ABSTRACT
Grayscale abdomen ultrasound (US) is routinely performed in pregnant women with suspected pregnancy-related liver dysfunction, but its diagnostic yield is very low. We aimed to investigate the association between Doppler-US findings, liver stiffness measurement (LSM) and different causes of pregnancy-related liver dysfunction. This is a prospective cohort study of pregnant women referred to our tertiary center for any suspected gastrointestinal disease between 2017 and 2019 and undergoing Doppler-US and liver elastography. Patients with previous liver disease were excluded from the analysis. For group comparisons of categorical and continuous variables, the chi-square test or Mann-Whitney test, and the McNemar test were used, as appropriate. A total of 112 patients were included in the final analysis, of whom 41 (36.6%) presented with suspected liver disease: 23 intrahepatic cholestasis of pregnancy (ICP), six with gestational hypertensive disorders and 12 cases with undetermined causes of elevated liver enzymes. Values of LSM were higher and significantly associated with a diagnosis of gestational hypertensive disorder (AUROC = 0.815). No significant differences at Doppler-US or LSM were found between ICP patients and controls. Patients with undetermined causes of hypertransaminasemia showed higher hepatic and splenic resistive indexes than controls, suggesting splanchnic congestion. The evaluation of Doppler-US and liver elastography is clinically useful in patients with suspected liver dysfunction during pregnancy. Liver stiffness represents a promising non-invasive tool for the assessment of patients with gestational hypertensive disorders.
ABSTRACT
OBJECTIVES: A wide variety of approaches have been proposed to manage anticoagulant drugs in patients undergoing dental surgery; vitamin K antagonists and novel direct oral anticoagulants have been used. The present study aims to explore the existing evidence concerning the management of patients in anticoagulant therapy undergoing oral surgery procedures and to give suggestions related to peri- and post-operative measures. MATERIALS AND METHODS: A comprehensive search of databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The present scoping review was realized in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The publications varied from randomized controlled trials (RCT) to cohort trials. Only articles written in English language and published between 2000 to 2020 were screened. The studies were included if discussing the management of a patient in anticoagulant therapy (warfarin or direct oral anticoagulants) scheduled for tooth extraction. RESULTS: 33 studies were selected and included in the qualitative review. Nineteen considered anticoagulant therapy with warfarin, six considered anticoagulant therapy with new oral anticoagulants and eight compared patients taking warfarin with patients taking direct oral anticoagulants. CONCLUSIONS: No case of extractive surgery should alter the posology of the drug: thromboembolic risks derived from discontinuation are heavier than hemorrhagic risks. CLINICAL RELEVANCE: direct oral anticoagulants are safer in terms of bleeding and manageability and bleeding episodes are manageable with local hemostatic measures.
ABSTRACT
BACKGROUND AND AIMS: Cirrhotic patients with hepatitis C virus (HCV) infection remain at risk of developing hepatocellular carcinoma (HCC) even after the sustained virologic response (SVR). We aimed to evaluate whether the IL28 (rs12979860) single nucleotide polymorphism (SNP) may constitute a predisposing genetic factor and to identify the SVR patients at risk of HCC. METHODS: Two hundred patients undergoing DAAs treatment for chronic hepatitis C with advanced fibrosis (F3- F4) were consecutively enrolled. Besides normal routine laboratory testing for HCV, patients' sera were evaluated also for retinol, retinol-binding protein 4 and the following SNPs: PNPLA3 (rs738409), TM6SF2 (rs58542926), MBOAT7 (rs641738), IL28B (rs12979860), TIMP-1 (rs4898), TIMP-2 (rs8179090), NF-kB promoter (rs28362491). Statistical analyses were conducted using Stata/SE 14.2 statistical software (Stata Corp, College Station, TX). RESULTS: Almost all patients (197/200) obtained SVR24. Seventeen patients had a previous history of treated HCC before DAAs. Six patients developed HCC recurrence and five patients developed de novo HCC after a mean period of 18 months since EOT. All these patients had SVR. A significant association between IL28B - TT genotype and HCC development after DAAs therapy was observed (OR 4.728, CI 95% 1.222 - 18.297, p=0.024). CONCLUSION: IL28B rs12979860 polymorphism was significantly associated with HCC development after DAAs. Assessment of this SNP may better identify patients at risk of developing HCC after treatment. Further prospective studies are required to confirm these hypotheses.
