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1.
Gastroenterol Nurs ; 43(1): 22-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31913958

RESUMEN

Nurses have been at the forefront of the care of patients with hepatitis C since hepatitis C virus was identified in 1989. Treatments of patients with hepatitis C have evolved over the time to the present moment, where there are numerous options available for patients that are efficacious, simple, and well-tolerated. However, many patients with hepatitis C do not know they are infected or have never been treated. Nurses can continue to influence patients' engagement in their care, direct patients toward testing, and support them through their treatment and follow-up. This article discusses the role of the nurse in the management of hepatitis C and offers the most up-to-date information regarding the current standards of care for patients, from identifying patients for testing to managing patients through treatment and follow-up.


Asunto(s)
Hepatitis C/terapia , Rol de la Enfermera , Hepatitis C/diagnóstico , Humanos
2.
J Clin Gastroenterol ; 53(2): 147-154, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29912759

RESUMEN

BACKGROUND: Limited data exist with regard to treatment outcomes in Asian Americans with chronic hepatitis C (CHC). We evaluated sofosbuvir (SOF)-based regimens in a national cohort of Asian Americans. METHODS: Eligible Asian Americans patients with CHC who had posttreatment follow-up of 24 weeks for SOF -based therapies from December 2013 to June 2017 were enrolled from 11 sites across the United States. The primary endpoint was sustained virologic response (SVR) rates at posttreatment weeks 12 and 24. Secondary endpoints were to evaluate safety by tolerability and adverse events (AEs). RESULTS: Among 231 patients screened, 186 were enrolled. At baseline, 31% (57/186) patients were cirrhotic, 34% (63/186) were treatment experienced. Most of the subjects (42%, 79/186) received ledispavir/SOF therapy. The overall SVR12 was 95%, ranging from 86% in genotype (GT) 1b on SOF+ribavirin to 100% in GT 1b patients on ledipasvir/SOF at subgroup analyses. SVR12 was significantly lower in cirrhotic than in noncirrhotic patients [88% (50/57) vs. 98% (126/129), P<0.01]. Stratified by GT, SVR12 were: 96% (43/45) in GT 1a; 93% (67/72) in GT 1b; 100% (23/23) in GT 2; 90% (19/21) in GT 3; 100% (1/1) in GT 4; 83% (5/6) in GT 5; and 100% (16/16) in GT 6. Cirrhotic patients with treatment failure were primarily GT 1, (GT 1a, n=2; GT 1b, n=4) with 1 GT 5 (n=1). Patients tolerated the treatment without serious AEs. Late relapse occurred in 1 patient after achieving SVR12. CONCLUSIONS: In Asian Americans with CHC, SOF-based regimens were well tolerated without serious AEs and could achieve high SVR12 regardless of hepatitis C viral infection GT.


Asunto(s)
Antivirales/administración & dosificación , Asiático , Hepatitis C Crónica/tratamiento farmacológico , Sofosbuvir/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Bencimidazoles/administración & dosificación , Estudios de Cohortes , Quimioterapia Combinada , Femenino , Fluorenos/administración & dosificación , Estudios de Seguimiento , Genotipo , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/virología , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ribavirina/administración & dosificación , Respuesta Virológica Sostenida , Resultado del Tratamiento , Uridina Monofosfato/administración & dosificación , Uridina Monofosfato/análogos & derivados , Adulto Joven
3.
J Gen Intern Med ; 33(4): 551-557, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29352420

RESUMEN

Hepatitis C virus (HCV) infection is a significant health problem worldwide, and is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the United States. The management of HCV has changed significantly over the last 5 years, as treatments have become simpler and more efficacious. Medication efficacy is now greater than 90%, with a high barrier to resistance and few side effects. This review is a collaboration between primary care and hepatology providers to explore all aspects of HCV management: acute versus chronic HCV infection, transmission and testing, and diagnosis and treatment. Specific medications for the treatment of HCV infection are considered, and patient and medication factors including genotype, liver disease status, and comorbidities affecting medication choice are discussed. This is a new era for the management of HCV infection, and interested primary care physicians, family doctors, and general internists can be at the forefront of diagnosis, management, and treatment of HCV.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/aislamiento & purificación , Hepatitis C/diagnóstico , Genotipo , Hepatitis C/tratamiento farmacológico , Hepatitis C/transmisión , Humanos , Cirrosis Hepática/complicaciones , Tamizaje Masivo/métodos , Atención Primaria de Salud/métodos , Carga Viral/efectos de los fármacos
4.
N Engl J Med ; 381(6): 589-590, 2019 08 08.
Artículo en Inglés | MEDLINE | ID: mdl-31390515
5.
Dig Dis Sci ; 62(11): 3193-3199, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28913613

