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1.
Front Immunol ; 12: 665300, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981312

RESUMO

The irruption of SARS-CoV-2 during 2020 has been of pandemic proportions due to its rapid spread and virulence. COVID-19 patients experience respiratory, digestive and neurological symptoms. Distinctive symptom as anosmia, suggests a potential neurotropism of this virus. Amongst the several pathways of entry to the nervous system, we propose an alternative pathway from the infection of the gut, involving Toll-like receptor 4 (TLR4), zonulin, protease-activated receptor 2 (PAR2) and zonulin brain receptor. Possible use of zonulin antagonists could be investigated to attenuate neurological manifestations caused by SARS-CoV-19 infection.


Assuntos
COVID-19/complicações , Haptoglobinas/metabolismo , Doenças do Sistema Nervoso/complicações , Precursores de Proteínas/metabolismo , Barreira Hematoencefálica/metabolismo , Barreira Hematoencefálica/virologia , Encéfalo/metabolismo , Encéfalo/virologia , COVID-19/metabolismo , COVID-19/virologia , Proteínas do Sistema Complemento/metabolismo , Gastroenteropatias/complicações , Gastroenteropatias/metabolismo , Gastroenteropatias/virologia , Humanos , Doenças do Sistema Nervoso/metabolismo , Doenças do Sistema Nervoso/virologia , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidade , Receptor 4 Toll-Like/metabolismo
2.
Nutrients ; 13(3)2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33801020

RESUMO

Decreased serum vitamin D (VD) levels have been associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS). VD can also modulate the intestinal barrier. Given the link between the GI barrier's alterations and diet, attention has aroused the positive effects of the Low FODMAP Diet (LFD) on IBS patients' symptom profile. We evaluated the GI symptoms and the urinary and circulating markers of GI barrier function, the markers of inflammation and intestinal dysbiosis in 36 IBS patients with predominant diarrhea (IBS-D) (5 men and 31 women, 43.1 ± 1.7 years) categorized for their circulating VD levels in low (L-VD) and normal (N-VD) (cutoff = 20 ng/mL). Evaluations were performed before and after 12 weeks of LFD. At the baseline, L-VD patients showed a significantly worse symptom profile and altered small intestinal permeability (s-IP) than N-VD. After LFD, a significant increase in the circulating VD levels in both the subgroups and a significant improvement of s-IP in L-VD patients occurred. Finally, VD levels negatively correlated with the symptom score and fecal zonulin. These data highlight the close relationship between VD and the intestinal barrier and support their involvement in IBS-D pathophysiology. Moreover, the potentially positive role of LFD in the management of IBS-D was confirmed.


Assuntos
Diarreia/dietoterapia , Dieta com Restrição de Carboidratos/métodos , Gastroenteropatias/dietoterapia , Síndrome do Intestino Irritável/dietoterapia , Vitamina D/sangue , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Diarreia/complicações , Fezes/química , Feminino , Fermentação , Gastroenteropatias/complicações , Haptoglobinas , Humanos , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Pessoa de Meia-Idade , Precursores de Proteínas/sangue
3.
BMC Infect Dis ; 21(1): 368, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874899

RESUMO

BACKGROUND: Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. METHODS: A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008-2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. RESULTS: Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. CONCLUSION: As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.


Assuntos
Gastroenteropatias/complicações , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Proteína C-Reativa/análise , Criança , Pré-Escolar , Aneurisma Coronário/etiologia , Estudos Transversais , Exantema/etiologia , Feminino , Febre/etiologia , Cardiopatias/complicações , Humanos , Incidência , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Contagem de Plaquetas , Estudos Retrospectivos
4.
mBio ; 12(1)2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436436

RESUMO

Coronavirus disease 2019 (COVID-19), which has been declared a pandemic, has exhibited a wide range of severity worldwide. Although this global variation is largely affected by socio-medical situations in each country, there is also high individual-level variation attributable to elderliness and certain underlying medical conditions, including high blood pressure, diabetes, and obesity. As both elderliness and the aforementioned chronic conditions are often associated with an altered gut microbiota, resulting in disrupted gut barrier integrity, and gut symptoms have consistently been associated with more severe illness in COVID-19 patients, it is possible that dysfunction of the gut as a whole influences COVID-19 severity. This article summarizes the accumulating evidence that supports the hypothesis that an altered gut microbiota and its associated leaky gut may contribute to the onset of gastrointestinal symptoms and occasionally to additional multiorgan complications that may lead to severe illness by allowing leakage of the causative coronavirus into the circulatory system.


