RESUMO
Ashwagandha, an herb popular in Ayurvedic medicine, is renowned for its health-enhancing properties. However, its association with liver damage in recent years has raised significant concerns, necessitating careful assessment and management. This case underscores the dangers of Ashwagandha, particularly for individuals with preexisting liver conditions, where it can lead to life-threatening acute-on-chronic liver failure. The lack of solid clinical evidence supporting Ashwagandha's health claims emphasizes the need for an evidence-based approach. Public education is essential to raise awareness of the risks associated with herbal supplements and prevent liver diseases.
RESUMO
BACKGROUND: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. AIM: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. METHODS: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. RESULTS: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase -86 (30-172) vs. 78 [30-160], p 0.03- and overall -185 (72-400) vs. 157 (60-460), p = 0.003- for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). CONCLUSIONS: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.
Assuntos
Anestésicos Intravenosos/administração & dosagem , Colonoscopia , Propofol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Bombas de Infusão , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300 mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Hemorragia Gastrointestinal/tratamento farmacológico , Talidomida/administração & dosagem , Idoso de 80 Anos ou mais , Feminino , Humanos , Medição de Risco , Índice de Gravidade de Doença , TromboseRESUMO
BACKGROUND: Split dosage of bowel preparations has been shown to substantially improve bowel cleansing. AIM: To compare the split dose (SD) sodium picosulphate/magnesium oxide/anhydrous citric acid (Citrafleet(®)) regimen for morning colonoscopies with standard cleansing the day before. METHODS: Consecutive outpatients were randomized to receive Citrafleet(®) the day before colonoscopy or SD, in whom the second half was administered on an individual basis from 2 to 6 hours before the procedure. No bisacodyl was administered. All procedures were performed with non-anesthesiologist administered propofol sedation. The Boston scale was used to assess the quality of bowel preparation (adequate cleansing if score ≥ 6, with no score of 0/1 in any segment). RESULTS: A total of 193 patients were included. Overall bowel cleansing was significantly better in the SD group (7 vs. 5.2, p<0.001), as well as in the cecum (2.4 vs. 1.4, p < 0.001), ascending colon (2.5 vs. 1.6, p<0.001) and transverse colon (2.4 vs. 2, p=0.004). A significant proportion of SD patients had adequate bowel cleansing (71% vs. 30%, p<0.001). Patients in the SD group drank a greater amount of liquid (4.9 vs. 4 liters, p=0.006) and more frequently perceived the cleansing process to be easy or very easy to complete (89 vs. 68%, p=0.04), although they slept significantly fewer hours (6.5 vs. 7.9, p<0.001). No bronchoaspiration pneumonia was reported. CONCLUSIONS: SD Citrafleet(®) 2 to 6 hours before colonoscopy increased the rate of procedures with adequate bowel cleansing by 40%, especially in the proximal colon, allowed more liquids to be drunk and increased the perception of ease in completing the preparation, with no sedation-related complications.
Assuntos
Catárticos/administração & dosagem , Citratos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia , Compostos Organometálicos/administração & dosagem , Picolinas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Catárticos/efeitos adversos , Citratos/efeitos adversos , Ácido Cítrico/efeitos adversos , Diarreia/induzido quimicamente , Comportamento de Ingestão de Líquido , Esquema de Medicação , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Aceitação pelo Paciente de Cuidados de Saúde , Picolinas/efeitos adversos , Privação do Sono , Adulto JovemRESUMO
Primary pancreatic tuberculosis (PPTB) is an extremely rare entity defined by an isolated pancreatic lesion with microbiological confirmation, in the absence of previously identified tuberculosis (TB) and involvement of any other organ. We report the case of a 47-year-old man referred for abdominal pain and weight loss, in whom several imaging techniques revealed a solid mass in the head of the pancreas. CT-guided fine-needle aspiration cytology was consistent with necrotic granuloma. Intradermic tuberculin reaction was positive, but acid fast bacilli staining was negative in repeat cytology. No additional evidence of TB was found after exhaustive diagnostic work-up. Exploratory laparotomy was proposed for a definitive diagnosis, but cultures grew Mycobacterium tuberculosis at 50 days. The pancreatic lesion disappeared after 4 months of antitubercular therapy. This is the first case report of PPTB in an immunocompetent person in Spain. A high index of suspicion and accurate samples for microbiology are mandatory to avoid unnecessary surgical procedures.
