Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 116
Filter
2.
Arq. gastroenterol ; 57(4): 354-360, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142334

ABSTRACT

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.


RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.


Subject(s)
Humans , Female , Adult , Aged , Outpatients , Gastrointestinal Diseases/etiology , Neoplasms/complications , Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Vomiting/etiology , Weight Loss , Nutritional Status , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Constipation/etiology , Diarrhea/etiology , Dyspepsia/etiology , Middle Aged , Nausea
3.
Pesqui. vet. bras ; 40(6): 417-425, June 2020. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1135641

ABSTRACT

A retrospective study of gastric disorders in autopsied cattle in the Western region of Rio Grande do Sul State, was performed. The exam reports of bovine necropsy of the Veterinary Pathology Laboratory, Unipampa, were analyzed in the period from 2010 to 2018. All cases in which death was primarily caused by disturbance in the gastric chambers were included. During the period evaluated, 141 cattle were necropsied. Of those, 25 had gastric disorders. Of those, 53% had alterations in the rumen, followed by abomasum (17%), involvement of two chambers (13%) and reticulum (9%). Most cases corresponded to beef cattle raised in an extensive system and most them for calf production and fattening with an average age of approximately three years. The cases occurred in farms of four different municipalities. Bullous bloat by excessive Trifolium repens ingestion was the gastric disturbance with the highest number of dead cattle observed in this study, especially in irrigated áreas of livestock farms. Cases such as lactic acidosis, ruminal alkalosis due to excessive urea ingestion and Baccharis coridifolia poisoning were also important gastric disturbances in necropsied cattle, associated especially with poor management and period of scarcity of good quality fodder. Cases of Clostridium perfringens infection were also observed in young cattle suggesting that it is an important infectious agent in the evaluated cattle herds, also showing failures in vaccination of the herds. As observed, gastric disturbances in cattle in the western region of Rio Grande do Sul have several causes. Metabolic/toxic and infectious disturbances were important causes of mortality in the herds, inducing considerable economic losses. Based on this study, it is clear that the majority of outbreaks or isolated cases occurred due to errors in the management of the properties and the vast majority of them could have been avoided with improvements in the technical qualification of the workers and simple adjustments in the farming methods. It is also emphasized the importance of the conclusive diagnosis to control these disorders, once after the orientation to the producers, was observed significant decrease in cattle losses in the farms.(AU)


Foi realizado estudo retrospectivo dos distúrbios gástricos em bovinos necropsiados na região Oeste do Rio Grande do Sul. Foram analisados os relatórios de exame de necropsia de bovinos do Laboratório de Patologia Veterinária (LPV) da Universidade Federal do Pampa (Unipampa), Rio Grande do Sul, no período de 2010 a 2018. Foram incluídos todos os casos nos quais a morte foi causada primariamente pelo distúrbio nas câmaras gástricas. De um total de 141 bovinos necropsiados, 25 corresponderam a distúrbios gástricos. Dentre esses, 53% apresentaram alterações no rúmen, seguido de abomaso 17%, acometimento concomitante de duas câmaras 13% e retículo 9%. A maioria dos casos ocorreram em bovinos de corte criados em sistema extensivo e a maioria destinados à produção de bezerros e engorda com média de idade de aproximadamente três anos. Os casos ocorreram em propriedades rurais de quatro municípios da região Oeste do estado. O timpanismo bolhoso por ingestão excessiva de Trifolium repens foi o distúrbio gástrico com maior número de bovinos mortos observados nesse estudo, especialmente em propriedades com criação de animais em áreas de irrigação. Casos como acidose láctica, alcalose ruminal por intoxicação por ureia e intoxicação por Baccharis coridifolia também foram importantes distúrbios gástricos nos bovinos necropsiados e percebeu-se sua associação a falhas no manejo e à época de escassez de forragem de boa qualidade. Foram observados ainda casos de infecção por Clostridium perfringens em bovinos jovens o que sugere também tratar-se de um importante agente infeccioso nos rebanhos bovinos avaliados, demonstrando ainda falhas na vacinação dos rebanhos. Conforme observado, diversos são os distúrbios gástricos em bovinos na região Oeste do Rio Grande do Sul, tendo como importantes causas de mortalidades os distúrbios metabólicos/tóxicos e infecciosos, induzindo consideráveis perdas econômicas. Com base nesse levantamento, percebe-se que a maioria dos surtos ou casos isolados estudados ocorreram por erros no manejo nas propriedades e, na sua grande maioria, poderiam ter sido evitados com especialização da mão de obra e ajustes simples. Ressalta-se ainda a importância do diagnóstico conclusivo para controle desses distúrbios, uma vez que, após a orientação aos produtores, observou-se significativa diminuição das perdas de bovinos nas propriedades.(AU)


Subject(s)
Animals , Cattle , Cattle Diseases , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/pathology , Gastrointestinal Diseases/veterinary , Gastrointestinal Diseases/epidemiology , Plant Poisoning/veterinary , Clostridium Infections/veterinary , Diet/veterinary
4.
Gastroenterol. latinoam ; 31(1): 35-38, mayo 2020.
Article in Spanish | LILACS | ID: biblio-1103381

ABSTRACT

The pandemic of the novel coronavirus SARS-CoV-2 has caused more than 2.5 millions of confirmed cases worldwide, with a mortality rate around 7%. Most cases appear to be mild with the most common symptoms being fever, dry cough, myalgia, fatigue, and dyspnea but can result in more severe disease. Also, there are described gastrointestinal manifestations: anorexia 27%, diarrhea 12%, nausea/vomiting 10%, and abdominal pain 9%. In Chile, diarrhea has been described in 7.3%, and abdominal pain 3.7%. The primary mechanism proposed is the entry of SARS-CoV-2 into the enterocytes binding the Angiotensin-converting enzyme 2 (ACE2), which is widely distributed among the gastrointestinal tract. Also, SARS-CoV-2 can cause elevated liver enzymes in up to 40% of cases. This alteration could also be caused by the binding to the ACE2 receptor in hepatocytes and cholangiocytes. Gastrointestinal symptoms and elevated liver enzymes are more frequent in severe cases. Viral RNA has been detected in stools, which may suggest a possible fecal-oral transmission. It is essential to pay attention to gastrointestinal manifestations because they are frequent and more prevalent in severe cases. The presence of viral RNA in stool forces us to take preventive measures faced with a possible mechanism of fecal-oral transmission, mainly in the gastroenterology and endoscopy services.


