Recurrent obstruction of biliary stent-in-stent: a heated solution.

Intraductal radiofrequency ablation (RFA) has been used in the management of malignant biliary obstruction and ampullary neoplasms. Some small studies refer to its role in managing benign biliary strictures with some promising results. The complications are not neglectable, namely cholangitis, pancreatitis, bleeding, and perforation, although most of them can be managed conservatively. There are two catheters available. Only the ERLA (EndoLumunal Radiofrequency Ablation, Taewoong Medical) catheter can control temperature and impedance, allowing it to reduce the risk of complications.

Sleep disorders, anxiety and obesity associated with untreated dental caries in children eight to ten years of age.

OBJECTIVE: To evaluate the presence of sleep disorders, obesity and anxiety associated with cavitated carious lesions in children aged 8 to 10 years. MATERIALS AND METHODS: A cross-sectional study was carried out in the Northeast of Brazil. The sample was comprised of 793 schoolchildren randomly selected from public and private schools. Calibrated examiners (Kappa >0.80) performed the clinical examination of dental caries using the International Caries Detection and Assessment System and applied the Revised Children's Manifest Anxiety Scale and the Sleep Disturbance Scale for Children questionnaires. The anthropometric variables evaluated were weight and height. Negative binomial regressions (α ≤ 0.05) were performed. A Directed Acyclic Graph was prepared using DAGitty software (version 3.0), to select the co-variables for the statistical fits. RESULTS: The prevalence of tooth decay was 52.8%. The mean number of tooth surfaces with cavitated caries was 2.2(2.8), 58.9% of the schoolchildren had some type of sleep disorder, while 20.2% were anxious and 29.1% were obese. Sleep disturbance (RR = 1.38; 95% CI: 1.05-1.83), general anxiety (RR = 1.71; 95% CI: 1.32-2.21), obesity (RR = 1.48; 95% CI: 1.17-1.86) were associated with dental caries in the final model. CONCLUSION: The presence of carious lesions was higher in children with sleep disorders, anxiety, obesity, and those who experienced dry mouth.

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study.

The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Infliximab Induction Strategies in Corticosteroid-Refractory Acute Severe Ulcerative Colitis: A Case Series and Literature Review.

Acute severe ulcerative colitis (ASUC) is an emergent medical condition and particularly challenging to treat efficaciously. Infliximab is one of the medical salvage treatment options after corticosteroid refractoriness, but the best induction strategy is not yet defined. With this case series, the authors intend to describe three corticosteroid-refractory ASUC cases with different intensified/accelerated infliximab induction approaches and review the literature on this topic. The first case describes an 18-year-old girl with ASUC at disease onset with rapid progression to toxic megacolon, complicated also with anemia, hypoalbuminemia, and coagulopathy. After corticosteroid failure, both accelerated and intensified (10 mg/kg) infliximab regimen was completed within 11 days, with solid clinical response and colon imaging normalization. Second, we present a 26-year-old male with left-sided ulcerative colitis known for 2 years, under mesalazine, who developed a moderate flare and was started on infliximab after partial and inconsistent response to corticosteroids. During the induction period, he presented this time an ASUC episode, which motivated an early and intensified third dose with good clinical response. Finally, we describe the case of a 78-year-old man with ulcerative proctitis for 12 years presenting ASUC with proximal disease extension as well. After unsatisfactory response to corticosteroids, infliximab was initiated on an accelerated induction regimen, completed in 13 days, with the standard dose, achieving clinical remission. Accelerated or intensified infliximab induction plans are becoming current clinical practice in corticosteroid-refractory ASUC. Current guidelines refer to the possibility of this type of strategies, not determining the optimal regimen due to lack of solid evidence. Literature is mainly based on retrospective studies, not randomized, with heterogeneous groups according to disease severity, and the effect on colectomy rates, mainly on the long term, is not clear. Additional well-supported studies are needed on this subject in order to seek a more widely uniform approach.

