No abstract

The study evaluated the drinking water quality from 45 public schools in the city of Curitiba, Brazil. Water samples were harvested from two different points at each school: the first one, drinking fountain used by students (n=45) and the second, kitchen faucet (n=45), comprising 90 samples. The samples were submitted to analysis according to current legislation, such as: dosage of free chlorine; colony counts of heterotrophic bacteria; presence of total coliform bacteria and Escherichia coli. In addition, an enterococci analysis was also included as a complementary microbiological indicator of fecal contamination. The isolated strains of enterococci were identified and submitted to an antibiotic susceptibility test. In relation to the legal parameters, 35.5% (n=16) of the 45 schools evaluated did not meet the quality water standards set by the Brazilian legislation. Although none of the 90 samples exhibited the presence Escherichia coli, 6.6% (n=6) of the analyzed samples presented enterococci contamination. Regarding the antibiotic susceptibility test, the isolated strains demonstrated a similar behavior, became resistant to six antibiotics and had intermediate sensitivity to one (Streptomycin) of the nine antibiotics tested. The drinking water destined for human consumption in the public schools may pose health risks for students since the fecal contamination by enterococci was confirmed, and it could be observed that the water may be a source of genes from bacteria resistant to antimicrobials. This study reinforces the importance of monitoring complementary microbiological indicators to assure water quality, seeing that fecal contamination was detected only when alternative parameters were inserted, emphasizing the relevance of including microbiological indicators beyond what the legislation requires to evaluate the drinking water more effectively and to safeguard public health.

Revisão integrativa realizada com a finalidade de identificar as ferramentas de triagem/avaliação nutricional do paciente idoso em estado crítico que constituem alternativas às limitações dos parâmetros tradicionais. Foram utilizadas quatro bases de dados e critérios de inclusão de artigos originais disponíveis na íntegra referentes à temática, em português e inglês, entre 2013 e 2017. As palavras-chave foram: "elderly AND critical ill AND nutritional assessment" e "elderly AND intensive care AND nutritional assessment". Nove artigos foram selecionados e divididos entre os que utilizaram parâmetros nutricionais convencionais e alternativos. Observou-se, no final do desenvolvimento, a ausência de estudos que utilizaram a análise da bioimpedância elétrica (BIA) e foram incluídos na discussão os artigos viáveis à temática do trabalho, segundo as palavras-chave "bioelectrical impedance analysis", "bioelectrical impedance vectorial analysis", "phase angle" e "intensive care". Os estudos que utilizaram o escore Nutrition Risk in Critically ill (NUTRIC), que inclui os escores Acute Physiology and Chronic Health disease Classification System II (APACHE II) e Sepsis-related Organ Failure Assessment (SOFA), e os que utilizaram esses escores isoladamente apresentaram bons resultados. Apesar do valor final do SOFA ter se mantido o mesmo nos estudos incluídos neste trabalho, nota-se que esse instrumento pode ser promissor. Sugere-se a exploração de estudos que avaliem a utilização da BIA, em pacientes idosos graves, da qual derivam o ângulo de fase, a análise vetorial da bioimpedância elétrica (BIVA) e outros que avaliem o NUTRIC associado ao ângulo de fase e/ou BIVA, nos pacientes críticos com baixo nível de consciência e/ou edema. PALAVRAS-CHAVE: envelhecimento; unidades de terapia intensiva; avaliação nutricional.