Clinical and endoscopic features in patients with hospital-acquired diarrhea associated with Clostridium difficile infection. / Características clínicas y endoscópicas en diarrea hospitalaria asociada a infección por Clostridium difficile.

INTRODUCTION AND AIMS: Clostridium difficile infection is the main cause of hospital-acquired diarrhea, and the clinical and endoscopic findings in those patients have been studied very little in Mexico. The aim of the present study was to describe those findings. MATERIALS AND METHODS: A prospective cohort study was conducted that included patients with hospital-acquired diarrhea associated with Clostridium difficile diagnosed through polymerase chain reaction. The hypervirulent NAP027 strain was also determined. The clinical and endoscopic findings in the study patients, as well as the variables associated with severity, were analyzed. RESULTS: Of the 127 patients with hospital-acquired diarrhea, 97 were excluded from the study due to lack of colonoscopy. The remaining 39 study patients had a mean age of 48 years, and their most common signs/symptoms were abdominal pain (49%), mucus in stools (41%), and blood in stools (10%). The most common alterations in the laboratory results were leukocytosis in 49%, fecal leukocytes (61%), and hypoalbuminemia (67%). The main risk factor was antibiotic use in 62%, and ceftriaxone was the most widely used. The hypervirulent strain was present in 54% of the cases. Endoscopic abnormalities were found in 87% of the patients. Thirty-eight percent presented with pseudomembranous colitis, with lesions in the left colon in 53%, and in the right colon in 13%. No association was found between proton-pump inhibitor use and Clostridium difficile-associated diarrhea. There was a significant association between hypoalbuminemia (< 3.3g/dL) and a greater risk for severe colitis, with a RR of 8.2 (p=0.008). CONCLUSIONS: Pseudomembranous colitis lesions associated with the hypervirulent Clostridium difficile strain were predominant in the left colon. Hypoalbuminemia was a significant severity predictor.

[Effectiveness of the modify tomographic severity index in patients with severe acute pancreatitis.]. / Eficacia del índice de gravedad tomográficomodificado en enfermos con pancreatitisaguda grave.

INTRODUCTION: Acute pancreatitis (AP) is a very important cause of morbidity and mortality in Mexico.In 2001 AP was the 17th cause of death. Since 1994,the computed tomography (CT) scan was accepted for the screening of the severity (a) according to the Computed Tomography Severity Index (CTSI). In 2004 Mortele et al., developed a new tomography classification, Modified Computed Tomography Severity Index (MCTSI) including pancreatic and extra pancreatic disease, obtaining a very good correlation with those with organ failure. This study proposes compare the tomography classifications as indicators of severity. METHODS: Cross-sectional study. Were included 30 patients with acute pancreatitis; APACHE II >= 8, non improvement with medical treatment and with initial mild pancreatitis,with addition of signs of complication in the first 72 hours of evolution, under CT scan, CTSIM and CTSI were compared. Statistical analysis using X2 test was calculated, kappa concordance coefficient(k) for the severity classifications. RESULTS: AP prevalence was 51.07%.Of the 30 patients including,19 man with mean age of 39.0 years (18-58 years),and 11 woman, with mean age of 50.9 years (22-82 years). The main causes were biliary pancreatitis in 16 cases (53.3%), and the second was alcohol,8 cases (26.7%). The kappa concordance coefficient for both tomography scans was 0.48 (p <= 0.003). For the CTSIM and CTSI sensitivity was 61% vs. 38%,specificity 66% vs. 100% and positive predictive value of 81% vs. 100%, respectively. CONCLUSIONS: The CTSIM is more useful for the screening in patients with severe acute pancreatitis than CTSI.