A agudização grave de colite ulcerosa é uma emergência médica, particularmente difícil de tratar de forma eficaz. O infliximab é uma das opções de tratamento médico de resgate após refractariedade aos corticosteróides, porém a melhor estratégia de indução ainda não está definida. Com este relato de série de casos, os autores pretendem descrever três casos de agudização grave de colite ulcerosa refratária a corticosteróides com diferentes abordagens de indução intensificada/acelerada de infliximab e rever a literatura sobre este tópico. O primeiro caso descreve uma jovem de 18 anos com agudização grave de colite ulcerosa, à apresentação da doença, com rápida progressão para megacólon tóxico, complicada também com anemia, hipoalbuminemia e coagulopatia. Após ausência de resposta a corticosteróides, foi iniciado regime acelerado e intensificado (10 mg/kg) de infliximab, concluído em 11 dias, com resposta clínica e normalização das alterações imagiológicas do cólon. Em segundo lugar, apresentamos um homem de 26 anos com colite ulcerosa esquerda conhecida há 2 anos, sob messalazina, que apresentou uma agudização moderada da doença e iniciou infliximab após resposta parcial e inconsistente aos corticosteróides. Durante o período de indução, apresentou desta vez um episódio de agudização grave, o que motivou uma terceira dose precoce e intensificada com boa resposta clínica. Por fim, descrevemos o caso de um homem de 78 anos com proctite ulcerosa há 12 anos apresentando agudização grave de colite ulcerosa, também com extensão proximal da doença. Após resposta insatisfatória a corticosteróides, foi iniciado infliximab em regime de indução acelerada, completado em 13 dias, com a dose padrão, obtendo remissão clínica. Os esquemas de indução de infliximab acelerados ou intensificados têm vindo a tornar-se prática clínica habitual nos casos de agudização grave de colite ulcerosa refratária a corticosteróides. As diretrizes atuais referem a possibilidade deste tipo de estratégias, não indicando qual o regime ideal por falta de evidência sólida. A literatura baseia-se principalmente em estudos retrospetivos, não randomizados, com heterogeneidade de grupos de estudo de acordo com a gravidade da doença e o efeito nas taxas de colectomia, sobretudo a longo prazo, não é claro. Estudos mais fundamentados são necessários sobre esta matéria de modo a que seja possível uma abordagem amplamente mais uniforme.

Effects of voluntary running on the skeletal muscle of rats with pulmonary artery hypertension.

The effects of voluntary running on the skeletal muscle of rats with pulmonary arterial hypertension (PAH) were tested in the present study. PAH was induced in rats by a single injection of monocrotaline (MCT, 60 mg/kg). Rats in the sedentary hypertension (HS) group had their tolerance to physical exertion reduced throughout the experiment, while those in the sedentary control (SC), exercise control (EC), exercise hypertension (EH) and median exercise (EM) groups maintained or increased. Despite that, the muscular citrate synthase activity was not different between groups. The survival time was higher in the EH (32 days) than in the SH (28 days) (p = 0.0032). SH and EH groups showed a lower percentage of muscle fiber and a higher percentage of extracellular matrix compared to control groups (p < 0.0001). However, the EM and EH groups presented higher percentage of muscle fiber and lower percentage of extracellular matrix than SH group (p < 0.0001). Regarding muscular gene expression, the SH and EM groups showed a lower expression of PGC1-α (p = 0.0024) and a higher expression of VEGF (p = 0.0033) compared to SC, while PGC1-α was elevated in the EH. No difference between groups was found for the carbonylated protein levels (p > 0.05), while the TNF-α/IL-10 ratio was augmented in the EH (p = 0.0277). In conclusion, voluntary running augments the proportion of fiber and affects the gene expression of inflammatory and mitochondrial biogenesis' markers in the skeletal muscle of rats with MCT-induced PAH, which benefits their survival and tolerance to physical effort.

THE ROLE OF BOWEL DIARIES IN A "REAL-LIFE" SETTING.

BACKGROUND: Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. OBJECTIVE: The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. METHODS: In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. RESULTS: Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). CONCLUSION: Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

O papel dos diários intestinais na consulta de gastrenterologia / The role of bowel diaries in a "real-life" setting

ABSTRACT Background Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. Objective The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. Methods In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. Results Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). Conclusion Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

