Background & aims Nutrition has become an important component in treating individuals during the COVID-19 pandemic, which is increasingly affecting the world population, and bringing with it a collapse in health services. Prolonged hospitalization, involving immobilization and catabolism, induces a decrease in body weight and muscle mass that may result in sarcopenia, a condition that impairs respiratory and cardiac function, worsening the prognosis. The present study aimed to analyze enteral nutritional support and the clinical evolution of patients admitted for COVID-19 in Brazil. Methods This was a retrospective study, carried out from March to May 2020, with patients admitted to a referral hospital in cardiology and pulmonology in Fortaleza-Ce/Brazil, 200 patients with COVID-19 were selected. Sociodemographic, clinical, and nutritional data were collected from electronic medical records, and associations between outcomes and use of prone body position with nutritional variables were analyzed by linear regression. The odds ratio and 95% confidence interval estimates for the death outcome were analyzed by logistic regression. Results Of the 112 patients who fed by the enteral route, the majority were male (n = 61, 54.5%), elderly (n = 88, 78.6%), with no current smoking habit (n = 81, 72.3%). The median hospital stay was 14 days, mostly in the intensive care units (median of 9 days). Prone body positioning impacted the nutritional therapy. In general, those patients who maintained a prone body position tested lower for kcal/kg of body weight, proteins/kg of body weight, percentage of diet adequacy, and total caloric value. In addition, patients who died had lower mean maximum kcal/kg body weight, protein/kg body weight, percentage of diet adequacy, and total caloric value compared to surviving patients. Conclusions There was an association between inadequacies in protein and energy supply with mortality was confirmed suggesting that nutritional support optimization be prescribed in such situations.
Background The Simplified Acute Physiology Score (SAPS) 3 is a reliable score to predict mortality. This study aims to investigate the predictive values of SAPS 3 and other clinical parameters for death in critically ill coronavirus disease 2019 (COVID-19) patients. Methods This is a prospective study in a tertiary hospital for patients who required intensive care due to COVID-19 infection in northeast Brazil. Two distinct groups were constructed according to the epidemiological data: first wave and second wave. The severity of patients admitted was estimated using the SAPS 3 score. Results A total of 767 patients were included: 290 were enrolled in the first wave and 477 in the second wave. Patients in the first wave had more comorbidities, were put on mechanical ventilation and required dialysis and vasopressors more frequently (p<0.05). During the second wave, non-invasive ventilation was more often required (p<0.05). In both periods, older patients and higher SAPS 3 scores on admission were associated with death (p<0.05). Non-invasive ventilation use showed a negative association with death only in the second wave period. In the first wave, the SAPS 3 score was more useful (area under the curve [AUC] 0.897) in predicting death in critically ill COVID-19 patients than in the second wave (AUC 0.810). Conclusion The SAPS 3 showed very reliable predictive values for death during the waves of the COVID-19 pandemic, mostly together with kidney and pulmonary dysfunction.
O presente artigo constitui-se como uma revisão do estudo “Um estrangeiro em família: ser surdo como diferença linguística” e tem o objetivo de refletir sobre os resultados de uma tese de doutoramento com o estudo desenvolvido em uma universidade particular. Por meio de uma pesquisa qualitativa, com desenho etnográfico, que ocorreu no período de maio de 2010 a maio de 2012, com dez estudantes surdos universitários. Esses estudantes, sete alunos do sexo masculino e três alunos do sexo feminino, de 18 a 38 anos, faziam uso da língua de sinais como meio de comunicação principal no Campus, provenientes de vários cursos, além da participação de seus familiares ouvintes, na investigação. Fez-se uso da técnica de Grupo Focal e de entrevistas semiabertas, com a formação de dois grupos, um composto por surdos e o outro por seus familiares. Como recurso para análise de dados empregou-se o software Nvivo, apontando oito categorias: Comunicação, Oralização Obrigatória, Cultura Surda, Preconceito, Escolarização Inadequada, Família, Perspectiva da Diferença e Perspectiva Médica, que revelam correlações entre si e demonstram divergências de percepções, entre os dois grupos. Deixando claro que os surdos sustentam a perspectiva da condição de ser surdo como uma diferença, enquanto os familiares apontam como uma deficiência, na perspectiva do modelo médico. A revisão do estudo constatou que os surdos não aceitam a perspectiva da deficiência, enquanto os ouvintes familiares, como a sociedade asseguram-se de que há uma falta e que a condição de ser surdo é uma deficiência.
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