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1.
Medicine (Baltimore) ; 100(13): e25321, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787625

RESUMO

ABSTRACT: Factors related to developing postoperative ileus (POI) vary from pharmacologic, inflammatory, hormonal, metabolic, gastrointestinal physiology, neurologic, to psychological factors. Although orthopedic-related incidence of postoperative ileus is about 10%, these studies are limited to spine surgery and pelvic surgery. The purpose of this study was to investigate prevalence of POI and to analyze effect of chewing gum on POI and bowel function in elderly patients after hip fracture surgery.A prospective randomized controlled trial was conducted at the Gyeongsang National University Hospital. Elderly patients with hip fracture who underwent surgery from March 2017 to June 2018 were eligible to participate. Patients were excluded if they had a mastication disability, impaired cognitive function, previous history of gastrointestinal disease, respiratory disease and low oxygen saturation, hip arthroplasty with causes other than hip fractures, acetabular fractures, periprosthetic fractures, or pathological fractures. Patients with consciousness problem by excessive anesthesia were also excluded. Patients were classified into 2 groups by randomization. Group I received sugar-free gum and were encouraged to chew 6 hours following surgery until the first intestinal gas is released. Group II was given the same postoperative procedure and encouraged to consume water after 6 hours.After applying exclusion criteria, 74 patients were finally included. Thirty-one patients were classified to Group I and 43 patients were classified to the Group II. Prevalence of POI in all patients with hip fracture was 63.5% (47/74). Prevalence of POI in Group I was statistically significant lower than that in Group II (Group I: 41%, Group II: 79.1%, P = .01)The prevalence of POI in elderly patients with hip fracture was 63.5%. Chewing gum had a significant effect on reduction of POI in elderly patients with hip fractures.


Assuntos
Goma de Mascar , Fraturas do Quadril/cirurgia , Íleus/epidemiologia , Enteropatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Humanos , Íleus/etiologia , Íleus/prevenção & controle , Enteropatias/etiologia , Enteropatias/prevenção & controle , Masculino , Peristaltismo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Prospectivos , Resultado do Tratamento
3.
PLoS One ; 15(8): e0238079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845916

RESUMO

BACKGROUND: Sitosterolemia is an inherited lipid disorder which presents with elevated serum sitosterol and can result in an increased risk of premature cardiovascular disease. However, sitosterol cannot be accurately measured by routine diagnostic assays, meaning that sitosterolemia diagnosis can often be difficult, especially with many clinical features overlapping with familial hypercholesterolemia. With such complications resulting in increasing reports of misdiagnosis, the prevalence of sitosterolemia is predicted to be much higher than previously reported. METHODS: Gas chromatography-mass spectrometry was utilized to measure sitosterol levels of normocholesterolemic and hypercholesterolemic children. Subsequently, an epidemiologically determined cutoff level of sitosterol was calculated and applied to estimate the prevalence of children with increased sitosterol and identify potential sitosterolemia patients. Massively parallel sequencing was used to confirm the diagnosis in suspected patients. RESULTS: Samples from 109 normocholesterolemic and 220 hypercholesterolemic were tested for phytosterols. Sitosterol and campesterol levels were significantly increased in hypercholesterolemic children (mean 22.0±45.9 µmol/L for sitosterol and 26.0±32.8 µmol/L for campesterol) compared to normocholesterolemic children (mean 12.1±4.9 µmol/L for sistosterol and 14.8±6.7 µmol/L for campesterol). Via application of a cutoff of 35.9 µmol/L, the prevalence rates for increased and overtly increased sitosterol in hypercholesterolemic children were 6.4% and 1.4% respectively. Furthermore, 3 suspected sitosterolemia patients were identified, with 2 patients receiving molecular confirmation for sitosterolemia diagnosis. CONCLUSIONS: Our findings reaffirm that the prevalence of sitosterolemia is probably much higher than previously reported, which also indicates the significant risk of misdiagnosis of sitosterolemia with familial hypercholesterolemia. Special lipid testing including sitosterol, especially in children with uncontrolled hypercholesterolemia, is recommended in children in order to identify potential sitosterolemia patients that would otherwise be neglected.


