Função muscular e qualidade de vida na doença de Crohn

Introduction: Crohn's disease (CD) is an inflammatory bowel disease, marked by exacerbations and remissions periods. Peripheral manifestations in CD may be present with the syndrome of skeletal muscle dysfunction (SMD), which is characterized by loss of muscle strength, fatigue complain, limited exercise capacity and impaired quality of life of these patients. Objective: Evaluate muscle strength, physical capacity and quality of life of patients with CD and compare them with healthy controls. Methods: 18 patients CD and 12 healthy controls matched for age and sex were involved. Peripheral muscle strength evaluated by handgrip strength of the dominant hand and respiratory muscle strength by measures of respiratory muscle strength (maximal inspiratory/expiratory pressure – MIP and MEP). Exercise capacity evaluated by Shuttle test (ST) and the quality of life by the Short-form 36 (SF-36) and by the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Patients with CD presented a lower respiratory muscle strength (MIP = -68.93 ± 26.61 vs 29.63 ± -100 cmH2O, p = 0.0013 and MEP = 81.07 ± 30.26 vs 108 ± 25.30 cmH2O, p = 0.032) and a tendency the lower peripheral muscle strength (31.72 ± 8.55 vs 39.00 ± 13.37 kgf, p = 0.09). In addition, CD patients presented worse physical capacity on the ST compared to the control group (513.7 ± 237m vs 983.0 ± 263m, p < 0.05) and worse quality of life in 7 of 8 domains of the SF-36 and in all dimensions of the IBDQ. Conclusion: Patients with CD showed muscle functional impairment and poorer quality of life compared to healthy control group. These findings suggest that the assessment and maybe interventions in the muscle function must be used in clinical practice.Introdução: A doença de Crohn (DC) é uma doença inflamatória intestinal marcada por agudizações e remissões. Manifestações sistêmicas na DC podem estar associadas à síndrome da disfunção muscular esquelética (SDM), a qual é caracterizada por perda de força, queixa de fadiga, limitação ao exercício e prejuízo na qualidade de vida. Objetivo: Avaliar a força muscular, a capacidade de exercício e a qualidade de vida de pacientes com DC e compará- los com controles saudáveis. Métodos: Foram envolvidos 18 pacientes com DC e 12 controles saudáveis pareados por idade e sexo. A força muscular periférica foi avaliada pela força de preensão palmar da mão dominante; e a força muscular respiratória pelas medidas de pressões respiratórias máximas (pressão inspiratória/expiratória máxima – PIM e PEM). A capacidade ao exercício foi avaliada por meio do teste de Shuttle (TS) e a qualidade de vida pelo relacionada à saúde pelo Short Form-36 e pelo The Inflammatory Bowel Disease Questionnaire (IBDQ). Resultados: A força muscular respiratória mostrou-se reduzida nos pacientes com DC comparado ao grupo controle (PIM = -68,93 ± 26,61 vs -100 ± 29,63 cmH2O, p = 0,0013 e PEM = 81,07 ± 30,26 vs 108 ± 25,30 cmH2O, p = 0,032) e, com tendência a menor força muscular periférica no grupo de pacientes (31,72 ± 8,55 vs 39,00 ± 13,37 kgf, p = 0,09). Pacientes com DC apresentaram ainda pior capacidade de exercício no TS (513,7 ± 237m vs 983,0 ± 263m, p < 0,05) e pior qualidade de vida comparados aos controles. Conclusão: Pacientes com DC mostraram prejuízo funcional muscular e pior qualidade de vida. Estes achados sugerem que a avaliação e possível intervenção da função muscular deve ser adotada na prática clínica

Atividade física de vida diária, capacidade de exercício e qualidade de vida de pacientes com doença de Crohn em remissão infliximab-induzida