Assuntos
COVID-19/patologia , Gastroenteropatias/patologia , Microbioma Gastrointestinal , SARS-CoV-2/patogenicidade , COVID-19/complicações , COVID-19/virologia , Disbiose , Gastroenteropatias/complicações , Gastroenteropatias/virologia , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/virologia , Índice de Gravidade de Doença
6.
Pediatr Clin North Am ; 68(1): 41-60, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228942

RESUMO

Pulmonary manifestations of gastrointestinal (GI) diseases are often subtle, and underlying disease may precede overt symptoms. A high index of suspicion and a low threshold for consultation with a pediatric pulmonologist is warranted in common GI conditions. This article outlines the pulmonary manifestations of different GI, pancreatic, and liver diseases in children, including gastroesophageal reflux disease, inflammatory bowel disease, pancreatitis, alpha1-antitrypsin deficiency, nonalcoholic fatty liver disease, and complications of chronic liver disease (hepatopulmonary syndrome and portopulmonary hypertension).


Assuntos
Gastroenteropatias/complicações , Hepatopatias/complicações , Pneumopatias/etiologia , Pancreatopatias/complicações , Criança , Ecocardiografia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/terapia , Pneumopatias/diagnóstico , Pneumopatias/terapia , Pancreatopatias/diagnóstico , Pancreatopatias/terapia , Testes de Função Respiratória
7.
Med Clin North Am ; 105(1): 175-186, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246517

RESUMO

Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.


Assuntos
Perda de Peso , Envelhecimento/fisiologia , Doenças Cardiovasculares/complicações , Doença Crônica , Doenças Transmissíveis/complicações , Diagnóstico Diferencial , Suplementos Nutricionais , Doenças do Sistema Endócrino/complicações , Gastroenteropatias/complicações , Humanos , Anamnese , Transtornos Mentais/complicações , Neoplasias/complicações , Exame Físico , Doenças Respiratórias/complicações , Doenças Reumáticas/complicações , Perda de Peso/fisiologia
8.
Gastroenterol. hepatol. (Ed. impr.) ; 43(10): 614-619, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197976

RESUMO

INTRODUCCIÓN: Las Aeromonas son la causa de múltiples enfermedades en humanos, siendo la gastroenteritis la más frecuente. El papel de Aeromonas como patógeno en las enterocolitis y su relación con la enfermedad inflamatoria intestinal siguen siendo controvertidos. OBJETIVO: Determinar la incidencia de la infección por Aeromonas en nuestro entorno y su posible relación con la enfermedad inflamatoria intestinal. PACIENTES Y MÉTODOS: Estudio retrospectivo y observacional de todos los pacientes adultos con al menos un aislamiento de Aeromonas en el cultivo de heces entre enero de 2015 y diciembre de 2017 en el Hospital Galdakao-Usansolo (Vizcaya). RESULTADOS: Se identificaron 98 pacientes con un cultivo de heces positivo para Aeromonas (edad media 62 años, 51% mujeres), estimando una incidencia de 32 casos/105 habitantes-año. El 11% tenía un diagnóstico previo de enfermedad inflamatoria intestinal (4 colitis ulcerosa y 7 enfermedad de Crohn). Estos pacientes se encontraban en tratamiento inmunosupresor con más frecuencia, aunque tenían menos comorbilidades que el grupo sin esta patología. También observamos que la comorbilidad era el factor que más se asociaba a la infección por Aeromonas. CONCLUSIONES: La infección por Aeromonas tiene una incidencia de 32 casos/105 habitantes-año, y afecta tanto a pacientes inmunocompetentes como a inmunodeprimidos. La incidencia está influida por la inmunosupresión en pacientes con enfermedad inflamatoria intestinal, mientras que la comorbilidad parece conferir un mayor riesgo en pacientes sin esta patología


