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Magro DO, Sassaki LY, Chebli JMF. Interaction between diet and genetics in patients with inflammatory bowel disease. World J Gastroenterol 2024; 30:1644-1650. [PMID: 38617734 PMCID: PMC11008370 DOI: 10.3748/wjg.v30.i12.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
In this editorial, we comment on the article by Marangoni et al, published in the recent issue of the World Journal of Gastroenterology 2023; 29: 5618-5629, about "Diet as an epigenetic factor in inflammatory bowel disease". The authors emphasized the role of diet, especially the interaction with genetics, in promoting the inflammatory process in inflammatory bowel disease (IBD) patients, focusing on DNA methylation, histone modifications, and the influence of microRNAs. In this editorial, we explore the interaction between genetics, gut microbiota, and diet, in an only way. Furthermore, we provided dietary recommendations for patients with IBD. The Western diet, characterized by a low fiber content and deficiency the micronutrients, impacts short-chain fatty acids production and may be related to the pathogenesis of IBD. On the other hand, the consumption of the Mediterranean diet and dietary fibers are associated with reduced risk of IBD flares, particularly in Crohn's disease (CD) patients. According to the dietary guidance from the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD), the regular consumption of fruits and vegetables while reducing the consumption of saturated, trans, dairy fat, additives, processed foods rich in maltodextrins, and artificial sweeteners containing sucralose or saccharine is recommended to CD patients. For patients with ulcerative colitis, the IOIBD recommends the increased intake of natural sources of omega-3 fatty acids and follows the same restrictive recommendations aimed at CD patients, with the possible inclusion of red meats. In conclusion, IBD is a complex and heterogeneous disease, and future studies are needed to elucidate the influence of epigenetics on diet and microbiota in IBD patients.
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Affiliation(s)
- Daniéla Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, Sao Paulo State University (UNESP), Botucatu 18618-687, São Paulo, Brazil
| | - Júlio Maria Fonseca Chebli
- Department of Medicine, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora 36036-247, Minas Gerais, Brazil
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Garcia KS, de Azevedo MFC, Carlos ADS, Barros LL, Oba J, Sobrado Junior CW, Sipahi AM, Alves ODDC, Navarro-Rodriguez T, Parra RS, Chebli JMF, Chebli LA, Flores C, Vieira A, do Ceará CDA, Queiroz NSF, Damião AOMC. Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial. Biomedicines 2023; 11:1757. [PMID: 37371853 DOI: 10.3390/biomedicines11061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Therapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL ≥ 10 μg/mL was considered optimal. Patients with suboptimal ITL (<10 µg/mL) were guided according to ATI levels. Those who presented ATI ≤ 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
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Affiliation(s)
- Karoline Soares Garcia
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Alexandre de Sousa Carlos
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Luísa Leite Barros
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Jane Oba
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Aytan Miranda Sipahi
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Tomás Navarro-Rodriguez
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Rogério Serafim Parra
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | | | - Liliana Andrade Chebli
- University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil
| | - Cristina Flores
- Crohn's and Colitis Reference Center, Rio Grande do Sul 90560-002, Brazil
| | - Andrea Vieira
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil
| | | | - Natália Sousa Freitas Queiroz
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil
- IBD Center, Santa Cruz Hospital, Curitiba 80420-090, Brazil
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Parra RS, Chebli JMF, Chebli LA, Lima Junior SFD, Lins Neto MA, Medeiros TRD, Faria FM, Feitosa MR, Nigro CMC, Féres O. Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study. J Clin Med 2023; 12:jcm12093165. [PMID: 37176606 PMCID: PMC10179457 DOI: 10.3390/jcm12093165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients. METHODS Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy. RESULTS There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn's disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4-12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months). CONCLUSIONS LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.
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Affiliation(s)
- Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Júlio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | - Liliana Andrade Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | | | - Manoel Alvaro Lins Neto
- Department of Gastrointestinal Surgery, Federal University of Alagoas-UFAL, Maceió 57051-090, Brazil
| | | | - Francesca Maia Faria
- Department of Pathology and Forensic Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Cintia Maura Caseiro Nigro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
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Imbrizi M, Baima JP, Azevedo MFCD, Andrade AR, Queiroz NSF, Chebli JMF, Chebli LA, Argollo MC, Sassaki LY, Parra RS, Quaresma AB, Vieira A, Damião AOMC, Moraes ACDS, Flores C, Zaltman C, Vilela EG, Morsoletto EM, Gonçalves Filho FDA, Penna FGCE, Santana GO, Zabot GP, Parente JML, Costa MHDM, Zerôncio MA, Machado MB, Cassol OS, Kotze PG, Fróes RDSB, Miszputen SJ, Ambrogini Junior O, Saad-Hossne R, Coy CSR. SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF CROHN'S DISEASE IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB). Arq Gastroenterol 2023; 59:20-50. [PMID: 36995888 DOI: 10.1590/s0004-2803.2022005s1-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn's disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. OBJECTIVE To guide the safest and effective medical treatments of adults with CD. METHODS This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. RESULTS AND CONCLUSION The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.
