Tuberculin skin testing in inflammatory bowel disease patients from an endemic area of Brazil

Objective: Inflammatory bowel disease (IBD) is a chronic disorder involving the gastrointestinal tract. Immunosuppressive drugs are usually prescribed to treat IBD patients, and this treatment can lead to tuberculosis reactivation. This paper aimed to analyze tuberculin skin test (TST) results in IBD patients at a reference center in Brazil. Methods: We evaluated TST results in IBD patients using a cross-sectional study. We also analyzed the medical records of patients treated at a reference IBD outpatient unit where TST is routinely performed. Results: We reviewed 119 medical records of 57 (47.9%) Crohn's disease (CD), 57 (47.9%) ulcerative colitis (UC) and 5 (4.2%) indeterminate colitis (IC) patients. The mean (SD) age was 43.5 (13.7) years old. TST was positive in 24 (20.2%) of the patients. TST was positive in 16/57 (28.1%) UC and 6/57 (10.5%) CD patients (prevalence ratio [PR] 2.7). Forty-one patients (34.5%) were taking immunosuppressive drugs (azathioprine or prednisone) at the time of the TST, and six of these patients (14.6%) had positive test results. Two patients using infliximab had negative TST results. Thirty-five of the 41 patients (85.4%) on immunosuppressive treatment were anergic compared with 73.1% (57/78) of the untreated patients (PR 1.2). Conclusions: Patients with IBD have TST results similar to the general Brazilian population. Within the IBD population, CD patients have a lower frequency of TST positivity than UC patients. .

Tuberculin skin testing in inflammatory bowel disease patients from an endemic area of Brazil.

OBJECTIVE: Inflammatory bowel disease (IBD) is a chronic disorder involving the gastrointestinal tract. Immunosuppressive drugs are usually prescribed to treat IBD patients, and this treatment can lead to tuberculosis reactivation. This paper aimed to analyze tuberculin skin test (TST) results in IBD patients at a reference center in Brazil. METHODS: We evaluated TST results in IBD patients using a cross-sectional study. We also analyzed the medical records of patients treated at a reference IBD outpatient unit where TST is routinely performed. RESULTS: We reviewed 119 medical records of 57 (47.9%) Crohn's disease (CD), 57 (47.9%) ulcerative colitis (UC) and 5 (4.2%) indeterminate colitis (IC) patients. The mean (SD) age was 43.5 (13.7) years old. TST was positive in 24 (20.2%) of the patients. TST was positive in 16/57 (28.1%) UC and 6/57 (10.5%) CD patients (prevalence ratio [PR] 2.7). Forty-one patients (34.5%) were taking immunosuppressive drugs (azathioprine or prednisone) at the time of the TST, and six of these patients (14.6%) had positive test results. Two patients using infliximab had negative TST results. Thirty-five of the 41 patients (85.4%) on immunosuppressive treatment were anergic compared with 73.1% (57/78) of the untreated patients (PR 1.2). CONCLUSIONS: Patients with IBD have TST results similar to the general Brazilian population. Within the IBD population, CD patients have a lower frequency of TST positivity than UC patients.

Polymorphisms of the cytokine genes TGFB1 and IL10 in a mixed-race population with Crohn's disease.

BACKGROUND: Most Crohn's disease (CD) genes discovered in recent years are associated with biological systems critical to the development of this disease. TGFB1 and IL10 are cytokines with important roles in CD. The aim of this study was to evaluate the association between CD, its clinical features and TGFB1 and IL10 gene polymorphisms. METHODS: This case-control study enrolled 91 patients and 91 controls from the state of Bahia, Brazil. Five single nucleotide polymorphisms (SNPs) were studied in the TGFB1 gene (codon 10 T > C--rs1800470; codon 25 G > C--rs1800471) and IL10 gene (-1082 A > G--rs1800896; -819 T > C--rs1800871; -592 A > C--rs1800872). An analysis of the genetic polymorphisms was performed using a commercial kit. A comparison of allele frequencies and genotypes was estimated by calculating the odds ratio (OR) with a confidence interval adjusted via the Bonferroni test for a local alpha of 1%. A stratified analysis was applied for gender, race and smoking history. Patients with CD were characterized according to the Montreal classification. RESULTS: The C allele and CC genotype of the TGFB1 gene rs1800470 were both significantly associated with CD. The stratified analysis showed no confounding factors for the co-variables of gender, race and smoking history. The IL10 gene rs1800896 G allele was significantly associated with age at diagnosis of CD, while the T allele of the IL10 gene rs1800871 was significantly associated with perianal disease. The SNPs rs1800871 and rs1800872 were in 100% linkage disequilibrium. CONCLUSIONS: TGFB1 gene polymorphisms may be associated with susceptibility to the development of CD, and IL10 gene polymorphisms appear to influence the CD phenotype in this admixed population.

