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BACKGROUND AND AIMS: Golimumab has an established exposure-response relationship in patients with ulcerative colitis [UC]. However, the association of serum golimumab trough levels [TL] with objective markers of disease activity, such as endoscopic and histological activity scores and concentrations of biomarkers, remains less understood. This report describes the relationship of serum golimumab TL at the end of the induction period [Week 6] with clinical, endoscopic, histological, and biomarker parameters. METHODS: This was an open-label, uncontrolled, prospective and interventional study. Moderate to severely active UC patients naïve to biologic therapy were treated with golimumab. Serum golimumab TL and faecal calprotectin levels were measured at baseline [Week 0 of induction] and Week 6. RESULTS: A total of 34 patients completed the induction phase [Week 6] and were included in this analysis. Overall, 47.1% and 14.7% of patients achieved clinical response and remission with significantly higher serum golimumab TL in patients with early response or remission [3.7 µg/mL vs 1.3 µg/mL, p = 0.0013; and 3.1 µg/mL vs 1.7 µg/mL, p = 0.0164, respectively]. In addition, golimumab TL were significantly higher in patients achieving histological remission [4.2 µg/mL vs 1.7 µg/mL, p = 0.0049]. Week 6 golimumab TL were inversely correlated with the total Mayo score [rs = -0.546; p = 0.0008], the Mayo endoscopic subscore [rs = -0.381; p = 0.0262], the Geboes histological activity score [rs = -0.464; p = 0.0057], and faecal calprotectin levels [rs = -0.497; p = 0.0044]. CONCLUSIONS: A higher early exposure to golimumab is associated with a better objective response in active UC patients and appears to drive the outcome at Week 6.
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Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/sangre , Colitis Ulcerosa/tratamiento farmacológico , Adulto , Biomarcadores/análisis , Proteína C-Reactiva/análisis , Colitis Ulcerosa/patología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Endoscopía Gastrointestinal , Heces/química , Femenino , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/sangre , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Complejo de Antígeno L1 de Leucocito/análisis , Masculino , Portugal , Estudios Prospectivos , Inducción de RemisiónAsunto(s)
Colitis Ulcerosa/complicaciones , Neoplasias Colorrectales/etiología , Complicaciones Posoperatorias , Reservoritis/etiología , Enfermedad Aguda , Cuidados Posteriores/métodos , Enfermedad Crónica , Colitis Ulcerosa/psicología , Colitis Ulcerosa/cirugía , Colonoscopía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/terapia , Progresión de la Enfermedad , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Reservoritis/diagnóstico , Reservoritis/terapia , Proctocolectomía Restauradora , Factores de RiesgoRESUMEN
PURPOSE: To estimate inflammatory bowel disease (IBD) prevalence in Portugal from 2003 to 2007, and to obtain disease, sex and age specific estimates. METHODS: A pharmaco-epidemiological approach based on intestinal anti-inflammatory (IAI) drugs consumption was used. Proportion of patients taking IAI drugs and mean prescribed daily dose (PDD) were estimated from a sample of 513 IBD patients. Assumptions were made about unknown parameters and sensitivity analysis performed: drug compliance (80% in base case; range 70-85%) and proportion of sulphasalazine used in IBD (52%; range 40-80%). Sex and age specific estimates were based on a proposed methodological extension and results from a nationwide (n = 5893) cross-sectional study. RESULTS: IBD prevalence increased from 86 patients per 100 000 in 2003 to 146 in 2007. Regions more affected were Lisboa and Porto (173 and 163 per 100 000 in 2007, respectively). Prevalence increased from 42 and 43 per 100 000 in 2003 to 71 and 73 in 2007, respectively for ulcerative colitis (UC) and Crohn's disease (CD). In 2007, prevalence was higher in the 40-64 age stratum for UC (99 per 100 000) and in the 17-39 stratum for CD (121). Prevalence was consistently higher in females. CONCLUSIONS: Portugal is half way between countries with the highest and lowest IBD prevalence, but is steeply making the road to the highest-level group. Despite limitations of the proposed methods, assumptions were reasonable and estimates seem to be valid. Feasibility and comparability of this methodology makes it an interesting tool for future studies on IBD epidemiology.
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Antiinflamatorios no Esteroideos/efectos adversos , Fármacos Gastrointestinales/efectos adversos , Enfermedades Inflamatorias del Intestino/epidemiología , Farmacoepidemiología/métodos , Adulto , Factores de Edad , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Estudios Transversales , Femenino , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/uso terapéutico , Humanos , Masculino , Mesalamina/administración & dosificación , Mesalamina/efectos adversos , Mesalamina/uso terapéutico , Cooperación del Paciente/estadística & datos numéricos , Farmacoepidemiología/estadística & datos numéricos , Portugal/epidemiología , Prevalencia , Factores Sexuales , Sulfasalazina/administración & dosificación , Sulfasalazina/efectos adversos , Sulfasalazina/uso terapéuticoRESUMEN
The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients' and their caregivers' daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn's disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N=324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care.
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Actividades Cotidianas , Cuidadores/psicología , Colitis Ulcerosa/psicología , Enfermedad de Crohn/psicología , Calidad de Vida , Adaptación Psicológica , Adulto , Ansiedad/etiología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/terapia , Costo de Enfermedad , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/terapia , Servicios de Información sobre Medicamentos , Empleo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Higiene , Masculino , Limitación de la Movilidad , Dolor/psicología , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Portugal , Calidad de la Atención de Salud , Sistema de Registros , Encuestas y Cuestionarios , Adulto JovenRESUMEN
No disponible
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Humanos , Femenino , Adulto , Falla de Equipo , Endoscopía Gastrointestinal , Colon Sigmoide , Diarrea/etiología , Dolor Abdominal/etiología , Grabación en VideoRESUMEN
An increasing incidence of nosocomial infections caused by non-multiresistant methicillin-resistant Staphylococcus aureus (nMMRSA) has been reported worldwide. The present study genotyped nMMRSA isolates obtained from hospitals in two cities in Brazil. The hospital isolates displayed pulsed-field gel electrophoresis (PFGE) patterns that were similar to those of the USA100 (ST5-SCCmecII) and USA 800 (ST5-SCCmecIV) strains, which are related to the New York/Japan and paediatric clones, respectively. Carriage of SCCmecIV and the classification by multilocus sequence typing (MLST) of a representative of this PFGE pattern in clonal complex 5 (CC5) confirmed the genetic relationship of the Brazilian isolates with USA800. The USA800-related Brazilian isolates were responsible for severe nosocomial infections in compromised adults and elderly patients in Brazil. A higher growth rate, an ability to form biofilm on inert polystyrene surfaces and the presence of the egc locus may have contributed, at least in part, to the fitness of these organisms as global nosocomial pathogens.
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Infección Hospitalaria/microbiología , Resistencia a la Meticilina , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Técnicas de Tipificación Bacteriana , Biopelículas/crecimiento & desarrollo , Brasil/epidemiología , Niño , Preescolar , Infección Hospitalaria/epidemiología , Dermatoglifia del ADN , ADN Bacteriano/química , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Incidencia , Persona de Mediana Edad , Epidemiología Molecular , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/crecimiento & desarrolloRESUMEN
No disponible
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Masculino , Persona de Mediana Edad , Humanos , Perforación del Esófago/complicaciones , Hemorragia Gastrointestinal/etiología , Síndrome de Mallory-Weiss/diagnóstico , Técnicas de Sutura , Vómitos/complicacionesRESUMEN
BACKGROUND AND STUDY AIMS: The risk of variceal bleeding cannot be accurately predicted using endoscopy alone. Although variceal pressure has been demonstrated to be a major determinant for the rupture of esophageal varices, direct determination by needle puncture is unsuitable for routine clinical use. Due to their operator-dependency, current noninvasive endoscopic methods for determination of variceal pressure have not gained wide acceptance. We have developed a new method of measuring variceal pressure, using endoscopic power Doppler imaging to monitor the manometry of esophageal varices. The aims of this study were to test in vitro the accuracy of Doppler-guided manometry and to assess the clinical feasibility of this method. MATERIALS AND METHODS: Experimental validation of this technique was performed using an in vitro model of artificial varices of different sizes. A linear-array endosonography (EUS) probe with power Doppler capability was used to assess flow in the varices and a balloon for manometry of esophageal varices was attached to the tip of the probe. Pressure readings were made at the time of disappearance of the Doppler signal during variceal compression by the balloon. Linear regression analysis was used to compare the results of Doppler-guided and direct intraluminal pressure measurement in the artificial varices. Variceal pressure was then measured with this technique in 28 patients with portal hypertension and esophageal varices without previous bleeding, and the results were compared with portal pressure assessed according to the hepatic vein pressure gradient (HVPG). RESULTS: In vitro studies demonstrated a good correlation between the pressure measured with Doppler monitoring and the actual intravariceal pressure (r > or = 0.922; P < 0.001). The determination of variceal pressure with this method was technically successful in 26/28 patients (93 %). The intraoperator variance was 9.3 +/- 8.6 %. Overall, the mean variceal pressure was significantly lower than the mean HVPG (21.2 +/- 5.3 mmHg vs. 24.3 +/- 7.8 mmHg; P < 0.01). Variceal pressure and portal pressure (as assessed by the HVPG) correlated significantly (r = 0.64; P < 0.001). CONCLUSIONS: Our preliminary results indicate that EUS Doppler-guided manometry of esophageal varices is feasible and accurate. This technique may become a more reliable method for noninvasive measurement of variceal pressure and warrants further investigation.
