Inflammatory Bowel Disease: Clinical Diagnosis and Pharmaceutical Management.

Inflammatory bowel disease has an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn's disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient's psychological functioning and endoscopy services. Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn's disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.

Association Between Cancer Prevalence and Different Socioeconomic Strata in the US: The National Health and Nutrition Examination Survey, 1999-2018.

Background: Inequality in health outcomes in relation to Americans' socioeconomic status (SES) is rising. American Cancer Society depicts that the most common cancers are diagnosed in men and women in 2021. We aim to study socioeconomic inequalities in related cancers to investigate whether the cancer prevalence differs within the family income to poverty ratio (PIR). Methods: The study investigated data from adults aged 20-85 years participated in the 1999-2018 National Health and Nutrition Examination Survey (NHANES) who had complete data available on PIR and cancer or malignancy information (n = 49,720). Participants were stratified into 3 categories of PIR: high income (PIR ≥ 4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Results: The prevalence of prostate cancer was higher in the middle-income (3.61% [n = 464]) and high-income groups (3.36% [n = 227]) than in the low-income group (1.83% [n = 84], all p < 0.001). The prevalence of breast cancer was higher in middle-income (2.86% [n = 390]) and high-income participants (3.48% [n = 218]) than in low-income participants (2.00% [n = 117], all p < 0.001). Compared with the low-income group in men (0.48% [n = 22]), a higher prevalence of colon and rectum cancer occurs in the middle-income (0.87% [n = 112], p = 0.012) and high-income groups (0.89% [n = 58], p = 0.018). The prevalence of lung cancer in women was lower in high-income participants than middle-income participants (0.10% [n = 6] vs. 0.29% [n = 39], p = 0.014). Conclusions: Increasing disparities in cancer prevalence were identified across all socioeconomic categories analyzed in this study. To ensure the sustainable development goals, it is a global health priority to understand inequalities in health and to target interventions accordingly.

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview.

This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn's colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis "CC" or "UC". This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.

Etiological & clinical spectrum of Liquefied Petroleum Gas (LPG) related burns: A three-year study from a tertiary care burn centre in New Delhi.

Burns, an endemic public health problem has had a dynamic epidemiology in India, in sync with economic and social changes. In the last decade a major shift of kitchen fuel usage from kerosene to the Liquefied Petroleum Gas has resulted in an increase in the incidence of burns from LPG mishaps. This prospective descriptive study conducted in a tertiary care burn centre in an urban area aims to determine the causes of LPG related burns, its injury profile, identify the population at risk and also to determine the level of knowledge of users regarding the safety issue with LPG usage. In the study LPG burns accounted for 52.3% of the admitted flame burns. On the whole there were 33 incidents of LPG mishaps involving multiple victims. Most common age group affected was 26-50 years. Leakage from larger cylinders was more common and malfunction of valve/regulator was the most common cause. Level of knowledge was dismally low across all socioeconomic strata. Our study highlights impact of changing socioeconomic pattern of the country on burns epidemiology and the glaring lack of public awareness regarding safe management principles.

Status of diabetes control and knowledge about diabetes in patients.

PURPOSE: There are a number of studies in the literature which show that knowledge about the diabetes mellitus is related to socioeconomic status, education, duration of diabetes, age, sex, and family history. The above facts have prompted us to evaluate the status of knowledge of diabetes in our patients at the diabetic clinic Vivekananda Polyclinic and Institute of Medical Sciences (VPIMS), Lucknow, India. The main objective of this study is to evaluate the knowledge of diabetes among the suffering with people with type-2 diabetes mellitus and its correlation with diabetes control. METHODS: The participants' knowledge about diabetes and their understanding about control and complications of diabetes were assessed by a standardized questionnaire. The data was collected at a single, routine visit of the patient to the diabetic clinic at VPIMS, Lucknow, India over a period of 1 year after detailed clinical examination and relevant investigations. RESULT: Only 50% of the patients know what diabetes is, 46% know it is a hereditary disease, 68.8% know about its symptoms, 50% have complete knowledge about complications, 45.2%, know simple treatments of diabetes. Among educated graduate and professional category majority of subjects (62.5%) had good level of knowledge about diabetes which was statistically significant (p<0.001). Those having frequent/regular exercise, having higher education and shorter duration of diabetes had a better control over postprandial (PP) blood sugar as compared to those having occasional/no exercise and lower level of education (p<0.05). CONCLUSION: The findings indicate a greater need for behavioral change to control diabetes and its associated threats.

Status of diabetes control and knowledge about diabetes in patients.

