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Atención nutricional convencional (ANC) en pacientes quirúrgicos hospitalizados
Leandro-Merhi,V. A.;
Nutrición Hospitalaria , 2007,
Abstract: objective: to compare nutritional status assessment methods on hospital admission and discharge in surgical patients receiving conventional nutritional support (cns). methods: one hundred eighty-three patients hospitalized in the surgical ward of the hospital of puc-campinas and aging from 30 to 60 years were assessed; of these, 54.6% were females and 45.4% were males. a nutritional support protocol was used to collect the data with identification and diagnosis data obtained from medical records, antecedents, anthropometry, eating history during hospitalization, total energy intake in the usual diet (ud), energy requirement (er) and nutritional status. the wilcoxon test was used for the statistical analysis and the kappa (k) coefficient was used to verify the agreement between the nutritional status on hospital admission and discharge. the adopted significance level was 5% (0.05). results: the analysis of the values on hospital admission and discharge showed that the nutritional status remained constant on admission and discharge when analyzed by groups of diseases. the relationship between nutritional status on hospital admission and discharge in patients with benign biliary tract diseases and vascular diseases presented an excellent agreement between the two moments (k = 1000). it was verified that, discounting the effect of randomness, the nutritional status on admission and discharge agreed in 71.43% and 50% respectively in these two clinical conditions regarding the nutritional diagnosis of being well nourished. in benign diseases of the digestive tract and neoplasias, a good agreement was also observed (k = 0,887 and k = 0,820 respectively). in the total sample, the agreement analysis was high (k = 0,918) showing that the nutritional status remained constant during hospitalization. conclusion: these findings may be attributed to the routine monitoring of nutritional status which allowed an adequate support during hospitalization even when the energy requiremen
Atención nutricional convencional (ANC) en pacientes quirúrgicos hospitalizados Conventional Nutritional Support (CNS) in hospitalized surgical patients
V. A. Leandro-Merhi
Nutrición Hospitalaria , 2007,
Abstract: Objetivo: Comparar medidas de evaluación del estado nutricional en el momento de la internación y en la alta hospitalaria, en pacientes de clínica quirúrgica, recibiendo atendimiento nutricional convencional (ANC). Casuística y método: Han sido estudiados 183 pacientes, siendo 54,6% del sexo femenino y 45,4% del sexo masculino con edad entre 30 y 60 a os, internados en clínica quirúrgica del HMCP, Puc-Campinas. Para la coleta de los datos ha sido utilizado un protocolo de atendimiento nutricional con dados de identificación y diagnóstico, los cuales han sido colectados de los prontuarios médicos, antecedentes personales, antropometría, historia alimentar en la internación, consumo energético total de la dieta habitual (CE), necesidad energética (NE) y estado nutricional. Para el análisis estadístico ha sido aplicado el teste de Wilcoxon, y para verificar la concordancia del estado nutricional en la internación con el estado nutricional en la alta hospitalaria, ha sido aplicado el Coeficiente Kappa (k). El nivel de significancia adoptado ha sido 5% (0,05). Resultados: El análisis de los valores de la internación y de la alta hospitalaria ha mostrado que el estado nutricional se ha mantenido en los 2 momentos, cuando analizados por grupos de enfermedades. La relación entre el estado nutricional en la internación y en la alta hospitalaria, en pacientes con enfermedades benignas de vías biliares y enfermedades vasculares, ha presentado excelente concordancia entre los dos momentos (k = 1,000). Se ha verificado que, descontando el efecto del acaso, el estado nutricional en la internación y en la alta concordaron en 71,43% y 50,0%, respectivamente, en estas dos situaciones clínicas, cuanto al diagnóstico nutricional de eutrofia. En las enfermedades benignas del aparato digestivo y en las neoplasias, también ha sido observada buena concordancia (k = 0,887 e k = 0,820, respectivamente). En la muestra total, este análisis de concordancia ha sido alto (k = 0,918), indicando que el estado nutricional se ha mantenido durante el período de internación. Conclusión: Tales hallados pueden atribuirse al monitoreo del estado nutricional de rutina, que permite un aporte adecuado durante el período de internación, aún habiendo diferencia entre necesidad y consumo energético. Objective: To compare nutritional status assessment methods on hospital admission and discharge in surgical patients receiving conventional nutritional support (CNS). Methods: One hundred eighty-three patients hospitalized in the surgical ward of the Hospital of PUC-Campinas and aging from 30 to 60 year
Investigation of nutritional risk factors using anthropometric indicators in hospitalized surgery patients
Leandro-Merhi, Vania Aparecida;Aquino, José Luiz Braga de;
