O nosso objetivo foi mensurar os níveis de Interleucina-6 (IL-6) no fluido gengival de pacientes com periodontite e doença inflamatória intestinal (DII), comparando-os com pacientes sistemicamente saudáveis, com periodontite. Como objetivo secundário será avaliada a IL-6 no soro desses pacientes. Foram selecionados 15 pacientes com doença de Crohn (DC, idade média 38.2, DP 11.4 anos), 15 com retrocolite ulcerativa idiopática (RCUI, 45.0 10.5 anos) e 15 pacientes saudáveis (C, 42.1 7.8 anos). A Profundidade de bolsa (PB), nível de inserção clínica (NI), presença de placa e de sangramento a sondagem foram avaliados em seis sítios por dente. O fluido gengival foi coletado de quatro sítios com periodontite (PP: PB ≥ 5mm, NI ≥ 3mm) e quatro sítios com gengivite (GP: PB ≤ 3mm e NI≤ 1mm), em dentes diferentes, com pontas de papel absorvente pré-fabricadas. O soro destes pacientes também foi coletado. A análise da IL-6 foi realizada pelo LUMINEX. A quantidade total e concentração da IL-6 estavam significantemente maiores no fluido gengival dos sítios PP do grupo RCUI quando comparados aos sítios PP do grupo controle (p=0.028; p=0.044, respectivamente). O grupo DC apresentou a quantidade total de IL-6 significantemente maior no sítio PP do que no GP (p=0.028). Já no soro, a IL-6 não diferiu entre os grupos. Sendo assim, pode-se concluir que os indivíduos com retrocolite ulcerativa idiopática apresentavam níveis mais altos de IL-6 nos sítios com periodontite, o que pode indicar um importante papel dessa citocina no estabelecimento e progressão da doença periodontal nesses pacientes. / Our aim was to measure the levels of interleukin-6 in gingival crevicular fluid (GCF) from patients with periodontitis and inflammatory bowel disease (IBD), and compare with systemically healthy controls with periodontitis. Besides, was measured IL-6 level in serum. Fifteen patients with Crohns disease (CD, mean age 38.2 11.4 years), 15 with ulcerative colitis (RCUI, 45.0 10.5) and 15 controls (C, 42.1 7.8) participated in this study. Probing pocket depth (PPD), attachment loss (CAL), presence of plaque and presence of bleeding on probing, were assessed in six sites per tooth. In each subject, GCF from four sites with gingivitis (GP- PPD≤ 3mm and CAL ≤ 1mm) and from 4 sites with periodontitis (PP- PPD ≥ 5mm and CAL ≥ 3mm), on different teeth, were collected with filter strips. The serum of those patients was also collected. The IL-6 was analyzed in the Luminex. The total amount and the concentration of IL-6 in GCF was significantly higher in PP sites from RCUI than in controls (p=0.028 e p=0.044, respectively). The total amount of IL-6 was significantly higher in PP than GP sites in the DC group (p=0.028). In serum, IL-6 does not differ between groups. Therefore was concluded that subjects with ulcerative colitis showed higher levels of IL-6 in periodontitis sites, which might indicate an important role of this cytokine in the onset and progression of periodontal disease in such patients.

Introdução: A retocolite ulcerativa indeterminada é uma doença inflamatória que envolve exclusivamente o cólon e o reto, sendo caracterizada por infiltrado leucocitário e úlceras superficiais na mucosa intestinal. A produção e liberação de espécies reativas de oxigênio e nitrogênio parecem ser cruciais na determinação da fisiopatologia da doença, pois resultam em dano oxidativo. A partir dessas informações, a busca por opções terapêuticas com propriedades antioxidantes são importantes e têm sido testadas na colite experimental. Objetivo: Este estudo tem como objetivo avaliar os efeitos do extrato seco da planta Boswellia serrata em modelo experimental de colite induzida por ácido acético sobre os danos teciduais, a pressão anal esfincteriana, o estresse oxidativo, a atividade das enzimas antioxidantes superóxido dismutase (SOD) e glutationa peroxidase (GPx) e atividade da glutationa (GSH), a concentração dos metabólitos do óxido nítrico e expressão da enzima óxido nítrico sintase induzível (iNOS) por imunohistoquímica. Material e métodos: Foram utilizados 25 ratos Wistar machos, com peso médio de 350g, divididos em 5 grupos: Controle (CO); Controle+Boswellia serrata (C+B); Colite (CL); Colite+Boswellia serrata (CL+B) e Boswellia serrata+Colite (B+CL). Os animais foram submetidos à administração intracolônica por enema com solução de ácido acético diluído a 4% e com volume de 4 mL. O tratamento com o extrato aquoso da planta via oral, na dose de 34,2 mg/Kg diluído em 4 mL de solução fisiológica, ocorreu uma vez ao dia durante 48 horas antes e após a indução da colite. Foi realizada a medida de pressão anal esfincteriana dos animais. As análises histológicas do intestino foram através da coloração de Hematoxilina-Eosina e realizada imunohistoquímca com anticorpo iNOS. O homogeneizado do intestino foi utilizado para avaliação da lipoperoxidação (LPO) através das substâncias reativas ao acido tiobarbitúrico (TBARS), avaliação dos metabólitos do óxido nítrico pela técnica de nitritos e nitratos totais, avaliação da atividade das enzimas antioxidantes SOD e GPx e avaliação da GSH. Resultados: Na análise da pressão anal esfincteriana os animais dos grupos CL+B e B+CL apresentaram um aumento significativo em relação ao grupo CL. Nos níveis de LPO e metabólitos do óxido nítrico foi observada uma diminuição significativa nos grupos CL+B e B+CL quando comparados ao grupo CL. A atividade da SOD mostrou um aumento no grupo CL e uma diminuição significativa nos grupos CL+B e B+CL equivalendo à média do grupo CO. A GPx e GSH apresentaram um aumento significativo nos grupos CL+B e B+CL em relação ao grupo CL. Conclusão: Sugerimos que a administração do extrato da planta Boswellia serrata possa ser uma possibilidade de terapia antioxidante na colite ulcerativa. / Introduction: Ulcerative rectocolitis is an inflammatory disease that involves only the colon and rectum, being characterized by leukocyte infiltrate and superficial ulcers in the intestinal mucosa. The production and release of reactive oxygen and nitrogen species appears to be crucial in determining the pathophysiology of the disease, since both result in oxidative damage. Therefore, the search for treatment options with antioxidant properties is important currently and has been tested in experimental colitis. Objective: This study aimed to evaluate the effects of dry extract of Boswellia serrata plant in an experimental model of colitis induced by acetic acid on tissue injury, anal sphincter pressure, oxidative stress, on the activity of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione (GSH), concentration of nitric oxide metabolites and expression of inducible nitric oxide synthase enzyme (iNOS) by immunohistochemistry. Methods: We used 25 male Wistar rats with an average weight of 350g, divided into 5 groups: control (CO), Control + Boswellia serrata (CO+B); Colitis (CL); Colitis + Boswellia serrata (CL+B) and Boswellia serrata + colitis (B+CL). The animals were submitted to intracolonic administration by enema with acetic acid solution diluted to 4% in a volume of 4 ml. The treatment with aqueous plant extract was performed orally at a dose of 34.2 mg/kg diluted in 4 ml of saline. The administration occurred once daily for 48 hours before and after the induction of colitis. We performed the measurement of anal sphincter pressure animals. Histological analyzes of bowel the after were made staining with hematoxylin-eosin and immunohistochemistry, performed with iNOS antibody. The homogenized intestine was used for evaluation of lipid peroxidation (LPO) through thiobarbituric acid reactive substances (TBARS), assessment of nitric oxide metabolites by the technique of total nitrites and nitrates and evaluation of the antioxidant enzymes SOD, GPx and GSH. Results: The analysis of anal sphincter pressure of the animals in groups CL+B and B+CL showed a significant increase when compared to the CL group. LPO and nitric oxide metabolites levels demonstrated significant decrease in groups CL+B and B+CL when compared to CL. SOD activity showed an increase in CL group and a significant decrease in groups CL+B and B+CL, remainig to the average of the CO group. The GPx and GSH showed a significant increase in groups CL+B and B+CL group when compared to CL group. Conclusion: We suggest that the administration of Boswellia serrata plant extract may be a possibility of antioxidant therapy in ulcerative colitis.

Diploma thesis The influence of nutritional measures on the course of ulcerative colitis deals with the influence of dietary habits on the course of ulcerative colitis (especially probiotic foods), namely impact on relapses of the disease. The theoretical part is divided into two parts. The first part describes ulcerative colitis, from definition to treatment. The second part deals with the intestinal microbiome and the factors that affect it, with an emphasis on the influence of food. The semi-structured interview method based on the questionnaire was used to elaborate the practical part. The research group consisted of respondents with ulcerative colitis who were in remission and relapse. A questionnaire was filled with respondents, which consisted of questions about the course of the disease and a frequency questionnaire targeting different groups of foods. The established eating habits were compared to each other among the respondents, given the frequency of relapse of their illnesses. Research has shown that only fermented dairy products are related to relapse rate and retention of remission. For foods that contain fiber that also modulates the intestinal microbe, the relationship between food consumption and relapse has not been proven. Also, the relationship between consumption of fatty...

As doenças inflamatórias intestinais (DII) são doenças crônicas incapacitantes com significativa morbidade. A Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU) são as maiores representantes. O diagnóstico é baseado na suspeita clínica e complementado por achados endoscópicos, histopatológicos e radiológicos. Como não existe um teste padrão, o diagnóstico destas doenças permanece sendo um problema para gastroenterologistas e patologistas. O desenvolvimento de terapias mais específicas torna cada vez mais importante o diagnóstico preciso para uma escolha terapêutica individualizada. A imunidade inata está ativada de forma semelhante nas duas DII, porém na RCU os linfócitos CD4 TH2 são os principais envolvidos. Estes linfócitos expressam o receptor CD30 na sua membrana plasmática e produzem citocinas que ativam os eosinófilos. Levando em consideração o conhecimento fisiopatológico atual, este estudo tem como principal objetivo avaliar a relevância da expressão do marcador CD30 por imuno-histoquímica, a contagem de eosinófilos e as características histopatológicas no diagnóstico diferencial das DII. Foram avaliados 185 pacientes de um ambulatório especializado em um Hospital Universitário (105 com DC 80 com RCU). O diagnóstico foi estabelecido pelos critérios de Lennard-Jones, revisados por um gastroenterologista especializado e corroborado por cinco anos de seguimento. As biópsias foram realizadas por diversos profissionais na rotina assistencial, porém todas foram analisadas por um patologista com experiência em tubo digestivo. Nenhum paciente estava usando tratamento no momento da coleta das biópsias. As variáveis histopatológicas que demonstraram poder estatístico para auxiliar no diagnóstico diferencial foram a extensão do processo inflamatório para a submucosa, a presença de granuloma, erosões aftóides e variabilidade de acometimento entre os fragmentos. Avaliando estas características em conjunto, foi possível obter uma acurácia de 69.1% para o diagnóstico diferencial entre DC e RCU. Estudando o segmento mais alterado encontrou-se uma mediana de eosinófilos de 42 (25,5 – 63,5), nos pacientes com DC e 107 (67 – 123) nos pacientes com RCU (p< 0.001). Assumindo como ponto de corte um número V a 70 eosinófilos, a sensibilidade foi de 78,3% e a especificidade de 71% favorecendo o diagnóstico de RCU, a área sob a curva ROC foi de 0,767 (IC 95%: 0,696–0,838). A imuno-histoquímica com CD30 demonstrou uma mediana de 3 células CD30+ (2-6) na DC e 33 (24-52) na RCU, demonstrando uma diferença estatística significativa para o diagnóstico diferencial entre as duas doenças (p<0,001). Além disso, nos pacientes com RCU as células CD30+ estavam distribuídas mais frequentemente em agrupamentos nos centros dos folículos linfoides. O ponto de corte determinado pela curva ROC foi de 15 células marcadas (S = 97,5%, E = 94,3%, RV + = 17,1; RV = 0.03, área sob a curva: 0.967, IC 95%: 0.941 - 0.993). Todos estes parâmetros estudados tiveram capacidade discriminatória para o diagnóstico de DC e RCU. Designando um valor para cada variável, baseado no poder estatístico de cada uma e de forma a obter uma soma de 10 pontos no total, foi construído um escore histopatológico para o diagnóstico da DC. Considerando-se a soma das variáveis V 5 obteve-se uma especificidade de 100% e uma sensibilidade de 86,8%. Considerando 4 como ponto de corte do escore, a sensibilidade aumenta para 95,3%, e a especificidade reduz de 100% para 94,9%. Concluindo, o uso rotineiro da avaliação das características histopatológicas descritas em associação com a contagem de eosinófilos e células CD30+ proporciona uma alta acurácia no diagnóstico diferencial entre DC e RCU. Todos os parâmetros estudados são de fácil avaliação tanto por patologistas especialistas quanto generalistas. Sugere-se a realização de um estudo prospectivo para validação deste escore. / Inflammatory bowel diseases (IBD) are chronic disabling diseases with significant morbidity, being Crohn’s disease (DC) and Ulcerative colitis (UC) their greatest representatives. Diagnosis is based on clinical suspicious and complemented by endoscopic, histopathological and radiological findings. However, there is not a gold standard test, so it remained a problem for gastroenterologists and pathologists. The development of more targeted therapies makes it even more important to establish an accurate diagnosis for a better individualized therapeutic approach. Innate immune response is activated in both IBD, but in UC the lymphocytes CD4 TH2-like are mainly engaged, this kind of lymphocytes has CD30 expressed in their plasma membrane and produces cytokines that activate eosinophils. Considering the current pathophysiological knowledge, this study aimed to evaluate the relevance of CD30 expression by immunohistochemical, eosinophil count and histopathological features in differential diagnosis