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This review explores current guidelines for integrating psychosocial support, nutrition, and physical activity into cancer care and examines the resources available to deliver comprehensive care effectively and equitably, with a focus on telehealth solutions. A review of current guidelines related to psychosocial support, nutrition, and exercise in oncology published between the years 2020 and 2024 was conducted. Additionally, relevant articles from the authors' personal archives were included. Current guidelines emphasize routine psychosocial distress screening, nutritional assessment, and tailored physical activity interventions for patients with cancer. The National Comprehensive Cancer Network and ASCO highlight the need for regular psychosocial evaluations and the management of common psychiatric disorders. The American Cancer Society and the Academy of Nutrition and Dietetics recommend nutritional screening, personalized counseling, and exercise to improve treatment tolerance and overall quality of life. Despite these recommendations, challenges such as resource limitations, time constraints, and financial barriers hinder their implementation. Integrating psychosocial support, medical nutrition therapy, and physical activity into cancer care is essential to enhancing patients' quality of life. Telehealth offers a viable solution to overcome barriers by providing remote access to supportive services, facilitating comprehensive care, and promoting patient engagement. The effectiveness of telehealth in delivering psychosocial, nutritional, and physical activity support highlights its potential to improve patient outcomes and overcome barriers to care. Telehealth technologies hold high potential to optimize cancer care delivery, ensuring personalized support for patients throughout their cancer journey.

Este artigo examina como o Tribunal de Justiça do Distrito Federal e Territórios (TJDFT) aplica três importantes teses jurídicas relacionadas a infrações e crimes de trânsito, definidas pelos Tribunais Superiores (STJ e STF). O Tema 901 do STJ trata do crime de confiar a direção de veículo automotor a pessoa não habilitada ou sem condições de dirigir, classificado como crime de perigo abstrato. O Tema 1060 aborda a desobediência à ordem legal de parada emitida por agentes de segurança pública. Já o Tema 1079 do STF trata da recusa em realizar testes de alcoolemia e suas respectivas sanções administrativas. A análise mostra que o TJDFT segue de perto as orientações dos tribunais superiores, reforçando a uniformidade na aplicação da legislação de trânsito.

Nutrition in rabbit farming accounts for about 70% of all costs; in this sense, C. argentea is an excellent alternative as a feed, due to its bromatological composition. Our goal is to evaluate the nutritional value of diets formulated with the dried leaves of C. argentea to feed growing rabbits. Twenty-eight white rabbits of the New Zealand breed, 55 days old, of both sexes, were used. Two treatments (n = 14, 7 males, and 7 females) were evaluated in a randomized block experimental design in a 2 x 2 factorial scheme. The control diet (CTRL) was formulated to meet the nutritional requirements of growing rabbits, and the test diet (DRY) was obtained by replacing 20% of the CTRL diet with dried leaves of C. argentea. The experimental period was comprised of 11 days, with seven days of adaptation and four days of total feces collection. The average daily gain, dry matter intake, feed conversion, and final body weight were not affected by replacing the CTRL diet with the dried leaves of C. argentea. The coefficient of dry matter digestibility showed better results in CTRL rabbits (female: 72.19%, male: 72.48%). Rabbits fed with the CTRL diet exhibited a higher consumption of crude protein compared to those fed with the DRY diet, however, these rabbits showed higher elimination and lower retention of crude protein. It is concluded that C. argentea presents values of 1,400.67 kcal per kg of dry matter, digestible energy, and 3.34% digestible protein per kg of dry matter.

ABSTRACT Background: Inflammatory bowel diseases (IBD) have rising incidence and prevalence rates globally. In IBD, there are scarce studies comparing differences between patients according to socioeconomic status. Our aim was to comparatively evaluate hospitalizations, use of biologics and rates of surgery in patients with IBD between public and private healthcare systems. Methods: Single-center retrospective cohort study in patients with IBD from a tertiary referral unit from Latin America, between 2015 and 2021. CD and UC patients were classified into two subgroups: public and private systems. Demographic characteristics, hospitalizations, need for surgery and biologics were compared. Results: A total of 500 patients were included, 322 with CD and 178 with UC. CD-related hospitalizations were frequently observed in both healthcare systems (76.28% in private and 67.46% in public). More than half of the patients had been submitted to one or more CD-related abdominal surgery, with no significant difference between the subgroups. Although there was no difference in the rates of use of biological therapy in CD subgroups, infliximab was more used in the public setting (57.69% vs 43.97%). There was no difference in UC-related hospitalizations between the subgroups (public 30.69% and private 37.66%) as well as the rates of colectomy (public: 16.83%, private: 19.48%). Biologics were prescribed almost twice as often in private as compared to public (45.45 vs 22.77%). Conclusion: There were no differences in the rates of hospitalization and abdominal surgery between the systems. In patients with UC, there was greater use of biological therapy in the private healthcare setting.

