RESUMO
BACKGROUND: Effective control of the inflammatory process in Crohn's disease (CD) is reflected in intestinal mucosal healing. The performances of faecal calprotectin (fcal), clinical and serologic parameters in the inflammatory activity evaluation and their correlation to the simple endoscopic score (SES-CD) are the goals of this study. METHODS: Patients with CD referred for ileocolonoscopy were prospectively included and distributed according to the degree of endoscopic inflammatory activity into remission, mild activity, and moderate to severe activity groups. The different degrees of endoscopic activity were correlated with the following indexes: Crohn's disease activity index (CDAI), fCal, serum C-reactive protein (CRP), and haemogram. The control group comprised individuals without known intestinal disease who were referred for colorectal cancer screening. RESULTS: Eighty colonoscopies were performed in patients with CD and 21 in the control group. The control group had a lower median fCal (59.7 mcg/g) than patients with CD (683 mcg/g, p < 0.001). A moderate Spearman correlation occurred between SES-CD and CRP (r = 0.525), fCal (r = 0.450), and CDAI (r = 0.407), while a weak correlation was found with the platelet count (r = 0.257). Only fCal distinguished patients in remission from those with mild activity (236.6 mcg/g × 654.9 mcg/g, p = 0.014) or moderate to severe activity (236.6 mcg/g × 1128 mcg/g, p < 0.001). An fCal cut-off of 155 mcg/g was sensitive (96%) and accurate (78%) for the diagnosis of endoscopic activity. CONCLUSIONS: fCal provides greater diagnostic accuracy than the other activity markers for endoscopic activity of patients with CD, moderate correlation to SES-CD, and a capacity to discriminate patients in remission from those with mild or moderate to severe activity.
Assuntos
Doença de Crohn/patologia , Fezes/química , Mucosa Intestinal/patologia , Complexo Antígeno L1 Leucocitário/análise , Adulto , Idoso , Biomarcadores/análise , Proteína C-Reativa/análise , Colonoscopia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Inflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management. AIM: To describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil. METHODS: A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05). RESULTS: Of the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients. CONCLUSION: Moderate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.
Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Brasil/epidemiologia , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Estudos Transversais , Emprego/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Chagas cardiomyopathy (CDC) is associated with a poor prognosis compared to other cardiomyopathies. Speckle tracking echocardiography (STE), which provides direct assessment of myocardial fiber deformation, may be useful in predicting prognosis. OBJECTIVE: This study assessed STE in CDC and compared with idiopathic cardiomyopathy (IDC), and also examined the incremental prognostic information of STE over left ventricular ejection fraction (LVEF) in these patients. METHODS: We enrolled 112 patients, age of 56.7 ± 11.8 years, 81 with CDC and 31 with IDC. STE indices were obtained at baseline in all patients. The endpoint was a composite of death, hospitalization for heart failure, or need for heart transplantation. RESULTS: Patients with IDC had worse LV systolic function compared to CDC, with LVEF of 34.5% vs 41.3%, p = 0.004, respectively. After adjustment for LVEF, there were no differences in STE values between CDC and IDC. During a median follow-up of 18.2 months (range, 11 to 22), 26 patients met the composite end point (24%). LV longitudinal strain was a strong predictor of adverse events, incremental to LVEF and E/e' ratio (HR 1.463, 95% CI 1.130-1.894; p = 0.004). The risk of cardiac events increased significantly in patients with GLS > - 12% (log-rank p = 0.035). CONCLUSIONS: STE indices were abnormal in patients with dilated cardiomyopathy, without differences between CDC and IDC. LV longitudinal strain was a powerful predictor of outcome, adding prognostic information beyond that provided by LVEF and E/e' ratio.
Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Chagásica/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/mortalidade , Cardiomiopatia Chagásica/fisiopatologia , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Volume Sistólico/fisiologia , Análise de Sobrevida , Função Ventricular Esquerda/fisiologiaRESUMO
Amphotericin B deoxycholate is the main option for intravenous (i.v.) treatment of severe paracoccidioidomycosis (PCM). This is the first report of amphotericin B lipid complex (ABLC) in the treatment of PCM. Among 28 patients, cure was achieved in all patients (100%) using ABLC. Mean and median daily doses of ABLC were 3.39 mg/kg/day and 3.35 mg/kg/day, respectively. ABLC may be a choice in the treatment of severe forms of PCM or when i.v. options are required.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Paracoccidioidomicose/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The diversity of freshwater triclads in the Neotropical region is considered to be low, but extensive areas of South America remain almost unexplored. Herein we describe two cave-dwelling, new species of Girardia, one from a transition zone of the Cerrado and Caatinga phytophysiognomies and the other from the Cerrado phytophysiognomy. The species from the Cerrado-Caatinga transition is a troglobite, eyeless and whitish; the species from the Cerrado area is possibly a troglophile, since it shows heavily pigmented body and eyes. Each species is easily recognized by a unique combination of features in its external morphology and copulatory apparatus. The two new species of Girardia show a restricted distribution, even the troglophile, and occur in caves without legal protection. Therefore, they must be considered as vulnerable organisms in a conservation context.
Assuntos
Água Doce/parasitologia , Platelmintos/classificação , Distribuição Animal , Animais , Biodiversidade , Tamanho Corporal , Cavernas , Ecossistema , Feminino , Masculino , Tamanho do Órgão , Platelmintos/anatomia & histologia , Platelmintos/crescimento & desenvolvimento , América do SulRESUMO
Brazilian cave diversity, especially of invertebrates, is poorly known. The Bodoquena Plateau, which is located in the Cerrado Biome in central Brazil, has approximately 200 recorded caves with a rich system of subterranean water resources and high troglobitic diversity. Herein we describe a new troglobitic species of Girardia that represents the first obligate cave-dwelling species of the suborder Continenticola in South America. Specimens of the new species, which occur in a limestone cave in the Bodoquena Plateau, in the Cerrado biome, are unpigmented and eyeless. Species recognition in the genus Girardia is difficult, due to their great morphological resemblance. However, the new species can be easily recognized by a unique feature in its copulatory apparatus, namely a large, branched bulbar cavity with multiple diverticula.
RESUMO
Species diversity of Brazilian cave fauna has been seriously underestimated. A karst area located in Felipe Guerra, northeastern Brazil, which is a hotspot of subterranean diversity in Brazil, has revealed more than 20 troglobitic species, most of them still undescribed. Based on recent samplings in this karst area, we document the occurrence of the suborder Cavernicola (Platyhelminthes) in South American hypogean environments for the first time and describe a new genus and species for this suborder. Hausera Leal-Zanchet & Souza, gen. n. has features concordant with those defined for the family Dimarcusidae. The new genus is characterized by two unique features, viz. an intestine extending dorsally to the brain and ovovitelline ducts located dorsally to the nerve cords, which is complemented by a combination of other characters. The type-specimens of Hauserahauseri Leal-Zanchet & Souza, sp. n. are typical stygobionts, unpigmented and eyeless, and they may constitute an oceanic relict as is the case of other stygobiotic invertebrates found in this karst area in northeastern Brazil.
