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.

Prevalence and molecular characterization of Hepatozoon canis in dogs from urban and rural areas in Southeast Brazil.

The objective of this survey was to investigate the prevalence of Hepatozoon infection in dogs in the rural and urban areas of Uberlândia, Brazil by PCR and molecular characterization. DNA was obtained from blood samples collected from 346 local dogs from both genders and various ages. Seventeen PCR products from positive blood samples of urban dogs and 13 from the rural dogs were sequenced. Partial sequences of the 18S rRNA gene indicated that all 30 dogs were infected with Hepatozoon canis similar in sequence to H. canis from southern Europe. Four local dog sequences were submitted to GenBank (accessions JN835188; KF692038; KF692039; KF692040). This study indicates that H. canis is the cause of canine hepatozoonosis in Uberlândia and that infection is similarly widespread in rural and urban dogs.

Arm vein as an alternative autogenous conduit for infragenicular bypass in the treatment of critical limb ischaemia: a 15 year experience.

OBJECTIVES: The value of alternative autogenous venous conduits for treating critical limb ischaemia (CLI) with infragenicular bypass surgery is well established. In this study, the results of using arm veins as alternative conduits for treating CLI over a 15-year period have been evaluated. METHODS: This was a retrospective study. Between 1991 and 2005. 120 infragenicular bypasses using arm vein conduits (AVCs) were performed in 120 patients. CLI was the main indication (87.5%) for the procedures. The indications for using arm veins were inadequacy or absence of the ipsilateral greater saphenous vein (GSV). Survival, limb salvage, and patency rates were calculated using the Kaplan-Meier method. RESULTS: There was a predominance of male gender (65%), and the group mean age was 68.1 ± 8.3 years. The mean follow-up period was 29.6 ± 26.3 months. The operative mortality (30 days) rate was 7.5%. The main alternative conduit was non-spliced cephalic vein (37.5%). Composite grafts included GSV + AVC (45.2%), AVC + AVC (43.3%) and small saphenous vein + AVC (11.5%). The 5-year primary and secondary patency (SP) rates were 45.2 ± 5.6% and 56.5 ± 5.0%, respectively. The 5-year SP rate was greatest when using non-spliced cephalic vein (65.8 ± 7.6%), but there was no difference in cumulative patency between spliced and non-spliced veins (49.5 ± 8.0% vs. 61.2 ± 6.4%; p = 0.501). The 5-year limb salvage and survival rates were 70.6 ± 5.9% and 59.6 ± 5.8%, respectively. CONCLUSIONS: The favourable long term results of secondary patency and limb salvage rates encourage the use of arm veins as alternative conduits for infragenicular bypass surgery.

Alelos HLA na contratura de Dupuytren

A Contratura de Dupuytren (DC) é uma doença fibroproliferativa caracterizada pela formação de nódulos e cordões fibrosos que se retraem longitudinalmente em direção aos dedos causando à contratura digital que determina o aspecto de mão em garra, sendo por isso citada como diagnóstico diferencial da hanseníase. Sua incidência é maior na raça branca de origem européia, principalmente em adultos do sexo masculino com idade superior a 50 anos. Embora existam evidências do envolvimento genético no aparecimento da DC, até o momento nenhum gene foi associado como fator de risco para a doença.

Anticoccidial efficacy of drinking water soluble diclazuril in the control of Eimeria acervulina oocysts on experimentally-infected broiler chickens / Eficiência do diclazuril (formulação líquida) no controle de oocistos de Eimeria acervulina em frangos de corte experimentalmente infectados

The experiment was carried out with 150 Cobb broiler chickens divided into 3 groups with 50 birds each. The groups of infected chickens orally received 1ml of inoculum containing 3x103 Eimeria acervulina sporulated oocysts at 12 days of age. Group 1 was kept as a positive control with infected non-medicated birds, group 2 was medicated with diclazuril (1%) with a dose of 1mL/4 L of drinking water for 2 successive days, 5 days after infection, while group 3 was kept as negative control with non-infected and non-medicated birds. Oocysts count per gram of feces, score of macroscopic intestinal lesions and weight gain were evaluated. The group treated with diclazuril showed significant and satisfactory improvement in the assessment criteria when compared to the infected non-medicated group. The results revealed more reduction in the total oocyst count and intestinal lesion score in the medicated than in the infected non-treated group. The results confirmed that (1%) liquid diclazuril is effective to control Eimeria infection.

