Inhibitors of Tumoral Necrosis Factor Alpha in Inflammatory Bowel Disease

The treatment of inflammatory bowel disease (IBD) has undergone a major paradigm shift in the last two decades with the introduction of biological drugs. Tumoral necrosis factor (TNF) antagonists were the first monoclonal antibodies available for treatment of IBD. New emerging concepts as early initiation of treatment during the “opportunity window,” and “treat to target” with a tight control strategy have contributed to optimum utilization of these drugs allowing better long-term outcomes for treated patients. This chapter aims to review all current pivotal data regarding efficacy and safety of infliximab, adalimumab, certolizumab pegol, and golimumab, as long as real life experience with these agents. Comparative efficacy among anti-TNF agents and the role of therapeutic drug monitoring in the management of IBD will also be discussed. Last, the authors present future perspectives with the drugs and position anti-TNF agents as viable therapeutic options in the current IBD therapeutic armamentarium

IMPLEMENTAÇÃO DE UM ERP EM UMA EMPRESA DE PEQUENO PORTE

No momento atual, as organizações, sejam elas de pequeno, médio ou grande porte, confrontam com um mercado altamente competitivo, fazendo com que as mesmas, busquem ferramentas atualizadas que como resposta, as insiram no mercado competitivo e supram as exigências do público consumidor. Assim, os softwares de gestão integrada têm ganhado destaque notável no mercado atual, com a promessa de aumentar os lucros através da integração das informações. Diante disso, este estudo foi conduzido com o propósito de responder à problemática: Como uma empresa de médio porte pode utilizar o sistema ERP como ferramenta de diferenciação e competitividade no mercado atual? O presente trabalho, de natureza exploratória, tem uma abordagem de pesquisa qualitativa, e estudo de caso para evidenciar os resultados, analisando então, o processo de implementação de um sistema ERP em uma empresa do setor de vendas, de médio porte. A obtenção de dados se deu por meio de entrevistas estruturadas e observações, afim de conhecer dados mais específicos e relevantes para o trabalho. As evidências obtidas nesta pesquisa, permitiram constatar e confirmar aspectos já observados em outros estudos, bem como demostrar que apesar das dificuldades enfrentadas, os benefícios adquiridos com a implementação do ERP são compensatórios

Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance

The world is fighting the COVID-19 outbreak and health workers, including inflammatory bowel diseases specialists, have been challenged to address the specific clinical issues of their patients. We hereby summarize the current literature in the management of inflammatory bowel disease (IBD) patients during the COVID-19 pandemic era that support the rearrangement of our IBD unit and the clinical advice provided to our patient

LEVANTAMENTO DOS CASOS DE AVULSÃO DENTÁRIA DO CENTRO ESPECIALIZADO MARINGAENSE DE TRAUMATISMO ODONTOLÓGICO

As lesões traumáticas dentárias se caracterizam como um dos mais sérios problemas de saúde bucal entre crianças e adolescentes e representam uma das causas mais comuns de procura dos serviços de pronto-atendimento. A avulsão dentária se caracteriza pelo completo deslocamento do dente de seu alvéolo, e o melhor prognóstico está diretamente relacionado ao tempo extra-alveolar antes do reimplante e com as condições sob as quais o dente foi armazenado. O objetivo deste trabalho foi analisar, através de prontuários odontológicos, os casos de avulsões dentárias que compareceram ao Centro Especializado Maringaense de Traumatismo Odontológico (CEMTrau-Odonto) da Universidade Estadual de Maringá. A pesquisa foi realizada através da análise de 50 prontuários odontológicos dos casos de avulsões dentárias do Projeto CEMTrau-Odonto. Os pacientes possuíam idade entre 2 e 44 anos sendo que 34% se concentrava entre 2 e 9 anos e 19% dos casos foram causados por quedas de bicicleta. O reimplante foi realizado em 56% dos casos e 37% dos dentes foram mantidos a seco por mais de 30 minutos. Sabendo-se disso, os profissionais devem estar preparados para receber pacientes com história de traumatismos, sejam eles mais simples como uma fratura de esmalte, ou até mais complexos, como a avulsão

Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study.

Low bone mineral density (BMD) and osteoporosis remain frequent problems in patients with inflammatory bowel diseases (IBDs). Several guidelines with nonidentical recommendations exist and there is no general agreement regarding the optimal approach for osteoporosis screening in IBD patients. Clinical practice of osteoporosis screening and treatment remains insufficiently investigated.In the year 2014, a chart review of 877 patients included in the Swiss IBD Cohort study was performed to assess details of osteoporosis diagnostics and treatment. BMD measurements, osteoporosis treatment, and IBD medication were recorded.Our chart review revealed 253 dual-energy x-ray absorptiometry (DXA) scans in 877 IBD patients; osteoporosis was prevalent in 20% of tested patients. We identified widely differing osteoporosis screening rates among centers (11%-62%). A multivariate logistic regression analysis identified predictive factors for screening including steroid usage, long disease duration, and perianal disease; even after correction for all risk factors, the study center remained a strong independent predictor (odds ratio 2.3-21 compared to the center with the lowest screening rate). Treatment rates for patients with osteoporosis were suboptimal (55% for calcium, 65% for vitamin D) at the time of chart review. Similarly, a significant fraction of patients with current steroid medication were not treated with vitamin D or calcium (treatment rates 53% for calcium, 58% for vitamin D). For only 29% of patients with osteoporosis bisphosphonate treatment was started. Treatment rates also differed among centers, generally following screening rates. In patients with longitudinal DXA scans, calcium and vitamin D usage was significantly associated with improvement of BMD over time.Our analysis identified inconsistent usage of osteoporosis screening and underuse of osteoporosis treatment in IBD patients. Increasing awareness of osteoporosis as a significant clinical problem in IBD patients might improve patient care

