Troubles gastro-intestinaux et activités sportives [Lower intestinal distress during sports activities].

This article reviews the literature regarding gastrointestinal disturbances in particular in runners. The lower intestinal problems of motility and blood loss are discussed. These problems are directly related to running. These symptoms, especially diarrhea are common and can impact adversely both performance and the health of the athlete. Most cases are relatively benign. The sport medicine clinician should be familiar with the management of these problems in order to optimize the treatment and facilitate return to sport.

Distribution of hospital admissions in a middle-income country of the African region

Introduction: Few studies have reported the distribution of all hospital admissions at the entire country level in low and middle-income countries (LMICs). We examined this question in Seychelles, a rapidly developing small island state in the Africa region, in which access to health care is provided free of charge to all inhabitants through a national health system and all hospital admissions are routinely registered. Methods: Based on all admissions to all hospitals in Seychelles in 2005-2008, we calculated the distribution of hospital admissions, age at admission, length of stay and bed occupancy (i.e. cumulated number of patients * number of days spent in all hospitals) according to both hospital departments and broad causes of diseases (using codes of the ICD-10 classification of diseases). Results: Bed occupancy was largest in the surgical wards (36.7% of all days spent in all hospitals), followed by the medical wards (24.3%), gynecology/obstetrics wards (18.4%), pediatric wards (11.2%), and psychiatric wards (7.2%). According to broad causes of diseases/conditions, bed occupancy was highest for obstetrics/gynecology conditions (19.9% of all days spent at hospital), mental diseases (8.6%), cardiovascular diseases (8.1%), upper aerodigestive/pulmonary diseases (8%), infectious/parasitic diseases (8%), gastrointestinal diseases (7.2%), and urogenital diseases (6.7%). Adjusted to 100'000 population, 153 hospital beds are needed every day, including 31 for obstetrics/gynecologic conditions, 13 for mental diseases, 12 for cardiovascular diseases, 12 for upper aerodigestive diseases, 12 for infectious/parasitic diseases, and 11 for gastrointestinal diseases. Conclusion: Our findings give a good indication of the overall distribution of admissions according to both hospital departments and broad causes of diseases in a middle-income country. These findings provide important information for health care planning at the national level

Assessment of airborne virus contamination in wastewater treatment plants

INTRODUCTION: Occupational exposure to bioaerosols in wastewater treatment plants (WWTP) and its consequence on workers׳ health are well documented. Most studies were devoted to enumerating and identifying cultivable bacteria and fungi, as well as measuring concentrations of airborne endotoxins, as these are the main health-related factors found in WWTP. Surprisingly, very few studies have investigated the presence and concentrations of airborne virus in WWTP. However, many enteric viruses are present in wastewater and, due to their small size, they should become aerosolized. Two in particular, the norovirus and the adenovirus, are extremely widespread and are the major causes of infectious gastrointestinal diseases reported around the world. The third one, hepatitis E virus, has an emerging status. GOAL AND METHODS: This study׳s objectives were to detect and quantify the presence and concentrations of 3 different viruses (adenovirus, norovirus and the hepatitis E virus) in air samples from 31 WWTPs by using quantitative polymerase chain reaction (qPCR) during two different seasons and two consecutive years. RESULTS: Adenovirus was present in 100% of summer WWTP samples and 97% of winter samples. The highest airborne concentration measured was 2.27×10(6) genome equivalent/m(3) and, on average, these were higher in summer than in winter. Norovirus was detected in only 3 of the 123 air samples, and the hepatitis E virus was not detected. CONCLUSIONS: Concentrations of potentially pathogenic viral particles in WWTP air are non-negligible and could partly explain the work-related gastrointestinal symptoms often reported in employees in this sector.

Chirurgie viscérate chez le patient greffé ou en attente d'une transplantation [Visceral surgery in organ transplant recipients or in patients awaiting transplantation]

Patients receiving immunosuppression are at higher risk for gastrointestinal complications: mortality is high if they are not diagnosed and treated rapidly. Systematic screening for cholelithiasis or diverticular disease, and prophylactic surgery, are not recommended systematically anymore. Patients awaiting a transplant with abdominal symptoms should be investigated without delay and surgery, if indicated and whenever possible based on the anaesthetic evaluation, should be performed. In the transplant population, a high degree of suspicion must be raised in case of any abdominal symptom. Radiological investigations and surgery without delay are often the only ways to preserve the function of the graft and optimize the patient's survival.