Assuntos
Hipercolesterolemia/diagnóstico , Sitosteroides/análise , Membro 5 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 8 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Adolescente , Criança , Pré-Escolar , Colesterol/análogos & derivados , Colesterol/análise , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Lactente , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/genética , Erros Inatos do Metabolismo Lipídico/diagnóstico , Erros Inatos do Metabolismo Lipídico/epidemiologia , Erros Inatos do Metabolismo Lipídico/genética , Lipoproteínas/genética , Masculino , Linhagem , Fitosteróis/efeitos adversos , Fitosteróis/análise , Fitosteróis/genética , Prevalência
4.
J Laparoendosc Adv Surg Tech A ; 30(9): 1001-1007, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32589496

RESUMO

Introduction: Emergency departments (EDs) during the novel coronavirus disease 2019 (COVID-19) pandemic are perceived as possible sources of infection. The effects of COVID-19 on patients presenting to the hospital with surgical complaints remain uncertain. Methods: A single tertiary center retrospective study analysis compared the ED attendance rate and severity of patients with surgical complaints between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2019 and 2018. Results: Overall, 6,017 patients were included. The mean daily ED visits of patients with nontrauma surgical complaints in the COVID-19 outbreak period declined by 27%-32% (P value <.01) compared with pre-COVID-19 periods. The log number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Israel in March 2020 was negatively correlated with the number of ED visits (Pearson's r = -0.59, P < .01). The proportion of patients requiring hospitalization increased by up to 8% during the outbreak period (P < .01), and there was a higher proportion of tachycardic patients (20% versus 15.5%, P = .01). The percentage of visits to the ED by men declined by 5% (P < .01). The ED diagnosis distribution significantly changed during COVID-19 (P = .013), with an 84% decrease in the number of patients hospitalized for diverticular disease (P < .05). Conclusion: During the COVID-19 outbreak, the overall number of patients presenting at the ED with surgical complaints decreased significantly, and there was a higher admissions ratio. The extent to which the pandemic affects hospital ED attendance can help health care professionals prepare for future such events. ClinicalTrials.gov ID: NCT04338672.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Betacoronavirus , Feminino , Pessoal de Saúde , Hospitalização , Humanos , Enteropatias/epidemiologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores Sexuais , Taquicardia/epidemiologia , Adulto Jovem
5.
Nutr. hosp ; 37(3): 599-608, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193869

RESUMO

INTRODUCCIÓN: la nutrición parenteral domiciliaria (NPD) constituye el tratamiento de elección para pacientes con fallo intestinal que no requieren ingreso hospitalario. En esta revisión sistemática, nuestro objetivo fue realizar un análisis epidemiológico y de práctica clínica en NPD. MÉTODOS: la revisión se realizó siguiendo la guía PRISMA. Para ello, se hizo una búsqueda bibliográfica en PubMed® y EMBASE® de los estudios publicados entre 2009 y 2019 en inglés o español que realizaran el seguimiento de pacientes con NPD durante al menos 5 años. Esta búsqueda se completó manualmente. Se excluyeron los artículos centrados únicamente en pacientes oncológicos, una patología específica o embarazadas o bien en complicaciones. RESULTADOS: se identificaron 267 artículos, de los que cumplieron los criterios 9 (3 de población pediátrica y 6 de adultos). En adultos, la principal diferencia entre los estudios fue la patología de base. La indicación mayoritaria fue el síndrome de intestino corto y la causa de exitus, la enfermedad primaria. La mayor parte de la población pediátrica recibió este apoyo en los primeros meses de vida. Además, destaca el mayor porcentaje de conversión a vía oral y el menor número de fallecimientos frente a población adulta. CONCLUSIONES: la utilización de la NPD en patología oncológica está sometida a una amplia variabilidad geográfica. Sería recomendable establecer directrices de uso en enfermos oncológicos y la realización de estudios de calidad que aporten información rigurosa y homogénea


