RESUMO
BACKGROUND: New therapies have revolutionized the treatment of Crohn's disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6-6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0-1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2-1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
Assuntos
Doença de Crohn , Humanos , Doença de Crohn/cirurgia , Doença de Crohn/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos Retrospectivos , Fatores de Risco , HospitaisRESUMO
ABSTRACT BACKGROUND New therapies have revolutionized the treatment of Crohn's disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6-6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0-1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2-1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.
RESUMO RACIONAL Novas terapias revolucionaram o tratamento da Doença de Crohn, mas em alguns países a taxa de cirurgias não se modificou, a frequência de cirurgias de emergência é subestimada e o risco cirúrgico é pouco estudado. OBJETIVOS Analisar fatores de risco e as indicações para cirurgia primária em pacientes com doença de Crohn, em Hospital terciário. MÉTODOS: Análise de banco de dados coletado prospectivamente, de 107 pacientes com doença de Crohn de 2015 a 2021. Os principais desfechos foram a incidência de tratamento cirúrgico, tipos de procedimentos realizados, recidiva cirúrgica, tempo livre de cirurgia e fatores de risco. RESULTADOS: A intervenção cirúrgica foi realizada em 54.2% dos pacientes, sendo a maioria dos procedimentos cirúrgicos de urgência (68.9%). Os procedimentos eletivos (31.1%) foram realizados mais de 11 anos após o diagnóstico. As principais indicações cirúrgicas foram estenose ileal (34,5%) e fístula anorretal (20,7%), sendo o procedimento mais frequente a enterectomia (24,1%). As cirurgias para recidiva foram mais comuns em procedimentos de urgência (OR 2,1; IC95% 1,6-6,6). O fenótipo de comportamento estenosante Montreal L1 (RR = 1,3; IC 95%: 1,0-1,8, p=0,04) e a doença perianal (RR 1,43; IC95% 1,2-1,7) aumentaram o risco de cirurgias de emergência. A regressão linear múltipla mostrou a idade ao diagnóstico como fator de risco para cirurgia (p=0,004). O estudo do tempo livre de cirurgia não mostrou diferença na curva de Kaplan Meier para a classificação Montreal (p=0,73). CONCLUSÕES: Os principais fatores de risco para intervenções cirúrgicas foram estenoses em doenças ileais e jejunais, idade ao diagnóstico, doença perianal e indicações de urgência.
RESUMO
BACKGROUND: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. METHODS: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. RESULTS: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. CONCLUSIONS: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.
Assuntos
COVID-19 , SARS-CoV-2 , Brasil/epidemiologia , Surtos de Doenças , Hospitais Gerais , Humanos , Unidade Hospitalar de Psiquiatria , SARS-CoV-2/genéticaRESUMO
ABSTRACT Background: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. Methods: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. Results: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. Conclusions: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.
RESUMO
AIM: The main goal in Crohn´s disease (CD) is a sustained suppression of inflammatory activity associated with mucosa healing in endoscopic evaluation. During clinical routine, there are small numbers of good markers to monitor inflammatory activity under treatment. We postulated that Oral 67Gallium Citrate Scintigraphy is able to mark inflammatory disease in mucosa and deep inflammation in CD, when used in oral form. OBJECTIVE: Measure the accuracy of Oral 67Gallium Citrate Scintigraphy in intestinal inflammatory activity of Crohn´s disease. PATIENTS AND METHODS: In a prospective consecutive cross-sectional study from January 2018 to June 2019, the ileocolonic region of 32 patients with CD were studied by dividing into four regions of interest (ROI) from the ileum to the rectum. A total of 128 intestinal segments were analyzed in cluster data. Accuracy values of Oral 67Gallium Scintigraphy and colonoscopy tests were evaluated with the histological reference test. Values of the respective receiver operating characteristic (ROC) curves were obtained and compared. The reliability between the tests was evaluated by Kappa statistical with the segment-level analyses using variance adjustments. All statistical analyses were performed with a test significance level of 0.05. RESULTS: The study population included 32 patients with CD (10 men, 22 women; average age 39 years). Disease time was five years on average. Anti-TNFs treatment was found in 71%. The most found phenotype of the Montreal classification was L3. Differences in ROC curves for colonoscopy (0.94) and Oral 67Ga Scintigraphy (0.96) did not show significant value (p = 0.32). The sensitivity of scintigraphy to detect intestinal inflammatory activity in CD was 64%, specificity of 96% and accuracy of 84%. A high agreement was found between oral scintigraphy and histological measurements with kappa = 0.64. CONCLUSIONS: Oral 67Ga Scintigraphy had similar accuracy and agreement compared to colonoscopy in the identification of inflammatory activity in Crohn´s Disease. This new approach may be useful and less invasive for long term follow-ups.