O experimento foi realizado com 150 frangos de corte da linhagem Cobb, divididos em 3 grupos de 50 aves cada. Os frangos de dois grupos (G1 e G2) receberam, por via oral, 1mL de inóculo contendo 3x103 oocistos de Eimeria acervulina aos 12 dias de idade. O grupo 1 foi mantido como grupo controle positivo (infectado não medicado), o grupo 2 foi medicado com diclazuril (1%) na dose de 1mL/4 litros de água potável por dois dias sucessivos, cinco dias após a infecção. Um terceiro grupo (G3) foi mantido como controle negativo não infectado e não medicado. O número de oocistos por grama de fezes (OOPG), o escore de lesões macroscópicas intestinais e o ganho de peso corporal foram avaliados. No G1, o OOPG foi de 3,67x106 e o peso final foi de 1,392kg, valores significativamente diferentes do OOPG de 1,93x106 oocistos e do peso final de 1,613kg do G2 (diclazuril). Os resultados provaram que o diclazuril (1%) em formulação líquida e na dosagem de 1mL/4 litros de água por dois dias sucessivos foi eficaz no controle de Eimeria acervulina.

Inframalleolar bypass grafts for limb salvage.

OBJECTIVE: To report our experience of long-term results of inframalleolar bypass. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We analysed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Most patients were treated for critical ischaemia (97%). The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3%) and the greater saphenous vein (84.4%) as the conduit. The follow-up periods ranged from 1 to 60 months. The endpoints analysed were graft patency, limb salvage, preservation of deambulation and survival rate. RESULTS: The cumulative patency was 58.2% at 3 years and 53.4% at 5 years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation rates of 57.3% and 47.1%, respectively. There were 36 major and 45 minor amputations. At 3 years, the survival rate was 50.2% and the surgical mortality 13%. Female sex was associated with worse results for cumulative patency and limb salvage (P<0.01). CONCLUSIONS: In the long term, inframalleolar bypass is a satisfactory option for limb salvage.

Giardia duodenalis: kinetics of cyst elimination and the systemic humoral and intestinal secretory immune responses in gerbils (Meriones unguiculatus) experimentally infected.

This study aimed to determine the pre-patent period and to evaluate the kinetics of cyst elimination and the systemic humoral (IgA, IgG(1), IgG(2a), IgM, IgE) and intestinal secretory (IgA) immune responses in gerbils (Meriones unguiculatus) experimentally innoculated with different doses of Giardia duodenalis trophozoites. Forty-eight animals aged 6-8 weeks were used, equally distributed among six groups, five groups innoculated with different doses of trophozoites (10(1), 10(2), 10(3), 10(4), 10(5)) and one control (non-infected) group. Coproparasitological examinations were carried out daily up to 91 days after inoculation (d.a.i.) to determine the pre-patent period and the kinetics of cyst elimination. Blood and stool samples were weekly collected for antibody assays. The pre-patent period was observed from the 9 d.a.i. onwards, with intermittent elimination of variable quantities of cysts up to 27 d.a.i.. All infected gerbils, irrespective of the dose received, were able to mount systemic humoral immune responses as evidenced by specific IgM titers from 7 to 28 d.a.i., corresponding to the peak of cyst elimination, followed by high and persistent IgG1 titers. Intestinal secretory responses were also seen with two peaks of fecal IgA titers, corresponding to IgM and IgG1 response peaks, respectively. In conclusion, systemic and intestinal humoral immune responses were related to the control of giardiasis in this experimental model.

Histomorphometry and macroscopic intestinal lesions in broilers infected with Eimeria acervulina.

