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1.
J Crohns Colitis ; 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38243908

RESUMO

BACKGROUND AND AIMS: Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study's primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. METHODS: The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. RESULTS: The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in all its different definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. CONCLUSION: In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.

2.
Parasitol Res ; 123(1): 94, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-38212547

RESUMO

The aim of this study was to evaluate the efficacy of a topical combination of moxidectin 3.5%, imidacloprid 10% and praziquantel 10% for the prevention of Dirofilaria immitis (Leidy, 1856) infection in dogs. For this purpose, a randomized and controlled clinical trial was conducted between August 2021 and October 2022, in the municipality of Goiana, state of Pernambuco, north-eastern Brazil, where heartworm is highly prevalent. Of the 213 dogs initially sampled (baseline), 68 (31.9%) were positive for adult antigens (SNAP 4Dx Plus, Idexx) and/or microfilariae (modified Knott's test). On day 0, 140 negative dogs were randomly included in the treatment and control groups, 70 animals each. During the study, 60 dogs (34 treated and 26 untreated) were removed for different reasons. At the end of the study (day 360 ± 2), 36 treated and 44 untreated were sampled and included in the efficacy calculation. The efficacy against the development of adults and microfilariae was 84.7%, with only one treated dog being positive for adult antigens but negative for microfilariae. On the other hand, eight untreated dogs were positive for adult antigens and/or microfilariae, resulting in a significant difference in the number of positives between groups (Chi-square test = 4.706, df = 1, P = 0.0301). Remarkably, the efficacy against the appearance of D. immitis microfilariae was 100% (i.e., all treated dogs negative) and three untreated dogs were positive for microfilariae. The topical combination of moxidectin 3.5%, imidacloprid 10% and praziquantel 10% significantly reduced the risk of D. immitis infection in treated dogs as compared with untreated dogs, in a highly endemic area in north-eastern Brazil.


Assuntos
Dirofilaria immitis , Dirofilariose , Doenças do Cão , Neonicotinoides , Nitrocompostos , Animais , Cães , Dirofilariose/tratamento farmacológico , Dirofilariose/prevenção & controle , Doenças do Cão/tratamento farmacológico , Doenças do Cão/prevenção & controle , Quimioterapia Combinada , Macrolídeos/uso terapêutico , Microfilárias , Praziquantel/uso terapêutico
4.
Dig Liver Dis ; 2023 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-37980274

RESUMO

BACKGROUND: The emergence of new treatments the inflammatory bowel diseases (IBD) raised questions regarding the role of older agents, namely thiopurines. AIMS: To clarify the benefits of combination treatment with thiopurines on Crohn's disease (CD) patients in the maintenance phase of infliximab. METHODS: In this analysis of the 2-year prospective multicentric DIRECT study, patients were assessed in terms of clinical activity, faecal calprotectin (FC), C-reactive protein (CRP), and infliximab pharmacokinetics. A composite outcome based on clinical- and drug-related items was used to define treatment failure. RESULTS: The study included 172 patients; of these, 35.5 % were treated with combination treatment. Overall, 18 % of patients achieved the composite outcome, without statistically significant differences between patients on monotherapy and on combination treatment (21.6% vs 11.5 %, p = 0.098). Median CRP, FC, and infliximab pharmacokinetic parameters were similar in both groups. However, in the sub-analysis by infliximab treatment duration, in patients treated for less than 12 months, the composite outcome was reached in fewer patients in the combination group than in the monotherapy group (7.1% vs 47.1 %, p = 0.021). CONCLUSION: In CD patients in maintenance treatment with infliximab, combination treatment does not seem to have benefits over infliximab monotherapy beyond 12 months of treatment duration.

5.
Parasit Vectors ; 16(1): 391, 2023 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-37891604

RESUMO

BACKGROUND: The tick Amblyomma cajennense sensu stricto (A. cajennense s.s.) frequently parasitizes animals and humans in the Amazon biome, in addition to being a vector of Rickettsia amblyommatis. In the present study, we evaluated both the population dynamics of A. cajennense s.s. in a degraded area of the Amazon biome and the presence of rickettsial organisms in this tick population. METHODS: The study was carried out in a rural area of the Santa Inês municipality (altitude: 24 m a.s.l.), Maranhão state, Brazil. Ticks were collected from the environment for 24 consecutive months, from June 2021 to May 2023. The region is characterized by two warm seasons: a rainy season (November-May) and a dry season (June-October). We characterized the temporal activity of A. cajennense s.s. on the vegetation by examining questing activity for each life stage (larvae, nymphs, adults [males and females]) in relation to the dry and rainy season. Ticks collected in this study were randomly selected and individually tested by a TaqMan real-time PCR assay that targeted a 147-bp fragment of the rickettsial gltA gene. RESULTS: Overall, 1843 (62.4%) adults (52.6% females, 47.4% males), 1110 (37.6%) nymphs and 398 larval clusters were collected. All adult females and nymphs were morphologically identified as A. cajennense s.s. Larval activity was observed from April to December, with a peak from June to September (dry season); nymph abundance peaked from September to November (transition period between dry and rainy seasons); and adult ticks were abundant from October to May (spring/summer/early autumn). The infection rate by R. amblyommatis in A. cajennense s.s. ticks was at least 7% (7/99). CONCLUSION: Our data suggest a 1-year generation pattern for A. cajennense s.s., with a well-defined seasonality of larvae, nymphs and adults in the Amazon biome. Larvae predominate during the dry season, nymphs are most abundant in the dry-rainy season transition and adults are most abundant in the rainy season. The presence of R. amblyommatis in adult ticks suggests that animals and humans in the study region are at risk of infection by this species belonging to the spotted fever group of Rickettsia.


Assuntos
Ixodidae , Infecções por Rickettsia , Rickettsia , Carrapatos , Animais , Humanos , Masculino , Feminino , Estações do Ano , Amblyomma , Rickettsia/genética , Infecções por Rickettsia/epidemiologia , Infecções por Rickettsia/microbiologia , Carrapatos/microbiologia , Brasil/epidemiologia , Ninfa/microbiologia , Larva/microbiologia , Ecossistema
7.
J Pediatr Nurs ; 73: 137-156, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37690429

RESUMO

PROBLEM: Changes in the ventilation demand nursing interventions duly adapted to the management of said impairment and to the adaptability of the child/parents. This revision aimed to investigate the evidence behind the interventions performed on children with impaired ventilation.' ELIGIBILITY CRITERIA: Systematic reviews of literature in English, Spanish, French, and Portuguese from studies on nursing interventions related to children with impaired ventilation in all contexts of the clinical practice. The Joanna Briggs Institute recommendations were followed. SAMPLE: We conducted a comprehensive search as of January 2022 and updated as of June 2023. The following electronic databases were searched: SCOPUS, Web of Science, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE (via PubMed), CINAHL (via EBSCO), MedicLatina (via EBSCO), The Cochrane Database of Systematic Reviews (via EBSCO), and Database of Abstracts of Reviews of Effects (DARE). Nineteen articles published between 2012 and 2022 were included in this review. RESULTS: Nineteen studies investigated the efficacy of respiratory exercises (Breathing Control - relaxed breathing, pursed lip breathing, Diaphragmatic breathing exercises, respiratory expansion exercise - deep breathing exercise, thoracic expansion exercises (with device), exercises for respiratory muscle strengthening and position to optimize ventilation. In the majority of the studies, it was not possible to evaluate the interventions separately. Thirteen studies evidenced the efficacy of respiratory exercises, BIPAP, and oxygen therapy. Seven articles demonstrated the effectiveness of respiratory muscle-strengthening exercises, and only three mentioned the efficacy of positioning regarding impaired ventilation. Interventions based on respiratory exercises and respiratory muscle training were the most common ones. CONCLUSIONS: The results suggest that nursing interventions to optimize ventilation are efficient. Nevertheless, the same present a low to moderate evidence degree, justified by the population characteristics (small and heterogeneous). IMPLICATIONS: There is proof of evidence for the studied interventions. However, the lack of methodological robustness points to future research to duly describe interventions, data, and comparable results, using reliable samples in which the focus of the study is clear.


