Purpose: Ulcerative colitis (UC) can be managed with immunomodulation or surgery. We aimed to understand whether these strategies had a different impact on patients’ health-related quality of life (HRQoL). Methods: This was a retrospective, cross-sectional study: patients who had a moderate to severe UC episode that prompted the utilization of immunomodulatory drugs or surgery were invited to complete a generic (short form [36] health survey [SF-36]) and a disease-specific (inflammatory bowel disease questionnaire [IBDQ]) survey. Results: We included 157 patients, 65 (41.4%) surgically treated. The therapeutic procedure had a minimal impact on HRQoL: only the social dimension of the IBDQ and the physical function component of the SF-36 were significantly different between the study arms – lower for the surgically treated patients. The type of surgery had no impact, but the occurrence of pouchitis, namely, in a chronic form, was associated with a lower HRQoL. Regression analysis confirmed surgery as an independent predictor of lower scores in the social dimension of the IBDQ (–4.646, 95% CI –6.953 to –2.339) and in the physical functioning (–9.622, 95% CI –17.061 to –2.183) and physical role functioning (–3.669, 95% CI –7.339 to 0.001) dimensions of the SF36. Conclusions: Although usually feared by patients, surgery has a limited impact on UC patients HRQoL when compared to medical management with immunomodulatory drugs.
This paper presents a discussion on the application of different techniques (e.g. network reliability and logistics concepts) for emergency management. Special attention is given to decision-making support in the context of roading networks before, during and after stress emergency situations. It is understood that the complexity of emergencies can quickly overwhelm organizations and personnel and ultimately lead to poor decision-making and loss of life and wealth. In this respect, a method is proposed to both support network analysis and resource allocation to fix road networks prone to disasters. A Road Network Emergency Management model has been designed to assist technically-sound preparations and decision-making during emergencies. Case study results indicate that the chosen techniques and the proposed model can help organizations to better manage emergencies; however, they do not satisfy all the resource, personnel and governmental managerial needs identified for dealing with real emergencies. In this context, a new field of study, namely Humanitarian Logistics, is proposed in an effort to fill the conceptual gaps observed in many previous studies of Emergency Management.
Purpose: Whipple's disease is a rare systemic disorder caused by infection with Tropheryma whipplei, that is a diagnostic challenge due to the unspecificity of its symptoms. Simultaneous infection with Giardia lamblia is an uncommon association, for which etiology is still a matter of debate. The authors present the case of a 61-year-old female who was referred to the gastroenterology department for abdominal pain, diarrhea and arthralgias. The investigation revealed anemia, hypoalbuminemia and inflammatory markers' elevation, and fecal smears were positive for Giardia lamblia. After effective treatment, the patient remained symptomatic. Colonoscopy was normal and the upper endoscopy revealed edematous mucosa on the second duodenal portion. Histopathology of the duodenal biopsy revealed macrophages infiltration, inconclusive for periodic acid-schiff and negative for Ziehl-Nielsen stains. However, polymerase chain reaction (PCR) for Tropheryma whipplei was positive. A capsule endoscopy revealed areas of whitish reticular pattern and dilated villi with lymphangiectasias in the jejunum and ileum. Whipple's disease was suspected and antibiotherapy with ceftriaxone followed by trimethoprim-sulfamethoxazole was done. After eight months of treatment, the patient was asymptomatic; anterograde and retrograde single balloon enteroscopy were performed revealing resolution of the lesions, and the biopsies had negative histological findings and PCR for Tropheryma whipplei. This case is original for the association between giardiasis and Whipple's disease, for which etiology is still a matter of debate, as well as for the paucity of changes in the duodenal mucosa along with exuberant changes of the jejunum and ileum in the context of Whipple's disease.
'/%3e%3c/g%3e%3cuse xlink:href='%23d' x='45.714'/%3e%3cuse xlink:href='%23e' transform='matrix(-1 0 0 1 479.792 0)'/%3e%3cg id='f' fill='%23fff'%3e%3cpath fill='%23039' d='M232.636 202.406v.005c0 2.212.85 4.227 2.212 5.69 1.365 1.466 3.245 2.377 5.302 2.377 2.067 0 3.944-.905 5.303-2.365 1.358-1.459 2.202-3.472 2.202-5.693v-10.768l-14.992-.013-.028 10.766'/%3e%3ccircle cx='236.074' cy='195.735' r='1.486'/%3e%3ccircle cx='244.392' cy='195.742' r='1.486'/%3e%3ccircle cx='240.225' cy='199.735' r='1.486'/%3e%3ccircle cx='236.074' cy='203.916' r='1.486'/%3e%3ccircle cx='244.383' cy='203.905' r='1.486'/%3e%3c/g%3e%3cuse xlink:href='%23f' y='-26.016'/%3e%3cuse xlink:href='%23f' x='-20.799'/%3e%3cuse xlink:href='%23f' x='20.745'/%3e%3cuse xlink:href='%23f' y='25.784'/%3e%3c/svg%3e)
