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BACKGROUND & AIMS: Latin America is a region of great interest for studying the clinical presentation of idiosyncratic drug-induced liver injury (DILI). A comprehensive analysis of patients enrolled into the LATINDILI Network over a decade is presented. METHODS: Demographics, clinical presentation, histological findings and outcome of prospectively recruited DILI cases in the LATINDILI Network were analyzed. Suspected culprit drugs were classified according to the Anatomical Therapeutic Chemical classification. Causality was assessed using the Roussel Uclaf Causality Assessment Method (RUCAM) scale. RESULTS: Overall, 468 idiosyncratic DILI cases were analyzed (62% women; mean age, 49 years). Hepatocellular injury predominated (62%); jaundice was present in 60% of patients, and 42% were hospitalized. Of the cases, 4.1% had a fatal outcome, and 24 patients (12%) developed chronic DILI. The most common drug classes were systemic anti-infectives (31%), musculoskeletal agents (12%), antineoplastic and immunomodulating agents (11%), and herbal and dietary supplements (9%). Notably, none of the patients with DILI due to antibacterials or immunosuppressants had a fatal outcome. In fact, Hy's law showed to have drug-specific predictive value, with anti-tuberculosis drugs, nimesulide, and herbal and dietary supplements associated with the worst outcome, whereas DILI caused by amoxicillin-clavulanate, nitrofurantoin, and diclofenac, which fulfilled Hy's law, did not have a fatal outcome. CONCLUSION: Features of DILI in Latin America are comparable to other prospective registries. However, the pattern of drugs responsible for DILI differs. An increasing incidence of herbal and dietary supplements, with high mortality rate, and likewise, nimesulide and nitrofurantoin, was noted. Thus, public health policies should raise awareness of the potential adverse effects of these compounds.
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Introducción: La Enteroscopia Doble Balón (EDB) y la Videocápsula Endoscópica (VCE) se introdujeron en el Hospital Universitario de Maracaibo desde 2007 y 2008, respectivamente. Se analizó y comparó el desempeño de estas pruebas para diagnosticar enfermedades del intestino delgado. Pacientes y Métodos: Se revisaron retrospectivamente los casos sometidos a EDB superior (EDBS), EDB inferior (EDBI) y/o VCE, desde su implementación hasta enero de 2010. Resultados: En 94 casos (55 ♂ y 39 ♀; 10-89 años) se realizaron 155 procedimientos: 52 EDBS, 8 EDBI, 16 VCE y 79 procedimientos combinados. Indicaciones predominantes: Hemorragia de origen oscuro, hemorragia digestiva superior o inferior, anemia, diarrea crónica y sospecha de tumoración intestinal. Visualización completa del tracto entérico: 86,7% (EDBS), 57,7% (EDBI) y 100% (VCE). Biopsias, terapias y/o cromomarcaje: 58,2% (EDBS) y 23,1% (EDBI). Diagnósticos endoscópicos predominantes: Malformaciones vasculares, enteropatías de aspecto parasitario, neoplasias malignas, enteropatías ulcerosas y erosivas. Concordancia indicación/diagnóstico: 74,3% (EDBS), 57,7% (EDBI) y 70% (VCE). Conclusiones: La EDB y la VCE constituyen herramientas eficientes con ventajas particulares para diagnosticar patologías del intestino delgado: La EDB permite realizar procedimientos adicionales; la VCE ofrece mayor probabilidad de visualizar todo el tracto entérico. En casos concretos, combinar estar pruebas podría aumentar su eficiencia diagnóstica y terapéutica.
Introduction: Double Balloon Enteroscopy (DBE) and Endoscopic Viocapsule (EVC) were introduced in the University Hospital of Maracaibo since 2007 and 2008, respectively. Their performance in diagnosing small bowel diseases were analyzed and compared. Patients and Methods: Cases undergoing upper DBE (UDBE), lower DBE (LDBE) and/or CE, were retrospectively reviewed since the introduction of these techniques, until January 2010. Results: In 94 cases (♂: 55; ♀:39; Ages: 10 to 89), 155 diagnostic procedures were performed: 52 UDBE, 8 LDBE, 16 EVC and 79 combined procedures. Predominating indications: obscure gastrointestinal bleeding, upper and/or lower gastrointestinal bleeding, anemia, chronic diarrhea, and suspicion of an intestinal tumor. Full visualization of small bowel: 86.7% (UDBE), 57.7% (DBUE) and 100% (EVC). Biopsies, therapies and/or India ink tattooing: 58.2% (UDBE) and 23.1% (DBLE). Predominant endoscopic diagnoses: vascular malformations, parasitic enteropathies, malign tumor, ulcerative enteropathies and erosive enteropathies. Agreement indication/diagnosis: 74.3% (UDBE), 57.7% (LDBE) and 70% (EVC). Conclusions: DBE and EVC constitute efficient methods with particular advantages for diagnosing small bowel pathologies: DBE allows additional procedures; EVC provides a greater chance of full visualization of small intestine. In specific cases, combination of these tests could improve their diagnostic and therapeutic efficiency.