Arquivos de Gastroenterologia , 2012, DOI: 10.1590/S0004-28032012000100006
Abstract: context: the investigation of risk factors associated with nutritional status could contribute for better knowledge of the malnutrition. objective: to investigate the incidence of malnutrition and its possible association with many parameters that assess nutritional status and to identify the associated risk factors. methods: the nutritional status was assessed in 235 hospitalized patients. malnutrition was defined as present when the patient presented at least two anthropometric criteria below the normal range and habitual energy intake below 75% of the energy requirement (hei/er<75%). gender, age, type of disease, recent weight change and dental problems were investigated as possible associated risk factors. the chi-square and mann-whitney tests were used to compare the data and univariate and multiple logistic regressions were used to identify the factors associated with malnutrition. the odds ratio (or) and confidence interval (ci) of 95% were calculated with the significance level set at 5% (p<0.05). results: one-fifth (20%) of the patients were malnourished on admission to the hospital and 27.5% reported recent weight loss. malnutrition (p<0.0001) was greater in patients with malignant diseases. the only variables significantly associated with malnutrition according to univariate logistic regression were recent weight loss (p = 0.0058; or = 2.909; ic95% = 1.362; 6.212) and malignant disease (p = 0.0001; or = 3.847; ic95% = 1.948; 7.597). when multiple regression was used in the model which included type of disease, malignant disease was shown to increase the chance of malnutrition fourfold (p = 0.0002; or = 3.855; ic95% = 1.914; 7.766). when disease was excluded, recent weight loss also increased malnutrition fourfold (p = 0.0012; or = 3.716; ic95% = 1.677; 8.236). conclusion: patients with a history of recent weight loss and those with malignant diseases are more susceptible to malnutrition.
Nutritional status and length of hospital stay for surgical patients El estado nutricional y duración de la estancia en los pacientes quirúrgicos
V. A. Leandro-Merhi,J. L. Braga de Aquino
Nutrición Hospitalaria , 2010,
Abstract:
Nutritional status and functional capacity of hospitalized elderly
Maria RM Oliveira, Kelly CP Foga?a, Vania A Leandro-Merhi
Nutrition Journal , 2009, DOI: 10.1186/1475-2891-8-54
Abstract: A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%.Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition.There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.Deterioration of the nutritional status affects and is affected by disease, especially among the elderly [1]. Nutritional diagnosis and the identification of factors that contribute to this diagnosis are, therefore, essential but complex processes. This complexity is due to the occurrence of many changes, both physiological and pathological, which may be taken as inherent to the aging or disease process. However, indirect indicators that likely guarantee proper and healthy eating, such as economic, social, lifestyle and quality of life aspects may represent important tools for assessing nutritional risk [2].The MNA (Mini Nutritional Assessment) [3] has been an extensively used method to identify risk of malnutrition in the elderly and in those that may benefit from e
Risco nutricional no período pré-operatório
Leandro-Merhi, Vania Aparecida;Aquino, José Luis Braga de;Chagas, José Francisco Sales;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2009, DOI: 10.1590/S0102-67202009000300002
Abstract: background: bad nutricional status in preoperative period - mainly associated to weight loss -, may lead to grater number of postoperative complications. aim: to investigate the nutritional risk indicators in preoperative period, stratified by disease groups treated at the site. methods: a total of 512 patients with the following conditions were assessed: acute abdomen, digestive tract diseases, biliary diseases, gynecological diseases, vascular diseases, hernias and traumas. the following data were analyzed: body mass index, recent weight loss, habitual energy intake, lymphocyte count and length of hospital stay. the data were compared among the disease groups. the chi-square test or fisher's exact test when necessary was used to compare proportions. the significance level was set at 5%. results: trauma patients followed by those with digestive tract diseases and acute abdomen had significantly lower body mass index (p=0.0222), and the ones with acute abdomen presented recent weight loss at hospital admittance (p=0.0048). a greater percentage of severe and moderate immune depletion was seen in patients with acute abdomen (p<0.0001) and those with vascular diseases had a greater percentage of patients with energy intake below 1000 kcalories (p=0.0311). trauma patients presented longer hospital stays (p<0.0001). conclusion: trauma and acute abdomen patients had greater nutritional risk during the preoperative period. thus, nutritional care strategies should be oriented towards them since the hospital admittance.
