients with gastric/duodenal cancer outlet obstruction. Arq Gastroenterol 2015; 52:72-5. [PMID: 26017087 DOI: 10.1590/s0004-28032015000100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/11/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Stent palliation is the gold standard for gastric/duodenal cancer outlet obstruction. When stenting is impossible, feeding may be achieved through a gastrojejunostomy (PEG-J), but displacement of jejunal tube is frequent due to manipulation for feeding and drainage. Gastric outlet obstruction results on increased gastroesophageal reflux or extra-tube leakage. In order to reduce the jejunostomy tube manipulation and the gastric residuum, we created a second gastrostomy (PEG) dedicated to gastric drainage, reducing the PEG-J handling. OBJECTIVE Our aim was evaluating of the usefulness of an added second gastrostomy in a PEG-J patient, for: 1. controlling symptomatic reflux and extra-tube leakage; 2. preventing jejunal tube dislocation. Methods We retrospectively evaluated patients were stent palliation of gastric/duodenal cancer outlet obstruction was not achieved, who were referred and underwent PEG-J. We selected four of these patients who needed a second PEG dedicated to gastric drainage, which was performed a few centimetres apart from the gastrojejunostomy. In order to achieve an efficient gastric drainage and provide the maximum comfort to the patient, the drainage PEG tube could be linked to an ileostomy bag. RESULTS The four PEG-J cancer patients with longer survival developed symptoms associated with an important gastric residuum. After the drainage gastrostomy, symptoms subsided or vanished and there were no jejunal tube dislocations. CONCLUSIONS When stenting is not possible in patients with gastric/duodenal outlet obstruction due to cancer growing, feeding PEG-J plus drainage PEG may be an alternative, allowing duodenal/jejunal feeding and gastric drainage with minimal manipulation of the jejunal tube.
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Affiliation(s)
- Jorge Fonseca
- Hospital Garcia de Orta, Serviço de Gastrenterologia, GENE - Grupo de Estudo de Nutrição Entérica, Pragal, Almada, Portugal
| | - Carla Adriana Santos
- Hospital Garcia de Orta, Serviço de Gastrenterologia, GENE - Grupo de Estudo de Nutrição Entérica, Pragal, Almada, Portugal
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Fonseca J, Meira T, Nunes A, Santos CA. Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding. Arq Gastroenterol 2014; 51:128-32. [PMID: 25003265 DOI: 10.1590/s0004-28032014000200011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/20/2014] [Indexed: 11/22/2022]
Abstract
CONTEXT Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. OBJECTIVES The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. METHODS From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. RESULTS From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score <5. One persistent bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall <5 patients started oral diet sooner than Rockall ≥5. Patients that underwent endoscopic therapy were refed earlier than those without endotherapy. CONCLUSIONS Most feeding records are missing. Data reveals delayed refeeding, especially in patients with low-risk lesions who should have been fed immediately. Nonvariceal upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.
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Affiliation(s)
- Jorge Fonseca
- Hospital Garcia de Orta, Serviço de Gastrenterologia, Grupo de Estudo de Nutrição Entérica - GENE, Pragal, Almada, Portugal
| | - Tânia Meira
- Hospital Garcia de Orta, Serviço de Gastrenterologia, Grupo de Estudo de Nutrição Entérica - GENE, Pragal, Almada, Portugal
| | - Ana Nunes
- Hospital Garcia de Orta, Serviço de Gastrenterologia, Grupo de Estudo de Nutrição Entérica - GENE, Pragal, Almada, Portugal
| | - Carla Adriana Santos
- Hospital Garcia de Orta, Serviço de Gastrenterologia, Grupo de Estudo de Nutrição Entérica - GENE, Pragal, Almada, Portugal
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Tunçalp Ö, Souza JP, Hindin MJ, Santos CA, Oliveira TH, Vogel JP, Togoobaatar G, Ha DQ, Say L, Gülmezoglu AM. Education and severe maternal outcomes in developing countries: a multicountry cross-sectional survey. BJOG 2014; 121 Suppl 1:57-65. [PMID: 24641536 DOI: 10.1111/1471-0528.12634] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the relationship between education and severe maternal outcomes among women delivering in healthcare facilities. DESIGN Cross-sectional study. SETTING Twenty-nine countries in Africa, Asia, Latin America, and the Middle East. POPULATION Pregnant women admitted to 359 facilities during a period of 2-4 months of data collection between 2010 and 2011. METHODS Data were obtained from hospital records. Stratification was based on the Human Development Index (HDI) values of the participating countries. Multivariable logistic regression analyses were conducted to assess the association between maternal morbidity and education, categorised in quartiles based on the years of formal education by country. Coverage of key interventions was assessed. MAIN OUTCOME MEASURES Severe maternal outcomes (near misses and death). RESULTS A significant association between low education and severe maternal outcomes (adjusted odds ratio, aOR, 2.07; 95% confidence interval, 95% CI, 1.46-2.95), maternal near miss (aOR 1.80; 95% CI 1.25-2.57), and maternal death (aOR 5.62; 95% CI 3.45-9.16) was observed. This relationship persisted in countries with medium HDIs (aOR 2.36; 95% CI 1.33-4.17) and low HDIs (aOR 2.65; 95% CI 1.54-2.57). Less educated women also had increased odds of presenting to the hospital in a severe condition (i.e. with organ dysfunction on arrival or within 24 hours: aOR 2.06; 95% CI 1.36-3.10). The probability that a woman received magnesium sulphate for eclampsia or had a caesarean section significantly increased as education level increased (P < 0.05). CONCLUSIONS Women with lower levels of education are at greater risk for severe maternal outcomes, even after adjustment for key confounding factors. This is particularly true for women in countries that have poorer markers of social and economic development.
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Affiliation(s)
- Ö Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Correira Pereira MA, Santos CA, Almeida Brito J, Fonseca J. Scored Patient-Generated Subjective Global Assessment, albumin and transferrin for nutritional assessment of gastrostomy fed head or neck cancer patients. NUTR HOSP 2014; 29:420-6. [PMID: 24528363 DOI: 10.3305/nh.2014.29.2.7066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Gastrostomy fed head or neck cancer patients frequently have impaired speech capacities. Enteral feeding teams frequently depend on laboratorial or anthropometrical parameters for nutritional assessment. AIMS In these patients, this study aimed to evaluate: (1) the practicability of Scored - Patient-Generated Subjective Global Assessment (PG-SGA); (2) their nutritional status using the Scored-PG-SGA; (3) association of serum albumin and transferrin values to the nutritional status rating using PG-SGA. METHODS On adult outpatients with head or neck cancer under prolonged (> 1 month) gastrostomy feeding, Scored-PGSGA, albumin and transferrin were evaluated during the same appointment. RESULTS Scored-PG-SGA was easily feasible in 42 patients, even in patients with speech difficulties. Twenty-five patients were moderately/severely undernourished (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as ≥ 2, thus needing nutritional/ pharmacologic intervention. Albumin was low in 13 patients. Transferrin was low in 19 patients. Average albumin and transferrin in moderately/severely undernourished patients (PG-SGA/B+C) was significantly lower than in well-nourished (PG-SGA/A). There was association between Scored- PG-SGA rating, albumin and transferrin. CONCLUSIONS In PEG fed head or neck cancer patients, PGSGA was practicable and useful, even in patients with impaired speaking skills. Most patients displayed moderate/severe malnutrition (PG-SGA/B+C). Scored-PG-SGA rated 41 patients as needing for nutritional/pharmacological intervention. Scored-PG-SGA should be systematically included in the evaluation of these patients. In these patients, albumin and transferrin levels showed relation with Scored-PG-SGA and should be considered as nutritional biomarkers.
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Affiliation(s)
| | | | - José Almeida Brito
- CiiEM. Centro de Investigação Interdisciplinar Egas Moniz. Almada. Portugal..
| | - Jorge Fonseca
- GENE. Enteral Feeding Group. Hospital Garcia de Orta. Almada. Portugal. CiiEM. Centro de Investigação Interdisciplinar Egas Moniz. Almada. Portugal..
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Santos CA, Fonseca J, Brito J, Fernandes T, Gonçalves L, Sousa Guerreiro A. Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition. NUTR HOSP 2014; 29:359-64. [PMID: 24528353 DOI: 10.3305/nh.2014.29.2.7035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIMS Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. METHODS From patients that underwent gastrostomy a blood sample was obtained minutes before the procedure. Serum and whole blood zinc was evaluated using Wavelength Dispersive X-ray Fluorescence Spectroscopy. Serum albumin and transferrin were evaluated. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). RESULTS The study involved 32 patients (22 males), aged 43-88 years: HNC = 15, ND = 17. Most (30/32) had low serum zinc, 17/32 presented normal values of whole blood zinc. Only two, with traumatic brain injury, presented normal serum zinc. Serum zinc levels showed no differences between HNC and ND patients. There was no association between serum zinc and serum albumin or transferrin. There was no association between serum and whole blood zinc. CONCLUSIONS Patients had low serum zinc when gastrostomy was performed, similar in HNC and ND, being related with prolonged fasting and unrelated with the underlying disease. Decrease serum zinc was unrelated with low serum proteins. Serum zinc was more sensitive than whole blood zinc for identifying reduced zinc intake. Teams taking care of PEG-patients should include zinc evaluation as part of the nutritional assessment, or include systematic dietary zinc supply.
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Affiliation(s)
| | - Jorge Fonseca
- GENE. Enteral Feeding Group. Hospital Garcia de Orta. Almada. Portugal..
| | - José Brito
- WDXRF Lab. Instituto Superior de Ciências da Saúde Egas Moniz. Campus Universitário. Almada. Portugal..
| | - Tânia Fernandes
- WDXRF Lab. Instituto Superior de Ciências da Saúde Egas Moniz. Campus Universitário. Almada. Portugal..
| | - Luísa Gonçalves
- WDXRF Lab. Instituto Superior de Ciências da Saúde Egas Moniz. Campus Universitário. Almada. Portugal..
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Favaro MTP, de Toledo MAS, Alves RF, Santos CA, Beloti LL, Janissen R, de la Torre LG, Souza AP, Azzoni AR. Development of a non-viral gene delivery vector based on the dynein light chain Rp3 and the TAT peptide. J Biotechnol 2014; 173:10-8. [PMID: 24417903 DOI: 10.1016/j.jbiotec.2014.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/20/2013] [Accepted: 01/02/2014] [Indexed: 02/02/2023]
Abstract
Gene therapy and DNA vaccination trials are limited by the lack of gene delivery vectors that combine efficiency and safety. Hence, the development of modular recombinant proteins able to mimic mechanisms used by viruses for intracellular trafficking and nuclear delivery is an important strategy. We designed a modular protein (named T-Rp3) composed of the recombinant human dynein light chain Rp3 fused to an N-terminal DNA-binding domain and a C-terminal membrane active peptide, TAT. The T-Rp3 protein was successfully expressed in Escherichia coli and interacted with the dynein intermediate chain in vitro. It was also proven to efficiently interact and condense plasmid DNA, forming a stable, small (∼100nm) and positively charged (+28.6mV) complex. Transfection of HeLa cells using T-Rp3 revealed that the vector is highly dependent on microtubule polarization, being 400 times more efficient than protamine, and only 13 times less efficient than Lipofectamine 2000™, but with a lower cytotoxicity. Confocal laser scanning microcopy studies revealed perinuclear accumulation of the vector, most likely as a result of transport via microtubules. This study contributes to the development of more efficient and less cytotoxic proteins for non-viral gene delivery.
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Affiliation(s)
- M T P Favaro
- Laboratório de Análise Genética e Molecular, Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - M A S de Toledo
- Laboratório de Análise Genética e Molecular, Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - R F Alves
- Departamento de Engenharia Química, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - C A Santos
- Laboratório de Análise Genética e Molecular, Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - L L Beloti
- Laboratório de Análise Genética e Molecular, Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - R Janissen
- Instituto de Física Aplicada "Gleb Wataghin", Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - L G de la Torre
- Faculdade de Engenharia Química, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - A P Souza
- Laboratório de Análise Genética e Molecular, Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - A R Azzoni
- Departamento de Engenharia Química, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil.
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Toledo MAS, Favaro MTP, Alves RF, Santos CA, Beloti LL, Crucello A, Santiago AS, Mendes JS, Horta MAC, Aparicio R, Souza AP, Azzoni AR. Characterization of the human dynein light chain Rp3 and its use as a non-viral gene delivery vector. Appl Microbiol Biotechnol 2013; 98:3591-602. [PMID: 24077724 DOI: 10.1007/s00253-013-5239-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 08/30/2013] [Accepted: 09/04/2013] [Indexed: 12/01/2022]
Abstract
Dynein light chains mediate the interaction between the cargo and the dynein motor complex during retrograde microtubule-mediated transport in eukaryotic cells. In this study, we expressed and characterized the recombinant human dynein light chain Rp3 and developed a modified variant harboring an N-terminal DNA-binding domain (Rp3-Db). Our approach aimed to explore the retrograde cell machinery based on dynein to enhance plasmid DNA (pDNA) traffic along the cytosol toward the nucleus. In the context of non-viral gene delivery, Rp3-Db is expected to simultaneously interact with DNA and dynein, thereby enabling a more rapid and efficient transport of the genetic material across the cytoplasm. We successfully purified recombinant Rp3 and obtained a low-resolution structural model using small-angle X-ray scattering. Additionally, we observed that Rp3 is a homodimer under reducing conditions and remains stable over a broad pH range. The ability of Rp3 to interact with the dynein intermediate chain in vitro was also observed, indicating that the recombinant Rp3 is correctly folded and functional. Finally, Rp3-Db was successfully expressed and purified and exhibited the ability to interact with pDNA and mediate the transfection of cultured HeLa cells. Rp3-Db was also capable of interacting in vitro with dynein intermediate chains, indicating that the addition of the N-terminal DNA-binding domain does not compromise its function. The transfection level observed for Rp3-Db is far superior than that reported for protamine and is comparable to that of the cationic lipid Lipofectamine™. This report presents an initial characterization of a non-viral delivery vector based on the dynein light chain Rp3 and demonstrates the potential use of modified human light chains as gene delivery vectors.
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Fonseca J, Adriana Santos C, Brito J. Predicting survival of endoscopic gastrostomy candidates using the underlying disease, serum cholesterol, albumin and transferrin levels. NUTR HOSP 2013; 28:1280-5. [PMID: 23889653 DOI: 10.3305/nh.2013.28.4.6494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Endoscopic gastrostomy (PEG) is the gold standard for long-term enteral feeding. An adequate PEG candidate must have life expectancy longer than a few weeks. Patients surviving less than three weeks should have a nasogastric tube, and gastrostomy should be avoid. There are few studies looking to prognostic factors and fewer attempts of creating a predictor model for PEG patient's survival. AIM The aim of this study was creating a predictive survival model for PEG candidates, using underlying disease, cholesterol, albumin and transferrin. METHODS Data was obtained from records of adult patients that underwent PEG between 1999 and 2011. Patients surviving < 3 weeks were considered short survivors; surviving ≥ 3 weeks were considered adequate survivors. A full logistic regression model was used to classify future cases into one of the two groups of survival. RESULTS An equation for the probability of future cases was generated, in order to obtain a P value. In the future, patients with a P ≥ 0,88 will have a 64,7% probability of adequate surviving; patients with a P < 0,88 will have a 70.3% probability of short surviving. CONCLUSIONS When clinical evaluation alone does not display a clear prognosis, this equation should be included in the evaluation of gastrostomy candidates, avoiding useless gastrostomy.
