RESUMO
BACKGROUND: Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS: Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS: IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS: A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION: Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.
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Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Doença Crônica , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Ácido Micofenólico/uso terapêutico , Sistema de RegistrosRESUMO
BACKGROUND: Quality of care (QoC) is a highly important topic in inflammatory bowel disease (IBD). We recently elaborated a decalogue of QoC indicators (IQCARO-QoC) developed by IBD patients. The aim of the present study was to assess the factors associated with patients' evaluation of QoC in Spain using the IQCARO-QoC Decalogue recently developed by IBD patients. METHODS: A survey including patients' socio-demographic and clinical characteristics, and the IQCARO-QoC Decalogue, was completed by IBD patients. We described patients' assessment of QoC across Spanish patients. A univariable and multivariable analysis was performed to explore the associations between patients' characteristics and QoC. RESULTS: Questionnaires from 788 participant patients were analysed. Participants' mean age was 43.4 years, 63% were females and 58% had Crohn's disease. The mean QoC score was 8.1 (± 2.4 SD) points out of a maximum of 10. Items with the lowest score were related to the provision of information and the implication of the medical team throughout the entire patient care. Factors associated with better QoC scores included: being employed better disease control, fewer numbers of unscheduled visits, and being followed by a gastroenterologist specialized in IBD. CONCLUSIONS: Spanish patients' reported QoC seems to be globally good although there is room for improvement, especially in providing adequate information to patients. Care provided by specialized IBD gastroenterologists seems to be related with higher QoC scores.
Assuntos
Colite , Doença de Crohn , Doenças Inflamatórias Intestinais , Adulto , Doença de Crohn/terapia , Feminino , Humanos , Doenças Inflamatórias Intestinais/terapia , Qualidade da Assistência à Saúde , Inquéritos e QuestionáriosRESUMO
BACKGROUND: There are limited data of ustekinumab administered according to the doses recommended in the UNITI studies. AIM: To assess the real-world, short-term effectiveness of ustekinumab in refractory Crohn's disease (CD) METHODS: Multicentre study of CD patients starting ustekinumab after June 2017 at the recommend dose (260, 390 or 520 mg based on weight ~6 mg/kg IV week 0 and 90 mg subcutaneously week 8). Values for Harvey-Bradshaw Index (HBI), C-reactive protein (CRP) and faecal calprotectin (FC) were recorded at baseline and at weeks 8 and 14. Demographic and clinical data, previous treatments, AEs and hospitalisations were documented. Possible predictors of clinical remission were examined. RESULTS: Three hundred and five patients were analysed (≥2 previous anti-TNFα therapies 64% and vedolizumab 29%). At baseline, 217 (72%) had an HBI >4 points. Of these, 101 (47%) and 126 (58%) achieved clinical remission at weeks 8 and 14, respectively. FC levels returned to normal (<250 µg/g) in 46% and 54% of the patients at weeks 8 and 14 respectively. CRP returned to normal (<3 mg/L) in the 35% and 41% of the patients at week 8 and 14 respectively. AEs were recorded in 38, and 40 patients were hospitalised. Intolerance to the most recent anti-TNF agent and fewer previous anti-TNF agents were associated with clinical remission at week 14. Endoscopic severity was associated with poor response. CONCLUSION: This is the first study to show the real-world effectiveness and safety of ustekinumab administered according to the recommended induction regimen in a cohort of highly refractory CD patients.
Assuntos
Doença de Crohn/tratamento farmacológico , Ustekinumab/uso terapêutico , Adulto , Estudos de Coortes , Doença de Crohn/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Indução de Remissão/métodos , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: Despite having adopted preventive measures, tuberculosis (TB) may still occur in patients with inflammatory bowel disease (IBD) treated with anti-tumour necrosis factor (anti-TNF). Data on the causes and characteristics of TB cases in this scenario are lacking. Our aim was to describe the characteristics of TB in anti-TNF-treated IBD patients after the publication of the Spanish TB prevention guidelines in IBD patients and to evaluate the safety of restarting anti-TNF after a TB diagnosis. METHODS: In this multicentre, retrospective, descriptive study, TB cases from Spanish hospitals were collected. Continuous variables were reported as mean and standard deviation or median and interquartile range. Categorical variables were described as absolute and relative frequencies and their confidence intervals when necessary. RESULTS: We collected 50 TB cases in anti-TNF-treated IBD patients, 60% male, median age 37.3 years (interquartile range [IQR] 30.4-47). Median latency between anti-TNF initiation and first TB symptoms was 155.5 days (IQR 88-301); 34% of TB cases were disseminated and 26% extrapulmonary. In 30 patients (60%), TB cases developed despite compliance with recommended preventive measures; *not performing 2-step TST (tuberculin skin test) was the main failure in compliance with recommendations. In 17 patients (34%) anti-TNF was restarted after a median of 13 months (IQR 7.1-17.3) and there were no cases of TB reactivation. CONCLUSIONS: Tuberculosis could still occur in anti-TNF-treated IBD patients despite compliance with recommended preventive measures. A significant number of cases developed when these recommendations were not followed. Restarting anti-TNF treatment in these patients seems to be safe.
