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The development and course of inflammatory bowel disease (IBD) are significantly influenced by inflammation and oxidative stress. Antioxidant therapy is a promising therapeutic option to enhance the clinical results of these individuals in this particular scenario. The purpose of this study is to assess the impact of curcumin, with or without piperine, on cytokines, fecal calprotectin (CalF), and oxidative stress enzymatic and non-enzymatic indicators in patients with IBD. METHODS: Patients with Crohn's disease (CD) or ulcerative colitis (UC) who were at least 18 years old and had intact liver and kidney function participated in this randomized, double-blind trial (trial registration: ensaiosclinicos.gov.br as RBR-89q4ydz). For 12 weeks, participants were randomly assigned to one of three groups: placebo, curcumin (1000 mg/day), or curcumin plus piperine (1000 mg + 10 mg/day). In order to examine oxidative stress indicators, CalF, and pro-inflammatory cytokines, blood and fecal samples were obtained, both prior to and following the intervention time. RESULTS: After adjusting for age, sex, and type of IBD, the curcumin plus piperine group had substantially higher serum levels of superoxide dismutase (SOD) than the placebo group (4346.9 ± 879.0 vs. 3614.5 ± 731.5; p = 0.041). There were no discernible variations between the groups in CalF, inflammatory markers, or other indicators of oxidative stress. CONCLUSIONS: In patients with inflammatory bowel disease (IBD), our study indicates that a 12-week curcumin plus piperine treatment effectively increases enzymatic antioxidant defense, especially SOD. These results demonstrate the potential therapeutic benefits of managing redox imbalance in individuals with IBD.
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Abstract Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidec-tomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.
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Humanos , Fístula Rectal/cirugía , Anestesia Raquidea/métodos , Anestésicos , Dolor Postoperatorio/prevención & control , Anestesia LocalRESUMEN
Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin. (AU)
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Humanos , Masculino , Femenino , Enfermedades Inflamatorias del Intestino/terapia , Monitoreo de Drogas , Proteína C-Reactiva , Estudios Retrospectivos , Albúminas , Infliximab/uso terapéuticoRESUMEN
BACKGROUND: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). METHODS: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. RESULTS: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). CONCLUSION: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidectomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.
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Anestesia Raquidea , Anestésicos , Fístula Rectal , Humanos , Anestesia Raquidea/métodos , Dolor Postoperatorio/prevención & control , Anestesia Local , Fístula Rectal/cirugíaRESUMEN
BACKGROUND: Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients. METHODS: Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy. RESULTS: There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn's disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4-12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months). CONCLUSIONS: LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.
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BACKGROUND: Colorectal cancer (CRC) is the third most incident cancer in the world and the second leading cause of cancer death. Significant decreases in incidence and mortality can be achieved by reducing risk factors and adhering to healthy lifestyle recommendations, as well as screening for the disease. OBJECTIVE: To evaluate the clinical nutritional profile of individuals at medium risk screened for CRC residing in the city of Piranhas/Alagoas. METHODS: Cross-sectional study conducted from September to October 2020, with individuals at medium risk for CRC, of both sexes and aged between 50 and 70 years old. Participants were screened for CRC with fecal immunochemical testing (FIT) and colonoscopy. Personal, socioeconomic, clinical, lifestyle and nutritional assessment data were collected. The latter was performed using anthropometric data (weight, height, arm circumference and triceps skinfold thickness), body composition (bioimpedance) and physical examination. Descriptive analysis of data frequencies and dichotomization according to the presence or absence of overweight was performed, followed by comparison of means and medians and frequencies by chi-square or Fisher's exact test. RESULTS: In total, 82 people agreed to undergo the clinical nutritional assessment, most of them female (56.1%; n=46), adults (56.1%; n=46), with a mean age of 59.02 years (±6.30 SD). Pre-cancerous lesions were identified in 54.5% (n=42) of those screened, 52.4% (n=43) were smokers or former smokers, and 65.9% (n=54) did not practice scheduled physical activity. Nutritional assessment showed that 64.6% (n=53) were overweight according to body mass index. On the other hand, the muscle mass, % arm muscle circumference adequacy and body muscle mass (kg) markers showed that 32.9% (n=27) and 47.6% (n=39) of the subjects were muscle depleted, respectively. Above all, overweight participants had, in parallel, lower muscle mass (P<0.05), suggesting sarcopenic obesity in this population. CONCLUSION: Obesity is one of the main risk factors for CRC; when concomitant with sarcopenia, it favors worse health outcomes. In this context, evidence shows the need to assess muscle composition in people with obesity, especially through other methods of assessing body composition. Our results add to the evidence on the importance of the population being guided about screening and adherence to healthy lifestyle recommendations, especially strategies aimed at weight control and the practice of physical activity.
