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Sans Cuffi M, Argüelles Arias F, Echarri Piudo A, Ginard Vicens D, Gutiérrez Casbas A, Marín-Jiménez I. Optimizing treatment of mild to moderate ulcerative colitis: CU-forum Delphi consensus. Gastroenterol Hepatol 2023; 46:784-794. [PMID: 36803681 DOI: 10.1016/j.gastrohep.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Ulcerative colitis (UC) clinical guidelines include the best available evidence, although not all clinical situations are answered, so their management can be controversial. The aim of this study is to identify the situations of mild to moderate UC susceptible to controversy and to evaluate the degree of agreement or disagreement with specific proposals. METHODS Inflammatory bowel disease (IBD) expert discussion meetings were used to identify criteria, attitudes and opinions regarding the management of UC. A Delphi questionnaire was then developed with 60 items regarding antibiotics, salicylates and probiotics; local, systemic and topical corticosteroids; and immunosuppressants. RESULTS Consensus was reached in 44 statements (73.3%); 32 in agreement (53.3%) and 12 in disagreement (20.0%). Some of them were: it is not necessary the systematic use of antibiotics despite the severity of the outbreak, being reserved when there is suspicion of infection or systemic toxicity; when faced with a mild-moderate outbreak of UC and in patients who do not respond to aminosalicylates, it is appropriate to use a dose of beclomethasone of 10mg/day for one month and 5mg/day for another month; it is advised that the dose of azathioprine be administered in a single dose. CONCLUSIONS IBD experts agree on most of the proposals identified for managing mild to moderate UC and there is a need for scientific evidence in some specific situations where expert opinion may be helpful.
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Affiliation(s)
- Miquel Sans Cuffi
- Servicio Gastroenterología/ISADMU, Centro Médico Teknon. Barcelona, España.
| | | | | | - Daniel Ginard Vicens
- Servicio Aparato Digestivo, Hospital Universitario Son Espases. Palma de Mallorca, España
| | - Ana Gutiérrez Casbas
- Servicio Aparato Digestivo, Hospital General Universitario de Alicante Doctor Balmis, Alicante, España
| | - Ignacio Marín-Jiménez
- Servicio Aparato Digestivo, Hospital General Universitario Gregorio Marañón. Madrid, España
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Rivero Calle I, Del Rosal Rabes T, Garrote Llanos E, Núñez Cuadros E, Navarro Gómez ML, Ramos Amador JT, Calvo C, Álvarez García F. Consensus document of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Association of Pediatrics for vaccination of immunosuppressed individuals. An Pediatr (Barc) 2023; 99:403-421. [PMID: 38057232 DOI: 10.1016/j.anpede.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
The number of people with immunosuppression is increasing considerably due to their greater survival and the use of new immunosuppressive treatments for various chronic diseases. This is a heterogeneous group of patients in whom vaccination as a preventive measure is one of the basic pillars of their wellbeing, given their increased risk of contracting infections. This consensus, developed jointly by the Sociedad Española de Infectología Pediátrica (Spanish Society of Pediatric Infectious Diseases) and the Advisory Committee on Vaccines of the Asociación Española de Pediatría (Spanish Association of Paediatrics), provides guidelines for the development of a personalised vaccination schedule for patients in special situations, including general recommendations and specific recommendations for vaccination of bone marrow and solid organ transplant recipients, children with inborn errors of immunity, oncologic patients, patients with chronic or systemic diseases and immunosuppressed travellers.
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Affiliation(s)
- Irene Rivero Calle
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP), Instituto de Investigación Hospital Clínico Universitario de Santiago de Compostela (IdiCHUS), CIBERes Ciber de Respiratorio, Santiago de Compostela, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP.
