EVALUATING LACTOFERRIN AND CALPROTECTIN AS MARKERS OF INTESTINAL INFLAMMATION INCHRONIC PANCREATITIS.

BACKGROUND: The treatment of chronic pancreatitis does not consistently solve intestinal abnormalities, and despite the implementation of various therapeutic measures, patients often continue to experience persistent diarrhea. Therefore, it is imperative to recognize that diarrhea may stem from factors beyond pancreatic insufficiency, and intestinal inflammation emerges as a potential contributing factor. OBJECTIVE: The aim of this study was to assess fecal lactoferrin and calprotectin levels as indicators of intestinal inflammation in patients with chronic pancreatitis experiencing persistent diarrhea. METHODS: In this study, 23 male patients with chronic pancreatitis primarily attributed to alcohol consumption and presenting with diarrhea (classified as Bristol stool scale type 6 or 7), underwent a comprehensive evaluation of their clinical and nutritional status. Fecal lactoferrin and calprotectin levels were mea-sured utilizing immunoassay techniques. RESULTS: The average age of the participants was 54.8 years, 43.5% had diabetes, and 73.9% were smokers. Despite receiving enzyme replacement therapy and refraining from alcohol for over 4 years, all participants exhibited persistent diarrhea, accompanied by elevated calprotectin and lactoferrin levels indicative of ongoing intestinal inflammation. CONCLUSION: The findings of this study underscore that intestinal inflammation, as evidenced by elevated fecal biomarkers calprotectin and lactoferrin, may contribute to explaining the persistence of diarrhea in patients with chronic pancreatitis. BACKGROUND: • Exploration of intestinal inflammation in chronic pancreatitis patients with altered bowel habits. BACKGROUND: • Assessment of 23 patients using lactoferrin and calprotectin as intestinal inflammation biomarkers. BACKGROUND: • Intestinal inflammation was detected in all patients; positive correlation between both biomarkers. BACKGROUND: • Established connection between altered bowel habits and intestinal inflammation in chronic pancreatitis.

Avaliação da lactoferrina e da calprotectina como marcadores de inflamação intestinal na pancreatite crônica / Evaluating lactoferrin and calprotectin as markers of intestinal inflammation inchronic pancreatitis

ABSTRACT Background: The treatment of chronic pancreatitis does not consistently solve intestinal abnormalities, and despite the implementation of various therapeutic measures, patients often continue to experience persistent diarrhea. Therefore, it is imperative to recognize that diarrhea may stem from factors beyond pancreatic insufficiency, and intestinal inflammation emerges as a potential contributing factor. Objective: The aim of this study was to assess fecal lactoferrin and calprotectin levels as indicators of intestinal inflammation in patients with chronic pancreatitis experiencing persistent diarrhea. Methods: In this study, 23 male patients with chronic pancreatitis primarily attributed to alcohol consumption and presenting with diarrhea (classified as Bristol stool scale type 6 or 7), underwent a comprehensive evaluation of their clinical and nutritional status. Fecal lactoferrin and calprotectin levels were mea­sured utilizing immunoassay techniques. Results: The average age of the participants was 54.8 years, 43.5% had diabetes, and 73.9% were smokers. Despite receiving enzyme replacement therapy and refraining from alcohol for over 4 years, all participants exhibited persistent diarrhea, accompanied by elevated calprotectin and lactoferrin levels indicative of ongoing intestinal inflammation. Conclusion: The findings of this study underscore that intestinal inflammation, as evidenced by elevated fecal biomarkers calprotectin and lactoferrin, may contribute to explaining the persistence of diarrhea in patients with chronic pancreatitis.

RESUMO Contexto: O tratamento da pancreatite crônica não resolve de forma consistente as anomalias intestinais e, apesar da implementação de várias medidas terapêuticas, os pacientes muitas vezes continuam a apresentar diarreia persistente. Portanto, é imperativo reconhecer que a diarreia pode resultar de fatores além da insuficiência pancreática, e a inflamação intestinal surge como um potencial fator contribuinte. Objetivo: O objetivo deste estudo foi avaliar os níveis fecais de lactoferrina e calprotectina como indicadores de inflamação intestinal em pacientes com pancreatite crônica com diarreia persistente. Métodos: Neste estudo, 23 pacientes do sexo masculino com pancreatite crônica atribuída principalmente ao consumo de álcool e apresentando diarreia (classificada na escala de fezes de Bristol tipo 6 ou 7), foram submetidos a uma avaliação abrangente de seu estado clínico e nutricional. Os níveis fecais de lactoferrina e calprotectina foram medidos utilizando técnicas de imunoensaio. Resultados: A idade média dos participantes foi de 54,8 anos, 43,5% tinham diabetes e 73,9% eram fumantes. Apesar de receber terapia de reposição enzimática e abster-se de álcool por mais de 4 anos, todos os participantes apresentaram diarreia persistente, acompanhada por níveis elevados de calprotectina e lactoferrina, indicativos de inflamação intestinal contínua. Conclusão: Os achados deste estudo ressaltam que a inflamação intestinal, evidenciada pelos biomarcadores fecais elevados calprotectina e lactoferrina, pode contribuir para explicar a persistência da diarreia em pacientes com pancreatite crônica.