ABSTRACT Background: Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. Objective: The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. Methods: Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. Results: A total of 101 patients with IBD were included, 75 with Crohn’s disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn’s disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). Conclusion: The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD.

ABSTRACT Background: Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea. Objective: We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series. Methods: All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label. Results: During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug. Conclusion: Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated.

ABSTRACT Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.

Brewers’ spent grain (BSG) is an important waste produced by beer companies and has a high potential to be transformed into commercial by-products. The present paper reports a forecasting technology study with the aid of bibliographic review and patent analysis tools aiming to investigate the maturity of certain technologies, considering the use of BSG on a closed-loop biorefinery and circular bioeconomy concept integrated into a brewery. To evaluate the possibilities of production of high-added-value products in Brazil, we present an overview of BSG’s scientific, technological, and marketing products and applications. The comparison between the numbers of articles versus patents shows that the solutions proposed by research articles are not being transformed into maturated viable technologies. The results suggest that there is a gap between the scientific research in the institutions and their applications in the industry, which lead to the destination of BSG for more economically attractive investments when compared with research in Brazil. Ultimately, from the carried-out analysis, it is possible to propose a brewing process connected to the biorefinery system, showing its possibility in the newly arising brewery industries.

Nosso objetivo foi caracterizar a cinética de degradação de resíduos agroindustriais fibrosos e amiláceos que podem ser utilizados na alimentação de ruminantes. Foram avaliados feno de palha de braquiária não processado (UBH), feno de palha de braquiária processado (briquetagem) (PBH), um subproduto amiláceo do processamento de batata (SBP) e fécula de mandioca (CST). Duas dietas foram formuladas: uma incluindo UBH e CST (UBH-CSTd); e o outro PBH e SBP (PBH-SBPd). Para o estudo da cinética de degradação, foi utilizada a técnica de fermentação de produção cumulativa de gás in vitro, na qual o modelo Monomolecular-G3G1 de dois compartimentos forneceu um ajuste mais provável. Os volumes cumulativos de gás produzidos foram 23,2 (UBH), 29,6 (PBH), 39,1 (SBP), 36,6 (CST), 27,9 (UBH-CSTd) e 28,5 (PBH-SBPd) mL por 0,1 g de matéria seca. Os alimentos amiláceos apresentaram fermentação mais intensa nas primeiras horas. Essa fermentação ágil ocorre porque se trata de um alimento solúvel e/ou rapidamente degradável que contém uma quantidade muito pequena de matéria fibrosa. Já para os alimentos fibrosos, UBH e PBH, a fermentação ocorreu mais lentamente nas primeiras horas, liberando menos gases. Como a fibra tem uma parte lentamente degradável e insolúvel, a fase assintótica demora mais para ser alcançada. Já as dietas apresentaram fermentação intermediária às dos alimentos amiláceos e fibrosos, o que acompanhou fielmente o perfil de produção de gases de seus ingredientes. Ambas as dietas apresentaram menores valores de k1 e maiores valores de k2 quando comparadas à silagem de milho. Este resultado confirma a real possibilidade de utilização dos dejetos estudados na alimentação de ruminantes. Ou seja, além de serem ingredientes com potencial de utilização na produção de ruminantes, a utilização de subprodutos na alimentação animal pode eliminar um problema substancial de poluição para a indústria.

Abstract Background There is a rapid increase in the incidence of inflammatory bowel diseases (IBD) in newly industrialized countries, yet epidemiological data is incomplete. We herein report the methodology adopted to study the incidence of IBD in newly industrialized countries and to evaluate the effect of environmental factors including diet on IBD development. Methods Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) is a population-based cohort of newly diagnosed persons with Crohn’s disease and ulcerative colitis in Asia, Africa, and Latin America to be followed prospectively for 12 months. New cases were ascertained from multiple sources and were entered into a secured online system. Cases were confirmed using standard diagnostic criteria. In addition, endoscopy, pathology and pharmacy records from each local site were searched to ensure completeness of case capture. Validated environmental and dietary questionnaires were used to determine exposure in incident cases prior to diagnosis. Results Through November 2022, 106 hospitals from 24 regions (16 Asia; 6 Latin America; 2 Africa) have joined the GIVES-21 Consortium. To date, over 290 incident cases have been reported. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, medication history and environmental and dietary exposures data collected. We have established a comprehensive platform and infrastructure required to examine disease incidence, risk factors and disease course of IBD in the real-world setting. Conclusions The GIVES-21 consortium offers a unique opportunity to investigate the epidemiology of IBD and explores new clinical research questions on the association between environmental and dietary factors and IBD development in newly industrialized countries.

