992 resultados para GASTROENTEROLOGY
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Introduccin: La enfermedad celiaca (EC) es una enfermedad autoinmune (EA) intestinal desencadenada por la ingesta de gluten. Por la falta de informacin de la presencia de EC en Latinoamrica (LA), nosotros investigamos la prevalencia de la enfermedad en esta regin utilizando una revisin sistemtica de la literatura y un meta-anlisis. Mtodos y resultados: Este trabajo fue realizado en dos fases: La primera, fue un estudio de corte transversal de 300 individuos Colombianos. La segunda, fue una revisin sistemtica y una meta-regresin siguiendo las guas PRSIMA. Nuestros resultados ponen de manifiesto una falta de anti-transglutaminasa tisular (tTG) e IgA anti-endomisio (EMA) en la poblacin Colombiana. En la revisin sistemtica, 72 artculos cumplan con los criterios de seleccin, la prevalencia estimada de EC en LA fue de 0,46% a 0,64%, mientras que la prevalencia en familiares de primer grado fue de 5,5 a 5,6%, y en los pacientes con diabetes mellitus tipo 1 fue de 4,6% a 8,7% Conclusin: Nuestro estudio muestra que la prevalencia de EC en pacientes sanos de LA es similar a la notificada en la poblacin europea.
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El trasplante de rganos y/o tejidos es considerado como una opcin teraputica viable para el tratamiento tanto de enfermedades crnicas o en estadios terminales, como de afectaciones no vitales, pero que generen una disminucin en la calidad de vida percibida por el paciente. Este procedimiento, de carcter multidimensional, est compuesto por 3 actores principales: el donante, el rgano/tejido, y el receptor. Si bien un porcentaje significativo de investigaciones y planes de intervencin han girado en torno a la dimensin biolgica del trasplante, y a la promocin de la donacin; el inters por la experiencia psicosocial y la calidad de vida de los receptores en este proceso ha aumentado durante la ltima dcada. En relacin con esto, la presente monografa se plantea como objetivo general la exploracin de la experiencia y los significados construidos por los pacientes trasplantados, a travs de una revisin sistemtica de la literatura sobre esta temtica. Para ello, se plantearon unos objetivos especficos derivados del general, se seleccionaron trminos o palabras claves por cada uno de estos, y se realiz una bsqueda en 5 bases de datos para revistas indexadas: Ebsco Host (Academic Search; y Psychology and Behavioral Sciences Collection); Proquest; Pubmed; y Science Direct. A partir de los resultados, se establece que si bien la vivencia de los receptores ha comenzado a ser investigada, an es necesaria una mayor exploracin sobre la experiencia de estos pacientes; exploracin que carecera de objetivo si no se hiciera a travs de las narrativas o testimonios de los mismos receptores
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Introduccin: La obstruccin intestinal es una patologa de alta prevalencia e impacto en los servicios de ciruga general a nivel mundial. El manejo de esta entidad puede ser mdico o quirrgico. Cuando se requiere intervencin quirrgica, se busca evitar el desarrollo de isquemia intestinal y resecciones intestinales; durante el postoperatorio, pueden existir complicaciones. El objetivo de este estudio es identificar los factores asociados al desarrollo de complicaciones post operatorias en un grupo de pacientes con obstruccin intestinal mecnica llevados a manejo quirrgico. Metodologa: Estudio analtico tipo casos y controles en un grupo de pacientes con diagnstico de obstruccin intestinal mecnica llevados a manejo quirrgico de su patologa. Los casos corresponden a los pacientes con complicaciones postoperatorias y los controles aquellos que no presentaron complicaciones. Se identificaron factores asociados a complicacin post operatoria mediante modelos estadsticos bivariados y multivariados de regresin logstica para factores como edad, sexo, antecedente quirrgico, presentacin clnica, paraclnica y diagnstico postoperatorio de malignidad, entre otras. Resultados: Se identificaron un total de 138 pacientes (54 casos y 129 controles). Los rangos de edad entre 55-66 aos y mayor de 66 aos fueron asociados con complicaciones postoperatorias (OR 3,87 IC95% 1,58-9,50 y OR 3,62 IC95% 1,45-9,08 respectivamente). El dficit de base inferior a 5 mEq/litro se relaciona con complicaciones postoperatorias (OR 2,64 IC95% 1.33-5,25) Otras pruebas de laboratorio, caractersticas radiolgicas, hallazgos de malignidad en el postoperatorio y la evolucin de los pacientes no fueron asociados con complicaciones. Conclusiones: Las disminucin de las complicaciones durante el manejo quirrgico de obstruccin intestinal mecnica contina siendo un reto para la ciruga general. Factores no modificables como edad avanzada y modificables como el equilibrio cido base deben ser tenidos en cuenta dada su correlacin en el desarrollo de complicaciones postoperatorias.
