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Background/Objectives: Early identification of patients at risk of developing severe acute pancreatitis (SAP) is still an issue. Dynamic assessment of clinical and laboratory parameters within the first 48 h of admission may offer valuable insights into the prediction of unfavorable outcomes such as SAP and death. Methods: A prospective observational study was conducted on a cohort of patients admitted for AP at a tertiary referral hospital. Clinical and laboratory data were collected on admission and at 48 h. Patients were classified based on the Revised Atlanta classification. Logistic regression analysis was performed to identify independent risk factors for SAP. Likelihood ratios and post-test probabilities were calculated to assess the clinical usefulness of predictive markers. Results: 227 patients were included, with biliary etiology being the most common and a prevalence of SAP and death of 10.7% and 5.7%, respectively. BISAP ≥ 2 on admission, presence of SIRS after 48 h, rise in heart rate over 20 bpm, and any increase in BUN after 48 h were independent risk factors for SAP. The combination of these factors increased the post-test probability of SAP and death, with BISAP ≥ 2 combined with the presence of SIRS after 48 h showing the highest probability (82% and 73%, respectively). Conclusions: Dynamic assessment of BUN, heart rate, and SIRS within the first 48 h of admission can aid in predicting the development of SAP and death in patients with AP. These findings underscore the importance of continuous monitoring, although multicenter studies are warranted to refine predictive models for SAP.
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(1) Background: Colorectal cancer (CRC) is one of the most common causes of cancer. Timely diagnosis is critical, with even minor delays impacting prognosis. Primary care providers face obstacles in accessing specialist care. This study investigates the impact of implementing an electronic consultation (eConsult) system combined with a specific prioritization system on CRC diagnosis delay and tumor staging. (2) Methods: The study analyzes 245 CRC patients from November 2019 to February 2022, comparing those referred before and after the eConsult system's implementation during the COVID-19 pandemic. Data on referral reasons, pathways, diagnosis delays, and staging were collected. Multivariate analysis aimed to identify independent risk factors for advanced staging at diagnosis. (3) Results: The eConsult system significantly reduced CRC diagnosis delay from 68 to 26 days. The majority of patients referred via eConsult presented with symptoms. Despite expedited diagnoses, no discernible difference in CRC staging emerged between eConsult and traditional referrals. Notably, patients from screening programs or with a positive fecal immunochemical test (FIT) experienced earlier-stage diagnoses. A positive FIT without symptoms and being a never-smoker emerged as protective factors against advanced-stage CRC. (4) Conclusions: This study highlights eConsult's role in reducing CRC diagnosis delay, improving diagnostic efficiency and prioritizing urgent cases, emphasizing FIT effectiveness.
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Insuficiência Hepática Crônica Agudizada/complicações , Insuficiência Hepática Crônica Agudizada/mortalidade , COVID-19/complicações , Vírus da Hepatite B/genética , Hepatite B Crônica/complicações , Cirrose Hepática/complicações , SARS-CoV-2/isolamento & purificação , Adulto , Antivirais/uso terapêutico , COVID-19/diagnóstico , COVID-19/virologia , DNA Viral/genética , Evolução Fatal , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/virologia , Humanos , Masculino , Tenofovir/uso terapêutico , Resultado do TratamentoRESUMO
Nintedanib is a multikinase inhibitor used for the treatment of pulmonary idiopathic fibrosis. We present the first report published to date of severe hepatotoxicity and jaundice secondary to nintedanib.
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Doença Hepática Induzida por Substâncias e Drogas , Fibrose Pulmonar Idiopática , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Humanos , Indóis/efeitos adversosRESUMO
A 36-year-old male was admitted to our hospital with diarrhea, weakness and loss of appetite over two months. He had received a liver transplant two years before and was taking immunosuppressors (everolimus, mycophenolate mofetil and tacrolimus). Initial laboratory tests showed iron-deficiency anemia (Hb 9.8 g/dl), lymphopenia and mild elevation in C-reactive protein (35 mg/l). Blood and stool cultures, and cytomegalovirus (CMV) quantitation in blood were all negative. Finally, the colonoscopy showed two rectal fimbriated ulcers close to the anal sphincter and multiple biopsies from the ulcer margins identified the presence of Epstein-Barr virus (EBV). All symptoms were completely resolved three weeks after immunosuppression was diminished. He underwent a follow-up colonoscopy, without any evidence of the former ulcers.
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Infecções por Vírus Epstein-Barr , Herpesvirus Humano 4 , Adulto , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Humanos , Imunossupressores/efeitos adversos , Fígado/patologia , Masculino , Tacrolimo , Úlcera/etiologia , Úlcera/patologiaRESUMO
We introduce a 20-year-old patient, with prior diagnosis of ataxia-telangiectasia syndrome, urgently assesed because of an upper gastrointestinal bleeding, identifying in the urgent endoscopy an intestinal-type gastric adenocarcinoma as its origin.