João Gomes Netinho

Associations among socio-demographic and clinical factors and the quality of life of ostomized patients

This study identifies the socio-demographic and clinical factors of patients with irreversible colostomy secondary to colorectal cancer and correlates them with quality of life (QOL). It is a cross-sectional study. Socio-demographic and clinical data were collected through interviews and the WHOQOL-bref to assess QOL. The sample comprised 60 patients. Most of the patients were male, elderly individuals, half were married and half did not have a sexual partner, with complete primary education, receiving up to two times the minimum wage, carried a stoma for three months on average, were instructed they would carry a stoma, but did not have their stoma marked prior to surgery. The average QOL score was 75.500, while the psychological, social and physical domains were the most affected. No statistically significant differences were found in QOL in relation to the following socio-demographic and clinical factors: female gender, low income, no sexual partners, and lack of instruction. The patients with an intestinal stoma presented a satisfactory QOL.Os objetivos deste estudo foram identificar os fatores sociodemograficos e clinicos dos pacientes com estoma intestinal definitivo, secundario ao câncer colorretal, e correlaciona-los a qualidade de vida (QV). Como metodos usaram-se o estudo transversal, utilizando a entrevista como instrumento de coleta de dados sociodemograficos e clinicos, e, para avaliacao da QV, o WHOQOL-bref. A amostra foi composta por 60 pacientes. Como resultados tem-se que a maioria dos pacientes era do sexo masculino, idoso, casado, sem parceiro sexual, com ensino fundamental completo, recebia ate dois salarios-minimos, tempo medio de estoma de tres meses, foram orientados que portariam um estoma, mas nao foi demarcado para a cirurgia. A media da QV foi de 75,00, sendo que os dominios psicologico, social e fisico foram os mais afetados. Os fatores sociodemograficos e clinicos: sexo feminino, baixa renda, nao ter parceiros sexuais e falta de orientacao apresentaram diferencas estatisticas significantes na QV. Conclui-s que os pacientes portadores de estoma intestinal demonstraram QV satisfatoria.

Associação dos fatores sociodemográficos e clínicos à qualidade de vida dos estomizados

This study identifies the socio-demographic and clinical factors of patients with irreversible colostomy secondary to colorectal cancer and correlates them with quality of life (QOL). It is a cross-sectional study. Socio-demographic and clinical data were collected through interviews and the WHOQOL-bref to assess QOL. The sample comprised 60 patients. Most of the patients were male, elderly individuals, half were married and half did not have a sexual partner, with complete primary education, receiving up to two times the minimum wage, carried a stoma for three months on average, were instructed they would carry a stoma, but did not have their stoma marked prior to surgery. The average QOL score was 75.500, while the psychological, social and physical domains were the most affected. No statistically significant differences were found in QOL in relation to the following socio-demographic and clinical factors: female gender, low income, no sexual partners, and lack of instruction. The patients with an intestinal stoma presented a satisfactory QOL.Os objetivos deste estudo foram identificar os fatores sociodemograficos e clinicos dos pacientes com estoma intestinal definitivo, secundario ao câncer colorretal, e correlaciona-los a qualidade de vida (QV). Como metodos usaram-se o estudo transversal, utilizando a entrevista como instrumento de coleta de dados sociodemograficos e clinicos, e, para avaliacao da QV, o WHOQOL-bref. A amostra foi composta por 60 pacientes. Como resultados tem-se que a maioria dos pacientes era do sexo masculino, idoso, casado, sem parceiro sexual, com ensino fundamental completo, recebia ate dois salarios-minimos, tempo medio de estoma de tres meses, foram orientados que portariam um estoma, mas nao foi demarcado para a cirurgia. A media da QV foi de 75,00, sendo que os dominios psicologico, social e fisico foram os mais afetados. Os fatores sociodemograficos e clinicos: sexo feminino, baixa renda, nao ter parceiros sexuais e falta de orientacao apresentaram diferencas estatisticas significantes na QV. Conclui-s que os pacientes portadores de estoma intestinal demonstraram QV satisfatoria.

