Pub Date : 2025-02-21DOI: 10.1016/j.medcle.2024.09.013
Carolina Mundim Couto Magalhães , Marina Ribeiro Bartholo , Bernardo Henrique Mendes Correa , Maria de Lourdes Abreu Ferrari , Teresa Cristina Abreu Ferrari
Introduction
Tumor necrosis factor-alpha inhibitor (anti-TNF-α) agents are essential in treating inflammatory bowel diseases (IBD). Their use, however, may cause dermatoses. This study aims to characterize the dermatoses in IBD patients on anti-TNF-α therapy.
Methods
A total of 175 IBD patients, 105 (60%) on anti-TNF-α therapy were consecutively selected in a Brazilian referral center of gastroenterology and were evaluated by a dermatologist, regardless of whether they had dermatological complaints.
Results
The most prevalent disorders in patients receiving anti-TNF-α were skin infections (52.4%), unspecified alopecia not associated with psoriasiform eruptions (32.4%), seborrheic dermatitis (27.6%), infusion/injection reactions (14.5%), and psoriasiform eruptions (11.4%). The group not on anti-TNF-α treatment also presented a high prevalence of infection, seborrheic dermatitis, and alopecia, but no psoriasiform eruptions. There was a higher prevalence of dermatoses, when considered together, in patients taking anti-TNF-α. The use of these agents was independently associated with presence of dermatoses when grouped.
Conclusion
The prevalence of dermatoses, considering together, was higher in the anti-TNF-α group. Infections, alopecia, seborrheic dermatitis, administration reactions, and psoriasiform eruptions were the most frequent dermatoses in patients taking anti-TNF-α.
{"title":"Dermatoses in patients with inflammatory bowel disease under tumor necrosis factor-alpha inhibitors treatment","authors":"Carolina Mundim Couto Magalhães , Marina Ribeiro Bartholo , Bernardo Henrique Mendes Correa , Maria de Lourdes Abreu Ferrari , Teresa Cristina Abreu Ferrari","doi":"10.1016/j.medcle.2024.09.013","DOIUrl":"10.1016/j.medcle.2024.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumor necrosis factor-alpha inhibitor (anti-TNF-α) agents are essential in treating inflammatory bowel diseases (IBD). Their use, however, may cause dermatoses. This study aims to characterize the dermatoses in IBD patients on anti-TNF-α therapy.</div></div><div><h3>Methods</h3><div>A total of 175 IBD patients, 105 (60%) on anti-TNF-α therapy were consecutively selected in a Brazilian referral center of gastroenterology and were evaluated by a dermatologist, regardless of whether they had dermatological complaints.</div></div><div><h3>Results</h3><div>The most prevalent disorders in patients receiving anti-TNF-α were skin infections (52.4%), unspecified alopecia not associated with psoriasiform eruptions (32.4%), seborrheic dermatitis (27.6%), infusion/injection reactions (14.5%), and psoriasiform eruptions (11.4%). The group not on anti-TNF-α treatment also presented a high prevalence of infection, seborrheic dermatitis, and alopecia, but no psoriasiform eruptions. There was a higher prevalence of dermatoses, when considered together, in patients taking anti-TNF-α. The use of these agents was independently associated with presence of dermatoses when grouped.</div></div><div><h3>Conclusion</h3><div>The prevalence of dermatoses, considering together, was higher in the anti-TNF-α group. Infections, alopecia, seborrheic dermatitis, administration reactions, and psoriasiform eruptions were the most frequent dermatoses in patients taking anti-TNF-α.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 4","pages":"Pages 173-177"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.medcle.2024.08.013
Ningning Yang, Xiaoyun Ding
Mesenteric panniculitis (MP) is a rare disease characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue. It is a benign disease that is influenced by many factors, mainly abdominal trauma and surgery. At present, the pathogenesis and clinical characteristics of MP are still not clear. Most patients with MP are asymptomatic, few will present gastrointestinal symptoms, especially abdominal pain. The diagnosis of MP mainly relies on imaging, such as CT. Medicine treatment is unnecessary for asymptomatic patients, and the curative effect of glucocorticoids is effective in patients with symptom. In the absence of severe intestinal obstruction, surgical treatment should not be considered. The purpose of this paper is to systematically introduce and summarize the epidemiology, etiology, histopathology, clinical manifestations, diagnosis, treatment and prognosis of MP, so as to improve the understanding of this disease.