Background: Physical activity in daily life and exercise capacity have never been assessed in Crohn’s disease (CD) patients on infliximab-induced remission. Objective: We aimed to evaluate the physical activity in daily life, exercise capacity, quality of life (QoL) and mood disorders in patients with moderate-to-severe CD on infliximab-induced remission, and to investigate variables associated with physical activity in daily life in these patients. Methods: A cross-sectional study was conducted, in which 26 patients with CD were selected. Controls were currently asymptomatic individuals with functional dyspepsia. Patients underwent to evaluation of physical activity in daily life by a triaxial accelerometer, exercise capacity (shuttle walk test-SWT), handgrip strength, QoL and mood disorders. The associations between the physical activity in daily life and QoL or mood disorders were tested. Results: The number of steps taken (7446 ± 3081 vs. 7898 ± 2487), the active time (80.56 ± 41.97 min vs. 89.65 ± 24.30 min), the SWT distance (662.69 ± 252.86 m vs. 728.82 ± 346.55 m) and the handgrip (34.3 ± 11.1 kgf vs. 32.9 ± 11.9 kgf) didn’t show significant difference between CD patients and controls, respectively. The time spending lying down (116.31 ± 107.38 min vs. 63.71 ± 55.79 min) and some domains of quality of life were superior in CD patients (p0.05). Conclusions: We found that patients with CD on infliximab-induced remission have the same level of physical activity in daily life and exercise capacity when compared with controls.Introdução: Atividade física de vida diária e capacidade de exercício nunca foram avaliadas em pacientes com Doença de Crohn (DC) em remissão induzida por infliximabe. Objetivos: Nosso objetivo foi avaliar a atividade física de vida diária, capacidade de exercício, qualidade de vida (QV) e desordens do humor em pacientes com DC moderada a grave em remissão induzida por infliximabe, e investigar variáveis associadas com atividade física de vida diária nestes pacientes. Métodos: Um estudo transversal foi conduzido, com 26 pacientes com DC foram selecionados. Controles foram indivíduos assintomáticos com dispepsia funcional. Os pacientes foram avaliados quanto à atividade física de vida diária pelo acelerômetro triaxial, à capacidade de exercício (shuttle walk test – SWT), força de preensão manual, QV e desordens de humor. As associações entre a atividade física de vida diária e a QV ou desordens do humor foram testadas. Resultados: O número de passos dado (7446 ± 3081 vs. 7898 ± 2487), o tempo ativo (80,56 ± 41,97 min vs. 89,65 ± 24,30 min), a distância percorrida no SWT (662,69 ± 252,86 m vs. 728,82 ± 346,55 m) e a força de preensão manual (34,3 ± 11,1 kgf vs. 32,9 ± 11,9 kgf) não mostraram significância estatística entre pacientes com DC e controles. O tempo gasto deitado (116,31 ± 107,38 min vs. 63,71 ± 55,79 min) e alguns domínios da QV foram superiores em pacientes com DC (p0,05). Conclusão: Nós encontramos que pacientes com DC em remissão induzida por infliximabe tem o mesmo nível de atividade física de vida diária e capacidade de exercício quando comparados com controles

A new microsporidian parasite, Ordospora pajunii sp. nov (Ordosporidae), of Daphnia longispina highlights the value of genomic data for delineating species boundaries

Speciation is a complex and continuous process that makes the delineation of species boundaries a challenging task in particular in species with little morphological differentiation, such as parasites. In this case, the use of genomic data is often necessary, such as for the intracellular Microsporidian parasites. Here, we characterize the genome of a gut parasite of the cladoceran Daphnia longispina (isolate FI-F-10), which we propose as a new species within the genus Ordospora: Ordospora pajunii sp. nov (Ordosporidae). FI-F-10 closest relative, Ordospora colligata is only found in D. magna. Both microsporidian species share several morphological features. Although it is not possible to estimate divergence times for Microsporidia due to the lack of fossil records and accelerated evolutionary rates, we base our proposal on the phylogenomic and genomic distances between both microsporidian lineages. The phylogenomic reconstruction shows that FI-F-10 forms an early diverging branch basal to the cluster that contains all known O. colligata strains. Whole-genome comparisons show that FI-F-10 presents a greater divergence at the sequence level than observed among O. colligata strains, and its genomic average nucleotide identity (ANI) values against O. colligata are beyond the intraspecific range previously established for yeast and prokaryotes. Our data confirm that the ANI metrics are useful for fine genetic divergence calibration across Microsporidia taxa. In combination with phylogenetic and ecological data, genome-based metrics provide a powerful approach to delimitate species boundaries