RESUMO Contexto: Apesar das potenciais vantagens do diário intestinal como complemento à entrevista clínica, raros estudos avaliam a relevância da informação clínica obtida a partir de diários intestinais na prática clínica. Objetivo Os principais objetivos deste estudo foram avaliar o papel do diário intestinal como ferramenta diagnóstica numa consulta dedicada a patologia digestiva baixa. Métodos Foi realizado um estudo transversal, num período de 3 meses, em que no final das consultas os pacientes foram entrevistados relativamente a dados demográficos, antecedentes clínicos e hábitos e sintomas intestinais. Em seguida, foi solicitado o auto-preenchimento de um diário intestinal durante 2 semanas. Foram comparadas as respostas obtidas na entrevista clínica com os registos dos diários intestinais. Resultados: Cinquenta e três pacientes participaram no estudo. A frequência de evacuações reportada nas entrevistas clínicas e nos diários intestinais dos pacientes foi significativamente diferente (P=0,007). Verificou-se apenas uma concordância mínima entre a consistência das fezes descrita nas entrevistas e registada nos diários (κ=0,281). Em relação ao esforço evacuatório os pacientes sobrestimaram o seu esforço ao evacuar nas entrevistas (P=0,012). Adicionalmente, verificou-se que pacientes com doenças proctológicas descreveram menos evacuações nas suas entrevistas (P=0,033). A descrição do esforço durante a evacuação foi superestimada nas entrevistas de pacientes sem distúrbios proctológicos (P=0,028) e de pacientes com um nível mais elevado de educação (P=0,028). Conclusão: Globalmente verificaram-se discrepâncias entre a entrevista clínica e o diário intestinal dos pacientes em relação ao número de dejeções, à consistência das fezes e ao esforço evacuatório. Assim, esta ferramenta revelou-se uma potencial mais-valia na prática clínica diária, permitindo objetivar as queixas e consequentemente tratar os pacientes de forma mais adequada.

Influence of the practice of sports, sleep disorders, and habits on probable sleep bruxism in children with mixed dentition.

OBJECTIVE: Investigate the association between sleep disorders and probable sleep bruxism (SB) in children eight to ten years of age. METHODS: A cross-sectional study was conducted with 739 schoolchildren in Brazil. Parents/guardians answered a sociodemographic questionnaire, the sleep disturbance scale for children, and the Circadian Energy Scale. Parafunctional habits were evaluated using the Nordic Orofacial Test-Screening. Multivariate logistic regression was performed (α = 5%), and a directed acyclic graph was used in the statistical model. RESULTS: The prevalence of probable SB was 9.1% and 58.6% of the children had sleep disorders. In the final model, having unmarried parents/guardians (OR = 1.98; 95% CI: 1.07-3.65), exhibiting parafunctional habits (OR = 2.02; CI: 1.01-4.06), not practicing sports (OR = 1.92; CI: 1.04-3.54), sleep-wake transition disorders (SWTD) (OR = 2.01; 95%CI: 1.12-3.62), and excessive daytime sleepiness (EDS) (OR = 2.17; 95%CI: 1.11-4.29) were significant associated with probable SB. CONCLUSION: The occurrence of probable sleep bruxism was influenced by the marital status of the parents/guardians, parafunctional habits, the non-practice of sports, and sleep disturbance (SWTD and EDS). This research contributes to the planning of public policies that include educational regimens at school to prevent sleep disorders and favor the reduction in sleep bruxism prevalence.

Transmural remission improves clinical outcomes up to 5 years in Crohn's disease.

INTRODUCTION: Evidence supporting transmural remission (TR) as a long-term treatment target in Crohn's disease (CD) is still unavailable. Less stringent but more reachable targets such as isolated endoscopic (IER) or radiologic remission (IRR) may also be acceptable options in the long-term. METHODS: Multicenter retrospective study including 404 CD patients evaluated by magnetic resonance enterography and colonoscopy. Five-year rates of hospitalization, surgery, use of steroids, and treatment escalation were compared between patients with TR, IER, IRR, and no remission (NR). RESULTS: 20.8% of CD patients presented TR, 23.3% IER, 13.6% IRR and 42.3% NR. TR was associated with lower risk of hospitalization (odds-ratio [OR] 0.244 [0.111-0.538], p < 0.001), surgery (OR 0.132 [0.030-0.585], p = 0.008), steroid use (OR 0.283 [0.159-0.505], p < 0.001), and treatment escalation (OR 0.088 [0.044-0.176], p < 0.001) compared to no NR. IRR resulted in lower risk of hospitalization (OR 0.333 [0.143-0.777], p = 0.011) and treatment escalation (OR 0.260 [0.125-0.540], p < 0.001), while IER reduced the risk of steroid use (OR 0.442 [0.262-0.745], p = 0.002) and treatment escalation (OR 0.490 [0.259-0.925], p = 0.028) compared to NR. CONCLUSIONS: TR improved clinical outcomes over 5 years of follow-up in CD patients. Distinct but significant benefits were seen with IER and IRR. This suggests that both endoscopic and radiologic remission should be part of the treatment targets of CD.

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Evaluation of the association between self-reported sleep bruxism and chronotype and sleep quality among dental students / Avaliação da associação entre cronotipo, qualidade do sono e autorrelato de bruxismo do sono entre estudantes universitários de Odontologia

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

Use of electronic devices, practice of sports, and awake bruxism in schoolchildren aged eight to ten years.

