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1.
Diabet Med ; 37(7): 1094-1102, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32333691

RESUMO

The month of Ramadan forms one of the five pillars of the Muslim faith. Adult Muslims are obligated to keep daily fasts from dawn to sunset, with exceptions. This year Ramadan is due to begin on 23 April 2020 and the longest fast in the UK will be approximately 18 hours in length. In addition, due to the often high-calorie meals eaten to break the fast, Ramadan should be seen as a cycle of fasting and feasting. Ramadan fasting can impact those with diabetes, increasing the risk of hypoglycaemia, hyperglycaemia and dehydration. This year, Ramadan will occur during the global COVID-19 pandemic. Reports show that diabetes appears to be a risk factor for more severe disease with COVID-19. In addition, the UK experience has shown diabetes and COVID-19 is associated with dehydration, starvation ketosis, diabetic ketoacidosis and hyperosmolar hyperglycaemic state. This makes fasting in Ramadan particularly challenging for those Muslims with diabetes. Here, we discuss the implications of fasting in Ramadan during the COVID-19 pandemic and make recommendations for those with diabetes who wish to fast.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Jejum/metabolismo , Férias e Feriados , Islamismo , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Desidratação/epidemiologia , Desidratação/metabolismo , Desidratação/prevenção & controle , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Cetoacidose Diabética/epidemiologia , Dietoterapia , Gerenciamento Clínico , Jejum/efeitos adversos , Hidratação , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/metabolismo , Hiperglicemia/prevenção & controle , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/metabolismo , Hipoglicemia/epidemiologia , Hipoglicemia/metabolismo , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Cetose/epidemiologia , Cetose/metabolismo , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Medição de Risco , Reino Unido
3.
Clín. investig. arterioscler. (Ed. impr.) ; 32(2): 49-58, mar.-abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-187146

RESUMO

Background and aims: The first line of therapy in children with hypercholesterolaemia is therapeutic lifestyle changes (TLSC). The efficacy of lifestyle intervention in children with familial hypercholesterolaemia (FH), where LDL-C levels are genetically driven, deserves a focused study. Aims: To evaluate the impact of a lifestyle education program, focused on food patterns and physical activity, on lipid profiles assessed by nuclear magnetic resonance (NMR) in children with FH vs. non-FH. Methods: Phase 1 was a cross-sectional study of baseline characteristics, and phase 2 was a prospective TLSC intervention study. In total, the study included 238 children (4 to 18 years old; 47% girls) attending the lipid unit of our hospital due to high cholesterol levels. Eighty-five were diagnosed with FH (72% genetic positive), and 153 were diagnosed with non-Familial hypercholesterolaemia. A quantitative food frequency questionnaire (FFQ) including 137 items was used. Physical activity (PA) was assessed by the Minnesota questionnaire. The lipid profile was assessed using the 2D-1H-NMR (Liposcale test). A total of 127 children (81 in the FH group) participated in the prospective phase and were re-assessed after 1 year of the TLSC intervention, consisting of education on lifestyle changes delivered by a specialized nutritionist. Results: The FH and non-FH groups were similar in anthropometry and clinical data, except that those in the FH were slightly younger than those in the non-FH group. Both the FH and non-FH groups showed a similar diet composition characterized by a high absolute calorie intake and a high percentage of fat, mainly saturated fat. The PA was below the recommended level in both groups. After one year of TLSC, the percentage of total and saturated fats was reduced, and the amount of fiber increased significantly in both groups. The percentage of protein increased slightly. The number of children engaged in at least 1 hour/day of PA increased by 56% in the FH group and by 53% in the non-FH group, and both these increases were significant. The total and small-LDL particle numbers were reduced in both groups, although the absolute change was greater in the FH group than in the non-FH group. Conclusions: Educational strategies to implement TLSC in children lead to empowerment, increased adherence, and overall metabolic improvement in children with high blood cholesterol, including those with FH


