Julio Baima

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Daniel L Cerqueira

Universidade Federal do Maranhão - UFMA

Éliton Pereira

Instituto Federal de Educação, Ciência e Tecnologia de Goiás - Campus Goiânia

Rui Matoso

ESAD - Escola Superior de Artes e Design

Sheila Zagury

Universidade Federal do Rio de Janeiro (UFRJ)

Marcelo Dalla Vecchia

UFSJ - Federal University of São João Del-Rei

Wendell Emmanuel Brito de Sousa

Instituto Federal de Educação, Ciência e Tecnologia do Amazonas

Jana Javornik

University of East London

Gwen Robbins Schug

University of North Carolina at Greensboro

Gabriel Gutierrez-Alonso

University of Salamanca

John Sutton

Macquarie University

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Papers by Julio Baima

Clinical and Psychological Factors Associated with Addiction and Compensatory Use of Facebook Among Patients with Inflammatory Bowel Disease: A Cross-Sectional Study

International Journal of General Medicine

Background: Inflammatory bowel diseases are chronic conditions characterized by incapacitating sy... more Background: Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient's quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients. Methods: This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale. Results: The patient group included 54 patients with Crohn's disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients

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Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

World Journal of Gastroenterology

BACKGROUND Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs... more BACKGROUND Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden, especially in patients with moderate-to-severe disease. The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil (RISE BR) study was a noninterventional study designed to evaluate disease control, treatment patterns, disease burden and health-related quality of life in patients with moderate-to-severe active IBD. We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD. AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil. METHODS This was a prospective, noninterventional study of adult patients with active Crohn’s disease (CD: Harvey-Bradshaw Index ≥ 8, CD Activity Index ≥ 220), inadequate CD control (i.e., calprotectin > 200 µg/g or colonoscopy previous results), or active ulcerative colitis (UC: Partial Mayo score ≥ 5). Enrollment occurred in 14 centers from October 2016 to February 2017. The proportion of active IBD patients after 9-12 mo of follow-up, Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation, discontinuation and dose changes were examined. RESULTS The study included 118 CD and 36 UC patients, with mean ± SD ages of 43.3 ± 12.6 and 44.9 ± 16.5 years, respectively. The most frequent drug classes at index were biologics for CD (62.7%) and 5-aminosalicylate derivates for UC patients (91.7%). During follow-up, 65.3% of CD and 86.1% of UC patients initiated a new treatment at least once. Discontinuations/dose changes occurred in 68.1% of CD patients [median 2.0 (IQR: 2-5)] and 94.3% of UC patients [median 4.0 (IQR: 3-7)]. On average, CD and UC patients had 4.4 ± 2.6 and 5.0 ± 3.3 outpatient visits, respectively. The median time to first mild or no activity was 319 (IQR: 239-358) d for CD and 320 (IQR: 288-358) d for UC patients. At 9-12 mo, 22.0% of CD and 20.0% of UC patients had active disease. CONCLUSION Although a marked proportion of active IBD patients achieved disease control within one year, the considerable time to achieve this outcome represents an unmet medical need of the current standard of care in a Brazilian real-world setting.

Anti-TNF therapy for ulcerative colitis in Brazil: a comparative real-world national retrospective multicentric study from the Brazilian study group of IBD (GEDIIB)

BMC Gastroenterology

Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC... more 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 wh...

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N02 The importance of the multidisciplinary team (MDT) and its impact on quality of life and medication adherence in patients with Inflammatory Bowel Disease

Journal of Crohn's and Colitis, 2022

Background IBD is a chronic immune-mediated disease that requires continuous patient care. The fr... more Background IBD is a chronic immune-mediated disease that requires continuous patient care. The frequent contact and the good relationship with the multidisciplinary team (MDT) are essential for improving quality of life (QoL) and medication adherence aiming at treatment success. The aim of the study was to assess the importance of MDT in the view of patients with IBD and its impact on QoL and in medication adherence. Methods A cross-sectional study was carried out, including 114 patients from an IBD reference center in Brazil. The relevance of MDT was assessed through a questionnaire that included the importance of physicians, nurses, nutritionists and psychologists in the patient care. QoL was assessed by IBDQ. Treatment adherence and knowledge about the disease were assessed using the Morisky and CCKNOW questionnaires, respectively. Results In total, 69 (60.53%) patients with CD and 45 (39.47%) patients with UC were included. The mean age was 39.16 (±13.50) years and 58.77% were f...