The aim of the present study was to investigate whether possible awake bruxism (AB) is associated with the use of electronic devices and the practice of sports in schoolchildren aged eight to ten years. A cross-sectional study was conducted with 739 students in public and private schools in the city of Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing sociodemographic data. The children answered questions about use of electronic devices, practice of sports, and AB. Statistical analysis involved robust logistic regression for complex samples (α = 5%). The prevalence of possible AB was 14.9%. Being female (OR = 1.71, 95%CI: 1.11-2.63), being the middle child (OR = 2.19, 95%CI: 1.14-3.88), having unmarried parents (OR = 1.73, 95%CI: 1.13-2.65), daily use of a cell phone/tablet/computer (OR = 1.82, 95%CI: 1.19-2.80), use of electronic devices for two or more hours per day (OR = 1.97, 95%CI: 1.35-2.86), and playing sports in and/or out of school (OR = 1.60, 95%CI: 1.18-2.52) remained associated with possible AB in the final model. The presence of possible AB was influenced by the use of electronic devices and the practice of sports among schoolchildren aged eight to ten years.

Impact of the COVID-19 pandemic on sleep quality and sleep bruxism in children eight to ten years of age.

This study aimed to determine the impact of the COVID-19 pandemic on sleep quality and possible sleep bruxism (SB) in children eight to ten years of age. The study hypothesis was that sleep disturbances influenced a higher occurrence of bruxism during the COVID-19 pandemic. A longitudinal study was conducted at two time points: in person prior to the COVID-19 pandemic (T1), and online during the pandemic (T2). The sample comprised 105 children. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics, the use of electronic devices, reported (vs. clinical) SB, and the Sleep Disturbance Scale for Children (SDSC) at both T1 and T2. McNemar's and Wilcoxon's tests were used to compare SB and sleep disorders at both time points. Poisson regression analysis determined the relative risk (RR) among the variables, and the incidence of possible SB (p≤0.05). The comparison of the two time points (T1 and T2) revealed a significant increase in possible SB (p<0.01) and sleep disorders (p < 0.04). Children whose parents had a lower schooling level (RR: 2.67; 95%CI: 1.19-6.01), those with their own electronic devices (RR: 1.97; 95%CI: 1.09-2.50), and those with sleep disorders during the pandemic (RR: 1.74; 95%CI: 1.35-2.24) were at greater risk of developing SB during the pandemic. Moreover, the incidence of bruxism and sleep disorders was greater during the pandemic. The factors influencing SB incidence during the pandemic were a lower level of mothers' schooling, greater access to electronic devices, and the occurrence of sleep disorders.

One appendix too many: a severe IBD-U case in remission after appendectomy.

A 39-year-old female was diagnosed with inflammatory bowel disease unclassified (IBD-U) in 2011, during the post-partum period, after developing chronic bloody diarrhea and marked weight loss. She underwent colonoscopy showing erosive ileitis and pancolitis. Biopsies were compatible with unspecified chronic ileocolitis.

Is the Wistar Rat a more Suitable Normotensive Control for SHR to Test Blood Pressure and Cardiac Structure and Function?

Abstract Background: There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research. Objective: The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains. Methods: To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established. Results: The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05). Conclusion: WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.

Colitis due to Cytomegalovirus and Herpes Simplex Type 2 as a Complication of a First Presentation of Inflammatory Bowel Disease.

INTRODUCTION: The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. CASE PRESENTATION: We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. DISCUSSION/CONCLUSION: This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.

INTRODUÇÃO: A Colite Ulcerosa pode apresentar-se de forma aguda em até 15% dos casos, com necessidade de internamento hospitalar. Na agudização severa de Colite Ulcerosa refractária a corticoterapia deve ser excluída a infeção por Citomegalovirus (CMV), dado tratar-se de uma causa frequente de doença refractária. A colite por Herpes simplex é mais rara nos doentes com Colite Ulcerosa e associa-se frequentemente a imunossupressão. DESCRIÇÃO DO CASO: Relata-se a apresentação inaugural de Colite Ulcerosa complicada por co-infeção por CMV e herpes simplex tipo 2. Após terapêutica prolongada com corticoids sistémicos, foi diagnosticada colite tanto por CMV como Herpes simplex. Apesar de tratamento anti-vírico, foi necessária colectomia por perfuração cólica. DISCUSSÃO/CONCLUSÃO: Este caso sublinha a importância de um alto grau de suspeição para infeções oportunistas em doentes com doença refractária a corticóide/imunomoduladores, mesmo na primeira agudização.