Search

Background: The most appropriate strategy for completing a previous incomplete colonoscopy (IC) is not standardized. We aimed to compare the efficacy and safety of two strategies for completing a previous IC: colon capsule endoscopy (CCE) versus repeat conventional colonoscopy. Methods: A retrospective cohort study that included consecutive adult patients referred to our center after IC under sedation due to irreducible loop formation or colonic fixed angulation was performed. Patients underwent CCE (PillCam COLON2 Medtronic®) or repetition of conventional colonoscopy under sedation. In this setting, an appropriate CCE progression was defined as the capsule reaching the segment achieved during the previous IC. Repeated conventional colonoscopy was considered complete when cecal intubation was accomplished. We compared the rate of appropriate CCE colon progression with the cecal intubation rate from repeated conventional colonoscopy. Quality of colon preparation, diagnostic yeld and rate of adverse events for CCE and colonoscopy was also analyzed. Results: A total of 192 CCE and 181 colonoscopies were performed for IC, primarily due to fixed angulation of the left colon (69.2%, n = 258). There were no significant differences between the two groups (CCE vs. colonoscopy) concerning age, sex, overweight/obesity status, previous abdominal surgery, and reasons for IC. The rate of appropriate colon progression with CCE was not significantly different from the cecal intubation rate of repeated colonoscopy (95.3% vs. 90.1%, P = 0.073, respectively), even after adjusting for the quality of colon preparation (P = 0.122), which differed significantly between the groups (76.0% vs. 92.8%, P < 0.001, respectively). There were no significant differences in overall colorectal findings identified between the CCE and colonoscopy groups (55.2% vs. 62.4%, P = 0.172, respectively), and no adverse events were reported in either group. Conclusions: Our findings suggest that both CCE or repeat conventional colonoscopy are effective and safe options for completing a previous incomplete colonoscopy.

Introduction: Celiac disease has been associated with gastrointestinal malignancies, most commonly gastrointestinal lymphoma. Nevertheless, rarer malignancies have also been reported, such as small bowel adenocarcinoma, mainly located in the duodenum or jejunum. Case Presentation: We report a case of a female patient with celiac disease with poor adherence to a gluten-free diet who presented with small bowel obstruction due to a primary ileal adenocarcinoma. The patient remains asymptomatic, adherent to the gluten-free diet, and without clinical, biochemical, or imaging evidence of cancer recurrence. Discussion/Conclusion: This case should raise awareness about the importance of the gluten-free diet and the early diagnosis and appropriate management of rare small bowel malignant complications of celiac disease, namely, adenocarcinoma.

BackgroundDetecting invalid cognitive performance is an important clinical challenge in neuropsychological assessment. The aim of this study was to explore behavior and eye-fixations responses during the performance of a computerized version of the Test of Memory Malingering (TOMM-C) under standard vs. feigning conditions.Participants and methodsTOMM-C with eye-tracking recording was performed by 60 healthy individuals (31 with standard instruction – SI; and 29 were instructed to feign memory impairment: 21 Naïve Simulators – NS and 8 Coached Simulators – CS) and 14 patients with Multiple Sclerosis (MS) and memory complaints performed. Number of correct responses, response time, number of fixations, and fixation time in old vs. new stimuli were recorded. Nonparametric tests were applied for group comparison.ResultsNS produced fewer correct responses and had longer response times in comparison to SI on all three trials. SI showed more fixations and longer fixation time on previously presented stimuli (i.e., familiarity preference) specially on Trial 1, whereas NS had more fixations and longer fixation time on new stimuli (i.e., novelty preference) specially in the Retention trial. MS patients produced longer response time and had a different fixation pattern than SI subjects. No behavioral or oculomotor difference was observed between NS and CS.ConclusionHealthy simulators have a distinct behavioral and eye-fixation response pattern, reflecting a novelty preference. Oculomotor measures may be useful to detect exaggeration or fabrication of cognitive dysfunction. Though, its application in clinical populations may be limited.

Background: The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary: We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn’s disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages: PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.

Introduction: In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim:To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods: Retrospective, single center, cohort study. Patients’ demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results: We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion: A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.

Background and study aims Polyethylene glycol (PEG) bowel preparations are effective but associated with high ingestion volume. In this study, 1-L PEG and 2-L PEG preparations were compared in a randomized, colonoscopist-blinded, single-center trial. Patients and methods Patients were aged > 18 years, required colonoscopy, and provided informed consent. Randomization was 1:1 to 1-L PEG or 2-L PEG, based on hospital identification number (odd or even). Preparations were administered using same-day dosing adjusted for colonoscopy start time. The primary endpoint was successful bowel preparation on the Boston Bowel Preparation Scale (BBPS) (no segment scored

Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients’ quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.

Introduction Crohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).Methods A prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.Results Study enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.Conclusion Panenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration number ClinicalTrials.gov NCT03241368

The purpose of this paper is to present a discussion about silence as an agent responsible for the eradication of the struggle and (re)existence of LGBTQ+ social groups persecuted by the Brazilian military regime on the grounds that they are considered to be "deviant" in season. As theoretical support, we use the theoretical reflections on silence and discourse, based on Eni Orlandi (1992). We understand that this research collaborates with the need to think of homosexuality as articulated to the discourse, contributing to the understanding of the silencing of the discussion on these themes. Thus, we aimed to analyze the social relevance of a newspaper that opposed the repressive ideology of a military government in the 1970s and 1980s, established in Brazil. In traditional approaches, in the language sciences, silence is given a negative condition by being considered only a lack of words. However, Orlandi refers to it as something that is not the shadow of the verbal, it is not the emptiness: it is something that means. From these questions, we will reflect on the relation between discourse and silence in relation to homosexuality, a hypothesis that we defend still to perpetuate in the contemporaneity in our country. In order to do so, we analyze the article "The words: Why fear them?", Found in the newspaper, dedicated to the discussion of homosexuality entitled Lampião da Esquina, from which we reflect on the effects of meaning that are produced when we choose certain endings for homosexual subjects.

Introduction: Comfort is a key element in the provision of nursing care to patients with Palliative Care. Comfort is a complex act. To promote comfort is to be attentive to all manifestations of distress, to take into account all dimensions of the human being and to provide measures for the relief of suffering (Morse, 2000). We can see that there is no clear definition for the concept of comfort, however, it is unanimous that this emerges as a lifelong need in health and illness, therefore, providing comfort is one of the main functions and a challenge for the Practice of nursing care (Ribeiro and Costa 2012). Objective: The objective of this study is to understand the nurses' perception regarding the comfort of the person at the end of life in a home context, identifying the comfort conception for the nurse with respect to the person at the end of life. Material and Methods: A qualitative, descriptive study was carried out through semi-structured interviews with 8 participants. The methodology used for data processing was content analysis. (Bardin, 2014) Results: After analyzing our data, we can say that, in terms of Comfort Design (Domain), four categories were found: Physical Expression, Multifocal / Multidimensional Expression of Comfort, Affective Expression and Basic Needs Fulfilled ). Conclusion: The main contribution of this study is to explore the phenomenon of comfort with regard to the end-of-life person in a home context, reinforcing the importance that nurses assume in the implementation of comforting care. Based on a humanistic-affective approach, the comfort process is mediated by the nurse-patient / family interaction.

Introduction: Helicobacter pylori eradication has become increasingly difficult as resistances to several antibiotics develop. We aimed to compare Helicobacter pylori eradication rates between triple therapy and sequential therapy in a naive Portuguese population. Material and Methods: Prospective randomized trial including consecutive patients referred for first-line Helicobacter pylori eradication treatment. Exclusion criteria: previous gastric surgery/neoplasia, pregnancy/lactancy, allergy to any of the drugs. The compared eradication regimens were triple therapy (pantoprazol, amoxicillin and clarithromycin 12/12 hours, 14 days) and sequential therapy (pantoprazol 12/12 hours for 10 days, amoxicillin 12/12 hours for days 1 - 5 and clarithromycin plus metronidazol 12/12 hours during days 6 - 10). Eradication success was confirmed with urea breath test. Statistical analysis was performed with SPSS v21.0 and a p-value < 0.05 was considered statistically significant. Results: Included 60 patients, 39 (65%) female with mean age 52 years (SD ± 14.3). Treatment groups were homogeneous for gender, age, indication for treatment and smoking status. No statistical differences were encountered between sequential and triple therapy eradication rates (86.2% vs 77.4%, p = 0.379), global eradication rate was 82%. Tobacco consumption was associated with a significantly lower eradication success (54.5 vs 87.8%, p = 0.022). Discussion: In this randomized controlled trial in a naive Portuguese population, we found a satisfactory global Helicobacter pylori eradication rate of 82%, with no statistical differences observed in the efficacy of the treatment between triple and sequential regimens. Conclusion: These results support the use of either therapy for the first-line eradication of Helicobacter pylori.

The small bowel is affected in the vast majority of patients with Crohn's Disease (CD). Small bowel capsule endoscopy (SBCE) has a very high sensitivity for the detection of CD-related pathology, including early mucosal lesions and/or those located in the proximal segments of the small bowel, which is a major advantage when compared with other small bowel imaging modalities. The recent guidelines of European Society of Gastrointestinal Endoscopy (ESGE) and European Crohn's and Colitis Organisation (ECCO) advocate the use of validated endoscopic scoring indices for the classification of inflammatory activity in patients with CD undergoing SBCE, such as the Lewis Score or the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). These scores aim to standardize the description of lesions and capsule endoscopy reports, contributing to increase inter-observer agreement and enabling a stratification of the severity of the disease. On behalf of the Grupo de Estudos Português do Intestino Delgado (GEPID) – Portuguese Small Bowel Study Group, we aimed to summarize the general principles and clinical applications of current endoscopic scoring systems for SBCE in the setting of CD, covering the topic of suspected CD as well as the evaluation of disease extent (with potential prognostic and therapeutic impact), evaluation of mucosal healing in response to treatment and evaluation of post-surgical recurrence in patients with previously established diagnosis of CD.

Background: Ulcerative colitis (UC) has a recognized phenotypic heterogeneity. Some studies suggest that age at diagnosis may influence features and natural history of the disease. Aim: This study aimed to compare patients', disease's and treatment's features between Portuguese patients diagnosed before and after the age of 40-years-old. Methods: Retrospective single-center study that included 310 patients with UC, divided in two groups: Those diagnosed before the age of 40-years-old (early onset UC) and those diagnosed later than that (late onset UC). In each group features of the patients (gender, family history, smoking), of the disease (duration, extension, severity, clinical course, hospitalization, extraintestinal manifestations), and of treatment (oral aminosalicylates, systemic steroids or immunomodulators) were analyzed. Statistical analysis was performed using SPSSv22.0. Univariate and multivariate analyses were performed to assess factors associated with early and late onset UC. Results: From the analyzed patients, 207 had UC diagnosed before the age of 40 years old (43.5% men; mean age at diagnosis 29.4 ± 6.9 years) and 103 were diagnosed after that age (61.2% men; mean age at diagnosis 51.8 ± 8.1 years). In the group diagnosed before 40 years old, female gender (p = 0.003), severe disease (p = 0.002), chronic intermittent clinical course (p = 0.026), and hospitalizations (p = 0.001) were significantly more frequent. The use of oral aminosalicylates (p = 0.032), systemic steroids (p = 0.003) and immunomodulators (p = 0.012) were also more common in the early onset UC group. No differences between groups were found in family history, smoking, disease's extension, extraintestinal manifestations, and use of biological agents. Multivariate analysis pointed early onset UC to be significantly associated with female gender (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.08-2.91; p = 0.024), chronic intermittent symptoms (OR, 2.34; 95% CI, 1.17-4.70; p = 0.016), and need of hospitalization (OR, 2.89; 95% CI, 1.46-5.72; p = 0.002). Conclusions: When diagnosed before the age of 40-years-old, UC preferably affects women and manifests as a more severe disease, with more frequent hospitalizations and chronic intermittent symptoms. These facts might have implications in planning timely and individualized future therapeutic strategies.

A fim de investigar o uso de tabaco e fatores associados entre universitários do Sul do Brasil no ano de 2010, realizou-se estudo transversal com questionários autoaplicáveis. A amostra foi dividida em dois grandes grupos: área da Saúde e demais cursos. A amostra de cada grupo foi dividida de acordo com a proporção em relação ao número total de alunos. Os alunos foram selecionados do primeiro e último ano de cada curso. A análise estatística foi realizada no Software SPSS versão 17.0(r). Responderam aos questionários 584 alunos. A prevalência de tabagismo entre os acadêmicos foi de 8,9%, sendo 4,7% tabagistas ativos e 4,2% fumantes ocasionais; 2,6% declararam-se ex-fumantes. A idade média foi de 23,0 anos (±9,7), sendo 62,3% do sexo feminino. Dentre os fumantes 49% começaram a fumar por vontade própria e 27,4% por influência de amigos. A maioria declarou fumar para relaxar. Observou-se associação significativa entre o tabagismo e o uso de álcool (OR 5,80; IC95% 1,20-28,01) e de drogas ilícitas (OR 42,29; IC95% 11,45-175,1) e a existência de outros familiares fumantes (OR 4,02; IC95% 2,05-7,85). A prevalência de tabagismo encontrada neste estudo foi baixa. O tabagismo foi significativamente associado a alunos usuários de drogas ilícitas, que fazem uso de álcool e que tem algum tabagista na família.

The aim of this study was to evaluate the unilateral strength in knee flexion and extension, and the Hamstring/Quadriceps Ratio (H/Q Ratio), in dominant and non-dominant lower limbs in professional dancers. This was a cross-sectional study, carried out with 12 health adults (27.5±1.27years, 66.6±3.11kg, 173±0.02cm, 22.1±0.51kg/m2), professional dancers of a national company. The volunteers, after physical measurements, were submitted to a 1 Repetition Maximum (1RM) test, unilaterally, in both lower limbs at Flexor and Extensor Bench seat exercises. After 1 week, a 1RM retest was carried out to confirm the real total load for each limb. The torque and H/Q Ratio were calculated unilaterally. In knee extension, the dominant limb presented strength 18.77% higher than non-dominant limb (p

Background and study aims: One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. Patients and methods: Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. Results: Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). Conclusions: One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.

O papilomavírus humano (HPV) é um fator etiológico bem estabelecido para o câncer cervical. Esse vírus de DNA infecta primariamente o epitélio e pode induzir lesões benignas ou malignas na pele e na mucosa. Alguns HPVs são considerados de alto risco, responsáveis pela progressão das lesões precursoras até câncer cervical. A infecção genital pelo HPV é comum em mulheres jovens e geralmente é transitória. Uma pequena proporção de mulheres infectadas desenvolve câncer cervical, implicando o envolvimento de fatores ambientais e fatores genéticos na carcinogênese. Essa revisão aborda a estrutura viral, classificação e patologia do HPV, história natural e fatores de risco para neoplasia cervical e perspectivas futuras com a vacina anti-HPV.Human papillomavirus (HPV) has been established as an important etiological factor for the development of cervical cancer. This DNA virus primarily infects the epithelium and can induce benign and malignant lesions of the mucous membranes and skin. Some HPVs are considered high risk due to their role in malignant progression of cervical tumors. Genital HPV infections are common and usually transient among young sexually active women. Only a small fraction of infected women develop cervical cancer, implying the involvement of environmental and genetic cofactors in cervical carcinogenesis. Classification, virology, pathology, natural history, epidemiological features of genital HPV infection, and future prospects for cervical cancer prevention with HPV vaccines will be reviewed here.

Introduction: Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice. Material and Methods: Bibliographic review of relevant and recent papers indexed in PubMed. Results and Discussion: Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with “negative“ small bowel capsule endoscopy is debatable. Cross-sectional imaging may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn’s disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn’s disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac disease is evolving. Conclusions: Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn’s disease, or patients with known Crohn’s disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.

Objectives. Small bowel capsule endoscopy (SBCE) plays a decisive role in the obscure gastrointestinal bleeding (OGIB) diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential), P1 (uncertain bleeding potential: erosions), and P2 (high bleeding potential: angioectasias, ulcers, and tumors). We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4%) were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026). We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

O objetivo do presente estudo foi analisar os efeitos do treinamento aquático (TA) no perfil lipídico e nas estruturas ventriculares esquerdas de camundongos hiperlipidêmicos. Foram utilizados 28 camundongos LDLr-/-, machos, divididos aleatoriamente em 4 grupos: sedentários alimentados com ração padrão (C); treinados alimentados com ração padrão (C+TRE), sedentários alimentados com ração hiperlipídica (HL) e treinados alimentados com ração hiperlipídica (HL+TRE). Os animais dos grupos treinados praticaram TA em intensidade moderada, por 60 minutos durante 60 dias consecutivos. Após 48 horas do término do período de treinamento e 12 horas de jejum de repouso os animais foram eutanasiados, o sangue coletado e o soro utilizado para análises laboratoriais de triglicérides, colesterol total e suas frações (LDL, HDL, VLDL). O coração foi removido e o ventrículo esquerdo foi pesado a fresco para se calcular a proporção do peso ventricular esquerdo (mg)/ peso do animal (g). Os resultados mostraram que o TA sem cargas adicionais foi mais eficiente na melhora das concentrações plasmáticos de lipídeos quando acompanhado por uma dieta adequada, confirmando que a associação exercício físico com dieta equilibrada é essencial para obtenção de seus benefícios. O treinamento ocasionou hipertrofia ventricular esquerda excêntrica no grupo alimentado com dieta padrão e, principalmente, diminuiu o depósito de colágeno intersticial no miocárdio dos animais alimentados com dieta hiperlipídica, o que pode indicar uma melhora na função diastólica com consequente melhora da função sistólica. Concluiu-se que o treinamento aquático de intensidade leve a moderada induz adaptações benéficas e profiláticas ao coração, promovendo saúde e prevenindo doenças.

Rheumatoid arthritis is a chronic inflammatory auto-immune disease characterized by a progressive destruction of joints and variable extra-articular manifestations. More prevalent among women, usually develops between 35 and 50 years, and there is a genetic predisposition. The etiology remains unknown but is consensus the importance of T lymphocytes, B lymphocytes and cytokines in the inflammatory process. It is important then to tackle the disease by a multi-disciplinary strand which includes symptoms control with the use of analgesics and anti-inflammatory drugs, and use of glucorticosteroids, disease-modifying drugs and new biological drugs aimed to control disease progression. It’s associated to the pharmacological approach complementary therapies, surgery and patient education programs. This review intended to raise awareness of the complexity of this disease and what the science has offered us, as new strategies pharmacological / non-pharmacological, always with the aim of contributing to an improved quality of life in patients with rheumatoid arthritis.

A imunossupressão crónica é um reconhecido factor de risco para a tuberculose. O nosso objectivo foi o de obter um consenso para o rastreio e prevenção da tuberculose em portadores de doenças inflamatórias imuno- mediadas candidatos a terapêutica biológica. Métodos: Revisão crítica da literatura e opinião de peritos acerca das terapêuticas imunossupressoras e risco de tuberculose. Resultados e Conclusão: O método actualmente recomenda- do para o rastreio é o teste cutâneo da tuberculina e o doseamento do interferão gama, após exclusão da tuberculo- se activa. Doentes com rastreio positivo devem receber tratamento para a tuberculose latente. Estes doentes podem iniciar a terapêutica biológica após 1 a 2 meses, desde que a sua adesão seja rigorosa e apresentem boa tolerância à terapêutica profilática. PALAVRAS-CHAVE – Tuberculose latente; Terapêutica biológica; Terapêutica anti-TNF; Doenças inflamatórias imu- no-mediadas.

A sobrecarga do cuidador principal constitui um problema importante, o que desperta interesse não só de trabalhos de investigação mas também de instrumentos de avaliação, como a Zarit Burden Interview que avalia a sobrecarga do cuidador em diferentes níveis. Objectivo: Validação da escala de Zarit (Zarit Burden Interview) para os cuidadores de doentes paliativos em âmbito domiciliário, para a realidade portuguesa. Processo metodológico: Estudo metodológico de natureza quantitativa, aplicado a uma amostra de 104 cuidadores de doentes em cuidados paliativos domiciliários, nas diversas equipas existentes no país. Este estudo descreve a construção e as características psicométricas do instrumento. Resultados: A avaliação da consistência interna foi efectuada através do alfa de Cronbach, sendo o valor obtido de 0,884. O total da média dos scores totais da escala de Zarit neste grupo de cuidadores foi de 37,26, o que indica sobrecarga moderada. Da análise estatística do instrumento evidenciam-se cinco factores multidimensionais de sobrecarga. Conclusão: A escala de sobrecarga “The Zarit Burden Interview” tem boas características psicométricas, pelo que se aconselha a sua aplicação a cuidadores de doentes em cuidados paliativos domiciliários na população portuguesa.

Arterial stiffness is a progressive aging process that predicts cardiovascular disease. Pulse wave velocity (PWV) has emerged as a noninvasive, valid, and reliable measure of arterial stiffness and an independent risk predictor for adverse outcomes. However, up to now, PWV measurement has mostly been used as a tool for risk prediction and has not been widely used in clinical practice. This consensus paper aims to discuss multiple PWV measurements currently available in Asia and to provide evidence-based assessment together with recommendations on the clinical use of PWV. For the methodology, PWV measurement including the central elastic artery is essential and measurements including both the central elastic and peripheral muscular arteries, such as brachial-ankle PWV and cardio-ankle vascular index, can be a good alternative. As Asian populations are rapidly aging, timely detection and intervention of "early vascular aging" in terms of abnormally high PWV values are recommended. More evidence is needed to determine if a PWV-guided therapeutic approach will be beneficial to the prevention of cardiovascular diseases beyond current strategies. Large-scale randomized controlled intervention studies are needed to guide clinicians.

Abstract Background Endothelial dysfunction is an independent risk factor for cardiovascular events. Inflammatory mediators released by the adipose tissue can lead to local insulin resistance and endothelial dysfunction. This study addressed the relationship of adipocytokines with endothelial function and blood pressure. Methods In 92 newly diagnosed, drug-naïve essential hypertensive patients (HT, mean age 49 yrs) without organ damage and 66 normotensive subjects (NT, mean age 47 yrs), by an automated system, we measured endothelium-dependent and -independent vasodilation as brachial artery flow-mediated dilation before and after administration of glyceryl-trinitrate. Retinol binding protein-4 (RBP4) and resistin levels were determined by ELISA and RIA, respectively. Oxidative stress was evaluated by measuring serum malondyaldehyde (MDA). Results Flow-mediated dilation was significantly (p = 0.03) lower in HT (5.3 ± 2.6%) than NT (6.1 ± 3.1%), while response to glyceryl-trinitrate (7.5 ± 3.7% vs 7.9 ± 3.4%) was similar. RBP4 (60.6 ± 25.1 vs 61.3 ± 25.9 μg/ml), resistin (18.8 ± 5.3 vs 19.9 ± 6.1 ng/ml) and MDA levels (2.39 ± 1.26 vs 2.08 ± 1.17 nmol/ml) were not different in HT and NT. RBP4 (r = −0.25; p = 0.04) and resistin levels (r = −0.29; p = 0.03) were related to flow-mediated dilation in NT, but not in HT (r = −0.03 and r = −0.10, respectively). In NT, multivariate analysis including RBP4 and confounders showed that only BMI or waist circumference remained related to flow- mediated dilation. In the multivariate model including resistin and confounders, BMI, age and resistin were significantly related to flow-mediated dilation, while only age significant correlated with this parameter when BMI was replaced by waist circumference. Conclusions Adipocytokine levels may be independent predictors of endothelial dysfunction in the peripheral circulation of healthy subjects, providing a pathophysiological link between inflammation from adipose tissue and early vascular alterations.