Assuntos
Exercícios Respiratórios , Terapia por Exercício , Criança , Humanos , Revisões Sistemáticas como Assunto , Exercícios Respiratórios/métodos , Exercício Físico
8.
United European Gastroenterol J ; 11(6): 531-541, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37318072

RESUMO

BACKGROUND: Timely stratification of Crohn's disease (CD) is essential for patients' management. The use of noninvasive accurate biomarkers is key to monitor treatment and to pursue mucosal healing, the ultimate treatment endpoint in CD. OBJECTIVE: We aimed to evaluate the performance of readily available biomarkers and develop risk matrices to predict CD progression. METHODS: Data from 289 CD patients receiving infliximab (IFX) maintenance therapy for 2 years was collected; those patients were included in DIRECT, a prospective multicenter observational study. Disease progression was evaluated using two composite outcomes incorporating clinical and drug-related factors, the first including IFX dose and/or frequency adjustments. Univariate and multivariable logistic regressions were used to calculate the odds ratios (OR) and to develop risk matrices. RESULTS: The isolated presence of anemia at least once during follow-up was a significant predictor of disease progression (OR 2.436 and 3.396 [p ≤ 0.001] for composite outcomes 1 and 2, respectively) regardless of confounding factors. Isolated highly elevated C-reactive protein (CRP; >10.0 mg/L) and fecal calprotectin (FC; >500.0 µg/g) in at least one visit were also significant predictors, while milder elevations (3.1-10.0 mg/L and 250.1-500.0 µg/g) were only relevant when detected in at least two visits (consecutive or not). The combination of biomarkers in risk matrices had good ability to predict progression; patients simultaneously presenting anemia, highly elevated CRP and FC at least once had 42%-63% probability of achieving the composite outcomes. CONCLUSION: The combined evaluation of hemoglobin, CRP, and FC in at least one time point and their incorporation into risk matrices seems to be the optimal strategy for CD management, as data from additional visits did not meaningfully influence the predictions and may delay decision-making.


Assuntos
Doença de Crohn , Humanos , Infliximab/uso terapêutico , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/metabolismo , Estudos Prospectivos , Biomarcadores , Prognóstico , Progressão da Doença
10.
Artigo em Inglês | MEDLINE | ID: mdl-37047855

RESUMO

This umbrella review aimed to determine the effectiveness of nonpharmacological interventions in pulmonary ventilation and their impact on respiratory function. An individual with impaired ventilation displays visible variations manifested in their respiratory frequency, breathing rhythm ratio (I:E), thoracic symmetry, use of accessory muscles, dyspnea (feeling short of breath), oxygen saturation, diaphragm mobility, minute ventilation, peak flow, walking test, spirometry, Pimax/Pemax, diffusion, and respiratory muscle strength. Any variation in these markers demands the need for interventions in order to duly manage the signs and symptoms and to improve ventilation. METHOD: Systematic reviews of the literature published in English, Spanish, French, and Portuguese were used, which included studies in which nonpharmacological interventions were used as a response to impaired ventilation in adults in any given context of the clinical practice. The recommendations given by the Joanna Briggs Institute (JBI) for umbrella reviews were followed. This research took place in several databases such as MEDLINE, CINAHL Complete, CINHAL, MedicLatina, ERIC, Cochrane Reviews (Embase), and PubMed. The Joanna Briggs critical analysis verification list was used for the systematic review. The data extraction was performed independently by two investigators based on the data extraction tools of the Joanna Briggs Institute, and the data were presented in a summary table alongside the support text. RESULTS: Forty-four systematic reviews, thirty randomized clinical essays, and fourteen observational studies were included in this review. The number of participants varied between n = 103 and n = 13,370. Fifteen systematic revisions evaluated the effect of isolated respiratory muscular training; six systematic revisions evaluated, in isolation, breathing control (relaxed breathing, pursed-lip breathing, and diaphragmatic breathing exercises) and thoracic expansion exercises; and one systematic review evaluated, in isolation, the positions that optimize ventilation. Nineteen systematic reviews with combined interventions that reinforced the role of education and capacitation while also aiming for their success were considered. The articles analyzed isolated interventions and presented their efficacy. The interventions based on respiratory exercises and respiratory muscular training were the most common, and one article mentioned the efficacy of positioning in the compromisation of ventilation. Combined interventions in which the educational component was included were found to be effective in improving pulmonary function, diffusion, oxygenation, and functional capacity. The outcomes used in each study were variable, leading to a more difficult analysis of the data. CONCLUSIONS: The interventions that were the focus of the review were duly mapped. The results suggest that nonpharmacological interventions used to optimize ventilation are effective, with a moderate to high level of evidence. There is a strong foundation for the use of the chosen interventions. The lack of studies on the intervention of "positioning to optimize ventilation" points out the need for a deeper analysis of its effects and for studies with a clear focus. This study supports the decisions and recommendations for the prescription of these interventions to patients with impaired ventilation.


Assuntos
Exercícios Respiratórios , Respiração , Adulto , Humanos , Exercício Físico/fisiologia , Revisões Sistemáticas como Assunto
11.
Rev. Rol enferm ; 46(3,supl): 16-21, mar. 2023. tab
Artigo em Português | IBECS | ID: ibc-216893

RESUMO

Enquadramento: A transição parental pode ter um significado relevante na saúde mental dos pais. Facilitar esta transição é uma importante função dos enfermeiros. A informoterapia pode beneficiar tomadas de decisão parentais. Um portal orientado para a promoção das competências parentais administrado pela internet, integrado no plano de cuidados individual, pode promover competências parentais, neste caso, relativamente à segurança do recém-nascido. Objetivos: Definir um modelo de dados relativo às oportunidades de desenvolvimento do conhecimento parental sobre segurança do recém-nascido articulado com a ontologia de enfermagem, definir conteúdos multimédia necessários para uma literacia promotora da transição parental saudável. Metodologia: Análise de conteúdo ao material usado nos cursos de preparação e apoio à parentalidade e gravidez em funcionamento nos anos 2020 e 2021, no âmbito das Unidades de Cuidados na Comunidade dos Centros de Saúde da Boavista e de Paranhos. O processo de análise foi realizado por 3 investigadores sem modelo de análise à priori. Resultados: Relativamente ao conhecimento sobre segurança, foram identificadas duas categorias: segurança rodoviária e segurança não rodoviária. Na categoria segurança rodoviária foram definidas vinte subcategorias do conhecimento. Para cada subcategoria determinaram-se questões a colocar aos pais e o elenco de respostas indicativas de conhecimento facilitador ou potencial para melhorar o conhecimento. Conclusões: O conhecimento associado à transição parental pode ser alterado pela ação do enfermeiro através da informoterapia. O uso da internet mediado pelo enfermeiro pode promover a literacia em saúde como parte do processo de cuidados, facilitando a mestria dos pais e a perceção da sua saúde mental. (AU)


Background: Parental transition can impact parents’ mental health. Facilitating this transition process is an essential role of nurses. Information therapy can benefit parental decision-making. A website oriented towards the promotion of parenting skills administered over the internet, integrated into the individual care plan, can promote parenting skills such as newborn safety. Objectives: To define a data model regarding the opportunities for developing parental knowledge about newborn safety, articulated with a nursing ontology, and to define multimedia content appropriated for literacy that promotes a healthy parental transition. Methodology: A content analysis on the material used in parenting and pregnancy courses was carried out under the scope of Boavista and Paranhos Health Centers in 2020 and 2021. The analysis was performed by three independent researchers without a prior analysis model. Results: In the domain of parents’ knowledge about newborn safety, two categories were identified: newborn safety in traffic and newborn safety other than traffic. In the newborn safety in the traffic category, twenty subcategories of knowledge were identified. For each subcategory, a set of questions were defined to be answered by parents and a set of possible answers that represents accurate knowledge and lack of knowledge on each issue. Conclusions: Parents’ knowledge about newborn safety can be modified by nursing therapeutics using information therapy. Nurse-mediated internet use can promote health literacy as part of the care process by facilitating parents’ mastery and perception of their mental health. (AU)


Assuntos
Humanos , Saúde Mental , Poder Familiar , Medicina na Literatura , Internet , Enfermeiras e Enfermeiros
12.
Cogitare Enferm. (Online) ; 28: e90831, Mar. 2023. tab, graf
Artigo em Português | LILACS-Express | LILACS, BDENF - Enfermagem | ID: biblio-1520755