Antecedentes y objetivos: La primera línea de terapia en niños con hipercolesterolemia son los cambios terapéuticos en el estilo de vida (TLSC). La eficacia de la intervención en el estilo de vida en niños con hipercolesterolemia familiar (HF), en los que los niveles de LDL-C son generados genéticamente, merece un estudio específico. Objetivos: Evaluar el impacto de un programa de educación sobre el estilo de vida, centrado en los patrones alimentarios y la actividad física, sobre el perfil lipídico evaluado por resonancia magnética nuclear (RMN) en niños con HF versus no HF. Métodos: La fase 1 fue un estudio transversal de las características basales, y la fase 2 fue un estudio prospectivo de intervención mediante TLSC. En total, el estudio incluyó a 238 niños (de 4 a 18 años; 47% niñas) que asistieron a la unidad de lípidos de nuestro hospital debido a los altos niveles de colesterol. Ochenta y cinco fueron diagnosticados con HF (72% genéticamente positivos), y 153 fueron diagnosticados de no HF. Se utilizó un cuestionario cuantitativo de frecuencia de alimentos (FFQ) que incluye 137 ítems. La actividad física (AF) se evaluó mediante el cuestionario de Minnesota. El perfil lipídico se evaluó mediante la prueba 2D-1H-NMR (Liposcale Test). Un total de 127 niños (81 en el grupo HF) participaron en la fase prospectiva y fueron reevaluados después de 1 año de la intervención mediante TLSC, que consistió en educación sobre cambios en el estilo de vida impartida por una nutricionista especializada. Resultados: Los grupos HF y no HF fueron similares en los datos antropométricos y clínicos, excepto que los HF eran ligeramente más jóvenes que los no HF. Los participantes de ambos grupos mostraron una composición de dieta similar caracterizada por un alto consumo de calorías totales y un alto porcentaje de grasas, principalmente grasas saturadas. La AF estuvo por debajo del nivel recomendado en ambos grupos. Después de un año de TLSC, se redujo el porcentaje de grasas totales y saturadas, y la cantidad de fibra aumentó significativamente en ambos grupos. El porcentaje de proteína aumentó ligeramente. El número de niños involucrados en al menos 1 hora/día de AF aumentó en un 56% en el grupo de HF y en un 53% en el grupo sin HF, y ambos aumentos fueron significativos. Los números de partículas LDL totales y pequeñas se redujeron en ambos grupos, aunque el cambio absoluto fue mayor en el grupo HF que en el grupo no HF. Conclusiones: Las estrategias educativas para implementar TLSC en niños conducen al empoderamiento, al aumento de la adherencia y a la mejora metabólica general en niños con colesterol alto en sangre, incluidos aquellos con HF


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Hipercolesterolemia/sangue , Hipercolesterolemia/terapia , Estilo de Vida , Educação de Pacientes como Assunto , Lipoproteínas LDL/sangue , Dietoterapia , Terapia por Exercício , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/terapia , Ressonância Magnética Nuclear Biomolecular , Estudos Transversais , Estudos Prospectivos , Resultado do Tratamento
5.
Demetra (Rio J.) ; 15(1): 43534, jan.- mar.2020. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1097303

RESUMO

O objetivo do presente estudo foi avaliar, por meio de uma revisão da literatura, evidências da utilização de dietas com restrição de carboidratos no manejo do diabetes mellitus (DM). As buscas eletrônicas e manuais foram até abril de 2019, e incluíram trabalhos publicados a partir de 2008. Foram excluídos estudos de pesquisas in vitro e em animais, revisões de literatura, livros, monografias, dissertações, teses, estudos de caso e relatos de caso. Os artigos remanescentes foram submetidos à análise de sua qualidade metodológica pela Escala JADAD cinco pontos. Um total de 19 estudos randomizados e com qualidade média de três pontos foram selecionados e analisados quanto aos tipos de dieta utilizadas, adesão, tipo de DM, tempo de intervenção, consumo reportado de carboidratos e resultados observados para os grupos controle e intervenção. Dentre os parâmetros escolhidos para mensurar os possíveis efeitos das dietas, destacaram-se alteração de peso e IMC, Hb1Ac, variabilidade ou controle glicêmico, perfil lipídico e alteração nas doses de insulina ou medicação utilizadas. Em quatro estudos não foram observadas vantagens significativas de uma dieta restrita em carboidratos, e 15 trabalhos relataram melhoras em um ou mais parâmetros. Tais resultados podem representar uma grande vantagem na adoção desta estratégia alimentar no manejo do DM e na prevenção de complicações da doença. Contudo, existem limitações nos estudos, que precisam ter suas hipóteses verificadas no longo prazo, e pesquisas adicionais devem ser realizadas para configurar uma estratégia oficial no controle do DM. (AU)