This study aimed at measuring intestinal villi and assessing the intestinal absorptive area in broilers infected with Eimeria acervulina under different treatments to control coccidiosis. The experiment was divided into two stages, carried out in successive housings, raised in the same environment (or aviary). In the first stage, on 25 May 2008, fifty 12-day-old birds were orally inoculated with 3 x 10(3) oocysts of E. acervulina. In the second stage, on July 2008, other 50 birds were allocated on litter contaminated by the feces of birds on the first housing (natural infection by oocysts present in the reused litter). The experiment was arranged in a complete randomized design with five treatments and three replicates of 10 chicks per treatment. Broiler chicks were housed at 1 day of age and autopsies were performed at 21 days of age. Three 2-cm-long segments of the duodenum were excised from each bird and fixed in 10% buffered formalin. A total of 30 slides were prepared for each treatment, totaling 150 evaluated histological sections using H&E staining. Villus morphology was carried out by the HL Image 97 software. The intestinal absorptive area was calculated and macroscopic lesions were classified according to standard lesion scores. Results showed that intestinal villus measurements and absorptive area are directly affected by E. acervulina and that there is direct and positive correlation between the macro and microscopic findings observed in intestinal coccidiosis. E. acervulina causes shortening of villi and reduction in the intestinal absorptive area, affecting broiler growth. The prevention method of litter fermentation during the interval between housings and oral administration of Diclazuril can reduce the severity of intestinal lesions by E. acervulina in broilers impairing oocyst virulence or viability.

An alternative method for DNA extraction and PCR identification of Entamoeba histolytica and E. dispar in fecal samples.

Since it is known that Entamoeba dispar is non-pathogenic and morphologically similar to E. histolytica, there are many targets used in PCR for differentiating these species. However, obtaining high quality DNA from fecal samples is fundamental for PCR. Most methods are laborious or use kits that make diagnosis expensive. In the present work, a new simple, fast and cheap technique of DNA extraction from fecal samples was combined with a PCR for an episomal target in order to identify E. histolytica and E. dispar in feces.

Concordância entre duas técnicas coproparasitológicas para diagnóstico de Fasciola hepatica em bovinos / Evaluation of two available methods to detect eggs of Fasciola hepatica in cattle faeces

Two different methods to detect Fasciola hepatica in faeces using kappa index were compared with four tamises technics and sequencial fitration in two tamises using Flukefinder® apparatus. High accordance between the two methods was observed. The values showed high sensibility and specificity.

Infection of dogs by experimental inoculation with human isolates of Giardia duodenalis: clinical and laboratory manifestations.

The susceptibility of dogs to experimental inoculation with trophozoites and cysts of human isolates of Giardia duodenalis and the clinical and laboratory profiles of infection of these animals were studied. Two groups (A and B), each comprising three dogs, were inoculated with G. duodenalis trophozoites and cysts, respectively. A third group of two dogs was not inoculated and remained as control. After inoculation feces were collected daily to determine the pre-patent period, by flotation in 33% zinc sulfate solution. Blood samples (5mL) were collected from animals at 15-day intervals during the 165 days of the experimental period and were used to carry out the hemogram and biochemical evaluation of the levels of total protein, albumin, alanine aminotransferase, gamma glutamyltransferase, urea and creatinine. A prepatent period was observed at 5-6 days post-inoculation (p.i.) in the inoculated dogs, with cysts eliminated for approximately 3 months. No alterations were seen in the clinical parameters evaluated. Anemia was observed at 15 p.i. in the inoculated dogs. The mean eosinophil count of inoculated groups was higher than that of the control (p< or =0.05) but none of the biochemical parameters analyzed presented significant differences. The results of this study show that G. duodenalis from human isolates is able to infect dogs with minimal systemic manifestations without producing clinical signs of giardiasis.

Prevalence of Giardia duodenalis and Cryptosporidium spp. in dogs from different living conditions in Uberlândia, Brazil.

