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Fróes RDSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep 2024; 14:4314. [PMID: 38383742 PMCID: PMC10881489 DOI: 10.1038/s41598-024-54332-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.
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Affiliation(s)
| | | | | | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cyrla Zaltman
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Bafutto
- Department of Gastroenterology, Instituto Goiano de Gastroenterologia, Goiânia, Goiás, Brazil
| | - Abel Botelho Quaresma
- Universidade do Oeste de Santa Catarina - UNOESC - Department of Health Sciences, Joaçaba, Santa Catarina, Brazil
| | | | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | | | | | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Rogerio Saad-Hossne
- Department of Surgery, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Dotti AZ, Magro DO, Vilela EG, Chebli JMF, Chebli LA, Steinwurz F, Argollo M, Carvalho NS, Parente JML, Lima MM, Parra RS, Perin RL, Flores C, Morsoletto EM, da Costa Ferreira S, Ludvig JC, Kaiser Junior RL, Faria MAG, Nicollelli GM, Andrade AR, Queiroz NSF, Kotze PG. Vedolizumab in Mild-to-Moderate Crohn's Disease Patients Naïve to Biological Therapy: A Multicentric Observational Study. Crohns Colitis 360 2023; 5:otad053. [PMID: 37859629 PMCID: PMC10583759 DOI: 10.1093/crocol/otad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background In real-world experience, the number of patients using vedolizumab as first-line biological therapy was low. We aimed to evaluate the effectiveness and safety of vedolizumab in mild-to-moderate Crohn's disease (CD) biologic-naïve patients. Methods We performed a retrospective multicentric cohort study with patients who had clinical activity scores (Harvey-Bradshaw Index [HBI]) measured at baseline and weeks 12, 26, 52, as well as at the last follow-up. Clinical response was defined as a reduction ≥3 in HBI, whereas clinical remission as HBI ≤4. Mucosal healing was defined as the complete absence of ulcers in control colonoscopies. Kaplan-Meier survival analysis was used to assess the persistence with vedolizumab. Results From a total of 66 patients, 53% (35/66) reached clinical remission at week 12. This percentage increased to 69.7% (46/66) at week 26, and 78.8% (52/66) at week 52. Mucosal healing was achieved in 62.3% (33/53) of patients. Vedolizumab was well tolerated, and most adverse events were minor. During vedolizumab treatment, 3/66 patients underwent surgery. Conclusions This study demonstrates the effectiveness and safety of vedolizumab as a first-line biological agent in patients with mild-to-moderate CD.
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Affiliation(s)
| | | | - Eduardo Garcia Vilela
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | - Rogério Serafim Parra
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | | | | | | | - Sandro da Costa Ferreira
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 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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Perin RL, Magro DO, Andrade AR, Argollo M, Carvalho NS, Damião AOMC, Dotti AZ, Ferreira SDC, Flores C, Ludvig JC, Nones RB, Queiroz NSF, Parra RS, Steinwurz F, Teixeira FV, Kotze PG. Effectiveness and Safety of Tofacitinib in the Management of Ulcerative Colitis: A Brazilian Observational Multicentric Study. Crohns Colitis 360 2022; 5:otac050. [PMID: 36777366 PMCID: PMC9855307 DOI: 10.1093/crocol/otac050] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease which affects the colorectal mucosa with a relapsing-remitting pattern. The therapeutic options currently available for the medical management of UC include many options. Tofacitinib is an oral small molecule, Janus kinase (JAK) inhibitor, more selective for JAK1 and JAK3, which reduces the inflammatory process involved in the pathogenesis of UC. Methods Retrospective observational multicentric study of patients with UC who used tofacitinib in any phase of their treatment. Clinical remission and response (according to Mayo score), mucosal healing, primary and secondary loss of response, discontinuation of the drug with possible causes, and the need for dose optimization or switching to biologicals, need for surgery and adverse events were evaluated. Results From a total of 56 included patients, clinical remission was observed in 43.6% at week 12, 54.5% at week 26, 57.9% at week 52, and 40% at the last follow-up visit. Clinical response was observed in 71.4%, 81.8%, 89.5%, and 61.8% at the same time periods, respectively. Mucosal healing rates were 50% and 17.8% needed colectomy. Conclusions Tofacitinib was effective in induction and maintenance of clinical response and remission rates, compatible to other international real-word studies and meta-analyses.