Muscle function and quality of life in the Crohn’s disease

Abstract Introduction: Crohn’s disease (CD) is an inflammatory bowel disease, marked by exacerbations and remissions periods. Peripheral manifestations in CD may be present with the syndrome of skeletal muscle dysfunction (SMD), which is characterized by loss of muscle strength, fatigue complain, limited exercise capacity and impaired quality of life of these patients. Objective: Evaluate muscle strength, physical capacity and quality of life of patients with CD and compare them with healthy controls. Methods: 18 patients CD and 12 healthy controls matched for age and sex were involved. Peripheral muscle strength evaluated by handgrip strength of the dominant hand and respiratory muscle strength by measures of respiratory muscle strength (maximal inspiratory/expiratory pressure - MIP and MEP). Exercise capacity evaluated by Shuttle test (ST) and the quality of life by the Short-form 36 (SF-36) and by the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Patients with CD presented a lower respiratory muscle strength (MIP = -68.93 ± 26.61 vs 29.63 ± -100 cmH2O, p = 0.0013 and MEP = 81.07 ± 30.26 vs 108 ± 25.30 cmH2O, p = 0.032) and a tendency the lower peripheral muscle strength (31.72 ± 8.55 vs 39.00 ± 13.37 kgf, p = 0.09). In addition, CD patients presented worse physical capacity on the ST compared to the control group (513.7 ± 237m vs 983.0 ± 263m, p < 0.05) and worse quality of life in 7 of 8 domains of the SF-36 and in all dimensions of the IBDQ. Conclusion: Patients with CD showed muscle functional impairment and poorer quality of life compared to healthy control group. These findings suggest that the assessment and maybe interventions in the muscle function must be used in clinical practice

Impacto da terapia biológica em portadores de doença de Crohn: Um estudo prospectivo

Introduction: Protein-energy malnutrition in Crohn's disease (CD) has been reported in 20 to 92% of patients, and is associated with increased morbidity and mortality and higher costs for the health system. Anti-TNF drugs are a landmark in the clinical management, promoting prolonged remission in patients with CD. It is believed that the remission of this disease leads to nutritional recovery. The effect of biological therapy on body composition and nutritional status is unclear. Method: Prospective study of body assessment by bioelectrical impedance method in patients with moderate to severe CD undergoing treatment with infliximab. The main outcome was the body composition before and after 6 months of anti-TNF therapy. Results: There was a predominance of females (52%) with a mean age of 42±12 years. Most patients were eutrophic at baseline and remained so. There was an increase in all parameters of body composition after anti-TNF treatment: BMI (22.9±3.2 versus 25±3.8; p=0.005), waist circumference (88.1±6.7 versus 93.9±7.7; p=0.002), lean mass index (17.5±2.2 versus 18.2±2.3; p=0.000) and fat mass index (5.5±2.3 versus 6.8±2.3; p=0.000). Phase angle remained unchanged (6.2 versus 6.8; p=0.94). Conclusion: After therapy with IFX, all components of body composition increased, except for phase angle. The substantial increase in fat mass index and waist circumference led to concern regarding cardiovascular risk and, thus, to the need for further studies.Introdução: Desnutrição proteico-calórica em pacientes de doença de Crohn (DC) tem sido relatada em 20 a 92% dos casos associando-se a maior morbimortalidade e maiores custos para o sistema de saúde. Agentes anti-TNF são um marco no controle clínico, promovendo remissão prolongada em portadores de DC. Acredita-se que a remissão da doença leve à recuperação nutricional desses pacientes. O efeito da terapia biológica na composição corporal e no estado nutricional é pouco conhecido. Método: Estudo prospectivo de avaliação corporal por método de bioimpedância em portadores de DC moderada a grave submetidos a terapia com infliximabe (IFX). O desfecho principal foi a composição corporal antes e após 6 meses de terapia anti-TNF. Resultados: Houve predomínio do sexo feminino (52%), com média de idades de 42±12 anos. A maioria dos pacientes era eutrófica na inclusão do estudo e assim permaneceu. Houve aumento de todos os parâmetros da composição corporal após o tratamento anti-TNF: IMC (22,9±3,2 versus 25±3,8; p=0,005), circunferência abdominal (88,1±6,7 versus 93,9±7,7; p=0,002), índice de massa magra (17,5±2,2 versus 18,2±2,3; p=0,000) e índice de massa gorda (5,5±2,3 versus 6,8±2,3; p=0,000). O ângulo de fase manteve-se inalterado (6,2 versus 6,8; p=0,94). Conclusão: Após terapia com IFX, observou-se aumento de todos os componentes da composição corporal, exceto no ângulo de fase. O aumento substancial do índice de massa gorda e da circunferência abdominal levantam a preocupação de aumento nos riscos cardiovasculares e necessidade de estudos complementares