INTRODUCTION: home parenteral nutrition (HPN) is a fundamental treatment for patients with intestinal failure who do not require hospitalization. We aimed to conduct an epidemiological and clinical practice analysis of HPN through a systematic review. METHODS: the systematic review was conducted according to the PRISMA guidelines. A search was performed using the Healthcare Databases Advanced Search of PubMed® and EMBASE®, to identify articles which followed patients treated with HPN for at least 5 years, published between 2009 and 2019 in English or Spanish language. In addition, we manually retrieved other publications of interest. We excluded articles about subgroups of patients with a specific pathology, cancer or pregnant patients. We excluded studies collecting exclusively HPN complications. RESULTS: a total of 267 references were identified, of which 9 met criteria (3 of pediatric population and 6 of adults). In adults, the main difference found between publications was the underlying pathologies. The most common indication was short bowel syndrome and the main cause of exitus was the underlying pathology. Most of the pediatric patients received this support in the first months of life. In addition, children showed a higher conversion rate to oral intake and a lower number of deaths when compared to adults. CONCLUSIONS: the use of HPN in cancer pathology is subject to wide geographic variability. It would be advisable to establish indication guidelines in patients with cancer and conduct quality studies, which provide rigorous and homogeneous information


Assuntos
Humanos , Masculino , Criança , Adulto , Nutrição Parenteral no Domicílio/métodos , Enteropatias/epidemiologia , Análise de Sobrevida , Nutrição Parenteral no Domicílio/estatística & dados numéricos
6.
Am J Trop Med Hyg ; 103(1): 520-527, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32431271

RESUMO

The microbial communities residing in the child gut are thought to play an important role in child growth, although the relationship is not well understood. We examined a cohort of young children from Mirzapur, Bangladesh, prospectively over 18 months. Four fecal markers of environmental enteropathy (EE) (high levels of alpha-1-antitrypsin, calprotectin, myeloperoxidase, and neopterin) were examined and anthropometric measures obtained from a cohort of 68 children. The 16S rRNA gene of bacterial DNA was sequenced from stool samples and used to estimate amplicon sequence variants (ASVs). We age-matched children with poor growth to children with normal growth within 1 month and compared the change in abundance and diversity of ASVs over time. Elevated EE markers and poor linear growth in children were associated with changes in microbial communities in the gut. There were increased amounts of Escherichia/Shigella and Proteobacteria and decreased amounts of Prevotella associated with poorly growing children consistent with the mounting evidence supporting the relationship between intestinal inflammation, child growth, and changes in gut microbiota composition. Future research is needed to investigate this association among young children in low- and middle-income countries.


Assuntos
Microbioma Gastrointestinal/genética , Transtornos do Crescimento/microbiologia , Enteropatias/metabolismo , Complexo Antígeno L1 Leucocitário/metabolismo , Neopterina/metabolismo , Peroxidase/metabolismo , alfa 1-Antitripsina/metabolismo , Bangladesh/epidemiologia , Biomarcadores , Estudos de Casos e Controles , Pré-Escolar , Escherichia , Fezes/química , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/metabolismo , Humanos , Lactente , Inflamação , Enteropatias/epidemiologia , Masculino , Prevotella , Proteobactérias , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Shigella
7.
J Nutr ; 150(8): 2175-2182, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32455424

RESUMO

BACKGROUND: Environmental enteric dysfunction (EED), characterized by altered intestinal permeability/inflammation, microbial translocation, and systemic inflammation (SI), may be a significant contributor to micronutrient deficiencies and poor growth in infants from low-resource settings. OBJECTIVE: We examined associations among EED, SI, growth, and iron status at 6 mo of age. METHODS: We performed a cross-sectional analysis of 6-mo-old infants (n = 548) enrolled in a Ugandan birth-cohort study (NCT04233944). EED was assessed via serum concentrations of anti-flagellin and anti- LPS immunoglobulins (Igs); SI was assessed via serum concentrations of ɑ1-acid glycoprotein (AGP) and C-reactive protein (CRP); iron status was assessed via serum concentrations of hemoglobin (Hb), soluble transferrin receptor (sTfR), and ferritin. Associations were assessed using adjusted linear regression analysis. RESULTS: At 6 mo, ∼35% of infants were stunted [length-for-age z score (LAZ) < -2] and ∼53% were anemic [hemoglobin (Hb) <11.0 g/dL]. Nearly half (∼46%) had elevated AGP (>1 g/L) and ∼30% had elevated CRP (>5 mg/L). EED and SI biomarkers were significantly correlated (r = 0.142-0.193, P < 0.001 for all). In adjusted linear regression models, which included adjustments for SI, higher anti-flagellin IgA, anti-LPS IgA, and anti-LPS IgG concentrations were each significantly associated with lower LAZ [ß (95% CI): -0.21 (-0.41, 0.00), -0.23 (-0.44, -0.03), and -0.33 (-0.58, -0.09)]. Furthermore, higher anti-flagellin IgA, anti-flagellin IgG, and anti-LPS IgA concentrations were significantly associated with lower Hb [ß (95% CI): -0.24 (-0.45, -0.02), -0.58 (-1.13, 0.00), and -0.26 (-0.51, 0.00)] and higher anti-flagellin IgG and anti-LPS IgG concentrations were significantly associated with higher sTfR [ß (95% CI): 2.31 (0.34, 4.28) and 3.13 (0.75, 5.51)]. CONCLUSIONS: EED is associated with both low LAZ and iron status in 6-mo-old infants. Further research on the mechanisms by which EED affects growth and micronutrient status is warranted.