INTRODUCTION: Aeromonas can cause several diseases in humans, with gastroenteritis accounting for most cases. The role of Aeromonas as a pathogen in human enterocolitis has been questioned in recent years. OBJECTIVE: To determine the incidence of gastrointestinal infection caused by Aeromonas in our area and its possible relationship to inflammatory bowel disease. PATIENTS AND METHODS: This was a retrospective observational study. All adult patients with a positive stool culture for Aeromonas were identified between January 2015 and December 2017 at Hospital Galdakao-Usansolo (Vizcaya, Spain). RESULTS: Ninety-eight patients were identified (median age 62 years; 51% women). Therefore, the incidence in our area was 32 cases per 105 inhabitants per year. Eleven per cent of them had been previously diagnosed with inflammatory bowel disease (four with ulcerative colitis and seven with Crohn's disease). Patients with inflammatory bowel disease more often received immunosuppressive therapy. Conversely, patients without inflammatory bowel disease suffered from more comorbidities. We also found comorbidity to be the risk factor most associated with Aeromonas infection. CONCLUSION: Aeromonas infection is a common gastrointestinal infection that may occur in both immunocompetent and immunocompromised patients. Immunosuppression is a significant factor in inflammatory bowel disease patients, while comorbidity seems to confer a higher risk on patients without this disease


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Inflamatórias Intestinais/epidemiologia , Gastroenteropatias/epidemiologia , Doenças Transmissíveis/epidemiologia , Infecções por Bactérias Gram-Negativas/etiologia , Doenças Inflamatórias Intestinais/etiologia , Gastroenteropatias/complicações , Estudos Retrospectivos , Fezes , Aeromonas/isolamento & purificação , Dor Abdominal/etiologia , Fatores de Risco
9.
Signal Transduct Target Ther ; 5(1): 256, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33139693

RESUMO

Coronavirus disease-2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is spreading globally and poses a huge threat to human health. Besides common respiratory symptoms, some patients with COVID-19 experience gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and loss of appetite. SARS-CoV-2 might infect the gastrointestinal tract through its viral receptor angiotensin-converting enzyme 2 (ACE2) and there is increasing evidence of a possible fecal-oral transmission route. In addition, there exist multiple abnormalities in liver enzymes. COVID-19-related liver injury may be due to drug-induced liver injury, systemic inflammatory reaction, and hypoxia-ischemia reperfusion injury. The direct toxic attack of SARS-CoV-2 on the liver is still questionable. This review highlights the manifestations and potential mechanisms of gastrointestinal and hepatic injuries in COVID-19 to raise awareness of digestive system injury in COVID-19.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastroenteropatias/epidemiologia , Hepatopatias/epidemiologia , Pneumonia Viral/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/genética , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Induzida por Substâncias e Drogas/virologia , Infecções por Coronavirus/genética , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Fezes/virologia , Gastroenteropatias/complicações , Gastroenteropatias/genética , Gastroenteropatias/virologia , Trato Gastrointestinal/lesões , Trato Gastrointestinal/patologia , Trato Gastrointestinal/virologia , Humanos , Fígado/fisiopatologia , Fígado/virologia , Hepatopatias/genética , Hepatopatias/patologia , Hepatopatias/virologia , Pandemias , Peptidil Dipeptidase A/genética , Pneumonia Viral/genética , Pneumonia Viral/patologia , Pneumonia Viral/virologia
10.
Sci Rep ; 10(1): 17846, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082472

RESUMO

In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl 13.9-21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI 16.5-25.7%) was higher compared to China (12.9%, 95% CI 8-17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95% CI 3.2-79.4%) compared to areas outside Wuhan in China (7.1%, 95% CI 4.0-10.3%). The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days. Conclusions and relevance: gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Fezes/virologia , Gastroenteropatias/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus/isolamento & purificação , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diarreia/complicações , Diarreia/diagnóstico , Diarreia/epidemiologia , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , RNA Viral/metabolismo
11.
Artigo em Inglês | MEDLINE | ID: mdl-32882981