Infection rates with Giardia duodenalis and Cryptosporidium spp. were compared among dogs living under different conditions. Stool samples (n = 433) collected from dogs of different ages, gender, living conditions and origin were analyzed using three techniques, i.e., centrifugal flotation in zinc sulfate solution, centrifugal flotation in sucrose solution, and methylene blue gram safranin staining. Eighty-nine of the samples were from stay dogs living in shelters run by animal protection societies, 199 were from kennels and 122 from households. A total of 119 (29.0%) had G. duodenalis cysts and six (1.4%) were positive for Cryptosporidium spp. oocysts. Dogs from kennels were most frequently affected by G. duodenalis (49.7%) while those from shelters showed a higher prevalence of Cryptosporidium spp. (2.2%). A significant difference (p < or = 0.05) was observed between immature dogs and adults only with respect to Giardia infection. There was no significant difference between the gender with regard to the presence of either protozoan.

Evaluation of health-related quality of life in gastroesophageal reflux disease patients before and after treatment with pantoprazole.

Gastrooesophageal reflux disease (GERD) is highly prevalent in the Western world but its true population prevalence is difficult to estimate without a validated instrument to detect it. The evaluation of health-related quality of life (HRQoL) is an useful tool in this assessment. The aims of this study are to translate and validate a GERD specific HRQoL questionnaire and evaluate HRQoL in a Brazilian population before and after GERD treatment. GERD patients with typical symptoms and Los Angeles Classes A to C esophagitis were included in the study. Two HRQoL questionnaires and upper digestive endoscopy were performed before and after 6 weeks treatment with pantoprazole 40 mg/day followed by 80 mg/day for another 8 weeks if healing did not occur. A generic (SF-36) and one disease-specific questionnaire (GERD score) were used. The latter was translated and validated for Brazilian Portuguese. From January 2002 to December 2003, 100 patients were enrolled. Of these, 78 patients were evaluated in a per protocol analysis (35 men, mean age: 40 years). The translated questionnaire (Brazilian GERD Score, BGERDS) demonstrated adequate psychometric properties (validity, responsiveness and reliability). SF-36 and BGERDS domains significantly improved after treatment (P < 0.01 and P < 0.001 respectively). The BGERDS was shown to be valid and reliable. Patients with esophagitis showed an impaired HRQoL that improved or normalized after treatment with pantoprazole.

Biochemical serum profiles in dogs experimentally infected with Angiostrongylus vasorum (Baillet, 1866).

The biochemical profiles of crossbred dogs experimentally infected with the parasite Angiostrongylus vasorum were studied. Two groups of five dogs were experimentally inoculated with 50 and 100 third stage infective larvae (L3) of A. vasorum per kilogram of body weight. A third group of five uninfected animals were used as control. Serum from these animals were used for biochemical tests to measure total and fractioned proteins, urea, creatinine and to determine the activities of aspartate (AST), alanine (ALT) aminotransferase, gamma-glutamyl transferase (GGT), alkaline phosphatase (PAL) and creatine kinase isoenzyme MB (CK-MB). The alpha-1, alpha-2 and beta-globulins fractions showed alterations during acute phase of the infection. No modifications were observed in the biochemical profiles of ALT, AST, GGT, PAL, urea and creatinine. CK-MB was shown to be a good early indicator of cardiac injury in dogs experimentally infected with A. vasorum.

Freqüência de helmintos em gatos de Uberlândia, Minas Gerais / Frequency of helminthes parasites in cats of Uberlândia, Minas Gerais

Necropsies in 50 cats, males and females of different ages were performed from August 2000 to December 2001. Forty five (90 percent) of them had parasites. Eleven cats (22 percent) had single infection, 34 (75.6 percent) multiple infection, and only 5 (10 percent) were free of infection. The parasitic frequencies were as follow: Platynosomum fastosum (40 percent), Ancylostoma braziliensis (38 percent), Physaloptera praeputialis (34 percent), Aelurostrongylus abstrusus (18 percent), Dipylidium caninum (14 percent), Ancylostoma caninum (14 percent), Toxocara mistax (14 percent), Toxocara canis (10 percent), Trichuris campanula (6 percent), Toxascaris leonina (4 percent), Spirometra mansonoides (4 percent), Taenia taeniaeformis (4 percent) e Trichuris vulpis (2 percent).

Prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas of the city of Uberlândia, Minas Gerais--Brazil.