Avalia??o do estado nutricional precedente ao uso de nutri??o enteral
Leandro-Merhi, Vania Aparecida;Morete, Juliana Luisi;Oliveira, Maria Rita Marques de;
Arquivos de Gastroenterologia , 2009, DOI: 10.1590/S0004-28032009000300015
Abstract: context: a proper diagnosis of the nutritional status is of the utmost importance for prescribing enteral nutrition therapy in the hospital environment. objective: to assess nutritional status indicators of patients about to receive enteral nutrition therapy in a hospital unit. methods: this cross-sectional study examined the nutritional status of 100 adult patients before they were introduced to enteral nutrition therapy by calculating their body mass index . their height and weight were estimated by prediction formulas and laboratory indicators of nutritional and metabolic statuses. results: almost one-third (29%) of the patients were classified as malnourished according to their body mass index, while 80% of them had low albumin values (<3.2 g/dl). when patients were grouped according to body mass index, the distribution of the reasons for hospitalization did not differ between the groups. cardiovascular and pulmonary diseases prevailed as the main reasons for hospitalization. when patients were grouped according to body mass index and diagnosis upon admission, the rates of low albumin concentration, i.e., concentration below the reference value, did not differ between the groups. conclusion: the estimated body mass index was a specific indicator of nutritional status but lacked sensitivity. meanwhile, albumin was more sensitive, demonstrating that it is necessary to use many indicators in combination to diagnose nutritional status properly.
Reconstru??o esofágica pela esofagocoloplastia no megaes?fago avan?ado em pacientes gastrectomizados
Aquino, Jose Luis Braga de;Said, Marcelo Manzano;Maziero, Diana;Oliveira, Jean Marc Prado de;Leandro-Merhi, Vania Aparecida;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2009, DOI: 10.1590/S0102-67202009000400003
Abstract: background: esophagocoloplasty in advanced chagasic megaesophagus is seldom necessary. but, when realized, brings with it a major incidence of complications. aim: to verify the complications following esophagus reconstruction by esophagocoloplasty in patients with previous gastrectomy submitted to transmediastinal esophagectomy for chagasic megaesophagus end-stage. methods: from july 1983 to april 2009, 204 patients with chagasic megaesophagus stage iii and iv were submitted to esophageal resection at the surgery department at the hospital celso pierro puc-campinas, brasil. ninety-two patients had the procedure done by esophageal mucosectomy; 84 under-went a transhiatal esophagectomy and in 38, esophagectomies were done through a transthoracic approach. in 194 patients (95%) the reconstruction was done by gastric interposition and in the 10 remaining patients (5%) it was by transposition of the transverse colon. this procedure was recommend due to previous gastrectomy done in all patients. all of them were male with average age of 47.5 years old. results: seven patients (70%) developed one or more complications, either systemic or local. among the systemic complications, one patient had thrombophlebitis in the lower extremity, with good recovery; one had a myocardial infarction with fatal evolution; three patients (30%) had pulmonary infection with good recovery. amongst the local complications, four patients had cervical anastomotic leak with satisfactory recovery with conservative treatment. five had cervical anastomotic stricture between the 35th and the 63rd post-operative day, with good recovery after endoscopic anastomotic dilatations. from the eight patients followed during this period, six (75%) had good deglutition for solids and/or semi-solids, and satisfied with the surgery since were able to return to their regular diet. conclusions: despite the fact that the esophagocoloplasty results in a good deglutition and quality of life, in short and medium terms,
Comparación del estado nutricional, consumo alimenticio y tiempo de hospitalización de pacientes de dos hospitales, uno público y otro privado
Leandro-Merhi,AV. A.; Diez Garcia,R. W.; M?naco,D. V.; Marques de Oliveira,M. R.;
Nutrición Hospitalaria , 2006,