Esse estudo objetiva analisar o conceito de território como um conhecimento indispensável para a resistência dos povos do campo, de comunidades e povos tradicionais. Tem como base epistêmica o pensamento de fronteira e a pesquisa bibliográfica, documental e entrevistas como bases metodológicas. Analisa como a desvalorização dos vínculos territoriais dos outros povos para ocultação de sua importância, fundadas nas diferenças étnicas e raciais, num sentido de interferência na produção de conhecimento. Destaca a importância da implantação da territorialidade dominante do colonizador, ancorada na subjetividade da terra como mercadoria, para a colonialidade da natureza. Busca elucidar a correlação da gestão fundiária com a colonialidade e sua interrelação com as categorias míticas que revitalizam a complexa colonização do imaginário dos povos inferiorizados para o seu controle. Analisa conceitos e exemplos que têm ancorado a resistência no sentido oposto da colonialidade, rumo à decolonialidade ou à contra colonização. Destaca a importância do território como lócus epistêmico e aponta para importância conceitual de território como uma base para a resistência de diversos povos e populações do campo na América Latina.

Objetivo: analisar os elementos gerais da regulação e o papel do Estado Regulador brasileiro com foco na salvaguarda dos direitos fundamentais, em especial do direito à saúde. Metodologia: a pesquisa apoiou-se no método dedutivo de René Descartes, utilizando, como premissas, os princípios gerais do direito, o ordenamento jurídico em torno do direito da saúde e do papel do Estado Regulador e a jurisprudência do Supremo Tribunal Federal relativa à vigilância sanitária. Resultados: a efetiva proteção da saúde, que envolve a garantia de que os cidadãos terão acesso a produtos e serviços de saúde seguros e eficazes, demanda uma estrutura regulatória sólida e devidamente reconhecida pelas instituições democráticas do país. O agente regulador deve interferir nas atividades econômicas que destoam do que se considera contrário ao interesse público e, sobretudo, no que concerne ao direito fundamental à saúde. Conclusão: a atuação independente e bem fundamentada das agências reguladoras é essencial para garantir a segurança e o bem-estar dos cidadãos em matéria de saúde.

BackgroundLeprosy is caused by multiple interactions between Mycobacterium leprae (M. leprae) and the host's peripheral nerve cells. M. leprae primarily invades Schwann cells, causing nerve damage and consequent development of disabilities. Despite its long history, the pathophysiological mechanisms of nerve damage in the lepromatous pole of leprosy remain poorly understood. This study used the findings of 18F-FDG PET/CT on the peripheral nerves of eight lepromatous patients to evaluate the degree of glucose uptake by peripheral nerves and compared them with clinical, electrophysiological, and histopathological evaluations.MethodsEight patients with lepromatous leprosy were included in this study. Six patients were evaluated up to three months after leprosy diagnosis using neurological examination, nerve conduction study, 18F-FDG PET/CT, and nerve biopsy. Two others were evaluated during an episode of acute neuritis, with clinical, neurophysiological, and PET-CT examinations to compare the images with the first six.ResultsInitially, six patients already had signs of peripheral nerve injury, regardless of symptoms; however, they did not present with signs of neuritis, and there was little or no uptake of 18F-FDG in the clinically and electrophysiologically affected nerves. Two patients with signs of acute neuritis had 18F-FDG uptake in the affected nerves.Conclusions18F-FDG uptake correlates with clinical neuritis in lepromatous leprosy patients but not in silent neuritis patients. 18F-FDG PET-CT could be a useful tool to confirm neuritis, especially in cases that are difficult to diagnose, such as for the differential diagnosis between a new episode of neuritis and chronic neuropathy.

