Malnourished patients with gastrointestinal tumours are at risk for postoperative complications and death. The aim of this study was to determine which nutritional assessment method better predicts outcome. Seventy-four patients, 45 men and 29 women; mean (SD) age of 63 (102) yr (range = 34 to 83), undergoing surgical resections for esophageal (n = 19) gastric (n = 43) and pancreatic (n = 12) tumors were preoperatively assessed by Patient Generated Subjective Global Assessment, anthropometry, and by laboratory sampling. Forty-three (58%) of them were unnourished; 25 Subjective Global Assessment (SGA)-A, 34 SGA-B, and 15 SGA-C cases. Mean (SD) of dominant hand adductor pollicis muscle thickness (DAPM) was 13 (3.5) mm and mean (SD) serum albumin was 3.8 (0.5) g/dL. Mean (SD) hospital staying for patients who complicated and died was 34 (29) days and 23 (13) days for survivors (not significant); SGA-B cases were significantly associated with higher mortality (n = 12, P<0.001). Patients with a mean (SD) DAPM below 10.8 (3.7) mm died more frequently than those with a mean (SD) greater than 14 (3) mm (P < 0.001). None of the methods was significantly related to hospital stay, but receiver operating characteristic curves (95% confidence interval) for PG-SGA and DAPM thickness (0.75 and 0.74) reliably predicted mortality (P<0.001) and these methods may be used as preoperative parameter.

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Objective The present study describes the epidemiological profile of patients with colorectal cancer (CRC) from the Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brazil, between January 1, 2007 and December 31, 2016. Method Retrospective analysis of secondary data of 1,001 patients from the Hospital Cancer Registry. Results Most subjects were Caucasian males, with a mean age of 63.68 years old. The majority of patients had incomplete elementary education and were married. In addition, 44.5% of the patients had a family history of cancer. Most subjects with a positive past or current history of alcohol intake or smoking were male. The diagnosis was mostly based on anatomopathological findings, with a predominance of adenocarcinomas and upper rectum and distal colon localization. Most lesions were in advanced stages, and the liver was the most common site for metastasis. The predominant treatment was surgery with neoadjuvant/adjuvant therapy. After the first treatment, 49.0% of the patients reported complete remission. The survival rate was 78.8% in 10 months. Conclusion The present research analyzed the profile of CRC patients.

One of the most challenging phenotypes of Crohn’s disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn’s disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.

BACKGROUND This is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions. AIM To estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019. METHODS This is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range. RESULTS We included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population. CONCLUSION Our results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.

Spectroscopic methods have already been used as effective tools in several studies involving the detection of cancer. Fourier transform infrared spectroscopy (FTIR) has already been applied in the discrimination of cancer cells and tissues or blood of patients with the disease, observing that this technique requires the use of chemometric algorithms to obtain such results. The aim of this study was to employ a partial least squares discriminant analysis (PLS-DA) with FTIR data in the discrimination of plasma samples from patients with colorectal cancer (RCC) and healthy individuals. Multivariate analysis was performed using PLS-DA of the sample triplicates (n=90) with different types of processing. The best PLS-DA condition was obtained using the 1st derivative, 1 orthogonal signal correction (OSC) and no pre-processing. With 1 factor only, the model presented a mean square error of cross-validation (RMSECV) of 0.0004 and coefficient of determination (r^2) of 1.0000. The accuracy, precision and sensitivity of the model were 100%.

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Background There are few data on the quality-of-care for inflammatory bowel disease (IBD) in public, private or mixed hospitals, especially in Latin America. The aim of the study was to evaluated clinic and quality parameters and their association with need for ICU and death in Brazilian hospitals. Methods This was a multicentre study carried out in 26 hospitals. Four hundred eighty-eight admissions of patients with IBD were analysed between June 2021 and October 2022. Results The median stay length was 6 days (0–121). The median age was 38 years (16–87), and 265 (54.6%) were female. Three hundred and thirty-nine patients (69.5%) had Crohn's disease (CD) and 149 (30.5%) ulcerative colitis (UC). The median time between symptoms onset and hospital admission was 72 months (1-504) in CD and 49 months (1-300) in UC. In the CD group, there was structural damage in 248 cases (73.2%). UC in pancolitis form was seen in 97 (66%). The Charlson Comorbidity Index (CCI) was scored at least at one point in 182 records (37.3%), and the median was 2 (1-17). Three hundred-seven admissions (62.9%) were urgent, and 208 cases (42.6%) remained in the emergency room (ER) for 2 days (1-22). Disease activity and structural damage accounted for 58.6% of admissions. One-hundred and eighty-three surgeries were performed (37.5%), and 35 (18.1%) postoperative complications were reported. The most prescribed drugs were biologicals (52.8%) before admission and corticosteroids during hospitalization (37.3%). Red days were verified in 45.3%. Intensive care unit (ICU) admission was required in 55 cases (11.3%). One hundred and nine (22.3%) bacterial infections were registered. There were 16 deaths (3.3%), and the main cause was sepsis (37.5%). Surgery, infection, duration of CD symptoms, and CCI were associated with the need for ICU (p= 0.000; 0.000; 0.043; 0.014, respectively). The CCI of 1 best predicted the need for ICU (AUROC 0.588; S 52.7%, E 64.7%). Infection, age, days in the ER, ICU, and CCI were associated with death (p= 0.004; 0.022; 0.006; 0.000; 0.000, respectively). The CCI of 1 is also the best predicted death (AUROC 0.782; S 81.3%, E 64.2%). The need to stay in ER and red days were lower in private and mixed hospitals (p= 0.000). Infection and death rates were similar (p= 0.323). Conclusion A sample with complications associated with IBD but with low CCI due to their younger age was characterized. The majority had CD, and more than 60% of admissions were urgent. The CCI accuracy in predicting ICU and death was obtained. A system deficiency was more evidenced in public hospitals in the rate of individuals who remained in ER. From the red days, greater problem-solving agility was found in private and mixed hospitals.