Assuntos
Anemia Ferropriva/epidemiologia , Anemia Ferropriva/etiologia , Desenvolvimento Infantil , Enteropatias/microbiologia , Enteropatias/patologia , População Rural , Adulto , Estudos de Coortes , Feminino , Microbioma Gastrointestinal , Humanos , Lactente , Inflamação , Enteropatias/epidemiologia , Masculino , Uganda/epidemiologia , Adulto Jovem
8.
Zhonghua Nei Ke Za Zhi ; 59(2): 124-128, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074685

RESUMO

Objective: To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics. Methods: From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People's Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea. Results: The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn's disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05]. Conclusions: Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico , Enteropatias/diagnóstico , Intestino Delgado/patologia , Doença de Crohn/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Enteropatias/epidemiologia , Masculino
9.
J Gastroenterol Hepatol ; 35(8): 1340-1346, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31999379

RESUMO

BACKGROUND AND AIMS: Small intestinal lesions in patients with Behçet disease (BD) have a risk of perforation and hemorrhage requiring surgery. However, no screening strategy for such lesions has been established. We investigated small intestinal lesions in BD patients with video capsule endoscopy (VCE) and analyzed clinical characteristics to identify noninvasive biomarkers of such lesions. METHODS: This study included 33 BD patients who underwent VCE (PillCam® SB3) at our institution from June 2016 to January 2019. Clinical characteristics, including age, sex, disease duration, body mass index, gastrointestinal symptoms, eye involvement, and blood examinations, were obtained from the medical records of 27 of the 33 patients. Fecal immunochemical tests for hemoglobin, fecal calprotectin (FC), and fecal lactoferrin (FL) were measured. VCE findings of 145 healthy Japanese individuals from a previous report were used as controls. RESULTS: Two intestinal BD patients were included in the 27 patients. We observed that BD patients exhibit more small intestinal lesions compared with healthy individuals, including erosions, ulcers, and total lesions (erosions or ulcers). FC and FL levels were significantly higher in patients with versus without small intestinal lesions (P = 0.034 and P = 0.046, respectively). Receiver operating characteristic analyses demonstrated that FC (cutoff value = 119 µg/g) and FL (cutoff value = 17 µg/g) were biomarkers for small intestinal lesions in patients with BD. CONCLUSION: The present study using VCE showed that patients with BD had more small intestinal lesions than healthy individuals. FC and FL could be useful for screening BD patients who may have small intestinal lesions.


Assuntos
Síndrome de Behçet/complicações , Endoscopia por Cápsula , Fezes/química , Enteropatias/diagnóstico , Enteropatias/etiologia , Intestino Delgado , Lactoferrina/análise , Complexo Antígeno L1 Leucocitário/análise , Adolescente , Adulto , Biomarcadores/análise , Feminino , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco , Adulto Jovem
10.
Curr Gastroenterol Rep ; 22(1): 4, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940112

RESUMO

PURPOSE OF REVIEW: Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume. RECENT FINDINGS: CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.


Assuntos
Divertículo/diagnóstico , Enteropatias/diagnóstico , Divertículo/epidemiologia , Divertículo/etiologia , Divertículo/terapia , Humanos , Enteropatias/epidemiologia , Enteropatias/etiologia , Enteropatias/terapia , Intestino Delgado/fisiopatologia
11.
PLoS Negl Trop Dis ; 14(1): e0007975, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31929525

RESUMO

BACKGROUND: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity. METHODS: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype. RESULTS: Eight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet's AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort. CONCLUSIONS: We propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world.


