Manejo nutricional em pacientes com risco de síndrome de realimentação

Refeeding syndrome (RS) is a life-threatening complication that occurs after prolonged starvation in malnourished patients or after severe catabolic events. It usually happens in the first 72 hours after the beginning of either enteral or parenteral nutrition and can affect one third of the patients. The most important risk factors are low body mass index (BMI), unintentional weight loss, none or low caloric supply for at least 5 days, history of alcohol or drug abuse and baseline electrolyte disturbances. Thiamine and electrolyte (phosphate, potassium and magnesium) supplementation is mandatory. The initiation and progression of nutrition therapy must be gradual with low amount of calories in the first days, with daily electrolyte monitoring. In the case of low electrolyte levels, especially hypophosphatemia, diet infusion should be reduced and slowly increased over 48 hours. RS deserves special attention the nutrition team to be prevented, identified and treated early.

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Low body mass index, young age and female gender as risk factors predicting negative imaging of insulinomas by endoscopic ultrasound

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-2007-972369 ◽

2007 ◽

Vol 115 (S 1) ◽

Author(s):

S Schaefer ◽

PH Kann

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Body Mass ◽

Endoscopic Ultrasound ◽

Female Gender ◽

Young Age ◽

Low Body Mass Index ◽

Negative Imaging

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Modifiable and Non-Modifiable Risk Factors for Atherothrombotic Ischemic Stroke among Subjects in the Malmö Diet and Cancer Study

Nutrients ◽

10.3390/nu13061952 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1952

Author(s):

Anna Johansson ◽

Isabel Drake ◽

Gunnar Engström ◽

Stefan Acosta

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Body Mass Index ◽

Ischemic Stroke ◽

Family History ◽

Diet Quality ◽

Alcohol Intake ◽

Modifiable Risk Factors ◽

History Of ◽

Diet And Cancer

Risk factors for ischemic stroke is suggested to differ by etiologic subtypes. The purpose of this study was to examine the associations between modifiable and non-modifiable risk factors and atherothrombotic stroke (i.e., excluding cardioembolic stroke), and to examine if the potential benefit of modifiable lifestyle factors differs among subjects with and without predisposing comorbidities. After a median follow-up of 21.2 years, 2339 individuals were diagnosed with atherothrombotic stroke out of 26,547 study participants from the Malmö Diet and Cancer study. Using multivariable Cox regression, we examined non-modifiable (demographics and family history of stroke), semi-modifiable comorbidities (hypertension, dyslipidemia, diabetes mellitus and atherosclerotic disease), and modifiable (smoking, body mass index, diet quality, physical activity, and alcohol intake) risk factors in relation to atherothrombotic stroke. Higher age, male gender, family history of stroke, and low educational level increased the risk of atherothrombotic stroke as did predisposing comorbidities. Non-smoking (hazard ratio (HR) = 0.62, 95% confidence interval (CI) 0.56–0.68), high diet quality (HR = 0.83, 95% CI 0.72–0.97) and high leisure-time physical activity (HR = 0.89, 95% CI 0.80–0.98) decreased the risk of atherothrombotic ischemic stroke independent of established risk factors, with non-significant associations with body mass index and alcohol intake. The effect of the lifestyle factors was independent of predisposing comorbidities at baseline. The adverse effects of several cardiovascular risk factors were confirmed in this study of atherothrombotic stroke. Smoking cessation, improving diet quality and increasing physical activity level is likely to lower risk of atherothrombotic stroke in the general population as well as in patient groups at high risk.

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Clinical Study of Postoperative Bleeding after Tonsillectomy in 497 Cases

International Journal of Practical Otolaryngology ◽

10.1055/s-0041-1723787 ◽

2021 ◽

Vol 4 (01) ◽

pp. e17-e20

Author(s):

Takeshi Tanaka ◽

Kenji Ishii ◽

Kyoko Matsumoto ◽

Koushirou Miura ◽

Ayako Kihara ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Clinical Study ◽

General Anesthesia ◽

Retrospective Analysis ◽

Body Mass ◽

Smoking Habit ◽

Postoperative Bleeding ◽

Operation Time ◽

History Of

AbstractWe conducted a retrospective analysis of 497 patients who underwent tonsillectomy at Kamio Memorial Hospital from September 2015 to August 2018. A total of 35 cases (7.0%) developed postoperative bleeding and three cases (0.6%) needed a second operation under general anesthesia to stop the bleeding. Postoperative bleeding most frequently occurred between 24 hours and 6 days after the operation. The incidence of postoperative bleeding was significantly higher in males and in patients aged 20 to 39 years old. The operation time, body mass index, smoking habit, and history of hypertension were not identified as clinical risk factors for bleeding after tonsillectomy in this study.

