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Godoy BZ, Faintuch J, Marin MLM, Nogueira MA, Pinto VB, Pollara WM. Off label pharmacological therapy in patients with short bowel syndrome. Eur Rev Med Pharmacol Sci 2013; 17:3285-3290. [PMID: 24379057] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Short bowel syndrome is a disabling disease requiring long-term nutritional support and ancillary drugs. Aiming to analyze the most commonly prescribed drugs, a retrospective analysis was conducted is an outpatient cohort. PATIENTS AND METHODS Stable patients (N= 37, 59.5% males, age 51.1 ± 20.1 years, body mass index 20.1 ± 7.9 kg/m2) with three or more appointments in the Outpatient Service during the last 18 months were retrospectively analyzed. regarding oral pharmacologic prescriptions. Medications were classified as on label or off label. RESULTS A total of 257 oral prescriptions were retrieved from computer files, encompassing 17 different preparations. The majority was employed on label however 28.8% (74/257) were classified as off label and scrutinized with regard to indications. The main categories were pharmacologic modulators of gastrointestinal secretions and motility, along with antibiotics. Virtually all patients required one or more of such drugs, without differences regarding demographic or clinical variables. Adverse effects or premature drug discontinuation were not observed. CONCLUSIONS This is the first study to our knowledge highlighting the importance of adjuvant drugs, particularly with unconventional indications, in the management of short bowel syndrome. Antidiarrheic agents, pancrelipase micropellets, antacids and antibiotics represented the most relevant off label prescriptions for this population.
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Affiliation(s)
- B Z Godoy
- Pharmacy Division, Hospital das Clínicas, São Paulo University Medical School, SP, Brazil.
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Faintuch J, Souza SAF, Fabris SM, Cecconello I, Capodaglio P. Rehabilitation needs after bariatric surgery. Eur J Phys Rehabil Med 2013; 49:431-437. [PMID: 23736904] [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: 06/02/2023]
Abstract
BACKGROUND Bariatric surgery has grown from an obscure experimental procedure to one of the most popular operations in the world. Such accelerated progress left many gaps, notably concerning subsequent rehabilitation needs of this population. AIM In the present study, a brief description of both the patients and the interventions is provided, along with potentially disabling features especially concerning the locomotor system, which has received comparatively little attention . DESIGN Based on reported protocols and actual experience, major issues are addressed. SETTING Bariatric patients are initially managed in the hospital, however long-term and even lifetime needs may be recognized, requiring major lifestyle and physical activity changes. These have to be focused in all settings, inside and outside the healthcare institutions. POPULATION Initially only adults were considered bariatric candidates, however currently also adolescents and the elderly are admitted in many centers. RESULTS Bariatric weight loss is certainly successful for remission or prevention of metabolic, cardiovascular and cancer comorbidities. Yet benefits for bones, joints and muscles, along with general physical performance are still incompletely established. This should be no reason for denying continued care to such individuals, within the context of well-designed protocols, as available evidence points toward favorable rehabilitation in the realms of physical, social and workplace activities. CONCLUSION The importance of a physiatric curriculum in medical schools has been emphasized. Even more crucial is the presence of such a specialists in obesity and bariatric teams, a requirement recognized in a few countries but not in others. CLINICAL REHABILITATION IMPACT The relevance of obesity as a disabling condition is reviewed, along with the positive changes induced by surgical weight loss. Although obesity alleviation is a legitimate end-point it is not a sufficient one. The shortcomings of such result from the point of view of physical normalization are outlined, and recommendations are suggested.
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Affiliation(s)
- J Faintuch
- Department of Gastroenterology, Hospital das Clinicas, Sao Paulo, Brazil. j.faintuch @hc.fm.usp.br
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Silva EM, Moráis LCSL, Medeiros Filho JEM, Asciutti LSR, Rocha HAC, Costa MJC, Gonçalves MCR, Faintuch J. Should ascitis volume and anthropometric measurements be estimated in hospitalized alcoholic cirrotics? NUTR HOSP 2013; 27:2089-92. [PMID: 23588461 DOI: 10.3305/nh.2012.27.6.6123] [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] [Received: 08/20/2012] [Accepted: 10/13/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Ascitis and undernutrition are frequent complications of cirrhosis, however ascitis volume and anthropometric assessment are not routinely documented or considered in prognostic evaluation. In a homogeneous cohort followed during two years these variables were scrutinized, aiming to ascertain relevance for longterm outcome. METHODS Population (N = 25, all males with alcoholic cirrhosis) was recruited among patients hospitalized for uncomplicated ascitis. Exclusion criteria were refractory or tense ascitis, cancer, spontaneous bacterial peritonitis, bleeding varices and critical illness. Measurements included ultrasonographically estimated ascitis volume, dry body mass index/BMI , upper arm anthropometrics, hematologic counts and liver function tests. RESULTS Population (age 48.3 ± 11.3 years, BMI 21.1 ± 3.5 kg/m², serum albumin 2.5 ± 0.8 g/dL) was mostly in the Child-Pugh C category (77.8%) but clinically stable. During the follow-up period of 22.6 ± 3.8 months, additional hospitalizations numbered 1.7 ± 1.0 and more than one quarter succumbed. Admission ascitis volume corresponded to 7.1 ± 3.6 L and dry BMI to 18.3 ± 3.5 kg/m². Child Pugh index was relevant for both mortality and rehospitalization. Nevertheless, similar matches for mortality were documented with ascitis volume and dry BMI, and arm circumference below the 5th percentile was highly significantly associated with rehospitalization. CONCLUSIONS A greater association than hitherto acknowledged, between ascitis volume and anthropometric measurements from one side, and long-term rehospitalization and mortality from the other, was demonstrated in male stable alcoholic cirrhotics. Further studies with alcoholic and other modalities of cirrhosis including women are recommended.
