Extraintestinal manifestations and characteristics of ulcerative colitis in Xinjiang Uygur Autonomous Region / 中华消化杂志

Objective To analyze the extraintestinal manifestations and clinical characteristics of patients with ulcerative colitis (UC) and to improve the knowledge,diagnosis and treatment of UC with extraintestinal manifestations.Methods From January 2013 to December 2017,at the Department of Gastroenterology,People's Hospital of Xinjiang Uygur Autonomous Region,260 hospitalized patients diagnosed as UC were collected.The demographic characteristics,clinical phenotypes and extraintestinal manifestations were analyzed.Chi square test was used for statistical analysis.Results Among 260 UC patients,41.9％ (109/260) had extraintestinal manifestations,including fatty liver (17.3％,45/260),gallbladder stone (11.9％,31/260),type Ⅰ peripheral arthritis (8.1％,21/260),type Ⅱ peripheral arthritis (3.1％,8/260),oral ulcer (4.6 ％,12/260),erythema nodosum (3.8％,10/260),irireitis (1.9％,5/260),ankylosing spondylitis (1.5％,4/260),sacroiliitis (1.5％,4/260),pyoderma gangrenosum (0.4％,1/260) and primary sclerosing cholangitis (0.4％,1/260).Gender,ethnicity,age,history of intestinal surgery and body mass index (BMI) could affect the occurrence of extraintestinal manifestations in patients with UC (x2 =7.901,4.318,9.291,8.162 and 10.397,all P＜0.05).The incidence of joint lesions in Uygur UC patients was higher than that in Han UC patients (16.6 ％,24/145 vs.7.0％,8/115),and the difference was statistically significant (x2 =5.471,P=0.019).The incidence of extraintestinal manifestations in UC patients in the active phase was higher than that of UC patients in the inactive phase (52.9％,92/174 vs.19.8％,17/86),and the difference was statistically significant (x2 =25.908,P＜0.01).Conclusions UC is complicated with a variety of extraintestinal manifestations.The most commonly involved organs are liver and gallbladder,joint and oral cavity.The extraintestinal manifestations are more common in female,Uygur,patients with high BMI,youth,patients with a history of intestinal surgery and UC patients at the active phase.

La mutación R92Q del gen TNFRSF1A se asocia con manifestaciones extra-intestinales en la enfermedad de Crohn / The TNFRSF1A gene R92Q mutation is associated with extra-intestinal manifestations of Crohn’s disease

It has been suggested that the R92Q mutation of the tumour necrosis factor receptor superfamily 1A (TNFRS1A) gene may be implicated in different inflammatory disorders. The aim of this study was to establish the role of this mutation as a determinant of Crohn`s disease (CD) susceptibility and/or clinical phenotype. One hundred and sixty-five CD patients and 203 healthy controls were prospectively included. The frequency of individuals carrying the R92Q mutation was similar between CD patients (4.24 percent) and controls (4.43 percent) (OR: 0.95; 95 percent CI = 0.34-2.62). In the genotype-phenotype evaluation, the univariate analysis showed that extra-intestinal manifestations were positively associated with the presence of R92Q mutation (p = 0.025; OR: 5.56; 95 percent CI = 1.04-29.6). In the multivariate analysis, presence of R92Q mutation was independently associated to extra-intestinal manifestations of CD, specially cutaneous manifestations (p = 0.02; OR: 5.17, 95 percent CI = 1.07-24.8). The R92Q mutation of TNFRSF1A gene is not a determinant of CD susceptibility, but contributes to the appearance of extra-intestinal manifestations of the disease.

Se ha sugerido que la mutación R92Q del gen de la super-familia del receptor del factor de necrosis tumoral 1A (TNFRS1A) podría estar relacionada con diversos trastornos inflamatorios. El objetivo de este estudio fue determinar el papel de esta mutación como factor determinante de la susceptibilidad y/o fenotipo clínico de la enfermedad de Crohn (EC). Ciento sesenta y cinco pacientes con EC y 203 controles sanos fueron incluidos de manera prospectiva. La frecuencia de individuos portadores de la mutación R92Q fue similar entre los pacientes con EC (4,24 por ciento) y los controles (4,43 por ciento) (OR: 0,95; 95 por ciento IC = 0,34-2,62). En la evaluación genotipo-fenotipo, el análisis univariado indicó que las manifestaciones extra-intestinales estaban relacionadas con la presencia de la mutación R92Q (p = 0,025; OR: 5,56; 95 por ciento IC = 1,04-29,6). En el análisis multivariado, la presencia de la mutación R92Q estuvo relacionada de manera independiente con las manifestaciones extra-intestinales de la EC, especialmente manifestaciones cutáneas (p = 0,02; OR: 5,17, 95 por ciento IC = 1,07-24,8). La mutación R92Q del gen TNFRSF1A no es un factor determinante de susceptibilidad a EC, pero contribuye a la aparición de manifestaciones extra-intestinales de la enfermedad.

