Total retocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgery of choice for patients with ulcerative colitis (UC) that are refractory to clinical treatment. Pouchitis is one of the most common complications after this procedure. Defects in autophagy have been reported in inflammatory bowel diseases. However, there are no studies on the IP. Therefore, we studied markers for autophagy in the IP mucosa of UC and FAP patients comparing them to controls with a normal distal ileum. Sixteen patients with IP in "J" shape, asymptomatic and with endoscopically normal IP were evaluated. The control group consisted of eight patients with normal colonoscopy. There was a significant decrease in the transcriptional levels of ATG5, MAP1LC3A and BAX in the FAP group. There was also a decrease in the protein level of Beclin-1 in the UC and FAP compared to the control group. Although the LC3II levels by immunoblot were higher in the UC group, LC3/p62 co-localization were lower in the immunofluorescence analysis in the UC and FAP compared to the control group. Corroborating these results, there was an increase of p62 by immunoblot in the UC group. These findings indicated a modulation of macroautophagy markers in the IP, which may explain the mucosa inflammation predisposition.Ulcerative colitis (UC) is a chronic intestinal inflammation that can affect the large intestine and rectum. Its etiology is not completely established. Familial adenomatous polyposis (FAP) is an autosomal dominant disease which affects young individuals and is associated with the formation of multiple polyps in the large intestine and rectum, which invariably implies a greater risk of cancer 1,2 . Both diseases, despite being different, may require the same surgical procedure. The ileal pouch-anal anastomosis (IPAA) is the elective procedure of choice in the surgical management of refractory UC, and FAP with many polyps in the rectum 3 . The main complication after this procedure is the pouch inflammation (pouchitis) that can affect up to 45 percent of patients who are submitted to IPAA for UC, and only five percent of the FAP patients who undergo the same procedure 4 . This suggests that constitutive differences between UC and FAP pouches have a critical role in its pathogenesis.Pouchitis develops only after ileostomy closure, when the pouch mucosa starts to be exposed to the fecal stream 5 . The distinct immunological aspects of the different inflammatory bowel diseases (IBD), specifically UC, which involve impaired innate and adaptive responses, associated to genetic susceptibility, environmental factors, and intestinal microbiota may be involved in the pouch inflammation etiology 5,6 . Autophagy is an evolutionarily conserved catabolic pathway that consists of selective degradation of cellular components and a homeostatic mechanism that protects cells exposed to stress situations (toxins, starvation) 7,8 . There are three primary forms of authophagy: macroautophagy, microautophagy and chaperone-mediated autophagy (CMA) 9 . Although there ar...

ResumoContexto: Não há estudos metodologicamente adequados sobre a eficácia da homeopatia na depressão. Relatos de casos clínicos são os primeiros degraus da evidência clínica, a caminho de estudos controlados. Objetivos: Relatar resultados preliminares do tratamento homeopático de pacientes com depressão no SUS de Jundiaí. Métodos: Revisão dos prontuários dos casos novos, atendidos entre março e dezembro de 2006. O diagnóstico foi confirmado por entrevista estruturada. Os pacientes receberam homeopatia individualizada e a evolução foi avaliada pela escala de Montgomery & Åsberg (MADRS). Resultados: Foram tratados 15 casos e observou-se resposta terapêutica (redução maior que 50% dos escores de depressão) em 14 pacientes (93%), após uma média de sete semanas de tratamento; um paciente apresentou piora clínica e foi encaminhado ao tratamento convencional. O escore média (± dp) na Escala de Avaliação de Depressão de Montgomery-Åsberg diminuiu de 24,9 (± 5,8) a 9,7 (± 8,2, p < ,0001) na segunda avaliação, resultados mantidos no decorrer da terceira e quarta consultas. Conclusões: Os resultados sugerem que a homeopatia pode ser uma alternativa terapêutica no tratamento da depressão, mas estudos randomizados e controlados são necessários para se testar a eficácia e segurança do tratamento homeopático dos transtornos depressivos.Adler U.C. et al. / Rev. Psiq. Clín 35 (2); 74-78, 2008 Palavras-chave: Homeopatia, depressão, SUS, relato de série de casos. AbstractBackground: Evidence for the efficacy of homeopathy for depression is limited due to lack of clinical trials of high quality. Case reports are the first steps of clinical evidence, towards controlled trials. Objectives: To report preliminary results of homeopathic treatment of depression in Jundiai's public health system, Sao Paulo. Methods: Review of the medical records of new patients, treated between March and December 2006. Their diagnosis was confirmed by a semi-structured interview. Patients received individualized homeopathy and their response was measured by the Montgomery & Åsberg depression scale (MADRS). Results: Fifteen patients were treated and response (more than 50% decrease of MADRS scores) was observed in 14 patients (93%), after an average of seven weeks of treatment; one patient had clinical worsening and was refered to conventional antidepressant therapy. The MADRS mean scores (± dp) decreased from 24.9 (± 5.8) to 9.7 (± 8.2, p < .0001) in the 2 nd evaluation, and these results signifcance were sustained through the 3 rd and 4 th assessments. Discussion: these results suggest that homeopathy may be an alternative therapeutics for depression, but randomized and controlled studies are needed to test the efficacy and safety of the homeopathic treatment of the depressive disorders.

