Early-onset Crohn's disease is a risk factor for smaller final height.

OBJECTIVES Growth retardation is a frequent complication of paediatric inflammatory bowel disease (IBD). Only a few studies report the final height of these patients, with controversial results. We compared adult height of patients with paediatric IBD with that of patients with adult-onset disease. METHODS Height data of 675 women 19-44 years of age and 454 men 23-44 years of age obtained at inclusion in the Swiss IBD cohort study registry were grouped according to the age at diagnosis: (a) prepubertal (men≤13, women≤11 years), (b) pubertal (men 13-22, women 11-18 years) and (c) adult (men>22, women>18 years of age), and compared with each other and with healthy controls. RESULTS Male patients with prepubertal onset of Crohn's disease (CD) had significantly lower final height (mean 172±6 cm, range 161-182) compared with men with pubertal (179±6 cm, 161-192) or adult (178±7 cm, 162-200) age at onset and the general population (178±7 cm, 142-204). Height z-scores standardized against heights of the normal population were significantly lower in all patients with a prepubertal diagnosis of CD (-0.8±0.9) compared with the other patient groups (-0.1±0.8, P<0.001). Prepubertal onset of CD emerged as a risk factor for reduced final height in patients with prepubertal CD. No difference for final height was found between patients with ulcerative or unclassified IBD diagnosed at prepubertal, pubertal or adult age. CONCLUSION Prepubertal onset of CD is a risk for lower final height, independent of the initial disease location and the necessity for surgical interventions.

Serum ficolin-2 correlates worse than fecal calprotectin and CRP with endoscopic Crohn's disease activity.

BACKGROUND AND AIMS Ficolin-2 is an acute phase reactant produced by the liver and targeted to recognize N-acetyl-glucosamine which is present in bacterial and fungal cell walls. We recently showed that ficolin-2 serum levels were significantly higher in CD patients compared to healthy controls. We aimed to evaluate serum ficolin-2 concentrations in CD patients regarding their correlation with endoscopic severity and to compare them with clinical activity, fecal calprotectin, and CRP. METHODS Patients provided fecal and blood samples before undergoing ileo-colonoscopy. Disease activity was scored clinically according to the Harvey-Bradshaw Index (HBI) and endoscopically according to the simplified endoscopic score for CD (SES-CD). Ficolin-2 serum levels and fecal calprotectin levels were measured by ELISA. RESULTS A total of 136 CD patients were prospectively included (mean age at inclusion 41.5±15.4 years, 37.5% females). Median HBI was 3 [2-6] points, median SES-CD was 5 [2-8], median fecal calprotectin was 301 [120-703] μg/g, and median serum ficolin-2 was 2.69 [2.02-3.83] μg/mL. SES-CD correlated significantly with calprotectin (R=0.676, P<0.001), CRP (R=0.458, P<0.001), HBI (R=0.385, P<0.001), and serum ficolin-2 levels (R=0.171, P=0.047). Ficolin-2 levels were higher in CD patients with mild endoscopic disease compared to patients in endoscopic remission (P=0.015) but no difference was found between patients with mild, moderate, and severe endoscopic disease. CONCLUSIONS Ficolin-2 serum levels correlate worse with endoscopic CD activity when compared to fecal calprotectin or CRP.

Factors Associated with Durable Response to Infliximab in Crohnʼs Disease 5 Years and Beyond: A Multicenter International Cohort

