Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study.

BACKGROUND: Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence. METHODS: This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis. RESULTS: A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05). CONCLUSION: G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.

Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis.

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case­control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)x100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

Use of the vaccination register to evaluate influenza vaccine coverage in seniors in the 2010/11 influenza season, Navarre, Spain.

People aged 65 and older have a high risk of suffering from complications of influenza, therefore it is recommended that they receive annual influenza vaccination. However, vaccination coverage falls far short of the target of 75%. In this study we use the vaccination register to evaluate the coverage of influenza vaccine in non-institutionalised persons aged 65 and over in Navarre, Spain, in the 2010/11 season (104,427 persons). Vaccination coverage was 58.6%, lower than the 62.7% coverage in the 2009/10 season. In the multivariate analysis, lower coverage was associated with being female, age under 80 or over 94 years, immigrant status and hospitalisation in the previous year. In contrast, persons with major chronic conditions, high level of dependence or those with more visits to the general practitioner in the previous year had higher vaccination coverage. Influenza vaccination in the previous season was a strong predictor of vaccination in the current season (odds ratio: 37.0, 95% confidence interval: 35.7­38.4). The vaccination register has been shown to be useful to monitor the coverage of influenza vaccination in seniors and may help guide strategies to improve coverage.

[Azathioprine-induced hepatotoxicity in a patient with Crohn's disease]. / Hepatotoxicidad inducida por azatioprina en paciente con enfermedad de Crohn.

Immunosuppressive drugs are among the pharmacological groups with the most theoretical potential to induce adverse reactions, including hepatic reactions. We report the case of a 35-year-old patient with Crohn's disease treated with azathioprine for steroid dependence which, after a hepatic biopsy, was diagnosed with nodular regenerative hyperplasia secondary to this treatment.

Hepatotoxicidad inducida por azatioprina en paciente con enfermedad de Crohn / Azathioprine-induced hepatotoxicity in a patient with Crohn’s disease

Los inmunosupresores se encuentran entre los grupos farmacológicos con mayor potencial teórico de inducir reacciones adversas, entre ellas las hepáticas. Presentamos el caso de un paciente de 35 años con enfermedad de Crohn en tratamiento con azatioprina por corticodependencia al que se le diagnosticó tras realización de una biopsia hepática de hiperplasia nodular regenerativa secundaria a este tratamiento (AU)

Immunosuppressive drugs are among the pharmacological groups with the most theoretical potential to induce adverse reactions, including hepatic reactions. We report the case of a 35-year-old patient with Crohn’s disease treated with azathioprine for steroid dependence which, after a hepatic biopsy, was diagnosed with nodular regenerative hyperplasia secondary to this treatment (AU)

¿Se realizan las mismas actividades preventivas en las consultas docentes que en las no docentes? / Are the same prevention activities carried out in teaching clinics as in non-teaching ones?

Introducción. Se conoce la variabilidad existente entre los equipos de atención primaria en la realización de actividades preventivas existiendo un mayor cumplimiento cuando la carga asistencial es menor y postulándose la falta de tiempo como la barrera principal para la atención preventiva. Asimismo, la docencia a médicos residentes es otra actividad más dentro de las propias del tutor de médicos de residentes, y que incrementa la carga laboral en la consulta. Introducción. El objetivo principal es determinar si existe diferencia en la cumplimentación de actividades preventivas entre las consultas que tienen a su cargo un médico residente en medicina de familia y comunitaria y las consultas no docentes. Material y métodos. Estudio descriptivo transversal que incluyó como población a estudio los 143 médicos especialistas de medicina de familia y comunitaria (pertenecientes a los 13 centros de salud de Vitoria-Gasteiz) que estaban en situación laboral activa en enero de 2010. Se recogieron datos referentes al grado de cumplimiento de actividades preventivas en Osabide (historia digital única) a fecha enero de 2010. Resultados. Se observaron diferencias estadísticamente significativas en las actividades de cribado de tensión arterial (61,52±14,35 frente 53,87±15,89; p=0,037) y de consumo de alcohol (60,67±16,92 frente a 52,77±17,91; p=0,047) entre las consultas docentes y no docentes. Conclusiones. A partir de los resultados se puede sugerir que el tiempo que el tutor invierte en la docencia a los médicos residentes no tiene un efecto negativo en el proceso preventivo, por lo que es necesario involucrar a todos los facultativos en dicho proceso (AU)

Introduction. We know the variability in carrying out preventive activities between primary care teams; increasing compliance when workload is lower, and the lack of time is postulated as the main barrier to preventive care. Likewise, teaching medical residents is one more activity within those of the medical residents tutor and increases the workload in the clinic. Introduction. The main objective of this study was to determine if there are differences in the level of carrying out prevention activities among physicians who are tutors of residents in family medicine and physicians who are not tutors. Material and methods. We conducted a cross sectional study involving 143 family medicine physicians (belonging to the 13 Primary Health Centres in Vitoria-Gasteiz) who were in active work in January 2010. We collected data on the level of prevention activities accomplishment “Osabide” (single digital history). Results. We only found statistically significant differences in the activities “screening blood pressure” (61.52±14.35 vs 53,87±15.89; P=.037) and “alcohol consumption” (60.67±16.92 vs 52.77±17.91; P=.047) between teaching and non-teaching clinics. Conclusions. From the results obtained in this study it can be suggested that time spent by tutors in teaching resident physicians does not have a negative effect on the prevention process; therefore necessary to involve all physicians need to be involved in this process (AU)

Compresión gástrica extrínseca simulando un tumor submucoso: diagnóstico por ecoendoscopia / Submucosal impression of the stomach like a submucosal tumour: diagnosis by endoscopic ultrasound

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