La pandemia por el nuevo coronavirus SARS-CoV-2 ha causado más de 2,5 millones de casos confirmados en el mundo, con una mortalidad cercana al 7%. La mayoría de los casos parecen ser leves y los síntomas más comunes son fiebre, tos seca, mialgia, fatiga y disnea, pero pueden provocar una enfermedad más grave. También se han descrito síntomas gastrointestinales: anorexia 27%, diarrea 12%, náuseas/vómitos 10%, y dolor abdominal 9%. En Chile, se ha descrito diarrea en 7,3%, y dolor abdominal 3,7%. El principal mecanismo fisiopatológico propuesto es el ingreso al enterocito utilizando la Enzima Convertidora de Angiotensina 2 (ECA2) como receptor, el cual es ampliamente distribuido a lo largo del tracto gastrointestinal. También se ha descrito alteración de pruebas hepáticas hasta en 40% de los casos. Esta alteración también podría ser causada por el ingreso a los hepatocitos y colangiocitos mediante la ECA2. Los síntomas gastrointestinales, y las alteraciones de pruebas hepáticas son más frecuentes en los pacientes graves. Se ha detectado la presencia de ARN viral en deposiciones de pacientes, lo que podría sugerir una posible vía de transmisión fecal-oral. Es importante prestar atención a las manifestaciones gastrointestinales, ya que son comunes y más frecuentes en pacientes graves. La presencia viral en las heces nos obliga a tomar medidas de precaución y prevención de un posible mecanismo de transmisión fecal-oral, especialmente en los servicios de gastroenterología y endoscopia.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Betacoronavirus , Gastrointestinal Diseases/etiology , Pneumonia, Viral/transmission , Coronavirus Infections/transmission , Feces/virology , Pandemics
5.
Rev. pediatr. electrón ; 17(1): 1-12, abr 2020.
Article in Spanish | LILACS | ID: biblio-1099829

ABSTRACT

Introducción: El dengue representa un importante problema de salud pública en países como Colombia. Usualmente se trata de una patología autolimitada con buena respuesta a manejo sintomático ambulatorio, sin embargo, cuadros con síntomas atípicos pueden complicar el diagnóstico dando lugar a manifestaciones inusuales que comprometen la vida del paciente. Objetivo: Describir la información del tema expuesto resaltando aspectos relevantes como diagnóstico y manejo. Metodología: Se efectuó una revisión bibliográfica con búsqueda electrónica en las siguientes bases de datos: PubMed, MEDLINE, Medscape, Scopus; en inglés y español incluyéndose diferentes tipos de artículo (artículos originales, revisiones de temas y guías de manejo que abordaran síntomas inusuales de dengue en pediatría desde el año 2009 al 2019. Resultados: Se obtuvo 414 referencias después de una revisión de artículos, donde se describe el tema de complicaciones relacionadas con esta patología en pediatría, se seleccionaron 50 artículos en texto completo que cumplían los requisitos de búsqueda. Conclusiones: El tema de manifestaciones atípicas del dengue tiene poca revisión registrada en el área de pediatría, son complicaciones poco frecuentes por lo cual la evidencia es escasa, estas se deben tener en cuenta para manejo y tratamiento oportuno.


Introduction: Dengue represents a major public health problem in countries like Colombia. Usually it is a self-limited pathology with good response to outpatient symptomatic management, however, pictures with atypical symptoms can complicate the diagnosis resulting in unusual manifestations that compromise the patient's life. Objective: Describe the information on the exposed topic highlighting relevant aspects such as diagnosis and management. Methodology: A bibliographic review was carried out with electronic search in the following databases: PubMed, MEDLINE, Medscape, Scopus; in English and Spanish including different types of article (original articles, review of topics and management guides that will address unusual symptoms of dengue in pediatrics from 2009 to 2019. Results: 414 references were obtained after an article review, which describes the topic of complications related to this pathology in pediatrics, 50 articles were selected in full text that met the search requirements. Conclusions: The issue of atypical manifestations of dengue has little revision registered in the area of pediatrics, they are rare complications, so the evidence is scarce, these should be taken into account for timely management and treatment.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Dengue/complications , Dengue/diagnosis , Dengue/pathology , Dengue Virus , Disease Progression , Acute Kidney Injury/etiology , Gastrointestinal Diseases/etiology , Nervous System Diseases/etiology
6.
Pesqui. vet. bras ; 40(1): 17-28, Jan. 2020. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1091657