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Affiliation(s)
- E M Silva
- University Hospital Lauro Wanderley, Federal University of Paraiba. João Pessoa. Brazil
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Schiper L, Sadigursky D, Rosario DAV, Schiper SP, Passos LC, Faintuch J. Hip fracture prognosis: could bioimpedance be an alternative to conventional nutritional assessment? NUTR HOSP 2012; 26:904-6. [PMID: 22470041 DOI: 10.1590/s0212-16112011000400034] [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] [Received: 03/07/2011] [Accepted: 04/05/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk-factors for mortality in hip fractures encompass nutritional status, nominally body mass index, but not body composition. Given the difficulty of anthropometric assessment in bedridden patients a prospective study with bioimpedance analysis was designed. METHODS Elderly patients with hip fracture were consecutively recruited. Biochemical tests, primitive bioimpedance measurements (resistance, reactance and phase angle) and follow-up till one year were targeted. RESULTS Patients (N = 69, 81.2 ± 8.1 years old, 72.5% females) stayed in the hospital for 15.5 ± 17.1 days, and 18.8% (13/69) required further hospitalization during the ensuing months. Mortality was 11.6% within 30 days, coinciding with hospital mortality, and an additional 11.6% till one year, thus reaching 23.2%. Anemia, hypoalbuminemia and low transferrin, along with elevated glucose and urea were frequent, suggesting undernutrition with metabolic derangements. Reactance, urea and creatinine were different in patients suffering both early and late demise. Resistance, white blood cell count and osteoporosis were risk factors for early mortality only , and anemia exclusively for late mortality. CONCLUSIONS Primitive bioimpedance measurements, which had not been hitherto investigated , were prognostically related to early and late mortality. These markers of disease-related malnutrition and especially reactance should be further studied in patients unfit for anthropometric evaluation due to fracture and immobility.
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Affiliation(s)
- L Schiper
- Orthopedic and Traumatologic Clinic, Salvador, BA, Brazil
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Matos DAR, Filizzola RG, Costa MJC, Diniz AS, Faintuch J. Are calcium and fiber beneficial for poorly controlled diabetic patients? NUTR HOSP 2011; 26:410-4. [PMID: 21666982 DOI: 10.1590/s0212-16112011000200025] [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] [Received: 11/03/2010] [Accepted: 11/07/2010] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED No nutritional protocol for poorly controlled diabetic patients receiving well-managed drug treatment is currently available. OBJECTIVE Aims were to compare dietary consumption of calcium and fibers with lipid profile and glycosilated hemoglobin HbA1c. METHODOLOGY This was a prospective observational study. Patients with poorly controlled diabetes were consecutively recruited. A food-frequency questionnaire and tests for lipid profile, HbA1c, and C reactive protein were collected, along with clinical and anthropometric assessment. RESULTS Patients (N = 114, age 65.7 ± 6.5 years, 75.4% females, BMI 29.0 ± 5.3 kg/m²) were often insulin-dependent (32.5%) and with systemic inflammation (C-reactive protein 4.2 ± 3.9 mg/L). Diet was energy restricted (1,365 ± 565 kcal/day) and mostly adequate but with suboptimal fiber (15.4 ± 8.6 g/day) and very low calcium (592.4 ± 204.4 mg/day). Calcium and fiber in the diet correlated with serum lipids, whereas fiber alone displayed a protective association regarding diabetes (HBA1c, insulin use) and arterial hypertension. CONCLUSIONS Calcium and fiber ingestion exhibited correlations with important markers of metabolic status and cardiovascular risk. Future studies should address enhancement of these ingredients by means of dietary changes and supplements.
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Affiliation(s)
- D A R Matos
- Federal University of Paraiba, João Pessoa, Paraiba, Brazil
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Faintuch J, Bortolotto LA, Marques PC, Faintuch JJ, França JI, Cecconello I. Systemic inflammation and carotid diameter in obese patients: pilot comparative study with flaxseed powder and cassava powder. NUTR HOSP 2011; 26:208-213. [PMID: 21519749] [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: 06/30/2010] [Accepted: 09/30/2010] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Botanical omega-3 fatty acid (alphalinolenic acid/ALA) has been shown to alleviate the prothrombotic and proinflammatory profile of metabolic syndrome, however clinical protocols are still scarce. Aiming to focus an obese population, a pilot study was designed. METHODS Morbidly obese candidates for bariatric surgery (n = 29, age 46.3 ± 5.2 years), 82.8% females (24/29), BMI 44.9 ± 5.2 kg/m², with C-reactive protein/CRP > 5 mg/L were recruited. Twenty were randomized and after exclusions, 16 were available for analysis. Flaxseed powder (60 g/day, 10 g ALA) and isocaloric roasted cassava powder (60 g/day, fat-free) were administered in a double-blind routine for 12 weeks. RESULTS During flaxseed consumption neutrophil count decreased and fibrinogen, complement C4, prothrombin time and carotid diameter remained stable, whereas placebo (cassava powder) was associated with further elevation of those measurements. CONCLUSIONS Inflammatory and coagulatory markers tended to exhibit a better outlook in the flaxseed group. Also large-artery diameter stabilized whereas further increase was noticed in controls. These findings raise the hypothesis of a less deleterious cardiovascular course in seriously obese subjects receiving a flaxseed supplement.
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Affiliation(s)
- J Faintuch
- Nutrology Residency Program, Hospital das Clinicas, São Paulo, Brazil.
