RESUMO
The incidence of inflammatory bowel disease (IBD) is increasing. Microbiome is one of the most important factors in its development and affects the different clinical outcomes of IBD patients depending on its composition and different alterations. We conducted a systematic review to discuss the association between microbiome and IBD in terms of immune regulation, and therapies that can modify microbiota. A comprehensive systematic literature search was performed through April 2020 in PubMed, Web of Science, the Cochrane Library, and clinicaltrials.gov. Inclusion criteria required IBD immune regulation and alternate therapeutics for IBD. This analysis helps explain the multifactorial origin of microbiome diversity including normal immune regulation, immune pathophysiology of IBD, and shows the evidence of several therapeutic targets to change microbiome in patients with IBD, such as prebiotics, probiotics, antibiotics, fecal microbiota transplant, and others.
Assuntos
Microbioma Gastrointestinal , Doenças Inflamatórias Intestinais , Probióticos , Antibacterianos/uso terapêutico , Doença Crônica , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/fisiologia , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Prebióticos , Probióticos/uso terapêuticoRESUMO
Fatty liver has been present in the lives of patients and physicians for almost two centuries. Vast knowledge has been generated regarding its etiology and consequences, although a long path seeking novel and innovative diagnostic biomarkers for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is still envisioned. On the one hand, proteomics and lipidomics have emerged as potential noninvasive resources for NAFLD diagnosis. In contrast, metabolomics has been able to distinguish between NAFLD and NASH, even detecting degrees of fibrosis. On the other hand, genetic and epigenetic markers have been useful in monitoring disease progression, eventually functioning as target therapies. Other markers involved in immune dysregulation, oxidative stress, and inflammation are involved in the instauration and evolution of the disease. Finally, the fascinating gut microbiome is significantly involved in NAFLD and NASH. This review presents state-of-the-art biomarkers related to NAFLD and NASH and new promises that could eventually be positioned as diagnostic resources for this disease. As is evident, despite great advances in studying these biomarkers, there is still a long path before they translate into clinical benefits.
RESUMO
Helicobacter pylori (H. pylori) affects nearly half of the world's population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient's clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.
Assuntos
Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Antibacterianos/uso terapêutico , Biópsia , Testes Respiratórios , Claritromicina/farmacologia , Farmacorresistência Bacteriana , Humanos , Linfoma de Zona Marginal Tipo Células B/microbiologia , Úlcera Péptica/microbiologia , Probióticos/uso terapêutico , Reprodutibilidade dos Testes , Neoplasias Gástricas/microbiologia , Úlcera Gástrica/microbiologia , Resultado do Tratamento , Ureia/metabolismo , Urease/metabolismoRESUMO
Background. Minimal hepatic encephalopathy (MHE) has implications for health-related quality of life as well as for survival of cirrhotic patients, but a standardized diagnostic test is not available. Objective. To determine the prevalence of MHE among cirrhotic patients by using the psychometric hepatic encephalopathy score (PHES) system and the critical flicker frequency (CFF) test to diagnose MHE and to identify factors that influence the results of these tests. Material and methods. From April 2007 to March 2008, PHES and CFF tests were performed on patients with cirrhosis but no overt hepatic encephalopathy. Descriptive statistics were used to express the results and the Spearman correlation was used to evaluate CFF and PHES results according to age and education level. Results. We studied 104 patients. The prevalence of MHE was 55.8% (n = 58) based on a positive result for either the PHES or the CFF test, 32.7% (n = 34) based on positive PHES results alone, 34.6% (n = 36) based on positive CFF test results alone and 11.5% (n = 12) based on a positive result for both tests. According to PHES, the incidence of MHE was correlated with education level (r = 0.333, p = 0.001), but not with age. According to CFF, the incidence of MHE was correlated with age (r = -0.93, p = 0.049), but not with education level. Conclusion. The prevalence of MHE was similar to that previously reported. Patient literacy influences MHE diagnosis with PHES but not with CFF. CFF is a simple and feasible method that identifies patients with MHE who may benefit from treatment independently of their education level.
Assuntos
Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Cirrose Hepática/complicações , Índice de Gravidade de Doença , Adulto , Escolaridade , Feminino , Seguimentos , Encefalopatia Hepática/mortalidade , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Psicometria , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
By the end of the nineteenth century, ammonia had been identified as the main factor responsible for hepatic encephalopathy syndrome. Ammonia is one of the principal products of hepatic metabolism and high concentrations are toxic to the body. Under physiological conditions, the main way by which the body restricts the blood concentration of ammonia to a nontoxic level is by converting it to urea in the liver via the Krebs cycle. The synthesis of glutamine represents an alternative pathway for ammonia detoxification in cirrhotic patients. Although high concentrations of ammonia have been strongly associated with brain edema, estimates of the strength of the correlation between serum ammonia levels and the severity of hepatic encephalopathy vary. The accuracy of ammonia assays depends on the site of specimen collection, treatment of the specimen and the analytical method used. New methods involving measurement of the partial pressure of ammonia and new noninvasive techniques involving quantification of ammonium in the breath have been described. The purpose of this review is to identify factors that affect serum ammonia levels, from its origin and metabolism to its analysis and interpretation of results in the laboratory. In conclusion, variations in estimates of serum ammonia level and the severity of hepatic encephalopathy arise because of individual differences in ammonia metabolism and differences in the accuracy of analytical methods.
Assuntos
Amônia/sangue , Encefalopatia Hepática/sangue , Encefalopatia Hepática/etiologia , Cirrose Hepática/complicações , Testes Respiratórios , Testes Diagnósticos de Rotina , Encefalopatia Hepática/diagnóstico , Humanos , Testes Neuropsicológicos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Hepatitis C is a major public health issue. It infects about 200 million people worldwide and is a major cause of chronic liver disease. Its transmission in medical facilities is a topic of increased concern, as outbreaks of the disease had raised the attention of media and medical authorities. To date, evidence suggests that infection from in which a health-care worker is involved is mostly result of bad injecting practices as well as the result of shared medical devices. Furthermore, the infection caused by physicians is rare and very few well documented cases exist on the literature. Among countries, different definitions and legislation exist, in that mode that the responsibility of this issue almost is an obligation of individual institutions. Nonetheless, Hepatitis C virus transmission in medical facilities is an important source of new cases, and as treatments options are very limited, it's recommendable that institutions as well as governments implement policies to avoid Hepatitis C spread in a almost fully preventable setting.
Assuntos
Infecção Hospitalar/transmissão , Hepatite C/transmissão , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional , Doenças Profissionais/virologia , Exposição Ocupacional , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Política de Saúde , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/ética , Transmissão de Doença Infecciosa do Paciente para o Profissional/legislação & jurisprudência , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Saúde Ocupacional/legislação & jurisprudência , Medição de Risco , Fatores de RiscoRESUMO
Our aim was to determine the prevalence of multidrug resistance of Acinetobacter baumannii and other pathogens at a tertiary-care teaching hospital in Mexico over a 3-year period. Clinical isolates of A. baumannii (n = 550), Pseudomonas aeruginosa (n = 250), some Enterobacteriaceae species (n = 500) and Staphylococcus aureus (n = 250) collected over a 3-year period were included. Susceptibility tests were performed by the broth microdilution method. 74% of A. baumannii, 40% of Escherichia coli, 34% of P. aeruginosa, 22% of Klebsiella pneumoniae, 9% of Enterobacter cloacae, and 7% of Serratia sp. were multidrug resistant. 59% of A. baumannii clinical isolates were meropenem-resistant. A. baumannii isolates from the lower respiratory tract were the most susceptible, followed by urine clinical isolates. Species from Enterobacteriaceae showed susceptibility rates higher than 90% to meropenem and tigecycline and Serratia sp. showed the highest susceptibility to the drugs evaluated. For P. aeruginosa, the most potent drug was levofloxacin, followed by meropenem and piperacillin-tazobactam. With regard to S. aureus, 96% of the isolates were susceptible to vancomycin, followed by tigecycline and minocycline (91% of strains susceptible). The high multidrug resistance observed underscores the need for surveillance of bacterial drug resistance.