of IBD. A total of 185 patients were evaluated (105 CD/ 80 UC). Patients were followed at a specialized clinic of a university hospital, diagnosed according to Lennard- Jones criteria reviewed by a gastroenterologist expert and corroborated by five years of follow up. Biopsy samples were taken by different professionals in routine care, but analyzed by an experienced gastrointestinal pathologist. None of the patients were using treatment at the time of biopsy. Of all the pathological variables assessed, those that had statistical capacity to assist in the differential diagnosis were extension of the inflammatory process to submucosa, granuloma, aphthous erosion and variability of involvement between fragments. Evaluating these variables together, an accuracy of 69.1% in the differential diagnosis between CD and UC was found. Assessing the most altered sample the median of eosinophils was 42 (25.5 – 63.5) in CD patients and 107 (67 – 123) in UC patients (p< 0.001). Assuming a cutoff V 70 eosinophils, the sensitivity was 78,3% and specificity of 71% favoring the UC diagnosis, the area under the ROC curve was 0.767 (CI 95%: 0,696–0,838). Immunohistochemical CD30+ cells presented with a median of 3 cells (2-6) in CD and 33 cells (24-52) in UC, demonstrating a highly significant statistical difference between the two diseases (p<0.001). Besides, CD30+ cells were distributed most clustered in the center of lymphoid follicles in UC patients. The cutoff determined by ROC curve was 15 (S = 97.5%, E = 94.3%, LR + = 17.1;-RV = 0.03, AUC: 0.967, 95% CI: 0.941 - 0.993). All these parameters studied had discriminatory capacity for diagnosis of CD and UC. A value was assigned to each variable based on the statistical power of each, making a total sum of 10 points to build a histopathological score for the CD diagnosis. Setting the cutoff as V 5 we found a specificity of 100% and a sensitivity of 86.8%. When we consider as cutoff as V 4 points the score sensitivity comes to 95.3%, and reduces the specificity of 100% to 94.9%. In conclusion, the use of routine assessment of the histopathological features described previously in association with the eosinophils and CD30+ cells count provides a high accuracy for CD and UC differential diagnosis. All parameters assessed here are easily performed by pathologists specialists and generalists. The next step seems to be the validation of this score in a prospective study.

As doenças inflamatórias intestinais (DII) são doenças crônicas incapacitantes com significativa morbidade. A Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU) são as maiores representantes. O diagnóstico é baseado na suspeita clínica e complementado por achados endoscópicos, histopatológicos e radiológicos. Como não existe um teste padrão, o diagnóstico destas doenças permanece sendo um problema para gastroenterologistas e patologistas. O desenvolvimento de terapias mais específicas torna cada vez mais importante o diagnóstico preciso para uma escolha terapêutica individualizada. A imunidade inata está ativada de forma semelhante nas duas DII, porém na RCU os linfócitos CD4 TH2 são os principais envolvidos. Estes linfócitos expressam o receptor CD30 na sua membrana plasmática e produzem citocinas que ativam os eosinófilos. Levando em consideração o conhecimento fisiopatológico atual, este estudo tem como principal objetivo avaliar a relevância da expressão do marcador CD30 por imuno-histoquímica, a contagem de eosinófilos e as características histopatológicas no diagnóstico diferencial das DII. Foram avaliados 185 pacientes de um ambulatório especializado em um Hospital Universitário (105 com DC 80 com RCU). O diagnóstico foi estabelecido pelos critérios de Lennard-Jones, revisados por um gastroenterologista especializado e corroborado por cinco anos de seguimento. As biópsias foram realizadas por diversos profissionais na rotina assistencial, porém todas foram analisadas por um patologista com experiência em tubo digestivo. Nenhum paciente estava usando tratamento no momento da coleta das biópsias. As variáveis histopatológicas que demonstraram poder estatístico para auxiliar no diagnóstico diferencial foram a extensão do processo inflamatório para a submucosa, a presença de granuloma, erosões aftóides e variabilidade de acometimento entre os fragmentos. Avaliando estas características em conjunto, foi possível obter uma acurácia de 69.1% para o diagnóstico diferencial entre DC e RCU. Estudando o segmento mais alterado encontrou-se uma mediana de eosinófilos de 42 (25,5 – 63,5), nos pacientes com DC e 107 (67 – 123) nos pacientes com RCU (p< 0.001). Assumindo como ponto de corte um número V a 70 eosinófilos, a sensibilidade foi de 78,3% e a especificidade de 71% favorecendo o diagnóstico de RCU, a área sob a curva ROC foi de 0,767 (IC 95%: 0,696–0,838). A imuno-histoquímica com CD30 demonstrou uma mediana de 3 células CD30+ (2-6) na DC e 33 (24-52) na RCU, demonstrando uma diferença estatística significativa para o diagnóstico diferencial entre as duas doenças (p<0,001). Além disso, nos pacientes com RCU as células CD30+ estavam distribuídas mais frequentemente em agrupamentos nos centros dos folículos linfoides. O ponto de corte determinado pela curva ROC foi de 15 células marcadas (S = 97,5%, E = 94,3%, RV + = 17,1; RV = 0.03, área sob a curva: 0.967, IC 95%: 0.941 - 0.993). Todos estes parâmetros estudados tiveram capacidade discriminatória para o diagnóstico de DC e RCU. Designando um valor para cada variável, baseado no poder estatístico de cada uma e de forma a obter uma soma de 10 pontos no total, foi construído um escore histopatológico para o diagnóstico da DC. Considerando-se a soma das variáveis V 5 obteve-se uma especificidade de 100% e uma sensibilidade de 86,8%. Considerando 4 como ponto de corte do escore, a sensibilidade aumenta para 95,3%, e a especificidade reduz de 100% para 94,9%. Concluindo, o uso rotineiro da avaliação das características histopatológicas descritas em associação com a contagem de eosinófilos e células CD30+ proporciona uma alta acurácia no diagnóstico diferencial entre DC e RCU. Todos os parâmetros estudados são de fácil avaliação tanto por patologistas especialistas quanto generalistas. Sugere-se a realização de um estudo prospectivo para validação deste escore. / Inflammatory bowel diseases (IBD) are chronic disabling diseases with significant morbidity, being Crohn’s disease (DC) and Ulcerative colitis (UC) their greatest representatives. Diagnosis is based on clinical suspicious and complemented by endoscopic, histopathological and radiological findings. However, there is not a gold standard test, so it remained a problem for gastroenterologists and pathologists. The development of more targeted therapies makes it even more important to establish an accurate diagnosis for a better individualized therapeutic approach. Innate immune response is activated in both IBD, but in UC the lymphocytes CD4 TH2-like are mainly engaged, this kind of lymphocytes has CD30 expressed in their plasma membrane and produces cytokines that activate eosinophils. Considering the current pathophysiological knowledge, this study aimed to evaluate the relevance of CD30 expression by immunohistochemical, eosinophil count and histopathological features in differential diagnosis of IBD. A total of 185 patients were evaluated (105 CD/ 80 UC). Patients were followed at a specialized clinic of a university hospital, diagnosed according to Lennard- Jones criteria reviewed by a gastroenterologist expert and corroborated by five years of follow up. Biopsy samples were taken by different professionals in routine care, but analyzed by an experienced gastrointestinal pathologist. None of the patients were using treatment at the time of biopsy. Of all the pathological variables assessed, those that had statistical capacity to assist in the differential diagnosis were extension of the inflammatory process to submucosa, granuloma, aphthous erosion and variability of involvement between fragments. Evaluating these variables together, an accuracy of 69.1% in the differential diagnosis between CD and UC was found. Assessing the most altered sample the median of eosinophils was 42 (25.5 – 63.5) in CD patients and 107 (67 – 123) in UC patients (p< 0.001). Assuming a cutoff V 70 eosinophils, the sensitivity was 78,3% and specificity of 71% favoring the UC diagnosis, the area under the ROC curve was 0.767 (CI 95%: 0,696–0,838). Immunohistochemical CD30+ cells presented with a median of 3 cells (2-6) in CD and 33 cells (24-52) in UC, demonstrating a highly significant statistical difference between the two diseases (p<0.001). Besides, CD30+ cells were distributed most clustered in the center of lymphoid follicles in UC patients. The cutoff determined by ROC curve was 15 (S = 97.5%, E = 94.3%, LR + = 17.1;-RV = 0.03, AUC: 0.967, 95% CI: 0.941 - 0.993). All these parameters studied had discriminatory capacity for diagnosis of CD and UC. A value was assigned to each variable based on the statistical power of each, making a total sum of 10 points to build a histopathological score for the CD diagnosis. Setting the cutoff as V 5 we found a specificity of 100% and a sensitivity of 86.8%. When we consider as cutoff as V 4 points the score sensitivity comes to 95.3%, and reduces the specificity of 100% to 94.9%. In conclusion, the use of routine assessment of the histopathological features described previously in association with the eosinophils and CD30+ cells count provides a high accuracy for CD and UC differential diagnosis. All parameters assessed here are easily performed by pathologists specialists and generalists. The next step seems to be the validation of this score in a prospective study.

Introdução: A retocolite ulcerativa indeterminada é uma doença inflamatória que envolve exclusivamente o cólon e o reto, sendo caracterizada por infiltrado leucocitário e úlceras superficiais na mucosa intestinal. A produção e liberação de espécies reativas de oxigênio e nitrogênio parecem ser cruciais na determinação da fisiopatologia da doença, pois resultam em dano oxidativo. A partir dessas informações, a busca por opções terapêuticas com propriedades antioxidantes são importantes e têm sido testadas na colite experimental. Objetivo: Este estudo tem como objetivo avaliar os efeitos do extrato seco da planta Boswellia serrata em modelo experimental de colite induzida por ácido acético sobre os danos teciduais, a pressão anal esfincteriana, o estresse oxidativo, a atividade das enzimas antioxidantes superóxido dismutase (SOD) e glutationa peroxidase (GPx) e atividade da glutationa (GSH), a concentração dos metabólitos do óxido nítrico e expressão da enzima óxido nítrico sintase induzível (iNOS) por imunohistoquímica. Material e métodos: Foram utilizados 25 ratos Wistar machos, com peso médio de 350g, divididos em 5 grupos: Controle (CO); Controle+Boswellia serrata (C+B); Colite (CL); Colite+Boswellia serrata (CL+B) e Boswellia serrata+Colite (B+CL). Os animais foram submetidos à administração intracolônica por enema com solução de ácido acético diluído a 4% e com volume de 4 mL. O tratamento com o extrato aquoso da planta via oral, na dose de 34,2 mg/Kg diluído em 4 mL de solução fisiológica, ocorreu uma vez ao dia durante 48 horas antes e após a indução da colite. Foi realizada a medida de pressão anal esfincteriana dos animais. As análises histológicas do intestino foram através da coloração de Hematoxilina-Eosina e realizada imunohistoquímca com anticorpo iNOS. O homogeneizado do intestino foi utilizado para avaliação da lipoperoxidação (LPO) através das substâncias reativas ao acido tiobarbitúrico (TBARS), avaliação dos metabólitos do óxido nítrico pela técnica de nitritos e nitratos totais, avaliação da atividade das enzimas antioxidantes SOD e GPx e avaliação da GSH. Resultados: Na análise da pressão anal esfincteriana os animais dos grupos CL+B e B+CL apresentaram um aumento significativo em relação ao grupo CL. Nos níveis de LPO e metabólitos do óxido nítrico foi observada uma diminuição significativa nos grupos CL+B e B+CL quando comparados ao grupo CL. A atividade da SOD mostrou um aumento no grupo CL e uma diminuição significativa nos grupos CL+B e B+CL equivalendo à média do grupo CO. A GPx e GSH apresentaram um aumento significativo nos grupos CL+B e B+CL em relação ao grupo CL. Conclusão: Sugerimos que a administração do extrato da planta Boswellia serrata possa ser uma possibilidade de terapia antioxidante na colite ulcerativa. / Introduction: Ulcerative rectocolitis is an inflammatory disease that involves only the colon and rectum, being characterized by leukocyte infiltrate and superficial ulcers in the intestinal mucosa. The production and release of reactive oxygen and nitrogen species appears to be crucial in determining the pathophysiology of the disease, since both result in oxidative damage. Therefore, the search for treatment options with antioxidant properties is important currently and has been tested in experimental colitis. Objective: This study aimed to evaluate the effects of dry extract of Boswellia serrata plant in an experimental model of colitis induced by acetic acid on tissue injury, anal sphincter pressure, oxidative stress, on the activity of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione (GSH), concentration of nitric oxide metabolites and expression of inducible nitric oxide synthase enzyme (iNOS) by immunohistochemistry. Methods: We used 25 male Wistar rats with an average weight of 350g, divided into 5 groups: control (CO), Control + Boswellia serrata (CO+B); Colitis (CL); Colitis + Boswellia serrata (CL+B) and Boswellia serrata + colitis (B+CL). The animals were submitted to intracolonic administration by enema with acetic acid solution diluted to 4% in a volume of 4 ml. The treatment with aqueous plant extract was performed orally at a dose of 34.2 mg/kg diluted in 4 ml of saline. The administration occurred once daily for 48 hours before and after the induction of colitis. We performed the measurement of anal sphincter pressure animals. Histological analyzes of bowel the after were made staining with hematoxylin-eosin and immunohistochemistry, performed with iNOS antibody. The homogenized intestine was used for evaluation of lipid peroxidation (LPO) through thiobarbituric acid reactive substances (TBARS), assessment of nitric oxide metabolites by the technique of total nitrites and nitrates and evaluation of the antioxidant enzymes SOD, GPx and GSH. Results: The analysis of anal sphincter pressure of the animals in groups CL+B and B+CL showed a significant increase when compared to the CL group. LPO and nitric oxide metabolites levels demonstrated significant decrease in groups CL+B and B+CL when compared to CL. SOD activity showed an increase in CL group and a significant decrease in groups CL+B and B+CL, remainig to the average of the CO group. The GPx and GSH showed a significant increase in groups CL+B and B+CL group when compared to CL group. Conclusion: We suggest that the administration of Boswellia serrata plant extract may be a possibility of antioxidant therapy in ulcerative colitis.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / VÃrios distÃrbios neurolÃgicos foram observados em pacientes com doenÃa inflamatÃria intestinal (DII), porÃm sua prevalÃncia exata à desconhecida. Estudamos prospectivamente a incidÃncia e a prevalÃncia das manifestaÃÃes neurolÃgicas em uma coorte de 82 pacientes com DII (protocolo 1) e a presenÃa e gravidade de tremor em pacientes com DII e voluntÃrios sadios (Protocolo 2). Os pacientes do protocolo 1 foram avaliados no ambulatÃrio de DII do Hospital Walter CantÃdio por um perÃodo de pelo menos 1 ano, realizando avaliaÃÃes neurolÃgicas completas periÃdicas. O segundo protocolo consistiu na quantificaÃÃo de tremor em espirais de Arquimedes realizadas por pacientes com doenÃa de Crohn (DC, N=31), retocolite ulcerativa (RCU, N=63) e voluntÃrios sadios (N=41) por um neurologista especializado em distÃrbios de movimento (Dr. Elan Louis, Columbia University, Nova Iorque). Polineuropatia de fibras grossas sensitivas ou sensitivo-motoras foi observada em 16,1% dos pacientes com DC e 19,6% dos pacientes com RCU, sendo usualmente leve, predominantemente simÃtrica, distal e axonal. SÃndrome do tÃnel do carpo foi observada comumente em mulheres com RCU. Sintomas sensitivos sem anormalidades eletromiogrÃficas, sugestivos de neuropatia de pequenas fibras ou mielopatia subclÃnica, foram observados em 29% dos pacientes com DC e 11,8% com RCU. ApÃs excluir outros fatores etiolÃgicos ou contributÃrios para polineuropatia, 13,4% dos pacientes com doenÃa inflamatÃria intestinal apresentaram polineuropatia de fibras grossas ou fibras finas (7,3% com polineuropatia de fibras grossas sensitivo-motoras). CefalÃia nÃo debilitante foi a queixa neurolÃgica mais comum, 3 pacientes apresentaram acidente vascular cerebral isquÃmico, 5 epilepsia e 1 corÃia transitÃria. Pacientes com DII apresentaram menor quantidade de tremor que os voluntÃrios sadios devido ao menor uso de cafeÃna. Nos pacientes com DC, houve correlaÃÃo significativa entre a nota do tremor, uso de medicaÃÃes com aÃÃo sobre o sistema nervoso central, uso e quantidade de cafeÃna e presenÃa de doenÃas neurolÃgicas. Em pacientes com RCU, sà houve correlaÃÃo significativa entre a nota do tremor e idade ou uso/quantidade de cafeÃna ingerida. Em resumo, pacientes com RCU e DC apresentam uma vasta gama de manifestaÃÃes neurolÃgicas que sÃo com freqÃÃncia clinicamente negligenciadas / Several neurological disorders have been described in inflammatory bowel disease (IBD) patients, but their exact prevalence is unknown. We prospectively studied the prevalence and incidence of neurological disorders in a cohort of 82 patients with IBD (protocol 1) and the presence and severity of tremor in patients with IBD or healthy volunteers (Protocol 2). Patients from protocol 1 were evaluated at the IBD Clinic from the Hospital Walter CantÃdio for at least one year, with complete periodic neurological evaluations. The second protocol consisted in quantifying the amount of tremor in Archimedes spirals from patients with CrohnÂs disease (CD, N=31), ulcerative colitis (UC, N=63) and healthy volunteers (N=41) by a neurologist specialized in movement disorders (Dr. Elan Louis, Columbia University, New York City). Sensory or sensorimotor large-fiber polyneuropathy was observed in 16.1% of the patients with CD and 19.6% of the patients with UC. Neuropathy was usually mild, predominantly distal, symmetric, and axonal. Carpal tunnel syndrome was more commonly observed in women with UC. Sensory complaints without electrodiagnostic (EMG) abnormalities suggestive of small fiber neuropathy or subclinical myelopathy were observed in 29% of the patients with CD and 11.8% of the patients with UC. After excluding other etiological or contributory factors for the development of neuropathy, still 13.4% of the IBD patients had large or small fiber neuropathy (7.3% had large-fiber polyneuropathy). Non-debilitating headache was the most common neurological complaint, 3 patients had strokes, 5 were diagnosed with epilepsy and one had transient chorea. Patients with IBD had lower scores of tremor in the Archimedes spiral assessment due to decreased caffeine intake. In patients with CD, there was a significant correlation between tremor grade, use of medications with effect on the central nervous system, use and amount of caffeine intake and presence of other neurological conditions. In patients with UC, there was only a significant correlation between tremor grade, age and use and the amount of caffeine intake prior to the evaluation. In summary, patients with CD and UC exhibit a wide range of neurological manifestations that are frequently neglected clinically

No description available.

Introduction: Inflammatory bowel disease (IBD), Crohn’s Disease and ulcerative colitis, are long term conditions which follow a relapsing and remitting pattern. The rising incidence of IBD in adults and children has implications for the lifelong burden of disease and the provision of specialist services. Patients are predominantly managed by secondary care and follow a traditional, scheduled follow-up cycle, which is unsustainable and unsatisfactory. Patients with IBD should have access to specialist care which is delivered according to their values and needs. However few studies have examined patients’ views of follow-up care. There is also concern in the UK that services for patients with long term conditions are not orgnised to promote independence with silo working in primary and secondary care.These may be brought together formally through the development of models of care. Utilization of current out-patient spaces to regularly review stable patients is inappropriate and is challenged by commissioners. The question remains as to what models of follow-up are we able to offer patients which are acceptable and what is the role of the general practitioner (GP) and primary care within this. The aim of this study was to develop an integrated, acceptable, model of follow-up care for patients with IBD.Methods The study follows the development phase of the MRC Framework for complex interventions. A best evidence synthesis was undertaken to identify the follow-up care models in IBD. A meta-synthesis of the health and social care needs of patients with IBD was conducted to explore the impact of living with IBD. Qualitative interviews with 24 IBD patients (18 patients had CD, and 6 UC, age range 27-72 years, disease duration range 2 – 40yr) and 20 GPs purposively selected from across NW England were carried out. Patients were asked about their experience, values and preference of follow-up care. The GPs were questioned about their current and potential role in IBD. Analysis was undertaken using Framework Analysis. The best evidence synthesis, meta-synthesis and interviews were synthesised by an expert panel, Consultant Gastroenterologist, patient, GP, IBD Nurse, to develop the model of follow-up care.Results There were similarities and commonalities between the patient and general practitioner interviews. Patients did not want to be seen when well, GPs wanted more involvement in care and there is scope for an IBD outreach nurse at the interface of primary/secondary care. Discharging quiescent patients into enhanced GP care, to ensure equitable treatment, was acceptable to all, as was the concept of ‘virtual’ clinics. Patients would initiate self referral within the ‘virtual’ arm whilst patients under GP care would be referred back into secondary care as a rapid referral < 7days and not using a new patient tariff. Complex IBD patients would remain under secondary care. A stratified model of follow-up care was developed.Conclusion This study provides an acceptable integrated model of follow-up for patients with IBD. It takes into account the growing incidence of IBD and UK policy to reduce inappropriate follow-up. It emphasises role of self management, the integration of primary and secondary care, placing the patient closer to home whilst allowing secondary care to concentrate on complex patient management.

Introduction: Inflammatory bowel disease is a common, complex relapsing disorder characterised by immune dysregulation, altered intestinal permeability and microbial insult. Limited knowledge is available regarding the metabolic changes observed during progression of the disease, and limited biomarkers of disease available that have been validated and shown to be of sound clinical value. Aim of Study: A two stage metabolomics approach was adopted to determine if metabolic signature profiles, could distinguish inflammatory bowel disease Crohn’s disease (CD) patients from ulcerative colitis (UC) patients and from healthy controls. Methods: A serum metabolomics approach was undertaken to define metabolic changes associated with UC and CD. Serum samples from a discovery study of 30 UC, 30 CD and 29 ethnically, age and gender matched controls were analysed by ultra-performance liquid chromatography mass spectrometry. A subsequent validation study was preformed using 28UC, 31CD, and 29 gender matched controls were also analysed using UPLC-MS.ResultsClasses of metabolites, identified as biologically interesting and at significantly different levels (p<0.05) in comparisons of control and CD and UC cohorts included: steroids and steroid derivatives, phosphocholine, Vitamin D metabolites, fatty acids and conjugates, glycerolipids, isoprenoids, amino acids, and phosphosphingolipids. There were fewer discriminatory metabolites differentiating the CD and UC cohorts. Conclusion: Serum Metabolomic profiling may represent a novel technology which could be used to distinguish individuals with CD from those with UC and healthy controls.