Development of an instrument to evaluate the knowledge that the patient with hepatic cirhosis has about his disease and treatment

Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge about his or her clinical condition is a determining factor in its adherence.Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. To improve the student knowledge on liver cirrhosis. Development of skills related to physical examination of the patient with HC.Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument (1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the instrument (3 rd stage).Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists and approved in the criteria proposed.Conclusions:1) The development of the instrument followed the steps described in literature.2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the proposal of the instrument.3) it was possible to achieve satisfactorily the proposal of the construction of the instrument.Key words: Liver cirrhosis; Self concept; Surveys and questionnaires; Health education

Chemical components separation with the use of botulinum toxin A: a critical review for correction of ventral hernia

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections.Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications.Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method

Development of an instrument to evaluate the knowledge that the patient with hepatic cirrhosis has about his disease and treatment

Introdução: cirrose hepática (CH) é uma doença com alta morbidade e mortalidade no Brasil. Seu tratamento é complexo e requer desde mudanças no estilo de vida até se submeter a grandes cirurgias, como o transplante hepático. Para alcançar os melhores resultados é necessário que o paciente tenha uma boa aderência ao tratamento. Estudos indicam que o conhecimento do paciente sobre sua condição clínica é um fator determinante na aderência. Objetivos: criar um instrumento que meça o conhecimento que um paciente com CH tem sobre sua doença e seu tratamento. Methodologia: o processo de desenvolvimento do instrument foi dividido em 3 estágios: construção do instrument (1º estágio), avaliação do conteúdo e claridade do instrument (2º estágio) e avaliação da confiabilidade do instrument (3º estágio). Results: um instrument para avaliar o conhecimento do paciente cirrótico sobre sua doença foi feito, analisado por especialistas e aprovado pelos critérios propostos. Conclusions: 1) O desenvolvimento do instrumento seguiu os passos descritos na literatura. 2) As sugestões dos avaliadores foram seguidas na reestruturação das questões, tornando-as mais claras e relevantes para a proposta do instrumento. 3) Foi possível alcançar de forma satisfatória a proposta de construção do instrumento.Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge about his or her clinical condition is a determining factor in its adherence. Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument (1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the instrument (3 rd stage). Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists and approved in the criteria proposed. Conclusions: 1) The development of the instrument followed the steps described in literature. 2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the proposal of the instrument. 3) it was possible to achieve satisfactorily the proposal of the construction of the instrument

Chemical components separation with the use of Botulinum toxin A: a critical review for correction of ventral hernia

Introdução: Hérnias ventrais são um resultado prevalente de cirurgias abdominais que podem representar um desafio cirúrgico em casos complexos, principalmente devido à tensão na musculatura da parede abdominal. A falha na correção cirúrgica pode levar a necessidade de um tratamento mais mórbido, além de um considerável impacto socioeconômico. Para que o risco de complicações seja menor, o uso da toxina botulínica A (TBA) pode ser uma alternativa pré-operatória para reduzir a tensão da parede abdominal, através de uma paralisia sustentada e reversível. Esta revisão crítica da literatura propõe avaliar o uso adjacente de TBA em correções de hérnias ventrais cirúrgicas. Métodos: Usando o banco de dados PubMed, as palavras-chave “ventral hernia” e “botullinum toxin” foram pesquisadas usando o operador “AND”. Os artigos foram selecionados com base em sua relevância e informações atualizadas. Os desfechos de interesse incluíram a mudança na largura do defeito da hérnia ventral e no comprimento do músculo da parede abdominal lateral, dor, recidiva de hérnia e complicações. Resultados: Foram encontrados 20 artigos de 2009 a 2018. Foram excluídos artigos devido à técnica irrelevante, uso de modelos animais e falta de dados sobre resultados. Redução da espessura da parede abdominal aumentando seu comprimento, menos dor perioperatória, redução de hérnia e correção com menos tensão foram observados após o uso da injeção de BTA. Nenhuma complicação ocorreu durante as aplicações. Conclusão: O uso de TBA parece ser uma alternativa promissora no manejo de hérnias ventrais devido à sua capacidade de reduzir a tensão na parede abdominal. No entanto, mais estudos são necessários para determinar a eficácia deste método.Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections. Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications. Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications. Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method

Intussusception reveals MUTYH-related polyposis syndrome and colorectal cancer: a case report

We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYHassociated polyposis, autosomal genetic syndrome associated with this disease. We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease

The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: A systematic review and meta-analysis.

BackgroundSarcopenia is defined as the loss of muscle mass combined with loss of muscle strength, with or without loss of muscle performance. The use of this parameter as a risk factor for complications after surgery is not currently used. This meta-analysis aims to assess the impact of sarcopenia defined by radiologically and clinically criteria and its relationship with complications after gastrointestinal surgeries.Materials and methodsA review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42019132221). Articles were selected from the PUBMED and EMBASE databases that adequately assessed sarcopenia and its impact on postoperative complications in gastrointestinal surgery patients. Pooled estimates of pre-operative outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Subgroup analysis were performed to assess each type of surgery.ResultsThe search strategy returned 1323, with 11 studies meeting the inclusion criteria. A total of 4265 patients were analysed. The prevalence of sarcopenia between studies ranged from 6.8% to 35.9%. The meta-analysis showed an OR for complications after surgery of 3.01 (95% CI 2.55-3.55) and an OR of 2.2 (95% CI 1.44-3.36) for hospital readmission (30 days).ConclusionSarcopenia, when properly diagnosed, is associated with an increase in late postoperative complications, as well as an increase in the number of postoperative hospital readmissions for various types of gastrointestinal surgery. We believe that any preoperative evaluation should include, in a patient at risk, tests for the diagnosis of sarcopenia and appropriate procedures to reduce its impact on the patient's health