Eosinophilic esophagitis-endoscopic distinguishing findings

Eosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases. The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction. Gastroesophageal reflux disease- like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE. Due to its unclear pathogenesis and unspecific symptoms, it is difficult to diagnose EE without a strong suspicion. Although histological criteria are necessary to diagnosis EE, there are some characteristic endoscopic features. We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months. This case report stresses the most distinguishing endoscopic findings-mucosa rings, white exudative plaques and linear furrows-that can help in the prompt recognition of this condition

Phonological awareness screening and assessment tool for European Portuguese speaking children

Trabalho apresentado em 10th European CPLOL Congress of Speech and Language Therapy, 10-120 maio 2018, Estoril, PortugalN/

Role of a micronized purified flavonoid fraction as an adjuvant treatment to rubber band ligation for the treatment of patients with hemorrhoidal disease: a longitudinal cohort study

Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting. Purpose: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting. Methods: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies. Results: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse). Conclusion: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first wee

Educational technologies designed to promote cardiovascular health in adults: integrative review

Objetivo Investigar as tecnologias educacionais desenvolvidas para promoção da saúde cardiovascular em adultos. Método Revisão integrativa realizada nas bases de dados PubMed, SciELO e LILACS, com a seleção de 15 artigos. Resultados Mais da metade (60%) dos estudos foi de Ensaios Clínicos Randomizados. As tecnologias educacionais desenvolvidas foram programas envolvendo três estratégias e com a duração de um ano, além de tecnologias lúdicas com contação de histórias, programas de computador ou software para smartfones e folheto eletrônico. Essas tecnologias resultaram em redução dos níveis pressóricos, peso, circunferência abdominal, diminuição de internações e aumento dos anos de vida. Conclusão Os estudos com melhores impactos na saúde cardiovascular dos adultos foram os que trouxeram a tecnologia em forma de programa e com a duração de um ano.



Objetivo Investigar las tecnologías educativas desarrolladas para la promoción de la salud cardiovascular en adultos. Método Revisión integrativa llevada a cabo en las bases de datos PubMed, SciELO e LILACS, mediante la selección de 15 artículos. Resultados Más de la mitad (60%) de los estudios fue de Ensayos Clínicos Randomizados. Las tecnologías educativas desarrolladas fueron programas que abarcaban tres estrategias y con duración de un año, además de tecnologías lúdicas mediante el acto de contar historias, programas de computadora o software para smartphones y folleto electrónico. Dichas tecnologías resultaron en la reducción de los niveles presóricos, de peso y de la circunferencia abdominal, y también en la reducción de hospitalizaciones y aumento de los años de vida. Conclusión Los estudios con mejores impactos en la salud cardiovascular de los adultos fueron los que proporcionaron la tecnología a modo de programa y con duración de un año.
Objective Investigating the educational technologies developed for promoting cardiovascular health in adults. Method Integrative review carried out in the databases of PubMed, SciELO and LILACS, with 15 articles selected. Results Over half (60%) of the studies were randomized clinical trials. The developed educational technologies were programs involving three strategies, with duration of one year, use of playful technologies with storytelling, computer programs or software for smartphones, and electronic brochure. These technologies resulted in reduction of blood pressure, weight, waist circumference, decreased hospitalizations and increased years of life. Conclusion The studies with better impact on the cardiovascular health of adults were those who brought the technology in the form of program and duration of one year

Does a light meal change liver stiffness in transient elastography? A prospective study

Introdução: A elastografia hepática transitória (EHT) é um método não invasivo de avaliação de fibrose utilizado na doença hepática, principalmente na infeção crónica pelo vírus da hepatite C (VHC). Está demonstrada a sua acuidade na identificação de doentes com fibrose avançada ou cirrose. No entanto, existem fatores capazes de interferir na medição da dureza hepática (DH) para além da fibrose. A ingestão alimentar poderá constituir um desses fatores de erro, embora esteja pouco estudada e até agora não esteja definida a condição em que deve ser realizado o exame. Objetivos: Avaliar a influência da ingestão alimentar na DH medida por EHT e a sua potencial interferência na orientação clínica de doentes com infeção crónica pelo vírus da hepatite B (VHB) e VHC. Doentes e métodos: Estudo prospetivo observacional em que se procedeu à realização de EHT em 2 tempos --- em jejum e após (30-60 minutos) uma refeição padronizada --- numa amostra de 42 doentes com infec¸ão crónica pelo VHB, 26 pelo VHC e 42 controlos. A análise foi complementada pela divisão em subgrupos, de acordo com o estádio presumido de fibrose. Resultados: Apesar da DH variar em todos os grupos com a ingestão alimentar, só se verificou um aumento estatisticamente significativo nos indivíduos sem fibrose presumida (baixa DH) infetados pelo VHB (p = 0,001). Constatou-se que as variações observadas poderiam interferir na orientação clínica de 11,8% dos doentes. Conclusão: No nosso estudo a ingestão alimentar fez variar o valor de DH no subgrupo de doentes com hepatite crónica pelo VHB com baixa fibrose presumida. Neste sentido, não parece interferir de forma significativa com a decisão e orientação clínica dos doentes, o que não nos permite fazer sugestões sobre a utilidade de efetuar o exame em jejum.Introduction: Transient Elastography (TE) is a noninvasive method widely used to evaluate hepatic fibrosis in patients with liver disease, especially in chronic hepatitis C. It has excellent accuracy in identifying patients with advanced fibrosis or cirrhosis. However, some factors can interfere with liver stiffness (LS) measurement. The food intake may be one of those confounding factors and there are no defined conditions under which the examination should be performed. Objectives: To evaluate the influence of food intake in LS and its potential interference with the clinical management of patients with chronic hepatitis B and chronic hepatitis C. Patients & Methods: Observational prospective study in which TE was performed in two physiological conditions --- fasting and after (30-60 minutes) a standard meal --- in a sample of 42 patients with chronic hepatitis B, 26 chronic hepatitis C and 42 controls. The analysis was complemented by the division into subgroups according to the presumed stage of fibrosis. Results: Despite the LS variation in all groups with food intake, a significant increase was only seen in individuals with chronic hepatitis B without suspected fibrosis (low LS) (p = 0,001). This variation could influence the clinical orientation in 11.8% of cases. Conclusion: In our study, a meal altered LS value in chronic hepatitis B without suspected fibrosis (low LS). As it does not seem to interfere significantly with the clinical management of our patients, we can not, at this point, make any suggestion about the usefulness of performing this exam in the fasting condition

