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Quality of care in patients with inflammatory bowel disease from a public health center in Brazil

World Journal of Clinical Cases 2022年第33期10卷 12184-12199页

作者： Debora Mayumi Takamune Giovana Signorelli Astolfi Cury Giulia Ferrás Giedre Soares Prates Herrerias Adriana Rivera Jaqueline Ribeiro Barros julio pinheiro baima Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618686São PauloBrazil Research Unit Virgen Macarena University HospitalSeville 41009Spain Department of Medicine Nove de Julho UniversityBauru 17011-102São PauloBrazil Department of Surgery São Paulo State University(Unesp)Medical SchoolBotucatu 18618686São PauloBrazil

BACKGROUND Inflammatory bowel diseases(IBDs)are chronic diseases that demand continuous interaction between patients and healthcare providers.Quality of care(QoC)is a factor that contributes to a patient’s adherence to treatment and its success.AIM To evaluate QoC in patients from a single IBD reference center.METHODS This cross-sectional study included 133 patients from a single Brazilian IBD public health center.QoC was evaluated through the QoC Through the Eyes of Patients with IBD(QUOTE-IBD)questionnaire(based on patient perspectives),which measures eight dimensions of care.We compared QoC among patients with Crohn’s disease and ulcerative colitis and analyzed the clinical and psychological factors associated with QoC satisfaction.Clinical evaluations assessed disease characteristics,quality of life,anxiety,and depression levels.RESULTS Sixty-nine patients with Crohn’s disease and 64 with ulcerative colitis were interviewed.The mean age was 37.26 years±13.05 years,and 63.91%of the patients were women.The mean duration of the disease was 8.44 years±7.59 years,where most patients were in remission(70.31%of patients with ulcerative colitis and 62.32%with Crohn’s disease).The total QoC score of the sample was 8.61 years±1.31 points,indicating that the QoC provided by the center was unsatisfactory.According to univariate logistic regression,patients with Crohn’s disease had higher satisfaction rates than those with ulcerative colitis[odds ratio(OR):2.746;95%confidence interval(CI):1.360-5.541;P=0.0048]and patients on infliximab(OR:2.175;95%CI:1.037-4.562;P=0.0398).CONCLUSION Patients from the IBD public center reported good doctor-patient relationships,but had problems related to the healthcare structure.Evaluation of healthcare centers is of paramount to improve QoC for the patients involved.

关键词： QUOTE-IBD questionnaire Quality of care Crohn’s disease Ulcerative colitis Inflammatory bowel disease Doctor-patient relationship

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Acute heart failure as an adverse event of tumor necrosis factor inhibitor therapy in inflammatory bowel disease:A review of the literature

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World Journal of Cardiology 2023年第5期15卷 217-228页

作者： Thais Gagno Grillo Caroline Ferreira da Silva Mazeto Pupo Silveira Ana Elisa Valencise Quaglio Renata de Medeiros Dutra julio pinheiro baima Silmeia Garcia Zanati Bazan Ligia Yukie Sassaki Department of Internal Medicine Medical SchoolSão Paulo State UniversityBotucatuBotucatu 18618686Brazil Department of Biophysics and Pharmacology Institute of BiosciencesSão Paulo State UniversityBotucatuBotucatu 18618689Brazil

Tumor necrosis factor inhibitors(anti-TNFs)are widely used therapies for the treatment of inflammatory bowel diseases(IBD);however,their administration is not risk-free.Heart failure(HF),although rare,is a potential adverse event related to administration of these medications.However,the exact mechanism of development of HF remains obscure.TNFαis found in both healthy and damaged hearts.Its effects are concentration-and receptor-dependent,promoting either cardio-protection or cardiomyocyte apoptosis.Experimental rat models with TNFαreceptor knockout showed increased survival rates,less reactive oxygen species formation,and improved diastolic left ventricle pressure.However,clinical trials employing anti-TNF therapy to treat HF had disappointing results,suggesting abolishment of the cardioprotective properties of TNFα,making cardiomyocytes susceptible to apoptosis and oxidation.Thus,patients with IBD who have risk factors should be screened for HF before initiating anti-TNF therapy.This review aims to discuss adverse events associated with the administration of anti-TNF therapy,with a focus on HF,and propose some approaches to avoid cardiac adverse events in patients with IBD.

关键词： Tumor necrosis factor inhibitors Inflammatory bowel disease Heart failure Adverse event TNFαreceptor

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Non-Hodgkin＇s Lymphoma： An Important Differential Diagnosis in Inflammatory Bowel Disease

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Chinese Medical Journal 2018年第11期131卷 1377-1378页

作者： Rogerio Saad-Hossne Carina De Fatima De Sibia julio pinheiro baima Ligia Yukie Sassaki Department of Surgery Division of Coloproctology Botucatu Medical School Sao Paulo State University-UNESP Botucatu SP 18618-687 Brazil Department of Internal Medicine (Gastroenterology) Botucatu Medical School Sao Paulo State University-UNESP Botucatu SP 18618-687 Brazil

To the Editor： The gastrointestinal tract （GIT） is the most common extranodal location ofnon-Hodgkin＇s lymphoma, but it represents only 0.4% of primary colonic malignancies. Symptoms are nonspecific and may include diarrhea, constipation, abdominal pain, weight loss, and gastrointestinal bleeding. In colon, the most common types are conventional large cell lymphoma, mucosa-associated lymphoid tissue lymphoma, and T-cell lymphoma.

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MicroRNA expression in inflammatory bowel disease-associated colorectal cancer

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World Journal of Gastrointestinal Oncology 2021年第9期13卷 995-1016页

作者： Thais Gagno Grillo Ana Elisa Valencise Quaglio Rodrigo Fedatto Beraldo Talles Bazeia Lima julio pinheiro baima Luiz Claudio Di Stasi Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618-686São PauloBrazil Department of Biophysics and Pharmacology São Paulo State University(Unesp)Institute of BiosciencesBotucatu 18618-689São PauloBrazil

MicroRNAs(miRNAs)are non-coding RNA molecules composed of 19–25 nucleotides that regulate gene expression and play a central role in the regulation of several immune-mediated disorders,including inflammatory bowel diseases(IBD).IBD,represented by ulcerative colitis and Crohn’s disease,is characterized by chronic intestinal inflammation associated with an increased risk of colorectal cancer(CRC).CRC is one of the most prevalent tumors in the world,and its main risk factors are obesity,physical inactivity,smoking,alcoholism,advanced age,and some eating habits,in addition to chronic intestinal inflammatory processes and the use of immunosuppressants administered to IBD patients.Recent studies have identified miRNAs associated with an increased risk of developing CRC in this population.The identification of miRNAs involved in this tumorigenic process could be useful to stratify cancer risk development for patients with IBD and to monitor and assess prognosis.Thus,the present review aimed to summarize the role of miRNAs as biomarkers for the diagnosis and prognosis of IBD-associated CRC.In the future,therapies based on miRNA modulation could be used both in clinical practice to achieve remission of the disease and restore the quality of life for patients with IBD,and to identify the patients with IBD at high risk for tumor development.

关键词： MicroRNA Colorectal cancer Inflammatory bowel disease Crohn's disease Ulcerative colitis Cancer Diagnosis Prognosis Targets

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Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level:A case report

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World Journal of Clinical Cases 2021年第13期9卷 3219-3226页

作者： Ana Lorena Sousa de Vasconcelos Garate Thiara Barcelos Rocha Luciana Rocha Almeida Rodrigo Quera Jaqueline Ribeiro Barros julio pinheiro baima Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618687São PauloBrazil Inflammatory Bowel Disease Program GastroenterologyMedicine DepartmentClínica Universidad de los AndesSantiago 7550000Chile

BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearance of anti-tumor necrosis factordrugs. Dose-intensified infliximab treatment can be beneficial and is associatedwith lower rates of colectomy. The aim of the study was to present a case of apatient with ASUC and megacolon, treated with hydrocortisone and acceleratedscheme of infliximab that was monitored by drug trough level.CASE SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented withdiarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen.During investigation, a positive toxin for Clostridium difficile and colonic dilatationof 7 cm consistent with megacolon were observed. She was treated with oralvancomycin for pseudomembranous colitis and intravenous hydrocortisone forsevere colitis, which led to the resolution of megacolon. Due to the persistentsevere colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drugtrough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based onthe low infliximab trough level after one week from the first infliximab dose, thepatient received a second infusion at week 1, consistent with the acceleratedregimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical andendoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSIONInfliximab accelerated infusions can be beneficial in ASUC unresponsive to thetreatment with intravenous corticosteroids. Longitudinal studies are necessary todefine the best therapeutic drug monitoring and treatment regimen for thesepatients.

关键词： Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report

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Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature

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World Journal of Clinical Cases 2021年第33期9卷 10382-10391页

作者： Thais Gagno Grillo Luciana Rocha Almeida Rodrigo Fedatto Beraldo Mariana Barros Marcondes Diego Aparecido Rios Queiróz Daniel Luiz da Silva Rodrigo Quera julio pinheiro baima Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618687São PauloBrazil Department of Pathology São Paulo State University(Unesp)Medical SchoolBotucatu 18618687São PauloBrazil Inflammatory Bowel Disease Program Digestive Disease Center Clínica Universidad de los AndesSantiago 7550000Chile

BACKGROUND Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease(CD).Heart failure(HF)is a rare but potential adverse effect of these medications.The objective of this report is to describe a patient with CD who developed HF after the use of infliximab.CASE SUMMARY A 50-year-old woman with a history of hypertension and diabetes presented with abdominal pain,diarrhea,and weight loss.Colonoscopy and enterotomography showed ulcerations,areas of stenosis and dilation in the terminal ileum,and thickening of the intestinal wall.The patient underwent ileocolectomy and the surgical specimen confirmed the diagnosis of stenosing CD.The patient started infliximab and azathioprine treatment to prevent post-surgical recurrence.At 6 mo after initiating infliximab therapy,the patient complained of dyspnea,orthopnea,and paroxysmal nocturnal dyspnea that gradually worsened.Echocardiography revealed biventricular dysfunction,moderate cardiac insufficiency,an ejection fraction of 36%,and moderate pericardial effusion,consistent with HF.The cardiac disease was considered an infliximab adverse effect and the drug was discontinued.The patient received treatment with diuretics for HF and showed improvement of symptoms and cardiac function.Currently,the patient is using anti-interleukin for CD and is asymptomatic.CONCLUSION This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.

关键词： Heart failure Infliximab Anti-tumor necrosis factor therapy Crohn's disease Inflammatory bowel disease Case report

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The Impact of an Educational Intervention on Inflammatory Bowel Disease for Nurses in Brazil

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Open Journal of Nursing 2020年第12期10卷 1178-1185页

作者： Jaqueline Ribeiro de Barros Adriana Rivera-Sequeiros julio pinheiro baima Fernanda Lofiego Renosto Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine Medical School S&#227 o Paulo State University (UNESP) Botucatu Brazil Department of Internal Medicine San Juan de Dios del Aljarafe Hospital Seville Spain Department of Surgery Medical School S&#227 o Paulo State University (UNESP) Botucatu Brazil

Background: The inflammatory bowel disease nurse plays a key role in the multidisciplinary team. The aim of the study was to evaluate the inflammatory bowel disease knowledge before and after the educational intervention with nurses. Methods: A cross-sectional, descriptive and comparative study was performed from June to August 2016. The sample consisted of 26 nurses from the nursing staff of a public university hospital in São Paulo State, Brazil. The study was divided into three phases: pre-educational intervention, educational intervention and post-educational intervention (test application). A p-value Results: The study included 26 general nurses with an average of 9.20 ± 5.78 years of experience. There was an increase in safety in administering biological therapy after the course (from 33.34% to 78.26%), and an increase in knowledge about the main inflammatory bowel disease symptoms (64.29% vs 96.30%, p = 0.0224), and about infliximab infusion (35.71% vs 74.07%, p = 0.0404). Conclusion: The educational intervention effectively contributed to the increase of knowledge of the nursing staff.