Assuntos
Desenvolvimento Infantil , Meio Ambiente , Transtornos do Crescimento/etiologia , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Biópsia , Criança , Pré-Escolar , Duodeno/patologia , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Enteropatias/complicações , Masculino , América do Norte/epidemiologia , Paquistão/epidemiologia , Zâmbia/epidemiologia
12.
J Minim Invasive Gynecol ; 27(1): 141-147, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30885782

RESUMO

STUDY OBJECTIVE: To examine whether existing quality of health outcome measures can be used to predict or have an association with nonresponse surgery for endometriosis. DESIGN: Retrospective cohort study. SETTINGS: Single endometriosis referral center. PATIENTS: Women (n = 198) undergoing surgery for endometriosis. INTERVENTIONS: Validated health questionnaires and visual analogue scales. MEASUREMENTS AND MAIN RESULTS: Patients were given validated health questionnaires, including Endometriosis Health Profile 30, Gastrointestinal Quality of Life Index, EuroQol-5, Hospital Anxiety and Depression Scale, preoperatively and at 12 months after full surgical excision of endometriosis. Visual analogue scales were also used that measured dyschezia, dysmenorrhea, dyspareunia, and chronic pelvic pain. Surgical management was dependent on severity of disease. Superficial disease was treated by laparoscopic peritoneal excision or laser ablation. Deep infiltrating disease involving the bowel was excised completely together with laparoscopic bowel surgery (shave, disc, or segmental resection) with/without concomitant total hysterectomy and bilateral salpingo-oophorectomy. Nonresponders were defined as women who failed to demonstrate an improvement in pain scores 12 months postoperatively. We examined preoperative and postoperative questionnaires, visual analogue scores, and other variables such as age at onset of symptoms, type of surgery, and the presence of postoperative complications comparing responder and nonresponder women to identify the factors associated with nonresponse. Of 102 women treated for superficial endometriosis, 25 (24.51%) were nonresponders. No factors were associated with nonresponse at 12 months. Of 96 women treated for severe endometriosis involving the bowel, 10 (10.41%) were nonresponders. Nonresponders had significantly less preoperative pain (p = .031) and feeling of control (p = .015) than responders. There was no association between nonresponders and women who underwent a hysterectomy with bilateral salpingo-oophorectomy or those with complications. Radical bowel surgery (resection) was associated with nonresponders. CONCLUSION: Minimal preoperative factors are associated with nonresponse for women having surgery for endometriosis. The severity of pain experienced by women with endometriosis may be used to predict their response to surgery.


Assuntos
Endometriose/cirurgia , Enteropatias/cirurgia , Doenças Peritoneais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Endometriose/epidemiologia , Feminino , Humanos , Enteropatias/epidemiologia , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças Peritoneais/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pré-Operatório , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricos , Falha de Tratamento
13.
PLoS One ; 14(12): e0225800, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800600

RESUMO

Gastrointestinal illnesses are the most frequently diagnosed conditions among returning U.S. travelers. Although most episodes of travelers' diarrhea do not require antibiotic therapy, fluoroquinolones (a type of quinolone antibiotic) are recommended for treatment of moderate and severe travelers' diarrhea as well as many other types of severe infection. To assess associations between quinolone susceptibility and international travel, we linked data about isolate susceptibility in NARMS to cases of enteric infections reported to FoodNet. We categorized isolates as quinolone-nonsusceptible (QNS) if they were resistant or had intermediate susceptibility to ≥1 quinolone. Among 1,726 travel-associated infections reported to FoodNet with antimicrobial susceptibility data in NARMS during 2004-2014, 56% of isolates were quinolone-nonsusceptible, of which most (904/960) were Campylobacter. International travel was associated with >10-fold increased odds of infection with quinolone-nonsusceptible bacteria. Most QNS infections were associated with travel to Latin America and the Caribbean (390/743; 52%); however, the greatest risk of QNS infection was associated with travel to Africa (120 per 1,000,000 passenger journeys). Preventing acquisition and onward transmission of antimicrobial-resistant enteric infections among travelers is critical.