Assuntos
Adalimumab/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Infecções Oportunistas/prevenção & controle , Tuberculose/prevenção & controle , Adulto , Feminino , Seguimentos , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Guias de Prática Clínica como Assunto , Retratamento , Estudos Retrospectivos , Espanha , Resultado do Tratamento , Teste Tuberculínico/estatística & dados numéricos , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/epidemiologiaRESUMO
La fractura de tobillo es una patologíatraumática muy frecuente, que cuando debe ser intervenidaquirúrgicamente, lo habitual es el uso de placade osteosíntesis, la misma puede ser colocada en unade sus dos caras, externa o posterior. La externa se encuentradividida por una cresta en una superficie triangularanterior subcutánea y una pósteroexterna, diferentesautores recomiendan la colocación en una u otracara. El objetivo de este trabajo es evaluar cuál de lascaras del tercio distal del peroné, es la más adecuadaanatómicamente para la colocación de la placa deosteosíntesis.MATERIALES Y MÉTODOS: Se evaluó el tercio distal de25 perones, 15 correspondieron al lado izquierdo y 10 allado derecho las muestras fueron obtenidas de la Cátedrade Anatomía Normal. Facultad de Ciencias Médicas(UNC. Córdoba), se realizaron mediciones tanto de lacara ánteroexterna como de la pósteroexterna. Para lamedición se utilizó un calibre digital.RESULTADOS: Los resultados obtenidos indicaron unadistancia promedio de la cara ánteroexterna de 75 mmdesde el maléolo hasta el vértice de la cresta (rango 65mm a 92 mm) y una distancia promedio de 65 mm en lacara pósteroexterna desde la fosita de los peroneos hastala unión de ambas (rango 60 mm a 72.3 mm).CONCLUSIÓN: El estudio anatómico del peroné distalnos permite afirmar que ninguna de sus caras terminansiendo ideales para la colocación de una placa, estaosteosíntesis de 7 orificios puede utilizarse en ambascaras ánteroexterna y pósteroexterna, cuando se tratade una fractura transindesmal, pero no es anatómicamenteviable colocar en la cara ánteroexterna cuandohablamos de fracturas suprasindesmales. Debe colocarseen la cara pósteroexterna aunque en esta partetambién interfiera la unión de ambas caras...
The fibula is a long thin bone thatarticulates with the tibia at both ends. A study wasconducted over 25 perones anatomical and analyzed thedistal third. Our goal is to evaluate which of the faces ofthe distal fibula is the most appropriate anatomically tothe placement of the osteosynthesis plate.MATERIALS AND METHODS: Was evaluated peronesdistal third of 25, 15 corresponded to the left and rightside 10 samples were obtained from plants of NormalAnatomy Chair Faculty of Medical Sciences (UNCCordoba), were measured both as the anterolateral theposterolateral was used for measuring a digital caliper.RESULTS: The results showed an average distance of75 mm anterolateral from the malleolus to the apex of theridge (range 65 to 92 mm) and an average distance of 65mm in the posterolateral from the pit of the peroneal tothe junction of two (range 60 to 72.3 mm).CONCLUSION: We conclude that none of its faces endup being suitable for placement of a plate, theosteosynthesis plate of holes 7 may be used on both sidesanterolateral and posterolateral when dealing with fractureanatomically syndesmotic but not feasible to placeon the face when speaking of fractures anterolateralsuprasindesmales. Should be placed in the posterolateralbut also interfere in this part of the union of both sides...