This study aimed to evaluate, through a literature review, evidence of the use of diets with carbohydrate restriction in the management of diabetes mellitus (DM). Electronic and manual searches were conducted until April 2019, including works published from 2008 onwards. Studies on in vitro and animal research, literature reviews, books, monographs, dissertations, theses, case studies and case reports were excluded. The remaining articles were submitted to analysis of their methodological quality by the five-point JADAD Scale. Nineteen randomized studies with an average quality of three points were selected and analyzed regarding the types of diet used, adherence, type of DM, time of intervention, reported consumption of carbohydrates and results observed for the control and intervention group. Among the parameters chosen to measure the possible effects of diets, weight and BMI changes, Hb1Ac, variability or glycemic control, lipid profile and changes in insulin doses or medication used stood out. In four studies, no significant advantages were observed from a carbohydraterestricted diet, and 15 studies reported improvements in one or more parameters. Such results can represent a great advantage in adopting this dietary strategy in the management of DM and in preventing complications of the disease. However, there are limitations in the studies, which need to have their hypotheses verified in the long term, and additional research must be carried out to configure an official strategy in the control of DM. (AU)


Assuntos
Carboidratos , Diabetes Mellitus , Dieta Rica em Proteínas e Pobre em Carboidratos , Carboidratos da Dieta , Dieta com Restrição de Gorduras , Dietoterapia , Dieta com Restrição de Carboidratos
6.
Dig Dis Sci ; 65(3): 840-851, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32006211

RESUMO

Diet is an important risk factor for colorectal cancer (CRC), and several dietary constituents implicated in CRC are modified by gut microbial metabolism. Microbial fermentation of dietary fiber produces short-chain fatty acids, e.g., acetate, propionate, and butyrate. Dietary fiber has been shown to reduce colon tumors in animal models, and, in vitro, butyrate influences cellular pathways important to cancer risk. Furthermore, work from our group suggests that the combined effects of butyrate and omega-3 polyunsaturated fatty acids (n-3 PUFA) may enhance the chemopreventive potential of these dietary constituents. We postulate that the relatively low intakes of n-3 PUFA and fiber in Western populations and the failure to address interactions between these dietary components may explain why chemoprotective effects of n-3 PUFA and fermentable fibers have not been detected consistently in prospective cohort studies. In this review, we summarize the evidence outlining the effects of n-3 long-chain PUFA and highly fermentable fiber with respect to alterations in critical pathways important to CRC prevention, particularly intrinsic mitochondrial-mediated programmed cell death resulting from the accumulation of lipid reactive oxygen species (ferroptosis), and epigenetic programming related to lipid catabolism and beta-oxidation-associated genes.


Assuntos
Apoptose/fisiologia , Neoplasias Colorretais/dietoterapia , Neoplasias Colorretais/microbiologia , Dietoterapia/métodos , Microbioma Gastrointestinal/fisiologia , Animais , Neoplasias Colorretais/patologia , Dieta/métodos , Fibras na Dieta/administração & dosagem , Ácidos Graxos Ômega-3/administração & dosagem , Humanos
7.
Adv Neurobiol ; 24: 573-586, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006374

RESUMO

Autism is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a "developmental disorder" because symptoms generally appear in the first 2 years of life. The primary cause of autism is still not clear and therapy is currently restricted to controlling behavioral abnormalities. However, emerging studies have shown a link between mitochondrial dysfunction and autism. Dietary supplements that promote mitochondrial biogenesis and inhibit the production of oxidative stress have been used to treat autism patients. Dietary adjustments in treating autism is a novel approach to suppress autistic symptoms. Supplementation with antioxidants has been found to not only inhibit cognitive decline but also improve behavioral symptoms in autism. Dietary supplements fortified with vitamins should only be given under the supervision of a physician. A wide range of nutraceuticals are under clinical trials to understand whether they physiologically target mitochondrial pathways and improve the quality of life in autism.


Assuntos
Transtorno Autístico/dietoterapia , Dietoterapia , Proteínas na Dieta/uso terapêutico , Transtorno Autístico/metabolismo , Transtorno Autístico/patologia , Suplementos Nutricionais , Humanos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Estresse Oxidativo/efeitos dos fármacos , Qualidade de Vida
8.
Ann Allergy Asthma Immunol ; 124(5): 459-465, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001367

