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1.
Nutr Hosp ; 34(3): 622-630, 2020 Jul 13.
Artigo em Espanhol | MEDLINE | ID: mdl-32603180

RESUMO

Introduction: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/dietoterapia , Cuidados Críticos/métodos , Estado Terminal , Desnutrição/dietoterapia , Pandemias , Pneumonia Viral/dietoterapia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Proteínas na Dieta/administração & dosagem , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Gastroenteropatias/complicações , Humanos , Inflamação/epidemiologia , Inflamação/fisiopatologia , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/prevenção & controle , Metanálise como Assunto , Micronutrientes/administração & dosagem , Avaliação Nutricional , Necessidades Nutricionais , Apoio Nutricional , Obesidade/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Síndrome da Realimentação/prevenção & controle , Respiração Artificial , Sarcopenia/epidemiologia
2.
Indian Pediatr ; 57(6): 533-535, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32562397

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), though primarily a respiratory pathogen, also involves the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2) co-express in the gastrointestinal tract, which facilitates viral entry into the tissue. Less than 10% of children with infection develop diarrhea and vomiting. Prolonged RT PCR positivity in the stool has raised the possibility of feco-oral transmission. Elevated transaminases are common, especially in those with severe coronavirus disease (COVID-19). Children with inflammatory bowel disease and post liver transplant patients do not have an increased risk of disease, and should remain on medications they are already on. Children with chronic liver disease should continue their medications as usual. All elective procedures like endoscopy should be postponed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenteropatias/complicações , Gastroenteropatias/virologia , Trato Gastrointestinal/virologia , Pneumonia Viral/complicações , Criança , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Gastroenteropatias/terapia , Trato Gastrointestinal/fisiopatologia , Humanos , Hepatopatias/complicações , Hepatopatias/terapia , Hepatopatias/virologia , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
3.
Medicine (Baltimore) ; 99(19): e20098, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384482

RESUMO

Bacillus coagulans (PROBACI) bacteria have been examined for efficacy against infectious or inflammatory bowel diseases. The aim of this observational and cross-sectional study was to evaluate the effects of PROBACI against various functional bowel symptoms.Thirty-eight enrolled patients (36.5 ±â€Š12.6 years) with functional bowel disorders in a gastrointestinal clinic were administered PROBACI (300-mg formulation containing 1 × 10 colony-forming units of B coagulans) twice/day over a 4-week period. Abdominal pain, abdominal distention, and global assessment were evaluated using a 5-point visual analog scale. The defecation characteristics, discomfort level, and effort required for defecation were recorded. The gut-microbiota composition in terms of the Firmicutes/Bacteroidetes ratio was analyzed by 16S-ribosomal RNA gene sequencing with stool samples at days 0, 14, and 28 post-treatment.The 38 patients achieved significant improvements in abdominal pain (2.8 ±â€Š0.5 to 3.3 ±â€Š0.7, P = .0009), abdominal distention (2.5 ±â€Š0.7 to 3.2 ±â€Š0.8, P = .0002), and global assessment (2.7 ±â€Š0.6 to 3.6 ±â€Š0.7, P = .0001) from days 0 to 14. Compared with the diarrhea group, the constipation group achieved greater improvements in terms of discomfort during defecation (2.5 ±â€Š0.7 to 3.1 ±â€Š0.7, P = .02) and normalization of defecation style (50% vs 7.1%, P = .007) by day 28. A difference was observed in the Firmicutes/Bacteroidetes ratio between the constipation-dominant group (118.0) and diarrhea-dominant group (319.2), but this difference was not significant.PROBACI provided control of abdominal pain, less discomfort during defecation, and a more normalized defecation style, especially in the constipation-dominant group.