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ANTECEDENTES:El aislamiento de clulas fetales libres o ADN fetal en sangre materna abre una ventana de posibilidades diagnsticas no invasivas para patologas monognicas y cromosmicas, adems de permitir la identificacin del sexo y del RH fetal. Actualmente existen mltiples estudios que evalan la eficacia de estos mtodos, mostrando resultados costo-efectivos y de menor riesgo que el estndar de oro. Este trabajo describe la evidencia encontrada acerca del diagnstico prenatal no invasivo luego de realizar una revisinsistemtica de la literatura. OBJETIVOS:El objetivo de este estudio fuereunir la evidencia quecumplacon los criterios de bsqueda, en el tema del diagnstico fetal no invasivo por clulas fetales libres en sangre materna para determinar su utilidad diagnstica. MTODOS:Se realiz una revisinsistemtica de la literatura con el fin de determinar siel diagnstico prenatal no invasivo por clulas fetales libres en sangre materna es efectivo como mtodo de diagnstico. RESULTADOS:Se encontraron 5,893 artculos que cumplan con los criterios de bsqueda;67 cumplieron los criterios de inclusin: 49.3% (33/67) correspondieron a estudios de corte transversal, 38,8% (26/67) a estudios de cohortes y el 11.9% (8/67) a estudios casos y controles.Se obtuvieron resultados de sensibilidad, especificidad y tipo de prueba. CONCLUSIN:En la presente revisin sistemtica, se evidencia como el diagnstico prenatal no invasivo es una tcnica feasible, reproducible y sensible para el diagnstico fetal, evitando el riesgo de un diagnstico invasivo.
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Introduccin: El cncer colorrectal es el tercer cncer ms diagnosticado en los hombres y el segundo en las mujeres a nivel mundial. Hasta 1.000 casos nuevos se diagnostican en Colombia cada ao, por lo que es importante conocer la experiencia con esta patologa en un centro de experiencia recientemente creado en el Mderi, Hospital Universitario Mayor. Materiales y mtodos: Se realiz un estudio de corte transversal de la poblacin con diagnstico de cncer colorrectal atendida entre agosto 2012 y diciembre 2014 que corresponde al tiempo de funcionamiento del servicio de Coloproctologa. Resultados: Se atendieron un total de 152 pacientes con cncer colorrectal en la institucin. Se oper el 91% de los pacientes. El estado ms frecuente fue el IV. Solo el 4.9% present dehiscencia de anastomosis, datos concordantes con la literatura cuando el manejo es a cargo de expertos. El subtipo histolgico ms frecuente fue adenocarcinoma moderadamente diferenciado y la mortalidad perioperatoria de 2.63%. Discusin: El cncer colorrectal es una entidad con alta morbimortalidad lo cual puede cambiar si se realizan pruebas de tamizaje, para realizar un manejo temprano y oportuno. Adems juega un papel importante la experiencia del cirujano y la discusin de los pacientes en juntas multidisciplinarias. Palabras clave: cncer de colon, cncer de recto, epidemiologa, estadificacin
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Determinar el efecto de la ciruga laparoscpica versus ciruga abierta sobre la supervivencia en el manejo de pacientes del cncer colorectal.