RESUMO

RESUMO Objetivo: identificar o perfil epidemiológico das vítimas que sofreram violência sexual, em Anápolis - Goiás - Brasil, entre os anos 2017 a 2020. Métodos: estudo descritivo de natureza quantitativa. Foram utilizados dados da ficha de notificação de violência sexual cadastrada no Departamento de Vigilância Epidemiológica. Utilizado o teste qui-quadrado com nível de significância de 5% (p<0,05). Resultados: foram notificados 850 casos, com o pico em 2020, sendo 82,1% do sexo feminino, entre a faixa etária de dois a 10 anos (42,2%), de cor parda (61,2%) e solteira (37,1%). A principal conduta realizada após violência sexual foi a coleta de sangue (21,6%); os principais agressores foram os pais (20,9%), o tipo de violência sexual principal foi estupro (68,7%) e as vítimas foram encaminhadas, principalmente, para o Conselho tutelar (48,2%). Conclusão: os resultados apontam a necessidade de se fortalecer intervenções no sentido de ampliar a rede de proteção social às crianças e adolescentes.


ABSTRACT Objective: to identify the epidemiological profile of victims who suffered sexual violence, in Anápolis - Goiás - Brazil, between the years 2017 to 2020. Methods: descriptive study of quantitative nature. Data from the notification form of sexual violence registered in the Department of Epidemiological Surveillance were used. Chi-square test was used with a significance level of 5% (p<0.05). Results: 850 cases were notified, with the peak in 2020, 82.1% were female, between the age group of two to 10 years (42.2%), brown (61.2%) and single (37.1%). The main conduct carried out after sexual violence was blood collection (21.6%); the main aggressors were the parents (20.9%), the main type of sexual violence was rape (68.7%) and the victims were mainly referred to the Guardianship Council (48.2%). Conclusion: The results point to the need to strengthen interventions to expand the social protection network for children and adolescents.


RESUMEN Objetivo: identificar el perfil epidemiológico de las víctimas que han sufrido violencia sexual, en Anápolis - Goiás - Brasil, entre los años 2017 a 2020. Método: estudio descriptivo de naturaleza cuantitativa. Se utilizaron datos de la ficha de notificación de violencia sexual registrada en el Departamento de Vigilancia Epidemiológica. Se utilizó la prueba de chi cuadrado con un nivel de significación del 5% (p<0,05). Resultados: Fueron notificados 850 casos, con el pico en 2020, siendo 82,1% mujeres, entre el grupo de edad de dos a 10 años (42,2%), morenas (61,2%) y solteras (37,1%). La principal conducta realizada después de la violencia sexual fue la extracción de sangre (21,6%); los principales agresores fueron los padres (20,9%), el principal tipo de violencia sexual fue la violación (68,7%) y las víctimas fueron encaminadas principalmente al Consejo Tutelar (48,2%). Conclusión: los resultados apuntan a la necesidad de reforzar las intervenciones para ampliar la red de protección social de niños y adolescentes.

13.
Cureus ; 15(1): e33270, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36741598

RESUMO

Introduction Meniscal tears represent one of the most frequent knee injuries and are the most common cause of knee surgery. Historically, age has been considered an independent factor contraindicating meniscal repair due to the assumption that meniscal injuries in this population are frequently chronic tears, mostly with a degenerative tear pattern, and low healing potential. However, recent literature has questioned this paradigm with studies reporting successful outcomes with meniscal repair in older patients. Our study aimed to evaluate and compare the short-term clinical outcomes of meniscal repair versus partial meniscectomy in patients aged ≥40 years old. Methods A retrospective study was conducted that included patients over the age of 40 years, diagnosed with meniscal tears, that underwent arthroscopically assisted meniscal repair or partial meniscectomy between 01 January and 31 December 2020. The patients were divided into two groups: Group 1- partial meniscectomy (PM) and Group 2- meniscal repair (MR). The clinical evaluation was performed 24 months after the surgery, and the studied variables were: function (Tegner Lysholm Knee Scoring Scale), pain (Visual Analogue Scale), patient satisfaction, and failure rate.  Results Fifty-one patients met the inclusion criteria, and 7 were excluded due to loss of follow-up during telephone contact. Thus, the final sample consisted of 44 patients (mean age 52.18y), both groups with 22 patients. In both groups, we found an improvement in pain 2 years after the surgery, with a decrease in the VAS value between the pre and post-surgery. On average, the VAS score decreased from 7.9 to 4.5 in the group subjected to partial meniscectomy, and from 7.5 to 3.2 in the meniscal repair. This was statistically significant in both groups, with a p-value <0.01, but not between them (p-value = 0.363). Comparing the degree of satisfaction between both groups, we found no statistically significant difference between them (p=0.167). Regarding the functional outcome (Tegner Lysholm Knee Scoring Scale), the group that underwent the meniscal repair obtained a statistically superior score compared to the partial meniscectomy group (77.55 vs. 64.77; p-value 0.033). The failure rate was exactly equal in both groups (4.5%), therefore no statistically significant difference was found in this variable.  Conclusion Age, as an independent factor, should not be considered a contraindication for meniscus repair. In fact, if technically possible, meniscal repair should always be performed as it is associated with better functional outcomes, similar failure rates, and may be protective against the development and progression of arthritis.

