Vedolizumab in Mild-to-Moderate Crohn's Disease Patients Naïve to Biological Therapy: A Multicentric Observational Study.

Background: In real-world experience, the number of patients using vedolizumab as first-line biological therapy was low. We aimed to evaluate the effectiveness and safety of vedolizumab in mild-to-moderate Crohn's disease (CD) biologic-naïve patients. Methods: We performed a retrospective multicentric cohort study with patients who had clinical activity scores (Harvey-Bradshaw Index [HBI]) measured at baseline and weeks 12, 26, 52, as well as at the last follow-up. Clinical response was defined as a reduction ≥3 in HBI, whereas clinical remission as HBI ≤4. Mucosal healing was defined as the complete absence of ulcers in control colonoscopies. Kaplan-Meier survival analysis was used to assess the persistence with vedolizumab. Results: From a total of 66 patients, 53% (35/66) reached clinical remission at week 12. This percentage increased to 69.7% (46/66) at week 26, and 78.8% (52/66) at week 52. Mucosal healing was achieved in 62.3% (33/53) of patients. Vedolizumab was well tolerated, and most adverse events were minor. During vedolizumab treatment, 3/66 patients underwent surgery. Conclusions: This study demonstrates the effectiveness and safety of vedolizumab as a first-line biological agent in patients with mild-to-moderate CD.

Phase angle values and ultra-processed food consumption are associated with changes in oxidative stress in inflammatory bowel disease patients.

BACKGROUND & AIMS: Changes in dietary habits including increased intake of refined sugars and fats and decreased intake of fiber have been suggested as potential risk factors for the development of inflammatory bowel diseases (IBD). Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status. In this study, we for the first time investigated the relationship of PhA and ultra-processed food intake with oxidative stress, body composition and biochemical parameters in adult patients with IBD. METHODS: Body composition and PhA were evaluated through electrical bioimpedance. Nitrite (Nox), myeloperoxidase (MPO), glutathione (GSH), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were determined in both groups. Food consumption was obtained by a food frequency questionnaire (FFQ). RESULTS: In comparison with the control group, the IBD group had increased (p < 0.05) concentrations of Nox (19.95 ± 1.4 vs. 35.43 ± 7.7 µM), MDA (0.70 ± 0.31 vs. 4.56 ± 0.62 nmol/L), and GSH (9.35 ± 0.38 vs. 10.74 ± 0.51 mg NPSH/µL plasma). PhA was positively correlated with GSH (R2:0.22; p:0.02) and SOD (R2:0.25; p:0.01). IBD patients ingested higher amounts of ultra-processed foods (IBD:17.04 ± 2.76 vs. Control:24.88 ± 2.30%). However, IBD patients had better consumption of unprocessed or minimally processed foods (IBD:79.06 ± 3.07 vs. Control:67.83 ± 2.32%). We found a positive correlation between ultra-processed food consumption and MDA (R2 0.43; p:0.01). CONCLUSIONS: PhA may be a practical and effective measure in clinical follow-up of IBD patients, being associated with bilirubin levels and antioxidant enzymes. Also, we recommend evaluating consumption of ultra-processed foods, since this was related with increasing oxidative stress markers in clinical follow-up of IBD patients.

Emergence of melioidosis in Brazil: a case series.

BACKGROUND: Melioidosis is a serious disease caused by the bacterium Burkholderia pseudomallei which affects humans and animals. It results in a wide spectrum of clinical manifestations, mainly in the respiratory tract, progressing to septic shock and death. CASE PRESENTATION: Herein, we present a series of seven patients (median age: 41 years) with confirmed melioidosis, treated at a public hospital in Piauí State, Brazil between 2019 and 2021. The most common clinical presentations were fever, cough, pneumonia, and abdominal pain. The mean duration of antibacterial therapy with 1 g of meropenem was 28.6 ± 1.1 days. Six patients recovered and one died. The mean hospitalization time was 51.0 ± 39.2 days. CONCLUSIONS: Melioidosis is an emerging infectious disease in Brazil. Health professionals in endemic areas need to be aware of the clinical presentation and appropriate clinical management of the disease because early diagnosis and early initiation of antibiotic therapy can be life-saving.