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Neoplasias Colorrectales , Sarcopenia , Adulto , Masculino , Femenino , Humanos , Persona de Mediana Edad , Anciano , Sobrepeso , Estudios Transversales , Obesidad/complicaciones , Obesidad/epidemiología , Índice de Masa Corporal , Sarcopenia/diagnóstico , Neoplasias Colorrectales/diagnóstico , MúsculosRESUMEN
Background: The surgery with total mesorectal excision recommended by R. J. Heald in 1982 is the gold standard. Rectal cancer (RC) surgery has a morbidity rate ranging from 6 to 35%, and it can cause functional issues such as sexual, urinary, and bowel dysfunction in the long term. Neoadjuvant chemoradiotherapy (CRT) has been gaining ground in patients with lesions in the middle and lower rectum. The aim of the present study is to present the experience of a reference service in the treatment of RC. Patients and Methods: A retrospective study involving 53 patients diagnosed with RC between January 2017 and December 2019 with follow-up until December 2020. We examined tumor location, disease stage, digital rectal exam findings, carcinoembryonic antigen (CEA), therapeutic modality offered, and follow-up time. Results: A total of 32% of the patients were men and 68% were women, with a mean age of 60 years old. Location: upper rectum in 6 cases, middle rectum in 21 cases, and lower rectum in 26 cases with evolution from 9.8 to 13.5 months. The most frequent complaints were hematochezia and constipation. A total of 36 patients underwent neoadjuvant therapy: 11 complete clinical response (CCR) (30.5%), 20 (55.5%) partial clinical response (PCR), and no response in 5 patients (14%). The follow-up ranged from 12 to 48 months, with a mean of 30.5 months. A total of 25% of the patients had RC that went beyond the mesorectal fascia, and 22.64% had metastases in other parts of the body when they were diagnosed. Conclusion: Neoadjuvant radio and chemotherapy present themselves as an alternative in the treatment of rectal cancer. In 36 patients, 30.5% had a complete clinical response, 55.5% had a partial clinical response, and 14% had no response. It was worth doing the "Watch and Wait" (W&W) to sample. A definitive colostomy was avoided. However, it is necessary to expand the study to a larger follow-up and more patients. Additionally, it is necessary to implement a multicenter study. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/terapia , Terapia Neoadyuvante , Recto/cirugía , Antígeno Carcinoembrionario , Estudios de Seguimiento , Colon/cirugía , Tacto Rectal , Estadificación de NeoplasiasRESUMEN
ABSTRACT Background: Colorectal cancer (CRC) is the third most incident cancer in the world and the second leading cause of cancer death. Significant decreases in incidence and mortality can be achieved by reducing risk factors and adhering to healthy lifestyle recommendations, as well as screening for the disease. Objective: To evaluate the clinical nutritional profile of individuals at medium risk screened for CRC residing in the city of Piranhas/Alagoas. Methods: Cross-sectional study conducted from September to October 2020, with individuals at medium risk for CRC, of both sexes and aged between 50 and 70 years old. Participants were screened for CRC with fecal immunochemical testing (FIT) and colonoscopy. Personal, socioeconomic, clinical, lifestyle and nutritional assessment data were collected. The latter was performed using anthropometric data (weight, height, arm circumference and triceps skinfold thickness), body composition (bioimpedance) and physical examination. Descriptive analysis of data frequencies and dichotomization according to the presence or absence of overweight was performed, followed by comparison of means and medians and frequencies by chi-square or Fisher's exact test. Results: In total, 82 people agreed to undergo the clinical nutritional assessment, most of them female (56.1%; n=46), adults (56.1%; n=46), with a mean age of 59.02 years (±6.30 SD). Pre-cancerous lesions were identified in 54.5% (n=42) of those screened, 52.4% (n=43) were smokers or former smokers, and 65.9% (n=54) did not practice scheduled physical activity. Nutritional assessment showed that 64.6% (n=53) were overweight according to body mass index. On the other hand, the muscle mass, % arm muscle circumference adequacy and body muscle mass (kg) markers showed that 32.9% (n=27) and 47.6% (n=39) of the subjects were muscle depleted, respectively. Above all, overweight participants had, in parallel, lower muscle mass (P<0.05), suggesting sarcopenic obesity in this population. Conclusion: Obesity is one of the main risk factors for CRC; when concomitant with sarcopenia, it favors worse health outcomes. In this context, evidence shows the need to assess muscle composition in people with obesity, especially through other methods of assessing body composition. Our results add to the evidence on the importance of the population being guided about screening and adherence to healthy lifestyle recommendations, especially strategies aimed at weight control and the practice of physical activity.