ABSTRACT

The early use of antimicrobial therapy has been introduced in many farms to prevent diarrhea and respiratory disease in young calves; however, there is controversy about whether this practice has a beneficial effect on the health of these animals. This study evaluated the influence of the early use of antimicrobials on the health and performance of neonatal Holstein calves. Twenty-six Holstein calves were screened and divided into two groups, according to the administration (ATB+), or not (ATB-) of tulathromycin (2.5mg/kg, subcutaneously) within the first 12 hours of life. Calves were evaluated by general clinical examination, fecal score, respiratory score, and external palpation of the umbilical region, besides fecal output of dry matter. Anemia was determined by using an automatic system and, also, using a commercial kit for iron dosage. Diarrhea was diagnosed by a centrifuge-flotation technique using a sugar solution (Cryptosporidium) and multiplex semi-nested RT-PCR (rotavirus/coronavirus). The performance of the calves was estimated by Daily Weight Gain (DWG). The young dairy calves were evaluated within 12 hours of birth (≤12h) and at 3-5th (D3-5), 7-9th (D7-9), 13-15th (D13-15), 20-23rd (D20-23), and 27-30th (D27-30) days of life. No difference was noted between the ATB+ and ATB- groups concerning heart rate, respiratory frequency, and rectal temperature. Erythrogram showed a higher frequency of anemia in ATB- group (P=0.016) at the D3-5 check-up; lower values of serum iron were also observed simultaneously (P=0.051). Thirteen cases of respiratory disease were detected during this study; however, no significant difference was observed between the groups in this regard. The frequency of diarrhea (fecal score 2-3) was high in both groups, peaking at D13-D15. No differences were noted between the groups regarding the frequency of diarrhea when considering the dry fecal matter. The predominant etiological agent for diarrhea was Cryptosporidium spp.. The DWG was similar between groups, with maximum weight reduction on D13-15. The administration of tulathromycin in prophylactic dose (2.5mg/kg) at birth decreased the frequency of anemia but did not influence weight gain or the prevalence of diarrhea.(AU)


O uso precoce de antimicrobianos tem sido adotado em muitas fazendas para profilaxia das diarreias e doença respiratória em bezerras, no entanto existem controvérsias sobre os beneficios desta prática na saúde desses animais. Esta pesquisa avaliou a influência do uso precoce de antimicrobiano na sanidade e desempenho de bezerras holandesas recém-nascidas. Para tanto foram selecionadas 26 bezerras Holandesas distribuídas de acordo com a aplicação (ATB+) ou não (ATB-) de tulatromicina (2,5mg/Kg) por via subcutânea até 12h de vida. As bezerras foram examinadas por meio de exame clínico geral, escore fecal, escore respiratório e palpação externa da região umbilical, além da matéria seca fecal. A presença de anemias foi determinada pelo eritrograma utilizando sistema automático e além da dosagem de ferro utilizando kit comercial. O diagnóstico etiológico das diarreias foi investigado por meio da técnica de flutuação em solução saturada de sacarose (Cryptosporidium) e multiplex semi-nested RT-PCR (rotavírus/coronavírus). O desempenho das bezerras foi estimado pelo ganho de peso. As bezerras foram avaliadas até doze horas após o nascimento (≤12h); 3-5º (D3-5); 7-9º (D7-9); 13-15º (D13-15); 20-23º (D20-23); e 27-30º dias de vida (D27-30). Não foram encontradas diferenças entre os grupos ATB+ e ATB- em relação à frequência cardíaca, frequência respiratória e temperatura retal. O eritrograma revelou maior frequência de anemias no grupo ATB- (P=0,016) no D3-5. Neste momento também foram observados menores valores de ferro sérico (P=0,051). Foram detectados treze casos de doença respiratória durante o estudo, no entanto não foi possível detectar diferença entre os grupos. A frequência de diarreias (escore fecal 2 e 3) foi alta em ambos os grupos, observando-se pico no D13-15 (ATB+=92,3%; ATB-=92,3%). Não observamos diferenças entre os grupos em relação a frequência de diarreia considerando-se a matéria seca fecal. O agente etiológico predominante nas diarreias foi o Cryptosporidium. O ganho de peso diário foi igual entre grupos, com intensa redução no GPD no D13-15. A administração de tulatromicina na dose profilática (2,5mg/Kg) ao nascimento diminuiu a frequência de anemias e não influenciou no ganho de peso e prevalência de diarreias.(AU)


Subject(s)
Animals , Female , Cattle , Rotavirus Infections/veterinary , Macrolides/therapeutic use , Dysentery/etiology , Gastrointestinal Diseases/etiology , Anemia/prevention & control , Anti-Infective Agents/therapeutic use , Coronavirus, Bovine , Coronavirus Infections/veterinary , Cryptosporidiosis
7.
Pesqui. vet. bras ; 40(1): 7-11, Jan. 2020. tab
Article in English | LILACS, VETINDEX | ID: biblio-1091651

ABSTRACT

Calf diarrhea causes substantial economic losses in the cattle industry worldwide. Bovine rotavirus A (RVA) is the main viral agent that leads to enteric infection and diarrhea outbreaks in calves throughout the world. The aim of this retrospective (2006-2015) study was to determine the frequency of RVA detection in diarrheic fecal samples from beef and dairy calves from the three main cattle-producing regions of Brazil. Diarrheic fecal samples (n=1,498) of 124 beef and 56 dairy cattle herds from the Midwest, South, and Southeast geographical regions of Brazil were evaluated using the silver-stained polyacrylamide gel electrophoresis (ss-PAGE) technique. RVA double stranded-RNA was identified by the ss-PAGE technique in 410 (27.4%) fecal samples. The frequency of positive samples found in beef calves (31.9%; 328/1,027) was higher than the frequency found in diarrheic fecal samples from dairy calves (17.4%; 82/471). RVA infection was identified in calves from the three Brazilian geographical regions analyzed. However, the frequency of positive diarrheic calves in the Midwest region (39.4%), predominantly beef calves, was higher than in the South (19.4%) and Southeast (17.6%) regions. The temporal distribution of RVA-infected calves evaluated by two five-year periods (2006-2010, 24.5%; 2011-2015, 28.8%) demonstrated a very similar frequency of RVA in both periods. Considering the wide regional and temporal scope of this study, it can be concluded that RVA remains an important etiology of neonatal diarrhea in calves of Brazilian cattle herds.(AU)