RESUMO

OBJECTIVE: Peanut allergy has historically been difficult to manage, with most cases persisting into adulthood. Novel therapies for peanut allergy treatment are on the horizon, yet allergists must maintain a robust understanding of the risks and benefits of the current standard of therapy, avoidance diet. DATA SOURCES: A comprehensive literature search using PubMed of reviews and clinical articles was performed. STUDY SELECTIONS: Articles discussing peanut or other food-related allergic reactions, accidental exposures or anaphylaxis pertinent to avoidance diet or comparative to oral immunotherapy trials were selected. RESULTS: Peanut remains a leading allergen associated with accidental ingestions responsible for food-related reactions, both mild and severe. Fatal reactions, however, are rare and measures such as anaphylaxis plans can significantly decrease the risk of accidental anaphylaxis. Patients may over estimate situations thought to increase risk for reactions to peanut, such as inhalation or contact through skin. In oral immunotherapy trials, the rate of anaphylaxis secondary to treatment was significantly higher than avoidance practices. CONCLUSION: Clinicians should continue to discuss avoidance as a viable option for long-term peanut allergy management and empower patients to differentiate relevant situations in which accidental reactions might occur.


Assuntos
Anafilaxia/prevenção & controle , Dessensibilização Imunológica/métodos , Hipersensibilidade a Amendoim/dietoterapia , Alérgenos/imunologia , Animais , Antígenos de Plantas/imunologia , Arachis/imunologia , Ensaios Clínicos como Assunto , Dietoterapia , Epinefrina/administração & dosagem , Humanos
9.
Am J Gastroenterol ; 115(2): 165-178, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32023228

RESUMO

Small intestinal bacterial overgrowth is defined as the presence of excessive numbers of bacteria in the small bowel, causing gastrointestinal symptoms. This guideline statement evaluates criteria for diagnosis, defines the optimal methods for diagnostic testing, and summarizes treatment options for small intestinal bacterial overgrowth. This guideline provides an evidence-based evaluation of the literature through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the available evidence was not appropriate for a formal GRADE recommendation, key concepts were developed using expert consensus.


Assuntos
Antibacterianos/uso terapêutico , Síndrome da Alça Cega/diagnóstico , Síndrome da Alça Cega/terapia , Dietoterapia , Transplante de Microbiota Fecal , Probióticos/uso terapêutico , Testes Respiratórios , Técnicas de Cultura , Humanos , Hidrogênio/análise , Intestino Delgado , Metano/análise , Sucção
10.
J Allergy Clin Immunol ; 145(1): 1-7, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31910983

RESUMO

Eosinophilic esophagitis (EoE) is an eosinophil-rich, TH2 antigen-mediated disease of increasing pediatric and adult worldwide prevalence. Diagnosis requires greater than or equal to 15 eosinophils per high-power field on light microscopy. Symptoms reflect esophageal dysfunction, and typical endoscopic features include linear furrows, white plaques, and concentric rings. Progressive disease leads to pathologic tissue remodeling, with ensuing esophageal rigidity and loss of luminal diameter caused by strictures. Therapies include proton pump inhibitors, elimination diets, and topical corticosteroids. Effective treatment can reverse tissue fibrosis in some patients, as well as decrease the rate of food impactions. Esophageal dilation might be required to increase luminal patency. The chronic nature of EoE necessitates long-term therapy to avoid disease recurrence and complications. This review serves the function of providing the current state-of-the-art diagnostic criteria and disease management for adult and pediatric EoE.


Assuntos
Corticosteroides/uso terapêutico , Dietoterapia , Esofagite Eosinofílica , Inibidores da Bomba de Prótons/uso terapêutico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/imunologia , Esofagite Eosinofílica/patologia , Esofagite Eosinofílica/terapia , Eosinófilos/imunologia , Eosinófilos/patologia , Esôfago/imunologia , Esôfago/patologia , Humanos
11.
Am J Gastroenterol ; 115(2): 224-233, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31913192