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Affiliation(s)
| | - Júlio Pinheiro Baima
- Universidade Nove de Julho, Bauru, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | | | | | | | | | | | - Rogerio Serafim Parra
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | - Andrea Vieira
- Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil
| | | | | | - Cristina Flores
- Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Cyrla Zaltman
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Eduardo Garcia Vilela
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | | | | | - Gilmara Pandolfo Zabot
- Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil
| | | | | | | | | | | | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | | | - Sender Jankiel Miszputen
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
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Baima JP, Imbrizi M, Andrade AR, Chebli LA, Argollo MC, Queiroz NSF, Azevedo MFCD, Vieira A, Costa MHDM, Fróes RDSB, Penna FGCE, Quaresma AB, Damião AOMC, Moraes ACDS, Santos CHMD, Flores C, Zaltman C, Vilela EG, Morsoletto E, Gonçalves Filho FDA, Santana GO, Zabot GP, Parente JML, Sassaki LY, Zerôncio MA, Machado MB, Cassol OS, Kotze PG, Parra RS, Miszputen SJ, Coy CSR, Ambrogini Junior O, Chebli JMF, Saad-Hossne R. SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB). Arq Gastroenterol 2023; 59:51-84. [PMID: 36995889 DOI: 10.1590/s0004-2803.2022005s1-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. OBJECTIVE This consensus aims to provide guidance on the most effective medical management of adult patients with UC. METHODS A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. RESULTS AND CONCLUSION The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.
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Affiliation(s)
- Júlio Pinheiro Baima
- Universidade Nove de Julho, Bauru, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | | | | | | | | | - Andrea Vieira
- Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil
| | | | | | | | | | | | | | | | - Cristina Flores
- Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Cyrla Zaltman
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Eduardo Garcia Vilela
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | | | - Gilmara Pandolfo Zabot
- Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil
| | | | | | | | | | | | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Rogerio Serafim Parra
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Drumond DG, de Góis Speck NM, Chebli JMF, de Moraes Sarmento Condé C, Chebli LA, Pannain GD, Esperança SD. Treatment of Rectovaginal Fistula Using Fractionate CO 2 Vaginal Laser: A Case Series. Photobiomodul Photomed Laser Surg 2021; 39:622-629. [PMID: 34546109 DOI: 10.1089/photob.2020.4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Rectovaginal fistulas (RVFs) are abnormal tracts that connect the lower gastrointestinal tract with the vagina. They can result from obstetric trauma, infection, local surgeries, cancer, radiation damage, and Crohn's disease. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment. Objective: To report five cases of patients with RVF submitted to intravaginal CO2 fractional laser treatment, as a complementary and additional therapeutic option in this scenery. Materials and methods: Five laser sessions with monthly intervals followed by complete evaluation through clinical examination and magnetic resonance imaging of the pelvis were performed for all patients. Results: Three patients had complete resolution of symptoms after the end of planned vaginal laser sessions, whereas two patients reported significant improvement in symptoms. Four patients who had stopped having sex due to their condition admitted to resuming regular sexual activity. In addition, all five patients had closure of the fistulous track confirmed by pelvic MRI. No adverse events from vaginal laser therapy were reported by any of the patients. Conclusions: We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of RVF. It may potentially enable return to regular sexual activity. Future studies using this therapeutic strategy are needed to confirm the efficacy and safety of this method in this clinical setting. Clinical trial registration no.: CAAE 93673618.4.0000.5133.
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Affiliation(s)
- Denise Gasparetti Drumond
- Department of Surgery, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Chebli JMF, Queiroz NSF, Damião AOMC, Chebli LA, Costa MHDM, Parra RS. How to manage inflammatory bowel disease during the COVID-19 pandemic: A guide for the practicing clinician. World J Gastroenterol 2021; 27:1022-1042. [PMID: 33776370 PMCID: PMC7985732 DOI: 10.3748/wjg.v27.i11.1022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/11/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications' impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.
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Affiliation(s)
- Júlio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | | | | | - Liliana Andrade Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | | | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, SP, Brazil
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Henrique DMN, Malaguti C, Limonge TM, Siqueira MR, Paticcie TMF, Mira PAC, Laterza MC, Mourão-Junior CA, Pacce FHDL, Chebli JMF. Six-Minute Walking Test as a Predictor of Clinical Decompensation in Patients with Cirrhosis. J Gastrointestin Liver Dis 2021; 30:103-109. [PMID: 33548126 DOI: 10.15403/jgld-3122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The 6-minute walk test (6MWT) is a measure of the overall functional capacity and is associated with the risk of mortality in patients with liver cirrhosis and in those listed for liver transplantation. Nevertheless, physical performance has not yet been established as a predictor of the risk of clinical decompensation in patients with cirrhosis. We aimed to determine the capacity of the 6MWT to predict the clinical decompensation in patients with cirrhosis after 1 year of follow-up. METHODS This prospective cohort study included patients with compensated cirrhosis of several etiologies. All participants had stable clinical conditions for at least 6 months prior to baseline. At baseline, patients performed the 6MWT and were followed up for 1 year to detect the decompensation outcomes. RESULTS A total of 55 participants completed the evaluation and follow-up. The mean age was 56.3±10.5 years, and 65% were men. Around 65.4% were classified as Child-Pugh class A. In the receiver operating characteristic analysis, a walking distance ≤ 401.8 m during the 6MWT was set as the threshold for predicting clinical decompensation with 64% sensitivity and 82% specificity. Kaplan-Meier curve analysis revealed that patients who covered a distance of < 401.8 m during the test had a decompensation-free outcome rate of 30% as compared to the rate of 75% of those who walked > 401.8 m (p<0.001). CONCLUSIONS The 6MWT was a significant predictor of clinical decompensation in patients with cirrhosis. A cutoff of 401.8 m was related to an increased risk of clinical decompensation in cirrhotic patients with a stable clinical condition at baseline. The 6MWT should be added to the clinical assessment of the cirrhotic population.