Assuntos
Humanos , Masculino , Feminino , Fíbula , Fíbula/anatomia & histologia , Fíbula/crescimento & desenvolvimento , Fíbula/patologiaRESUMO
BACKGROUND: Despite medical therapy, 30% of patients with ulcerative colitis (UC) need to undergo surgery. Around 50% of patients with proctocolectomy with ileal pouch-anal anastomosis (IPAA) develop complications of the pouch. Clinical evidence for the use of infliximab (IFX) in refractory pouchitis is limited. The aim of this study was to report efficacy of IFX in these patients. METHODS: A retrospective, multicenter study was designed. Patients older than 18 years with chronic refractory pouchitis treated with IFX (5 mg/kg) were included. Short-term IFX efficacy was evaluated at week 8 and mid-term efficacy at weeks 26 and 52. Complete response was defined as cessation of diarrhea and urgency and partial response as marked clinical improvement but persisting symptoms. The modified Pouchitis Disease Activity Index (mPDAI) without endoscopy was calculated when available. RESULTS: Thirty-three consecutive UC patients with chronic refractory pouchitis were included (18 male, mean age 45 years, range 21-67). At week 8, 21% patients achieved complete response and 63% showed partial clinical response. At weeks 26 and 52, 33% and 27% achieved complete response and 33% and 18% showed partial clinical response, respectively. Thirteen patients (39%) withdrew treatment (four for lack of efficacy, four for loss of response and five for adverse events). None of the potential factors analyzed had an influence on response to IFX. CONCLUSIONS: IFX was effective in the short- and mid-term in patients with chronic refractory pouchitis. However, medication had to be discontinued in a high number of patients.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Colite Ulcerativa/complicações , Fármacos Gastrointestinais/uso terapêutico , Complicações Pós-Operatórias , Pouchite/tratamento farmacológico , Adulto , Idoso , Doença Crônica , Colite Ulcerativa/cirurgia , Feminino , Seguimentos , Humanos , Infliximab , Masculino , Pessoa de Meia-Idade , Pouchite/diagnóstico , Pouchite/etiologia , Proctocolectomia Restauradora , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
To assess the value of bone marrow (BM) assessment by flow cytometry FCM after therapy in the clinical outcome of WM patients, we analyzed 42 WM patients who were evaluated before and after therapy. Patients were studied with a panel that always included the CD19, CD22, CD25, and κ/λ light chain immunoglobulin monoclonal antibodies. The mean of abnormal B-cells in the pre-therapeutic BM was 17.8% ± 12.1%, which decreased was after therapy to 5.4% ± 0.7% (P = .049). A linear correlation was seen between the better quality of response and the reduction in the tumor B-lymphocyte counts at the BM, since the ratio of abnormal B cells between pre and posttherapy BM was 1172.17, 221.64, 3.37, 1.03, and 0.56 for responses complete, partial, minor, stable disease and progression, respectively (P < .001). Intensive and rituximab-containing therapies correlated with deeper tumor cell reductions. Finally, the B-cell decrease correlated with the better overall and progression-free survival.
Assuntos
Medula Óssea/patologia , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/mortalidade , Idoso , Idoso de 80 Anos ou mais , Antígenos CD19/metabolismo , Feminino , Citometria de Fluxo , Humanos , Imunofenotipagem , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , PrognósticoRESUMO
BACKGROUND: Low thiopurine-methyl-transferase (TPMT) activity and high 6-thioguanine-nucleotide (6TGN) concentrations have been linked to therapeutic success in inflammatory bowel disease patients treated with thiopurines; however, this has not been implemented in clinical practice. AIM: To identify a therapeutic threshold value for TPMT or 6TGN concentrations, and their capability to predict treatment safety and efficacy. METHODS: Prospective multicentre study including steroid-resistant/dependent patients starting thiopurines. The TPMT activity was determined at inclusion (>5 U/mL required). Azathioprine metabolites [6TGN, 6-methyl-mercaptopurine ribonucleotides (6MMP), and 6TGN/6MMP and 6TGN/TPMT ratios] were periodically monitored during steroid tapering and after withdrawal for 6 months or until a new flare occurred. RESULTS: A total of 113 patients were analysed (62% clinical response). Areas under the receiver operating characteristic (ROC) curve (AUC) relating clinical response and metabolite levels at 2, 4 and 6 months after steroid withdrawal were less than 0.7. The AUCs relating final response and initial TPMT activity or metabolite concentrations at 2, 4, 8 and 16 weeks after starting thiopurines were less than 0.7. No cut-off point with worthwhile sensitivity/specificity was found. Eight (7%) patients developed thiopurine-related toxicity that could not be linked to TPMT activity or 6TGN levels. CONCLUSIONS: Our results do not support determination of TPMT activity or 6TGN concentrations to predict treatment outcome, and no useful serum metabolites threshold value to adjust the drug's dose was identified.
