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Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.
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Colite Ulcerativa , Adalimumab/uso terapêutico , Adulto , Colite Ulcerativa/tratamento farmacológico , Humanos , Infliximab/uso terapêutico , Inibidores do Fator de Necrose Tumoral , Ustekinumab/uso terapêuticoRESUMO
INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.
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Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Consenso , Humanos , América Latina , Indicadores de Qualidade em Assistência à SaúdeRESUMO
Families' health, safety, and economic stability were jeopardized during the pandemic. Parental stress is a risk factor for hostile and less supportive parenting. Parenting styles are a set of attitudes, feelings and behaviors related to parenting that modulate the child's psychosocial functioning and might impact on the adaptability to a stressful time. OBJECTIVE: To investigate the group differences among children raised by negative and positive parenting families during COVID-19 pandemic. METHODS: We have done an online survey with 329 parents. Parents answer about parenting strategies and styles, children's behavior, Covid related questions, socio-economic information, sleep and gaming disorders. RESULTS: Parents' frequent use of negative strategies were a risk factor to have a negative outcome related to mental health, games, sleep, and children behavior. DISCUSSION: Parenting strategies are some targets pointed in this study for intervention. Parents' styles and strategies training to better manage children might be even more important to avoid negative consequences for children in stressful times.
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COVID-19 , Comportamento Problema , Transtornos do Sono-Vigília , Brasil/epidemiologia , COVID-19/epidemiologia , Criança , Humanos , Pandemias , Poder Familiar/psicologia , Pais/psicologia , Tempo de Tela , Transtornos do Sono-Vigília/epidemiologiaRESUMO
This is the first Latin American Consensus of the Pan American Crohn's and Colitis Organisation (PANCCO) regarding special situations in patients with inflammatory bowel disease (IBD). The aim of this consensus is to raise awareness in the medical community in all Latin American countries with respect to pregnancy, vaccinations, infections, neoplasms, including colorectal cancer, and pediatric issues in patients with IBD.
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Doenças Inflamatórias Intestinais/terapia , Adulto , Criança , Colite Ulcerativa/complicações , Colite Ulcerativa/terapia , Consenso , Doença de Crohn/complicações , Doença de Crohn/terapia , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , América Latina , Masculino , GravidezRESUMO
The incidence and prevalence of inflammatory bowel disease (IBD) has increased in recent years in several Latin American countries. There is a need to raise awareness in gastroenterologists and the population in general, so that early diagnosis and treatment of ulcerative colitis (UC) and Crohn's Disease (CD) can be carried out. It is important for all physicians to have homogeneous criteria regarding the diagnosis and treatment of IBD in Latin America. The Pan American Crohn's and Colitis Organisation (PANCCO) is an organization that aims to include all the countries of the Americas, but it specifically concentrates on Latin America. The present Consensus was divided into two parts for publication: 1) Diagnosis and treatment and 2) Special situations. This is the first Latin American Consensus whose purpose is to promote a perspective adapted to our Latin American countries for the diagnosis, treatment, and monitoring of patients with UC and CD.
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Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Colite Ulcerativa/complicações , Doença de Crohn/complicações , Humanos , América LatinaRESUMO
IMPORTANCE: The current recommendation is for at least 12 months of dual antiplatelet therapy after implantation of a drug-eluting stent. However, the optimal duration of dual antiplatelet therapy with specific types of drug-eluting stents remains unknown. OBJECTIVE: To assess the clinical noninferiority of 3 months (short-term) vs 12 months (long-term) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) with zotarolimus-eluting stents. DESIGN, SETTING, AND PATIENTS: The OPTIMIZE trial was an open-label, active-controlled, 1:1 randomized noninferiority study including 3119 patients in 33 sites in Brazil between April 2010 and March 2012. Clinical follow-up was performed at 1, 3, 6, and 12 months. Eligible patients were those with stable coronary artery disease or history of low-risk acute coronary syndrome (ACS) undergoing PCI with zotarolimus-eluting stents. INTERVENTIONS: After PCI with zotarolimus-eluting stents, patients were prescribed aspirin (100-200 mg daily) and clopidogrel (75 mg daily) for 3 months (n = 1563) or 12 months (n = 1556), unless contraindicated because of occurrence of an end point. MAIN OUTCOMES AND MEASURES: The primary end point was net adverse clinical and cerebral events (NACCE; a composite of