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1.
Aliment Pharmacol Ther ; 40(4): 363-73, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24980270

RESUMO

BACKGROUND: The safety of anti-tumour necrosis factor (TNF) agents during pregnancy is a major concern for child-bearing women and physicians. AIM: To assess the impact of anti-TNF therapy on adverse pregnancy and foetal outcomes in women with inflammatory bowel disease (IBD). METHODS: Pregnancies occurring during anti-TNF treatment or less than 3 months after its cessation in IBD patients followed in GETAID centres were recorded from January 2009 to December 2010. Ninety-nine pregnancies in women without anti-TNF treatment were identified from the CESAME registry. We compared pregnancy and neonatal outcomes by a case-control study. RESULTS: In the 124 IBD patients followed, 133 pregnancies were reported. At the conception time, 23% of patients had active disease. Eighty-eight per cent (n = 117) of the 133 pregnancies followed until delivery resulted in 118 liveborns (one twin pregnancy). Complications were observed in 47 (35%) women and 24 (20%) newborns. In multivariate analysis, factors associated with pregnancy complications were: current smoking (P = 0.004), a B2 (stenotic) phenotype in CD women (P = 0.004), occurrence of a flare during pregnancy (P = 0.006) and a past history of complicated pregnancy (P = 0.007). Current smoking was the only factor associated with severe (i.e. potentially lethal) pregnancy complications (P = 0.02). Having IBD for more than 10 years prior to conception was associated with newborn complications (P = 0.007). No difference was found with the control group for any of the pregnancy and neonatal outcomes. CONCLUSION: In our series, the safety profile of anti-TNF therapy during pregnancy and the neonatal period appears similar to control group of IBD women not treated with anti-TNF therapy.


Assuntos
Doenças Inflamatórias Intestinais/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Doenças Inflamatórias Intestinais/complicações , Análise Multivariada , Gravidez , Complicações na Gravidez/fisiopatologia , Sistema de Registros , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo , Adulto Jovem
2.
Swiss Med Wkly ; 141: w13306, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22180157

RESUMO

QUESTIONS UNDER STUDY/PRINCIPLES: Prosthetic joint infections (PJI) may be a potential sentinel event for an unknown neoplastic or infectious source in elderly patients. However, the value and cost-effectiveness of investigations to determine the origin of these infections is unknown. METHODS: Retrospective study at Geneva University Hospitals, evaluating associated medical examinations performed in search of the origin of all presumed surgical site and haematogenous arthroplasty infections. RESULTS: A total of 182 PJI were found in 182 patients (median age 75 years). Seventy PJI (38%) were classified as probably haematogenous, occurring more than 2 years post-implantation, with 27 (15%) due to Gram-negative pathogens. Overall, the origin of PJI was found solely by admission history in 28 cases (15%). Among the remaining 154 cases, no remote origin could be detected despite 17 echocardiograms, 17 other sonograms, 49 chest x-rays, 23 computed tomograms, 107 urinary cultures, 11 endoscopies, 9 scintigraphies and 31 medical specialist consultations. The average cost of these exams was 675 Swiss francs (845 US$) per PJI. At long-term follow-up six patients were found to have developed a neoplasm, of which only one (hepatocellular carcinoma after PJI due to Streptococcus bovis) could eventually be attributed to prior infection. CONCLUSIONS: From an epidemiologic point of view, patient history is the best way to predict the origin of PJI. Blind additional radiographic or endoscopic exams are costly, inconclusive and do not contribute to the management of these cases.


Assuntos
Artroplastia/efeitos adversos , Bactérias/isolamento & purificação , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Anamnese , Infecções Relacionadas à Prótese/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/economia , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos
3.
J Gynecol Obstet Biol Reprod (Paris) ; 40(7): 612-9, 2011 Nov.
Artigo em Francês | MEDLINE | ID: mdl-21733636

