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Objectives Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. Aim Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. Methods NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). Results Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64-0.84) and 0.76 (0.65-0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73-0.90) and 0.82 (0.71-0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71-0.93) and 0.80 (0.69-0.92) (P = 0.66). Conclusion Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.

Purpose: Ulcerative colitis (UC) can be managed with immunomodulation or surgery. We aimed to understand whether these strategies had a different impact on patients’ health-related quality of life (HRQoL). Methods: This was a retrospective, cross-sectional study: patients who had a moderate to severe UC episode that prompted the utilization of immunomodulatory drugs or surgery were invited to complete a generic (short form [36] health survey [SF-36]) and a disease-specific (inflammatory bowel disease questionnaire [IBDQ]) survey. Results: We included 157 patients, 65 (41.4%) surgically treated. The therapeutic procedure had a minimal impact on HRQoL: only the social dimension of the IBDQ and the physical function component of the SF-36 were significantly different between the study arms – lower for the surgically treated patients. The type of surgery had no impact, but the occurrence of pouchitis, namely, in a chronic form, was associated with a lower HRQoL. Regression analysis confirmed surgery as an independent predictor of lower scores in the social dimension of the IBDQ (–4.646, 95% CI –6.953 to –2.339) and in the physical functioning (–9.622, 95% CI –17.061 to –2.183) and physical role functioning (–3.669, 95% CI –7.339 to 0.001) dimensions of the SF36. Conclusions: Although usually feared by patients, surgery has a limited impact on UC patients HRQoL when compared to medical management with immunomodulatory drugs.

BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. The diagnosis of nonalcoholic steatohepatitis (NASH), the most severe form of NAFLD, is crucial and has prognostic and therapeutic implications. However, currently this diagnosis is based on liver biopsy and has several limitations. AIM To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging (GA-MRI) in differentiating isolated steatosis from NASH in patients with NAFLD. METHODS In this prospective study, 56 patients with NAFLD (18 with isolated steatosis and 38 with NASH) underwent GA-MRI. The contrast enhancement index (CEI) was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration. Between-group differences in mean CEI were examined using Student's t test. The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were evaluated. RESULTS The mean CEI for all subjects was 1.82 ± 0.19. The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis (P = 0.008). Two CEI cut-off points were used: < 1.66 (94% specificity) to characterize NASH and > 2.00 (89% sensitivity) to characterize isolated steatosis. CEI values between 1.66 and 2.00 indicated liver biopsy, and the procedure could be avoided in 40% of patients with NAFLD. CONCLUSION GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis, and could help to avoid liver biopsy in patients with NAFLD.

Background and aim Fat distribution may have prognostic value in the evaluation of non-alcoholic fatty liver disease. This study was conducted to evaluate associations of magnetic resonance imaging-measured abdominal fat areas with steatosis, steatohepatitis, and fibrosis, assessed histopathologically, in patients with type 2 diabetes. Methods This prospective study included 66 patients with type 2 diabetes (12 males, 54 females, age 26-68 years), without chronic liver disease of other causes. Axial dual-echo magnetic resonance images were acquired. Visceral, subcutaneous, and preperitoneal fat areas were measured using Osirix software. Liver biopsy specimens were obtained from all patients and examined histopathologically to evaluate steatosis, steatohepatitis, and fibrosis. Linear (for steatosis) and logistic (for steatohepatitis and fibrosis) regression models were fitted for the outcomes. R2 was used as a measure of how much model variance the predictors explained and to compare different predictors of the same outcome. Results Visceral and preperitoneal fat areas correlated well with histopathologically determined liver steatosis grade (both P = 0.004) and liver fibrosis (P = 0.008 and P = 0.037, respectively). All fat areas correlated well with steatohepatitis (P ≤ 0.002). Preperitoneal and visceral fat areas were the best predictors of steatohepatitis (R2 = 0.379) and fibrosis (R2 = 0.181), respectively. Conclusions Visceral fat area was the best predictor of fibrosis in patients with type 2 diabetes. Preperitoneal fat area was the best predictor of steatohepatitis and is a potential new non-invasive marker for use in the screening of these patients to detect more aggressive forms of non-alcoholic fatty liver disease.