14.
Dig Liver Dis ; 55(8): 1001-1009, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36681569

RESUMO

The burden of Inflammatory Bowel Disease (IBD) is increasing worldwide, with a particular increase in the prevalence in the elderly population, due to the ageing of young-onset IBD as well as to the increasing incidence in elderly patients. Elderly IBD patients present specific challenges to the treating physician, as they have comorbidities, lower functional reserves, and higher risk of treatment-related complications. The diagnosis of IBD in the elderly may be difficult due to a more subtle disease presentation and to a wide range of differential diagnosis. Moreover, as these patients are often excluded from clinical trials, there is a lack of high-quality evidence to inform on the most appropriate management. Despite an increasing prevalence, the management of IBD in the elderly is still hindered by frequent misconceptions by physicians treating these patients. Due to a erroneous notion of a milder disease course and fear of adverse events, elderly IBD-patients are managed with frequent and continuous use of steroids and undertreated with effective medical therapies. In this review, we describe the principles of management of IBD in the elderly, which is a topic of increasing importance to IBD clinics, that will have to progressively adapt to care for an ageing population.


Assuntos
Colite Ulcerativa , Doenças Inflamatórias Intestinais , Idoso , Humanos , Doenças Inflamatórias Intestinais/terapia , Doenças Inflamatórias Intestinais/tratamento farmacológico , Comorbidade , Esteroides/uso terapêutico , Diagnóstico Diferencial , Progressão da Doença , Colite Ulcerativa/epidemiologia
15.
J Crohns Colitis ; 17(7): 1031-1045, 2023 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-36626338

RESUMO

There are now a growing number of licensed biological therapies for patients with Crohn's disease. However, there can be significant costs associated with long-term maintenance treatment, as well as some concerns about potential side-effects. As a result, there has been increasing interest in elective biological treatment discontinuation in selected patients, after a sustained period of remission. Following discontinuation, in cases of relapse, evidence to date has suggested that remission may often be regained by re-treatment with the same biological agent. Therefore, a concept has emerged in which cycles of biological therapy might be used. If this treatment strategy were to be applied in a subgroup of patients at low risk of relapse, cycling might allow a substantial number of patients to have a lower, overall therapeutic burden-ensuring decreased exposure to biological therapy but still enabling appropriate disease control. Currently, there remains uncertainty about the benefit-risk balance for using cycles of biological treatment for patients with Crohn's disease. Accordingly, an expert panel was convened by the European Crohn's and Colitis Organisation [ECCO] to review the published literature and agree a series of consensus practice points. The panel aimed to provide evidence-based guidance on multiple aspects of biological treatment discontinuation and cycling, including the risk of relapse after elective treatment discontinuation, predictors of probable relapse or remission, safety, patient preferences, and pharmacoeconomic aspects. Crucially, discussions about biological treatment discontinuation and cycling should be individualized, to enable shared decision-making by patients with their clinicians.