BACKGROUND: Infliximab (IFX) has been used for over a decade worldwide. Less is known about the natural history of IFX use beyond a few years and which patients are more likely to sustain benefits. METHODS: Patients with Crohn's disease (CD) exposed to IFX from Massachusetts General Hospital, Boston, Saint-Antoine Hospital, Paris, and the Swiss IBD Cohort Study were identified through retrospective and prospective data collection, complemented by chart abstraction of electronic medical records. We compared long-term users of IFX (>5 yr of treatment, long-term users of infliximab [LTUI]), with non-LTUI patients to identify prognostic factors. RESULTS: We pooled data on 1014 patients with CD from 3 different databases, of whom 250 were defined as LTUI. The comparison group comprised 290 patients with CD who discontinued IFX: 48 primary nonresponses, 95 loss of responses, and 147 adverse events. Factors associated with LTUI were colonic involvements and an earlier age at the start of IFX. The prevalence of active smokers and obese patients differed markedly, but inversely, between American and European centers but did not impact outcome. The discontinuation rate was stable around 3% to 6%, each year from years 3 to 10. CONCLUSIONS: Young age at start of IFX and colonic CD are factors associated with a beneficial long-term use of IFX. After 5 years of IFX, there is still a 3% to 5% discontinuation rate annually. Several factors associated with a good initial response such as nonsmoker and shorter disease duration at IFX initiation do not seem associated with a longer term response.

Monitoring disease activity and progression in Crohn's disease. A Swiss perspective on the IBD ahead 'optimised monitoring' recommendations.

BACKGROUND AND AIMS The structured IBD Ahead 'Optimised Monitoring' programme was designed to obtain the opinion, insight and advice of gastroenterologists on optimising the monitoring of Crohn's disease activity in four settings: (1) assessment at diagnosis, (2) monitoring in symptomatic patients, (3) monitoring in asymptomatic patients, and (4) the postoperative follow-up. For each of these settings, four monitoring methods were discussed: (a) symptom assessment, (b) endoscopy, (c) laboratory markers, and (d) imaging. Based on literature search and expert opinion compiled during an international consensus meeting, recommendations were given to answer the question 'which diagnostic method, when, and how often'. The International IBD Ahead Expert Panel advised to tailor this guidance to the healthcare system and the special prerequisites of each country. The IBD Ahead Swiss National Steering Committee proposes best-practice recommendations adapted for Switzerland. METHODS The IBD Ahead Steering Committee identified key questions and provided the Swiss Expert Panel with a structured literature research. The expert panel agreed on a set of statements. During an international expert meeting the consolidated outcome of the national meetings was merged into final statements agreed by the participating International and National Steering Committee members - the IBD Ahead 'Optimized Monitoring' Consensus. RESULTS A systematic assessment of symptoms, endoscopy findings, and laboratory markers with special emphasis on faecal calprotectin is deemed necessary even in symptom-free patients. The choice of recommended imaging methods is adapted to the specific situation in Switzerland and highlights the importance of ultrasonography and magnetic resonance imaging besides endoscopy. CONCLUSION The recommendations stress the importance of monitoring disease activity on a regular basis and by objective parameters, such as faecal calprotectin and endoscopy with detailed documentation of findings. Physicians should not rely on symptoms only and adapt the monitoring schedule and choice of options to individual situations.

Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

BACKGROUND The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown. AIM To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. METHODS Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. RESULTS The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006). CONCLUSIONS Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication.

High Rates of Smoking Especially in Female Crohn's Disease Patients and Low Use of Supportive Measures to Achieve Smoking Cessation--Data from the Swiss IBD Cohort Study

BACKGROUND AND AIMS Smoking is a crucial environmental factor in inflammatory bowel disease [IBD]. However, knowledge on patient characteristics associated with smoking, time trends of smoking rates, gender differences and supportive measures to cease smoking provided by physicians is scarce. We aimed to address these questions in Swiss IBD patients. METHODS Prospectively obtained data from patients participating in the Swiss IBD Cohort Study was analysed and compared with the general Swiss population [GSP] matched by age, sex and year. RESULTS Among a total of 1770 IBD patients analysed [49.1% male], 29% are current smokers. More than twice as many patients with Crohn's disease [CD] are active smokers compared with ulcerative colitis [UC] [UC, 39.6% vs CD 15.3%, p < 0.001]. In striking contrast to the GSP, significantly more women than men with CD smoke [42.8% vs 35.8%, p = 0.025], with also an overall significantly increased smoking rate compared with the GSP in women but not men. The vast majority of smoking IBD patients [90.5%] claim to never have received any support to achieve smoking cessation, significantly more in UC compared with CD. We identify a significantly negative association of smoking and primary sclerosing cholangitis, indicative of a protective effect. Psychological distress in CD is significantly higher in smokers compared with non-smokers, but does not differ in UC. CONCLUSIONS Despite well-established detrimental effects, smoking rates in CD are alarmingly high with persistent and stagnating elevations compared with the GSP, especially in female patients. Importantly, there appears to be an unacceptable underuse of supportive measures to achieve smoking cessation.

