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1.
Chest ; 159(2): e107-e113, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33563452

RESUMO

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Bacteriemia/complicações , /fisiopatologia , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Tosse/fisiopatologia , Diarreia/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , /diagnóstico por imagem , Linfopenia/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Oximetria , Pneumonia Estafilocócica/complicações , Radiografia Torácica , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 100(3): e24318, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546062

RESUMO

RATIONALE: The immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is a rare disorder that most often manifests in the early stages of life. IPEX syndrome with a late onset, presenting with severe gastritis has rarely been reported. PATIENT CONCERNS: Two male adolescents presented with recurrent vomiting, severe malnutrition, and growth retardation due to severe gastritis. DIAGNOSES: Esophagogastroduodenoscopy of the 2 patients revealed rare presentations of severe gastritis with multiple ulcers and stenosis of the pylorus. Next-generation sequencing revealed 2 novel variants in gene FOXP3 in the patients who were diagnosed with the IPEX syndrome. INTERVENTIONS: Both patients were treated with a high calorie formular enteral nutritional therapy. In addition, the pylorus of patient 1 was enlarged by balloon dilation, while patient 2 was treated with mercaptopurine and low dose prednisone. OUTCOMES: Symptoms and nutritional status of the patients improved after treatment. LESSONS: Chronic severe gastritis with stenosis of the pylorus could be an atypical manifestation of the IPEX syndrome. The use of next-generation sequencing is highly suitable for the diagnosis of atypical IPEX syndromes.


Assuntos
Diabetes Mellitus Tipo 1/congênito , Diarreia/complicações , Diarreia/diagnóstico , Gastrite/etiologia , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças do Sistema Imunitário/congênito , Fatores de Tempo , Adolescente , China , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/fisiopatologia , Diarreia/fisiopatologia , Fatores de Transcrição Forkhead/genética , Gastrite/fisiopatologia , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Humanos , Doenças do Sistema Imunitário/complicações , Doenças do Sistema Imunitário/diagnóstico , Doenças do Sistema Imunitário/fisiopatologia , Masculino , Desnutrição/etiologia
3.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495170

RESUMO

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.


Assuntos
Bacteriemia/diagnóstico , Disenteria/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Pneumonia/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Bacteriemia/complicações , Hemocultura , Proteína C-Reativa , Diagnóstico Diferencial , Diarreia/fisiopatologia , Escore de Alerta Precoce , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/fisiopatologia , Humanos , Hipóxia , Ácido Láctico , Leucocitose , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Infecções Estafilocócicas , Insuficiência da Valva Tricúspide/etiologia , Vômito/fisiopatologia
4.
Am J Gastroenterol ; 116(1): 17-44, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315591

RESUMO

Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline.


Assuntos
Agonistas dos Canais de Cloreto/uso terapêutico , Terapia Cognitivo-Comportamental , Constipação Intestinal/terapia , Diarreia/terapia , Dietoterapia , Fármacos Gastrointestinais/uso terapêutico , Agonistas da Guanilil Ciclase C/uso terapêutico , Síndrome do Intestino Irritável/terapia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Constipação Intestinal/fisiopatologia , Técnica Delfos , Diagnóstico Diferencial , Diarreia/fisiopatologia , Gerenciamento Clínico , Fezes/química , Gastroenterologia , Humanos , Hipnose , Doenças Inflamatórias Intestinais/diagnóstico , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/fisiopatologia , Complexo Antígeno L1 Leucocitário/análise , Rifaximina/uso terapêutico , Testes Sorológicos , Sociedades Médicas
5.
J Headache Pain ; 21(1): 121, 2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33050880

RESUMO

BACKGROUND: Headache is the most common COVID-19-related neurological symptom. We aimed to reveal diagnostic clues of headache for COVID-19 infection and to investigate the course of primary headaches during the pandemic. METHODS: We developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. FINDINGS: A total of 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21 ± 11.2 years contributed to the survey. Among them, 262 participants had COVID-19 diagnosis and 126 (48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p < 0.000). COVID-19 related headaches were more closely associated with anosmia/ageusia and gastrointestinal complaints (p < 0.000 and p < 0.000), and showed different characteristics like pulsating, pressing, and even stabbing quality. Logistic regression analyses showed that bilateral headache, duration over 72 h, analgesic resistance and having male gender were significant variables to differentiate COVID-19 positive patients from those without COVID-19 (p = 0.04 for long duration and p < 0.000 for others). A worsening of previous primary headaches due to the pandemic-related problems was not reported in the majority of patients. INTERPRETATION: Bilateral, long-lasting headaches, resistance to analgesics and having male gender were more frequent in people with COVID-19 in conjunction with anosmia/ageusia and gastrointestinal complaints. These features may be helpful for diagnosing the headache related to COVID-19 during the pandemic.