Assuntos
Doença de Crohn , Humanos , Doença de Crohn/complicações , Indução de Remissão , Recidiva , Medição de Risco
17.
Pathogens ; 13(1)2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38251322

RESUMO

This study was carried out from February 2020 to September 2021 in Parque Nacional das Emas (PNE), a national park located in the Cerrado biome, midwestern Brazil, as well as in surrounding rural properties. Serum and tick samples were collected from dogs, terrestrial small mammals, and humans. Ticks were also collected from the environment. Dogs were infested with Rhipicephalus linnaei adults, whereas small mammals were infested by immature stages of Amblyomma spp., Amblyomma triste, Amblyomma dubitatum, and Amblyomma coelebs. Ticks collected from vegetation belonged to several species of the genus Amblyomma, including A. coelebs, A. dubitatum, Amblyomma naponense, Amblyomma sculptum, and A. triste. Two Rickettsia species were molecularly detected in ticks: Rickettsia parkeri in A. triste from the vegetation and a Rickettsia sp. (designated Rickettsia sp. strain PNE) in A. sculptum and A. triste collected from lowland tapirs (Tapirus terrestris). Based on short gltA gene fragments, this rickettsial organism showed 99.7-100% to Rickettsia tillamookensis. Seroreactivity to Rickettsia antigens was detected in 21.9% of dogs, 15.4% of small mammals, and 23.5% of humans. The present study reveals the richness of ticks and demonstrates the circulation of rickettsial agents in one of the largest conservation units in the Cerrado biome in Brazil. To our knowledge, this is the first report of a rickettsial phylogenetically related to R. tillamookensis in Brazil.

18.
Rev. am. med. respir ; 23(4): 207-216, 2023. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1535467

RESUMO

RESUMEN Introducción: Durante la pandemia por SARS-CoV-2, la cánula nasal de alto flujo (CNAF) se usó como soporte en espera de Unidad de terapia intensiva (UTI) o como alternativa a la ventilación invasiva. Objetivos: Primario: Determinar si la cánula nasal de alto flujo evita la intubación oro traqueal. Secundarios: Analizar predictores de éxito al inicio de la cánula nasal de alto flujo y análisis descriptivo de la muestra. Materiales y métodos: Estudio observacional descriptivo retrospectivo. Se incluyeron pacientes mayores de 16 años positivos para SARS-CoV-2, atendidos en guardia y unidad de terapia intensiva, que utilizaron cánula nasal de alto flujo entre octubre de 2020 y marzo 2021. Se recolectaron datos en planillas individuales, analizadas por un profesional externo. Resultados: Se incluyeron en el trabajo 72 pacientes (de 16 a 88 años), 20 mujeres y 52 hombres. El 50 % de la muestra evitó la intubación orotraqueal. El IROX inicio grupo "éxito" vs. grupo "fracaso", p = 0,006. Comparación Irox 12 h grupo "éxito" vs. grupo "fracaso" p < 0,001. Comparación "tiempo desde ingreso a inicio de cánula nasal de alto flujo" grupo "éxito" vs. grupo "fracaso", p = 0,133. Comparación "Delta IROX" grupo "éxito" vs grupo "fracaso" p = 0,092. Conclusión: Se evitó la intubación orotraqueal en el 50 % de los casos. El IROX de inicio y el IROX a las 12 h del uso de cánula nasal de alto flujo fue estadísticamente significativo, lo que es un buen predictor del éxito en esta población. La fecha de inicio de síntomas y el uso de cánula nasal de alto flujo y el delta del IROX durante las pri meras 12 h no fue estadísticamente significativo para el éxito de la terapia. Estos datos son una herramienta útil con el objeto de generar protocolos de selección de pacientes para esta patología.


ABSTRACT Introduction: During the SARS-CoV-2 pandemic, the high flow nasal cannula (HFNC) was used as support while waiting for the Intensive Care Unit (ICU) or as an alternative to invasive ventilation. The objective of this work is the description and analysis of the use of CNAF in our population. Objectives: Primary: Determine if HFNC prevents orotracheal intubation. Secondary: Analyze predictors of success at the start of CNAF and a descriptive analysis of the sample Materials and method: Retrospective descriptive observational study. Patients over 16 years of age positive for SARS-CoV-2, treated in Guard and ICU were included. who used CNAF between October 2020 and March 2021 Data was collected in individual forms, analyzed by an external professional. Results: The study included 72 patients (16 to 88 years old), 20 women and 52 men; 50 % of the sample avoided orotracheal intubation. Start IROX, group "success" vs. group "failure" p = 0.006. Comparison Irox.12 h group "success" vs. group "failure" p < 0.001. Comparison "Time from admission to start of CNAF" group "success" vs. group "failure" p = 0.133. Comparison "Delta IROX" group "success" vs. group "failure" p = 0.092. Conclusion: HFNC avoided orotracheal intubation in the 50 % of the cases. The initial IROX and the IROX 12 hours after the use of HFNC were statistically significant, which is a good predictor of success in this population. The date of onset of symptoms and the use of FNAF and IROX delta during the first 12 hours were not statistically significant for the success of the therapy. These data are a useful tool for generating patient selection protocols for this pathology.

