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Biomedical subjects

D L Waitzberg

Publications and source records attributed to D L Waitzberg.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Clinical use of growth hormone and glutamine in short bowel syndrome.

Growth hormone (GH) and glutamine (GLN) are considered bowel trophic factors and are used experimentally after bowel resection. Their clinical uses in short bowel syndrome (SBS) are still not standardized. It is of interest to verify metabolic, nutritional and side effects of the association of GH and GLN in SBS. Three patients, 39 (A), 33 (B), and 01 years old (C) underwent bowel resection with jejunum anastomosis 15 cm (A) and 60 cm (B) distant from the Treitz angle, and 40 cm (C) preserving the ileo cecal valve. GH Saizen (Serono-A), Genotropin (Pharmacia-B), and Norditropin (Novonordisk C) were administered in doses of 0.14 mg/kg/day. GLN (0.4 g/kg/day) was given orally for 10 days (A), 30 days (B) and 60 days to patient C (0.28 g/kg/day). Central TPN and adequate oral diet was administered according to the bowel adaptation phase. On the first day after beginning treatment patient A exhibited symptoms of hypoglycemia. There were no other side effects. After treatment, body weight was higher and analysis by bioelectrical impedance showed more lean mass and less fat mass compared to pre-treatment measurements. Nitrogen retention was progressively higher with treatment. Simultaneous treatment with GH and GLN does not cause significant side effects, and is associated with a favorable distribution of the body compartments and nitrogen retention in patients with the short bowel syndrome.

Adult↗
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Long term (five-year) survival following radical surgical treatment plus adjuvant chemotherapy (FAM) in advanced gastric cancer: a controlled study.

Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate.

Antineoplastic Combined Chemotherapy Protocols↗
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Small bowel adaptation with growth hormone and glutamine after massive resection of rat's small bowel.

The use of glutamine (GLN) and growth hormone (GH) improves intestinal adaptation in short bowel syndrome (SBS). The present study aimed to assess the effect of a diet rich in glutamine and the use of GH on intestinal adaptation in experimental SBS. 80 Wistar rats (240 g) were randomized into 6 groups: 1) RGLN (20)--95% small bowel resection and fed on GLN diet; 2) RGLNGH (20)--95% SBR, GLN diet and GH; 3) RC (10)--95% SBR and fed on a low GLN control diet (C); 4) RCGH (10)--95% SBR and C diet and GH; 5) TAGLIN (10)--intestinal transection and anastomosis (Ta) and fed on a GLN diet; 6) TAGLNGH (10)--Ta and GLN diet and GH. GH was given SC at a dose of 0.14 mg/kg/day. The rats were weighed daily and nitrogen balance was made. Rats were sacrificed after 15 days and mucosa cell proliferation was studied with PC10 antibody. Statistical analysis was performed. All SBR rats lost weight as compared to their initial weight (8% to 13%). GH improved Ta rats weight (18.98 x 5.04%). The use of GLN diet and GH improved nitrogen balance and bowel growth on SBR groups, as compared to controls, but not cell proliferation. In conclusion, the use of GLN enriched diet and GH improves intestinal adaptation after massive resection of the small bowel in rats.

Animals↗
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Risk factors for malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients.

OBJECTIVE: The aim of this study was to assess the nutritional status of 374 surgical patients with gastrointestinal disease and hernias of the abdominal wall; to identify risk factors associated with a poorer nutritional status in this group of patients and to assess awareness of the patient's nutritional status by medical teams. SUMMARY BACKGROUND DATA: Malnutrition is prevalent among surgical patients and is associated with higher surgical complication rates and mortality. The major causes of poor nutritional status are related to the underlying disease, socio-economic factors, age, and length of hospitalization. Despite its high prevalence, medical teams often overlook malnutrition, and screening of these patients is not routine. It is of utmost importance to identify patients at risk for malnutrition in order to prevent related complications. METHODS: The 374 patients evaluated in this study were a subgroup of a larger multicenter, cross-sectional, randomized study that was carried out in 1996. Nutritional status was assessed by using Subjective Global Assessment. RESULTS: Malnutrition was present in 55% of the patients, with 19% of the patients severely malnourished. The presence of cancer, infection, age over 60 years, upper gastrointestinal disease, and longer length of hospital stay all negatively influenced nutritional status. Despite the high prevalence of malnutrition, the medical teams only assessed the nutritional status of a few patients. CONCLUSION: Malnutrition was highly prevalent in this setting of patients. Therefore, patients with the risk factors above presented should routinely undergo nutritional screening and/or assessment in order to be able to early diagnose or prevent malnutrition and its correlated morbidity and mortality.