TLR2 and TLR4 polymorphisms influence mRNA and protein expression in colorectal cancer

AIM To evaluate the effect of promoter region polymorphisms of toll-like receptor (TLR)2-196 to -174del and TLR4-1607T/C (rs10759932) on mRNA and protein expression in tumor tissue and of TLR4+896A/G (rs4986790) on colorectal cancer (CRC) risk. METHODS The TLR2-196 to -174del polymorphism was investigated using allele-specific polymerase chain reaction (PCR) and the TLR4-1607T/C and TLR4+896A/G by PCR-restriction fragment length polymorphism (RFLP). We genotyped 434 DNA samples from 194 CRC patients and 240 healthy individuals. The mRNA relative quantification (RQ) was performed in 40 tumor tissue samples by quantitative PCR TaqMan assay, using specific probes for TLR2 and TLR4 genes, and ACTB and GAPDH reference genes were used as endogenous controls. Protein expression was analyzed by immunohistochemistry with specific primary antibodies. RESULTS No association was found for TLR4-1607T/C and TLR4+896A/G by three statistical models (log-additive, dominant and recessive). However, based on dominant and log-additive models, the polymorphic variant TLR2-196 to -174del was associated with increased CRC risk [dominant: odds ratio (OR) = 1.72, 95%CI: 1.03-2.89; P = 0.038 and log-additive: OR =1.59, 95%CI: 1.02-2.48; P = 0.039]. TLR2 mRNA expression was increased in tumor tissue (RQ = 2.36) when compared to adjacent normal tissue (RQ = 1; P < 0.0001), whereas the TLR4 mRNA showed a basal expression (RQ = 0.74 vs RQ = 1, P = 0.452). Immunohistochemistry analysis of TLR2 and TLR4 protein expression was concordant with the findings of mRNA expression. In addition, the TLR2-196 to -174del variant carriers showed mRNA relative expression 2.19 times higher than wild-genotype carriers. The TLR2 protein expression was also higher for the TLR2-196 to -174del variant carriers [117 ± 10 arbitrary unit (a.u.) vs 95 ± 4 a.u., P = 0.03]. However, for the TLR4 -1607T/C polymorphism no significant difference was found for both mRNA (P = 0.56) and protein expression (P = 0.26). CONCLUSION Our findings suggest that TLR2-196 to -174del polymorphism increases TLR2 mRNA expression and is associated with higher CRC risk, indicating an important role in CRC genetic susceptibility.

Prevalência de constipação intestinal entre estudantes de medicina de uma instituição no Noroeste Paulista

Introduction: Constipation is a highly prevalent disease in the Western world. It has a complex and multifactorial etiology, and courses with important impacts from a medical and socio-economical point of view. It is possible that health professionals and medical students, given the nature of their professional activities, trend to present higher rates of the disease in comparison to the general population. Objectives: To determine the prevalence rates of constipation among students of a single medical school according to diagnostic criteria in the literature, and to compare them with those reported among the general population. Patients and Methods: A transversal study was carried out with a sample of 360 medical students of a single medical school in Northwestern Sao Paulo State, by means of a self-administered questionnaire; a total of 150 students (42%) completed the questionnaire; definition of constipation was based on the Rome III diagnostic criteria. Results: The overall prevalence rate of constipation was 35%, with predominance of the disease among female (55%; p< 0.0001); female students also had a lower frequency of daily evacuations and a higher frequency of laxative use (p< 0.05). Conclusions: The prevalence rate of constipation in the studied population was higher than that reported among general population in several studies, and a more accurate search about this fact will be object of further studies.