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Lima RLFC, Costa MJC, Filizola RG, Asciutti LSR, Leite RF, Ferreira ASM, Faintuch J. Consumption of fruits and vegetables and C-reactive protein in women undergoing cosmetic surgery. NUTR HOSP 2010; 25:763-767. [PMID: 21336433] [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: 03/04/2010] [Accepted: 04/06/2010] [Indexed: 05/30/2023] Open
Abstract
UNLABELLED Low-grade inflammation adversely influences metabolism and cardiovascular prognosis, nevertheless increased intake of fruits and vegetables has rarely been studied in this context. OBJECTIVE In a prospective controlled study, the effect on C-reactive protein (CRP) levels was assessed. METHODOLOGY Sixty consecutive women undergoing cosmetic abdominal surgery were instructed to consume six servings each of fruits and vegetables during the first postoperative month. Detailed 24 h interviewer-administered dietary recall was conducted at baseline and at the end of the study, with weekly returns to monitor unscheduled dietary changes and compliance with the protocol. Variance (ANOVA) and covariance (ANCOVA) were evaluated to confirm significance and minimize confounding variables. RESULTS No differences concerning age (42.2±5.3 vs 41.1±6.0 years) or BMI (25.5±3.1 vs 25.0±3.0 kg/m²) occurred. Ingestion of fruits increased to approximately 5.2 vs 3.9 and of vegetables 5.9 vs 3.4 servings/ day, respectively. CRP decreased more conspicuously in the treated group (P=0.028), and correlation between vitamin C input and CRP in supplemented participants was demonstrated (P=0.014). CONCLUSIONS Higher intake of antioxidant foods was feasible, and an antiinflammatory effect occurred. Further studies with longer administration and follow-up period are recommended.
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Affiliation(s)
- R L F C Lima
- Nutritional Sciences-University of Paraíba, João Pessoa, Brazil.
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Ribeiro AG, Faintuch J, Dias MCG, Cecconello I. Euglycemia and normolipidemia after anti-obesity gastric bypass. NUTR HOSP 2009; 24:32-39. [PMID: 19266110] [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: 02/20/2008] [Accepted: 05/14/2008] [Indexed: 05/27/2023] Open
Abstract
UNLABELLED Weight loss and resolution of comorbidities is well established after modern bariatric procedures, however chronology of glyco-lipidic biochemical response is still debated. OBJECTIVE Aiming to analyze this variable as well as its correlation with food amount and composition, a prospective study was designed. METHODOLOGY Eighty consecutive patients undergoing Roux-en-Y gastric bypass were investigated every three months until one year after surgery. Females only were accepted and variables included general and nutritional course as well as glucose and lipid measurements. Energy intake was documented including percentage of macronutrients in the diet. RESULTS Surgery was successful with about 71% excess body weight loss at the end of the first year. Mean energy intake on the 4 postoperative quarters was respectively 519.6 +/- 306.6, 836.0 +/- 407.9, 702.1 +/- 313.1 and 868.8 +/- 342.8 kcal/day (mean +/- SD). Fat intake was initially low but reached 34.1 +/- 7.9% of total calories at final measurement. Blood glucose and lipid fractions tended to be borderline or abnormal preoperatively, and favorably changed by 12 months. Consumption of glucose-and lipid-lowering medication significantly diminished, but each of these was still necessary in 6.3% of the group. Correlation between body mass index and also calorie intake versus glucose and lipid measurements was highly significant (P = 0.000). CONCLUSIONS 1) Energy intake after operation was very low; 2) Weight loss proceeded rapidly and correlated with meal pattern; 3) Improvement of glucose and lipid tests was adequate but took several quarters to normalize; 4) Decreased requirements for glucose- and lipid-lowering medication was significant but not absolute; 4) Fat percentage of total calories exceeded 30% at the end of the observation period, despite recommendations to the contrary.
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Affiliation(s)
- A G Ribeiro
- Federal University of Paraiba, Joao Pessoa, Brazil
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Sakai P, Kuga R, Safatle-Ribeiro AV, Faintuch J, Gama-Rodrigues JJ, Ishida RK, Furuya CK, Yamamoto H, Ishioka S. Is it feasible to reach the bypassed stomach after Roux-en-Y gastric bypass for morbid obesity? The use of the double-balloon enteroscope. Endoscopy 2005; 37:566-9. [PMID: 15933931 DOI: 10.1055/s-2005-861444] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. PATIENTS AND METHODS This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. RESULTS The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. CONCLUSIONS Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
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Affiliation(s)
- P Sakai
- Endoscopy Unit, Dept. of Gastroenterology, São Paulo University Medical School, Hospital das Clinicas, São Paulo, Brazil.
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Beer I, de Cleva R, Faintuch J, Matsuda M, Zilberstein B, Gama-rodrigues J. Crit Care 2005; 9:P121. [DOI: 10.1186/cc3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Silva M, Ferreira A, Faintuch J, Maio M, Bresciani C, Gama-Rodrigues J, Zilberstein B. Psychological importance of body image in obese women. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Silva M, Silva A, Matsuoka V, Faintuch J, Zilberstein B, Gama-Rodrigues J. Psychological fragility of obese women. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zanini A, Oller A, Henrique L, Oliveira T, Souza A, Faintuch J. Management of hypoalbuminemia in hospitalized patients. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Faintuch J, Matsuda M, Cruz M, Silva M, Dias M, Oliveira C, Rascovski A. Severe protein-calorie malnutrition after bariatric intervention. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marin ML, Chaves CE, Zanini AC, Faintuch J, Faintuch D, Cipriano SL. Cost of drugs manufactured by the university hospital--role of the Central Pharmacy. Rev Hosp Clin Fac Med Sao Paulo 2001; 56:41-6. [PMID: 11460203 DOI: 10.1590/s0041-87812001000200002] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clínicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.