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Affiliation(s)
- Diane Michela Nery Henrique
- Department of Medicine, Division of Gastroenterology, Federal University of Juiz de Fora, Juiz de Fora, Brazil. .
| | - Carla Malaguti
- Graduate Program on Rehabilitation Sciences, Federal University of Juiz de Fora, Juiz de Fora, Juiz de Fora, Brazil.
| | - Tuany Mangeste Limonge
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | | | | | - Pedro Augusto Carvalho Mira
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | - Mateus Camaroti Laterza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | | | - Fabio Heleno de Lima Pacce
- Department of Medicine, Division of Gastroenterology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | - Júlio Maria Fonseca Chebli
- Department of Medicine, Division of Gastroenterology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
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Bertges ER, Chebli JMF. PREVALENCE AND FACTORS ASSOCIATED WITH SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH CROHN'S DISEASE: A RETROSPECTIVE STUDY AT A REFERRAL CENTER. Arq Gastroenterol 2020; 57:283-288. [PMID: 33027485 DOI: 10.1590/s0004-2803.202000000-64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) appears to be common in patients with Crohn's disease (CD). The rate of SIBO has been estimated at 25%-88% in this setting. However, different demographic, socioeconomic, and disease-related factors may exist between South American and North American or European populations that may limit the generalization of these findings, as the data are mainly derived from North American or European studies. OBJECTIVE We studied the prevalence and predictors of SIBO in CD outpatients. METHODS In this retrospective study, between June 2011 and June 2016, the medical records of 110 CD patients were assessed for presence of SIBO using the H2/CH4 glucose breath test. Univariate analysis was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein and erythrocyte sedimentation rate). RESULTS The SIBO rate was high in CD patients (30%). Patients with and without SIBO were comparable according to demographics, systemic inflammatory biomarkers, and disease characteristics, except to the stricturing phenotype more common in the SIBO-positive CD patients (48.5% vs 19.5%, P=0.001). CONCLUSION In Brazilian CD patients, SIBO is a highly prevalent condition. Stricturing phenotype demonstrated association with SIBO. An individualized screening plan followed by the timely treatment for SIBO should be carried out as part of quality of care improvement in CD individuals.
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De Oliveira JM, Pace FL, Ghetti FDF, Barbosa KVBD, Cesar DE, Chebli JMF, Ferreira LEVVDC. Non-alcoholic Steatohepatitis: Comparison of Intestinal Microbiota between Different Metabolic Profiles. A Pilot Study. J Gastrointestin Liver Dis 2020; 29:369-376. [PMID: 32830817 DOI: 10.15403/jgld-497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Non-alcoholic steatohepatitis (NASH) has multifactorial etiopathogenesis, and intestinal microbiota is co-responsible in this process. The aim of this study was to evaluate the intestinal microbiota in NASH patients with different metabolic profiles. METHODS Patients with biopsy-proven NASH were evaluated. Subjects were divided into two groups according to their metabolic profile, with or without metabolic syndrome (MS). Their characteristics in relation to liver disease and intestinal microbiota were analyzed. To evaluate the microbiota, breath tests to investigate small intestinal bacterial overgrowth (SIBO) and fecal microbiota analysis by fluorescence in situ hybridization (FISH) were performed. RESULTS There was a high prevalence of SIBO in both groups, with no significant difference between them. Breathing tests were positive in 43.8% of patients with MS and 50% of those without MS. There was a significant difference regarding the quantification of Verrucomicrobiales, less abundant in patients with NASH without MS. Its lower concentration also correlated with higher serum ferritin levels and higher hepatocyte ballooning. This order of bacteria, through its representative in human microbiota, Akkermansia muciniphila, is associated with mucosal protection and metabolic processes with liver aggression. CONCLUSIONS Our results suggested that lower Verrucomicrobiales concentration is associated with higher inflammatory activity in patients with NASH without MS, where the disease etiopathogenesis does not have its classic metabolic substrate.
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Affiliation(s)
| | - Fábio Lima Pace
- University Hospital and School of Medicine, Federal University of Juiz de Fora, Brazil.
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Cabalzar AL, Azevedo FMD, Lucca FDA, Reboredo MDM, Malaguti C, Chebli JMF. PHYSICAL ACTIVITY IN DAILY LIFE, EXERCISE CAPACITY AND QUALITY OF LIFE IN PATIENTS WITH CROHN'S DISEASE ON INFLIXIMAB-INDUCED REMISSION: A PRELIMINARY STUDY. Arq Gastroenterol 2020; 56:351-356. [PMID: 31618395 DOI: 10.1590/s0004-2803.201900000-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Physical activity in daily life and exercise capacity have not been assessed in patients with Crohn's disease to date. OBJECTIVE To evaluate the physical activity in daily life, exercise capacity, quality of life, and prevalence of mood disorders in patients with moderate-to-severe Crohn's disease on infliximab-induced remission and the possible associations among variables. METHODS A cross-sectional preliminary study was conducted. Twenty-six patients with Crohn's disease and 20 controls were selected. Participants underwent evaluation of physical activity in daily life (triaxial accelerometer), exercise capacity (shuttle walk test), handgrip strength, quality of life, and presence of mood disorders. RESULTS The number of steps taken (7446±3081 vs 7898±2487), active time (80.6±42 vs 89.7±24.3min), shuttle walk test distance [665 (405) vs 710 (409) m] and handgrip strength [31 (15) vs 29 (20) kgf did not show any difference between the patients with Crohn's disease and the controls. The time spent lying down [95.8 (68.8) vs 60.9 (74.7) min] was greater and some domains of the quality of life were superior in the patients with Crohn's disease. No correlation was observed between the physical activity in daily life and quality of life or presence of mood disorders in patients with Crohn's disease. CONCLUSION Patients with Crohn's disease on infliximab-induced remission, despite to more time spent lying down, they have the same level of physical activity in daily life and exercise capacity min compared with the controls.
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Affiliation(s)
- Andrea Lemos Cabalzar
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Fernando de Azevedo Lucca
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Maycon de Moura Reboredo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Júlio Maria Fonseca Chebli
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
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Fonseca Chebli JM, Da Silva RJ, Gomes Guércio B, Rocha Couto V, Sousa Pereira M, Fernandes Oliveira IN, Castro de Rezende G, Laranjeira Lima EJ. Preparo dos pacientes com doença inflamatória intestinal para terapia biológica na prática clínica. hu rev 2019. [DOI: 10.34019/1982-8047.2019.v45.28789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: A terapia biológica revolucionou o tratamento das doenças inflamatórias intestinais (DII). Embora muito efetivas, as medicações biológicas colocam os pacientes em maior risco de desenvolvimento de reações infusionais e paradoxais, infecções e alguns tipos de câncer como linfomas, este último especialmente quando feita em combinação com tiopurinas. A adequada seleção, aconselhamento e educação dos pacientes são itens importantes para o uso bem sucedido dos biológicos. Objetivo: Revisar a melhor estratégia para mostrar uma visão atualizada das etapas imprescindíveis no preparo dos pacientes com DII para terapia biológica. Material e Métodos: Realizou-se uma revisão sistemática da literatura, em fevereiro de 2018, utilizando os termos de pesquisa: “doença de Crohn”, “doença inflamatória intestinal”, “imunização”, “imunossupressores” e “terapia biológica”, em língua inglesa e portuguesa. Foram incluídos apenas artigos originais e de revisão. Discussão e Conclusão: Uma história detalhada para excluir contraindicações destas medicações e um monitoramento baseado em diretrizes são passos importantes antes de iniciar a terapia. Biológicos devem ser considerados somente se uma avaliação confirmar que o paciente tem doença ativa. É relevante também excluir condições que mimetizam a atividade de doença. Até o momento, os agentes biológicos demonstraram um perfil de segurança favorável em pacientes com DII. No entanto, é importante que o início da terapia biológica seja discutido atentamente com os pacientes, explicando os riscos e benefícios do tratamento. Antes de iniciar o uso de biológicos, os pacientes necessitam ser rastreados para tuberculose latente, hepatites B e C, e infecção por HIV. Idealmente, o status vacinal deve ser verificado e atualizado antes do início da terapia imunossupressora. As diretrizes atuais recomendam aos pacientes adultos com DII o mesmo esquema de imunização de rotina da população geral, evitando as vacinas de agentes vivos durante a terapia imunossupressora. Todas essas medidas são essenciais para estabelecer de forma segura a terapia esperada pelo uso de biológicos.