CYP1A1, CYP2E1 and EPHX1 polymorphisms in sporadic colorectal neoplasms

AIM To investigate the contribution of polymorphisms in the CYP1A1, CYP2E1 and EPHX1 genes on sporadic colorectal cancer (SCRC) risk. METHODS Six hundred forty-one individuals (227 patients with SCRC and 400 controls) were enrolled in the study. The variables analyzed were age, gender, tobacco and alcohol consumption, and clinical and histopathological tumor parameters. The CYP1A1*2A, CYP1A1*2C CYP2E1*5B and CYP2E1*6 polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The EPHX1 Tyr113His, EPHX1 His139Arg and CYP1A1*2C polymorphisms were detected by real-time PCR. Chi-squared test and binary logistic regression were used in the statistical analysis. Haplotype analysis was conducted using the Haploview program, version 2.05. RESULTS Age over 62 years was a risk factor for SCRC development (OR = 7.54, 95%CI: 4.94-11.50, P < 0.01). Male individuals were less susceptible to SCRC (OR = 0.55, 95%CI: 0.35-0.85, P < 0.01). The CYP2E1*5B polymorphism was associated with SCRC in the codominant (heterozygous genotype: OR = 2.66, 95%CI: 1.64-4.32, P < 0.01), dominant (OR = 2.82, 95%CI: 1.74-4.55, P < 0.01), overdominant (OR = 2.58, 95%CI: 1.59-4.19, P < 0.01), and log-additive models (OR = 2.84, 95%CI: 1.78-4.52, P < 0.01). The CYP2E1*6 polymorphism was associated with an increased SCRC risk in codominant (heterozygous genotype: OR = 2.81, 95%CI: 1.84-4.28, P < 0.01; homozygous polymorphic: OR = 7.32, 95%CI: 1.85-28.96, P < 0.01), dominant (OR = 2.97, 95%CI: 1.97-4.50, P < 0.01), recessive (OR = 5.26, 95%CI: 1.35-20.50, P = 0.016), overdominant (OR = 2.64, 95%CI: 1.74-4.01, P < 0.01), and log-additive models (OR = 2.78, 95%CI: 1.91-4.06, P < 0.01). The haplotype formed by the minor alleles of the CYP2E1*5B (C) and CYP2E1*6 (A) polymorphisms was associated with SCRC (P = 0.002). However, the CYP1A1*2A, CYP1A1*2C, EPHX1 Tyr113His and EPHX1 His139Arg polymorphisms were not associated with SCRC. CONCLUSION In conclusion, the results demonstrated that CYP2E1*5B and CYP2E1*6 minor alleles play a role in the development of SCRC.

Fungal Colitis by Paracoccidioides brasiliensis: a case report

Paracoccidioidomycosis (PBM) is an infection caused by a dimorphic fungus called Paracoccidioides brasiliensis. It occurs in Latin America, with incidence of 1 to 3 per 100,000 inhabitants in endemic areas. The digestive tract is usually not affected, but when it occurs, it may lead to events similar to colorectal neoplasm and inflammatory bowel disease (IBD). This is a case report of a 68-year-old female patient, with diarrhea without blood or mucus for 6 months, weight loss of 8 kg over the period. Abdominal ultrasonography showed some mass in the right colon, suggestive of cancer and liver perihilar lymph node. Colonoscopy showed lesions suggestive of Crohns disease. Biopsy showed chronic granulomatous colitis of fungal etiology: Paracoccidioidomycosis. The patient did not tolerate oral treatment with itraconazole and subsequently sulfadiazine, requiring hospital admission for the treatment with amphotericin B. The presence of Paracoccidioidomycosis in the digestive tract may be associated with bloody diarrhea, mucus, rectal hemorrhage, abdominal pain, malabsorption syndrome. Histopathological studies show the fungus and a chronic inflammatory infiltrate and granulation tissue. The differential diagnoses are tuberculosis, colorectal cancer and inflammatory bowel disease. The treatment is oral antifungal (itraconazole, sulfadiazine) or intravenous (amphotericin B) based. The case has caused diagnostic confusion between colon cancer (clinical and US) and Crohns disease (colonoscopy).

Linfoma primário de cólon: relato de caso

O linfoma colorretal primario e uma doenca rara (0.2 a 0.6% de todas as neoplasias colonicas), apresentando pior prognostico quando comparado com o linfoma gastrico primario ou com o adenocarcinoma do colon. E uma doenca com sintomatologia inespecifica, o que dificulta o diagnostico precoce. O objetivo deste relato e mostrar um caso de linfoma primario do colon, revisar criterios diagnosticos e tratamento.

Molecular evaluation of glutathione S transferase family genes in patients with sporadic colorectal cancer

