Inducción de tormenta de citocinas en pacientes infectados con SARS- CoV-2 y desarrollo de COVID-19: Tiene el tracto gastrointestinal alguna relación en la gravedad? / Induction of "Cytokine storm" in patients infected with SARS-CoV-2 and development of COVID-19. Does the gastrointestinal tract any relation in severity?

Los coronavirus son una extensa familia de virus; algunos pueden ser causa de diversas enfermedades humanas, que van desde el resfriado común hasta el síndrome respiratorio agudo severo. La enfermedad por coronavirus (COVID-19) es causada por el coronavirus zoonótico SARS-CoV-2, y comenzó en China en diciembre de 2019. En marzo de 2020, la Organización Mundial de la Salud (OMS) lo declaró una pandemia mundial. Esta enfermedad tiene un gran espectro de signos y síntomas, predominantemente se presenta con tos y fiebre, lo que resulta en una proporción de pacientes que desarrollan síndrome de dificultad respiratoria aguda (SDRA). Se ha planteado que la afectación pulmonar grave por el virus puede ser causada también por hiperinflamación y un cuadro similar a la linfohistiocitosis hemofagocítica (HLH), el cual es un síndrome clínico provocado por una respuesta inadecuada del sistema inmunológico a un desencadenante, sea infec-cioso, neoplásico, metabólico o reumatológico, que resulta en una reacción inflamatoria desproporcionada. Esta respuesta inmune altamente activada causa una liberación exagerada o tormenta de citocinas respon-sable del cuadro clínico. De allí la importancia de revisar el concepto actual y su desenlace en COVID-19. Recientemente se han publicado artículos en los que se sugiere que la presencia de síntomas gastrointesti-nales se ha asociado a COVID 19 con mayores indicadores de gravedad, lo que motiva al gastroenterólogo a explorar cómo el sistema digestivo podría impactar en esta hiperinflamación.(AU)

Coronaviruses are an extensive family of viruses, some of them can produce different kind of human diseases, ranging from the common cold to severe acute respiratory syndrome. Coronavirus disease (COVID-19) is caused by the SARS-CoV-2 zoonotic coronavirus and started in China in December 2019. In March 2020, the World Health Organization (WHO) declared it a global pandemic. This disease has a wide spectrum of signs and symptoms, predominantly presenting with cough and fever, resulting in a proportion of patients who develop acute respiratory distress syndrome (ARDS). It has been argued that severe lung involvement by the virus may also be caused by hyperinflammation and a condition similar to hemophagocytic lymphohistiocyto-sis (HLH), which is a clinical syndrome caused by an inadequate response of the immune system to a trigger, whether infectious, neoplastic, metabolic, or rheumatologic, leading to a disproportionate inflammatory reac-tion. This activated immune response producing an exaggerated release or storm of cytokines responsible for this disease. There are recently publications suggesting that the presence of gastrointestinal symptoms is associated with COVID 19 disease with higher indicators of severity, which motivates the gastroenterologist to explore how the digestive system could impact this hyperinflammation

COVID-19 and the gastrointestinal tract: what do we already know? / COVID-19 e o trato gastrintestinal: o que já sabemos?

ABSTRACT The new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.

RESUMO Com quase 17,5 milhões de infectados e 700 mil mortos até o início de agosto no mundo, a pandemia do novo coronavírus está marcando o ano de 2020. O agente causador da doença é o vírus SARS-CoV-2, e a transmissão é por via respiratória. Os infectados podem ser assintomáticos, apresentar sintomas típicos (febre, tosse seca e dispneia), sintomas gastrintestinais (diarreia, náusea, vômito e dor abdominal) e RNA viral nas fezes. O objetivo deste trabalho foi revisar a literatura relacionada com a prevalência dos sintomas gastrintestinais, e verificar se é possível a transmissão fecal-oral da doença. Fizemos uma pesquisa na base de dados PubMed® sobre a COVID-19 e o trato gastrintestinal, selecionando artigos pelo método PRISMA. Eliminamos artigos com base em títulos e resumos, quantidade pequena de pacientes e sobre mecanismo de infecção, restando 14 estudos. Comorbidades e alterações laboratoriais (elevação de aminotransferases hepáticas e bilirrubina) foram relacionadas com piora da doença. A prevalência de sintomas gastrintestinais variou entre 6,8% e 61,3%, sendo eles diarreia (8,14% a 33,7%), náusea/vômito (1,53% a 26,4%), anorexia (12,1% a 40,0%) e dor abdominal (0% a 14,5%). A presença do RNA viral foi pouco testada, mas foi positiva entre 0% a 48,1%. O trato gastrintestinal é muito acometido pela COVID-19, provocando sintomas específicos, alterações laboratoriais e presença viral nas fezes. Contudo, os resultados de prevalência e a possibilidade de transmissão fecal-oral foram variados, necessitando de estudos maiores para conclusões mais assertivas. É importante a atenção de profissionais da saúde a isso, visto que essas alterações podem ajudar no diagnóstico e a iniciar tratamento precoce.