Latin America (LATAM) is a large region comprising 47 countries and territories. Each one carries a different cultural and historical background, diverse political systems, and a particular approach to healthcare management. There is a lack of high-quality data on the epidemiology of inflammatory bowel diseases (IBD) in this region, including broad and detailed information about the penetration of biological and advanced therapies as treatment strategies. From an IBD perspective, patients experience, in general, fragmentations and inequities in the healthcare systems, with different and usually delayed access to qualified health services. This review explores the barriers to accessing IBD care throughout LATAM. The authors compiled data from multiple sources, such as studies focusing on epidemiology, biological penetration, and surgical rates. In addition, overall access to IBD treatments was assessed through a questionnaire distributed to physicians in LATAM via email and direct messaging to capture local perspectives.

Abstract Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. Methods A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. Results Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p

ABSTRACT BACKGROUND In many patients, the diagnosis of Crohn’s disease (CD) is made during surgery for appendicitis in urgent settings. Intraoperative diagnosis can be challenging in certain cases, especially for less experienced surgeons. OBJECTIVE: Review of the literature searching for scientific evidence that can guide surgeons through optimal management of ileocecal CD found incidentally in surgery for acute appendicitis (AA). METHODS: Included studies were identified by electronic search in the PubMed database according to the Preferred Items of Reports for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality and bias assessments were performed by Methodological Index for Non-Randomized Studies (MINORS) criteria for non-randomized studies. RESULTS: A total of 313 studies were initially identified, six of which were selected (all retrospective) for qualitative assessment (two studies were comparative and four only descriptive case series). Four studies identified a high rate of complications when appendectomy or ileocolectomy were performed and in only one, there was no increased risk of postoperative complications with appendectomy. In the sixth study, diarrhea, previous abdominal pain, preoperative anemia and thrombocytopenia were independent predictors for CD in patients previously operated for suspected AA. CONCLUSION: Despite the paucity of data and low quality of evidence, a macroscopically normal appendix should be preserved in the absence of complicated disease when CD is suspected in surgery for AA. Ileocecal resections should be reserved for complicated disease (inflammatory mass, ischemia, perforation or obstruction). Further prospective studies are needed to confirm these claims.

ABSTRACT BACKGROUND: Dyspeptic symptoms are among the eight symptoms that most lead to the use of self-medication globally. OBJECTIVE: The aim of the present study was to evaluate the frequency of use and profile of the population doing self-medication to control dyspeptic symptoms in a capital from South Brazil. METHODS: Application of a survey consisting of topics regarding individual’s socio-cultural data, self-reported comorbidities, use of self-medication in the 15 days prior to the interview and information on the use of this medication. Statistical analysis was performed on the data collected to determine the prevalence of self-medication for dyspeptic symptoms (SMDS) and to establish correlations with independent factors, such as gender, age, body mass index (BMI), education, family income and self-reported comorbidities. RESULTS: A total of 719 individuals from the public health system were interviewed. Overall, 67.7% were female, 65.3% had a BMI greater than 25; 28.4% presented with self-reported hypertension, 21.4% with depression and 13.8% with diabetes. The prevalence of self-medication to control digestive symptoms in this population was 28.7% (95%CI: 25.3-32), 91.8% (n=189) due to complaints of dyspeptic origin. Proton pump inhibitors were the most used class of medication (67%), followed by antacids (15%). There was a relationship between SMDS and age >38 years (OR=1.734, 95%CI: 1.177-2.580, P=0.001), BMI >26 (OR=1.660, 95%CI: 1.166-2.362, P38 years, BMI >26 and self-reported depression were associated with SMDS.

ABSTRACT Background: Real-world data on the use of Ustekinumab (UST) in Brazilian and Latin American patients with Crohn’s disease (CD) are scarce. Objective: The primary endpoint was assessment of clinical remission at weeks 8 and 52, and secondary endpoints were: assessment of clinical response at weeks 8 and 52, endoscopic remission, adverse events, and rates of CD-related abdominal surgery during follow-up. Methods: observational and retrospective study, including patients with CD treated at two centers, who received UST at any time during their treatment. Remission and clinical response were defined as a Harvey-Bradshaw index ≤4 and ≥3 points reduction, respectively. Results: Seventy-four patients were included, 85.1% previously exposed to anti-TNFs. Clinical remission was observed in 45.8% and 59.4% of patients at weeks 8 and 52, respectively. The clinical response rates were 54.2% and 67.6% at weeks 8 and 52. Endoscopic remission was observed in 21.8% of patients. Seventeen patients had adverse events, mostly mild infections, with 22.9% of patients undergoing abdominal surgery (ileocolectomy being the most common procedure). Conclusion UST therapy resulted in significant rates of remission and clinical response, as described in other real-world studies. Few patients had adverse events during treatment, showing its adequate safety profile.