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Humanos , Masculino , Feminino , Endoscopia por Cápsula , Enteroscopia de Duplo Balão/métodos , Intestino Delgado/anatomia & histologia , Intestino Delgado/fisiopatologia , Diagnóstico por Imagem , Gastroenterologia , Microscopia de VídeoRESUMO
Introducción: Se ha demostrado ampliamente que el genotipo F del virus de la hepatitis B (VHB) es dominante en nuestra población Amerindia. Recientemente, nosotros identificamos que en los pacientes infectados por VHB habitantes no migratorios de áreas urbanas venezolanas prevalece también el genotipo F. Objetivo: Determinar los genotipos del VHB en portadores crónicos urbanos migratorios y compararlos con el grupo no migratorio. Material y Métodos: Se investigaron 136 portadores crónicos del VHB, 110 no inmigrantes y 26 inmigrantes de origen asiático. Se evaluaron antígeno eHB y anti-eHB y los genotipos del VHB, este último mediante PCR. Resultados: En los 110 pacientes urbanos venezolanos persistió la elevada frecuencia del genotipo F (95%) con 3 casos coinfectados, 2 por genotipos A+F y 1 caso con genotipos E+F. Interesantemente, 2 casos demostraron genotipo D del VHB. Hepatitis crónica B (HCB) antígeno-e positivo fue diagnosticada en 83 pacientes (80,6%) mientras 20 casos (19,4%) presentaron HCB antígeno-e negativo. En los pacientes asiáticos infectados con un solo genotipo se identificó el C en 11 casos, el B en 4 pacientes, el F en 3 y, en 1 caso, genotipo D. Se demostró coinfección entre estos diferentes genotipos, incluyendo un caso coinfectado con genotipo E. El genotipo F se encontró coinfectando a 4 pacientes, 2 de ellos con genotipo C. Doce casos presentaron HCB antígeno e positivo y 14 pacientes HCB antígeno e negativo. De los pacientes infectados con genotipo C, 7 de ellos (54%), incluyendo los 2 coinfectados con genotipo F, presentaron HCB antígeno-e negativo. Conclusión: Es notoria la elevada circulación del genotipo F del VHB en nuestras áreas urbanas...
Introduction: It has been widely demonstrated that the genotype F of hepatitis B virus (HBV) is dominant in our Amerindian population. Recently, we identified that genotype F is prevalent in HBV non-migratory infected patients living in urban areas. Objective: To determine the genotypes of HBV in migratory chronic carriers compared to non-migratory population. Material and Methods: We investigated 136 chronic HBV carriers, 110 non-immigrants and 26 immigrants of Asian origin. We assessed hepatitis B e-antigen and antibody and HBV genotypes, the latter using PCR. Results: High prevalence (95%) of genotype F persisted among 110 Venezuelan urban patients, with 3 co-infected patients, 2 with genotypes A+F and 1 case with E+F. Interestingly, 2 cases showed HBV genotype D. Chronic hepatitis B (CHB) e-antigen positive was diagnosed in 83 patients (80.6%) while 20 cases (19.4%) showed CHB e-antigen negative. In Asian patients infected with one sole genotype, C was identified in 11 cases, B in 4 patients, F in 3, and in 1 case, genotype D. Co-infection was demonstrated among these different genotypes, including one case co-infected with genotype E. Genotype F was found in 4 co-infected patients, 2 with genotype C. Twelve cases had CHB e-antigen positive and 14 CHB e-antigen negative. From patients infected with genotype C, 7 of them (54%), including 2 co-infected with genotype F, demonstrated CHB e-antigen negative. Conclusion: It is remarkable the high circulation of HBV genotype F in our urban areas. However, given the distinct outcome described in CHB genotype F and the identification of other genotypes rather than F in urban areas, suggests that inclusion of HBV genotypes in Venezuela, should be considered standard in the management of CHB regardless the patients geographical origin.