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Affiliation(s)
- Ramir Luan Perin
- Address correspondence to: Ramir Luan Perin, MD, Thomaz Gonzaga, 799, Passo Fundo - RS, CEP 99020-170, Brazil ()
| | | | | | | | | | | | | | - Sandro da Costa Ferreira
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP), Ribeirão Preto, Brazil
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Ruiz MA, Parra RS, Zabot GP, Andrade AR, Piron-Ruiz L, Fonseca-Hial AMR, Martin EM, Pinho TS, Quadros LGD, Kaiser Junior RL, Parente JML. HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CROHN'S DISEASE: POSITION PAPER FROM THE TRANSPLANTATION COMMITTEE OF THE BRAZILIAN GROUP FOR THE STUDY OF INFLAMMATORY BOWEL DISEASES (GEDIIB). Arq Gastroenterol 2022; 59:462-477. [PMID: 36515338 DOI: 10.1590/s0004-2803.202204000-83] [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: 02/04/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Crohn's disease (CD) is a relapse-remitting inflammatory bowel disease that can affect any part of the digestive system. This heterogeneous disease has multiple factors that contribute to an abnormal immune response to intestinal microorganisms. Treatment is based on the use of anti-inflammatories, corticosteroids, immunosuppressants and biologic biologic agents either alone or in combination. Surgical treatment is usual and, ten years after diagnosis, more than 80% of patients report having undergone surgical procedures related to the disease. Unfortunately, none of the treatments described offer a cure, and many cases become refractory or without therapeutic options. In this scenario, hematopoietic stem cell transplantation has been suggested because clinical remission was obtained in patients who had CD associated with malignant hematological diseases and an alternative since the first reports in 2010. In this report, the Transplantation Committee of the Brazilian Group for the Study of Inflammatory Bowel Diseases reviews the history and results of the procedure in patients with CD, detailing and discussing the various relevant points that permeate hematopoietic stem cell transplantation and cell therapy in this disease.
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Affiliation(s)
- Milton Artur Ruiz
- Associação Portuguesa Beneficência, São José do Rio Preto, SP, Brasil
| | - Rogério Serafim Parra
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Departamento de Cirurgia e Anatomia, Ribeirão Preto, SP, Brasil
| | | | | | - Lilian Piron-Ruiz
- Associação Portuguesa Beneficência, São José do Rio Preto, SP, Brasil
| | | | | | | | | | | | - José Miguel Luz Parente
- Universidade Federal do Piauí, Departamento de Clínica Médica, Gastroenterologia, Teresina, PI, Brasil
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Leitão DS, Andrade AR, Medeiros NCL, Martins MFC, Ferreira LO, Santos VC, Hamoy AO, Barbas LAL, Muto NA, Jóia de Mello V, Lopes DCF, Hamoy M. Benzodiazepine partially reverses tonic-clonic seizures induced by thiocolchicoside. Braz J Med Biol Res 2022; 55:e11771. [PMID: 35239777 PMCID: PMC8905675 DOI: 10.1590/1414-431x2021e11771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/17/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Seizures are a disorder caused by structural brain lesions, life-threatening metabolic derangements, or drug toxicity. The present study describes the behavior related to proconvulsant activity induced by thiocolchicoside (TCC) in rats and investigates the electrocorticographic patterns of this behavior and the effectiveness of classic antiepileptic drugs used to control these seizures. Forty-nine adult male Wistar rats were used and divided into two phases of our experimental design: 1) evaluation of seizure-related behavior and electrocorticographic patterns induced by TCC and 2) evaluation of the efficacy of classical antiepileptic drugs to control the proconvulsive activity caused by TCC. Our results showed that TCC induced tonic-clonic seizures that caused changes in electrocorticographic readings, characteristic of convulsive activity, with average amplitude greater than that induced by pentylenetetrazole. Treatment with anticonvulsants, especially diazepam, reduced the electrocorticographic outbreaks induced by TCC. The results suggested that TCC caused seizures with increased power in brain oscillations up to 40 Hz and that diazepam may partially reverse the effects.
