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Introduction: Malignant small bowel neoplasms are rare entities, and knowledge about them remains limited due to their histological diversity and the challenges associated with their investigation. However, their rising incidence has generated increasing clinical and research interest. This study aimed to describe the demographic and clinical characteristics of patients with malignant neoplasms of small bowel and the evolution in their diagnosis over 20 years in a tertiary center. Methods: Single-center retrospective study of data of patients with malignant small bowel neoplasms diagnosed between 2001 and 2020 in a tertiary hospital was performed. Statistical analysis was performed with SPSS version 29.0 (significance level ≤0.05). Results: Out of 135 patients included, 57% were male. Eighty-nine neoplasms (65.9%) were found in the jejunum/ileum. Adenocarcinomas were the most frequently diagnosed neoplasms (31.1%), followed by neuroendocrine tumors (28.1%). At the time of diagnosis, the majority of patients (80.7%) were symptomatic, with severe complications – including obstruction, hemorrhage, or perforation – occurring in 55.4% of cases. Diagnosis typically involved CT scan (40.7%) or upper digestive endoscopy (22.2%); notably, 22.2% patients still required surgery for diagnosis. Diagnoses were mainly made between 2011 and 2020 (65.9%). Between 2001 and 2010, the most common diagnosed tumors were adenocarcinomas (37.0%), whereas between 2011 and 2020, the most frequently diagnosed malignant neoplasms were neuroendocrine tumors (37.1%). The distribution of histological types differed significantly over the years (p = 0.016). Adenocarcinoma had a higher mortality rate (54.8%) compared to neuroendocrine tumors (7.9%). Discussion/Conclusion: Given the rarity of these tumors, the cohort of malignant small bowel neoplasms collected at this tertiary center over a 20-year period represents a substantial sample. More than half of patients were symptomatic at diagnosis, despite diagnostic advances over the years. In the last 10 years of the study, there has been an increase in incidence as well as in 5-year survival rates, possibly due to the higher incidence of neuroendocrine tumors and the lower incidence of adenocarcinomas. Notably, the diagnosis of each histological neoplasm type differed significantly statistically over the years, with neuroendocrine tumors being the most diagnosed in recent years.

Introduction: Considered an unpredictable and recurring problem, Neurogenic Bowel does not resolve over time and progressively worsens, translating into a physical and psychological challenge, significantly reducing Quality of Life. Objective: To construct and validate the face and content of an educational technology for use by nurses in the rehabilitation of Neurogenic Bowel in people with Spinal Cord Injury. Materials and Methods: A methodological, quantitative study developed in two stages: the construction of an educational technology on the Canvas platform based on a literature review based on Wanda Horta's Theory of Human Needs and its validation by expert judges. The validation process included nurses with ability in neurogenic bowel in teaching, research or care. The criterion for validation was agreement of over 80%, analyzed using the Content Validation Index and binomial test with confidence intervals of 95.00% (p<0.05). Results: The integrative literature review proved necessary for the construction of the proposed educational technology and covered characteristics of the Neurogenic Bowel, bowel emptying techniques, guidelines and the systematization of nursing care. The protocol was validated by ten expert judges who had graduated in nursing for more than 10 years (100.00%), with an average age of 41.8 years, female (60.00%) and an average training period of 18.6 years. An overall Content Validation Index of 0.96 (p≤0.001) was obtained for the items assessed (objective, content, relevance, functionality, efficiency and appearance/diagramming). Discussion: The implementation of an intestinal rehabilitation program aims, above all, to achieve frequent, regular and consistent stools in people with spinal cord injury and nurses, as multipliers of knowledge, can be facilitators in the teaching-learning process for carers, people with this condition and other members of the healthcare team. Conclusion: It can be concluded that the educational technology has been validated and could help the teaching-learning process for nurses in the clinical practice of caring for people with Neurogenic Bowel Disease.