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Santos CA, Caldeira ML, Lopes da Silva T, Novais JM, Reis A. Enhanced lipidic algae biomass production using gas transfer from a fermentative Rhodosporidium toruloides culture to an autotrophic Chlorella protothecoides culture. Bioresour Technol 2013; 138:48-54. [PMID: 23612161 DOI: 10.1016/j.biortech.2013.03.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/16/2013] [Accepted: 03/18/2013] [Indexed: 06/02/2023]
Abstract
In order to produce single-cell oil for biodiesel, a yeast and a microalga were, for the first time, grown in two separate reactors connected by their gas-phases, taking advantage of their complementary nutritional metabolisms, i.e., respiration and photosynthesis. The yeast Rhodosporidium toruloides was used for lipid production, originating a carbon dioxide-enriched outlet gas stream which in turn was used to stimulate the autotrophic growth of Chlorella protothecoides in a vertical-alveolar-panel (VAP) photobioreactor. The microalgal biomass productivity was 0.015 gL(-1)h(-1), and its lipid productivity attained 2.2 mgL(-1)h(-1) when aerated with the outlet gas stream from the yeast fermenter. These values represent an increase of 94% and 87%, respectively, as compared to a control culture aerated with air. The CO2 bio-fixed by the microalgal biomass reached an estimated value of 29 mgL(-1)h(-1) in the VAP receiving the gas stream from the fermenter, a value 1.9 times higher than that measured in the control VAP.
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Affiliation(s)
- C A Santos
- LNEG, U. Bioenergia, edificio F, Estrada do Paço do Lumiar, 22, 1649-038 Lisbon, Portugal
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Fonseca J, Santos CA. [Clinical anatomy: anthropometry for nutritional assessment of 367 adults who underwent endoscopic gastrostomy]. ACTA MEDICA PORT 2013; 26:212-218. [PMID: 23815834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/05/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Patients suffering from long standing dysphagia need tube feeding through gastrostomy. Nutritional assessment of these patients is challenging and must be supported on objective data, including anthropometric evaluation. AIM The aim of this study was the evaluation of the usefulness of anthropometry for identifying and grading malnutrition, as part of the initial assessment of patients that underwent endoscopic gastrostomy. MATERIAL AND METHODS From the files of consecutive adults underwent gastrostomy we selected patients with anthropometric data obtained before the procedure: Body Mass Index, Mid Upper Arm Circumference, Triceps Skinfold Thickness and Mid Arm Muscle Circumference. Nutritional status was classified according with World Health Organization criteria for Body Mass Index, and for Mid Upper Arm Circumference, Triceps Skinfold Thickness and Mid Arm Muscle Circumference using comparison with Frisancho reference-tables. RESULTS Were selected 367 patients (median of ages: 74.1 years): neurological disease: 172; head and neck cancer: 176; other diseases: 19. Body Mass Index identified 136 underweight and 231 eutrophic or overweight patients. Mid Upper Arm Circumference identified 310 malnourished and 57 eutrophic or overweight patients. Triceps Skinfold Thickness identified 301 malnourished and 66 eutrophic or overweight patients. Mid Arm Muscle Circumference identified 269 malnourished, 97 eutrophic and one with MAMC above normal. DISCUSSION AND CONCLUSIONS Anthropometry identified the malnourished endoscopic gastrostomy-patients, contributed for malnutrition grading and demonstrated the impact on muscle and fat reserves. Mid Upper Arm Circumference, Triceps Skinfold Thickness and Mid Arm Muscle Circumference identified malnutrition in nearly 80% of the patients, most clearly with fat tissue wasting than muscle. Easily accessible e inexpensive, anthropometry allowed personalized nutritional therapy. Anthropometry must be recognized as a fundamental tool for enteral feeding teams.