RESUMEN

BACKGROUND: Several studies show inconsistencies in the rate of hepatitis C virus (HCV) detection among baby boomers (born 1945-1965). We conducted a cross-sectional HCV screening followed by a case-controlled comparison of the newly screened population with established HCV subjects. METHOD: Enrollment was offered to subjects aged 40-75 at our gastroenterology and hepatology clinics. Demographic data and potential risk factors were obtained, and HCV antibody test was offered to those who had never been screened and compared with a group with established HCV. Logistic regression analysis and Fisher's exact test were performed. RESULTS: Six hundred and seventy-five patients were offered participation, of whom 128 declined while 50 consented to participate but did not perform the HCV antibody test. Of 497 enrolled subjects, 252 patients had HCV, while 245 subjects (188 patients among "baby boomer") underwent screening for HCV. There were more females (62.4 vs. 41.7%) and immigrants (34.7 vs. 22.2%) among the newly screened group. Among the screened population, five patients had HCV antibody (2.04%), and two of them had positive viral load (0.82%) of whom only one fell in the baby boomer category (0.53%). Compared to HCV group, screened group had significantly lower-risk factors, such as IV drug use (1.22 vs. 43.3%), intranasal cocaine use (14.3 vs. 49.6%), and blood transfusion (18.8 vs. 32.5%). CONCLUSION: We found a slightly lower but similar prevalence of HCV antibody when screening based on birth cohort as compared to larger baby boomer studies. Future studies evaluating addition of other screening strategies or possibly universal screening may be needed.


Asunto(s)
Gastroenterología , Hepacivirus/inmunología , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/diagnóstico , Servicio Ambulatorio en Hospital , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , Estudios Transversales , Femenino , Hepatitis C/sangre , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Estudios Seroepidemiológicos , Pruebas Serológicas , Carga Viral
7.
Liver Int ; 33(9): 1398-405, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23763360

RESUMEN

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) patients with elevated serum alanine aminotransferase (ALT) generally undergo a liver biopsy to evaluate for possible non-alcoholic steatohepatitis (NASH) or advanced fibrosis. However, patients with normal ALT could also have advanced stages of NAFLD. AIM: To determine ALT value that will accurately predict NASH and advanced fibrosis using area under the receiver operating characteristics curve (AUROC) analysis. METHODS: Demographic, clinical and laboratory data of an ethnically diverse cohort of biopsy proven NAFLD patients were retrospectively analysed under univariate and multivariate analyses. Liver biopsies were scored using NASH clinical research network (NASH CRN) system. AUROC were performed for NAFLD Activity Score ≥5 (NASH) and fibrosis score ≥2 (advanced fibrosis). RESULTS: Two hundred and twenty-two patients were analysed. Fifty six (23%) had normal ALT. There was no difference in the rate of advanced fibrosis between normal and elevated ALT (26.8% vs. 18.1%, P = 0.19). However, significantly lower percentage of normal ALT group had NASH compared with elevated ALT group (10.7% vs. 28.9%, P < 0.01). Overall, 37.5% of normal ALT group had NASH or advanced fibrosis, whereas 53% of elevated ALT had no NASH or advanced fibrosis. Higher ALT values correlated with higher specificity, but lower sensitivity for both NASH and advanced fibrosis. AUROC for ALT level correlating NASH and advanced fibrosis were 0.62 and 0.46 respectively. CONCLUSION: There is no optimal ALT level to predict NASH and advanced fibrosis. Metabolic risk factors should be evaluated to select patients for a liver biopsy to confirm NASH and advanced fibrosis.


