RESUMO
A 77-year-old male patient with heart disease, kidney disease under study, and quiescent multiple myeloma. He presented a 2 years history of weight loss and digestive symptoms. In the endoscopic study, multiple gastric ulcers were observed, whose histological study ruled out the initial suspicion. The patient died a month later from refractory shock.
RESUMO
Though not exempt from adverse events, azathioprine (AZA) is an inexpensive and effective drug in the induction and maintenance treatment of patients with inflammatory bowel disease. We present the case of a 20-year-old female patient with left-side ulcerative colitis in whom AZA was started at a dose of 1.5 mg/kg/day due to dependence on corticoids (thiopurine methyltransferase activity: 14.9 U/mL). Two weeks after starting treatment she began to report excessive hair loss, resulting in an almost complete loss of scalp hair.
Assuntos
Colite Ulcerativa , Doenças Inflamatórias Intestinais , Adulto , Alopecia/induzido quimicamente , Alopecia/tratamento farmacológico , Azatioprina/efeitos adversos , Biomarcadores , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/tratamento farmacológico , Feminino , Humanos , Imunossupressores/efeitos adversos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mercaptopurina/uso terapêutico , Metiltransferases/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). This study aimed to evaluate its efficacy in a real-life setting. METHODS: a retrospective and multicenter observational study was performed with UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety were analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. RESULTS: seventy-four patients were included, 98.3 % had received prior biological treatment, 55.4 % with three or more biologicals and up to 64.9% with two or three different mechanisms of action. Clinical remission and response rates were 37.8 % and 77 % at eight weeks, and 41.8 % and 70.1 % at 16 weeks. With regard to non-responders at eight weeks, 37.5 % achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95 % CI: 16-22), with a treatment survival of 56 % at 28 months, and remission and response rates at 24 months of 53.8 % and 61.5 %. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only four were severe and led to treatment discontinuation. CONCLUSION: tofacitinib has a demonstrated efficacy in clinical practice to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
Assuntos
Colite Ulcerativa , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/tratamento farmacológico , Humanos , Piperidinas/efeitos adversos , Pirimidinas/efeitos adversos , Estudos RetrospectivosRESUMO
Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases.
Assuntos
Doença de Crohn/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Diagnóstico Diferencial , HumanosRESUMO
BACKGROUND: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. PURPOSE: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. METHODS: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. RESULTS: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients). The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. CONCLUSIONS: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Imunossupressores/uso terapêutico , Adolescente , Adulto , Anticorpos Monoclonais/administração & dosagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto JovemRESUMO
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.
Assuntos
Gastroscopia , Gastrostomia/métodos , Humanos , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodosRESUMO
Multiple splenic abscesses is a rare condition in the clinical practice encountered mostly in immunocompromised patients. We report the case of a 81 year old male admitted to the hospital for fever, abdominal pain and jaundice. An abdominal ultrasound and computed tomography demonstrated multiple splenic abscesses. The splenectomy and antibiotics were a very effective therapy. The percutaneous drainage as an alternative may be appropriate only in selected patients, in order to preserve splenic function.
Assuntos
Abscesso Abdominal/diagnóstico , Esplenopatias/diagnóstico , Abscesso Abdominal/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Terapia Combinada , Humanos , Masculino , Esplenectomia , Esplenopatias/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
La tuberculosis (TBC) es la infección más prevalente del mundo y afecta a un tercio de la población mundial, predominantemente a países subdesarrollados, representando la TBC intestinal la sexta causa en frecuencia de afectación tuberculosa extrapulmonar. La enfermedad de Crohn (EC) es una enfermedad inflamatoria crónica intestinal que surge de la interacción de factores inmunológicos, ambientales y genéticos. El diagnóstico diferencial entre TBC intestinal y EC puede resultar un reto, sobre todo en pacientes inmunodeprimidos y en aquellos procedentes de áreas endémicas de TBC, debido a los cambios en la epidemiología de ambas patologías. Además, tanto la TBC intestinal como la EC tienen predilección por la región ileocecal y suelen presentar hallazgos clínicos, radiológicos y endoscópicos muy similares. El diagnóstico y tratamiento incorrectos podrían conllevar una elevada morbimortalidad, por lo que es necesario un alto índice de sospecha así como conocer algunas características que nos ayuden a diferenciar ambas enfermedades
Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases
Assuntos
Humanos , Tuberculose Gastrointestinal/diagnóstico , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Mycobacterium bovis , Mycobacterium tuberculosis/patogenicidade , Fatores de Risco , Teste Tuberculínico/estatística & dados numéricos , Reação em Cadeia da PolimeraseAssuntos
Humanos , Alopecia/induzido quimicamente , Alopecia/tratamento farmacológico , Azatioprina/efeitos adversos , Colite Ulcerativa/induzido quimicamente , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mercaptopurina/uso terapêutico , Biomarcadores , Imunossupressores/efeitos adversos , Metiltransferases/efeitos adversosRESUMO
Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients). The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied (AU)
No disponible
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Receptores do Fator de Necrose Tumoral/análise , Receptores do Fator de Necrose Tumoral , Fator 1 Associado a Receptor de TNF/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Resultado do Tratamento , Avaliação de Eficácia-Efetividade de Intervenções , Estudos Retrospectivos , Corticosteroides/uso terapêutico , Azatioprina/uso terapêuticoRESUMO
La gastrostomía endoscópica percutánea resulta un método eficaz y seguro para el soporte nutricional en pacientes con desnutrición e imposibilidad para la ingesta oral, con una supervivencia estimada superior a 2 meses que requieran nutrición enteral más allá de 4 semanas. Las principales indicaciones incluyen las neoplasias de tracto aéreo-digestivo superior y las enfermedades neurológicas, considerándose actualmente la demencia una indicación discutida. Las alteraciones anatómicas y los procesos infecciosos suponen las contraindicaciones más frecuentes. Existen distintas técnicas endoscópicas, siendo el método por tracción el más utilizado, teniendo en común todas ellas una baja mortalidad. Las complicaciones ocurren con mayor frecuencia en pacientes pluripatológicos y de edad avanzada, siendo las más prevalentes la infección de la herida, la extracción y obstrucción de la sonda y la neumonía broncoaspirativa. Una adecuada preparación previa del paciente y un exhaustivo cuidado y mantenimiento de la sonda pueden reducir la aparición de estas
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these
Assuntos
Humanos , Nutrição Enteral , Endoscopia do Sistema Digestório/efeitos adversos , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Gastropexia/métodos , Estomas Cirúrgicos , Gastrostomia/classificação , Infecções/etiologiaRESUMO
Los abscesos esplénicos son una entidad clínica infrecuente en la práctica clínica, encontrándose mayormente en pacientes inmunocomprometidos. Presentamos el caso de un hombre de 81 años que ingresó en el hospital por fiebre, dolor abdominal e ictericia. La ecografía abdominal y la tomografía computerizada demostraron abscesos esplénicos múltiples. La esplenectomíay los antibióticos fueron un tratamiento efectivo. El drenaje percutáneo como alternativa podría ser apropiado solamente en pacientes seleccionados, con el objeto de preservar la función esplénica.
Multiple splenic abscesses is a rare condition in the clinical practice encountered mostly in immunocompromised patients. We report the case of a 81 year old male admitted to the hospital for fever, abdominal pain and jaundice. An abdominal ultrasound and computed tomography demonstrated multiple splenic abscesses. The splenectomy and antibiotics were a very effective therapy. The percutaneous drainage as an alternative may be appropriate only in selected patients, in order to preserve splenic function.