Targeted vs. standard treatment against Helicobacter pylori: safety assessment clinical trial

Helicobacter pylori (H. pylori) is a gram negative bacteria that represents a considerable global burden in the world and is related to many gastrointestinal diseases (peptic ulcer, gastric MALT lymphoma or gastric cancer). Currently the triple standard therapy is less used as there is an increase of the clarithromycin resistance. Therefore patients have to receive several lines of treatment with the consequence of adverse events and the possibility to interrupt the treatment. This is why the main objective is to determine if making a culture and antibiogram to do a targeted treatment cause less adverse events with the same eradication than making an empirical treatment to eradicate H. pylori. The secondary objective is to determine the prevalence of resistance to clarithromycin in the province of GironaThis is a multicentre clinical trial without blinding; patients are selected by non-probabilistic sampling, with a total sample of 868 patients randomized in two equal groups of 434 patients in each group. The study will last 2 years. The endpoints will be to evaluate the adverse events and eradication of each group of patients. Also it will be evaluated the resistance to clarithromycin

Prevalencia del ausentismo en una entidad de salud de Floridablanca (Colombia) en el año 2014 y los factores laborales y satisfacción asociados

Introducción: El ausentismo es considerado una problemática de interés en el entorno laboral, debido a sus consecuencias en el ámbito personal, productivo, competitivo, organizacional y social. Objetivo: Determinar la prevalencia del ausentismo laboral en una institución de salud de Floridablanca (Colombia) en el año 2014 y los factores laborales y de satisfacción asociados. Métodos: Estudio descriptivo de corte transversal, se realizó un muestreo por conveniencia, se aplicó una encuesta auto-administrada que evaluaba factores personales, laborales, satisfacción laboral y ausentismo en 169 trabajadores de una entidad de salud de segundo nivel de Floridablanca (Colombia). Se calculó la prevalencia del ausentismo y el promedio de días de duración; también, se realizó un análisis bivariado mediante la prueba de Chi2 y la prueba de T de Student para identificar asociaciones. Resultados: Se encontró una prevalencia de ausentismo laboral en los trabajadores del área asistencial de 15.7%, con una duración promedio de 5 días; asimismo, las principales alteraciones de salud que ocasionaron ausentismo fueron las enfermedades respiratorias, virosis y enfermedades gastrointestinales (15%, 20% y 15%, respectivamente). Se encontraron asociaciones estadísticamente significativas entre el área de desempeño, el estrato económico y el nivel académico con el ausentismo laboral; sin embargo, no se encontró asociación con la satisfacción laboral. Conclusiones: A pesar de que los hallazgos del presente estudio deben ser interpretados con precaución debido al tipo de muestreo, éstos permiten identificar las posibles asociaciones con el ausentismo laboral en trabajadores de entidades de salud; además, se sugiere evaluar el ausentismo con las variables inmersas en la satisfacción laboral.

Caracterización del perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio

Introducción: La desnutrición intrahospitalaria es variable en los estudios publicados. Tiene impacto en el curso tórpido de la enfermedad, en la prolongación de la estancia hospitalaria y en los altos costos subsecuentes. No existen estudios realizados en Colombia en relación al estado nutricional del paciente pediátrico hospitalizado. Por este motivo se decidió caracterizar el perfil nutricional de pacientes pediátricos hospitalizados en la Clínica Infantil Colsubsidio Materiales y métodos: Se desarrolló un estudio transversal en pacientes pediátricos hospitalizados en un periodo entre Junio 2014 – Marzo 2015. Se realizó descripción de las variables y análisis univariado. Resultados: Se analizaron 320 pacientes: 50% niños y 50% niñas. Edad promedio: 4.6 años, predominio del grupo de los lactantes. Media de estancia hospitalaria: 4,6 días. Baja ingesta, ayuno, dolor de moderada intensidad y factor de estrés grado I fueron las variables más frecuentemente relacionadas con desnutrición. Al ingreso a hospitalización el 57.5 % se encontraron eutróficos, el 17.19% con desnutrición crónica, el 8.44% con desnutrición aguda y el 16.88% con aumento anormal de peso. Al egreso, los eutróficos disminuyeron a 56.25 %, la desnutrición crónica y el aumento anormal de peso se mantuvieron igual y la desnutrición aguda aumento al 10%. Conclusión: Los hallazgos de este estudio están en concordancia con los hallazgos descritos en la literatura. El mayor compromiso nutricional se asoció a patologías respiratorias y gastrointestinales y a mayor estancia hospitalaria.