RESUMO
O objetivo deste artigo é discutir os principais desafios e benefícios associados à adoção de modelos lógicos em avaliação de sistemas instrucionais. Análises da produção de conhecimentos nesta área mostraram lacunas na investigação de relacionamentos entre efeitos de programas no nível dos egressos e impactos indiretos desses programas instrucionais sobre a organização. Essas lacunas nas pesquisas estimularam a adoção de estratégias metodológicas que facilitassem a compreensão da realidade dos programas. Os modelos lógicos são ferramentas eficazes na avaliação de programas sociais e governamentais. Este artigo apresenta, a título de demonstração empírica, dois casos de aplicação bem-sucedida da abordagem de modelos lógicos em avaliação de sistemas instrucionais. O primeiro apresenta a avaliação de um treinamento corporativo e o segundo, a avaliação de um mestrado profissional. Nesses estudos foram realizadas diversas etapas de pesquisa qualitativa, a partir das quais foram confeccionados modelos lógicos e figuras, que resumem a teoria do programa, tal como concebida pelos stakeholders, participantes da pesquisa. As pesquisas são descritas brevemente, de modo a ilustrar a aplicação de modelos lógicos nos dois contextos estudados. Ao final, são discutidos benefícios e limitações dessa abordagem na avaliação de sistemas instrucionais.
The aim of this article is to discuss the main challenges and benefits associated with the adoption of logical models to evaluate instructional systems. Analyses of the production of knowledge in this area have shown gaps in the investigation of relationships between program effects for egresses as well as the indirect impacts of these instructional programs on the organization. These gaps in the research have stimulated the adoption of methodological strategies to improve the understanding of the reality of such programs. Logical models are effective tools for the evaluation of social and governmental programs. This article presents, by way of empirical demonstration, two cases in which logical models were successfully used for instructional systems evaluation. The first presents the evaluation of a corporate training course and the second the evaluation of a professional master's. Several qualitative research steps were conducted in these studies and from them logical models were created. These models summarize the theory of the program, as conceived by the stakeholders, who were also participants in the study. The studies are described briefly, to illustrate the application of the logical models in these two contexts. Finally, the benefits and limitations of this approach for the evaluation of instructional systems are discussed.
Assuntos
Humanos , Masculino , Feminino , EducaçãoRESUMO
O objetivo deste artigo é discutir os principais desafios e benefícios associados à adoção de modelos lógicos em avaliação de sistemas instrucionais. Análises da produção de conhecimentos nesta área mostraram lacunas na investigação de relacionamentos entre efeitos de programas no nível dos egressos e impactos indiretos desses programas instrucionais sobre a organização. Essas lacunas nas pesquisas estimularam a adoção de estratégias metodológicas que facilitassem a compreensão da realidade dos programas. Os modelos lógicos são ferramentas eficazes na avaliação de programas sociais e governamentais. Este artigo apresenta, a título de demonstração empírica, dois casos de aplicação bem-sucedida da abordagem de modelos lógicos em avaliação de sistemas instrucionais. O primeiro apresenta a avaliação de um treinamento corporativo e o segundo, a avaliação de um mestrado profissional. Nesses estudos foram realizadas diversas etapas de pesquisa qualitativa, a partir das quais foram confeccionados modelos lógicos e figuras, que resumem a teoria do programa, tal como concebida pelos stakeholders, participantes da pesquisa. As pesquisas são descritas brevemente, de modo a ilustrar a aplicação de modelos lógicos nos dois contextos estudados. Ao final, são discutidos benefícios e limitações dessa abordagem na avaliação de sistemas instrucionais. (AU)
The aim of this article is to discuss the main challenges and benefits associated with the adoption of logical models to evaluate instructional systems. Analyses of the production of knowledge in this area have shown gaps in the investigation of relationships between program effects for egresses as well as the indirect impacts of these instructional programs on the organization. These gaps in the research have stimulated the adoption of methodological strategies to improve the understanding of the reality of such programs. Logical models are effective tools for the evaluation of social and governmental programs. This article presents, by way of empirical demonstration, two cases in which logical models were successfully used for instructional systems evaluation. The first presents the evaluation of a corporate training course and the second the evaluation of a professional master's. Several qualitative research steps were conducted in these studies and from them logical models were created. These models summarize the theory of the program, as conceived by the stakeholders, who were also participants in the study. The studies are described briefly, to illustrate the application of the logical models in these two contexts. Finally, the benefits and limitations of this approach for the evaluation of instructional systems are discussed. (AU)