Small Intestinal Hemangioma: A Case Report

American Journal of Case Reports, 2021

Patient: Female, 46-year-old Final Diagnosis: Hemangioma Symptoms: Abdominal distension • abdomin... more Patient: Female, 46-year-old Final Diagnosis: Hemangioma Symptoms: Abdominal distension • abdominal pain • anemia Medication: — Clinical Procedure: Colonoscopy • laparotomy Specialty: Gastroenterology and Hepatology • Pathology Objective: Rare disease Background: Hemangiomas are benign vascular neoplasms that originate from fast-growing embryonic mesodermal tissue and have a proliferation of endothelial cells, which manifest themselves in different forms, locations, and dimensions. Owing to its rarity and similarity of symptoms with other chronic bowel diseases, intestinal hemangioma is a differential diagnosis to be considered in patients presenting with symptoms such as abdominal pain and anemia. Case Report: A 46-year-old woman with a history of diffuse abdominal pain and abdominal distension for 20 years presented with a worsening of symptoms in the past year. She denied weight loss or changes in bowel habits or stool appearance. Laboratory investigations showed microcytic hypochromic anemia. Colonoscopy results were normal. A contrast-enhanced abdominal computed tomography scan showed focal and concentric thickening of the small intestine, measuring 8.3 cm, and associated with calcifications, intestinal dilation, mesenteric lymph node enlargement, and vascular dilatation and consistent with infectious granulomatous diseases such as intestinal tuberculosis, carcinoid tumor, Crohn’s disease, and lymphoma. The tuberculin skin test resulted in a strong 25-mm reaction. We suspected intestinal tuberculosis or expansive injury, and the patient underwent exploratory laparotomy with visualization of a 4- to 5-cm bluish/blackish vegetating lesion located 220 cm from the Treitz angle. The anatomopathological study showed cavernous hemangioma of the small intestine, measuring 2.6×1.0 cm. The patient recovered well and remained asymptomatic. Conclusions: Although rare, intestinal hemangioma should be on the list of differential diagnoses for chronic intestinal diseases, especially if there is anemia due to coexisting iron deficiency.

P049 Investigation of Liver Diseases by Ultrasound in Patients With Inflammatory Bowel Disease

American Journal of Gastroenterology, 2021

BACKGROUND: Inflammatory Bowel Disease (IBD), which can be divided into Crohn’s Disease (CD) and ... more BACKGROUND: Inflammatory Bowel Disease (IBD), which can be divided into Crohn’s Disease (CD) and Ulcerative Colitis (UC), is an immune mediated disease featured by gastrointestinal tract involvement. Hepatic disease, such as non-alcoholic fatty liver disease (NAFLD), cirrhosis, cholelithiasis, hepatic thromboembolic events and primary sclerosing cholangitis (PSC) are some hepatic complications presented by IBD patients. Since these hepatic disorders have a higher prevalence in IBD patients, ultrasonography is a noninvasive low-cost versatile tool, that allows to identify these manifestations at early stages. Therefore, this study aims to analyze the prevalence of hepatic diseases in patients with IBD. METHODS: A cross-sectional study was performed in a single IBD center, Brazil. This study considered clinical and sociodemographic data of these individuals, besides the evaluation of disease activity, biochemical tests, and liver ultrasound with doppler. Statistical analysis: descript...