Dyslipidemia in racially admixtured children with cystic fibrosis.

OBJECTIVES: There are few studies reporting lipid profile in cystic fibrosis (CF) and most of them are in adult Caucasians. Therefore, the aim of this study was to evaluate the lipid profile of racially admixtured youths with CF. MATERIALS AND METHODS: A cross-sectional survey conducted between August and September 2009 at a reference service for CF, evaluating clinical and laboratory data. RESULTS: Forty-six patients aged from 6 years to 16 years and 2 months (median: 9 years and 10 months; 65.2% males) were evaluated. Of these, 26% were Whites, 54.4% Mulattoes and 19.6% Blacks. There were no diabetics, one patient had glucose intolerance and three had insulin resistance. Pancreatic sufficiency was present in 74% and malnutrition in 26% of the patients. The lipid profile revealed hypertriglyceridemia in 56%, hypercholesterolemia in 17.4% and hypocholesterolemia in 46.5%. In 30.4% of the patients, hypertriglyceridemia and hypocholesterolemia was observed. The serum levels of high density lipoprotein (HDL) were low in 56.5% and the low density lipoprotein (LDL) elevated in 15.2% of the patients. CONCLUSIONS: The lipid profile of this sample of Brazilian racially admixtured patients with CF showed a higher prevalence of hypertriglyceridemia and hypocholesterolemia. There was no association of dyslipidemia with the various racial groups, nutritional status, pancreatic sufficiency or glucose tolerance.

Botulinum toxin type A versus amitriptyline for the treatment of chronic daily migraine.

OBJECTIVE: To compare the effects of botulinum toxin type A with those of amitriptyline on the treatment of chronic daily migraines. METHODS: Chronic migraine sufferers were randomized into two groups and treated with 25 or 50mg/day of amitriptyline or 250U of botulinum toxin type A. A reduction of at least 50% in the number of pain episodes, in the intensity of pain, and in the number of drug doses for pain and reports of improvement by the patient or by the examiner were the main endpoints. RESULTS: Seventy-two subjects were enrolled in the study. A reduction of at least 50% in the number of days of pain was recorded in 67.8% of the patients in the BTX-A group and 72% (n=23) of the patients in the AM group (p=0.78; RR=0.94; CI=0.11-8). The reduction in the intensity of pain, as assessed using the visual analogical scale, was 50% in the BXT-A group and 55.6% in the AM group (p=0.79; RR=1.11; CI=0.32-3.8). The reduction in the number of pain drug doses was 77% for the toxin group and 71% for the amitriptyline group (p=0.76; RR=0.92; CI=0.45-1.88). CONCLUSIONS: Botulinum toxin type A was as effective as amitriptyline for the prophylactic treatment of chronic daily migraines.

Low prevalence of glucose intolerance in racially mixed children with cystic fibrosis.

OBJECTIVE: To evaluate glucose tolerance in racially mixed Brazilian youth with cystic fibrosis (CF). METHODS: Cross-sectional study conducted between August and September 2007, at a reference service for CF, evaluating: glycated hemoglobin (HbA1c), blood glucose, and insulin levels, before and 2 h after a glucose overload. RESULTS: There were 46 patients aged between 6 yr and 16 yr and 2 months (median: 9 yr and 10 months) of whom 64% were boys. Of these, 26% were Whites; 54.4% Mulattoes; and 19.6% Blacks. HbA1c was normal in all patients. Only one participant (12-yr old) had glucose intolerance. Insulin levels ranged from 1 to 23 µIU/mL (median: 4.5 µIU/mL) at baseline and from 3.2 to 192.1 µIU/mL (median: 11 µIU/mL) after a glucose overload. Insulin resistance evaluated by the HOMA index, stratified by sex and age, was present in three patients. The ΔF508 mutation was present in only 4.3% of the sample, all of them being heterozygous. CONCLUSIONS: The low prevalence of carbohydrate intolerance in this population is probably a result of their young age. Another possibility is the low frequency of the ΔF508 mutation. Although not conclusive, these data suggest that in addition to age, the genotype:phenotype ratio may influence the development of glucose intolerance in patients with CF.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients.

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51 percent) patients did not have any psychiatric diagnosis, while 44 (49 percent) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1 percent) had a current mental disorder, out of which 22 (84.6 percent) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Effect of nicotine treatment and withdrawal on random-pattern skin flaps in rats.

