Educar em saúde: conhecendo as principais doenças do intestino

 O câncer colorretal apresenta elevada taxa de incidência na população brasileira e é o quinto tipo de câncer em mortalidade no país. Outras doenças intestinais, como a diverticulite, a apendicite e as hemorroidas, também são bastante comuns, responsáveis por grande parte dos atendimentos em unidades de urgência e emergência. A fim de alertar a população e estimular a prevenção das doenças intestinais e do câncer colorretal, foi desenvolvida uma atividade de extensão universitária que ocorreu a partir de visitas de adultos e crianças ao "Intestino Gigante", que é uma réplica de intestino grosso, de tamanho suficientemente grande para permitir um passeio informativo em seu interior. As visitas foram supervisionadas por alunos de graduação e de pós-graduação, previamente treinados para discutir sobre os temas abordados com os participantes. Dois mil e vinte e sete visitantes participaram da atividade, durante os 5 dias de exposição. Cento e trinta e um visitantes responderam questionários para avaliação de conhecimentos antes e após a visitação. Cinquenta e um participantes responderam ao questionário específico sobre câncer colorretal e 80 responderam ao questionário específico sobre outras doenças intestinais. Houve aumento do significativo do conhecimento, antes e após as visitas, para os dois questionários utilizados. O conhecimento prévio dos participantes era significativamente maior em relação ao câncer colorretal do que em relação às doenças do intestino. Por outro lado, o ganho de conhecimento foi significativamente superior para as perguntas relacionadas às doenças do intestino do que ao câncer colorretal, fazendo com que esta diferença deixasse de apresentar significância estatística no momento pós-visita. A evolução de ganho de conhecimento não demonstrou diferença estatisticamente significativa entre as diferentes faixas etárias. A atividade de extensão universitária proposta foi considerada eficaz, promovendo educação em saúde pela difusão de conhecimentos para a comunidade, abordando as principais doenças do intestino e incentivando a prevenção, diagnóstico precoce e melhora do tratamento

A ingestão de substâncias cáusticas na infância: A construção e divulgação de vídeo educativo sobre medidas de prevenção / The ingestion of caustic substances in childhood: The construction and dissemination of an educational video on prevention measures

A ingestão de substâncias cáusticas na infância é um problema de saúde pública e acarreta alta morbidade aos pacientes, que geralmente desenvolvem estenose esofágica. Os tratamentos disponíveis para estenose cáustica são pouco satisfatórios e por isso realizamos um trabalho para divulgação de medidas de prevenção. Trata-se de vídeo explicativo sobre os perigos da ingestão de substâncias cáusticas e como evitar tais acidentes com crianças. O vídeo foi produzido a partir do relato de familiares de pacientes vítimas da ingestão acidental de soda cáustica

Severe distal cytomegalovirus esophagitis with aerodigestive symptoms in an immunocompetent infant

We report a case of an immunocompetent infant, with no evidence of neurological disorders, which developed clinical manifestation of recurrent crisis of choking, dysphagia, laryngeal stridor and sub costal retractions since the first day of life. Direct laryngoscopy was unremarkable. Upper gastrointestinal series showed a dilated tortuous esophagus with severe peristalsis impairment and reflux episodes till the proximal third of the esophagus. An upper gastrointestinal endoscopy showed a moderately dilated esophagus with erosive lesions in the distal esophagus. Esophageal biopsy specimens revealed CMV inclusion bodies associated to moderate inflammation and immunohistochemistry was positive for CMV early antigen. Prolonged 24 h esophageal pH metry was within normal limits. Antiviral therapy with intravenous ganciclovir was introduced and was associated with rapid improvement of the symptoms. Child gradually increased oral intake and weight gain, and there were no side effects related to therapy. Thus, the respiratory symptoms could have been a supra esophageal manifestation of a non-acid reflux disease related to the CMV esophagitis

Brazilian Portuguese translation and cross-cultural adaptation of the “Caregiver Priorities and Child Health Index of Life with Disabilities” (CPCHILD©) questionnaire

BACKGROUND: Consideration of the quality of life in relation to individual health status is crucial for planning and maintaining a system of patient-centered care. Until recently, there have been no suitable instruments to assess health-related quality of life (HRQoL,) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The “Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire” (CPCHILD(©)) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD(©) Questionnaire into Brazilian Portuguese, thus permitting researchers in Brazil to access this important tool for measuring HRQoL in this population, as well as the possibility of making comparisons with other studies that use the same questionnaire in other languages. METHOD: The cross-cultural adaptation included two forward translations by independent translators, their synthesis, two back-translations by independent translators, an assessment of the versions by an expert committee and the development of a pre-final version, which was tested on 30 caregivers of children (5 -18) with severe cerebral palsy (GMFCS IV & V). RESULTS: Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications were required to account for the socioeconomic and cultural levels of the target population. CONCLUSION: The translation and cross-cultural adaptation of the CPCHILD(©) questionnaire provides a Brazilian Portuguese equivalent to measure the HRQoL of children with severe developmental disabilities, with the potential to measure the benefits of various procedures that are indicated for these patients. This adaptation exhibited a satisfactory level of semantic equivalence between the Portuguese target and the original English source versions. The validity of the Brazilian version of the instrument must be established in the future by assessing its psychometric properties on Brazilian epidemiological samples