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Affiliation(s)
- Jorge Fonseca
- Serviço de Gastrenterologia, Grupo de Estudo de Nutrição Entérica, Hospital Garcia de Orta, Almada, Portugal
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Santos CA, Panchoni LC, Bini D, Kuwano BH, Carmo KB, Silva SMCP, Martines AM, Andrade G, Andrade DS, Cardoso EJBN, Zangaro W, Nogueira MA. Land application of municipal landfill leachate: fate of ions and ammonia volatilization. J Environ Qual 2013; 42:523-531. [PMID: 23673845 DOI: 10.2134/jeq2012.0170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Landfill leachates are pollutants rich in ammoniacal N, Na, and K, but land application potentially offers an alternative for recycling these leachate nutrients. We applied landfill leachate corresponding to 0, 110, 220, 330, and 440 kg ha of total N, divided in three applications (July, August, and October 2008), onto the surface of an acidic (pH 5.5-6.0) clay (79% clay) Ultisol and monitored NH volatilization just after applications and microbiological (0-10 cm) and chemical attributes (0-60-cm soil depth) in August 2008, January 2009, and May 2009. Ammonium (up to 30 mg kg), NO (up to 160 mg kg), Na, K (up to 1.1 cmol kg each), and electrical conductivity (up to 1 dS m) increased transiently in soil following applications. Despite >90% of the total leachate N being ammoniacal, NO predominated in the first soil sampling, 14 d after the second application, suggesting fast nitrification, but it decreased in the soil profile thereafter. From 5 to 25% of the total applied N volatilized as NH, with maximum losses within the first 3 d. Applications inhibited (50%) the relative nitrification rate and increased (50%) hot-water-soluble carbohydrates in the soil at the highest rate. No effects were observed on soil microbial biomass C (114-205 mg kg) and activity (5-8 mg CO-C kg d) or on corn grain yields (6349-7233 kg ha). Controlled land application seems to be a viable alternative for landfill leachate management, but NO leaching, NH volatilization, and accumulation of salinizing ions must be monitored in the long term to prevent environmental degradation.
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Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq Gastroenterol 2013; 49:227-31. [PMID: 23011248 DOI: 10.1590/s0004-28032012000300012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/28/2012] [Indexed: 01/27/2023]
Abstract
CONTEXT Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory parameters were roughly stable 1 and 3 months after the gastrostomy procedure. CONCLUSIONS In patients with advanced upper esophageal cancer where only palliative treatment is possible, nutritional support is easily achieved with percutaneous endoscopic gastrostomy, allowing patients to be at homes, surviving a significant period of time. Percutaneous endoscopic gastrostomy feeding should be considered as standard definitive nutritional palliation in patients with upper esophageal cancer, unsuitable for esophageal stenting.
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Affiliation(s)
- Ana Grilo
- Serviço de Gastrenterologia, Gastrenterologia Hospital Garcia de Orta, Almada, Portugal
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Martines AM, Nogueira MA, Santos CA, Nakatani AS, Andrade CA, Coscione AR, Cantarella H, Sousa JP, Cardoso EJBN. Ammonia volatilization in soil treated with tannery sludge. Bioresour Technol 2010; 101:4690-4696. [PMID: 20171093 DOI: 10.1016/j.biortech.2010.01.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 12/07/2009] [Accepted: 01/24/2010] [Indexed: 05/28/2023]
Abstract
The utilization of tannery sludge in agricultural areas can be an alternative for its disposal and recycling. Despite this procedure may cause the loss of nitrogen by ammonia volatilization, there is no information about this process in tropical soils. For two years a field experiment was carried out in Rolândia (Paraná State, Brazil), to evaluate the amount of NH(3) volatilization due to tannery sludge application on agricultural soil. The doses of total N applied varied from zero to 1200 kg ha(-1), maintained at the surface for 89 days, as usual in this region. The alkalinity of the tannery sludge used was equivalent to between 262 and 361 g CaCO(3) per kg. Michaelis-Menten equation was adequate to estimate NH(3)-N volatilization kinetics. The relation between total nitrogen applied as tannery sludge and the potentially volatilized NH(3)-N, calculated by the chemical-kinetics equation resulted in an average determination coefficient of 0.87 (P>0.01). In this period, the amount of volatilized NH(3) was more intense during the first 30 days; the time to reach half of the maximum NH(3) volatilization (K(m)) was 13 an 9 days for the first and second experiments, respectively. The total loss as ammonia in the whole period corresponded in average to 17.5% of the total N applied and to 35% of the NH(4)(+)-N present in the sludge. If tannery sludge is to be surface applied to supply N for crops, the amounts lost as NH(3) must be taken into consideration.
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Affiliation(s)
- A M Martines
- Universidade de São Paulo, Escola Superior de Agricultura Luiz de Queiroz, Departamento de Ciência do Solo, CEP 13418-900 Piracicaba, SP, Brazil
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Santos CA, Falconi FA. Relationship between ecological concepts and biosafety in broiler breeder farms. Rev Bras Cienc Avic 2007. [DOI: 10.1590/s1516-635x2007000300002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Santos CA, Freedman BD, Ghosn S, Jacob JS, Scarpulla M, Mathiowitz E. Evaluation of anhydride oligomers within polymer microsphere blends and their impact on bioadhesion and drug delivery in vitro. Biomaterials 2003; 24:3571-83. [PMID: 12809786 DOI: 10.1016/s0142-9612(03)00219-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The effect of the addition of small molecular weight anhydride oligomers to polymer microspheres was evaluated and increased bioadhesion of the composite was demonstrated. Blends of low molecular weight anhydride oligomers with thermoplastic poly(fumaric-co-sebacic anhydride) [p(FASA)] and polycaprolactone were examined. The effects of anhydride oligomers on polymer microsphere degradation, crystallinity, and surface morphology were also explored. The results demonstrated that fumaric anhydride oligomer remained within polymer microspheres for several hours after exposure to phosphate buffer, formed a homogenous crystalline blend, increased bioadhesion as measured on rat intestine, and enhanced drug delivery in vitro as measured by the everted sac technique.