P045 Prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD) in a Brazilian public healthcare clinic

American Journal of Gastroenterology, 2021

BACKGROUND: Inflammatory Bowel Disease (IBD) is an inflammatory and chronic disease, as well as n... more BACKGROUND: Inflammatory Bowel Disease (IBD) is an inflammatory and chronic disease, as well as non-alcoholic fatty liver disease (NAFLD). Current literature has shown that IBD patients are at high risk for NAFLD. In those patients, the pathogenesis of NAFLD may be more complex and related to multifactor causes, such as gut dysbiosis, unhealthy nutritional behavior, body composition and systemic inflammation. There is an increase in NAFLD's incidence in the general population, otherwise, there are few studies evaluating NAFLD prevalence in IBD patients. So, this study aimed to evaluate prevalence of NAFLD and identify the clinical factors associated with the presence of NAFLD in patients with IBD. METHODS: This cross-sectional, descriptive, observational study included 71 IBD patients from an IBD public outpatient in São Paulo State, Brazil. Laboratory evaluation and clinical data were collected. The presence of NAFLD was evaluated by ultrasonography. The exclusion criteria were...

Factors Associated with Patient´s Preference in Choosing Their Therapy for Inflammatory Bowel Disease in Brazil

Arquivos de Gastroenterologia, 2020

BACKGROUND: Biological therapy and new drugs have revolutionized the treatment of inflammatory bo... more BACKGROUND: Biological therapy and new drugs have revolutionized the treatment of inflammatory bowel disease. Ideally, the choice of medication should be a shared decision with the patient, aiming at greater satisfaction, compliance, and consequently, favorable clinical outcome. OBJECTIVE: This study aims to evaluate patient’s preferences in the choice of their therapy and the factors that influence this choice. METHODS: This cross-sectional study enrolled 101 outpatients with Crohn’s disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients’ preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors’ indication). RESULTS: The mean age was 43.6±13.5 years, 75.3% were female, and ...

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Hidradenitis Suppurativa as a Paradoxical Side Effect to the Use of Adalimumab in Patients with Crohn’s Disease?

Clinical and Experimental Gastroenterology, 2020

Background: Hidradenitis suppurativa is a chronic inflammatory skin disorder associated with infl... more Background: Hidradenitis suppurativa is a chronic inflammatory skin disorder associated with inflammatory bowel disease. However, it can arise as a paradoxical side effect of anti-TNF treatment. Methods: The article reports on three patients with Crohn's disease who developed hidradenitis suppurativa during the treatment with adalimumab. Results: Case 1: A 38-year-old female exhibited an infiltrative lesion in the inguinal region and vulva, consistent with hidradenitis suppurativa, after three months of adalimumab. These lesions were treated with partial vulvectomy. Case 2: After adalimumab treatment, a 27-year-old female, originally diagnosed with ileocolonic Crohn's disease, went into clinical and endoscopic remission. The patient eventually presented two hyperchromic nodules in the inguinal region, which were diagnosed as hidradenitis suppurativa. The patient showed improvement after treatment with oral doxycycline and local therapy. Case 3: A 34-year-old female with fistulizing and stenosing ileocolonic Crohn's disease, started adalimumab in 2010, with optimization in 2015. One year after, the patient developed bilateral, erythematous, hardened, inguinal nodulations with purulent drainage, consistent with hidradenitis suppurativa. Treatment with oral doxycycline, fusidic acid, and infiltration with triamcinolone resulted in partial improvement of the lesions. In 2018, the lesions deteriorate. The patient underwent surgical treatment. Conclusion: Patients with inflammatory bowel disease are more likely to the development of other mediated inflammatory diseases, such as hidradenitis suppurativa. Hidradenitis suppurativa may appear as a paradoxical reaction to anti-TNF therapy. Clinical teams must be aware of this type of complication. Early diagnosis and treatment are essential for controlling the disease and preventing the onset of complications.