A diarreia neonatal ocasiona perdas econômicas importantes na pecuária bovina em todo o mundo. Rotavírus A (RVA) é o principal agente etiológico viral de infecções entéricas e surtos de diarreia em bezerros de rebanhos de corte e leite. O objetivo deste estudo retrospectivo (2006-2015) foi determinar a frequência de detecção de RVA em amostras de fezes diarreicas de bezerros de corte e leite das três principais regiões produtoras de bovinos do Brasil. Amostras de fezes diarreicas (n=1.498) de 124 rebanhos bovinos de corte e 56 rebanhos bovinos de leite das regiões Centro-Oeste, Sul e Sudeste do Brasil foram avaliadas utilizando a técnica de eletroforese em gel de poliacrilamida (EGPA). O genoma segmentado de RVA foi identificado pela técnica de EGPA em 410 (27,4%) amostras de fezes. A frequência de amostras positivas encontrada em bezerros de rebanhos de corte (31,9%; 328/1.027) foi maior que a frequência identificada em amostras de fezes diarreicas de bezerros de rebanhos leiteiros (17,4%; 82/471). A infecção por RVA foi identificada em bezerros das três regiões geográficas brasileiras analisadas. No entanto, a frequência de bezerros com diarreia positivos para RVA na região Centro-Oeste (39,4%), predominantemente de bezerros de rebanhos de corte, foi maior que nas regiões Sul (19,4%) e Sudeste (17,6%). A distribuição temporal dos bezerros infectados com RVA avaliados por dois períodos de cinco anos (2006-2010, 24,5%; 2011-2015, 28,8%) demonstrou uma frequência muito semelhante em ambos os períodos. Considerando a amplitude regional e temporal deste estudo, pode-se concluir que RVA continua sendo uma importante etiologia de diarreia neonatal em bezerros de rebanhos bovinos brasileiros.(AU)


Subject(s)
Animals , Cattle , Rotavirus Infections/veterinary , Rotavirus Infections/epidemiology , Rotavirus/pathogenicity , Gastrointestinal Diseases/etiology , Electrophoresis, Gel, Two-Dimensional/veterinary
8.
Article in Spanish | LILACS | ID: biblio-1097136

ABSTRACT

La pandemia por SARS-Cov-2, ha tomado gran relevancia por su impacto en los diversos sistemas de sa-lud en el mundo. Inicialmente solo se contemplaba la importancia de los síntomas respiratorios y la fiebre; sin embargo, a diario tenemos más reportes y publicaciones sobre la relevancia que está teniendo en el sistema digestivo, ya que algunos pacientes informan síntomas gastrointestinales como diarrea, vómito y dolor abdominal. Los estudios han identificado el ARN del SARS-CoV-2 en muestras de heces de pacientes infectados, en las que se encontró que su receptor que es el de la enzima convertidora de angiotensina 2 (ECA2) se expresaba altamente en las células epiteliales gastrointestinales. Esto sugiere que el SARS-CoV-2 puede infectar activamente y replicarse en el tracto gastrointestinal. Esto tiene implicaciones importantes para el tratamiento de la enfermedad, la transmisión y el control de infecciones. En pacientes con patologías crónicas como la enfermedad inflamatoria intestinal (EII), se han generado gran cantidad de preguntas e incertidumbres ante la presencia de COVID-19 junto con las implicaciones que pueden tener tanto en la severidad de los síntomas, como en la descompensación de la patología de base y en la continuidad del tratamiento inmunosupresor.(AU)


The SARS-Cov-2 pandemic has taken great relevance due to its diverse impact in the worldwide health systems. Initially, only the importance or respiratory symptoms and fever was considered, however daily we have more reports and publications about the relevance that gastrointestinal symptoms, like diarrhea, vomit, and abdominal pain, are having in COVID-19. Several studies have identified SARS-CoV-2 RNA in stool samples of infected patients, and it was also found that the viral receptor, the angiotensin-converting enzyme 2 (ACE2) receptor is highly express in the gastrointestinal cells. These findings suggest that SARS-Cov-2 can actively infect and replicate in the gastrointestinal tract. All the above have relevant implications in the disease treatment, transmission, and infection control. In patients with chronic pathologies, such as inflammatory bowel disease (IBD), many questions and uncertainties, about symptoms severity, disease decompensation and use of immunosuppressive drugs, have been generated in the presence of COVID-19.(AU)


Subject(s)
Humans , Coronavirus Infections/transmission , Feces/virology , Betacoronavirus/isolation & purification , Gastrointestinal Diseases/etiology
9.
Article in Spanish | LILACS | ID: biblio-1097169

ABSTRACT

El 11 de marzo del 2020 la Organización Mundial de la Salud (OMS) declaró la pandemia por el brote de la enfer-medad por coronavirus 2019 (COVID-19). Los primeros datos acerca de las manifestaciones clínicas provienen de estudios retrospectivos de Wuhan, China, epicentro de la pandemia; además del compromiso respiratorio, se ha descrito la afectación del sistema gastrointestinal. Aunque no está del todo claro el porqué del tropismo de COVID-19 por el tracto gastrointestinal, se ha demostrado que la enzima convertidora de angiotensina 2 (ECA2), la cual tiene una alta expresión en el sistema gastrointestinal, es empleada como receptor de entrada del virus. Se ha logrado documentar la posibilidad de trasmisión fecal-oral luego de demostrar la existencia del virus en las heces, incluso hasta dentro de 7-12 días después de la conversión negativa en la muestra faríngea, inde-pendientemente de la presencia o no de síntomas gastrointestinales. La afectación del sistema gastrointestinal en pacientes con infección por COVID-19 no es infrecuente; los datos reportan que los pacientes con síntomas gastrointestinales tienen un peor pronóstico. El conocimiento de estas manifestaciones nos permite aumentar la sospecha clínica y, de esta manera, establecer diagnósticos tempranos.(AU)