RESUMO Contexto: O câncer colorretal (CCR) é o terceiro câncer mais incidente no mundo e a segunda principal causa de morte por câncer. Diminuições significativas da incidência e mortalidade podem ser alcançadas a partir da redução de fatores de risco e adesão às recomendações de estilo de vida saudável, bem como rastreamento da doença. Objetivo: Avaliar o perfil clínico nutricional de indivíduos em risco médio rastreados para o CCR residentes na cidade de Piranhas/Alagoas. Métodos: Estudo transversal, conduzido de setembro a outubro de 2020, com indivíduos de médio risco para o CCR, de ambos os sexos e idades entre 50 e 70 anos. Os participantes realizaram rastreamento para o CCR com teste imunoquímico fecal (FIT) e colonoscopia. Foram coletados dados pessoais, socioeconômicos, clínicos, de estilo de vida e avaliação nutricional. Esta última foi realizada através de dados antropométricos (peso, altura, circunferência do braço e prega cutânea tricipital), composição corporal (bioimpedância) e exame físico. Foi realizada análise descritiva das frequências dos dados e dicotomização segundo a presença ou não de excesso de peso, seguida da comparação de médias e medianas e das frequências por qui-quadrado ou teste exato de Fisher. Resultados: No total, 82 pessoas aceitaram realizar a avaliação clínica nutricional, a maioria do sexo feminino (56,1%; n=46), adultos (56,1%; n=46), com média de idade de 59,02 anos (±6,30 DP). Foram identificadas lesões pré-cancerígenas em 54,5% (n=42) dos rastreados, 52,4% (n=43) eram tabagista ou ex-tabagista e 65,9% (n=54) não praticavam atividade física programada. A avaliação nutricional demonstrou que 64,6% (n=53) estavam com excesso de peso pelo índice de massa corporal (IMC). Em contrapartida, os marcadores de massa muscular, % de adequação da circunferência muscular do braço (CMB) e massa muscular corporal (kg), mostraram que 32,9% (n=27) e 47,6% (n=39) dos indivíduos estavam com depleção muscular, respectivamente. Sobretudo os participantes com excesso de peso apresentavam, paralelamente, menor massa muscular (P<0,05), sugerindo obesidade sarcopênica nessa população. Conclusão: A obesidade é um dos principais fatores de risco para o CCR; quando concomitante a sarcopenia, favorece a piores desfechos para saúde. Nesse contexto, as evidências mostram a necessidade de avaliar a composição muscular em pessoas com obesidade, sobretudo, por outros métodos de avaliação da composição corporal. Nossos resultados se somam as evidências sobre a importância da população ser orientada sobre o rastreamento e adesão às recomendações de estilo de vida saudável, principalmente estratégias voltadas para o controle de peso e a prática de atividade física.
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BACKGROUND: Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. METHODS: A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. RESULTS: Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p < 0.0001) and 52 (65.24% vs. 51.35%, p < 0.0001) when compared to ADA. According to Kaplan-Meier survival curve loss of response was less frequent in the Infliximab compared to Adalimumab group (p = 0.001). Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). Age, non-prior exposure to biological therapy, use of IFX and endoscopic remission at week 26 were associated with clinical remission after 52 weeks. Variables associated with endoscopic remission were non-prior exposure to biological therapy, and clinical and endoscopic remission at week 26. CONCLUSIONS: IFX was associated with higher rates of clinical remission after 1 year in comparison to ADA. Non-prior exposure to biological therapy and early response to anti-TNF treatment were associated with higher rates of clinical and endoscopic remission.
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Colitis Ulcerosa , Adalimumab/uso terapéutico , Adulto , Brasil , Colitis Ulcerosa/inducido químicamente , Colitis Ulcerosa/tratamiento farmacológico , Femenino , Humanos , Infliximab/efectos adversos , Infliximab/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Inhibidores del Factor de Necrosis Tumoral/uso terapéuticoRESUMEN
BACKGROUND: Crohn's disease and ulcerative colitis are the primary inflammatory bowel diseases (IBD), and its pathogenesis is related to genetic and environmental factors. Currently, the diagnosis of IBD results in a multidisciplinary approach with significant disadvantages, such as its invasive nature, time spent, and the fact that 10% of patients remain without diagnostic classification. However, new methodologies of analysis have emerged that allowed the expansion of knowledge about IBD, as the metabolomics, the study of metabolites. The presence and prevalence of such metabolites may prove to be useful as biomarkers in the diagnosis of IBD. OBJECTIVE: Analyze fecal samples for metabolic analysis in the diagnosis of inflammatory bowel diseases (IBD), providing differentiation between Crohn's disease and ulcerative colitis. METHODS: This is an observational study with 21 patients diagnosed with IBD (ulcerative colitis 11 and Crohn's disease 10) and 15 healthy controls, all with the consent and clarification. The fecal extracts of all patients are submitted to a high-resolution Nuclear Magnetic Resonance Hydrogen (1H-NMR) spectroscopy combined with multivariate and univariate pattern recognition techniques. Through the metabolomics of fecal extracts, gives us a characterization of employing a noninvasive approach. RESULTS: We identify some metabolites, such as lactate, succinate, alanine, and tyrosine, in the Crohn's disease fecal samples, and leucine, alanine, and tyrosine in the ulcerative colitis fecal samples. All the amino acids presented positive covariance for disease correlation. CONCLUSION: The results showed different metabolic profiles between IBD patients and healthy volunteers based on 1H-NMR analysis of fecal extracts. Moreover, the approach discriminated patients with Crohn's disease and ulcerative colitis. The metabolomics analysis is promising as a novel diagnostic technique for further IBD recognition and surveillance. New studies are necessary to validate these findings.