PURPOSE: There are a number of studies in the literature which show that knowledge about the diabetes mellitus is related to socioeconomic status, education, duration of diabetes, age, sex, and family history. The above facts have prompted us to evaluate the status of knowledge of diabetes in our patients at the diabetic clinic Vivekananda Polyclinic and Institute of Medical Sciences (VPIMS), Lucknow, India. The main objective of this study is to evaluate the knowledge of diabetes among the suffering with people with type-2 diabetes mellitus and its correlation with diabetes control. METHODS: The participants' knowledge about diabetes and their understanding about control and complications of diabetes were assessed by a standardized questionnaire. The data was collected at a single, routine visit of the patient to the diabetic clinic at VPIMS, Lucknow, India over a period of 1 year after detailed clinical examination and relevant investigations. RESULT: Only 50% of the patients know what diabetes is, 46% know it is a hereditary disease, 68.8% know about its symptoms, 50% have complete knowledge about complications, 45.2%, know simple treatments of diabetes. Among educated graduate and professional category majority of subjects (62.5%) had good level of knowledge about diabetes which was statistically significant (p<0.001). Those having frequent/regular exercise, having higher education and shorter duration of diabetes had a better control over postprandial (PP) blood sugar as compared to those having occasional/no exercise and lower level of education (p<0.05). CONCLUSION: The findings indicate a greater need for behavioral change to control diabetes and its associated threats.

Acerca del placer de comer en los estratos socioeconómicos bajos venezolanos / On eating's pleasure of the Venezuelan low income socioeconomic status

La alimentación desde una perspectiva integral, es un proceso interdisciplinario que no se limita a la satisfacción de los requerimientos alimentarios y nutricionales para reparar tejidos y coadyuvar en funciones vitales para el organismo. Es un proceso multidimensional en el cual se articulan lo biológico, lo ecológico, lo social y lo cultural, que ocupa un lugar importante en la vida de los humanos al evocar recuerdos y memorias afectivas, dando lugar a procesos de identificación individual, familiar, sociales y culturales. Este estudio intenta explorar las preferencias y aspiraciones que despiertan los deseos de consumir alimentos en los estratos socioeconómicos bajos y estudiar algunos elementos del entorno asociados a los mismos. Se trata de una investigación cualitativa realizada mediante entrevistas a cocineras y madres que acuden a comedores de asistencia nutricional en la presente crisis que experimenta Venezuela. Los resultados conllevan un escenario desalentador para la preservación de las tradiciones culinarias Venezolanas, debido a que tanto las cocineras como las madres que asisten a los comedores refieren que sus preparaciones elegidas como el "sueño" si el dinero no fuera un problema, son las pastas o el arroz con pollo o carne, mostrando una ausencia en las preferencias de platos tradicionales venezolanos incluyendo los postres. Se concluye que existe las preferencias de este grupo de mujeres no incluyen platos venezolanos tradicionales y se sugiere que dentro de la educación nutricional para mejorar la variedad y calidad de la dieta de las comunidades, deben incluirse módulos de gastronomía y preparación de recetas que puedan orientar y rescatar el gusto por las tradiciones culinarias venezolanas(AU)

Feeding people from a comprehensive perspective is an interdisciplinary process that is not limited to meeting food and nutritional requirements to repair tissues and assist in vital functions for the body. It is a multidimensional process in which the biological, the ecological, the social and the cultural dimensions are intertwined, and has an important place in the lives of humans by evoking affective memories, giving as a result identification processes at individual, family, social and cultural levels. This study intents to explore the preferences and aspirations that arouse the desire to consume certain foods in the Venezuelan lower socioeconomic strata and to study some elements of the environment associated with them. This is a qualitative research conducted through interviews with cooks and mothers who go to assistance soup-kitchens in the current crisis that Venezuela is experiencing. The results lead to a discouraging scenario for the preservation of Venezuelan culinary traditions, because both the cooks and the mothers who attend the referred centers reported that their "dream" chosen preparations if money were not a problem, are pasta or rice with chicken or meat, showing an absence in the preferences of traditional Venezuelan dishes including desserts. It is concluded that the preferences of this group of women do not include traditional Venezuelan dishes and it is suggested that within the nutritional education to improve the variety and quality of the communities' diet, modules of gastronomy and preparation of recipes that can guide and rescue the taste for Venezuelan culinary traditions should be included(AU)

Developmental Changes in Early Comprehension and Production of Drawings: Evidence From Two Socioeconomic Backgrounds.