The World ́s Heath Organization (WHO) declared the new coronavirus infection COVID-19 a pandemic in March 11 2020. The first data about the disease clinical features were reported from Wuhan China the epi-center of the outbreak; aside from the respiratory involvement, gastrointestinal manifestations have been described. Even though the exact mechanism for the new coronavirus tropism for the gastrointestinal tract is not well understood, angiotensin converting enzyme 2 receptor seems to play an important role as the entry site for the virus, since it is widespread located throughout the enteric mucosa. Fecal oral transmission is a possible contagion route, regardless of the presence of gastrointestinal symptoms, the virus has been isolated from feces even 7-12 days after a negative pharyngeal swab. COVID's-19 gastrointestinal involvement is not an infrequent event, data reports patients who present with these symptoms have worst prognosis. Knowing the possible gastrointestinal manifestations might rise our clinical suspicion in order to establish earlier and timely diagnosis.(AU)


Subject(s)
Humans , Coronavirus Infections/transmission , Feces/virology , Betacoronavirus/isolation & purification , Gastrointestinal Diseases/etiology
10.
Einstein (Säo Paulo) ; 18: eAE4799, 2020. tab, graf
Article in English | LILACS | ID: biblio-1090073

ABSTRACT

ABSTRACT The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.


RESUMO O Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro foi aprovado pela Sociedade Brasileira de Transplante de Medula Óssea, com a participação de 26 centros brasileiros de transplante de células-tronco hematopoiéticas. O Consenso descreve as principais condutas nutricionais em casos de doença do enxerto contra o hospedeiro, a principal complicação do transplante de células-tronco hematopoiéticas.


Subject(s)
Consensus Development Conferences as Topic , Hematopoietic Stem Cell Transplantation/adverse effects , Nutrition Therapy/standards , Graft vs Host Disease/diet therapy , Graft vs Host Disease/etiology , Nutritional Requirements , Severity of Illness Index , Brazil , Congresses as Topic , Nutrition Therapy/methods , Gastrointestinal Diseases/diet therapy , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/physiopathology , Graft vs Host Disease/physiopathology
11.
Rev. chil. pediatr ; 89(6): 726-731, dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-978147

ABSTRACT

Resumen: Introducción: Hay pocos estudios sobre Desórdenes Gastrointestinales Funcionales superpuestos (DGFs-s). Objetivo: Describir la prevalencia y posibles factores de riesgo en niños Latinoamericanos (Latam) para presentar DGFs-s. Pacientes y Método: Estudio de prevalencia en niños escolares La tam entre 8-18 años. Se incluyeron variables sociodemográficas; se utilizaron los Criterios de Roma III en español, y se consideró DGFs-s cuando se presentaron 2, 3 o 4 y más DGFs en un mismo niño. El análisis estadístico incluyó t de student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y cálculo de los ORs e IC95%, siendo considerada una p < 0,05 significativa. Resul tados: Fueron analizados 6193 niños Latam (11,8 ± 2,2 años; 62,2% entre 8-12 años; 50,4% niñas; 68,0% colegio público), con diagnóstico de algún DGFs del 23,4%. Hubo superposición de DGFs en un mismo niño, en 8,4% (5,5% con 2 DGFs; 2,1% con 3 DGFs y 0,9% con 4 o más DGFs), siendo las principales superposiciones el Síndrome de intestino irritable (SII) + Dolor abdominal funcio nal (DAF) (2,6%) y el SII + DAF + Estreñimiento funcional (1,1%). Hubo predomino del género femenino. Conclusión: Hay una baja prevalencia de DGFs-s en escolares y adolescentes Latam, con predominio en el sexo femenino y de presentación muy variable.


Abstract: Introduction: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). Objective: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. Patients and Method: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. Results: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. Conclusion: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.


Subject(s)
Humans , Male , Female , Child , Adolescent , Gastrointestinal Diseases/epidemiology , Comorbidity , Prevalence , Cross-Sectional Studies , Risk Factors , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/etiology , Latin America/epidemiology
12.
Rev. gaúch. enferm ; 39: e20180095, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-978499

ABSTRACT

Resumo OBJETIVO Identificar as reações adversas ligadas à infusão de células-tronco hematopoéticas no dia zero do transplante de células-tronco hematopoéticas. MÉTODO Revisão integrativa da literatura, sem recorte temporal, a partir de fontes de informação: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science e CAPES; a amostra final foi constituída por dezoito artigos científicos, publicados entre 1998 e 2017, com base nos critérios de inclusão e exclusão. RESULTADOS Reações adversas leves e moderadas foram mais frequentes nos estudos que utilizaram a classificação por severidade, sendo náusea e êmese as de maior incidência; os sistemas orgânicos mais afetados foram o cardiovascular, respiratório e gastrointestinal. CONCLUSÕES As principais reações adversas identificadas nos estudos foram náusea e êmese. As classificadas como leves e moderadas foram as mais frequentes nos estudos que utilizaram a classificação por severidade; e os sistemas cardiovascular, respiratório e gastrointestinal foram os mais afetados naqueles que utilizaram a classificação por sistemas orgânicos.


Resumen OBJETIVO Identificar las reacciones adversas ligadas a la infusión de células madre hematopoyéticas en el día cero del trasplante de células madre hematopoyéticas. METODOLOGÍA Revisión integrativa de la literatura, sin recorte temporal, a partir de los siguientes bancos de datos: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science y CAPES; la muestra final fue constituida por 18 artículos científicos, publicados entre 1998 y 2017, sobre la base de los criterios de inclusión y exclusión. RESULTADOS Las reacciones adversas leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad, siendo náuseas y vómito las de mayor incidencia; los sistemas orgánicos más afectados fueron el cardiovascular, respiratorio y gastrointestinal. CONCLUSIÓN Las principales reacciones adversas identificadas en los estudios fueron náuseas y éstas. Las clasificadas como leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad; y los sistemas cardiovascular, respiratorio y gastrointestinal fueron los más afectados en aquellos que utilizaron la clasificación por sistemas orgánicos.