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Introduccin: El trasplante heptico ortotpico es la colocacin de un nuevo hgado en la misma ubicacin del explantado. El objetivo es prolongar la duracin y la calidad de vida en pacientes con enfermedades hepticas terminales. Sin embargo, las infecciones bacterianas son una complicacin en los pacientes receptores del trasplante, comprometiendo el xito del procedimiento. El objetivo fue determinar los factores asociados a infecciones bacterianas en el primer mes tras realizada la intervencin y describir las caractersticas demogrficas de esa poblacin. De 332 trasplantes realizados, que 262 cumplieron criterios para el anlisis. Mtodos: Se realiz un estudio observacional analtico de casos y controles anidado en una cohorte, en mayores de 18 aos, receptores de trasplante heptico primario, de la FCI-IC de 2005 a 2014; excluyendo trasplante combinado hgado rin, retrasplantes o fallecidos por causa diferente a la infecciosa durante el primer mes. Resultados: Se encontr que la ventilacin mecnica por ms de 1 da, el catter venoso central mayor de 3 das son los principales factores de riesgo para infecciones bacterianas. La albmina mayor de 2,6gr/dl se asoci a menor infeccin. Los agentes etiolgicos predominantes fueron grmenes gram negativos como E. coli, K. pneumonia y E. cloacae. Mientras que bacteremia, infeccin urinaria y peritonitis fueron las infecciones ms frecuentes. La incidencia de infeccin bacteriana en esta poblacin fue 24%. Discusin: Se recomienda por tanto extubacin antes de 24 horas, uso de catter central menor de 3 das y limitar el uso del catter vesical.
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H. pylori um microrganismo responsvel por gastrites e implicado, em associao com outros factores, na lcera gastroduodenal e no cancro gstrico. O diagnstico da infeco por microrganismo pode realizar-se recorrendo a mtodos invasivos atravs da obteno de uma bipsia gstrica obtida por endoscopia digestiva alta e a mtodos no invasivos. Nenhum dos mtodos, desenvolvido at hoje, constitui o mtodo ideal. Todos eles possuem as suas vantagens e desvantagens consoante a situao em que so aplicados. A reaco de polimerizao em cadeia (PCR) conduziu a uma modificao fundamental no campo da biologia molecular, abrindo novos horizontes nas cincias mdicas e biolgicas. Apesar da cultura de H. pylori a partir de bipsia gstrica continuar a ser o mtodo de referncia para o diagnstico da infeco por esta bactria, ela apresenta inconvenientes que podem ser ultrapassados pela utilizao da PCR, como sejam o longo perodo para a obteno de resultados e o respeito de condies estritas de transporte da bipsia gstrica. Recentemente foi desenvolvido um protocolo baseado no principio da PCR em tempo real, utilizando o aparelho LightCycler Roche Diagnostics. Este protocolo permite a obteno de um resultado de deteco da presena de H. pylori na bipsia gstrica assim como do seu perfil de susceptibilidade aos macrlidos. A PCR em tempo real dotada de uma grande sensibilidade e especificidade, rapidez de obteno de resultados o que aliado sua capacidade de deteco de mutaes responsveis pela resistncia dos microrganismos aos antibiticos faz com que esta tcnica seja a metodologia do futuro no diagnstico das doenas infecciosas.