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Affiliation(s)
- M L Marin
- Pharmacy Division, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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Abstract
Refeeding syndrome encompasses fluid and electrolyte imbalances and metabolic, intestinal, and cardiorespiratory derangements associated with appreciable morbidity and mortality. Although refeeding syndrome has been well documented in concentration-camp subjects, and more recently during parenteral therapy of critically ill patients, little is known about the importance of refeeding syndrome during recovery from a hunger strike. Thus, we studied the response to a four-step dietary replenishment routine in eight hunger strikers who refused food for 43 d. In this retrospective, observational study, we assessed the safety and efficacy of the refeeding procedure and analyzed the clinical and nutritional course of the cohort during both starvation and refeeding, mainly on the basis of clinical as well as a few biochemical determinations. During starvation, average weight loss was about 18% and, with the exception of occasional oral vitamins and electrolytes, the subjects consumed only water. Available body-composition and biochemical profiles showed no clinically significant changes during starvation, but one-half of the group displayed spontaneous diarrhea at some time before refeeding. Stepwise nutritional replenishment lasted for 9 d, after which all patients tolerated a full, unrestricted diet. Only one episode of diarrhea occurred during this phase, and both clinical and biochemical indexes confirmed a favorable clinical course, without any manifestation of refeeding syndrome. In conclusion, we observed the following: 1) Hypophosphatemia and other micronutrient imbalances did not occur, nor was macronutrient intolerance detected. 2) Despite some episodes of diarrhea, nutritional replenishment was not associated with significant enteral dysfunction. 3) There was some fluid retention, but this was mild. 4) Acute-phase markers were abnormally elevated during the refeeding phase, without associated sepsis or inflammation.
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Affiliation(s)
- J Faintuch
- Nutrition Group and Department of Emergency Medicine, Hospital das Clinicas, São Paulo, Brazil.
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Faintuch J, Soriano FG, Ladeira JP, Janiszewski M, Velasco IT, Gama-Rodrigues JJ. Changes in body fluid and energy compartments during prolonged hunger strike. Rev Hosp Clin Fac Med Sao Paulo 2000; 55:47-54. [PMID: 10959123 DOI: 10.1590/s0041-87812000000200003] [Citation(s) in RCA: 9] [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] [Indexed: 11/22/2022]
Abstract
UNLABELLED Prolonged total food deprivation in non-obese adults is rare, and few studies have documented body composition changes in this setting. In a group of eight hunger strikers who refused alimentation for 43 days, water and energy compartments were estimated, aiming to assess the impact of progressive starvation. Measurements included body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC), and bioimpedance (BIA) determinations of water, fat, lean body mass (LBM), and total resistance. Indirect calorimetry was also performed in one occasion. The age of the group was 43.3+/-6.2 years (seven males, one female). Only water, intermittent vitamins and electrolytes were ingested, and average weight loss reached 17.9%. On the last two days of the fast (43rd-44th day) rapid intravenous fluid, electrolyte, and vitamin replenishment were provided before proceeding with realimentation. Body fat decreased approximately 60% (BIA and TSF), whereas BMI reduced only 18%. Initial fat was estimated by BIA as 52.2+/-5.4% of body weight, and even on the 43rd day it was still measured as 19.7+/-3.8% of weight. TSF findings were much lower and commensurate with other anthropometric results. Water was comparatively low with high total resistance, and these findings rapidly reversed upon the intravenous rapid hydration. At the end of the starvation period, BMI (21.5+/-2.6 kg/m2) and most anthropometric determinations were still acceptable, suggesting efficient energy and muscle conservation. CONCLUSIONS 1) All compartments diminished during fasting, but body fat was by far the most affected; 2) Total water was low and total body resistance comparatively elevated, but these findings rapidly reversed upon rehydration; 3) Exaggerated fat percentage estimates from BIA tests and simultaneous increase in lean body mass estimates suggested that this method was inappropriate for assessing energy compartments in the studied population; 4) Patients were not morphologically malnourished after 43 days of fasting; however, the prognostic impact of other impairments was not considered in this analysis.
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Affiliation(s)
- J Faintuch
- Department of Emergency Medicine, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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Faintuch J. [Nutritional disorders in chronic hepatic disease]. Arq Gastroenterol 2000; 37:1-2. [PMID: 10962619 DOI: 10.1590/s0004-28032000000100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Faintuch S, de Cleva R, Faintuch J, Gama-Rodrigues JJ. Increased intestinal permeability after upper gastrointestinal surgery during enteral nutrition. JPEN J Parenter Enteral Nutr 2000; 24:49-50. [PMID: 10638472 DOI: 10.1177/014860710002400149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Faintuch J. Prevention of liver injury by cytokines. JPEN J Parenter Enteral Nutr 1999; 23:366-7. [PMID: 10574488 DOI: 10.1177/0148607199023006366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Faintuch J, Leme RB, Cruz ME, Lima AM, Giannella Neto D, Gama-Rodrigues JJ. Low blood glucose levels and other complications during growth hormone supplementation in sepsis. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:135-8. [PMID: 10779822 DOI: 10.1590/s0041-87811999000400007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood glucose levels in the high normal range or even moderate hyperglycemia is the expected profile in septic postoperative patients receiving high-calorie enteral alimentation. The addition of growth hormone as an anabolic agent should additionally reinforce this tendency. In a cancer patient undergoing partial gastrectomy with lymphadenectomy and suffering from postoperative subphrenic abscess and prolonged sepsis, tube feeding (38.3 kcal/kg/day) and growth hormone (0.17 IU/kg/day) were simultaneously administered for 25 days. Blood glucose levels were in the lower limits of the normal range before growth hormone introduction, and continued with a similar tendency during most of the therapeutic period. Two additional complications, namely heart arrest and peripheral edema, were documented during the same period. It is concluded that sepsis was the most likely mechanism for low glucose values, and that high-calorie enteral diet and growth hormone supplementation did not prevent that result. It is uncertain whether heart arrest was due to the drug, but its association with peripheral edema is well documented in clinical series.