Asunto(s)
Alanina Transaminasa/sangre , Hígado Graso/diagnóstico , Cirrosis Hepática/diagnóstico , Biopsia , Hígado Graso/sangre , Hígado Graso/complicaciones , Hígado Graso/etiología , Hígado Graso/patología , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/etiología , Modelos Logísticos , Enfermedad del Hígado Graso no Alcohólico , Curva ROC , Valores de Referencia , Estudios Retrospectivos
8.
Clin Transplant ; 26(6): 826-32, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22554357

RESUMEN

Immune function test (Immuknow™) is a measure of cell-mediated immunity based on peripheral CD4+ T cell adenosine triphosphate activity (desired range, 225-525 ng/mL). We evaluated the role of immune function test (IFT) in monitoring and adjustment of immunosuppression in orthotopic liver transplant (OLT) recipients. A total of 289 IFTs were obtained from 171 patients from March 2007 to June 2008. Graft/patient status was classified as stable, serious infection, or malignancy. IFT levels were analyzed with duration of follow-up after OLT, graft/patient status, and the presence of hepatitis C (HCV) infection. The mean age was 54±14 yr, with 62% men. The median follow-up was 65 (2-249) months. Mean IFT levels were significantly lower in patients who were <24 months than in those≥24 months post-OLT (220±19.5 vs. 257±11.3 ng/mL, p=0.03). Clinically stable patients had higher IFT levels than those with serious infection or malignancy (254±11.1 vs. 162.5±23.9, p<0.001). HCV-infected patients had lower IFT levels than uninfected patients (206.7±15.7 vs. 273±12.0 ng/mL, p<0.001). Immunosuppression was reduced in 58 patients with IFT levels<225 ng/mL, and 90% maintained stable graft function after a median follow-up of 22 (1-39) months. IFT may be a useful tool in monitoring and lowering of immunosuppression in long-term OLT recipients.


Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Rechazo de Injerto/inmunología , Hepatitis C/inmunología , Terapia de Inmunosupresión , Hepatopatías/cirugía , Trasplante de Hígado/inmunología , Monitorización Inmunológica , Linfocitos T CD4-Positivos/metabolismo , Femenino , Estudios de Seguimiento , Hepacivirus/inmunología , Hepatitis C/virología , Humanos , Inmunidad Celular , Inmunoensayo , Inmunosupresores/uso terapéutico , Infecciones/complicaciones , Trasplante de Hígado/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Factores de Riesgo
9.
J Racial Ethn Health Disparities ; 8(5): 1161-1167, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-32946070

RESUMEN

OBJECTIVES: Investigate whether or not race is associated with differences in hospitalization and survival to discharge among patients with coronavirus disease-2019 (COVID-19) at the height of the pandemic in New York City (NYC). METHODS: Single-center retrospective cohort study of COVID-19 patients hospitalized at our university-affiliated NYC hospital from 3/10/20 through 4/13/20 with follow-up to 5/1/20. Our primary endpoint was hospitalization rate among patients with confirmed COVID-19 compared with the regional population based on race. Our secondary endpoint survival to discharge among hospitalized COVID-19 patients. NYC Department of Health data were used to calculate hospitalization odds ratios. Chi-square and t tests were used to compare categorial and continuous variables, respectively. Cox proportional hazards regression and predictive analysis were used to investigate our endpoints further. RESULTS: Our cohort of 734 patients included 355 women (48.4%), 372 Blacks (50.7%), 214 Whites (29.2%), and 92 Hispanics (12.5%) in our analysis. Blacks were nearly twice as likely as Whites to require hospitalization for COVID-19 (OR 1.89, 95% CI, 1.59-2.24, p < 0.001). Hispanics were also more likely to suffer in-hospital mortality from COVID-19 compared with Whites (HR 1.84; 95% CI 1.21-2.80; p = 0.005). There was a non-significant increased hazard of in-hospital mortality among Blacks when compared with Whites (HR, 1.30; 95% CI, 0.95-1.78; p = 0.09). CONCLUSIONS AND RELEVANCE: Blacks were more likely than Whites to require hospitalization for COVID-19 while Hispanics were more likely to experience in-hospital mortality. Further investigation into the socioeconomic factors underlying racial disparities in COVID-19 survival and severity requiring hospitalization is needed on a national scale.


Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , COVID-19/etnología , Disparidades en el Estado de Salud , Hispánicos o Latinos/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Hospitalización/estadística & datos numéricos , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/mortalidad , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Población Blanca/estadística & datos numéricos , Adulto Joven
10.
Ann Gastroenterol ; 34(3): 316-322, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33948055

RESUMEN

BACKGROUND: Publication history is a key factor in securing academic promotion, but historical underrepresentation of women in gastroenterology may be an ongoing obstacle to achieving gender parity in leadership positions. METHODS: We carried out a cross-sectional study of gastroenterology programs in the United States, with data including faculty and trainee names, leadership positions, Hirsch indices, and year of first gastroenterology certification gathered from 1 February 2020 to 1 March 2020. Our outcomes of interest were: 1) sex representation in various leadership positions in academic gastroenterology departments; and 2) mean difference in Hirsch indices between men and women, for which we used univariate and multivariate regression models. RESULTS: Our cohort included 3655 faculty members and trainees across 163 academic gastroenterology programs in the United States. Women comprised 28.7% (1049/3655) of the cohort, including 713/2657 (26.8%) of faculty and 56/289 (19.4%) of all fellowship program directors and divisional/departmental chairs and chiefs. Male faculty had higher mean Hirsch indices compared to women (11.4 vs. 5.5, P<0.001), and when adjusted for year of first gastroenterology certification, men had a larger Hirsch index by 2.8 (95% confidence interval 1.3-4.1, P<0.001). Women were also underrepresented in various subspecialties of gastroenterology, particularly advanced endoscopy. CONCLUSIONS: Women in academic gastroenterology remain underrepresented in leadership positions and have lower Hirsch indices than men. Our findings may stem not only from differences in mentorship and career goals, but also from underlying structural factors that disadvantage women.

11.
Dig Dis Sci ; 55(3): 560-78, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20101463

RESUMEN

The spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Hepatic steatosis occurs when free fatty acids, released in the setting of insulin resistance and the metabolic syndrome, are taken up by the liver. Additional biochemical insults, including oxidative stress, upregulation of inflammatory mediators, and dysregulated apoptosis, can result in inflammation (producing NASH) and fibrosis. Noninvasive methods (e.g., abdominal ultrasonography) are safe ways to support a diagnosis of hepatic steatosis, but advanced liver histopathologic findings including NASH and fibrosis cannot be identified without pursuing liver biopsy. Recent advances in serologic and imaging methods aim to determine severity of inflammation and fibrosis noninvasively. Currently, therapeutic options for NAFLD are limited to medications that reduce risk factors, but the future holds promise for therapies that might slow the progression of this increasingly prevalent disorder.


Asunto(s)
Hígado Graso , Hígado Graso/diagnóstico , Hígado Graso/etiología , Hígado Graso/terapia , Humanos
12.
Indian Pediatr ; 57(2): 143-157, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32060242

RESUMEN

JUSTIFICATION: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS: Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.


Asunto(s)
Cardiopatías Congénitas/terapia , Procedimientos Quirúrgicos Cardíacos , Fármacos Cardiovasculares/administración & dosificación , Fármacos Cardiovasculares/uso terapéutico , Niño , Preescolar , Consenso , Humanos , Lactante , Tiempo de Tratamiento
13.
J Hepatol ; 50(4): 797-804, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19231016

