CROHN'S DISEASE AND GASTROINTESTINAL REPERCUSSIONS: A DETAILED STUDY OF COMORBIDITIES AND CLINICAL IMPLICATIONS

Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract, characterized by transmural and segmental inflammation that can involve any part of the digestive system, from the mouth to the anus. This pathology presents a wide range of clinical manifestations, including abdominal pain, diarrhea, rectal bleeding, fistulas, strictures and even extraintestinal complications. The complexity of Crohn's disease lies not only in its varied clinical presentation, but also in its comorbidities and clinical implications, which can significantly affect patients' quality of life and require multifaceted therapeutic approaches. Objective: To identify and synthesize the evidence available in the scientific literature over the last 10 years on the comorbidities and clinical implications of Crohn's Disease, in order to provide a comprehensive and updated view of this aspect of gastrointestinal pathology. Methodology: The systematic review was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scielo and Web of Science databases were used to identify relevant studies published in the last 10 years. The descriptors used were "Crohn's disease", "gastrointestinal manifestations", "comorbidities", "clinical implications" and "systematic review". The inclusion criteria involved studies that specifically investigated the comorbidities and clinical implications of Crohn's Disease, with results available in English, Spanish or Portuguese. Exclusion criteria included duplicate studies, case reports and studies with small samples or less robust methods. Results: Analysis of the selected studies revealed a wide variety of comorbidities associated with Crohn's disease, including arthritis, dermatitis, uveitis, osteoporosis and liver disorders. Furthermore, the significant clinical implications of Crohn's disease were highlighted, such as increased risk of hospitalizations, need for intestinal surgeries and impact on patients' quality of life. Conclusion: Crohn's disease presents a clinical complexity that goes beyond intestinal manifestations, with a series of comorbidities and clinical implications that require an integrated and multidisciplinary approach in its management. This review highlights the importance of understanding these aspects to improve the care and quality of life of patients with this chronic gastrointestinal condition.Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract, characterized by transmural and segmental inflammation that can involve any part of the digestive system, from the mouth to the anus. This pathology presents a wide range of clinical manifestations, including abdominal pain, diarrhea, rectal bleeding, fistulas, strictures and even extraintestinal complications. The complexity of Crohn's disease lies not only in its varied clinical presentation, but also in its comorbidities and clinical implications, which can significantly affect patients' quality of life and require multifaceted therapeutic approaches. Objective: To identify and synthesize the evidence available in the scientific literature over the last 10 years on the comorbidities and clinical implications of Crohn's Disease, in order to provide a comprehensive and updated view of this aspect of gastrointestinal pathology. Methodology: The systematic review was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scielo and Web of Science databases were used to identify relevant studies published in the last 10 years. The descriptors used were "Crohn's disease", "gastrointestinal manifestations", "comorbidities", "clinical implications" and "systematic review". The inclusion criteria involved studies that specifically investigated the comorbidities and clinical implications of Crohn's Disease, with results available in English, Spanish or Portuguese. Exclusion criteria included duplicate studies, case reports and studies with small samples or less robust methods. Results: Analysis of the selected studies revealed a wide variety of comorbidities associated with Crohn's disease, including arthritis, dermatitis, uveitis, osteoporosis and liver disorders. Furthermore, the significant clinical implications of Crohn's disease were highlighted, such as increased risk of hospitalizations, need for intestinal surgeries and impact on patients' quality of life. Conclusion: Crohn's disease presents a clinical complexity that goes beyond intestinal manifestations, with a series of comorbidities and clinical implications that require an integrated and multidisciplinary approach in its management. This review highlights the importance of understanding these aspects to improve the care and quality of life of patients with this chronic gastrointestinal condition

Epithelial Ovarian Cancer: The Importance of Early Diagnosis and Individualized Treatment with Combination Chemotherapy and Targeted Therapy