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Affiliation(s)
- J Faintuch
- Nutrition Group, Department of Gastroenterology, Hospital das Clínicas, São Paulo, SP, Brazil
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Affiliation(s)
- J Faintuch
- Nutrition Group, Hospital das Clinicas, Sao Paulo, Brazil
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Barbosa E, Moreira EA, Goes JE, Faintuch J. Pilot study with a glutamine-supplemented enteral formula in critically ill infants. Rev Hosp Clin Fac Med Sao Paulo 1999; 54:21-4. [PMID: 10488597 DOI: 10.1590/s0041-87811999000100005] [Citation(s) in RCA: 38] [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] [Indexed: 01/01/2023]
Abstract
Seriously ill infants often display protein-calorie malnutrition due to the metabolic demands of sepsis and respiratory failure. Glutamine has been classified as a conditionally essential amino acid, with special usefulness in critical patients. Immunomodulation, gut protection, and prevention of protein depletion are mentioned among its positive effects in such circumstances. With the intent of evaluating the tolerance and clinical impact of a glutamine supplement in seriously ill infants, a prospective randomized study was done with nine patients. Anthropometric and biochemical determinations were made, and length of stay in the intensive care unit (ICU), in the hospital, and under artificial ventilation, and septic morbidity and mortality were tabulated. Infants in the treatment group (n = 5) were enterally administered 0.3 g/kg of glutamine, whereas controls received 0.3 g/kg of casein during a standard period of five days. Septic complications occurred in 75% of the controls (3/4) versus 20% of the glutamine-treated group (1/5, p < or = 0.10), and two patients in the control group died of bacterial infections (50% vs. 0%, p < or = 0.10). Days in the ICU, in the hospital, and with ventilation numerically favored glutamine therapy, although without statistical significance. The supplements were usually well tolerated, and no patient required discontinuation of the program. The conclusion was that glutamine supplementation was safe and tended to be associated with less infectious morbidity and mortality in this high-risk population.
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Affiliation(s)
- E Barbosa
- Hospital Infantil Joana de Gusmão, Department of Nutrition, Federal University of Santa Catarina
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26
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Jampietro S, Faintuch J, Pinotti H. P.130 Metabolic and nutritional impact of chronic parasiticinfestation in symptomless workers. Clin Nutr 1998. [DOI: 10.1016/s0261-5614(98)80286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Morais AA, Comarella AP, Pitanga KC, Faintuch J. Interest of conventional clinical, biochemical and bioimpedance measurements as indicators of mortality risk in critical patients. Rev Hosp Clin Fac Med Sao Paulo 1998; 53:176-80. [PMID: 9922496] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Risk assessment is nowadays an essential part of the management of seriously ill subjects, and multiple scoring methods are available, based on single or preferably multiple determinations. Some of these protocols have been successfully used around the world, and they permit the prediction of outcomes in different clinical populations. However, many indices are labor-intensive or demand an expanded set of biochemical determinations, thus representing an economical burden. Aiming to evaluate the prognostic value of ordinary variables that are already present in the clinical observation, 50 consecutive patients admitted at the intensive care unit were prospectively documented. Methods included clinical (age, sex, stay in ICU, FIO2), biochemical (serum albumin, hemoglobin, glucose, creatinine, WBC count), and bioimpedance variables (resistance, reactance, body impedance coefficient). All these values were registered at admission and before discharge or death, and compared with survival rate. Initially only WBC count was significantly different in survivors, but ongoing documentation revealed that later on, four indices were endowed with prognostic impact: serum album, glucose levels, WBC count and FIO2 requirements. Organ or function-sustaining procedures were also associated with outcome, nominally mechanical ventilation, vasoactive drugs, and enteral/parenteral nutrition. Furthermore, patients submitted to two or three of these methods exhibited higher mortality than those receiving just one, with even better result for those not requiring any. It is concluded that observation of ongoing changes in conventional clinical variables available in the clinical chart are a valid means of estimating the mortality risk in critical cases.
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Affiliation(s)
- A A Morais
- Department of Surgery, Santa Casa Medical School (EMESCAM) Vitória, Espírito Santo, Brazil
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28
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Morais AA, Tavares GM, Pezzin AC, Moana AA, Galvão HP, Faintuch J. [Assessment of body composition in pregnant women at term]. Rev Assoc Med Bras (1992) 1997; 43:109-13. [PMID: 9336045 DOI: 10.1590/s0104-42301997000200006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pregnancy is associated with well-known physiologic changes of maternal fluid and energy compartments, along with organ hypertrophies and the appearance of fetal and placental tissues. As a consequence, body composition is modified, but this phenomenon has not been well documented. The advent of bioimpedance has contributed to the documentation of the desired information in a safe and practical way. AIMS The aims of this study were: To register the principal anthropometric variables in a population of pregnant women at term; To determine body composition by bioimpedance analysis; To compare these findings with the former results, as well as with other assessment procedures reported in the literature. PATIENTS AND METHOD The population consisted of 30 pregnant women at term admitted for delivery, without complications, fetal distress or multiple pregnancy, and submitted to the following measurements: Anthropometry--Weight, height, body mass index, triceps skinfold, arm muscle circumference; Bioimpedance analysis--Body fat, lean body mass, total water, intra and extra-cellular water, third space, and exchangeable Na/K ratio. RESULTS Body weight and body mass index were increased but within the expected values for these patients. Total body water was similar to results in non-pregnant women when expressed as percentage, in accordance with other studies, but with a trend toward increase in the extracellular compartment and presence of third space fluid. Body fat was elevated, but the proportions were not much different from previous anthropometric surveys. CONCLUSIONS In the conditions of this investigation, in which a bioimpedance equation for general use was employed, the method indicated results that were consistent with the clinical course, anthropometric documentation, and the findings of other groups. It is concluded that bioimpedance analysis compares favorably with other assessment procedures in pregnancy, and further studies with this method should be undertaken.