Objetivo: propor uma intervenção em um trecho central da cidade de Montes Claros, nas proximidades da Igreja Matriz de Nossa Senhora da Conceição, a fim de garantir melhor qualidade de vida à população que transita pelo local, além de oferecer novos usos dos locais existentes e garantir a preservação das construções e história que o espaço abriga. Materiais e Métodos: trata-se de um estudo aprofundado sobre o estado de conservação em que se encontra o trecho a ser projetado e, para isso, realizou-se uma análise in loco com registro fotográfico e escrito, além da análise de imagens de satélite e fotografias antigas para melhor compreensão das patologias existentes ao longo do tempo. Para o desenvolvimento do projeto, utilizou-se softwares, como o Autocad, SketchUp, V-Ray e Word. Resultados: o projeto foi desenvolvido visando à revitalização de elementos existentes no espaço e à adaptação para necessidades atuais, evitando intervenções que descaracterizassem uma área histórica e culturalmente relevante. As adaptações primaram pelo bem-estar e bom uso dos pedestres, além de uma restauração estética do local, preservando suas características principais. Conclusão: a intervenção apresentada proporciona melhorias, não só para a qualidade de vida dos habitantes de Montes Claros, mas, também, para o plano urbanístico e o patrimônio cultural e histórico local, garantindo sua preservação e integridade.

O direito processual civil pode ser aprimorado para a resolução de conflitos coletivos, por intermédio dos processos estruturais e negócios jurídicos processuais. O acesso à Justiça é um direito fundamental, que pode ser concretizado por várias vias, além do processo judicial. Processual significa a prática de atos contínuos e sequenciados para a realização de determinada atividade. Abarca o processo judicial e o extrajudicial, judicial, legislativo e administrativo. Negócios jurídicos e processos estruturais são ferramentas processuais, que exigem engajamento das partes no processo de resolução, assumindo responsabilidades e se comprometendo com a manutenção do resultado para o conflito. Conflitos coletivos, envolvendo políticas públicas, envolvem múltiplos interesses e sujeitos. Estruturar o processo é estruturar as relações em conflito, não apenas a relação processual. O conflito nem sempre será resolvido, ou extinto, o que exige o implemento de ferramentas de gestão do conflito, que eduquem e conscientizem as partes para situações futuras.

Historically, toxins from animal venoms have contributed significantly to the discovery of new drugs, as illustrated by captopril, the first drug developed from an animal toxin approved for human use [...]

With the overspread use of measurement of serum levels of anti-tumor necrosis factor (TNF) agents (therapeutic drug monitoring, TDM), new therapeutic strategies have been used in the management of Crohn’s disease (CD). Different targets are correlated with increased levels of circulating drugs. Recent evidence demonstrated that higher serum levels of anti-TNF agents may be associated to better outcomes in perianal fistulizing CD (PFCD). Overall, patients with healed fistulas had higher serum levels of infliximab and adalimumab as compared to those with active drainage. This was demonstrated in some cohort studies, in induction and maintenance, in adults and children with PFCD. In this narrative review, authors summarize current evidence on the use of serum level measurement of anti-TNF agents and its correlation with perianal fistula healing in CD patients. Data on the use of TDM in PFCD is discussed in detail. The retrospective design of the studies and the lack of objective parameters to measure fistula healing are the main limitations of published data. Prospective studies, with central reading of objective radiological parameters, such as pelvic magnetic resonance imaging scores, can improve the level of evidence on the possible advantages of TDM in perianal fistula in CD and are warranted.

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient.

Background: Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn’s disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics. Summary: The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm. Key Messages: While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.