Assuntos
Pancreatite/diagnóstico , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Pancreatite/tratamento farmacológico , Pancreatite/epidemiologia , Pancreatite/microbiologia , Espanha/epidemiologia , Tomografia Computadorizada por Raios X , Tuberculoma/diagnóstico , Tuberculoma/microbiologia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/microbiologiaAssuntos
Dietoterapia/métodos , Esofagite Eosinofílica/dietoterapia , Eosinófilos/imunologia , Hipersensibilidade Alimentar/dietoterapia , Adolescente , Adulto , Alérgenos/imunologia , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/diagnóstico , Esôfago/imunologia , Esôfago/patologia , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Adulto JovemAssuntos
Branquioma/diagnóstico , Transtornos de Deglutição/etiologia , Fístula Esofágica/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Sulfato de Bário , Branquioma/complicações , Meios de Contraste , Endoscopia Gastrointestinal , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Esofagoscopia , Esôfago/irrigação sanguínea , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/métodos , Idoso , Terapia Combinada , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/cirurgia , Hemorragia Gastrointestinal/terapia , Hematemese/etiologia , Hemostáticos/administração & dosagem , Hemostáticos/uso terapêutico , Humanos , Hipertensão Portal/complicações , Injeções Intralesionais , Ligadura/instrumentação , Masculino , Melena/etiologia , Mielofibrose Primária/complicações , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
BACKGROUND AND AIMS: This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS: This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS: A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS: The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.
Assuntos
Dieta , Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Doenças Inflamatórias Intestinais/fisiopatologia , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Estado Nutricional , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Doença de Crohn , Impedância Elétrica , Feminino , Alimentos , Força da Mão , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Prevalência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Exacerbação dos Sintomas , Adulto JovemAssuntos
Canal Anal/irrigação sanguínea , Hemorragia Gastrointestinal/etiologia , Reto/irrigação sanguínea , Malformações Vasculares/complicações , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio , Endoscopia por Cápsula , Colonoscopia , Comorbidade , Epinefrina/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Ligadura , Masculino , Polidocanol , Polietilenoglicóis/uso terapêutico , Recidiva , Escleroterapia , Técnicas de Sutura , Malformações Vasculares/diagnóstico , Malformações Vasculares/cirurgiaRESUMO
BACKGROUND: Aim was to evaluate the efficacy and tolerability of a moxifloxacin-containing second-line triple regimen in patients whose previous Helicobacter pylori eradication treatment failed. METHODS: Prospective multicentre study including patients in whom a triple therapy or a non-bismuth-quadruple-therapy failed. Moxifloxacin (400mg qd), amoxicillin (1g bid), and esomeprazole (40 mg bid) were prescribed for 14 days. Eradication was confirmed by (13)C-urea-breath-test. Compliance was determined through questioning and recovery of empty medication envelopes. RESULTS: 250 patients were consecutively included (mean age 48 ± 15 years, 11% with ulcer). Previous (failed) therapy included: standard triple (n = 179), sequential (n = 27), and concomitant (n = 44); 97% of patients took all medications, 4 were lost to follow-up. Intention-to-treat and per-protocol eradication rates were 82.4% (95% CI, 77-87%) and 85.7% (95% CI, 81-90%). Cure rates were similar independently of diagnosis (ulcer, 77%; dyspepsia, 82%) and previous treatment (standard triple, 83%; sequential, 89%; concomitant, 77%). At multivariate analysis, only age was associated with eradication (OR = 0.957; 95% CI, 0.933-0.981). Adverse events were reported in 25.2% of patients: diarrhoea (9.6%), abdominal pain (9.6%), and nausea (9.2%). CONCLUSION: 14-day moxifloxacin-containing triple therapy is an effective and safe second-line strategy in patients whose previous standard triple therapy or non-bismuth quadruple (sequential or concomitant) therapy has failed, providing a simple alternative to bismuth quadruple regimen.
Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Esomeprazol/uso terapêutico , Fluoroquinolonas/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Testes Respiratórios , Estudos de Coortes , Quimioterapia Combinada , Feminino , Helicobacter pylori , Humanos , Masculino , Pessoa de Meia-Idade , Moxifloxacina , Estudos Prospectivos , Retratamento , Falha de Tratamento , Resultado do Tratamento , Ureia/análiseAssuntos
Adenocarcinoma/complicações , Alopecia em Áreas/etiologia , Síndromes Paraneoplásicas/etiologia , Neoplasias Gástricas/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Evolução Fatal , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/diagnósticoRESUMO
Percutaneous endoscopic colostomy (PEC), using the classic pull-through technique in the ascending or the descending colon, has been proven useful to treat chronic intestinal pseudo-obstruction. We report the case of a high-surgical risk 70-year-old male with refractory chronic intestinal pseudo-obstruction, in whom the ascending colon could not be reached due to tortuous left dolichocolon. Endoscopic-assisted colopexy and push colostomy in the proximal transverse colon was decided accordingly. Colopexy was performed under direct endoscopic vision in the proximal transverse colon using 3 preloaded T-fasteners surrounding the intended stoma site. The stoma tract was created with an introducer needle, allowing the advance of the 24 Fr 4-sleeve dilator over a guidewire. Afterwards, the dilator was removed and the peel-away sheath was left in place. Over the guidewire, a 20-Fr gastrostomy tube was advanced into the colon lumen through the covering, which was finally removed. The patient recovered uneventfully, despite postprocedure pneumoperitoneum, which was related to the technique. He died a month later due to unrelated comorbidities, without further abdominal complaints after discharge. This is the first report of PEC both using a push technique, and the first report in a different location than the ascending or the descending colon. We believe this novel push technique may be feasible for PEC, avoiding the need of reinsertion in patients with difficult colonoscopy.