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Affiliation(s)
- A A Morais
- Escola de Medicina da Santa Casa de Misericórdia de Vitória, ES
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Morais AA, Costa RA, Grilo MG, Bezerra ME, Vieira MM, Alves RF, Carmo SC, Faintuch J. Measurement of body composition changes during hemodialysis by bioimpedance analysis. Rev Hosp Clin Fac Med Sao Paulo 1996; 51:121-3. [PMID: 9163971] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Monitoring of fluid exchanges during hemodialysis is essential for the safety and efficacy of the procedure. Bioimpedance analysis has been used for the measurement of body compartments in many settings, but experience during hemodialysis is relatively scare. In a prospective study of 28 cases of chronic renal failure treated by long-term hemodialysis on an outpatient basis, body composition studies were done immediately before and after the dialysis session. Methods included body weight, serum albumin, hematocrit, hemoglobin, sodium and osmolality. These variables were compared with impedance (BIA) findings, namely lean body mass, body fat, total water, extra and intra-cellular water, third space, and exchangeable sodium/potassium ratio. Patients lost weight and improved hematocrit, hemoglobin, osmolality and serum sodium during the therapy, and BIA measurements were consistent with these changes. Lean body mass and body fat markedly changed along the dialysis session (respectively -24.5% and + 7.5%), and these results were out of proportion regarding known gains and losses in that period. It is concluded that BIA was useful for monitoring water fluxes during hemodialysis, but provided unreliable information about body fat and lean body mass.
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Affiliation(s)
- A A Morais
- Department of Surgery, EMESCAM Medical School, Vitória, Espírito Santo
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Vieira MJ, Gama-Rodrigues JJ, Habr-Gama A, Faintuch J, Waitzberg DL, Pinotti HW. Preoperative assessment in cases of adult megacolon suffering from moderate malnutrition. Nutrition 1996; 12:491-5. [PMID: 8878140 DOI: 10.1016/s0899-9007(96)91724-4] [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: 02/02/2023]
Abstract
Acquired megacolon is a chronic disease associated with constipation and malnutrition. Surgical treatment may be required for the alleviation of the intestinal symptoms, emphasizing the interest of nutritional assessment in this population. In a prospective study of 33 patients suffering from acquired megacolon and requiring either anterior resection or pull-through operation, standard anthropometric and biochemical measurements as well as the PNI of Buzby and Mullen were preoperatively assessed. Mean age of the population was 49 +/- 13 y, with 17 males and 16 females. The combined nutritional score indicated 63.6% of the population were malnourished (21/33) of the patients, whereas the Prognostic nutritional index (PNI) revealed 3 high-risk cases (9.1%), 9 with moderate risk (27.3%), and reduced risk for all others. Indeed, 39.4% (13/33) of the patients displayed surgical or septic problems. Chi-square analysis confirmed that both studied criteria were significantly associated with complications (p < 0.05), as morbidity was restricted predominantly to cases with unfavorable Prognostic nutritional index (PNI) results or clear signs of nutritional deficit. Both PNI and conventinoal nutritional assessment are valuable tools for the screening of these surgical candidates. Artificial alimentation was not used in this experience, but deserves consideration in selected patients. Nutritional status improved in the late postoperative period, with normalization of bowel function.
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Affiliation(s)
- M J Vieira
- Division of Gastrointestinal Surgery, Hospital das Clínicas, São Paulo, Brazil
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31
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Faintuch J, Machado FK, Freire AN, Reis JR, Machado M, Pinto LP, Ramos SM, Loebens M, Jovchelevich V, Pinotti HW. Hematologic disorders in trauma patients during parenteral alimentation with lipids. Rev Hosp Clin Fac Med Sao Paulo 1996; 51:60-64. [PMID: 9008934] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.
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Affiliation(s)
- J Faintuch
- Nutrition Group, Hospital das Clínicas, São Paulo
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32
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Dias MC, Nadalin W, Baxter YC, Faintuch J, Waitzberg DL, Maculevicius J. [Nutritional assistance to patients during radiotherapy]. Rev Hosp Clin Fac Med Sao Paulo 1996; 51:53-9. [PMID: 9008933] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With the aim of assessing the possible benefits of nutritional therapy, 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +/- 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100%, and a lymphocyte count diminished along this period (1933 +/- 1033 vs 1265 +/- 688, p. 0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases initially, significantly improved to just 40% inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21% of the patients, taste changes in 79%, xerostomy in 81%, anorexia in 66% and odinophagia in 59%. In the individuals selected for enteral feeding, side-effects were represented by technical problems (20%) and gastrointestinal disorders (13%). All patients completed the nutritional support program and there was no mortality in this series. It is concluded that; 1) Early nutritional support during radiotherapy was able to maintain or improve the nutritional status; 2) Tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; 3) Reduction of total lymphocytes could not be prevented by the mentioned therapy; 4) Complications of enteral alimentation were mild and affected a small proportion of the population; 5) Troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of food; 6) The compliance to the therapeutic plan was excellent and can be attributed to the efforts of the multidisciplinary team as well as to the help of the specialized home alimentation unit (PROSNED): Diet therapy. Cancer. Nutritional assessment. Radiotherapy. Nutritional support.
