Asunto(s)
Humanos , Masculino , Anciano , Pacientes Internos , Examen Físico , Trastornos de Deglución/diagnóstico , Anamnesis , Gastroenterología , EndoscopíaRESUMEN
Introducción y objetivos: La colangitis esclerosante primaria (CEP) es una enfermedad hepática colestásica rara, que típicamente afecta a varones de mediana edad con colitis ulcerosa (CU). No obstante, estudios recientes apuntan a cambios epidemiológicos. Nuestro objetivo es determinar si la epidemiología, presentación clínica y curso evolutivo de pacientes con CEP seguidos en un centro de referencia se asemejan a lo descrito en la literatura. Pacientes y métodos: Búsqueda retrospectiva de pacientes con diagnóstico de CEP atendidos en nuestro centro entre los años 2000 y 2019.Resultados: Cohorte de 55 pacientes (media de edad: 37 años), el 44% mujeres, afectos de CEP, el 79% de ducto grande. Casi dos tercios fueron diagnosticados a partir de 2011. En el momento del diagnóstico, un 63% de los pacientes se encontraba asintomático. La mediana de tiempo desde la sospecha hasta el diagnóstico fue de 2 años. Un 34% desarrolló cirrosis en el seguimiento, y un 25% requirió trasplante hepático (TH) tras una media de tiempo de 7 años; entre estos, la enfermedad recurrió en un 46%. Un 45% presentaba una enfermedad inflamatoria intestinal (EII), sobre todo CU. Si bien no se alcanzó significación estadística, la CEP en mujeres se caracterizó por mayor tasa de presentación asintomática, mayor asociación con CU frente a otras formas de EII, así como cirrosis al diagnóstico y necesidad de TH con mayor frecuencia que los varones.Conclusiones: La epidemiología de la CEP está cambiando. El número de mujeres afectas es mayor al descrito previamente, objetivándose un aumento reciente de la incidencia. Podrían existir diferencias entre sexos en la forma de presentación y evolución que deberán confirmarse en estudios posteriores. (AU)
Background and aims: Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease that typically affects middle-aged men with ulcerative colitis (UC). However, recent studies point out to epidemiological changes. Our aim was to determine if the epidemiology, clinical course and outcome of patients with PSC followed at a reference hepatology center resemble what is described in the literature. Patients and method: Retrospective search of patients with a diagnosis of PSC treated in our center between 2000 and 2019.Results: Cohort of 55 patients (mean age: 37 years), 44% women. Most were large duct type (79%). Most diagnoses were made after 2011. At time of diagnosis, 63% of patients were asymptomatic. The median time from suspicion to diagnosis was 2 years. After a mean follow-up time of 7 years, one third developed cirrhosis, and 25% required liver transplantation (LT); among these, the disease recurred in almost half. Inflammatory bowel disease (IBD) was present in 45%, especially UC. Although statistical significance was not reached, PSC in women was characterized by higher rate of asymptomatic presentation and more frequent association with UC versus other forms of IBD. Women also had more frequently cirrhosis at diagnosis and required LT more often than men.Conclusion: The epidemiology of PSC is changing. The number of women affected is greater than what was expected from the literature, with a recent increase in incidence. There seems to be differences between sexes in the form of presentation and disease course that should be confirmed in subsequent studies. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Factores Sexuales , Factores de Tiempo , Trasplante de Hígado/estadística & datos numéricos , Cirrosis Hepática/epidemiología , Enfermedad de Crohn/epidemiología , Colitis Ulcerosa/epidemiología , Resultado del Tratamiento , Estudios Retrospectivos , Músculo Liso/inmunología , Cirrosis Hepática/cirugía , Colangitis Esclerosante , Anticuerpos Antinucleares , Anticuerpos Anticitoplasma de NeutrófilosAsunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Diverticulosis del Estómago , Enfermedades Duodenales , Duodeno , Hemorragia Gastrointestinal , Quimioterapia , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico por imagen , Pacientes Internos , GastroenterologíaAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Dermatosis del Pie/inducido químicamente , Fármacos Gastrointestinales/efectos adversos , Adalimumab/uso terapéutico , Adulto , Erupciones por Medicamentos/patología , Dermatosis del Pie/patología , Humanos , Masculino , Psoriasis , Sífilis Cutánea/diagnóstico , Insuficiencia del Tratamiento , Inhibidores del Factor de Necrosis Tumoral/uso terapéuticoRESUMEN
BACKGROUND AND AIMS: Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease that typically affects middle-aged men with ulcerative colitis (UC). However, recent studies point out to epidemiological changes. Our aim was to determine if the epidemiology, clinical course and outcome of patients with PSC followed at a reference hepatology center resemble what is described in the literature. PATIENTS AND METHOD: Retrospective search of patients with a diagnosis of PSC treated in our center between 2000 and 2019. RESULTS: Cohort of 55 patients (mean age: 37 years), 44% women. Most were large duct type (79%). Most diagnoses were made after 2011. At time of diagnosis, 63% of patients were asymptomatic. The median time from suspicion to diagnosis was 2 years. After a mean follow-up time of 7 years, one third developed cirrhosis, and 25% required liver transplantation (LT); among these, the disease recurred in almost half. Inflammatory bowel disease (IBD) was present in 45%, especially UC. Although statistical significance was not reached, PSC in women was characterized by higher rate of asymptomatic presentation and more frequent association with UC versus other forms of IBD. Women also had more frequently cirrhosis at diagnosis and required LT more often than men. CONCLUSION: The epidemiology of PSC is changing. The number of women affected is greater than what was expected from the literature, with a recent increase in incidence. There seems to be differences between sexes in the form of presentation and disease course that should be confirmed in subsequent studies.
Asunto(s)
Colangitis Esclerosante , Adolescente , Adulto , Anciano , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Anticuerpos Antinucleares/sangre , Enfermedades Asintomáticas , Niño , Colangitis Esclerosante/complicaciones , Colangitis Esclerosante/diagnóstico , Colangitis Esclerosante/epidemiología , Colangitis Esclerosante/cirugía , Estudios de Cohortes , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Cirrosis Hepática/epidemiología , Cirrosis Hepática/cirugía , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Músculo Liso/inmunología , Recurrencia , Estudios Retrospectivos , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
Carbapenems are antibiotics of the cephalosporin family with a good penetrance into the central nervous system. Neurotoxicity is a rare adverse effect, most often associated with imipenem (0.4-10 %) and unusual with ertapenem. It usually presents as seizures, although encephalopathy or hallucinations may develop. However, a recent large study (n = 544) found neurotoxicity associated to the use of ertapenem with an incidence of 4.6 %. There were associated factors such as advanced age or renal dysfunction (ertapenem has a renal metabolism level of 80 %).