关键词： Inflammatory Bowel Diseases Knowledge Nursing Education Nurses Continuing Education

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The Impact of a Real-Life Inflammatory Bowel Disease Education Course for Brazilian Physicians from the Perspective of Its Participants

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Open Journal of Gastroenterology 2021年第9期11卷 151-160页

作者： Rodrigo Fedatto Beraldo julio pinheiro baima Jaqueline Ribeiro de Barros Fernanda Lofiego Renosto Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine Medical School S&#227o Paulo State University (Unesp) Botucatu Brazil Department of Surgery Medical School S&#227o Paulo State University (Unesp) Botucatu Brazil

Background: Physicians must acquire the necessary skills to provide Inflammatory Bowel Disease (IBD) patients with state-of-the-art clinical care, aiming to improve patient’s quality of life and disease outcomes. Purpose: To describe the queries and experiences of doctors enrolled in an IBD education course and to evaluate the impact of the course. Methods: A retrospective study included 100 physicians, of which 78 attended the course. A questionnaire was applied evaluating how the course had an impact on their IBD-knowledge. The 20-hour-course consisted of practical “real-life” activities and theoretical discussions. Results: The majority of doctors’ expertise was in gastroenterology (53%) and coloproctology (44%). A significant portion had no experience with biological therapy for ulcerative colitis (19.4%) or Crohn’s disease (5.05%). The main topics doctors wanted to discuss were biological therapy (93%), new drugs (74%) and differential diagnosis (64%). A considerable number of physicians did not feel confident at prescribing biological therapy before the course (44.4%), a percentage that decreased to 8.5% after the course (p Discussion: The ideal course should have a practical and theoretical component, as well as the support of an experienced multidisciplinary team. A real-life practical-theoretical IBD course proved a success at increasing IBD knowledge.

关键词： Continuing Medical Education Crohn’s Disease Ulcerative Colitis Inflammatory Bowel Disease

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Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

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World Journal of Gastroenterology 2021年第23期27卷 3396-3412页

作者： Ligia Yukie Sassaki Sender J Miszputen Roberto Luiz Kaiser Junior Wilson R Catapani Mauro Bafutto António S Scotton Cyrla Zaltman julio pinheiro baima Hagata S Ramos Mikaell Alexandre Gouvea Faria Carolina D Gonçalves Isabella Miranda Guimaraes Cristina Flores Heda M B S Amarante Rodrigo Bremer Nones JoséMiguel Luz Parente Murilo Moura Lima Júlio Maria Chebli Maria de Lourdes Abreu Ferrari Julia F Campos Maria G P Sanna Odery Ramos Rogério Serafim Parra Jose J R da Rocha Omar Feres Marley R Feitosa Rosana Fusaro Caratin Juliana Tosta Senra Genoile Oliveira Santana Department of Internal Medicine Botucatu Medical School at Sao Paulo State University(UNESP)Botucatu 18618-687São PauloBrazil Department of Gastroenterology Escola Paulista de MedicinaSao PauloSão Paulo 18618-687São PauloBrazil Department of Proctology Kaiser Day HospitalSão Jose do Rio Preto 15015-110São PauloBrazil Department of Gastroenterology Faculdade de Medicina do ABCSanto Andre 09060-870São PauloBrazil Department of Gastroenterology Faculdade de MedicinaGoiania 74535-170GoiásBrazil Department of Gastroenterology CMIP Centro Mineiro de PesquisaJuiz de Fora 36010-570Minas GeraisBrazil Department of Internal Medicine Federal University of Rio de JaneiroRio de Janeiro 21941-913Rio de JaneiroBrazil Department of Gastroenterology Escola Paulista de MedicinaSão Paulo 04023-900São PauloBrazil Hospital de Clínicas de Porto Alegre Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903Rio Grande do SulBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba ParanáParanáBrazil Gastroenterology Department Hospital Nossa Senhora das GraçasCuritiba 80810-040ParanáBrazil Department of General Medicine Universidade Federal do PiauíTeresina 64049-550PiauíBrazil Gastroenterology Hospital Universitario da Universidade Federal do PiauiTeresina 64049-550PiauíBrazil Department of Medicine University Hospital of Federal University of Juiz de ForaJuiz de ForaJuiz de Fora 36036-247Minas GeraisBrazil Department of Clinical Medicine Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba 80060-900ParanáBrazil Department of Surgery and Anatomy Ribeirao Preto Medical SchoolUniversity of Sao PauloRibeirão Preto 14048-900São PauloBrazil Scientific Affairs Takeda Pharmaceuticals BrazilSao Paulo 04709-011Brazil Clinical Research Takeda PharmaceuticalsSão Paulo 04709-011Sã