Assuntos
Bacillus coagulans , Terapia Biológica/métodos , Constipação Intestinal/terapia , Adulto , Constipação Intestinal/etiologia , Estudos Transversais , Feminino , Gastroenteropatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Arab J Gastroenterol ; 21(1): 3-8, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32253172

RESUMO

Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), has posed a serious threat to global health and is currently causing a major pandemic. While patients typically present with fever and a respiratory illness, mounting evidence indicates that patients might also report extra-pulmonary manifestations, including those affecting the liver and gastrointestinal tract. This involvement may have important implications to the disease management, transmission, and prognosis, especially in patients with pre-existing hepatic or digestive co-morbidities. In this review, the characteristics and possible explanations of hepatic and gastrointestinal involvement caused by SARS-CoV-2 infection are summarized, adding to our knowledge of the spectrum of COVID-19. In addition, preventive measures implemented in endoscopy departments to prevent further dissemination of SARS-CoV-2 infection are proposed.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Gastroenteropatias , Hepatopatias , Pandemias , Pneumonia Viral , Animais , Infecções por Coronavirus/complicações , Gastroenteropatias/complicações , Humanos , Hepatopatias/complicações , Pneumonia Viral/complicações , Fatores de Risco
5.
Rev Med Suisse ; 16(N° 691-2): 845-848, 2020 Apr 29.
Artigo em Francês | MEDLINE | ID: mdl-32348050

RESUMO

The current epidemic of SARS-CoV-2 infection poses new challenges in the management of patients with gastrointestinal or liver disease. Consultations with patients with chronic diseases should ideally be done via telemedicine and treatments administered at home if possible. The latter should be maintained in non-infected subjects to limit the risk of decompensation of their underlying disease. In the event of proven infection, immunomodulatory or biological treatments will tend to be reduced or discontinued unless the disease is in a severely active phase. Elective endoscopy should be postponed, and urgent procedures should be performed with appropriate personal protective equipment.


Assuntos
Infecções por Coronavirus , Gastroenteropatias , Hepatopatias , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Procedimentos Cirúrgicos Eletivos , Gastroenteropatias/complicações , Gastroenteropatias/terapia , Humanos , Hepatopatias/complicações , Hepatopatias/terapia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(1): 47-54, 2020 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-32131939

RESUMO

Objective To investigate the application of Acute Gastrointestinal Injury(AGI) grading in evaluating gastrointestinal failure in patients with acute pancreatitis(AP). Methods In this retrospective observational study,patients presented with moderate severe AP and severe AP in our hospital from October 2013 to October 2016 were consecutively enrolled.Logistic regression analysis and receiver operating characteristic curve were used to explore and evaluate potential predictors of gastrointestinal failure. Results A total of 202 patients were included in this study,with 90 cases(44.6%) identified as gastrointestinal failure.Survival curve showed significantly increased risk of death in patients with gastrointestinal failure(P < 0.05).Logistic regression analysis showed age(OR=1.06,95%CI:1.03-1.09,P<0.001),complaint of stopping flatus and defecation(OR=7.02,95%CI:2.08-23.66,P=0.002),increased counts of white blood cells in peripheral blood(OR=1.09,95%CI:1.02-1.17,P=0.015),decreased level of serum albumin(OR=0.93,95%CI:0.86-1.00,P=0.048),and increased level of serum creatinine at admission(OR=1.02,95%CI:1.01-1.04,P=0.001) were the independent risk factors of gastrointestinal failure.The area under curves of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Beside Index for Severity in Acute Pancreatitis (BISAP) scores in diagnosing gastrointestinal failure were 0.999 and 0.782,respectively. Conclusions Gastrointestinal failure can remarkably increase the risk of death in patients with AP.Both APACHE Ⅱ and BISAP scores at admission are useful in diagnosing gastrointestinal failure in patients with AP.


Assuntos
Gastroenteropatias/diagnóstico , Pancreatite/complicações , APACHE , Doença Aguda , Área Sob a Curva , Diagnóstico Precoce , Gastroenteropatias/complicações , Humanos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
J Headache Pain ; 21(1): 15, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054443