Assuntos
Azatioprina/sangue , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mercaptopurina/análogos & derivados , Mercaptopurina/administração & dosagem , Metiltransferases/sangue , Adolescente , Adulto , Idoso , Área Sob a Curva , Biomarcadores/metabolismo , Relação Dose-Resposta a Droga , Feminino , Nucleotídeos de Guanina/sangue , Humanos , Doenças Inflamatórias Intestinais/enzimologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Tionucleotídeos/sangue , Resultado do Tratamento , Adulto JovemRESUMO
2 cases of proteinuria in obese non-diabetic young males, both corresponding to focal segmental glomerulosclerosis are presented. Effective reduction of body weight by bariatric surgery was followed by sustained remission of proteinuria allowing significant reduction or total removal of blockers of the reninangiotensin- system.
Assuntos
Cirurgia Bariátrica , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/cirurgia , Obesidade/complicações , Obesidade/cirurgia , Adulto , Humanos , Masculino , Adulto JovemRESUMO
Objetivo: Evaluar el efecto antibacteriano, antifúngico y antioxidante de diferentes extractos del Calophyllum brasiliense Cambess. Material y Métodos: El efecto antioxidante fue determinado por captación de radicales libres, midiendo la decoloración de una solución de 2,2-difenil-1-picril hidrazilo (DPPH); La actividad antibacteriana y antifúngica, in Vitro, se determinó mediante la prueba de dilución. El efecto antibacteriano se evaluó en cepas de E. coli ATCC25922 y Staphylococcus aureus ATCC25923, utilizando medios de cultivo: Caldo y Agar Mueller Hinton. Para evaluar el efecto antifúngico, se utilizó cepas de Cándida albicans en medio de Agar Sabouraud. Resultados: La actividad antioxidante de los extractos acuoso, metanólico y etanólico fue muy satisfactoria, siendo de 110.56 por ciento, 99.17 por ciento y 99.57 por ciento, respectivamente, a una concentración de 100 ug/mL, en comparación con la Vitamina C que presentó 86,5 por ciento. Asimismo, observamos un buen efecto antifúngico para los extractos acuoso y etanólico al 20 por ciento p/v a los volúmenes de 3, 3.5 y 4mL. y en el caso del extracto etanólico también presentó un buen efecto a una concentración del 10 por ciento a un volumen de 1.6mL. Conclusiones: Los extractos: acuoso, metanólico y etanólico, presentaron un buen efecto antioxidante y antifúngico, en las cepas estudiadas.
Objetive: To evaluate, in vitro, the antibacterial, antifungal andantioxidant effects of different extracts of Calophyllum brasiliense Cambess. Material and Methods: The antioxidant effect was tested by free radicals capture, measuring discoloration of the 2,2-diphenyl-1-pycryl hydrazyle solution (DPPH). We used a dilution to measure antibacterial and antifungal in vitro activity. Strains of E. coli ATCC25922 and Staphylococcus aureus ATCC25923 were used to evaluate antibacterial effect; using Broth and Mueller Hinton Agar as culture medium. Strains of Candida albicans and Agar Sabouraud as culture medium were usedto evaluate antifungal effect. Results: Aqueous, methanolic and ethanolic extracts, showed good antioxidant activity having 110.56 per cent, 99.17 per cent and 99.57 per cent of antioxidant activity at 100 ug/mL concentration, respectively. This is superior to the vitamin C referencepattern that showed 86,5 per cent activity. Good antifungal effect for aqueous and ethanol extracts at a 20 per cent concentration for 3, 3.5 and 4 ml of volume was determined. Ethanol extracts had the same antifungal effect at a 10 per cent concentration for 1.6mL. of volume. Conclusions: The aqueous, methanolic and ethanolic extracts showed a good antioxidant and antifungal activity on the strains studied.
