Epidemiological characterization of patients with intestinal stomas

Objective: To characterize the sociodemographic and clinical variables of people with intestinal stomas. Materials and Methods: We conducted a cross-sectional study with 47 patients of a Specialized Rehabilitation Center (CER II/APAE) in the municipality of Três Lagoas, state of Mato Grosso do Sul, Midwestern Brazil, from December 2019 to June 2020. Data was analyzed using inferential descriptive statistics (Anderson-Darling, Chi-squared, and Mann-Whitney normality tests). Results: Regarding the patients, 87.23% were from Três Lagoas, 51.06% were female, 40.43% were aged from 60 to 69 years, 59.57% were married, 53.19% were brown, 59.57% were catholic, 36.17% finished elementary school, 46.81% were retired, and 57.45% earned a monthly income below 1 minimum wage. Moreover, 61.70% had undergone terminal colostomy (61.70%), 61.70% had received guidance about its placing, 57.45% had it placed due to situations of urgency, 74.47% had a stoma installed due to a neoplasia, 38.30% were permanent, with 46.81% located in the inferior left quadrant (ILQ), 59.57% presented pasty effluent, 63.83% had a circular diameter, 53.19% had pouches with 2 pieces and 57.45%, with a flexible base, 87.23% had other adjunct equipment, and 95.74% had been trained in self-care. The most common complication was skin/peristomal irritant contact dermatitis (59,57%), and 65,95% of these cases were solved by teaching self-care. The type of stoma was significantly associated with the consistency of the effluent and the size of the protrusion (p> 0.05). Conclusion: The results found can support strategies to implement practices to promote health, develop new public policies, to provide training in self-care, and prevent and treat complications. (AU)

The effect of microplastics on the depuration of hydrophobic organic contaminants in Daphnia magna: A quantitative model analysis.

Microplastics are emerging pollutants that can absorb large amounts of hydrophobic organic contaminants (HOCs). However, no biodynamic model has yet been proposed to estimate their effects on HOC depuration in aquatic organisms, where the HOC concentrations are time-varying. In this work, a microplastic-inclusive biodynamic model was developed to estimate the depuration of HOCs via ingestion of microplastics. Several key parameters of the model were redefined to determine the dynamic HOC concentrations. Through the parameterized model, the relative contributions of dermal and intestinal pathways can be distinguished. Moreover, the model was verified and the vector effect of microplastics was confirmed by studying the depuration of polychlorinated biphenyl (PCB) in Daphnia magna (D. magna) with different sizes of polystyrene (PS) microplastics. The results showed that microplastics contributed to the elimination kinetics of PCBs because of the fugacity gradient between the ingested microplastics and the biota lipids, especially for the less hydrophobic PCBs. The intestinal elimination pathway via microplastics would promote overall PCB elimination, contributing 37-41 % and 29-35 % to the total flux in the 100 nm and 2 µm polystyrene (PS) microplastic suspensions, respectively. Furthermore, the contribution of microplastic uptake to total HOC elimination increased with decreasing microplastic size in water, suggesting that microplastics may protect organisms from HOC risks. In conclusion, this work demonstrated that the proposed biodynamic model is capable of estimating the dynamic depuration of HOCs for aquatic organisms. The results can shed light on a better understanding of the vector effects of microplastics.

Investigation of Intestinal Absorption and Excretion of Paracetamol in Streptozotocin-Induced Hyperglycemia.

The phenolic drug molecules can be metabolized, among others, by the small intestine's enterocytes. The conjugation reactions (glucuronidation and sulfation) show great importance in these transformations, although the oxidation reactions can be significant. These processes are dependent on the substituents of the phenolic compounds or the reacting functional groups (hydroxyl or carboxyl). Pathologic conditions, e.g., permanent hyperglycemia and diabetes, can alter the activities of the conjugative and possibly the oxidative enzymes, thus forming a change in the metabolic pattern and eventually provoking oxidative stress. A rat intestinal perfusion model was used to investigate the way in which experimental hyperglycemia affects the paracetamol's intestinal elimination and metabolism. Hyperglycemia was induced by the administration of streptozotocin. Two hundred and fifty µM paracetamol was used in the intestinal perfusion solution. For the quantitation of the paracetamol and its major metabolites in the intestinal perfusate, an isocratic high-performance liquid chromatography method with UV-Vis detection was developed. The results revealed that quantities of all of the measured metabolites (glucuronide, sulfate, cysteine, and mercapturic acid conjugates) increased as the effect of the streptozotocin-induced hyperglycemia also did. In the small intestine's homogenate, the glutathione levels showed that there was a decrease in the hyperglycemia levels after the paracetamol administration. In contrast, the tissue levels of the cysteine were lower in the streptozotocin-induced hyperglycemia and increased after the administration of the paracetamol. The changes in the activity of the intestinal CYP 3A4, CYP 2E1, and cyclooxygenase (COX) enzymes were determined in the control and the hyperglycemic cases. Still, there was a significant observable enzyme activity elevation in the intestinal COX enzymes, but there was a decrease in the amount of activity of the intestinal CYP3A4 enzymes, and the CYP2E1 enzyme activity was practically changeless. The results on the cysteine levels in the intestinal homogenate, at least partly, can be explained by the regulation function of the cysteine during the occurrence of oxidative stress.

Escalas validadas para avaliação das fezes: revisão integrativa / Validated scales for stool assessment: integrative review

Introdução: A eliminação intestinal é uma necessidade fisiológica humana básica, que deve ser considerada e avaliada em toda a assistência prestada pelos profissionais de saúde. Objetivo: identificar as escalas validadas utilizadas na atualidade para avaliação das fezes em adultos e idosos. Método: revisão integrativa, protocolada na plataforma Open Science Framework, cujo registro está disponível sob o DOI https://doi.org/10.17605/OSF.IO/9CTMB, que incluiu estudos primários publicados na íntegra, que utilizaram escalas para avaliação de fezes, publicados nos idiomas inglês, português ou espanhol, no período de janeiro de 2001 a julho de 2021. As buscas foram realizadas nas bases de dados eletrônicas PubMed, LILACS, CINAHL e EMBASE em 16 de julho de 2021. Em seguida, as referências identificadas foram exportadas para o aplicativo Rayyan para remoção das duplicatas, seleção e avaliação dos estudos por dois revisores de forma independente e mascarada; os casos de divergência foram avaliados por um terceiro revisor. As evidências foram sintetizadas de forma descritiva. Resultados: a busca nas bases de dados resultou em 1.567 estudos. Após o processo de seleção e leitura na íntegra, 353 estudos foram considerados nesta revisão, dos quais 339 utilizaram escalas validadas (333 estudos utilizaram a Escala de Bristol e seis outras escalas) e 14 escalas não validadas. Também se verificou aumento na quantidade de publicações que avaliaram a consistência das fezes a partir do ano de 2015. Após a leitura dos 353 estudos, foram identificadas cinco escalas validadas: Escala de Forma das Fezes de Bristol, King's Stool Chart, Escala de consistência das fezes segundo Anastasi e Capili (2001) e Hansen (1981), Escala pictórica validada do Diarrhea Questionnaire e a ferramenta de avaliação fecal de Ohno. Conclusão: foram identificadas cinco escalas validadas e utilizadas nos últimos 20 anos para avaliação das fezes. Adicionalmente, os dados mostraram aumento mundial do uso das escalas e a necessidade de desenvolvimento de uma escala para avaliação das fezes com estudos de validação mais robustos

Introduction: Bowel elimination is a basic human physiological need, which must be considered and evaluated in all care provided by health professionals. Aim: to identify the validated scales used to assess stool in adults and the elderly. Method: an integrative review, registered on the Open Science Framework platform and available under DOI 10.17605/OSF.IO/9CTMB, which included primary studies published in full that used scales for stool assessment, published in English, Portuguese or Spanish, between January 2001 and July 2021. Searches of the PubMed, LILACS, CINAHL, and EMBASE electronic databases were performed on July 16, 2021. Afterward, the identified references were exported to the Rayyan application for removal of duplicates, selection, and independent and masked evaluation of studies by two reviewers; cases of divergence were evaluated by a third reviewer. The evidence was synthesized descriptively. Results: the database search resulted in 1,567 studies. After the selection process and reading in full, 353 studies were considered in this review. Of these 353, 339 used validated scales (333 studies used the Bristol Scale and six studies used other scales) and 14 studies used non-validated scales. There was also an increase in the number of publications that evaluated stool consistency from the year 2015. After reading the 353 studies, five validated scales were identified: Bristol Stool Form Scale, King's Stool Chart, Stool Consistency Scale according to Anastasi and Capili (2001) and Hansen (1981), the Diarrhea Questionnaire's validated pictorial scale, and Ohno's fecal assessment tool. Conclusion: Five validated scales were identified and used in the last 20 years for stool assessment. Additionally, the data showed a worldwide increase in the use of scales and the need to develop a scale to assess stool with more robust validation studies

Intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal e família em contexto de cuidados de saúde primários / Nursing intervention for the elderly with intestinal elimination ostomy and family in the context of primary health care

O envelhecimento populacional é uma tendência a nível global, refletindo-se na saúde dos indivíduos e conduzindo a um aumento de doenças crónicas. Estas apresentam-se com maior incidência em pessoas cuja idade é de 65 anos ou mais. Em Portugal o cancro do colon e reto é a doença que se confronta com maior número de novos casos anuais, com cerca de 10 270 (WHO, 2018), e é a principal razão para a existência de ostomias de eliminação intestinal (OEI) (Barata, 2010), estimando-se cerca de 20 000 pessoas (Farmácias Portuguesas, 2020), sendo a OEI predominante (Barata, 2010). A presença de uma OEI, especialmente numa pessoa idosa (PI), requer competências, tanto do portador como das suas familias, tornando-se a intervenção de enfermagem essencial para a recuperação e melhoria da qualidade de vida. Após a cirurgia, estes doentes são referenciados para os cuidados de saúde primários, sendo constatado, que os enfermeiros deste nivel de cuidados, nem sempre estão preparados, com o nivel de conhecimentos necessários para poder dar resposta às expectativas destas pessoas. Sendo a relação de ajuda indissociável da intervenção de enfermagem, foi elaborado o projeto "Intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal e família em cuidados de saúde primários", com o intuito de ajudar a suprimir as lacunas existentes. Este trabalho, resulta do percurso delineado no projeto e implementado por nós ao longo do estágio. Para a sua concecução, utilizámos a metodologia do projeto, assente no modelo conceptual de défice de autocuidado de Orem. Tivemos como objetivos: desenvolver competências como mestre e enfermeira especialista na intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal (PIOEI) e família; envolver a equipa multidisciplinar na promoção do autocuidado à PIOEI e família. O resultado deste percurso permitiu-nos: o desenvolvimento de competências como mestre e enfermeira especialista, nomeadamente na prestação de cuidados à PIOEI e suas familias; a realização de duas sessões de formação à equipe de enfermagem de um agrupamento de centros de saúde (ACES), contribuindo desta forma para a capacitação dos enfermeiros, nos cuidados a prestar a pessoas idosas com OEI e família; elaboração de um manual de boas práticas que foi disponibilizado aos enfermeiros da unidade de cuidados na comunidade (UCC) e aos enfermeiros do ACES que participaram na formação.

Population ageing is a global trend, reflecting on the health of individuals and leading to an increase in chronic diseases. They have a higher incidence in people whose age is 65 years or older. In Portugal colon and rectum cancer is the disease that faces the highest number of new annual cases,, with about 10 270 (WHO, 2018), and is the main reason for the existence of intestinal elimination ostomies (IEO) (Barata, 2010),with an estimated 20 000 people (Portuguese Pharmacies, 2020), with the predominant IOE (Barata, 2010). The presence of an IEO, especially in an old person (OP), requires competencies, from the carrier and their families, making it the essential nursing intervention for the recovery and improvement of quality of life. After surgery, these patients are referred to primary health care, and it is found that nurses at this level of care, are not always prepared with the necessary level of knowledge, to be able to meet the expectations of these people. Since the relationship of help is inseparable from the nursing intervention, the project "Nursing intervention to the old person with intestinal elimination ostomy and family in primary health care" was designed, in order to help eliminate existing gaps. This work results from the path outlined in the project and carried out by us throughout the internship. For its design, we used the project methodology, based on Orem's conceptual self-care deficit theory. We had the objectives: to develop competencies as a master and nurse specialist in the nursing intervention to the old person with intestinal elimination ostomy (OPIEO) and family; to involve the multidisciplinary team in the promotion of self-care to the OPIEO and family. The result of this journey allowed us to: the development of skills as a master and specialist nurse, namely in the provision of care to OPIEO and its families; the realization of two training sessions to the nursing team of a Group of Health Centers (GHC) in Lisbon, thus contributing to the training of nurses, in the care provided to the old person with IEO and family; a guide was prepared and made available to the Community Care Unit nurses and GHC nurses who participated in the training.

Investigation of intestinal elimination and biliary excretion of ibuprofen in hyperglycemic rats.

An in vivo intestinal perfusion model was used to investigate how experimental hyperglycemia affects intestinal elimination and biliary excretion in the rat. Experimental diabetes was induced by administration of streptozotocin (65 mg/kg, i.v.). The intestinal perfusion medium contained 250 µM (±)-ibuprofen. An isocratic high-performance liquid chromatography method with UV-visible detection was developed to quantitate ibuprofen in the intestinal perfusate, while a gradient method was applied to quantitate ibuprofen and ibuprofen-ß-d-glucuronide in the bile. The limit of quantitation of ibuprofen was found to be 0.51 µM in the perfusate of the small intestine. In the bile, the limit of quantitation of ibuprofen and ibuprofen-ß-d-glucuronide was 4.42 and 10.3 µM, respectively. Unconjugated ibuprofen and ibuprofen-ß-d-glucuronide were detected in the bile; however, no ß-d-glucuronide of ibuprofen could be detected in the intestinal perfusate. The results indicate that experimental diabetes can cause a decrease in the disappearance of ibuprofen from the small intestine. Excretion of both ibuprofen and ibuprofen-ß-d-glucuronide decreased to the bile in experimental diabetes. The results can be explained by the results of molecular biological studies indicating streptozotocin-initiated alterations in the intestinal and hepatic transport processes.

Cultural adaptation of the adaptation scale to elimination ostomy for use in Brazil / Adaptación cultural de la escala de adaptación a la ostomía de eliminación para uso en Brasil / Adaptação cultural da escala de adaptação à ostomia de eliminação para uso no Brasil

ABSTRACT Objective: to culturally adapt the Adaptation Scale to Elimination Ostomy for the Brazilian Portuguese language and to evaluate the content validity. Method: a methodological study, which stages of cultural adaptation were: adaptation to Brazilian Portuguese; committee of seven experts to evaluate the semantic, idiomatic, cultural and conceptual equivalences; and pre-test with 30 people with ostomy, performed between 2016 and 2017. The content validation was then performed, according to the Content Validity Coefficient greater than or equal to 0.80 and kappa coefficient. Results: the target population demonstrated good understanding in the pre-test. The Content Validity Coefficient of the scale reached values of 0.9 for the criteria: language clarity, practical relevance and theoretical relevance, and for the "dimension" category, the kappa mean value (0.587). Conclusion: the Adaptation Scale to Elimination Ostomy, built and validated originally in Portugal, was culturally adapted to Brazil, constituting an easy-to-understand resource, but it is still necessary to attest the psychometric properties of this version.

RESUMEN Objetivo: adaptar culturalmente la Escala de Adaptación a la Ostomía de Eliminación a la lengua portuguesa de Brasil y evaluar la validez de contenido. Método: estudio metodológico, cuyas etapas de la adaptación cultural fueron las siguientes: adaptación al portugués de Brasil; comité de siete especialistas para evaluar las equivalencias semántica, idiomática, cultural y conceptual; y pre-evaluación con 30 estomizados, realizado entre 2016 y 2017. Luego se llevó a cabo la validez de contenido, según el Coeficiente de Validez de Contenido mayor o igual a 0,80 y se calculó el coeficiente kappa. Resultados: la población-meta demostró un buen entendimiento en la pre-evaluación. El Coeficiente de Validez de Contenido de la escala alcanzó valores de 0,9 en los criterios: claridad del lenguaje, pertinencia práctica y relevancia teórica, y en la categoría "dimensión" el kappa medio obtuvo un valor moderado (0,587). Conclusión: la Escala de Adaptación a la Ostomía de Eliminación, construida y validada en un principio en Portugal, se adecuó culturalmente para Brasil, constituyéndose así en un recurso de fácil comprensión, pero aún es necesario que las propiedades psicométricas de esta versión sean testadas.

