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2.
Artigo em Inglês | MEDLINE | ID: mdl-28745840

RESUMO

BACKGROUND: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder (FGID) characterized by intermittent episodes of nausea and vomiting. Our aim was to report its prevalence and associated features. METHODS: Data concerning demographics, symptoms, and psychiatric comorbidity were collected. Symptoms compatible with CVS were classified as per Rome III criteria. We recorded whether a diagnosis of CVS was considered in patients after negative investigation. We compared demographics and association with other FGIDs in patients with and without CVS. KEY RESULTS: 920 of 1002 patients provided data. Of the 920 patients, 112 (12.2%) had symptoms compatible with CVS. Thirteen (11.6%) of these had an organic cause for their symptoms, but 99 patients (88.4%) were deemed to have CVS (prevalence=10.8%). Organic causes for symptoms compatible with CVS included gastroparesis, large hiatus hernia, achalasia, and small bowel obstruction. Only 39.4% of patients with CVS were asked about vomiting symptoms at their initial consultation, and a diagnosis of CVS was considered in only four (4.0%) of the 99 patients. CVS was associated with younger age, tobacco smoking, never having married, psychiatric comorbidity, and presence of symptoms compatible with other FGIDs (P≤.01). CONCLUSIONS AND INFERENCES: Prevalence of CVS in this outpatient gastroenterology adult population was 10.8%. Identified associations included younger age, tobacco smoking, psychiatric comorbidity, and symptoms compatible with other FGIDs. The condition was considered as a possible diagnosis in <5% of patients who met the diagnostic criteria.


Assuntos
Vômito/epidemiologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Gastroenterologia , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prevalência , Vômito/diagnóstico
4.
Environ Pollut ; 231(Pt 1): 406-414, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28822331

RESUMO

In recent years, behavior-related endpoints have been proposed as rapid and reliable ecotoxicological tools for risk assessment. In particular, the use of detritivores to test the toxicity of pollutants through feeding is currently becoming a well-known method. Experiments combining feeding with other behavioral endpoints can provide relevant information about direct and indirect toxicological effects of chemicals. We carried out a feeding experiment with the shredder Gammarus pulex in order to detect indirect (through leaf conditioning) and direct effects (through water exposure) of two pollutants at environmentally relevant concentrations: the fungicide prochloraz (6 µg/L) and the antidepressant fluoxetine (100 ng/L). Prochloraz inhibited fungal growth on leaves, but it did not affect either the microbial breakdown rates or the C:N ratio of the leaves. Individuals of G. pulex that were fed with treated leaves presented lower consumption rates, not only those fed with prochloraz-treated leaves, but also those fed with fluoxetine-treated leaves, and those fed with the mixture-treated leaves. Mixed-effects models revealed that the swimming velocity of the amphipods after the experiment was modulated by the exposure to fluoxetine, and also by the exposure to prochloraz. We demonstrate that both the antidepressant and the fungicide may cause significant sublethal effects at low concentrations. The combination of behavioral endpoints together with the application of mixed models provided a useful tool for early detection of the effects of toxicity mixtures in freshwater ecosystems.


Assuntos
Anfípodes/fisiologia , Antidepressivos/toxicidade , Fluoxetina/toxicidade , Fungicidas Industriais/toxicidade , Imidazóis/toxicidade , Poluentes Químicos da Água/toxicidade , Anfípodes/efeitos dos fármacos , Animais , Antidepressivos/metabolismo , Comportamento Animal/efeitos dos fármacos , Ecossistema , Fluoxetina/metabolismo , Água Doce , Fungos , Folhas de Planta/efeitos dos fármacos
7.
Aliment Pharmacol Ther ; 46(4): 389-400, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28653751

RESUMO

BACKGROUND: Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBD). Evidence implicates disturbances of the gastrointestinal microbiota in their pathogenesis. AIM: To perform a systematic review and meta-analysis to examine the efficacy of probiotics in IBD. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (until November 2016). Eligible randomised controlled trials (RCTs) recruited adults with UC or CD, and compared probiotics with 5-aminosalicylates (5-ASAs) or placebo. Dichotomous symptom data were pooled to obtain a relative risk (RR) of failure to achieve remission in active IBD, or RR of relapse of disease activity in quiescent IBD, with 95% confidence intervals (CIs). RESULTS: The search identified 12 253 citations. Twenty-two RCTs were eligible. There was no benefit of probiotics over placebo in inducing remission in active UC (RR of failure to achieve remission=0.86; 95% CI=0.68-1.08). However, when only trials of VSL#3 were considered there appeared to be a benefit (RR=0.74; 95% CI=0.63-0.87). Probiotics appeared equivalent to 5-ASAs in preventing UC relapse (RR=1.02; 95% CI=0.85-1.23). There was no benefit of probiotics in inducing remission of active CD, in preventing relapse of quiescent CD, or in preventing relapse of CD after surgically induced remission. CONCLUSIONS: VSL#3 may be effective in inducing remission in active UC. Probiotics may be as effective as 5-ASAs in preventing relapse of quiescent UC. The efficacy of probiotics in CD remains uncertain, and more evidence from RCTs is required before their utility is known.