Assuntos
Antibacterianos , Antifúngicos , Antioxidantes , Calophyllum , Calophyllum/crescimento & desenvolvimentoRESUMO
BACKGROUND: Chronic allograft nephropathy (CAN) is the most frequent cause of chronic dysfunction and late loss of renal allografts. Epithelial mesenchymal transition (EMT) has been identified as responsible for the presence of activated interstitial fibroblasts (myofibroblasts) and transforming growth factor beta (TGF-beta)/Smad is the key signaling mediator. It has been proposed that the bone morphogenetic protein 7 (BMP-7) antagonist, Gremlin, could participate in EMT, as a downstream mediator of TGF-beta. METHODS: We evaluated 33 renal allograft biopsies, 16 of which showed CAN, versus 17 controls. By in situ hybridization we studied the expression of TGF-beta and Gremlin mRNA. Gremlin, BMP-7, E-cadherin, and alpha-smooth muscle actin (alpha-SMA) proteins were evaluated by immunohistochemistry and Smad3 activation by Southwestern. In cultured human tubuloepithelial cells (HK2 cell line), Gremlin induction by TGF-beta was studied by confocal microscopy. RESULTS: Among renal biopsies of transplanted patients with CAN, we detected up-regulation of TGF-beta in colocalization with Gremlin (RNA and protein), mainly in areas of tubulointerstitial fibrosis. In the same tubules, we observed decreased expression of E-cadherin and induction of vimentin and alpha-SMA. BMP-7 was significantly decreased in the CAN biopsies. In addition, HK2 stimulated with TGF-beta (1 ng/mL) induced Gremlin production at 72 hours. CONCLUSION: We postulated that Gremlin is a downstream mediator of TGF-beta, suggesting a role for Gremlin in EMT observed in CAN.
Assuntos
Células Epiteliais/patologia , Transplante de Rim/patologia , Mesoderma/patologia , Complicações Pós-Operatórias/patologia , Diferenciação Celular , Doença Crônica , Fibrose , Humanos , Hibridização In Situ , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Transplante HomólogoRESUMO
OBJECTIVE: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion. MATERIAL AND METHOD: ALL consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and effectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization. RESULTS: WE found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic therapy. No surgery was needed. The mortality rate during hospitalization was 4.87%. CONCLUSIONS: Dieulafoy's lesion is an uncommon, but potentially severe cause of gastrointestinal bleeding. It may be found in any location within the gastrointestinal tract. Endoscopic therapy is effective and safe. Injected epinephrine alone is associated with a higher risk of rebleeding.
Assuntos
Endoscopia Gastrointestinal , Mucosa Gástrica/irrigação sanguínea , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Mucosa Intestinal/irrigação sanguínea , Doenças Vasculares/complicações , Idoso , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Ruptura EspontâneaRESUMO
BACKGROUND: Quadruple rescue therapy requires a complex scheme with four drugs. AIM: To evaluate the efficacy of ranitidine bismuth citrate-tetracycline-metronidazole rescue regimen, and to compare two different metronidazole dose schemes. METHODS: Prospective multicentre study including proton-pump inhibitor + clarithromycin + amoxicillin failures. Rescue regimen included two 7-day treatment: (i) ranitidine bismuth citrate (400 mg b.d.)-tetracycline (500 mg q.d.s.)-metronidazole (500 mg t.d.s.; RTM1); or (ii) the same regimen but with metronidazole 250 mg q.d.s. (RTM2). Eradication was confirmed with (13)C-urea breath test. RESULTS: A total of 150 patients were included (58 RTM1, 92 RTM2). All patients but two (one in each group) returned after treatment. About 86% in group RTM1 and 95% in RTM2 correctly took all the medications (P = 0.076). Per-protocol eradication rates with RTM1 and RTM2 were 74 (95% CI: 60-84) and 69% (59-78). The intention-to-treat eradication rates were 64 (51-75) and 70% (59-78; P > 0.05). The type of regimen was not associated with eradication in the multivariate analysis. Adverse effects were more frequent with RTM1 (41%) than with RTM2 (30%; P > 0.05). CONCLUSION: Seven-day triple rescue therapy with ranitidine bismuth citrate-tetracycline-metronidazole is effective for Helicobacter pylori eradication, and represents an encouraging alternative to quadruple therapy, with the advantage of simplicity. The administration of metronidazole every 6 h (together with tetracycline), and at a low dose (250 mg), achieves similar efficacy and is probably associated with a better compliance and a lower incidence of adverse effects.