Megalopyge opercularis (Smith) (Lepidoptera: Megalopyridae) is a nocturnal moth of medical importance because it causes adverse immunological reactions in humans. In this study, we determined the microbiota composition of M. opercularis at the larval (caterpillars) and adult (moths) stages by next-generation sequencing. DNA was extracted from the caterpillars and moths, and the 16S rRNA prokaryote gene was then amplified and sequenced with next-generation sequencing to assess bacterial richness. Comparison of the microbiota of the caterpillars and adults revealed variation in species composition and diversity. The microbiota of the caterpillars of M. opercularis was composed of 259 species, dominated by the families Geodermatophilaceae (12%), Propionibacteriaceae (10.41%), Clostridiaceae (9.63%), and Nitriliruptoraceae (7.72%). In the adult moths, we found 138 species, and the most abundant families were Nostocaceae (24%) and Methylobacteriaceae (21%). Species richness in M. opercularis was higher in the caterpillars compared to adults. We determined that only some groups of bacteria could persist from 1 stage to another. The results obtained are essential to know about the ecology of M. opercularis and contribute to our understanding of the impact that microorganisms have on the physiological mechanisms of poisonous lepidopterans. Megalopyge opercularis (Smith) (Lepidoptera: Megalopyridae) es una especie de polilla nocturna perteneciente a la familia Megalopyridae de importancia médica debido a las reacciones inmunológicas causadas en humanos por sustancias urticantes ubicadas en sus estructuras espinosas. En este estudio, determinamos el microbioma de M. opercularis en su estado larval y en su estado adulto. Se extrajo el ADN de larvas y adultos y se amplificó el gen rRNA 16S mediante tecnologías de secuenciación de nueva generación. Las comparaciones del microbioma larval contra el microbioma adulto revelaron variación tanto en la composición como en la diversidad de especie. El microbioma larval de M. opercularis está compuesto de 259 especies, dominado por las familias Geodermatophilaceae (12%), Propionibacteriaceae (10.41%), Clostridiaceae (9.63%), y Nitriliruptoraceae (7.72%). En el microbioma adulto encontramos 138 espcies, las familias más abundantes fueron Nostocaceae (24%) y Methylobacteriaceae (21%). La riqueza de especies encontradas en M. opercularis fue mayor en las orugas en comparación con los adultos. Determinamos que solo algunos grupos de bacterias podían persistir de una etapa a otra. Los resultados obtenidos son importantes para conocer la ecología de esta polilla y contribuyen a comprender el impacto que tienen los microorganismos en los mecanismos fisiológicos de los lepidópteros venenosos.

BackgroundDespite a significant 30% ten-year readmission rate for SBO patients, investigations into recurrent risk factors after non-operative management are scarce. The study aims to generate a risk factor scoring system, the ‘Small Bowel Obstruction Recurrence Score’ (SBORS), predicting 6-month recurrence of small bowel obstruction (SBO) after successful non-surgical management in patients who have history of intra-abdominal surgery.MethodsWe analyzed data from patients aged ≥ 18 with a history of intra-abdominal surgery and diagnosed with SBO (ICD-9 code: 560, 568) and were successful treated non-surgically between 2004 and 2008. Participants were divided into model-derivation (80%) and validation (20%) group.ResultsWe analyzed 23,901 patients and developed the SBORS based on factors including the length of hospital stay > 4 days, previous operations > once, hemiplegia, extra-abdominal and intra-abdominal malignancy, esophagogastric surgery and intestino-colonic surgery. Scores > 2 indicated higher rates and risks of recurrence within 6 months (12.96% vs. 7.27%, OR 1.898, p < 0.001 in model-derivation group, 12.60% vs. 7.05%, OR 1.901, p < 0.001 in validation group) with a significantly increased risk of mortality and operative events for recurrent episodes. The SBORS model demonstrated good calibration and acceptable discrimination, with an area under curve values of 0.607 and 0.599 for the score generation and validation group, respectively.ConclusionsWe established the effective ‘SBORS’ to predict 6-month SBO recurrence risk in patients who have history of intra-abdominal surgery and have been successfully managed non-surgically for the initial obstruction event. Those with scores > 2 face higher recurrence rates and operative risks after successful non-surgical management.

The irritable bowel syndrome is reported often in the general population. Studies show that stress coexists with this malady. The purpose of this study was to identify physical and psychological symptoms of chronic stress as predictors of the irritable bowel syndrome in medical students at a public university in Mexico. A random representative sample of 561 students was evaluated in 2014. The Stress Symptom Inventory and the ROMA III Criteria were used. A multiple regression analysis was performed. This study showed that the psychophysiological symptoms of chronic stress: difficulties in concentrating, an urge to constantly eat, clinched jaw, abdominal pain, weakness-dizziness, anxiety feelings and constipation, were predictors of the irritable bowel syndrome. Therefore, the recommendation is to implement educational programs aimed at the identification and timely prevention of the psychophysiological symptoms of chronic stress as a risk factor for the presence of irritable bowel syndrome in medical students.

AbstractBackground: In 2018, the authors surveyed the clinical practices among Portuguese gastroenterologists (PGEs) regarding treatment targets in Crohn’s disease (CD) and ulcerative colitis (UC). Since then, new evidence has emerged supporting additional targets, such as transmural remission and histological remission. This study provides an updated assessment of treatment practices among PGE with special emphasis on these new targets. Methods: Using the Portuguese Inflammatory bowel disease Study Group (GEDII) physician database, we invited PGE to participate in an anonymous online survey. Results: Fifty-six physicians agreed to participate in the study. Deep remission, steroid-free clinical remission, endoscopic remission, and biomarker remission were ranked among the most important treatment targets in CD (89%, 80%, 89%, and 84%, respectively) and UC (82%, 84%, 79%, and 84%, respectively). In CD, transmural remission was considered a target by 70% of participants, with 48% agreeing to intensify treatment to achieve it. In UC, histological remission was aimed by only 45% of PGE with most (88%) being unwilling to intensify treatment to achieve this goal. Physicians were more likely to seek endoscopic remission in CD and UC in younger and healthier patients, compared to older patients with comorbidities. Conclusion: PGEs are increasingly pursuing tougher treatment targets such as transmural remission in CD and, to a lesser extent, histological remission in UC. Physicians are more willing to escalate treatment to achieve endoscopic remission in younger patients.