Assuntos
Citratos/administração & dosagem , Doença de Crohn/complicações , Radioisótopos de Gálio/administração & dosagem , Gálio/administração & dosagem , Inflamação/diagnóstico por imagem , Cintilografia/métodos , Administração Oral , Adulto , Antineoplásicos/farmacologia , Citratos/química , Estudos Transversais , Feminino , Gálio/química , Radioisótopos de Gálio/química , Humanos , Íleo/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/química , Reto/metabolismo , Reprodutibilidade dos Testes , Medição de Risco , Resultado do Tratamento , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Se estudiaron 81 individuos al azar (49 mujeres y 32 hombres) que concurrieron a la Unidad de Prevención Cardiovascular entre octubre de 2000 y enero de 2001. Las edades oscilaban entre los 22-73 años. Once de los 81 pacientes (13,6%) presentaron valores de homocisteína basal por encima del valor de corte (12 µmol/L). Diez de los 81 pacientes presentaron valores de homocisteína entre 12-15 µmol/L (12,3%) y fueron seleccionados para realizar el test de sobrecarga de metionina para ponderar así probables hiperhomocisteinemias en el futuro. De ellos, 2 pacientes presentaron homocisteinemias post-sobrecarga por encima de los valores de referencia. Tres de los 81 pacientes (3,7%) que observaron hiperhomocisteinemia detectada en forma basal o indirectamente a través del test de sobrecarga de metionina fueron sometidos a tratamiento con suplemento vitamínico. Ocho de 81 (9,9%) individuos que presentaron homocisteinemia por encima del valor de corte pero observaron respuesta normal al test de sobrecarga fueron asesorados en mejorar conductas alimenticias y modificar hábitos de vida.
Eighty-one patients, randomly selected from our Cardiovascular Prevention Unit, were checked for fasting homocysteinemia levels between October 2000 and January 2001. Forty-nine females and 32 males aged between 22-73 years old were studied. 11/81 patients (13,6%) showed homocysteinemia over expected cutoff value (12 µmol/L). 10/81 (12,3%) presented homocysteinemia values between 12-15 µmol/L. These patients were selected undergo a methionine loading test in order to evaluate future hiperhomocysteinemia. 2/10 presented post prandial homocysteinemia over reference values. 3/81 (3,7%) were finally treated with vitamin supplement. 8/81 (9,9%) patients who showed homocisteinemia between 12-15 µmol/L but normal response to the loading test were instructed in improving quality food consumption and healthy living conditions.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Trombose , Sistema Cardiovascular/patologia , Fatores de Risco , Hemostasia , Homocisteína , Metionina , Prevenção Primária , Sistema Cardiovascular , Hiper-HomocisteinemiaRESUMO
En el período comprendido entre marzo de 1998 y abril de 1999 se investigó la presencia de anticuerpos anti hepatitis C (VHC) en 276 mujeres embarazadas inmunocompetentes (HIV 1 y 2 no reactivas). Se observó una seroprevalencia del 0,72 por ciento (2/276). En uno de los dos niños nacidos de madres infectadas se realizó un protocolo de seguimiento para verificar la transmisibilidad del virus. A lo largo de un año se observaron en el neonato aminotransferasas normales, siendo indetectables anticuerpos anti VHC y RNA de VHC hacia el sexto y noveno mes de vida, respectivamente. El genotipo observado en madre e hijo fue el 2 b (AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Hepatite C/epidemiologia , Hepatite C/transmissão , Hepatite C/imunologia , Estudos Soroepidemiológicos , Seguimentos , Anticorpos/sangue , Complicações Infecciosas na GravidezRESUMO
