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BACKGROUND: Patients with cancer receiving adequate enteral nutrition (EN) have improved clinical outcomes. Unfortunately, discrepancies may exist between the amounts prescribed and received. This study aimed to investigate: (1) the receiving exclusive EN, (2) the relationship between inadequacy and unfavorable outcomes, and (3) the impact of inadequate EN administration on the survival of patients with cancer. METHODS: This study included hospitalized patients with solid tumors who exclusively received EN and were evaluated using data extracted from electronic medical records. Nutritional risk was evaluated using Nutritional Risk Screening (NRS - 2002). EN adequacy was assessed from days 3-7 of hospitalization. Calorie and protein delivery by EN was classified as adequate (≥80 % of EN administration) or inadequate (<80 % of EN administration). Data were analyzed using dispersion and Bland-Altman plots, Pearson's chi-square and Fisher's exact tests, and Kaplan-Meier survival curves. RESULTS: A total of 114 patients were evaluated (63.9 ± 13.1 years of age, 67.5 % male, 32.5 % with head and neck cancer, and 86.8 % at nutritional risk). During the 5-day evaluation period, only 14 % of the patients received the mean volume, proteins, and calories according to the EN prescription. A relationship was observed between inadequate EN (<80 %) and 30-day in-hospital mortality. This result was confirmed by Kaplan-Meier survival analysis (p = 0.020), which showed a survival benefit in patients at nutritional risk who received adequate calories and protein. CONCLUSION: This study demonstrated significant caloric and protein deficits related with EN. Furthermore, adequate calorie and protein administration could contribute to improved survival in patients with cancer who are at a risk of malnutrition, however, randomized controlled trials are required to confirm whether adequate calorie administration could contribute to improved survival.

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BACKGROUND: Previous studies found high prevalence of inadequate intakes of vitamins E, D and K, calcium and potassium among Brazilian pre-school children, with suboptimal consumption of dairy products. Dietary modelling was applied to determine the theoretical impact of improving dairy products consumption on nutrient adequacy in 4-5-year-old Brazilian children. METHODS: Adherence to the dairy recommendation of two servings/day was calculated using data from the Brazil Kids Nutrition and Health Study (KNHS) (n = 228). Two modelling scenarios were applied to test the impact on nutrient intakes of (1) adding one or two servings of a frequently consumed cow's milk or a widely available fortified alternative: pre-school children milk (PCM), and of (2) substituting the current milk consumed by PCM. Mean nutrient intakes and percentage of children adhering to the nutrient recommendations were determined at baseline and after applying modelling scenarios. RESULTS: Seventy-six percent (n = 174) of children did not meet the recommended daily two servings of dairy products, 56% had less than one serving of dairy products on the day of recall. The mean consumption of whole milk (fortified and unfortified) was 147 g/d, yoghurt 114 g/d and cheese 34 g/d. The addition of one serving of cow's milk demonstrated a 17% reduction in calcium inadequacy, 18% reduction in vitamin A and 3% reduction in zinc inadequacy. Adding one serving of PCM further reduced calcium inadequacy from 87 to 41%, vitamin E from 81 to 37%, and zinc inadequacy by 10%. Replacing the child's current milk with a PCM resulted in further reduction of micronutrient inadequacies, including calcium, vitamin D and vitamin E. CONCLUSIONS: Dairy products consumption in pre-school children should be encouraged to reduce nutrient inadequacies. In particular, consumption of PCM would help to reduce calcium, vitamin D and vitamin E inadequacy, nutrients of concern in this population.

