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INTRODUCTION: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. METHODS: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. RESULTS: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. CONCLUSION: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients' satisfaction.
Subject(s)
Propofol , Simethicone , Adult , Female , Humans , Middle Aged , Aged , Acetylcysteine , Prospective Studies , Endoscopy, Gastrointestinal/methods , Premedication/methodsABSTRACT
Introduction: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. Methods: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. Results: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. Conclusion: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients satisfaction (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Endoscopy, Gastrointestinal/methods , Premedication , Simethicone/administration & dosage , Antifoaming Agents/administration & dosage , Acetylcysteine/administration & dosage , Prospective Studies , Cohort StudiesABSTRACT
Background@#We studied whether musclin function in humans is related to glycemic control, body composition, and cardiorespiratory capacity. @*Methods@#A cross-sectional study was performed in sedentary adults with or without metabolic syndrome (MS). Serum musclin was measured by enzyme-linked immunosorbent assay. Insulin resistance (IR) was evaluated by the homeostatic model assessment (HOMA-IR). Body composition was determined by dual-energy X-ray absorptiometry and muscle composition by measuring carnosine in the thigh, a surrogate of fiber types, through proton magnetic resonance spectroscopy. Cardiorespiratory capacity was assessed through direct ergospirometry. @*Results@#The control (n=29) and MS (n=61) groups were comparable in age (51.5±6.5 years old vs. 50.7±6.1 years old), sex (72.4% vs. 70.5% women), total lean mass (58.5%±7.4% vs. 57.3%±6.8%), and peak oxygen consumption (VOpeak) (31.0±5.8 mL O2./kg.min vs. 29.2±6.3 mL O2/kg.min). Individuals with MS had higher body mass index (BMI) (30.6±4.0 kg/m2 vs. 27.4± 3.6 kg/m2), HOMA-IR (3.5 [95% confidence interval, CI, 2.9 to 4.6] vs. 1.7 [95% CI, 1.1 to 2.0]), and musclin (206.7 pg/mL [95% CI, 122.7 to 387.8] vs. 111.1 pg/mL [95% CI, 63.2 to 218.5]) values than controls (P˂0.05). Musclin showed a significant relationship with HOMA-IR (β=0.23; 95% CI, 0.12 to 0.33; P˂0.01), but not with VOpeak, in multiple linear regression models adjusted for age, sex, fat mass, lean mass, and physical activity. Musclin was significantly associated with insulin, glycemia, visceral fat, and regional muscle mass, but not with BMI, VCO2peak, maximum heart rate, maximum time of work, or carnosine. @*Conclusion@#In humans, musclin positively correlates with insulinemia, IR, and a body composition profile with high visceral adiposity and lean mass, but low body fat percentage. Musclin is not related to BMI or cardiorespiratory capacity.
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Antecedentes: la hepatitis aguda por virus de la hepatitis E (VHE) en Europa era tradicionalmente una infección adquirida por personas que viajaban a zonas endémicas, fundamentalmente Asia y África. Actualmente, cada vez es mayor el número de casos autóctonos esporádicos diagnosticados en Occidente. Objetivo: analizar los casos diagnosticados de hepatitis aguda por virus hepatitis E (VHE) en nuestro medio, identificando las características clínicas-epidemiológicas. Material y método: se recogieron los casos diagnosticados de hepatitis aguda por VHE (IgM anti-VHE positiva y/o ARN-VHE presente en suero) desde enero de 2008 a diciembre 2014. Se analizaron diversas variables clínicas y epidemiológicas y la evolución posterior. Resultados: se encontraron 23 casos, todos ellos naturales de España. Catorce sujetos (60,87%) presentaban ictericia en el momento del diagnóstico y marcada citolisis (aspartato aminotransferasa [AST] 1.106,91 U/l y alanina aminotransferasa [ALT] 1.407,04 U/l). Veintidós casos fueron considerados autóctonos y uno había realizado un viaje a China tres meses antes. El tiempo medio de resolución fue de 11,2 semanas. En total, diez pacientes (43,5%) mostraban algún marcador de autoinmunidad positivo. Dos sujetos estaban diagnosticados de enfermedad hepática crónica previa y fueron catalogados como 'acute-on-chronic liver failure' (ACLF); uno de ellos finalizó en exitus y el otro, en trasplante hepático. Conclusión: la hepatitis aguda por VHE en nuestro medio es una entidad autóctona, probablemente infradiagnosticada, que se manifiesta con ictericia y citolisis. La presencia de marcadores de autoinmunidad positivos supone un epifenómeno que en ocasiones dificulta su diagnóstico (AU)