Introduction: Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBDs) characterised by chronic inflammation of the digestive tract. Patients with IBD often present a suboptimal disease control due to the limited efficacy of current treatments and inadequate disease management. A suboptimal disease control is often associated with poor quality of life (QoL) and a higher economic burden. The objective of this study was to assess the proportion of suboptimal disease control in daily clinical practice, the associated impact on QoL, and the economic burden in patients with UC and CD in Portugal. Methods: This was a non-interventional, multicentre study, wherein clinician-reported outcomes, patient-reported outcomes, and retrospective data were collected from medical chart review from May 17, 2022, to October 17, 2022, in five hospital centres in Portugal. The primary outcomes of this study were to estimate: (1) the proportion of CD and UC patients with suboptimal disease control, according to the STRIDE-II based recommendations, and (2) the associated impact on QoL of optimal and suboptimal controlled CD or UC. Results: Of 130 patients included (67 with CD and 63 with UC), 56.7% of CD and 31.7% of UC patients were reported to have suboptimal disease control according to STRIDE-II based recommendations. Notably, 82.1% and 54.0% of the patients with CD and UC were currently on targeted immunomodulator (TIM). Patients with CD and UC and suboptimal disease control showed an impaired QoL compared to those with optimal control. Mean annual healthcare costs were substantially higher among patients with CD with optimal control and patients with UC with suboptimal control. Conclusion: Despite the high rate of treatment with TIM, a considerable proportion of patients with IBD had a suboptimal disease control, indicating a substantial disease burden. Ensuring effective disease management of these patients is crucial as a suboptimal disease control may negatively affect the patient’s long-term clinical outcomes and QoL.

Abstract Background: Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy. Summary: Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment. Key Messages: CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.

Essential oils (EOs) are important aromatic components of herbs and spices and their biological activities have been known and utilised since ancient times in perfumery, food preservation, flavouring, and medicine. Some of their biological activities include antibacterial, antifungal, anti-oxidant and anti-inflammatory effects amongst others. EOs have received attention in recent years as potential 'natural' alternatives for replacing antibiotic growth promoters (AGPs) in animal diets due to their positive impact on growth performance, gut microbiota and welfare. The purpose of this paper is to provide an overview of our own published and unpublished data on the antibacterial, antifungal and insecticidal activity of thymol and cinnamaldehyde (TC blend), and to describe the effects of this specific EO blend on gut microbiota, growth performance and welfare, carcass characteristics and food safety. The possible modes of action of EOs are discussed and areas for future research are proposed.

Abstract Background: Short bowel syndrome is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). Patients need parenteral support for months or years. Ideally, it should be delivered at home, reducing limitations in everyday life activities. Summary: The Portuguese Health Directive 017/2020 was the first step in the regulation of home CIF management, and more patients are now being treated in an ambulatory setting. However, much work still needs to be performed in this area. Our country lacks a network of units capable of providing home parenteral nutrition (HPN), and only a few centers have expertise to take care of these complex patients: fluid support, oral, enteral, and parenteral nutrition; disease/HPN-related complications; pharmacologic treatment; and surgical prevention/treatment. Providing adequate transition from pediatric to adult care is a mandatory issue that should only be addressed by expert centers. Key Messages: Implementation of a national network, as well as the creation of an intestinal failure registry, with an initial focus on adult patients, will start a new era in the identification and management of these complex CIF patients. Background: Short bowel syndrome is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). Patients need parenteral support for months or years. Ideally, it should be delivered at home, reducing limitations in everyday life activities. Summary: The Portuguese Health Directive 017/2020 was the first step in the regulation of home CIF management, and more patients are now being treated in an ambulatory setting. However, much work still needs to be performed in this area. Our country lacks a network of units capable of providing home parenteral nutrition (HPN), and only a few centers have expertise to take care of these complex patients: fluid support, oral, enteral, and parenteral nutrition; disease/HPN-related complications; pharmacologic treatment; and surgical prevention/treatment. Providing adequate transition from pediatric to adult care is a mandatory issue that should only be addressed by expert centers. Key Messages: Implementation of a national network, as well as the creation of an intestinal failure registry, with an initial focus on adult patients, will start a new era in the identification and management of these complex CIF patients.