all-cause death, myocardial infarction [MI], stroke, or major bleeding); the expected event rate at 1 year was 9%, with a noninferiority margin of 2.7%. Secondary end points were major adverse cardiac events (MACE; a composite of all-cause death, MI, emergent coronary artery bypass graft surgery, or target lesion revascularization) and Academic Research Consortium definite or probable stent thrombosis. RESULTS: NACCE occurred in 93 patients receiving short-term and 90 patients receiving long-term therapy (6.0% vs 5.8%, respectively; risk difference, 0.17 [95% CI, -1.52 to 1.86]; P = .002 for noninferiority). Kaplan-Meier estimates demonstrated MACE rates at 1 year of 8.3% (128) in the short-term group and 7.4% (114) in the long-term group (HR, 1.12 [95% CI, 0.87-1.45]). Between 91 and 360 days, no statistically significant association was observed for NACCE (39 [2.6%] vs 38 [2.6%] for the short- and long-term groups, respectively; HR, 1.03 [95% CI, 0.66-1.60]), MACE (78 [5.3%] vs 64 [4.3%]; HR, 1.22 [95% CI, 0.88-1.70]), or stent thrombosis (4 [0.3%] vs 1 [0.1%]; HR, 3.97 [95% CI, 0.44-35.49]). CONCLUSIONS AND RELEVANCE: In patients with stable coronary artery disease or low-risk ACS treated with zotarolimus-eluting stents, 3 months of dual antiplatelet therapy was noninferior to 12 months for NACCE, without significantly increasing the risk of stent thrombosis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01113372.
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Síndrome Coronariana Aguda/terapia , Aspirina/administração & dosagem , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Inibidores da Agregação Plaquetária/administração & dosagem , Ticlopidina/análogos & derivados , Idoso , Aspirina/efeitos adversos , Clopidogrel , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Inibidores da Agregação Plaquetária/efeitos adversos , Risco , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados , Acidente Vascular Cerebral , Trombose , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversosRESUMO
Lafoensia pacari (Lythraceae), popularly known in Brazil as "pacari", is a small tree native to the Cerrado that is used in folk medicine to treat cancer and as an anti-inflammatory and cicatrizing agent. We evaluated the genotoxic, cytotoxic, antigenotoxic, and anticytotoxic activities of an ethanol extract of L. pacari stem bark (EESB) using the Ames test and the mouse bone marrow micronucleus test. In the Ames test, EESB did not significantly increase the number of His(+) revertants in Salmonella typhimurium tester strains TA98 and TA100 at all doses, demonstrating lack of mutagenicity. Only the highest dose of EESB significantly increased the micronucleated polychromatic erythrocyte frequency in the micronucleus test, indicating mild genotoxicity. EESB produced a mutagenic index lower than the negative control in the Ames test. In the micronucleus test, at all doses, EESB caused a significant decrease in the polychromatic/normochromatic erythrocyte ratio (PCE/NCE) at 24 h compared with the negative control. EESB co-administered together with the respective positive control caused a significant decrease in the number of His(+) revertant colonies in the Ames test and in the frequency of micronucleated polychromatic erythrocytes in the micronucleus test, demonstrating a DNA protector effect. EESB co-administered with mitomycin C significantly increased the PCE/NCE ratio at all doses, showing an anticytotoxic effect. We conclude that EESB has antigenotoxic and anticytotoxic properties.
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Antimutagênicos/farmacologia , Dano ao DNA/efeitos dos fármacos , Lythraceae/química , Casca de Planta/química , Extratos Vegetais/farmacologia , Animais , Relação Dose-Resposta a Droga , Eritrócitos/química , Etanol/metabolismo , Masculino , Camundongos , Testes para Micronúcleos , Mitomicina/farmacologia , Mutagênicos/análise , Salmonella typhimurium/efeitos dos fármacosRESUMO
We demonstrate theoretically that the presence of ions in insulating materials such as nematic liquid crystals may be responsible for the dielectric spectroscopy behavior observed experimentally. It is shown that, at low frequencies, an essentially non-Debye relaxation process takes place due to surface effects. This is accomplished by investigating the effects of the adsorption-desorption process on the electrical response of an electrolytic cell when the generation and recombination of ions is present. The adsorption-desorption is governed by a non-usual kinetic equation in order to incorporate memory effects related to a non-Debye relaxation and the roughness of the surface. The analysis is carried out by searching for solutions to the drift-diffusion equation that satisfy the Poisson equation relating the effective electric field to the net charge density. We also discuss the effect of the mobility of the ions, i.e., situations with equal and different diffusion coefficients for positive and negative ions, on the impedance and obtain an exact expression for the admittance. The model is compared with experimental results measured for the impedance of a nematic liquid crystal sample and a very good agreement is obtained.