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Endosonografía , Várices Esofágicas y Gástricas/fisiopatología , Manometría/métodos , Estudios de Factibilidad , Humanos , Hipertensión Portal/fisiopatología , Modelos Biológicos , Ultrasonografía DopplerRESUMEN
The cardiothoracic team has to be ready with a strategy that corners the preoperative to postoperative period, but the cardiothoracic surgeon has to be prepared to perform the optimal procedure by concentrating on the procedure and avoiding circulatory arrest. If it is not possible to avoid circulatory arrest the surgeon should choose the ideal cerebroprotective technique for each patient, which is not always the same technique, change the method during the procedure if necessary, and remember that cerebral protection is not the same as cerebral metabolic preservation.
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Trastornos Cerebrovasculares/prevención & control , Encéfalo/irrigación sanguínea , Encéfalo/fisiopatología , Circulación Cerebrovascular/fisiología , Trastornos Cerebrovasculares/fisiopatología , Trastornos Cerebrovasculares/cirugía , HumanosRESUMEN
BACKGROUND/AIMS: To assess the value of octreotide in the control of acute bleeding esophageal varices, in a prospective randomized study. METHODOLOGY: One hundred and ninety-seven patients admitted for variceal bleeding confirmed at endoscopy were recruited and divided into two groups: group I (n = 111) with endoscopic stigmata of recent bleeding; and group II (n = 86) with active bleeding at emergency endoscopy. Patients in group I were randomized to receive a continuous infusion of octreotide (n = 58) or emergency sclerotherapy (n = 53). Patients in group II were assigned to sclerotherapy (n = 42) or to sclerotherapy plus octreotide (n = 44). At the end of the period of study (48 hours), patients were submitted to sclerotherapy or band ligation until variceal obliteration was achieved. RESULTS: In group I, octreotide was found to be as effective as sclerotherapy regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. Transfusion needs were not significantly different for the two treatment modalities. In group II, the association of octreotide with sclerotherapy was significantly better than sclerotherapy alone either in controlling acute active bleeding (P < 0.001) or in achieving hemostasis at 48 hours (P < 0.01). Transfusion needs were significantly fewer in patients treated with this therapeutic association as compared to sclerotherapy alone. CONCLUSIONS: These results suggest that octreotide infusion is effective in the treatment of variceal bleeding. In patients with recent bleeding, octreotide infusion is as effective as emergency sclerotherapy. In active variceal bleeding, it is a valuable adjuvant treatment in association with emergency sclerotherapy.
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Várices Esofágicas y Gástricas/tratamiento farmacológico , Octreótido/uso terapéutico , Enfermedad Aguda , Urgencias Médicas , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Octreótido/administración & dosificación , Estudios Prospectivos , EscleroterapiaRESUMEN
BACKGROUND/AIMS: A prospective randomized study was performed to assess the effectiveness and safety of 5 different methods of hemostasis in selected patients with high-risk bleeding peptic ulcers. METHODOLOGY: Two hundred and eight patients (n = 208; mean age: 61.6 yrs) with endoscopic stigmata of active hemorrhage, non-bleeding vessel or adherent fresh clot were randomized during emergency endoscopy to receive one of the following modalities of endoscopic therapy (with or without pharmacological therapy): I) injection of absolute alcohol (n = 44); II) multipolar electrocoagulation (BICAP; n = 42); III) Nd-YAG laser (n = 40); IV) injection of absolute ethanol + octreotide (n = 42); V) injection of absolute ethanol + omeprazole (n = 40). RESULTS: The 5 treatment groups were clinically and endoscopically comparable. The initial hemostatic success was > 90% in every group. No significant differences between groups were found in any of the following parameters assessed during hospitalization: incidence of rebleeding (I = 14.8% vs. II = 19.0% vs. III = 16.6% vs. IV = 18.1% vs. V = 20.0%; P > 0.05 mean = 17.7%); incidence of definitive hemostasis (I = 89.3% vs. II = 85.7% vs. III = 86.6% vs. IV = 84.0% vs. V = 86.6%; P > 0.05; mean = 86.5%); incidence of emergency surgery (I = 8.5% vs. II = 11.9% vs. III = 10.0% vs. IV = 6.8% vs. V = 11.1%; P > 0.05; mean = 9.6%); mortality rate (I = 4.2% vs. II = 4.7% vs. III = 3.3% vs. IV = 13.6% vs. V = 4.4%; P > 0.05; mean = 6.2%). Mean age of deceased patients was significantly higher than living patients (71.2 +/- 13.4 vs. 60.9 +/- 14.4; P < 0.05). Approximately 2/3 of the fatal cases were strongly weakened by coexistent medical diseases. The duration of hospital stay was similar for all groups. The BICAP group required less units of blood transfusion (1.9 +/- 1.8 vs. I = 3.0 +/- 2.6; III = 3.5 +/- 3.6; IV = 2.8 +/- 2.3; V = 3.1 +/- 2.5; P < 0.05), perhaps due to the higher mean value of hemoglobin of these patients at hospital admission, compared to all other groups. No significant complications were reported. CONCLUSIONS: This study provides good evidence that injection of absolute ethanol, multipolar electrocoagulation (BICAP) and Nd-YAG laser are equally safe and effective in the endoscopic therapy of acute bleeding peptic ulcers. In contrast, no additional hemostatic benefits arose from the association of pharmacological agents (octreotide or omeprazole) to sclerosis injection.