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13
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Teixeira FV, Vilela EG, Damião AOMC, Vieira A, Albuquerque ICD, Parente JML, Chebli JMF, Ambrogini Junior O, Hossne RS, Miszputen SJ. Ulcerative colitis - treatment with biologicals. ACTA ACUST UNITED AC 2019; 65:547-553. [PMID: 31066808 DOI: 10.1590/1806-9282.65.4.547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 02/08/2023]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Fabio Vieira Teixeira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Eduardo Garcia Vilela
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Aderson Omar Mourão Cintra Damião
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Andrea Vieira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Idblan Carvalho De Albuquerque
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - José Miguel Luz Parente
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Júlio Maria Fonseca Chebli
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Orlando Ambrogini Junior
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Rogerio Saad Hossne
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Sender Jankiel Miszputen
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
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14
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Drumond DG, Chebli JMF, Speck NMDG, Chebli LA, Pannain GD, Esperança SD, Condé CDMS. Case Report: Treatment for Rectovaginal Fistula in Crohn's Disease Using Fractionate CO 2 Vaginal Laser with Anti-TNF Therapy. Photobiomodul Photomed Laser Surg 2019; 37:451-454. [PMID: 31210577 DOI: 10.1089/photob.2019.4643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Rectovaginal fistulas (RVFs) are defined as any connection between the anorectum and the vagina. They can have several causes, being Crohn's disease, the second leading cause of RVFs, responsible for ∼10% of the RVFs. Despite the advances in surgical and clinical treatment, there is no consensus regarding the best line of treatment. Objective: To report another therapeutic option, we describe the case of a patient with Crohn's disease and RVF refractory to anti-tumor necrosis factor (TNF) therapy, submitted to intravaginal CO2 fractional laser treatment. Materials and methods: Three laser sessions with monthly interval and analysis by clinical examination, sexual evaluation questionnaire, and magnetic resonance of the pelvis were performed. Results: We obtained an important improvement of the symptoms and of the dimension of the fistulous path. Conclusions: We believe this method to be a complementary, promising, and safe therapeutic alternative for the management of vaginal fistula. Future studies using this therapeutic strategy are needed to confirm the efficacy of this method in this clinical setting.
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Affiliation(s)
- Denise Gasparetti Drumond
- 1 Department of Surgery, Faculty of Medicine, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
| | - Júlio Maria Fonseca Chebli
- 2 Department of Medical Clinic, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
| | | | - Liliana Andrade Chebli
- 4 Department of Medical Clinic, Universidade Federal de Juiz de Fora Faculdade de Medicina, Juiz de Fora, Brazil
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Abstract
Abstract Introduction: Crohn’s disease (CD) is an inflammatory bowel disease, marked by exacerbations and remissions periods. Peripheral manifestations in CD may be present with the syndrome of skeletal muscle dysfunction (SMD), which is characterized by loss of muscle strength, fatigue complain, limited exercise capacity and impaired quality of life of these patients. Objective: Evaluate muscle strength, physical capacity and quality of life of patients with CD and compare them with healthy controls. Methods: 18 patients CD and 12 healthy controls matched for age and sex were involved. Peripheral muscle strength evaluated by handgrip strength of the dominant hand and respiratory muscle strength by measures of respiratory muscle strength (maximal inspiratory/expiratory pressure - MIP and MEP). Exercise capacity evaluated by Shuttle test (ST) and the quality of life by the Short-form 36 (SF-36) and by the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Patients with CD presented a lower respiratory muscle strength (MIP = -68.93 ± 26.61 vs 29.63 ± -100 cmH2O, p = 0.0013 and MEP = 81.07 ± 30.26 vs 108 ± 25.30 cmH2O, p = 0.032) and a tendency the lower peripheral muscle strength (31.72 ± 8.55 vs 39.00 ± 13.37 kgf, p = 0.09). In addition, CD patients presented worse physical capacity on the ST compared to the control group (513.7 ± 237m vs 983.0 ± 263m, p < 0.05) and worse quality of life in 7 of 8 domains of the SF-36 and in all dimensions of the IBDQ. Conclusion: Patients with CD showed muscle functional impairment and poorer quality of life compared to healthy control group. These findings suggest that the assessment and maybe interventions in the muscle function must be used in clinical practice.
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Gomes EP, Reboredo MM, Carvalho EV, Teixeira DR, Carvalho LFCD, Filho GFF, de Oliveira JCA, Sanders-Pinheiro H, Chebli JMF, de Paula RB, Pinheiro BDV. Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer. Biomed Res Int 2015; 2015:645645. [PMID: 26090432 PMCID: PMC4458275 DOI: 10.1155/2015/645645] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Abstract
Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity.
