LOGISTICS AND RESULTS OF A COLORECTAL CANCER SCREENING PROGRAM IN A MUNICIPALITY IN THE HINTERLAND OF ALAGOAS.

BACKGROUND: Colorectal cancer (CRC) has high mortality rates worldwide. In Brazil, it is the second most common cancer in both sexes. Delay in detecting premalignant lesions contributes to increased morbidity and mortality. In this scenario, the Piranhas project was created to track CRC in a low-income population in the hinterland of Alagoas. OBJECTIVE: The study aimed to establish the main strategies and verify the feasibility of implementing a CRC tracking program and demonstrate the results obtained in the CRC Prevention Campaign in Piranhas/AL. METHODS: The program took place in Piranhas, Alagoas, Brazil, through public-private partnerships. Individuals aged between 50 and 70 years of age were included for screening with a fecal occult blood test (FOBT) and colonoscopy in positive cases. Patient data were collected on standard forms. RESULTS: A total of 2152 patients, aged between 50 and 70 years, were screened, 130 of which underwent colonoscopy. Several preneoplastic lesions were detected in 58 patients. The adenoma detection rate (ADR) was 33.85%. CONCLUSION: The study proved to be effective and viable since 44.6% of the program participants, who underwent screening with FOBT, followed by colonoscopy in positive cases, had some type of preneoplastic lesion. In addition, the program generated a significant social impact on the population of Piranhas due to the opportunity to diagnose and treat CRC precursor lesions.

Logistíca e resultados de um programa de prevenção do câncer colorretal em um município do Sertão de Alagoas / Logistics and results of a colorectal cancer screening program in a municipality in the hinterland of alagoas

ABSTRACT Background: Colorectal cancer (CRC) has high mortality rates worldwide. In Brazil, it is the second most common cancer in both sexes. Delay in detecting premalignant lesions contributes to increased morbidity and mortality. In this scenario, the Piranhas project was created to track CRC in a low-income population in the hinterland of Alagoas. Objective: The study aimed to establish the main strategies and verify the feasibility of implementing a CRC tracking program and demonstrate the results obtained in the CRC Prevention Campaign in Piranhas/AL. Methods: The program took place in Piranhas, Alagoas, Brazil, through public-private partnerships. Individuals aged between 50 and 70 years of age were included for screening with a fecal occult blood test (FOBT) and colonoscopy in positive cases. Patient data were collected on standard forms. Results: A total of 2152 patients, aged between 50 and 70 years, were screened, 130 of which underwent colonoscopy. Several preneoplastic lesions were detected in 58 patients. The adenoma detection rate (ADR) was 33.85%. Conclusion: The study proved to be effective and viable since 44.6% of the program participants, who underwent screening with FOBT, followed by colonoscopy in positive cases, had some type of preneoplastic lesion. In addition, the program generated a significant social impact on the population of Piranhas due to the opportunity to diagnose and treat CRC precursor lesions.

RESUMO Contexto: O câncer colorretal (CCR) possui altas taxas de mortalidade em todo mundo. No Brasil é o segundo câncer mais comum em ambos os sexos. O atraso na detecção de lesões pré-malignas contribui com o aumento da morbimortalidade. Neste cenário, o projeto Piranhas foi criado para rastrear o CCR em uma população carente do sertão alagoano. Objetivo: O estudo teve como meta estabelecer as principais estratégias e verificar a viabilidade da implementação de um programa de rastreamento do CCR, assim como demonstrar os resultados obtidos na Campanha de prevenção de CCR no município de Piranhas/AL. Métodos: O programa aconteceu em Piranhas, Alagoas, Brasil, através de parcerias público-privadas. Foram incluídos indivíduos entre 50 e 70 anos para triagem com pesquisa de sangue oculto nas fezes (PSOF) e colonoscopia dos casos positivos. Os dados dos pacientes foram coletados em formulários padrão. Resultados: Foram rastreados um total de 2152 pacientes com idade entre 50 e 70 anos, sendo destes, 130 submetidos à colonoscopia. Várias lesões pré-neoplásicas foram detectadas em 58 pacientes. A taxa de detecção de adenoma foi de 33,85%. Conclusão: O estudo demonstrou-se eficaz e viável, uma vez que 44,6% dos participantes do programa que realizaram a triagem com PSOF seguido de colonoscopia nos casos positivos apresentava algum tipo de lesão pré-neoplásica. Além disso, o programa gerou grande impacto social na população de Piranhas, pela oportunidade de diagnóstico e tratamento de lesões precursoras do CCR.

Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study

BackgroundIndirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of immunosuppression. ObjectiveCharacterise the factors associated with worsening psoriasis in the COVID-19 pandemic, using mental health status (anxiety and depression) as the main exposure of interest. MethodsGlobal cross-sectional study using a primary outcome of self-reported worsening of psoriasis. Individuals with psoriasis completed an online self-report questionnaire (PsoProtectMe; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me) between May 2020 and January 2021. Each individual completed a validated screen for anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-2). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression. Results4,043 people with psoriasis (without COVID-19) from 86 countries self-reported to PsoProtectMe (mean age 47.2 years [SD 15.1]; mean BMI 27.6kg/m2 [SD 6.0], 2,684 [66.4%] female and 3,016 [74.6%] of white European ethnicity). 1,728 (42.7%) participants (1322 [77%] female) reported worsening of their psoriasis in the pandemic. A positive screen for anxiety or depression associated with worsening psoriasis in age and gender adjusted (OR 2.04, 95% CI 1.77-2.36), and fully adjusted (OR 2.01, 95% CI 1.72-2.34) logistic regression models. Female sex, obesity, shielding behaviour and systemic immunosuppressant non-adherence also associated with worsening psoriasis. The commonest reason for non-adherence was concern regarding complications related to COVID-19. ConclusionsThese data indicate an association between poor mental health and worsening psoriasis in the pandemic. Access to holistic care including psychological support may mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis. The study also highlights an urgent need to address patient concerns about immunosuppressant-related risks, which may be contributing to non-adherence.

Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

ObjectivesRegistry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. MethodsOnline surveys were completed by individuals with Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterised international variation in a mixed effects model. ResultsOf 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (60.8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term shielding). A greater proportion of those receiving targeted therapies (biologics and JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (OR 1.37, 95% CI 1.27-1.48) and a positive anxiety or depression screen (OR 1.57, 95% CI 1.36-1.80). Modest differences in the proportion shielding were observed across nations. ConclusionsGreater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk mitigation strategies and may help inform updated public health guidelines as the pandemic continues. Key messagesO_ST_ABSWhat is already known about this subject?C_ST_ABSO_LIAt the beginning of the COVID-19 pandemic, patients with immune mediated inflammatory diseases (IMIDs) on targeted systemic immunosuppressive therapy were considered to be at higher risk of severe COVID-19. Subsequent registry data suggest that this may not the case. C_LI What does this study add?O_LIHere we characterise shielding behaviour in patients with IMIDs from a global survey. We identified that targeted systemic therapy associates with increased shielding behaviour, as do demographic risk factors for severe COVID-19 including male gender and obesity. C_LIO_LIShielding behaviour varies across nations, albeit modestly when case-mix is taken into account. C_LI How might this impact on clinical practice or future developments?O_LIVariable shielding behaviour amongst patients with IMIDs may be an important confounder when considering differential COVID-19 risk between therapy types, so should be accounted for in analyses where possible. C_LI

EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY.

BACKGROUND: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. AIM: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group. METHOD: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data. RESULTS: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26 kg/m2 and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients. CONCLUSION: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals.

EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY / ANÁLISE DOS RESULTADOS DA ENDOSCOPIA DIGESTIVA ALTA NOS PACIENTES EM PRÉ-OPERATÓRIO DE CIRURGIA BARIÁTRICA

Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients.Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group.Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data.Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients.Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals.