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Electrocoagulación/métodos , Etanol/administración & dosificación , Técnicas Hemostáticas , Hemostáticos/administración & dosificación , Coagulación con Láser , Octreótido/administración & dosificación , Omeprazol/administración & dosificación , Úlcera Péptica Hemorrágica/terapia , Antiulcerosos/administración & dosificación , Transfusión Sanguínea , Femenino , Hemostasis Endoscópica , Humanos , Inyecciones , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Tector has described the off-pump total arterial revascularization technique, using multiple anastomosis with both internal thoracic arteries. To reduce surgical morbid-mortality, we have proposed the use of this technique without extracorporeal circulation. PATIENTS AND METHODS: From April, 1998 the off-pump <
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Anastomosis Interna Mamario-Coronaria/métodos , Adulto , Anciano , Angiografía , Femenino , Estudios de Seguimiento , Humanos , Anastomosis Interna Mamario-Coronaria/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiologíaRESUMEN
BACKGROUND: The role of enterovirus infection in the pathogenesis of dilated cardiomyopathy (DCM) remains unclear. The objective of this study was to determine the prevalence of enterovirus in hearts explanted from patients with DCM and to compare it with enterovirus prevalence in hearts explanted from patients with other etiologies and in healthy donor hearts. METHODS: A total of 138 cardiac samples were analyzed, 70 from heart donors and 68 from transplant recipients (22 with DCM). A highly sensitive enterovirus-specific nested RT-PCR was used to test for enterovirus. RESULTS: All tests were negative except for one positive result that was attributed to carryover because sequencing of the amplification product showed it to be identical to the positive control. CONCLUSIONS: In this study the sample of explanted hearts nested RT-PCR showed no evidence of the presence of enteroviral RNA. This suggests that if enterovirus had a role in the genesis of DCM, it does not require or lead to the persistence of the virus in myocardial tissue.
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Cardiomiopatía Dilatada/virología , Enterovirus/aislamiento & purificación , Corazón/virología , ARN Viral/aislamiento & purificación , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaAsunto(s)
Enfermedad Coronaria/epidemiología , Trasplante de Corazón/fisiología , Donantes de Tejidos , Adolescente , Adulto , Factores de Edad , Cadáver , Causas de Muerte , Niño , Angiografía Coronaria , Trasplante de Corazón/mortalidad , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Sistema de Registros , EspañaRESUMEN
Blue rubber bleb nevus syndrome is a rare condition characterized by the presence of multiple angiomatic lesions of the skin. These are associated with similar lesions in other organs, namely in the gastrointestinal tract, causing anemia through chronic bleeding. We describe the case of a 72-year-old woman with microcytic anemia. A barium study revealed irregular lacunae in the distal esophagus. A subsequent endoscopy showed blue nodular lesions similar to angiomas of the esophagus and stomach fundus. Endosonography confirmed its angiomatic nature. Exploration of other organs, using magnetic resonance and cranial computed tomography, did not reveal the presence of this type of lesion. In physical examination, two angiomatic lesions were observed on the face and lips, respectively. These were blue in color and compressible, leaving an empty wrinkled sac that rapidly refilled, typical of angiomas.
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Endosonografía , Neoplasias Esofágicas/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Nevo Azul/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Neoplasias Esofágicas/complicaciones , Neoplasias Faciales/complicaciones , Femenino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Labio , Nevo Azul/complicaciones , Neoplasias Gástricas/complicaciones , SíndromeRESUMEN
To combine the advantages of conventional and modified ultrafiltration while keeping cardiopulmonary bypass technique simple, we have developed a simplified circuit of combined ultrafiltration, which is presently used in our pediatric patients. In addition to the benefits of combined ultrafiltration, this circuit allows the rewarming and prevention of heat loss in small children and neonates.