Assuntos
Ageusia/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Diarreia/fisiopatologia , Cefaleia/fisiopatologia , Transtornos do Olfato/fisiopatologia , Pneumonia Viral/fisiopatologia , Adulto , Analgésicos/uso terapêutico , Betacoronavirus , Feminino , Cefaleia/tratamento farmacológico , Pessoal de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores Sexuais , Inquéritos e Questionários
6.
Pediatr Pulmonol ; 55(12): 3252-3267, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32965785

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM: To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY: An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS: The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS: Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.


Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Adolescente , Infecções Assintomáticas , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/mortalidade , Tosse/fisiopatologia , Diarreia/fisiopatologia , Febre/fisiopatologia , Humanos , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/mortalidade , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Vômito/fisiopatologia
7.
J Med Internet Res ; 22(10): e20509, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-32936770

RESUMO

BACKGROUND: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Lack of a vaccine or optimized intervention raised the importance of characterizing risk factors and symptoms for the early identification and successful treatment of patients with COVID-19. OBJECTIVE: This study aims to investigate and analyze biomedical literature and public social media data to understand the association of risk factors and symptoms with the various outcomes observed in patients with COVID-19. METHODS: Through semantic analysis, we collected 45 retrospective cohort studies, which evaluated 303 clinical and demographic variables across 13 different outcomes of patients with COVID-19, and 84,140 Twitter posts from 1036 COVID-19-positive users. Machine learning tools to extract biomedical information were introduced to identify mentions of uncommon or novel symptoms in tweets. We then examined and compared two data sets to expand our landscape of risk factors and symptoms related to COVID-19. RESULTS: From the biomedical literature, approximately 90% of clinical and demographic variables showed inconsistent associations with COVID-19 outcomes. Consensus analysis identified 72 risk factors that were specifically associated with individual outcomes. From the social media data, 51 symptoms were characterized and analyzed. By comparing social media data with biomedical literature, we identified 25 novel symptoms that were specifically mentioned in tweets but have been not previously well characterized. Furthermore, there were certain combinations of symptoms that were frequently mentioned together in social media. CONCLUSIONS: Identified outcome-specific risk factors, symptoms, and combinations of symptoms may serve as surrogate indicators to identify patients with COVID-19 and predict their clinical outcomes in order to provide appropriate treatments.


Assuntos
Infecções por Coronavirus/fisiopatologia , Aprendizado de Máquina , Pneumonia Viral/fisiopatologia , Mídias Sociais , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tosse/fisiopatologia , Coleta de Dados , Diarreia/fisiopatologia , Surtos de Doenças , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Mialgia/fisiopatologia , Oxigenoterapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Publicações , Estudos Retrospectivos , Fatores de Risco
8.
Scand J Gastroenterol ; 55(9): 1049-1056, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32749177

RESUMO

BACKGROUND AND AIMS: Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined. METHODS: This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined. RESULTS: The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p = .029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p = .04), higher positive viral RNA in stool (80.0% vs. 52.4%, p = .016) than those with both diarrhea and respiratory symptoms. CONCLUSIONS: Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Pneumonia Viral/epidemiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diarreia/fisiopatologia , Diarreia/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
9.
Blood ; 136(7): 914, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32790856
10.
BMJ Case Rep ; 13(8)2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32859618

RESUMO

During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.


Assuntos
Anorexia/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Diarreia/fisiopatologia , Hipóxia/fisiopatologia , Pulmão/diagnóstico por imagem , Náusea/fisiopatologia , Pneumonia Viral/fisiopatologia , Idoso , Betacoronavirus , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/diagnóstico , Medicina Geral , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X
11.
J Fam Pract ; 69(6): 293-300, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32724908

RESUMO

Metronidazole is no longer the drug of choice for first-line therapy. And fecal microbiota transplantation has proven effective for certain patients.


Assuntos
/patogenicidade , Infecções por Clostridium/tratamento farmacológico , Dor Abdominal/etiologia , Dor Abdominal/fisiopatologia , Antibacterianos/uso terapêutico , Infecção Hospitalar , Diarreia/etiologia , Diarreia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Vancomicina/uso terapêutico
13.
Medicine (Baltimore) ; 99(28): e21293, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664185

RESUMO

BACKGROUND: In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.


Assuntos
Infecções por Coronavirus , Diarreia , Fadiga , Massagem/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diarreia/etiologia , Diarreia/fisiopatologia , Diarreia/terapia , Fadiga/etiologia , Fadiga/prevenção & controle , Humanos , Metanálise como Assunto , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
14.
Am J Gastroenterol ; 115(7): 1094-1102, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32618660