RESUMO

OBJECTIVES: Mast cells (MCs) are increased in eosinophilic esophagitis (EoE). Endoscopic abnormalities, symptoms, and epithelial changes can persist after treatment despite a reduction of esophageal eosinophilia. It is unknown whether this could be due to persistent MC infiltration. We aimed to determine whether patients with histologically inactive (HI) EoE (defined as <15 eosinophils per high-powered field) with persistent symptoms, endoscopic, or epithelial abnormalities after treatment have increased MCs. METHODS: Secondary analysis of prospective data from 93 children with EoE undergoing post-treatment endoscopy between 2011 and 2015. Thirty-five non-EoE controls were included. Immunohistochemistry for tryptase, an MC marker, was performed on mid and distal esophageal biopsies. Total and degranulated intraepithelial MCs per high-powered field (MC/hpf) were quantified. Symptoms and endoscopic findings were recorded at time of endoscopy. MC/hpf were compared between HI-EoE and control, and among HI-EoE based on endoscopic and histologic findings, and symptoms. Nine clinical remission (CR) patients were identified, with absence of endoscopic abnormalities and symptoms. RESULTS: MC/hpf were increased in HI-EoE compared with control (17 ± 11 vs 8 ± 6, P < 0.0). Patients with persistent endoscopic abnormalities had increased total (20 ± 12 vs 13 ± 10, P = 0.001) and degranulated (8 ± 6 vs 5 ± 4, P = 0.002) MC/hpf, with no difference in eosinophils. MC/hpf predicted furrowing (odds ratio = 1.06, P = 0.01) and rings (odds ratio = 1.05, P = 0.03) after controlling for treatment type, proton-pump inhibitor, eosinophils, and duration of therapy. Patients with persistent basal zone hyperplasia and dilated intercellular spaces had increased MC/hpf. Eosinophils were weakly correlated with MC/hpf in the mid (r = 0.30, P < 0.001) and distal (r = 0.29, P < 0.001) esophagus. Clinical remission patients had lower MC/hpf compared with patients with persistent symptoms and/or endoscopic abnormalities. DISCUSSION: MC density is increased in patients with endoscopic and epithelial abnormalities, as well as a few symptoms, despite resolution of esophageal eosinophilia after treatment. This association warrants further study to ascertain whether MCs play an eosinophil independent role in EoE.


Assuntos
Esofagite Eosinofílica/patologia , Eosinófilos/patologia , Mastócitos/patologia , Adolescente , Corticosteroides/uso terapêutico , Criança , Pré-Escolar , Dietoterapia/métodos , Edema/patologia , Esofagite Eosinofílica/fisiopatologia , Esofagite Eosinofílica/terapia , Esofagoscopia , Exsudatos e Transudatos , Feminino , Humanos , Masculino
13.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(1): 20-27, ene. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186143

RESUMO

Background and objectives: Bariatric surgery (BS) leads to several changes in nutritional habits that can be attributed to different mechanisms. Some of these changes could be achievable with a preoperative nutritional intervention. The objective was to evaluate dietary modifications during the preoperative and postoperative periods of BS. Methods: Prospective observational study of patients who underwent BS between 2010 and 2014 at the Hospital del Mar; 60 consecutive patients were included. Food consumption was measured by a validated food-frequency questionnaire at inclusion in the bariatric surgery program, after preoperative nutritional intervention, and one year after surgery. Generalized estimating equation models were used to assess differences in food group intake during follow up. Results: Energy intake significantly decreased from inclusion to 1 year of surgery (p = 0.003). After the preoperative intervention and prior to surgery, there was an increase in intake of nuts, vegetables, poultry and rabbit, fruit, fish and skimmed milk products and a decrease in bread, soft drinks and pastry. At one year post-surgery, a continued decrease in the consumption of bread and soft drinks and an increase in nuts was observed (linear non-quadratic trend). Consumption of fruit, pastry, fish and skimmed milk products remained stable showing a linear and quadratic trend. Vegetables and poultry and rabbit increased in the preoperative period and decreased after surgery, showing a quadratic but not linear trend. Conclusions: a preoperative nutritional intervention in morbidly obese patients can associate favorable dietary changes that are mostly maintained one year after bariatric surgery


Introducción y objetivos: La cirugía bariátrica produce diferentes cambios en los hábitos alimentarios que se han atribuido a diferentes mecanismos. Algunos de estos cambios se podrían conseguir con una intervención nutricional preoperatoria. El objetivo fue estudiar los cambios dietéticos durante el periodo preoperatorio y postoperatorio de la cirugía bariátrica. Métodos: Estudio prospectivo de pacientes intervenidos de cirugía bariátrica entre los años 2010 y 2014 en el Hospital del Mar de Barcelona. Se incluyeron 60 pacientes consecutivos. El registro de alimentos se midió mediante cuestionarios de frecuencia de consumo de alimentos a la inclusión en el programa de cirugía bariátrica, después de una intervención nutricional preoperatoria y un año después de la cirugía. Se usaron las ecuaciones de estimación generalizadas para determinar diferencias en el consumo de los grupos de alimentos durante el seguimiento. Resultados: El consumo de energía disminuyó desde la inclusión un año después de la intervención (p = 0,003). En el periodo preoperatorio y antes de la cirugía se detectó un aumento en el consumo de frutos secos, vegetales, aves y conejo, fruta, pescado y lácticos desnatados y un descenso en el consumo de pan, bebidas azucaradas y bollería. Un año después de la cirugía, se observó que el consumo de pan y bebidas azucaradas siguió descendiendo y el de frutos secos siguió aumentando (tendencia lineal pero no cuadrática). El consumo de fruta, pescado y lácticos desnatados se mantuvo estable (tendencia lineal y cuadrática). El consumo de vegetales, aves y conejo aumentó en el periodo preoperatorio y disminuyó después de la cirugía (tendencia cuadrática pero no lineal). Conclusiones: Una intervención nutricional preoperatoria en pacientes con obesidad mórbida puede asociarse a cambios dietéticos favorables, los cuales se mantienen en su mayoría un año después de la intervención