Effect of dietary interventions on inflammatory biomarkers of inflammatory bowel diseases: A systematic review of clinical trials.

OBJECTIVES: In this review, we systematically assess whether dietary interventions are effective in attenuating inflammatory biomarkers in IBDs based on clinical trials available in the literature. RESEARCH METHODS & PROCEDURES: This review was conducted in accordance with the guidelines of the PRISMA. We used the PubMed and SciVerse Scopus databases and the Cochrane collaboration tool to assess the risk of bias in clinical trials. The PICO (patient, intervention, comparison, and outcomes) strategy was used, with the descriptors: "Inflammatory bowel disease", "Crohn's disease", "cd", "ibd", "ulcerative colitis", "uc", "Diet", "Diet Habits", "Feeding", "Nutrients", "Food Intake", "Dietary patterns", "Inflammations", "Inflammation", "acute-phase proteins", "C-reactive protein", "interleukins", "tumor necrosis factor-alpha" and "inflammatory response". There is no conflict of interest. DATA ANALYSIS: Fifteen studies were included, with a total of 627 participants. Of the total studies included, seven showed a reduction in some inflammatory markers in response to dietary interventions. This review was registered with the PROSPERO platform under number: CRD42021235150. CONCLUSIONS: The results presented in this review reveal that dietary intervention with specific characteristics may be important during the treatment of the inflammatory process in patients with IBDs.

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden, especially in patients with moderate-to-severe disease. The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil (RISE BR) study was a noninterventional study designed to evaluate disease control, treatment patterns, disease burden and health-related quality of life in patients with moderate-to-severe active IBD. We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD. AIM: To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil. METHODS: This was a prospective, noninterventional study of adult patients with active Crohn's disease (CD: Harvey-Bradshaw Index ≥ 8, CD Activity Index ≥ 220), inadequate CD control (i.e., calprotectin > 200 µg/g or colonoscopy previous results), or active ulcerative colitis (UC: Partial Mayo score ≥ 5). Enrollment occurred in 14 centers from October 2016 to February 2017. The proportion of active IBD patients after 9-12 mo of follow-up, Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation, discontinuation and dose changes were examined. RESULTS: The study included 118 CD and 36 UC patients, with mean ± SD ages of 43.3 ± 12.6 and 44.9 ± 16.5 years, respectively. The most frequent drug classes at index were biologics for CD (62.7%) and 5-aminosalicylate derivates for UC patients (91.7%). During follow-up, 65.3% of CD and 86.1% of UC patients initiated a new treatment at least once. Discontinuations/dose changes occurred in 68.1% of CD patients [median 2.0 (IQR: 2-5)] and 94.3% of UC patients [median 4.0 (IQR: 3-7)]. On average, CD and UC patients had 4.4 ± 2.6 and 5.0 ± 3.3 outpatient visits, respectively. The median time to first mild or no activity was 319 (IQR: 239-358) d for CD and 320 (IQR: 288-358) d for UC patients. At 9-12 mo, 22.0% of CD and 20.0% of UC patients had active disease. CONCLUSION: Although a marked proportion of active IBD patients achieved disease control within one year, the considerable time to achieve this outcome represents an unmet medical need of the current standard of care in a Brazilian real-world setting.

Effects of glutamine supplementation on inflammatory bowel disease: A systematic review of clinical trials.

