Perfil clínico-epidemiológico de pacientes com Doença de Crohn em uso de terapia biológica de um centro de referência em Salvador, Bahia / Clinical and epidemiological profile of patients with Crohn's disease in biological therapy from a reference center in Salvador, Bahia

Objetivo: Descrever o perfil clínico-epidemiológico dos pacientes com Doença de Crohn em terapia biológica em um centro de referência em Salvador, Bahia. Metodologia: Estudo transversal, realizado entre julho de 2017 e julho de 2018, através da aplicação de questionário e revisão de prontuários de pacientes atendidos em centro de referência em Salvador, Bahia. Foram analisadas variáveis epidemiológicas, classificação de Montreal e Índice de Harvey-Bradshaw. A análise estatística foi realizada utilizando o software SPSS versão 21.0 Resultados: Foram incluídos 116 pacientes com Doença de Crohn, sendo que 50% (N=58) utilizavam terapia biológica. Desses, a maioria era proveniente de zona urbana (87,1%), pardos (55,2%) e negros (32,7%) com renda familiar de até 2 salários mínimos (74,9%), idade média de 39 anos, tempo médio de doença de 94,8 meses, com mesma proporção (50%) de homens e mulheres. Maior parte dos pacientes apresentaram idade ao diagnóstico entre 17-40 anos (75,9%), localização colônica (46,5%), comportamento não estenosante não penetrante (44,6%) e alta taxa de remissão (83,7%). Conclusão: Os pacientes avaliados com doença de Crohn em uso de terapia biológica eram na maioria adultos jovens, procedentes de área urbana, pardos ou negros, com baixa renda familiar, tinham alta frequência de remissão da doença, apresentavam idade ao diagnóstico entre 17-40 anos, localização colônica e doença complicada

Caracterização clínico-epidemiológica da doença Crohn de acordo com o comportamento da doença em uma organização hospitalar pública / Clinical and epidemiological characterization of Crohn’s disease according to the disease behavior in a public hospital unit

A doença de Crohn (DC) faz parte do grupo de doença inflamatória intestinal (DII). A DC pode ter comportamento desde mais leves (inflamatória), até as formas mais graves (estenosante e penetrante). O presente trabalho tem objetivo de caracterizar a DC de acordo com o comportamento da doença inflamatório, estenosante ou penetrante. Trata-se de um estudo transversal observacional, com entrevista dos pacientes e revisão dos prontuários após aplicação do TCLE. As variáveis foram analisadas pelo pacote estatístico SPSS versão 21.0. Foram incluídos 92 pacientes, 55,4% (51) eram do sexo feminino. A média de idade foi 44,4 anos (± 14,6) e a média de tempo de doença foi 114,6 meses. A idade de diagnóstico mais frequente nos três fenótipos foi entre 17 e 40 anos. Um total de 54,3% (50) apresentavam o comportamento não estenosante/não penetrante, 23,9% (22) estenosante e 22,2% (20) penetrante. Em todos os comportamentos da doença, a grande maioria se autodeclarou como pardo, seguido por negro. Os comportamentos estenosante e penetrante mantiveram predominância do sexo feminino, enquanto que na forma não estenosante/ não penetrante, do sexo masculino. Entre os pacientes com doença de comportamento não penetrante e não estenosante e com o comportamento penetrante, a principal localização foi a colônica, Entre os pacientes com doença estenosante, a maioria apresentou localização ileocônica. Os pacientes com a doença penetrante foram mais jovens no momento da entrevista, com localização mais frequente colônica e maior frequência de doença perianal associada.Nosso trabalho conclui que o comportamento não penetrante/não estenosante foi o mais observado na amostra estudada. Os pacientes com as formas complicadas, tiveram o diagnóstico mais tardio e apresentaram maior tempo de duração da doença. A forma penetrante apresentou mais frequente localização colônica e doença perianal associada. O comportamento estenosante teve predominante localização ileocolonica, enquanto na doença não penetrante/ não estenosante a localização colônica foi a mais frequente

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn’s Disease from a Reference Center in Bahia, Brazil

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn’s disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn’s disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma

Núcleos de Ensino da Unesp: artigos 2010: volume 4: as disciplinas escolares, os temas transversais e o processo de educação

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit