Orientador: Sandra Cecilia Botelho Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T12:19:53Z (GMT). No. of bitstreams: 1 Roesler_BrunaMaria_M.pdf: 3428404 bytes, checksum: ee37171bd6740210c88477c4839317fb (MD5) Previous issue date: 2006 / Resumo: O Helicobacter pylori é uma bactéria gram-negativa que está estritamente relacionada com o desenvolvimento de doenças gástricas, inclusive malignas, sendo classificada como carcinógeno do grupo I pela Agência Internacional para Pesquisa do Câncer. Apesar de grande parte da população mundial estar contaminada pela bactéria, a maioria dos indivíduos permanece assintomática. Muitas abordagens são sugeridas para diferenciar os isolados de H. pylori e diversas técnicas de biologia molecular têm sido aplicadas para caracterizar as amostras clínicas de diferentes pacientes. A análise de restrição (RFLP) usada em conjunto com a PCR tem sido amplamente utilizada para a tipagem de isolados clínicos, utilizando vários genes do genoma do H. pylori como alvos para esse método. Padrões de eletroforese da nested PCR e da PCR para as regiões dos genes urease C e urease B do H. pylori foram obtidos com enzimas de restrição e comparados entre pacientes com úlcera péptica e gastrite crônica. Os produtos da nested PCR para urease C foram digeridos com a enzima Mbo I e os produtos da PCR para urease B com a enzima Hae III, sendo os fragmentos obtidos analisados por eletroforese em gel de agarose. Foram encontrados 7 padrões de genotipagem para urease B e 17 padrões para urease C. O grupo prevalente para gastrite crônica obtido com essa última genotipagem foi o denominado grupo ureC MboI G, com fragmentos de 110, 120, 250 e 310 pares de bases, ocorrendo em 13 pacientes (15,7% dos casos). Em relação aos casos de úlcera péptica, o grupo de genotipagem mais prevalente foi o denominado ureC MboI E, com 110, 180 e 500 pares de bases, ocorrendo em 11 pacientes (24,4% do total de casos). O grupo prevalente obtido com a genotipagem para urease B foi o denominado ureB I, com um fragmento único de 750 pares de bases. Esse grupo foi o prevalente tanto para os casos de úlcera péptica (27), com 60,0%, quanto para os de gastrite crônica (53), com 63,9%. Não foram observadas diferenças significativas entre os padrões encontrados para ambas as doenças. A nested PCR para detecção prévia do DNA do H. pylori também foi realizada, obtendo-se 100% de concordância. Os métodos de tipagem dos produtos obtidos por nested PCR e PCR proporcionam um esquema funcional e de grande reprodutibilidade para estudos epidemiológicos e de caracterização de cepas / Abstract: Helicobacter pylori is a gram-negative bacterium that has been implicated as a major human gastric pathogen responsible for gastritis and peptic ulcer disease. It has been classified as a group I carcinogen by the International Agency for Research on Cancer and is regarded as a primary factor for gastric cancer. A significant proportion of the world population is infected with H. pylori, even though most infections are asymptomatic. To isolate H. pylori, many approaches have been presented and several molecular techniques have been applied to separate clinical isolates from different patients. PCR-RFLP analysis has been widely developed for the typing of clinical isolates, with several genes within H. pylori having been targeted by this method. Eletroforesis patterns of nested PCR and PCR to urease C and urease B gene regions of H. pylori were obtained by restriction fragment length polymorphism and compared among patients with peptic ulcer and chronic gastritis. Nested PCR products for urease C were digested with MboI enzyme and PCR products for urease B with Hae III enzyme, and the obtained fragments were analyzed by eletroforesis in agarosis gel. We have encountered 7 genotyping patterns for urease B and 17 patterns for urease C. The prevalent group for chronic gastritis which was obtained with this last genotyping was named ureC MboI G group, with fragments of 110, 120, 250 and 310 base pairs, occurring in 13 patients (15,7% of the cases). Regarding the peptic ulcer cases, the most prevalent genotyping group was named ureC MboI E group, with 110, 180 and 500 base pairs, occurring in 11 patients (24,4% of the cases). The prevalent group obtained with the genotyping for urease B was named ureB I, with only one fragment of 750 base pairs. This group was the prevalent one both in peptic ulcer cases (27) with 60,0%, and in chronic gastritis case (53), with 63,9%. We haven¿t found meaningful differences among the encountered patterns for both diseases. Nested PCR for previous detection of H. pylori DNA has also been performed, and we have obtained 100% of concordance. The typing methods of the products obtained by nested PCR and PCR show a functional scheme and of great reproduction for epidemiologic studies and of H. pylori strains characterization / Mestrado / Mestre em Farmacologia

Orientadores: Maria Aparecida Mesquita, Ciro Garia Montes / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:48:46Z (GMT). No. of bitstreams: 1 CustodioLima_Juliana_M.pdf: 1668374 bytes, checksum: ee0f2db5e25a3f2b8735d67b17331357 (MD5) Previous issue date: 2013 / Resumo: A hemorragia digestiva alta (HDA) é a emergência gastrointestinal mais frequente em todo o mundo. De acordo com a etiologia, a HDA se divide em varicosa e não varicosa. Existem poucos dados recentes da literatura nacional com relação à evolução dos pacientes com HDA, especialmente no que se refere à população idosa. Além disso, o uso de escalas prognósticas para avaliar o risco dos pacientes, como o escore de Rockall, embora recomendado por várias diretrizes, ainda não foi incorporado na prática clínica da maior parte dos hospitais brasileiros. Os objetivos do presente estudo foram avaliar as características clínicas, os achados endoscópicos e a evolução em 30 dias de pacientes com HDA não varicosa, e identificar os principais aspectos associados com a idade avançada...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital / Abstract: Upper gastrointestinal bleeding (UGIB) is the most frequent gastrointestinal emergency worldwide. According to the etiology, UGIB is classified into variceal and non variceal bleeding. There is a lack of recent data regarding the outcomes of non variceal UGIB in Brazil, specially in the elderly. Furthermore, although recommended by several guidelines, the use of prognostic scales for risk assessment, such as the Rockall score, has not yet been included in the daily practice of most Brazilian hospitals. The aims of this study were to evaluate the clinical features, endoscopic findings and outcomes within 30 days in patients with non variceal UGIB, and to identify the main characteristics related to advanced age...Note: The complete abstract is available with the full electronic document / Mestrado / Clinica Medica / Mestra em Clínica Médica

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21005号 / 医博第4351号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小西 靖彦, 教授 福原 俊一, 教授 小池 薫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Oral iron replacement therapy is often used as a first-line modality for the treatment of iron deficiency anemia (IDA). Oral iron replacement options include tablets, capsules, and liquid formulations. Esophagitis due to iron tablet administration is a well-documented phenomenon, yet peptic ulcer disease secondary to iron tablet administration is less well-known. An 83-year-old female with a past medical history of chronic kidney disease stage V, anemia of inflammatory disease, heart failure with preserved ejection fraction, and gastroesophageal reflux disease presented to the hospital with diffuse abdominal pain and dark red emesis. She was started on ferrous sulfate supplementation two weeks ago and described progressive abdominal pain and nausea since beginning the medication. She was not taking nonsteroidal anti-inflammatories (NSAIDs), antiplatelets, or anticoagulants. Six months ago, she had an unremarkable upper endoscopy performed for new-onset gastroesophageal reflux disease. Laboratory studies revealed a hemoglobin of 7.3 mg/dL and due to a concern for rapid blood loss, she was given one unit of packed red blood cells. A non-contrast computed tomography was performed showing wall thickening of the stomach and the first two portions of the duodenum. A possible ulcer was seen in the distal posterior stomach. The patient was made NPO, and twice daily intravenous pantoprazole was started. An upper endoscopy was performed which revealed a 2.5 cm clean-based ulcer in the duodenal bulb. Biopsies showed acute inflammation and positivity for iron debris but were negative for Helicobacter pylori. Once daily pantoprazole was continued, and her ferrous sulfate tablets were discontinued. Her symptoms did not return. Ferrous sulfate may erode and ulcerate the gastric and duodenal mucosa like that of a chemical burn. Iron deposits may be seen on biopsies performed with Prussian blue staining. Brown crystalline deposits may be seen on hematoxylin and eosin staining. Iron injury may be seen in pill or capsule formulations due to a concentration effect, but this is typically not seen with solution forms. Treatment includes discontinuation of tablet or capsule formulations and substitution with liquid forms.

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

INTRODUÇÃO: A prevalência da úlcera péptica e outras afecções esofagogastroduodenais associadas à infecção pelo H. pylori foram alteradas em decorrência da erradicação desta infecção e uso de inibidores de secreção gástrica ácida. OBJETIVO: Determinar a prevalência da infecção pelo Helicobacter pylori associada às afecções diagnosticadas pela endoscopia digestiva alta e analisar fatores de risco. MÉTODOS: Foram analisados dados de 1478 pacientes, e as informações dos achados endoscópicos foram correlacionadas com resultado de teste de urease, faixa etária e gênero. Os pacientes com exame endoscópico normal foram considerados como grupo controle para análise estatística dos fatores de risco, perfazendo um total de 272 indivíduos. RESULTADOS: A prevalência da infecção por H. pylori foi de 53% (n=786), e maior na faixa etária entre 31 e 40 anos. Os achados endoscópicos mais frequentes foram gastrites (n=810; 54,8%), úlceras pépticas duodenais e gástricas (n=494; 33,4%), duodenites (n=287; 19,4%) e esofagites (n=217; 14,7%). Apenas a gastrite nodular e úlcera péptica foram associadas com infecção por H. pylori (p<0,05). Gastrite erosiva no antro (n=644, 78,5%) predominou em relação à pangastrite (n=166; 20,2%) e aquelas no corpo (n=19; 2,3%). Entre os casos de úlcera péptica, 103 (7%) foram gástricas, 343 (23,2%) foram duodenais e 48 (3,2%) foram gástrica e duodenal. A esofagite geralmente foi leve (grau A; 63,1%), 23,5% foram moderada (grau B) e 13,3% foram intensa (graus C e D). Infecção por H. pylori aumentou o risco de úlceras gástrica e duodenal em 1,9 e 1,6 vezes, respectivamente. Gênero masculino e maior idade foram riscos de todas as outras afecções. CONCLUSÃO: Infecção pelo H. pylori associada com maior idade e gênero masculino foram determinantes importantes para evolução de afecções gastrintestinais / Introduction: Peptic ulcer prevalence and other esophageal and gastroduodenal disorders associated with H. pylori infection changed as a consequence of its eradication and the use of gastric acid secretor inhibitors. Purpose: To establish H. pylori infection prevalence associated with clinical disorders diagnosed by upper gastrointestinal endoscopy, and determine the risk factors. Methods: Data from 1478 patients were analyzed, and the endoscopic findings were correlated with the urease test results, age and gender. Patients with normal endoscopy were considered control group for statistical analysis of the risk factors, comprising a total of 272 individuals. Results: The overall prevalence of H. pylori infection was 53% (n=786), being higher between 31 and 40 years old. The most frequent endoscopic findings were gastritis (n=810, 54.8%), peptic ulcer (n=494, 33.4%), duodenitis (n=287, 19.4%) and esophagitis (n=217, 14.7%). Only nodular gastritis and peptic ulcer were associated with H. pylori infection (p<0.05). Erosive gastritis (70%) in the antrum (n=644; 78.5%) predominated in relation to pangastritis (n=166, 20.2%) and the ones in the corpus (n=19, 2.3%). Among peptic ulcer cases, 103 (7%) were gastric, 343 (23.2%) were duodenal and 48 (3.2%) were gastric and duodenal. Esophagitis usually was mild (grade A in 63.1%), 23.5% were moderate (grade B) and 13.3% were intense (grades C and D). H. pylori infection increased the risk of gastric and duodenal ulcers by 1.9 and 1.6-fold, respectively. Male gender and being older were risks of all the other conditions. Conclusion: H. pylori infection associated with older age and male gender were important determinants to gastrointestinal diseases outcome

<p>Transcatheter Arterial Embolization (TAE) is a method in which a catheter is inserted into an artery under fluoroscopy guidance. By using material that creates a thrombus, inserted through the catheter, the artery can be occluded and the bleeding stopped.</p><p>Endoscopy is the treatment of choice in upper gastrointestinal (GI) bleeding, but 10% to 30% of patients rebleed and needs other treatment options. Post Partum Hemorrhage (PPH) may evolve rapidly and can become life threatening. Obstetrical treatment will manage most cases, but in some cases emergency surgery is needed and in the worst case hysterectomy.</p><p>The primary aim of this thesis was to evaluate the clinical usefulness, improve the TAE technique and compare the outcome of TAE with surgery used as “salvage therapy” in patients with upper GI bleeding. Evaluate TAE technique and the long-term effect on the menstrual cycle and fertility in severe PPH.</p><p>To evaluate the clinical usefulness 13 patients were treated with TAE after endoscopic treatment failure and 5 were treated for recurrent hemorrhage after emergency surgery. </p><p>The clinical outcome and mortality rate of 40 patients treated with TAE was compared with 51 patients treated with surgery of upper GI bleedings. </p><p>In 13 patients the ulcer was marked with placement of a metallic clip at endoscopy to be able to locate the exact site of the bleeding ulcer during the TAE procedure.</p><p>A retrospective study of 20 patients with severe PPH treated with bilateral TAE of the uterine artery was performed. </p><p>TAE was found to be effective and an alternative to emergency surgery for control of massive upper GI bleeding. The 30-day mortality was lower in the TAE group (3%) compared to the surgical group (14%). </p><p>By marking the bleeding ulcer at endoscopy using a metallic clip the site of bleeding could be identified on angiography without extravasation of contrast media.</p><p>No major impact on fertility or menstruation cycle was found in patients treated with TAE in PPH. TAE in PPH is safe and have no major long-term side effect. By using TAE in PPH hysterectomy can be avoided.</p>

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Gastrointestinal symptoms have a prevalence of 20-40% in the general adult population in the Western world. These symptoms are generally considered to be poor predictors of organic findings [e.g. peptic ulcer disease (PUD) or malignancy]. Approximately 50% of patients seeking care for such symptoms have no organic explanation for these upon investigation. When other organic or other functional conditions are excluded [e.g. PUD, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS)] the remaining patients are labelled as having functional dyspepsia (persistent or recurrent pain and/or discomfort centred in the upper abdomen). Management of functional dyspepsia remains a challenge, reflecting the heterogeneity of the patients and the uncertain role of drug treatment. Also, prognostic factors for treatment success are largely unknown. I have therefore performed a series of studies to shed light on these issues: The first study (Paper I) was performed in a randomly selected adult population (n=1,001) assessing upper and lower gastrointestinal symptoms at two occasions with 1 to 6 month intervals. The results show that gastrointestinal symptoms are common (57%) and fluctuate to some extent in the shorter term. Troublesome dyspeptic symptoms remain in two out of three individuals. This proportion was similar whether or not organic findings were present. In the second study (Paper II) 799 patients with dyspeptic symptoms were evaluated with regard to whether gastrointestinal symptoms, identified by self-administered questionnaires, correlate with endoscopic diagnoses and discriminate organic from non-organic (functional) dyspepsia. The impact of dyspeptic symptoms on health-related well-being was also evaluated. Approximately 50% of these dyspeptic patients were found to have functional dyspepsia at upper endoscopy. A difference was discovered in the symptom profile between patients with organic and functional dyspepsia. Predicting factors for functional dyspepsia were found. This study shows that use of self-administered symptom questionnaires may aid in clinical decision making for patient management, e.g. by reducing the number of endoscopies, although probabilities of risks for organic dyspepsia are difficult to transfer to management of the individual patient. The results also indicate that the health-related well-being in patients with functional and organic dyspepsia is impaired to the same extent, illustrating the need for effective treatment of patients with functional dyspepsia, a group not well served by currently available treatment modalities. The aim of the third study (Paper III) was to develop and evaluate a selfadministered questionnaire focusing on upper abdominal and reflux complaints to allow for identification of patients with heartburn and factors that might predict symptom relief with omeprazole both in GERD and functional dyspepsia patients. The diagnostic validity of the questionnaire was tested against endoscopy and 24-hour pH monitoring. The questionnaire had a sensitivity of 92%, but a low specificity of 19%. Symptom relief by omeprazole was best predicted by the presence of predominant heartburn described as ‘a burning feeling rising from the stomach or lower chest up towards the neck’ and ‘relief from antacids’. These results indicate that this questionnaire which used descriptive language, appeared to be useful in identifying heartburn and predicting responses to omeprazole in patients with upper gastrointestinal symptoms. The fourth study (Paper IV) was a pilot study investigating the symptom response to omeprazole 20 mg twice daily or placebo for a duration of 14 days in 197 patients with functional dyspepsia. We concluded that a subset of patients with functional dyspepsia, with or without heartburn, would respond to therapy with omeprazole. In the final study (Paper V) the aim was to identify prognostic factors for the treatment success to a 4-week course of omeprazole 10 or 20 mg once daily in 826 patients with functional dyspepsia. The most highly discriminating predictor of treatment success was the number of days without dyspeptic symptoms during the first week of treatment. Fewer days with symptoms during the first week indicated higher response rates at four weeks. In addition, positive predictors of treatment response to omeprazole were identified as age &gt;40 years, bothersome heartburn, low scores of bloating and diarrhoea, history of symptoms for &lt;3 months and low impairment of vitality at baseline. The results indicate that early response during the first week to treatment with a proton pump inhibitor seems to predict treatment success after four weeks in patients with functional dyspepsia. Conclusion: These studies have shown that a large proportion of adult individuals in society, both those who seek and those who do not seek medical care, suffer from symptoms located in the upper part of the abdomen regardless of whether an organic cause is present. A subset of patients without organic findings and other functional conditions, i.e. functional dyspepsia, respond to therapy with omeprazole irrespective of the presence or absence of heartburn . An excellent way to predict the response to a full course of omeprazole in functional dyspepsia is to assess the early response (first week) to treatment. These findings allow for better and faster targeting of acid inhibitory therapy in functional dyspepsia, which potentially can result in more effective clinical management of these patients and savings of health care resources.

Transcatheter Arterial Embolization (TAE) is a method in which a catheter is inserted into an artery under fluoroscopy guidance. By using material that creates a thrombus, inserted through the catheter, the artery can be occluded and the bleeding stopped. Endoscopy is the treatment of choice in upper gastrointestinal (GI) bleeding, but 10% to 30% of patients rebleed and needs other treatment options. Post Partum Hemorrhage (PPH) may evolve rapidly and can become life threatening. Obstetrical treatment will manage most cases, but in some cases emergency surgery is needed and in the worst case hysterectomy. The primary aim of this thesis was to evaluate the clinical usefulness, improve the TAE technique and compare the outcome of TAE with surgery used as “salvage therapy” in patients with upper GI bleeding. Evaluate TAE technique and the long-term effect on the menstrual cycle and fertility in severe PPH. To evaluate the clinical usefulness 13 patients were treated with TAE after endoscopic treatment failure and 5 were treated for recurrent hemorrhage after emergency surgery. The clinical outcome and mortality rate of 40 patients treated with TAE was compared with 51 patients treated with surgery of upper GI bleedings. In 13 patients the ulcer was marked with placement of a metallic clip at endoscopy to be able to locate the exact site of the bleeding ulcer during the TAE procedure. A retrospective study of 20 patients with severe PPH treated with bilateral TAE of the uterine artery was performed. TAE was found to be effective and an alternative to emergency surgery for control of massive upper GI bleeding. The 30-day mortality was lower in the TAE group (3%) compared to the surgical group (14%). By marking the bleeding ulcer at endoscopy using a metallic clip the site of bleeding could be identified on angiography without extravasation of contrast media. No major impact on fertility or menstruation cycle was found in patients treated with TAE in PPH. TAE in PPH is safe and have no major long-term side effect. By using TAE in PPH hysterectomy can be avoided.