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Costa MC, Santos CA, Sobrinho CL, Freitas JO, Ferreira KA. [Mother-infant indicators in adolescence and youth: socio-demographic, prenatal, delivery and newborns]. J Pediatr (Rio J) 2001; 77:235-42. [PMID: 14647589 DOI: 10.2223/jped.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE: To identify characteristics and associations between maternal age and gestation, delivery, and livebirths of adolescent and young adult mothers in the city of Feira de Santana, state of Bahia, Brazil. METHODS: We carried out a cross-sectional, epidemiological study with a population of livebirths and adolescent mothers (aged 10-16 and 17-19 years) and young adult mothers (aged 20-24 years). The information were obtained from the Livebirths Information System (SINASC-1998) for a total of 5,279 livebirths. Study variables were classified into socio-demographic factors (age, schooling of the mother, sex of the newborn) and related to term, delivery, gestational age, birth weight, and Apgar score. Data were processed using prevalence ratio and multivariate analysis. Logistic regression was used to control confounding factors (prenatal and gestational age) and to establish an association between maternal age and birth weight. RESULTS: In 1998, 21.6% of all livebirths in the city of Feira de Santana were from adolescent mothers; out of these mothers, 51.2% had not finished junior high or elementary school. Prevalence ratio and adjusted odds ratio for the 10-16 years of age group indicated increased prevalence of illiteracy, no prenatal examination, and low birth weight and a low prevalence of adequate weight of the newborn in comparison to other age groups studied. Logistic regression showed a positive association between maternal age and low birth weight. We also observed that the SINASC database lacked information in many different fields. CONCLUSIONS: Our results indicated, for adolescent mothers, a high prevalence of livebirths and low schooling. Also, especially for the 10-16 years of age group, we observed increased risks for illiteracy, no prenatal examinations, low birth weight, and inadequate weight of the newborn in comparison to other age groups.
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Affiliation(s)
- M C Costa
- Universidade Estadual de Feira de Santana (UEFS), BA, Brazil
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Barreto ML, Rodrigues LC, Silva RC, Assis AM, Reis MG, Santos CA, Blanton RE. Lower hookworm incidence, prevalence, and intensity of infection in children with a Bacillus Calmette-Guérin vaccination scar. J Infect Dis 2000; 182:1800-3. [PMID: 11069259 DOI: 10.1086/317627] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2000] [Revised: 08/14/2000] [Indexed: 11/03/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG), the most common vaccine worldwide, has broad effects on the immune system. Hookworm infections are a major source of morbidity. In response to a preliminary report of BCG vaccination protection against nematodes in human immunodeficiency virus-infected adults, data from an ongoing prospective study were analyzed to determine the intensity (eggs per gram of stool), prevalence, and incidence of different helminths in children with and without a BCG vaccination scar. Adjusted prevalence and incidence ratios were estimated by using logistic regression. Children with a BCG vaccination scar were found to have statistically significantly lower hookworm prevalence (41%), incidence (37%), and mean egg counts (39%), after controlling for age, sex, and socioeconomic factors. There was no BCG association with incidence, prevalence, or intensity of infection with Schistosoma mansoni, Ascaris lumbricoides, or Trichuris trichiura. Such protection would have implications for public health and for research on mechanisms behind human immunological responses to hookworm.
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Affiliation(s)
- M L Barreto
- Instituto de Saúde Coletiva/UFBa, Rua Padre Feijó, 29/4o andar-Canela 40.110-170 Salvador, Bahia Brazil.
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Abstract
The isolation of (+)-uleine (1) and (+)-demethoxyaspidospermine (2) from the bark of Plumeria lancifolia is reported along with (1)H- and (13)C-NMR data.
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Affiliation(s)
- O O França
- Department of Pharmacy, Universidade Federal do Paraná, Rua Pref. Lothario Meissner, 3400, Jardim Botânico, 80210-070 Curitiba, Brazil
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Santos CA, Jacob JS, Hertzog BA, Freedman BD, Press DL, Harnpicharnchai P, Mathiowitz E. Correlation of two bioadhesion assays: the everted sac technique and the CAHN microbalance. J Control Release 1999; 61:113-22. [PMID: 10469908 DOI: 10.1016/s0168-3659(99)00109-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This contribution correlates two in vitro methods utilized to determine bioadhesion. One method, the everted intestinal sac technique, is a passive test for bioadhesion involving several polymer microspheres and a section of everted intestinal tissue. The other method, the CAHN microbalance, employs a CAHN dynamic contact angle analyzer with modified software to record the tensile forces measured as a single polymer microsphere is pulled from intestinal tissue. This study demonstrates that CAHN and everted sac experiments yield similar results when used to quantify the bioadhesive nature of polymer microsphere systems. A polymer showing high adhesion in one method also demonstrates high bioadhesion in the other method; polymers that exhibit high fracture strength and tensile work measurements with the CAHN microbalance also yield high binding percentages with the everted sac method. The polymers tested and reported here are poly(caprolactone) and different copolymer ratios of poly(fumaric-co-sebacic anhydride). The results of this correlation demonstrate that each method alone is a valuable indicator of bioadhesion.