Helicobacter spp. in domestic cats: identification and relationship with anatomical and histopathological gastric changes in animals of blood group A / Helicobacter spp. em gatos domésticos: identificação e relação com alterações gástricas anatômicas e histopatológicas em animais de sangue tipo A

The aim of this study was to evaluate the presence of gastric Helicobacter-like organisms and the endoscopic and histopathological changes in domestic cats with blood type A. Samples from the stomach antrum, body and fundus were collected from 32 mixed-breed stray domestic cats using gastroscopy. Urease testing and cytological analysis were performed in fresh samples. Tissue sections were processed and stained with hematoxylin and eosin (H&E) and the Warthin-Starry (WS) silver staining methods for histopathological examination. Helicobacter spp. were detected in 100% of samples subjected to silver staining and cytological analysis, and in 96.9% of samples subjected to urease testing. In 87.5% of the cats, mononuclear inflammatory-cell infiltrates were identified. The graduation and distribution of inflammatory infiltrates in these cats revealed mild (78.1%) to moderate (9.4%) inflammatory changes in at least one gastric region. These changes were independent of the colonization score. Hyperplasia of the lymphoid follicles was detected in three cats. Cats of blood group A are often colonized by Helicobacter spp. and the macroscopic and microscopic findings are consistent with studies in domestic cats reported to date, concluding that the most common blood group in cats is not associated with high susceptibility to symptomatic gastritis.(AU)

O objetivo deste estudo foi avaliar a presença de organismos semelhantes a Helicobacter e as alterações endoscópicas e histopatológicas em estômago de gatos domésticos de sangue tipo A. Amostras de antro, corpo e fundo gástricos foram coletadas de 32 gatos, sem raça definida, não domiciliados através de gastroscopia. Teste de urease e análise citológica foram realizados em amostras frescas. Secções teciduais foram processadas e coradas com hematoxilina e eosina e pela prata pelo método de Warthin-Starry para avaliação histológica. Helicobacter spp. foi detectado em 100% das amostras submetidas às análises citológicas e coloração pela prata e em 96,9% das amostras submetidas ao teste de urease. Em 87,5% dos gatos foi identificado infiltrado inflamatório mononuclear. A graduação e distribuição do infiltrado inflamatório nestes gatos revelaram alterações leves (78,1%) a moderada (9,4%) em pelo menos uma região gástrica. Estas alterações eram independentes do escore de colonização. Hiperplasia de folículos linfoides foram detectadas em 3 gatos. Gatos do grupo sanguíneo A são frequentemente colonizados por Helicobacter spp. e os achados macro e microscópicos são consistentes com estudos em gatos domésticos realizados até a presente data. Conclui-se que o grupo sanguíneo mais comum em gatos não está associado com uma alta susceptibilidade a gastrite sintomática causada por Helicobacter spp.(AU)

Opioid peptides and gastrointestinal symptoms in autism spectrum disorders

Autism spectrum disorders (ASDs) are characterized by deficits in the individual’s ability to socialize, communicate, and use the imagination, in addition to stereotyped behaviors. These disorders have a heterogenous phenotype, both in relation to symptoms and regarding severity. Organic problems related to the gastrointestinal tract are often associated with ASD, including dysbiosis, inflammatory bowel disease, exocrine pancreatic insufficiency, celiac disease, indigestion, malabsorption, food intolerance, and food allergies, leading to vitamin deficiencies and malnutrition. In an attempt to explain the pathophysiology involved in autism, a theory founded on opioid excess has been the focus of various investigations, since it partially explains the symptomatology of the disorder. Another hypothesis has been put forward whereby the probable triggers of ASDs would be related to the presence of bacteria in the bowel, oxidative stress, and intestinal permeability. The present update reviews these hypotheses.

