MÉTODOS CLÍNICOS DISPONÍVEIS PARA TRATAR A DOENÇA DO REFLUXO GASTROESOFÁGICO

A doença do refluxo gastroesofágico (DRGE) é uma afecção crônica causada pelo retorno do conteúdo gastroduodenal para o esôfago e para órgãos adjacentes a ele decorrente do relaxamento inadequado do musculo liso do esfíncter inferior do esôfago (EIE). A DRGE pode ser subdividida em dois, doença típica e atípica de acordo com os sintomas referidos pelo paciente. A típica é caracterizada pela presença de sintomas como pirose e regurgitação, enquanto que a atípica é pela presença de dor torácica, tosse, afecções orais. Há outra subdivisão relacionada a presença ou ausência de danos à mucosa esofágica, sendo classificada em erosiva e não erosiva, respectivamente. Essa doença atinge 38% norte-americanos e 12% dos brasileiros, podendo ser classificada como um problema de saúde pública. Vários exames são utilizados para auxiliar no diagnóstico clínico, tais como pHmetria, exames radiológicos, cintilografia e endoscopia digestiva alta. Para definir o exame complementar de melhor sensibilidade para o diagnóstico da doença do refluxo gastroesofágico foi realizada uma pesquisa de seleção de artigos do através de um levantamento bibliográfico nas fontes PUBMED, SciELO e LILACS utilizando os seguintes descritores: doença do refluxo gastroesofágico e diagnóstico. Foram selecionados artigos em português e em língua estrangeira que abordaram o tema. Após a leitura e a análise de todos os artigos selecionados pelos relatores deste resumo expandido, conclui-se que o exame de pHmetria é o mais sensível para o diagnóstico, apesar de não auxiliar no diagnóstico de refluxo alcalino. Quanto aos outros exames complementares, não houve consenso entre os articulistas utilizados

Resumos concluídos - Bioquímica

Resumos concluídos - Bioquímic

Resumos concluídos - Bioquímica

Resumos concluídos - Bioquímic

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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)