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Enfermedades Inflamatorias del Intestino , Heces , Humanos , MetabolómicaRESUMEN
ABSTRACT BACKGROUND: Crohn's disease and ulcerative colitis are the primary inflammatory bowel diseases (IBD), and its pathogenesis is related to genetic and environmental factors. Currently, the diagnosis of IBD results in a multidisciplinary approach with significant disadvantages, such as its invasive nature, time spent, and the fact that 10% of patients remain without diagnostic classification. However, new methodologies of analysis have emerged that allowed the expansion of knowledge about IBD, as the metabolomics, the study of metabolites. The presence and prevalence of such metabolites may prove to be useful as biomarkers in the diagnosis of IBD. OBJECTIVE: Analyze fecal samples for metabolic analysis in the diagnosis of inflammatory bowel diseases (IBD), providing differentiation between Crohn's disease and ulcerative colitis. METHODS: This is an observational study with 21 patients diagnosed with IBD (ulcerative colitis 11 and Crohn's disease 10) and 15 healthy controls, all with the consent and clarification. The fecal extracts of all patients are submitted to a high-resolution Nuclear Magnetic Resonance Hydrogen (1H-NMR) spectroscopy combined with multivariate and univariate pattern recognition techniques. Through the metabolomics of fecal extracts, gives us a characterization of employing a noninvasive approach. RESULTS: We identify some metabolites, such as lactate, succinate, alanine, and tyrosine, in the Crohn's disease fecal samples, and leucine, alanine, and tyrosine in the ulcerative colitis fecal samples. All the amino acids presented positive covariance for disease correlation. CONCLUSION: The results showed different metabolic profiles between IBD patients and healthy volunteers based on 1H-NMR analysis of fecal extracts. Moreover, the approach discriminated patients with Crohn's disease and ulcerative colitis. The metabolomics analysis is promising as a novel diagnostic technique for further IBD recognition and surveillance. New studies are necessary to validate these findings.
RESUMO CONTEXTO: A doença de Crohn e retocolite ulcerativa são as principais doenças inflamatórias intestinais (DII), e sua patogênese está relacionada a fatores genéticos e ambientais. Atualmente, o diagnóstico de DII resulta em uma abordagem multidisciplinar e apresenta desvantagens significativas, como sua natureza invasiva, tempo gasto e o fato de 10% dos pacientes permanecerem sem classificação diagnóstica. No entanto, surgiram novas metodologias de análise que permitiram ampliar o conhecimento sobre a DII, como a metabolômica, o estudo dos metabólitos. A presença e a prevalência desses metabólitos podem ser úteis como biomarcadores no diagnóstico da DII. OBJETIVO: Avaliar as amostras fecais por análise metabolômica no diagnóstico de DII, diferenciando os perfis metabólicos entre doença de Crohn e retocolite ulcerativa. MÉTODOS: Estudo observacional com 36 indivíduos (doença de Crohn 11, retocolite ulcerativa 10 e 15 controles saudáveis), todos com consentimento esclarecido. Os extratos fecais de todos os pacientes são submetidos a uma espectroscopia de alta resolução por ressonância magnética nuclear de hidrogênio (1H-RMN) combinada com técnicas de reconhecimento de padrões multivariados e univariados. Por meio da metabolômica utilizando extratos fecais, foi possível obter uma caracterização adequada das doenças inflamatórias intestinais através de uma abordagem não invasiva. RESULTADOS: Foi possível identificar os seguintes metabólitos nos pacientes com doença de Crohn: lactato, succinato, alanina e tirosina e, no grupo retocolite ulcerativa encontrou-se leucina, alanina e tirosina. Todos os aminoácidos apresentaram covariância positiva para a doença. CONCLUSÃO: Os resultados demonstraram diferentes perfis metabólicos entre pacientes com DII e voluntários saudáveis, com base na análise por 1H-RMN dos extratos fecais. Além disso, pacientes com doença de Crohn e retocolite ulcerativa também podem ser discriminados usando essa abordagem. A análise metabolômica é promissora como uma nova técnica não invasiva de diagnóstico para melhor reconhecimento das DII. Novos estudos são necessários para validar esses achados.