Adult↗
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Pharmacological nutrition in inflammatory bowel diseases.

Inflammatory Bowel Diseases--ulcerative colitis and Crohn's disease--are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted. Total parenteral nutrition has been used to correct and prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with a high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission of disease in adults and promoting growth in children. Recent research has focused on the use of specific nutrients as primary treatment agents. Although some reports have indicated that glutamine, short-chain fatty acids, antioxidants and immunonutrition with omega-3 fatty acids are an important therapeutic alternative in the management of inflammatory bowel diseases, the beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these nutrients still need further evaluation through prospective and randomized trials.

Colitis, Ulcerative↗
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Nutritional assessment of adult patients admitted to a hospital of the Amazon region.

UNLABELLED: Changes in nutritional status are important in clinical practice because they relate to an increase in morbidity and mortality. Studies about nutritional problems in hospitalized adults have been reported since the 1970s. The prevalence of malnutrition has varied from 10 to 70%, depending on the diagnostic criteria used. The hospital studied and the duration of admission. AIM: To assess, in the first day of hospital stay, the nutritional status of adults admitted to undergo elective surgery in a public hospital of the State of Acre, Amazon Region, Brazil. STUDY DESIGN: Sectional study from April 7 to May 22, 2002. PATIENTS AND METHODS: 155 consecutive nutritional evaluations were performed using several parameters-global subjective assessment (GSA), anthropometric measurement and some laboratory tests. For the diagnosis of malnutrition the Index Suggestive of Malnutrition (ISM), as proposed by Waitzberg, was adopted. In the evaluation of obesity the BMI (Body Mass Index), with cutoffs suggested by WHO was used. RESULTS: 75.2% were women. Average age was 34.4 +/- 10.1 years. Mulatto (63.1%) was the prevailing racial group. Gynecological (43.6%) was the most frequent surgery. ISM disclosed a 12.1% prevalence of malnutrition. BMI classified 2.0% of the patients as grade I overweight and 15.4% as being obese. Among 76 patients classified as normal by BMI, 15 (19.7%) were considered malnourished by ISM criteria. Concordance between ISM and BMI was weak (k = 0.07). GSA classified 100% of the cases as well nourished. CONCLUSION: Lack of a golden standard to make the diagnosis of changes in nutritional status has been one of the determinants of the wide variations observed in the pertinent literature and it has hindered valid comparisons. The present study suggests that BMI should be used as an indicator of proportion and not of nutritional status. GSA underestimates the diagnosis of malnutrition. This paper concludes that establishing uniform standards for diagnostic criteria for malnutrition is urgently required and suggests preferring IMS (Index Suggestive of Malnutrition) because of its easy use, low coast and high sensitivity.

Adult↗
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[The effect of lipid emulsions on the mechanisms of organic defense in infectious injury].

For treatment of metabolic derangements in infective states intravenous lipidic emulsions have been used. Their use is however not harmless existing reports on fat inhibiting the function of blood polymorphonuclear leukocytes and macrophages. The purpose of the research reported herewith was to study in rats the effect of new intravenous lipidic emulsions containing medium chain triglycerides and long chain triglycerides and compare it with the effect of long chain triglycerides emulsion on function of polymorphonuclear leukocytes (chemotaxis, phagocytosis and bactericidal activity). The intraperitoneal implant of an E. coli capsule was used for the study. The transfusions of both lipidic emulsions in septic rats have not altered functions of polymorphonuclear leukocytes when compared with saline infusion. However there was found hepatic steatosis, hypertrophy and presence of fat globules in the Kupffer cells in rats infused with medium chain and long chain triglyceride emulsions. Sequential blood cultures obtained from rats infused with the emulsions showed increased bacterial growth with medium chain triglyceride emulsion. There was no significant difference between the rats that received both lipid infusions and those that received saline infusions as to the mortality. Our experimental study suggests that the use of fat emulsions in infective states be done with care and monitoring of seric triglycerides and steroids.

Analysis of Variance↗
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Pre-and postoperative nutritional evaluation in patients with chagasic megaesophagus.