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Relation Between Preclinical Atherosclerosis and Venous Thromboembolism in Patients With Thrombophilias – Longitudinal Study

Physiological Research ◽

10.33549/physiolres.932879 ◽

2014 ◽

pp. S403-S409 ◽

Cited By ~ 1

Author(s):

O. AUZKÝ ◽

R. DEMBOVSKÁ ◽

J. MRÁZKOVÁ ◽

Š. NOVÁKOVÁ ◽

L. PAGÁČOVÁ ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Longitudinal Study ◽

Venous Thromboembolism ◽

Waist Circumference ◽

Systolic Blood Pressure ◽

Body Mass ◽

History Of ◽

Preclinical Atherosclerosis

Preclinical atherosclerosis may represent a risk factor for venous thromboembolism (VTE). In longitudinal study we followed longitudinally 96 patients (32 men) with thrombophilias with (n=51) and without (n=45) history of VTE. In both groups we studied the changes of preclinical atherosclerosis at peripherally located arteries detected by ultrasound. In addition, we assessed changes in selected risk factors of atherosclerosis. During the mean follow-up of 56.0±7.62 months we did not find significant change in preclinical atherosclerosis defined as Belcaro score in either group (–3 % in the VTE group vs 0 % in non VTE group). Significant increase in body mass index (1.03±1.98 kg*m-2, resp. 1.21±1.67 kg*m-2, p<0.01) and non-significant increase in systolic blood pressure were detected in both groups. Waist circumference increased significantly only in patients without VTE (4.11±7.84 cm, p<0.05). No differences in changes of risk factors under study between both groups were detected. In summary, patients with thrombophilia and history of VTE showed no evidence of greater progression of atherosclerosis or increase in traditional risk factors of atherosclerosis than patients with thrombophilia without history of VTE. Unfavorable changes of body mass index, waist circumference and systolic blood pressure were detected in both groups during study period.

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Haemophagocytic lymphohistiocytosis secondary to brucellosis in a young child

BMJ Case Reports ◽

10.1136/bcr-2020-240759 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240759

Author(s):

Jashan Mittal ◽

Prawin Kumar ◽

Jagdish Prasad Goyal ◽

Abhishek Purohit

Keyword(s):

Haemophagocytic Lymphohistiocytosis ◽

Appetite Loss ◽

Specific Therapy ◽

Adequate Treatment ◽

Underlying Condition ◽

Persistent Fever ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication

Brucellosis is a common zoonotic disease worldwide. It has protean clinical manifestation and sometimes may has a life-threatening complication. A 4-year-old boy presented with a history of fever, myalgia and appetite loss for 3 weeks. On examination, he had hepatosplenomegaly. The initial working diagnosis was an infection, autoimmune disease and malignancy. Investigations showed positive Brucella serology, and he was started on rifampicin and cotrimoxazole. He was further investigated because of persistent fever, which revealed evidence of haemophagocytic lymphohistiocytosis (HLH). He continued treatment for brucellosis, except rifampicin which was replaced with doxycyclin due to a worsening liver function. The child showed complete clinical and biochemical improvement after 6 weeks of therapy. HLH is a life-threatening condition and should be suspected in children with brucellosis, who did not respond to appropriate antibiotics treatment. Secondary HLH does not always require specific therapy; it may improve with adequate treatment of the underlying condition.

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Waist-to-Height Ratio (WHtR) in Predicting Coronary Artery Disease Compared to Body Mass Index and Waist Circumference in a Single Center from Saudi Arabia

Cardiology Research and Practice ◽

10.1155/2020/4250793 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mostafa Q. Alshamiri ◽

Faisal Mohd A Habbab ◽

Saad Saeed AL-Qahtani ◽

Khalil Abdullah Alghalayini ◽

Omar Mohammed Al-Qattan ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Body Mass Index ◽