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Affiliation(s)
- M C Dias
- Divisão de Nutrição e Dietética, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
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Baxter YC, Gonçalves Dias MC, Maculevicius J, Faintuch J, Cecconello I, Pinotti HW. [Iron-deficiency anemia in enteral nutrition: correlation with tube position]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:330-3. [PMID: 8731255] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Enteral alimentation is a commonly employed procedure for pre-operative rehabilitation and nutritional maintenance of depleted patients suffering from esophageal diseases. In a prospective study of 61 cases exhibiting benign (n = 38) and malignant (n = 23) conditions, a commercial polymeric diet was supplied in the proportion of 40 Kcal/kg/day during at least two weeks. The liquid preparation was infused by bolus technique at home, by the patients themselves, via nasogastric (n = 25) or nasoduodenal silastic tube (n = 36). Total food intake, that before treatment had been under 60% of estimated requirements, reached the expected range throughout the therapeutic period, and also iron input was adequate (0.3 mg/kg/day). Standart anthropometric and biochemical assessment of these cases, with included serum iron and hemoglobin concentration, indicated stabilization of general nutritional parameters, but with persistence of moderate anemia(hemoglobin 12.6 +/- 2.0 g/dl; iron 59.2 +/- 35.7 mg/dl). Stratification of the population according to enteral tube position demonstrated similar diagnoses and clinical conditions for both groups. Mean initial iron and hemoglobin concentration was also the same, but final serum iron was increased after gastric administration (p < 0.05) and diminished with duodenal diet (p < 0.05). It is concluded that: home enteral nutrition in malnourished patients with esophageal diseases is consistent with an acceptable nutritional status, but without significant recovery from anemia, serum iron in this population only increases after intra-gastric alimentation; it is probable that this last finding is related to impaired ionization and absorption of dietary iron, when food is introduced in a postpyloric site.
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Affiliation(s)
- Y C Baxter
- Faculdade de Medicina da Universidade de São Paulo
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Faintuch J, Faintuch JJ. [Cardiovascular effects of arginine and nitric oxide]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:334-8. [PMID: 8731256] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Amino acids are an unusual chemical category because they are endowed with alimentary properties, but at the same time they may determine typical pharmacologic responses in some circumstances. These facts were responsible for the origin of modern pharmaconutrition, which has been using arginine for some time because of its beneficial impact on immune function, nitrogen anabolism and wound healing. The recent identification of its metabolite NO (nitric oxide), a powerful mediator related to a large number of physiologic and pathophysiologic phenomenons, has augmented the interest for this amino acid.
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Morais AA, Santos JE, Faintuch J. [Comparative study of arginine and glutamine supplements in malnourished surgical patients]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:276-9. [PMID: 8578093] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Protein-calorie malnutrition is frequently diagnosed in patients with serious digestive conditions displaying obstructive symptoms, notably in esophageal cancer. In the present study a homogeneous group of subjects affected by esophageal cancer and candidates for elective surgery was randomly treated by one of the following oral supplements: arginine (group I), glutamine (group II), or mixed commercial amino acids (Group III-controls). The methods included nutritional measurements (biochemical and anthropometric assement), immunologic survey (skin tests), and general clinical and surgical findings, with emphasis on surgical morbidity. Body weight remained stable throughout the study, whereas serum albumin, total lymphocytes and skin tests tended to improve in all groups, with statistical confirmation for albumin in arginine-treated cases (group II). Post-operative hospitalization was numerically shorter during glutamine supplementation, and this trend was statistically significant when total morbidity was compared between the groups. It is concluded that: 1) Malnutrition and anergy were a major problem in this population, with equally severe post-operative morbidity; 2) Administration of arginine enabled serum albumin levels to improve; 3) Glutamine-treated subjects displayed reduced post-operative morbidity; 4) No side effects could be attributed to the therapy here employed.
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Affiliation(s)
- A A Morais
- Instituto Mineiro de Oncologia (Hosp. Prof. João Batista de Rezende Alves
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36
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Faintuch J, Waitzburg DL, Bertevello PL, Silva ML, Borges VC, Pereira SS, Gama-Rodrigues JJ, Pinotti HW. Conservative management of septic parenteral nutrition catheters. JPEN J Parenter Enteral Nutr 1995; 19:428-9. [PMID: 8577029 DOI: 10.1177/0148607195019005428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Leme R, Faintuch J, Teixeira C, Garrido A, Gama-Rodriques J, Maculevicius J, Pinotti H. P.66 Initial weight loss after surgical treatmentfor morbid obesity not due to fat reduction. Clin Nutr 1995. [DOI: 10.1016/s0261-5614(95)80215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Faintuch J, Aguilar PB, Dias MC, Nadalin W, Pinotti HW. [Nutritional support, free radicals, and antioxidants]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:133-135. [PMID: 8525253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Antioxidants and free radical scavengers are molecules endowed with the ability of neutralizing reactive oxygen species that may accumulate in the organism during various pathologic processes. In circumstances of peroxidation of lipids and damage to enzymatic chains, cell membranes and other structures may be followed by functional losses and even cell death. Many antioxidants are normal constituents of the diet in the form of vitamins, trace elements and amino acids, and other useful properties cannot be easily distinguished from their free-radical scavenging abilities. Much controversy surrounds also the indications of these substances, both for prophylactic and therapeutic purposes. The first large-scale population studies have only recently been arranged, and additional investigations are required in many promising areas, including cancer patients undergoing chemo and radiotherapy.