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Introduction: Iodine deficiency during pregnancy can cause hypothyroidism and goiter; in schoolchildren, it can cause reduced intelligence quotient. In excess, iodine can cause thyroiditis, goiter, and Hashimoto's hypothyroidism. Currently, schoolchildren and pregnant women are classified as risk groups for excessive iodine intake and iodine deficiency, respectively. Thus, determining iodine from all sources of consumption is important for intervention planning. Objective: To construct a theoretical model for the iodine intake of schoolchildren and pregnant women of a city in the Zona da Mata Mineira region, considering a healthy diet, salt consumption and water intake. Methodology: The dietary iodine intake of pregnant women was analyzed based on a dietary iodine table compiled from an international database. A dietary plan was prepared following the Brazilian Food Guide. Iodine concentration of different salt brands sold in local establishments was checked, and drinking water samples from healthcare facilities were analyzed. A descriptive and exploratory statistical analysis was performed and the results were presented in absolute and relative frequencies, and measures of central tendency and dispersion. Results: According to the proposed diet, pregnant women and schoolchildren would have a daily intake of 71.6 µg and 71 µg, respectively. Thirteen salt brands were evaluated, 69.2% complied with the legislation and the mean iodine content was 29.88 mg. The mean concentration of iodine in water was 25 µg iodine/liter and 14 µg iodine/liter, respectively, in summer and autumn. Considering the intake of food, salt, and drinking water according to the proposed dietary plan, the daily intake for pregnant women would be 279.5 and 253.5 µg for schoolchildren. Conclusion: The daily iodine intake of schoolchildren and pregnant women according to this theoretical model was excessive, considering a healthy dietary pattern. This theoretical model can guide actions and public policies aimed at targeting all forms of iodine intake.

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Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to drinking water using survival analysis. Methods: We performed the triangle test methodology for samples of water with added calcium using three different calcium salts: calcium chloride, calcium gluconate and calcium lactate. For each salt, a panel of 54 consumers tested seven batches of three water samples. Data were adjusted for chance and sensory threshold was estimated using the survival methodology and a discrimination of 50%. Results: The threshold value estimation for calcium gluconate was 587 ± 131 mg/L of water, corresponding to 25% discrimination, for calcium lactate was 676 ± 186 mg/L, corresponding to 50% discrimination, and for calcium chloride was 291 ± 73 mg/L, corresponding to 50% discrimination. Conclusions: These results show that water with calcium added in different salts and up to a concentration of 500 mg of calcium/L of water is feasible. The calcium salt allowing the highest calcium concentration with the lowest perceived changes in taste was calcium gluconate. Future studies need to explore stability and acceptability over longer periods of time.

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OBJECTIVE: To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases. DESIGN: Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI. SETTING: Brazil. PARTICIPANTS: The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk). RESULTS: The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI. CONCLUSIONS: The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

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Introduction: According to the literature, education and income are determinants factors of diet quality and consequently of micronutrient intake. However, this association is still little known among adults who live in middle-income countries. Objective: To estimate energy and micronutrients intake by men and women living in a capital city in southern Brazil, according to education and income levels, and to identify prevalence of inadequate micronutrient intake according also to education and income levels. Method: This is a second wave cross-sectional analysis of a population-based longitudinal study, the EpiFloripa Adultos, including 1,222 individuals of 22-63 years. Data on food consumption were obtained through applying two 24-hour dietary recalls, and the prevalence of inadequate micronutrient intake, following the recommendations of the Institute of Medicine and from the National Research Council. Results: A tendency of increased intake with an increase in income (calcium, vitamins C, E) and education levels (calcium, vitamins A, C, D) was observed for most of the micronutrients analyzed (p<0.05 in all cases); still, a prevalence of inadequacy according to Estimated Average Requirement (EAR) between 85.5-100% in intake of vitamins A, D and E were found for the whole sample. Iron inadequate intake was associated with education level and among women less than 50 years of age (p=0.018). Conclusion: The results showed an influence of the education and income levels on micronutrient intake, point to the need of daily food consumption, of minimally processed and in natura foods (as fruits, vegetables, whole grains, milk and its derivatives) as a means to reduce the encountered inadequacies.

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OBJECTIVE: To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe. DESIGN: Two cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design. SETTING: São Paulo, Brazil. SUBJECTS: Adolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661). RESULTS: The Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19-50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors. CONCLUSIONS: The mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.

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Se presentan 2 casos clínicos de féminas de 49 y 25 años, que acudieron a la consulta de Optometría en la Facultad de Enfermería y Tecnología de la Salud "Dr. Juan Manuel Páez Inchausti" de Santiago de Cuba, por presentar marcado cansancio visual durante el trabajo prolongado e intolerancia a la nueva corrección óptica. Se efectuó una evaluación optométrica integral, que mostró en ambos casos una insuficiencia de convergencia. Por las características de las pacientes, se decidió indicar prisma inducido por descentración del centro óptico en la que presentaba presbicia, y continuar la adaptación de la nueva corrección óptica, además de ejercicios de convergencia, en la afectada más joven. Con estos procedimientos se eliminaron los síntomas en ellas.