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Affiliation(s)
- C A Santos
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Box G-B393, Providence, RI 02912, USA
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Santos CA, Freedman BD, Leach KJ, Press DL, Scarpulla M, Mathiowitz E. Poly(fumaric-co-sebacic anhydride). A degradation study as evaluated by FTIR, DSC, GPC and X-ray diffraction. J Control Release 1999; 60:11-22. [PMID: 10370167 DOI: 10.1016/s0168-3659(99)00016-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The degradation of three poly(fumaric-co-sebacic anhydride) [P(FA:SA)] copolymers is examined in a composition of microspheres made by the hot melt encapsulation process. The emergence of low molecular weight oligomers occurs during degradation of the copolymer microspheres, as evidenced by a variety of characterization methods. Characterization was conducted to determine the extent of degradation of the polyanhydride microspheres using Fourier-transform infrared spectroscopy (FTIR), gel permeation chromatography (GPC), differential scanning calorimetry (DSC) and X-ray diffraction. It is demonstrated that degradation of P(FA:SA) is greatly accelerated at basic pH, yet there is little difference between degradation in neutral and acidic buffers. A good correlation exists between the results of each characterization method, which allows a better understanding of the degradation process and the resulting formation of low molecular weight oligomers in poly(fumaric-co-sebacic anhydride).
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Affiliation(s)
- C A Santos
- Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Box G-B393, Providence, RI 02912, USA
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Noronha CV, Machado EP, Tapparelli G, Cordeiro TR, Laranjeira DH, Santos CA. [Violence, ethnic groups and skin color: a study on differences in the metropolitan region of Salvador, Bahia, Brazil]. Rev Panam Salud Publica 1999; 5:268-77. [PMID: 10355326 DOI: 10.1590/s1020-49891999000400010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The objective of this study was to analyze the distribution of various forms of violence--structural, institutional, interpersonal, and crime-related--in the three most common color groups of Bahian society: mulattos, whites, and blacks. The study compared the levels of victimization of mulatto, white, and black individuals with their assessments of the efficiency of crime-control institutions, in order to ascertain how that relates to those same citizens' acceptance of authoritarian attitudes and norms. The data analyzed came from the multicenter project on Attitudes and Cultural Standards about Violence (ACTIVA) project, from a sample of 1,384 residents of the Salvador metropolitan region. The study was designed as a cross-sectional survey, with interviews done in the people's homes between September and December of 1996. The sample selection was done in three stages: first, residential areas were chosen at random; then, a systematic selection was made from the homes in each of the selected areas; finally, the persons to be interviewed were chosen at random. To collect the data the researchers used a pretested questionnaire that had been designed for the ACTIVA study. The results showed an unequal distribution of structural violence that mainly affected blacks. There were no differences by color group for interpersonal and institutional violence. Criminal violence impacted whites and blacks to the same degree. Distrust in the efficiency of the civil and military police and in the justice and penal systems was very high among all three color groups. Moreover, few differences were found among the groups with regard to authoritarian attitudes and norms. Based on the results, it is possible to conclude that public order is threatened if the dissatisfaction with institutions for crime prevention and reduction continues at a high level at the same time that individuals tend to support violence to resolve conflicts.
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Affiliation(s)
- C V Noronha
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, Bahia, Brasil.
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Morris SS, Santos CA, Barreto ML, Cousens SN, Strina A, Santos LM, Assis AM. Measuring the burden of common morbidities: sampling disease experience versus continuous surveillance. Am J Epidemiol 1998; 147:1087-92. [PMID: 9620053 DOI: 10.1093/oxfordjournals.aje.a009403] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Longitudinal prevalence, the proportion of all days of observation that a given individual manifests symptoms of illness, is a measure of disease frequency that is easy to generate from daily morbidity data and has been shown to be strongly related to subsequent health outcome. It is hypothesized that this measure could be derived using a representative sample of days of observation rather than continuous surveillance. The authors use 1990-1991 data from a Brazilian supplementation trial comprising a year's daily records of the occurrence of diarrhea, fever, and cough in 906 children under 5 years of age to examine how many days of morbidity data need to be observed to rank subjects into quintiles of illness frequency. Systematic samples of the full data set, based on every 2nd, 3rd, 5th, 10th, 15th, 20th, and 30th day of data, are compared with the continuous record. For diarrhea and fever, estimates based on less than 72 days of observation result in over one fourth of individuals who should have been in the extreme quintiles of the morbidity distribution being misclassified, and over one fifth of all subjects appear (falsely) to suffer no morbidity. Estimates of longitudinal prevalence should be based on at least 72 days of observation.