Assuntos
Colite Ulcerativa/terapia , Doença de Crohn/terapia , Probióticos/uso terapêutico , Adulto , Humanos , Mesalamina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Prevenção Secundária , Resultado do Tratamento
12.
Aliment Pharmacol Ther ; 45(6): 824-832, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28105700

RESUMO

BACKGROUND: The accuracy of symptom-based diagnostic criteria for irritable bowel syndrome (IBS) is modest. AIMS: To derive and validate a new test that utilises latent class analysis. METHODS: Symptom, colonoscopy, and histology data were collected from 1981 patients and 360 patients in two cohorts referred to secondary care for investigation of their gastrointestinal symptoms in Canada and the UK, respectively. Latent class analysis was used to identify naturally occurring clusters in patient-reported symptoms in the Canadian dataset, and the latent class model derived from this was then applied to the UK dataset in order to validate it. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for the latent class models. RESULTS: In the Canadian cohort, the model had a sensitivity of 44.7% (95% CI 40.0-50.0) and a specificity of 85.3% (95% CI 83.4-87.0). Positive and negative LRs were 3.03 (95% CI 2.57-3.56) and 0.65 (95% CI 0.59-0.71) respectively. A maximum positive LR of 3.93 was achieved following construction of a receiver operating characteristic curve. The performance in the UK cohort was similar, with a sensitivity and specificity of 52.5% (95% CI 42.2-62.7) and 84.3% (95% CI 79.3-88.6), respectively. Positive and negative LRs were 3.35 (95% CI 2.38-4.70) and 0.56 (95% CI 0.45-0.68), respectively, with a maximum positive LR of 4.15. CONCLUSIONS: A diagnostic test for IBS, utilising patient-reported symptoms incorporated into a latent class model, performs as accurately as symptom-based criteria. It has potential for improvement via addition of clinical markers, such as coeliac serology and faecal calprotectin.


Assuntos
Testes Diagnósticos de Rotina/normas , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Inquéritos e Questionários/normas , Adulto , Biomarcadores/metabolismo , Canadá/epidemiologia , Colonoscopia/métodos , Colonoscopia/normas , Testes Diagnósticos de Rotina/métodos , Feminino , Humanos , Síndrome do Intestino Irritável/metabolismo , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Reino Unido/epidemiologia
13.
Aliment Pharmacol Ther ; 45(1): 63-74, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27778366

RESUMO

BACKGROUND: Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. AIM: To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. METHODS: The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. RESULTS: Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P < 0.001), use of immunosuppressants (P = 0.025), Crohn's and Colitis UK membership (P = 0.001), frequent use of the hospital IBD team (P = 0.032), and frequent use of official information websites (P = 0.005) were associated with higher disease-related patient knowledge. Female sex (P = 0.004), clinically active disease (P < 0.001), frequent use of general practitioners (P = 0.014), alternative health websites (homoeopathy, nutritionists, etc.) (P = 0.004) and random links (P = 0.016) were independently associated with higher anxiety. CONCLUSIONS: Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety.


Assuntos
Ansiedade/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Doenças Inflamatórias Intestinais/psicologia , Internet/estatística & dados numéricos , Folhetos , Educação de Pacientes como Assunto/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/terapia , Estudos Transversais , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários , Adulto Jovem
14.
Leukemia ; 31(5): 1079-1086, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27807368

RESUMO

The origin of cancers is associated with etiology as well as therapeutics. Several studies reveal that malignancies in children can originate in utero. However, a diagnostic approach to distinguish between cancers initiated pre- or postnatally is absent. Here we identified a transcriptional factor FEV (fifth Ewing variant) that was expressed in fetal hematopoietic cells and became silent after birth. We characterized that FEV was essential for the self-renewal of hematopoietic stem cells (HSCs). We next found that FEV was expressed in most infant leukemia samples, but seldom in adult samples, in accord with the known prenatal origins of the former. We further determined the majority of pediatric acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML) were FEV positive. Moreover, FEV knockdown markedly impaired the leukemia-propagating ability of leukemic stem cells. We therefore identified FEV is unique to fetal HSCs and stably expressed in leukemic cells of prenatal origin. It may also provide a tractable therapeutic target.


Assuntos
Proteínas de Ligação a DNA/análise , Doenças Fetais/diagnóstico , Células-Tronco Hematopoéticas/metabolismo , Leucemia/etiologia , Proteínas Nucleares/análise , Animais , Células Cultivadas , Proteínas de Ligação a DNA/biossíntese , Feminino , Doenças Fetais/metabolismo , Expressão Gênica , Xenoenxertos , Humanos , Leucemia/diagnóstico , Leucemia/metabolismo , Leucemia Mieloide Aguda , Camundongos , Proteínas Nucleares/biossíntese , Leucemia-Linfoma Linfoblástico de Células Precursoras , Gravidez , Fatores de Transcrição
15.
Aliment Pharmacol Ther ; 45(1): 91-99, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27807884