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Affiliation(s)
- D S Leitão
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - A R Andrade
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - N C L Medeiros
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - M F C Martins
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - L O Ferreira
- Laboratório de Neuropatologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - V C Santos
- Laboratório de Neuropatologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - A O Hamoy
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - L A L Barbas
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Castanhal, PA, Brasil
| | - N A Muto
- Centro de Valorização de Compostos Bioativos da Amazônia, Universidade Federal do Pará, Belém, PA, Brasil
| | - V Jóia de Mello
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - D C F Lopes
- Laboratório de Neuropatologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - M Hamoy
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
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Prieto JMI, Andrade AR, Magro DO, Imbrizi M, Nishitokukado I, Ortiz-Agostinho CL, Dos Santos FM, Luzia LA, Rondo PHDC, Leite AZDA, Carrilho FJ, Sipahi AM. Nutritional Global Status and Its Impact in Crohn's Disease. J Can Assoc Gastroenterol 2021; 4:290-295. [PMID: 34877468 PMCID: PMC8643688 DOI: 10.1093/jcag/gwab006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Malnutrition among inflammatory bowel disease (IBD) subjects is well documented in literature and may emerge from factors including inadequate dietary intake, malabsorption and disease activity. The aim of this study was to complete a comprehensive nutrition assessment and explore what possibilities may help bring a better quality of life for IBD subjects. Methods Nutritional status based on biochemical tests, body composition and body mass index (BMI). Food intake was assessed by an alternate 3-day food record and the adequacy of intake was evaluated according to national and international references. Clinical disease activity was evaluated by the Harvey-Bradshaw index and CRP levels. Results The study included 217 patients and 65 controls, where 54.4% of these patients were classified as normal weight with a mean BMI lower than controls (23.8 ± 4.9 versus 26.9 ± 4.8 kg/m2, P = 0.02). Patients with disease activity showed more overweight and obesity than patients with controlled disease. Vitamin B12 deficiency was present in 19% of Crohn’s disease (CD), mainly in patients with ileal commitment and small bowel resections. Anemia was present in 21.7% of patients, being more common in patients with active disease (25%) and bowel resection (23%). Regarding calorie intake (EI), CD group ingested more than controls (1986.3 ± 595.9 kcal versus 1701.8 ± 478.9 kcal; P = 0.003). Conclusions CD patients presented micronutrient deficiency when compared with controls, explained for other reasons than intake restrictions. Also, fat excess might have contributed to disease burden as continuously reported in the literature.
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Affiliation(s)
- Juliana Midori Iqueda Prieto
- Institute of Nutrition, Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brasil
| | - Adriana Ribas Andrade
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, University of Sao Paulo, São Paulo, Brasil
| | - Daniela Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, SP Brazil
| | - Marcello Imbrizi
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, SP Brazil
| | - Iêda Nishitokukado
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, HC-FMUSP, Laboratory of Experimental Clinical Gastroenterology, LIM 07, University of São Paulo Medical School, São Paulo, Brasil
| | - Carmen Lucia Ortiz-Agostinho
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, HC-FMUSP, Laboratory of Experimental Clinical Gastroenterology, LIM 07, University of São Paulo Medical School, São Paulo, Brasil
| | - Fabiana Maria Dos Santos
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, HC-FMUSP, Laboratory of Experimental Clinical Gastroenterology, LIM 07, University of São Paulo Medical School, São Paulo, Brasil
| | - Liania Alves Luzia
- Institute of Nutrition, Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brasil
| | | | - André Zonetti de Arruda Leite
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, University of Sao Paulo, São Paulo, Brasil
| | - Flair José Carrilho
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, University of Sao Paulo, São Paulo, Brasil
| | - Aytan Miranda Sipahi
- Department of Gastroenterology, Clinical Hospital of the University of São Paulo, University of Sao Paulo, São Paulo, Brasil
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9
