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1.
Pediatr Clin North Am ; 68(6): 1147-1155, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34736581

RESUMO

Social determinants of health (SDH) as outlined by Healthy People 2020 encompasses 5 key domains: economic, education, social and community context, health and health care, and neighborhood and built environment. This article emphasizes pediatric populations and some of the existing SDH and health care disparities seen in pediatric gastroenterology. We specifically review inflammatory bowel disease, endoscopy, bariatric surgery, and liver transplantation. We also examine the burgeoning role of telehealth that has become commonplace since the coronavirus disease 2019 era.


Assuntos
Proteção da Criança/estatística & dados numéricos , Gastroenterologia/organização & administração , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde , Criança , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Fatores Socioeconômicos , Estados Unidos
2.
Pediatr Clin North Am ; 68(6): 1157-1169, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34736582

RESUMO

Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.


Assuntos
COVID-19/epidemiologia , Proteção da Criança/estatística & dados numéricos , Gastroenterologia/organização & administração , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde , Criança , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Fatores Socioeconômicos , Estados Unidos
3.
World J Gastroenterol ; 27(40): 6794-6824, 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34790008

RESUMO

The development of artificial intelligence (AI) has increased dramatically in the last 20 years, with clinical applications progressively being explored for most of the medical specialties. The field of gastroenterology and hepatology, substantially reliant on vast amounts of imaging studies, is not an exception. The clinical applications of AI systems in this field include the identification of premalignant or malignant lesions (e.g., identification of dysplasia or esophageal adenocarcinoma in Barrett's esophagus, pancreatic malignancies), detection of lesions (e.g., polyp identification and classification, small-bowel bleeding lesion on capsule endoscopy, pancreatic cystic lesions), development of objective scoring systems for risk stratification, predicting disease prognosis or treatment response [e.g., determining survival in patients post-resection of hepatocellular carcinoma), determining which patients with inflammatory bowel disease (IBD) will benefit from biologic therapy], or evaluation of metrics such as bowel preparation score or quality of endoscopic examination. The objective of this comprehensive review is to analyze the available AI-related studies pertaining to the entirety of the gastrointestinal tract, including the upper, middle and lower tracts; IBD; the hepatobiliary system; and the pancreas, discussing the findings and clinical applications, as well as outlining the current limitations and future directions in this field.


Assuntos
Esôfago de Barrett , Gastroenterologia , Inteligência Artificial , Diagnóstico por Imagem , Endoscopia , Humanos
5.
World J Gastroenterol ; 27(37): 6191-6223, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34712027

RESUMO

Artificial intelligence (AI) is an umbrella term used to describe a cluster of interrelated fields. Machine learning (ML) refers to a model that learns from past data to predict future data. Medicine and particularly gastroenterology and hepatology, are data-rich fields with extensive data repositories, and therefore fruitful ground for AI/ML-based software applications. In this study, we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application. Specifically, we refer to the applications of AI/ML-based models in prevention, diagnosis, management, and prognosis of gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal premalignant and malignant lesions, other nonmalignant gastrointestinal lesions and diseases, hepatitis B and C infection, chronic liver diseases, hepatocellular carcinoma, cholangiocarcinoma, and primary sclerosing cholangitis. At the same time, we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them. Notably, we elaborate on the concerns regarding intrinsic biases, data protection, cybersecurity, intellectual property, liability, ethical challenges, and transparency. Even at a slower pace than anticipated, AI is infiltrating the healthcare industry. AI in healthcare will become a reality, and every physician will have to engage with it by necessity.


Assuntos
Gastroenterologia , Hepatopatias , Inteligência Artificial , Humanos , Aprendizado de Máquina , Prognóstico
6.
J Clin Gastroenterol ; 55(10): 823-829, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34617932

RESUMO

Climate change has been described as the greatest public health threat of the 21st century. It has significant implications for digestive health. A multinational team with representation from all continents, excluding Antarctica and covering 18 countries, has formulated a commentary which outlines both the implications for digestive health and ways in which this challenge can be faced.


Assuntos
Mudança Climática , Gastroenterologia , Humanos
7.
Acta Gastroenterol Belg ; 84(3): 443-450, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34599569

RESUMO

Background and study aims: The international consensus Fukuoka guideline (Fukuoka ICG), The European evidence-based guideline on pancreatic cystic neoplasms (European EBG) and the American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts (AGA IG) are 3 frequently cited guidelines for the risk stratification of neoplastic pancreatic cysts. The aim of this study was to assess the accuracy of detecting malignant cysts by strictly applying these guidelines retrospectively to a cohort of surgically resected pancreatic cysts. Patients and methods: 72 resected cysts were included in the analysis. Invasive carcinoma, high grade dysplasia and neuro-endocrine tumour were considered as "malignant cysts" for the purpose of the study. Results: 32% of the resected cysts were malignant. The analysis showed that the Fukuoka ICG, European EBG and AGA IG had a sensitivity of 66,8%, 95,5%, 80%; a specificity of 26,8%, 11,3%, 43,8%; a positive predictive value of 31,8%, 35%, 47,1% and a negative predicted value of 61,1%, 83,3%, 77,8% respectively. The missed malignancy rate was respectively 11,3%, 1,5%, 7,7% and surgical overtreatment was respectively 48,4%, 59,1%, 34,6%. Conclusion: In this retrospective analysis, the European EBG had the lowest rate of missed malignancy at the expense of a high number of "unnecessary" resections. The Fukuoka ICG had the highest number of missed malignancy. The AGA IG showed the lowest rate of unnecessary surgery at the cost of a high number of missed malignancy. There is need to develop better biomarkers to predict the risk of malignancy.


