Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017).

BACKGROUND: The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil. OBJECTIVES: The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD. PATIENTS AND METHODS: A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database. RESULTS: Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.

Effects of photobiomodulation therapy on the extracellular matrix of human dental pulp cell sheets.

Photobiomodulation therapy (PBMT) and the cell sheet (CS) technology improve processes relevant to tissue regeneration. The aim of this study was to investigate the effects of different PBMT parameters on the architecture (histology), protein composition (Western blotting and immunohistochemistry) and ultrastructure [scanning electron microscopy (SEM) and transmission electron microscopy (TEM)] of the extracellular matrix (ECM) synthesized by CSs composed by human dental pulp stem cells (hDPSCs). METHODS: Thawed cells were recharacterized by the expression profile of the surface molecules of mesenchymal stem cells (MSCs) using flow cytometry. Clonogenic medium supplemented with vitamin C (20 µg/ml) was used for obtaining the CSs. PBMT was performed with continuous-wave diode laser (660 nm, 20 mW, 0.028cm2, 0.71 W/cm2) in punctual and contact mode. The CSs were allocated in 3 experimental groups: Control: no further treatment; PBMT1 [4 s, 3 J/cm2 (lower energy density), 0.08 J/point] and PBMT2 [7 s, 5 J/cm2 (higher energy density), 0.14 J/point]. Statistical comparisons were performed (p ≤ .05). RESULTS: The cells presented the classical immunoprofile of MSCs. Type I and type III collagens and fibronectin were present in the ECM of the CSs. PBMT1 induced higher amount of fibronectin. The overall ultrastructure of the CSs in the PBMT1 was epithelial-like, whereas the PBMT2 leads to CSs with fusiform cells arranged in bundles. TEM identified a more mature ECM and signs of apoptosis and necrosis in the PBMT2 group. CONCLUSION: PBMT influence the composition and ultrastructure of the ECM of CSs of hDPSCs. Thus, PBMT, specifically when applied in the lower energy density, could be of importance in the determination of the mechanical quality of CSs, which may favor cell therapy by improving the CS transplantation approach.

The impact of infliximab infusion reactions on long-term outcomes in patients with Crohn's disease.

BACKGROUND: Little is known about long-term outcomes in patients who experience infusion reactions while receiving infliximab. AIM: To investigate long-term outcomes in patients who experience infusion reactions while receiving infliximab. METHODS: Retrospective electronic chart review of long-term clinical outcomes. RESULTS: Clinical data on 287 patients who received infliximab infusions for Crohn's disease were reviewed, of whom 51 developed at least one infusion reaction (18%). Ileo-colonic disease (OR 2.2, 95% CI 1.1-4.4) and episodic infliximab (OR 2.4, 95% CI 1.2-4.7) were associated with a higher risk of infusion reactions in univariate analysis, but concomitant azathioprine/mercaptopurine therapy at the initiation of infliximab was associated with a reduced risk (OR 0.4, 95% CI 0.2-0.8). Only the effect of concomitant immunomodulators persisted on multivariate analysis. Patients who experienced infusion reactions were less likely to be in remission at 1 year (OR 0.6, 95% CI 0.3-1.2), 2 years (OR 0.4, 95% CI 0.2-0.8, P = 0.01), or 5 years (OR 0.4, 95% CI 0.1-1.3) and more likely to require surgery (OR 2.2, 95% CI 1.1-4.1, P = 0.01) than those who did not experience such reactions. CONCLUSIONS: Patients who experienced infusion reactions to infliximab had a high rate of discontinuation of therapy in this cohort. Concomitant immunomodulators and maintenance therapy reduced the risk of infusion reactions.

Enquete sur les connaissances; attitudes et pratiques face au paludisme sur l'ile de Bioko (Guinee Equatoriale) : novembre 1993

Cette etude descriptive de prevalence realisee sur un echantillon aleatoire de 438 habitants de l'ile de Bioko (Guinee Equatoriale) montre que le paludisme existe a l'etat endemique dans cette ile et les tranches d'age les plus touchees sont celles de 1 a 4 ans et de 5 a 9 ans. Les infections avec les parasitemies les plus elevees apparaissent dans ces memes tranches d'age. Une personne atteinte de paludisme presume prend en premier recours des remedes traditionnels ou achete elle-meme des medicaments a la pharmacie

Chimiosensibilite de plasmodium falciparum a la chloroquine in vivo dans l'Ile de Bioco; Guinee Equatoriale (1991)

Il s'agit d'une etude transversale descriptive sur la chimiosensibilite de plasmodium falciparum a la chloroquine in vivo dans l'ile de Bioco; realisee dans le cadre de la mise en place d'un programme national de lutte contre le paludisme en Guinee Equatoriale. Sur un echantillon de 269 personnes; 81 ont ete selectionnees et 71 ont ete suivies sur 7 jours. La chloroquine a ete administree a la posologie de 25 mg/kg de poids repartie sur 3 jours. Le taux de resistance de type RII a ete de 12;5 pour cent; celui de type RIII de 7;4 pour cent. Le temps moyen d'elimination des parasites a ete inferieur a 3 jours