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Andrade AR, da Rocha TRF, Ortiz-Agostinho CL, Nishitokukado I, Carlos AS, de Azevedo MFC, Hashimoto CL, Damião AOMC, Carrilho FJ, D’Amico E, Sipahi AM, de Arruda Leite AZ. Endoscopic activity, tissue factor and Crohn's disease: findings in clinical remission patients. Therap Adv Gastroenterol 2020; 13:1756284820939412. [PMID: 34025780 PMCID: PMC8114167 DOI: 10.1177/1756284820939412] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/14/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As Crohn's disease (CD) is associated with a high risk of thromboembolic events (TE), including patients with subclinical inflammation, we aim to evaluate the correlation between the impact of endoscopic activity (EA) in the coagulation profiling of CD patients while in clinical remission. METHODS From 164 consecutive CD patients included in clinical remission [Crohn's disease activity index (CDAI) < 150], 75 were in the EA group [Simplified Endoscopic Score for CD (SES-CD) ⩾ 7], 89 were in the endoscopic remission (ER) group (SES-CD ⩽ 2), and 50 were included as healthy controls in the study. Blood samples were analyzed for tissue factor (TF), factor VIII (FVIII), thrombomodulin (TM), ADAMTS-13, von Willebrand factor (VWF), and endogenous thrombin potential (ETP), as well as collecting data regarding risk factors for TE and CD profile. RESULTS Mean plasma TF activity showed significantly higher levels in the EA group when compared with the ER and control groups (127 pM versus 103 pM versus 84 pM; p = 0.001), although the VWF:Ag (160% versus 168% versus 110%; p = 0.001), VWF/ADAMTS-13 (191 versus 219 versus 138; p = 0.003), FVIII (150% versus 144% versus 90%; p = 0.001) and TM (5.13 ng/ml versus 4.91 ng/mL versus 3.81 ng/ml; p < 0.001) were only increased in CD regardless of EA status when compared with controls. Lastly, ETP with and without TM remained the same in all three groups. CONCLUSIONS CD patients in clinical remission with EA present endothelial lesion inducing TF exposure and subsequent coagulation cascade activation. Recommended thromboprophylaxis for EA outpatient subgroups will require additional investigation in order to be validated.
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Affiliation(s)
- Adriana Ribas Andrade
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Tania Rubia Flores da Rocha
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Carmen Lucia Ortiz-Agostinho
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Iêda Nishitokukado
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Alexandre Sousa Carlos
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Matheus Freitas Cardoso de Azevedo
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Claudio Lioshi Hashimoto
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Aderson Omar Moura Cintra Damião
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Flair José Carrilho
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Elbio D’Amico
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
| | - Aytan Miranda Sipahi
- Gastroenterology, Laboratório de Gastroenterologia Clínica e Experimental (LIM 07), University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Division of Hematology, Coagulation Laboratory, University of Sao Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, Sao Paulo, Brazil
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Malluta ÉF, Maluf-Filho F, Leite AZDA, Ortiz-Agostinho CL, Nishitokukado I, Andrade AR, Lordello MLL, dos Santos FM, Sipahi AM. Pancreatic endosonographic findings and clinical correlation in Crohn's disease. Clinics (Sao Paulo) 2019; 74:e853. [PMID: 31166473 PMCID: PMC6542499 DOI: 10.6061/clinics/2019/e853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the incidence of pancreatic alterations in Crohn's disease using endoscopic ultrasound (EUS) and to correlate the number of alterations with current clinical data. METHODS Patients diagnosed with Crohn's disease (n=51) were examined using EUS, and 11 variables were analyzed. A control group consisted of patients with no history of pancreatic disease or Crohn's disease. Patients presenting with three or more alterations underwent magnetic resonance imaging (MRI). Pancreatic function was determined using a fecal elastase assay. RESULTS Two of the 51 patients (3.9%) presented with four EUS alterations, 3 (5.9%) presented with three, 11 (21.5%) presented with two, and 13 (25.5%) presented with one; in the control group, only 16% presented with one EUS alteration (p<0.001). Parenchymal abnormalities accounted for 39 of the EUS findings, and ductal abnormalities accounted for 11. Pancreatic lesions were not detected by MRI. Low fecal elastase levels were observed in 4 patients, none of whom presented with significant pancreatic alterations after undergoing EUS. Ileal involvement was predictive of the number of EUS alterations. CONCLUSION A higher incidence of pancreatic abnormalities was found in patients with Crohn's disease than in individuals in the control group. The majority of these abnormalities are related to parenchymal alterations. In this group of patients, future studies should be conducted to determine whether such morphological abnormalities could evolve to induce exocrine or endocrine pancreatic insufficiency and, if so, identify the risk factors and determine which patients should undergo EUS.
