This article covers the epidemiology, pathophysiology/complications and management of diabetic gastroparesis (DGP), and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed gastric emptying (GE). Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation (GES). To date, few population-based studies have estimated the true prevalence and incidence of gastroparesis. Nonetheless, its prevalence appears to be rising, as does its incidence among minority populations, documented via hospitalizations, which can impose significant economic burdens on patients.
INCIDENCE OF GASTRITIS AND DUODENITIS IN THE POPULATION OF PERNAMBUCO: AN ANALYSIS FROM NATIONAL HEALTH INDICATORS
Introduction: Gastritis is the inflammation of the mucosa that lines the inner walls of the stomach. Duodenitis consists of an inflammation of the duodenum. The main complaints are abdominal pain and epigastric burning. One of the main risk factors for these diseases is infection with the bacterium Helicobacter pylori. In Brazil, it is estimated that 80% of the population is a carrier of the bacteria, which is alarming if compared to the world average. Objective: Analyze prevalence data of new gastritis and duodenitis cases from 2013 to 2017 per sample of municipalities in the State of Pernambuco with more than 100 new cases in the period. Methodology: It is a study in secondary databases, conducted from the Basic Data indicators of Brazil, an integral tool of the health information system, using quantitative analysis of variables. Results: The new cases in 2013 halved in 2017. The municipality of Petrolândia obtained the largest relative reduction of the new cases in the period, from 38 in 2013 to 1 new case in 2017. Recife presented 96 new cases less when comparing 2017 and 2013, which is the largest absolute reduction among municipalities. Afogados da Ingazeira, Jaboatão dos Guararapes and Pesqueira also reduced the number of new cases in the period. On the other hand, the municipality of Buíque maintained the same rate of new cases in the period. Discussion: With the exception of the municipality of Buíque, it is generally observed that there were significant reductions in the number of new cases when evaluating the totality of the municipalities of Pernambuco, which may possibly be associated with the expansion of preventive public health education policies aimed at awareness of the population about adequate food hygiene, with a view to reducing the number of infections and reducing public spending on procedures and treatments. Conclusion:…
Electronic Procedural Reporting for Colonoscopy; Challenges (Discrepancies) in Data Entry and Report Generation
Aims: Computerized reporting systems that generate standardized endoscopy reports are available and facilitate easy retrieval of data for quality assurance review. We aim to compare the accuracy of extracted database fields in our reporting system (endoPRO) for key measures of quality to the final edited endoscopy report for colonoscopy procedures. Methods: In a retrospective analysis, we compared data retrieved from endoPRO to the final colonoscopy reports at Hamilton Health Sciences (HHS). The data included demographics, indications for procedures, bowel prep quality, findings, extent of exam, and recommendations. Discrepancies, changes or missing information pertaining to key quality indicators for colonoscopies were recorded. Results: In total, 1843 colonoscopy procedures were done at HHS from January to March 2010, and reports for 592 colonoscopies, randomly selected, were analyzed for this study. Discrepancies were seen in: Indication – 34 cases (5.7%), Assistants present during colonoscopy – 94 cases (15.9%), Quality of bowel preparation – 35 cases (5.9%), Findings & impressions – 38 cases (6.4%) including polyps, inflammation, diverticulosis and haemorrhoids. Conclusions: Our study demonstrates the variability between data found in patients’ final colonoscopy reports and data retrieved from the endoscopy databases. Structured endoscopy reporting and the use of databases facilitate quality assurance but editing of procedure reports after structured data entry compromises accuracy of the data in key quality measures. Inaccurate or incomplete data recording will compromise the enhancements in quality assurance that would accrue otherwise from regular audit processes.
Breakfast, the first meal of the day, is considered the most important meal throughout the day. As nutritionist Adelle Davis famously put it back in the 1960s: “Eat breakfast like a king, lunch like a prince and dinner like a pauper”. Breakfast is most commonly skipped meal more than lunch and dinner specifically in the young adult in the university study period and those who wake up late. Lack of time is the main reason behind skipping meals, in general, lack of appetite, inability to cook, fasting/religion, and not being hungry. Many people are used to be in a hurry for job, business, children’s’ school in the morning where a filled stomach may prevent them to walk a long way. It is obvious that the irregular omission of breakfast may be effective in energy intake reduction over the next 24 hours and in this day, exercise performance may be compromised. There is no evidence that breakfast skipping reduces overeating or prevent weight gain. Some people argue that breakfast and good health is a marketing strategy by breakfast companies.
Introduction: The ostomy is a surgical procedure that creates an abdominal canal for the elimination of fecal or urinary remains in an external pouch. The clinical conditions that lead to an intestinal ostomy are related to the benign or malignant pathologies of the gastroenterological organ. Ostomy may be temporary or permanent, and its characteristics can not be voluntary, as is the case of the colostomy. This type of procedure may bring biopsychosocial impacts for the patient. Objective: Analyze the emotional effects on patients using a colostomy bag. Method: Integrative review and reporting of experience. Results: While providing psychological support for patients with colostomy, it is possible to see what are the different types of changes in their routine, which are not physiological, but also psychological, emotional and social. The adaptation is a long and continuous process, and it is related to the underlying disease, the degree of physical weakness, the individual values and the type of personality of the patient. The ostomy procedure implies not only the use of the colostomy bag, but also a new body image that needs to be reconstructed, which has direct connection with self-esteem, self-image, self concept, body concept and body scheme, important components of the patient’s identity. Having undergone the procedure, some patients may experience feelings of alienation of their own body for their body have changed after the surgery. Using a bag collector represents a mutilation on the patient’s body and leads to a lack of control over physiological excretion, the body, physical beauty and health, eventually causing self-rejection. This situation is experienced by patients with a feeling of incapacity and inutility, as a sensation of loss of productive capacity may arise, and it can still arouse feelings like hatred, disgust, repulsion and fear, making one move away from the social environment. In…
Phytochemical Antimicrobial Screening of Costus Afer Extract and Its Alleviation of Carbon Tetrachloride Induced Toxicity
Plants of medicinal values contain bioactive compounds capable of preventing and combating several oxidative related diseases. Many diseases have been wrongly attended to using several medicinal plants of choice by mere instinct or sunrise. The phytochemical screening, (antimicrobial activity of Costus afer extract and its alleviation of carbon tetrachloride induced toxicity were evaluated. The phytochemical screening of both qualitative and quantitative analyses showed the presence of Tannins, Steroids, Phenols, Phytate, Hydrogen cyanide (HCN). Saponin, Alkaloids and Flavonoids in the aqueous, methanol and n-hexane stem extract. The antimicrobial activity of Costus afer extract using two different solvents showed its bactericical effect and no antibiotic effect on fungi microorganisms at different concentration. The study based on the toxicity of the substance, carbon tetrachloride showed the serum elevation of alanine aminotransferase (ALT, EC 188.8.131.52.), aspirate aminotransferase (AST, EC 184.108.40.206) and alkaline phosphase (ALT, EC 220.127.116.11) in the liver of the rabbits in response to the oral administration of the chemical. The rabbits fed with the Costus afer extract of methanol and N-hexane showed a moderate effect while the rabbits fed with the chemical carbon tetrachloride had a very high elevation on the enzymes. The rabbits, however fed with both the Costus afer and the chemical compound, carbon tetrachloride showed a considerable alleviation on the level of toxicity of the chemical. The rabbits fed with the Costus afer extract and the chemical carbon tetrachloride mixture statistically showed significant (p
Introduction: Due to the aging process, there are disabling chronic diseases that have gained greater evidence in the public health scenario. Among them is diabetes mellitus (DM), which is one of the most common chronic diseases among the elderly. Life style is an important determinant of glycemic control in type 2 diabetic patients. Objectives: To describe the lifestyle of type 2 diabetic patients treated at the Family Health Basic Unit III, in the city of Santa Cecília-PB. Methodology: Descriptive study, population composed of 55 diabetics, adults, type 2, data collected from a pre-structured interview. Results and Discussion: 56% female, 44% male, 29% have good eating habits, 8% practice regular physical exercises, 75% are overweight, 20% are medicated. The World Health Organization considers that the diet of the diabetic is one of the factors responsible for keeping the glycemic levels within desirable limits. The survey found that only 29% of those involved have a proper diet with a very low index. Many studies suggest that sedentarism favored by modern life is a risk factor as important as inadequate diet in the etiology of obesity and has a direct and positive relationship with the increased incidence of DM 2 in adults. The practice of physical exercise for people living with diabetes is very low. Only 8% reported regular exercise. Conclusion: It is important to emphasize that glycemic control depends, in addition to drug therapy, on changes in lifestyle. Since 90% of respondents said they had good adherence to drug treatment. It is necessary to implement strategies that seek to raise awareness about the importance of lifestyle change.
Introduction: Diabetic neuropathy is one of the complications that integrates the pathogenic diabetic foot triad. This neuropathy leads to a foot sensory loss, making the patient vulnerable to minor injuries that could precipitate lesions, subsequent infection and foot amputation. Therefore, the diagnosis needs to come from a complete and detailed physical examination. Objective: The present study aims to investigate the incidence of diabetic foot in diabetic patients who are users of the Basic Health Unit (BHS) in the city of Olinda, Pernambuco. Methodology: The sample of this descriptive exploratory of quantitative methods study was composed of 50 diabetic users of the Basic Health Unit. After signing a Free and Informed Consent Form, a questionnaire was applied regarding the perception of the diabetic on signs and symptoms which are observed in the diabetic foot, proceeding with a thorough evaluation of the feet using 10g of monofilament and performing the Pin Prick Test. Results and Discussion: In total, 70% of patients reported poor glycemic control, 63% reported neuropathic symptoms such as numbness and tingling in the feet and 57% of the evaluated patients have thickened nails and dried or scaly feet. Regarding the vascular evaluation 47% of the evaluated presented with a decreased pedal pulse and 7% presented with this same pulse absent, while 40% had decreased posterior tibial pulse and 7% did not present any pulse at palpation. Regarding the sensitivity assessment, 30% of diabetics presented abnormal results in one of the feet and 7% had no painful and tactile reflex through the sting sensation test. Conclusion: A preventive evaluation of the feet on diabetic patients resulted in important data that informs about the high prevalence of neuropathic findings, contributing to a greater knowledge for the UBS professional team about the presence of neuropathic foot in their diabetic users.
Introduction: Obesity is a chronic disease, besides a risk factor for cardiovascular diseases, nowadays, it is characterized as a worldwide epidemic. The food imbalance and physical inactivity are factors that contribute to the emergence of obesity as well as diabetes. Objective: To evaluate the injury on glucose tolerance and insulin sensitivity in obese rats induced by high fat diet. Methodology: Male Rats Wistar (8 weeks old) were submitted to the standard diet (chow group, 11.8% kcal-Lipids; n = 5) and dietary intervention with high fat diet during 8 weeks (HFD group, 58.4% kcal-Lipids; n= 5). It was evaluated the body weight weekly, and fasting and fed blood glucose. At the end of the experimental period, was measured the glucose tolerance, insulin sensitivity and gluconeogenesis. After the animal sacrifice, it was analyzed relative weight of white adipose tissue, as well as the adipocytes diameter (epididymal white adipose tissue) and circulating levels of leptin. Results and Discussion: The group HFD presented higher body weight (from the 2nd week of diet), an increase accumulation of epididymal and perirenal white adipose tissue. In addition, in these animals, it was observed a significant increase in the adipocytes diameter and the levels of leptin in plasma when compared to animals chow, indicating obesity with increased release of cytokines. In HFD group, the fasting blood glucose levels were significantly higher in the 6th week of high fat diet consumption compared to the chow group. Adding up to the frame of obesity, at the end of the 8th week of high fat diet consumption, the obese group had higher fasting plasma glucose in fed state, glucose intolerance, insulin resistance, as well as increased gluconeogenesis as compared with the chow group. Conclusion: Obesity with adipocyte hypertrophy, induced by high fat diet, induces glycemic damages, as the elevation of blood…
Introduction: The high intake of carbohydrates and lipids is one of factors that contribute to the onset of Metabolic Syndrome (MetS), a complex clinical situation which brings together, besides obesity, several cardiovascular and metabolic risk factors, including non-alcoholic fatty liver disease (NAFLD). Objective: To develop a hyperlipidemic dietetic animal model to obesity associated with NAFLD. Methodology: Male Rats Wistar (8 weeks old) were submitted to the standard diet (chow group, 11,8% kcal- lipids) and hypercaloric and hyperlipidemic during 8 weeks (HFD group, 58,4% kcal-lipids). After the dietary intervention, body weight, plasma and hepatic lipid profile (triglycerides, total cholesterol, VLDL and fatty acids) and adiposity index were evaluated. Moreover, histological assessment of hepatic lipid deposition and fibrosis, as well as the hepatic damage marker (alanine aminotransferase-ALT) were evaluated. Results and Discussion: Comparing to the chow group, HFD animals presented higher body weight, both in fasting and in the fed state, increased abdominal circumference, adiposity index, as well as plasma levels of total cholesterol and non-esterified fatty acids, characterizing the dietary phenotype of obesity. In addition, the HFD group had a significant decrease in brown adipose tissue, together with the lowest weight loss induced by 16h overnight fasting, suggesting a decrease in energy expenditure. In the liver, the HFD group presented a significant increase in the levels of triglycerides, cholesterol, VLDL and non-esterified fatty acids, and, qualitatively, increased lipid deposition and fibrosis. Together, these results associated with increased plasma ALT activity indicate NAFLD with hepatocyte damage. Conclusion: A high fat diet intake induces comorbidities that characterize MetS, such as obesity associated with decreased energy expenditure, as well as NAFLD.