-Context -The incidence and populational prevalence of inflammatory bowel diseases, hitherto unknown in Brazil, were estimated for a region in the Midwest of São Paulo State, Brazil. Methods -Using a sequential registry of 115 adult patients (>15 years old) with inflammatory bowel diseases -exclusively residing in the studied region with 533,508 inhabitants (2005) and attended at the reference hospital during a 20 year interval (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) -were estimated, in four consecutives periods of 5 years each, the incidences according to gender, type of the disease and the prevalence of these diseases, and its inner-relations evaluated by the Poisson regression model. Results -The inflammatory bowel diseases in the studied region predominated among young, white race and people living in urban area, and the incidence on the female population rose during this period. The incidence of ulcerative colitis were higher than Crohn's disease and non-classified colitis, and showed a progressive increase in the first three periods with a decrease in the last one (2001)(2002)(2003)(2004)(2005), where the observed rates of ulcerative colitis, Crohn's disease and non-classified colitis were 4.48, 3.50 and 1.75 cases/100,000 inhabitants, with prevalence of 22.61, 14.81, 5.65, 2.14 cases/100,000 inhabitants for total inflammatory bowel diseases. Conclusion -The inflammatory bowel diseases incidence in the studied area was as low as in other countries of Latin America and smaller than that found in countries of South Europe. The crescent prevalence justifies the policies to adequate medical cares for inflammatory bowel diseases patients in this area. HEADINGS -Inflammatory bowel disease, epidemiology. Colitis, ulcerative, epidemiology. Crohn disease, epidemiology. São Paulo (Brasil).
RESUMO -Racional -Pacientes com constipação funcional que não melhoram com suplementação de fibras dietéticas, representam importante problema clínico. Objetivos -Avaliar as relações entre as quantidades de fibras ingeridas, intensidade da constipação e o tempo de trânsito colônico em pacientes com constipação funcional. Métodos -Foram avaliados 30 pacientes constipados funcionais, sem melhoras após suplementação dietética com fibras e 18 pessoas controle, sadias, sem queixas digestivas, utilizando inquéritos individuais quanto à ingestão de fibras e a intensidade da constipação e, por meio da técnica dos marcadores radiopaco, o tempo de trânsito colônico, total e segmentar.Resultados -Apesar da maior ingestão diária de fibras (26,3 ± 12,9 g, constipados x 9,3 ± 5,2 g, controles), os sintomas da constipação mostraram-se intensos nos constipados (escore médio = 21,3 ± 4,07). O tempo normal para o trânsito colônico foi de 58,8h. O trânsito colônico total, em média, foi mais lento nos constipados (41,0 ± 22,8h, constipados x 21,8 ± 18,5h, controles). Constipados com trânsito lento (>58,8h) apresentaram inércia colônica (oito), obstrução de saída (um) e lentificação no cólon esquerdo (um). Constipados com trânsito normal (<58,8h), apresentaram lentificações isoladas no cólon direito (nove), no cólon esquerdo (três) e no segmento retossigmoideano (oito). Não houve correlação entre a quantidade ingerida de fibra, intensidade da constipação e tempo de trânsito colônico nos constipados funcionais. Conclusões -Em constipados funcionais a gravidade da constipação não depende apenas da ingestão de fibras, que, também não é a única contributiva para as variações no tempo de trânsito colônico. Este diferencia os pacientes normais dos constipados e nestes, aqueles com trânsito alterado que exigem abordagens diferentes da suplementação de fibras. DESCRITORES -Constipação intestinal. Fibra alimentar. Trânsito gastrointestinal. INTRODUÇÃOA constipação não é uma doença e nem um sinal, mas um sintoma (9,19) e, como tal, pode ser originada de vários distúrbios intestinais ou extra-intestinais (27) . Chega a atingir cerca de 50% dos atendimentos em ambulatório de clínica especializada em gastroenterologia e 14% a 15% da população em geral (16,22,24,42,44) , freqüência esta que aumenta com a idade, chegando a atingir 40% de pacientes idosos, com idade acima de 65 anos (43) . A principal queixa dos pacientes com constipação é a diminuição da freqüência das evacuações. Entretanto, atualmente, a freqüência evacuatória, por si só, está deixando de ser importante na definição da constipação (46) . Os pacientes constipados relatam, muitas vezes, a presença de dor evacuatória, dor abdominal, fezes endurecidas, ressecadas (45) , que perderam sua forma tornandose, freqüentemente, fragmentadas, com aspecto caracterizado como coprólitos, que são eliminadas em quantidades menores que o habitual, porém em freqüência diária dentro de um padrão que pode ser considerado normal, isto é, dentro da faixa de três evacuações por dia a uma evacuação a cad...
. The shorter-chain bolaform surfactants (n = 16, 12, X = Br) are less effective. Twin-chain surfactants of didodecyl and dicetyldimethylammonium salts (C,,H,,),NMe,X, X = Br, CI, (SO,),, and (C,,H,,),NMe,X, X = CI, (SO,),, and pyridinium-ion surfactants C,,H,,NC,H,CI and its 4-(dimethylamino) derivative, also speed hydrolysis. The first-order rate constants increase to limiting values (kh) when substrate is fully bound and these values are not very sensitive to the nature of the surfactant and are generally greater than in water by factors of 20-1 10. However, the extent of binding of 2,4-DNPP is sensitive to the nature of the surfactant. Tertiary amines, e.g., pyridine and DABCO speed the reaction in CTACI by generating an intermediate phosphoramidate.Cationic micelles catalyze hydrolysis of dianionic 2,4-dinitrophenyl phosphate, (2,4-DNPP2-)I and of monoanionic 2,4-dinitrophenyl sulfate2. . 4 D N P PTri-n-octylalkylarnrnonium ions d o not form micelles in water, but they speed hydrolysis of 2,4-DNPP2-, probably because of interactions between it and clusters of the ammonium ion'. In these reactions, first-order rate constants increase on addition of surfactant or hydrophobic ammonium ion, and become constant when the substrate is fully bound to micelles or similar assembles. Colloidal assemblies of single-chain and twin-tailed surfactants and hydrophobic ammonium ions have very different gross structures, but for both the ionic-head groups are in contact with water and associated counter-ions4. They should therefore have similar effects upon rates of reactions that occur at their surfaces. This question is best studied with spontaneous reactions, because rates of bimolecular nonsolvolytic reactions depend upon the distribution of both reactants between water and the assemblies, whereas only substrate distribution has to be considered for spontaneous reactions5-'. Cationic micelles and similar assemblies also catalyze spontaneous decarboxylation of, for example, 6-nitrobenzisoxazole-3-carboxylate ion (1)"'. This reaction, like dephosphorylation, involves dispersion of an existing charge in transition state formation very sensitive to medium and rates of both reactions are They provide useful probes of the properties of surfaces of aqueois colloids, for example of surface polarity or water content and effects of changes in head groups or counter-ions. In this work, we examine effects of variations of head group, hydrophobic residue and counter-ion in a series of cationic surfactants. The single-chain surfactants are cetyl*trimethylammonium chloride (C,,H,,NMe,CI, CTACI), cetylpyridinium chloride (C,,
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