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Affiliation(s)
- Edimar Pedrosa Gomes
- Pulmonology Division, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Maycon Moura Reboredo
- Pulmonology Division, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Erich Vidal Carvalho
- Pulmonology Division, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Daniel Rodrigues Teixeira
- Internal Medicine Department, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | | | | | | | - Helady Sanders-Pinheiro
- Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Júlio Maria Fonseca Chebli
- Internal Medicine Department, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Rogério Baumgratz de Paula
- Interdisciplinary Center for Studies, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
| | - Bruno do Valle Pinheiro
- Pulmonology Division, Faculty of Medicine, Federal University of Juiz de Fora, 36036-110 Juiz de Fora, MG, Brazil
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Oliveira LGD, Cunha ALD, Duarte AC, Castañon MCMN, Chebli JMF, Aguiar JAKD. Positive correlation between disease activity index and matrix metalloproteinases activity in a rat model of colitis. Arq Gastroenterol 2015; 51:107-12. [PMID: 25003261 DOI: 10.1590/s0004-28032014000200007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/10/2013] [Indexed: 01/01/2023]
Abstract
CONTEXT Inflammatory bowel disease, including ulcerative colitis and Crohn's disease, comprising a broad spectrum of diseases those have in common chronic inflammation of the gastrointestinal tract, histological alterations and an increased activity levels of certain enzymes, such as, metalloproteinases. OBJECTIVES Evaluate a possible correlation of disease activity index with the severity of colonic mucosal damage and increased activity of metalloproteinases in a model of ulcerative colitis induced by dextran sulfate sodium. METHODS Colitis was induced by oral administration of 5% dextran sulfate sodium for seven days in this group (n=10), whereas control group (n=16) received water. Effects were analyzed daily by disease activity index. In the seventh day, animals were euthanized and hematological measurements, histological changes (hematoxylin and eosin and Alcian Blue staining), myeloperoxidase and metalloproteinase activities (MMP-2 and MMP-9) were determined. RESULTS Dextran sulfate sodium group showed elevated disease activity index and reduced hematological parameters. Induction of colitis caused tissue injury with loss of mucin and increased myeloperoxidase (P<0.001) and MMP-9 activities (45 fold) compared to the control group. CONCLUSIONS In this study, we observed a disease activity index correlation with the degree of histopathological changes after induction of colitis, and this result may be related mainly to the increased activity of MMP-9 and mieloperoxidase.
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Affiliation(s)
- Luiz Gustavo de Oliveira
- Laboratório de Análise de Glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil
| | - André Luiz da Cunha
- Laboratório de Análise de Glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil
| | - Amaury Caiafa Duarte
- Laboratório de Análise de Glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil
| | | | | | - Jair Adriano Kopke de Aguiar
- Laboratório de Análise de Glicoconjugados, Departamento de Bioquímica, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil
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do Valle Pinheiro B, de Moura Reboredo M, Fonseca Chebli JM, Abreu de Oliveira JC. Silicosis conglomerada en un trabajador de limpieza con chorro de arena. Med Clin (Barc) 2014; 143:238. [DOI: 10.1016/j.medcli.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 04/10/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Chebli JMF, Gaburri PD, Chebli LA, da Rocha Ribeiro TC, Pinto ALT, Ambrogini Júnior O, Damião AOMC. A guide to prepare patients with inflammatory bowel diseases for anti-TNF-α therapy. Med Sci Monit 2014; 20:487-98. [PMID: 24667275 PMCID: PMC3972052 DOI: 10.12659/msm.890331] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Current therapy of moderate-to-severe inflammatory bowel disease (IBD) often involves the use of anti-tumor necrosis factor alpha (TNF-α) agents. Although very effective, theses biologics place the patient at increased risk for developing infections and lymphomas, the latter especially when in combination with thiopurines. Appropriate patient selection, counseling, and education are all important features for the successful use of anti-TNF-α therapy. A thorough history to rule-out contraindications of this therapy and emphasis on monitoring guidelines are important steps preceding administration of anti-TNF-α agents. This therapy should only be considered if a recent evaluation has established that the patient has active IBD. In addition, it is important to exclude disease mimickers. Anti-TNF-α agents have been considered to present a globally favorable benefit/risk ratio. However, it is important that in routine practice, initiation of anti-TNF-α therapy be carefully discussed with the patient, extensively explaining the potential benefits and risks of such treatment. Prior to starting anti-TNF-α therapy, the patients need to be screened for latent tuberculosis, hepatitis B virus infection, and (usually) hepatitis C virus and HIV infection. Vaccination schedules of IBD patients should be evaluated and updated prior to the commencement of anti-TNF-α therapy. Ordinarily, immunization in adult patients with IBD should not deviate from recommended guidelines for the general population. With the exception of live vaccines, immunizations can be safely administered in patients with IBD, even those on immunosuppressants or biologics. The purpose of this review is providing an overview of appropriate steps to prepare patients with IBD for anti-TNF-α therapy.
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Affiliation(s)
- Júlio Maria Fonseca Chebli
- Division of Gastroenterology, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Pedro Duarte Gaburri
- Division of Gastroenterology, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Liliana Andrade Chebli
- Division of Gastroenterology, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - André Luiz Tavares Pinto
- Division of Gastroenterology, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Rocha MCGSD, Carminate DLG, Tibiriçá SHC, Carvalho IPD, Silva MLDRE, Chebli JMF. Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity. Arq Gastroenterol 2012; 49:259-65. [PMID: 23329220 DOI: 10.1590/s0004-28032012000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 09/18/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT: Acute diarrhea is a common cause of hospitalization among children under 5 years of age. Knowing the prevalence and risk factors associated with the severity of acute diarrhea is essential to control morbidity and mortality. OBJECTIVE: Describe the prevalence of demographic, epidemiologic and clinical features of children under 6 years of age hospitalized for acute diarrhea, and investigate the association between these determinants and the severity of the diarrheic episode. METHOD: Retrospective, cross-sectional study, during the period from January, 2005 through December, 2008, in the municipality of Juiz de Fora, MG, Brazil. Files from 6,201 children from 0 to 6 years of age, hospitalized in two public teaching institutions (which account for 84% of all the hospitalizations in the municipality), were assessed. Acute diarrhea was defined as the presence of at least three evacuations of liquid or loose stools, within 24 hours, for a maximum period of 14 days. The patients with acute diarrhea were divided in two groups, according to disease severity, severe diarrhea being considered whenever hospitalization lasted for at least 4 days. Epidemiologic and clinical data were assessed and compared through the application of the chi-squared test and the binomial logistic regression model. RESULTS: The prevalence rate for admission due to acute diarrhea was 8.4%. The factors significantly associated with the severity of the diarrheic episode were: age under 6 months (P = 0.01, OR = 2.762); disease onset during fall (P = 0.033, OR = 1.742), presence of fever (P = 0.017, OR = 1.715) and antibiotic use during hospitalization (P = 0.000, OR = 3.872). CONCLUSIONS: Diarrhea is the third most common cause of hospitalization among children under 6 years of age in Juiz de Fora. Young age (under or equal to 6 months), fever, antibiotic use during hospitalization and disease onset during fall are risk factors associated with longer hospital stay.