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Íons/química , Cristais Líquidos/química , Modelos Químicos , Modelos Moleculares , Adsorção , Simulação por Computador , Impedância Elétrica , Propriedades de SuperfícieRESUMO
BACKGROUND: Current recommendations for antithrombotic therapy after drug-eluting stent (DES) implantation include prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel ≥12 months. However, the impact of such a regimen for all patients receiving any DES system remains unclear based on scientific evidence available to date. Also, several other shortcomings have been identified with prolonged DAPT, including bleeding complications, compliance, and cost. The second-generation Endeavor zotarolimus-eluting stent (E-ZES) has demonstrated efficacy and safety, despite short duration DAPT (3 months) in the majority of studies. Still, the safety and clinical impact of short-term DAPT with E-ZES in the real world is yet to be determined. METHODS: The OPTIMIZE trial is a large, prospective, multicenter, randomized (1:1) non-inferiority clinical evaluation of short-term (3 months) vs long-term (12-months) DAPT in patients undergoing E-ZES implantation in daily clinical practice. Overall, 3,120 patients were enrolled at 33 clinical sites in Brazil. The primary composite endpoint is death (any cause), myocardial infarction, cerebral vascular accident, and major bleeding at 12-month clinical follow-up post-index procedure. CONCLUSIONS: The OPTIMIZE clinical trial will determine the clinical implications of DAPT duration with the second generation E-ZES in real-world patients undergoing percutaneous coronary intervention.
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Aspirina/uso terapêutico , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/uso terapêutico , Sirolimo/análogos & derivados , Ticlopidina/análogos & derivados , Adulto , Aspirina/efeitos adversos , Brasil , Clopidogrel , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Quimioterapia Combinada , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Período Pós-Operatório , Estudos Prospectivos , Projetos de Pesquisa , Sirolimo/administração & dosagem , Ticlopidina/efeitos adversos , Ticlopidina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The electrical response of an electrolytic cell in which the diffusion of mobile ions in the bulk is governed by a fractional diffusion equation of distributed order is analyzed. The boundary conditions at the electrodes limiting the sample are described by an integro-differential equation governing the kinetic at the interface. The analysis is carried out by supposing that the positive and negative ions have the same mobility and that the electric potential profile across the sample satisfies the Poisson's equation. The results cover a rich variety of scenarios, including the ones connected to anomalous diffusion.
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There is a lack of publications concerning the use of primary prophylaxis in developing countries. The aim of this study was to evaluate the effectiveness of primary prophylaxis therapy in preventing the development of arthropathy in children with severe haemophilia A or B. From January 1999 to April 2009, a prospective study was carried out involving 39 patients with severe haemophilia A or B. These haemophilia A and haemophilia B patients received 20-40 UI kg(-1) of factors VIII and IX, three and two times per week, respectively. The patients were followed up by a multidisciplinary team. The analysis was carried out in 23 patients who had been on prophylaxis therapy for at least 12 months. The orthopaedic evaluation was performed according to the recommendations of the Orthopedic Advisory Committee of the World Federation of Hemophilia, by evaluating pain and bleeding, and by conducting physical examination and radiological assessment (Pettersson's Joint Score and magnetic resonance): 82.6% of patients who had used the factor regularly did not present any clinical or radiographic changes in the studied joints; 17.4% used the factor irregularly at the beginning of the treatment and of those, most patients presented mild changes in the joints; and 4.3% presented transient knee and ankle pain in spite of regular factor use. The preliminary results of primary prophylaxis confirm its effectiveness in preventing haemophilic arthropathy. Socioeconomic factors did not play a significant role.