Chagasic megaesophagus is a chronic disease that courses with progressive dysphagia, regurgitation and protein-calorie malnutrition. Advanced or recurrent megaesophagus can be treated with Serra Dória's operation (cardioplasty, partial gastrectomy and gastrojejunal Roux-en-Y anastomosis). A nutritional evaluation was performed on 27 patients (mean age 58 +/- 10 years) with chagasic megaesophagus at admission and after postoperative day 90. The nutritional state was assessed through global subjective nutritional evaluation (GSNE), anthropometry and laboratorial exams, besides the analysis of alimentary intake. In the preoperative period, GSNE pointed to malnutrition in 2/3 patients, while the anthropometric and laboratorial evaluation revealed that over 60% of the patients had protein-calorie malnutrition of the marasmic type. The preoperative nutritional state as evaluated by GSNE did not correlate with complications or postoperative mortality. The postoperative evaluation showed an increase in the intake of proteins, recovery in the body mass index and a reduction in the hemoglobin levels of the peripheral blood.

Adult↗
PubMedDate not supplied

A proposal for clinical nutrition education for health care university students and professionals in the Amazon.

UNLABELLED: Changes in nutritional status are related to an increase in morbidity and mortality. It is well established that health care professionals, particularly physicians, lack formal education to recognize nutritional disorders, which malnutrition may worsen in the hospital, and that appropriate education could effectively correct this problem. AIM: To evaluate the awareness of the health care university students and professionals about the nutrition disorders in Amazon region hospitalized patients before and after a specific education program. STUDY DESIGN: An intensive Course on Clinical Nutrition, given in three weekly classes was offered to the multidisciplinary health care students and professionals of the health care tem. CASES AND METHODS: 195 participants started the course. They were 97 students of nursing, 52 students of medicine, 20 nurses, 15 resident physicians, 3 physicians, 3 dietitians, 2 others, 1 no answer. 165 participants concluded it. Precourse and postcourse tests were answered. The results of these tests are presented in this study. RESULTS AND DISCUSSION: 76.4% of the participants were graduation students. 40% of participants had no contact with patients yet. When the exposure of the participants of the course to the theme Nutrition was analyzed, 46.7% of the resident physicians considered

Academic Medical Centers↗
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Diet and colorectal cancer: current evidence for etiology and prevention.

The etiology of colorectal cancer (CRC) involves the interaction of cell molecular changes and environmental factors, with a great emphasis on diet components. But the paths connecting lifestyle characteristicas and the colorectal carcinogenesis remain unclear. Several risk factors are commonly found in western diets, such as high concentrations of fat and animal protein, as well as low amounts of fiber, fruits and vegetables. A large number of experimental studies have found a counteractive effect of fiber on neoplasia induction, especially in relation to fermentable fiber (wheat bran and cellulose). Epidemiological correlation studies have also indicated that a greater ingestion of vegetables, fruit, cereal and seeds is associated to a lower risk for colorectal neoplasia. Moreover, beneficial properties of fiber (especially from vegetable sources) were documented in more than half of case-control studies. Nevertheless, recent epidemiological data from longitudinal and randomized trials tended not to support this influence. Future research should evaluate what sources of fiber provide effective anti-neoplasic protection, carrying out interventional studies with specific fibers for longer periods. Red meat, processed meats, and perhaps refines carbohydrates are also implicated in CRC risk. Recommendantions to decrease red meat intake are well accepted, although the total amount and composition of specific fatty acids may have distinct roles in this setting. Current evidence favors the substitution of long and medium-chain fatty acids and arachidonic acid for short-chain fatty acids and eicosapentaenoic acid. Excess boy weight and excess energy intake inducing hyperinsulinemia have been also associated to CRC, as well as personal habits such as physical inactivy, high alcohol consumption, smoking and low consumption of folate and methionine. Thus, current recommendations for decreasing the risk of CRC include dietary measures such as increased plant food intake; the consumption of whole grains, vegetables and fruits; and reduced red meat intake.

Colorectal Neoplasms↗
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Nutritional intervention improves the caloric and proteic ingestion of head and neck cancer patients under radiotherapy.