In Brazil there are few reports on the prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas. Serum samples from 450 dogs, 300 from urban, 58 from periurban and 92 from rural areas, were tested for the detection of anti-N. caninum IgG antibodies using IFAT: indirect fluorescent antibody test (IFAT, > or =50). Antibodies were observed in 63 (14%) of the 450 serum samples analyzed, with 32 (10.7%) in dogs coming from the urban area, 11 (18.9%) from the periurban area and 20 (21.7%) from the rural area. Statistical differences were seen between the occurrences in animals from the urban area and those of the rural area (P = 0.01). The antibody titers found were: 1:50 in 20 dogs, 1:100-1:800 in 41 dogs, and 1:3200 in two dogs. In the female dogs, a smaller prevalence of dogs with antibodies was observed in those from the urban area (7.5%) in comparison with those of the rural (21.0%) (P = 0.05) and periurban (23.3%) (P = 0.01) areas. There were growing levels of antibody prevalence with the increase in age of the dogs in all three areas studied. Although this increase was not significant, it indicates a tendency towards more infections with age, suggesting post-natal exposure to N. caninum. However, a significant difference (P = 0.05) was observed in the occurrence of anti-N. caninum antibodies in dogs with ages = 2 years in urban (13.1% urban) versus rural environments (27.1% rural). Among the other age brackets studied the difference was not significant. The results confirm the presence of N. caninum in the region and reveal the important role of dogs in the parasite's epidemiology.

Freqüência de Giardia spp. por duas técnicas de diagnóstico em fezes de cães / Frequency of Giardia spp. for two diagnosis methods in feces of dogs

One hundred fecal samples from male and female dogs of several ages and breeds were collected in kennels of Uberlândia in Minas Gerais, Brazil. These samples were analyzed to determine the frequency of Giardia spp. using two different diagnostic methods: zinc sulfate flotation technique and merthiolate-iodine-formaldehyde concentration (MIFC). The frequency of giardiasis was 41 percent. Dogs, which were less than 12 months of age, were the most parasitized (68.4 percent). No difference between male and female frequency of giardiasis (31.4 percent and 46.1 percent, respectively) was observed. MIFC detected 38 percent of positive samples and zinc sulfate flotation technique 29 percent. Giardia spp. is present in dogs of Uberlândia's kennels in a high frequency

Classificação endoscópica do megaesôfago / Endoscopic CLassification of megaesophagus

Apesar de apresentar diminuição em sua incidência, a doença de Chagas aina é a terceira doença tropical mais frequente. A endoscopia digestiva alta (EDA) cresce em importância como metódo auxiliar para eses pacientes, principalmente na avaliação da mucosa e diagnóstico de neoplasias. Até o presente momento, não se encontra na literatura uma classificação para padronizar a descrição das alterações endoscópicas nos pacientes com megaesôfago. Tal classisficação que tivesse boa correlação radiológica, poderia facilitar o tratamento desses pacientes, reduzindo o número de exames. Objetivos: Apresentar uma proposta de classificação endoscópica para pacientes com megaesôfago. Material e Método: Sessenta e cinco pacientes consecutivos com megaesôfago foram avaliados por dois endoscopistas experientes, cegos entre si, durante um único exame. A análise estatistica realizada pelo teste de Kappa, comparando os resultados obtidos com os achados radiológicos pela classificação de Rezende, além de análise da variaçãointerobservador. resultados: Os endoscopistas apresentaram indice de concordância excelenmte (K= 0,90) quando comparados entre si e concordâancia forte (K=0,67) quando comparados com a classificação radiológica. Conclusões: Esta classificação pode ser útil, já que parece haver boa concordância com os achados radiológicos e ser facilmente reproduzida. Novos estudos são necessários para comprovar os benefícios de sua utilização na prática clínica.

Western blot analysis of the humoral response of dogs experimentally infected with Angiostrongylus vasorum (Baillet, 1866).

Seven cross-bred dogs were inoculated with Angiostrongylus vasorum and serum samples were analyzed using the enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). ELISA detected specific antibodies anti-A. vasorum, from 14 to 28 days after inoculation (DAI) and persisted throughout the experiment. Using WB, the main antigens detected had molecular weight of approximately 115, 102, 86, 76, 69, 56, 41, 32, 28, 20-22 and 10kDa.