Signs and symptoms associated with digestive tract development / Sinais e sintomas associados com o desenvolvimento do trato digestivo

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.

Manifestação esofágica atípica na esclerose sistêmica difusa: relato de caso / Esophageal atypical manifestation in diffuse systemic sclerosis: case report

A Esclerose Sistêmica (ES) é uma doença difusa do tecido conjuntivo caracterizada pelo envolvimento cutâneo e multissistêmico. O acometimento gastrointestinal, em especial, está presente em 90% de seus portadores e acarreta considerável prejuízo à sua qualidade de vida. A precocidade do diagnóstico do envolvimento gastrointestinal permite o estabelecimento de planos terapêuticos específicos de suas complicações. Relataremos o caso de um paciente diagnosticado com Esclerose Sistêmica do tipo difusa com manifestações pulmonares e esofagogástricas e achado atípico de acometimento esofágico.

Systemic Sclerosis is a diffuse connective tissue disease characterized by cutaneous involvement and multisystemic. The gastrointestinal involvement, in particular, is present in 90% of its carriers, and causes considerable damage to their quality of life. The early diagnosis of gastrointestinal involvement, allows for the establishment of specific treatment plans for its complications. We will report the case of a patient diagnosed with diffuse Systemic Sclerosis, presenting pulmonary and esophagogastric manifestations, as well as an atypical esophageal involvement.

Ocorrência de leishmania infantum em fezes de cão / Occurrence of leishmania infantum in dog feces

Este é o primeiro relado sobre a ocorrência de Leishmaniasp. em fezes de cão. Foram encontradas formas amastigotas intra e extracelulares por meio de citologia de amostra fecal de um cão apresentando hematoquezia recorrente associada à leishmaniose visceral canina. O diagnóstico de Leishmania infantumfoi confirmado por PCR de fezes e por cultura e PCR em amostras de baço.

This is the first report of the occurrence of Leishmania sp. in dog feces. Intra and extracellular amastigote forms were found by cytology in fecal samples from a dog presenting recurrent hematochezia associated with canine visceral leishmaniasis. Diagnosis of Leishmania infantum was confirmed in the feces by PCR and in spleen samples by culture and PCR.

Dispepsia / Dyspepsia

Etmologicamente, a palavra dispepsia (do grego dis = difícil e pepse = digestão) significa digestão difícil. Sob o ponto de vista clínico, corresponde a uma série de sintomas de origem gastroduodenal, como dor, queimação ou desconforto epigástrico, plenitude pós-prandial ou saciedade precoce associadas ou não a náusea, vômitos e distensão em andar superior do abdome. Traduz, pois, um distúrbio funcional ou orgânico, de localização epigástrica e origem gastroduodenal...

Etymologically, the greek word dis means hard and pepse means digestion. Therefore, dyspepsia is a poor digestion. From the clinical point of view, dyspepsia corresponds to a range of symptoms originated from gastroduodenal, like pain, heartburn or epigastric discomfort, postprandial fullness or early fullness related or not to nausea, vomiting, upper abdominal distension. So, this explain that a functional or organic decline situated at the epigastric area and it is originated from gastroduodenal...

Ação de extratos de plantas medicinais sobre a motilidade do trato gastrointestinal / Action of medicinal plant extracts on the gastrointestinal tract motility

Muitas plantas são utilizadas pela população para o tratamento e a cura de doenças. Entre elas encontram-se a Persea major Kopp, Piper mollicomum Kunth. e Serjania erecta Radlk. as quais são utilizadas para diversas enfermidades, inclusive para tratar distúrbios do trato gastrointestinal. O objetivo deste trabalho foi estudar os efeitos dos extratos dessas três plantas sobre a motilidade gastrointestinal. Camundongos Swiss foram tratados com os extratos pela via oral 1 hora antes da administração de uma solução semisólida de carboximetilcelulose 1,5% e vermelho de fenol 0,05% e, após 15 minutos, o esvaziamento gástrico e o trânsito intestinal avaliados. O extrato hidroalcoólico da P. major (100 a 1000 mg Kg-1, p.o.) e o extrato hidroalcoólico da P. mollicomum (100 e 300 mg Kg-1, p.o.) aumentaram o trânsito intestinal. No entanto, somente o extrato da P. major (100 e 300 mg Kg-1) também aumentou o esvaziamento gástrico. O extrato etanólico da S. erecta (100 a 1000 mg Kg-1, p.o.) não alterou a motilidade gastrointestinal. Estes resultados sugerem que a Persea major e a Piper mollicomum mereçam estudos mais aprofundados em busca de princípios ativos ou matéria vegetal efetiva para o tratamento de distúrbios do trato gastrointestinal como a constipação.