RESUMEN

BACKGROUND/AIMS: Previous studies examining ethnic differences in non-alcoholic fatty liver disease (NAFLD) are limited by small sample sizes and the lack of liver biopsy as a diagnostic modality. METHODS: We retrospectively examined the influence of ethnicity on the biochemical and liver histological differences in NAFLD patients. RESULTS: The proportion of African Americans (AA) in the NAFLD sample (total 238 patients; 15.1% AA) was lower than in the base population (68.2%). Median ALT (47 IU/L; p=0.05) and triglyceride (134mg/dL, p=0.002) levels were lower in AA than other ethnicities. AA showed lower degrees of steatosis [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.89; p=0.02] than Whites. In contrast, Asians showed higher grades of ballooning than Whites (OR 2.67, 95% CI 1.03-6.93; p=0.04) and other ethnicities combined (OR 2.71, 95% CI 1.06-6.92; p=0.04). Hispanics showed a higher rate of Mallory bodies than Whites (OR 2.38, 95% CI 1.05-5.39; p=0.04) and other ethnicities combined (OR 2.41, 95% CI 1.09-5.34; p=0.03). CONCLUSIONS: African Americans showed a lower degree of steatosis than Whites. In contrast, Asians and Hispanics showed higher grades of ballooning and Mallory bodies, respectively, than Whites and other ethnicities combined. These findings highlight the need for prospective studies to evaluate ethnic differences in NAFLD.


Asunto(s)
Etnicidad/estadística & datos numéricos , Hígado Graso/epidemiología , Hígado Graso/patología , Adulto , Alanina Transaminasa/sangre , Pueblo Asiatico/estadística & datos numéricos , Aspartato Aminotransferasas/sangre , Biopsia , Población Negra/genética , Población Negra/estadística & datos numéricos , Colesterol/sangre , Etnicidad/genética , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Grupos Raciales/genética , Grupos Raciales/estadística & datos numéricos , Triglicéridos/sangre , Triglicéridos/metabolismo , Población Blanca/genética , Población Blanca/estadística & datos numéricos
14.
Case Rep Gastrointest Med ; 2019: 7182976, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30719360

RESUMEN

Actinomyces species are Gram positive anaerobic or microaerophilic bacteria that are part of the human flora in the oropharyngeal, gastrointestinal, and genitourinary tract. In the presence of a mucosal injury, they can become pathogenic and infect the underlying tissue without respect for tissue planes, leading to abscesses, fistulas, and sinus tracts. Through contiguous and hematogenous spread, virtually any organ can become infected. The presentation can be myriad and often mimics tumors, tuberculosis, or other more common infections and inflammatory conditions. While the cervicofacial region is the most common site of infection, involvement of the esophagus is unusual. Esophageal actinomycosis mostly occurs in patients with compromised immunity or prior esophageal injuries. Occurrence in immunocompetent individuals without risk factors is exceedingly rare. We report a case of esophageal actinomycosis complicated by an esophageal stricture in a patient with no apparent predisposing conditions.

15.
Ann Pediatr Cardiol ; 12(3): 254-286, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31516283

RESUMEN

A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.

16.
Indian Heart J ; 71(3): 207-223, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31543193

RESUMEN

INTRODUCTION: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. OBJECTIVES: The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS: Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Países en Desarrollo , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/tratamiento farmacológico , Humanos , India , Recién Nacido , Complicaciones Posoperatorias/prevención & control , Factores de Tiempo
17.
World J Gastroenterol ; 14(2): 318-21, 2008 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-18186575

RESUMEN

The combination of pegylated interferon (Peg-IFN) and ribavirin is the standard of care for chronic hepatitis C virus (HCV) infection treatment. In general, common side effects related to this combination therapy are mild and are very well tolerated. However, peripheral neuropathy including demyelinating polyneuropathy related to Peg-IFN is extremely rare. We present the first case of an acute inflammatory demyelinating polyneuropathy (AIDP) associated with Peg-IFN-alpha 2a (Pegasys) after 16 wk of a combination therapy with Pegasys and ribavirin in a 65-year-old woman with chronic HCV infection. She developed tingling, numbness, and weakness of her upper and lower extremities and was hospitalized for acute neurological deficits. Her clinical course, neurological findings, an electromyogram (EMG), nerve conductions studies (NCS), muscle biopsy, and a sural nerve biopsy were all consistent with AIDP likely related to Pegasys use. The patient recovered completely with the use of intravenous immunoglobulin (IVIG) including physical therapy and neurological rehabilitation. It is very important that gastroenterologists and/or hepatologists recognize this rare neurological complication related to Peg-IFN treatment very early, since it requires a prompt discontinuation of therapy including an immediate referral to a neurologist for the confirmation of diagnosis, management, and the prevention of long-term neurological deficits.


