ABSTRACT
INTRODUCTION: Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy. METHODS: This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, nâ =â 93; 7-8 g/dl, nâ =â 47; 8-9 g/dl, nâ =â 61; and >9 g/dl, nâ =â 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%. RESULTS: A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63-82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9-93.5%, Pâ =â 0.109) and 81.8% (range: 78.5-85.1%, Pâ =â 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay (Pâ =â 0.263) or risk of further bleeding (Pâ =â 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27-0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38-1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12-1.25) and further bleeding (HR: 39.08, 95% CI: 4.01-181.24) were poor prognostic factors. No serious adverse events were reported. CONCLUSIONS: In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding.
ABSTRACT
OBJECTIVE: To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN: International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS: Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION: Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER: NCT02328131.
ABSTRACT
Regarding our article "Daño pancreático: pancreatitis aguda en pacientes COVID-19", we would like to clarify that the case previously described met the diagnostic criteria for acute pancreatitis, defined in the Atlanta classification and mentioned in several guidelines.
Subject(s)
Abdominal Injuries , COVID-19 , Pancreatitis , Acute Disease , Humans , Pancreatitis/chemically induced , SARS-CoV-2ABSTRACT
We read with great interest the two letters published in November regarding SARS-CoV-2 infection and acute pancreatitis (AP). We report our only case of AP related to such infection.
Subject(s)
COVID-19 , Pancreatitis , Respiratory Distress Syndrome , Acute Disease , Humans , Pancreatitis/complications , Respiratory Distress Syndrome/etiology , SARS-CoV-2ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Levofloxacin/adverse effects , Anti-Bacterial Agents/adverse effects , Pancreatitis/chemically induced , Respiratory Tract Infections/drug therapy , Levofloxacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Acute DiseaseABSTRACT
According to some series, 0.3-1.5% of all cases of acute pancreatitis are drug induced. Acute pancreatitis due to levofloxacin is included in its safety data sheet as an adverse effect.
Subject(s)
Levofloxacin , Pancreatitis , Acute Disease , Humans , Levofloxacin/adverse effects , Pancreatitis/chemically inducedABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Foreign Bodies/complications , Anemia, Iron-Deficiency/etiology , Colon , ColonoscopyABSTRACT
An 81-year-old man with mild iron deficiency anemia (Hb 12 g/dl) and a positive fecal occult blood test was referred for a colonoscopy. The patient was asymptomatic and not undergoing any treatment. A foreign body that crossed the colonic lumen and prevented the colonoscope progression was identified at 40 cm from the anal verge via colonoscopy. The object seemed to be hard and fixed when manipulated with biopsy forceps.
Subject(s)
Colon/diagnostic imaging , Foreign Bodies/diagnostic imaging , Horns , Aged, 80 and over , Anemia, Iron-Deficiency/complications , Animals , Cattle , Colonoscopy , Humans , Male , Occult BloodABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Granuloma/drug therapy , Granuloma/pathology , Actinomyces , Actinomycosis/drug therapy , Actinomycosis/pathology , Penicillins/therapeutic use , Amoxicillin/therapeutic use , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary , Pathology/methods , Actinomyces/isolation & purification , Actinomycosis/diagnosisABSTRACT
Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen. The most frequent locations for colonization are cervicofacial (50%), abdominal (20%) and thoracic (15-20%). The abdominal actinomycosis predisposing factors include recent surgery, trauma and neoplasias. Certain cases have been associated with the intrauterine contraception device (IUD).