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81.
Periendoscopic management of antiplatelet therapy: Prospective evaluation of adherence to guidelines
Gema Plumé Carla Satorres Francia C. Diaz Noelia Alonso Belén Navarro Marta Ponce Vicente Pons-Beltrán Lidia Argüello Marco Bustamante-Balén 《Gastroenterologia y hepatologia》2019,42(7):423-428
IntroducciónAdherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement.Patients and methodsCross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded.Results675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)]. Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy.DiscussionIn many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal. 相似文献
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Noelia Ripoll Trujillo Lidia Martínez Sánchez Anna Habimana Jordana Victoria Trenchs Sainz de La Maza Víctor Vila Miravet Carles Luaces Cubells 《Anales de pediatría (Barcelona, Spain : 2003)》2019,90(4):207-212
Introduction
The ingestion of a caustic agent is the most common cause of admission after being in contact with a domestic product. A group of patients could be considered low risk and not require aggressive procedures such a corticosteroid administration and endoscopy, especially in the paediatric population.Objective
To evaluate the safety and benefit of a less aggressive protocol for patients defined as low risk.Material and methods
An analytical-observational study conducted on patients who consulted for caustic ingestion between January 2011 and December 2015. Two periods were differentiated according to the current protocol. Period-1: usual protocol (which included admission and parenteral corticosteroid and antibiotic administration) and Period-2: less aggressive protocol for the low risk patients (oral intake test after 6 hours and discharged if they remained asymptomatic). Low risk patients were considered as those who met the following criteria: unintentional intake, absence of symptoms and oral lesions. In the rest of the patients the usual protocol was performed. Re-admission with a diagnosis of digestive lesions was considered as a complication.Results
Forty-eight patients were included in period 1, and 35 in period 2. In period 2, thirteen patients met low risk criteria. The adherence to the less aggressive protocol was 100%. None of the low risk patients required admission or endoscopy after discharge. In period 1 the adherence to the usual protocol was 60.4%. Six patients would have benefited from the application of the less aggressive protocol.Conclusions
Adopting a more conservative attitude in low risk patients is safe. These patients benefit from clinical observation, without performing more aggressive measures with their possible iatrogenic adverse effects. 相似文献86.
Norovirus infections and seroprevalence of genotype gii.4‐specific antibodies in a spanish population
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87.
Telehealth system: A randomized controlled trial evaluating the impact of an internet‐based exercise intervention on quality of life,pain, muscle strength,and fatigue in breast cancer survivors
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Caroline Roduit Remo Frei Ruth Ferstl Susanne Loeliger Patrick Westermann Claudio Rhyner Elisa Schiavi Weronika Barcik Noelia Rodriguez‐Perez Marcin Wawrzyniak Christophe Chassard Christophe Lacroix Elisabeth Schmausser‐Hechfellner Martin Depner Erika von Mutius Charlotte Braun‐Fahrlnder Anne M. Karvonen Pirkka V. Kirjavainen Juha Pekkanen Jean‐Charles Dalphin Josef Riedler Cezmi Akdis Roger Lauener Liam O'Mahony 《Allergy》2019,74(4):799-809
90.
Gema Gordo Lara Rodriguez-Laguna Noelia Agra Pilar Mendez Marta Feito Pablo Lapunzina Juan C. Lopez-Gutierrez Victor Martinez-Glez 《Clinical genetics》2019,95(4):516-519
Capillary malformation-arteriovenous malformation (CM-AVM) is caused by germline RASA1 and EPHB4 alterations. RASA1 intralesional second hits have also been reported. Here we report RASA1 constitutional mosaicism, defined here as the presence of a mosaic variant in all cell types of an individual, in two patients with CM-AVM. High-throughput sequencing was used to search for RASA1 pathogenic variants in blood samples from two unrelated patients with CM-AVM. An affected tissue sample from one of the patients was also analyzed. Both patients showed different nonsense RASA1 variants in mosaic, ranging from 7% to 21.5%, in blood samples and in the corresponding affected tissue sample from one of the patients. In conclusion, we report for the first time the presence of RASA1 constitutional mosaicism in CM-AVM. Constitutional mosaicism has implications for accurate molecular diagnosis and recurrence risk and helps to explain the great phenotypic variability in CM-AVM. 相似文献