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Humanos , Enfermedades Inflamatorias del Intestino , Metabolómica , HecesRESUMEN
Introduction: Several clinical conditions imply the realization of a bowel ostomy, as a treatment option. However, the presence of a stoma is an important limitation in the quality of life of the ostomized patient. Aim: To define the epidemiological profile of patients enrolled in the Ostomy Program from two reference services in the city of Maceió, Alagoas, regarding gender, age, classification (as permanent or temporary), type of ostomy with respect to the bowel segment used, and causes. Method: This was a descriptive cross-sectional study whose data were obtained from registration forms of active patients in Ostomy Programs on May 2013. Results: Of 216 patients analyzed, 50.5% were female and 49.5% male. The age group with the highest number of cases was that between 60 and 69 years (23.6%) and the average age was 51.3 years. Colostomies accounted for 89.4% of the procedures performed, and 56.9% of procedures were temporary ostomies. As for the cause, the most prevalent was colorectal cancer (40.7%), followed by trauma (18.1%) and acute abdomen (12.0%). Conclusion: The study provides relevant data that can be used as input for prevention and strategies to improve the health of the ostomized population.
Introdução: Diversas condições clínicas implicam a realização de uma ostomia intestinal como opção de tratamento. Entretanto, a presença de um estoma é um importante limitador na qualidade de vida da pessoa ostomizada. Objetivo: Definir o perfil epidemiológico dos pacientes cadastrados no Programa de Ostomizados de dois serviços de referência em Maceió, Alagoas quanto a gênero, idade, classificação da ostomia em definitiva ou temporária, tipo de ostomia quanto ao segmento intestinal utilizado e causas. Método: Trata-se de um estudo transversal descritivo cujos dados foram obtidos de fichas cadastrais de pacientes ativos em Programas de Ostomizados no mês de maio de 2013. Resultados: Dos 216 pacientes analisados, 50,5% eram do gênero feminino e 49,5% do gênero masculino. A faixa etária com maior número de casos foi a de 60 a 69 anos (23,6%) e a média de idade foi de 51,3 anos. As colostomias representaram 89,4% dos procedimentos realizados e 56,9% das ostomias foram temporárias. Quanto à causa, a mais prevalente foi o câncer colorretal (40,7%), seguido dos traumatismos (18,1%) e do abdome agudo (12,0%). Conclusão: O estudo apresenta dados relevantes que podem ser utilizados como subsídio para ações de prevenção e estratégias de melhoria da saúde da população ostomizada.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Perfil de Salud , Estomía , Neoplasias Colorrectales/cirugía , Estomas Quirúrgicos , Abdomen Agudo/cirugía , Calidad de Vida , Anomalías Congénitas , Colostomía , Ileostomía , Neoplasias Colorrectales/epidemiología , Abdomen Agudo/epidemiologíaRESUMEN
OBJECTIVE: the aim of this study was to identify the prevalence of constipation in diabetic patients treated at the endocrinology outpatient clinic at Hospital Universitário Professor Alberto Antunes and PAM Salgadinho, from April to August 2013. METHODS: a descriptive and cross-sectional study, carried out through a questionnaire using the Rome III criteria in 372 patients treated at the outpatient endocrinology clinic. RESULTS: of 372 patients evaluated, the frequency of constipation found was 31.2% among diabetic patients. Females predominated in the sample (72.8%) as well as for the frequency of constipation (80.2%). The incidence of type II diabetes was 97.3% and it was observed that 80.2% of the sample was older than 50 years. One hundred and twelve patients with inadequate glycemic control (HgA1c = 7) had an association with constipation. CONCLUSION: there was an increased frequency of constipation in patients with diabetes mellitus according to the Rome III criteria, in relation to the general population. The inadequate glycemic control in patients with diabetes mellitus increases the frequency of constipation and it is necessary to perform studies that allow the confirmation of this association to demonstrate this hypothesis. (AU)
