ABSTRACT
Introducción. La exposición a radiación ionizante procedente de pruebas médicas puede ser responsable del 0,5-2% de los cánceres a nivel mundial. Debido al curso crónico en brotes y al comienzo temprano de la enfermedad de Crohn (EC), estos pacientes requieren múltiples exploraciones radiológicas ionizantes. Objetivo. Estimar la cantidad de radiación ionizante que reciben nuestros pacientes con EC así como identificar aquellos factores de riesgo asociados a recibir una dosis de radiación debida a su enfermedad (DEED)>50mSv. Material y métodos. Estudio de cohorte retrospectivo (2001-2014). Población: pacientes con EC. Dosis de riesgo >50mSv. Para el cálculo de dosis efectiva total y DEED se recogieron las exploraciones radiológicas a las que fueron sometidos. Para la identificación de factores predictivos asociados a recibir una DEED > 50mSv se realizó mediante regresión logística uni- y multivariante utilizando la dosis >50mSv como variable dependiente. Resultados. De los 267 pacientes con EC analizados, el 24,6% recibieron una dosis efectiva total >50mSv y el 15,2% una DEED >50mSv. En el análisis multivariante las variables que de forma independiente se asociaron a recibir una DEED >50mSv fueron la cirugía mayor (OR= 2,1; IC95% [1,1-3,8]; p=0,019) y la gravedad (OR=20,1; IC95% [2,7-148,4]; p<0,001). Conclusiones. Los pacientes con EC están más expuestos a recibir una DEED de riesgo, por lo que sería conveniente monitorizar la DE recibida para anticipar nuestra actuación con el fin de evitar llegar a dicha dosis. La ecografía y la entero-RNM son alternativas a considerar en estos casos, aunque su accesibilidad está limitada en algunos centros (AU)
Introduction. It is estimated that diagnostic medical radiation exposure may be responsable for 0.5-2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually requiere multiple ionizing radiation test. Objective. Stimating the total cumulative effective dose received by our CD patients and identifying the risk factors associated with the exposure to a cumulative effective dose due to the disease (CEED) > 50mSv. Materials and methods. Retrospective cohort study (2001-2014). Population: patients with CD. Risk dose >50mSv. For calculating de cumulative effective dose and the CEED, all the ionizing test done were taken. For identifying predictive factors for receiving a CEDD >50mSv, an univariate and a multivariate logistic regression analyses were performed using a >50mSv dose as dependent variable. Results. Of the 267 patients analyzed the 24.6% of them received a cumulative effective dose > 50mSv and the 15.2% a CEED>50mSv. In the multivariate analysis, the following variables were identified as independent predictors associated with a CEDD >50mSv: major surgery (OR= 2.1; IC95% [1.1-3.8]; p=.019) and severity (OR= 20.6; IC95% [4.5-94.8]; p<.01). Conclusions. Patients with CD are more at risk of receiving risk CEED, so it would be advisable to monitor the cumulative effective dose received to anticipate our intervention in order to avoid reaching that dose. The ultrasounds and abdominal resonance enterography are alternatives in these cases, although their accessibility is limited in some centers (AU)
Subject(s)
Humans , Crohn Disease/complications , Radiation, Ionizing , Neoplasms, Radiation-Induced/epidemiology , Crohn Disease/diagnostic imaging , Risk Factors , Retrospective Studies , Dose-Response Relationship, Radiation , Radiation RisksABSTRACT
INTRODUCTION: It is estimated that diagnostic medical radiation exposure may be responsable for 0.5-2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually requiere multiple ionizing radiation test. OBJECTIVE: Stimating the total cumulative effective dose received by our CD patients and identifying the risk factors associated with the exposure to a cumulative effective dose due to the disease (CEED) > 50mSv. MATERIALS AND METHODS: Retrospective cohort study (2001-2014). POPULATION: patients with CD. Risk dose >50mSv. For calculating de cumulative effective dose and the CEED, all the ionizing test done were taken. For identifying predictive factors for receiving a CEDD >50mSv, an univariate and a multivariate logistic regression analyses were performed using a >50mSv dose as dependent variable. RESULTS: Of the 267 patients analyzed the 24.6% of them received a cumulative effective dose > 50mSv and the 15.2% a CEED>50mSv. In the multivariate analysis, the following variables were identified as independent predictors associated with a CEDD >50mSv: major surgery (OR= 2.1; IC95% [1.1-3.8]; p=.019) and severity (OR= 20.6; IC95% [4.5-94.8]; p<.01). CONCLUSIONS: Patients with CD are more at risk of receiving risk CEED, so it would be advisable to monitor the cumulative effective dose received to anticipate our intervention in order to avoid reaching that dose. The ultrasounds and abdominal resonance enterography are alternatives in these cases, although their accessibility is limited in some centers.
