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PubMed | University of Amsterdam, University Hospital Heraklion, University of Zürich, Semmelweis University and 7 more.
Type: Journal Article | Journal: Journal of Crohn's & colitis | Year: 2016

Perianal fistulas affect up to one-third of Crohns patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohns and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohns disease [CD].The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohns disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD.The treatment of perianal fistulising Crohns disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohns perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.


De Moraes A.C.F.,University of Sao Paulo | De Moraes A.C.F.,Epidemiology and Physical Activity Research Group | De Moraes A.C.F.,Exercise and Metabolism Research Group | Fadoni R.P.,Catholic University of Parana | And 10 more authors.
Obesity Reviews | Year: 2011

The objectives of this study were to (i) review extant literature on the prevalence of abdominal obesity (AO) in adolescents of both sex (10-19 years old); (ii) analyse the cut-off points used for the diagnosis of AO and (iii) compare its prevalence between developed and developing countries. The search was carried out using online databases (MEDLINE, Web of Science, EMBASE, SPORTDiscus, SCIELO and BioMed Central), references cited by retrieved articles and by contact with the authors, considering articles published from the establishment of the databanks until 19 October 2009. Only original articles and those using waist circumference in the diagnosis were considered. Twenty-nine studies met the inclusion criteria. Fourteen of these studies were performed in developed countries. The prevalence of AO varied from 3.8% to 51.7% in adolescents from developing countries. The range of results was smaller among developed countries; with values from 8.7% to 33.2%. Eighteen different cut-off points were used. It was concluded the AO prevalence is high among adolescents, but is not clear what sex has a higher proportion and it is greater in adolescents from developing countries; however, there is no consensus in the literature about the criteria to be used. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.


Ghanem V.C.,Sadalla Amin Ghanem Eye Hospital | Ghanem V.C.,University of Sao Paulo | Ghanem R.C.,Sadalla Amin Ghanem Eye Hospital | Ghanem R.C.,University of Sao Paulo | De Oliveira R.,Catholic University of Parana
Cornea | Year: 2013

PURPOSE: To evaluate the postoperative pain after corneal collagen cross-linking (CXL). METHODS: This prospective study included 178 consecutive eyes of 135 patients with progressive keratoconus who underwent CXL at Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. Pain was assessed postoperatively using the need for analgesia with 30 mg of codeine (Tylex) and by the patients' subjective evaluation on the Wong-Baker FACES Pain Rating Scale at the end of each day until postoperative day (PO) 5. Correlation of postoperative pain with maximum keratometric reading and central corneal thickness, which were assessed preoperatively, was investigated. RESULTS: Mean patient age was 23.38 ± 5.86 years. Mean (±SD) patient-scored pain decreased significantly (P < 0.05) from 2.78 (±1.68) on the day of surgery (immediate postoperative period, iPO) to 0.12 (±0.46) on PO5. The mean number of codeine pills was 0.94, 0.72, and 0.28 at iPO, PO1, and PO2, respectively, showing a significant decrease at each time point. Statistical analysis showed significant (P < 0.05) correlation between age and pain at PO3 and PO4 (the younger the patients the greater the pain) and between age and the number of codeine pills on iPO. There was no significant correlation between mean overall pain and preoperative apical keratometry (P = 0.546) and pachymetry (P = 0.072) readings. CONCLUSIONS: CXL postoperative pain can be intense, especially in the first 3 days, even with an aggressive pain control regimen; however, pain and the need for analgesia decreased significantly on each consecutive day. Pain was significantly correlated with the patient's age. Copyright © 2012 by Lippincott Williams & Wilkins.


PubMed | Thomas Jefferson University, University of Maryland University College, University Utrecht, University of British Columbia and 6 more.
Type: Journal Article | Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2016

The aims of this study were (1) to demonstrate the AOSpine thoracolumbar spine injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those injury types which are difficult for spine surgeons to classify reliably.A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient ().The overall Kappa coefficient for all cases was 0.56, which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility.In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine trauma patients as or more reliably than previously described systems.


PubMed | Leiden University, Johns Hopkins University, Keio University, Beth Israel Deaconess Medical Center and 5 more.
Type: Journal Article | Journal: Journal of cardiovascular computed tomography | Year: 2016