OBJETIVO: analisar a prevalência da constipação intestinal em pacientes diabéticos atendidos no ambulatório de endocrinologia do Hospital Universitário Professor Alberto Antunes e no PAM Salgadinho (HUPAA), de abril de 2013 a agosto 2013. MÉTODO: estudo descritivo e transversal, realizado através da aplicação de um questionário com os critérios de Roma III no ambulatório de endocrinologia do HUPAA. RESULTADO: em 372 pacientes, 271 feminino, 101 masculino, 162 de etnia branca, 55 negros e 155 pardos, 297 pacientes estavam acima de 50 anos, houve uma frequência de constipação de 31,2% nos pacientes diabéticos. O gênero feminino prevaleceu na amostra (73%) assim como no índice de frequência da constipação (80,2%). Em nossa amostra a diabetes Tipo II foi verificada em 360 pacientes (97%) e o tipo 1 em 12 pacientes (3%), observou-se que 80% da amostra apresentavam idade superior a 50 anos. Em 112 pacientes com controle glicêmico inadequado (HgA1c =7) havia uma associação com a constipação intestinal. CONCLUSÃO: encontramos maior frequência da constipação intestinal em pacientes com Diabetes Mellitus, segundo os critérios de Roma III, em relação à população geral. Há uma associação entre o controle glicêmico inadequado nos pacientes com Diabetes Mellitus e a frequência da constipação, faz-se necessário a realização de outros estudos que possibilitem confirmar a associação dessa varíavel para comprovação desta hipótese. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Estreñimiento/clasificación , Estreñimiento/etiología , Diabetes Mellitus , Hemoglobina Glucada , Encuestas y Cuestionarios , Complicaciones de la DiabetesRESUMEN
Colorectal neoplasm is one of the most common cancers in developed countries and its incidence has grown progressively. The currently used attempts to prognostic assessment are limited, since they are restricted to the observation of tumor morphology, such as the TNM staging. The quantification of free DNA in peripheral blood aims to find a way to relate it to the clinical status of patients with cancer. OBJECTIVE: To evaluate the prognosis of patients with colorectal cancer with the quantification of ALU247 fragments in peripheral blood and TNM staging. METHODS: We evaluated 79 patients in the following groups: Operated, and Non-Operated and Control as to the ALU247 fragment dosage and its correlation with tumor staging. RESULTS: The amount of ALU247 fragments revealed very different results when comparing the different groups. The mean quantity in the Non-Operated group was 14.62 pg, while the mean was 0.48 pg for the Control Group and 0.93 pg for the Operated Group. Serum levels of ALU247 were higher in more advanced morphofunctional classes of the TNM staging. CONCLUSIONS: We suggest there is a relation between the advanced TNM stage and high doses of free DNA in peripheral blood with worse prognosis. (AU)
A neoplasia colorretal é uma das formas mais comuns de câncer nos países desenvolvidos e sua incidência tem crescido de maneira contínua. As tentativas de avaliação prognóstica usadas atualmente apresentam a grave limitação de se restringirem à observação da morfologia tumoral, como o estadiamento TNM. A quantificação do DNA livre no sangue periférico busca encontrar uma forma de relacioná-lo com o estado clínico dos portadores de câncer. OBJETIVO: Avaliar o prognóstico dos pacientes portadores do câncer colorretal por meio da quantificação de fragmentos de ALU247 no sangue periférico e do estadiamento TNM. MÉTODOS: Foram avaliados 79 pacientes nos Grupos Operados, Não Operados e Controle quanto à dosagem de fragmento de ALU247 e sua correlação com os estádios dos tumores. RESULTADOS: A quantidade de fragmentos ALU247 revelou resultados bastante distintos quando os diferentes grupos foram comparados. A média da quantificação nos Não Operados foi de 14,62 pg, de 0,48 pg no Grupo Controle e 0,93 pg no Grupo Operados. Os valores séricos do ALU247 encontraram-se mais elevados nas classes morfofuncionais mais avançadas do estadiamento TNM. CONCLUSÕES: Sugere-se uma relação entre o avanço do estádio TNM e a dosagem elevada do DNA livre no sangue periférico com pior prognóstico. (AU)
Asunto(s)
Neoplasias del Recto/diagnóstico , Sangre , Neoplasias del Colon/diagnóstico , Estadificación de Neoplasias , Pronóstico , Biomarcadores de TumorRESUMEN
BACKGROUND: The value of the preparation of the colon prior colorectal surgery remains debatable. Since installed as traditional the use of this routine, few studies have been conducted to support the safety of surgeries done without mechanical bowel preparation. AIM: To determine if there is a correlation between postoperative complications and no use of mechanical bowel preparation in operated patients. METHODS: Was conducted a prospective study in patients undergoing coloproctology abdominal surgery without prior bowel preparation. RESULTS: The sample consisted of 126 patients, 57 men and 69 women. The average age was 54 years (19 to 89). Among patients who had comorbidities (43 patients - 34,12%), 30 (23,80%) had arterial hypertension. Antibiotic prophylaxis was used in 89,70%. Among the patients, 14,28% had complications: eight (6,34%) wound infection, six (4,76%) anastomotic dehiscence and four (3,17%) fistula. CONCLUSION: The pre-operative mechanical bowel preparation is not essential in the routine of colorectal surgeries.