AIM To evaluate the association between polymorphisms in glutathione S transferases (GSTs) and the risk of sporadic colorectal cancer (SCRC), tumor progression and the survival of patients. METHODS A case-control study of 970 individuals from the Brazilian population was conducted (232 individuals from the case group with colorectal cancer and 738 individuals from the control group without a history of cancer). PCR multiplex and PCR-RFLP techniques were used to genotype the GST polymorphisms. The tumors were categorized according to the TNM classification: tumor extension (T), affected lymph nodes (N), and presence of metastasis (M). Logistic regression, multiple logistic regression and survival analysis were used to analyze the data. The results are presented in terms of odds ratio (OR) and 95% confidence interval (CI). The level of significance was set at 5% (P ≤ 0.05). RESULTS Age equal to or over 62 years (OR = 8.79; 95%CI: 5.90-13.09, P < 0.01) and female gender (OR = 2.91; 95%CI: 1.74-4.37; P < 0.01) were associated with increased risk of SCRC. Analysis of the polymorphisms revealed an association between the GSTM1 polymorphisms and a risk of SCRC (OR = 1.45; 95%CI: 1.06-2.00; P = 0.02), as well as between GSTT1 and a reduced risk of the disease (OR = 0.65; 95%CI: 0.43-0.98; P = 0.04). An interaction between the presence of the wild-type allele of GSTP1 Ile105Val polymorphism and tobacco consumption on risk of SCRC (OR = 2.33; 95%CI: 1.34-4.05; P = 0.05) was observed. There was an association between the GSTM1 null genotype and the presence of advanced tumors (OR = 2.33; 95%CI: 1.23-4.41; P = 0.009), as well as increased risk of SCRC in the presence of a combination of GSTT1 non-null/GSTM1 null genotypes (OR = 1.50; 95%CI: 1.03-2.19; P = 0.03) and GSTT1 non-null/GSTM1 null/GSTP1 Val* (OR = 1.85; 95%CI: 1.01-3.36, P = 0.04). Combined GSTT1 non-null/GSTM1 null genotypes (OR = 2.40; 95%CI: 1.19-4.85; P = 0.01) and GSTT1 non-null/GSTM1 null/GSTP1 Val* (OR = 2.92; 95%CI: 1.05-8.12; P = 0.04) were associated with tumor progression. Polymorphisms were not associated with the survival of patients with SCRC. CONCLUSION Females aged 62 years or older are more susceptible to SCRC. Polymorphisms of GSTT1 and GSTM1 null genotypes modulated the susceptibility to SCRC in the population studied.

Percepções dos estomizados intestinais sobre o estoma após cirurgia/Perceptions of ostomy patients concerning stoma after surgery

The purpose of this study was to understand perceptions about stoma of ostomized patients after after surgery. This descriptive study with a qualitative approach used three guiding questions and the testimonies of 13 ostomized patients cared for in a coloprotoctology outpatient clinical of a university hospital in the interior of Sao Paulo, Brazil were submitted to Andre’s Prose Analysis. Four themes emerged: experienced feelings, difficulties experienced after the stoma, sexual life after stoma, and future expectations. Another ten topics were identified: anger, resignation, faith, difficulties faced to self-care, social re-insertion, apparel changes, sex with loss, support from family members, healing, and improved quality of life. The studied perceptions led to the conclusion that the teaching-learning process of self-care and stimulus for social re-insertion enabled by the nurse and team consists the central focus of care provided to ostomized patients.

Asociación de los factores sociodemográficos y clínicos a la calidad de vida de los ostomizados

This study identifies the socio-demographic and clinical factors of patients with irreversible colostomy secondary to colorectal cancer and correlates them with quality of life (QOL). It is a cross-sectional study. Socio-demographic and clinical data were collected through interviews and the WHOQOL-bref to assess QOL. The sample comprised 60 patients. Most of the patients were male, elderly individuals, half were married and half did not have a sexual partner, with complete primary education, receiving up to two times the minimum wage, carried a stoma for three months on average, were instructed they would carry a stoma, but did not have their stoma marked prior to surgery. The average QOL score was 75.500, while the psychological, social and physical domains were the most affected. No statistically significant differences were found in QOL in relation to the following socio-demographic and clinical factors: female gender, low income, no sexual partners, and lack of instruction. The patients with an intestinal stoma presented a satisfactory QOL.Os objetivos deste estudo foram identificar os fatores sociodemograficos e clinicos dos pacientes com estoma intestinal definitivo, secundario ao câncer colorretal, e correlaciona-los a qualidade de vida (QV). Como metodos usaram-se o estudo transversal, utilizando a entrevista como instrumento de coleta de dados sociodemograficos e clinicos, e, para avaliacao da QV, o WHOQOL-bref. A amostra foi composta por 60 pacientes. Como resultados tem-se que a maioria dos pacientes era do sexo masculino, idoso, casado, sem parceiro sexual, com ensino fundamental completo, recebia ate dois salarios-minimos, tempo medio de estoma de tres meses, foram orientados que portariam um estoma, mas nao foi demarcado para a cirurgia. A media da QV foi de 75,00, sendo que os dominios psicologico, social e fisico foram os mais afetados. Os fatores sociodemograficos e clinicos: sexo feminino, baixa renda, nao ter parceiros sexuais e falta de orientacao apresentaram diferencas estatisticas significantes na QV. Conclui-s que os pacientes portadores de estoma intestinal demonstraram QV satisfatoria.