Many plants are popularly used for the treatment and healing of diseases. The Persea major Kopp, Piper mollicomum Kunth. and Serjania erecta Radlk. are used in several illnesses, including the treatment of disorders of the gastrointestinal tract. The aim of this study was to evaluate the effects of the extracts of these plants on the gastrointestinal motility. Swiss mice were orally treated with extracts one hour before the administration of a semisolid solution of 1.5% carboxymethylcellulose and 0.05% phenol red. After 15 minutes, the gastric emptying and intestinal transit were determined. The hydroalcoholic extract of P. major (100 to 1000 mg Kg-1, p.o.) and the hydroalcoholic extract of P. mollicomum (100 and 300 mg Kg-1, p.o.) increased the intestinal transit. However, only the P. major extract (100 and 300 mg Kg-1) increased the gastric emptying. The ethanolic extract of S. erecta (100 to 1000 mg Kg-1, p.o.) did not alter the gastrointestinal motility. These results suggest that Persea major and Piper mollicomum can be of interest for further studies in the search of active principles or effective plant material for the treatment of disorders of the gastrointestinal tract, such as constipation.

El papel de la microbiota intestinal en el desarrollo de la obesidad y de la diabetes de tipo-2 / The role of intestinal microbiota in the development of obesity and type-2 diabetes

The intestinal microbiota (IM) is a complex consortium including a great number of bacteria, fungi, yeasts, virus and phages. The harmonic crosstalk between the IM, the epithelia barrier and the local immune system determine gut homeostasis in the healthy subject. The IM plays a key role in regulating energy harvest, energy expenditure, fat storage and food intake in the host. Increasing evidence suggests that bacterial composition, functional genes and metabolic activities of the IM are altered in the subjects with obesity or type-2 diabetes (T2D). It appears that dietary fat is also an important factor which affects the IM composition as well as the gut barrier function and the plasma levels of LPS. This metabolic endotoxemia would contribute to the development of systemic low grade inflammation, insulin resistance and T2D. The development of dietary (prebiotics, probiotics) and therapeutic (antibiotics, microbiota transplantation) tools to reestablish the homeostasis of the IM constitute interesting new strategies for the prevention or management of obesity and T2D...

Síndrome do intestino irritável pós-infecção intestinal / Irritable bowel syndrome after intestinal infection

A síndrome do intestino irritável (SII) é um distúrbio funcional do trato gastrointestinal, caracterizado por dor abdominal e alterações do hábito intestinal, não explicadas por anormalidades bioquímicas ou orgânicas. Embora a maioria dos pacientes relate início insidioso dos sintomas, em um subgrupo eles aparecem após episódio de gastroenterite aguda, denominada SII pós-infecciosa (SII-PI). Os agentes infecciosos envolvidos incluem vírus, parasitas e bactérias patogênicas. O tratamento da SII-PI é semelhante ao da SII idiopática. Antibióticos e probióticos são terapias promissoras

Irritable bowel syndrome (IBS) is a funcional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits, not explained by any organic or biochemical abnormalities. Although most patients describe an insidious onset of symptoms, a subgroup of individuals describes the onset of IBS symptoms following an episode of acute gastroenteritis, know as post-infectious IBS (PI-IBS). The infectious agents involved in the development of PI-IBS include pathogenic bacteria, parasites and viruses. Treatment of PI-IBS is similar to that idiopathic IBS. Antibiotics and probiotics appear to represent promising therapies in PI-IBS

Enteral nutrition discontinuation and outcomes in general critically ill patients

OBJECTIVE: To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients. MATERIALS AND METHODS: All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed. RESULTS: The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality. CONCLUSION: The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score.