Total atherosclerotic plaque burden assessment by CT angiography (CTA) is a promising tool for diagnosis and prognosis of coronary artery disease (CAD) but its validation is restricted to small clinical studies. We tested the feasibility of semi-automatically derived coronary atheroma burden assessment for identifying patients with hemodynamically significant CAD in a large cohort of patients with heterogenous characteristics.This study focused on the CTA component of the CORE320 study population. A semi-automated contour detection algorithm quantified total coronary atheroma volume defined as the difference between vessel and lumen volume. Percent atheroma volume (PAV=[total atheroma volume/total vessel volume]100) was the primary metric for assessment (n=374). The area under the receiver operating characteristic curve (AUC) determined the diagnostic accuracy for identifying patients with hemodynamically significant CAD defined as 50% stenosis by quantitative coronary angiography and associated myocardial perfusion abnormality by SPECT.Of 374 patients, 139 (37%) had hemodynamically significant CAD. The AUC for PAV was 0.78 (95% confidence interval [CI] 0.73-0.83) compared with 0.84 [0.79-0.88] by standard expert CTA interpretation (p=0.02). Accuracy for both CTA (0.91 [0.87, 0.96]) and PAV (0.86 [0.81-0.91]) increased after excluding patients with history of CAD (p<0.01 for both). Bland-Altman analysis revealed good agreement between two observers (bias of 280.2mm(3) [161.8, 398.7]).A semi-automatically derived index of total coronary atheroma volume yields good accuracy for identifying patients with hemodynamically significant CAD, though marginally inferior to CTA expert reading. These results convey promise for rapid, reliable evaluation of clinically relevant CAD.


PubMed | Thomas Jefferson University, University of Maryland University College, University Utrecht, Center for Spinal Surgery and 6 more.
Type: Journal Article | Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2016

This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes.A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1month apart. Kappa coefficients () were calculated for intraobserver and interobserver reliability.The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (=0.75 and 0.64, respectively).The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.


Tonelli M.,University of Alberta | Riella M.C.,Catholic University of Parana
Nature reviews. Nephrology | Year: 2014

'Chronic kidney disease (CKD) in older people' is the focus of World Kidney Day 2014. In this article, we discuss the key links between kidney function, age, health and illness, as well as the implications of the ageing population for the care of people with CKD.


Riella M.C.,Catholic University of Parana | Roy-Chaudhury P.,University of Cincinnati
Nature Reviews Nephrology | Year: 2013

Despite all the progress achieved since Scribner first introduced the arteriovenous (AV) shunt in 1960 and Cimino and Brescia introduced the native AV fistula in 1962, we have continued to face a conundrum in vascular access for dialysis, in that dialysis vascular access is at the same time both the 'lifeline' and the 'Achilles' heel' of haemodialysis. Indeed, findings from a multitude of published articles in this area, unfortunately mainly observational studies, reflect both our frustration and our limited knowledge in this area. Despite improved understanding of the pathophysiology of stenosis and thrombosis of the vascular access, we have unfortunately not been very successful in translating these advances into either improved therapies or a superior process of care. As a result, we continue to face an epidemic of arteriovenous fistula (AVF) maturation failure, a proliferation of relatively ineffective interventions such as angioplasty and stent placement, an extremely high incidence of catheter use, and more doubts rather than guidance with regard to the role (or lack thereof) of surveillance. An important reason for these problems is the lack of focused translational research and robust randomized prospective studies in this area. In this Review, we will address some of these critical issues, with a special emphasis on identifying the best process of care pathways that could reduce morbidity and mortality. We also discuss the potential use of novel therapies to reduce dialysis vascular access dysfunction. © 2013 Macmillan Publishers Limited. All rights reserved.


Tonelli M.,University of Alberta | Riella M.,Catholic University of Parana
Nephron - Clinical Practice | Year: 2014

Due to improvements in socioeconomic development and increased life expectancy, the proportion of older people in the general population is increasing worldwide. While this trend is something to celebrate, it also brings with it challenges for health care systems. One particular challenge is an increase in chronic kidney disease, the prevalence of which is higher in older people. This article reviews the key links between kidney function, age, health and illness, and discusses the implications of the ageing population for the care of people with chronic kidney disease. © 2014 S. Karger AG, Basel.


PubMed | Cajuru University Hospital, University of Campinas and Catholic University of Parana
Type: | Journal: Digestive diseases and sciences | Year: 2016

The real impact of anti-tumor necrosis alpha (TNF) therapy in postoperative complications after intestinal resections in Crohns disease (CD) still needs to be determined.To compare the postoperative complication rates after elective intestinal resections in CD patients, with or without previous exposure to anti-TNF therapy.This was a retrospective and observational study, with elective intestinal resections for CD (emergency procedures were excluded). Patients were allocated in two groups according to preoperative anti-TNF status. Surgical and medical complications were analyzed and subsequently compared between the groups.A total of 123 patients were included (71 with and 52 without preoperative anti-TNF). The groups were considered homogeneous, except for perianal CD, previous azathioprine, and stomas. There was no significant difference between the groups regarding overall surgical complications (32.69% in anti-TNF- vs. 39.44% in anti-TNF+patients, p=0.457) or overall medical complications (21.15 vs. 21.13%, respectively, p=1.000). In univariate analysis, previous steroids, perianal CD, and stomas were considered risk factors for surgical complications, and previous steroids and hypoalbuminemia for medical complications. In multivariate analysis, previous steroids were associated with higher rates of surgical and medical complications, while hypoalbuminemia was associated with higher medical complication rates.There was no influence of the previous use of anti-TNF agents in postoperative surgical and medical complication rates in elective intestinal resections for CD. Previous steroids and hypoalbuminemia were associated with higher complication rates. This was the first case series of the literature describing outcomes in exclusively elective operations.

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