RESUMO
INTRODUCTION AND AIMS: Cardiovascular disease is a growing public health problem. Forty percent of the general population will suffer from the disease by 2030, consequently requiring antithrombotic therapy. Cardiogastroenterology is a new area of knowledge that evaluates the gastrointestinal effects and complications of antithrombotic therapy. Our aim was to evaluate, through a validated questionnaire, the knowledge held by a group of specialists and residents in the areas of gastroenterology and internal medicine, about pharmacology and drug prescription, as well as gastrointestinal risks and complications, in relation to antithrombotic therapy. PATIENTS AND METHODS: A validated questionnaire composed of 30 items was applied to a group of specialists and residents in the areas of gastroenterology and internal medicine. The questions were on indications, pharmacology, evaluation of risks for gastrointestinal bleeding and thromboembolic events, and use of antithrombotic therapy during endoscopic procedures. Sufficient knowledge was defined as 18 or more (≥ 60%) correct answers. RESULTS: The questionnaire was answered by 194 physicians: 82 (42%) internal medicine residents and gastroenterology residents and 112 (58%) specialists. Only 40 (20.6%) of the participants had sufficient knowledge of cardiogastroenterology. Residents had a higher number of correct answers than specialists (53 vs. 36%, P<.0001). The gastroenterology residents had more correct answers than the internal medicine residents, gastroenterologists, and internists (70 vs. 53, 40, and 46%, respectively, P<.001). Only residents had sufficient knowledge regarding pharmacology and the use of antithrombotic therapy in endoscopy (P<.0001). All groups had insufficient knowledge in evaluating the risk for gastrointestinal bleeding and thrombosis. CONCLUSIONS: Knowledge of cardiogastroenterology was insufficient in the group of residents and specialists surveyed. There is a need for medical education programs on the appropriate use of antithrombotic therapy.
Assuntos
Cardiologia , Competência Clínica/estatística & dados numéricos , Gastroenterologia , Medicina Interna , Especialização , Adulto , Cardiologia/educação , Estudos Transversais , Feminino , Gastroenterologia/educação , Humanos , Medicina Interna/educação , Internato e Residência , Masculino , MéxicoRESUMO
Some patients with autoimmune liver disease have characteristics of cholestasis, as well as of autoimmune hepatitis. Despite the fact that this is a relatively frequent clinical condition seen in referral centers for liver diseases, there is little evidence as regards the clinical management of these syndromes due to their low prevalence and the lack of standardized definitions and diagnostic criteria. This is relevant, given that published studies report that there is a lower therapeutic response and poorer outcome in patients with overlap syndrome than in those presenting solely with autoimmune hepatitis. Whether overlap syndromes are distinct entities or the presence of 2 concurrent diseases is still a subject of debate. They should be suspected in autoimmune hepatitis patients that present with signs of cholestasis, as it is known that overlap behavior tends to be more aggressive, with higher rates of cirrhosis and the need for liver transplantation. Treatment response is also poorer and should be directed at the predominant component. Standardized definitions are necessary so that these syndromes can be studied in controlled clinical trials.
Assuntos
Colangite Esclerosante/diagnóstico , Colangite Esclerosante/terapia , Colestase/diagnóstico , Colestase/terapia , Hepatite Autoimune/complicações , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/terapia , Colangite Esclerosante/complicações , Colestase/complicações , Diagnóstico Diferencial , Humanos , Cirrose Hepática Biliar/complicações , Transplante de Fígado , SíndromeRESUMO
The mechanisms involved in impaired immunity in malnourished children are not well understood. CD4(+) CD62L(-) and CD8(+) CD28(-) do not express the naive cell markers CD62L and CD28, suggesting that they function as effector T cells. Using a flow cytometry-based analysis we examined the proportions of CD4(+) CD62L(-) and CD8(+) CD28(-) T cell subsets in well-nourished infected (WNI) and malnourished infected (MNI) children. Here we report that WNI children had a higher percentage of CD4(+) CD62L(-) (11.1 +/- 1.0) and CD8(+) D28(-) (40.2 +/- 5.0) T cell subsets than healthy (6.5 +/- 1.0 and 23.9 +/- 4.8) and MNI children (7.4 +/- 1.1 and 23.1 +/- 6.2, respectively) (P < 0.5). Data suggest that WNI children respond efficiently against pathogenic microbes. In contrast, relatively low numbers of circulating of CD4(+) CD62L(-) and CD8(+) CD28(-) T cells in MNI children may represent an ineffective response to infection. Levels of effector T cells in children with gastrointestinal infections versus those suffering from respiratory infections were also significantly different within the WNI group. While WNI children with gastrointestinal infections had higher absolute and relative values of CD8(+), and CD8(+) CD28(-) T subsets, by those with respiratory infections had higher values of CD4(+) lymphocytes. However, due to the small number of subjects examined, our results in WNI children should be interpreted with caution and confirmed using a larger sample size. Our data suggest that altered expression of CD62L and CD28 receptors may contribute to impaired T cell function observed in MNI children.
Assuntos
Infecções Bacterianas/imunologia , Desnutrição/imunologia , Infecções Oportunistas/imunologia , Subpopulações de Linfócitos T/imunologia , Infecções Bacterianas/complicações , Antígenos CD28/sangue , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Pré-Escolar , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/imunologia , Humanos , Lactente , Selectina L/sangue , Contagem de Leucócitos , Masculino , Desnutrição/complicações , Infecções Oportunistas/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/imunologiaRESUMO
The aim of this study was to assess DNA repair capacity in lymphocytes of children with protein calorie malnutrition using the single-cell gel electrophoresis (comet) assay. Repair capacity was assessed by estimating the relative decrease of DNA migration length 5, 15, 30, and 60 min after hydrogen peroxide treatment, in three groups of children: well-nourished (WN), well-nourished infected (WN-I), and malnourished infected (MN-I). In addition, the DNA migration length was evaluated in all groups before and after peroxide treatment. Comparison of mean migration lengths observed in WN and WN-I children showed significant differences at all times tested; between WN-I and MN-I differences were also observed, except after hydrogen peroxide exposure. This implies that lymphocytes of WN-I and MN-I children were equally sensitive to hydrogen peroxide. Nevertheless, the MN-I group clearly shows the greatest overall percentage of damaged cells at all times tested. In relation to repair capacity, at 5 min it was approximately 30% in both groups of well-nourished children, but only 20% in MN-I; 15 min after exposure, repair capacity increased to 51% in well-nourished children but only to 31% in MN-I; and at 60 min this capacity increased to 82% in well-nourished but only to 55% in MN-I. These data indicate that lymphocytes of malnourished children show a decreased capacity to repair hydrogen peroxide-induced DNA damage compared to that of well-nourished controls. This reflects that only malnutrition is associated with decreased DNA repair capacity. Additionally, the data confirm that severe infection and malnutrition are two factors clearly associated with increased DNA damage.