Role of endoscopy after an acute episode of diverticulitis: analysis of a cohort of Portuguese patients from a tertiary referral center.

INTRODUCTION: Acute diverticulitis represents an inflammatory process originating in a colonic diverticulum. Although acute diverticulitis usually follows a benign course - uncomplicated diverticulitis (UCD), up to 25% may develop complicated diverticulitis (CD) including abscesses, fistulas, strictures, and perforation. Current guidelines recommend performing colonoscopy after an episode of acute diverticulitis to rule out colorectal cancer (CRC). However, the literature supporting this recommendation is still scarce. AIM AND METHODS: Our aim was to assess the relevance of endoscopy following an acute diverticulitis. Using a large cohort from a tertiary center, we retrospectively evaluated endoscopic and histologic findings in patients with acute diverticulitis confirmed by abdominal ultrasound or computed tomography. Findings were characterized as (a) normal endoscopy (highlighting only the presence of diverticula), (b) abnormal endoscopy with low-grade lesions, and (c) abnormal endoscopy with high-grade lesions. RESULTS: A total of 427 patients were evaluated, including 347 cases with UCD and 80 cases with CD. The prevalence of normal findings at endoscopy was 67.3%. An advanced adenoma or neoplasm was found in 23.7%. The estimated number of endoscopies required for diagnosing a CRC was 29 in UCD and 10 in CD. Increasing age and male sex were associated significantly with the presence of polyps at endoscopy. Increasing age was associated with CD and cancer. CONCLUSION: In our series, the prevalence of high-grade lesions and CRC was higher than that in other studies. In our opinion, the findings justify endoscopic evaluation, especially in older patients with CD.

Prothrombin complex concentrate (Octaplex): a Portuguese experience in 1152 patients.

In emergency/clinical practice it is often necessary to restore the balance of blood coagulation: the rapid reversal of oral anticoagulant therapy (OAT) is crucial in cases of serious acute bleeding and emergency surgery in patients with high international normalized ratios (INRs). Coagulation can be normalized via the application of haemostatic products, including fresh frozen plasma (FFP) or prothrombin complex concentrates (PCCs). Guidelines recommend PCCs for the reversal of OAT in preference to FFP in patients with major/life-threatening bleeding and high INRs. Advantages of PCCs include: minimal disruption to haemostasis, rapid administration and fast onset of action. One such PCC is Octaplex which is available in many countries, including Portugal. The aim of this retrospective, observational, multicentre study was to assess the clinical applications and efficacy (via reduction in INR after treatment) of Octaplex. Over the 4-year study period, 1194 infusions of Octaplex were administered in 1152 patients (69.2% for reversal of OAT, 17.3% for liver dysfunction, 10.2% for uncontrolled bleeding). The mean patient age was 64 years and the mean dose of Octaplex was 20.37 ± 7.00 IU/kg. Overall, Octaplex treatment was associated with a significant reduction in INR (P < 0.0001). In 95% of all treatment episodes, only one dose of Octaplex was required. No adverse drug reactions or thromboembolic events were reported. Octaplex effectively and significantly reduces INR values in patients requiring the restoration of blood coagulation. It effectively reverses the effect of OAT and was efficacious in the majority of bleeding episodes in patients with liver dysfunction.

Infección por Chlamydia trachomatis en el primer año de vida / Chlamydia trachomatis infection in the first year of life

Introducción: En la embarazada el rastreo de Chlamydia trachomatis (C. trachomatis) es controvertido. La colonización asintomática ocurre en el 2—20%. El 40—70% de los recién-nacidos son infectados. Objetivo: Caracterizar la infección por C. trachomatis en los niños con menos de 1 año de edad. Material y métodos: Estudio retrospectivo de 13 años (enero de 1997 a diciembre de 2009)de las infecciones diagnosticadas en lactantes por immunofluorescencia del raspado ocular o inmunoglobulina M sérica. Se analizaron datos demográficos, clínicos, radiológicos y la evolución clínica. Resultados: Fueron incluidos 46 niños, con una incidencia de 0,7/1.000 recién nacidos vivos. Lae dad media fue de 2 meses (rango: 7 días-11 meses). Siete madres presentaban otras coinfecciones: virus de la inmunodeficiencia 1 (1), antígeno HBs (AgHBs) (1) y Streptococcus del grupo B (5). El parto fue vaginal en el 81,4% y en el 13,0% hubo rotura de bolsa amniótica superior a 12 h. Cinco niños fueron prematuros. Ocurrió infección respiratoria en 41 pacientes (89,1%) y conjuntivitis en 17 (36,9%). La conjuntivitis se manifestó a los primeros 30 días de vida (rango: 7—52 días) y la infección respiratoria a los 45 días de vida (rango: 8 días-11 meses). Diez (29,4%) niños presentaron complicaciones: hipoxemia (9), otitis media aguda (2), apnea (3) y atelectasia (1). La radiografía de tórax mostró infiltrado intersticial en 25 casos (65,8%) y fue normal en 4 niños. La mayoría (80,5%) tuvo una evolución favorable, pero 5 niños fueron reingresados y 8 (17,4%) desarrollaron broncospasmo recurrente. Conclusiones: En el primer año de vida la C. trachomatis debe considerarse entre los agentes etiológicos de conjuntivitis e infecciones respiratorias. En Portugal, la prevalencia es desconocida, pero probablemente es subdiagnosticada (AU)

