Ischemic retinopathy associated with Crohn’s disease

Rubens Camargo Siqueira,1,2 Roberto Luiz Kaiser Junior,2 Lilian Piron Ruiz,2 Milton Arthur Ruiz2 1Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil; 2Department of Bone Marrow Transplantation, Beneficencia Portuguesa Hospital, Sao José do Rio Preto, Sao Paulo, Brazil Purpose: To report a case of a patient with ischemic retinopathy associated with Crohn’s disease.Case report: This report presents a case of a 28-year-old female patient with Crohn’s disease and sudden decrease of visual acuity in the right eye. Fluorescein angiography, optical coherence tomography, and multifocal electroretinography confirmed the clinical features of ischemic retinopathy. After systemic corticosteroid treatment, the patient developed epiretinal membrane without significant improvement in visual acuity.Discussion: The patient presented with ischemic retinopathy associated with Crohn’s disease with deficiency of central visual acuity. Periodic examination by a retina specialist is recommended for patients being treated for Crohn’s disease. Keywords: Crohn, ischemic retinopathy, epiretinal membrane, OCT, ER

Hematopoietic stem cell transplantation in a severe refractory Crohn’s disease patient with intestinal stoma: a case report

Milton Artur Ruiz,1 Roberto Luiz Kaiser Junior,2 Luiz Gustavo de Quadros,2 Gustavo Henrique Xavier Caseiro,2 Aderson Francisco Oliveira,1 Tatiana Peña-Arciniegas,1 Lilian Piron-Ruiz,1 Fernanda Soubhia Liedtke Kaiser,2 Vera Lucia Oliveira2 1Bone Marrow Transplant Department, Associação Portuguesa de Beneficencia de São José do Rio Preto, 2Kaiser Clinica, Centro Médico Avançado de São José do Rio Preto, Sao Paulo, Brazil Background: Hematopoietic stem cell transplantation (HSCT) can be used in the treatment of patients with refractory Crohn’s disease (CD) when no alternative treatment is available. However, HSCT increases the risk of infections, in particular during the aplasia of mobilization and conditioning. Moreover, intestinal stomas in CD augment the risk of morbidity in immunocompromised patients and under aplastic conditions. The objective of this report was to describe the results of the first year after HSCT in a CD patient with an intestinal stoma. Methods: The patient was assessed in respect to disease symptoms and endoscopic findings before the procedure and 30, 90, 180, and 365 days after HSCT.Results: No complications were observed during mobilization and conditioning with sufficient CD34+ cells being harvested in just one apheresis session. Toxicity was restricted to the hematological series. Scores of all the CD indexes and the quality of life of the patient improved. However, two of three endoscopic scores remained unchanged even though improvements were found in the appearance of the lesions.Conclusion: HSCT may be an alternative treatment for refractory CD in patients with an intestinal stoma, and a priori, carefully selected patients with stomas should not be excluded as candidates for this procedure. Keywords: Crohn’s disease, intestinal stoma, hematopoietic stem cell transplant, stem cell therapy, autologous HSCT, autoimmune diseases, nonmyeloablative HSC

Low-level phototherapy to improve exercise capacity and muscle performance: a systematic review and meta-analysis

The aim of this study was to evaluate the effectiveness of pre-exercise low-level phototherapy (Light-Emitting Diode therapy [LEDtherapy] or Light Amplification by Stimulate Emission of Radiation therapy [LASERtherapy]) in increasing exercise capacity and muscle performance of people undergoing exercise when compared to placebo treatment. Randomized controlled trials and crossover studies were sought on CENTRAL, MEDLINE, EMBASE, SciELO, PEDro and LILACS from its inception up to February 2015. References lists of included studies were sought for additional relevant research. Two authors independently extracted data on study design, treatment parameters, exercise capacity (number of repetitions, time to exhaustion, blood lactate concentration and lactate dehydrogenase activity) and muscle performance (torque, power and strength) using an structured table. Agreement should be reached by consensus or by a third reviewer. Sixteen studies involving 297 participants were included. Improvement of number of repetitions (mean difference [MD] [95 % confidence interval] = 3.51 repetitions [0.65–6.37]; P = 0.02), delay in time to exhaustion (MD = 4.01 s [2.10–5.91]; P < 0.0001), reduction in lactate levels (MD = 0.34 mmol/L [0.19–0.48]; P < 0.00001) and increased peak torque (MD = 21.51 Nm [10.01–33.01]; P < 0.00001) were observed when LASERtherapy was applied. LEDtherapy meta-analyses were performed with two studies and retrieved no between-group statistically significant difference in power, lactate levels or time to exhaustion. Although our results suggest that LASERtherapy is effective in improving skeletal muscle exercise capacity, the quality of the current evidence is limited