RESUMO

Autism spectrum disorders (ASD) are characterized by impairments in social interaction, communication, and restricted, stereotyped behavior. Gastrointestinal (GI), nutritional, and feeding problems are often reported in ASD. We investigated the prevalence of GI symptoms, food selectivity, and mealtime difficulties, and their associations with dietary interventions, food supplement use, and behavioral characteristics in a sample involving 247 participants with ASD and 267 controls aged 2-18 years. Data were collected by a questionnaire. GI symptoms were observed in 88.9% of children and adolescents with ASD, more often in girls than in boys. High rates of food selectivity (69.1%) and mealtime problems (64.3%) were found. Food supplements were used by 66.7% of individuals, mainly vitamins/minerals, probiotics, and omega-3 fatty acids. In the ASD sample, 21.2% of subjects followed a diet, mostly based on gluten and milk restriction, including individuals exhibiting food selectivity. Frequency of GI symptoms, food selectivity, and mealtime problems correlated weakly, but significantly with behavioral characteristics in the ASD group, but not with food supplement use. The study demonstrated that higher frequency of GI symptoms, food selectivity, and mealtime problems are a common problem in pre-schoolers, schoolchildren, and adolescents with ASD, and together with dietary modification, they are significantly associated with ASD.


Assuntos
Transtorno do Espectro Autista , Suplementos Nutricionais , Transtornos da Alimentação e da Ingestão de Alimentos , Gastroenteropatias , Adolescente , Transtorno do Espectro Autista/complicações , Criança , Pré-Escolar , Dieta , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Preferências Alimentares , Gastroenteropatias/complicações , Humanos , Masculino
12.
PLoS One ; 15(8): e0237740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822372

RESUMO

BACKGROUND: Sarcopenia is defined as the loss of muscle mass combined with loss of muscle strength, with or without loss of muscle performance. The use of this parameter as a risk factor for complications after surgery is not currently used. This meta-analysis aims to assess the impact of sarcopenia defined by radiologically and clinically criteria and its relationship with complications after gastrointestinal surgeries. MATERIALS AND METHODS: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42019132221). Articles were selected from the PUBMED and EMBASE databases that adequately assessed sarcopenia and its impact on postoperative complications in gastrointestinal surgery patients. Pooled estimates of pre-operative outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Subgroup analysis were performed to assess each type of surgery. RESULTS: The search strategy returned 1323, with 11 studies meeting the inclusion criteria. A total of 4265 patients were analysed. The prevalence of sarcopenia between studies ranged from 6.8% to 35.9%. The meta-analysis showed an OR for complications after surgery of 3.01 (95% CI 2.55-3.55) and an OR of 2.2 (95% CI 1.44-3.36) for hospital readmission (30 days). CONCLUSION: Sarcopenia, when properly diagnosed, is associated with an increase in late postoperative complications, as well as an increase in the number of postoperative hospital readmissions for various types of gastrointestinal surgery. We believe that any preoperative evaluation should include, in a patient at risk, tests for the diagnosis of sarcopenia and appropriate procedures to reduce its impact on the patient's health.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sarcopenia/complicações , Sarcopenia/diagnóstico , Gastroenteropatias/complicações , Gastroenteropatias/cirurgia , Humanos , Período Pós-Operatório , Prevalência , Fatores de Risco
13.
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
14.
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
15.
Arch. argent. pediatr ; 118(3): e271-e277, jun. 2020.
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1116919

