RESUMO
Herbs and other botanicals have been used in different cultures with medicinal and dietary purposes for centuries. Contrary to the belief of being natural and safe products, their hepatotoxic potential is recognized in several studies worldwide, and represent a health problem that deserves greater attention. The reported prevalence of hepatotoxicity associated with botanicals is variable and depends on various factors such as population, period and design of the study. There have been reports of a total of 60 products with herbal medicinal and dietary purposes, which may cause liver damage; however, the pathophysiological mechanisms involved are not fully elucidated. Their clinical and histological features, not unlike liver injury associated with drugs in most patients, have a pattern of hepatocellular injury. Diagnosis is by exclusion, and represents a clinical challenge. It is essential the clinical suspicion and the differential diagnosis with other acute and chronic conditions. Hence, future researches are aimed at improving existing diagnostic methods and introducing new toxicological, genetic and immunological technologies. Treatment is complex and presents a challenge for the specialist, as there are no antidotes. Management based on the discontinued use of the product and in the symptomatic treatment, decreases the progression to an acute fulminant hepatic failure.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Preparações de Plantas/efeitos adversos , Plantas Medicinais/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Suplementos Nutricionais/efeitos adversos , Humanos , Medicina Tradicional/efeitos adversos , Fitoterapia/efeitos adversos , Plantas Medicinais/química , PrevalênciaRESUMO
Drug-induced liver injury (DILI) is an important cause of morbidity and mortality worldwide, with varied geographical differences. The aim of this prospective, descriptive, cross-sectional study was to identify and characterize cases of DILI in a hospital of Zulia state, Venezuela. Thirteen patients with a presumptive diagnosis of DILI attended by the Department of Gastroenterology, Hospital Universitario, Zulia state, Venezuela, from December-2012 to December-2013 were studied. Ibuprofen (n = 3; 23.1%), acetaminophen (n = 3; 23.1), isoniazid (n = 2; 15.4%) and Herbalife products (n = 2; 15.4%) were the main drugs involved with DILI. Acetaminophen and ibuprofen showed a mixed pattern of liver injury (n = 3; 23.1%) and isoniazid presented a hepatocellular pattern (n = 2; 15.4%). The CIOMS/RUCAMS allowed the identification of possible (n = 7; 53.9%), probable (n = 4; 30.8%) and highly-probable cases (n = 2; 15.4%) of DILI. Amoxicillin/clavulanate, isoniazid, isotretinoin, methotrexate and Herbalife nutritional products were implicated as highly-probable and probable agents. The highest percentage of DILI corresponded to mild cases that recovered after the discontinuation of the agent involved (n = 9; 69.3%). The consumption of Herbalife botanical products is associated with probable causality and fatality (n = 1; 7.7%). In conclusion, the frequency of DILI cases controlled by the Department of Gastroenterology of the Hospital Universitario of Maracaibo was low, being ibuprofen, acetaminophen, isoniazid and products Herbalife the products most commonly involved. It is recommended to continue with the prospective registration of cases, with an extended follow up monitoring period and to facilitate the incorporation of other hospitals in the Zulia State and Venezuela.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Venezuela , Adulto JovemRESUMO
Las hierbas y otros productos de origen botánico, han sido utilizados por siglos en diversas culturas con fines medicinales y dietéticos. Contrario a la creencia de ser productos naturales y seguros, su potencial hepatotóxico es reconocido en diversos estudios a nivel mundial, lo que constituye un problema de salud que amerita mayor atención. La prevalencia reportada de hepatotoxicidad asociada a productos botánicos es variable y depende de diversos factores como población estudiada, período y diseño del estudio. Se han reportado un total de 60 productos a base de hierbas con fines medicinales y dietéticos, que pueden causar lesión hepática; sin embargo, el mecanismo fisiopatológico no está completamente dilucidado. Su cuadro clínico y características histológicas, no difieren de la lesión hepática asociada a medicamentos y la mayoría de los pacientes tienen un patrón de lesión hepatocelular. El diagnóstico se hace por exclusión, representando un desafío clínico importante, por lo que resulta fundamental la sospecha clínica y el diagnóstico diferencial de otras patologías agudas y crónicas. De allí que las investigaciones futuras están orientadas a mejorar los métodos diagnóstico existentes e introducir nuevas tecnologías toxicológicas, genéticas e inmunológicas. El manejo es complejo y representa un reto para el especialista puesto que no existe antídoto; el manejo se basa en suspender el uso del producto y en el tratamiento sintomático que disminuya la progresión a la falla hepática aguda fulminante.
Herbs and other botanicals have been used in different cultures with medicinal and dietary purposes for centuries. Contrary to the belief of being natural and safe products, their hepatotoxic potential is recognized in several studies worldwide, and represent a health problem that deserves greater attention. The reported prevalence of hepatotoxicity associated with botanicals is variable and depends on various factors such as population, period and design of the study. There have been reports of a total of 60 products with herbal medicinal and dietary purposes, which may cause liver damage; however, the pathophysiological mechanisms involved are not fully elucidated. Their clinical and histological features, not unlike liver injury associated with drugs in most patients, have a pattern of hepatocellular injury. Diagnosis is by exclusion, and represents a clinical challenge. It is essential the clinical suspicion and the differential diagnosis with other acute and chronic conditions. Hence, future researches are aimed at improving existing diagnostic methods and introducing new toxicological, genetic and immunological technologies. Treatment is complex and presents a challenge for the specialist, as there are no antidotes. Management based on the discontinued use of the product and in the symptomatic treatment, decreases the progression to an acute fulminant hepatic failure.