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cirurgia Bariátrica/métodos , Dietoterapia/métodos , Liberação de Cirurgia , Consumo de Energia , Obesidade Mórbida/dietoterapia , Cuidados Pós-Operatórios , Estudos Prospectivos , Inquéritos e Questionários , Micronutrientes , Frutas
14.
Nat Rev Gastroenterol Hepatol ; 17(1): 21-39, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31690829

RESUMO

Functional constipation is common in children and adults worldwide. Functional constipation shows similarities in children and adults, but important differences also exist regarding epidemiology, symptomatology, pathophysiology, diagnostic workup and therapeutic management. In children, the approach focuses on the behavioural nature of the disorder and the initial therapeutic steps involve toilet training and laxatives. In adults, management focuses on excluding an underlying cause and differentiating between different subtypes of functional constipation - normal transit, slow transit or an evacuation disorder - which has important therapeutic consequences. Treatment of adult functional constipation involves lifestyle interventions, pelvic floor interventions (in the presence of a rectal evacuation disorder) and pharmacological therapy. When conventional treatments fail, children and adults are considered to have intractable functional constipation, a troublesome and distressing condition. Intractable constipation is managed with a stepwise approach and in rare cases requires surgical interventions such as antegrade continence enemas in children or colectomy procedures for adults. New drugs, including prokinetic and prosecretory agents, and surgical strategies, such as sacral nerve stimulation, have the potential to improve the management of children and adults with intractable functional constipation.


Assuntos
Constipação Intestinal/terapia , Fármacos Gastrointestinais/uso terapêutico , Laxantes/uso terapêutico , Agonistas do Receptor 5-HT4 de Serotonina/uso terapêutico , Adulto , Ácidos e Sais Biliares/uso terapêutico , Biorretroalimentação Psicológica , Criança , Agonistas dos Canais de Cloreto/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Dietoterapia , Fibras na Dieta , Gerenciamento Clínico , Terapia por Estimulação Elétrica , Enema , Microbioma Gastrointestinal , Trânsito Gastrointestinal , Agonistas da Guanilil Ciclase C/uso terapêutico , Humanos , Manometria , Educação de Pacientes como Assunto , Prebióticos , Probióticos , Treinamento no Uso de Toaletes
15.
Ann Otol Rhinol Laryngol ; 129(4): 313-325, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31729247

RESUMO

OBJECTIVE: To develop and validate the Reflux Sign Assessment (RSA), a clinical instrument evaluating the physical findings of laryngopharyngeal reflux (LPR). METHODS: A total of 106 patients completed a 3-month treatment based on the association of diet, pantoprazole, alginate, or magaldrate with the LPR characteristics (acid, nonacid, mixed). Forty-two asymptomatic individuals completed the study (control group). The RSA results and reflux finding score (RFS) were documented for the LPR patients at baseline and after treatment. Intrarater reliability was assessed through a test-retest blinded evaluation of signs (7-day intervals). Interrater reliability was assessed by comparing the RSA evaluations of three blinded otolaryngologists through Kendall's W. Responsiveness to change was evaluated through a comparison of the baseline and 3-month posttreatment findings. The RSA cutoffs for determining the presence and absence of LPR were examined by receiver operating characteristic (ROC) analysis. RESULTS: A total of 102 LPR patients completed the study (68 females). The mean age was 53 years. The mean RSA at baseline was 25.95 ± 9.58; it significantly improved to 18.96 ± 7.58 after 3 months of therapy (P < .001). RSA exhibited good intra- (r = 0.813) and interrater (Kendall's W = 0.663) reliabilities (N = 56). There was no significant association between the RSA, gastrointestinal endoscopy findings, and the types of reflux (acid, nonacid, or mixed) according to impedance-pH monitoring. An RSA >14 may be suggestive of LPR. CONCLUSION: The RSA is a complete clinical instrument evaluating both laryngeal and extralaryngeal findings associated with LPR. The RSA demonstrated high intra- and interrater reliabilities and responsiveness to change.