Network-based genome-wide association study of Crohn's disease

Genome-wide association studies (GWAS) have rapidly become a standard method for disease gene discovery. Many recent GWAS indicate that for most disorders, only a few common variants are implicated and the associated SNPs explain only a small fraction of the genetic risk. The current study incorporated gene network information into gene-based analysis of GWAS data for Crohn's disease (CD). The purpose was to develop statistical models to boost the power of identifying disease-associated genes and gene subnetworks by maximizing the use of existing biological knowledge from multiple sources. The results revealed that Markov random field (MRF) based mixture model incorporating direct neighborhood information from a single gene network is not efficient in identifying CD-related genes based on the GWAS data. The incorporation of solely direct neighborhood information might lead to the low efficiency of these models. Alternative MRF models looking beyond direct neighboring information are necessary to be developed in the future for the purpose of this study.^

Análisis de las condiciones generales de vida de las familias tabacaleras con personas discapacitadas del municipio se San Vicente, provincia de Misiones: Representaciones sociales sobre agrotóxicos, discapacidad-enfermedad y modos de atención de las necesidades socio sanitarias de sus integrantes. 16H271

A través del presente proyecto se pretende describir: a) la incidencia de personas discapacitadas y enfermas en familias tabacaleras que trabajan con agrotóxicos (determinando cantidad de discapacitados y enfermos entre familias tabacaleras, Su ubicación y distribución geográfica en el Municipio de San Vicente, Departamento Guaraní, Provincia de Misiones); b) las características de la vida cotidiana, sus posibilidades para cubrir las demandas de educación y atención de sus integrantes, particularmente, de aquellos categorizados como discapacitados o enfermos y, c) modos en que las familias tabacaleras interpretan la relación de los problemas de enfermedad y discapacidad con sus condiciones de vida y el trabajo agrícola con agrotóxicos. A través de la categoría calidad de vida de las familias tabacaleras, identificar y describir el potencial de estas unidades para articular con la sociedad local los distintos elementos de atención (educación, asesoramiento, medica-sanitaria, rehabilitación socio-psicofísica, cobertura de beneficios legales, económicos y sociales) que permitan a las personas enfermas y/o discapacitadas alcanzar el máximo de sus potencialidades y autovalimiento en relación con los ciclos vitales de la familia. Con la participación de profesionales de la medicina y del medio ambiente se indagará entre los productores sobre el posible impacto de los agrotóxicos en aquellos aspectos relacionados a la calidad del suelo de dicado a la producción de alimentos y de la agua para beber.

Análisis de las condiciones generales de vida de las familias tabacaleras con personas discapacitadas del municipio de San Vicente, Provincia de Misiones: representaciones sociales sobre agrotóxicos, discapacidad-enfermedad y modos de atención de las necesidades socio sanitarias de sus integrantes. 16H271

Actividades desarrolladas durante el período: conformación del Equipo de investigadores; búsqueda, identificación y análisis de bibliografía vinculada con las temáticas cultivos con uso de agrotóxicos, economía familiar y atención de la población de estas unidades socioproductivas en lo referente a procesos de salud - enfermedad – atención, y discapacidad; formulación de un marco teórico conceptual para el proyecto; organización y realización de reuniones con autoridades locales involucradas con la temática de la discapacidad; articulación con el INTA, y el Ministerio de Salud Pública de la Provincia de Misiones y otras entidades públicas y privadas (Fundación del Bco. Macro., Fundación para la Investigación y Ext. de las Cs. Económicas, etc) Articulación con el INTA, y el Ministerio de Salud Pública de la Provincia de Misiones y otras entidades públicas y privadas (Fundación del Bco. Macro., Fundación para la Investigación y Ext. de las Cs. Económicas, etc); recolección de datos de fuentes secundarias; análisis de información proveniente de fuentes secundarias y producción de datos estadísticos; revisión de objetivos específicos, dimensiones y variables Diseño del relevamiento de entrevistas a profesionales médicos, trabajadores sociales, docentes, autoridades religiosas; diseño del relevamiento de entrevistas a profesionales médicos, trabajadores sociales, docentes, autoridades religiosas; selección de muestra para entrevistas abiertas; realización de las entrevistas abiertas.

