Therapeutic drug monitoring in inflammatory bowel disease

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)

Immunonutrition in head and neck cancer: Systematic review and metanalysis of its clinical and nutritional effects.

BACKGROUND AND AIMS: A systematic review was conducted to assess the effects of glutamine, arginine and omega-3 supplementation on the tolerance to treatment, nutritional status and immune function of head and neck cancer (HNC) patients undergoing chemoradiotherapy. METHODS: Randomized clinical trials were searched in MEDLINE, EMBASE, CENTRAL, LILACS, ClinicalTrials.gov, OpenGrey and Proquest. Tolerance to treatment, nutritional status, immune function and mortality rate were the primary outcomes investigated. Secondary outcomes comprised functional status, weight loss and body composition. Risk of bias of individual studies and the overall quality of the evidence were assessed using the Cochrane and the GRADE tools, respectively. RESULTS: Nineteen articles met the inclusion criteria and nine were included in the meta-analyses, which assessed mucositis severity, weight loss and handgrip strength. Ten studies were evaluated as high risk of bias. Glutamine supplementation has significantly reduced the risk of grade 2-4 mucositis (RR: 0.76, IC95% [0.63; 0.92], P = 0.006, I2 = 0%; P = 0.792; 4 studies). Omega-3 supplementation did not show statistically significant results on weight loss (SMD: -0.042, 95% CI [-0.322; 0.238], P = 0.769, I2 = 33.4%; P = 0.212; 4 studies). The overall quality of the evidence ranged from low to very low. CONCLUSIONS: These results must be interpreted with caution due to differences between supplementations regimen, lack of methodological rigor in most studies and due to the possible role of glutamine in tumor metabolism. Studies focused on elucidating the contribution of each immunonutrient to HNC patients undergoing chemoradiotherapy deserve further investigation.

Aconselhamento dietético em pacientes com vírus da imunodeficiência humana / Dietary advice in patients with human immunodeficiency virus / Consejo dietético en pacientes con virus de inmunoficiencia humana

Objetivo: verificar a influência do aconselhamento dietético na manutenção ou recuperação do estado nutricional de pacientes recém diagnosticados com o vírus HIV. Método: estudo de coorte prospectiva, com participação de 21 sujeitos, acompanhados individualmente no Hospital-Dia da Universidade Federal de Mato Grosso do Sul, por meio de avaliação antropométrica do consumo alimentar e aconselhamento dietético durante 12 meses, após a aprovação do projeto pelo Comitê de Ética em Pesquisa, Protocolo n. 654. Resultados: houve maior diferença entre o peso corporal teórico e o peso final naqueles pacientes que não seguiram as orientações nutricionais. O grupo que seguiu as orientações apresentou maior diferença entre peso teórico e final (p = 0,005) e reduziram o valor calórico total no final do estudo (p = 0,030) e os que não seguiram apresentaram um consumo alimentar aumentados no final (p = 0,038). Conclusão: os 16 pacientes que seguiram as orientações nutricionais apresentaram melhora no consumo alimentar; e, destes, 7 (43,8%) não utilizavam terapia antirretroviral, fato que favoreceu a adesão ao aconselhamento dietético (p = 0,029).(AU)

Objective: to verify the influence of dietary advice in the maintenance or recovery of the nutritional status of patients newly diagnosed with HIV. Method: prospective cohort study, with the participation of 21 subjects, followed individually in the Day Hospital of the Federal University of Mato Grosso do Sul, through anthropometric assessment of food consumption and dietary advising for 12 months after approval of the project by the Research Ethics Committee Protocol 654. Results: greater difference between the theoretical body weight and final weight in those patients who did not follow the nutritional guidelines. The group followed the guidelines presented the greatest difference between theoretical and final weight (p=0.005) and reduced the total caloric value at the end of the study (p=0.030) and those who did not follow it, presented a food increased in the final consumption (p=0.038). Conclusion: the 16 patients who followed the nutritional guidelines, showed improvement in food consumption; although 7 (43.8%) were not using antiretroviral therapy, a fact which favored adherence to dietary advice (p=0.029).(AU)