RESUMO

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are invalidating inflammatory affections, which evolve by relapse interrupted with clinical remission. Crohn's disease commonly affects young women in their reproductive years with a peak of incidence between 20 and 30. Infertility and sexual dysfunction are equivalent to that of the general population while they are increasing in patients with active IBD or after colorectal surgery. IBD are well controlled by medical treatments and the frequency of relapse during the pregnancy is similar to that of the non-pregnant IBD patients. The data concerning the risk of congenital malformations in IBD are contradictory. The risk of preterm delivery and low birth weight is significantly increased and correlated to the disease activity. When a medical treatment insures a quiescent disease before the pregnancy, it is advisable to continue it during the pregnancy because the benefits of controlled disease outweigh the risks of medication. IBD, possible perianal lesions and colorectal surgical interventions influence the mode of delivery, but the indication of caesarean section should primarily be governed by obstetric necessity. Preconceptional counseling seems desirable because of the risks during pregnancy, according to the disease activity, the surgical histories and the therapeutic agents.


Assuntos
Cesárea/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/cirurgia , Gravidez , Complicações na Gravidez/etiologia , Recidiva , Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Adulto Jovem
4.
J Gynecol Obstet Biol Reprod (Paris) ; 40(6): 492-7, 2011 Oct.
Artigo em Francês | MEDLINE | ID: mdl-21733638

RESUMO

Anti-TNFα treatments have modified the medical care, the course and the quality of life of the patients with autoimmune rheumatic, cutaneous or bowel inflammatory diseases. On the other hand, these treatments may have potential severe side effects during pregnancy (congenital malformations, fetal infections). Actually, many pregnancies have been reported during anti-TNFα exposures, with good maternal and neonatal outcomes. The introduction or the discontinuation of these treatments will always have to be discussed with the specialist of the chronic disease and, ideally, during a preconceptional counselling. In gynecology, anti-TNFα drugs may offer a new safe and effective approach to treating patients with recurrent miscarriages or unexplained or failed in vitro fertilization cycles. On the other hand, these treatments significantly increase the risk for serious infections or viral reactivations and may promote gynaecological malignancies. An adapted gynaecological survey is necessary.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Ginecologia/métodos , Obstetrícia/métodos , Complicações na Gravidez/tratamento farmacológico , Fator de Necrose Tumoral alfa/imunologia , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Feminino , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab , Gravidez , Doenças Reumáticas/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores
5.
Rev Med Suisse ; 5(215): 1725-6, 1728, 1730-1, 2009 Sep 02.
Artigo em Francês | MEDLINE | ID: mdl-19803225

RESUMO

Cirrhotic cardiomyopathy is defined as structural and functional cardiac abnormalities occurring in patients with cirrhosis, in the absence of any other associated cardiac disease. Its main clinical features include systolic and diastolic dysfunctions, and electrophysiological changes. Cirrhotic cardiomyopathy is generally clinically latent and is unmasked when the patient is exposed to major physiological stress or after some procedures, thus leading to an overt cardiac failure. Pathogenic mechanisms include impaired beta-adrenergic receptor signal transduction and increased activity of cardio-depressor pathways. A certain reversibility has been shown in the medium-long term after a liver transplantation. This article proposes to review the physiopathological mechanisms underlying these abnormalities, their clinical impacts, and the management options.


Assuntos
Cardiomiopatias/etiologia , Cirrose Hepática/complicações , Cardiomiopatias/fisiopatologia , Humanos , Cirrose Hepática/fisiopatologia
6.
Rev Med Suisse ; 3(129): 2345-9, 2007 Oct 17.
Artigo em Francês | MEDLINE | ID: mdl-18018826

RESUMO

Although used widely and recognized as a safe drug at therapeutic dose, acetaminophen has a narrow therapeutic margin. Its hepatotoxic potential differs for each individual and depends essentially on associated risk factors which could lead to a severe hepatotoxicity even at therapeutic doses. A systematic screening of these risk factors is essential for an accurate risk stratification and selection of the most adapted treatment strategy. In this article, we review the principal risk factors and propose an approach to aminotranferase elevation in patients using acetaminophen.


Assuntos
Acetaminofen/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas , Fígado/patologia , Acetaminofen/farmacocinética , Consumo de Bebidas Alcoólicas , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/farmacocinética , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Fígado/efeitos dos fármacos , Hepatopatias/patologia , Hepatopatias/prevenção & controle , Fatores de Risco
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