Doenças de chinchilas (Chinchilla lanigera) / Diseases of chinchilla (Chinchilla lanigera)

As doenças de chinchilas foram estudadas através da avaliação de laudos de necropsia entre janeiro de 1997 e dezembro de 2011. Em 202 chinchilas necropsiadas, 189 (93,5%) tiveram o diagnóstico determinado, e 13 (6,5%) tiveram diagnóstico inconclusivo, por ausência de lesões ou autólise acentuada. Dentre as 202 chinchilas computadas, 162 eram fêmeas (80%), 37 eram machos (18%), e em quatro chinchilas (2%) o sexo não foi anotado. As chinchilas tinham entre um dia a 12 anos de idade. As doenças foram agrupadas nas seguintes categorias: doenças inflamatórias, doenças causadas por intoxicações, doenças causadas por agentes físicos, doenças metabólicas, doenças parasitárias, doenças degenerativas, distúrbios circulatórios, neoplasmas, distúrbios do desenvolvimento e "outros distúrbios". As doenças inflamatórias foram as mais prevalentes (52 casos [25,7%]) e foram representadas por casos de gastrite (10 casos), listeriose (5 casos), septicemia (5 casos), broncopneumonia bacteriana (4 casos), enterite necrosante (4 casos), piometra (4 casos), diarreia com isolamento de Proteus sp. (3 casos), abscessos subcutâneos e em linfonodos (2 casos), endometrite (2 casos), otite (2 casos), pielonefrite (2 casos), abscesso do ligamento redondo do fígado (1 caso), pneumonia fibrinosa (1 caso), pneumonia intersticial (1 caso), hepatite e colecistite com isolamento de Salmonella sp. (1 caso), histiocitose pulmonar (1 caso), miosite linfo-histiocítica (1 caso) e um caso de dermatofitose (Trichopyton metagrophytes). O segundo grupo de doenças mais prevalentes foram as intoxicações (22,3%), representado por 45 casos de intoxicação por salinomicina. As doenças causadas por agentes físicos (21 casos [10,4%]) incluíam casos de traumas causados por outros animais (8 casos), automutilação após injeção intramuscular (8 casos), prolapso de reto (3 casos) e parto distócico (2 casos). A categoria de doenças metabólicas foi representada por 16 casos (7,9%) de lipidose hepática. As doenças parasitárias (8 casos [4%]) consistiram em infestação por pulga (4 casos), piolho (3 casos) e giardíase (1 caso). Doenças degenerativas (4 casos [2,5%]) incluíam insuficiência renal crônica (2 casos), necrose aleatória de hepatócitos (1 caso) e necrose muscular de origem desconhecida (1 caso). Os distúrbios circulatórios incluíram dois casos (0,99%) de insuficiência cardíaca congestiva. Neoplasmas foram representados por dois casos (0,99%) de adenocarcinoma gástrico. Um caso de atresia ani, associado a ausência do trato reprodutor, intestino grosso e rins policíticos representou a categoria de distúrbios do desenvolvimento (0,5%). Algumas doenças não se enquadraram nas categorias acima e foram enquadradas em "outros distúrbios" (38 casos [18,8%]). Nesta categoria, doenças dentárias foi o distúrbio mais comum, diagnosticado em 9% (18 de 202) de todas as chinchilas examinadas. Seguido por casos de hipertermia (14 casos), dois casos de anemia, dois casos de metaplasia de células adiposas do córtex da adrenal, e dois casos de mucometra.(AU)