Assuntos
Humanos , Plantas Medicinais/efeitos adversos , Preparações de Plantas/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Plantas Medicinais/química , Prevalência , Suplementos Nutricionais/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Fitoterapia/efeitos adversos , Medicina Tradicional/efeitos adversosRESUMO
La cápsula endoscópica (CE) para intestino delgado inició una revolución tecnológica que se extendió a esófago buscando alternativas para la endoscopia digestiva superior (EDS), gold standard en estudio de várices esofágicas (VE) pero invasivas y desagradables sin sedación. Antes de EDS con sedación moderada, 9 pacientes cirróticos de consulta de Hepatología, 6 para seguimiento VE (66.6%) y 3 para despistaje (33.4%) ingirieron PillCamESO (Given Imaging). Endoscopista entrenado en CE (ciego a hallazgos EDS pero no a historia del paciente) leyó dos veces los resultados. Se evaluó en imágenes CE y EDS: Presencia-tamaño de várices esofágicas, Riesgo de sangrado, Presencia-grado de Gastropatía Portal Hipertensiva (GPH), várices gástricas. Se aplicaron dos cuestionarios de satisfacción: pre y post procedimiento. CE demostró 88,8% de sensibilidad para determinar tamaño y riesgo de sangrado y 66.6% para GPH. Un hallazgo visto solo por CE, incluyó una várice gástrica. 88% de los pacientes manifestó mayor ansiedad-incomodidad con EDS, prefiriendo CE para futuros procedimientos. A pesar de la eficacia, comodidad y utilidad de CE para seleccionar pacientes para EDS, no creemos que pueda sustituir totalmente a EDS por imposibilidad de tratamiento y costo. Los resultados son prometedores, ampliando la muestra tendremos conclusiones más sólidas...
Endoscopic Capsule (EC) for small bowl is a gastrointestinal breakthrough which extended to esophagus searching for alternatives to esophagogastroduodenoscopy (EGD); gold standard for esophageal varices (EV) study (but invasive and uncomfortable without sedation). We report our preliminary EC results in Maracaibo. Before EGD with moderated sedation, 9 cirrhotic patients, 6 (55%) for surveillance and 3 for variceal screening, underwent EC PillCamESO (Given Imaging). Endoscopist with EC training (blinded to EGD founds but not to patients history) read twice the results. EC and EGD images were evaluated for EV size, bleeding risk, portal hypertensive gastropathy (PHG) grade, gastric varices and other founds. Two satisfaction questionnaires were applied (pre and post procedure). EC showed 88.8% sensibility in determining EV size and bleeding risk and 66.6% sensitivity for PHG. A gastric varice was seen only by EC. 88% of the patients were more anxious and uncomfortable with EGD preferring EC for future procedures. Though EC is efficient, comfortable and useful in deciding which patients would benefi t from EGD we dont think it will totally replace EGD, due to its cost and impossibility for treatment. Results are promising although bigger samples are necessary for solid conclusions...
Assuntos
Humanos , Masculino , Feminino , Endoscopia por Cápsula/métodos , Endoscopia do Sistema Digestório/métodos , Gastropatias/diagnóstico , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas , GastroenterologiaRESUMO
A pesar de que en 1996 se implantó un nuevo programa de Gerencia en el Servicio de Gastroenterología del Hospital Universitario de Maracaibo, se realizó entre los años 1996-1998, la intención de nuestro trabajo es evaluar la Gerencia y el desempeño de nuestro servicio, además evaluar las políticas de estado y su eficiencia en el desempeño de la salud pública
Assuntos
Convênios Hospital-Médico/normas , Pesquisa sobre Serviços de Saúde , Gastroenterologia , VenezuelaRESUMO
Este trabajo tiene como propósito evaluar el modelo de gestión en base a criterios de gerencia estratégica del Servicio de Gastroenterología del Hospital Universitario y formular una propuesta que contribuya a optimizar la eficacia y eficiencia de sus funciones básicas: Asistencia, administración, docencia, investigación y extensión, proponiendo un cambio en la cultura y desarrollo organizacional del personal adscrito al mismo, para tal fin se ralizó un análisis estratégico, mediante la aplicación de la matriz FODA, con la intervención de todos los actores en el proceso. Del resultado obtenido de este análisis, surgió la formulación de estratégia globales y específicas del Servicio, de acuerdo al área de intervención. La implementación del modelo gerencial en el Servicio permitirá agilizar y facilitar la gerencia médica, fomentando una cultura y desarrollo organizacional en su personal. El modelo propuesto orientara la formulación del plan operativo para el servicio con la finalidad de optimizar