RESUMO

The terminology "gut-brain axis "points out a bidirectional relationship between the GI system and the central nervous system (CNS). To date, several researches have shown that migraine is associated with some gastrointestinal (GI) disorders such as Helicobacter pylori (HP) infection, irritable bowel syndrome (IBS), and celiac disease (CD). The present review article aims to discuss the direct and indirect evidence suggesting relationships between migraine and the gut-brain axis. However, the mechanisms explaining how the gut and the brain may interact in patients with migraine are not entirely clear. Studies suggest that this interaction seems to be influenced by multiple factors such as inflammatory mediators (IL-1ß, IL-6, IL-8, and TNF-α), gut microbiota profile, neuropeptides and serotonin pathway, stress hormones and nutritional substances. Neuropeptides including CGRP, SP, VIP, NPY are thought to have antimicrobial impact on a variety of the gut bacterial strains and thus speculated to be involved in the bidirectional relationship between the gut and the brain. According to the current knowledge, migraine headache in patients harboring HP might be improved following the bacteria eradication. Migraineurs with long headache history and high headache frequency have a higher chance of being diagnosed with IBS. IBS and migraine share some similarities and can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status. Migraine has been also associated with CD and the condition should be searched particularly in patients with migraine with occipital and parieto-occipital calcification at brain neuroimaging. In those patients, gluten-free diet can also be effective in reducing migraine frequency. It has also been proposed that migraine may be improved by dietary approaches with beneficial effects on gut microbiota and gut-brain axis including appropriate consumption of fiber per day, adhering to a low glycemic index diet, supplementation with vitamin D, omega-3 and probiotics as well as weight loss dietary plans for overweight and obese patients.


Assuntos
Gastroenteropatias/complicações , Trato Gastrointestinal/fisiopatologia , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/fisiopatologia , Encéfalo , Microbioma Gastrointestinal , Trato Gastrointestinal/microbiologia , Humanos , Síndrome do Intestino Irritável/complicações , Transtornos de Enxaqueca/microbiologia , Neuropeptídeos , Probióticos
9.
Epidemiol Infect ; 148: e39, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-32102708

RESUMO

Nutritional factors and infectious agents may contribute to paediatric growth deficits in low- and middle-income countries; however, the contribution of enteric pathogens is only beginning to be understood. We analysed the stool from children <5 years old from an open cohort, cluster-randomised controlled trial of a point-of-collection water chlorinator in urban Bangladesh. We compared the presence/absence of 15 enteric pathogens detected via multiplex, molecular methods in the stool with concurrent Z-scores/Z-score cut-offs (-2 standard deviations (s.d.)) for height-for-age (HAZ/stunting), weight-for-age (WAZ/underweight) and weight-for-height (WHZ/wasting), adjusted for sociodemographic and trial-related factors, and measured caregiver-reported diarrhoea. Enteric pathogen prevalence in the stool was high (88% had ≥1 enteric pathogen, most commonly Giardia spp. (40%), Salmonella enterica (33%), enterotoxigenic E. coli (28%) and Shigella spp. (27%)) while reported 7-day diarrhoea prevalence was 6%, suggesting high subclinical infection rates. Many children were stunted (26%) or underweight (24%). Adjusted models suggested Giardia spp. detection was associated with lower HAZ (-0.22 s.d., 95% CI -0.44 to 0.00; prevalence ratio for stunting: 1.39, 95% CI 0.94-2.06) and potentially lower WAZ. No pathogens were associated with reported diarrhoea in adjusted models. Giardia spp. carriage may be associated with growth faltering, but not diarrhoea, in this and similar low-income settings. Stool-based enteric pathogen detection provides a direct indication of previous exposure that may be useful as a broader endpoint of trials of environmental interventions.


Assuntos
Portador Sadio/epidemiologia , Doenças Transmissíveis/complicações , Doenças Transmissíveis/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Animais , Antropometria , Bactérias/classificação , Bactérias/isolamento & purificação , Bangladesh/epidemiologia , Estatura , Peso Corporal , Pré-Escolar , Estudos Transversais , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Parasitos/classificação , Parasitos/isolamento & purificação , Prevalência , População Urbana
10.
Am J Trop Med Hyg ; 102(4): 884-888, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32100684