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A homeopatia uma forma holstica de medicina, que visa um dos prncipios hipocrticos Similia similibus curantur, o semelhante cura o semelhante, isto , a doena pode ser tratada atravs da administrao de princpios activos que induzam, num animal saudvel, sintomas semelhantes aos provocados pela doena. possvel prescrever em diversas situaes clnicas, como nica opco ou complementar de diferentes teraputicas, de forma a promover a sade animal. A presente dissertao consta de um estudo retrospectivo baseado numa amostra com 68 gatos e 23 ces, observados durante 60 dias no decorrer do estgio curricular na Clnica Refgio da Bicharada, na qual se procede caracterizao da aplicao da homeopatia na prtica clnica. A aplicao de tratamento homeoptico verifica-se em 75% dos animais da amostra, enquanto que o tratamento homeoptico complementar em 25% da amostra. O tratamento homeoptico exclusivo foi prescrito com maior frequncia na rea da etologia (100%; n=28), seguido de doenas do tracto respiratrio (90%; n=18) e gastroenterologia (55%; n=6). As doenas em que mais foi prescrito o tratamento homeoptico exclusivo foi em coriza (93%; n=14); agressividade em ninhadas (100%; n=14); apatia comportamental (100%; n=9); osteoartrose (57%; n=4); gengivo-estomatite e asma brnquica (75%; n=3); e obstipao (100%; n=3). Verifica-se que em vrias circunstncias se recorre a medicamentos homeopticos como opo teraputica, aplicando-os como tratamento nico ou complementar na prtica clnica de pequenos animais.
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Atualmente a radiografia um exame complementar de diagnstico presente na grande maioria dos centros clnicos veterinrios, estando assim facilmente acessvel, motivo pelo qual dever na maioria das vezes ser o primeiro exame auxiliar de diagnstico por imagem a ser empregue em estudos do abdmen. A radiografia convencional do trato gastrointestinal permite avaliar a posio do mesmo, o seu contedo e tamanho, no sendo no entanto o meio de diagnstico mais eficaz para a avaliao da integridade da sua mucosa. Devido ao seu potencial diagnstico, o exame radiogrfico deve ser realizado para diagnstico de patologia do TGI sempre que o animal se apresente consulta com sinais clnicos compatveis com patologia do mesmo, como: vmito, regurgitao, tenesmo, diarreia, disquzia, etc Assim, tendo em conta o referido tornou-se pertinente determinar qual a utilidade do exame radiogrfico na prtica clnica. Deste modo, o presente estudo retrospetivo tem como objetivo determinar a utilidade do exame radiogrfico na avaliao da morfologia e patologia do trato gastrointestinal. Para tal foi utilizada uma amostra composta por 44 indivduos, 35 da espcie canina e 9 da espcie felina, que realizaram consulta no Hospital Veterinrio do Baixo Vouga, apresentando sintomatologia compatvel com afeo do trato gastrointestinal e que realizaram exame radiogrfico abdominal. No exame radiogrfico avaliaram-se vrios parmetros da morfologia do estmago (contedo e tamanho), intestino delgado (contedo, dimetro luminal e distribuio pela cavidade abdominal) e intestino grosso (contedo, dimetro luminal). Com base nas observaes registadas, pde concluir-se que a observao dos rgos do trato gastrointestinal o fator que condiciona a avaliao morfolgica radiogrfica, pois sempre que estes so radiograficamente visveis todos os fatores so passveis de serem avaliados. Quanto utilidade do exame radiogrfico na avaliao da patologia do trato gastrointestinal, pde concluir-se que este possui uma sensibilidade de 63,89% e especificidade de 25%, pelo que, apresenta razovel utilidade na prtica clnica, justificando-se a sua realizao.
