http://hdl.handle.net/11422/25224 2026-04-24T23:51:46Z 2026-04-24T23:51:46Z Troncoso, Augusto Torres http://hdl.handle.net/11422/26119 2025-06-13T03:00:11Z 2024-01-01T00:00:00Z

Title: Terapia imunobiológica dupla na doença inflamatória intestinal refratária à terapia de primeira linha Author(s)/Inventor(s): Troncoso, Augusto Torres Advisor: Santos, Isabel Fonseca Abstract: The study of Inflammatory Bowel Diseases (IBD) involves the comprehension of a complex interaction between genetic factors, gut microbiota, diet, and the immune system. The treatment of IBD, including Crohn's disease and ulcerative colitis, has evolved with the growing use of combined immunobiological therapies (CoT). These therapies aim to treat severe and refractory forms of the disease, in which conventional treatments have failed. Biological therapies such as anti-tumor necrosis factor therapy (anti-TNF), anti-integrins (such as vedolizumab) and anti-interleukins (such as ustekinumab) have shown good results when used as monotherapy, but combining these treatments may lead to higher rates of clinical remission and mucosal healing. Reviewed studies indicate that combinations such as anti-TNF with vedolizumab or ustekinumab have proven effective in inducing remission, with endoscopic improvements observed in up to 93% of patients. Despite their promising results, CoT still faces challenges, such as the lack of conclusive data on safety and the risk of adverse events. Although initial results suggest that these therapies may reduce the need for more aggressive interventions, such as surgeries, the data remain limited and require further follow-up. CoT has shown particularly good responses in patients with severe IBD, whether with uncontrolled luminal or extra-intestinal manifestations. However, the choice of therapeutic combination should be carefully considered due to the potential for severe adverse effects, such as infections and allergic reactions. Therefore, while combined biological therapies represent a promising strategy, more studies are needed to define their long-term efficacy and safety in the treatment of IBD. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização

2024-01-01T00:00:00Z Paula, Mariana Martins de Mello http://hdl.handle.net/11422/25784 2025-05-15T08:26:51Z 2024-01-01T00:00:00Z

Title: Tumor neuroendócrino esofagiano: um relato de caso raro Author(s)/Inventor(s): Paula, Mariana Martins de Mello Advisor: Peixoto, Eduardo Antônio Pereira Abstract: Esophageal neuroendocrine tumor (NET-e) is considered the rarest gastrointestinal tract neuroendocrine tumor (NET-TGI), with a prevalence of 4.9% amongst the NET-TGI, varying according to the geographic region. NET-e has an aggressive behavior and fast dissemination, so, early diagnosis is very important. Diagnosis can be a challenge because there are no specific symptoms. Patients may either be asymptomatic or they may present a range of symptoms, like dysphagia, chest pain, weight loss, odynophagia and digestive bleeding. Upper gastrointestinal endoscopy is a diagnostic tool that allows visualization of the tumor and obtainance of material for histopathological analysis. NET-e is characterized by a single polypoid lesion in the distal esophagus. Once diagnosed, it is important to follow up with an oncologist to initiate specific treatment. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização

2024-01-01T00:00:00Z Pedrosa, Paulo Roberto Bose Ximenes http://hdl.handle.net/11422/25450 2025-05-15T08:13:13Z 2024-01-01T00:00:00Z

Title: HIV, tuberculose e doença inflamatória intestinal: diagnósticos diferenciais com base em relato de caso Author(s)/Inventor(s): Pedrosa, Paulo Roberto Bose Ximenes Advisor: Zaltman, Cyrla Abstract: Inflammatory bowel diseases (IBD) have a multifactorial etiology. The association between IBD and HIV infection, which is not very prevalent, is a diagnostic and therapeutic challenge. This study was approved by the Ethics Committee of its institution and presents the case report of a young patient with AIDS (acquired immunodeficiency syndrome) and a history of previous tuberculosis, who developed acute abdomen and underwent multiple surgeries due to infectious complications, developing enterocutaneous fistulas. He was ultimately referred for right ileocolectomy. The absence of specific microbiological findings, clinical response to empirical treatment with RHZE (rifampicin, isoniazid, pyrazinamide and ethambutol) and anatomopathological findings of the surgical specimen suggestive or conclusive of intestinal tuberculosis reinforce the hypothesis of penetrating Crohn's disease (CD). The therapeutic strategy was similar to the one of patients without HIV, prioritizing the level of medication safety for opportunistic infections. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização

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