Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis. METHODS: We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors. RESULTS: We identified 45 studies, comprising 21,421 individuals with enteritis, followed for 3 months to 10 years for development of IBS. The pooled prevalence of IBS at 12 months after infectious enteritis was 10.1% (95% confidence interval [CI], 7.2-14.1) and at more than 12 months after infectious enteritis was 14.5% (95% CI, 7.7-25.5). Risk of IBS was 4.2-fold higher in patients who had infectious enteritis in the past 12 months than in those who had not (95% CI, 3.1-5.7); risk of IBS was 2.3-fold higher in individuals who had infectious enteritis more than 12 months ago than in individuals who had not (95% CI, 1.8-3.0). Of patients with enteritis caused by protozoa or parasites, 41.9% developed IBS, and of patients with enteritis caused by bacterial infection, 13.8% developed IBS. Risk of IBS was significantly increased in women (odds ratio [OR], 2.2; 95% CI, 1.6-3.1) and individuals with antibiotic exposure (OR, 1.7; 95% CI, 1.2-2.4), anxiety (OR, 2; 95% CI, 1.3-2.9), depression (OR, 1.5; 95% CI, 1.2-1.9), somatization (OR, 4.1; 95% CI, 2.7-6.0), neuroticism (OR, 3.3; 95% CI, 1.6-6.5), and clinical indicators of enteritis severity. There was a considerable level of heterogeneity among studies. CONCLUSIONS: In a systematic review and meta-analysis, we found >10% of patients with infectious enteritis develop IBS later; risk of IBS was 4-fold higher than in individuals who did not have infectious enteritis, although there was heterogeneity among studies analyzed. Women-particularly those with severe enteritis-are at increased risk for developing IBS, as are individuals with psychological distress and users of antibiotics during the enteritis.

Rituximab-induced regression of CREST-related calcinosis.

About a quarter of sclerodermic patients present calcinosis. However, patients with limited form of the disease are more likely to have calcinosis than patients with diffuse form. We report a case of a 54-year-old female patient with limited cutaneous scleroderma using rituximab (RTX) to treat lung fibrosis and arthritis. Into RTX treatment, she also had a complete resolution of calcinosis in her hands. The patient reported improvement in dyspnea and synovitis after two courses of RTX (four weekly infusions 375 mg/m(2) each). After 7 months of the first infusion, the calcinosis in her fingers had a complete remission, especially the right thumb. Based on current evidences, we discuss the use of rituximab as a promising therapy to treat not only lung disease but also calcinosis in patients with scleroderma.

Conhecimento dos usuários, trabalhadores da saúde e gestores sobre conselheiros e Conselhos de Saúde / Knowledge of users, workers and managers about Health Councils and councilors

A criação de um espaço democrático de participação na condução do Sistema Único de Saúde (SUS) constituiu indubitável conquista dos brasileiros. O pleno exercício deste direito implica, no entanto, no conhecimento do próprio direito, dos espaços e dos mecanismos de participação, que permitam uma ação autônoma. No presente trabalho avalia-se o grau de conhecimento nos diversos segmentos sociais acerca da questão. Foram entrevistados usuários e trabalhadores do SUS, além de membros dos Conselhos de Saúde. Os resultados demonstram grande desinformação dos usuários, dos novos conselheiros e da maioria dos trabalhadores, em contraste com os gestores e os conselheiros com mais tempo no cargo.

The creation of a democratic space for participation in the conduction of the Sistema Único de Saúde ( SUS) - Brazilian Public Health Care System - was undoubtedly an achievement for Brazilians. Full exercise of this right implies, however, knowledge of the right itself, spaces and mechanisms for participation, allowing for autonomous action. The present study evaluates the degree of knowledge in the various social segments on this issue. Users and workers of SUS health care units were interviewed as well as members of Health Councils. Results show misinformation from most councilors and health workers when compared to managers and advisors who have worked longer in their positions.