RESUMO

The impact of HIV infection on the burden of gastrointestinal pathogens in Myanmar is poorly defined. Stools of 103 HIV-infected and 105 HIV-uninfected adult outpatients at a tertiary referral hospital in Yangon were examined microscopically. Stool antigen tests for Helicobacter pylori infection were positive in 63/103 (61%) HIV-infected and 61/105 (58%) HIV-uninfected patients (P = 0.65). Soil-transmitted helminth infections were much less common, occurring in 9/103 (9%) HIV-infected and 13/103 (13%) HIV-uninfected patients (P = 0.50). One HIV-uninfected patient had Giardia duodenalis, but there were no cases of Strongyloides stercoralis, Entamoeba histolytica, Capillaria philippinensis, Isospora, Cyclospora, or Schistosoma infection in the entire cohort. Despite the high prevalence of H. pylori, only 1/208 (0.5%) had ever received eradication, compared with 159/208 (76%) who had ever been dewormed. Helicobacter pylori appears to be an underappreciated pathogen in Myanmar. Its strong association with gastric cancer and peptic ulcer disease necessitates a more aggressive approach to its management.


Assuntos
Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Doenças Parasitárias/complicações , Doenças Parasitárias/epidemiologia , Adulto , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Doenças Parasitárias/parasitologia
11.
Infect Immun ; 88(4)2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-31988173

RESUMO

Sexually transmitted Chlamydia, which can cause fibrotic pathology in women's genital tracts, is also frequently detected in the gastrointestinal tract. However, the medical significance of the gastrointestinal Chlamydia remains unclear. A murine Chlamydia readily spreads from the mouse genital tract to the gastrointestinal tract while inducing oviduct fibrotic blockage or hydrosalpinx. We previously proposed a two-hit model in which the mouse gastrointestinal Chlamydia might induce the second hit to promote genital tract pathology, and we are now providing experimental evidence for testing the hypothesis. First, chlamydial mutants that are attenuated in inducing hydrosalpinx in the genital tract also reduce their colonization in the gastrointestinal tract, leading to a better correlation of chlamydial induction of hydrosalpinx with chlamydial colonization in the gastrointestinal tract than in the genital tract. Second, intragastric coinoculation with a wild-type Chlamydia rescued an attenuated Chlamydia mutant to induce hydrosalpinx, while the chlamydial mutant infection in the genital tract alone was unable to induce any significant hydrosalpinx. Finally, the coinoculated gastrointestinal Chlamydia failed to directly spread to the genital tract lumen, suggesting that gastrointestinal Chlamydia may promote genital pathology via an indirect mechanism. Thus, we have demonstrated a significant role of gastrointestinal Chlamydia in promoting pathology in the genital tract possibly via an indirect mechanism. This study provides a novel direction/dimension for further investigating chlamydial pathogenic mechanisms.


Assuntos
Infecções por Chlamydia/patologia , Chlamydia/crescimento & desenvolvimento , Gastroenteropatias/complicações , Gastroenteropatias/microbiologia , Infecções do Sistema Genital/complicações , Infecções do Sistema Genital/microbiologia , Animais , Chlamydia/genética , Modelos Animais de Doenças , Feminino , Gastroenteropatias/patologia , Camundongos , Infecções do Sistema Genital/patologia , Virulência
12.
Radiol Clin North Am ; 58(1): 19-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731901

RESUMO

Gastrointestinal tract perforation involving the stomach, duodenum, small intestine, or large bowel occurs as a result of full-thickness gastrointestinal wall injury with release of intraluminal contents into the peritoneal or retroperitoneal cavity. Most cases are associated with high mortality and morbidity, requiring urgent surgical evaluation. Initial patient presentations can be nonspecific with a broad differential, which can delay timely management. This article provides brief overviews of different causes of perforation. Various imaging modalities and protocols are discussed, along with direct and indirect imaging findings of perforation. Specific findings associated with different causes are also described to aid in the diagnosis.


Assuntos
Diagnóstico por Imagem/métodos , Gastroenteropatias/complicações , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/lesões , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Gastroenteropatias/patologia , Trato Gastrointestinal/patologia , Humanos , Perfuração Intestinal/patologia
13.
PLoS One ; 14(12): e0225364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856259

RESUMO

We evaluated to define the clinically significant chronic nausea in general population and to assess the prevalence of chronic unexplained nausea after exclusion of organic causes through the meticulous medical examination. Two phase studies were conducted. In phase 1, telephone survey was conducted to define the clinically significant nausea in 5000 representative subjects for a general population. Clinically significant nausea was identified by lowered quality of life if the frequency was 'more than one day per week'. Its prevalence was 1.6% (1.4-1.8%) and about 90% of nausea was not accompanied with vomiting. In phase 2, 5096 participants in a comprehensive health-screening cohort were enrolled. We investigated demographics, gastrointestinal symptoms, somatization symptoms and health related quality of life using validated questionnaire. All participants underwent meticulous medical examinations including endoscopy, abdominal ultrasound, thyroid function test, and blood testing. Among a total of 5096 subjects (men 51.8%, mean age 47.5 ± 10.0 years), organic diseases associated with chronic nausea were reflux esophagitis, duodenal ulcer and hyperthyroidism. The prevalence of chronic unexplained nausea was 0.6% (95% CI 0.4-0.8%) and there were significant overlap with functional dyspepsia and irritable bowel syndrome. HRQoL is significantly lower in people with nausea occurring 'more than one day per week' in a general population. Most chronic nausea was not accompanied with vomiting. Chronic unexplained nausea is uncommon affecting only 0.6% of the population but are more likely to report functional dyspepsia and irritable bowel syndrome.


Assuntos
Gastroenteropatias/complicações , Sintomas Inexplicáveis , Náusea/epidemiologia , Qualidade de Vida , Adulto , Doença Crônica/epidemiologia , Feminino , Gastroenteropatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico por imagem , Náusea/etiologia , Prevalência , República da Coreia/epidemiologia , Inquéritos e Questionários , Ultrassonografia , Adulto Jovem
14.
Br J Hosp Med (Lond) ; 80(10): C150-C154, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31589497

RESUMO

Prescription opioid abuse has become a public health crisis. It is often challenging to manage affected patients as their symptoms are often viewed through a prism of complex psychosocial issues. Clinicians are often unaware of the lack of evidence regarding opioid prescribing for non-cancer pain, and these trends in prescribing have been significantly escalated by pharmaceutical companies and prescribing culture in recent years. Opioid prescribing in the context of disorders of gut-brain interaction (formerly known as functional gastrointestinal disorders) can worsen conditions such as centrally-mediated abdominal pain syndrome and narcotic bowel syndrome. Opioids should not be prescribed to these patients as the harm is significantly greater than the benefit. However, in certain patients, such as those being investigated for organic abdominal pain, a trial of opioids may be indicated. In these groups, an opioid contract should be used, in addition to risk tools to identify those most vulnerable to the negative effects of these drugs. Prevention and treatment of the long-term effects of opioids requires a multidisciplinary approach and health-care professionals should all become 'opioid aware'.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Gastroenteropatias/complicações , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Fatores Etários , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Comorbidade , Humanos , Constipação Induzida por Opioides/tratamento farmacológico , Padrões de Prática Médica , Fatores de Risco
15.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 427-430, 2019 Sep 26.
Artigo em Chinês | MEDLINE | ID: mdl-31612681

RESUMO

OBJECTIVE: To investigate the prevalence of the serum anti-Toxoplasma gondii antibody among patients with malignant tumors of the digestive tract in Hainan Province. METHODS: A total of 1 932 patients with malignant tumors of the digestive tract were enrolled in Hainan Province from 2016 to 2019, including 376 esophageal cancer patients, 475 gastric cancer patients, 401 colorectal cancer patients, 427 hepatic cancer patients and 253 pancreatic cancer patients, and 400 healthy people served as controls. The serum IgG and IgM antibodies specific to T. gondii were detected using enzyme-linked immunosorbent assay, and the seroprevalence was compared. RESULTS: The overall seroprevalence of anti-T. gondii IgG antibody was significantly greater in patients with malignant tumors of the digestive tract than in healthy controls (19.82% vs. 3.75%; χ2 = 60.49, P < 0.01), and no significant difference was seen in the overall seroprevalence of anti-T. gondii IgM antibody between patients with malignant tumors of the digestive tract and healthy controls (1.09% vs. 0.50%; χ2 = 1.17, P > 0.05). The seroprevalence of anti-T. gondii IgG antibody was 15.16%, 19.58%, 21.70%, 23.65% and 17.79% in patients with esophageal cancer, gastric cancer, colorectal cancer, hepatic cancer and pancreatic cancer, which was all significantly greater than in healthy controls ( χ2 = 29.97, 50.29, 58.03, 67.85 and 36.59; all P < 0.01); however, the seroprevalence of anti-T. gondii IgG antibody in patients with esophageal cancer (1.06%), gastric cancer (1.47%), colorectal cancer (0.75%), hepatic cancer (1.17%) and pancreatic cancer (0.79%) did not differ from that in healthy controls ( χ2 = 0.80, 2.02, 0.20, 1.11 and 0.21; all P > 0.05). There was a significant difference in the seroprevalence of anti-T. gondii IgG antibody among various types of malignant tumors of the digestive tract ( χ2 = 10.65, P < 0.05); however, no significant difference was detected in the seroprevalence of anti-T. gondii IgM antibody ( χ2 = 1.33, P > 0.05). CONCLUSIONS: There is a high seroprevalence of anti-T. gondii IgG antibody among patients with malignant tumors of the digestive tract in Hainan Province, and there is a significant difference in the seroprevalence in terms of the cancer type. It is suggested that the screening for T. gondii infections should be intensified in patients with malignant tumors of the digestive tract to effective prevent and control the damages to patients with malignant tumors of the digestive tract caused by T. gondii infections.


Assuntos
Gastroenteropatias , Neoplasias , Toxoplasmose , Anticorpos Antiprotozoários/sangue , Gastroenteropatias/complicações , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Neoplasias/complicações , Estudos Soroepidemiológicos , Toxoplasma , Toxoplasmose/sangue , Toxoplasmose/complicações , Toxoplasmose/prevenção & controle
16.
Neurotoxicology ; 75: 186-199, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31505196

RESUMO

Gastrointestinal (GI) disturbances are one of the earliest symptoms affecting most patients with Parkinson's disease (PD). In many cases, these symptoms are observed years before motor impairments become apparent. Hence, the molecular and cellular underpinnings that contribute to this early GI dysfunction in PD have actively been explored using a relevant animal model. The MitoPark model is a chronic, progressive mouse model recapitulating several key pathophysiological aspects of PD. However, GI dysfunction and gut microbiome changes have not been categorized in this model. Herein, we show that decreased GI motility was one of the first non-motor symptoms to develop, evident as early as 8 weeks with significantly different transit times from 12 weeks onwards. These symptoms were observed well before motor symptoms developed, thereby paralleling PD progression in humans. At age 24 weeks, we observed increased colon transit time and reduced fecal water content, indicative of constipation. Intestinal inflammation was evidenced with increased expression of iNOS and TNFα in the small and large intestine. Specifically, iNOS was observed mainly in the enteric plexi, indicating enteric glial cell activation. A pronounced loss of tyrosine hydroxylase-positive neurons occurred at 24 weeks both in the mid-brain region as well as the gut, leading to a corresponding decrease in dopamine (DA) production. We also observed decreased DARPP-32 expression in the colon, validating the loss of DAergic neurons in the gut. However, the total number of enteric neurons did not significantly differ between the two groups. Metabolomic gas chromatography-mass spectrometry analysis of fecal samples showed increased sterol, glycerol, and tocopherol production in MitoPark mice compared to age-matched littermate controls at 20 weeks of age while 16 s microbiome sequencing showed a transient temporal increase in the genus Prevotella. Altogether, the data shed more light on the role of the gut dopaminergic system in maintaining intestinal health. Importantly, this model recapitulates the chronology and development of GI dysfunction along with other non-motor symptoms and can become an attractive translational animal model for pre-clinical assessment of the efficacy of new anti-Parkinsonian drugs that can alleviate GI dysfunction in PD.


Assuntos
Gastroenteropatias/complicações , Microbioma Gastrointestinal , Transtornos Parkinsonianos/complicações , Animais , Western Blotting , Cromatografia Líquida de Alta Pressão , Colo/química , Modelos Animais de Doenças , Esvaziamento Gástrico , Gastroenteropatias/microbiologia , Trânsito Gastrointestinal , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Neurotransmissores/análise , Neurotransmissores/metabolismo , Transtornos Parkinsonianos/microbiologia , Reação em Cadeia da Polimerase em Tempo Real
17.
Med Ultrason ; 21(3): 225-231, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476200

RESUMO

AIMS: Hyperechoic/echo-rich periportal cuffing (ErPC) is defined as an increase in echogenicity relative to the adjacentliver parenchyma. Thickening in the periportal area may occur with proliferation of bile ducts, hemorrhage, oedema, fibrosis,inflammatory changes or a combination of these. The aim of this study is to determine which intraabdominal inflammatory diseases are associated with the presence of ErPC in the pediatric population and to calculate the sensitivity and specificity of this finding. MATERIAL AND METHODS: In this prospective study 200 consecutive children who underwent abdominal ultrasonography (US) were included: group 1, the patient group (100 children with appendicitis, gastroenteritis, mesenteric lymphadenitis, intestinal infection, terminal ileitis and invagination as cause of intra-abdominal inflammation) and group 2, the control group (100 children). RESULTS: The ErPC was positive in 74 (74%) cases in the patient group and in 3 (3%) in the control group. According to final diagnoses, we found ErPC in most of patients with gastroenteritis (16/17), perforated appendicitis (10/11), mesenteric lymphadenitis (5/6) and acute appendicitis (27/37). The sensitivity of ErPC in indicating intra-abdominal inflammation was 0.80 and its specificity was 0.87. No significant correlation between ErPC and age, gender and CRP was found but a moderate and significant positive correlation between ErPC and WBC (p=0,010; r=0.255) was detected. Very good concordance between observers in terms of the presence of ErPC on abdominal US was found (concordance 97% and kappa 0.93). CONCLUSIONS: We consider that the presence of ErPC in pediatric patients, when evaluated alongside clinical and laboratory findings, has a high sensitivity and specificity for inflammatory intra-abdominal pathology.


Assuntos
Gastroenteropatias/complicações , Gastroenteropatias/diagnóstico por imagem , Inflamação/complicações , Inflamação/diagnóstico por imagem , Fígado/diagnóstico por imagem , Ultrassonografia/métodos , Abdome/diagnóstico por imagem , Abdome/fisiopatologia , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Gastroenteropatias/fisiopatologia , Humanos , Inflamação/fisiopatologia , Fígado/fisiopatologia , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
18.
Niger J Clin Pract ; 22(7): 950-956, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293260

RESUMO

Background: Accurate assessment of the degree of dehydration is essential in the management and fluid therapy of dehydrated children. The invasiveness of central venous pressure limits its routine clinical use. Fortunately, some studies have suggested that ultrasonographic measurement of inferior vena cava (IVC) diameter: aorta diameter ratio (IADR) is an objective method of assessing intravascular volume. Objectives: To determine the clinical usefulness of ultrasound measurement of IADR in assessment of children with dehydration. Methodology: This was a cross-sectional study which compared dehydrated children to age- and sex-matched euvolemic healthy children as controls. The maximum anteroposterior diameter of the abdominal aorta (at peak systole) and maximum IVC diameter (in expiration) were measured. Results: A total of 120 subjects and 120 controls were evaluated. The mean age was 21.73 ± 20.89 months for subjects and 21.19 ± 22.13 months for control. The mean IADR for children with mild, moderate, and severe dehydration was 0.75 ± 0.07, 0.55 ± 0.07, and 0.33 ± 0.05, respectively. The mean IADR for controls was 0.99 ± 0.06. IADR had an inverse relationship with the degree of dehydration in the subjects. A cut-off point of 0.86, with a sensitivity and specificity of 96.7% in predicting dehydration, was derived, with the sensitivity and specificity increasing with increasing level of dehydration. Conclusion: IADR is sensitive and specific for assessing moderate and severe dehydration in Nigerian children.