Two studies examined young children's comprehension and production of representational drawings across and within 2 socioeconomic strata (SES). Participants were 130 middle-SES (MSES) and low-SES (LSES) Argentine children, from 30 to 60 months old, given a task with 2 phases, production and comprehension. The production phase assessed free drawing and drawings from simple 3-dimensional objects (model drawing); the comprehension phase assessed children's understanding of an adult's line drawings of the objects. MSES children solved the comprehension phase of the task within the studied age range; representational production emerged first in model drawing (42 months) and later in free drawing (48 months). The same developmental pathway was observed in LSES children but with a clear asynchrony in the age of onset of comprehension and production: Children understood the symbolic nature of drawings at 42 months old and the first representational drawings were found at 60 months old. These results provide empirical evidence that support the crucial influence of social experiences by organizing and constraining graphic development.

Malignant melanoma in Chile: different site distribution between private and state patients

BACKGROUND: The body site location of primary Malignant Melanoma (MM) has been correlated with prognosis and survival. Ethnic, genetics, sun exposure factors are related to the anatomical distribution of MM. Low and high socioeconomic strata in Chile differ in ethnic, genetic and cultural conditions. The purpose of this study was to analyze the anatomical MM distribution in the Chilean population in both strata searching for differences due to their ethno-genetic-cultural differences. Records of 1148 MM, 575cases from state hospitals (Low Socioeconomic Strata, LSS) and 573 cases from private clinics (High Socioeconomic Strata, HSS) were analyzed by body site. RESULTS: Females from LSS showed a higher number of MM in soles, cheeks, and around the eye area. Females from the HSS showed a higher number of MM in dorsal feet and dorsal hands. Males from LSS showed a higher number of MM in soles, around the eye area, and cheeks. However, males from HSS showed a higher number of MM in the trunk, and in the arms. Acral MM was significantly higher in LSS than in the HSS in both sexes. The Chilean population from the HSS and LSS showed differences in the distribution of MM by site. Furthermore, gender differences in the proportion of MM analyzed by anatomical site are observed in both strata. CONCLUSIONS: Results show evidence that differential genetics factors, sun exposure, or other environmental or cultural factors of both strata may account for these differences.

Lactancia materna y estado nutricional de niños entre 1 y 3 años de edad / Breastfeeding and nutritional status of children between 1 and 3 years of age

Se estudia la relación entre la lactancia materna y el estado nutricional de 127 niñas y 143 niños (n =270) de 1 a 3 años de edad, mediante un estudio de campo descriptivo y transversal, en ambulatorios de Caracas. Las variables estudiadas fueron: edad, sexo, estrato socioeconómico, tiempo y duración de la lactancia materna, peso, talla y las circunferencias del brazo y cabeza, para obtener la combinación de indicadores peso para la edad, peso para la talla y talla para la edad, y con ambas circunferencias el Índice de Kanawati-McLaren (K-McL= Circunferencia de brazo/Circunferencia de cabeza). Se aplicaron cuestionarios semiestructurados, al binomio madre-niño Predominaron los estratos sociales IV y V (Pobreza relativa y Crítica, respectivamente) según Graffar modificado, solamente el 17 % de la muestra pertenecía al estrato III (condiciones económicas medias). Al establecer la relación entre la lactancia y el estado nutricional según los indicadores hubo un comportamiento sin diferencias estadísticamente significativas. En cuanto a la combinación de indicadores y el tiempo y tipo de lactancia practicada en los niños ubicados entre percentiles 10 y 90 y con seis meses de lactancia exclusiva fue realizada sólo por el 8,33% de ellos. En los desnutridos con talla normal, la cifra fue igualmente cercana: 10,81% para esa práctica. Los varones estaban desnutridos en un 21% y las niñas en un 13%. Al aplicar K-McL: 75,63% de los niños amamantados hasta el día de la entrevista resultaron normales (percentil 50 o mediana) y los no amamantados hasta ese momento sumaron un 70,83%(AU)

This study examines the relationship between breastfeeding and nutritional status of 127 girls and 143 boys (n =270) 1 to 3 years of age. It was carried out a field descriptive and cross-sectional study in clinics of Caracas. The anthropometric variables were: age, sex, socioeconomic strata, time and duration of the maternal breastfeeding, weight, height, and cephalic and arm circumferences, for the combination of indicators: weight for age, weight for height and height for age, and with both the index Kanawati-McLaren (K-McL) circles and semi structure questionnaires have been implemented. The social stratum IV and V predominated (relative poverty and criticism, respectively) according to modified Graffar, only 17% of the sample belongs to the stratum III (average economic conditions). To establish the relationship between breastfeeding and nutritional status according to the indicators, there was a behavior without statistically significant differences. The combination of indicators and the time and breastfeeding practiced in located children (between 10 and 90 percentile) and six months of exclusive breastfeeding was performed only by 8.33 % of them. In the malnourished with normal stature, the figure was also close: 10,81% for this practice. The boys were undernourished by 21% and the girls by 13%. Applying K-McL: 75, 63% of the children breastfed until the day of the interview were normal (percentile 50 or median), and not breastfed until that time amounted to 70, 83 %(AU)