Asunto(s)
Cirugía Colorrectal/normas , Cuidados Preoperatorios/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Adulto JovenRESUMEN
RACIONAL: O valor do preparo de cólon prévio nas operações colorretais continua discutível, visto que devido à tradição da rotina do preparo poucos estudos têm sido realizados para sustentação da operação segura sem o preparo mecânico. OBJETIVO: Verificar se há correlação entre as complicações pós-operatórias e a não utilização do preparo mecânico dos cólons nos pacientes operados. MÉTODOS: Foi realizado um estudo prospectivo nos pacientes submetidos a procedimentos cirúrgicos coloproctológicos abdominal sem prévio preparo intestinal. Foram coletadas informações antropométricas e epidemiológicas, co-morbidades existentes nos pacientes, antibioticoprofilaxia utilizada, complicações infecciosas e deiscências. RESULTADOS: A amostra foi composta de 126 pacientes, 57 homens e 69 mulheres com média de idade de 54 anos (19 a 89). Entre os pacientes que apresentaram comorbidades (43 pacientes - 34,12%), 30 (23,80%) eram hipertensos. A antibioticoprofilaxia foi utilizada em 89,70% dos pacientes. Dentre eles, 14,28% apresentaram complicações, sendo oito (6,34%) com infecção de ferida operatória, seis (4,76%) com deiscência de anastomose e quatro (3,17%) fístulas. CONCLUSÃO: O preparo dos cólons não é fundamental na rotina pré-operatória.
BACKGROUND: The value of the preparation of the colon prior colorectal surgery remains debatable. Since installed as traditional the use of this routine, few studies have been conducted to support the safety of surgeries done without mechanical bowel preparation. AIM: To determine if there is a correlation between postoperative complications and no use of mechanical bowel preparation in operated patients. METHODS: Was conducted a prospective study in patients undergoing coloproctology abdominal surgery without prior bowel preparation. RESULTS: The sample consisted of 126 patients, 57 men and 69 women. The average age was 54 years (19 to 89). Among patients who had comorbidities (43 patients - 34,12%), 30 (23,80%) had arterial hypertension. Antibiotic prophylaxis was used in 89,70%. Among the patients, 14,28% had complications: eight (6,34%) wound infection, six (4,76%) anastomotic dehiscence and four (3,17%) fistula. CONCLUSION: The pre-operative mechanical bowel preparation is not essential in the routine of colorectal surgeries.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Cirugía Colorrectal/normas , Cuidados Preoperatorios/normas , Complicaciones Posoperatorias/prevención & control , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
OBJETIVO: Rastreamento do papilomavírus humano (HPV) assim como sua correlação com a neoplasia anorretal nos pacientes portadores do vírus da imunodeficiência humana (HIV) por meio da anuscopia de alta resolução (AAR) e da citologia anal. MÉTODOS: Desenvolvemos um estudo observacional, transversal e duplo-cego em que participaram 31 pacientes portadores do HIV independente de queixas proctológicas. Os pacientes foram submetidos à AAR e citologia anal cujas lâminas foram enviadas ao setor de anatomia patológica para coloração e posterior análise. RESULTADOS: Verificamos 22 pacientes do sexo masculino e 9 do sexo feminino entre 20 e 67 anos. Dos 31 analisados, quatro encontravam-se em estágio de imunodepressão, 23 utilizavam terapia antirretroviral, 16 com passado de sexo anal receptivo e 12 com passado de condiloma acuminado. À AAR 11 pacientes tinham alterações e 7 foram confirmados pela citologia. Verificamos ainda oito pacientes com alterações à citologia os quais possuíam ausência de alterações à AAR. À citologia apresentaram três células escamosas atípicas de significância (Ascus, do inglês atypical squamous cells of undetermined significance), cinco com paraceratose e/ou hiperceratose, seis lesões intraepiteliais de baixo grau e uma lesão intraepitelial de alto grau. CONCLUSÃO: Sugerimos a utilização da AAR aliada à citologia anal para rastreamento nos pacientes portadores do HIV, visto que esses exames complementam-se para a detecção de lesões que estejam relacionadas ao câncer anorretal.