Diseases of chinchilla were studied through the review of necropsy reports of 202 postmortem examinations carried out in this species from January 1997 to December 2011. One hundred and eighty nine of these necropsies (93.5%) had a conclusive diagnosis and in 13 (6.5%) a conclusive diagnosis was not reached due either absence of lesions or advanced autolysis. One hundred and sixty two (80%) of the necropsied chinchilla were females and 37 (18%) were males and the sex was not recorded in four cases (2%). Ages of necropsied chinchillas varied from one day to 12-years-old. The encountered diseases were grouped in the following categories: inflammatory diseases, diseases caused by intoxications, diseases caused by physical agents, metabolic diseases, parasitism, degenerative diseases, circulatory disturbances, developmental disorders and "other disorders". Inflammatory diseases were the most prevalent (52 cases [25.7%]) and included gastritis (10 cases), necrotizing enteritis (6 cases), listeriosis (5 cases), septicemia (5 cases), bacterial bronchopneumonia (4 cases), pyometra (4 cases), diarrhea associated with Proteus sp. (3 cases), subcutaneous and lymph node abscesses (2 cases), endometritis (2 cases), otitis (2 cases), pyelonephritis (2 cases), abscesses in hepatic the round ligament (1 cases), fibrinous pneumonia (1 case), interstitial pneumonia (1 case), hepatitis and cholecystitis associated with Salmonella sp. (1 case), pulmonary histiocytosis (1 case), and dermatophytosis by Trichopyton metagrophytes (1 case). The second most prevalent group of diseases was that caused by intoxications (22,3% of the cases) including 45 cases of intoxication by salinomycin. Diseases caused by physical agents (21 cases [10.4%]) included trauma cases caused by other animals (8 cases), self mutilation secondary to intramuscular injection (8 cases), rectal prolapsed (3 cases) and dystocia (2 cases). Metabolic diseases were represented by 16 cases (7.9%) of hepatic lipidosis. Parasitic diseases were represented by 8 cases (4%) flea (4 cases) lice (3 cases) infestations and one case o giardiasis. Degenerative diseases (4 cases or 2,5%) included two cases of chronic renal failure, one case of scattered hepatocellular necrosis and one case of muscle necrosis of unknown origin. Circulatory disturbances included two cases (0.99%) of congestive heart failure. Neoplasms were represented by two cases (0.99%) of gastric adenocarcinoma. Developmental disorders included one (0,5%) case of atresia ani associated with polycystic kidneys and absence of reproductive tract and large intestine. Thirty eight cases (18.8%) did not fit in any of the above categories and were placed as "other disorders". In this category dental disease was the most commonly (8 cases or 9%) diagnosed disorder, followed by 14 cases (6,9%) of hyperthermia, tow cases of anemia, two cases of fat metaplasia of adrenal cortex and two cases of mucometra.(AU)

[Wegner's granulomatosis with gastrointestinal manifestation: a case report]

A 55 year-old man was referred with periumbilical and colicky abdominal pain cutaneous lesions' palpable purpura in extremities and 10 kg weight loss. A 55 cm cavitary mass lesion was seen in the lower lobe of right lung in CXR. Pansinusitis in paranasal CT scan was reported. Intramural hemorrhage in ileum and jejunum in abdominal CT scan was noted. ESR was >100 and C-ANCA was positive. Microscopic hematuria was reported in lab studies.Wegner's granulomatosis was diagnosed and prednisolone plus cyclophosphamide was administered. He was improved dramatically in a few days. After 3 months' he had no symptoms or signs' lab data were normal and lung mass lesion became smaller. After six months' he had deep vein thrombosis in left lower extremity

Efeitos do exercício físico sobre o trato gastrintestinal / Effects of physical exercise on the gastrointestinal tract

O impacto do exercício sobre o trato gastrintestinal (TGI), apesar de pouco investigado, é uma área de grande interesse. O exercício aeróbio intenso e de longa duração pode provocar sintomas gastrintestinais. Estes podem ser divididos em sintomas superiores (vômitos, náuseas e pirose retroesternal - azia) e inferiores (diarréia, cólica abdominal, perda de apetite, sangramento, aceleração dos movimentos intestinais e vontade de defecar). A etiologia desses sintomas durante o exercício é multifatorial e inclui a redução do fluxo sanguíneo intestinal, a liberação de hormônios gastrintestinais, o estresse mecânico sobre o TGI, a desidratação, os fatores psicológicos, a idade, o sexo, a dieta e o nível de treinamento do indivíduo. Por outro lado, o exercício de baixa intensidade tem efeito protetor sobre o TGI, principalmente com relação à predisposição a certas doenças como o câncer de cólon, a diverticulite, a colelitíase e a constipação. Diversos mecanismos são postulados para explicar os efeitos do exercício sobre o TGI, contribuindo para o desenvolvimento de estratégias terapêuticas no tratamento de indivíduos com sintomas e doenças gastrintestinais.

The impact of exercise on the gastrointestinal tract (GI tract), although being little investigated, is a field of high interest. Intense endurance aerobic exercise can lead to gastrointestinal symptoms. These symptoms can be classified into upper symptoms (vomiting, nausea and retrosternal pyrosis - heartburn) and lower symptoms (diarrhea, abdominal cramps, loss of appetite, bleeding, accelerated bowel transit time, urge to defecate). These symptoms’ etiology during exercise is multifactorial and includes: reduction of intestinal blood flow, release of gastrointestinal hormones, mechanical stress on the GI tract, dehydration, psychological factors, age, gender, diet, and training status. On the other hand, low intensity exercise has a protective effect on the GI tract; mainly, with certain diseases, such as, colon cancer, diverticular disease, cholelithiases, and constipation. A variety of mechanisms have been postulated to explain the effects of exercise on the GI tract, contributing to the development of therapeutic strategies in the treatment of patients with gastrointestinal symptoms and diseases.