Epithelial ovarian cancer is a malignant neoplasm that represents the majority of ovarian cancer cases. It is characterized by aggressiveness, often late diagnosis and therapeutic challenges. Early diagnosis is crucial to improving patients' survival rates and quality of life. Individualized treatment, combining chemotherapy and targeted therapy, has been a promising approach to optimize therapeutic results and minimize adverse effects. Objective: to analyze and synthesize the available evidence on the importance of early diagnosis and individualized treatment with combined chemotherapy and targeted therapy in epithelial ovarian cancer. Methodology: Using the PRISMA checklist, this review was conducted based on articles published in the last 10 years. The databases used were: PubMed, Scielo, Web of Science. The descriptors: "epithelial ovarian cancer", "early diagnosis", "individualized treatment", "combined chemotherapy", "targeted therapy". Inclusion criteria: original studies in humans, published in English or Portuguese, addressing the early diagnosis and/or individualized treatment of epithelial ovarian cancer. Exclusion criteria: animal studies, systematic reviews, studies with non-representative samples. Results: The results of this review highlight the importance of early diagnosis through imaging techniques and tumor markers. Furthermore, they highlight the effectiveness of combination chemotherapy, especially regimens containing platinum and taxanes, together with targeted therapy, such as PARP inhibitors, in improving response rates and survival in patients with epithelial ovarian cancer. Conclusion: Early diagnosis and individualized treatment with combination chemotherapy and targeted therapy play a key role in the management of epithelial ovarian cancer. This multifaceted approach can significantly improve patients' clinical outcomes and quality of life, highlighting the importance of personalized therapeutic strategies in this challenging clinical context.Epithelial ovarian cancer is a malignant neoplasm that represents the majority of ovarian cancer cases. It is characterized by aggressiveness, often late diagnosis and therapeutic challenges. Early diagnosis is crucial to improving patients' survival rates and quality of life. Individualized treatment, combining chemotherapy and targeted therapy, has been a promising approach to optimize therapeutic results and minimize adverse effects. Objective: to analyze and synthesize the available evidence on the importance of early diagnosis and individualized treatment with combined chemotherapy and targeted therapy in epithelial ovarian cancer. Methodology: Using the PRISMA checklist, this review was conducted based on articles published in the last 10 years. The databases used were: PubMed, Scielo, Web of Science. The descriptors: "epithelial ovarian cancer", "early diagnosis", "individualized treatment", "combined chemotherapy", "targeted therapy". Inclusion criteria: original studies in humans, published in English or Portuguese, addressing the early diagnosis and/or individualized treatment of epithelial ovarian cancer. Exclusion criteria: animal studies, systematic reviews, studies with non-representative samples. Results: The results of this review highlight the importance of early diagnosis through imaging techniques and tumor markers. Furthermore, they highlight the effectiveness of combination chemotherapy, especially regimens containing platinum and taxanes, together with targeted therapy, such as PARP inhibitors, in improving response rates and survival in patients with epithelial ovarian cancer. Conclusion: Early diagnosis and individualized treatment with combination chemotherapy and targeted therapy play a key role in the management of epithelial ovarian cancer. This multifaceted approach can significantly improve patients' clinical outcomes and quality of life, highlighting the importance of personalized therapeutic strategies in this challenging clinical context

ARTERIAL HYPERTENSION AND DYSLIPIDEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: RISK FACTORS, INTERVENTION STRATEGIES AND IMPACT ON CARDIOVASCULAR HEALTH.