Two case reports of 49 and 25 years women are presented that went to the Optometry Service of "Dr. Juan Manuel Páez Inchausti" Nursing and Health Technology Faculty in Santiago de Cuba, due to a marked visual fatigue during the lingering work and intolerance to the new optic correction. A comprehensive optometric evaluation was made that showed in both cases a convergence inadequacy. Due to the characteristics of the patients, it was decided to indicate prism induced by unfocused optic center in the one presenting presbyopia, and to continue the adaptation of the new optic correction, besides convergence exercises, in the younger affected patient. With these procedures the symptoms were eliminated in them.

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A partir de um caso clínico de um morador da zona rural que migra para o centro urbano, destaca-se a vivência de inadequação provocada pelo sentimento de desterro. Considera-se que os processos de identificação não se manifestam apenas com pessoas, mas também com o meio onde se convive. Estabelece uma correlação entre a relação idealizada que o paciente estabelecia com a "mãe terra" ao sentimento de exclusão característico da perda da ilusão edípica. Utilizando-se de uma "moda de viola", investiga-se como a angústia gerada na perda da identidade provocou somatizações e sofrimento. A superação desse estado se deu com o desenvolvimento da capacidade de pensar e simbolizar, atribuindo significados psíquicos às vivências afetivas.(AU)

From the clinical case of a rural inhabitant that migrates to an urban centre, we highlight the experience of inadequacy caused by the feeling of exile. It is considered that the identification processes do not manifest only with people but also with the environment where one lives. A correlation is established between the idealised relationship the patient had with their "motherland" with the feeling of exclusion, characteristic of the loss of oedipal illusion. Using "country songs", we've tried to investigate how the anxiety generated by the loss of identity caused somatisation and suffering. Overcoming this state occurred with the development of the ability to think and symbolise, assigning psychic meanings to affective experiences.(AU)

A partir de un caso clínico que describe un habitante rural que migra a un núcleo urbano, se destaca la vivencia de inadecuación causada por el sentimiento de destierro. Se considera que los procesos de identificación no se manifiestan sólo con las personas, sino también con el entorno donde se vive. El autor establece una correlación entre la relación idealizada que el paciente tenía con la "madre tierra" y el sentimiento de exclusión característico de la pérdida de la ilusión edípica. Usando "canciones folklóricas" se investigó cómo la angustia generada por la pérdida de identidad había provocado somatizaciones y sufrimiento. La superación de esta situación fue posible gracias al desarrollo de la capacidad de pensar y simbolizar, pudiendo asignar significados psíquicos a las experiencias afectivas.(AU)

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A partir de um caso clínico de um morador da zona rural que migra para o centro urbano, destaca-se a vivência de inadequação provocada pelo sentimento de desterro. Considera-se que os processos de identificação não se manifestam apenas com pessoas, mas também com o meio onde se convive. Estabelece uma correlação entre a relação idealizada que o paciente estabelecia com a "mãe terra" ao sentimento de exclusão característico da perda da ilusão edípica. Utilizando-se de uma "moda de viola", investiga-se como a angústia gerada na perda da identidade provocou somatizações e sofrimento. A superação desse estado se deu com o desenvolvimento da capacidade de pensar e simbolizar, atribuindo significados psíquicos às vivências afetivas...

From the clinical case of a rural inhabitant that migrates to an urban centre, we highlight the experience of inadequacy caused by the feeling of exile. It is considered that the identification processes do not manifest only with people but also with the environment where one lives. A correlation is established between the idealised relationship the patient had with their "motherland" with the feeling of exclusion, characteristic of the loss of oedipal illusion. Using "country songs", we've tried to investigate how the anxiety generated by the loss of identity caused somatisation and suffering. Overcoming this state occurred with the development of the ability to think and symbolise, assigning psychic meanings to affective experiences...