RESUMO

BACKGROUND: Clinicians are advised to refer patients with lower gastrointestinal (GI) alarm features for urgent colonoscopy to exclude colorectal cancer (CRC). However, the utility of alarm features is debated. AIM: To assess whether performance of alarm features is improved by using a symptom frequency threshold to trigger referral, or by combining them into composite variables, including minimum age thresholds, as recommended by the National Institute for Health and Care Excellence (NICE). METHODS: We collected data prospectively from 1981 consecutive adults with lower GI symptoms. Assessors were blinded to symptom status. The reference standard to define CRC was histopathological confirmation of adenocarcinoma in biopsy specimens from a malignant-looking colorectal lesion. Controls were patients without CRC. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values were calculated for individual alarm features, as well as combinations of these. RESULTS: In identifying 47 (2.4%) patients with CRC, individual alarm features had sensitivities ranging from 11.1% (family history of CRC) to 66.0% (loose stools), and specificities from 30.5% (loose stools) to 75.6% (family history of CRC). Using higher symptom frequency thresholds improved specificity, but to the detriment of sensitivity. NICE referral criteria also had higher specificities and lower sensitivity, with PPVs above 4.8%. More than 80% of those with CRC met at least one of the NICE referral criteria. CONCLUSIONS: Using higher symptom frequency thresholds for alarm features improved specificity, but sensitivity was low. NICE referral criteria had PPVs above 4.8%, but sensitivities ranged from 2.2% to 32.6%, meaning many cancers would be missed.


Assuntos
Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Trato Gastrointestinal/patologia , Atenção Secundária à Saúde/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/tendências , Neoplasias Colorretais/terapia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Encaminhamento e Consulta/tendências , Atenção Secundária à Saúde/tendências , Adulto Jovem
17.
Intern Med J ; 46(9): 1081-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27391555

RESUMO

BACKGROUND: A cross-sectional survey of all patients reviewed by the aged care assessment team (ACAT) service and memory clinics between 1 January and 31 December 2012. The ACAT catchment included an estimated 14 325 people over the age of 70. AIMS: To determine the numbers and outcomes of assessments for cognitive problems by the ACAT and hospital memory clinics for patients within a single ACAT catchment area. METHODS: Data collected included patient demographics, diagnoses, referral and pharmacological treatment. Flow of referrals to the services that diagnose and manage dementia, and the number of incident dementia cases diagnosed in 2012 were determined. RESULTS: The ACAT service assessed 1005 patients from the catchment, of which 241 patients already had a diagnosis of dementia. When compared with the estimated dementia prevalence in Australia, 19% of prevalent dementia cases (n = 1260) within the catchment were reviewed by the ACAT. The two memory clinics saw a combined 186 new referrals (91 and 95 respectively) from within the catchment, with a total of 82 patients (22 and 60 respectively) receiving a new diagnosis of dementia. Using Australian estimates of dementia incidence, this would suggest 29% of 286 incident cases were managed through these memory clinics. CONCLUSIONS: Geriatric services are responsible for the assessment and management of a large proportion of the estimated number of patients with dementia in this catchment area. Further resourcing and standardisation of the pathways to dementia assessment is required in Australia in order to diagnose and manage effectively people with dementia.


Assuntos
Demência/diagnóstico , Demência/epidemiologia , Avaliação Geriátrica , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto Jovem
20.
Aliment Pharmacol Ther ; 44(2): 117-26, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27193202

RESUMO

BACKGROUND: Tobacco smoking is associated with a reduced risk of developing ulcerative colitis (UC). A high proportion of UC patients perceive a benefit in disease outcomes secondary to smoking. However, the effects of smoking on the natural history of UC are uncertain. AIM: To conduct a systematic review and meta-analysis of the effects of tobacco smoking on the natural history of UC. METHODS: A search of MEDLINE, EMBASE and EMBASE classic was carried out (up to December 2015) to identify observational studies reporting data on smoking and rates of colectomy, flare of disease activity, proximal disease extension, and development of pouchitis following panproctocolectomy and ileal pouch-anal anastomosis in patients with UC. Dichotomous data were pooled to obtain odds ratios (ORs), with 95% confidence intervals (CIs). RESULTS: The search identified 16 eligible studies: five (2615 patients) studying colectomy; four (620 patients) reporting on flare of disease activity; four (687 patients) examining proximal disease extension and three (355 patients) assessing development of pouchitis. Compared with nonsmokers, the odds of colectomy (OR = 0.89; 95% CI 0.62-1.26), flare of disease activity (OR = 1.26; 95% CI 0.65-2.44), proximal extension of disease (OR = 0.57; 95% CI 0.20-1.66) or the development of pouchitis (OR = 0.57; 95% CI 0.21-1.53) were not significantly lower in smokers. CONCLUSIONS: Smoking may not improve the natural history of ulcerative colitis. Given the health benefits of smoking cessation and the lack of clear benefit in ulcerative colitis, smoking cessation advice should be incorporated into guidance on the management of ulcerative colitis.


Assuntos
Colite Ulcerativa/etiologia , Pouchite/epidemiologia , Fumar/efeitos adversos , Canal Anal/cirurgia , Colectomia , Colite Ulcerativa/cirurgia , Bolsas Cólicas , Humanos
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