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Affiliation(s)
- Éverson Fernando Malluta
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fauze Maluf-Filho
- Departamento de Gastroenterologia, Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, SP, BR
| | - André Zonetti de Arruda Leite
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carmen Lucia Ortiz-Agostinho
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Iêda Nishitokukado
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Adriana Ribas Andrade
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Laura Lacava Lordello
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabiana Maria dos Santos
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aytan Miranda Sipahi
- Laboratorio de Gastroenterologia Clinica e Experimental, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Guedes ALV, Andrade AR, Nunes VS, Lima FR, de Mello ES, Ono SK, Terrabuio DRB, Cançado ELR. Histological remission of autoimmune hepatitis after the addition of allopurinol and azathioprine dose reduction. Autops Case Rep 2017; 7:35-42. [PMID: 28740837 PMCID: PMC5507567 DOI: 10.4322/acr.2017.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/02/2017] [Indexed: 12/30/2022] Open
Abstract
The standard therapy for some autoimmune diseases consists of a combination of corticosteroids and thiopurines. In non-responders to thiopurine drugs, the measurement of the metabolites of azathioprine, 6-thioguanine, and 6-methylmercaptopurine, can be a useful tool. The measurement has been used during the treatment of inflammatory bowel diseases and, less commonly, in autoimmune hepatitis. Many patients preferentially metabolize thiopurines to 6-methylmercaptopurine (6-MMP), which is potentially hepatotoxic, instead of 6-thioguanine, the active immunosuppressive metabolite. The addition of allopurinol shifts the metabolism of thiopurine towards 6-thioguanine, improving the immunosuppressive effect. We present the case of a 51-year-old female with autoimmune hepatitis who had a biochemical response after azathioprine and prednisone treatment without histological remission, and who preferentially shunted to 6-MMP. After the addition of allopurinol, the patient’s 6-thioguanine levels increased, and she reached histological remission with a reduction of 67% of the original dose of azathioprine. The patient did not develop clinical manifestations as a consequence of her increased immunosuppressive state. We also review the relevant literature related to this issue. In conclusion, the addition of allopurinol to thiopurine seems to be an option for those patients who do not reach histological remission and who have a skewed thiopurine metabolite profile.
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Affiliation(s)
- Ana Luiza Vilar Guedes
- University of São Paulo, School of Medicine, Department of Gastroenterology. São Paulo, SP, Brazil
| | - Adriana Ribas Andrade
- University of São Paulo, School of Medicine, Department of Gastroenterology. São Paulo, SP, Brazil
| | - Vinicius Santos Nunes
- University of São Paulo, School of Medicine, Department of Gastroenterology. São Paulo, SP, Brazil
| | - Fabiana Roberto Lima
- University of São Paulo, School of Medicine, Department of Pathology. São Paulo, SP, Brazil
| | | | - Suzane Kioko Ono
- University of São Paulo, School of Medicine, Department of Gastroenterology. São Paulo, SP, Brazil
| | | | - Eduardo Luiz Rachid Cançado
- University of São Paulo, School of Medicine, Department of Gastroenterology. São Paulo, SP, Brazil.,University of São Paulo, Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil
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12
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Horvat N, Tavares CC, Andrade AR, Cabral JCS, Leao-Filho HM, Caiado AHM, Ueda SKN, Leite AZA, Sipahi AM, Rocha MS. Inter- and intraobserver agreement in computed tomography enterography in inflammatory bowel disease. World J Gastroenterol 2016; 22:10002-10008. [PMID: 28018107 PMCID: PMC5143746 DOI: 10.3748/wjg.v22.i45.10002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/08/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate intra- and interobserver agreement in imaging features in inflammatory bowel disease and comparison with fecal calprotectin (FC) levels.
