Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

What does the freshwater clam, Corbicula largillierti, have to tell us about chlorothalonil effects?

Chlorothalonil (CLT) is a broad spectrum, and non-systemic fungicide applied in foliar structures to prevent and treat pathogens. This compound reaches to aquatic environments and affects the biota. In this context, the main goal of this study was to assess the effects of CLT at biochemical, tissular, and individual levels of biological organization using the invasive bivalve Corbicula largillierti as a bioindicator species. Clams were exposed to different sublethal concentrations (0, 10, 20 and 50 µg. L-1 CLT) for 96 h. At biochemical level, the enzymatic activity (Glutathione-s-Transferase, Catalase, Acetyl-, Butiryl- and Carboxyl-esterases) and lipid peroxidation were measured in gills and the visceral mass. Also, the digestive gland morphometry through quantitative histological indexes was registered at the tissular level. Finally, filtering activity and burial behavior at the individual level were measured. At the highest CLT concentration, the most significant changes were observed in enzymatic activity (except for butyrylcholinesterase), lipid peroxidation and in digestive gland morphometry. It was also registered increases of the filtering activity and the latency time to burial. Most of the biomarkers assessed showed significant responses under CLT exposure. Therefore, taking into account that C. largillierti was affected by CLT, it can be expected that other species could be in a potential risk if this fungicide is present in freshwater systems.

A multilevel response approach reveals the Asian clam Corbicula largillierti as a mirror of aquatic pollution.

The endobenthic bivalves are widely used as a bioindicators since they inhabit the sediment-water interface and are able to accumulate a different kind of contaminants. In the present work, we evaluated wild Corbicula largillierti (Phillippi, 1844) as a bioindicator of water quality in the central region of Argentina. The responses at different levels of the biological organization were used. We measured organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) levels in water and clams tissues. The biomarkers selected were enzymatic activities (Glutathione S-Transferase, Catalase, Acetyl-, Butyryl-cholinesterase, and Carboxylesterase) morphometry of the digestive gland, condition index and morphology of valves. In order to integrate all the responses a multivariate analysis and integrated stress index were applied. Our results showed the presence of contaminants along the studied river and the ability of C. largillierti to bioaccumulate them. All the biomarkers selected varied according to the water quality gradient, although there was no specific correlation with OCPs and PCBs levels. At the most polluted sites, the detoxification and oxidative stress enzymes, the morphometric analysis of the digestive gland and the variation in the morphology of the valves indicated the water quality degradation. The multivariate analyses allowed to discriminate the sites according to the different biomarker responses. The IBR index also showed a variation pattern according to the environmental quality gradient along the basin. According to the responses shown by C. largillierti we suggest this species as an useful bioindicator of aquatic pollution.

Acculturation and breast self-examination among immigrant Latina women in the USA.

This article is an extension of previous work, which identified acculturation as an important variable in predicting breast self-examination (BSE) in this sample of women. Here, acculturation is further examined as an intervening factor in predicting BSE. This paper presents the association between level of acculturation to mainstream culture in the USA and the practice of BSE among a population of low-income immigrant Mexican and Puerto Rican women (n = 111) in an urban area of the Midwest in the USA. The majority of women (84.7%) scored a low level of acculturation and 85% did not practice correct BSE. The crude odds ratio indicated that Latina women having a high level of acculturation (15.3%) were twice as likely to practice correct BSE than women with low acculturation. We would suggest that a clearer understanding of the variables that define the performance of BSE will assist in enabling nurses globally to incorporate assessments in their practice that will lead to more successful interventions.

Breast care among Latino immigrant women in the U.S.

Although the U.S. is recognized as a developed country, knowledge of how to perform a breast self-examination (BSE) and the availability and accessibility screening mammography are not evenly distributed across ethnic, racial, and socioeconomic groups. Some U.S. organizations have decreased their emphases on BSE and are strongly promoting technological advances such as mammography. Disparities in obtaining breast health care are found worldwide. In this article we present the findings of a study that was conducted in a large urban area in the Midwest of the United States, to identify factors associated with breast care in Latino immigrant women (n = 111). Limited knowledge about breast care, unemployment, and short period of residence in the U.S. were all found to be related to inadequate breast care in this group of women. These findings have global implications for health care practitioners in directing attention toward discovering factors that promote and inhibit early breast cancer detection.

Cervical cancer screening practices among Latino women in Chicago.

Previous studies have determined that Latino women, especially Mexican women, have the lowest rates of cancer-screening practices of any racial and ethnic group in the United States (L. S. Caplan, B. L. Wells, & S. Haynes, 1992; L. C. Harlan, A. B. Bernstein, & L. G. Kessler, 1991). The purpose of this descriptive study was to identify factors associated with irregular Papanicolaou (Pap) screening among Latino women. The convenience sample consisted of 111 Mexican and Puerto Rican women ages 40 and older, recruited through two inner-city clinics, located in two major Latino communities in Chicago. The women were interviewed face-to-face by trained bilingual interviewers, using a structured questionnaire. Mexican ethnicity and older age were found to be associated with irregular cervical cancer-screening practices. These results suggest that interventions need to be developed for educating Latino women about the purpose and importance of Pap test-screening practices. Further research is needed to examine other barriers that impede these women from using cervical cancer-screening services.