Socioeconomic profile and degree of satisfaction of patients attending Gastroenterology Outpatient Clinics of a University Institution.

OBJECTIVE: To evaluate the degree of satisfaction and the socioeconomic profile of patients attending Gastroenterology Outpatient Clinics at a University institution linked to the Brazilian Unified Health System. METHOD: A researcher-administered questionnaire was applied during a structured interview in outpatient clinics. RESULTS: Two hundred and forty (240) patients were included in the study (mean age of 53 years, 55% women). About 30% of the patients had incomplete elementary education, 25% had complete secondary education, and 53% were active workers. Approximately 87% attending the outpatient clinics were from the B2, C1 and C2 socioeconomic classes with an estimated family income of USD$275.00 to USD$825.00/month. Ninety-two percent (92%) of patients were satisfied with the care received; the items associated with a lower degree of satisfaction were facilities/comfort, cleanliness, and waiting time for consultation. No relationship was observed between socioeconomic profile and degree of satisfaction. CONCLUSION: Satisfaction surveys are important to identify opportunities for improving healthcare services, and it is incumbent upon managers, health professionals and even users to promote compliance with laws and decrees that seek to improve healthcare.

Socioeconomic profile and degree of satisfaction of patients attending Gastroenterology Outpatient Clinics of a University Institution / Perfil socioeconômico e grau de satisfação de pacientes que são atendidos em clínicas externas de gastrenterologia de uma instituição universitária / Perfil socioeconómico y grado de satisfacción de pacientes atendidos en clínicas externas de gastroenterología de un centro universitario

ABSTRACT Objective: To evaluate the degree of satisfaction and the socioeconomic profile of patients attending Gastroenterology Outpatient Clinics at a University institution linked to the Brazilian Unified Health System. Method: A researcher-administered questionnaire was applied during a structured interview in outpatient clinics. Results: Two hundred and forty (240) patients were included in the study (mean age of 53 years, 55% women). About 30% of the patients had incomplete elementary education, 25% had complete secondary education, and 53% were active workers. Approximately 87% attending the outpatient clinics were from the B2, C1 and C2 socioeconomic classes with an estimated family income of USD$275.00 to USD$825.00/month. Ninety-two percent (92%) of patients were satisfied with the care received; the items associated with a lower degree of satisfaction were facilities/comfort, cleanliness, and waiting time for consultation. No relationship was observed between socioeconomic profile and degree of satisfaction. Conclusion: Satisfaction surveys are important to identify opportunities for improving healthcare services, and it is incumbent upon managers, health professionals and even users to promote compliance with laws and decrees that seek to improve healthcare.

RESUMO Objetivo: Avaliar o grau de satisfação e o perfil socioeconômico de pacientes que são atendidos em Clínicas Externas de Gastrenterologia de uma instituição universitária vinculada ao Sistema Único de Saúde brasileiro. Método: Um questionário administrado por pesquisador foi aplicado durante uma entrevista estruturada em clínicas externas. Resultados: Duzentos e quarenta (240) pacientes foram incluídos no estudo (idade média de 53 anos, 55% mulheres). Aproximadamente 30% dos pacientes tinham ensino fundamental incompleto, 25% tinham ensino médio incompleto e 53% eram trabalhadores na ativa. Cerca de 87% dos que eram atendidos nas clínicas externas se encontravam nas classes econômicas B2, C1 e C2 com renda familiar estimada entre 275,00 e 825,00 dólares americanos por mês. Noventa e dois por cento (92%) dos pacientes estavam satisfeitos com o atendimento recebido; os itens associados a baixo grau de satisfação foram as instalações/conforto, limpeza e tempo de espera para consulta. Nenhuma relação foi observada entre perfil socioeconômico e grau de satisfação. Conclusão: Pesquisas de satisfação são importantes para identificar oportunidades para melhorar os serviços de saúde e para que seus gerentes responsáveis, profissionais da saúde e até mesmo usuários possam promover o cumprimento às leis e decretos que visam melhorar o atendimento em saúde.

RESUMEN Objetivo: Evaluar el grado de satisfacción y el perfil socioeconómico de pacientes atendidos en Clínicas Externas de Gastroenterología de un centro universitario vinculado al Sistema Único de Salud brasileño. Método: Un cuestionario administrado por investigador fue aplicado durante entrevista estructura en clínicas externas. Resultados: Doscientos cuarenta (240) pacientes fueron incluidos en el estudio (edad media de 53 años, el 55% mujeres). Un 30% de los pacientes tenían educación básica incompleta, el 25% tenían el bachillerato/secundaria incompleto/a y el 53% eran trabajadores activos. Cerca del 87% de los que eran atendidos en la clínicas externas se hallaban en las clases económicas B2, C1 y C2 con ingresos familiares estimados entre 275,00 y 825,00 dólares estadounidenses por mes. El noventa y dos por ciento (92%) de los pacientes estaban satisfechos con la atención recibida; los puntos asociados con bajo grado de satisfacción fueron las instalaciones/comodidad, limpieza y tiempo de espera para consulta. Ninguna relación fue observada entre perfil socioeconómico y grado de satisfacción. Conclusión: Encuestas de satisfacción son importantes para identificar oportunidades de mejorar los servicios sanitarios y para que sus gerentes responsables, profesionales sanitarios e incluso los mismos usuarios puedan promocionar el cumplimiento a la leyes y decretos a fin de mejorar la atención sanitaria.

Complicação tardia em biópsia hepática percutânea: é possível? / Late complication after percutaneous liver biopsy: is it possible?

A biópsia hepática percutânea, guiada ou não por ultrassonografia, consiste na retirada de fragmento de tecido hepático. É um procedimento invasivo para estudo histopatológico do órgão, propor terapêutica, avaliar resultados de tratamento e fazer acompanhamento após transplante em várias doenças hepáticas. A taxa de complicações deste procedimento está em torno de 1%, podendo citar dor, hipotensão, hemorragia, pneumotórax, peritonite biliar, bacteremia transitória e morte, e, na sua grande maioria, ocorre dentro das primeiras 48 horas. Relatamos o caso de um paciente do sexo masculino, 62 anos, com história de infecção crônica pelo vírus da hepatite C, submetido à biópsia hepática para estadiamento METAVIR. Após duas semanas, retornou ao serviço de urgência com quadro de abdome agudo hemorrágico, evoluindo a óbito. Com base no relato, os autores discutem as complicações da biópsia hepática, as causas de sangramento abdominal considerando a apresentação tardia do sangramento e a provável causa do óbito do paciente.

Liver biopsy, guided by ultrasonography or not, is an invasive procedure in which a hepatic tissue is removed for histopathological study of the organ, treatment planning, evaluate treatments results and follow-up after liver transplant in several hepatic diseases. Complication rate of the procedure is around 1%, including pain, hypotension, bleeding or hemorrhage, pneumothorax, biliary peritonitis transitory bacteremia and death, and most of them occur within 48 hours after the biopsy. We report a case about a male patient, 62 years old, with previous chronic hepatitis C virus infection, which underwent a liver biopsy for METAVIR staging. After two weeks, patient returns to the hospitals emergency service with hemorrhagic acute abdomen, leading to death. Based on the case report, authors discuss the complications of the liver biopsy, causes of abdominal bleeding considering its late manifestation and the patients probable cause of death.

[Educational program in schistosomiasis: a model for a methodological approach]. / Programa educativo em esquistossomose: modelo de abordagem metodológica.

OBJECTIVE: Lack of knowledge is one of the factors responsible for the persistence of infectious diseases in Brazil. This study had the objective of developing, implementing and evaluating a low-cost educational program using schistosomiasis patients as a model. METHODS: This was a descriptive study developed using a population of healthy people (group 1) and schistosomiasis patients (groups 2 and 3), with 20 individuals in each group. Teaching material (illustrated manual and album of leaflets) and a questionnaire consisting of 17 questions to evaluate the groups' knowledge were devised. The questionnaire was applied to groups 1 and 2 before and to group 3 after the educational program. The variables studied were the educational program, level of schooling, age, clinical form of schistosomiasis, symptoms, and the subject's performance when answering the questionnaire. For the statistical analysis, Fisher's exact test and variance analysis with one fixed factor were utilized. RESULTS: The educational program was evaluated in the form of four topics: cycle, clinical presentation, treatment and prevention of the disease. The median number of correct responses to the questionnaire was higher for group 3 than for groups 1 and 2, for all the topics dealt with. This median was also higher for group 2 than for group 1, for all topics except for the item "prevention". CONCLUSIONS: The educational process applied was efficient and improved the knowledge of the disease. It may provide an effective low-cost methodological model that can also be applied to combating other endemic diseases.

Programa educativo em esquistossomose: modelo de abordagem metodológica / Educational program in schistosomiasis: a model for a methodological approach

OBJETIVO: A falta de conhecimento é um dos fatores relacionados à persistência de doenças infecciosas no Brasil. O presente estudo tem como objetivo desenvolver, implementar e avaliar um programa educativo de baixo custo, usando como modelo portadores de esquistossomose. MÉTODOS: Estudo descritivo desenvolvido com população constituída por pessoas saudáveis (grupo 1) e esquistossomóticos (grupos 2 e 3), com 20 indivíduos em cada grupo. Foi elaborado material didático (manual ilustrado e álbum seriado) e um questionário de 17 questões para avaliar o conhecimento nos grupos. Nos grupos 1 e 2, o questionário foi aplicado antes e no grupo 3, depois do programa educativo. As variáveis estudadas foram: programa educativo, nível de escolaridade, idade, forma clínica da esquistossomose e sintomatologia e o desempenho dos indivíduos na resposta ao questionário. Para a análise estatística foram utilizados o teste exato de Fisher e análise de variância com um fator fixo. RESULTADOS: O programa educativo foi avaliado em quatro tópicos: ciclo, clínica, tratamento e prevenção da doença. Verificou-se que o grupo 3 apresentou mediana de respostas certas superior aos grupos 1 e 2 em todos os tópicos abordados. O grupo 2 apresentou mediana de respostas certas superior ao grupo 1 em todos os tópicos, exceto em relação ao tópico prevenção. CONCLUSÕES: O processo educativo aplicado foi eficiente, melhorou o conhecimento sobre a doença, podendo constituir-se num modelo de atuação efetiva e de baixo custo que também pode ser aplicado no combate a outras endemias.

Construcão e implementacão de acões de enfermagem em ambulatório de gastroenterologia / Construction and implementation of nursing actions in the gastroenterology outclinic

Em 1998, iniciou-se reestruturacão do Setor de Esquistossomose da Disciplina de Gastroenterologia da UNIFESP, com a implantacão do Servico de Enfermagem. Objetivo: desenvolver acões administrativas de enfermagem, sistematizacão da assistência e programa de orientacão ao esquistossomótico. Método: estudo descritivo, realizado no Ambulatório de Gastroenterologia que atende portadores de esquistossomose, nas suas diferentes formas clínicas. Resultados e discussão: a reestruturacão das atividades do Setor resultaram em: criacão de estrutura organizacional e implantacão da consulta de enfermagem; criacão e distribuicão dos folhetos explicativos e desenvolvimento do Programa de Educacão em Esquistossomose; início de projeto piloto de banco de dados de todos os clientes do ambulatório e do cadastro eletrônico da coleta de materiais biológicos. Conclusão: a iniciativa abriu nova oportunidade de atuacão para o enfermeiro e contribuiu para melhorar a qualidade do atendimento ambulatorial.

Elevação da gamma-glytamiltransferase sérica na hepatopatia esquistossomótica com a carga parasitária e precede alterações ultra-sonográficas / Serum gamma-glutamyltransferase alteration in hepatic schistosomiasis doesn't correlate with parasitic load and precedes ultrasound alterations

Liver disorders are the major manifestations of schistosomiasis mansoni. Factors that account for increased concentrations of cholestasis-indicating enzymes in the hepatosplenic form of the disease are unknown. OBJECTIVE: To assess the correlation between increased gamma-glutamyltransferase serum levels and both the parasitic load and ultrasound alterations in patients with schistosomiasis. PATIENTS AND METHODS: Twenty-five patients with the chronic form of schistosomiasis were assessed for the presence or absence of increased enzymatic levels, for the parasitic load (low x medium/high) and for ultrasound parameters. Furthermore, analysis of prothrombin time and a platelet count were performed. RESULTS: Of the 25 patients, 13 showed increased gamma-glutamyltransferase plasma levels. No significant correlation was found between increased gamma-glutamyltransferase levels and the parasitic load, or between increased enzyme levels and ultrasound alterations. Nor did the prothrombin index or the platelet count differ between the two groups (normal gamma-glutamyltransferase levels and increased gamma-glutamyltransferase levels). CONCLUSION: The parasitic load explains no rise in gamma-glutamyltransferase plasma levels in patients with the chronic form of schistosomiasis, and conventional ultrasound is not a sensitive method to detect the alteration suggested by the increased enzyme level in those patients

Malignant melanoma with liver and spleen metastases: case report

CONTEXT: The diagnosis of primary melanoma is easily confirmed after histological analysis of the lesion, whereas it is rarely diagnosed when the patient even has distant metastases. DESIGN: Case report CASE REPORT: Malignant melanoma is responsible for about 1 percent of all deaths caused by cancer in the USA and only 3 percent of all malig-nant skin diseases. Malignant melanoma is a rare disease, although it corresponds to 65 percent of all deaths caused by skin cancer. The liver and spleen are rarely the first sites of melanoma metastases. This paper reports on the clinical picture of a patient with fatal malignant melanoma and hepatic and spleen metastases. As this was an un-usual presentation, the melanoma diagnosis could only be made after pathological analysis of the skin and hepatic lesions