Assuntos
Resistência Microbiana a Medicamentos , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/microbiologia , Enteropatias/epidemiologia , Enteropatias/microbiologia , Quinolonas/farmacologia , Doença Relacionada a Viagens , Viagem , Doenças Transmitidas por Alimentos/tratamento farmacológico , Doenças Transmitidas por Alimentos/história , História do Século XXI , Humanos , Enteropatias/tratamento farmacológico , Enteropatias/história , Razão de Chances , Vigilância da População , Estados Unidos/epidemiologia
14.
Future Oncol ; 15(35): 4105-4118, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31746639

RESUMO

Aim: To systematically review the prophylactic and therapeutic interventions for reducing the incidence or severity of intestinal symptoms among cancer patients receiving radiotherapy. Materials & methods: A literature search was conducted in the PubMed database using various search terms, including 'radiation enteritis', 'radiation enteropathy', 'radiation-induced intestinal disease', 'radiation-induced intestinal damage' and 'radiation mucositis'. The search was limited to in vivo studies, clinical trials and meta-analyses published in English with no limitation on publication date. Other relevant literature was identified based on the reference lists of selected studies. Results: The pathogenesis of acute and chronic radiation-induced intestinal damage as well as the prevention and treatment approaches were reviewed. Conclusion: There is inadequate evidence to strongly support the use of a particular strategy to reduce radiation-induced intestinal damage. More high-quality randomized controlled trials are required for interventions with limited evidence suggestive of potential benefits.


Assuntos
Enteropatias/etiologia , Neoplasias/complicações , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Animais , Modelos Animais de Doenças , Humanos , Incidência , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/prevenção & controle , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Mucosa Intestinal/efeitos da radiação , Neoplasias/epidemiologia , Neoplasias/radioterapia , Lesões por Radiação/diagnóstico , Lesões por Radiação/epidemiologia , Lesões por Radiação/prevenção & controle , Radioterapia/métodos , Índice de Gravidade de Doença , Células-Tronco/metabolismo , Células-Tronco/efeitos da radiação
15.
Medicine (Baltimore) ; 98(44): e17783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689848

RESUMO

RATIONALE: Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS: During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES: Tube feeding associated postoperative intussusceptions. INTERVENTIONS: 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES: None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS: In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Nutrição Enteral/efeitos adversos , Enteropatias/epidemiologia , Intussuscepção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Enteropatias/etiologia , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prevalência , Estudos Retrospectivos
16.
J Nepal Health Res Counc ; 17(3): 262-267, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31735933

RESUMO

BACKGROUND: Colorectal malignancy is a very common disease of the gastrointestinal tract. Surgery following neoadjuvant chemoradiotherapy has been found to improve the survival of the patients with colorectal carcinoma. Research on bowel, bladder and sexual dysfunction following colorectal surgery remains limited in Nepal. The aim of this study is to evaluate the incidence of the bowel, bladder, and sexual dysfunction after colorectal surgery. METHODS: It is a cross-sectional study carried out at National Academy of Medical Science, Bir hospital. Patients who underwent low anterior resection and abdominoperineal resection with curative intention post neoadjuvant chemoradiotherapy were included in the study. RESULTS: A total of 26 patients [20 (76.9%) males and 6 (23.1%) females] who underwent surgery for the colorectal malignant disease were included. 24 (92.30%) underwent low anterior resection and 2(7.6%) patient underwent abdominoperineal resection respectively after neoadjuvant chemo radiotherapy. 19(79.16%) of the patients developed bowel dysfunction with mean low anterior resections score of 22.88±4.394. And 5(20.83%) had normal bowel function. Bladder dysfunction was seen in 3 (11.5%) patients. And rest of the 23 (88.5%) patient had normal bladder function. In males, Sexual Dysfunction was observed in 11 (42.3%)and no sexual dysfunction was observed in 15(57.69%). While in females, 38.46% had no sexual desire and 50% had dyspareunia due to vaginal dryness. CONCLUSIONS: This study clearly demonstrated a higher incidence of bowel and sexual dysfunction compared to bladder dysfunction following low anterior resection and abdominoperineal resection for colorectal malignant diseases.


Assuntos
Neoplasias Colorretais/cirurgia , Enteropatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Doenças da Bexiga Urinária/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Enteropatias/etiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Complicações Pós-Operatórias/etiologia , Disfunções Sexuais Fisiológicas/etiologia , Doenças da Bexiga Urinária/etiologia
17.
Semin Immunopathol ; 41(6): 655-664, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31673757

RESUMO

Allogeneic transplantation of hematopoietic stem cells (allo-HCT) represents an increasingly employed therapeutic approach to potentially cure patients suffering from life-threatening malignant and autoimmune disorders. Despite its lifesaving potential, immune-mediated allo-reactivity inherent to the allogeneic transplantation can be observed within up to 50% of all allo-HCT patients regularly resulting in the manifestation of acute and/or chronic graft-versus-host disease (GvHD). Mechanistically, especially donor T cells are assumed to chiefly drive inflammation that can occur in virtually all organs, with the skin, liver, and gut representing as the most frequently affected anatomic sites. Especially in the presence of intestinal manifestations of GvHD, the risk that the disease takes a life-threatening, potentially fatal course is significantly increased. In the light of a rapid gain of knowledge in respect to decode innate and adaptive immunity related mechanisms as, e.g., cytokine networks, intracellular signaling pathways or environmental triggers as, e.g., the intestinal microbiota and the development of novel therapeutic approaches, detailed insight into endogenous mechanisms seeking to counterbalance the proinflammatory machinery or to proactively foster signals promoting the resolution of allo-driven intestinal inflammation is emerging. Here, we seek to highlight the key aspects of those mechanisms involved in and contributing to the resolution of GvHD-associated intestinal inflammation. Concomitantly, we would like to briefly outline and discuss promising future experimental targets suitable to be therapeutically employed to directionally deflect the tissue response from a proinflammatory to an inflammation-resolving type of intestinal GvHD after allo-HCT.


Assuntos
Doença Enxerto-Hospedeiro/etiologia , Enteropatias/etiologia , Doença Aguda , Animais , Gerenciamento Clínico , Suscetibilidade a Doenças , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Homeostase , Humanos , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/terapia
18.
Chin Med J (Engl) ; 132(20): 2423-2429, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31651515

RESUMO

BACKGROUND: Crohn disease is a chronic bowel disease that causes serious complications. Prevalence of Crohn disease is increasing. Studies have shown that the behavior of the disease is not stable and severe complications secondary to behavior change over time have been shown. In this study, we aimed to evaluate the prognostic risk factors associated with phenotypic change in Crohn disease in a Turkish patient cohort. METHODS: Patients followed up from March 1986 to August 2011 were evaluated for demographic and clinical characteristics to determine possible risk factors and initial clinical phenotype of the disease based on the Montreal classification. The cumulative probabilities of developing stricturing or penetrating intestinal complications were estimated using the Kaplan-Meier analysis. Univariate and multivariate Cox-proportional hazard models were used to assess associations between baseline clinical characteristics and intestinal complications. RESULTS: Three hundred and thirty patients (mean age, 30.6 ±â€Š11.1 years; 148 female) were included in the study. Mean follow-up duration was 7.4 ±â€Š5.3 years (range: 1.0-25.0 years). At baseline 273 patients had inflammatory-type disease, 57 patients experienced stricturing/penetrating intestinal complications before or at the time of diagnosis. The cumulative probability of developing complicated disease was 37.4% at 5 years, 54.3% at 10 years, 78.8% at 25 years. Independent predictors associated with progression to intestinal complications were current smoking, perianal disease, extra-intestinal manifestations, and location of disease. CONCLUSIONS: Location of disease is the most powerful indicator for the development of stenosis and penetrating complications in inflammatory-type disease. Patients with ileal involvement should be considered for more aggressive immunosuppressive therapy.


Assuntos
Doença de Crohn/complicações , Enteropatias/etiologia , Adolescente , Adulto , Doença de Crohn/mortalidade , Progressão da Doença , Feminino , Humanos , Enteropatias/epidemiologia , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco , Adulto Jovem
19.
Am J Trop Med Hyg ; 101(5): 1009-1017, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31482782

RESUMO

Stunting, defined as height-for-age Z score equal to or lower than -2, is associated with increased childhood mortality, cognitive impairment, and chronic diseases. The aim of the study was to investigate the relationship between linear growth, intestinal damage, and systemic inflammation in infants at risk of stunting. We followed up 78 infants aged 5-12 months living in rural areas of Peru for 6 months. Blood samples for biomarkers of intestinal damage (intestinal fatty-acid-binding protein [I-FABP] and zonulin) and systemic inflammation (interleukin-1ß, interleukin-6, tumor necrosis factor α [TNF-α], soluble CD14, and lipopolysaccharide-binding protein [LBP]) and fecal samples for microbiome analysis were collected at baseline and closure of the study. The children's growth and health status were monitored through biweekly home visits by trained staff. Twenty-one percent of the children became stunted: compared with non-stunted children, they had worse nutritional parameters and higher levels of serum I-FABP at baseline. The likelihood of becoming stunted was strongly associated with an increase in sCD14 over time; LBP and TNF-α showed a trend toward increase in stunted children but not in controls. The fecal microbiota composition of stunted children had an increased beta diversity compared with that of healthy controls throughout the study. The relative abundance of Ruminococcus 1 and 2, Clostridium sensu stricto, and Collinsella increased in children becoming stunted but not in controls, whereas Providencia abundance decreased. In conclusion, stunting in our population was preceded by an increase in markers of enterocyte turnover and differences in the fecal microbiota and was associated with increasing levels of systemic inflammation markers.


Assuntos
Microbioma Gastrointestinal , Transtornos do Crescimento/etiologia , Enteropatias/patologia , Mucosa Intestinal/patologia , Desenvolvimento Infantil , Estudos de Coortes , Citocinas/genética , Citocinas/metabolismo , Fezes/microbiologia , Feminino , Regulação da Expressão Gênica , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Enteropatias/epidemiologia , Masculino , Estado Nutricional , Peru , Projetos Piloto
20.
BMC Infect Dis ; 19(1): 766, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477044

RESUMO

BACKGROUND: Intestinal infectious diseases (IIDs) have caused numerous deaths worldwide, particularly among children. In China, eight IIDs are listed as notifiable infectious diseases, including cholera, poliomyelitis, dysentery, typhoid and paratyphoid (TAP), viral Hepatitis A, viral Hepatitis E, hand-foot-mouth disease (HFMD) and other infectious diarrhoeal diseases (OIDDs). The aim of the study is to analyse the spatio-temporal distribution of IIDs from 2006 to 2016. METHODS: Data on the incidence of IIDs from 2006 to 2016 were collected from the public health science data centre issued by the Chinese Center for Disease Control and Prevention. This study applied seasonal decomposition analysis, spatial autocorrelation analysis and space-time scan analysis. Plots and maps were constructed to visualize the spatio-temporal distribution of IIDs. RESULTS: Regarding temporal analysis, the incidence of HFMD and Hepatitis E showed a distinct increasing trend, while the incidence of TAP, dysentery, and Hepatitis A presented decreasing trends over the last decade. The incidence of OIID remained steady. Summer is the season with the greatest number of cases of different IIDs. Regarding the spatial distribution, approximately all p values for the global Moran's I from 2006 to 2016 were less than 0.05, indicating that the incidences of the epidemics were unevenly distributed throughout the country. The high-risk areas for HFMD and OIDD were located in the Beijing-Tianjin-Tangshan (BTT) region and south China. The high-risk areas for TAP were located in some parts of southwest China. A higher incidence rates for dysentery and Hepatitis A were observed in the BTT region and some west provincial units. The high-risk areas for Hepatitis E were the BTT region and the Yangtze River Delta area. CONCLUSIONS: Based on our temporal and spatial analysis of IIDs, we identified the high-risk periods and clusters of regions for the diseases. HFMD and OIDD exhibited high incidence rates, which reflected the negligence of Class C diseases by the government. At the same time, the incidence rate of Hepatitis E gradually surpassed Hepatitis A. The authorities should pay more attention to Class C diseases and Hepatitis E. Regardless of the various distribution patterns of IIDs, disease-specific, location-specific, and disease-combined interventions should be established.


Assuntos
Doenças Transmissíveis/epidemiologia , Enteropatias/epidemiologia , Infecções Intra-Abdominais/epidemiologia , Adulto , Criança , China/epidemiologia , Disenteria/epidemiologia , Epidemias , Doença de Mão, Pé e Boca/epidemiologia , Hepatite E/epidemiologia , Humanos , Incidência , Prevalência , Estações do Ano , Análise Espacial , Análise Espaço-Temporal
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