Assuntos
Antiulcerosos/uso terapêutico , Bismuto/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Ranitidina/análogos & derivados , Ranitidina/uso terapêutico , Adulto , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Masculino , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Tetraciclina/uso terapêutico , Falha de TratamentoAssuntos
Nutrição Enteral/instrumentação , Hemorragia Gastrointestinal/etiologia , Gastroscópios/efeitos adversos , Gastrostomia/instrumentação , Intubação Gastrointestinal/instrumentação , Idoso , Nutrição Enteral/efeitos adversos , Fricção , Gastrostomia/efeitos adversos , Humanos , Intubação Gastrointestinal/efeitos adversos , Masculino , Úlcera Gástrica/etiologia , Úlcera Gástrica/fisiopatologiaRESUMO
Tissue damage induced by infection or injury can result in necrosis, a mode of cell death characterized by induction of an inflammatory response. In contrast, cells dying by apoptosis do not induce inflammation. However, the reasons for underlying differences between these two modes of cell death in inducing inflammation are not known. Here we show that necrotic cells, but not apoptotic cells, activate NF-kappaB and induce expression of genes involved in inflammatory and tissue-repair responses, including neutrophil-specific chemokine genes KC and macrophage-inflammatory protein-2, in viable fibroblasts and macrophages. Intriguingly, NF-kappaB activation by necrotic cells was dependent on Toll-like receptor 2, a signaling pathway that induces inflammation in response to microbial agents. These results have identified a novel mechanism by which cell necrosis, but not apoptosis, can induce expression of genes involved in inflammation and tissue-repair responses. Furthermore, these results also demonstrate that the NF-kappaB/Toll-like receptor 2 pathway can be activated both by exogenous microbial agents and endogenous inflammatory stimuli.
Assuntos
Proteínas de Drosophila , Regulação da Expressão Gênica/imunologia , Glicoproteínas de Membrana/fisiologia , NF-kappa B/fisiologia , Receptores de Superfície Celular/fisiologia , Cicatrização/genética , Cicatrização/imunologia , Animais , Apoptose/genética , Apoptose/imunologia , Linhagem Celular , Células Cultivadas , Quimiocina CXCL1 , Quimiocinas , Quimiocinas CXC , Citocinas/biossíntese , Embrião de Mamíferos , Fibroblastos/imunologia , Fibroblastos/metabolismo , Fibroblastos/patologia , Inflamação/genética , Inflamação/imunologia , Inflamação/patologia , Mediadores da Inflamação/metabolismo , Interleucina-1/fisiologia , Interleucina-8/biossíntese , Macrófagos/imunologia , Macrófagos/metabolismo , Macrófagos/patologia , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Necrose , Transdução de Sinais/imunologia , Receptor 2 Toll-Like , Receptores Toll-Like , Fator de Transcrição RelARESUMO
AIM: To evaluate outcome of test-and-scope strategy using 13C-urea breath test, Helicobacter pylori IgG serology, and CagA serology. PATIENTS AND METHODS: A series of 100 dyspeptic patients were studied. Biopsies were obtained for histology and rapid urease test (gold standard). Serum samples were obtained for Helicobacter pylori IgG and CagA serology, and 13C-urea breath test was carried out. RESULTS: If endoscopy had not been performed in Helicobacter pylori patients based on 13C-urea breath test, <45 years, without alarm symptoms, and without non-steroidal anti-inflammatory drug use, 15% of endoscopies would have been saved, and one gastric ulcer and two oesophagitis would have been missed. Based on Helicobacter pylori IgG serology, 21% of endoscopies would have been saved. Finally, if endoscopy had been performed only in CagA+ patients, 31% of endoscopies would have been saved, missing one gastric ulcer and two cases of oesophagitis. CONCLUSIONS: In our geographical area, the test-and-scope strategy based on 13C-urea breath test or Helicobacter pylori IgG serology would have saved only 15-20% of endoscopies. Although some relevant pathology would have been missed, it is not of a malignant type. 13C-urea breath test is the preferred non-invasive method to be used in this strategy, while Helicobacter pylori IgG serology is of limited value due to its low accuracy. With the use of CagA serology a larger number of unnecessary endoscopic examinations can be avoided.