BackgroundDifferential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn’s disease.Case presentationWe report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn’s disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome.ConclusionParacoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.

Emergency conditions in CD may result in significant morbidity, but are normally associated with low mortality, if identified and treated properly.

1-INTRODUÇÃO 1.1 -Considerações Gerais 1.2 -O Papel da Microbiota Intestinal 1.2.1 -Funções da microbiota 1.2.2 -Microbiota e o reservatório ileal 1.3 -Sistema imune inato 1.3.1 -Defensinas 1.3.2 -Vias de sinalização celular dos receptores de antígenos bacterianos 1.4 -Toll-like receptors e RCUI 1.5 -Vias de sinalização celular dos Toll-like receptors no reservatório ileal 2.0 -OBJETIVO 2.1 -Objetivo Geral 2.2 -Objetivos Específicos xx xxi 3.0 -CASUÍSTICA E MÉTODO 3.1 -Casuística 3.1.1 -Fatores de exclusão 3.1.2 -Parecer do Comitê de Ética em Pesquisa 3.2 -Método 3.2.1 -Coleta das amostras 3.2.2 -Anticorpos, reagentes químicos e materiais 3.2.3 -Soluções utilizadas 3.2.4 -Extração de tecidos e imunoblot 3.2.5 -Determinação das bandas 3.2.6 -Apresentação dos dados e análise estatística 3.2.7 -Análise Histológica (coloração com Hematoxilina -Eosina) 4.0 -RESULTADOS 4.1-Expressão de TLR2 4.2 -Expressão de TLR4 4.3 -Expressão de p-JNK 5.0 -DISCUSSÃO xxii xxiii 6.0 -CONCLUSÃO 7.0 -REFERÊNCIAS BIBLIOGRÁFICAS 8.0 -ANEXOS 8.1 -Grupo Retocolite Ulcerativa Inespecífica (RCUI) 8.2 -Grupo Polipose Adenomatosa Familiar (PAF) 8.3 -Controle 8.4 -Análise estatística -Caracterização da Casuística 8.4.1 -Grupo PAF 8.4.2 -Grupo RCUI 8.4.3 -Grupo Controle 8.4.4 -Análise de variância da distribuição por idade 8.4.5 -Análise de variância da distribuição por gênero 8.4.6 -Análise de variância da distribuição com relação ao tempo pós-operatório 8.4.7 -Análise de variância da distribuição com relação ao tempo de fechamento da ileostomia 8.5 -Mensuração do índice de atividade da ileíte do reservatório xxiv xxv no grupo RCUI 8.6 -Mensuração do índice de atividade da ileíte do reservatório no grupo PAF 8.7 -Questionário específico 8.8 -Hábito intestinal e continência fecal -Grupo RCUI 8.9 -Hábito intestinal e continência fecal -Grupo PAF 8.10 -Parecer de aprovação do estudo pelo Comitê de Ética em Pesquisa 8.11 -Parecer do Comitê de Ética (Adendo) 8.12 -Termo de consentimento informado -Grupos RCUI e PAF 8.13 -Termo de consentimento informado -Grupo Controle 8.14 -Descrição da análise estatística utilizada no estudo 8.14.1 -Análise de variância 8.14.2 -Desvio do erro padrão 8.14.3 -Valor p 8.14.4 -Teste de Tukey (Teste de Comparações Múltiplas) xxvi xxvii