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The inaugural meeting of the International Scientific Association for Probiotics and Prebiotics (ISAPP) was held May 3 to May 5 2002 in London, Ontario, Canada. A group of 63 academic and industrial scientists from around the world convened to discuss current issues in the science of probiotics and prebiotics. ISAPP is a non-profit organization comprised of international scientists whose intent is to strongly support and improve the levels of scientific integrity and due diligence associated with the study, use, and application of probiotics and prebiotics. In addition, ISAPP values its role in facilitating communication with the public and healthcare providers and among scientists in related fields on all topics pertinent to probiotics and prebiotics. It is anticipated that such efforts will lead to development of approaches and products that are optimally designed for the improvement of human and animal health and well being. This article is a summary of the discussions, conclusions, and recommendations made by 8 working groups convened during the first ISAPP workshop focusing on the topics of: definitions, intestinal flora, extra-intestinal sites, immune function, intestinal disease, cancer, genetics and genomics, and second generation prebiotics. Humans have evolved in symbiosis with an estimated 1014 resident microorganisms. However, as medicine has widely defined and explored the perpetrators of disease, including those of microbial origin, it has paid relatively little attention to the microbial cells that constitute the most abundant life forms associated with our body. Microbial metabolism in humans and animals constitutes an intense biochemical activity in the body, with profound repercussions for health and disease. As understanding of the human genome constantly expands, an important opportunity will arise to better determine the relationship between microbial populations within the body and host factors (including gender, genetic background, and nutrition) and the concomitant implications for health and improved quality of life. Combined human and microbial genetic studies will determine how such interactions can affect human health and longevity, which communication systems are used, and how they can be influenced to benefit the host. Probiotics are defined as live microorganisms which, when administered in adequate amounts confer a health benefit on the host.1 The probiotic concept dates back over 100 years, but only in recent times have the scientific knowledge and tools become available to properly evaluate their effects on normal health and well being, and their potential in preventing and treating disease. A similar situation exists for prebiotics, defined by this group as non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria. Prebiotics function complementary to, and possibly synergistically with, probiotics. Numerous studies are providing insights into the growth and metabolic influence of these microbial nutrients on health. Today, the science behind the function of probiotics and prebiotics still requires more stringent deciphering both scientifically and mechanistically. The explosion of publications and interest in probiotics and prebiotics has resulted in a body of collective research that points toward great promise. However, this research is spread among such a diversity of organisms, delivery vehicles (foods, pills, and supplements), and potential health targets such that general conclusions cannot easily be made. Nevertheless, this situation is rapidly changing on a number of important fronts. With progress over the past decade on the genetics of lactic acid bacteria and the recent, 2,3 and pending, 4 release of complete genome sequences for major probiotic species, the field is now armed with detailed information and sophisticated microbiological and bioinformatic tools. Similarly, advances in biotechnology could yield new probiotics and prebiotics designed for enhanced or expanded functionality. The incorporation of genetic tools within a multidisciplinary scientific platform is expected to reveal the contributions of commensals, probiotics, and prebiotics to general health and well being and explicitly identify the mechanisms and corresponding host responses that provide the basis for their positive roles and associated claims. In terms of human suffering, the need for effective new approaches to prevent and treat disease is paramount. The need exists not only to alleviate the significant mortality and morbidity caused by intestinal diseases worldwide (especially diarrheal diseases in children), but also for infections at non-intestinal sites. This is especially worthy of pursuit in developing nations where mortality is too often the outcome of food and water borne infection. Inasmuch as probiotics and prebiotics are able to influence the populations or activities of commensal microflora, there is evidence that they can also play a role in mitigating some diseases. 5,6 Preliminary support that probiotics and prebiotics may be useful as intervention in conditions including inflammatory bowel disease, irritable bowel syndrome, allergy, cancer (especially colorectal cancer of which 75% are associated with diet), vaginal and urinary tract infections in women, kidney stone disease, mineral absorption, and infections caused by Helicobacter pylori is emerging. Some metabolites of microbes in the gut may also impact systemic conditions ranging from coronary heart disease to cognitive function, suggesting the possibility that exogenously applied microbes in the form of probiotics, or alteration of gut microecology with prebiotics, may be useful interventions even in these apparently disparate conditions. Beyond these direct intervention targets, probiotic cultures can also serve in expanded roles as live vehicles to deliver biologic agents (vaccines, enzymes, and proteins) to targeted locations within the body. The economic impact of these disease conditions in terms of diagnosis, treatment, doctor and hospital visits, and time off work exceeds several hundred billion dollars. The quality of life impact is also of major concern. Probiotics and prebiotics offer plausible opportunities to reduce the morbidity associated with these conditions. The following addresses issues that emerged from 8 workshops (Definitions, Intestinal Flora, Extra-Intestinal Sites, Immune Function, Intestinal Disease, Cancer, Genomics, and Second Generation Prebiotics), reflecting the current scientific state of probiotics and prebiotics. This is not a comprehensive review, however the study emphasizes pivotal knowledge gaps, and recommendations are made as to the underlying scientific and multidisciplinary studies that will be required to advance our understanding of the roles and impact of prebiotics, probiotics, and the commensal microflora upon health and disease management.