To evaluate the diagnostic value of described thresholds of controlled attenuation parameter (CAP) and biomarker scores for liver steatosis and to evaluate new cut-offs to detect moderate-to-severe steatosis (S2–3) in patients with morbid obesity. In this prospective study, 32 patients with morbid obesity with indications for bariatric surgery (15 women and 17 men, mean age = 36 years, median BMI = 40.2 kg/m2) underwent CAP, magnetic resonance spectroscopy (MRS), three biomarker scores (Steato-ELSA, Fatty Liver Index (FLI), and Hepatic Steatosis Index (HSI)), and liver biopsy. Subjects were divided into an exploratory cohort (reliable CAP and liver biopsy) and a confirmatory cohort (reliable CAP and MRS) to evaluate new thresholds for CAP and biomarker scores to detect S2–3. Receiver operator characteristic (ROC) curves analyses were performed and the optimal cut-off points were identified using the maximal Youden index. A total of 22 patients had CAP measure and liver biopsy (exploratory cohort) and 24 patients had CAP measure with MRS (confirmatory cohort). New cut-offs were identified for detection of S2–3 by the non-invasive tests using liver biopsy as the reference standard (exploratory cohort). Considering the new proposed cut-offs for detection of S2–3 for CAP (≥ 314 dB/m), Steato-ELSA (≥ 0.832), FLI (≥ 96), and HSI (≥ 53), for the exploratory and confirmatory cohorts sensitivities were: 71–75%, 86–81%, 85–81%, and 71–69% and specificities were: 94–89%, 75–63%, 63–63%, and 75–88%, respectively. Higher cut-offs for CAP and biomarker scores may be better to diagnose moderate-to-severe steatosis in patients with morbid obesity.

Objectives: to validate nursing care effectiveness indicators of patient safety dimension. Methods: quantitative survey, using the electronic Delphi sampli, with 52 participants selected by the Snowball sampling. Eight indicators were evaluated regarding the attributes: availability, reliability, simplicity, representativeness, sensitivity, comprehensiveness, objectivity, cost, utility, stability and timeliness. For validation, the minimum agreement criterion was 70%. Results: Cronbach’s alpha (0.942) evidenced the high internal consistency among the attributes. The indicators fall with damage, hip fracture, and postoperative hip fracture, incidents related to equipment, incidents due to failures in patient identification, and pressure injury were validated in all attributes, and those of medication error and hand Hygiene were not validated. Conclusions: the validated indicators allow assessment of the effectiveness of hospital nursing care. Unavailability of data is an obstacle to monitoring patient safety. RESUMEN Objetivos: validar los indicadores de efectividad de la asistencia de enfermería hospitalaria en la dimensión seguridad del paciente. Métodos: estudio quantitativo, tipo survey, mediante la técnica Delphi electrónica, en el cual participaron 52 individuos seleccionados por la técnica Bola de Nieve. Se evaluaron ocho indicadores en los atributos disponibilidad, confiabilidad, sencillez, representatividad, sensibilidad, alcance, objetividad, costo, utilidad, estabilidad y tempestividad. El criterio mínimo de concordancia para validación fue del 70%. Resultados: el Alfa de Cronbach (0,942) evidenció la alta consistencia interna entre los atributos. Los indicadores caída con daño, fractura de cadera y fractura de cadera postoperatoria, incidentes relacionados con herramientas, incidentes debido a fallas en la identificación del paciente, y lesión por presión fueron validados en todos los atributos, y los de error de medicación y la higiene de las manos no han sido validados. Conclusiones: los indicadores validados permiten evaluar la efectividad asistencial de la enfermería. La indisponibilidad de datos es un obstáculo al monitoreo de la seguridad del paciente. RESUMO Objetivos: validar indicadores de efetividade da assistência de enfermagem hospitalar na dimensão segurança do paciente. Métodos: estudo quantitativo, tipo survey, mediante a técnica Delphi eletrônica, com 52 participantes selecionados pela técnica Bola de Neve. Oito indicadores foram avaliados quanto aos atributos disponibilidade, confiabilidade, simplicidade, representatividade, sensibilidade, abrangência, objetividade, custo, utilidade, estabilidade e tempestividade. Para validação o critério mínimo de concordância foi de 70%. Resultados: o alfa de Cronbach (0,942) evidenciou a alta consistência interna entre os atributos. Os indicadores queda com dano, fratura de quadril, e fratura de quadril pós-operatória, incidentes relacionados a equipamentos, incidentes devido a falhas na identificação do paciente, e lesão por pressão foram validados em todos os atributos, e os de erro de medicação e higiene de mãos não foram validados. Conclusões: os indicadores validados permitem avaliação da efetividade assistencial da enfermagem hospitalar. A indisponibilidade de dados é um óbice ao monitoramento da segurança do paciente.

Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited., Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists, Introdução: A colangiopancreatografia retrógrada endoscópica é o procedimento de escolha para a drenagem biliar, embora em alguns casos o acesso biliar convencional é difícil ou até impossível. As técnicas de drenagem guiadas por ecoendoscopia são uma alternativa nestes casos, embora a experiência seja ainda limitada. Caso: Apresentamos dois casos de drenagem biliar eficaz guiada por ecoendoscopia. No primeiro caso foi realizada hepaticogastrostomia numa doente com adenocarcinoma gástrico estadio IV, com icterícia obstrutiva devido a compressão hilar pela neoplasia, na qual o acesso à segunda porção duodenal se revelou impossível devido à neoplasia gástrica estenosante e a antecedentes de gastrojejunostomia paliativa. No segundo caso, uma doente com adenocarcinoma cefalo-pancreático com invasão duodenal que impedia a identificação da papila foi submetida a coledocoduodenostomia. Em ambos os procedimentos foi conseguida drenagem biliar eficaz e não ocorreram eventos adversos imediatos ou tardios. Discussão: Apesar de a experiência com técnicas de drenagem biliar guiadas por ecoendoscopia ser limitada, o seu perfil de eficácia e segurança parece ser favorável quando comparada com as alternativas (drenagem percutânea ou cirúrgica), pelo que devem ser consideradas quando exista equipamento e experiência necessária, (undefined), info:eu-repo/semantics/publishedVersion

Self-expanding metallic stents (SEMS) are the treatment of choice for incurable obstructive malignant esophageal strictures. Although the placement of SEMS is usually performed with fluoroscopic control (FC), recently several authors have shown the feasibility of placing SEMS under endoscopic control alone (EC). However, studies comparing the two techniques are lacking. The objective of this study was to compare the feasibility and safety of SEMS insertion under fluoroscopic control and endoscopic control. The study was performed through the retrospective analysis of patients who underwent SEMS insertion for malignant dysphagia between January 2005 and January 2010. Data concerning early and late complications and survival were retrieved. Early complications were defined as pain, vomiting, bleeding, malposition/migration, perforation, and/or dysphagia occurring until 30 days of SEMS insertion; and late complications as tumor ingrowth and overgrowth, migration, hemorrhage, fistulae, food impaction, and/or esophagitis occurring after 30 days. We placed 126 SEMS of which 87% for esophageal stricture, 8% for esophagus-respiratory fistula, and 5% for extrinsic compression. The mean age of the patients was 62 years, and 93 were male. SEMS insertion was performed with FC in 66 patients and EC in 60. Early complications occurred in 34 patients (52%) in the FC group and 28 (47%) in the EC group (P=0.71), including: pain in 22 patients of the FC group and 15 of the EC group (P=0.31); vomiting in 15 of the FC group and nine of the EC group (P=0.27); malposition/migration in three of the FC group and four of the EC group (P=0.60); hemorrhage in one of the FC group and two of the EC group (P=0.27); and dysphagia in two of the FC group and three of the EC group (P=0.57). Late complications occurred in 20 patients (30%) in the FC group and 22 (37%) in the EC group (P=0.44), including: tumor in/overgrowth in 13 patients of the FC group and 10 of the EC group (P=0.66); prostheses migration in five of the FC group and eight of the EC group (P=0.28); hemorrhage in two of the FC group and two of the EC group (P=0.54); appearance of esophageal fistulae in seven of the FC group and four of the EC group (P=0.43); food impaction in nine of the FC group and eight of the EC group (P=0.96); esophagitis in 12 of the FC group and 15 of the EC group (P=0.35). Median survival was 107 days (95% confidence interval [CI]=6-369 days) with no difference between the two groups. There were no statistical significant differences in the incidence of complications and in survival between patients undergoing SEMS placement under fluoroscopic control or endoscopic control.

The Picornaviridae family contains a large number of human pathogens such as rhinovirus, poliovirus and hepatitis A virus (HAV). Hepatitis A is an infectious disease that causes liver inflammation. It is highly endemic in developing countries with poor sanitation, where infections often occur in children. As in other picornaviruses, the genome of HAV contains one open reading frame encoding a single polyprotein that is subsequently processed by viral proteinases to originate mature viral proteins during and after the translation process. In the polyprotein, the N-terminal P1 region generates the four capsid proteins, while the C-terminal P2 and P3 regions contain the enzymes, precursors and accessory proteins essential for polyprotein processing and virus replication. Here, the first crystals of protein 2AB of HAV are reported. The crystals belonged to space group P41 or P43, with unit-cell parameters a = b = 90.42, c = 73.43 Å, and contained two molecules in the asymmetric unit. Native and selenomethionine-derivative crystals diffracted to 2.7 and 3.2 Å resolution, respectively. © 2011 International Union of Crystallography All rights reserved.

In this study, our aim was to explore the relationship between sleep quality/quantity, chronotype, pre-sleep arousal, arousability, stress, coping, neuroticism, extraversion, mood/affect, perceived health and sleep loss due to worry in college students. A total of 713 students (mean age 19.29 ± 1.256 years) completed a set of questionnaires that assessed sleep loss over worry (item from the General Health Questionnaire), other sleep–wake aspects (e.g., habitual sleep duration, sleep needs, sleep depth, subjective sleep quality, sleep latency, night awakenings, daytime sleepiness, sleep flexibility, sleep reactivity to stress), pre-sleep arousal (cognitive/somatic arousal), arousability, coping, neuroticism, extraversion, perceived physical/mental health, academic stress and positive/negative affect. Sleep disturbance due to worry was reported by 40.6 % of female and 19.2 % of male students. It was significantly correlated with perceived health and the majority of sleep–wake variables. Almost all correlations between the psychological traits under study and sleep loss over worry were significant. Results from the stepwise regression analyses, however, showed that only cognitive arousal (β = .353; p

We describe a 29-year-old pregnant woman at 16 weeks gestation and antiphospholipid antibodies who developed nephrotic syndrome with massive hematuria. Renal biopsy evidenced chronic glomerular lesions of ischemic nature without proliferative changes and immune deposits suggestive of lupus nephritis. Anticoagulation was initiated, along supportive measures, and the patient recovered completely. This case demonstrates that chronic renal lesions of antiphospholipid syndrome may present with marked clinical manifestation including hypertension, massive proteinuria and hematuria, resembling the course of acute thrombotic microangiopathy and/or lupus nephritis.

OBJECTIVE: To investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification. METHODS: Institutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 54 ± 9 years) underwent MRI and MRS at 3.0 T. The liver fat fraction was calculated from triple- and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. The accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman's correlation coefficients. RESULTS: The prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. The thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis. CONCLUSIONS: Liver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.

Summary Hepatic fibrosis staging is based on semiquantitative scores. Digital imaging analysis (DIA) appears more accurate because fibrosis is quantified in a continuous scale. However, high cost, lack of standardization and worldwide unavailability restrict its use in clinical practice. We developed an inexpensive and widely available DIA technique for fibrosis quantification in hepatitis C, and here, we evaluate its reproducibility and correlation with semiquantitative scores, and determine the fibrosis percentage associated with septal fibrosis and cirrhosis. 282 needle biopsies staged by Ishak and METAVIR scores were included. Images of trichrome-stained sections were captured and processed using Adobe® Photoshop® CS3 and Adobe® Bridge® softwares. The percentage of fibrosis (fibrosis index) was determined by the ratio between the fibrosis area and the total sample area, expressed in pixels calculated in an automated way. An excellent correlation between DIA fibrosis index and Ishak and METAVIR scores was observed (Spearman's r = 0.95 and 0.92; P

Infliximab is an effective agent in the treatment of patients with Crohn’s disease. Therapy with infliximab is generally well tolerated but there are concerns about its effects on the incidence of cancer. This case report refers to a 47-year-old patient with long-standing Crohn’s disease, without a family history of colorectal cancer, who had a previous diagnosis of low-grade dysplasia that was not confirmed in subsequent studies, and was diagnosed with adenocarcinoma of the colon with peritoneal invasion after the fourth infusion of infliximab.

Objective To evaluate the capability of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) to assess steatohepatitis and fibrosis determined by histopathology in type 2 diabetic patients. Methods Fifty-nine type 2 diabetic patients (49 women, 10 men; mean age, 54 ± 9 years) were submitted to liver biopsy for the evaluation of non-alcoholic fatty liver disease (NAFLD) and underwent DWI on a 3.0T MR system using 10 b values. Institutional approval and patient consent were obtained. Pure molecular-based (D), perfusion-related (D*), and vascular fraction (f) were calculated using a double exponential model and least squares curve fitting. D, D*, and f were compared between patients with and without steatohepatitis and between patients with and without fibrosis. The variables were compared by using the Ranksum test and Student t-test. Results Steatohepatitis was observed in 22 patients and fibrosis in 16 patients. A lower D median (0.70 s/mm2 vs. 0.83 s/mm2, p

Colorectal cancer (CRC) is the third most common cancer in the world, and mortality has remained the same for the past 50 years, despite advances in diagnosis and treatment. Because significant numbers of patients present with advanced or incurable stages, patients with pre-malignant lesions (adenomatous polyps) that occur as result of genetic inheritance or age should be screened, and patients with long-standing inflammatory bowel disease should undergo surveillance. There are different risk groups for CRC, as well as different screening strategies. It remains to be determined which screening protocol is the most cost-effective for each risk catagory. The objective of screening is to reduce morbidity and mortality in a target population. The purpose of this review is to analyze the results of the published CRC screening studies, with regard to the measured reduction of morbidity and mortality, due to CRC in the studied populations, following various screening procedures. The main screening techniques, used in combination or alone, include fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy. Evidence from the published literature on screening methods for specific risk groups is scanty and frequently does not arise from controlled studies. Nevertheless, data from these studies, combined with recent advances in molecular genetics, certainly lead the way to greater efficacy and lower cost of CRC screening. O câncer colorretal (CCR) é a terceira neoplasia mais freqüente no mundo. A mortalidade persiste inalterada nos últimos 50 anos a despeito dos avanços obtidos em diagnóstico e tratamento. Significativa parcela dos doentes se apresenta com tumores em estágio avançado ou incuráveis de onde se depreende a necessidade de rastreamento dos pacientes com lesões pré-malignas (pólipos adenomatosos) como resultado de herança genética ou idade, e de vigilância dos portadores de doença inflamatória intestinal de longa evolução. Na medida em que existem diferentes grupos de risco identificáveis para CCR e diferentes estratégias para o rastreamento, há que se determinar o protocolo de triagem capaz de oferecer maior relação custo-benefício. Uma vez que o objetivo das técnicas de rastreamento é diminuir a morbi-mortalidade da população analisada, o presente trabalho objetiva conhecer, sob essa perspectiva, os resultados dos estudos disponíveis até o momento para o rastreamento do CCR. Os principais métodos de rastreamento incluem, isoladamente ou em associação, o emprego da pesquisa de sangue oculto nas fezes, a sigmoidoscopia e o exame colonoscópico. As evidências de literatura a respeito dos métodos de rastreamento para os diversos grupos de risco específicos são insuficientes e, freqüentemente, não envolvem estudos controlados. A necessidade de realização desses estudos associada ao progresso nos estudos de genética molecular resultará em maior eficácia e menor custo associados ao rastreamento do CCR.

(range: 11-91). Mean total procedure time in TE cases: BDBE 179 (135-261) minutes; ODBE 107 (50-149) minutes; BDBE done on the same day 170 (114314) minutes. The TE rate for patients without prior alimentary tract resection was 60% (90/150) for BDBE and 75% (6/8) for ODBE. The TE rate for BDBE patients with small bowel resection was low at 35% (14/45). On the other hand, it was higher for patients with a Roux-en-Y gastric bypass (RYGB) 83%(5/6). In the ODBE group, 65%(15/23) of patients with a TE had a history of small bowel surgery. 77% (103/133) of TE patients had general anesthesia versus intravenous sedation (MAC) in 17% 23/133 (p 0.0001, Fisher’s Exact test). The average BMI in the TE of ODBE patients was 25 (range: 16-37) and 24(16-55)in the BDBE group. The average BMI in the non-TE of BDBE pts was 27 (range 15 -50) and 25 in ODBE pts (range 16-37). Indications for TE include: 27 obscure-overt gi bleed, 26 obscure-occult gi bleed, 14 anemia (anemia and fe def anemia), 9 Crohn disease, 21 abdominal pain, 13 suspected small bowel mass, 3 PeutzJeghers Syndrome, 11 metastatic carcinoid or suspected multifocal carcinoid lesions, and other 9 (FAP,diarrhea, protein-losing enteropathy, retained capsule, small bowel lymphoma). The yield of finding a clinically relevant lesion in TE for BDBE and ODBE for obscure GI bleeding was 62% (33/53). Conclusions: TE rates vary greatly among endoscopists performing DBE, although it can be achieved in more than half of our U.S. patients who undergo BDBE. On the contrary, TE is rare in ODBE. BDBE can be done in one setting in less than 3 hours, which is the same as that being done on separate days. General anesthesia contributes to TE completion as well as history of RYGB, and surprisingly BMI appears not to be a significant factor, although a larger sample size and further analysis is needed to verify this observation

A doença oncológica reveste-se de um carácter estigmatizante, sentida pelo utente e sua família que, associada a incertezas de prognóstico, provocam sofrimento, levantando questões ao nível da Qualidade de Vida (QV) dos indivíduos. Com a finalidade de compreender qual o impacto da gastrectomia em utentes com carcinoma gástrico (nutrição versus QV), a sua influência na satisfação do autocuidado e o papel do enfermeiro, ao longo do processo de transição saúde-doença efectuou-se uma Revisão Sistemática de Literatura (RSL), sem meta-síntese e sem metanálise. Foi seguida a metodologia PI[C]OD - Participantes; Intervenções; [Comparações]; Outcomes; Desenho do estudo - para a elaboração da pergunta de investigação e definição dos critérios de inclusão e exclusão dos estudos recolhidos, sendo que, doze constituíram a amostra: foram analisados, interpretados e sintetizados. Dessa análise pode concluir-se que a nutrição se traduz num benefício quando iniciada precocemente traduzindo-se numa melhoria da QV. O enfermeiro funciona como elemento facilitador no processo, promovendo a autonomia e independência necessárias para satisfazer as necessidades, expressas ou sentidas, de autocuidado. Em Portugal, surge a necessidade de reconhecer a importância da variável nutrição na minimização do impacto da cirurgia por carcinoma gástrico e desenvolver estudos neste âmbito transpondo os resultados para a prática. Cancer has a stigmatizing nature felt by the sufferer and his familie, associated with the uncertainty of prognosis, causing suffering, and raising issues of the Quality of Life (QOL) of individuals. In order to understand the impact on those having gastrectomy for gastric carcinoma (nutrition versus QOL), its influence on satisfaction with self-care and the nurse’s role during the health-disease transition process, a Systematic Literature Review (RSL) was conducted, without meta-synthesis and without meta-analysis. The PI[C]OD methodology - Participants; Interventions; [Comparisons]; Outcomes, Study design - was used to develop the research question and to define the criteria for inclusion and exclusion of studies identified, with twelve forming the sample; analysis, interpretation and summary were conducted. From this analysis it can be concluded that nutrition is beneficial when started early, leading to improvement in QOL. The nurse acts as a facilitator in the process, promoting autonomy and independence, to satisfy the needs, expressed or perceived, for self-care. In Portugal, there is a need to recognize the importance of nutrition in minimizing the impact of surgery for gastric carcinoma and to carry out studies in this area to transfer the results into practice. La enfermedad oncológica está impregnada de un carácter estigmatizante sentida por el usuario y su familia que, asociado a incertidumbres de pronóstico, provoca sufrimiento, planteando interrogantes respecto a la Calidad de Vida (QV) de los individuos. Con el fin de comprender cuál es el impacto de la gastrectomía en usuarios con carcinoma gástrico (nutrición versus calidad de vida), su influencia en la satisfacción del autocuidado y el papel del enfermero a lo largo del proceso de transición salud-enfermedad se efectuó una Revisión Sistemática de la Literatura (RSL), sin meta-síntesis y sin metanálisis. Se siguió la metodología PI[C]OD - Participantes; Intervenciones; [Comparaciones]; Resultados; Diseño del estudio - para la elaboración de la pregunta de investigación y definición de los criterios de inclusión y exclusión de los estudios recogidos siendo que, los doce que constituyeron la muestra fueron analizados, interpretados y sintetizados. De ese análisis pudo concluirse que la nutrición se traduce en un beneficio cuando es iniciada precozmente y que conlleva a una mejora de la Calidad de Vida. El enfermero funciona como elemento facilitador en el proceso, promoviendo la autonomía e independencia necesarias para satisfacer las necesidades, exprimidas o sentidas, de autocuidado. En Portugal, ha surgido la necesidad de reconocer la importancia de la variable nutrición en la minimización del impacto de la cirugía por carcinoma gástrico y de desarrollar estudios en este ámbito, transponiendo los resultados a la práctica.