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Monoterapia Versus Terapia Combinada Nas Taxas De Resposta Clínica, Remissão Clínica e Resposta Endoscópica Na Doença De Crohn

Arquivos Brasileiros de Cirurgia Digestiva Express, 2017

Tuberculose Laríngea Durante Tratamento Com Adalimumabe Na Doença De Crohn

Arquivos Brasileiros de Cirurgia Digestiva Express, 2017

Abdome Agudo Perfurativo Por Paracoccidioidomicose Juvenil Acometendo Todo Intestino Delgado

Arquivos Brasileiros de Cirurgia Digestiva Express, 2017

P085 Congestive Heart Failure as a Side Effect of Using Infliximab in the Treatment of Crohn's Disease

American Journal of Gastroenterology, 2019

BACKGROUND: The main biological agents used to treat Crohn's disease (CD) are anti-TNF agents... more BACKGROUND: The main biological agents used to treat Crohn's disease (CD) are anti-TNF agents. Despite its safety profile, the medication is not exempt from side effects such as infections, malignancy and cardiovascular complications such as heart failure (HF). The objective of this study is to report the case of a patient with CD who developed heart failure after the use of Infliximab (IFX). METHODS: Case study of a CD outpatient who developed HF after use of IFX. Anamnesis, physical examination, laboratory and imaging data were obtained by consulting their electronic medical records. RESULTS: A 50-year old female patient with a history of hypertension, diabetes and cholecystectomy, was admitted in 2016 with abdominal pain, diarrhea and weight loss of 25 kg in 6 months. Colonoscopy showed ulcers and intense inflammatory process with stenosis of the ileocecal valve. Anatomopathological evidenced nonspecific inflammatory infiltrate. Enterotomography revealed terminal ileum and je...

P021 Compensatory Use of Facebook Among Patients With Inflammatory Bowel Disease

American Journal of Gastroenterology, 2019

BACKGROUND: Inflammatory Bowel Diseases (IBD) are chronic conditions which symptoms can be incapa... more BACKGROUND: Inflammatory Bowel Diseases (IBD) are chronic conditions which symptoms can be incapacitating, compromising daily activities and presential social interaction. As the use of social media is continuously increasing and Facebook (FB) is one of the most accessed networks worldwide, the present study aims to compare quality of life among IBD patients and its’ relation to how they interact through FB. METHODS: This cross-sectional study enrolled 100 IBD outpatients of Botucatu Clinic Hospital and 100 healthy controls. The exclusion criteria were non-users of FB for both groups and chronic diseases or gastrointestinal complaints for control group. Disease activity was measured using the Crohn’sn Disease Activity Index (CDAI) and the Mayo Score, in Crohn’s Disease (CD) and Ulcerative Colitis (UC) patients, respectively. FB use was assessed through the Psycho-Social Aspects of Facebook Use (PSAFU) tool, which comprises 5 domains: compensatory use, self-presentation, socializatio...

P009 Characterization of Health Services That Provide Nursing Care for Inflammatory Bowel Disease Patients in Brazil

American Journal of Gastroenterology, 2019

BACKGROUND: Nursing care in inflammatory bowel disease (IBD) is essential to the success of the t... more BACKGROUND: Nursing care in inflammatory bowel disease (IBD) is essential to the success of the treatment. IBD patients need continuous and specialized care and the characterization of health services is necessary to identify the deficiencies for further resolution in the future. The aim of the study is to identify the characteristics of health services that provide nursing care for IBD patients in Brazil. METHODS: A descriptive study was performed. Participants were nurses who treat IBD patients. The identification of nurses was performed through: analysis of national curricula registered with the National Council for Scientific and Technological Development in Brazil, access to the Brazilian IBD Study Group records and referral by colleagues. A specific online survey questionnaire consisting of 37 questions was developed. RESULTS: 74 nurses were identified. Health services are located in the following Brazilian regions: Southeast (66.22%), Northeast (13.51%), South (9.46%), North ...