{"title":"Mesenteric panniculitis: A comprehensive description of a rare disease","authors":"Ningning Yang, Xiaoyun Ding","doi":"10.1016/j.medcle.2024.08.013","DOIUrl":"10.1016/j.medcle.2024.08.013","url":null,"abstract":"<div><div>Mesenteric panniculitis (MP) is a rare disease characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue. It is a benign disease that is influenced by many factors, mainly abdominal trauma and surgery. At present, the pathogenesis and clinical characteristics of MP are still not clear. Most patients with MP are asymptomatic, few will present gastrointestinal symptoms, especially abdominal pain. The diagnosis of MP mainly relies on imaging, such as CT. Medicine treatment is unnecessary for asymptomatic patients, and the curative effect of glucocorticoids is effective in patients with symptom. In the absence of severe intestinal obstruction, surgical treatment should not be considered. The purpose of this paper is to systematically introduce and summarize the epidemiology, etiology, histopathology, clinical manifestations, diagnosis, treatment and prognosis of MP, so as to improve the understanding of this disease.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 4","pages":"Pages 184-189"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.medcle.2024.09.014
Oscar Caso Maestro , Virginia García Moreno , Iago Justo Alonso , Alberto Marcacuzco Quinto , Jose María Aguado , Carmelo Loinaz Segurola , Carlos Jiménez Romero
Background
Multiple studies have shown good results with the use of octogenarian donors in non-HCV recipients and its use is universally accepted worldwide. There are no studies analyzing differences between hepatitis C virus (HCV) and non-HCV recipients transplanted with donors ≥ 80 years in the direct-action antivirals (DAA) period. The rate of liver transplantation (LT) using old donors is still low, and a change in the acceptance of these grafts could increase the liver pool available for LT.
Material and methods
Since the introduction of DAA therapy in our hospital in January 2014 to May 2022, 457 LT were performed, and 74 (16.2%) of these patients underwent LT with donors ≥ 80 years. A cohort study was carried-out comparing 15 HCV-positive recipients vs. 59 HCV-negative patients during the period of the study.
Results
Recipients were younger in the non-HCV group. MELD and subsequently DMELD were higher in non-HCV group. Nevertheless, the association of hepatocellular carcinoma (HCC) with HCV cirrhosis was higher than with non-HCV cirrhosis (86.7% vs. 28.8%; p < 0.001), but there were no recurrences within HCV group and only 1 case in the non-HCV group. The 1-, 3-, and 5-years patient and graft survival were similar in both groups. Recipient age and intraoperative transfusion requirements were predictors of graft survival [(HR 1.10, 95CI 1.01–1.21; p = 0.03) and (HR 1.03, 95CI 1.01–1.05; p < 0.001), respectively].
Conclusions
In conclusion, the use of octogenarian donors was a safe alternative to younger donors in HCV recipients requiring LT in the era of DAA with similar results to those obtained in non-HCV patients.
{"title":"Outcomes of liver transplantation with donors older than 80 years in HCV patients treated with direct-action antivirals vs. non-HCV patients","authors":"Oscar Caso Maestro , Virginia García Moreno , Iago Justo Alonso , Alberto Marcacuzco Quinto , Jose María Aguado , Carmelo Loinaz Segurola , Carlos Jiménez Romero","doi":"10.1016/j.medcle.2024.09.014","DOIUrl":"10.1016/j.medcle.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Multiple studies have shown good results with the use of octogenarian donors in non-HCV recipients and its use is universally accepted worldwide. There are no studies analyzing differences between hepatitis C virus (HCV) and non-HCV recipients transplanted with donors<!--> <!-->≥<!--> <!-->80 years in the direct-action antivirals (DAA) period. The rate of liver transplantation (LT) using old donors is still low, and a change in the acceptance of these grafts could increase the liver pool available for LT.</div></div><div><h3>Material and methods</h3><div>Since the introduction of DAA therapy in our hospital in January 2014 to May 2022, 457 LT were performed, and 74 (16.2%) of these patients underwent LT with donors<!--> <!-->≥<!--> <!-->80 years. A cohort study was carried-out comparing 15 HCV-positive recipients vs. 59 HCV-negative patients during the period of the study.</div></div><div><h3>Results</h3><div>Recipients were younger in the non-HCV group. MELD and subsequently DMELD were higher in non-HCV group. Nevertheless, the association of hepatocellular carcinoma (HCC) with HCV cirrhosis was higher than with non-HCV cirrhosis (86.7% vs. 28.8%; <em>p</em> <!--><<!--> <!-->0.001), but there were no recurrences within HCV group and only 1 case in the non-HCV group. The 1-, 3-, and 5-years patient and graft survival were similar in both groups. Recipient age and intraoperative transfusion requirements were predictors of graft survival [(HR 1.10, 95CI 1.01–1.21; <em>p</em> <!-->=<!--> <!-->0.03) and (HR 1.03, 95CI 1.01–1.05; <em>p</em> <!--><<!--> <!-->0.001), respectively].</div></div><div><h3>Conclusions</h3><div>In conclusion, the use of octogenarian donors was a safe alternative to younger donors in HCV recipients requiring LT in the era of DAA with similar results to those obtained in non-HCV patients.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 4","pages":"Pages 161-167"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.medcle.2024.07.029
