Awareness of sex and gender dimensions among physicians: the European federation of internal medicine assessment of gender differences in Europe (EFIM-IMAGINE) survey.

Sociocultural gender is a complex construct encompassing different aspects of individuals' life, whereas sex refers to biological factors. These terms are often misused, although they impact differently on individuals' health. Recognizing the role of sex and gender on health status is fundamental in the pursuit of a personalized medicine. Aim of the current study was to investigate the awareness in approaching clinical and research questions on the impact of sex and gender on health among European internists. Clinicians affiliated with the European Federation of Internal Medicine from 33 countries participated to the study on a voluntary basis between January 1st, 2018 and July 31st, 2019. Internists' awareness and knowledge on sex and gender issues in clinical medicine were measured by an online anonymized 7-item survey. A total of 1323 European internists responded to the survey of which 57% were women, mostly young or middle-aged (78%), and practicing in public general medicine services (74.5%). The majority (79%) recognized that sex and gender are not interchangeable terms, though a wide discrepancy exists on what clinicians think sex and gender concepts incorporate. Biological sex and sociocultural gender were recognized as determinants of health mainly in cardiovascular and autoimmune/rheumatic diseases. Up to 80% of respondents acknowledged the low participation of female individuals in trials and more than 60% the lack of sex-specific clinical guidelines. Internists also express the willingness of getting more knowledge on the impact of sex and gender in cerebrovascular/cognitive and inflammatory bowel diseases. Biological sex and sociocultural gender are factors influencing health and disease. Although awareness and knowledge remain suboptimal across European internists, most acknowledge the underrepresentation of female subjects in trials, the lack of sex-specific guidelines and the need of being more informed on sex and gender-based differences in diseases.

Venous thromboembolism in patients with liver diseases.

Essentials Emerging evidence shows that patients with liver disease are not protected from thrombotic events. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. The presence of VTE resulted in an increase in mortality for patients with liver disease. Hospitalized patients with moderate-severe liver disease had low risk of VTE during admission. SUMMARY: Background and Aims Patients with liver disease were traditionally believed to be protected against development of blood clots, but some studies have shown a potential increased risk of venous thrombotic complications. We assessed the risk of venous thromboembolism (VTE) in patients with liver disease. Methods Data in discharge reports of patients with liver disease and control patients without liver disease were analyzed from the national inpatient sample. Incidence of VTE was compared in patients with mild, moderate-severe or no liver disease, and the impact on in-hospital mortality and length of stay was calculated. Results The overall incidence of VTE for patients with no liver disease, mild liver disease and moderate-severe liver disease was 2.7, 2.4 and 0.9 per 100 patient discharges, respectively. In the presence of VTE, in-hospital mortality was 10.8%, 5.8%, and 21.7% for the no liver disease, mild disease and moderate-severe liver disease, respectively. The presence of VTE resulted in an increase in mortality for patients with no liver disease (OR, 1.16; 95% CI, 1.14-1.18) and moderate-severe liver disease (OR, 1.63; CI 95%, 1.42-1.88). Conclusions Patients with moderate-severe liver disease have a lower risk of VTE than those without liver disease. Development of thrombosis during admission increased the risk of in-hospital mortality.

[Nasogastric enteral nutrition in severe acute pancreatitis]. / Nutrición por sonda nasogástrica en la pancreatitis aguda grave.

BACKGROUND AND OBJECTIVE: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. PATIENTS AND METHOD: A total of 12 patients with severe acute pancreatitis (> or = 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. RESULTS: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. CONCLUSIONS: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes.

Nutrición por sonda nasogástrica en la pancreatitis aguda grave / Nasogastric enteral nutrition in severe acute pancreatitis

Fundamento y objetivo: Valorar la tolerancia a la nutrición por sonda nasogástrica de los pacientes con pancreatitis aguda grave. Pacientes y método: Incluimos a 12 pacientes con pancreatitis aguda grave (3 o más criterios de Ranson; proteína C reactiva > 210 mg/dl) y evolución clínica desfavorable ingresados durante el año 2006. Una vez establecida la gravedad de la pancreatitis, se inició alimentación por sonda nasogástrica (10 F) con dieta polipeptídica pobre en grasas (Dietgrif®) mediante bomba de perfusión continua. Se valoraron la tolerancia a la dieta y las complicaciones. Resultados: La edad media (desviación estándar) de los pacientes (4 mujeres y 8 varones) era de 70 (11) años y la estancia media fue de 86 días (intervalo: 14-405 días). La etiología de la pancreatitis fue biliar en 8 casos, alcohólica en uno y desconocida en 3. Todos los pacientes desarrollaron complicaciones médicas y/o pancreáticas. Siete presentaban necrosis pancreática significativa en la tomografía computarizada. Tres ingresaron en la unidad de cuidados intensivos y 2 fallecieron. Ocho de los 12 pacientes (67%) toleraron perfectamente la dieta por sonda nasogástrica independientemente de sus complicaciones. En 3 hubo que interrumpir inicialmente la dieta por íleo paralítico y precisaron nutrición parenteral total de forma transitoria. Sólo en un caso fue imposible la nutrición enteral debido a estenosis duodenal. Conclusiones: La nutrición por sonda nasogástrica en los pacientes con pancreatitis aguda grave es bien tolerada y podría plantearse como una alternativa a las otras formas de nutrición

Background and objetive: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. Patients and method: A total of 12 patients with severe acute pancreatitis ($ 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif®) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. Results: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. Conclusions: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes

A case of a solid renal mass together with a cystic pancreatic lesion in a 50-year-old patient.

CONTEXT: Pancreatic cysts may be incidentally detected in asymptomatic patients evaluated for other clinical manifestations. Microcystic adenomas are particularly rare among pancreatic cyst neoplasms. They are benign lesions and can present as solitary pancreatic tumors or as a radiological manifestation combined with other cystic and tumoral lesions affecting different organs. CASE REPORT: A 50-year-old man presented with hematuria. A computed tomography scan of the abdomen showed a 9-centimeter renal mass in the left kidney consistent with a renal-cell carcinoma as well as a cystic lesion the head of the pancreas. The histopathological study of the cystic mass, following a computed tomography guided biopsy, showed a microcystic adenoma. Therefore, further studies were performed so as to assess the relationship between both lesions and determine the final diagnosis. CONCLUSIONS: Microcystic adenomas are exceedingly rare tumors among pancreatic cysts. The combination of a solid renal mass and a pancreatic cystic lesion should lead to a broad differential diagnosis. Pancreatic magnetic resonance imaging has been proven to be particularly useful in evaluating cystic masses. The presence of walls and internal septations in the pancreatic mass with gadolinium enhancement should raise the possibility of an underlying Von Hippel-Lindau syndrome.

Púrpura trombótica trombocitopénica asociada a pancreatitis aguda / Thrombotic thrombocytopenic purpura occurring in association with acute pancreatitis

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Sarcoidosis tiroidea en mujer con antecedentes de cáncer de tiroides / Thyroid sarcoidosis in a woman with previous thyroid cancer

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