Arterial Hypertension (AH) and Dyslipidemia are conditions frequently associated with Type 2 Diabetes Mellitus (DM2), significantly increasing the risk of cardiovascular disease (CVD) and mortality. The interrelationship of these metabolic risk factors becomes a growing concern due to their increasing prevalence and the serious complications they entail. AH, characterized by high blood pressure, and dyslipidemia, marked by abnormal levels of lipids in the blood, are modifiable risk factors that play central roles in the pathogenesis of cardiovascular complications of DM2. Effective intervention strategies to manage these conditions are essential to reduce cardiovascular risk in this population. Objective: To carry out a systematic review of the literature to evaluate the risk factors, intervention strategies and impact on cardiovascular health of the coexistence of AH and dyslipidemia in patients with DM2. Methodology: A search was carried out in the PubMed, Scielo and Web of Science databases for articles published in the last 10 years. The descriptors used were "arterial hypertension", "dyslipidemia", "type 2 diabetes mellitus", "cardiovascular risk factors" and "intervention". Inclusion criteria: studies that investigated the relationship between AH, dyslipidemia and DM2, therapeutic interventions for these conditions and their impact on cardiovascular health. Exclusion criteria: studies focusing exclusively on DM1, non-systematic reviews and studies with heterogeneous samples unrelated to the topic. Results: The studies reviewed highlighted the association between AH, dyslipidemia and DM2, emphasizing the importance of glycemic, lipid and blood pressure control to reduce cardiovascular risk. Multifaceted interventions, including lifestyle modifications and pharmacological therapies, have been effective in improving cardiovascular outcomes in this population. Conclusion: The integrated approach to hypertension and dyslipidemia in patients with DM2 is crucial to prevent cardiovascular complications. Personalized intervention strategies based on solid scientific evidence are critical to improving health outcomes in this high-risk population.Arterial Hypertension (AH) and Dyslipidemia are conditions frequently associated with Type 2 Diabetes Mellitus (DM2), significantly increasing the risk of cardiovascular disease (CVD) and mortality. The interrelationship of these metabolic risk factors becomes a growing concern due to their increasing prevalence and the serious complications they entail. AH, characterized by high blood pressure, and dyslipidemia, marked by abnormal levels of lipids in the blood, are modifiable risk factors that play central roles in the pathogenesis of cardiovascular complications of DM2. Effective intervention strategies to manage these conditions are essential to reduce cardiovascular risk in this population. Objective: To carry out a systematic review of the literature to evaluate the risk factors, intervention strategies and impact on cardiovascular health of the coexistence of AH and dyslipidemia in patients with DM2. Methodology: A search was carried out in the PubMed, Scielo and Web of Science databases for articles published in the last 10 years. The descriptors used were "arterial hypertension", "dyslipidemia", "type 2 diabetes mellitus", "cardiovascular risk factors" and "intervention". Inclusion criteria: studies that investigated the relationship between AH, dyslipidemia and DM2, therapeutic interventions for these conditions and their impact on cardiovascular health. Exclusion criteria: studies focusing exclusively on DM1, non-systematic reviews and studies with heterogeneous samples unrelated to the topic. Results: The studies reviewed highlighted the association between AH, dyslipidemia and DM2, emphasizing the importance of glycemic, lipid and blood pressure control to reduce cardiovascular risk. Multifaceted interventions, including lifestyle modifications and pharmacological therapies, have been effective in improving cardiovascular outcomes in this population. Conclusion: The integrated approach to hypertension and dyslipidemia in patients with DM2 is crucial to prevent cardiovascular complications. Personalized intervention strategies based on solid scientific evidence are critical to improving health outcomes in this high-risk population

INFLUENCE OF HYPOTHYROIDISM ON PREGNANCY AND FETAL DEVELOPMENT: A COMPREHENSIVE INVESTIGATION OF THE RISKS, MECHANISMS AND MANAGEMENT STRATEGIES WITH LEVOTHYROXINE SODIUM

