Repositório RCAAP

Context It is unclear whether health-related quality of life (HRQL) is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB). Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up. Methods We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery. Results The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions. Conclusions RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality) in the short-term and two SF-36 domains (general health perceptions and vitality) in the long-term.

Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.

Context Constipation is a very common symptom in the general population. One way of non-pharmacological treatment of constipation is through the addition of probiotics to food. Obectives The aim of this study was to evaluate de effect of the consumption of a fresh cheese, enriched with Bifidobacterium lactis Bi-07 on the symptoms of constipated women. Methods A randomized controlled trial, carried out in the Basic Health Units of Guaporé's City – RS/Brazil, between january and may 2012, with 30 constipated women. The patients were randomized into two groups whom received, for 30 days, 30 g of fresh cheese enriched with Bifidobacterium lactis Bi-07 (n = 15) or regular fresh cheese (n = 15). Constipation symptoms were evaluated according to ROMA III Consensus, before and after the nutritional intervention. Also, data of clinical and anthropometric characteristics of the individuals were collected. Accepted level of significance 5% (P≤0,05). Results The medium age of the studied population was 37,5±14,4 years in the intervention group and 40,8±12,8 years in the control group. After 30 days we observed that the ingestion of fresh cheese enriched with Bifidobacterium lactis Bi-07 promoted benefic effects on the symptoms of strength to evacuate. Conclusion The consumption of 30g/day of a fresh cheese enriched with Bifidobacterium lactis Bi-07 has beneficial effects on constipation symptoms.

Context Functional dyspepsia represents a frequent gastrointestinal disorder in clinical practice. According to the Roma III criteria, functional dyspepsia can be classified into two types as the predominant sympton: epigastric pain and postprandial discomfort. Even though the pathophysiology is still uncertain, the functional dyspepsia seems to be related to multiple mechanisms, among them visceral hypersensitivity, changes in the gastroduodenal motility and gastric accommodation and psychological factors. Objective Evaluate the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients. Methods Randomized clinical trial in which were enrolled patients with functional dyspepsia patients in according with Rome III criteria. One group was submitted to drug therapy and specific acupuncture (GI) and the other to drug therapy and non-specific acupuncture (GII). The gastrointestinal symptoms, presence of psychiatric disorders and quality of life were evaluated, at the end and three months after treatment. Results After 4 weeks of treatment there was improvement of gastrointestinal symptoms in Group I (55 ± 12 vs 29 ± 8.8; P = 0.001) and Group II (50.5 ± 10.2 vs 46 ± 10.5; P = 0.001). Quality of life was significantly better in Group I than group II (93.4 ± 7.3 vs 102.4 ± 5.1; P = 0.001). Anxiety (93.3% vs 0%; P = 0.001) and depression (46.7% vs 0%; P = 0.004) were significantly lower in Group I than group II. When comparing the two groups after 4 weeks of treatment, gastrointestinal symptoms (29 ± 8.8 vs 46 ± 10.5; P<0.001) and quality of life (102.4 ± 5.1 vs 96 ± 6.1; P = 0.021) were significantly better in Group I than group II. Three months after the treatment, gastrointestinal symptoms remained better only in Group I, when compared to the pre-treatment values (38 ± 11.3 vs 55 ± 12; P = 0.001). Conclusion In patients with functional dyspepsia the complementary acupuncture treatment is superior to conventional treatment. Further studies with more patients are needed to confirm these findings.

Context To evaluate lung and liver changes in two experimental models using intraperitoneal carbon tetrachloride (CCl4) and bile duct ligation (BDL). Methods Twenty-four male Wistar rats were divided into a control group (CO) and an experimental group (EX). We evaluated the liver transaminases (AST, ALT, AP), arterial blood gases (PaO2, PCO2 and SpO2) and lipid peroxidation by TBARS (substances that react to thiobarbituric acid) and chemiluminescence. We also evaluated the antioxidant enzyme superoxide dismutase (SOD) and histology of lung tissue and liver. Results There were significant differences in AST, ALT, ALP and PaO2 between CO group and EX group (P<0.05). The levels of TBARS, chemiluminescence and activity of enzyme superoxide dismutase were increased to different degrees in the CCl4 groups: CO and in the BDL -EX (P<0.05, respectively). In the lung histology, an increase in the wall thickness of the pulmonary artery and a diameter reduction in the CCl4 animal model were observed: comparing CO group with EX group, we observed a reduction in thickness and an increase in the diameter of the artery wall lung. Conclusion Both experimental models have caused liver damage and alterations in the artery wall that are associated with major changes in pulmonary gas exchange.

Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6%) were performed totally laparoscopic; 4 (4.2%) needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%). Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

Context Hepatitis B virus (HBV) can cause fulminant hepatitis, cirrhosis and hepatocellular carcinoma, and is one of the most common causes of acute and chronic liver failure. The genetic variants of HBV can be decisive for the evolution of these diseases as well as for the election of therapy. Objectives The aim of this study was to evaluate and standardize an in house methodology based on the analysis of the melting curve polymerase chain reaction (PCR) of real-time (qPCR) to screen for genotypes A, D and F of HBV in patients from a hospital in Rio Grande do Sul, Brazil. Methods We evaluated 104 patients presumably with HBV chronic infection. Viral DNA was extracted from plasma and viral genotypes and different mutations were determined using PCR-based protocols. Results A PCR-based methodology was standardized for the analysis of genotypes A, D and F of HBV. The technique was based in a nested PCR with the final step consisting of a multiplex real-time PCR, using the melting curve as a tool for the differentiation of fragments. A higher frequency of genotype D (44.4%), followed by genotype A (22.2%) and genotype F (3.7%) was observed. Conclusion The standardized assay, a nested PCR-multiplex qPCR using specific primers, provides a rapid and accurate method for the differentiation of HBV genotypes that are more frequent in Southern Brazil – A, D and F. This method can be applied in the clinical practice.

Context Fructose is a monosaccharide frequently present in natural and artificial juice fruits. When the concentration of fructose in certain food is present in excess of glucose concentration some individuals may develop fructose malabsorption. Objectives To report the frequency of fructose malabsorption utilizing the hydrogen breath test in children with gastrointestinal and/or nutritional disorders. Methods Between July 2011 and July 2012, 43 patients with gastrointestinal and/or nutritional disorders, from both sexes, were consecutively studied, utilizing the hydrogen breath test with loads of the following carbohydrates: lactose, glucose, fructose and lactulose. Fructose was offered in a 10% aqueous solution in the dose of 1 g/kg body weight. Samples were collected fasting and at every 15 minutes after the intake of the aqueous solution for a 2 hour period. Malabsorption was considered when there was an increase of >20 ppm of hydrogen over the fasting level, and intolerance was diagnosed if gastrointestinal symptoms would appear. Results The age of the patients varied from 3 months to 16 years, 24 were boys. The following diagnosis were established: irritable bowel syndrome with diarrhea in 16, functional abdominal pain in 8, short stature in 10, lactose intolerance in 3, celiac disease in 1, food allergy in 1 and giardiasis in 1 patient. Fructose malabsorption was characterized in 13 (30.2%) patients, and intolerance in 1 (2.3%) patient. The most frequent fructose malabsorption was characterized in 7 (16.3%) patients with irritable bowel syndrome and in 4 (9.3%) patients with functional abdominal pain. Conclusions Patients with irritable bowel syndrome and functional abdominal pain were the main cause of fructose malabsorption.

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Gastric cancer is one of the most common cancers and a main cause of cancer-related death worldwide, since the majority of patients suffering of this malignancy are usually faced with a poor prognosis due to diagnosis at later stages. In order to improve treatment outcomes, the association of surgery with chemo and/or radiotherapy (multimodal therapy) has become the standard treatment for locally advanced stages. However, despite several treatment options currently available for management of these tumors, perioperative chemotherapy has been mainly accepted for the comprehensive therapeutic strategy including an appropriated D2-gastrectomy. This manuscript presents a (nonsystematic) critical review about the use of perioperative chemotherapy, with a special focus on the drugs delivery.

ContextGastrointestinal stromal tumors are uncommon abdominal neoplasms and can affect any portion of the gastrointestinal tract.ObjectivesDescribe the tomographic findings of the gastrointestinal stromal tumor of gastric origin, correlating it with the mitotic index.MethodsTwenty-one patients were selected within the period of January 2000 and 2008, with histopathological and immunohistochemical diagnosis of gastric gastrointestinal stromal tumors, who presented computed tomography done before the treatment. The tomographic variables analyzed were lesion topography, dimensions, contours, morphology, pattern and intensity enhancement through venous contrast, growth pattern, invasion of adjacent organs, presence of ulceration, fistula, calcifications, infiltration of mesenteric fat, lymphadenopathy and metastasis. The mitotic index was determined through optic microscopy, counting the number of mitosis figures in 50 high power fields.ResultsThe tumors were located in the body (66.7%) or gastric fundus (33.3%), with dimensions varying between 4.2 and 21.2 cm (average of 10.5 cm). The growth was predominantly extraluminal (47.6%) or intra/extra luminal (28.6%). The enhancement by venous contrast was heterogeneous in 66.7%. The statistical analysis showed that irregular morphology (P = 0.027) and infiltration of mesenteric fat (P = 0.012) presented correlation with the high mitotic index.ConclusionsIn the present study, most part of the tumors were located in the gastric body, with average size of 10.5 cm, presenting central hypo dense area, heterogeneous enhancement through contrast and predominantly extra luminal growth. Irregular morphology and infiltration of mesenteric fat present statistical correlation with high mitotic level.

ContextAge has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity.ObjectivesThe primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly.MethodsA retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam) were collected.ResultsOf the 207 patients (mean age 70.47 ± 7.04) with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77%) patients had some colonoscopy complications: 1 (0.48%) with the sedation (apnea), 4 (1.93%) with the procedure (abdominal pain and bacteremia) and 38 (18.35%) with the bowel preparation (acute renal failure, hypotension). Individuals ≥80 years had an RR = 3.4 (1.2-10.1),P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8), P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45).ConclusionThere was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.

ABSTRACT: The association of natural compounds isolated from medicinal plants with conventional antibiotics, both with similar mechanisms of action, have become a viable alternative strategy to overcome the problem of drug resistance. This study aimed to evaluate the in vitro antimicrobial activity of tannic substances present in the bark of Anacardium occidentale and Anadenanthera colubrina against samples of Staphylococcus aureus when in combination with cephalexin. These combinations were evaluated by determining the minimum inhibitory concentration (MIC). For this purpose, tannins and cephalexin were serially dissolved in distilled water at concentrations ranging from 0.976 mg/mL to 500 mg/mL and 2 mg/mL to 512 mg/mL, respectively. When combined, the compounds inhibited S. aureus growth forming halos ranging from 0.9 to 46 mm with an MIC of 7.8 mg/mL (tannins) and 4 µg/mL (cephalexin). The resulting effect of the combination of natural and synthetic substances with similar mechanisms of action presented better results than when tested alone. Thus, the conclusion is that both the tannins and cephalexin had their antimicrobial action enhanced when used in combination, enabling the use of lower concentrations while maintaining their antibacterial effect against strains of S. aureus.

ABSTRACT: Entomopathogenic nematodes are effective in controlling soil insects and they are used in agricultural systems. The virulence of entomopathogenic nematodes on crickets (Gryllus L.) (Orthoptera: Gryllidae) was evaluated under different conditions in order to select populations for application in the field. Virulence tests with Heterorhabditis amazonensis RSC05, H. amazonensis MC01, Steinernema carpocapsae All (Weiser) and H. amazonensis GL were performed. Evaluations were then made of the concentrations of infective juveniles (100, 200, 400 and 600 infective juveniles per insect); feeding preference with or without choice; and field tests using traps to evaluate insect sampling. All isolates were found to cause mortality in Gryllus sp., and H. amazonensis MC01 and S. carpocapsae All were selected; an increase in concentration resulted in increased insect mortality. Regarding the feeding preference tests, after 16 h there was no feeding in any of the treatments. In treatments with a chance of choice, it was verified that the crickets fed, independently of the presence of the nematodes. In the field tests, 19 live crickets were found in the traps, and, after application of entomopathogenic nematodes in aqueous suspension, 2 live crickets were found. Results suggested that H. amazonensis MC01 was promising in the control of Gryllus sp. under the tested conditions.

ABSTRACT: The present study evaluated the survival and injuries of Deois flavopicta (Hemiptera: Cercopidae) in pastures of Urochloa (Syn. Brachiaria) decumbens and U. brizantha, submitted to seed treatment with fipronil (Amulet®) and thiamethoxam (Cruiser 350 FS®), and dry mass yield. The experiment, carried out at the APTA Experimental Unity, São José do Rio Preto, SP, Brazil, was designed in randomly blocks, with six treatments (factorial 2x3) and four replications. Sowing was manual, with 12.0 kg ha-1 seeds. Twenty adults were released on the plot, in a 40x40x70 cm cage, forty-nine days after sowing. The insects were sampled every two days during twelve days, without replacement of dead insects. Injuries caused by the spittlebug were evaluated by a rating scale and by productivity (dry mass yield). Data were analyzed by F-test and means compared by Tukey’s test (p≤0.05). The survival of adults was higher in the U. decumbens pasture than in the U. brizantha pasture. Results show that seed treatment with thiamethoxam reduced the survival of D. flavopicta in pasture formation, but did not influence the injuries caused by insect and the dry mass yield of forage species.

ABSTRACT: The last destination of most herbicides used in agricultural systems is the soil. This is a dynamic interaction; herbicides can remain in the soil solution or be carried through the soil profile, reaching the water table. The objective of this work was to evaluate the leaching potential of the tebuthiuron herbicide using bioindicator plants grown in an Oxisol of sandy loam texture and in an Entisol of clay texture, after the occurrence of natural rainfall events. A complete randomized experimental design was used, in a 3×8 factorial arrangement, with four replications. The treatments consisted of three accumulated natural rainfall depths (30-40, 60-80, and 100-120 mm) and eight soil profile layers (0-3, 3-6, 6-9, 9-12, 12-15, 15-20, 20-25, and 25-30 cm). Soil samples were collected after the tebuthiuron herbicide application - 750 for clayey soil, and 600 g ha-1 for the sandy loam soil -and the rainfall events. PVC pipes with length of 30 cm and diameter of 15 cm were introduced into the soil profile for sampling. The pipes with soil columns were carefully removed by digging around them, to maintain the soil original integrity during collection and, subsequently, cut longitudinally for sowing the bioindicator species - cucumber (Cucumis sativus L.), and lettuce (Lactuca sativa L.). Then, the phytotoxicity in the bioindicator plants grown in these soils were evaluated at 5, 7, 10, and 12 days after sowing, using a grading scale of 0 to 100%. The mobility of the tebuthiuron herbicide was low in both soils, regardless of the rainfall depth, and the cucumber was the most suitable plant species to use as a bioindicator.

ABSTRACT: Collard greens Brassica oleracea var. acephala is one of the most important horticultural grown in Brazil for human feeding. The caterpillar Ascia monuste orseis (Lepidoptera: Pieridae) stands out among the important pest in Brassicaceae causing severe plant defoliation. The objective of this study was to identify resistant genotypes (antixenosis) in 26 collard greens genotypes to A. monuste orseis. In free-choice test, randomized blocks were used; and in the non-choice test we adopted a completely randomized design. Manteiga de Jundiaí, crespa de Capão Bonito, couve de Arthur Nogueira 1, manteiga I-1811, manteiga de Ribeirão Pires I-1811, orelha-de-elefante and Pires 1 de Campinas presented antixenosis (non-preference for oviposition). Pires 1 de Campinas, manteiga I-1811, manteiga de São José, verde-escura and manteiga de Monte Alegre presented antixenosis (non-preference for feeding). These collard greens genotypes can be directly used by farmers for cultivation or by breeders as donor sources in breeding programs for resistance to A. monuste orseis.

ABSTRACT: Equine herpesvirus type 1 (EHV-1) is an important pathogen that causes abortion, neonatal disease, respiratory disorders, and neurological syndrome in equine populations worldwide. To evaluate EHV-1 as a cause of abortion and perinatal mortality in Brazil, tissue samples from 105 aborted equine fetuses, stillbirths, and foals up to one month of age were examined using virus isolation, immunohistochemistry (IHC), histopathology, and nested polymerase chain reaction (PCR). Two fetuses were positive for EHV-1 by PCR, one of which showed syncytia and eosinophilic intranuclear inclusion bodies in bronchial epithelia, but it was negative by virus isolation. The other showed no characteristic histological lesions, but it was positive by viral isolation. No sample was positive by IHC. The results presented low occurrence of EHV-1 in the studied population and suggested that the use of a combination of techniques increases the likelihood of an accurate diagnosis of EHV-1.

ABSTRACT: This study was aimed at assessing some biological parameters of Bemisia tabaci B biotype at immature stages to examine antibiosis in six soybean genotypes, besides antixenosis resistance to oviposition in choice and non-choice tests, under greenhouse and laboratory conditions. Between April 2016 and August 2016, bioassays were carried out at the Laboratory of Applied Entomology at College of Agricultural Sciences at Federal University of Grande Dourados (UFGD) Dourados (MS), Brazil. The following variables were evaluated: egg incubation period, nymphal and egg-to-adult duration, egg and nymph viability, and egg-to-adult survival on the soybean genotypes 68i70 RSF IPRO, M6210 IPRO, MS 947 IPRO, BMX Potência RR, M6410 IPRO, and ANTA 82 RR. Antixenosis resistance to oviposition by the silverleaf whitefly was found for MS 947 IPRO, while oviposition was highest for ANTA 82 RR, M6210 IPRO, and M6410 IPRO. The genotype MS 947 IPRO adversely affected egg and nymph viability, and egg-to-adult survival rates was the lowest among genotypes (59.75%), suggesting antibiosis resistance to this pest.

ABSTRACT: The African snail Achatina fulica (Bowdich, 1822), originally from Africa, was introduced in Brazil and since then became an important pest, because of its resistance to abiotic conditions, hermaphroditism, polyphagia and absence of natural enemies. Considered as one of the 100 worst pests in the world, with the record of establishment in almost all Brazilian states, it causes sanitary, ecological and economic losses. In this context, the objective of this study was to determine the population dynamics and food preference of the giant snail in three areas of lettuce, located in Alagoas, Brazil. There was no statistical difference between food preference tests with and without choice among the varieties offered. To the fluctuation of the population of A. fulica, the Pearson correlation coefficients were negative only for temperature, and there was no correlation with precipitation and relative humidity.