COVID-19 - The clinical consequences of social isolation and the relation with sleep bruxism and comorbidities.

SARS-COV-2 is a highly pathogenic coronavirus that causes the disease known as COVID-19, which has infected more than 100 million people worldwide. The main form of containment of the pandemic is social isolation. However the isolation, the severity of the COVID-19 disease, the uncertainty of the future and the economic impact are the possible causes of anxiety as an adverse effect of the pandemic. The literature describes the possible association between anxiety with poor sleep quality, exacerbation of painful conditions, gastroesophageal reflux disease, increased consumption of drugs and the possibility of developing or enhancing sleep bruxism. Health professionals should keep in mind the possibility of overlapping with the different clinical conditions mentioned and the need for a multi-professional team to manage these patients.

Proton pump inhibitor indications in a Brazilian tertiary hospital.

OBJECTIVES To evaluate the frequency of prescription of proton pump inhibitors (PPIs) and their indications in patients hospitalized at the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU). METHODS This is a quantitative cross-sectional observational study that analyzes data obtained from patient records on prescriptions of PPIs for patients hospitalized at the HC-UFU and from a questionnaire applied to assistant physicians on the indications of the drug in each case and evaluates the indication based on literature data. RESULTS On a pre-determined day, of a total of 462 inpatients, there was a prescription of PPI for 183 (39.3%), with a higher frequency (73.5%) in the Intensive Care Unit (ICU), followed by the infirmaries and the Emergency Room. The assistant physician was located in 116 cases, and the main motivation referred to prescription was prophylaxis of digestive hemorrhage (77%). However, after reviewing medical records, it was noticed that in 50.8% of the cases, the prescription was not supported by the literature. CONCLUSION The frequency of PPI prescriptions for inpatients in the HC-UFU is among the lowest described in the literature, but there are still unnecessary prescriptions. Instruction and awareness of the assisting team can minimize these numbers.

Esophageal manometry in systemic sclerosis: findings and association with clinical manifestations.

INTRODUCTION: Systemic sclerosis (SSC) is an autoimmune disorder that affects several organs of unknown etiology, characterized by vascular damage and fibrosis of the skin and organs. Among the organs involved are the esophagus and the lung. OBJECTIVES: To relate the profile of changes in esophageal electromanometry (EM), the profile of skin involvement, interstitial pneumopathy (ILD), and esophageal symptoms in SSC patients. METHODS: This is an observational, cross-sectional study carried out at the SSC outpatient clinic of the Hospital de Clínicas of the Federal University of Uberlândia. After approval by the Ethics Committee and signed the terms of consent, 50 patients were initially enrolled, from 04/12/2014 to 06/25/2015. They were submitted to the usual investigations according to the clinical picture. The statistical analysis was descriptive in percentage, means, and standard deviation. The Chi-square test was used to evaluate the relationship between EM, high-resolution tomography, and esophageal symptoms. RESULTS: 91.9% of the patients had some manometric alterations. 37.8% had involvement of the esophageal body and lower esophageal sphincter. 37.8% had ILD. 24.3% presented the diffuse form of SSC. No association was found between manometric changes and clinical manifestations (cutaneous, pulmonary, and gastrointestinal symptoms). CONCLUSION: The present study confirms that esophageal motility alterations detected by EM are frequent in SSC patients, but may not be related to cutaneous extension involvement, the presence of ILD, or the gastrointestinal complaints of patients.

Esophageal manometry in systemic sclerosis: findings and association with clinical manifestations

SUMMARY INTRODUCTION Systemic sclerosis (SSC) is an autoimmune disorder that affects several organs of unknown etiology, characterized by vascular damage and fibrosis of the skin and organs. Among the organs involved are the esophagus and the lung. OBJECTIVES To relate the profile of changes in esophageal electromanometry (EM), the profile of skin involvement, interstitial pneumopathy (ILD), and esophageal symptoms in SSC patients. METHODS This is an observational, cross-sectional study carried out at the SSC outpatient clinic of the Hospital de Clínicas of the Federal University of Uberlândia. After approval by the Ethics Committee and signed the terms of consent, 50 patients were initially enrolled, from 04/12/2014 to 06/25/2015. They were submitted to the usual investigations according to the clinical picture. The statistical analysis was descriptive in percentage, means, and standard deviation. The Chi-square test was used to evaluate the relationship between EM, high-resolution tomography, and esophageal symptoms. RESULTS 91.9% of the patients had some manometric alterations. 37.8% had involvement of the esophageal body and lower esophageal sphincter. 37.8% had ILD. 24.3% presented the diffuse form of SSC. No association was found between manometric changes and clinical manifestations (cutaneous, pulmonary, and gastrointestinal symptoms). CONCLUSION The present study confirms that esophageal motility alterations detected by EM are frequent in SSC patients, but may not be related to cutaneous extension involvement, the presence of ILD, or the gastrointestinal complaints of patients.