En el período comprendido entre marzo de 1998 y abril de 1999 se investigó la presencia de anticuerpos anti hepatitis C (VHC) en 276 mujeres embarazadas inmunocompetentes (HIV 1 y 2 no reactivas). Se observó una seroprevalencia del 0,72 por ciento (2/276). En uno de los dos niños nacidos de madres infectadas se realizó un protocolo de seguimiento para verificar la transmisibilidad del virus. A lo largo de un año se observaron en el neonato aminotransferasas normales, siendo indetectables anticuerpos anti VHC y RNA de VHC hacia el sexto y noveno mes de vida, respectivamente. El genotipo observado en madre e hijo fue el 2 b
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Hepatite C , Anticorpos , Seguimentos , Hepatite C , Complicações Infecciosas na Gravidez , Estudos SoroepidemiológicosRESUMO
Se estudiaron 100 muestras de materia fecal, pertenecientes a niños entre 0-3 años de edad, con diagnóstico de gastroenteritis y que concurrieron a este laboratorio en el período febrero 1996-enero 1997. Las muestras fueron exclusivamente analizadas mediante la detección del electroferotipo típico del ARN viral de rotavirus por electroforesis en geles de poliacrilamida y posterior tinción argéntica. Se observaron 14 muestras positivas, todas correspondientes a rotavirus grupo A (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Rotavirus/isolamento & purificação , Gastroenterite/virologia , Diarreia Infantil/etiologia , Uruguai , Fezes/virologia , Eletroforese em Gel de Poliacrilamida/métodos , Diarreia Infantil/virologia , RNA Viral/diagnósticoRESUMO
Se estudiaron 100 muestras de materia fecal, pertenecientes a niños entre 0-3 años de edad, con diagnóstico de gastroenteritis y que concurrieron a este laboratorio en el período febrero 1996-enero 1997. Las muestras fueron exclusivamente analizadas mediante la detección del electroferotipo típico del ARN viral de rotavirus por electroforesis en geles de poliacrilamida y posterior tinción argéntica. Se observaron 14 muestras positivas, todas correspondientes a rotavirus grupo A
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Diarreia Infantil/etiologia , Gastroenterite/virologia , Rotavirus/isolamento & purificação , Diarreia Infantil/virologia , Eletroforese em Gel de Poliacrilamida , Fezes/virologia , RNA Viral , UruguaiRESUMO
Presentamos el caso de una niña de cinco años portadora de la variedad genética 1 de Angioedema Hereditario (déficit de C1-INH). Se realizaron estudios serológicos en familiares directos, destacándose la importancia de esta investigación por el carácter hereditario de esta afección. A propósito de este caso comentamos diversos aspectos de la patogenia, clínica, diagnóstico de laboratorio y tratamiento de esta enfermedad poco frecuente. En la revisión bibliográfica realizada no hallamos publicaciones nacionales de Angioedema Hereditario en Pediatría(AU)
Assuntos
INFORME DE CASO , Humanos , Feminino , Pré-Escolar , Angioedema/diagnóstico , Angioedema/genética , Doenças Genéticas InatasRESUMO
Presentamos el caso de una niña de cinco años portadora de la variedad genética 1 de Angiodema Hereditario (déficit de C1-INH). Se realizaron estudios serológicos en familiares directos, destacándose la importancia de esta investigación por el carácter hereditario de esta afección. A propósito de este caso comentamos diversos aspectos de la patogenia, clínica, diagnóstico de laboratorio y tratamiento de esta enfermedad poco frecuente. En la revisión bibliográfica realizada no hallamos publicaciones nacionales de Angioedema Hereditario en Pediatría