Abstract OBJECTIVE To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation. METHODOLOGY Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria. RESULTS Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal. CONCLUSION The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.


Subject(s)
Humans , Postoperative Complications/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Respiration Disorders/etiology , Time Factors , Vomiting/etiology , Cardiovascular Diseases/etiology , Cryopreservation , Cryoprotective Agents , Epoxy Compounds/adverse effects , Gastrointestinal Diseases/etiology , Nausea/etiology
14.
J. bras. nefrol ; 38(4): 478-482, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-829067

ABSTRACT

Abstract Introduction: Lupus cystitis is a rare manifestation of systemic lupus erythematosus, characterized by thickening of the bladder wall, associated with ureterohydronephrosis. In several cases gastrointestinal symptoms are the main manifestation. The optimal immunosuppressive regimen is still unknown. Methods: 16-year-old girl with systemic lupus erythematosus was admitted with dysuria, renal impairment, diarrhea, abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated moderate bilateral dilation from the pelvis to the ureterovesical junction, and the bladder exhibited reduced capacity and diffusely thickened walls. A diagnosis of chronic interstitial cystitis was performed and treatment with high dose methylprednisolone resulted in a significant relief of gastrointestinal and urinary symptoms and a reduction of the bladder thickness with improvement of their capacity. Conclusion: Lupus cystitis is a rare and underdiagnosed urinary manifestation of LES and the presence of mild urinary symptoms and abdominal pain may alert about this possibility.


Resumo Introdução: A Cistite Lúpica é uma manifestação rara do Lúpus Eritematoso Sistémico, caracterizada pelo espessamento da parede da bexiga, podendo estar associada com ureterohidronefrose. Em vários casos, os sintomas gastrointestinais são a principal manifestação e ainda não se sabe qual o regime imunossupressor mais adequado nesta situação. Método: Uma jovem de 16 anos de idade com lúpus eritematoso sistémico foi admitida com disúria, insuficiência renal, diarreia, dor abdominal, náuseas e vómitos. A tomografia computadorizada de abdome demonstrou dilatação moderada de ureter e pelve renal bilateralmente e bexiga exibindo capacidade reduzida e paredes difusamente espessadas. Foi feito o diagnóstico de cistite intersticial crónica e o tratamento com dose elevada de metilprednisolona resultou em um alívio significativo dos sintomas urinários e gastrointestinais e uma redução da espessura da bexiga, com melhora da sua capacidade. Conclusão: A Cistite Lúpica é uma manifestação urinária rara e subdiagnosticada do LES e a presença de sintomas urinários leves e dor abdominal devem alertar para essa possibilidade diganóstica.


Subject(s)
Humans , Female , Adolescent , Cystitis/complications , Gastrointestinal Diseases/etiology , Hydronephrosis/etiology , Lupus Erythematosus, Systemic/complications
15.
J. pediatr. (Rio J.) ; 92(3,supl.1): 46-56, tab
Article in English | LILACS | ID: lil-787519

ABSTRACT

ABSTRACT Objective: To analyze the development and prevalence of gastrointestinal signs and symptoms associated with the development of the digestive tract, and to assess the measures aimed to reduce their negative impacts. Source of data: Considering the scope and comprehensiveness of the subject, a systematic review of the literature was not carried out. The Medline database was used to identify references that would allow the analysis of the study topics. Synthesis of results: Infants frequently show several gastrointestinal signs and symptoms. These clinical manifestations can be part of gastrointestinal functional disorders such as infantile colic, infant regurgitation, and functional constipation. Allergy to cow's milk protein and gastroesophageal reflux disease are also causes of these clinical manifestations and represent an important and difficult differential diagnosis. The diseases that course with gastrointestinal signs and symptoms can have an impact on family dynamics and maternal emotional status, and may be associated with future problems in the child's life. Comprehensive pediatric care is essential for diagnosis and treatment. Maternal breastfeeding should always be maintained. Some special formulas can contribute to the control of clinical manifestations depending on the established diagnosis. Conclusion: During the normal development of the digestive tract, several gastrointestinal signs and symptoms may occur, usually resulting from functional gastrointestinal disorders, gastroesophageal reflux disease, and allergy to cow's milk protein. Breastfeeding should always be maintained.


RESUMO Objetivo: Analisar o desenvolvimento e a prevalência de sinais e sintomas gastrintestinais associados com o desenvolvimento do tubo digestivo e as medidas que visam a diminuir suas repercussões negativas. Fontes dos dados: Considerando a abrangência e amplitude do tema, não foi feita revisão sistemática da literatura. Usou-se a base de dados do Medline para a identificação de referências bibliográficas que permitissem contemplar os temas de estudo. Síntese dos resultados: O lactente apresenta com elevada frequência sinais e sintomas gastrintestinais. Essas manifestações clínicas podem fazer parte de distúrbios funcionais gastrintestinais, como cólica, regurgitação e constipação intestinal funcional. A alergia à proteína do leite de vaca e a doença do refluxo gastroesofágico também são causas dessas manifestações clínicas e representam um importante e difícil diagnóstico diferencial. As doenças que cursam com sintomas e sinais gastrintestinais podem ter consequências na dinâmica familiar e no estado emocional das mães. Podem se associar com problemas na vida futura da criança. A atenção pediátrica completa é fundamental para o diagnóstico e o tratamento. O aleitamento natural deve sempre ser mantido. Algumas fórmulas especiais podem contribuir para o controle das manifestações clínicas na dependência do diagnóstico estabelecido. Conclusão: Durante o desenvolvimento normal do tubo digestivo podem ocorrer sinais e sintomas gastrintestinais em geral decorrentes dos distúrbios gastrintestinais funcionais, da doença do refluxo gastroesofágico e da alergia à proteína do leite de vaca. Aleitamento natural deve sempre ser mantido.