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Fator IX/uso terapêutico , Fator VIII/uso terapêutico , Hemartrose/prevenção & controle , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Hemofilia B/complicações , Hemofilia B/tratamento farmacológico , Artropatias/prevenção & controle , Pré-Escolar , Fator IX/administração & dosagem , Fator VIII/administração & dosagem , Humanos , Lactente , Artropatias/diagnóstico por imagem , Artropatias/etiologia , Masculino , Estudos Prospectivos , RadiografiaAssuntos
Humanos , Animais , Gravidez , Probióticos , Alimento Funcional/microbiologia , Prebióticos , Simbióticos , Microbioma GastrointestinalRESUMO
Twenty-seven species of native Brazilian Cerrado plants commonly used by traditional healers to treat malaria and other diseases were collected and 204 hexanic and ethanolic extracts were obtained by maceration. The antiplasmodial activity of the extracts was tested in vitro against a chloroquine resistant strain (FcB1) of Plasmodium falciparum, and cytotoxicity against the cell lines L-6 of rats and MRC-5 of human was evaluated. Thirty-two extracts showed significant inhibition rates of Plasmodium falciparum growth and of these six showed cytotoxicity against the cell lines. The strongest antiplasmodial activity was found for the hexanic extracts of Xylopia aromatica root wood (IC(50)=4.7 microg/ml), Xylopia emarginata root bark (IC(50)=4.9 microg/ml), Casearia sylvestris var. lingua leaves, stem wood and stem bark, and root wood and root bark (IC(50) values from 0.9 to 2.3 microg/ml), and Cupania vernalis leaves (IC(50)=0.9 microg/ml); and for the ethanolic extract of Aspidosperma macrocarpon root bark (IC(50)=4.9 microg/ml). However, the best selectivity towards Plasmodium falciparum was observed for the hexanic root bark extract of Matayba guianensis (IC(50) on Plasmodium falciparum=6.1 microg/ml, SI=16.4 for MRC-5) and the ethanolic root bark extract of Aspidosperma macrocarpon (IC(50) on Plasmodium falciparum=4.9 micro/ml, SI=16.2 for MRC-5).
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Anti-InfecciososRESUMO
Larvicidal activities against Aedes aegypti have been determined in the ethanolic extracts obtained from 51 Brazilian medicinal plants. Eleven of the 84 extracts studied showed significant (LC50 < 100 microg mL(-1)) activities against larvae, with extracts from Annona crassiflora (root bark, LC50 = 0.71 microg mL(-1); root wood, LC50 = 8.94 microg mL(-1)) and Annona glabra (seed, LC50 = 0.06 microg mL(-1)) showing the highest activities. The results obtained should be of value in the search for new natural larvicidal compounds.
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Aedes/crescimento & desenvolvimento , Larva/efeitos dos fármacos , Extratos Vegetais/farmacologia , Plantas Medicinais/química , Animais , BrasilRESUMO
One hundred ninety hexanic and ethanolic extract from 27 plant species from the Cerrado biome of Brazil were tested for larvicidal activity against 3rd-stage Aedes aegypti larvae at 500 microg/ml. Fourteen extracts from 7 species showed activity (>65% mortality) against the larvae. Of these Dugeutia furfuracea, Piptocarpha rotundifolia, Casearia sylvestris var. lingua, Serjania lethalis, and Xylopia aromatica were active at 56.6, 162.31, 232.4, 285.76, and 384.37 microg/ml, respectively. Annona crassiflora and Cybistax antisyphilitica showed activity at 23.06 and 27.61 microg/ml. The larvicidal properties of these species are described for the first time, and may prove to be promising in active chemical compound isolation.
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Aedes , Inseticidas , Extratos Vegetais , Animais , Brasil , LarvaRESUMO
Ethanolic extract from seeds of Pterodon polygalaeflorus (Benth) has been shown to possess significant larvicidal activity against the mosquito Aedes aegypti. Bioassay-guided fractionation of the extract led to the isolation and characterization of the know diterpenoid furans 6alpha-hydroxyvouacapan-7beta,17beta-lactone (1), 6alpha,7beta-dihydroxyvouacapan- 17beta-oic acid (2) and methyl 6alpha,7beta-dihydroxyvouacapan-17beta-oate (3). The structures were established from infrared (IR), ultraviolet (UV), 1H-nuclear magnetic resonance (NMR), 13C-NMR, and mass spectral data: full NMR assignments are presented for compounds 1-3 and the diacetyl derivative of 3. Compounds 1-3 exhibited LC50 values of 50.08, 14.69, and 21.76 microg/mL against fourth-instar Aedes aegypti larvae.
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Aedes/efeitos dos fármacos , Diterpenos/isolamento & purificação , Diterpenos/farmacologia , Fabaceae/química , Inseticidas/farmacologia , Controle Biológico de Vetores/métodos , Animais , Bioensaio , Diterpenos/química , Larva/efeitos dos fármacos , Espectroscopia de Ressonância Magnética/métodos , Extratos Vegetais/farmacologia , Sementes/químicaRESUMO
The larvicidal activity against Aedes aegypti larvae of a stem wood hexane extract of Cybistax antisyphilitica was evaluated. Bioassay-guided fractionation of the crude extract, monitored by larvicidal assay, led to the isolation of a natural quinone identified as 2-hydroxy-3-(3-methyl-2-butenyl)-1.4-naphthoquinone (lapachol). This compound was quite potent against A. aegypti larvae (LC50 26.3 microg/ml).