Conocimientos, percepciones y prácticas sobre giardiasis de médicos de familia de los municipios Playa, La Lisa y Marianao / Knowledges, perceptions and practices of family physicians from Playa, La Lisa and Marianao municipalities on giardiasis

Objetivos: caracterizar los conocimientos, percepciones y prácticas de Médicos de Familia de los municipios Playa, La Lisa y Marianao en relación con la infección por Giardia lamblia. Métodos: se aplicó una encuesta sobre conocimientos, percepciones y prácticas en relación con esta parasitosis a 285 médicos de los municipios citados. De ellos 205, 1 y 79 eran especialistas de primer grado, de segundo y residentes, respectivamente y representaban el 76,8 por ciento de los que prestaban servicios en los consultorios y policlínicos de estos municipios. La investigación se realizó entre agosto de 2007 y marzo de 2008. La preparación de la encuesta pasó por cuatro fases: 1) entrevistas a médicos relacionados con el diagnóstico, tratamiento y control de la giardiasis; 2) preparación de un cuestionario preliminar en base a los resultados de esas entrevistas; 3) sometimiento del instrumento a criterio de expertos; y 4) validación del mismo mediante su aplicación a un pequeño grupo de galenos. Resultados: se encontró que en relación con la giardiasis y, de manera particular, con las manifestaciones cutáneas asociadas a esta, los dermatólogos de La Habana mostraban conocimientos insuficientes (de 19 interrogantes que evaluaban aspectos cognoscitivos, la media de respuestas correctas entre todos los participantes fue 7,5), percepciones inadecuadas y prácticas incorrectas. Conclusiones: para atenuar estas dificultades se hace necesario una intervención de tipo académica que haga énfasis en los aspectos formativos relacionados con las enfermedades parasitarias, en general, y la giardiasis, en particular...

Objectives: to characterizar on the knowledges, perceptions and practices of family physicians from Playa, La Lisa and Marianao municipalities related to Giardia lambia infection. Methods: a survey on knowledges, perceptions and practices of 285 family physicians from the above mentioned municipalities was applied on this parasitosis. From them, 205,1 and 79 were first degree specialists of second degree specialists and residents, respectively and accounted for the 76.8 percent of those working in consulting rooms and polyclinics from these municipalities. Research was made between August, 2007 and March, 2008. Survey design had four stages: 1) interviews to physicians related to diagnosis, treatment and giardiasis control; 2) design of a questionnaire based on results from these interviews; 3) submitting the tool used by expert criteria and 4) its validation by means of its application to a small groups of physicians. Results: we found that in relation to giardiasis and in a particular way, to cutaneous manifestations associated to it, dermatologists of Ciudad de La Habana showed insufficient knowledges (from 19 question marks assessing cognitive features, mean of correct answers among participants was of 7.5), inappropriate perceptions and incorrect practices. Conclusions: to reduce the strength of these difficulties, it is necessary a academic intervention emphasizing in the formative features related to parasitic diseases, in general, and the giardiasis in particular...

Extra-intestinal manifestations of ulcerative colitis / 中国综合临床

Objective To investigate the clinic features of extra-intestinal manifestations ( EM ) of ulcerative colitis (UC) in Chinese patients in Liao ning Province. Methods Two hundred and five UC cases in the First Hospital of China Medical University from Jan. 2002 to Feb. 2007 were reviewed retrospectively. Chi-square test was used to test the difference between groups. Results Skeletal and mouth manifestation were the most frequent extra-intestinal manifestations (6. 83% ). The incidence of parenteral performance in patients less than 40 years old was significantly higher than that in patients more than 40 years old (P <0. 01). There was no significant difference between male and female ( P > 0. 05). Our data showed that the extensive colitis had the highest incidence of extra-intestinal manifestations than of the other two types, LUC and DUC. Most extra-intestinal manifestations presented in UC active period ( P < 0. 05 ). The incidence of extra-intestinal manifestations in severe cases was significantly higher than that in mild cases(P <0. 05). There was a trend of increasing frequency from mild to moderate to severe type cases ( P < 0. 05 ). The occurrence of extra-intestinal manifestations was significantly higher in the group with disease course more than five years than that with less than five years group ( P < 0. 05). Conclusions Extra-intestinal manifestations had a high incidence in UC. The most frequently involved organs were joints, mouth, hepatobiliary, skin and eyes system. The patient could have multiple extra-intestinal manifestations and there was a tendency that EM was more likely occurred among patients in the higher age, active phase, longer course, severity degree of the disease.