Malnutrition is commonly associated with head and neck cancer, due especially to anorexia, which is aggravated by radiotherapy. The objective of this study was to evaluate modifications to nutritional ingestion following three types of nutritional intervention. Sixty-four male out-patients (62.1 +/- 1.5 years) were divided into three groups: oral group, (n=32) that received an adapted oral diet; feeding tube group, (n=16) under home enteral nutrition via a nasoenteral feeding tube (6x/day); and supplement group, (n=16) with oral diet associated to oral alimentary supplement between meals (3x/day). The groups were homogeneous and counseled to maintain a caloric ingestion of 40 kcal/kg. The diet for the oral group was adapted to the age and to the side effects of radiotherapyThe nutritional state of the three groups was evaluated for the caloric-proteic ingestion, anthropometric indicators (body weight, body mass index, triceps skinfold thickness, midarm muscle area), laboratorial indicators (total proteins, albumin, hematocrit, hemoglobin and total lymphocytes count), The results showed that all of the groups presented an increase in the ingestion of calories and proteins (p < 0.001). The nutritional therapy support for patients with head and neck cancer under radiotherapy, whether exclusive oral diet, enteral through a feeding tube, or with alimentary supplement associated to an oral diet achieved a significant increase in the total caloric ingestion. It is recommended that programs be implemented-to improve the ingestion of foods among these patients.

Administration, Oral↗
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[Degree of nutritional training of intensive care physicians. A survey in public hospitals of Asunción].

UNLABELLED: Nutritional support in the critically ill patient is an important mainstay within the specialty of intensive care medicine. Patients at the Intensive Care Unit (ICU) are usually hypercatabolic and require an adequate nutritional support. Usually, the intensive care physician prescribes nutrition type, its amount, and follow-up of patients; however, the qualification of these physicians regarding clinical nutrition is unknown. OBJECTIVE: to investigate the degree of knowledge on artificial nutrition and the interest on nutrition of intensive care physicians. METHODOLOGY: a prospective survey was done on 60 intensive care physicians from three public hospitals of Asunción (22 staff physicians and 38 internal residents), with a mean age of 34 +/- 6 years, and a mean professional practice of 5.8 +/- 6 years. The survey contained 10 questions and multiple-choice answers to determine the degree of knowledge depending on the grade obtained, and 5 questions on personal training and attitude towards nutritional support in the ICU. RESULTS: 98.3% of surveyed physicians considered that nutritional support of the ICU-admitted patient has an effect on morbidity and mortality of patients. Nevertheless, 88.3% of physicians considered their nutritional training in the ICU as insufficient. Seventy percent do not usually read papers on nutrition on scientific journals. Only 25% of them formulate parenteral nutrition, and 30% have attended a course on nutrition in the ICU within the last 5 years. The final grade for the 10 questions, the maximum grade possible being 10, was 6.1 +/- 1.9 for staff physicians, and 5.59 +/- 2.3 for internal residents (p = 0.3). When analyzing the correct answers by years of practice, the mean grade was 5.2 +/- 2.3 in those with less than 2 years of practice versus 6.4 +/- 1.7 in those with more than 2 years of practice (p = 0.02). CONCLUSIONS: nutritional training in intensive care medicine is incomplete and the degree of knowledge on nutrition in the critically ill patient is insufficient, being lower in physicians with a limited practice in the ICU. These results suggest the urgent need for training on clinical nutrition of intensive care physicians for the care of the critically ill patient being complete.

Adult↗
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[Clinical nutrition knowledge in health care members of University Hospitals of Paraguay].

BACKGROUND: Adequate clinical nutrition care is an integral part of the complete treatment of hospitalised patients, requiring specific knowledge from the health care team. The aim of this study is to assess, in Paraguay, the health care team ability in clinical care nutrition. MATERIALS AND METHODS: A survey was made including 174 people of Paraguay university hospitals (29% physicians, 29% medicine graduating students, 11% pharmaceutics, 24% nurses, 7% dieticians), by answering voluntarily a multiple choice questionnaire of 20 items. RESULTS: The median score of the 20 questions was 6 (0-15). Physicians obtained a median of 6 (2-15), graduating students 7 (2-14), pharmaceutics 7 (0-15), nurses 3 (0-11), and dieticians 9 (4-13). The dieticians obtained a significantly higher score than the other groups (p < 0.005). CONCLUSIONS: The knowledge about clinical nutrition in the health care members from university hospitals is not adequate. The level of education in clinical nutrition is better in the dietician.

Clinical Competence↗
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The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients.

