RESUMEN
The efficacy and safety of zanubrutinib, a highly selective next-generation Bruton's tyrosine kinase (BTK) inhibitor, in chronic lymphocytic leukemia and lymphoplasmocytoides immunocytoma seems favorable. Adverse events comprise neutropenia, thrombocytopenia, infection, anemia, and atrial fibrillation. This report describes a 75-year-old man suffering from polydipsia, polyuria, and blurred vision for 10 days. He was diagnosed with lymphoplasmocytoides immunocytoma in 2003. After various therapies, he was started on zanubrutinib in October 2022. A diagnosis of diabetes mellitus had never been established before. On arrival in the emergency department, his plasma glucose was 37.2â mmol/L (671â mg/dL) and glycated hemoglobin (HbA1c) was 14.2%. Circulating antibodies showed positivity for glutamic acid decarboxylase (GAD-65), and his C-peptide level was 1.3â nmol/L (normal range, 0.37-1.47â nmol/L), equivalent to 3.9â ng/mL (normal range 1.1-5.0â ng/mL). From the patient's medical history, it became obvious that the metabolic situation had been problematic for many years, and that diabetes could have been taken into account at least in the summer of 2020 when HbA1c was 6.7%. In patients on tyrosine kinase inhibitors, careful assessment of glycemic control (monitoring HbA1c and blood glucose levels periodically even for nondiabetic patients) is recommended to prevent a major diabetic emergency.
RESUMEN
INTRODUCTION: Colorectal carcinoma is a leading cause of cancer diseases in Europe. Due to modern therapies survival rate is increasing. Nevertheless, cancer and its treatment is associated with significant morbidity. Physical activity appears as having a positive impact on cancer risk, as well as, reducing peri- and postoperative morbidity and mortality. METHODS: We searched pubmed and googlescholar for English- and German-language studies from inception to September 2022. The search terms physical activity, colon cancer, colorectal cancer, diet, survivors. prehabilitation, postoperative morbidity, quality of life and outcome were used. Guidelines of national advisory commmittees and Cochrane reviews were included. RESULTS: There is considerable evidence that physical activity is associated with reduced risk of colon cancer, epigenetic mechanisms play a central role in connection. Different studies showed a risk reduction of 12 to 27 percent. A prehabilitation programme consisting of exercise, nutritional intervention, and psychosocial rehabilitation can reduce peri- and postoperative complications. Aerobic exercise and strength training can improve survival rates and overall mortality. However, a causal relationship between nutritional treatment and cancer related symptoms (e.g. fatigue) is missing. CONCLUSION: There is a wide range of scientific papers on the influence of physical activity and nutrition; nevertheless, its influence on the various stages of colorectal disease are not addressed adequately. Recommendations concerning prehabilitation and tertiary prevention can only be given on the basis of heterogeneous trial data.
Asunto(s)
Neoplasias del Colon , Neoplasias Colorrectales , Humanos , Calidad de Vida , Ejercicio Físico , Dieta , Atención a la Salud , Neoplasias Colorrectales/prevención & controlRESUMEN
BACKGROUND: Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS: This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS: The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION: Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
Asunto(s)
Catárticos , Diabetes Mellitus , Catárticos/efectos adversos , Colonoscopía/métodos , Dieta , Humanos , PolietilenglicolesRESUMEN
OBJECTIVE: Due to the growing diabetes pandemic, the number of colonoscopies performed in patients with diabetes is steadily rising. However, recommendations on adjustments of anti-hyperglycaemic agents (AHG) during bowel preparation for colonoscopy are limited. METHODS: A total of nine articles were revealed on a PubMed search using the search terms "diabetes" and "colonoscopy", "sigmoidoscopy", "endoscopy", "endoscopic intervention", "endoscopic invasive diagnostics", "endoscopic surgery", or "diabetes care in the hospital" and manual screening of the references of the articles reporting on AHG adjustment during bowel preparation. RESULTS: Regular glucose measurements and the opportunity to contact the diabetes team were commonly advised. Recommendations also agreed that all oral AHG and short-acting insulin should be omitted when patients are on clear fluids. Recent studies suggest discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors even three days before the colonoscopy. In contrast, recommendations differed regarding adjustment of basal insulin depending on diabetes type and time point in relation to the intervention. CONCLUSIONS: While discontinuation of oral AHG and short-acting insulin during bowel preparation for colonoscopy is generally accepted, recommendations on the adaptation of basal insulin follow different approaches.
Asunto(s)
Colonoscopía , Diabetes Mellitus , Hipoglucemiantes , Insulinas , Glucosa , Humanos , Hipoglucemiantes/uso terapéutico , Insulina de Acción Corta , Sodio , Transportador 2 de Sodio-GlucosaRESUMEN
Inflammatory bowel diseases have recorded increasing incidence. A long period of illness and immunsuppressive drugs run a high risk of complications, this is particularly true for neoplasias.Medical records of patients with inflammatory bowel diseases who developed a malignant disease during 2000 and 2020 were used for analysis.51 patients could be included. 56% of tumors were located extraintestinal and occurred more often in patient with Crohn's disease. Neoplasias were more frequent in men (61 %).Individual prevention recommendations are urgently needed. Our focus should be extended to extraintestinal neoplasias. Initial diagnosis is often made in the 50+ age group. Thus, standardizised prevention programs including life-style factors should be started at the time of IBD diagnosis.
Asunto(s)
Colitis , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Neoplasias , Colitis/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/terapia , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/terapia , MasculinoRESUMEN
Balanced diet and regular physical activity are of key importance to the prevention of the development and progression of non-communicable diseases. In 2050, 50% of the European population is expected to be obese. Cardiovascular diseases, diabetes mellitus, cancer, as well as joint impairments, will further increase. Therefore, programmes are critical to the improvement of the population's health status in the long run. New ways have to be found that allow addressing more people than with the current approaches. Football has a great potential to attract people at risk for or with already existing non-communicable diseases, such as type 2 diabetes, to participate in health-promoting programmes. The novel football version, walking football was developed for elderly players, aiming at avoiding injuries and physical overload. The present article gives a brief overview on the metabolic effects of recreational football, particularly walking football, as well as health-promoting programmes offered by professional football clubs in humans at risk for or with already existing non-communicable diseases.
Asunto(s)
Diabetes Mellitus Tipo 2 , Fútbol Americano , Fútbol , Anciano , Diabetes Mellitus Tipo 2/prevención & control , Fútbol Americano/lesiones , Estado de Salud , HumanosRESUMEN
BACKGROUND: Football training can be a primary prevention strategy to reach people who otherwise would not be physically active. This systematic review summarizes the evidence on the health effects of controlled recreational football training as an intervention in children, adolescents, adults and the elderly. METHODS: A systematic review (PROSPERO record CRD42018083665) of the literature was carried out in MEDLINE, Cochrane, Scopus, and SPORTDiscus databases to identify randomized and non-randomized intervention studies in which healthy individuals of any age participated in controlled football training and were investigated for health outcomes related to prevention of obesity, hypertension, diabetes mellitus, and cardiovascular disease. RESULTS: The studies included-14 randomized and three non-randomized intervention studies-have sample sizes too small for reliable statistical analysis and bear a considerable risk of systematic bias. The evidence of positive effects of playing football is limited to short-term loss of body fat and improvement in aerobic fitness. For all other health outcomes, no conclusive results were found. CONCLUSION: A considerable number of intervention studies reporting on football-based intervention programs have been published, and there is a widespread assumption that such programs have positive health effects. However, this systematic review shows that the empirical evidence is insufficient to permit such a conclusion.
Asunto(s)
Promoción de la Salud/métodos , Fútbol , Humanos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Evaluación de Programas y Proyectos de Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND AND GOALS: Magnetic resonance (MR) enterography provides the advantages of conventional enteroclysis and those of cross-sectional imaging. Adequate luminal distension, combined with ultrafast sequences, results in excellent delineation of mural and extramural manifestations of Crohn's disease. Recent technical advances, including ultra-high-field strength MR with its capability to provide fast multiplanar images with excellent soft tissue contrast, are only rarely included in abdominal studies. STUDY: One hundred four consecutive patients with a proved or suspected diagnosis of ileitis terminalis were prospectively selected for MR imaging studies and ileocolonoscopy. The final diagnosis was based on histopathological findings or based on a combined endpoint of clinical, laboratory, endoscopic, and imaging findings. RESULTS: According to the endoscopic examination, stenosis was present in 26 patients (25%) and could be ruled out in 78 patients (75%). Total agreement between MR and endoscopy could be reached in 74 patients (71%). Histology indicated absence of inflammation in 50 patients (48%). MR and endoscopic findings were concordant in 38 patients (76%) and 37 patients (74%), respectively. Corresponding results by ileocolonoscopy were 37 true negative, 29 true positive, 4 false positive, and 12 false negative (sensitivity, 70.7%; specificity, 74%). CONCLUSIONS: MR enterography with a 3.0-T scanner is a powerful tool in the evaluation of ileal diseases, and has therefore made MR enterography the first-line modality at our institution in patients with suspected inflammatory bowel disease.