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Every minute of every day more and more children die of diarrheal diseases and women, and girls become infected by HIV An estimated 7,000 women become infected each day. While many valiant efforts are being made to address these issues, until now they have proved to be markedly ineffective. The notion that lactic acid bacteria, formulated into food or dietary supplements, could have a role to play in slowing the morbidity and mortality associated with HIV/AIDS and gastroenteritis, is built upon sound clinical findings and scientific investigations, yet no international efforts have been placed in this approach, to date. We hereby summarize the reasons why such efforts should be made, provide an example of one model being set up in sub-Saharan Africa, and challenge the international community to consider the potential benefits of probiotics, especially for communities not reached by governmental and nongovernmental agencies.
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In nutritional sciences there is much interest in dietary modulation of the human gut. The gastrointestinal tract, particularly the colon, is very heavily populated with bacteria. Most bacteria are benign; however, certain gut species are pathogenic and may be involved in the onset of acute and chronic disorders. Bifidobacteria and lactobacilli are thought to be beneficial and are common targets for dietary intervention. Prebiotic is a non-viable food ingredient selectively metabolized by beneficial intestinal bacteria. Dietary modulation of the gut microflora by prebiotics is designed to improve health by stimulating numbers and/or activities of the bifidobacteria and lactobacilli. Having an 'optimal' gut microflora can increase resistance to pathogenic bacteria, lower blood ammonia, increase stimulation of the immune response and reduce the risk of cancer. This chapter examines how prebiotics are being applied to the improvement of human health and reviews the scientific evidence behind their use.
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Functional foods is an often-used term applied to dietary ingredients that serve to improve consumer health. Over the last few decades, these foods have gained in popularity with sales continuing to increase rapidly. Recent scientific, and some lay, reports have shown the popularity of both probiotics and prebiotics. These serve to elicit changes in the gut microbiota composition that increase populations of purported beneficial gut bacterial genera, for example, lactobacilli or bifidobacteria. Probiotics use live microbial feed additions, whereas prebiotics target indigenous flora components. As gastrointestinal disorders are prevalent in terms of human health, both probiotics and prebiotics serve an important role in the prophylactic management of various acute and chronic gut derived conditions. Examples include protection from gastroenteritis and some inflammatory conditions.
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Objective: Certain milk factors may promote the growth of a host-friendly gastrointestinal microbiota, for example, one that is predominated by bifidobacteria, a perceived healthpromoting genus. This may explain why breast-fed infants experience fewer intestinal infections than their formula-fed counterparts who are believed to have a more diverse microbiota, which is similar to that of adults. The effects of formulas supplemented with 2 such ingredients from bovine milk, a-lactalbumin (alpha-lac) and casein glycomacropeptide (GMP), on gut flora were investigated in this study. Patients and Methods: Six-week-old (4-8 wk), healthy term infants were randomised to a standard infant formula or 1 of 2 test formulae enriched in alpha-Jac with higher or lower GMP until 6 months. Faecal bacteriology was determined by the culture-independent procedure fluorescence in situ hybridisation. Results: There was a large fluctuation of bacterial counts within groups with no statistically significant differences between groups. Although all groups showed a. predominance of bifidobacteria, breast-fed infants had a small temporary increase in counts. Other bacterial levels varied in formula-fed groups, which overall showed an adult-like faecal microflora. Conclusions: It can be speculated that a prebiotic effect for alpha-lac and GMP is achieved only with low starting populations of beneficial microbiota (eg, infants not initially breast-fed.
