Besides extent of disease and age at disease onset, the presence of EIMs may be a marker of refractoriness to 5-ASA, corticosteroids, and AZT. IL23R SNPs are associated both with EIMs and with nonresponse to 5-ASA and corticosteroids.
In the present study, we were able to identify a number of clinical and genetic predictors of response to several therapies which may become of potential utility in clinical practice. These are preliminary results that need to be replicated in future pharmacogenomic studies.
Background and Aims: Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods: This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results: The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4–145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1–10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15–72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50–205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions: A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages: Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.
Objetivo: Analisar a acessibilidade do homem ao serviço de saúde. Método: Trata-se de uma pesquisa de campo com abordagem qualitativa, exploratória e descritiva, que foi realizada em uma unidade básica de saúde selecionada aleatoriamente na zona urbana da cidade de Caxias-MA no período de Agosto a Novembro de 2017. Foi utilizado para análise dos dados o Software Iramuteq, onde participaram do estudo 20 homens. Resultado: Os resultados foram processados a partir de um corpus no qual os segmentos de texto foram classificados em função da frequência dos vocábulos. Diante dessa classificação, surgiram 6 classes: classe 5: Motivo da procura do serviço de saúde. Classe 2: Percepção sobre serviços dispensados na unidade básica de saúde (UBS). Classe 3: Dificuldades enfrentadas ao acesso no serviço de saúde. Classe 4: Frequência do acesso do homem na unidade básica de saúde. Classe 6: Conhecimento dos homens sobre a UBS. Classe 1: A procura pelo atendimento nas unidades básicas de saúde. Conclusão: Pela análise das classe formuladas, conclui-se que a acessibilidade dos homens ás Unidades Básicas de Saúde é deficiente, pois os homens possuem conhecimento superficial sobre os serviços dispensados, e a ausência ou a frequência reduzida do mesmo, assim como o acesso a medicação em farmácias o próprio preconceito, a falta do auto cuidado proveniente de atribuições socioculturais, a insatisfação e a falta de confiança na assistência da atenção primária são fatores que dificultam a procura pelos homens á Unidades Básicas de Saúde.
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