Asunto(s)
Colonoscopía/métodos , Enfermedad de Crohn/diagnóstico , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Enfermedad de Crohn/patología , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
BACKGROUND & AIMS: Oral mesalamine (5-aminosalicylate) is the current standard of care for mild-to-moderate ulcerative colitis. We investigated the efficacy and safety of once daily administration of prolonged-release mesalamine granules in maintenance of remission in patients with quiescent ulcerative colitis, compared with the well established twice daily dosing regimen. METHODS: In this multicenter, randomized, single blind, noninferiority trial, 362 patients with quiescent ulcerative colitis were randomly assigned (1:1) to groups that were given oral mesalamine 2 g, once daily, or 1 g, twice daily, for 12 months. The primary objective was to compare remission rates at 1 year, based on the ulcerative colitis disease activity index score, using Kaplan-Meier methodology. RESULTS: At 1 year, 70.9% of the group given 2 g mesalamine once daily remained in remission vs 58.9% of the group given 1 g mesalamine twice daily; this difference was statistically significant (P = .024), indicating the increased efficacy of once daily, compared with twice daily, dosing. Self-reported adherence to therapy, measured by visual analog scale score after 4, 8, and 12 months, was significantly greater in the group given 2 g mesalamine once daily, compared with twice daily, at all but 1 study visit (P < .05). Compliance measured by medication taken was not significantly different between the groups. The difference between the 2 groups in overall incidence of adverse events was not statistically significant (P = .23). CONCLUSIONS: Patients with ulcerative colitis given prolonged-release oral mesalamine 2 g once daily had better remission rates, acceptability, and self-reported adherence to therapy compared with patients given oral mesalamine 1 g twice daily.
Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Mesalamina/administración & dosificación , Mesalamina/uso terapéutico , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Preparaciones de Acción Retardada/administración & dosificación , Preparaciones de Acción Retardada/efectos adversos , Preparaciones de Acción Retardada/uso terapéutico , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Mesalamina/efectos adversos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Diverticulitis , Divertículo , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Diferencial , Diverticulitis/complicaciones , Diverticulitis/diagnóstico , Diverticulitis/diagnóstico por imagen , Diverticulitis/tratamiento farmacológico , Diverticulitis/cirugía , Diverticulosis del Colon/complicaciones , Diverticulosis del Colon/diagnóstico , Diverticulosis del Colon/tratamiento farmacológico , Diverticulosis del Colon/cirugía , Divertículo/complicaciones , Divertículo/diagnóstico , Divertículo/tratamiento farmacológico , Divertículo/epidemiología , Divertículo/cirugía , Fármacos Gastrointestinales/uso terapéutico , Humanos , Masculino , Mesalamina/uso terapéutico , Persona de Mediana Edad , Peritonitis/etiología , Pronóstico , Recurrencia , Rifamicinas/uso terapéutico , Rifaximina , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To prospectively compare dark-lumen magnetic resonance (MR) colonography with conventional colonoscopy in the detection of colorectal polyps. MATERIALS AND METHODS: Local ethical committee approval and informed consent were obtained. One hundred consecutive patients (56 men, 44 women; mean age +/- standard deviation, 67.7 years +/- 14.7; range, 25-82 years) who were referred for conventional colonoscopy from January 2003 to January 2004 underwent MR colonography and conventional colonoscopy after standard precolonoscopic bowel cleansing. Colonoscopy was performed immediately after MR colonography. For MR colonography, the colon was filled with approximately 2000 mL of tap water. Imaging was performed with a 1.5-T MR unit with patients in the prone position. A T1-weighted three-dimensional volumetric interpolated breath-hold sequence was performed before and 75 seconds after intravenous administration of 0.2 mmol gadobenate dimeglumine per kilogram of body weight. Results of MR colonography were analyzed on a per-polyp and per-patient basis. Findings at colonoscopy were used as the reference for determining accuracy, sensitivity, specificity, and positive and negative predictive values of MR colonography. RESULTS: Of 100 patients recruited for study, 92 (52 men, 40 women; mean age, 61.5 years +/- 14.5; range, 25-82 years) underwent complete MR and conventional colonoscopy examinations. Forty-three of the 92 patients (47%) had normal findings at conventional colonoscopy. In the other 49 patients (53%), conventional colonoscopy depicted 107 polyps (82 adenomas, 25 hyperplastic polyps) and seven carcinomas. At per-polyp analysis, sensitivity of MR colonography in the detection of adenomatous polyps was 100% for polyps at least 10 mm in diameter and 84.2% for polyps 6-9 mm in diameter. At per-patient analysis, the accuracy of MR colonography was 93.1% (sensitivity, 89%; specificity, 96%) if detection of adenomatous polyps of all sizes was considered. CONCLUSION: Dark-lumen MR colonography is a promising modality with high accuracy for detecting colorectal polyps larger than 5 mm in diameter.
Asunto(s)
Pólipos del Colon/diagnóstico , Colonoscopía , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste/administración & dosificación , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Masculino , Meglumina/administración & dosificación , Meglumina/análogos & derivados , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
The introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the early 1970s provided gastroenterologists with a number of diagnostic as well as therapeutic possibilities for examining biliopancreatic systems. In the meantime, magnetic resonance cholangiopancreatography presents a non-invasive alternative to diagnostic ECRP providing the advantage of a lower rate of possible complications. This article addresses the two methods presently available for differentiating pancreatic tumors. The objective of this article is to describe the advantages and disadvantages as well as the possibilities inherent in both methods.