Abstract: introduction: to assess the nutritional status of hospitalized patients is important for the prevention of hospital malnutrition and planning of nutritional intervention. objective: to comparatively analyze the nutritional status of patients admitted to two hospitals, one public and another private, caring for populations with different socioeconomic profiles. case study and methods: this was a prospective study and samples were collected from patients of two hospitals, one public (puh) and another private (prh), which respectively represent the underprivileged and the more affluent populations. the analysis considered 51 patients from the puh, aged between 53.9 ± 15.6 years and 51 from the prh, aged between 55.0 ± 13.9 years, paired and grouped according to the following diseases: neoplasia (n+25), digestive tract disorders (n+11) and others (n+15). the statistical analysis was made by means of the t-student test to compare puh and prh variables with p < 0.05, as well as to compare different variables in the same hospital, with p < 0.05; p < 0.01; p < 0.005 and p < 0.001. results: there were no statistical differences when the variables evaluated in both hospitals were compared, except for the length of hospitalization of patients with digestive tract disorders, which was longer for hpr. upon hospitalization, 21.0% and 17.6% presented a body mass index (bmi) indicative of malnutrition. the patients with neoplasias presented current weight (cw) lower than habitual weight (hw). both the patients with neoplasias and those with digestive tract disorders presented insufficient energy consumption in the period before hospitalization (p < 0.05). a negative correlation was found between the length of hospitalization and the current weight/habitual weight ratio (r = 0.194, 0 < 0.05, n = 102) and bmi (r=-0.186, p < 0.05, n = 102), according to pearson's coefficient. conclusion: the similarity of nutritional conditions found points to similarity of nutritional status for pati
Avalia o da terapêutica cirúrgica do divertículo faringoesofágico pela sutura mecanica Pharyngoesophageal diverticulum surgical therapy using linear stapling device
José Luis Braga de Aquino,Marcelo Manzano Said,José Francisco Salles Chagas,Vania Aparecida Leandro-Merhi
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2012,
Abstract: RACIONAL: O divertículo faringoesofágico apresenta-se como distúrbio pouco frequente e é provável que este fato seja responsável pela dificuldade encontrada na escolha do método terapêutico mais eficaz. O tratamento cirúrgico ainda é a principal op o terapêutica. No entanto, há controvérsias quanto à técnica cirúrgica que garante melhores resultados. OBJETIVO - Avaliar a eficácia da diverticulectomia com miotomia do músculo cricofaríngeo pela sutura mecanica linear no tratamento cirúrgico do divertículo faringoesofágico em uma série de pacientes no tocante às suas complica es locais e sistêmicas. MéTODO: Foram atendidos 19 pacientes com divertículo de Zenker. Todos apresentavam as condi es clínicas necessárias e preenchiam os critérios de elegibilidade para realiza o do procedimento cirúrgico. Após a diverticulectomia com sutura mecanica todos foram submetidos a avalia o pós-operatória no sentido de identificar a manifesta o de qualquer tipo de complica o. Os pacientes foram estudados retrospectivamente através da análise de prontuários e descri o da interna o hospitalar realizada no momento da opera o e da evolu o ambulatorial. RESULTADOS: A totalidade apresentou resultados satisfatórios, sem evidência de fístula ao nível da sutura da faringe no período pós-operatório precoce. Somente dois indivíduos perderam seguimento na avalia o tardia e um desenvolveu estenose faríngea revertida com dilata o endoscópica. Todos referiram estar satisfeitos com o procedimento empregado e relataram melhora na qualidade de vida ao final do seguimento, proporcionada pelo retorno da degluti o. CONCLUS O: A diverticulectomia com a miotomia do músculo cricofaríngeo e posterior fechamento da faringe com sutura mecanica linear mostrou-se técnica eficaz, com poucas complica es pós-operatórias e melhora significativa na qualidade de vida. BACKGROUND: Pharyngoesophageal diverticulum presents itself as an uncommon disorder. Thus, choosing the most effective treatment method may be challenging. Surgical treatment remains as the main option. However, establishing the best surgical technique is still controversial. AIM: To evaluate the results of diverticulecomy with chricopharyngeal miotomy and linear stapler closure of the pharynx in a patient sample with Zenker`s diverticulum regarding local and systemic complications. METHODS: Nineteen patients with pharyngoesophageal diverticulum were admitted. All of them presented the clinical conditions required to indicate the surgical procedure. Patients were evaluated with regard to any post-operative complications. This st
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