A partir de un caso clínico que describe un habitante rural que migra a un núcleo urbano, se destaca la vivencia de inadecuación causada por el sentimiento de destierro. Se considera que los procesos de identificación no se manifiestan sólo con las personas, sino también con el entorno donde se vive. El autor establece una correlación entre la relación idealizada que el paciente tenía con la "madre tierra" y el sentimiento de exclusión característico de la pérdida de la ilusión edípica. Usando "canciones folklóricas" se investigó cómo la angustia generada por la pérdida de identidad había provocado somatizaciones y sufrimiento. La superación de esta situación fue posible gracias al desarrollo de la capacidad de pensar y simbolizar, pudiendo asignar significados psíquicos a las experiencias afectivas...

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Se realizó un estudio de tipo investigación en el campo de la educación médica de pregrado a 33 estudiantes del primer año de medicina en el primer semestre del curso 2010-2011 en el Policlínico Docente "Frank País García" de Santiago de Cuba, con vistas a identificar los factores determinantes de la deserción escolar de este período. Para obtener la información, se aplicó un cuestionario a los educandos, avalado por criterios de expertos, y se llevaron a cabo métodos teóricos y empíricos (descritos en el trabajo). Se obtuvo que la deserción escolar fuera elevada y entre sus principales causas estuvieron la insuficiencia docente, el abandono y la falta de orientación vocacional.

A study of investigation type was carried out in the field of pregraduate medical education to 33 first year students in the first semester of the course 2010-2011 at "Frank País García" Polyclinic in Santiago de Cuba, with the objective of identifying the determinant factors of the school desertion in this period. To obtain the information, a inquiry was applied to the students, endorsed by experts' criteria, and theoretical and empiric methods (described in the work) were carried out. It was obtained that the school desertion was high and among its main causes there were teaching inadequacy, desertion and the lack of vocational guide.

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Las cefalosporinas se han convertido en un recurso terapéutico valioso, pero su uso inadecuado ha estado asociado al desarrollo de resistencia antimicrobiana, problema de significativa importancia en la práctica clínica diaria. No existen informes sobre el tema en la literatura médica cubana, por lo que se realizó este estudio para identificar la frecuencia y los factores asociados al uso inadecuado de cefalosporinas en pacientes hospitalizados. Se realizó un estudio descriptivo, mediante prevalencias puntuales seriadas, de las prescripciones de cefalosporinas en los pacientes admitidos en el Hospital Joaquín Albarrán (mayo de 2008 a abril de 2009). De los pacientes se obtuvieron las características generales y de la prescripción de las cefalosporinas, y esta información fue analizada por expertos para identificar casos de prescripción inadecuada. Mediante regresión logística se determinó el grado de asociación de la inadecuación con las variables independientes. Se realizó análisis discriminante para identificar las variables que discriminaran los grupos de pacientes en función de la calidad de la prescripción. Se observaron inadecuaciones en el 18,4 por ciento de los 711 pacientes evaluados, y éstas fueron superiores en los pacientes de menor edad (p < 0,001), localización no respiratoria de infección (p < 0,001), de servicio quirúrgico (p < 0,001), antecedente de cirugía reciente (p < 0,05) e insuficiencia renal crónica (p < 0,05). El antecedente de insuficiencia respiratoria crónica se asoció a prescripción adecuada (p < 0,05). Las variables anteriores discriminaron los grupos de pacientes en función de la adecuación de la prescripción. Se identifica la frecuencia de inadecuación y se definen como factores relacionados la edad, la localización no respiratoria de infección, el antecedente de insuficiencia renal crónica, la cirugía reciente y el ser atendido en servicios quirúrgicos(AU)

The cephalosporins become a valuable therapeutical resort but its inappropriate use has been associated with the development of antimicrobial resistance a very significant problem in the daily clinical practice. There are available reports on this subject in the Cuban medical literature, thus a study was made to identify the frequency and the factors associated with the inappropriate use of cephalosporins in admitted patients. A descriptive study was conducted using the serial detailed prevalences of cephalosporins prescriptions in patients admitted in Joaquín Albarrán Hospital (from May, 2008 to April, 2009). From patients we get the general features and of the cephalosporin prescription and this information was analyzed by experts to identify the cases of inappropriate prescription. Using the logistic regression it was determined the unsuitable association degree with the independent variables. A discriminant analysis was carried out to identify the variables to differentiate the patient groups to determine the prescription quality. RESULTS. There was inadequacy in the 18,4 percent of the 711 assessed patients ant these were higher in younger patients (p < 0,001), non-respiratory localization of infection (p < 0,001), of surgical service (p < 0,001), a history of recent surgery (p < 0,005) and chronic renal failure (< 0.05). The history of chronic respiratory failure was associated with a suitable prescription (p < 0,05). The above variables discriminate the patient groups to adapt the prescription. Inadequacy frequency is identified defining as factors related to age, the infection non-respiratory localization, the chronic renal failure background, the recent surgery and being served in surgical services(AU)