Chagas, la enfermedad silenciosa

Este video es parte de una serie de producciones realizadas por alumnos de la Carrera de Comunicación Social de la UNCuyo, como trabajo final de la Cátedra de Televisión y Medios Audiovisuales en el año 2006. Los mismos participaron de una muestra audiovisual en el Cine de la Universidad en agosto de 2007. Son trabajos periodísticos y documentales de alumnos avanzados de la carrera, en formato profesional, abordando temáticas sociales, políticas, culturales y de arte, haciendo visible realidades y personajes de la provincia. Según alumnos y docentes, estos videos “van al encuentro del público mendocino para que nos conozca, critique, reflexione, sonría y se emocione…" CHAGAS, LA ENFERMEDAD SILENCIOSA, documental sobre los distintos aspectos de esta enfermedad: el contagio, sus etapas, la marginación y los estados psicológicos del enfermo.

Las enfermedades mentales según Tomás de Aquino : sobre el concepto de enfermedad

Este artículo es la primera parte de un estudio sobre las enfermedades mentales según santo Tomás. Aquí se exponen los temas de las fuentes médico-biológicas del Aquinate (fundamentalmente Aristóteles, Galeno, Nemesio y Avicena), la naturaleza de la enfermedad, su relación con las pasiones del alma y algunas consecuencias que se siguen para el tema de la enfermedad mental. En un artículo posterior se entrará en el detalle de las categorías psicopatológicas que aparecen en las obras del Aquinate y su significado a la luz de sus fuentes, así como en los temas de las enfermedades psicosomáticas y lo que santo Tomás llama “aegritudo animalis".

Enfermedad renal crónica : una epidemia

Fil: Alabart, E.. Universidad Nacional de Tucumán

Enfermedad de Darier-White

Fil: Parra, Viviana Gladys. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Cátedra de Dermatología

Adipocitoquinas y síndrome metabólico : rol de la vistafina en la patogenia de enfermedad cardiovascular

La enfermedad cardiovascular es la primera causa de morbi-mortalidad en los países industrializados. El síndrome metabólico, caracterizado por hipertensión, dislipidemia, obesidad e hiperglucemia, constituye el principal factor de riesgo para la enfermedad cardiovascular. El tejido adiposo visceral juega un papel fundamental en este proceso, dado que secreta una variedad de sustancias biológicamente activas denominadas adipoquinas o adipocitoquinas, tales como leptina, resistina, adiponectina, factor de necrosis tumoral alfa (TNFa), y visfatina entre otras. La visfatina es una citoquina descubierta recientemente y su rol en la enfermedad cardiovascular es controversial y aún no ha sido completamente dilucidado. Estudios realizados en humanos y en modelos experimentales en animales sugieren que la visfatina tendría un papel muy importante en las patologías asociadas a la enfermedad cardiovascular. Esta revisión intenta mostrar los últimos avances sobre el rol de la visfatina y las principales adipocitoquinas en las patologías cardiovasculares y el síndrome metabólico.

Enfermedad celíaca y su relación con la cavidad bucal

El objetivo del siguiente trabajo es describir las características de la enfermedad celíaca, y sus expresiones más frecuentes en la cavidad bucal. Las manifestaciones de esta patología pueden ser divididas en formas típicas y atípicas. Las formas atípicas saben mostrar alteraciones extra-intestinales entre las cuales los signos orales suelen constituir las señales iniciales de la enfermedad y podrían orientar al diagnóstico precoz de la misma, favoreciendo a implementar las medidas preventivas adecuadas.