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Souza AFMD, Pace FHDL, Chebli JMF, Ferreira LEVVDC. Insulin resistance in non-diabetic patients with chronic hepatitis C: what does it mean? ACTA ACUST UNITED AC 2012; 55:412-8. [PMID: 22011858 DOI: 10.1590/s0004-27302011000600008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 07/14/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the prevalence of insulin resistance (IR) in non-diabetic patients with chronic hepatitis C, and to assess the association between IR, laboratory parameters and histological findings. SUBJECTS AND METHODS Eighty-two patients had their serum analyzed for glucose, lipid profile, C-reactive protein (CRP), ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), HOMA-IR, viral load and HCV genotype. Patients with HOMA-IR levels > 2.5 were considered as carriers of insulin resistance. RESULTS IR was observed in 27% of patients and was associated with age, waist circumference and body mass index. IR patients were more likely to have more advanced hepatic fibrosis and necroinflammatory activity, higher levels of aminotransferases and liver steatosis than patients without IR. CONCLUSIONS Insulin resistance is often present in patients with chronic hepatitis C, and this parameter is associated with more advanced HCV-related hepatic fibrosis.
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Affiliation(s)
- Aécio Flávio Meirelles de Souza
- Hepatology Reference Center, Gastroenterology Department, Universidade Federal de Juiz de Fora, Rua Albino Martins Ribeiro 324, Juiz de Fora, Minas Gerais, Brazil.
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Cornélio RDCAC, Pinto ALT, Pace FHDL, Moraes JP, Chebli JMF. Não-adesão ao tratamento em pacientes com doença de Crohn: prevalência e fatores de risco. Arq Gastroenterol 2009; 46:183-9. [PMID: 19918683 DOI: 10.1590/s0004-28032009000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 02/16/2009] [Indexed: 11/22/2022]
Abstract
CONTEXTO: A não-adesão ao tratamento medicamentoso, em algum grau, ocorre universalmente. É uma das principais causas de insucesso no tratamento das doenças crônicas, tal como a doença de Crohn. OBJETIVO: Em doentes com doença de Crohn, avaliar a prevalência e os fatores de risco associados à baixa adesão ao tratamento medicamentoso. MÉTODOS: No período entre julho de 2006 e julho de 2007 foram incluídos prospectivamente, para avaliação da não-adesão ao tratamento, 100 doentes com doença de Crohn em seguimento clínico no ambulatório de doenças inflamatórias intestinais. Os pacientes responderam ao Teste de Medida de Adesão a Tratamentos de Morisky e Green, modificado. De acordo com este teste, os pacientes foram classificados em dois grupos, conforme o grau de adesão: adesão e não-adesão. A não-adesão foi subdividida em intencional e não-intencional. Variáveis clínicas, psicológicas e farmacoterapêuticas foram pesquisadas na busca de possíveis fatores associados à não-adesão. RESULTADOS: Entre os pacientes avaliados, 64% apresentaram escore compatível com não-adesão. O perfil mais frequente de não-adesão foi o do tipo não-intencional, e os pacientes mostraram ter conhecimento e motivação para o tratamento. Na comparação entre os dois grupos observou-se somente uma tendência a não-adesão entre os pacientes mais jovens (P = 0,07) e de raça não-branca (P = 0,06). Não houve correlação significativa entre o grau de adesão e as variáveis psicológicas e farmacoterapêuticas. CONCLUSÕES: Em pacientes com doença de Crohn, a prevalência de não-adesão ao tratamento medicamentoso é elevada (64%). Indivíduos jovens e aqueles não-brancos parecem ser os mais predispostos à não-adesão. Portanto, é preciso estar alerta para sua ocorrência e, caso necessário, implementar medidas que busquem aumentar o grau de adesão destes pacientes.
