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Made available in DSpace on 2022-05-01T09:31:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Cutaneous involvement is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). More commonly, pyoderma gangrenosum and erythema nodosum are noted, but psoriasis, aphthous stomatitis, Sweet's syndrome, and vasculitis may also occur. Leukocytoclastic vasculitis (LCV) is a rare cutaneous manifestation, characterized by the appearance of palpable purpura, urticaria, and ulcer-necrotic lesions predominantly in the lower extremities that improve with immunosuppressive therapy. In this case, we report a patient with CD and LCV. We also searched the literature on the diagnosis and treatment of LCV in patients with CD. Female, 31, presented with diarrhea containing mucus and blood, abdominal pain, arthralgia, and enanthematous plaques and ulcers with a hematinic background in the lower extremities. The results of the colonoscopy were compatible with CD and skin biopsy showed signs of LCV. Systemic autoimmune disease and primary vasculitis were ruled out. The patient received treatment with a systemic corticosteroid and the skin lesions improved. Outpatient treatment with antitumor necrosis factor therapy was initiated to promote skin healing and IBD clinical remission. As LCV is a rare manifestation of IBD, it is necessary to distinguish this dermatopathy from other systemic vasculitis. The engagement of a multidisciplinary team is essential for the correct diagnosis and management. São Paulo State University (Unesp) Medical School Clinica Universidad de Los Andes São Paulo State University (Unesp) Medical School

Made available in DSpace on 2021-06-25T15:03:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-06 BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 mu g/mL) and fecal calprotectin of 921 mu g/g (< 30 mu g/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy. CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients. Sao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, Brazil Clin Univ Los Andes, Med Dept, Gastroenterol, Inflammatory Bowel Dis Program, Santiago 7550000, Chile Sao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, Brazil

Inflammatory bowel disease (IBD) is a chronic condition that globally affects the health of people who suffer from it, deteriorating their quality of life (QoL). An aspect rarely explored by healthcare providers is the influence of the disease on the sexual functioning of individuals. This discretion is mainly due to an unconscious resistance when asking our patients about their sexual functioning because of a lack of knowledge and skills to tackle this topic or disinterest on the part of professionals, and fear or shame on the part of patients. Sexual function is a constant concern in IBD patients that has been reflected in several studies, especially if we consider that the prevalence of sexual dysfunction (SD) in IBD is higher than that reported in the general population. The etiology of SD in patients with IBD remains unclear but is likely to be multifactorial, where biological, psychosocial, and disease-specific factors are involved. Currently, there are no formal recommendations in the IBD clinical guidelines on how to manage SD in these patients. The use of validated clinical scales could improve the detection of SD and allow the treatment of the underlying causes in order to improve the QoL of patients with IBD. This review aims to illustrate the different aspects involved in SD in IBD patients and the importance of the participation of a multidisciplinary team in the early detection and treatment of SD at different stages of the disease.

OBJETIVOS: Identificar os conhecimentos de estudantes de Enfermagem sobre a psoríase e seus respectivos cuidados de Enfermagem. MÉTODO: Estudo descritivo de caráter qualitativo realizado de maneira virtual, no período de junho a novembro de 2021, com estudantes de Enfermagem de uma universidade pública, sendo analisado através da Análise de Conteúdo. RESULTADOS: Foram coletadas respostas de 22 estudantes que cursam entre o 7º e 10º período do curso de Enfermagem. Em relação à psoríase, 91,5% (n=21) dos estudantes relataram conhecer. Analisando as respostas, foi possível identificar que os participantes conhecem os principais sinais e sintomas da psoríase. Como principais resultados tem-se o relato dos participantes acerca da importância do profissional de Enfermagem em observar a adesão ao tratamento, que impacta diretamente a manifestação da doença, bem como dar suporte às necessidades biopsicossociais que tangem o cuidado ao indivíduo. CONCLUSÃO: Os acadêmicos de Enfermagem possuem distintos graus de conhecimentos sobre a psoríase, sendo adquirido durante a graduação ou relacionado às vivências pessoais. Recomenda-se que as universidades, em especial as grades curriculares dos cursos de Enfermagem, abordem com propriedade o assunto em questão, seus sinais e sintomas e formas de tratamento, a fim de garantir uma formação de qualidade aos futuros enfermeiros.

Background: Physicians must acquire the necessary skills to provide Inflammatory Bowel Disease (IBD) patients with state-of-the-art clinical care, aiming to improve patient’s quality of life and disease outcomes. Purpose: To describe the queries and experiences of doctors enrolled in an IBD education course and to evaluate the impact of the course. Methods: A retrospective study included 100 physicians, of which 78 attended the course. A questionnaire was applied evaluating how the course had an impact on their IBD-knowledge. The 20-hour-course consisted of practical “real-life” activities and theoretical discussions. Results: The majority of doctors’ expertise was in gastroenterology (53%) and coloproctology (44%). A significant portion had no experience with biological therapy for ulcerative colitis (19.4%) or Crohn’s disease (5.05%). The main topics doctors wanted to discuss were biological therapy (93%), new drugs (74%) and differential diagnosis (64%). A considerable number of physicians did not feel confident at prescribing biological therapy before the course (44.4%), a percentage that decreased to 8.5% after the course (p Discussion: The ideal course should have a practical and theoretical component, as well as the support of an experienced multidisciplinary team. A real-life practical-theoretical IBD course proved a success at increasing IBD knowledge.

Background: Inflammatory Bowel Disease is a term that covers intestinal diseases, including ulcerative colitis and Crohn’s disease. Due to the condition of chronic and complex disease, the disease requires specialized nursing care and management in the context of a multi-disciplinary approach. As a guarantee of quality nursing care, it is essential to carry out the nursing process. Considering the commitment to assist the patient with Crohn’s disease, the nurse, through the nursing consultation, is able to diagnose the patient’s needs, proceed to the prescription of care and later evaluate the interventions, having the opportunity to develop work aimed at improving the quality of life of these patients. Objective: To describe the nursing process in a patient with Crohn’s disease. Methods: Exploratory case report study, carried out at the outpatient clinic for inflammatory bowel diseases of a public hospital in the countryside of the state of Sao Paulo, from June 2019 to October 2019. Data collection was performed through anamnesis, physical examination and analysis of medical records. Results: Female patient, 34 years old, diagnosed with Crohn’s disease. With the completion of the nursing process, it was possible to identify five nursing diagnoses and the elaboration of interventions and outcomes. The nursing evaluation was continuous and the patient adhered to the proposed interventions. Final considerations: The systematization and organization of the work of the nursing team proved to be essential for quality care, with efficiency and effectiveness, guaranteeing the patient comfort, general well-being and good rehabilitation.

Background Hidradenitis suppurativa is a chronic inflammatory skin disorder associated with inflammatory bowel disease. However, it can arise as a paradoxical side effect of anti-TNF treatment. Methods The article reports on three patients with Crohn's disease who developed hidradenitis suppurativa during the treatment with adalimumab. Results Case 1: A 38-year-old female exhibited an infiltrative lesion in the inguinal region and vulva, consistent with hidradenitis suppurativa, after three months of adalimumab. These lesions were treated with partial vulvectomy. Case 2: After adalimumab treatment, a 27-year-old female, originally diagnosed with ileocolonic Crohn's disease, went into clinical and endoscopic remission. The patient eventually presented two hyperchromic nodules in the inguinal region, which were diagnosed as hidradenitis suppurativa. The patient showed improvement after treatment with oral doxycycline and local therapy. Case 3: A 34-year-old female with fistulizing and stenosing ileocolonic Crohn's disease, started adalimumab in 2010, with optimization in 2015. One year after, the patient developed bilateral, erythematous, hardened, inguinal nodulations with purulent drainage, consistent with hidradenitis suppurativa. Treatment with oral doxycycline, fusidic acid, and infiltration with triamcinolone resulted in partial improvement of the lesions. In 2018, the lesions deteriorate. The patient underwent surgical treatment. Conclusion Patients with inflammatory bowel disease are more likely to the development of other mediated inflammatory diseases, such as hidradenitis suppurativa. Hidradenitis suppurativa may appear as a paradoxical reaction to anti-TNF therapy. Clinical teams must be aware of this type of complication. Early diagnosis and treatment are essential for controlling the disease and preventing the onset of complications.

Background: The inflammatory bowel disease nurse plays a key role in the multidisciplinary team. The aim of the study was to evaluate the inflammatory bowel disease knowledge before and after the educational intervention with nurses. Methods: A cross-sectional, descriptive and comparative study was performed from June to August 2016. The sample consisted of 26 nurses from the nursing staff of a public university hospital in Sao Paulo State, Brazil. The study was divided into three phases: pre-educational intervention, educational intervention and post-educational intervention (test application). A p-value < 0.05 was considered to indicate statistically significance. Results: The study included 26 general nurses with an average of 9.20 ± 5.78 years of experience. There was an increase in safety in administering biological therapy after the course (from 33.34% to 78.26%), and an increase in knowledge about the main inflammatory bowel disease symptoms (64.29% vs 96.30%, p = 0.0224), and about infliximab infusion (35.71% vs 74.07%, p = 0.0404). Conclusion: The educational intervention effectively contributed to the increase of knowledge of the nursing staff.

Giovana Signorelli Astolfi Cury,1 Debora Mayumi Takamune,1 Giedre Soares Prates Herrerias,1 Adriana Rivera-Sequeiros,2 Jaqueline Ribeiro de Barros,1 Julio Pinheiro Baima,1 Rogerio Saad-Hossne,1 Ligia Yukie Sassaki1 1São Paulo State University (Unesp), Medical School, Botucatu, Brazil; 2Department of Internal Medicine, San Juan de Dios del Aljarafe Hospital, Seville, SpainCorrespondence: Giovana Signorelli Astolfi Cury, Tel +5514 38801171, Fax +55 14 38801667, Email curygigi@gmail.comBackground: Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient’s quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients.Methods: This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale.Results: The patient group included 54 patients with Crohn’s disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients: R = 0.22; p = 0.03; controls: R = 0.34; p = 0.0006) and inversely related to self-esteem scale (patients: R = − 0.27; p = 0.006; controls: R = − 0.37; p = 0.0001). Facebook addiction showed an inverse correlation with self-esteem (patients: R = − 0.32; p = 0.001; controls: R = − 0.24; p = 0.02) and quality of life (patients: IBDQ score, R = − 0.30; p = 0.003; controls: SF-36 score, R = − 0.29; p = 0.004).Conclusion: The use of Facebook was not different between study groups. Psychological aspects such as depression and low self-esteem were associated with the compensatory use of Facebook in both groups, which may be related to unsatisfactory personal aspects of social interaction.Keywords: Facebook, addiction, compensatory use, inflammatory bowel disease

BACKGROUND: Crohn’s disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors. OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn’s disease patients. METHODS: A cross-sectional study was conducted in 58 consecutive Crohn’s disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests. RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL. CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group. RESUMO CONTEXTO: A doença de Crohn (DC) é uma doença inflamatória intestinal caracterizada por uma inflamação crônica e recorrente do trato gastrointestinal causada por uma interação de fatores genéticos e ambientais. OBJETIVO: Comparar a qualidade e aceitação de dois volumes diferentes de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn. MÉTODOS: Um estudo transversal foi conduzido em 58 pacientes com doença de Crohn que receberam aleatoriamente um agente de contraste oral composto por 78,75 g de polietilenoglicol diluído em 1.000 mL ou 2.000 mL de água. Um exame foi realizado para avaliar a presença de inflamação ou complicações no intestino delgado. As variáveis incluíram a qualidade do preenchimento do segmento intestinal e distensão luminal e aceitação e tolerância do contraste oral nos pacientes. A análise estatística incluiu estatística descritiva e testes de associação. RESULTADOS: Foram avaliados 58 pacientes, dos quais 58,6% eram mulheres, 34,5% apresentavam doença clinicamente ativa e 63,8% estavam recebendo terapia biológica. Quanto à análise comparativa entre os dois diferentes volumes de contraste oral, não foi encontrada diferença estatisticamente significativa em relação ao enchimento da alça intestinal (P=0,58) e distensão luminal adequada (P=0,45). Pacientes que receberam um volume maior (2.000 mL) exibiram efeitos colaterais com mais frequência (51,7% vs 31,0%; P=0,06) e tiveram maior dificuldade para ingerir o agente (65,5% vs 37,9%; P=0,07) em comparação com um volume de 1.000 mL. CONCLUSÃO: A qualidade da entero-tomografia computadorizada não foi influenciada pelo volume de contraste. No entanto, aceitação e tolerância foram melhores no grupo de 1.000 mL.

Made available in DSpace on 2021-06-25T10:56:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective: Background: Case Report: Conclusions: Rare disease Hemangiomas are benign vascular neoplasms that originate from fast-growing embryonic mesodermal tissue and have a proliferation of endothelial cells, which manifest themselves in different forms, locations, and di-mensions. Owing to its rarity and similarity of symptoms with other chronic bowel diseases, intestinal hem-angioma is a differential diagnosis to be considered in patients presenting with symptoms such as abdominal pain and anemia. A 46-year-old woman with a history of diffuse abdominal pain and abdominal distension for 20 years presented with a worsening of symptoms in the past year. She denied weight loss or changes in bowel habits or stool appearance. Laboratory investigations showed microcytic hypochromic anemia. Colonoscopy results were nor-mal. A contrast-enhanced abdominal computed tomography scan showed focal and concentric thickening of the small intestine, measuring 8.3 cm, and associated with calcifications, intestinal dilation, mesenteric lymph node enlargement, and vascular dilatation and consistent with infectious granulomatous diseases such as intestinal tuberculosis, carcinoid tumor, Crohn’s disease, and lymphoma. The tuberculin skin test resulted in a strong 25-mm reaction. We suspected intestinal tuberculosis or expansive injury, and the patient underwent exploratory laparotomy with visualization of a 4-to 5-cm bluish/blackish vegetating lesion located 220 cm from the Treitz angle. The anatomopathological study showed cavernous hemangioma of the small intestine, measuring 2.6×1.0 cm. The patient recovered well and remained asymptomatic. Although rare, intestinal hemangioma should be on the list of differential diagnoses for chronic intestinal dis-eases, especially if there is anemia due to coexisting iron deficiency. Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Gastroenterology Clinica Universidad de los Andes Department of Surgery Medicine São Paulo State University (Unesp) Medical School Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Surgery Medicine São Paulo State University (Unesp) Medical School

Made available in DSpace on 2021-06-25T10:47:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-01. Added 1 bitstream(s) on 2021-07-15T14:35:20Z : No. of bitstreams: 1 S0004-28032020000400491.pdf: 576390 bytes, checksum: dfc1a81dcb8d7de8d121ff5df19e1df4 (MD5) Universidade Estadual Paulista Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background – Biological therapy and new drugs have revolutionized the treatment of inflammatory bowel disease. Ideally, the choice of medication should be a shared decision with the patient, aiming at greater satisfaction, compliance, and consequently, favorable clinical outcome. Objective – This study aims to evaluate patient’s preferences in the choice of their therapy and the factors that influence this choice. Methods – This cross-sectional study enrolled 101 outpatients with Crohn’s disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients’ preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors’ indication). Results – The mean age was 43.6±13.5 years, 75.3% were female, and 81.2% were cases of ulcerative colitis. Regarding the mode of administration, the majority of patients preferred oral (87.1%), followed by intravenous (6.93%) and subcutaneous (5.94%) medications. The reasons were “I prefer to take it at home” (42.57%), “I have more freedom” (36.63%), “I don’t like self-application” (29.70%), and “I believe it works better” (19.80%). Younger patients and patients in clinical disease activity preferred intravenous mode compared to the oral route (P

Made available in DSpace on 2020-12-12T02:18:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-07 Inflammatory bowel disease is associated with an increased risk of colorectal cancer. The study aims to identify the risk factors for ulcerative colitis-colorectal cancer and to perform a survival curve analysis of the outcome.This retrospective cohort study included 254 patients from March 2016 to October 2017. Age, age at diagnosis, follow-up time, smoking status, and family history of colorectal cancer were analyzed as risk factors for colorectal cancer.The mean patient age was 46.6 ± 16.9 years; 5.5% of the patients were smokers and 49.6% had pancolitis. Six patients (2.36%) had colorectal cancer, which was associated with age at diagnosis (odds/hazard ratio 1.059 [95% confidence interval: 1.001-1.121]; P = .04), family history of colorectal cancer (12.992 [1.611-104.7]; P = .02), and follow-up time (0.665 [0.513-0.864]; P = .002). Active smoking was the main identified risk factor, after both logistic (8.477 [1.350-53.232]; P = .02) and Cox proportional-hazards (32.484 [2.465-428.1]; P = .008) regression analysis. The risk of colorectal cancer was 3.17% at 10 years and 4.26% at 20 years of follow-up.Active smoking and family history were identified as risk factors for colorectal cancer. These findings should aid the early identification of patients who require vigorous surveillance, and prevent exposure to risk factors. Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School

Made available in DSpace on 2019-10-06T16:02:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Inflammatory bowel disease (IBD) affects young people of reproductive age. Therefore, a broad discussion is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used, especially biological therapy. This study aimed to describe the management of 4 Crohn's disease patients who received anti-TNF therapy during pregnancy and present a literature review. We reported 4 cases composed of young women who became pregnant while receiving anti-TNF agents. The patients presented a satisfactory response to the clinical treatment and the pregnancies progressed without complications. We did not observe maternal or embryonic toxicity, or unfavorable outcomes. The available data point to inflammatory activity as the main risk factor for unfavorable gestational evolution to date, and showed anti-TNF therapy to be safe during pregnancy and breastfeeding. However, the benefits and risks must be discussed with the patient and management decisions should be taken on an individual basis. Medical School Department of Internal Medicine São Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n Medical School Department of Surgery São Paulo State University (UNESP) Medical School Department of Internal Medicine São Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n Medical School Department of Surgery São Paulo State University (UNESP)