RESUMO INTRODUÇÃO A esclerose sistêmica (ES) é uma doença autoimune que afeta vários órgãos de etiologia desconhecida, caracterizada por dano vascular e fibrose da pele e órgãos. Entre os órgãos envolvidos estão o esôfago e o pulmão. OBJETIVOS Relacionar o perfil das alterações na eletromanometria (ME), o perfil de acometimento da pele, a pneumopatia intersticial (PI) e os sintomas esofágicos em pacientes com ES. MÉTODO Trata-se de um estudo observacional, transversal, realizado no ambulatório de SSC do Hospital das Clínicas da Universidade Federal de Uberlândia. Após aprovação pelo Comitê de Ética e assinatura dos termos de consentimento, 50 pacientes foram inicialmente convidados, de 04/12/2014 a 25/06/2015. Eles foram submetidos às investigações usuais de acordo com o quadro clínico. A análise estatística foi descritiva em porcentagem, média e desvio padrão. O teste Qui-quadrado foi utilizado para avaliar a relação entre ME, tomografia de alta resolução e sintomas esofágicos. RESULTADOS 91,9% dos pacientes apresentaram alterações manométricas. 37,8% tinham envolvimento do corpo esofágico e do esfíncter esofágico inferior. 37,8% tinham IP. 24,3% apresentaram a forma difusa da ES. Não há associação entre alterações manométricas e manifestações clínicas (sintomas cutâneos, pulmonares e gastrointestinais). CONCLUSÃO O presente estudo confirma que as alterações da motilidade esofágica detectadas pela EM são frequentes em pacientes com SSC, mas podem não estar relacionadas ao envolvimento cutâneo, à de DPI ou às queixas gastrointestinais dos pacientes.

Proton pump inhibitor indications in a Brazilian tertiary hospital

SUMMARY OBJECTIVES To evaluate the frequency of prescription of proton pump inhibitors (PPIs) and their indications in patients hospitalized at the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU). METHODS This is a quantitative cross-sectional observational study that analyzes data obtained from patient records on prescriptions of PPIs for patients hospitalized at the HC-UFU and from a questionnaire applied to assistant physicians on the indications of the drug in each case and evaluates the indication based on literature data. RESULTS On a pre-determined day, of a total of 462 inpatients, there was a prescription of PPI for 183 (39.3%), with a higher frequency (73.5%) in the Intensive Care Unit (ICU), followed by the infirmaries and the Emergency Room. The assistant physician was located in 116 cases, and the main motivation referred to prescription was prophylaxis of digestive hemorrhage (77%). However, after reviewing medical records, it was noticed that in 50.8% of the cases, the prescription was not supported by the literature. CONCLUSION The frequency of PPI prescriptions for inpatients in the HC-UFU is among the lowest described in the literature, but there are still unnecessary prescriptions. Instruction and awareness of the assisting team can minimize these numbers.

RESUMO OBJETIVOS Avaliar a frequência da prescrição de inibidores da bomba de prótons (IBPs) e suas indicações em pacientes internados no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). MÉTODOS Estudo observacional transversal quantitativo, análise de dados obtidos em prontuários sobre prescrições de IBPs para pacientes internados no HC-UFU, aplicação de questionário aos médicos assistentes sobre as indicações do medicamento em cada caso e avaliação dessas indicações com base em dados da literatura. RESULTADOS Em um dia predeterminado, de 462 pacientes internados, houve prescrição de IBP para 183 (39,3%), com maior frequência (73,5%) em Unidade de Terapia Intensiva (UTI), seguida das enfermarias e do pronto-socorro (PS). O médico assistente foi localizado em 116 casos, a principal motivação referida para prescrição foi a profilaxia de hemorragia digestiva (77%). Entretanto, após revisão de prontuários, percebeu-se que em 50,8% a prescrição não era respaldada por literatura. CONCLUSÃO A frequência de prescrição de IBP para pacientes internados no HC-UFU está entre as menores descritas na literatura, mas ainda há prescrições desnecessárias. Orientação e conscientização da equipe assistente podem minimizar esses números.