Luis G. Alcala-Gonzalez , Alfredo Guillen-del-Castillo , Carmen P. Simeón-Aznar , on behalf of the Scleroderma GI Research Working Group
{"title":"Patient perspectives and treatment gaps in managing gastrointestinal symptoms in systemic sclerosis","authors":"Luis G. Alcala-Gonzalez , Alfredo Guillen-del-Castillo , Carmen P. Simeón-Aznar , on behalf of the Scleroderma GI Research Working Group","doi":"10.1016/j.medcle.2024.07.029","DOIUrl":"10.1016/j.medcle.2024.07.029","url":null,"abstract":"","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 4","pages":"Pages 196-198"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.medcle.2024.09.015
Maria José Temido , Margarida Peixinho , Rosário Cunha , Andrea Silva , Sandra Lopes , Sofia Mendes , Ana Margarida Ferreira , Manuela Ferreira , Pedro Figueiredo , Francisco Portela
Background
An ideal test to evaluate the inflammatory burden in ulcerative colitis is still an unmet need. Fecal calprotectin (FCP) and C-reactive protein (CRP) have significant limitations. Plasma calprotectin (PC) seems to be promising in inflammatory diseases, but its value in IBD is still to be determined. Our aim was to assess whether PC correlates with inflammatory activity in UC.
Methods
Prospective single center cohort study. Consecutive patients previously diagnosed with UC undergoing endoscopy were included (June 2021–September 2022). Demographic, clinical, analytical (CRP, PC and FCP), endoscopic and histologic data was collected at the time of colonoscopy. PC was assessed with Gentian Calprotectin Immunoassay and, in a subgroup of patients, also with QUANTA Flash Circulating Calprotectin from INOVA.
Results
Inclusion of 98 patients (60.2% male) with a median age 49 (38–61) years. The extent of colitis was distal in 12 (12.2%), left-sided in 49 (50%), and extensive in 37 (37.8%). Mesalazine was taken by 65 (66.3%) patients, with biologic monotherapy used in 24 (24.5%) and combination therapy in 6 (6.1%). Clinical, endoscopic and histological remission were detected, in 56 (57.1%), 48 (49%) and in 55 (56.1%) patients, respectively.
Comparing MES 0/1 vs MES 2/3, a statistically significant difference was found with PC, CRP and FCP. Concerning endoscopic (MES = 1) and histological (GS < 2) remission, FCP was the only biomarker able to detect these outcomes. PC (Gentian) and PCi (INOVA) were highly correlated with CRP.
Conclusion
PC has low value in distinguishing patients in remission from patients with endoscopic or histologic activity in UC. This essential role must continue be played by FCP.
{"title":"Plasma calprotectin as a biomarker of inflammatory activity in ulcerative colitis","authors":"Maria José Temido , Margarida Peixinho , Rosário Cunha , Andrea Silva , Sandra Lopes , Sofia Mendes , Ana Margarida Ferreira , Manuela Ferreira , Pedro Figueiredo , Francisco Portela","doi":"10.1016/j.medcle.2024.09.015","DOIUrl":"10.1016/j.medcle.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>An ideal test to evaluate the inflammatory burden in ulcerative colitis is still an unmet need. Fecal calprotectin (FCP) and C-reactive protein (CRP) have significant limitations. Plasma calprotectin (PC) seems to be promising in inflammatory diseases, but its value in IBD is still to be determined. Our aim was to assess whether PC correlates with inflammatory activity in UC.</div></div><div><h3>Methods</h3><div>Prospective single center cohort study. Consecutive patients previously diagnosed with UC undergoing endoscopy were included (June 2021–September 2022). Demographic, clinical, analytical (CRP, PC and FCP), endoscopic and histologic data was collected at the time of colonoscopy. PC was assessed with Gentian Calprotectin Immunoassay and, in a subgroup of patients, also with QUANTA Flash Circulating Calprotectin from INOVA.</div></div><div><h3>Results</h3><div>Inclusion of 98 patients (60.2% male) with a median age 49 (38–61) years. The extent of colitis was distal in 12 (12.2%), left-sided in 49 (50%), and extensive in 37 (37.8%). Mesalazine was taken by 65 (66.3%) patients, with biologic monotherapy used in 24 (24.5%) and combination therapy in 6 (6.1%). Clinical, endoscopic and histological remission were detected, in 56 (57.1%), 48 (49%) and in 55 (56.1%) patients, respectively.</div><div>Comparing MES 0/1 vs MES 2/3, a statistically significant difference was found with PC, CRP and FCP. Concerning endoscopic (MES<!--> <!-->=<!--> <!-->1) and histological (GS<!--> <!--><<!--> <!-->2) remission, FCP was the only biomarker able to detect these outcomes. PC (Gentian) and PCi (INOVA) were highly correlated with CRP.</div></div><div><h3>Conclusion</h3><div>PC has low value in distinguishing patients in remission from patients with endoscopic or histologic activity in UC. This essential role must continue be played by FCP.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 4","pages":"Pages 168-172"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.medcle.2024.09.008
Ignasi Garcia-Olivé , Agustín Urrutia , Eva Janeiro , Marta Gutiérrez-Valencia , Leire Leache Alegría , Jose Ignacio Pijoan Zubizarreta , Elisabeth Carreras Robert , Rosa García Diez , representing the MAPAC-MPC group
Objective
The objective of this study is to analyze the appropriateness of the indication for urinary catheterization (UC) in hospitalized patients and to analyze possible associated factors.