Assuntos
Antiácidos/uso terapêutico , Dietoterapia/métodos , Endoscopia Gastrointestinal , Refluxo Laringofaríngeo , Inibidores da Bomba de Prótons/uso terapêutico , Avaliação de Sintomas/métodos , Bélgica , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/estatística & dados numéricos , Monitoramento do pH Esofágico/métodos , Monitoramento do pH Esofágico/estatística & dados numéricos , Feminino , Humanos , Refluxo Laringofaríngeo/diagnóstico , Refluxo Laringofaríngeo/terapia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Resultado do Tratamento
16.
Arthritis Rheumatol ; 72(1): 150-156, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31353871

RESUMO

OBJECTIVE: Few studies have systematically and quantitatively addressed the impact of urate-lowering therapy on monosodium urate (MSU) deposits. This study was undertaken to analyze the effect of lifestyle measures and conventional urate-lowering therapy on MSU deposits in patients with gout. METHODS: In this prospective study, subjects with gout according to the American College of Rheumatology/European League Against Rheumatism classification criteria and presence of MSU deposits seen on dual-energy computed tomography (DECT) scans received either lifestyle intervention or conventional urate-lowering therapy for a mean period of 18 months before a follow-up DECT scan. Detected MSU deposits were quantified by volumetric measurement and validated by semiquantitative scoring, and baseline and follow-up measurements were compared. RESULTS: Baseline and follow-up DECT scans were available for all 83 subjects. Six subjects discontinued treatment, and 77 subjects underwent a lifestyle intervention (n = 24) or were treated with allopurinol (n = 29), febuxostat (n = 22), or benzbromarone (n = 2) over the entire observation period. The mean serum uric acid (UA) level decreased from 7.2 to 5.8 mg/dl in the overall population. In patients who discontinued treatment, no change in MSU deposits or serum UA levels was observed. The burden of MSU deposits significantly decreased in patients undergoing lifestyle intervention (MSU volume P = 0.007; MSU score P = 0.001), and in patients treated with allopurinol (MSU volume and score P < 0.001) or febuxostat (MSU volume P < 0.001; MSU score P = 0.001). No significant decline in MSU deposits was noted in patients who discontinued treatment. CONCLUSION: These data show that lifestyle intervention and xanthine oxidase inhibitors significantly decrease the MSU deposit burden. Hence, conventional gout therapy not only lowers serum UA levels, but also reduces pathologic MSU deposits.


Assuntos
Dietoterapia , Articulações do Pé/diagnóstico por imagem , Supressores da Gota/uso terapêutico , Gota/terapia , Ácido Úrico/sangue , Idoso , Consumo de Bebidas Alcoólicas , Alopurinol/uso terapêutico , Benzobromarona/uso terapêutico , Febuxostat/uso terapêutico , Feminino , Frutose , Gota/diagnóstico por imagem , Humanos , Masculino , Carne , Pessoa de Meia-Idade , Estudos Prospectivos , Purinas , Frutos do Mar , Tomografia Computadorizada por Raios X , Uricosúricos/uso terapêutico
17.
Am J Med ; 133(1): 19-25, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494109

RESUMO

Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.


Assuntos
Dietoterapia , Dieta Saudável , Hospitais , Planejamento de Cardápio , Melhoria de Qualidade , Assistência Ambulatorial , Dieta Vegetariana , Qualidade dos Alimentos , Serviço Hospitalar de Nutrição , Hospitalização , Humanos , Política Nutricional , Política Organizacional
18.
Lancet Gastroenterol Hepatol ; 5(3): 316-328, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31859185

RESUMO

This Review summarises recent pharmacological and upcoming alternative interventions for children with functional abdominal pain disorders (FAPDs). Pharmacological targets include prokinetics and drugs affecting gastric accommodation to treat postprandial distress and nausea. Similarly, anti-inflammatory agents, junctional protein regulators, analgesics, secretagogues, and serotonin antagonists have a therapeutic role for irritable bowel syndrome. Non-pharmacological treatments include peripheral electrical nerve field stimulation to the external ear, gastric electrical stimulation, dietary interventions such as low fructose and fibre based diets, and nutraceuticals, which include probiotics, prebiotics, and synbiotics. Newer psychological advances such as exposure-based cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness meditation are being investigated for paediatric functional pain. Lastly, alternative therapies such as acupuncture, moxibustion, yoga, and spinal manipulation are also gaining popularity in the treatment of FAPDs.