Consumo de alimentos y estado nutricional según estrato socioeconómico en una población infantil de caracas / Dietary intake and nutritional status according to the socioeconomic status in a childhood population from caracas

La desnutrición calórica proteica por ingesta insuficiente de macro y micronutrientes, repercute en el crecimiento y desarrollo del niño, fundamentalmente cuando se produce en las primeras edades. Analizar el consumo de alimentos, su adecuación nutricional y el estado nutricional por indicadores antropométricos segúnestrato socioeconómico. 270 niños entre 1-3 años (143 niños y 127 niñas) de Caracas pertenecientes a los estratos sociales III (17%), IV (61%)y V (22%) según Graffar- Méndez Castellano. Se analizó el peso y la talla, por indicadores individuales y según diagnóstico com binado (DCOMB) con valores de referencia de la Organización Mundial de la Salud. Para el consumo de alimentos se aplicó recordatorio de un día, adecuación de nutrientes y fórmula dietética. Los varones resultaron con mayor déficit que las niñas según DCOMB y por indicadores antropométricos: peso edad (P-E), talla-edad (T-E) y peso-talla (P-T). El estado nutricional clasificó 7% sobre la norma, 75% normales y 17% de déficit, más acentuado en los niños menores. La fórmula dietética es adecuada en todos los nutrientes. La adecuación de la energía, en sus términos porcentuales con respecto al requerimiento ideal del individuo disminuyó significativamente al descender en la escala social. Las proteínas presentaron adecuaciones altas y se encontró elevado consumo de vitamina A y calcio, con manifiesto déficit (85-100%) en el consumo de hierro y zinc respectivamente. El consumo deficiente en calorías y nutrientes se observa acompañado de profundas carencias de hierro y de zinc, factores que afectan el estado nutricional de los niños, y que constituyen causa de retardo en el crecimiento físico

The concept of protein calorie malnutrition comprises a shortage of macro and micronutrients intake that influences the growth and development of children, especially when the insufficiency occurs during early childhood. The study was conducted in order to analyze according to socioeconomic status, dietary intake, nutritional adequacy and nutritional status. Sample comprises 270 children with ages 1-3 years (143 boys and 127 girls) classified according to Graffar Méndez-Castellano social methodology; stratum III (17%), IV (61%) and V (22%). Weight and height were analyzed by specific indicatorsand combined ranking of nutritional status (DCOMB), following WHO values. Food consumption, adequacy and dietetic formula were calculated by means of a 24-hour recall questionary. Combination rank of nutritional status, showed 7% above the norm, 75% normal and 17% nutritional deficit, especially in the younger ones. Results derived from all indicators suggested more vulnerability amongst boys than girls. On the other hand, the dietetic formula highlighted adequate proportion in all the nutrients, although there is a decrease of macro-nutrients as one moved down the social scale. Proteins showed high adequacy and high consumption of vitamin A and calcium was found, but other trace elements as iron and especially zinc showed especially low intake. Overall 25% of the children had protein-calorie malnutrition accompanied by nutritional deficiencies of iron and zinc. A failure of adequate caloric and energy dietary intakes comes along with a low consumption of iron and zinc, whichinfluence negatively the nutritional status in children and causes growth retardation

Human Sociogenetics

In three cities of Chile (Santiago, Valparaiso, Valdivia) the A allele and phenotype (ABO blood group) are more frequent in the higher socioeconomic strata (SES) and the O allele and phenotype are in the lower ones. This constitutes a structured sociogenetic cline (SGC). The B allele and phenotypes (B+AB) present a rather erratic or contradictory distribution among SES. This SGC was also found in England. The standard interpretation of the origin and maintenance of this SGC in Chile is founded on socio-ethno-historic-cultural and drift factors followed by socioeconomic assortative mating that has occurred since the origin of Chileans by the admixture of Europeans and Amerindians. This interpretation is insufficient to explain the coincidence of the cline in England and Chile, and for some findings in Chile. 1) The A and Rh(-) frequencies of the highest SES in Chile are significantly higher than those found in Europeans. 2) The B gene and phenotypes (with AB) behave differently and in contradiction to the socio-ethno-cultural-historical process. 3) There is a significant interaction of the SGC with gender in Chile and England. There is not at present a putative relationship between ABO and psycho-social factors that could account for this sociogenetic interaction. This SGC seems to be present in societies with a hierarchical organization in relation to power, prestige, ownership, income and life style, and when sampling includes the most extreme SES. It has not been found in two samples from Ireland and in a sample from Chile taken from a public hospital, probably because those variables and conditions were not ascertained.