BACKGROUND Crohn’s disease(CD)and ulcerative colitis(UC)are inflammatory bowel diseases(IBDs)with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden,especially in patients with moderate-to-severe disease.The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil(RISE BR)study was a noninterventional study designed to evaluate disease control,treatment patterns,disease burden and health-related quality of life in patients with moderate-to-severe active IBD.We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD.AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil.METHODS This was a prospective,noninterventional study of adult patients with active Crohn’s disease(CD:Harvey-Bradshaw Index≥8,CD Activity Index≥220),inadequate CD control(i.e.,calprotectin>200μg/g or colonoscopy previous results),or active ulcerative colitis(UC:Partial Mayo score≥5).Enrollment occurred in 14 centers from October 2016 to February 2017.The proportion of active IBD patients after 9-12 mo of follow-up,Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation,discontinuation and dose changes were examined.RESULTS The study included 118 CD and 36 UC patients,with mean±SD ages of 43.3±12.6 and 44.9±16.5 years,respectively.The most frequent drug classes at index were biologics for CD(62.7%)and 5-aminosalicylate derivates for UC patients(91.7%).During follow-up,65.3%of CD and 86.1%of UC patients initiated a new treatment at least once.Discontinuations/dose changes occurred in 68.1%of CD patients[median 2.0(IQR:2-5)]and 94.3%of UC patients[median 4.0(IQR:3-7)].On average,CD and UC patients had 4.4±2.6 and 5.0±3.3 outpatient visits,respectively.The median time to first mild or no activity was 319(IQR:239-358)d for CD and 320(IQR:288-358)d for UC patient

关键词： Crohn’s disease Ulcerative colitis Inflammatory bowel diseases Prospective study

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基于低成本立体视觉测距系统研究

基于低成本立体视觉测距系统研究

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作者： Cheman julio pinheiro 大连理工大学

学位级别：硕士

随着机器人领域的迅速发展,许多计算机视觉系统也得到了发展。立体视觉作为一种计算机视觉技术,它能够实现通过使用两个对齐的相机从场景中提取深度信息。而深度图像可以通过比较来自两个相机的对应像素的偏移来估计。但是,在实时立体... 详细信息

随着机器人领域的迅速发展,许多计算机视觉系统也得到了发展。立体视觉作为一种计算机视觉技术,它能够实现通过使用两个对齐的相机从场景中提取深度信息。而深度图像可以通过比较来自两个相机的对应像素的偏移来估计。但是,在实时立体视觉中,图像必须以合理的帧速率进行计算。实时立体视觉的移动机器人平台允许自主导航和提供深度的场景与环境互动。目前解决立体声对应问题成为研究热点,但现有的开发用于实时移动机器人平台的解决方案,其计算能力和硬件非常有限。在本论文中,我们提出了一种低成本的立体视觉系统,能够以30Hz的帧率从运动物体中提取深度图像。本文所提出的方法是基于局部密集立体对应算法,其使用先前的前景提取来简化视差。此外,本文提出了一种基于权重均值的方法来提高视差图像的稳定性。本实验结果表明了所提出的方法的鲁棒性和良好的时间性能。

关键词：立体视觉距离测量前景分割

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