Assuntos
Carcinoma , Gastroenterologia , Cisto Pancreático , Neoplasias Pancreáticas , Humanos , Cisto Pancreático/diagnóstico , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos
8.
Am J Gastroenterol ; 116(10): 1969, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618694
9.
Sci Rep ; 11(1): 20987, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697319

RESUMO

Acid suppressants are widely-used classes of medications linked to increased risks of aerodigestive infections. Prior studies of these medications as potentially reversible risk factors for COVID-19 have been conflicting. We aimed to determine the impact of chronic acid suppression use on COVID-19 infection risk while simultaneously evaluating the influence of social determinants of health to validate known and discover novel risk factors. We assessed the association of chronic acid suppression with incident COVID-19 in a 1:1 case-control study of 900 patients tested across three academic medical centers in California, USA. Medical comorbidities and history of chronic acid suppression use were manually extracted from health records by physicians following a pre-specified protocol. Socio-behavioral factors by geomapping publicly-available data to patient zip codes were incorporated. We identified no evidence to support an association between chronic acid suppression and COVID-19 (adjusted odds ratio 1.04, 95% CI 0.92-1.17, P = 0.515). However, several medical and social features were positive (Latinx ethnicity, BMI ≥ 30, dementia, public transportation use, month of the pandemic) and negative (female sex, concurrent solid tumor, alcohol use disorder) predictors of new infection. These findings demonstrate the value of integrating publicly-available databases with medical data to identify critical features of communicable diseases.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Refluxo Gastroesofágico/complicações , Determinantes Sociais da Saúde , Idoso , Comportamento , COVID-19/psicologia , California , Estudos de Casos e Controles , Biologia Computacional/métodos , Bases de Dados Factuais , Feminino , Gastroenterologia , Refluxo Gastroesofágico/tratamento farmacológico , Geografia , Antagonistas dos Receptores H2 da Histamina/farmacologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Inibidores da Bomba de Prótons/farmacologia , Fatores de Risco , Classe Social
11.
Hepatol Commun ; 5(10): 1791-1800, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34558861

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic created a crisis that disproportionately affected populations already disadvantaged with respect to access to health care systems and adequate medical care and treatments. Understanding how and where health care disparities are most widespread is an important starting point for exploring opportunities to mitigate such disparities, especially within our patient population with liver disease. In a webinar in LiverLearning, we discussed the impact of the pandemic on the United States, United Kingdom and Canada, highlighting the disproportionate effects on infection rates and death for certain ethnic minorities, those socioeconomically disadvantaged and living in higher density areas, and those working in health care and other essential jobs. We set forth a "call to action" for members of the American Association for the Study of Liver Diseases and the larger community of providers of liver disease care to generate viable solutions to improve access to care and vaccination rates of our patients against COVID-19, and in general help reduce health care disparities and improve the health of disadvantaged populations within their communities. Solutions will likely involve personalized interventions and messaging for communities that honor local leaders and embrace the diverse needs and different cultural sensitivities of our unique patient populations.


Assuntos
COVID-19/epidemiologia , Grupos Étnicos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Grupos Minoritários , Fatores Socioeconômicos , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Canadá/epidemiologia , Gastroenterologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Hepatopatias , SARS-CoV-2 , Classe Social , Determinantes Sociais da Saúde , Medicina Estatal , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Cobertura Vacinal
12.
13.
Rev Gastroenterol Mex (Engl Ed) ; 86(4): 328-334, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34518143

RESUMO

INTRODUCTION AND AIMS: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005-2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.


Assuntos
Colite Ulcerativa , Doença de Crohn , Gastroenterologia , Doenças Inflamatórias Intestinais , Criança , Colite Ulcerativa/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , América Latina/epidemiologia
14.
Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34518939

RESUMO

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Economia Hospitalar/organização & administração , Gastroenterologia/educação , Administração Hospitalar/métodos , SARS-CoV-2 , Cidades/economia , Cidades/epidemiologia , Educação de Pós-Graduação em Medicina/organização & administração , Gastroenterologia/economia , Administração Hospitalar/economia , Humanos , Internato e Residência , Michigan/epidemiologia , Afiliação Institucional/economia , Afiliação Institucional/organização & administração , Estudos Prospectivos , Faculdades de Medicina/organização & administração
15.
Ann Agric Environ Med ; 28(3): 367-371, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34558255