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Colli MV, Amaro TA, Pinto ALT, Gaburri PD, Chebli JMF. Toxicidade da azatioprina na doença de Crohn: incidência, abordagem e evolução. Rev Assoc Med Bras (1992) 2008; 54:415-21. [PMID: 18989561 DOI: 10.1590/s0104-42302008000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Accepted: 04/10/2008] [Indexed: 11/21/2022] Open
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Abstract
BACKGROUND As far as we have sought for in Medline and PubMed, not one study until now has evaluated the prevalence of onychomycosis in patients with inflammatory bowel disease (IBD). As there are great evidence of immunological disturbances linked to IBD, a possible relationship of this nail infection in association with those diseases and the possible risk factors might be relevant in IBD patients. METHODS A case-control prospective study using combined direct smear and cultures for fungus was performed. Sociodemographics, clinical and laboratorial data were recorded at baseline and samples of suspected nails were collected from 141 IBD (61 men and 80 women) and from a group of 100 non-IBD subjects (41 men and 59 women). Direct smear and cultures were performed on each suspected case to exclude other onychodystrophies. RESULTS The incidence of onychomycosis in IBD patients was highly significant in comparison to non-IBD patients (14.9% vs. 6%, respectively, P < 0.05). The risk factors predisposing IBD patients to onychomycosis were older age (P = 0.02) and leucopoenia in those using azathioprine therapy (P = 0.04) beyond a trend to lymphopenia (P = 0.06). The dermatophytes predominated (76.2%) over yeasts (19%) and moulds (4.8%). CONCLUSION The prevalence of onychomycosis in IBD patients was expressively high (14.9%) in comparison with non-IBD patients. Considering the sociodemographic factors, any one but two were related to fungal onychomycosis incidence. Therefore, as far as we are concerned, IBD must be included in the high-risk underlying conditions for onychomycosis occurrence.
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Affiliation(s)
- D Gaburri
- Department of Medicine, Division of Gastroenterology and Dermatology, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Minas Gerais, Brazil
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Gaburri PD, Souza GS, Chebli JMF. An unusual cause of extrahepatic cholestasis. Clin Gastroenterol Hepatol 2008; 6:e7-8. [PMID: 18187368 DOI: 10.1016/j.cgh.2007.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sá RGD, Teixeira CMLDO, Machado LG, Bonfante HDL, Chaves AMC, Chebli JMF, Oliveira RBD. Poliartrite e nódulos subcutâneos como primeira manifestação de carcinoma de pâncreas. Rev Bras Reumatol 2007. [DOI: 10.1590/s0482-50042007000500016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Coli MV, Chebli JMF, Gaburri PD. Education and imaging. Gastrointestinal: Whipple's disease. J Gastroenterol Hepatol 2007; 22:136. [PMID: 17201897 DOI: 10.1111/j.1440-1746.2006.04816.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- M V Coli
- Department of Internal Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Gaburri PD, Chebli JMF, Attalla A, Pereira CMN, Bonfante HL, Junior EVM, Gaburri AK. Colonic ulcers in propylthiouracil induced vasculitis with secondary antiphospholipid syndrome. Postgrad Med J 2005; 81:338-40. [PMID: 15879050 PMCID: PMC1743262 DOI: 10.1136/pgmj.2004.026104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.
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Affiliation(s)
- P D Gaburri
- Department of Medicine, Federal University of Juiz de Fora, Brazil.
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Barbosa KVBD, de Souza AFM, Chebli JMF, Proietti FA, Meirelles RSP, de Souza JL. Hereditary hemochromatosis: population screening based on phenotype in Brazilian blood donors. J Clin Gastroenterol 2005; 39:430-4. [PMID: 15815212 DOI: 10.1097/01.mcg.0000159218.85537.e5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
GOALS A population of blood donors was screened for hereditary hemochromatosis (HH) based on the phenotype strategy in accordance with the European consensus. STUDY Nonfasting serum samples were obtained from 1,050 donors. Transferrin saturation (TS) was measured using a threshold of 45%. Donors with a TS > or = 45% were retested in a fasting sample. If TS was elevated, the participants were tested for iron overload by ferritin measurement followed by genetic testing. All donors underwent clinical and laboratory workup for expression of the disease. RESULTS A total of 775 (74.6%) of the donors were men, 749 (72.1%) white, and had a mean age of 30 years (range, 8-60 years). Mean +/- SD TS was 25.9% +/- 13.1% (range, 2.1%-85.8%), and there were 58 (5.6%) donors with a TS > or = 45%. Fifty-four subjects had a repeat TS in a fasting serum sample with a mean +/- SD TS of 32.1% +/-16.1% (range, 15.4%-63.0%), and 12 donors had a TS > or = 45%. Ten complied with genetic testing and ferritin measurement. The study found four donors with HH-related mutations (C282Y and/or H63D); therefore, a gene allele frequency of 0.4%. Only the C282Y homozygote had diagnostic criteria for HH, defining a disease frequency of 0.1%. None of the donors who were mutations carriers had clinical or laboratory manifestations of organic injury. CONCLUSION We conclude that this is a feasible screening strategy that, by timely diagnosing HH, allows patients not only to benefit from effective treatment but also to have disease progression halted.
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Affiliation(s)
- Kátia Valéria Bastos Dias Barbosa
- Division of Gastroenterology, Department of Internal Medicine of Federal University of Juiz de Fora-Minas Gerais, Minas Gerais, Brazil.
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