Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV

Estudo ultra-estrutural da mucosa do jejuno na infeccao pelo HIV: correlacao clinico-morfologica

BV UNIFESP: Teses e dissertaçõe

Deficiência de ferro nas afecções gastrointestinais do adulto Iron deficiency related to gastrointestinal diseases in adults

A anemia por deficiência de ferro (ADF) ou a deficiência de ferro (DF) isolada são comuns em crianças e mulheres pré-menopausa. Entretanto, em adultos do sexo masculino e mulheres pós-menopausa, essa condição se associa frequentemente a perdas sanguíneas gastrointestinais ou mal absorção. A prevalência das lesões gastrointestinais torna essencial o exame do aparelho digestório superior e inferior através da endoscopia. Investigações complementares devem ser realizadas se os procedimentos endoscópicos não evidenciarem sangramento em situações clínicas, tais como a necessidade de múltiplas hemotransfusões, a ausência de sangramento visível à endoscopia digestiva alta e colonoscopia e a falta de resposta à reposição de ferro.Esses casos devem ser direcionados para investigação do intestino delgado com métodos radiológicos ou, mais recentemente, com a cápsula endoscópica e da enteroscopia com duplo balão. A cintigrafia com hemácias marcadas e a angiografia têm papel restrito, sendo utilizadas apenas no sangramento aberto. O tratamento varia de acordo com a etiologia, a intensidade da perda sanguínea e da deficiência de ferro.<br>Iron deficiency anaemia and isolated iron deficiency are common in children and pre-menopausal women. However, in male adults and post-menopausal women this condition is most frequently caused by gastrointestinal blood loss or malabsorption. The prevalence of gastrointestinal lesions makes the examination by endoscopy of both upper and lower gastrointestinal tracts essential. Further investigations, when the initial exams are negative, are only warranted in cases of multiple transfusions, visible blood loss or lack of response to oral iron supplementation. In these cases examinations should be focused on the small bowel by radiological methods or more recently using capsule endoscopy and double balloon enteroscopy. Nuclear medicine and angiography have a limited role to play in this investigation as both have restricted indications for visible gastrointestinal hemorrhages not detected by endoscopic methods. Treatment varies according to the source and severity of bleeding and iron deficiency

Enviromental factors (exposome) associated to inflammatory bowel disease development

Inflammatory bowel disease (IBD) is multifactorial, with interactions between genetic susceptibility (genome), individual immunological factors (immunome), gut microbiota (microbiome), and environmental exposure (exposome). The exposome starts its action at intrauterine life going through childhood to adulthood and acts as a likely trigger for the disease. Changes in the exposome favor the emergence of autoimmune diseases reinforced by non-modifiable genetic factors over the years, therefore the epidemiology of IBD might vary between countries, probably linked by the interaction between different gene pools and distinct environmental factor exposure. This article aims to review the main environmental factors related to the development of inflammatory bowel disease

Environmental factors (exposome) associated to Inflammatory Bowel Disease development

Inflammatory bowel disease (IBD) is multifactorial, with interactions between genetic susceptibility (genome), individual immunological factors (immunome), gut microbiota (microbiome), and environmental exposure (exposome). The exposome start their action in intrauterine life going through childhood to adulthood and acts as a likely trigger for the disease. Changes in the exposome favor the emergence of autoimmune diseases reinforced by non-modifiable genetic factors over the years, therefore the epidemiology of IBD might vary between countries, probably linked by the interaction between different gene pools and distinct environmental factor exposure. This article aims to review the main environmental factors related to the development of inflammatory bowel disease