RESUMEN
We present the case of a patient with liver cirrhosis and several previous episodes of ascitic decompensation, who was admitted for bacterial peritonitis secondary to Capnocytophaga canimorsus infection. The initial clinical presentation, diagnosis, treatment and resolution are described. This is the first case described of peritonitis caused by this agent in a patient with similar characteristics.
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Infecciones por Bacterias Gramnegativas , Peritonitis , Humanos , Antibacterianos/uso terapéutico , Capnocytophaga , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/etiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Peritonitis/complicaciones , Masculino , AncianoRESUMEN
Crohn's disease is a chronic multifactorial disease for which therapeutic options have expanded in the last decades. However there are still patients who lack or lose response to current standard treatment strategies. A unicentric, retrospective, study was performed in order to evaluate the clinical and biochemical response to intravenous ustekinumab manteinance therapy (IVUMT) in patients with refractory CD. We included 12 patients from our centre who started IVUMT between September 2018 and November 2021. 75% started IV treatment after previous subcutaneous (SC) treatment. At week 8 (n=8), 63% had clinical response, with 25% in clinical remission. At week 16 (n=10), 60% had clinical response, with 50% in clinical remission. At week 26 (n=10), 90% had clinical response, with 60% in clinical remission. At week 52 (n=11), 91% had clinical response, with 64% in clinical remission (Fig. 2). Basal faecal calprotectin (FCP) median level was 684µg/g, with a significant reduction at 52 weeks, with median FCP 97µg/g (p=0,017). Basal C-reactive protein (CRP) median level was 11,6mg/L. A significant reduction was observed at week 26, with median CRP 2,8mg/L (p=0,008); and 52 weeks, with median CRP 2,7 (p=0,013). Average follow-up was 117,1 weeks, average treatment survival was 105,9 weeks. There were no severe adverse events. Our results suggest IVUMT is a safe and effective treatment for most patients with refractory and complex CD and should be considered as an option in selected patients.
Asunto(s)
Enfermedad de Crohn , Ustekinumab , Humanos , Ustekinumab/efectos adversos , Enfermedad de Crohn/metabolismo , Estudios Retrospectivos , Inducción de Remisión , Administración Intravenosa , Resultado del TratamientoRESUMEN
We present the case of a 56-year-old female admitted to our centre for hepatitis. She had recieved the first dose of the BNT162b2 vaccine against SARS-CoV-2 10 days before the admission. Etiologic study was negative. The patient was diagnosed with vaccine-induced hepatitis.
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Vacuna BNT162 , COVID-19 , Enfermedad Hepática Inducida por Sustancias y Drogas , Hepatitis , Vacuna BNT162/efectos adversos , COVID-19/prevención & control , Femenino , Humanos , Persona de Mediana EdadRESUMEN
INTRODUCTION: The COVID-19 pandemic has delayed medical consultation, possibly leading to the diagnosis of gastrointestinal cancer. The aim of the study was to analyze the impact of SARS-Cov-2 pandemic on new diagnosis and short-term survival of patients with pancreatic cancer (PC). METHODS: All consecutive patients who had a suspected diagnosis of pancreatic lesion before (from March to September 2019) and during COVID 19 pandemic (from March to September 2020). Demographics, clinical and treatment were collected and compared. Short-term survival was assessed. RESULTS: A total of 25 patients (n=13 men) with diagnosis of adenocarcinoma of the pancreas and a median age of 70 years (IQR 62-74) were included. An increase was observed in the number of patients with newly diagnosed PC (n= 12 [19.1%] versus n=13 [20.9%]; P= 0.603). The subgroup analysis revealed a tendency toward a longer diagnosis (11 versus 12 days; P= 0.219) and treatment (28 versus 44; P= 0.375) delay for patients with PC during COVID-19 pandemic. A significant increase was observed for number of cases of advanced stage III and IV (n=4 [30.8%] versus n=7 [53.8%]; P= 0.006). Palliative treatment was the most frequent approach during COVID-19 period. During 1-year follow-up, 6 (50%) and 7 (61.5%) deaths were observed among patients diagnosed before and after COVID-19 (P= 0.449), respectively. CONCLUSIONS: The COVID-19 pandemic has led to delays in diagnosis and treatment in PC, which translates into an advanced staging and a worse prognosis. These data should stimulate health care provider to facilitate procedures for detection pancreatic cancer.
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COVID-19 , Neoplasias Pancreáticas , Anciano , Prueba de COVID-19 , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/terapia , Pandemias , SARS-CoV-2 , Neoplasias PancreáticasRESUMEN
We present the case of a 55-year-old male that was admitted to our hospital for cholestatic hepatitis. Other causes of hepatitis were excluded with imaging, laboratory and serologic tests. A liver biopsy was performed, which was compatible with toxicity-induced hepatitis. Re-assessing the patient, he mentioned the start of treatment with candesartan cilexetil 3 weeks prior to the onset of the symptoms. Candesartan was withdrawn, with a progressive improvement in cholestasis and complete normalization of liver biochemistry at 6 months. The patient was diagnosed with candesartan-induced cholestatic hepatitis, probable according to CIOMS/RUCAM scale.