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Humanos , Masculino , Feminino , Epidemiologia , Técnicas de Genotipagem , Hepatite B/diagnóstico , Hepatite B/etiologia , Hepatite B/genética , Gastroenterologia , Genótipo , VenezuelaRESUMO
Objetivo: Evaluar la "Gestión 2006-2008. Sociedad Venezolana de Gastroenterología": de acuerdo al modelo EFQM: "Resultados excelentes en rendimiento, satisfacción de personal y clientes e impacto social, lo logra solo un liderazgo que canalice procesos, política & estrategias, personas, alianzas y recursos". Método: Autoevaluación EFQM de la J. Directiva SVG. Agentes: LIDERAZGO: El Plan Estratégico promovió interacción y compromiso social. (90% Fortaleza) POL¸TICA&ESTRATEGIA: Se difundió el marco filosófico. "Captación-Retención de Miembros", "Liderazgo gratificador", "Más Programas de Entrenamiento-Información", "Fortalecimiento Alianzas existentes" ,"Generación de Finanzas" y "Desarrollo de Plataforma Organizacional" (64% Fortaleza). MANEJO DEL PERSONAL: Definición de perfiles "Gastroenterólogo venezolano" y "cargos SVG". Exitosas actividades académicas y beneficios económicos. (82% Fortaleza) RECURSOS: Se introdujo el Plan Operativo SVG a Empresas, fortaleciéndose alianzas estratégicas existentes y nuevas. (90% Fortaleza). PROCESOS: Se implementaron Procedimientos, Formatos, Soportes para archivos físicos & electrónicos. Se evaluaron Proveedores, Eventos y Bienes (82% Fortaleza). Resultados. Satisfacción: CLIENTES: 82% en médicos generales, especialistas y empresas. PERSONAL: 55% (aspecto a mejorar). Se generaron reconocimientos, intercambios internacionales y becas. IMPACTO SOCIAL: 82% Difundir información gastrointestinal fue crucial. SATISFACCION EMPRESARIAL: 82%, medida al finalizar eventos. Nuestra puntuación EFQM es muy buena pero puede ser excelente. Seguiremos planificando continuidad de gestión y difundiendo información a miembros, patrocinadores y comunidad.
Aim: 2006-2008 Venezuelan Gastroenterology Society management evaluation according with EFQM Model: "Excellent results in organization performance, staff &clients satisfaction with community impact can be only accomplished by a leadership able to guide process, strategies alliances, human and economic resources". Method: SVG staff auto evaluation. Agents: LEADEARSHIP: Strategic Plan promoted interaction and social commitment. (90% Strength) POLITICS & STRATEGY: SVG philosophical frame was spread. "Leadership in gratifying way", "Capture & Retain members", "More Training-Information Programs", "Fortify previous Alliances", "Financial Strategies" and "Organizational Platform" (64% Strength):. PERSONNEL: Gastroenterologist and SVG positions´s profiles were defined. Training activities and financial benefits were accomplished. (82% Strength) RESOURCE: Operative Plan was introduced to commercial enterprises. Previous and new alliances were strengthened (90% Strength). PROCESS: Proceedings, Forms and Activities Report were implemented. Providers, Events and Assets summary were evaluated. Physic& electronic files got support (82% Strength). Results: CLIENTS SATISFACTION: 82% in GPs, specialists, and Enterprises. PERSONNEL SATISFACTION: 55% (to be improved.) Awards, International exchanges and Fellowships were generated. SOCIAL IMPACT (82%): Spreading GI information was crucial point. ENTERPRISE SATISFACTION: 82% measured at the end of the events. 2006-2008 SVG EFQM score is good but may be optimized. We will keep planning management continuity, members training and information to community.
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El propósito del estudio fue identificar las formas de presentación más frecuentes con que cursan los pacientes con enfermedad diverticular que son atendidos en el SAHUM, en el período 2003 - 2006. Se realizó una revisión de historias clínicas de pacientes con enfermedad diverticular ambulatorios u hospitalizados, que fueron diagnosticados a través de colonoscopia o métodos de imagenes, cuyos datos fueron reportados en una ficha derecolección diseñada en función de las variables del estudio. Conclusiones: la forma mas frecuente de presentación de la enfermedad diverticular fue la simple con cerca de un 50 %, además es importante resaltar que la hemorragia digestiva inferior secundaria a esta enfermedad presento una incidencia elevada comparada con la reportada a nivel mundial.
The purpose of the study was to identify the forms of presentation more frequently found in patients with diverticular disease treated at the SAHUM, in the period 2003-2006. We made a revision of clinical histories of patients with diverticular disease ambulatory or hospitalized, who were diagnosed through colonoscopy or other imaging methods, whose data were reported in a card of data collection in function of the variables of the study. Conclusions: the presentation form most frequent of the diverticular disease was the simple one with close to 50%, moreover is important to stand out that lower digestive haemorrhage secondary to this disease presented a high incidence compared with the one reported at world level.