RESUMO

INTRODUCTION: Bile acid (BA) diarrhea is the cause in ∼26% of chronic unexplained (nonbloody) diarrhea (CUD) based on SeHCAT testing. To assess fecal BA excretion and healthcare utilization in patients with CUD. METHODS: In a retrospective review of 1,071 consecutive patients with CUD who completed 48-hour fecal BA testing, we analyzed the symptoms, diagnostic tests performed, and final diagnoses. RESULTS: After 135 patients were excluded because of mucosal diseases, increased BA excretion was identified in 476 (51%) of the 936 patients with CUD: 29% with selective increase in primary BA and 22% with increased total BA excretion (35% with normal primary BA excretion). There were no differences in demographics, clinical symptoms, or history of cholecystectomy in patients with elevated total or selective primary fecal BA excretion compared with patients with normal excretion. Before the 48-hour fecal BA excretion test was performed, patients completed on average 1.2 transaxial imaging, 2.6 endoscopic procedures, and 1.6 miscellaneous tests/person. Less than 10% of these tests identified the etiology of CUD. Total fecal BAs >3,033 µmol/48 hour or primary BAs >25% had a 93% negative predictive value to exclude mucosal disease. Among patients with increased fecal BA excretion, >70% reported diarrhea improved with BA sequestrant compared with 26% with normal fecal BA excretion. Patients with selective elevation in primary fecal BAs were 3.1 times (95% confidence interval, 1.5-6.63) more likely to respond to BA sequestrant therapy compared with those with elevated total fecal BAs. DISCUSSION: Increased fecal BA excretion is frequent (51%) in patients with CUD. Early 48-hour fecal BA evaluation has the potential to decrease healthcare utilization in CUD.


Assuntos
Ácidos e Sais Biliares/metabolismo , Diarreia/diagnóstico , Diarreia/etiologia , Fezes/química , Adulto , Idoso , Doença Crônica , Diarreia/fisiopatologia , Feminino , Trânsito Gastrointestinal/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 401-407, jun.-jul. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193365

RESUMO

La obesidad es un problema de salud frecuente en nuestra población. La cirugía bariátrica es el tratamiento de elección en los casos graves, es muy efectiva (junto con una adecuada modificación de los hábitos de vida), pero también se asocia a múltiples efectos secundarios. Uno de los más frecuentes y que puede reducir marcadamente la calidad de vida es la diarrea. La diarrea que aparece posterior a una cirugía bariátrica puede ser de distintas causas y mecanismos fisiopatogénicos que van a depender, en parte, del tipo de cirugía realizada. Las causas más frecuentes son el síndrome de dumping, la diarrea por vagotomía, el síndrome de intestino corto, la malabsorción de hidratos de carbono, la malabsorción proteica, las alteraciones de la microbiota, la infección por Clostridium difficile, el sobrecrecimiento bacteriano, la malabsorción de sales biliares, la insuficiencia pancreática, trastornos endocrinológicos, trastornos adictivos y otros trastornos digestivos no necesariamente relacionados con la cirugía


Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery


Assuntos
Humanos , Diarreia/etiologia , Complicações Pós-Operatórias/etiologia , Cirurgia Bariátrica/efeitos adversos , Enteropatias/etiologia , Síndromes de Malabsorção/etiologia , Microbiota , Diarreia/fisiopatologia , Síndrome de Esvaziamento Rápido/etiologia
16.
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32496340

Assuntos
Infecções por Coronavirus/fisiopatologia , Doenças do Sistema Digestório/fisiopatologia , Pneumonia Viral/fisiopatologia , Dor Abdominal/etiologia , Dor Abdominal/metabolismo , Dor Abdominal/fisiopatologia , Dor Abdominal/terapia , Assistência Ambulatorial , Anorexia/etiologia , Anorexia/metabolismo , Anorexia/fisiopatologia , Anorexia/terapia , Antibacterianos/efeitos adversos , Antipiréticos/efeitos adversos , Antivirais/efeitos adversos , Betacoronavirus , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/fisiopatologia , Doença Hepática Induzida por Substâncias e Drogas/terapia , China , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/terapia , Diarreia/etiologia , Diarreia/metabolismo , Diarreia/fisiopatologia , Diarreia/terapia , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/metabolismo , Doenças do Sistema Digestório/terapia , Endoscopia do Sistema Digestório , Gastroenterologia , Humanos , Hepatopatias/etiologia , Hepatopatias/metabolismo , Hepatopatias/fisiopatologia , Hepatopatias/terapia , Náusea/etiologia , Náusea/metabolismo , Náusea/fisiopatologia , Náusea/terapia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Pneumonia Viral/terapia , Probióticos/uso terapêutico , Sociedades Médicas , Vômito/etiologia
20.
Auris Nasus Larynx ; 47(4): 559-564, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32586739

RESUMO

OBJECTIVE: to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. METHODS: We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. RESULTS: within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). CONCLUSION: ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.


Assuntos
Infecções por Coronavirus/fisiopatologia , Transtornos do Olfato/fisiopatologia , Faringite/fisiopatologia , Pneumonia Viral/fisiopatologia , Tonsila Faríngea , Betacoronavirus , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Eritema/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Mialgia/fisiopatologia , Obstrução Nasal/fisiopatologia , Otorrinolaringopatias/fisiopatologia , Tonsila Palatina , Pandemias , Infecções Respiratórias/fisiopatologia
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