OBJECTIVE: Screening for HPV as well as its correlation with anorectal cancer in patients carrying the human immuno deficiency virus (HIV) through high-resolution anoscopy (HRA) and anal cytology. METHODS: We developed an observational study, double-blind attended by 31 patients with HIV independent proctologic complaints. Patients underwent HRA and anal cytology slides were sent to which sector pathology staining and analysis. RESULTS: We found 22 males and 9 females between 20 and 67 years. Of the 31 tested, 4 were in stage of immunosuppression, 23 were using antiretroviral therapy, 16 with history of receptive anal sex and 12 with a history of condyloma acuminata. In the HRA 11 patients had changes and 7 were confirmed by cytology. We also verified eight patients with abnormal cytology who had no changes to the HRA. In the atypical squamous cells of undetermined significance (Ascus) cytology had three, five with parakeratosis and/or hyperkeratosis, six intraepithelial lesions and a low grade squamous intraepithelial lesion high grade. CONCLUSION: We suggest the use of anoscopy high resolution combined with anal cytology for screening in patients with the HIV, since these examinations are complementary for the detection of lesions that are related to anorectal cancer.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Neoplasias del Ano , VIH , Infecciones por Papillomavirus , Estudios TransversalesRESUMEN
OBJETIVOS: Diagnosticar a presença do HPV anorretal em portadoras dessa afecção no trato genital inferior, através do exame coloproctológico com anuscopia de alta resolução. MÉTODOS: Estudo observacional e transversal realizado através de um protocolo de pesquisa, no Hospital Universitário da UFAL de Fevereiro a Julho de 2008, analisando 57 mulheres com diagnóstico prévio de infecção genital por HPV submetendo-as a uma avaliação através da anuscopia de alta resolução. RESULTADOS: A idade média variou de 31,2 anos, seis pacientes eram gestantes, 59,6 por cento cursaram apenas o 1º grau, 73,7 por cento tinham união estável; A idade média de menarca foi 12,6 anos e a sexarca de 17 anos. Em relação ao número de parceiros sexuais, 33,3 por cento tiveram 2 a 3 parceiros; 68,6 por cento apresentaram lesão intraepitelial genital de baixo grau (LGSIL), CONCLUSÕES: 89,5 por cento não apresentavam lesões e 10,5 por cento apresentavam através da anuscopia de alta resolução(AAR) lesões sub-clínicas perianal, vulvar e vaginal. É possível e viável ao especialista incorporar o exame de anuscopia de alta resolução para diagnóstico de HPV ano-retal na forma subclínica à sua rotina, já que é de simples execução, barato e a doença acomete pacientes sem lesões visíveis ao exame proctológico.
AIM: To diagnose the presence of anorectal HPV in women with lower genital tract lesions, through rectal examination with High Resolution Anuscopy. METHODS: Observational, transversal study conducted by a research protocol in the Hospital Universitário Prof. Alberto Antunes (HUPAA/UFAL) from February to July 2008, examining 57 women with a previous diagnosis of genital HPV infection by subjecting them to an assessment by High Resolution Anuscopy. RESULTS: The mean age ranged from 31.2 years, six patients were pregnant women, 59.6 percent had finished elementary school, 73.7 percent were in a stable union with a partner, the average age of menarche was 12.6 years and 17 years for the first intercourse. Regarding the number of sexual partners, 33.3 percent had 2 to 3 partners, 68.6 percent had low grade squamous intraepithelial lesion (LGSIL), CONCLUSIONS: 89,5 percent had no lesions and 10,5 percent had subclinical perianal, vulvar and vaginal lesions. It is possible and feasible to the professionals incorporate the High Resolution Anuscopy for diagnosis of HPV in anorectal subclinical lesions to their routine, it is simple,inexpensive and mainly because the disease affects patients with no visible lesions to the anorectal examination.
Asunto(s)
Humanos , Femenino , Enfermedades del Ano , Papillomaviridae , Infecciones por Papillomavirus , Enfermedades de Transmisión Sexual , Anomalías UrogenitalesRESUMEN
Com o objetivo de estudar comparativamente o preparo intestinal para colonoscopia, 55 pacientes foram distribuídos aleatoriamente em grupos submetidos a preparo com polietilenoglicol (PEG) e solução de manitol. A qualidade do preparo do cólon no grupo que utilizou o PEG foi considerada excelente em 12 pacientes (44,4 por cento), bom em 15 (55,6 por cento) e ruim em nenhum caso, enquanto que naqueles indivíduos preparados com manitol a 20 por cento a qualidade foi, respectivamente, de oito (28,6 por cento), 12 (42,9 por cento) e oito (28,6 por cento) indivíduos, sendo a diferença estatisticamente significante (p=0,010). Não houve diferença estatística entre os grupos quando comparamos o grau de satisfação dos pacientes, ou a quantidade de líquido no cólon durante o exame. Conclui-se que a qualidade do preparo intestinal com PEG para colonoscopia é superior ao manitol.
With the aim of studying comparatively intestinal prepare for colonoscopy, 55 patients were randomly distributed into two groups that used polyethylene glycol (PEG) and mannitol solution. The quality of bowel prepare in the group that used PEG was considered excellent in 12 patients (44,4 percent), good in 15 (55,6 percent) and bad in no cases, while in those prepared with manitol the quality of intestine preparation was, respectively, eight (28,6 percent), 12 (42,9 percent) and eight (28,6 percent) patients. The difference was considered statistically significant (p=0,010). There wasn't any statistical difference between the groups when we compared the satisfaction degree of the patients or the amount of liquid in the colon during the colonoscopy. We can conclude that the quality of bowel preparation for colonoscopy with PEG is superior to manitol.