19.
Healthcare (Basel) ; 10(10)2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36292262

RESUMO

BACKGROUND: Auriculotherapy may activate the parasympathetic nerve system and reduce anxiety levels. Short-term auriculotherapy's effects and safety on university students' anxiety levels was assessed prior to exams. METHODS: A randomized, controlled pilot trial was conducted. The day before the exam, university students were randomly allocated to the auriculotherapy group (AA, n = 13) or the waiting-list group (WG, n = 13). Baseline measures were taken 4 weeks before the exam at Time point (TP 0); at 7.30 a.m. on the day before the exam (TP I); at 11 a.m. before auriculotherapy (TP II); 30 min after AA (TP III); and at 7.30 a.m. before the exam (TP IV). The outcomes were the State-Trait-Anxiety Inventory (STAI); quality of night-sleep, Visual Analogue scale (VAS) for anxiety, and salivary cortisol. Adverse events were also recorded. RESULTS: A total of 26 students participated in this study and became more anxious as assessed by STAI in TPII (p = 0.002) and TPIV (p = 0.000) than TP0. AA reduced the STAI in TPIII (p = 0.045) and PIV (p = 0.001) and the VAS (p = 0.012) in TPIV. Cortisol was reduced in TPIII (p = 0.004), and the AA slept better (p = 0.014) at TPIV. Discomfort at the auricular site was reported in only one AA participant. CONCLUSIONS: Auriculotherapy appeared safe and effective in reducing anxiety levels before university exams.

20.
Parasitol Res ; 121(11): 3305-3311, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36102968

RESUMO

Canine vector-borne pathogens (CVBPs) comprise a group of disease agents mainly transmitted by ticks, fleas, mosquitoes and sand flies. In this study, we assessed the presence of CVBPs in an Afro-descendent community (Quilombola) of northeastern, Brazil. Dog blood samples (n = 201) were collected and analyzed by rapid test for the detection of antibodies against Leishmania spp., Anaplasma spp., Ehrlichia spp. and Borrelia burgdorferi sensu lato (s.l.), and antigens of Dirofilaria immitis. In addition, polymerase chain reactions were performed for Anaplasmataceae, Babesia spp., Hepatozoon spp., Rickettsia spp. and B. burgdorferi s.l. Overall, 66.7% of the dogs scored positive to at least one pathogen at serological and/or molecular methods. Antibodies against Ehrlichia spp. were the most frequently detected (57.2%; n = 115/201), followed by Anaplasma spp. (8.5%; n = 17/201), Leishmania spp. (8.5%; n = 17/201) and B. burgdorferi s.l. (0.5%; n = 1/201). For D. immitis, 11 out of 201 (5.5%) animals scored positive. At the molecular analysis, 10.4% (n = 21/201) of the samples scored positive for Babesia spp./Hepatozoon spp., followed by Anaplasmataceae (5.0%; n = 10/201) and Rickettsia spp. (3.0%; n = 6/201). All samples were negative for B. burgdorferi s.l. Our data demonstrated the presence of CVBPs in the studied population, with a high seropositivity for Ehrlichia spp. In addition, considering the detection of zoonotic pathogens in dogs and their relationship with people from Quilombola communities, effective control strategies are advocated for minimizing the risk of infection in this socially vulnerable human population and their pets.


Assuntos
Babesia , Dirofilaria immitis , Doenças do Cão , Ehrlichiose , Eucoccidiida , Rickettsia , Anaplasma , Animais , Babesia/genética , Brasil/epidemiologia , Cães , Ehrlichia , Ehrlichiose/veterinária , Humanos , Mosquitos Vetores , Rickettsia/genética
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