Coronary Artery ◽

Cardiometabolic Risk ◽

Height Ratio ◽

History Of ◽

Male Patients ◽

Waist To Height Ratio ◽

Artery Disease

This study aims to study the efficiency of the Waist-to-Height Ratio (WHtR) for determining coronary artery disease. It compares the frequency of abnormal WHtR, as a proxy for abdominal obesity, to that of body mass index (BMI) and waist circumference (WC). It also relates the findings to other cardiometabolic risk factors in University Hospital patients. A cross-sectional study design was used, where a sample of 200 patients (142 males and 58 females) who attended the adult cardiac clinic were purposively included. BMI, WC, and WHtR were measured, where frequencies of WHtR were compared to those of BMI and WC. The findings were related to the history of coronary artery disease (CAD) and history of cardiometabolic risk factors, including diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia. Majority of the male patients were older, taller, and had a lower BMI value. It also showed that the prevalence of dyslipidemia and CAD was higher in male patients. No significant difference between both genders was noticed for weight, WC, WHtR, hypertension, or DM. BMI was least associated with high-risk cardiac population in both males and females (39.4% and 60.3%), followed by WC (84.5% and 96.6%, respectively). WHtR showed the highest association with gender (male 98.6% and females 98.3%). These findings were noticed in patients with all risk factors. WHtR is superior to BMI and WC for determining the elevated risk of diabetes, hypertension, dyslipidemia, and CAD in a single university institute. The role of WHtR in both normal and diseased Saudi population should be delineated.

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Risk Factors for Low Bone Density in Inflammatory Bowel Disease: Use of Glucocorticoids, Low Body Mass Index, and Smoking

Digestive Diseases ◽

10.1159/000496935 ◽

2019 ◽

Vol 37 (4) ◽

pp. 284-290 ◽

Cited By ~ 7

Author(s):

Razi Even Dar ◽

Yoav Mazor ◽

Amir Karban ◽

Sofia Ish-Shalom ◽

Elena Segal

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Inflammatory Bowel Disease ◽

Bone Density ◽

Body Mass ◽

Bowel Disease ◽

Mineral Density ◽

Low Bone Density ◽

Low Body Mass Index ◽

Inflammatory Bowel

Background: Inflammatory bowel disease (IBD) patients are reported to have lower bone density compared to healthy controls. There is limited consensus regarding factors affecting bone density among these patients. Our aim, therefore, was to determine clinical and genetic variables that contribute to lower bone mineral density (BMD) in IBD patients. Methods: A cross-sectional study of IBD patients treated in a tertiary referral center was performed. Epidemiological and clinical data were collected, and genetic testing for the common mutations in Nucleotide-binding Oligomerization Domain-containing protein (NOD)2 was performed. We examined correlations between the different variables and BMD in the total hip, femoral neck, and lumbar spine. Results: Eighty-nine patients (49% males, 67 Crohn’s disease [CD]) participated in the study. 42Forty-two (63%) of the CD and 13 (59%) of the ulcerative colitis patients met the criteria for osteoporosis/osteopenia. Factors associated with lower Z scores were low body mass index (BMI; r = –0.307, p = 0.005), use of glucocorticoids (likelihood ratio [LR] 5.1, p = 0.028), and a trend for male gender (LR = 3.4, p = 0.079). Among CD patients, low bone density showed borderline significance for association with gastrointestinal surgery (LR = 4.1, p = 0.07) and smoking (LR = 3.58, p = 0.06). Low levels of 25OHD were not associated with low BMD, nor were mutations in NOD2. No increased rate of fractures was seen among patients with osteopenia or osteoporosis. Conclusion: In addition to the generally accepted risk factors for osteoporosis (glucocorticoids, low BMI, smoking), male IBD patients had a trend toward lower BMD. Carrying a mutaticon in NOD2 did not confer a risk for bone loss.

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Identification of Persistent Aortocaval Fistula Using Ultrasonography in the Outpatient Setting: A Case Report

Journal for Vascular Ultrasound ◽

10.1177/1544316720933379 ◽

2020 ◽

Vol 44 (3) ◽

pp. 150-153

Author(s):

Richard A. Meena ◽

Melissa N. Warren ◽

Thomas E. Reeve ◽

Olamide Alabi

Keyword(s):

Abdominal Aortic Aneurysm ◽

Case Report ◽

Surgical Repair ◽

Outpatient Setting ◽

Aortocaval Fistula ◽

Abdominal Aortic ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication

Aortocaval fistula (ACF) is a rare and life-threatening complication associated with rupture of an abdominal aortic aneurysm (rAAA). Early detection and management of ACF’s during surgical repair of rAAAs is recommended to reduce the risk of future aneurysm-related complications, including mortality. There is a paucity of current literature on the natural history of ACFs postendovascular exclusion. We present a case study describing the detection of a persistent ACF by duplex ultrasonography (DU) postendovascular aortic repair (EVAR).

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