Assuntos
Antígenos de Bactérias , Testes Respiratórios/métodos , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Ureia/análise , Adulto , Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/sangue , Biomarcadores/análise , Biópsia/métodos , Dispepsia/etiologia , Feminino , Gastroscopia , Infecções por Helicobacter/complicações , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Thyroid lymphoma represents less than 1% of malignant thyroid tumors and its diagnosis is difficult. We report a 25 years old woman, admitted with the diagnosis of diffuse euthyroid goiter and thyroid cancer. She was subjected to a subtotal thyroidectomy and the pathological study of the surgical piece showed a Hodgkin lymphoma, subtype nodular sclerosis. The patient was treated with three cycles of chemotherapy, using cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, blemycin, vinblastin and radiotherapy. She refused to continue treatment after the third cycle and after 3 years and 5 months of follow up, is well and free of disease.
Assuntos
Doença de Hodgkin/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/administração & dosagem , Feminino , Seguimentos , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Humanos , Mecloretamina/administração & dosagem , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia , Vincristina/administração & dosagemRESUMO
AIM: 13C-urea breath test is one of the best methods for the diagnosis of Helicobacter pylori infection. Although a citric acid solution is generally used prior to urea intake, the superiority of this strategy has not been sufficiently demonstrated. Thus, our aim was to compare 13C-urea breath test with and without citric acid solution, to evaluate whether 13C-urea breath test can also achieve favourable results when the test meal is omitted. METHODS: 13C-urea breath test with and without citric acid were compared prospectively in 53 subjects without prior Helicobacter pylori eradication therapy prescription. Basal samples and at 15', 30', and 45' after taking 100 mg of 13C-urea were obtained. The gold standard for Helicobacter pylori diagnosis was the 13C-urea breath test result with citric acid at 30', and "Delta Over Baseline" values >5 at that time were considered positive. RESULTS: The prevalence of Helicobacter pylori infection was 68%. Mean Delta Over Baseline values with citric acid at 15', 30' and 45' were: 29.6+/-39, 30.8+/-37 and 24.6+/-27; whereas respective values without citric acid were lower: 14.9+/-22, 12.2+/-17 and 10D+/-13 (pAssuntos
Anti-Infecciosos/uso terapêutico
, Radioisótopos de Carbono
, Quelantes
, Ácido Cítrico
, Infecções por Helicobacter/diagnóstico
, Gastropatias/diagnóstico
, Ureia/análise
, Adulto
, Biópsia
, Testes Respiratórios
, Diagnóstico Diferencial
, Feminino
, Gastroscopia
, Infecções por Helicobacter/tratamento farmacológico
, Infecções por Helicobacter/epidemiologia
, Infecções por Helicobacter/microbiologia
, Humanos
, Itália/epidemiologia
, Masculino
, Prevalência
, Estudos Prospectivos
, Reprodutibilidade dos Testes
, Gastropatias/tratamento farmacológico
, Gastropatias/microbiologia
RESUMO
AIM: A combination of omeprazole plus amoxycillin (Amo) and clarithromycin (CIa) for 7 days has been studied extensively. However, the role of other proton pump inhibitors, such as pantoprazole (Pan), in this therapy is not well known. On the other hand, ranitidine bismuth citrate (RBC) also seems to be effective when combined with Amo and CIa. Our aim was to evaluate and to compare these two novel short-term triple therapies (Pan+Amo+Cla and RBC+Amo+Cla) for treatment of Helicobacter pylori. METHODS: In a randomized clinical trial 150 consecutive patients (38 with duodenal ulcer, 112 with non-ulcer dyspepsia) infected by H. pylori were studied prospectively. Exclusion criteria were: previous H. pylori eradication therapy, gastroerosive drug use, gastric surgery, and associated diseases. One of two regimens was given for 7 days: Pan (40 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group Pan+Amo+Cla, n = 75); or RBC (400 mg b.i.d.), Amo (1 g b.i.d.), Cla (500 mg b.i.d.) (group RBC+Amo+Cla, n = 75). All drugs were administered together after meals. Compliance was evaluated by return tablet count. Data were analysed by univariate (chi2) and multivariate (multiple logistic