CONTEXT: Glutamine supplementation has been applied clinical practice to treat inflammatory bowel disease (IBD). However, scientific evidence about this is still controversial. OBJECTIVE: In this review, we systematically evaluated the effects of glutamine supplementation on IBD, based on evidence from randomized clinical trials. DATA SOURCE: This review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We used the PubMed and SciVerse Scopus databases. The Cochrane collaboration tool was used to assess the risk of bias in clinical trials. DATA EXTRACTION: The review was carried out by two independent researchers according to the established inclusion criteria. The PICO (patient, intervention, comparison, and outcomes) strategy was used, with the descriptors: "glutamine," "supplementation," "inflammatory bowel diseases," "Crohn's disease," and "ulcerative colitis". DATA SYNTHESIS: Seven research articles were selected for this systematic review. In these studies, glutamine was administered to the participants through oral (21-30g or 0.5g per kg of participant's body weight), enteral (7.87g-8.3 g/100g of the enteral formula), and/or parenteral (0.3  g/kg of the participant's body weight) routes. No changes in anthropometry or biochemical parameters were observed. However, in one study reduced intestinal permeability and morphometry were reported. In two other studies, a slight effect of glutamine on inflammation and oxidative stress was observed. Additionally, two other studies reported an effect of glutamine supplementation on disease activity. CONCLUSIONS: The findings obtained through this systematic review indicate that glutamine supplementation has no effect on disease course, anthropometric measurements, intestinal permeability and morphology, disease activity, intestinal symptoms, biochemical parameters, oxidative stress and inflammation markers in patients with IBD, regardless of the route of administration, either treated at a hospital or as outpatients.

Inflammatory Bowel Diseases and diet: an integrative review.

OBJECTIVE: To gather scientific evidence on the role of diet in inflammatory bowel diseases. METHODS: Integrative review with studies published in the last 10 years in national and international journals. Original studies developed with adult human beings aged ≥18 years were included and articles published before 2010, literature reviews, and those that did not focus on elements that answered the guiding question were excluded. RESULTS: 14 articles were selected that addressed important dietary elements in inflammatory bowel disease such as fermentable carbohydrates and polyols, foods of animal origin, foods rich in omega 3, consumption of fruits and vegetables, use of probiotic supplements, whey proteins and soy. CONCLUSION: The diet, as a potentially modifiable environmental factor, plays an important role in the prevention and treatment of inflammatory bowel diseases. The reduction in the consumption of fermentable carbohydrates and polyols combined with the increase in the consumption of fruits and vegetables as well as the exclusion of products of animal origin such as beef, pork, milk and eggs can help control inflammation and improve the quality of life of patients with inflammatory bowel diseases. The use of probiotics increases food tolerance and, whey and soy proteins, can alter body composition and reduce inflammation.

Inflammatory Bowel Diseases and diet: an integrative review

SUMMARY OBJECTIVE: To gather scientific evidence on the role of diet in inflammatory bowel diseases. METHODS: Integrative review with studies published in the last 10 years in national and international journals. Original studies developed with adult human beings aged ≥18 years were included and articles published before 2010, literature reviews, and those that did not focus on elements that answered the guiding question were excluded. RESULTS: 14 articles were selected that addressed important dietary elements in inflammatory bowel disease such as fermentable carbohydrates and polyols, foods of animal origin, foods rich in omega 3, consumption of fruits and vegetables, use of probiotic supplements, whey proteins and soy. CONCLUSION: The diet, as a potentially modifiable environmental factor, plays an important role in the prevention and treatment of inflammatory bowel diseases. The reduction in the consumption of fermentable carbohydrates and polyols combined with the increase in the consumption of fruits and vegetables as well as the exclusion of products of animal origin such as beef, pork, milk and eggs can help control inflammation and improve the quality of life of patients with inflammatory bowel diseases. The use of probiotics increases food tolerance and, whey and soy proteins, can alter body composition and reduce inflammation.