ABSTRACT BACKGROUND: The rates of postoperative endoscopic recurrence (PER) in patients with Crohn’s disease (CD) are consistent. Anti-TNF therapy has been increasingly used in the postoperative setting, despite the lack of robust data in the literature on the measurement of trough levels and consequences of their use. OBJECTIVE: The aim of this review was to assess trough levels of infliximab (IFX) in CD patients after ileocolonic resections in correlation with the presence of PER. METHODS: We searched for studies that evaluated trough levels of IFX in patients with CD, who underwent ileocaecal resections, and correlated them with the presence of PER. We used MEDLINE through PubMed and CENTRAL Cochrane library databases, and after matching the inclusion criteria, the studies were methodologically evaluated with qualitative analysis of the data. RESULTS: A total of 155 studies were initially identified in the databases search and only four matched the inclusion criteria. They comprised one prospective cohort study, one randomized controlled trial and two retrospective cohort studies, the last one performed in pediatric patients. This evidence suggested the correlation of PER with low trough levels of IFX and the presence of antibodies to the drug. The quality of the evidence generated varied from very low to high, due to the heterogeneity found between the studies and the risks of bias that were identified. CONCLUSION: Low levels of IFX and the presence of antibodies to the drug were directly associated with increased PER rates in patients with CD, who underwent ileocolonic resections. Controlled and randomized clinical trials with adequate methodological quality are warranted to confirm the conclusions from this systematic review.

ABSTRACT Therapeutic drug monitoring (TDM) of infliximab (IFX) has been recognized as an important strategy in the management of secondary loss of response to this agent, guiding clinical decision-making in the management of inflammatory bowel diseases (IBD). Although most of the data on the application of TDM for IFX refer to the maintenance phase of treatment, many studies have associated higher drug concentrations, specially in the induction phase, with achievement of important treatment targets, such as clinical remission and mucosal healing. This brief communication aims to summarize the literature on the use of TDM during induction phase of IFX and propose application of a simplified approach which can be useful into clinical practice, aiming better outcomes to IBD patients.

PURPOSEThe HOLA COVID-19 study sought to evaluate the impact of COVID-19 on oncology practices across Latin America (LATAM), challenges faced by physicians, and how practices and physicians adapted while delivering care to patients with cancer.METHODSThis international cross-sectional study of oncology physicians in LATAM included a 43-item anonymous online survey to evaluate changes and adaptations to clinical practice. Multivariable logistic regression analyses were used to evaluate the association of caring for patients with COVID-19 and changes to clinical practice.RESULTSA total of 704 oncology physicians from 19 countries completed the survey. Among respondents, the most common specialty was general oncology (34%) and 56% of physicians had cared for patients with COVID-19. The majority of physicians (70%) noted a decrease in the number of new patients evaluated during the COVID-19 pandemic when compared with prepandemic, and 73% reported adopting the use of telemedicine in their practice. More than half (58%) of physicians reported making changes to the treatments that they offered to patients with cancer. In adjusted models, physicians who had cared for patients with COVID-19 had higher odds of changing the type of chemotherapy or treatments that they offered (adjusted odds ratio 1.81; 95% CI, 1.30 to 2.53) and of delaying chemotherapy start (adjusted odds ratio 2.05; 95% CI, 1.49 to 2.81). Physicians identified significant delays in access to radiation and surgical services, diagnostic tests, and supportive care.CONCLUSIONThe COVID-19 pandemic has significantly disrupted global cancer care. Although changes to health care delivery are a necessary response to this global crisis, our study highlights the significant disruption and changes to the treatment plans of patients with cancer in LATAM resulting from the COVID-19 health care crisis.

Interview with Cynthia McLeod

This paper discusses cross-border projects and their respective social representations to local groups. We present as a case study the boatmen who pilot their boats between Brazil and France on the construction of the Binational Bridge. Catraieiros are currently responsible for much of the logistics between Amapá and French Guiana. Our theoretical framework is based on the literature on Regional Integration and Social Representation. We applied interviews to one third of the catraieiros. We concluded that in the Subject-Representation-Object relationship, the group that understood itself as responsible for the dialogue between two cities built a negative and threatening representation on the Bridge.

“History and international relations in the Guyana Region”

Despite some variability in ideal serum Adalimumab (ADA) concentrations, there is increasing evidence that higher concentrations of anti-TNF-α agents can be associated with sustained efficacy, and low or undetectable levels may lead to loss of response. This study aims to correlate serum ADA concentrations with clinical and endoscopic activity in patients with Crohn’s disease (CD). A cross-sectional and multicentric study was performed with patients with CD, who used ADA for at least 24 weeks. Patients were allocated into groups according to the presence of clinical or endoscopic disease activity. Serum ADA concentrations were measured and compared between groups. Overall, 89 patients were included. A total of 27 patients had clinically active CD and 62 were in clinical remission. Forty patients had endoscopic disease activity and 49 were in endoscopic remission. The mean serum ADA concentration was 10.2 μg/mL in patients with clinically active CD and 14.3 μg/mL in patients in clinical remission (p = 0.395). The mean serum ADA concentration in patients with endoscopic activity was 11.3 μg/mL as compared to 14.5 μg/mL in those with endoscopic remission (p = 0.566). There was no difference between serum ADA concentrations regarding clinical or endoscopic activity in CD, as compared to patients in remission