Assuntos
Aorta/diagnóstico por imagem , Desidratação , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Aorta/anatomia & histologia , Estudos de Casos e Controles , Pressão Venosa Central , Criança , Pré-Escolar , Estudos Transversais , Desidratação/diagnóstico , Desidratação/etiologia , Feminino , Gastroenteropatias/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença
19.
World J Gastroenterol ; 25(24): 3079-3090, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293343

RESUMO

BACKGROUND: Pediatric functional gastrointestinal disorders (FGIDs) are common and well-accepted to be etiologically complex in terms of the contribution of biological, psychological, and social factors to symptom presentations. Nonetheless, despite its documented benefits, interdisciplinary treatment, designed to address all of these factors, for pediatric FGIDs remains rare. The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic (APC) would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement. AIM: To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes. METHODS: Participants were 392 children, ages 8-18 [M = 13.8; standard deviation (SD) = 2.7], seen between August 1, 2013 and June 15, 2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital. To be eligible, patients had to be 8 years of age or older and have had abdominal pain for ≥ 8 wk at the time of initial evaluation. Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study. Logistic regression was used to model odds of reporting vs never reporting improvement, as well as to differentiate rapid from slower improvers. RESULTS: Nearly 70% of patients followed during the study period achieved resolution on at least one of the employed outcome indices. Among those who achieved resolution during follow up, 43% to 49% did so by the first follow up (i.e., within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment). Patient age, sleep, ease of relaxation, and depression all significantly predicted the likelihood of resolution. More specifically, the odds of clinical resolution were 14% to 16% lower per additional year of patient age (P < 0.001 to P = 0.016). The odds of resolution were 28% to 42% lower per 1-standard deviation (SD) increase on a pediatric sleep measure (P = 0.006 to P < 0.040). Additionally, odds of clinical resolution were 58% lower per 1-SD increase on parent-reported measure of depression (P = 0.006), and doubled in cases where parents agreed that their children found it easy to relax (P = 0.045). Furthermore, sleep predicted the rapidity of clinical resolution; that is, the odds of achieving resolution by the first follow up visit were 47% to 60% lower per 1-SD increase on the pediatric sleep measure (P = 0.002). CONCLUSION: Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep, ensuring adequate skills for relaxation, and screening of and referral for treatment of comorbid depression.


Assuntos
Dor Abdominal/terapia , Depressão/terapia , Gastroenteropatias/terapia , Clínicas de Dor/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adolescente , Criança , Comorbidade , Prestação Integrada de Cuidados de Saúde/organização & administração , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Seguimentos , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Comunicação Interdisciplinar , Masculino , Encaminhamento e Consulta , Terapia de Relaxamento , Estudos Retrospectivos , Sono/fisiologia , Resultado do Tratamento , Adulto Jovem
20.
Curr Pediatr Rev ; 15(3): 184-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264551

RESUMO

BACKGROUND: Increased oxidative stress has been reported in autistic patients besides, evidence linking oxidative stress to enhancement of advanced glycation and lipoxidation end products (AGEs and ALEs) and their precursors. OBJECTIVE: This study aimed to compare the plasma levels of the AGEs and precursors of ALEs in autistic and healthy children and to evaluate their relationship with autism comorbidities. METHODS: In this descriptive study, 54 children, 36 autistic and 18 healthy participated. Plasma levels of AGEs and precursors of ALEs were measured by ELISA method. Severity of autism and Gastrointestinal (GI) disorders were measured by GARSII questionnaire and QPGS-ROME III questionnaire, respectively. RESULTS: Plasma levels of AGEs and precursors of ALEs in autistic children were comparable with healthy children. Plasma levels of AGEs and precursor of ALEs were correlated with physical activity and GI disorders in autistic children. A strong association was also found between AGEs and precursors of ALEs. CONCLUSION: The results indicate that AGEs and ALEs have a strong correlation together but the AGEs and precursor of ALEs in autistic children are not different from healthy children.


Assuntos
Transtorno Autístico/sangue , Gastroenteropatias/sangue , Produtos Finais de Glicação Avançada/sangue , Peroxidação de Lipídeos/fisiologia , Estresse Oxidativo , Adolescente , Transtorno Autístico/complicações , Biomarcadores/sangue , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Gastroenteropatias/complicações , Glicosilação , Humanos , Masculino , Prognóstico
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