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Aedes , Bignoniaceae/química , Inseticidas/farmacologia , Naftoquinonas/farmacologia , Animais , Larva/efeitos dos fármacos , Naftoquinonas/isolamento & purificação , Caules de Planta/químicaRESUMO
Several plant species from the Cerrado biome in Brazil are popularly used as herbal medicines for its reputed analgesic, anti-acid, anti-microbial, anti-inflammatory and anti-tumoral properties, among others. It has been reported that some plant extracts interfere in the production of nitric oxide (NO), an important inflammatory mediator. In the present study, we investigated the effect of hexanic and ethanolic extracts from three plant species on NO production by LPS/IFN-gamma-activated J774 macrophages based on traditional use. The cytotoxic effect of the crude extracts was determined by the thiazolyl blue test (MTT) to measure cell viability. Serjania lethalis stem extracts and Cupania vernalis leaf extracts significantly inhibited NO production, while extracts from Casearia sylvestris var. lingua were inactive or showed low activity on NO production, or were very cytotoxic. The ethanolic stem bark and leaf extracts of Serjania lethalis and Cupania vernalis, respectively, almost completely inhibited the production of NO by J774 macrophages. It can be concluded that the selected extracts are potential sources of active compounds that might be used as anti-inflammatory agents.
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Macrófagos/metabolismo , Óxido Nítrico/biossíntese , Plantas Medicinais/química , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Antineoplásicos Fitogênicos/farmacologia , Brasil , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Coleta de Dados , Regulação para Baixo/efeitos dos fármacos , Ensaios de Seleção de Medicamentos Antitumorais , Humanos , Macrófagos/efeitos dos fármacos , Medicina Tradicional , Camundongos , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Células Tumorais CultivadasRESUMO
OBJECTIVE: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. RESEARCH METHODS & PROCEDURES: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. RESULTS: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. CONCLUSIONS: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.
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Educação de Pós-Graduação em Medicina , Apoio Nutricional , América Latina , Inquéritos e QuestionáriosRESUMO
AIM: (a) to establish Hp infection seroprevalence among patients under chronic dialysis and to compare it with that of general population, (b) to assess the relationship between Hp prevalence and parameters associated with a higher morbidity, such as serum albumin levels, dialysis adequacy, and quality of life in this population. METHODS: Ninety-three consecutive patients of both genders (58 M/35 F), X 57.5 +/- 17.2 years old, with end-stage chronic renal failure on maintenance dialysis were included. All of them received dialysis at Hospital Italiano, Buenos Aires. The presence of anti-Hp antibodies was established and its prevalence was compared with a control group. In all cases, serum albumin levels and time in dialysis were determined. In addition, dialysis adequacy was established by KT/V and quality of life was measured with Karnofsky's index. Patients and controls were matched according variables associated with Hp infection in our country, i.e., age, socioeconomic and education levels. RESULTS: Ninety-three dialysis patients were matched with 93 controls. According to the quick serological test, 44 out of 93 (47.3%) dialyzed patients and 55 out of 93 (53.6%) controls were Hp positive (ns). Forty-one out of 76 patients (53.9%) with a serum albumin level 3.5 g/dl and 3/17 (17.6%) with a serum albumin level < 3.5 g/dl were anti-Hp positive (odds ratio, 0.06; 95% CI, 0.01-0.39; p < 0.01). Fifty-five out of 80 patients (69.2%) with Kt/V > 1.2 and 6/13 (43.8%) with Kt/V 1.2 Pounds were anti-Hp positive (odds ratio, 0.10; 95% CI, 0.02-0.65; p < 0.05). Four out of 15 patients (26.7%) with Karnofsky's index > 70, and 40/78 (51.3%) with Karnofsky's index < or = 70 were anti-Hp positive (odds ratio, 0.37; 95% CI, 0.06-2.95, p = 0.26). CONCLUSION: According to our results, dialysis patients do no represent a high-risk group of Hp infection. Those individuals with higher morbidity and mortality rates as evidenced by low serum albumin levels or by a low Kt/V have a lower Hp prevalence, perhaps due to a poor immune response o due to the use of antibiotics. Therefore, Hp infection screening en dialysis units does not differ from the guidelines developed in Maastrich for the general population.