BACKGROUND: Tobacco use is associated with a high incidence of skin necrosis after surgery. The ideal timing for the cessation of tobacco use before plastic surgery has not, however, been precisely determined. The aim of this work was to define the ideal duration of nicotine withdrawal prior to random-pattern skin flap surgery in rats. METHODS: Groups of 11 animals were subcutaneously injected with saline or nicotine (2mg/kg) twice a day and subjected to random-pattern skin flap surgery according to the following protocol: Group I: continuously injected with saline 4 weeks before and 1 week after the surgery; Group II: injected with nicotine for 4 weeks until the day of the surgery; Group III: injected with nicotine for 4 weeks until one day before the surgery; Group IV: injected with nicotine for 4 weeks until 5 days before the surgery; Group V: injected with nicotine for 4 weeks until 10 days before the surgery; Group VI: continuously injected with nicotine for 4 weeks before and 1 week after the surgery. McFARLANE skin flaps were performed on the dorsal skin, and the rats were sacrificed 1 week after the surgery. RESULTS: The necrotic area was smaller in group I (8.85cm2) than in group II (12.15cm2), III (12.88cm2) and VI (14.84cm2) (ANOVA p<0.0001). There was no difference between groups I, IV (10.13cm2) and V (9.27cm2). CONCLUSIONS: In conclusion, 5 days before surgery was considered the ideal time for nicotine withdrawal in this experimental model.

Avaliação prospectiva do sistema cardiovascular em adolescentes jogadores de futebol / Prospective assessment of the cardiovascular system among teenage soccer players

Avaliar o efeito cardiovascular do treinamento físico em adolescentes jogadores de futebol da categoria infantil de um time profissional da cidade de Salvador. Métodos: Estudo prospectivo realizado durante o período de maio de 2004 a outubro de 2005 em 27 atletas do sexo masculino com a idade variando de 13 a 16 anos e um grupo de 11 adolescentes com prática esportiva a nível escolar. O grupo de atletas foi submetido em duas oportunidades e o grupo controle em uma, á avaliação clínica e a exames complementares como o ECG, Teste ergométrico, Ecocardiograma e a Espirometria. Estatística: a diferença entre as médias foi avaliada com o T de Teste Student para amostra pareadas. Resultados: Quando comparadas as duas avaliações funcionais (Anos 2004 a 2005 dos atletas, detectou-se um aumento significativo do V02 (p<0,009). A comparação entre os dois grupos mostrou um V02 superior nos jogadores (p<0,004). a comparação com os dois ecocardiogramas de 2004 e 2005 feitos nos atletas mostrou um aumento nos diâmetros das câmaras cardíacas (p<0,002), como também na massa ventricular (p<0,007). Já as espessuras musculares das paredes do ventrículo esquerdo não mostram uma diferença significativa (p<0,06). a comparação dos achados ecocardiográficos entre os dois grupos não demonstrou diferença em nenhuma das variáveis estudadas (p<0,4). Conclusão: A comparação das duas avaliações dos atletas mostrou um aumento significativo da superfície corporal, do V02, das câmaras cardíacas e massa ventricular. O estudo realizado com esta amostra sugere que o treinamento físico realizado nos atletas de futebol não causa um aumento significativo da massa ventricular ou das câmaras cardíacas quando comparado com outros esportes.

To evaluate the cardiovascular effect of regular physical training in adolescent football players of infantile category of professional teams of Salvador city. Methods: Prospective study carried from May 2004 to October 2005, in 27 men athletes, age ranging from 13 to 16 years, matched to 11 adolescents with exercise training by school level. The athlete group was evaluated twice and the control once clinical evaluation and the complementary examination as ECG, Ergometric Test, Echocardiogram and Spirometry. Statistics: The difference between averages was a significant of V02 (p<0,009). The comparison between group showed higher V02 in athletes (p<0,004). The comparasion of the two echocardiograms (Years 2004, 2005) in athletes showed an increase in the cardiac chambers diameters (p<0,002), as well as in the ventricular mass (p<0,007). Muscular thicknesses of the left ventricle walls did not show difference (p<0,6). The comparison of echocardiographic findings between groups did not demonstrate difference in none of the studied variables (p<0,4). Conclusion: The comparison of the two evaluations of the thçetes showed a significant increase of the corporal surface, V02, cardiac chambers and ventricular mass. the study suggests that physical training in the soccer athletes do not lead to significant of the ventricular mass or cardiac chambers when compared with other sports.