Caracterización del ausentismo laboral de una IPS que presta servicios de consulta externa de medicina general, 2014

RESUMEN El ausentismo laboral genera un gran impacto económico en las empresas y a la sociedad en general. Es un problema difícil de manejar ya que es multifactorial, porque a pesar de que en su gran mayoría es generado por enfermedad general, al analizarlo se puede encontrar otros factores que conlleven a la ausencia del trabajador y con ello producir alteración al normal funcionamiento de la empresa, por lo que resulta indispensable estudiar este tema. Objetivo Caracterizar las principales causas de ausentismo laboral en los médicos generales de una IPS que presta servicios de consulta externa de medicina general a nivel nacional durante el año 2014. Materiales y Métodos: es un estudio de corte transversal sobre datos secundarios correspondientes al registro de incapacidades que presento la IPS durante el año 2014. Los criterios de inclusión fueron los médicos generales con los que contaba la IPS que presta servicios de salud a nivel nacional durante el año 2014 y los criterios de exclusión fueron las licencias de maternidad y paternidad. El tamaño de la muestra final fue de 202 médicos y el número de incapacidades que se presentó durante el año 2014 fue 313. Se realizó análisis de distribución de frecuencias, porcentaje y prevalencia de las incapacidades. Resultados: durante el año 2014 se presentaron 313 incapacidades, en una población de 202 médicos generales con prevalencia en las mujeres. El diagnóstico más frecuente de las incapacidades fue la categoría diagnostica “otros” en el cual se encuentra migraña, vértigo, alteraciones de la mama con 59 incapacidades, seguida por enfermedades gastrointestinales con 25 incapacidades. Conclusiones y recomendaciones: Las incapacidades fueron más frecuentes en mujeres que en hombres. El diagnóstico de las incapacidades más frecuente fue “enfermedad genérica o ausencia de diagnóstico”. La incapacidad más frecuente de un día que se presentaron 46 registros. El médico que mayor número de incapacidades presento fue de 18 para el año 2014. Se recomienda a la empresa tener un seguimiento de las incapacidades repetitivas, ya que estas podrían tener relación con enfermedad laboral que aún no ha sido calificada. Se recomienda complementar la base de datos con información como el antecedente de enfermedad crónica y el sedentarismo, lo que puede permitir realizar nuevos estudios respecto al riesgo cardiovascular de esta población.

A case of intestinal lymphangictasia with lipogranulomatous lymphangitis in a female rottweiler dog

Uma cadela, fêmea, de raça Rottweiller de três anos de idade apresentou-se com sinais clínicos de diarreira crónica, perda de peso grave e vómito esporádico. A histopatologia revelou uma linfangiectasia intestinal com linfangite lipogranulomatosa. A linfangiectasia intestinal consiste numa dilatação patológica dos vasos linfáticos intestinais, sendo a causa mais frequente de enteropatia com perda de proteína no cão. Este trabalho consiste na apresentação do caso clínico e numa breve revisão da literatura.