Racional: A obesidade tornou-se epidemia e está associada à maior morbimortalidade. Seu tratamento é multidisciplinar. O tratamento cirúrgico é recurso consistente nos casos de obesidade grave. A indicação da endoscopia digestiva alta pré-operatória em pacientes assintomáticos é controversa; no entanto, a maioria dos estudos recomenda sua realização em todos os pacientes.Objetivo: Analisar os resultados da endoscopia em pacientes que se encontravam em pré-operatório de cirurgia bariátrica, e compará-los aos achados do grupo controle.Método: Série de 35 pacientes obesos em pré-operatório de cirurgia bariátrica com um grupo controle de 30 pacientes submetidos à endoscopia no período de fevereiro a julho de 2014. Foram analisados dados clínicos e endoscópicos.Resultados:A média de idade do grupo de pacientes foi de 43,54 anos e a maioria deste grupo era do sexo feminino. A média do valor do IMC no grupo de pacientes foi de 47,26 kg/m2 e no grupo controle de 24,21 kg/m2. A maioria dos pacientes era assintomática. A endoscopia estava alterada em 81,25% dos pacientes assintomáticos. As alterações endoscópicas no grupo de pacientes foram 57,1% decorrentes da doença ulceropéptica e 34,3% associadas à DRGE. A análise do número de achados endoscópicos no grupo de pacientes em relação ao grupo controle não demonstrou diferença estatística significante. A prevalência da infecção do H. pylori foi de 60% no grupo de pacientes.Conclusão: Recomenda-se que a endoscopia digestiva alta deva ser realizada em todos pacientes em pré-operatório de cirurgia bariátrica, embora o grau de obesidade não tenha relação com maiores alterações endoscópicas. Os obesos não têm maior número de alterações endoscópicas que os não obesos.

Transporte ascendente da mistura formulada de imazethapyr e imazapic em resposta à profundidade do lençol freático / Upward movement of the formulated mixture of imazethapyr and imazapic in response to height of the water table

Os herbicidas usados na cultura do arroz Clearfield® podem persistir no ambiente e causar danos no arroz não tolerante, cultivado em sucessão. Esse dano pode ser de intensidade variável, dependendo, dentre outros fatores, do movimento ascendente do herbicida para região de absorção do sistema radicular das plantas. O objetivo desta pesquisa foi verificar o efeito da altura do lençol freático no movimento ascendente do herbicida composto pela mistura formulada de imazethapyr e imazapic. Para isso, foram coletados lisímetros de solo com auxílio de tubos de PVC (15x30cm). O herbicida foi aplicado na superfície inferior dos lisímetros, onde foram simulados diferentes profundidades do lençol freático (0, 5, 10, 15 e 25cm da superfície do solo). Os lisímetros permaneceram nessa condição por período de 150 dias, quando foram cortados longitudinalmente, seccionados em porções de 5cm (0-5 a 25-30cm) e realizado bioensaio com a cultivar de arroz não tolerante, IRGA 417. Com os resultados obtidos, foi possível concluir que ocorre movimento ascendente da mistura formulada dos herbicidas imazethapyr e imazapic ao longo do perfil do solo de várzea durante o período da entressafra do arroz irrigado, sendo este maior quando o lençol freático está localizado mais próximo da superfície do solo. O movimento ascendente através da diluição do herbicida na solução do solo ocorre por fluxo de massa através do arraste pela água, transportada por capilaridade para zonas mais superficiais do solo.

The herbicides that use the Clearfield Rice System can persist in the environment and damage non-tolerant rice sowing in rotation. This damage can variable in intensity, depending on, among other factors, of the upward movement of the herbicide to the absorption region of the plant root system. The aim of this research was to verify the effect of the height of the water table in upward movement of the herbicide in intact soil cores. Intact soil cores were collected with PVC tubes 15cm in diameter and 30cm deep. The herbicide was applied on the bottom of the samples, and it was simulated water table depths (0, 5, 10, 15 and 25cm of the soil surface). The intact samples remained in this condition for a period of 150 days, when they were cut into 5cm slices (0-5 a 25-30cm) and bioassay were performed with the non-tolerant rice cultivar. With the results it was conclude that there is upward movement of the formulated mixture of imazethapyr and imazapic herbicides along the paddy soil profile during the fallow and this transport is greater when the water table is located closer to the soil surface. The upward movement by dilution of the herbicide in the soil solution occurs by mass flow through the water transported by capillarity to superficial sites of soil.