Biosimilars in Inflammatory Bowel Diseases: General Concepts and Clinical Implications

The treatment of inflammatory bowel disease (IBD) has changed over time with the increasing use of biologics to achieve therapeutic goals. As a result, the cost of treatment increased considerably, making it necessary to develop strategies that could increase access to biological therapies. In this scenario, the biosimilars were developed with the aim of reducing costs, maintaining safety and efficacy compared to the originator. Initially, its use in IBD was based on the extrapolation of studies in other specialties, such as rheumatology. More recently, studies in inflammatory bowel disease have emerged, with favorable results for its use. It is known that there are still knowledge gaps in the use of biosimilars and more experience is needed to increase clinicians’ confidence in their clinical practice. This chapter proposes a review of what is currently known about biosimilars in IBD. It discusses about aspects such as safety, efficacy, interchangeability, immunogenicity and switches

DISPLASIA FIBROSA MAXILAR: RELATO DE CASO CLÍNICO

A displasia fibrosa é uma lesão pseudo-neoplásica de etiologia desconhecida, com caráter benigno e recidivante, caracterizada pelo desenvolvimento de tecido fibroso através de osteóides que substituem gradualmente o osso normal

SILENCE IS GOLDEN: PUTTING YOURSELF IN THE PATIENTS’ SHOES

In order to develop empathy for patients and to have a better understanding of theirlimitations and difficulties of compliance to prescriptions and proscriptions, theDoctor-Patient Relationship discipline of a Brazilian medical school asks itsstudents to feel, for a certain time, the restrictions imposed by some disease orcondition. Five female students, self-defined as extremely talkative, remained silent for two days. An individual report was made, and the experience of all was checked in regards to: the motivation and the expectations for the work; the reaction of relatives, teachers and colleagues; the feelings and reflections provided by the experience

THE PORTRAIT ADVERSE EVENTS IN A MEDICAL CLINIC: ANALYSIS OF A DECADE

Estudo observacional do tipo descritivo transversal que teve como objetivo analisar os eventos adversos ocorridos em unidade de clínica médica de um hospital de Goiás. A coleta de dados foi realizada a partir da leitura de 12 livros de registros de enfermagem preenchidos de janeiro de 2005 a dezembro de 2014. Foram encontrados 1360 eventos adversos, dos quais 408 (30%) se referiam a retiradas acidentais de sondas, cateteres e cânulas; 288 (21,2%) erros de medicação; 157 (11,5%) erros envolvendo acesso vascular; 134 (9,8%) casos de infecção relacionada à assistência à saúde; 115 (8,4%) processos alérgicos; 91 (6,7%) quedas de pacientes; 72 (5,3%) úlceras por pressão; 56 (4,1%) episódios de falta de hemoderivados e 39 (2,9%) evasões. O estudo aponta o aumento dos registros dos eventos adversos ao longo da década, indicando a necessidade de adoção de medidas de prevenção e maior conscientização da enfermagem quanto à importância do relato desse incidente.Estudio observacional de tipo descriptivo transversal objetivando analizar los eventos adversos ocurridos en unidad de clínica médica de un hospital de Goiás. Datos recolectados a partir de lectura de 12 libros de registros de enfermería completados entre enero de 2005 y diciembre de 2014. Fueron hallados 1360 eventos adversos, de los cuales 408 (30%) hacían referencia a retiros accidentales de sondas, catéteres y cánulas; 288 (21,2%) errores de medicación; 157 (11,5%) errores involucrando acceso vascular; 134 (9,8%) casos de infección relacionada a atención de salud; 115 (8,4%) procesos alérgicos; 91 (6,7%) caídas de pacientes; 72 (5,3%) úlceras por presión; 56 (4,1%) episodios de falta de hemoderivados y 39 (2,9%) evasiones. El estudio expresa el aumento de registros de eventos adversos a lo largo de la década, indicando necesidad de adopción de medidas preventivas y mayor concientización de los enfermeros respecto de la importancia de informar estos incidentes.This was a cross-sectional descriptive observational study aimed at analyzing adverse events in a medical clinic unit of a hospital in Goiás. Data were collected from the reading of 12 nursing registry books completed from January 2005 to December 2014. The analysis found 1,360 adverse events, of which 408 (30%) referred to accidental removal of probes, catheters, and cannulas; 288 (21.2%) to medication errors; 157 (11.5%) to errors involving vascular access; 134 (9.8%) to cases of healthcare-associated infections; 115 (8.4%) to allergic processes; 91 (6.7%) to patient falls; 72 (5.3%) to pressure ulcers; 56 (4.1%) to episodes of lack of blood derivatives; and 39 (2.9%) to evasions. The study shows an increase in the registry of adverse events over the decade, pointing out the need to adopt preventive measures and raising nursing personnel’s awareness about the importance of reporting these incidents

Impact of COVID-19 on liver transplant recipients during the first pandemic wave, in a tertiary hospital, in Northeastern Brazil

Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients’ medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population