Subject(s)
Humans , Infant, Newborn , Infant , Gastrointestinal Tract/growth & development , Gastrointestinal Tract/physiopathology , Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Milk Hypersensitivity/complications , Age Factors , Constipation/etiology , Constipation/physiopathology , Constipation/therapy , Crying/physiology , Diarrhea/etiology , Diarrhea/physiopathology , Diarrhea/therapy , Gastrointestinal Microbiome/physiology , Gastrointestinal Diseases/etiology
16.
Gut and Liver ; : 303-309, 2016.
Article in English | WPRIM | ID: wpr-193414

ABSTRACT

BACKGROUND/AIMS: Concurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT. METHODS: Patients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT. RESULTS: A total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities. CONCLUSIONS: IMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer.


Subject(s)
Aged , Female , Follow-Up Studies , Gastrointestinal Diseases/etiology , Humans , Male , Middle Aged , Pancreatic Neoplasms/radiotherapy , Prospective Studies , Radiation Injuries/complications , Radiotherapy, Conformal/adverse effects , Radiotherapy, Intensity-Modulated/adverse effects , Risk Factors
17.
ABCD arq. bras. cir. dig ; 28(supl.1): 39-42, 2015. tab, graf
Article in English | LILACS | ID: lil-762844

ABSTRACT

Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients.Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group.Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data.Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients.Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals.


Racional: A obesidade tornou-se epidemia e está associada à maior morbimortalidade. Seu tratamento é multidisciplinar. O tratamento cirúrgico é recurso consistente nos casos de obesidade grave. A indicação da endoscopia digestiva alta pré-operatória em pacientes assintomáticos é controversa; no entanto, a maioria dos estudos recomenda sua realização em todos os pacientes.Objetivo: Analisar os resultados da endoscopia em pacientes que se encontravam em pré-operatório de cirurgia bariátrica, e compará-los aos achados do grupo controle.Método: Série de 35 pacientes obesos em pré-operatório de cirurgia bariátrica com um grupo controle de 30 pacientes submetidos à endoscopia no período de fevereiro a julho de 2014. Foram analisados dados clínicos e endoscópicos.Resultados:A média de idade do grupo de pacientes foi de 43,54 anos e a maioria deste grupo era do sexo feminino. A média do valor do IMC no grupo de pacientes foi de 47,26 kg/m2 e no grupo controle de 24,21 kg/m2. A maioria dos pacientes era assintomática. A endoscopia estava alterada em 81,25% dos pacientes assintomáticos. As alterações endoscópicas no grupo de pacientes foram 57,1% decorrentes da doença ulceropéptica e 34,3% associadas à DRGE. A análise do número de achados endoscópicos no grupo de pacientes em relação ao grupo controle não demonstrou diferença estatística significante. A prevalência da infecção do H. pylori foi de 60% no grupo de pacientes.Conclusão: Recomenda-se que a endoscopia digestiva alta deva ser realizada em todos pacientes em pré-operatório de cirurgia bariátrica, embora o grau de obesidade não tenha relação com maiores alterações endoscópicas. Os obesos não têm maior número de alterações endoscópicas que os não obesos.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bariatric Surgery , Endoscopy, Gastrointestinal , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/etiology , Obesity, Morbid/complications , Obesity, Morbid/surgery , Preoperative Care
18.
Article in English | WPRIM | ID: wpr-106796

ABSTRACT

BACKGROUND/AIMS: The dose of mycophenolate mofetil (MMF) has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT). METHODS: Two sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12) for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day) with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter), with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT. RESULTS: In the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day), and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively. CONCLUSIONS: A reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.


Subject(s)
Adult , Aged , Area Under Curve , Drug Therapy, Combination , Female , Follow-Up Studies , Gastrointestinal Diseases/etiology , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/blood , Leukopenia/etiology , Liver/pathology , Liver Failure/therapy , Liver Transplantation , Male , Middle Aged , Mycophenolic Acid/adverse effects , ROC Curve , Retrospective Studies , Tacrolimus/therapeutic use , Tissue Donors
19.
Invest. clín ; 54(3): 299-310, sep. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-740327

ABSTRACT

El dengue se caracteriza por fiebre, cefalea, artralgia y mialgia. La presencia de signos y síntomas gastrointestinales (SSGI), se considera señal de alarma en dengue; sin embargo, existe poca información respecto a la ocurrencia de estas manifestaciones. El objetivo de este estudio fue determinar la frecuencia de signos y síntomas gastrointestinales en una cohorte de pacientes con dengue. Se revisaron 1484 fichas clínicas de pacientes con diagnóstico confirmado de dengue, clasificados como: dengue con signos de alarma (DCSA) (n=700); sin signos de alarma (DSSA) (n=700) y dengue grave (DG) (n=84). El 65,71% de los pacientes con DSSA, el 92,59% DCSA y el 100% de los pacientes con DG presentaron SSGI. En los pacientes con DSSA, las náuseas/vómitos fue el síntoma más frecuente 319/700 (45,57%), seguido de dolor abdominal 142/700 (20,29%) y diarrea 125/700 (17,86%). No se registraron casos con melena, hepatomegalia y/o hematemesis. Mientras que en DCSA las náuseas/vómitos estuvieron en 529/700 (75,57%), dolor abdominal 439/700 (62,71%) y diarrea 198/700 (28,28%), fueron los más frecuentes (p<0,0001). Melena, hematemesis y hepatomegalia variaron de 0,57% a 1,86%. En DG, las náuseas/vómitos se registraron en el 100%, dolor abdominal 82/84 (97,62%), diarrea 65/84 (77,38%), melena 32/84 (38,10%), hepatomegalia 28/84 (33,33%) y hematemesis 26/84 (30,95%). Se evidencia alta frecuencia de SSGI en los casos de DCSA y DG a diferencia de DSSA, en los cuales fue significativamente menor. Se sugiere relación de los SSGI con la severidad del dengue y su presencia debe considerarse en la toma de decisiones del equipo de salud para el manejo adecuado del paciente.