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Faintuch J. Hypocaloric peripheral parenteral nutrition. NUTR HOSP 1995; 10:54-5. [PMID: 7711153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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41
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Faintuch J, Waitzberg DL, Bertevello PL, Borges VC, Silva ML, Santoro S, Gama-Rodrigues JJ, Pinotti HW. [Infections of central venous catheters]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:52-4. [PMID: 7481456] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The central venous catheter is considered the lifeline of patients requiring long-term parenteral nutrition, and its infectious complications accordingly represent a frequent cause for hospitalization and morbidity. Modern catheters made of Silastic increase the duration and efficiency of venous access, but their substitution is also more complex and expensive. In a small series of patients undergoing home parenteral nutrition due to short bowel syndrome, and carrying. Silastic catheters, infection of the cannula was treated by administration of systemic as well as local antimicrobial agents. The septic process was resolved without the need of removing the catheters, and with excellent tolerance to the medications. It is concluded that in-situ sterilization of long-term catheters should be attempted in selected cases.
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Affiliation(s)
- J Faintuch
- Disciplina de Cirurgia do Aparelho Digestivo, da Faculdade de Medicina da Universidade de São Paulo
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Faintuch J. [Hemophagocytosis: a new syndrome in critically ill patients]. Rev Hosp Clin Fac Med Sao Paulo 1994; 49:228-30. [PMID: 7610332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Faintuch J, Jampietro SM, Pinotti HW. [Nutrition and pharmaco-nutrition in severe liver diseases]. Rev Hosp Clin Fac Med Sao Paulo 1994; 49:145-7. [PMID: 7871320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
BACKGROUND Hepatic arterial infusion chemotherapy (HAIC) of liver metastases of colon cancer with an implantable pump is associated with liver and gastrointestinal complications. METHODS The authors retrospectively studied the clinical features and gastric histopathology of nine patients who received HAIC and had gastritis develop and in whom biopsy specimens were available. RESULTS Gastritis was heralded in these patients by epigastric pain and tenderness, nausea, vomiting, weakness, and anorexia. In seven patients, 18 gastric ulcers were endoscopically detected. Mucosal damage developed despite prophylactic antiulcer therapy and healed only upon cessation of HAIC. These observations suggest that the predominant drug given, floxuridine, was the responsible toxic agent. Seventeen biopsy specimens were reviewed, and all exhibited varied histologic evidence of inflammation, reactive glandular changes, and cell necrosis. These mucosal changes were present even in tissues obtained from patients without ulcers. In addition, floxuridine-induced glandular atypia was noted in eight biopsy samples from six patients. The crowded glands were distorted and lined by large cells that included bizarre forms with pleomorphic nuclei. CONCLUSIONS Gastric injury in HAIC appeared analogous to the general features encountered in reactive gastritis resulting from chemical irritants. The glandular atypia is peculiar to HAIC, and although the changes were morphologically alarming, in this clinical situation care should be exercised not to interpret floxuridine-induced atypia as carcinoma.
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Affiliation(s)
- M I Doria
- Department of Pathology, University of Chicago, Illinois
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45
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Faintuch J, Pinotti HW. Severe hypophosphatemia in postoperative patients. Nutr Clin Pract 1994; 9:41. [PMID: 8159141 DOI: 10.1177/011542659400900141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Baxter Y, Dias M, Maculevicius J, Faintuch J, Cecconello I, Pinotti H. Home tube feeding of anemic patients with benign and malignant diseases. Clin Nutr 1994. [DOI: 10.1016/0261-5614(94)90275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Dias M, Baxter Y, Maculevicius J, Nadalin W, Faintuch J. Enteral nutrition during radiotherapy does not prevent lymphopenia but promotes albumin normalisation. Clin Nutr 1994. [DOI: 10.1016/0261-5614(94)90259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Faintuch J. [Complications of central venous catheterization]. Rev Assoc Med Bras (1992) 1993; 39:258-9. [PMID: 8162094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Faintuch J, Cabraitz R, Martín Nieto AR, Yagi OK, Zilberstein B, Cecconello I, Pinotti HW, Wesdorp RI. [The prognostic value of cholesterol levels in malnourished patients with esophageal carcinoma]. NUTR HOSP 1993; 8:352-7. [PMID: 8373878] [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: 01/30/2023] Open
Abstract
A variety of clinical calculations, including serum cholesterol, have been used as parameters of prognostic value in surgical populations, but there are few studies aimed at patients with esophageal carcinoma. In a set of patients with established esophageal cancer, cholesterol and triglyceride levels were recorded, along with the following parameters: age, sex, body weight, serum albumin, total lymphocytes, and hemoglobin concentration. Manual grip strength was measured, along with delayed cutaneous hypersensitivity response, and the type of surgical treatment was distinguished (palliative versus radical). Total complications and postoperative hospitalisation time are the main indicators used in our study for the surgical results. Patients were divided into two groups: those with serum cholesterol levels over 150 mg/dl (Group I) and those under that figure (Group II). Most nutritional and functional values were lower in Group II patients, for whom the radical surgery rate was also lower, with greater postoperative morbidity. It was concluded that 1): Cholesterol depletion is associated with nutritional and immunological alterations and 2) post-surgical results are poorer in patients with levels below 150 mg/dl.
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Affiliation(s)
- J Faintuch
- Departamento de Gastroenterología, Hospital Das Clinicas, Sao Paulo, Brasil
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Faintuch J. Contamination of enteral feeding systems in the nosocomial environment. JPEN J Parenter Enteral Nutr 1993; 17:398-9. [PMID: 8271370 DOI: 10.1177/0148607193017004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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