P094 Response Rates and Clinical Remission With Different Treatment Patterns and Sequencing in Ulcerative Colitis Patients

American Journal of Gastroenterology, 2019

BACKGROUND: The treatment of ulcerative colitis (UC) remains challenging, with several strategies... more BACKGROUND: The treatment of ulcerative colitis (UC) remains challenging, with several strategies available. Therapeutic options include aminosalicylates, corticosteroids, immunosuppressants, and biological therapy. Rates of response vary with the medication used and the standard of treatment. The response rates are estimated to decrease with medication change, but studies are scarce in the literature. OBJECTIVES: To evaluate the treatment patterns, the sequencing and the response in patients with UC treated in Brazil. METHODS: Retrospective observational study with the inclusion of 44 IBD outpatients from a referral center in the interior of the state of São Paulo, Brazil. Frequency of medication used was evaluated as the first, second and third choice since the beginning of the UC treatment, in addition to the rates of response and remission according to the treatment. Disease activity was analyzed according to the Mayo score. Clinical response was defined as a score drop of at le...

P084 Quality of Care for Patients With Inflammatory Bowel Disease From a Brazilian Public Healthcare Center Using the Questionnaire QUOTE-IBD

American Journal of Gastroenterology, 2019

BACKGROUND: The Inflammatory Bowel Diseases (IBD), which comprise Crohn’s Disease (CD) and Ulcera... more BACKGROUND: The Inflammatory Bowel Diseases (IBD), which comprise Crohn’s Disease (CD) and Ulcerative Colitis (UC) are chronic diseases that demand continuous interaction between patients and the healthcare centers. The quality of care (QC) is a factor that interferes in adherence and contributes to the success of the treatment. The aim of the study was to evaluate the QC of a single Brazilian IBD reference center using the “Quality of Care through the eyes of patients with Inflammatory Bowel Disease” questionnaire (QUOTE-IBD). METHODS: Cross-sectional study including 133 patients with confirmed IBD (CD or UC) from a single IBD Center (Hospital das Clínicas de Botucatu) of São Paulo State, Brazil. Disease activity was evaluated through Crohn’s Disease Activity Index (CDAI) and Mayo Score, in CD and UC patients, respectively; quality of life, using IBDQ questionnaire; and QC, through the QUOTE-IBD questionnaire. The QUOTE-IBD tool relies on both Importance (I) and Performance (P) and...

Anti-TNF Exposure during Pregnancy in Crohn’s Disease Patients

Case Reports in Gastroenterology, 2018

Inflammatory bowel disease (IBD) affects young people of reproductive age. Therefore, a broad dis... more Inflammatory bowel disease (IBD) affects young people of reproductive age. Therefore, a broad discussion is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used, especially biological therapy. This study aimed to describe the management of 4 Crohn’s disease patients who received anti-TNF therapy during pregnancy and present a literature review. We reported 4 cases composed of young women who became pregnant while receiving anti-TNF agents. The patients presented a satisfactory response to the clinical treatment and the pregnancies progressed without complications. We did not observe maternal or embryonic toxicity, or unfavorable outcomes. The available data point to inflammatory activity as the main risk factor for unfavorable gestational evolution to date, and showed anti-TNF therapy to be safe during pregnancy and breastfeeding. However, the benefits and risks must be discussed with the patient and management decisi...

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Non-Hodgkin's Lymphoma: An Important Differential Diagnosis in Inflammatory Bowel Disease

Chinese Medical Journal, 2018

To the Editor: The gastrointestinal tract (GIT) is the most common extranodal location of non-Hod... more To the Editor: The gastrointestinal tract (GIT) is the most common extranodal location of non-Hodgkin's lymphoma, but it represents only 0.4% of primary colonic malignancies. [1] Symptoms are nonspecific and may include diarrhea, constipation, abdominal pain, weight loss, and gastrointestinal bleeding. In colon, the most common types are conventional large cell lymphoma, mucosa-associated lymphoid tissue lymphoma, and T-cell lymphoma. [1-3]

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