MARIANNY NAZARETH SULBARAN NAVA
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- Risk factors for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis: a prospective, single-center study(2018) SULBARAN, M.; CAMPOS, F. G.; RIBEIRO JR., U.; KISHI, H. S.; SAKAI, P.; MOURA, E. G. H. de; BUSTAMANTE-LOPEZ, L.; TOMITAO, M.; NAHAS, S. C.; CECCONELLO, I.; SAFATLE-RIBEIRO, A. V.Background and study aims To determine the clinical features associated with advanced duodenal and ampullary adenomas in familial adenomatous polyposis. Secondarily, we describe the prevalence and clinical significance of jejunal polyposis. Patients and methods This is a single center, prospective study of 62 patients with familial adenomatous polyposis. Duodenal polyposis was classified according to Spigelman and ampullary adenomas were identified. Patients with Spigelman III and IV duodenal polyposis underwent balloon assisted enteroscopy. Predefined groups according to Spigelman and presence or not of ampullary adenomas were related to the clinical variables: gender, age, family history of familial adenomatous polyposis, type of colorectal surgery, and type of colorectal polyposis. Results Advanced duodenal polyposis was present in 13 patients (21%; 9 male) at a mean age of 37.61 +/- 13.9 years. There was a statistically significant association between family history of the disease and groups according to Spigelman (P=0.03). Seven unrelated patients (6 male) presented ampullary adenomas at a mean age of 36.14 +/- 14.2 years. The association between ampullary adenomas and extraintestinal manifestations was statistically significant in multivariate analysis (P=0.009). Five endoscopic types of non-ampullary adenoma were identified, showing that lesions larger than 10mm or with a central depression presented foci of high grade dysplasia. Among 28 patients in 12 different families, a similar Spigelman score was identified; 10/12 patients (83.3%) who underwent enteroscopy presented small tubular adenomas with low grade dysplasia in the proximal jejunum. Conclusions Advanced duodenal polyposis phenotype may be predictable from disease severity in a first-degree relative. Ampullary adenomas were independently associated with the presence of extraintestinal manifestations.
- Diagnostic meta-analysis: Case study in oncology(2018) MARIANNY, S.; AFONSO, S.; LEONARDO, B.-L.Cancer represents a major public health problem worldwide. Although there have been significative advances against cancer in the last two decades, incidence and death rates are increasing for several cancer types, including liver and pancreas. Continued clinical and basic researches are needed to further improve clinical quality care and diminish mortality caused by malignancies. In this context meta-analysis of diagnostic test accuracy studies represents a reliable methodological tool that facilitates structured high-quality evidence for efficient evidence summary and optimized decision-making regarding oncologic diagnosis and prognosis. However, the relative unfamiliarity of diagnostic test accuracy methods and its interpretation represent a challenge to the clinician that must be overcome. Additionally, previous studies have highlighted a limited quality of the literature regarding assessment of reporting systematic reviews of oncologic diagnostic test accuracy studies. Improvement on the execution and reporting of systematic reviews of diagnostic studies is needed. In this chapter we will summarize specific strategies to simplify the methodological complex system for reporting and interpreting case studies in oncology that will clearly have a positive impact on the quality of systematic reviews and meta-analysis of oncologic diagnostic test accuracy studies. © Springer International Publishing AG, part of Springer Nature 2018.