Subject(s)
Antiviral Agents/therapeutic use , Carcinoma, Hepatocellular/genetics , Hepatitis C, Chronic/drug therapy , Interferons/genetics , Liver Neoplasms/genetics , Polymorphism, Single Nucleotide , Aged , Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/virology , Female , Genetic Predisposition to Disease , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/virology , Humans , Liver Neoplasms/blood , Liver Neoplasms/virology , Male , Middle Aged , Neoplasm Recurrence, Local/genetics , Risk Factors , Sustained Virologic Response , Vitamin A/bloodABSTRACT
Se realiza un estudio de los pacientes ingresados por patología traumática en unidades de cuidado intensivo (U.C.I.) de siete centros hospitalarios durante el período de un año (marzo 1992-abril 1993). Se reunieron 202 historias clínicas que proporcionaron los datos necesarios para el presente trabajo, siendo descartadas 68. De los datos epidemiológicos de interés se deduce que el promedio de edad de la población fue de 41 años, predominando el sexo masculino en 78 por ciento de los pacientes. El tipo de accidente que motivó más ingresos a la U.C.I. fue el "peatón embestido", seguido de los lesionados en accidentes automovilísticos. 67 por ciento de la población procedía de otro centro hospitalario, mientras que 18 por ciento ingresó directamente desde el escenario de la injuria. 49 por ciento de los pacientes de esta serie ingresaron a su centro definitivo de tratamiento luego de transcurridas 6 horas de la injuria. 88 por ciento presentó compromiso de cráneo, siendo la asociación lesional más frecuente el cráneo y las extremidades. La cuantificación de la severidad de la injuria evaluada por el Trauma Score Revisado (R.T.S.) al ingreso de los pacientes mostró un promedio de 9 puntos, mientras que el Injury Severity Score (I.S.S.) aplicado a las 24 horas tuvo una media de 21 puntos en el total de la población. Fueron graves con RTS menor de 12 puntos e ISS mayor de 16 puntos, 81 por ciento de la población. La complicación evolutiva más frecuente fue la infección nosocomial cuya incidencia fue de 43 por ciento. 36 por ciento de los pacientes que adquirieron una infección nosocomial evolucionaron a la sepsis falleciendo 72 por ciento. El foco pulmonar o respiratorio fue el más frecuente asiento de infecciones y los gérmenes involucrados prevalentes fueron el Stafiloccocus aureus y Pseudomas aeruginosa multirresistentes. La sepsis tuvo una media de aparición hacia el 9o. día de evolución. La complicación séptica fue exclusiva de los pacientes gravemente lesionados correspondiendo en 54 por ciento a peatones embestidos. La estadía promedio de los pacientes traumatizados ingresados en la U.C.I. fue de 10 días, y la mortalidad fue de 35 por ciento. Se identificaron factores de riesgo de muerte en la población, siendo el score de ISS mayor o igual a 16 puntos, el peatón embestido y la edad mayor o igual a 65 años quienes tuvieron significación estadística. No existió discriminación de la población con y sin factores de riesgo con relación a los tiempos de injuria-ingreso . Se registran, por último, importantes diferencias en la epidemiología y evolución de los pacientes según su centro de procedencia, así como también en la población de mayores y menores de 65 años
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Multicenter Studies as Topic , Multiple Trauma/epidemiology , Multiple Trauma/complications , Multiple Trauma/therapyABSTRACT
Contiene: el plan Nacional de la cadena de frio reune todos los elementos básicos y necesarios para la organización de la cadena de frío, pero unicamente una buena gestión asegurará que se garantice la potencia de la vacuna que se admite un niño. Es imprescindible que todo el personal de salud reconozcaque únicamente trasmitido sus conocimientos y precupaciones permitiránque los equipos rindan en forma efectiva.