Dengue is characterized by fever, headache, arthralgia and myalgia. The presence of gastrointestinal signs and symptoms (GISS) is considered a sign of alarm in dengue; however, little information exists regarding the occurrence of these events. The aim of this study was to determine the frequency of gastrointestinal signs and symptoms in a cohort of patients with dengue. A total of 1484 medical records of patients with confirmed dengue were reviewed and classified as: dengue without warning signs (DNWS) (n = 700), dengue with warning signs (DWWS) (n = 700) and severe dengue (SD) (n = 84). Of the studied records, 65.71% of patients with DNWS, 92.59% with DWWS and 100% of patients with SD had GISS. In patients with DNWS, nausea / vomiting were the most common symptoms in 319/700 cases (45.57%), followed by abdominal pain in 142/700 (20.29%) and diarrhea in 125/700 (17.86%). There were no cases with melena, hepatomegaly or hematemesis. While in DWWS nausea/vomiting were present in 529/700 (75.57%), abdominal pain in 439/700 (62.71%) and diarrhea in 198/700 (28.28%),(p <0.0001). Melena, hematemesis and hepatomegaly ranged from 0.57% to 1.86% of cases. In SD, nausea/vomiting were registered in 100% of the cases, abdominal pain in 82/84 (97.62%), diarrhea in 65/84 (77.38%), melena in 32/84 (38.10%), hepatomegaly in 28/84 (33.33%) and hematemesis in 26/84 (30.95%). It was evident the high frequency of GISS in cases of DWWS and SD, in contrast to DNWS, in which the frequency of GISS was significantly lower. This suggests a relationship of GISS with the severity of dengue, and their presence should be considered by the decision-making health team for appropriate patient management.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Dengue/complications , Gastrointestinal Diseases/etiology , Abdominal Pain/etiology , Cohort Studies , Dengue/epidemiology , Diarrhea/etiology , Endemic Diseases , Gastrointestinal Hemorrhage/etiology , Hepatomegaly/etiology , Nausea/etiology , Venezuela/epidemiology , Vomiting/etiology
20.
Rev. Inst. Med. Trop. Säo Paulo ; 54(2): 89-94, Mar.-Apr. 2012. tab
Article in English | LILACS | ID: lil-625265

ABSTRACT

Involvement of the digestive system in patients with acquired immunodeficiency syndrome (AIDS) is frequent and many changes in these patients are diagnosed only at autopsy. There are few studies of autopsy with detailed analysis of this system and only one was conducted in Brazil. We evaluated each segment of the digestive system in 93 consecutive autopsies of patients infected with human immunodeficiency virus (HIV) and the importance of these lesions to death. Of these, 90 (96.8%) patients had AIDS. We reviewed medical records, autopsy reports and histological sections from tongue to rectum stained with hematoxylin-eosin. When necessary, we analyzed special stains and immunohistochemistry to investigate infections. There was damage to the digestive system in 73 (78.5%) cases. The most common infections were candidiasis (42%), cytomegalovirus (29%), histoplasmosis (11.8%), toxoplasmosis (9.7%) and mycobacterial infection (9.7%). Malignancies were rare, present in four (4.3%) cases (two Kaposi's sarcoma, one adenocarcinoma and one metastatic embryonal carcinoma). All segments showed lesions: tongue (48.6%), esophagus (44.8%), stomach (44.7%), colon (43.2%) and small intestine (28.9%). The lesions found were immediate cause of death in five (5.4%) cases. In another 36 (38.7%) cases the basic disease was systemic and also compromised the digestive system.


Envolvimento do sistema digestório em pacientes com síndrome da imunodeficiência adquirida (AIDS) é frequente e muitas alterações nesses pacientes são diagnosticadas apenas à autopsia. Há escassos estudos de autopsia com análise detalhada desse sistema e apenas um deles foi realizado no Brasil. Neste estudo avaliamos cada segmento do sistema digestório em 93 autopsias consecutivas de indivíduos infectados pelo vírus da imunodeficiência humana (HIV) e a importância dessas lesões para o óbito. Desses, 90 (96,8%) pacientes apresentavam AIDS. Revisamos prontuários médicos, relatórios de autopsias e cortes histológicos da língua ao reto corados pela técnica de hematoxilina-eosina. Quando necessário, analisamos colorações especiais e imuno-histoquímica para pesquisar infecções. Havia lesões no sistema digestório em 73 (78,5%) casos. As alterações mais comuns foram infecciosas: candidíase (42%), citomegalovirose (29%), histoplasmose (11,8%), toxoplasmose (9,7%) e infecção por micobactérias (9,7%). Neoplasias malignas foram raras, presentes em quatro (4,3%) casos (dois sarcomas de Kaposi, um adenocarcinoma gástrico e um carcinoma embrionário metastático). Todos os segmentos apresentaram lesões: língua (48,6%), esôfago (44,8%), estômago (44,7%), intestino grosso (43,2%) e intestino delgado (28,9%). As lesões encontradas foram causa imediata do óbito em cinco (5,4%) casos. Em outros 36 (38,7%) casos a doença básica era sistêmica comprometendo, também, o sistema digestório.


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/pathology , Acquired Immunodeficiency Syndrome/pathology , Gastrointestinal Diseases/pathology , Autopsy , Acquired Immunodeficiency Syndrome/complications , Cause of Death , Gastrointestinal Diseases/etiology , Retrospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL