Dyspepsia is associated with low protein and calorie intake. Screening of dyspeptic symptoms can be routinely performed aiming to improve HD patients' nutritional status.
Inflammatory bowel diseases (IBD) present a broad inflammatory cascade that is sometimes difficult to control. Patients with ulcerative colitis (UC) and Crohn's disease (CD) are exposed to intense and harmful effects that compromise their quality of life. There is a constant need for new classes of drugs that act on different fronts of inflammation control. Initially, biologics revolutionized inflammatory bowel disease treatment. Anti-tumor necrosis factor (anti-TNF) agents and infliximab, followed by adalimumab and certolizumab pegol, have been proven to induce clinical and endoscopic remission. However, some patients are primary nonresponders, and a significant proportion of initial responders lose response throughout the treatment. The emergence of new therapies, such as anti-integrins, anti-interleukins, and inhibitors of Janus kinase (JAK), can become an alternative option for patients with previous therapeutic failures, besides offering greater safety than other biological therapies up to now. Among anti-integrins, vedolizumab is the drug with proven efficacy in both induction and maintenance of remission and has local and selective action in the intestine. Ustekinumab represents the group of anti-interleukins, acting to control interleukin-12 (IL12) and interleukin-23 (IL23). JAK inhibitors (tofacitinib) act on intracellular inflammatory mediators and have the advantage of being orally administered.
A linfangiomatose difusa, também conhecida como síndrome Gorham-Stout, é uma doença rara. A patologia causa alterações morfológicas devido a infiltração de tecido linfático, além da formação de derrame pleural quiloso e de ascite quilosa, podendo acometer diversos órgãos como ossos, baço, pulmão e outros. É ainda considerada um desafio diagnóstico devido ao pouco conhecimento sobre a doença, o número limitado de casos relatados, e devido ao acometimento difuso, com diversas possibilidades de manifestações clínicas a depender do órgão acometido.
O padrão ouro para diagnóstico continua sendo o anátomo-patológico, porém, achados radiológicos sugestivos, juntamente com clínica compatível e a comprovação de derrames quilosos, tendo outras etiologias afastadas, confirmam diagnóstico presuntivo de linfangiomatose difusa. Até o momento, nenhuma terapêutica se mostrou eficaz, sendo uma doença com evolução desfavorável e prognóstico ruim. O estudo em questão relata um caso de linfangiomatose difusa presumida.
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