Arquivos de Gastroenterologia最新文献

{"title":"TELEREGULATION IN GASTROENTEROLOGY AND THE BOTTLENECK OF SPECIALIZED HEALTH CARE.","authors":"Leticia Rosevics, Adriana Zanoni Dotti, Elisandre Caroline Dos Santos Cerutti, Fernanda Guimarães Bianchi, Kátia Cristina Kampa, Mônica Rosas Rocha","doi":"10.1590/S0004-2803.24612024-090","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612024-090","url":null,"abstract":"<p><strong>Background: </strong>Increasing population size and the presence of bottlenecks in access to specialized health care demonstrate the importance of developing measures for better clinical management. The implementation of teleregulation is expected to bring greater resolution in the system.</p><p><strong>Objective: </strong>The objective of the present study was to evaluate the results of teleregulation in gastroenterology for the resolution of referrals in a large Brazilian city.</p><p><strong>Methods: </strong>We carried out a retrospective cross-sectional study of primary health care teleregulation requests for gastroenterology in a Brazilian city. Data were collected from October 2022 to June 2023 in patients aged >18 years. Patient demographic data, the reason for requesting screening, and screening outcomes were collected. Requests for reassessment were excluded.</p><p><strong>Results: </strong>Of the 3,000 teleregulation sessions screened in the study period, 71.1% were included, of which 68.17% were for women with a mean age of 54.32±16.19 years. Among the reasons for referral, 1,368 (64.13%) were to request examinations, 568 (26.63%) to discuss conduct and 197 (9.24%) to request a referral to a specialist. Ten percent of cases required referral to a specialist, 6.61% were incorrect requests and 14.95% were prioritized.</p><p><strong>Conclusion: </strong>The present study highlights that teleregulation represents an important tool in health management, being able to bring resolution in 89.9% of cases.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24090"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INCIDENTAL HEPATIC STEATOSIS IDENTIFIED ON ULTRASOUND IN PATIENTS UNDERGOING CHOLECYSTECTOMY: HIGH PREVALENCE AND INSUFFICIENT INVESTIGATIVE AND CLINICAL MANAGEMENT.","authors":"Heloísa Mello Trapp, Paulo André Bispo Machado-Júnior, Silvania Klug Pimentel","doi":"10.1590/S0004-2803.24612024-118","DOIUrl":"10.1590/S0004-2803.24612024-118","url":null,"abstract":"<p><strong>Background: </strong>Steatotic liver disease (SLD) affects about 1 billion people globally, making its proper management essential to prevent progression to more severe stages.</p><p><strong>Objective: </strong>The aim of this study was to evaluate medical management concerning hepatic steatosis incidentally identified by ultrasound in patients undergoing elective cholecystectomy.</p><p><strong>Methods: </strong>This observational, cross-sectional, and retrospective study included patients aged 18 years or older who underwent elective cholecystectomy at Hospital do Trabalhador, in Curitiba/PR, between 2018 and 2022. Patients with external ultrasound reports or incomplete data in their medical records were excluded. Medical records, laboratory tests, and ultrasound reports were analyzed to evaluate the prevalence of steatosis in these patients.</p><p><strong>Results: </strong>The study sample consisted of 355 patients, and 103 (29.01%) of them presented steatosis on ultrasound. Older age (P=0.0022), male sex (P=0.03009), higher body mass index (P<0.001), obesity (P<0.001), hypertension (P<0.001), dyslipidemia (P=0.0072), and elevated levels of oxaloacetic and pyruvic aminotransferases (P=0.02112) were associated with the presence of this finding. No action was taken regarding the presence of steatosis in 60.19% of patients. Approximately 39.81% had the finding recorded in their medical records, 6.80% received lifestyle change counseling, and 4.85% were investigated for the stage of steatosis.</p><p><strong>Conclusion: </strong>A significant prevalence of hepatic steatosis was incidentally identified in the ultrasound of patients undergoing cholecystectomy. However, the approach to this finding was insufficient, highlighting the need for substantial improvements on its management and investigation.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24118"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SMALL INTESTINAL BACTERIAL OVERGROWTH IN PEOPLE WITH CYSTIC FIBROSIS: SYSTEMATIC REVIEW.","authors":"Maria Lidiane Lavor Landim, José Dirceu Ribeiro, Daniela de Souza Paiva Borgli, Danielle Rossana Queiroz Martins Bonilha, Elizete Aparecida Lomazi, Maria de Fátima Correa Pimenta Servidoni","doi":"10.1590/S0004-2803.24612024-110","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612024-110","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In patients with cystic fibrosis (pwCF) acid suppression therapy, gastrointestinal dysmotility, and post-operative bowel status, may predispose to the development of small intestinal bacterial overgrowth (SIBO). SIBO may continue to be present in the progression of the disease even on modulators. Breath testing is the most simple, non-invasive and available method for diagnosing SIBO. There are some divergencies over the operational procedures used to carry out and interpret breath tests in pwCF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We performed a systematic review of SIBO in pwCF to assess the methods used in breath tests and the existence of causal relationship between SIBO and following CF co-morbidities: liver disease, fat absorption, and eating disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the PubMed, Cochrane Library, Embase, LILACS, MEDLINE, OpenGray, medRxiv, Google Scholar, and CAPES databases up to March 20, 2024. We selected clinical cohort and case-control studies to assess SIBO in cwCF. We selected studies that met the following criteria: (1) participants - children and adolescents diagnosed with CF; (2) intervention - assessment of SIBO using H2 and CH4 breath tests; (3) control - patients without SIBO; and (4) outcome - assessment of breath tests for SIBO diagnosis and the causal relationship between SIBO and CF co-morbidities. The PRISMA statement was used to report the search. QUADAS 2 tool was used for assessing the quality of each study methodology. The protocol for this review was registered in the Prospective Registration of Systematic Review Database (CRD42024503593).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search strategy identified 279 studies. After screening titles and abstracts, 36 studies were selected for full-text review and 27 were excluded; nine studies involving 206 pwCFs were reviewed. All nine studies used H2 breath tests as a diagnostic method for SIBO, and five of them used a combined H2/CH4 test. There was no consistency in the timing of cessation of antibiotic therapy prior to testing. All patients performed the test after an overnight fast. A basal sample was collected prior to substrate (glucose or lactulose) ingestion, which ranged from 7 to 20 ppm. There was great variability between respiratory sample collection times, being times 0, 15, 30, 45, 60, 90, and 120 minutes the most used protocol. The methods for performing breath tests varied widely, making it difficult to reach conclusions on the role of SIBO as a co-morbidity in pwCF. There was no association between increased serum AST, ALT, and GGT levels and positive breath tests. There was no agreement regarding the role of SIBO and nutritional deficiency, but a reduction in fat absorption and the presence of hyporexia have been described under this condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Data on assessment of SIBO in pwCF is limited by the small number of studies available, the lack of appropriate controls in s","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24110"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RENAL INJURY AND METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE IN PATIENTS WITH OBESITY.","authors":"Kellyane Dias Carvalho, Cláudia Daltro, Carla Daltro, Helma Pinchemel Cotrim","doi":"10.1590/S0004-2803.24612025-008","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612025-008","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most prevalent cause of chronic hepatic disease worldwide. Recently, the association between MASLD and renal injury has emerged as an additional factor impacting the clinical course of MASLD.</p><p><strong>Objective: </strong>The present study evaluated the clinical association in patients with obesity.</p><p><strong>Methods: </strong>This study enrolled patients classified as having obesity class II and III (BMI >35 kg/m2) and MASLD from an obesity surgical treatment center. The diagnosis criteria for MASLD included the presence of hepatic steatosis as indicated by histology or imaging assessments. We use Fibrosis-4 (FIB-4) and NAFLD fibrosis score (NSF) to assess and determine the presence of liver fibrosis. The glomerular filtration rate (GRF) was determined using CKD-EPI (chronic kidney disease epidemiology collaboration) equation, with GFR levels ≥90 and <120 mL/min/1,73 m2 considered within the normal range.</p><p><strong>Results: </strong>The study comprised a total of 560 individuals with obesity grade II and III, 325 individuals with MASLD. Among these, 422 (75.4%) patients were female, and the mean age was 36±10 years. Systemic arterial hypertension (SAH) was present in 162 (41.1%) patients, and 218 (42.8 %) were diagnosed with type 2 Diabetes Mellitus (T2DM). A total of 286 individuals (51.1%) had a GFR below 114 mL/min, with 183 (64%) of them exhibiting a higher degree of liver fibrosis, as indicated by FIB-4 >0.54.</p><p><strong>Conclusion: </strong>In patients with obesity classified as grades II and III, age emerged as the primary determinant leading to decline in GFR. Furthermore, glomerular hyperfiltration could be an early sign of progression to chronic kidney disease. Nonetheless, the progression of hepatic fibrosis could also be a significant factor contributing to impaired renal function.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e25008"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RISK FACTORS FOR RENAL CALCULI IN PATIENTS WITH CROHN'S DISEASE.","authors":"Dídia Bismara Cury, Liana Cristina Bismara Cury, Ana Camila Michelletti, Rogerio Antonio Oliveira, Elsa Alidia Petry Gonçalves, Nestor Schor","doi":"10.1590/S0004-2803.24612024-023","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612024-023","url":null,"abstract":"<p><strong>Background: </strong>The incidence of nephrolithiasis has increased significantly, diet, obesity, and high animal protein intake having been reported to be risk factors. Nephrolithiasis has a great economic impact on society related to work absenteeism, recurrent attacks of renal colic, and urological interventions. Nephrolithiasis can also progress to renal failure. It is therefore important to identify the risk factors for nephrolithiasis. Inflammatory bowel diseases, which include Crohn's disease, represent a risk factor for the formation of renal calculi, due to the disease itself and to the use of drugs that can influence the metabolism of substances related to nephrolithiasis. In the past, Crohn's disease patients were often submitted to surgery, which is known to contribute to nephrolithiasis. New drugs have changed the clinical course of Crohn's disease, whose incidence has increased worldwide. Specialists should be on the alert not only for the complications of Crohn's disease but also for its extraintestinal manifestations, which can dramatically affect the quality of life of these patients and lead to renal failure. It is therefore important to screen this population for nephrolithiasis.</p><p><strong>Objective: </strong>To determine the prevalence of nephrolithiasis in a population of patients with Crohn's disease; to determine whether drugs, previous surgery, location of the disease, and clinical activity are risk factors for nephrolithiasis; and to alert specialists to the importance of screening for nephrolithiasis (through simple methods) in order to prevent chronic kidney disease.</p><p><strong>Methods: </strong>Were analyzed the electronic medical records of 93 Crohn's disease patients treated between 2009 and 2010 at the Inflammatory Bowel Disease Center of the Scope Clinic, located in the city of Campo Grande. All of the patients underwent ultrasound at the first medical appointment.</p><p><strong>Results: </strong>Of the 93 patients, 37 developed nephrolithiasis at some point during the study period. Risk factors for nephrolithiasis were disease location (P=0.023) and the use of ciprofloxacin (P=0.0001), corticosteroids (P=0.005), immunomodulators (P=0.001), or metronidazole (P=0.0005). Surgical status, age, and gender were not found to predispose to the formation of renal calculi.</p><p><strong>Conclusion: </strong>This study demonstrates the importance of using imaging methods to screen Crohn's disease patients for nephrolithiasis, regardless of their surgical status.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24023"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MILLET BASED NUTRITIONAL SUPPLEMENT FOR DIARRHEAL EPISODE IN PROTEIN ENERGY MALNOURISHED CONDITION: AN EXPERIMENTAL APPROACH IN CASTOR OIL MODEL.","authors":"Sachin V Tembhurne, Mansi S Jagdale, Payal Kate, Ziyaurrahman Ar","doi":"10.1590/S0004-2803.24612024-098","DOIUrl":"10.1590/S0004-2803.24612024-098","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diarrhea is a gastrointestinal transit disorder and mostly seen in malnourished children's as per WHO report. Malnourished individuals are found to be associated with compromised immunity and lack of nutrients, which makes person susceptible to diarrhoea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;For maintaining the gut health adequate and balance nutrition is essential. In this study, both fermented and non-fermented nutritional supplement was formulated and evaluated against castor-oil induced diarrhoea.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two groups of rats initially fed a 2% protein-deficient diet for ten weeks. After this period, one group received a diet enriched with nutritional components blended with fermented bovine colostrum, while the other group received a diet with non-fermented nutritional components. At the end of 20th week, castor oil was given to all animals except the control group to induce diarrhoea. Subsequently, these rats were subjected to various assessments including time of onset of the first diarrheal stool (min), faecal weight, faecal score, number of wet stools, intestinal fluid accumulation and Histopathological examination. DPPH radical-scavenging activity of nutritional blend was also determined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The undernourished rats fed with non-fermented and fermented diet showed delayed the onset of diarrhea and reduction of weight stool, the decrease in the frequency and severity of defecation as well as significantly protected against the intestinal fluid accumulation as compare to negative control groups. The results showed that both the fermented and non-fermented blended composition exhibited antioxidant activity. The intestine of undernourished rats fed with fermented nutritional diet showed the absence of infiltration and improved villi structure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study presents promising evidence of the potential benefits of the formulated nutritional compositions in alleviating the castor oil-induced diarrhea in undernourished wistar rats. The antioxidant activity, anti-diarrheal effects and improvements in gut histology suggest that, the nutritional compositions could be explored further as natural interventions for gastrointestinal health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• Diarrhea is common in malnourished children due to compromised immunity and lack of nutrients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• Rats were fed a protein-deficient diet (2%) for 10 weeks. One group received fermented bovine colostrum, while the other received non-fermented nutritional components.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• Diarrhea was induced in the animals, and they were evaluated for the onset of diarrhea, fecal weight, frequency, intestinal fluid accumulation, and histology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• Both supplements delayed the onset of diarrhea, reduced its severity, and exhibited antioxidant activity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• Th","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24098"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARCOPENIA AND GASTROINTESTINAL CANCER: NUTRITIONAL APPROACH FOCUSING ON CURCUMIN SUPPLEMENTATION.","authors":"Pamela S de Almeida, Katia Barão, Nora M Forones","doi":"10.1590/S0004-2803.24612024-068","DOIUrl":"10.1590/S0004-2803.24612024-068","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass. When associated with cancer, it correlates with poorer clinical outcomes. Cancers of the gastrointestinal tract, prevalent globally and in Brazil, are associated with a greater nutritional risk. Early detection and intervention for nutritional risks are critical in this population. Recent studies on turmeric/curcumin have demonstrated beneficial effects in cancer patients. Specifically, curcumin have shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia. This review aims to elucidate sarcopenia and sarcopenia secondary to cancer, emphasizing nutritional management and the role of curcumin supplementation. Effective cancer management, whether with or without sarcopenia, demands comprehensive public health strategies and multimodal interventions within healthcare institutions. Nutrition is pivotal across the cancer care journey, encompassing screening, guidance, and provision of nutrients that support maintaining or recovering body composition. Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management. Nevertheless, further clinical studies are warranted to substantiate these findings.</p><p><strong>Background: </strong>• Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass.</p><p><strong>Background: </strong>• Sarcopenia when associated with cancer, it correlates with poorer clinical outcomes.</p><p><strong>Background: </strong>• Curcumin has shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia.</p><p><strong>Background: </strong>• Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24068"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COLORECTAL CANCER: GLOBAL AND BRAZILIAN PERSPECTIVES, PREVENTION, AND THE IMPACT OF THE BLUE MARCH CAMPAIGN.","authors":"Marcelo Averbach, Eduarda Nassar Tebet, Eduardo Guimarães Hourneaux de Moura","doi":"10.1590/S0004-2803.24612025-000","DOIUrl":"10.1590/S0004-2803.24612025-000","url":null,"abstract":"","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e25000"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERFORMANCE OF SIX PREDICTIVE MODELS OF DEATH OF PATIENTS HOSPITALIZED FOR DECOMPENSATED CIRRHOSIS: A MULTICENTER STUDY.","authors":"Ajácio Bandeira de Mello Brandão, Isadora Zanotelli Bombassaro, Gabriela Perdomo Coral, Jonathan Soldera, Carlos Kupski","doi":"10.1590/S0004-2803.24612024-065","DOIUrl":"10.1590/S0004-2803.24612024-065","url":null,"abstract":"<p><strong>Background: </strong>The natural history of cirrhosis is characterized by an asymptomatic phase (compensated cirrhosis) followed by a rapidly progressive phase (decompensated cirrhosis). The ability to predict the survival of patients with cirrhosis is crucial for decision-making, some as complex as the indication for a liver transplant. Several models have been developed and validated.</p><p><strong>Objective: </strong>To analyze and compare the performance of models in predicting 90-day mortality among patients hospitalized with decompensated cirrhosis.</p><p><strong>Methods: </strong>A sample of 481 hospitalized patients, with a mean age of 59.04 years 73% male, diagnosed with decompensated cirrhosis and a mean Child-Pugh score of 9. The prognostic models were calculated based on tests performed on admission: MELD-Na, MELD-Plus, MELD 3.0, ReMELD, Refit MELD, and Refit MELD-Na. The accuracy of the models was assessed by calculating the area under the receiver operating characteristic (AUROC) curve, and their respective 95% confidence intervals. Comparisons between the areas were conducted using the DeLong test. A comparison was conducted among all scores, with a primary focus on MELD 3.0 and MELD-Plus. These specific scores were the focal points of interest.</p><p><strong>Results: </strong>The scores presented AUROC curve values of 0.703-0.758, indicating a moderate capacity to discriminate between survivors and deceased patients during the considered period. The comparison between the models did not unequivocally establish the superiority of one model over the other.</p><p><strong>Conclusion: </strong>The scores have a limited predictive ability for death within 90 days in patients with decompensated cirrhosis. Our study is unable to establish the prognostic superiority of a specific scoring system.</p><p><strong>Background: </strong>• This retrospective, multicenter study evaluated the accuracy of six predictive models of death within 90 days in 461 patients hospitalized for decompensated cirrhosis.</p><p><strong>Background: </strong>• The scores presented an area under the receiver operating characteristic curve of 0.703-0.758, indicating a good ability to discriminate between survivors and deceased patients during the considered period.</p><p><strong>Background: </strong>• The comparison between the models did not unequivocally establish the superiority of one model over the other.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24065"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREVALENCE AND RISK FACTORS ASSOCIATED WITH NON-ALCOHOLIC STEATOHEPATITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS ON HYDROXYCHLOROQUINE: A POPULATION-BASED STUDY.","authors":"Antoine Boustany, Somtochukwu Onwuzo, Adejoke Johnson, David Farhat, Mimi Najjar, Hadi Khaled Abou Zeid, Chidera N Onwuzo, Mohamad-Noor Abu-Hammour, Rashid Abdel-Razeq, Islam Mohamed, Barish Eren, Imad Asaad","doi":"10.1590/S0004-2803.24612024-100","DOIUrl":"10.1590/S0004-2803.24612024-100","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Non-alcoholic steatohepatitis (NASH) is becoming a leading cause of liver disease in the US, while Rheumatoid arthritis (RA) affects a significant portion of the global population. In recent times, newer drugs have been developed to slow down the progression of RA, one of which is hydroxychloroquine (HCQ). Despite HCQ being linked to slowly progressive transaminitis, its role in the development of NASH remains unclear. Our research fills this gap by examining the prevalence and risk factors of developing NASH in patients with RA on HCQ.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study analyzed 619,350 adult patients diagnosed with RA. Data were sourced from a multicenter database covering over 360 hospitals across 26 healthcare systems in the US from 1999 to September 2022, excluding pregnant individuals. Multivariate regression analysis assessed the risk of NASH, adjusting for confounders including smoking history, male gender, dyslipidemia, hypertension, type 2 diabetes mellitus, obesity, and hydroxychloroquine use. Statistical significance was set at P&lt;0.05, with analyses conducted using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In a cohort of 79.4 million individuals, 619,350 non-pregnant subjects had rheumatoid arthritis, with 3,080 diagnosed with NASH, while 616,270 did not. Patients with NASH displayed a higher prevalence of smoking history, hyperlipidemia, hypertension, type 2 diabetes mellitus, obesity, and HCQ use. Multivariate regression analysis identified increased NASH risk in smokers (OR: 1.24; 95%CI: 1.14-1.36), males (OR: 0.88; 95%CI: 0.81-0.96), individuals with dyslipidemia (OR: 1.34; 95%CI: 1.21-1.47), hypertension (OR: 1.11; 95%CI: 1.00-1.27), type 2 diabetes mellitus (OR: 3.24; 95%CI: 2.98-3.54), obesity (OR: 3.59; 95%CI: 3.31-3.89), and hydroxychloroquine use (OR: 1.79; 95%CI: 1.65-1.94).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;RA patients on HCQ showed an increased prevalence and odds of developing NASH, even after adjusting for common confounding factors. This indicates that HCQ may play a role in the development of hepatic steatosis and fibrosis. Clinicians should consider this association to prevent advanced liver disease. Future research should focus on optimal screening for early detection and enhancing patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• The study investigates the relationship between nonalcoholic steatohepatitis (NASH) and rheumatoid arthritis (RA), analyzing the impact of hydroxychloroquine (HCQ) use on the development of NASH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• HCQ slows the progression of RA; however, its effect on the liver is not yet fully understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• This multicenter retrospective cohort study analyzed 619,350 adult patients diagnosed with RA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;• RA patients on HCQ showed an increased prevalence and higher od","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"62 ","pages":"e24100"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}