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Affiliation(s)
- S S Morris
- Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Egilmez NK, Jong YS, Iwanuma Y, Jacob JS, Santos CA, Chen FA, Mathiowitz E, Bankert RB. Cytokine immunotherapy of cancer with controlled release biodegradable microspheres in a human tumor xenograft/SCID mouse model. Cancer Immunol Immunother 1998; 46:21-4. [PMID: 9520288 PMCID: PMC11037336 DOI: 10.1007/s002620050455] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A novel biodegradable poly(lactic acid) microsphere formulation was evaluated for in vivo cytokine immunotherapy of cancer in a human tumor xenograft/ severe combined immunodeficiency (SCID) mouse model. Co-injection of interleukin-2 (IL-2)-loaded microspheres with tumor cells into a subcutaneous site resulted in the complete suppression of tumor engraftment in 80% of animals. In contrast, bovine-serum-albumin(BSA)-loaded particles or bolus injections of poly(ethylene glycol)/IL-2 were ineffective in preventing tumor growth. The antitumor effect of IL-2 released by the microspheres was shown to be mediated by the mouse natural killer cells. This is the first evidence that the rejection of human tumor xenografts can be provoked by the sustained in vivo delivery of IL-2 from biodegradable microspheres. The use of poly(lactic acid) microspheres to deliver cytokines to the tumor environment could provide a safer and simpler alternative to gene therapy protocols in the treatment of cancer.
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Affiliation(s)
- N K Egilmez
- Department of Molecular Immunology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Mathiowitz E, Jacob JS, Jong YS, Carino GP, Chickering DE, Chaturvedi P, Santos CA, Vijayaraghavan K, Montgomery S, Bassett M, Morrell C. Biologically erodable microspheres as potential oral drug delivery systems. Nature 1997; 386:410-4. [PMID: 9121559 DOI: 10.1038/386410a0] [Citation(s) in RCA: 682] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biologically adhesive delivery systems offer important advantages over conventional drug delivery systems. Here we show that engineered polymer microspheres made of biologically erodable polymers, which display strong adhesive interactions with gastrointestinal mucus and cellular linings, can traverse both the mucosal absorptive epithelium and the follicle-associated epithelium covering the lymphoid tissue of Peyer's patches. The polymers maintain contact with intestinal epithelium for extended periods of time and actually penetrate it, through and between cells. Thus, once loaded with compounds of pharmacological interest, the microspheres could be developed as delivery systems to transfer biologically active molecules to the circulation. We show that these microspheres increase the absorption of three model substances of widely different molecular size: dicumarol, insulin and plasmid DNA.
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Affiliation(s)
- E Mathiowitz
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, Rhode Island 02912, USA.
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Pinho JR, Capacci ML, da Silva LC, Carrilho FJ, Santos CA, Pugliese V, Guz B, Levi JE, Ballarati CA, Bernardini AP. Hepatitis G virus/GB virus C in Brazil. Preliminary report. Rev Inst Med Trop Sao Paulo 1996; 38:243-6. [PMID: 9163994 DOI: 10.1590/s0036-46651996000300016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatitis G virus/GB virus C is a novel flavivirus recently detected in hepatitis non A-E cases. In this study, the presence of this virus in chronic non-B, non-C hepatitis patients was evaluated using GBV-C specific PCR and this virus was detected in one out of thirteen patients. This patient has presented a severe liver failure, has lived for a long time in the Western Amazon basin and no other cause for this clinical picture was reported. The impact of the discovery of this new agent is still under evaluation throughout the world. The study of the prevalence of this virus among chronic hepatitis patients and healthy individuals (as blood donors) will furnish subside to evaluate its real pathogenicity.
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Affiliation(s)
- J R Pinho
- Serviço de Virologia do Instituto Adolfo Lutz, São Paulo, Brasil
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Garcia C, Rocha AS, Rocha N, Scherr C, Coimbra M, Vieira S, Santos CA, Villela R, Ferreira M, Dutra P. [Myocardial revascularization in left coronary trunk lesion in patients over 65 years old]. Arq Bras Cardiol 1995; 64:217-20. [PMID: 7487507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To study the short and long-term follow-up of patients with left main coronary artery disease (LMCAD) and age over 65 years, by comparing the results with patients under 65 years-old. METHODS Twenty-two patients with LMCAD and mean age of 69 +/- 3.5 years (group I) were underwent isolated coronary artery bypass grafting (CABG) and compared to 31 patients with LMCAD, mean age of 54 +/- 7 years (group II), who also underwent isolated CABG. The life-table Kaplan-Meyer method was used to estimate the post-operative survival. The chi-square and Student "t" test were used when necessary. RESULTS Despite higher operative mortality in group I (9.1% x 3.2%), the difference was statistically not significant. The operative morbidity was similar in both groups. Actuarial survival at 4 years was 85% in group I and 95% in group II. Actuarial survival free of cardiac events was 69% in group II and 75% in group II. CONCLUSION The CABG is well tolerated and had low morbidity and acceptable mortality in old patients with LMCAD. The long-term survival in these patients was very similar to the younger patients.
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Affiliation(s)
- C Garcia
- Hospital de Cardiologia de Laranjeiras, Rio de Janeiro
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