Methods
Cross-sectional observational study conducted in 15 hospitals. Patients over the age of 18 with UC were included in the study. Information on age, sex, healthcare area, documentation of the order in the medical record, and reason for UC was collected. Indications were considered appropriate according to the Centers for Disease Control's (CDC) Urinary Tract Infection Prevention Guidelines. Logistic regression was used to study the relationship of different variables with the appropriateness of UC and the presence of documentation of the reason for UC.
Results
696 patients with UC at the time of evaluation were included, with a mean age of 73.3 years (SD 14.6), and 45.0% of them were female. The main indications for UC were preoperative, hemodynamic instability, and acute urinary retention. In 17.4% of cases, the reason for UC was not documented, and the prevalence of inappropriateness was 20.3%. Inappropriateness of UC was higher in the Emergency Department (35.1%), followed by medical services (17.2%) and surgical services (8.4%) (p < 0.001 in all comparisons). Appropriateness was lower in older patients (p = 0.021) and in centers with a higher number of beds (p < 0.001).
Conclusions
Unappropriateness of urinary catheterization is a significant problem in our centers, especially in the Emergency Department and in older patients. Specific and multifocal quality improvement programs are needed to enhance knowledge of appropriate indications for UC and potential adverse consequences.
{"title":"Appropriateness of urinary catheterization in the hospital setting: A multicenter observational study","authors":"Ignasi Garcia-Olivé , Agustín Urrutia , Eva Janeiro , Marta Gutiérrez-Valencia , Leire Leache Alegría , Jose Ignacio Pijoan Zubizarreta , Elisabeth Carreras Robert , Rosa García Diez , representing the MAPAC-MPC group","doi":"10.1016/j.medcle.2024.09.008","DOIUrl":"10.1016/j.medcle.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to analyze the appropriateness of the indication for urinary catheterization (UC) in hospitalized patients and to analyze possible associated factors.</div></div><div><h3>Methods</h3><div>Cross-sectional observational study conducted in 15 hospitals. Patients over the age of 18 with UC were included in the study. Information on age, sex, healthcare area, documentation of the order in the medical record, and reason for UC was collected. Indications were considered appropriate according to the Centers for Disease Control's (CDC) Urinary Tract Infection Prevention Guidelines. Logistic regression was used to study the relationship of different variables with the appropriateness of UC and the presence of documentation of the reason for UC.</div></div><div><h3>Results</h3><div>696 patients with UC at the time of evaluation were included, with a mean age of 73.3 years (SD 14.6), and 45.0% of them were female. The main indications for UC were preoperative, hemodynamic instability, and acute urinary retention. In 17.4% of cases, the reason for UC was not documented, and the prevalence of inappropriateness was 20.3%. Inappropriateness of UC was higher in the Emergency Department (35.1%), followed by medical services (17.2%) and surgical services (8.4%) (<em>p</em> <!--><<!--> <!-->0.001 in all comparisons). Appropriateness was lower in older patients (<em>p</em> <!-->=<!--> <!-->0.021) and in centers with a higher number of beds (<em>p</em> <!--><<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>Unappropriateness of urinary catheterization is a significant problem in our centers, especially in the Emergency Department and in older patients. Specific and multifocal quality improvement programs are needed to enhance knowledge of appropriate indications for UC and potential adverse consequences.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"164 3","pages":"Pages 123-128"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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