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Objetivos: apresentar os resultados obtidos com a paratireoidectomia (PTX) subtotal em pacientes com hiperparatireoidismo (HPT) secundário àinsuficiência renal crônica (IRC), enfocando a contribuição e as dificuldades técnicas da cirurgia. Pacientes e Métodos: no período de janeiro de 1998 ajunho de 2005 foram operados consecutivamente no Hospital Universitário Antonio Pedro, 33 pacientes renais crônicos portadores de HPT secundário. Ascirurgias foram realizadas pelo mesmo cirurgião e a mesma equipe de nefrologista se encarregou do controle pré e pós-operatório. Esse grupo foiconstituído por 19 homens e 14 mulheres com idade média de 40,5 (16/68) anos e todos se encontravam em tratamento dialítico regular, com tempo médiode diálise de 113 (20/189) meses. Além dos cuidados habituais, todos os pacientes receberam calcitriol após as três últimas sessões de diálise queantecederam a cirurgia. Resultados: os resultados mais expressivos se refletiram sobre o aparelho músculo-esquelético e foram muito significativas as remissões das queixas de dor ósteo-articular, fraqueza e prurido; as calcificações não vasculares foram reabsorvidas e sinais de remineralização ósseaforam identificados após a cirurgia. As complicações pós-operatórias mais freqüentes foram a rouquidão transitória (21%), a hiperpotassemia (12%) e osangramento pós-operatório (12%). Nesse grupo há uma recidiva comprovada e já reoperada e dois pacientes encontram-se em fase de investigação, por provável insucesso na cirurgia, já que o PTH continua elevado. Os resultados menos favoráveis foram mais freqüentes nos casos onde foram encontradas apenas três glândulas paratireóides. Não houve mortalidade operatória. Conclusões: a PTX subtotal pode ser realizada com segurança e é efetiva para a remissão de diversas manifestações do HPT secundário, desde que continuem sob rigoroso controle clínico para evitar possíveis recidivas por hiperplasia do resíduo glandular.

Objective: to report the results obtained with subtotal parathyroidectomy (PTX) in patients with hyperparathyroidism (HPT) secondary to chronic renaldisease (CRD), focusing on the contribution and technical difficulties of the surgery. Methods: From January of 1998 to June of 2005, thirty-three end-stagerenal disease (ESRD) patients consecutively underwent PTX in the university hospital. Their mean age was 40.5 years; Nineteen were male, and 14 female.Mean time on dialysis was 113 months. Surgeries were accomplished by the same surgeon and the same nephrologist was in charge of the pre- andpostoperative care of the whole patients. Among the clinical manifestations those related to the osteopathy were the most prevalent ones. All patientsunderwent preoperative care and received calcitriol after the last three dialysis sessions that preceded the surgery. Results: the most expressiveimprovements pertained to the muscle-skeletal system. The alleviation of bone pain, joint pain, muscle weakness and itch were marked. Extra-vascularcalcifications were reabsorbed and radiological signs of bone remineralization were identified after the surgery. The most frequent postoperativecomplications were temporary hoarseness (21%), hyperkalemia (12%), and postoperative bleeding (12%). So far, we have faced one proven recurrencethat was managed by a surgical reintervention. In addition, PTH continues to be high in two patients who are undergoing prepare for a new surgery. Bad results seemed to be more frequent on patients in which only three parathyroid glands were found during the operation. Surgery was not associated to fatalities. Conclusions: subtotal PTX can be accomplished with safety in ESRD patients being effective for the alleviation of several manifestations of the secondary HPT. Patients should be maintained under strict clinical control to monitor for recurrences due to hyperplasia of the residual glandular tissue.

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