Assuntos
Dor Abdominal/tratamento farmacológico , Síndrome do Intestino Irritável/tratamento farmacológico , Náusea/tratamento farmacológico , Período Pós-Prandial/efeitos dos fármacos , Dor Abdominal/fisiopatologia , Dor Abdominal/terapia , Terapia de Aceitação e Compromisso/métodos , Acupuntura/métodos , Adolescente , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Terapia Cognitivo-Comportamental/métodos , Dietoterapia/métodos , Suplementos Nutricionais/estatística & dados numéricos , Estimulação Elétrica/métodos , Feminino , Humanos , Masculino , Manipulação da Coluna/métodos , Atenção Plena/métodos , Moxibustão/métodos , Prebióticos/estatística & dados numéricos , Probióticos/uso terapêutico , Angústia Psicológica , Secretagogos/uso terapêutico , Antagonistas da Serotonina/uso terapêutico , Simbióticos/administração & dosagem , Resultado do Tratamento , Ioga , Adulto Jovem
20.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 737-743, jan.-dez. 2020. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1102738

RESUMO

Objetivo: Identificar as evidências científicas acerca das condutas para o manejo da anorexia em cuidados paliativos. Métodos: Trata-se de uma revisão integrativa, cujo levantamento bibliográfico dos dados deu-se através da pesquisa em quatro bases de dados/bibliotecas virtuais. Incluíram-se artigos em português, inglês e espanhol, publicados nos últimos dez anos e com o texto completo disponível. Resultados: Foram elegíveis 25 artigos, e foram atribuídos dois eixos temáticos para melhor ilustrar os dados encontrados: o manejo farmacológico e o não-farmacológico. Corticosteroides, progestinas, anamorelina e dronabinol foram os fármacos mais pesquisados para o controle da anorexia, com maiores evidências de eficácia nos 3 primeiros. No contexto não-farmacológico, o aconselhamento nutricional foi a medida mais indicada, incluindo a fortificação de alimentos e uso de suplementos e a nutrição artificial mais controversa. Conclusão: Os achados desta revisão podem colaborar para a elaboração de protocolos para o manejo da anorexia em cuidados paliativos


Objective: The study's main goal has been to identify scientific evidence on the management of anorexia in palliative care. Methods: This is an integrative review, whose data collection occurred by researching four databases/virtual libraries. Articles in Portuguese, English, and Spanish, published over the last ten years and with the full text available, were included. Results: 25 articles were selected, and two thematic axes were assigned to better illustrate the data found: pharmacological and non-pharmacological management. Corticosteroids, progestins, anamorelin, and dronabinol were the most-researched drugs for the control of anorexia, with greater evidence of effectiveness for the first three. In the non-pharmacological treatment, nutritional counseling was the most recommended measure, including the fortification of foods and the use of supplements and the more-controversial artificial nutrition. Conclusion: The findings of this review may aid in the development of protocols for the treatment of anorexia in palliative care


Objetivo: El propósito principal del estudio ha sido identificar evidencia científica sobre el manejo de la anorexia en los cuidados paliativos. Métodos: Esta es una revisión integradora, cuya investigación bibliográfica de datos ocurrió mediante búsqueda en cuatro bases de datos/bibliotecas virtuales. Se incluyeron artículos en portugués, inglés y español, publicados en los últimos diez años y con texto completo disponible. Resultados: Fueron elegibles 25 artículos, siendo atribuidos dos ejes temáticos para ilustrar mejor los datos encontrados: el manejo farmacológico y el no farmacológico. Corticosteroides, progestinas, anamorelina y dronabinol han sido los fármacos más buscados para el control de la anorexia, con mayores evidencias de eficacia en los 3 primeros. En el contexto no farmacológico, el asesoramiento nutricional fue la medida más indicada, incluyendo la fortificación de alimentos y uso de suplementos y la nutrición artificial más controversia. Conclusión: Los hallados de esta revisión pueden colaborar para la elaboración de protocolos para el manejo de la anorexia en cuidados paliativos


Assuntos
Humanos , Masculino , Feminino , Cuidados Paliativos , Anorexia/tratamento farmacológico , Dietoterapia
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