Background: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world. Objective: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics. Material and methods: We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed. Results: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as 'acute-on-chronic liver failure' (ACLF), one died and the other underwent liver transplantation. Conclusion: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hepatitis E/diagnosis , Hepatitis E/epidemiology , Jaundice/complications , Autoimmunity/physiology , Hepatitis A/diagnosis , Hepatitis, Autoimmune/diagnosis , Retrospective Studies , Immunoglobulin M/analysis , Immunoglobulin G/analysis , Enzyme-Linked Immunosorbent Assay/methods , Liver Failure/complications , Diagnosis, DifferentialABSTRACT
BACKGROUND: In Europe, acute hepatitis caused by the hepatitis E virus (HEV) traditionally was an infection found in people who had travelled to endemic zones, mainly Asia and Africa. However, a growing number of sporadic autochthonous cases are now being diagnosed in the Western world. OBJECTIVE: To analyze the cases of acute HEV hepatitis diagnosed in our setting, with the identification of the clinical-epidemiological characteristics. MATERIAL AND METHODS: We included the cases of acute HEV hepatitis diagnosed (positive anti-HEV IgM and/or HEV RNA present in serum) between January 2008 and December 2014. Different clinical, epidemiological and evolutive parameters were analyzed. RESULTS: A total of 23 patients were identified, all originating from Spain. Fourteen cases (60.87%) presented jaundice and marked cytolysis at the time of diagnosis (aspartate aminotransferase [AST] 1,106.91 U/l and alanine aminotransferase [ALT] 1,407.04 U/l). Twenty-two cases were regarded as autochthonous, and one patient had travelled to China three months before. The mean time to resolution was 11.2 weeks. Some autoimmune markers were positive in 43.5% of the patients. Two subjects were diagnosed with previous chronic liver disease and were classified as "acute-on-chronic liver failure" (ACLF), one died and the other underwent liver transplantation. CONCLUSION: Acute HEV hepatitis in our setting is an autochthonous condition that is probably underdiagnosed, manifesting with jaundice and cytolysis. Autoimmune marker positivity is an epiphenomenon, which in some cases complicates the diagnosis.
Subject(s)
Endemic Diseases/statistics & numerical data , Hepatitis E/epidemiology , Acute Disease , Adult , Aged , Aged, 80 and over , Disease Progression , Female , Hepatitis E/complications , Hepatitis E/diagnosis , Hepatitis E/therapy , Humans , Male , Middle Aged , Retrospective Studies , Spain/epidemiology , Treatment OutcomeABSTRACT
INTRODUCCIÓN La escala de Boston es una herramienta útil para estandarizar el nivel de preparación en la colonoscopia. El objetivo del trabajo fue analizar el grado de limpieza de la colonoscopia y los factores asociados a este en la práctica clínica habitual. MATERIAL Y MÉTODOS: Se incluyeron las colonoscopias realizadas desde enero hasta junio de 2013. Los motivos de exclusión fueron: edad < 15 años, antecedentes de cirugía colónica, enfermedad inflamatoria intestinal o hemorragia digestiva activa. Los parámetros estudiados en relación con el grado de limpieza (mediante la escala de Boston) fueron: la edad, el sexo, la indicación, el turno de la exploración (mañana o tarde), la procedencia (ambulante o ingresado) y los hallazgos encontrados. RESULTADOS: Se analizaron 947 exploraciones, excluyéndose 297. El 5,8% (38/650) de las exploraciones fueron incompletas, el 50% por falta de preparación. La edad media fue de 61,27 años (DS: 16,1), siendo el 51,8% mujeres. La