Sleep quality in medical students: a comparison across the various phases of the medical course

ABSTRACT Objective: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course. Methods: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups. Results: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C. Conclusions: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students

Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study

Objectives: Evaluate the effect of combinations of green banana biomass and laxatives in children and adolescents with chronic constipation. Methods: This was a randomized study of 80 children and adolescents with functional constipation according to the Rome IV Criteria, who were divided into five groups: (1) green banana biomass alone; (2) green banana biomass plus PEG 3350 with electrolytes; (3) green banana biomass plus sodium picosulfate; (4) PEG 3350 with electrolytes alone; and (5) sodium picosulfate alone. Primary outcome measure was the reduction of the proportion of patients with Bristol Stool Form Scale ratings 1 or 2. Secondary outcome measures were: increase of the proportion of >3 bowel movements/week and reduction of the proportion of fecal incontinence, straining on defecation, painful defecation, blood in stool, abdominal pain, and decreased laxative doses. Results: On consumption of green banana biomass alone, a statistically significant reduction was observed in the proportion of children with Bristol Stool Form Scale rating 1 or 2, straining on defecation, painful defecation, and abdominal pain. Conversely, no reduction was observed in fecal incontinence episodes/week, blood in stool, and no increase was observed in the proportion of children with >3 bowel movements/week. The percentage of children who required decreased laxative dose was high when green banana biomass was associated with sodium picosulfate (87%), and PEG 3350 with electrolytes (63%). Green banana biomass alone and associated with laxatives was well tolerated, and no adverse effects were reported. Conclusion: Green banana biomass is advantageous as an adjunct therapy on functional constipation, mainly for reducing doses of laxatives. Resumo: Objetivos: Avaliar o efeito das combinações da biomassa de banana verde e laxantes em crianças e adolescentes com constipação crônica. Métodos: Estudo randomizado de 80 crianças e adolescentes com constipação funcional de acordo com os Critérios de Roma IV divididos em cinco grupos: 1) Somente biomassa de banana verde; 2) Biomassa de banana verde mais PEG 3350 com eletrólitos; 3) Biomassa de banana verde mais picossulfato de sódio; 4) PEG 3350 somente com eletrólitos e 5) somente picossulfato de sódio. O desfecho primário foi a redução da proporção de pacientes com as classificações 1 ou 2 da Escala de Bristol para Consistência de Fezes. Os desfechos secundários foram: aumento da produção de > 3 evacuações/semana e redução da proporção de incontinência fecal, esforço na defecação, defecação dolorosa, sangue nas fezes, dor abdominal e redução nas dose de laxantes. Resultados: No consumo somente de biomassa de banana verde há uma redução estatisticamente significativa na proporção de crianças com classificação 1 ou 2 da Escala de Bristol para Consistência de Fezes, esforço na defecação, defecação dolorosa e dor abdominal. Por outro lado, não houve redução nos episódios fecais/semana de incontinência, sangue nas fezes e nenhum aumento na proporção de crianças com > 3 evacuações/semana. O percentual de crianças que tiveram sua dose de laxante reduzida foi alto quando a biomassa de banana verde foi associada a picossulfato de sódio (87%) e PEG 3350 com eletrólitos (63%). A biomassa de banana verde sozinha e associada a laxantes foi bem tolerada e não houve efeitos adversos relatados. Conclusão: A biomassa de banana verde é vantajosa como uma terapia adjuvante na constipação funcional, principalmente na redução das doses de laxantes. Keywords: Constipation, Dietary fiber, Green banana, Green banana biomass, Resistant starch, Palavras-chave: Constipação, Fibra dietética, Banana verde, Biomassa de banana verde, Amido resistent

Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study

Objectives: Evaluate the effect of combinations of green banana biomass and laxatives in children and adolescents with chronic constipation. Methods: This was a randomized study of 80 children and adolescents with functional constipation according to the Rome IV Criteria, who were divided into five groups: (1) green banana biomass alone; (2) green banana biomass plus PEG 3350 with electrolytes; (3) green banana biomass plus sodium picosulfate; (4) PEG 3350 with electrolytes alone; and (5) sodium picosulfate alone. Primary outcome measure was the reduction of the proportion of patients with Bristol Stool Form Scale ratings 1 or 2. Secondary outcome measures were: increase of the proportion of >3 bowel movements/week and reduction of the proportion of fecal incontinence, straining on defecation, painful defecation, blood in stool, abdominal pain, and decreased laxative doses. Results: On consumption of green banana biomass alone, a statistically significant reduction was observed in the proportion of children with Bristol Stool Form Scale rating 1 or 2, straining on defecation, painful defecation, and abdominal pain. Conversely, no reduction was observed in fecal incontinence episodes/week, blood in stool, and no increase was observed in the proportion of children with >3 bowel movements/week. The percentage of children who required decreased laxative dose was high when green banana biomass was associated with sodium picosulfate (87%), and PEG 3350 with electrolytes (63%). Green banana biomass alone and associated with laxatives was well tolerated, and no adverse effects were reported. Conclusion: Green banana biomass is advantageous as an adjunct therapy on functional constipation, mainly for reducing doses of laxatives. Resumo: Objetivos: Avaliar o efeito das combinações da biomassa de banana verde e laxantes em crianças e adolescentes com constipação crônica. Métodos: Estudo randomizado de 80 crianças e adolescentes com constipação funcional de acordo com os Critérios de Roma IV divididos em cinco grupos: 1) Somente biomassa de banana verde; 2) Biomassa de banana verde mais PEG 3350 com eletrólitos; 3) Biomassa de banana verde mais picossulfato de sódio; 4) PEG 3350 somente com eletrólitos e 5) somente picossulfato de sódio. O desfecho primário foi a redução da proporção de pacientes com as classificações 1 ou 2 da Escala de Bristol para Consistência de Fezes. Os desfechos secundários foram: aumento da produção de > 3 evacuações/semana e redução da proporção de incontinência fecal, esforço na defecação, defecação dolorosa, sangue nas fezes, dor abdominal e redução nas dose de laxantes. Resultados: No consumo somente de biomassa de banana verde há uma redução estatisticamente significativa na proporção de crianças com classificação 1 ou 2 da Escala de Bristol para Consistência de Fezes, esforço na defecação, defecação dolorosa e dor abdominal. Por outro lado, não houve redução nos episódios fecais/semana de incontinência, sangue nas fezes e nenhum aumento na proporção de crianças com > 3 evacuações/semana. O percentual de crianças que tiveram sua dose de laxante reduzida foi alto quando a biomassa de banana verde foi associada a picossulfato de sódio (87%) e PEG 3350 com eletrólitos (63%). A biomassa de banana verde sozinha e associada a laxantes foi bem tolerada e não houve efeitos adversos relatados. Conclusão: A biomassa de banana verde é vantajosa como uma terapia adjuvante na constipação funcional, principalmente na redução das doses de laxantes. Keywords: Constipation, Dietary fiber, Green banana, Green banana biomass, Resistant starch, Palavras‐chave: Constipação, Fibra dietética, Banana verde, Biomassa de banana verde, Amido resistent

Transcutaneous Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review and Meta-Analysis

Introduction: Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of retentive fecal incontinence. Neuromodulation has been used to treat many health problems, with promising results. Objective: To conduct a systematic review of randomized clinical trials based on the effects of transcutaneous neuromodulation in treating constipation and retentive fecal incontinence in children and adolescents. Methods: A systematic review of randomized clinical trials was performed. Medline (PubMed), PEDro, SciELO, Cochrane (CENTRAL), Embase, and Scopus databases were searched from March 2000 to August 2022. We included clinical trials evaluating transcutaneous neuromodulation in children with constipation and fecal incontinence compared or associated with other types of treatment. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted the data. Results: Three studies with 164 participants were included in this review. Two meta-analyses were generated based on these studies. These analyses revealed that transcutaneous neuromodulation is an effective adjuvant treatment modality that improves children’s constipation and retentive fecal incontinence. The methodological quality of the included studies was classified as high based on the assessment of the quality of evidence, with a high degree of confidence based on the GRADE system. Conclusions: Transcutaneous neuromodulation is an effective adjuvant treatment modality for children with constipation and retentive fecal incontinence

The use of mitomycin C in caustic esophagitis in rats

PURPOSE: To evaluate the topical effects of mitomycin C (MMC) in rats, with or without esophageal dilation, in different moments after esophageal caustic injury with NaOH10%. METHODS: Forty eight Wistar rats were divided into six groups: "GS" infusion of 0.9% saline solution in the esophagus; "CG" infusion of 0.9% saline solution in the esophagus, with temporary ligation of the organ; "NTG" induction of a caustic lesion without treatment; "GmmcD0" MMC applied immediately after the caustic injury; "GmmcD14" MMC applied 14 days after the caustic injury; "Gdil+mmcD14" esophageal dilation and application of MMC 14 days after caustic injury. We performed contrast esophagograms of four animals from each group, seven and 21 days after the caustic injury. On day 28, all animals were sacrificed, and histopathological analyses were performed on the esophageal specimens. RESULTS: The contrast images showed total stenosis in NTG and GmmcD0, improving to partial stenosis in GmmcD0. In GmmcD14 and Gdil+mmcD14, two animals of each group improved to partial stenosis. By histopathological analysis, NTG and GmmcD14 presented intermediate damage and GmmcD0 and Gdil+mmcD14 severe damage. CONCLUSION: The use of mitomycin C had beneficial effects specially when applied immediately after the induction of esophageal lesions