Objetivo: verificar la influencia del consejo dietético en el mantenimiento o recuperación del estado nutricional de pacientes recién diagnosticados con el virus HIV. Método: estudio de cohorte prospectivo, con participación de 21 sujetos, acompañados individualmente en el Hospital-Día de la Universidad Federal de Mato Grosso do Sul, por medio de evaluación antropométrica del consumo alimentar y consejo dietético durante 12 meses, luego de la aprobación del proyecto por el Comité de Ética en Investigación, Protocolo n. 654. Resultados: hubo mayor diferencia entre el peso corporal teórico y el peso final en aquellos pacientes que no siguieron las orientaciones nutricionales. El grupo que siguió las orientaciones presentó mayor diferencia entre peso teórico y final (p=0,005) y redujeron el valor calórico total en el final del estudio (p=0,030) y los que no siguieron, presentaron un consumo alimentar aumentado en el final (p=0,038). Conclusión: los 16 pacientes que siguieron las orientaciones nutricionales, presentaron mejora en el consumo alimentar; de estos, 7 (43,8%) no utilizaban terapia antiretroviral, hecho que favoreció la adherencia al consejo dietético (p = 0,029). (AU)

The effects of a diet formulation with oats, soybeans, and flax on lipid profiles and uricemia in patients with AIDS and dyslipidemia

Introduction Although the initiation of highly active antiretroviral therapy (HAART) is accompanied by an attenuation of viral load, metabolic disorders characterized by hyperglycemia, dyslipidemia, and lipodystrophy are often observed in patients under this treatment. Certain foods, such as oat bran, soy protein, and flaxseed, have been shown to improve a patient's lipid profile despite possible increases in uricemia. Thus, a bioactive compound was formulated using these foods to help patients with HIV/AIDS control metabolic disorders resulting from HAART. Methods An uncontrolled before and after study was performed. The total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and uric acid before and after 3 months of consuming the formulation were compared in patients. The compound was formulated such that 40g (the recommended daily intake) contained approximately 10g of flaxseed, 20g of oat bran, and 10g of textured soy protein. Results The study population consisted of 139 patients, 31 of whom were included in the final analysis. There were no significant variations between the laboratory results obtained before and after consumption of the compound. Conclusions The regular consumption of the formulation together with individualized dietary guidance did not reduce lipid levels and did not contribute to an increase in uricemia in the study group. However, new studies with higher doses of the foods that compose the formulation should be encouraged to investigate whether these foods can positively influence the lipid profiles of these patients. .

The effects of a diet formulation with oats, soybeans, and flax on lipid profiles and uricemia in patients with AIDS and dyslipidemia.

INTRODUCTION: Although the initiation of highly active antiretroviral therapy (HAART) is accompanied by an attenuation of viral load, metabolic disorders characterized by hyperglycemia, dyslipidemia, and lipodystrophy are often observed in patients under this treatment. Certain foods, such as oat bran, soy protein, and flaxseed, have been shown to improve a patient's lipid profile despite possible increases in uricemia. Thus, a bioactive compound was formulated using these foods to help patients with HIV/AIDS control metabolic disorders resulting from HAART. METHODS: An uncontrolled before and after study was performed. The total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and uric acid before and after 3 months of consuming the formulation were compared in patients. The compound was formulated such that 40g (the recommended daily intake) contained approximately 10g of flaxseed, 20g of oat bran, and 10g of textured soy protein. RESULTS: The study population consisted of 139 patients, 31 of whom were included in the final analysis. There were no significant variations between the laboratory results obtained before and after consumption of the compound. CONCLUSIONS: The regular consumption of the formulation together with individualized dietary guidance did not reduce lipid levels and did not contribute to an increase in uricemia in the study group. However, new studies with higher doses of the foods that compose the formulation should be encouraged to investigate whether these foods can positively influence the lipid profiles of these patients.