Asunto(s)
Antivirales/efectos adversos , Enfermedades Desmielinizantes/inducido químicamente , Síndrome de Guillain-Barré/inducido químicamente , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Polietilenglicoles/efectos adversos , Anciano , Femenino , Humanos , Interferón alfa-2 , Proteínas Recombinantes
18.
South Med J ; 101(11): 1173-6, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19088536

RESUMEN

A 58-year-old Arab-American male with HBeAg-negative chronic hepatitis B (HBV), presented with decompensated cirrhosis and a high HBV DNA level. He responded to entecavir with a significant reduction in serum HBV DNA level after 15 weeks of therapy with entecavir. However, he developed a progressive rise in prothrombin time/international normalized ratio (PT/INR) and bilirubin and underwent liver transplantation after receiving 22 weeks of entecavir therapy. Furthermore, with the continued use of combination entecavir and hepatitis B immunoglobulins (HBIG), he showed improvement in his clinical status with a nondetectable serum HBV DNA level 12 weeks after transplantation. He continued to maintain nondetectable serum HBV DNA 2 years following transplantation. To the best of our knowledge, this is the first reported case of a patient with decompensated chronic HBV who responded to entecavir both before and after transplantation without showing any evidence of recurrent HBV. Larger clinical trials are recommended to compare both short-term and long-term efficacy using entecavir among nucleoside-naïve decompensated chronic HBV patients before and after liver transplantation.


Asunto(s)
Antivirales/uso terapéutico , Guanina/análogos & derivados , Hepatitis B/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Enfermedad Crónica , ADN Viral/sangre , ADN Viral/efectos de los fármacos , Guanina/uso terapéutico , Hepatitis B/complicaciones , Hepatitis B/cirugía , Virus de la Hepatitis B/efectos de los fármacos , Humanos , Cirrosis Hepática/etiología , Cirrosis Hepática/cirugía , Trasplante de Hígado , Masculino , Persona de Mediana Edad
19.
Gastroenterology Res ; 11(5): 333-339, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30344803

RESUMEN

BACKGROUND: Cirrhosis of the liver is often not recognized until late in the disease state, when patients decompensate or develop hepatocellular carcinoma (HCC). This inquiry considered factors associated with undiagnosed cirrhosis. METHODS: Patients with undiagnosed cirrhosis were compared to patients with known diagnosis of cirrhosis, to evaluate the differences between these two groups. The study population is patients with confirmed diagnosis of HCC, stratified into patients with known diagnosis of cirrhosis (n = 36) and patients without the known diagnosis of cirrhosis who have features of cirrhosis (n = 36). RESULTS: There was no significant difference in insurance, gender, race, etiology of liver disease, presence of splenomegaly, model for end stage liver disease (MELD) score, fibrosis-4 index (FIB-4) or aspartate aminotransferase (AST) to platelet ratio index (APRI) scores between groups. However, the strongest predictor of the diagnosis of cirrhosis was age, with older patients being less likely to be diagnosed with cirrhosis (OR: 0.924, P = 0.012). Furthermore, tumor size in patients without known cirrhosis was larger than those diagnosed with cirrhosis (median: 4.9 cm versus 3.5 cm, P = 0.015). Of note, 50% of cases with cirrhosis were undiagnosed. CONCLUSION: Older age was the most significant predictor of the missed diagnosis of liver cirrhosis. This led to a larger tumor size at diagnosis, which may imply worse prognosis in these patients. Further evaluation of health disparities related to older age and outcomes of older patients with liver cirrhosis should guide the development of guidelines to prevent the missed diagnosis of cirrhosis.

20.
SAGE Open Med Case Rep ; 6: 2050313X18791069, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30083323

RESUMEN

Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. We present a case of splenic laceration with hemoperitoneum that manifested 5 days after the initial colonoscopy. The patient was treated conservatively. Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make an effort to inform the patient of this rare complication before the procedure.

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