Background: Chlamydia trachomatis (C. trachomatis) is the most frequent bacterial sexual infection in women. Pregnant women screening is controversial, with asymptomatic colonization occurring in 2—20%, and 40—70% newborns can be infected. Objectives: The aim of this work is to characterise C. trachomatis infections in children under 12 months. Material and methods: Retrospective study was carried out from January 1997 to December 2009 (13 years), on Chlamydia infections, diagnosed by immunofluorescence of ocular scraping or serum immunoglobulin M (IgM). Demographic, clinical features, imaging findings, and outcomes were analysed. Results: A total of 46 children were identified, with an overall incidence of 0.7/1,000 deliveries. Mean age was 2 months (range from 7 days to 11 months). Seven mothers had co-infections: Human Immunodeficiency Virus (HIV) (1), HBs antigen (HBsAg) (1) and group B Streptococcus (5). Most (81.4%) children had a vaginal delivery, with membrane rupture over 12 hours in 13.0%. Respiratory infection occurred in 41 (89.1%) cases and conjunctivitis in 17 (36.9%). Conjunctivitis manifested in the first 30 days of life (range from 7 days to 52 days). Respiratory symptoms occurred at age 45 days (range from 8 days to 11 months). Ten (29.4%) children had complications: hypoxemia (9), acute medial otitis (2), apnoea (3) and atelectasis (1). Chest X-ray revealed interstitial infiltrate in 25 (65.8%), and was normal in 4 children. Most children (80.5%) had a good outcome. Conclusions: C. trachomatis should be considered as an aetiologic agent of conjunctivitis and respiratory infections in the first year of life. The prevalence of C. trachomatis infection in Portugal is unknown, and is probably an underdiagnosed disease (AU)

[Chlamydia trachomatis infection in the first year of life]. / Infección por Chlamydia trachomatis en el primer año de vida.

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequent bacterial sexual infection in women. Pregnant women screening is controversial, with asymptomatic colonization occurring in 2-20%, and 40-70% newborns can be infected. OBJECTIVES: The aim of this work is to characterise C. trachomatis infections in children under 12 months. MATERIAL AND METHODS: Retrospective study was carried out from January 1997 to December 2009 (13 years), on Chlamydia infections, diagnosed by immunofluorescence of ocular scraping or serum immunoglobulin M (IgM). Demographic, clinical features, imaging findings, and outcomes were analysed. RESULTS: A total of 46 children were identified, with an overall incidence of 0.7/1,000 deliveries. Mean age was 2 months (range from 7 days to 11 months). Seven mothers had co-infections: Human Immunodeficiency Virus (HIV) (1), HBs antigen (HBsAg) (1) and group B Streptococcus (5). Most (81.4%) children had a vaginal delivery, with membrane rupture over 12 hours in 13.0%. Respiratory infection occurred in 41 (89.1%) cases and conjunctivitis in 17 (36.9%). Conjunctivitis manifested in the first 30 days of life (range from 7 days to 52 days). Respiratory symptoms occurred at age 45 days (range from 8 days to 11 months). Ten (29.4%) children had complications: hypoxemia (9), acute medial otitis (2), apnoea (3) and atelectasis (1). Chest X-ray revealed interstitial infiltrate in 25 (65.8%), and was normal in 4 children. Most children (80.5%) had a good outcome. CONCLUSIONS: C. trachomatis should be considered as an aetiologic agent of conjunctivitis and respiratory infections in the first year of life. The prevalence of C. trachomatis infection in Portugal is unknown, and is probably an underdiagnosed disease.