BACKGROUND AND AIM: To asses the nutritional status of hospitalised trauma patients and the repercussion on the clinical follow up. METHODS: In a prospective way 161 adult patients admitted to the units of Intensive Care (ICU), General Surgery, Maxillofacial Surgery and Orthopedics of the Centro de Emergencias Médicas in Asunción, Paraguay, from March 2002 to March 2004 were evaluated at admission by using the Subjective Global Assessment (SGA). Patients were followed to determine length of hospital stay, complications and in-hospital mortality. RESULTS: From the trauma patients median age was 27 (14-92) years and 94% were males. Most patients (74%) were from the countryside. The most frequent anatomic sites of trauma were: head 25%, thorax 16.6%, limbs 15.4%, abdomen 14%. The median Injury Severity Score (ISS) was 20 (1-39). From this population of patients, 40% were malnourished or at risk of malnutrition according to the SGA. Multivariate analysis identified as significant risk factors for mortality: malnutrition according to the SGA (p = 0.04, RR = 4 (1-15), and admission to the ICU (p = 0.0001, RR 53 (12-234). Risk factors for complications were malnutrition according to the SGA (p = 0.003, RR 2.9 (1.4-5.8) and ISS over 20 (p = 0.001, RR = 8.4 (2.3-29.9). The risk factors for length of stay were malnutrition according to the Subjective Global Assesment (p = 0.01, RR = 2.3 (1.2-4.7) and Injury Severity Score over 20, p = 0.03, RR = 2.8 (1-7.3). CONCLUSIONS: In the conditions of this study, malnutrition is frequent on admission in trauma patients, and is an independent risk factor for morbidity, mortality, and prolongs the length of hospitalisation. Efforts should be made to quickly assess the nutritional status of these patients and early start nutritional intervention.

Adolescent↗
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[Energy metabolism and experimental malignant tumor development].

Weight loss in cancer can be attributed to anorexia and/or increased energy expenditure. In order to understand the contribution of these variables, 36 Wistar rats fed regular diet were randomly distributed in 3 groups: T (12) bearing Walker 256 carcinosarcoma; PF (12) pair fed with T group and C (12) as control group; another group--D (12)--in which rats were fed with low protein (1%) diet. Caloric intake, body and tumor weight were measured daily. Indirect calorimetry was done sequentially each 4 days. After 2 weeks of tumor growth there was significant reduction of caloric intake and carcass weight in T group compared to those of C group. There was no difference in carcass weight between T and PF group. After 3 weeks it was significantly reduced in T group (55.7 Kcal/m2/h against 75.0 of N and 65.1 of PF group). Walker 256 carcinosarcoma is an hypometabolic tumor and the host weight loss associated to its development is due to anorexia.

Animals↗
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[Effects of parenteral nutrition on tumor growth: experimental aspects].

There still exist controversies about the effect of parenteral nutrition on cancer growth. For elucidation of this question the development of Walker 256 carcinosarcoma in rats submitted to parenteral nutrition (PN) was studied. Thirty-five Wistar rats were randomly distributed in three groups: OT group (11), tumor-bearing animals always under oral feeding for 14 days; PC group (14), tumor free animals under PN for 7 days; PT group (10), tumor-bearing rats under PT for 7 days. PT solution contained 15% glucose, 3% aminoacids and essential micronutrients. Body and tumor weight (in OT and PT groups) were evaluated daily. Carcass weight was obtained by the difference between the body and tumor weight. The rats of the PC group had an initial body weight loss that became stabilized afterwards at a lower plateau level. The rats of the PT group also presented an initial body weight loss recovered progressively afterwards. This difference is probably due to tumor mass expansion in PT animals, since PT rats carcass weight remained similar to that of body weight in PC group. The tumor growth has shown no difference between the oral and parenteral feeding groups, particularly when tumor weight/carcass weight ratio was considered. It is concluded that parenteral nutrition does not favor tumor growth in detriment to carcass weight development.

Animals↗
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[Effects of protein malnutrition on the metabolic response to trauma].

An experimental study was carried out in rats with the purpose to evaluate post-traumatic metabolic changes in the animals submitted to proteic malnutrition. Rats fed with diets with different contents were submitted to a standardized osteomuscular trauma and had nitrogen balance and body composition parameters analysed. After 21 days of feeding with normoproteic diet chow (N) or hypoproteic diet (D) all the animals were submitted to a dorsal skin wound (subgroups NJ (6) and DJ (6). Besides the skin wound part of the rats suffered also the osteomuscular trauma (subgroups NF (6) and DF (6). After 14 days of osteomuscular trauma all the rats were sacrificed and the carcasses were prepared for body composition measurements. Body weight, food intake, fecal and urinary total nitrogen were measured daily. It was observed that in rats with normoproteic diet the osteomuscular trauma promoted a decrease of food intake and loss of weight; in animals on hipoproteic diet it was observed an increase in total urinary nitrogen output and reduction of nitrogen balance. However, there was no reduction of food intake, loss of body weight and changes in composition of body compartments.

Animals↗