RESUMO

Los problemas médicos gastrointestinales, nutricionales, metabólicos, endocrinológicos y de microbiota en los pacientes pediátricos con diagnóstico de trastorno del espectro autista (TEA) son parte de los problemas médicos concomitantes al diagnóstico. La prevalencia alcanza a más del 91 % en el caso de los problemas gastrointestinales, hasta el 89 % para los nutricionales y metabólicos, más del 50 % de disfunción tiroidea y hasta el 100 % para los relacionados con la microbiota.Es urgente actualizar la práctica médica para incluir la evaluación, testeo, diagnóstico y tratamiento de estos problemas médicos concomitantes al diagnóstico de TEA en la población pediátrica, adolescente y adulta. El tratamiento riguroso de dichos problemas genera cambios positivos en la calidad de vida y en la sintomatología bajo la cual el TEA se diagnostica en muchos casos. Debe basarse en evidencia científica de alta calidad, con control y cuidado médico adecuado


Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions.There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Doenças do Sistema Endócrino/metabolismo , Microbiota , Transtorno do Espectro Autista/microbiologia , Gastroenteropatias/metabolismo , Sintomas Concomitantes , Estado Nutricional , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/metabolismo , Gastroenteropatias/complicações , Gastroenteropatias/dietoterapia
18.
Pharm. pract. (Granada, Internet) ; 18(2): 0-0, abr.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194065

RESUMO

BACKGROUND: There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF). OBJECTIVE: The objective was to describe prescribers' experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations. METHODS: A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes. RESULTS: One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents' descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances. CONCLUSIONS: While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs


No disponible


Assuntos
Humanos , Fibrilação Atrial/tratamento farmacológico , Anticoagulantes/administração & dosagem , Percepção , Prescrições/normas , Estudos Transversais , Inquéritos e Questionários , Gastroenteropatias/complicações , Gastroenteropatias/tratamento farmacológico
19.
Clin Gastroenterol Hepatol ; 18(10): 2366-2368.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32437870

RESUMO

Since February 2020, the COVID-19 pandemic has spread to Italy affecting more than 100,000 people. Several studies have reported a high prevalence of gastrointestinal (GI) symptoms, and investigated their potential association with clinical outcomes.1 The timing, clinical significance, and possible impact on viral spread of GI symptoms presentation have not been fully elucidated. Elevation of liver function tests and other laboratory values has also been reported; however, their prognostic significance has not been clearly established.2.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenteropatias/diagnóstico , Hospitais/estatística & dados numéricos , Pandemias , Pneumonia Viral/complicações , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pneumonia Viral/epidemiologia , Prevalência
20.
Aliment Pharmacol Ther ; 51(12): 1222-1232, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32372471

RESUMO

BACKGROUND: The initiating events of chronic gastrointestinal (GI) inflammation in Crohn's disease (CD) and ulcerative colitis (UC) are not well-defined, but GI infections are implicated. AIMS: To define the role of GI infections in risk of incident inflammatory bowel disease (IBD) and synthesise the current body of relevant translational data to provide biological context for associations between GI infections and IBD risk. METHODS: We systematically reviewed electronic databases through February 2020. Clinical studies that provided risk estimates of the association between GI infections and incident IBD were included. Inclusion criteria were broader for translational studies aiming to define mechanisms of GI infections and predisposition to or protection from IBD. RESULTS: Of the studies identified, 63 met full inclusion criteria. Among studies of clinical gastroenteritis, bacteria-specifically, Salmonella species, Campylobacter species and Clostridioides difficile-demonstrated consistent positive associations with risk of incident IBD. Of viruses, norovirus was associated with increased risk of incident CD. Regarding inverse associations with incident IBD, Helicobacter pylori and helminth infections were associated with a generally consistent reduced risk of IBD. Based on a qualitative analysis of the translational data, putative mechanisms involve multiple microbial and immunologic pathways. CONCLUSIONS: Based on this systematic review, certain enteric pathogens are associated with an increased risk of incident IBD, while others are potentially protective. Prospective studies are required to clarify the clinical implications of these enteric pathogens on the risk and course of IBD, and possible therapeutic or preventative benefit.


Assuntos
Doenças Transmissíveis/epidemiologia , Gastroenteropatias/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Colite Ulcerativa/epidemiologia , Doenças Transmissíveis/complicações , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Gastroenteropatias/complicações , Helicobacter pylori/imunologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/etiologia , Estudos Prospectivos , Fatores de Risco
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