regression) analysis. Eradication was defined as a negative 13C-urea breath test 1 month after completing therapy. RESULTS: The distribution of studied variables (age, gender, smoking, duodenal ulcer/non-ulcer dyspepsia) was similar in both therapy groups. Per-protocol eradication was achieved in 48/71 (68%) in group Pan+Amo+Cla, and in 61/70 (87%) in group RBC+Amo+Cla (P= 0.01). Intention-to-treat (ITT) eradication was achieved in, respectively, 48/ 75 (64%) and in 61/75 (81%) (P= 0.03). The RBC+ Amo+Cla regimen was more effective than Pan+Amo+Cla in non-ulcer dyspepsia patients (ITT, 84% vs 58%; P = 0.005), but statistically significant differences were not demonstrated in duodenal ulcer patients (72% vs 80%). In the multivariate analysis the odds ratio for the effect of the type of therapy on H. pylori eradication in patients with non-ulcer dyspepsia was 3.8 (95% Cl, 1.6-9.3; P = 0.003). No relevant adverse effects were reported with any regimen. CONCLUSION: A RBC+Amo+Cla regimen for only 1 week is a promising therapy for H. pylori infection, due to its high efficacy, simple posology, and excellent tolerability. Combination of Pan with Amo and Cla, although effective in duodenal ulcer patients, but in non-ulcer dyspepsia has not achieved the favourable results previously reported with other proton pump inhibitors.
Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Benzimidazóis/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Penicilinas/uso terapêutico , Ranitidina/uso terapêutico , Sulfóxidos/uso terapêutico , 2-Piridinilmetilsulfinilbenzimidazóis , Distribuição de Qui-Quadrado , Úlcera Duodenal/microbiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Omeprazol/análogos & derivados , Pantoprazol , Estudos Prospectivos , Resultado do TratamentoRESUMO
AIM: To prospectively evaluate the validity of a rapid office-based diagnostic serological test (using capillary blood) in our population, taking as reference a combination of standard diagnostic methods, as well as to compare the results of this technique with those of "classic" serological tests (using venous blood). PATIENTS AND METHODS: We prospectively studied 39 consecutive patients with symptoms of the upper digestive tract who had undergone oral gastroscopy. Gastric biopsies were taken for histology and rapid urease testing, and a 13C-urea breath test was performed. An enzyme-linked immunoassay that detects IgG antibodies against Helicobacter pylori was used as a "classic" serological test and the commercial kit FlexPack HP was used as a "rapid" serological test. The endoscopist, the pathologist and those responsible for reading the rapid urease test, the 13C-urea breath test and both serological tests did not know the results of the other diagnostic methods. Patients were considered H. pylori positive when at least two of the three validated tests (rapid urease test, histology, and 13C-urea breath test) revealed infection and were considered free of infection when all tests were negative. RESULTS: Thirty-nine patients were studied. Thirty-eight per cent were male (mean age 48 +/- 15 years). The prevalence of H. pylori infection detected by the gold standard was 69.2%. The sensitivity and specificity of the "classic" serological test was 96% 95% (CI: 79-99) and 91% (59-100). "Rapid" serological testing was positive in nine patients, negative in 28 and indeterminate in two. A single digital puncture was sufficient in 80% of the patients, 15% needed two and 5% needed three. Most patients (77%) had no preference for either type of serological test while 20.5% preferred digital puncture and 2.5% venous puncture. The sensitivity, specificity, positive predictive value and negative predictive value were 31% (16-50), 91% (59-100), 89% (52-100) and 36% (19-56) respectively. Sensitivity was unaffected by age but specificity was lower in patients older than 40 years (89% vs. 100%; McNemar's test: 8; p < 0.01). Kappa's coefficient between the "classic" and the "rapid" serological tests was 0.16 (SE 0.1) and McNemar's test was 12.2 (p < 0.001), which indicates that the prevalence of infection diagnosed by both methods was not homogeneous. CONCLUSION: The "rapid" office-based serological test used in our study is of insufficient diagnostic accuracy to be used in clinical practice to identify H. pylori infection.