Oncological outcomes after endoscopic removal of malignant colorectal polyps

Objective: malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients´ management.Methods: retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes.Results: thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4 %) patients: 8 (53.3 %) wall disease, 5 (33 %) nodal metastasis, and 2 (13.3 %) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30 %) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03).Conclusions: surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries

Psychometry and Pescatori projective test in coloproctological patients

Background Psychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools. Methods The 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers. Results Seventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn's disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn's disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients' also showed lower scores in the Pescatori projective test (P= 0.012). A weak association between the projective test and the depression subscale was found (P= 0.05). Conclusion Proctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls.info:eu-repo/semantics/publishedVersio

ELEMENTOS DE SATISFAÇÃO DOS ESTUDANTES DE CURSOS DE PÓS-GRADUAÇÃO LATO SENSU EM UMA INSTITUIÇÃO DO SISTEMA ACAFE NO MEIO-OESTE CATARINENSE

O objetivo que norteou este estudo foi identificar os elementos de satisfação dos acadêmicos de cursos de pós-graduação lato sensu em uma Instituição de Ensino Superior (IES) do Sistema ACAFE no Meio-Oeste Catarinense. O levantamento de dados deu-se por meio da aplicação de um questionário com 156 estudantes, na modalidade de ensino presencial. Adotou-se como proposta metodológica a abordagem quantitativa, com a aplicação da técnica descritiva; o tratamento e análise dos dados foram realizados por meio da estatística descritiva, Análise de Componentes Principais (ACP) e Análise Fatorial (AF). Os principais resultados apontam a agregação de todos os elementos do constructo produto no fator 1, processos no fator 2 e somente elementos relacionados ao constructo pessoas no fator 3. Adicionalmente, os elementos de maior satisfação dos acadêmicos é a localização do campus, o relacionamento interpessoal com os professores e com a coordenação. Em contraponto, quanto aos elementos com maior insatisfação se destacam o valor das taxas dos serviços prestados, o acervo da biblioteca e o acesso à internet

Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis

OBJETIVO Verificar os efeitos do tratamento anti-hipertensivo (farmacológico e não-farmacológico) na qualidade de vida relacionada à saúde de pessoas com hipertensão arterial. MÉTODOS Foi conduzida revisão sistemática com metanálise utilizando as bases de dados IBECS, Lilacs, SciELO, Medline, Cochrane, Science Direct, Scopus e o banco de teses da Capes. A análise estatística foi realizada pelo Review Manager versão 5.2. Foi utilizada a diferença da média na sumarização do efeito metanalítico pelo modelo de efeito fixo. Vinte estudos foram incluídos. RESULTADOS A sumarização do efeito mostrou incremento de 2,45 pontos na média (IC95% 1,02–3,87; p < 0,0008) da qualidade de vida em pessoas com adesão ao tratamento não farmacológico para hipertensão arterial. A adesão ao tratamento farmacológico indicou aumento de 9,24 pontos na média (IC95% 8,16–10,33; p < 0,00001) da qualidade de vida em pessoas com hipertensão arterial. CONCLUSÕES O tratamento não-farmacológico melhora a qualidade de vida global e o domínio físico de pessoas com hipertensão arterial. A adesão ao tratamento farmacológico impacta positivamente nos domínios mental, físico e escore total da qualidade de vida.OBJECTIVE To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension. METHODS We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included. RESULTS The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02–3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16–10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension. CONCLUSIONS Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score