RESUMO

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophins group which plays a crucial role in brain development and neurogenesis. In the hypothalamus it is described as playing a role in energy metabolism and feeding behaviour. The hippocampal concentration of BDNF is believed to play an important role in learning and memory, it has a protective role in neurodegeneration and stress responses. BDNF is also known to take part in many other processes, e.g. angiogenesis, proliferation, cell migration and apoptosis. With its receptor TrkB, neurotrophins are important agents that playa role in neural diseases, as well as in cardiovascular and metabolic disorders, such as diabetes mellitus or acute coronary syndrome. Over the last few years, BDNF interaction with TrkB has also been found to be involved in cancer development, including brain, breast, urinary and gastrointestinal cancer. TrkB expression itself has been described as an aggressive neural tumour. BDNF/TrkB signalling takes part in promoting tumour growth and metastasis. The presented review focuses on gastrointestinal cancer and presents the current literature concerning influence of BDNF and TrkB receptor in cancer progression. Special attention is also paid to data confirming the possible role of BDNF/TrkB interaction in chemotherapy resistance. This might present the opportunity to assess the BDNF and TrkB pathway as a possible novel target for anticancer therapies.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/metabolismo , Neoplasias Gastrointestinais/metabolismo , Animais , Fator Neurotrófico Derivado do Encéfalo/genética , Gastroenterologia , Neoplasias Gastrointestinais/genética , Humanos , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/metabolismo , Receptor trkB/genética , Receptor trkB/metabolismo
17.
J Popul Ther Clin Pharmacol ; 28(1): 46-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34533903

RESUMO

INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory disorder that may involve any part of the alimentary tract from mouth to anus and is characterized by periods of clinical remission alternating with periods of recurrence. Current clinical and endoscopic indices only measure disease activity at a specific time point. The recently published Lémann index (LI) is the first tool that aims to measure cumulative structural bowel damage and thus evaluates long-term disability. AIM OF STUDY: To measure the LI at initial presentation of CD in a sample of Iraqi patients attending the gastroenterology and hepatology teaching hospital (Baghdad). PATIENTS AND METHODS: This is a descriptive single-center study conducted in gastroenterology and hepatology teaching hospital and enrolled 30 patients with CD diagnosed from 2013 to 2015. They all underwent complete physical examination, abdominopelvic CT scan, upper endoscopy, and colonoscopy upon diagnosis for the purpose of assessing bowel damage by the LI. RESULTS: For the 30 patients included, median LI was 1.3 (range 0.2-12.6). CONCLUSIONS: The LI is now available and it enables, for the first time, assessment of bowel damage in CD.


Assuntos
Doença de Crohn , Gastroenterologia , Doença de Crohn/diagnóstico , Hospitais de Ensino , Humanos , Intestinos , Índice de Gravidade de Doença
19.
World J Gastroenterol ; 27(32): 5351-5361, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34539137

RESUMO

The close relationship of medicine with technology and the particular interest in this symbiosis in recent years has led to the development of several computed artificial intelligence (AI) systems aimed at various areas of medicine. A number of studies have demonstrated that those systems allow accurate diagnoses with histological precision, thus facilitating decision-making by clinicians in real time. In the field of gastroenterology, AI has been applied in the diagnosis of pathologies of the entire digestive tract and their attached glands, and are increasingly accepted for the detection of colorectal polyps and confirming their histological classification. Studies have shown high accuracy, sensitivity, and specificity in relation to expert endoscopists, and mainly in relation to those with less experience. Other applications that are increasingly studied and with very promising results are the investigation of dysplasia in patients with Barrett's esophagus and the endoscopic and histological assessment of colon inflammation in patients with ulcerative colitis. In some cases AI is thus better than or at least equal to human abilities. However, additional studies are needed to reinforce the existing data, and mainly to determine the applicability of this technology in other indications. This review summarizes the state of the art of AI in gastroenterological pathology.


Assuntos
Esôfago de Barrett , Gastroenterologia , Inteligência Artificial , Endoscopia Gastrointestinal , Humanos
20.
Rev Soc Bras Med Trop ; 54: e08072020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495262

RESUMO

INTRODUCTION: Hepatitis B virus (HBV) infection is a public health problem; therefore, we aimed to report HBV genotypes in Ceará, Brazil. METHODS: A total of 103 HBsAg-positive samples were subjected to HBV genotyping and subgenotyping. RESULTS: The following genetic compositions of samples were found: F-54% (F2-83.33%), A-40% (A1-65%), D-6%, C2-1%, E-1%, and G-1%. CONCLUSIONS: Some genotypes are only prevalent in certain parts of the world; however, the State of Ceará is a hub for migration and has one of the most important liver transplantation centers in Brazil, which can explain the prevalence of the F genotype.


Assuntos
Gastroenterologia , Hepatite B , Brasil/epidemiologia , DNA Viral/genética , Genótipo , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B/genética , Humanos , Prevalência
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