Background and Objectives: At present, there is no consensus definition of mild-to-moderate disease activity in patients with ulcerative colitis. The objective of the present study was to establish a reliable definition of mild-to-moderate disease activity in adult patients with ulcerative colitis. Materials and Methods: Twelve physicians from around the world participated in a virtual consensus meeting on 26 September 2022. All the physicians had expertise in the diagnosis and treatment of inflammatory bowel disease. After a systematic review of the literature and expert opinion, a modified version of the RAND/University of California, Los Angeles appropriateness method was applied. A total of 49 statements were identified and then anonymously rated (on a 9-point scale) as being appropriate (scores of 7 to 9), uncertain (4 to 6) or inappropriate (1 to 3). The survey results were reviewed and amended before a second round of voting. Results: Symptom and endoscopic-based measurements are of prime importance for assessing mild-to-moderate ulcerative colitis activity in clinical trials. The experts considered that clinical activity should be assessed in terms of stool frequency, rectal bleeding and fecal urgency, whereas endoscopic activity should be evaluated with regard to the vascular pattern, bleeding, erosions and ulcers. Fecal calprotectin was considered to be a suitable disease activity marker in mild-to-moderate ulcerative colitis. Lastly, mild-to-moderate ulcerative colitis should not have more than a small impact on the patient’s daily activities. Conclusions: The present recommendations constitute a standardized framework for defining mild-to-moderate disease activity in clinical trials in the field of ulcerative colitis.

Abstract Two experiments were carried out to test better stocking proportion according to animal size for tilapia (Oreochromis niloticus) and tadpole (Lithobates catesbeianus). The experiments were laid out in a completely randomized design with five treatments (in Experiment I) and four treatments (in Experiment II). In Experiment I, the treatments consisted of a tilapia monoculture; a 75% tilapia + 25% tadpole polyculture; a 50% tilapia + 50% tadpole; a 25% tilapia + 75% tadpole; and a tadpole monoculture. In Experiment II, the treatments were represented by a tilapia monoculture; a 12.5% tilapia + 87.5% tadpole polyculture; a 25% tilapia + 75% tadpole; and a tadpole monoculture. In the first trial, mortality rate differed significantly, with the polyculture treatments having almost 100% mortality of tadpoles. In the second experiment, after adjustments in the initial size of the species, there were significant differences between treatments, with the 12.5% tilapia + 87.5% tadpole polyculture and the tadpole monoculture providing the best results. Regardless of the chosen density, for a polyculture of Nile tilapia and bullfrog tadpoles, ideal conditions would be stocking tilapia fry weighing 50% of the weight initial tadpoles and the proportion of one tilapia for seven tadpoles.

ABSTRACT Purpose: To evaluate the effects of sucralfate enemas in tissue contents of E-cadherin and ?-catenin in an experimental diversion colitis. Methods: Thirty-six male Wistar rats were submitted to a proximal colostomy and a distal mucous fistula. They were allocated into three groups: first group received daily saline enemas (2 mL/day) and the two other groups daily enemas with sucralfate at dosage of 1 or 2 g/kg/day, respectively. Six animals of each group were euthanized after two weeks and six animals after four weeks. The inflammation of the excluded mucosa was evaluated by histological analysis. The oxidative damage was quantified by measurement of malondialdehyde tissue levels. The expression of E-cadherin and ?-catenin was identified by immunohistochemistry, and its contents were quantified by computer-assisted image analysis. Results: Sucralfate enemas reduced inflammation in animals subjected to treatment with 2 g/kg/day by four weeks, and the levels of oxidative damage in mucosa without fecal stream irrespective of concentration and time of intervention. E-cadherin and ?-catenin content increased in segments without fecal stream in those animals subjected to treatment with sucralfate. Conclusions: Sucralfate reduces the inflammation and oxidative stress and increases the tissue content of E-cadherin and ?-catenin in colonic mucosa devoid to the fecal stream.

O Agaricus blazei foi estudado em projeto temático quanto à tecnologia de cultivo, composição bioquímica e efeitos protetores.