METHODS Our institutional computed tomography enterography (CTE) database was retrospectively queried to identify patients who underwent CTE from January 2014 to June 2015. Patient inclusion criteria were confirmed inflammatory bowel disease (IBD) and FC collected < 4 mo after CTE without any change in clinical treatment or surgical treatment during this interval. The exclusion criterion was poor image quality. Two blinded abdominal radiologists, with 12 and 3 years of experience analyzed the CTE regarding localization (small bowel, colonic, both, or no disease detected); type of IBD (inflammatory, stenosing, fistulizing, > 1 pattern, or normal); and signs of active disease (present or absent). In 42 of 44 patients evaluated, routine CTE reports were made by one of the readers who re-evaluated the CTEs ≥ 6 mo later, to determine the intraobserver agreement. FC was considered a sign of disease activity when it was higher than 250 μg/g.
RESULTS Forty-four patients with IBD (38 with Crohn’s disease and 6 with ulcerative colitis) were included. There was a moderate interobserver agreement regarding localization of IBD (κ = 0.540), type of disease (κ = 0.410) and the presence of active signs in CTE (κ = 0.419). There was almost perfect intraobserver agreement regarding localization, type and signs of active disease in IBD. The κ values were 0.902, 0.937 and 0.830, respectively. After a consensus between both radiologists regarding inflammatory activity in CTE, we found that 24 (85.7%) of 28 patients who were classified with active disease had elevated FC, and six (37.5%) of 16 patients without inflammatory activity in CTE had elevated FC (P = 0.003). The correlation between elevated FC and the presence of active disease in CTE was significant (κ = 0.495, P = 0.001).
CONCLUSION We found almost perfect intraobserver and moderate interobserver agreement in the signs of active disease in CTE with concurrence of high FC levels.
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Abstract
Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5-17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it.
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Affiliation(s)
- E W Lambert
- Center for Mental Health Policy, Vanderbilt University, 1207 18th Avenue South, Nashville, Tennessee 37212, USA.
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Abstract
Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5-17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it.
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Affiliation(s)
- E W Lambert
- Center for Mental Health Policy, Vanderbilt University, 1207 18th Avenue South, Nashville, Tennessee 37212, USA.
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Bickman L, Lambert EW, Andrade AR, Penaloza RV. The Fort Bragg continuum of care for children and adolescents: mental health outcomes over 5 years. J Consult Clin Psychol 2000; 68:710-6. [PMID: 10965645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Controversial early results of the Fort Bragg mental-health-effectiveness study indicated that the continuum of care did not produce better outcomes (i.e., children's rate of improvement was the same in both the demonstration and comparison sites). The present study considered outcomes at 5-year follow-up to examine long-term effects from the continuum of care. A random regression longitudinal model analyzed 10 key outcome variables measured 7 times. Long-term outcomes in continuum-treated children were no better than those of comparison children; results are consistent with those of earlier studies.
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Affiliation(s)
- L Bickman
- Center for Mental Health Policy, Vanderbilt Institute for Public Policy, Nashville, Tennessee 37212, USA.
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Abstract
OBJECTIVE To compare the outcomes of children who received negligible amounts of outpatient treatment to children receiving more treatment. METHOD A random regression longitudinal model was used to analyze outcomes of children (aged 5-17 years) from the Fort Bragg Evaluation Project. RESULTS In examining several outcomes, the results show no statistically significant dose effect. CONCLUSIONS Children receiving substantial amounts of treatment showed no better mental health outcomes than those receiving negligible amounts of treatment. The results do not support the existence of a dose effect consistent enough to guide clinicians, administrators, or policymakers.
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Affiliation(s)
- A R Andrade
- Center for Mental Health Policy, Vanderbilt University, Nashville, TN 37212, USA.
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