Dispepsia funcional: nuevos conocimientos en la fisiopatogenia con implicaciones terapéuticas / Functional dyspepsia: new pathophysiologic knowledge with therapeutic implications

La dispepsia funcional (DF) es un complejo sintomático, heterogéneo y altamente prevalente en la comunidad y en la práctica general. La DF se define como la presencia de síntomas que se piensan originados en la región gastroduodenal, en ausencia de enfermedad orgánica, sistémica o metabólica que pueda explicarlos. Entre los factores fisiopatogénicos se incluyen los trastornos de la acomodación y del vaciamiento gástrico, dismotilidad duodenal, sensibilidad aumentada, factores psicosociales y una asociación con un estado postinfeccioso. Se han hecho numerosos esfuerzos para aumentar los conocimientos en la etiopatogenia del síndrome, incluyendo nuevos aspectos moleculares y genéticos. Sin embargo, el mecanismo etiopatogénico exacto que causa los síntomas en un paciente individual sigue siendo difícil de identificar. Los nuevos criterios de Roma III redefinen y subclasifican la DF basándose en sus síntomas principales, lo cual es de gran valor para la investigación, el desarrollo y el control estandarizados de nuevas estrategias terapéuticas así como la formulación de recomendaciones para la práctica clínica. Las modalidades terapéuticas que se han empleado incluyen: modificaciones dietéticas, agentes farmacológicos dirigidos a actuar sobre distintos blancos dentro del aparato gastrointestinal, del sistema nervioso central y periférico, y terapias psicológicas incluyendo la hipnoterapia. Desafortunadamente, hasta la fecha, todas estas terapias han rendido solamente resultados marginales. Después de excluir enfermedad orgánica, es esencial que el paciente esté informado sobre la naturaleza y el pronóstico benignos de su enfermedad, y esto puede ser, a veces, la inversión más provechosa tanto para el paciente como para su médico.

Functional dyspepsia (FD) is a heterogeneous, highly prevalent symptom complex in the community and general practice. FD is defined as the presence of symptoms considered as originated in the gastroduodenal region, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Pathogenetic features include disturbed gastric accommodation and emptying, duodenal dysmotility, heightened sensitivity, notably psychosocial disturbances and an association with a postinfective state. Increasing efforts are made to determine the etiopathogenesis of the disease, including new molecular and genetic aspects. However, the exact etiopathologic mechanism that causes the symptoms in an individual patient remains to be identified. The new Rome III criteria redefine and sub-characterize FD patients according to their main symptoms and this can be of value for standardized research, development and control of new therapeutic strategies and calculated therapeutic recommendations in the clinical practice. Various treatment modalities have been employed including dietary modifications, pharmacological agents directed at different targets within the gastrointestinal tract and central nervous system and psychological therapies including hypnotherapy. Unfortunately, to date, all of these therapies have yielded only marginal results. After excluding organic diseases, it is essential that the patient be assured about the benign nature and prognosis of the disease, and this can be sometimes the most helpful inversion for the patient and his/her physician.

Inhibidores de la bomba de protones en Pediatría: Una batalla ganada contra la acidez / Proton pump inhibitors in Paedriatrics: A battle won against acidity

Los inhibidores de la bomba de protones son usados con creciente frecuencia en la terapia de los trastornos del tracto digestivo superior en niños. El objetivo de esta investigación fue el alertar y hacer recomendaciones sobre el uso adecuado de estos medicamentos a la comunidad pediátrica nacional, para lo cual se realizó una revisión sobre el uso de ellos en pacientes pediátricos con enfermedad por reflujo gastroesofágico. Se evaluó su efectividad y seguridad tanto a corto como a largo plazo, así como las dosis óptimas y vías de administración mediante una búsqueda de artículos publicados en Medline y revistas relacionadas entre los años 1990 y noviembre 2003. Actualmente existe abundante literatura que confirma la efectividad de esta terapia sobre otros tratamientos y su seguridad a corto plazo en la enfermedad por reflujo gastroesofágico y otras patologías del tracto gastrointestinal. Hasta el momento se han determinado dosis pediátricas de omeprazol y lanzoprazol. Faltan aún datos sobre los efectos de la terapia de mantención a largo plazo.