RESUMO
BACKGROUND: Ulcerative proctitis (UP) can have a milder, less aggressive course than left-sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease-related complications, and to identify the need for immunosuppressive therapies. METHODS: We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio-demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. RESULTS: From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86-6.69; p < 0.001) required immunosuppressants. CONCLUSIONS: Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent.
Assuntos
Colite Ulcerativa , Imunossupressores , Proctite , Sistema de Registros , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Proctite/tratamento farmacológico , Colite Ulcerativa/tratamento farmacológico , Imunossupressores/uso terapêutico , Estudos ProspectivosRESUMO
OBJETIVOS: Verificar a adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação da amplitude de movimento do ombro homolateral à cirurgia e identificar as dificuldades na realização dos exercícios e das atividades de vida diária. MÉTODOS: Estudo prospectivo desenvolvido no Ambulatório de Oncomastologia do Hospital São Paulo/Universidade Federal de São Paulo, no período de 2003 a 2004. A amostra constitui-se de 28 mulheres mastectomizadas que aceitaram participar do programa de reabilitação, desde a alta hospitalar até o primeiro retorno ambulatorial. RESULTADOS: Aderiram ao programa 64,2 por cento das pacientes e 82,1 por cento referiram dificuldade para execução dos exercícios, principalmente devido à dor. A maioria realizou as atividades de vida diária sem dificuldades. CONCLUSÃO: Faz-se necessário um melhor controle da dor pós-operatória e reforço das orientações para incrementar a adesão das pacientes ao programa de reabilitação.
OBJECTIVES: The main objective was to measure adherence to an early rehabilitation program among women who underwent mastectomy. Other specific objectives included the identification of women's difficulties to comply with the exercise prescription and to perform daily life activities, and whether women's adherence to the rehabilitation program was effective in regaining their shoulder's full range of motion on the side of the surgery. METHODS: A prospective study design was used. A sample of 28 women who underwent mastectomy and agreed to participate in an early rehabilitation program from discharge to the first outpatient clinic follow-up participated in the study. Data were collected from 2003 to 2004 in the oncomastology outpatient clinic of the Hospital São Paulo of the University Federal of São Paulo. RESULTS: The majority of women (63.2 percent) adhered to the early rehabilitation program. The majority of women (82.1 percent) also reported having difficulties to perform the prescribed exercise program due to pain but not with daily life activities. CONCLUSION: Pain management and patient education must be addressed to improve adherence to the early rehabilitation program.
OBJETIVOS: Verificar la adhesión de mujeres mastectomizadas al inicio de un programa de rehabilitación temprana de la amplitud de movimiento del hombro homolateral a la cirugía, e identificar las dificultades en la realización de los ejercicios y de las actividades de vida diaria. MÉTODOS: Estudio prospectivo desarrollado en consulta externa de Oncomastología del Hospital São Paulo/Universidade Federal de São Paulo, en el período 2003 al 2004. La muestra se constituyó de 28 mujeres mastectomizadas que aceptaron participar del programa de rehabilitación, desde el alta hospitalario hasta el primer retorno ambulatorio. RESULTADOS: La adhesion al programa fue del 64,2 por ciento de las pacientes y el 82,1 por ciento refirieron dificultad para la ejecución de los ejercicios, principalmente debido al dolor. La mayoría realizó las actividades de vida diaria sin dificultades. CONCLUSION: Se hace necesario un mejor control del dolor post operatorio y refuerzo de las orientaciones para incrementar la adhesión de las pacientes al programa de rehabilitación.