distribución del nivel de preparación fue: 0-3 6,3%; 4-5 12,6%; 6-7 30,6%; 8-9 50,4%, siendo la media 7,04 (DS: 2,03). En el análisis multivariante los factores asociados a una mejor preparación que resultaron estadísticamente significativos fueron: una edad menor, el turno de tarde y el régimen ambulatorio. El porcentaje de pólipos en pacientes con una escala de Boston 5 fue de 10%, frente al 27,8% en pacientes con una puntuación > 5 (p = 0,014). CONCLUSIÓN: En la práctica clínica se obtiene un grado de preparación aceptable en el 80% de los pacientes. Los pacientes con más edad, aquellos que se realizan la colonoscopia de mañana o estando ingresados serían candidatos a medidas para mejorar el grado de preparación
INTRODUCTION: The Boston scale is useful to standardize colon cleansing at colonoscopy. The aim of this study was to analyze the degree of preparation before colonoscopy and the factors associated with cleansing in routine clinical practice. MATERIAL AND METHODS: We included colonoscopies performed from January to June 2013. Exclusion criteria were age < 15 years, a history of colon surgery, inflammatory bowel disease, and active gastrointestinal bleeding. The standard preparation was CitraFleet(R). The parameters related to the degree of bowel cleansing (using the Boston scale) were age, sex, indication, colonoscopy shift (morning or afternoon), patient origin (outpatient or hospitalized), and colonoscopy findings. RESULTS We analyzed 947 colonoscopies, with exclusion of 297. A total of 5.8% (38/ 650) of the colonoscopies were incomplete, 50% due to lack of preparation. The mean age of the patients was 61.27 years (SD: 16.1), and 51.8% were women. The distribution of the Boston scale was 0-3 in 6.3%, 4-5 in 12.6%, 6-7 in 30.6%, and 8-9 in 50.4%, with a mean 7.04 (SD: 2.03). On multivariate analysis, the factors statistically associated with better preparation were younger age, afternoon colonoscopy and the outpatient setting. The percentage of polyps in patients with a Boston scale score ≤ 5 was 10% compared with 27.8% in patients with a score > 5 (P = .014). CONCLUSION: In clinical practice, 80% of patients had an acceptable level of preparation. Older patients, those undergoing colonoscopy in the morning and hospitalized patients would be candidates for measures to improve the degree of colonic preparation
Subject(s)
Humans , Colonic Neoplasms/diagnosis , Colonoscopy/methods , Preoperative Care/methods , Gastrointestinal Contents , Early Detection of Cancer/methods , Retrospective Studies , Mass Screening/methods , Drug ToleranceABSTRACT
INTRODUCTION: The Boston scale is useful to standardize colon cleansing at colonoscopy. The aim of this study was to analyze the degree of preparation before colonoscopy and the factors associated with cleansing in routine clinical practice. MATERIAL AND METHODS: We included colonoscopies performed from January to June 2013. Exclusion criteria were age <15 years, a history of colon surgery, inflammatory bowel disease, and active gastrointestinal bleeding. The standard preparation was CitraFleet. The parameters related to the degree of bowel cleansing (using the Boston scale) were age, sex, indication, colonoscopy shift (morning or afternoon), patient origin (outpatient or hospitalized), and colonoscopy findings. RESULTS: We analyzed 947 colonoscopies, with exclusion of 297. A total of 5.8% (38/650) of the colonoscopies were incomplete, 50% due to lack of preparation. The mean age of the patients was 61.27 years (SD: 16.1), and 51.8% were women. The distribution of the Boston scale was 0-3 in 6.3%, 4-5 in 12.6%, 6-7 in 30.6%, and 8-9 in 50.4%, with a mean 7.04 (SD: 2.03). On multivariate analysis, the factors statistically associated with better preparation were younger age, afternoon colonoscopy and the outpatient setting. The percentage of polyps in patients with a Boston scale score ≤5 was 10% compared with 27.8% in patients with a score > 5 (P=.014). CONCLUSION: In clinical practice, 80% of patients had an acceptable level of preparation. Older patients, those undergoing colonoscopy in the morning and hospitalized patients would be candidates for measures to improve the degree of colonic preparation.