RESUMO OBJETIVO: Reunir evidências científicas sobre o papel da dieta nas doenças inflamatórias intestinais. MÉTODOS: Revisão integrativa com estudos publicados nos últimos 10 anos em periódicos nacionais e internacionais. Foram incluídos estudos originais desenvolvidos com seres humanos adultos com idade ≥18anos e excluídos artigos publicados antes de 2010, revisões de literatura, e os que não apresentassem como foco elementos que respondessem a pergunta norteadora. RESULTADOS: Foram selecionados 14 artigos que abordaram elementos dietéticos importantes na doença inflamatória intestinal como carboidratos e polióis fermentáveis, alimentos de origem animal, alimentos ricos em ômega 3, consumo de frutas e vegetais, uso de suplementos com probióticos, proteínas do soro do leite e soja. CONCLUSÃO: A dieta, como fator ambiental potencialmente modificável desempenha importante papel na prevenção e tratamento das doenças inflamatórias intestinas. A redução no consumo de carboidratos e polióis fermentáveis aliado ao aumento do consumo de frutas e vegetais como também a exclusão de produtos de origem animal como carne bovina, carne suína, leite e ovo podem auxiliar no controle da inflamação e melhoria da qualidade de vida dos pacientes com doenças inflamatórias intestinais. O uso de probióticos aumenta a tolerância alimentar e, proteínas do soro do leite e soja, podem alterar a composição corporal e reduzir a inflamação.

Zinc gluconate supplementation impacts the clinical improvement in patients with ulcerative colitis.

Ulcerative colitis is an inflammatory bowel disease that affects the mucous membrane of the colon. The pathogenesis is not clear, but there is evidence of a complex interaction between genetic, environmental, and immunological factors. In this regard, we highlight the role of zinc in the immune system and probable control of the disease. This study evaluated the effect of zinc supplementation on the inflammatory response in patients with ulcerative colitis. A blind interventional study involving 41 patients of both sexes, who underwent either zinc gluconate supplementation (n = 23), or treatment with a placebo (corn starch) (n = 18). Patients were evaluated for dietary zinc intake, plasma and erythrocyte zinc concentrations, and serum levels of Th1/Th2/Th17 type cytokines at baseline (T0) and 30 (T1) and 60 (T2) days after intervention. Patients in the zinc supplementation group had a lower probability of having an adequate zinc intake than placebo. In this same group, there was a significant difference between plasma zinc concentrations (T1 in relation to T0, T2 in relation to T1, and T2 in relation to T0) and erythrocyte zinc (T1 in relation to T0 and T2 in relation to T1). Zinc supplementation resulted in significant changes in the concentrations of IL-2 and IL-10 without differences in the other interleukins. Zinc gluconate intervention in patients with ulcerative colitis improves the nutritional status of this mineral in these patients and positively influences their clinical outcome, reinforcing the role of zinc as an important dietary component in disease control.

Sarcoma de Kaposi no trato gastrintestinal alto em paciente infectado por HIV / Upper gastrointestinal Kaposi's sarcoma in HIV-infected patient

Introdução: o Sarcoma de Kaposi (SK) é a neoplasia mais comum em portadores da Síndrome da Imunodeficiência Adquirida (SIDA). É raro o acometimento exclusivo do trato gastrointestinal por essa afecção, ocorrendo em 3,5% dos casos. O objetivo desse estudo é relatar o caso de um paciente portador de SIDA com anemia e vômitos, diagnosticado com SK gastrointestinal. Relato de caso: paciente do gênero masculino, 29 anos, foi admitido no Hospital Universitário (HU/UFPI) devido a sintomas inespecíficos com 1 mês de evolução. Paciente tinha antecedente pessoal de retrovirose. Para investigação dos sintomas, o paciente realizou endoscopia digestiva alta que revelou lesões violáceas sésseis de antro gástrico e duodeno. A análise histopatológica constatou fragmentos de mucosa gástrica e entérica exibindo, em lâmina própria, proliferação de capilares sanguíneos em fenda, células fusiformes atípicas com núcleos hipercromáticos e extravasamento de hemácias. O estudo imuno-histoquímico mostrou que as células neoplásicas expressaram o antígeno nuclear latente-1 do herpesvírus humano 8 (HHV8 LNA1; clone LN53, diluição 1:25, Diagnostic Biosystems, Pleasanton, CA) em padrão nuclear, confirmando o diagnóstico de SK. Em decorrência de múltiplas complicações e agravamento clínico, o paciente foi a óbito após 15 dias da admissão. Discussão e Conclusão: incidência de SK gastrointestinal é subestimada. Estômago, duodeno e o trato biliar são os locais mais comumente acometidos. A detecção do HHV-8 por imuno-histoquímica é uma ferramenta útil, especialmente na lesão inicial em que o caráter neoplásico não é evidente. A mortalidade dos pacientes com SK gastrointestinal exclusivo é significantemente maior em relação aos que não têm esse tipo de acometimento. Tal fato pode explicar o prognóstico reservado do paciente relatado no presente caso.

Introduction: Kaposi sarcoma (KS) is the most common malignancy in patients with Acquired Immunodeficiency Syndrome (AIDS). It is rare the exclusive involvement of the gastrointestinal tract by this condition, occurring in 3.5% of cases. The aim of this study is to report the case of an HIV-infected patient with anemia and vomiting diagnosed with gastrointestinal KS. Case report: a 29-year-old male patient admitted to the University Hospital (HU/UFPI) due to non-specific symptoms with one month of evolution. He had personal history of retrovirus. To research the symptoms, the patient underwent upper endoscopy that revealed sessile purplish lesions of gastric antrum and duodenum. Histopathological analysis found gastric and enteric mucosa fragments exhibiting in lamina propria proliferation of blood capillaries with formation of slit like spaces, atypical spindle cells with hyperchromatic nuclei and extravasation of red blood cells. Immunohistochemical study showed that tumor cells expressed human herpesvirus 8 latent nuclear antigen-1 (HHV-8 LNA1; clone LN53, dilution 1:25, Diagnostic Biosystems, Pleasanton, CA) in nuclear pattern, confirming the diagnosis of KS. Because of multiple complications and clinical worsening, the patient died after 15 days of admission. Discussion and Conclusion: the incidence of gastrointestinal KS is underestimated. Stomach, duodenum and biliary tract are the most commonly affected sites. The detection of HHV-8 for immunohistochemistry is a useful tool, particularly in the initial lesion in which the neoplastic character is not evident. The mortality of patients with exclusive gastrointestinal KS is significantly higher than those who do not have that involvement. This may explain the poor prognosis of the patient reported in this case.

Preservação dos ovários em cirurgia radical para câncer do colo uterino / Ovarian preservation in radical surgery for cervical cancer

Objetivo: avaliar a função ovariana em pacientes com câncer do colo uterino, que se submeteram a histerectomia radical com preservação dos ovários. Métodos: foram analisadas retrospectivamente pacientes com câncer do colo uterino, submetidas a histerectomia radical com preservação dos ovários na Clínica Ginecológica do Hospital São Marcos-SPCC, de abril de 1998 a outubro de 2001, com avaliação dos sintomas de privação estrogênica (fogachos, vagina seca) e mensuração dos níveis de FSH pós-operatórios. Os dados foram analisados pelo teste de Pearson. Resultados: os níveis de FSH foram mensurados em 42 pacientes; destas, 33 (78,5 por cento) apresentaram níveis normais de FSH no pós-operatório (menores que 30 mU/mL); os valores variaram entre 1,2 e 132,44 mU/mL (mediana de 21,05 mU/mL). Das nove pacientes com níveis elevados de FSH, cinco (55,6 por cento) haviam sido submetidas a radioterapia pós-operatória (p<0,0001). Não houve associação entre a idade das pacientes e os níveis de FSH (p=0,33). Cistos ovarianos funcionais ocorreram em quatro pacientes (7,7 por cento). Uma paciente apresentou recidiva da lesão na cúpula vaginal e metástase para o couro cabeludo, evoluindo para óbito. Conclusão: observou-se preservação da função ovariana em 78,5 por cento das pacientes. A transposição ovariana foi inadequada para preservar sua função em pacientes submetidas à radioterapia pós-operatória. Näo se observou associação entre idade e níveis de FSH no pós-operatório