Conocimientos, percepciones y prácticas en relación con giardiasis / Knowledge, perceptions and practices related to giardiasis

OBJETIVO: determinar los conocimientos, percepciones y prácticas de los clínicos de los municipios Playa, Lisa y Marianao en relación con la infección por Giardia lamblia. MÉTODOS: previo consentimiento informado de los clínicos que prestaban servicios en la red de policlínicos y hospitales de los municipios antes mencionados en el período que se realizó la investigación (89 de 103), se les aplicó una encuesta sobre conocimientos, percepciones y prácticas en relación con esta parasitosis. La preparación de la encuesta pasó por 4 fases: 1) entrevistas a médicos relacionados con el diagnóstico, tratamiento y control de la giardiasis; 2) preparación de un cuestionario preliminar sobre la base de los resultados de esas entrevistas; 3) sometimiento del instrumento a criterio de expertos y 4) validación de este mediante su aplicación a un pequeño grupo de galenos. RESULTADOS: se evidenció que en relación con la giardiasis y, de manera particular, con las manifestaciones cutáneas asociadas a esta, los clínicos de los citados municipios mostraban conocimientos insuficientes (de 19 interrogantes que evaluaban aspectos cognoscitivos, la media de respuestas correctas entre todos los participantes fue de 7,46), percepciones inadecuadas y prácticas incorrectas. CONCLUSIONES: se hace necesario una intervención de tipo académica, que haga énfasis en los aspectos formativos relacionados con las enfermedades parasitarias, en general y la giardiasis, en particular.

OBJECTIVE: to determine the knowledges, perceptions and practices of clinicians from Playa, Lisa and Marianao municipalities related to Giardia lamblia infection. METHODS: subject to informed consent from clinicians provided services in polyclinic and hospital network of above mentioned municipalities during the research period (89 of 103), we applied a survey on knowledges, perceptions and practices related to this parasitosis. Survey preparation had 4 phases: Interviews to diagnosis-related physicians, giardiasis treatment and control; Preparation of preliminary questionnaire based on results from those interviews; Instrument submission to expert criteria and its validation according to its application to a small group of physicians. RESULTS: we evidenced that in relation with giardiasis and particularly, with skin manifestations associated with it, clinicians of mentioned municipalities had insufficient knowledges (from 19 question marks assessing cognitive features, mean of correct answers among the participants was of 7.46), inappropriate perceptions and wrong practices. CONCLUSIONS: it is necessary an academic intervention emphasizing in formative features related to parasitic diseases in general and the giardiasis in particular.

Giardiasis extriintestinal: entre realidades y mitos / Extra intestinal manifestations of Giardia Infection: Among myth and reality

Revisar lo publicado sobre las asociaciones entre giardiasis y manifestaciones extraintestinales y, en los casos de las mejor estudiadas, sobre los mecanismos por los que G. lamblia podría ser capaz de producir daños en órganos y tejidos distantes de la superficie intestinal a la que se adhiere. Se revisaron, previa búsqueda en Medline , todos los artículos publicados sobre manifestaciones extraintestinales de la giardiasis, o relacionados con este tema, durante el período 1985-2006. Puntualmente, algunas monografías y reportes de casos fechados con anterioridad al intervalo mencionado también fueron consultados. Muy variadas son las lesiones asociaciadas a giardiasis descritas en la literatura revisada. De todas ellas, la urticaria y el angiedema, la lesión en “sal y pimienta” del epitelio pigmentado de la retina, la glositis y la artritis reactiva son las más rigurosamente demostradas. En relación con las restantes, estudios adicionales, con el empleo de diseños e instrumentación adecuados, deben demostrar hasta qué punto no son un mito. En perspectivas, además de la continuación de las investigaciones que confirmen y expliquen la existencia de las asociaciones citadas, se hace necesario incursionar en la exploración de los conocimientos, percepciones y prácticas de los médicos relacionados con el diagnóstico, tratamiento y control de la giardiasis. Ello es así, sobre todo, si tenemos en cuenta que en nuestra red de salud se ha hecho habitual el diagnóstico de giardiasis a pacientes con lesiones dermatológicas de naturaleza muy variada y causa no conocida, muchas veces sin el hallazgo del protozoo en sus heces o en el fluido duodenal correspondiente.

The purpose of this paper is to go through the literature to review what is published in connection with the association among giardia lamblia infection and extra intestinal manifestations of the disease and the mechanisms which intervene in producing such distant lesions taking in consideration the location of the parasite. Of all the lesions associated to the parasite, rash, angioedema, salt and pepper lesions in the pigments epithelium of the retina, glositis and reactive arthritis are the most rigorously long-established. Regarding others, experimental studies must be carried out to ascertain to which point they are a myth or not. In perspective, besides all the tests that are needed to confirmed the quoted associations, it is necessary to explore the knowledge, perception and practice of doctors related to the diagnosis, prevention and control of the giardia infection. In our Health Care System is very common to find a giardia infection diagnosis in the case of a dermatological infection of unknown origin, most of the times without the findings of the parasite in neither faeces nor bile.