Pregnancy is a critical period in which maternal health directly influences fetal development. Hypothyroidism, a condition characterized by insufficient production of thyroid hormones, can have a significant impact on this process. We investigated the risks, mechanisms and management strategies of hypothyroidism during pregnancy, focusing on the administration of levothyroxine sodium. This topic is crucial due to the potential adverse effects of untreated hypothyroidism on the mother and fetus, including complications such as miscarriage, pre-eclampsia, premature birth and deficits in the neurological development of the fetus. Objective: To conduct a systematic review of the literature to analyze the effects of hypothyroidism on pregnancy and fetal development, evaluate the effectiveness of levothyroxine sodium as a management strategy, and identify gaps in knowledge to guide future research. Methodology: Using the PRISMA checklist, the PubMed, Scielo and Web of Science databases were searched for articles published in the last 10 years. The descriptors used were "hypothyroidism", "pregnancy", "fetal development", "levothyroxine sodium" and "management". The inclusion criteria were original studies published in English, Portuguese or Spanish that investigated the effects of hypothyroidism on pregnancy and fetal development, as well as the effectiveness of levothyroxine sodium as a treatment. Exclusion criteria were duplicate studies, literature reviews and studies with small samples or inappropriate methodologies. Results: The studies reviewed highlighted the impacts of hypothyroidism during pregnancy, including an increased risk of obstetric complications and adversities in fetal development. Levothyroxine sodium has been shown to be effective in normalizing maternal hormone levels and reducing these risks, although questions about dosing and monitoring remain. More research is needed to fully elucidate the underlying mechanisms and optimize management strategies. Conclusion: Hypothyroidism during pregnancy represents a significant clinical challenge, but adequate administration of levothyroxine sodium can mitigate many of the associated risks. However, careful monitoring and additional research are essential to better understand and fully address the impacts of this condition on pregnancy and fetal development.Pregnancy is a critical period in which maternal health directly influences fetal development. Hypothyroidism, a condition characterized by insufficient production of thyroid hormones, can have a significant impact on this process. We investigated the risks, mechanisms and management strategies of hypothyroidism during pregnancy, focusing on the administration of levothyroxine sodium. This topic is crucial due to the potential adverse effects of untreated hypothyroidism on the mother and fetus, including complications such as miscarriage, pre-eclampsia, premature birth and deficits in the neurological development of the fetus. Objective: To conduct a systematic review of the literature to analyze the effects of hypothyroidism on pregnancy and fetal development, evaluate the effectiveness of levothyroxine sodium as a management strategy, and identify gaps in knowledge to guide future research. Methodology: Using the PRISMA checklist, the PubMed, Scielo and Web of Science databases were searched for articles published in the last 10 years. The descriptors used were "hypothyroidism", "pregnancy", "fetal development", "levothyroxine sodium" and "management". The inclusion criteria were original studies published in English, Portuguese or Spanish that investigated the effects of hypothyroidism on pregnancy and fetal development, as well as the effectiveness of levothyroxine sodium as a treatment. Exclusion criteria were duplicate studies, literature reviews and studies with small samples or inappropriate methodologies. Results: The studies reviewed highlighted the impacts of hypothyroidism during pregnancy, including an increased risk of obstetric complications and adversities in fetal development. Levothyroxine sodium has been shown to be effective in normalizing maternal hormone levels and reducing these risks, although questions about dosing and monitoring remain. More research is needed to fully elucidate the underlying mechanisms and optimize management strategies. Conclusion: Hypothyroidism during pregnancy represents a significant clinical challenge, but adequate administration of levothyroxine sodium can mitigate many of the associated risks. However, careful monitoring and additional research are essential to better understand and fully address the impacts of this condition on pregnancy and fetal development

LIVER TRANSPLANTATION IN LIVER CIRRHOSIS DUE TO HEPATITIS C: A CRITICAL ANALYSIS OF ITS ADVANTAGES, CHALLENGES AND IMPACT ON PATIENTS' QUALITY OF LIFE.

Liver cirrhosis caused by hepatitis C is a serious condition that often leads to the need for liver transplantation for patients in advanced stages of the disease. This procedure has been a crucial measure to improve survival and quality of life for these patients. However, its effectiveness and impact are the subject of critical analysis due to the associated challenges, such as the scarcity of donor organs, the risks of postoperative complications and the possibility of recurrence of hepatitis C virus infection in the new liver. Understanding the advantages and challenges of liver transplantation in hepatitis C liver cirrhosis is essential to optimize patient outcomes and quality of life. Objective: To critically analyze the advantages, challenges and impact on the quality of life of patients undergoing liver transplantation due to liver cirrhosis caused by hepatitis C. Methodology: A systematic literature review was carried out following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were searched for articles published in the last 10 years. The descriptors used were "liver transplant", "liver cirrhosis", "hepatitis C", "advantages", "challenges" and "quality of life". The inclusion criteria were original studies that addressed the topic in humans, written in English, Portuguese or Spanish. Exclusion criteria were animal studies, literature reviews and studies focusing on liver conditions other than hepatitis C. Results: The results highlighted the effectiveness of liver transplantation in improving the survival and quality of life of patients with liver cirrhosis due to hepatitis C. However, challenges persist, including the limited availability of donor organs and the risk of relapse of hepatitis C virus infection. Strategies to mitigate these challenges have been discussed, such as the use of next-generation antiviral therapies. Conclusion: Liver transplantation is a vital intervention for patients with liver cirrhosis caused by hepatitis C, providing significant benefits in terms of survival and quality of life. However, the associated challenges need to be addressed to further improve outcomes and ensure the long-term success of this procedure.Liver cirrhosis caused by hepatitis C is a serious condition that often leads to the need for liver transplantation for patients in advanced stages of the disease. This procedure has been a crucial measure to improve survival and quality of life for these patients. However, its effectiveness and impact are the subject of critical analysis due to the associated challenges, such as the scarcity of donor organs, the risks of postoperative complications and the possibility of recurrence of hepatitis C virus infection in the new liver. Understanding the advantages and challenges of liver transplantation in hepatitis C liver cirrhosis is essential to optimize patient outcomes and quality of life. Objective: To critically analyze the advantages, challenges and impact on the quality of life of patients undergoing liver transplantation due to liver cirrhosis caused by hepatitis C. Methodology: A systematic literature review was carried out following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were searched for articles published in the last 10 years. The descriptors used were "liver transplant", "liver cirrhosis", "hepatitis C", "advantages", "challenges" and "quality of life". The inclusion criteria were original studies that addressed the topic in humans, written in English, Portuguese or Spanish. Exclusion criteria were animal studies, literature reviews and studies focusing on liver conditions other than hepatitis C. Results: The results highlighted the effectiveness of liver transplantation in improving the survival and quality of life of patients with liver cirrhosis due to hepatitis C. However, challenges persist, including the limited availability of donor organs and the risk of relapse of hepatitis C virus infection. Strategies to mitigate these challenges have been discussed, such as the use of next-generation antiviral therapies. Conclusion: Liver transplantation is a vital intervention for patients with liver cirrhosis caused by hepatitis C, providing significant benefits in terms of survival and quality of life. However, the associated challenges need to be addressed to further improve outcomes and ensure the long-term success of this procedure