Subject(s)
Crohn Disease/diagnostic imaging , Radiation Exposure , Adolescent , Adult , Aged , Aged, 80 and over , Biological Products/therapeutic use , Combined Modality Therapy , Crohn Disease/drug therapy , Crohn Disease/pathology , Crohn Disease/surgery , Female , Hospitals, University , Humans , Immunologic Factors/therapeutic use , Inflammation , Male , Middle Aged , Radiation Dosage , Retrospective Studies , Risk Factors , Young AdultABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/drug therapy , Ceruloplasmin/analysis , Ceruloplasmin/therapeutic use , Iron Overload/complications , Iron Overload/diagnosis , Iron Overload/therapy , Iron Chelating Agents/therapeutic use , Deferoxamine/therapeutic use , Anemia, Iron-Deficiency/enzymology , Anemia, Iron-Deficiency/physiopathology , Copper/metabolism , Iron Chelating Agents/metabolism , Diagnosis, DifferentialABSTRACT
Like other chronic diseases, inflammatory bowel disease impairs the quality of life of affected individuals, with an impact on all phases of sexual functioning. The most important factors in this dysfunction are depressed mood, inflammatory activity and concomitant diseases. While the main objective of physicians is to improve the systemic and gastrointestinal symptoms of this disease, other factors are also involved in restoring quality of life. Although sexual problems are a concern to patients, this topic has been insufficiently studied and is not generally taken into account by physicians treating inflammatory bowel disease. If comprehensive care is to be provided to patients with inflammatory bowel disease, sexuality should be approached directly and patients should be referred to appropriate specialists if dysfunction is detected.
Subject(s)
Inflammatory Bowel Diseases/complications , Sexual Dysfunctions, Psychological/etiology , HumansABSTRACT
La enfermedad infl amatoria intestinal, como otras enfermedades crónicas, altera la calidad de vida de los individuos que la padecen, produciéndose un impacto en el funcionamiento sexual que afecta a todas las fases del mismo. El ánimo depresivo, la actividad infl amatoria y las enfermedades concomitantes son los factores más importantes implicados en dicha disfunción. Aunque el objetivo principal de los médicos está dirigido, fundamentalmente, a la mejora de los síntomas sistémicos y digestivos de la enfermedad, éstos no son los únicos factores implicados en el restablecimiento de la calidad de vida. Los problemas de la sexualidad se encuentran dentro de las preocupaciones de estos pacientes; sin embargo, dicho aspecto no ha sido sufi cientemente estudiado y, generalmente, no se tiene en cuenta por parte de los médicos responsables de dicha patología. Si se quiere prestar una atención integral a los pacientes con enfermedad infl amatoria intestinal, se debe abordar la sexualidad de una forma directa y remitir a los especialistas oportunos en caso de detectar una disfunción (AU)
Like other chronic diseases, infl ammatory bowel disease impairs the quality of life of affected individuals, with an impact on all phases of sexual functioning. The most important factors in this dysfunction are depressed mood, infl ammatory activity and concomitant diseases. While the main objective of physicians is to improve the systemic and gastrointestinal symptoms of this disease, other factors are also involved in restoring quality of life. Although sexual problems are a concern to patients, this topic has been insuffi ciently studied and is not generally taken into account by physicians treating infl ammatory bowel disease. If comprehensive care is to be provided to patients with infl ammatory bowel disease, sexuality should be approached directly and patients should be referred to appropriate specialists if dysfunction is detected (AU)
