The objective of the study is to investigate the effect of nutritional supplementation with eicosapentaenoic acid (EPA)-enriched formula on the inflammatory profile of patients with oral cavity cancer. The study was conducted with 53 patients with oral cavity cancer in antineoplastic pretreatment who were randomized into two groups: the control group received a powdered supplement without EPA during 4 wk and the intervention group received a liquid supplement enriched with EPA (2 g/day) during the same period. In the baseline and after 4 wk of supplementation, serum concentrations of albumin, prealbumin, C-reactive protein (CRP), and interleukin-6 (IL-6) were measured. Values of CRP and of CRP/albumin ratio were lower in the intervention group than those in the control group. However, when the two groups were compared to each other after intervention, any significant difference was not observed. There was a significant negative correlation between levels of CRP and albumin, and IL-6 and albumin, both in the control and in the intervention groups. In both groups, a positive correlation between concentrations of IL-6 and CRP was observed. No significant difference was encountered in the assessed parameters between the group that received standard supplement and the group that received EPA-enriched supplement.

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Introdução: O câncer de cavidade oral pode causar inúmeros sintomas de impacto nutricional, que afetam negativamente a qualidade de vida, aumentando a morbidade e mortalidade. A avaliação nutricional possibilita a detecção e o manejo desses sintomas, devendo ser realizada antes, durante e após o tratamento antineoplásico. Objetivo: Caracterizar o perfil nutricional de pacientes ambulatoriais com câncer de cavidade oral em pré-tratamento antineoplásico, investigar as alterações que comprometem a ingestão alimentar e avaliar o estado nutricional, visando à intervenção o mais precocemente possível, para maior tolerância ao tratamento antineoplásico e prevenção da desnutrição. Método: Estudo transversal com 29 indivíduos de ambos os sexos, entre 30 e 75 anos de idade, portadores de câncer de cavidade oral em pré-tratamento antineoplásico. O perfil nutricional desses pacientes foi analisado de acordo com os sintomas referidos, perda de peso, consistência da dieta, número de refeições diárias, parâmetros bioquímicos, antropométricos e bioimpedância elétrica. Resultados: A maioria dos pacientes se encontrava em estádio clínico IV (65,5%); referiu, no mínimo, dois sintomas de impacto nutricional (85,2%); e apresentou perda de peso grave em seis meses (56,5%). A circunferência muscular do braço e a área muscular do braço foram os parâmetros antropométricos que classificaram o maior percentual de desnutrição. Conclusão: Perda de peso não intencional, dificuldades de deglutição e reduzida ingestão alimentar foram observadas em grande proporção. A prevalência de desnutrição foi elevada e variou conforme o parâmetro utilizado, ressaltando que os parâmetros de avaliação devem ser utilizados complementarmente.

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Background Bleeding and hospital death have an independent association in observational records of acute coronary syndromes (ACS), leading to interpretation of this relationship as causal. However, association does not guarantee causality, and better exploitation of this phenomenon is necessary. Purpose To describe the association between bleeding and death of patients with ACS, exploring causality through the cascade of events that separate these two phenomena. Methods Patients consecutively admitted to Coronary Unit by objective criteria of ACS were included prospectively. Major bleeding during hospitalization was defined according to types 3 and 5 of the Universal Bleeding Classification. Logistic regression and sequence analysis of events were used to evaluate the association between bleeding and death. Results A total of 1104 patients were studied, age 65±14 years, 58% male, 23% with ST elevation. The incidence of major bleeding was 4.7% (52 cases). Bleeding patients presented mortality of 31% (16 deaths), compared to 4.7% death in the non-bleeding group (RR=6.6, 95% CI: 4.0–11). Those who bled had a GRACE score significantly higher than those free of bleeding (157±39 versus 121±38, P<0.001). After adjustment for this score, bleeding remained strongly associated with death (OR=4.5, 95% CI: 2.1–9.7, P<0.001). However, among the 16 deaths that occurred after bleeding, in 56% of the patients the death was due to hemorrhage, while the remainder was a consequence of the myocardial injury of the infarct or natural evolution of noncardiac morbidities. Conclusion The independent association between major bleeding and death in acute coronary syndromes is only partially mediated by causality. In the same proportion, deaths coexist with bleeding without a causal relationship. Funding Acknowledgement Type of funding source: None