Linfoma primário do cólon: um raro diagnóstico diferencial das doenças inflamatórias intestinais / Primary lymphoma of the colon: a rare differential diagnosis of inflammatory bowel diseases

Introdução: as doenças inflamatórias intestinais têm apresentado incidência crescente em todo o mundo, com elevada morbidade por suas manifestações clínicas. O linfoma primário do cólon corresponde a cerca de 1,4% de todos os casos de linfoma não-Hodgkin e menos de 1% das neoplasias malignas colorretais. Os dois subtipos histológicos mais frequentes no cólon são o linfoma difuso de grandes células B, que é uma variante agressiva da doença, e o linfoma MALT extranodal da zona marginal, que tem baixo grau de malignidade. A apresentação clínica e endoscópica do linfoma primário do cólon pode se assemelhar bastante às doenças inflamatórias intestinais, sendo que os achados clínicos mais observados consistem em perda de peso, alteração do hábito intestinal, dor abdominal e sangramento gastrointestinal. O pilar do tratamento é a quimioterapia, embora um número significativo de pacientes necessite de ressecção cirúrgica. Descreveremos o caso de um paciente que recebeu o diagnóstico de retocolite ulcerativa, sendo iniciado tratamento e após quatro anos sem melhora do quadro foi reavaliado e diagnosticado como portador de um linfoma MALT do cólon.

Inflammatory bowel disease have shown an increasing incidence worldwide, with a high morbidity associated with its clinical manifestations. The primary lymphoma of the colon accounts for approximately 1.4% of all cases of non-Hodgkin lymphoma and less than 1% of colorectal malignancies. The two histological subtypes are more frequent bowel lymphoma diffuse large cell B, which is an aggressive variant of the disease and MALT lymphoma of extranodal marginal zone which has a low degree of malignancy. The clinical presentation and endoscopic primary lymphoma of the colon may be confused with to inflammatory bowel disease, and the most frequently observed clinical findings consist of weight loss, changes in bowel habits, abdominal pain and gastrointestinal bleeding. The mainstay of treatment is chemotherapy, although a significant number of patients require surgical resection. We describe the case of a patient who was diagnosed with ulcerative colitis and treatment and after four years with no improvement was reevaluated and diagnosed with MALT lymphoma of the colon.

Metástases hepáticas de insulinoma 14 anos após a ressecção do turmor primário / Liver metástases 14 years after the insulinoma resection of the primary tumor

A Insulinoma é um tumor que pertence ao grupo de tumores neuroendócrinos do pâncreas. Sua incidência é rara (1-4 casos por milhão de pessoas por ano). A ressecção cirúrgica é o tratamento de escolha para o tumor localizado no pâncreas. Cerca de 90% dos tumores Exibiram um benigno comportamento e menos de 10% dos pacientes podem apresentar doença metastática, principalmente no fígado e nos linfonodos regionais. Na doença metastática, o controle da hipoglicemia, frequentemente grave e persistente, é o principal desafio para o médico da equipe que cuida do paciente. Descrevemos o caso de um paciente de 61 anos, que foi encaminhado à Unidade de Gastroenterologia no HC-UFU (Universidade Federal de Uberlândia), em julho de 2011, para a investigação de tumores no fígado, evidenciado na ultrassonografia abdominal. Também apresentou um histórico de episódios frequentes de diminuição de nível de consciência e comportamento anormal, além de 3 episódios de convulsões nos últimos 10 meses. Como história pessoal, a paciente relatou ter sido submetida a uma ressecção cirúrgica do nódulo no pâncreas em 1997 por episódio de hipoglicemia desde 1995, que se resolveu após a cirurgia. Ela relatou diagnóstico de hipertensão e de diabetes mellitus desde 2003, quando começou a usar anti-hipertensivos e metformina, sendo que o uso desta foi suspenso por 2 anos para a normalização da glicemia. No exame físico, ficou evidenciada apenas uma leve hepatomegalia,sem outras normalidades. Ela também teve glicemia no sangue de 51 mg/dl e diminuição do nível de consciência depois de um curto período de jejum. Foi necessária a aplicação de glicose em bomba de infusão no dia da internação para a enfermaria. Na revisão, verificou-se nos registros médicos da paciente que, em 1997, ela foi submetida à ressecção de um tumor no pâncreas por enucleação de 5 cm (a cabeça do pâncreas), com histopatologia que confirmou o diagnóstico de insulinoma. Para o diagnóstico em laboratório, a paciente foi mantida em jejum, com suspensão de infusão de glicose e, após 9 minutos, verificou-se a redução da consciência; em seguida, foi recolhida uma amostra periférica de insulina no sangue, de glicose, de dosagem de sulfonilureia, proinsulina e C-peptídeo. Os testes mostraram altos níveis de insulina, pró-insulina, além do peptídeo C alto dosagem de sulfonilureias negativa. A proporção de insulina / glicose de 5,95 era baseada em critérios laboratoriais de hiperinsulinismo. A TC de abdômen evidenciou múltiplos nódulos sugestivos de metástase do fígado e pâncreas normal. Em seguida, uma biópsia foi realizada da maior lesão hepática, guiada por ultrassom. O estudo imuno-histoquímico da lesão confirmou um tumor neuroendócrino de origem pancreática, sugestivo bem diferenciado de insulinoma. A lâmina de 1997 também foi revisada com estudo imuno-histoquímica e era consistente com o diagnóstico de lesões do fígado. No fim do estágio da doença, a paciente foi submetida a exame de cintilografia rotulados com 111In-DTPA-octreotid a, que mostrou captação do traçador em zonas múltiplas do fígado, sem evidências de lesões extra-hepáticas. Eles também foram condenados testes de laboratório que excluída a associação com neoplasia endócrina múltipla síndrome tipo 1. Foram prescritos propranolol, verapamil e hidroclorotiazida, numa tentativa de melhorar os níveis de glicemia, além de uma dose de depósito de octreotida (octreotida LAR) com boa resposta clínica, com a possível diminuição gradual em infusão de glicose e suspenso em 25 dias de aplicação da droga. A paciente está recebendo uma dose mensal de octreotida LAR. A paciente permanece em bom estado geral, sem queixas, apesar de envolvimento hepático difuso por lesões. Mantém normais testes laboratoriais (AST, ALT, fosfatase alcalina, Gama GT, bilirrubina e albumina TAP). Mantém os exames ambulatoriais regulares.

Insulinoma is a tumor that belongs to the group of neuroendocrine tumors of the pancreas. Its incidence is rare (1-4 cases per million people per year). Surgical resection is the treatment of choice for localized tumor in the pancreas. About 90% of the tumors exhibited a benign behavior and less than 10% of patients may show metastatic disease (mainly in liver and regional lymph nodes). In metastatic disease, the control of hypoglycemia, often serious and persistent is the key challenge for the medical team that cares of the patient. We describe a case of a patient of 61 years that was referred to the gastroenterology unit on HC-UFU in July 2011 for investigation of liver tumors (evidenced in abdominal ultrasonography)also presenting a history of frequent episodes of decreased level of consciousness and abnormal behavior, in addition to 3 episodes of seizures in the past 10 months. As personal history, the patient reported having undergone a surgical resection of the nodule in the pancreas in 1997 by hypoglycemic episodes since 1995 and which resolved after surgery. He also reported diagnoses of hypertension and diabetes mellitus since 2003, when it began using antihypertensives and metformin, with the use of this suspended for 2 years for normalization of glycemia. On arrival it was evident on physical examination only a mild hepatomegaly without other abnormalities. She also had blood glucose of 51 mg / dl and decreased level of consciousness after short periods of fasting. It required glucose infusion pump on the day of admission to the ward. In reviewing the medical records of the patient, it was found that in 1997 the patient underwent resection of a pancreatic tumor by enucleation (the head of the pancreas) of 5 cm, with histopathology confirmed the diagnosis of Insulinoma. For laboratory diagnosis, the patient was kept fasting, with suspension of glucose infusion and after 9 minutes showed decreased level of consciousness, and then collected in a sample of peripheral blood insulin,glucose; dosage of sulfonylurea; proinsulin and C-peptide The tests showed high levels of insulin, pro-insulin and C peptide Blood glucose was low in value and dosage of sulfonylurea was negative. The ratio insulin / glucose of 5.95 was laboratory criteria of hyperinsulinism. A CT of the abdomen showed multiple nodules suggestive of liver metastasis and normal pancreas. Then a biopsy was performed of the largest lesion liver guided by ultrasound. The immunohistochemical study of the lesion confirmed a neuroendocrine tumor of pancreatic origin suggestive of well-differentiated insulinoma. The blade of 1997 was also reviewed with immunohistochemical study and was consistent with the diagnosis of liver lesions. In order to stage the disease, the patient underwent the examination of scintigraphy labeled with 111In-DTPA-Octreotide, which showed tracer uptake in multiple areas of the liver, without evidence of extrahepatic lesions. They were also ordered laboratory tests that excluded the association with multiple endocrine neoplasia syndrome type 1. We prescribed propranolol, verapamil and hydrochlorothiazide in an attempt to improve blood glucose levels, plus a dose of Octreotide depot (Octreotide LAR) with good clinical response, with the possible gradual decrease in glucose infusion and suspended in 25 ° day application of the drug. The patient is receiving a monthly dose of Octreotide LAR. The patient remains in good condition overall, no complaints, despite diffuse liver involvement by injuries, maintains normal laboratory tests (AST, ALT, alkaline phosphatase, Gamma GT, bilirubin, and albumin TAP). Keeps regular outpatient follow.