RECTAL ADENOCARCINOMA: CLINICAL EVALUATION AND TREATMENT THROUGH ROBOTIC SURGERY

Rectal adenocarcinoma is a malignant neoplasm that develops in the glandular cells of the rectum. Its clinical evaluation and treatment have been objects of considerable interest, especially with the advancement of robotic surgery. The introduction of the robot in colorectal surgery has provided significant advantages, such as better visualization, precision and control of movements, resulting in potential benefits for patients. However, the literature on the effectiveness and outcomes of robotic surgery in the treatment of rectal adenocarcinoma is vast and varied. Objective: to examine and synthesize the available evidence on the clinical assessment and treatment of rectal adenocarcinoma using robotic surgery, focusing on the last 10 years. Methodology: The methodology followed the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to identify relevant articles published in the last 10 years. The descriptors used were "rectal adenocarcinoma", "robotic surgery", "clinical evaluation", "treatment" and "results". The inclusion criteria were studies that evaluated robotic surgery in the treatment of rectal adenocarcinoma, published in English or Portuguese. The exclusion criteria were studies unrelated to the topic, studies without access to the full text and studies with duplicate data. Results: The results revealed an increasing trend in the use of robotic surgery for the treatment of rectal adenocarcinoma. Key topics covered included oncological outcomes, postoperative complications, post-treatment quality of life, and comparisons with other surgical approaches. Conclusion: The review highlights the growing evidence supporting the efficacy and safety of robotic surgery in the treatment of rectal adenocarcinoma. However, additional studies are needed to further understand its clinical utility and its long-term impact on patient outcomes.Rectal adenocarcinoma is a malignant neoplasm that develops in the glandular cells of the rectum. Its clinical evaluation and treatment have been objects of considerable interest, especially with the advancement of robotic surgery. The introduction of the robot in colorectal surgery has provided significant advantages, such as better visualization, precision and control of movements, resulting in potential benefits for patients. However, the literature on the effectiveness and outcomes of robotic surgery in the treatment of rectal adenocarcinoma is vast and varied. Objective: to examine and synthesize the available evidence on the clinical assessment and treatment of rectal adenocarcinoma using robotic surgery, focusing on the last 10 years. Methodology: The methodology followed the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to identify relevant articles published in the last 10 years. The descriptors used were "rectal adenocarcinoma", "robotic surgery", "clinical evaluation", "treatment" and "results". The inclusion criteria were studies that evaluated robotic surgery in the treatment of rectal adenocarcinoma, published in English or Portuguese. The exclusion criteria were studies unrelated to the topic, studies without access to the full text and studies with duplicate data. Results: The results revealed an increasing trend in the use of robotic surgery for the treatment of rectal adenocarcinoma. Key topics covered included oncological outcomes, postoperative complications, post-treatment quality of life, and comparisons with other surgical approaches. Conclusion: The review highlights the growing evidence supporting the efficacy and safety of robotic surgery in the treatment of rectal adenocarcinoma. However, additional studies are needed to further understand its clinical utility and its long-term impact on patient outcomes