RESUMO Objetivo: adaptar culturalmente a Escala de Adaptação à Ostomia de Eliminação para a língua portuguesa do Brasil e avaliar a validade de conteúdo. Método: estudo metodológico, cujas etapas da adaptação cultural foram: adequação para o português do Brasil; comitê de sete especialistas para avaliar as equivalências semântica, idiomática, cultural e conceitual; e pré-teste com 30 estomizados, realizado entre 2016 e 2017. Em seguida realizou-se a validação de conteúdo, segundo o Coeficiente de Validade de Conteúdo maior ou igual a 0,80 e calculou-se o coeficiente Kappa. Resultados: a população-alvo demonstrou boa compreensão no pré-teste. O Coeficiente de Validade de Conteúdo da escala atingiu valores de 0,9 para os critérios: clareza de linguagem, pertinência prática e relevância teórica, e, para a categoria "dimensão", o kappa médio teve valor moderado (0,587). Conclusão: a Escala de Adaptação à Ostomia de Eliminação, construída e validada originalmente em Portugal, foi adaptada culturalmente para o Brasil, constituindo-se em um recurso de fácil compreensão, porém é necessário ainda que sejam atestadas as propriedades psicométricas dessa versão.

Ezetimibe Increases Endogenous Cholesterol Excretion in Humans.

OBJECTIVE: Ezetimibe improves cardiovascular outcomes when added to optimum statin treatment. It lowers low-density lipoprotein cholesterol and percent intestinal cholesterol absorption, but the exact cardioprotective mechanism is unknown. We tested the hypothesis that the dominant effect of ezetimibe is to increase the reverse transport of cholesterol from rapidly mixing endogenous cholesterol pool into the stool. APPROACH AND RESULTS: In a randomized, placebo-controlled, double-blind parallel trial in 24 healthy subjects with low-density lipoprotein cholesterol 100 to 200 mg/dL, we measured cholesterol metabolism before and after a 6-week treatment period with ezetimibe 10 mg/d or placebo. Plasma cholesterol was labeled by intravenous infusion of cholesterol-d7 in a lipid emulsion and dietary cholesterol with cholesterol-d5 and sitostanol-d4 solubilized in oil. Plasma and stool samples collected during a cholesterol- and phytosterol-controlled metabolic kitchen diet were analyzed by mass spectrometry. Ezetimibe reduced intestinal cholesterol absorption efficiency 30±4.3% (SE, P<0.0001) and low-density lipoprotein cholesterol 19.8±1.9% (P=0.0001). Body cholesterol pool size was unchanged, but fecal endogenous cholesterol excretion increased 66.6±12.2% (P<0.0001) and percent cholesterol excretion from body pools into the stool increased 74.7±14.3% (P<0.0001), whereas plasma cholesterol turnover rose 26.2±3.6% (P=0.0096). Fecal bile acids were unchanged. CONCLUSIONS: Ezetimibe increased the efficiency of reverse cholesterol transport from rapidly mixing plasma and tissue pools into the stool. Further work is needed to examine the potential relation of reverse cholesterol transport and whole body cholesterol metabolism to coronary events and the treatment of atherosclerosis. CLINICAL TRIALS REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01603758.

Absorption and elimination of imatinib through the rat intestine in vitro.

Imatinib is a potent selective inhibitor of tyrosine kinases and is used primarily in the treatment of chronic myeloid leukemia and the gastrointestinal stromal tumour. Although, it is well established that imatinib is a substrate of several transport proteins which are also active in the intestinal mucosa, the mechanisms of imatinib intestinal absorption and elimination were not systematically investigated yet. To do that, we used a Sweetana-Grass type of diffusion chambers with segments of rat intestine as a model of the intestinal mucosa, measured the permeability coefficients of imatinib and its major metabolite (N-desmethyl imatinib) in both directions with and without specific and general inhibition of active transport, and calculated the efflux ratios. The results show that the good bioavailability of imatinib is highly likely achieved by its active absorption from the intestine and that its active elimination through the intestinal mucosa is mediated by a synergistic activity of organic cation transporter 1 in the basolateral membrane and the added activity of two efflux proteins (P-glycoprotein and breast cancer resistant protein) in the apical membrane of enterocytes of the rat ileum. Interestingly, it was found that N-desmethyl imatinib is only transported by P-glycoprotein.