Agonists of protease-activated receptors 1 and 2 stimulate electrolyte secretion from mouse gallbladder

Cholecystitis is one of the most common gastrointestinal diseases. Inflammation induces the activation of proteases that can signal to cells by cleaving protease-activated receptors (PARs) to induce hemostasis, inflammation, pain, and repair. However, the distribution of PARs in the gallbladder is unknown, and their effects on gallbladder function have not been fully investigated. We localized immunoreactive PAR(1) and PAR(2) to the epithelium, muscle, and serosa of mouse gallbladder. mRNA transcripts corresponding to PAR(1) and PAR(2), but not PAR(4), were detected by RT-PCR and sequencing. Addition of thrombin and a PAR(1)-selective activating peptide (TFLLRN-NH(2)) to the serosal surface of mouse gallbladder mounted in an Ussing chamber stimulated an increase in short-circuit current in wild-type but not PAR(1) knockout mice. Similarly, serosally applied trypsin and PAR(2) activating peptide (SLIGRL-NH(2)) increased short-circuit current in wild-type but not PAR(2) knockout mice. Proteases and activating peptides strongly inhibited electrogenic responses to subsequent stimulation with the same agonist, indicating homologous desensitization. Removal of HCO(3)(-) ions from the serosal buffer reduced responses to thrombin and trypsin by >80%. Agonists of PAR(1) and PAR(2) increase intracellular Ca(2+) concentration in isolated and cultured gallbladder epithelial cells. The COX-2 inhibitor meloxicam and an inhibitor of CFTR prevented the stimulatory effect of PAR(1) but not PAR(2). Thus PAR(1) and PAR(2) are expressed in the epithelium of the mouse gallbladder, and serosally applied proteases cause a HCO(3)(-) secretion. The effects of PAR(1) but not PAR(2) depend on generation of prostaglandins and activation of CFTR. These mechanisms may markedly influence fluid and electrolyte secretion of the inflamed gallbladder when multiple proteases are generated.

Hippurate: the natural history of a mammalian-microbial co-metabolite

Hippurate, the glycine conjugate of benzoic acid, is a normal constituent of the endogenous urinary metabolite profile and has long been associated with the microbial degradation of certain dietary components, hepatic function and toluene exposure, and is also commonly used as a measure of renal clearance. Here we discuss the potential relevance of hippurate excretion with regards to normal endogenous metabolism and trends in excretion relating to gender, age, and the intestinal microbiota. Additionally, the significance of hippurate excretion with regards to disease states including obesity, diabetes, gastrointestinal diseases, impaired renal function, psychological disorders and autism, as well as toxicity and parasitic infection, are considered.

Alterações morfológicas de tecido laminar do casco e parâmetros clínicos e laboratoriais de equinos com síndrome cólica letal

As afecções gastrintestinais dos cavalos são agravadas por complicações como a laminite, cuja etiopatogenia está relacionada à degradação da membrana basal do tecido laminar por metaloproteinases (MMPs). A ativação das MMPs pode ocorrer devido à liberação local de citocinas inflamatórias ou enzimas provenientes de leucócitos infiltrados no tecido laminar. O objetivo deste trabalho foi avaliar as alterações morfológicas do tecido laminar de equinos com síndrome cólica letal e sua provável associação com parâmetros clínicos e laboratoriais. Observou-se intensa destruição da arquitetura laminar, principalmente nos animais com alterações físicas e laboratoriais mais acentuadas, como tempo de preenchimento capilar prolongado (TPC), membranas mucosas congestas, taquicardia, hemoconcentração e redução nas contagens de plaquetas e leucócitos. Os resultados sinalizam o provável momento do desenvolvimento de lesões do tecido laminar em equinos com síndrome cólica, no qual é possível adotar medidas preventivas contra a laminite.

Cytotoxic lignans from the stems of Styrax camporum (Styracaceae)

An ethanolic extract from the stems of Styrax camporum Pohl (Styracaceae), a plant traditionally used for gastrointestinal diseases, was fractionated and subjected to flash chromatography and afforded two benzofuran lignans, egonol and homoegonol, and one furofuran lignan, (+/-) syringaresinol, which were identified by spectral data interpretation. Their cytotoxic activities against Hep-2 (larynx epidermoid carcinoma), HeLa (human cervix carcinoma) and C6 (rat glioma) cell lines were evaluated using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide) assay at several concentrations for 24 h. Activities could be observed for egonol against C6 (IC50 = 3.2 mu g/mL) and Hep-2 (IC50 = 3.6 mu g/mL) cell lines, and for homoegonol against C6 (IC50 = 4.9 mu g/mL) and HeLa (IC50 =- 5.3 mu g/mL) cells.

Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo

RACIONAL: As doenças difusas do tecido conjuntivo afetam vários sistemas orgânicos, inclusive o digestório. Neste, as lesões variam em intensidade e freqüência na dependência da doença envolvida. A descrição das diferentes manifestações digestivas tem sido pouco freqüente, pouco detalhada e, não raro, baseada em experiências individuais e levantamentos retrospectivos. Tais formas de registro de dados produzem resultados muitas vezes conflitantes entre as diferentes casuísticas. OBJETIVO: Estabelecer de forma mais consistente, por intermédio de entrevista e questionário predefinido de sintomas, o conjunto e freqüência dos sintomas digestivos observados na esclerose sistêmica progressiva, artrite reumatóide, polimiosite/dermatomiosite, doença mista do tecido conjuntivo e lúpus eritematoso sistêmico. PACIENTES E MÉTODO: Estudaram-se 99 pacientes, 90% mulheres, com idade média de 45 anos. do total, 35 tinham artrite reumatóide, 26 esclerose sistêmica progressiva, 21 lúpus eritematoso sistêmico, 12 dermatomiosite/polimiosite e 5 doença mista do tecido conjuntivo. Todos foram submetidos, por investigador treinado, a entrevista e preenchimento de um questionário de sintomas digestivos, composto de 17 itens, previamente definidos. RESULTADOS: O estudo revelou elevada prevalência de sintomas gastrointestinais nas cinco doenças investigadas, muitas vezes afetando mais de 50% dos casos. Chamou a atenção a presença significativa de sintomas negligenciados pela literatura como a incontinência fecal. Discordante de trabalhos anteriores, os pacientes desta série com artrite reumatóide apresentaram variadas queixas digestivas, surpreendendo o achado de disfagia em 1/3 deles. CONCLUSÕES: As doenças difusas do tecido conjuntivo são causas de freqüentes e numerosos sintomas digestivos. O uso de questionários predefinidos mostrou-se instrumento válido na identificação de substancial número de sintomas, alguns deles ainda não referidos pela literatura. Por fim, foi constatada escassez de trabalhos passados e atuais relativos às manifestações gastrointestinais das doenças difusas do tecido conjuntivo, o que prejudicou análises comparativas mais amplas.

Efficacy and safety of a soy isoflavone extract in postmenopausal women: A randomized, double-blind, and placebo-controlled study

Objective: To investigate the efficacy of soy isoflavone on climacteric symptoms in postmenopausal women.Design: In this double-blind, randomized, placebo-controlled study, a total of 80 women (mean age =55.1 years), who reported 5 or more hot flush episodes per day, were randomized to receive either 250 mg of standardized soy extract (Glycine max AT) a total of 100 mg/day of isoflavone (n=40) or placebo (n=40). Exclusion criteria included: contra-indication for hormone therapy (HT), chronic gastrointestinal diseases, and users of HT within the preceding 6-months. For 10-months, climacteric symptoms were evaluated using a score card and the menopausal Kupperman index. Compliance and safety were also assessed. At baseline and the end of the study, lipid and hormonal profiles, as well as vaginal, mammographic and ultrasonographic parameters were measured. The t-test, Wilcoxon test and ANOVA were used in the statistical analysis.Results: At baseline, the mean number of hot flushes was 9.6 +/- 3.9 per day in the isoflavone group and 10.1 +/- 4.9 in the placebo group (p>0.05). After 10 months, there was a significant reduction in frequency of hot flushes among isoflavone users when compared to those on placebo (3.1 +/- 2.3 and 5.9 +/- 4.3, respectively) (p<0.001). Kupperman index mean values showed a significant reduction in both groups. However, soy isoflavone was significantly superior to placebo, in reducing hot flush severity (69.9% and 33.7%, respectively) (p<0.001). Endometrial thickness, mammography, vaginal cytology, lipids and hormonal profile did not change in both groups. No serious adverse event related to isoflavone treatment was reported.Conclusions: the soy isoflavone extract exerted favorable effects on vasomotor symptoms and good compliance, providing a safe and effective alternative therapeutic for postmenopausal women. (C) 2007 Elsevier B.V.. All rights reserved.