| | - Teresa Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), CIBERER U767, Instituto de Salud Carlos III, Madrid, Spain; Sociedad Española de Infectología Pediátrica
| | - Elisa Garrote Llanos
- Sección de Infectología, Servicio de Pediatría, Hospital Universitario, OSI Bilbao-Basurto, Bilbao, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - Esmeralda Núñez Cuadros
- Sección de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Grupo multidisciplinar pediátrico IBIMA, Málaga, Spain; Sociedad Española de Infectología Pediátrica
| | - María Luisa Navarro Gómez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISGM), CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Complutense, Madrid, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - José Tomás Ramos Amador
- Servicio Pediatría y Áreas Específicas, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Departamento de Salud Pública y Maternoinfantil, Universidad Complutense, CIBERINFEC Ciber de Enfermedades Infecciosas, Madrid, Spain; Comité Asesor de Vacunas de la AEP
| | - Cristina Calvo
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Autónoma de Madrid, Madrid, Spain; Sociedad Española de Infectología Pediátrica
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Ibarra Barrueta O, García Martín E, López Sánchez P, Ramírez Herráiz E, Merino Bohórquez V, Ais Larisgoitia A. Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases. Farm Hosp 2023; 47:39-49. [PMID: 36710223 DOI: 10.1016/j.farma.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The objective of this review is to gather the available evidence on the different drugs used in immune-mediated inflammatory diseases in pregnancy, lactation, their influence on female and male fertility, advice on discontinuation before conception and to help in routine clinical practice for better patient advice on family planning. METHODS A bibliographic search was carried out, where published articles (review studies, observational studies and case series) in English or Spanish until April 2020 that analyzed the management of pregnancy, lactation and/or fertility in patients on treatment in immune-mediated diseases were selected. RESULTS A total of 95 references were selected and the information on each drug was synthesized in tables. Drugs contraindicated in pregnancy are topical retinoids, pimecrolimus, cyclooxygenase 2 inhibitors, methotrexate, mycophenolate mofetil, leflunomide, acitretin, and thiopurines. The lack of data advises against the use of apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab and the new biologicals. Topical salicylates, paracetamol, ultraviolet therapy and hydroxychloroquine treatment are safe, and anti-TNF biological therapy are considered low risk, with certolizumab being the drug of choice throughout pregnancy and lactation. Most are compatible with paternal exposure except for sulfasalazine, mycophenolate and leflunomide, for which suspension of treatment prior to conception is recommended, and cyclosporine with dose requirements of less than 2mg/kg/day. CONCLUSIONS In this context of chronic treatments with teratogenic potential, it is necessary to highlight the importance of pregnancy planning to select the safest drug. Given the quality of the available data, it is still necessary to continuously update the information, as well as to promote observational studies of cohorts of pregnant patients and men of childbearing age, including prospective studies, in order to generate more scientific evidence.
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Ibarra Barrueta O, García Martín E, López Sánchez P, Ramírez Herráiz E, Merino Bohórquez V, Ais Larisgoitia A. [Translated article] Biological and immunosuppressive medications in pregnancy, breastfeeding and fertility in immune mediated diseases. Farm Hosp 2023; 47:T39-T49. [PMID: 36732114 DOI: 10.1016/j.farma.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/12/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this review is to gather the available evidence on the different drugs used in immune-mediated inflammatory diseases in pregnancy, lactation, their influence on female and male fertility, advice on discontinuation before conception and to help in routine clinical practice for better patient advice on family planning. METHODS A bibliographic search was carried out, where published articles (review studies, observational studies and case series) in English or Spanish until April 2020 that analyzed the management of pregnancy, lactation and/or fertility in patients on treatment in immune-mediated diseases were selected. RESULTS A total of 95 references were selected and the information on each drug was synthesized in tables. Drugs contraindicated in pregnancy are topical retinoids, pimecrolimus, cyclooxygenase 2 inhibitors, methotrexate, mycophenolate mofetil, leflunomide, acitretin, and thiopurines. The lack of data advises against the use of apremilast, tofacitinib, baricitinib, anakinra, abatacept, tocilizumab and the new biologicals. Topical salicylates, paracetamol, ultraviolet therapy and hydroxychloroquine treatment are safe, and anti-TNF biological therapy are considered low risk, with certolizumab being the drug of choice throughout pregnancy and lactation. Most are compatible with paternal exposure except for sulfasalazine, mycophenolate and leflunomide, for which suspension of treatment prior to conception is recommended, and cyclosporine with dose requirements of less than 2 mg/kg/day. CONCLUSIONS In this context of chronic treatments with teratogenic potential, it is necessary to highlight the importance of pregnancy planning to select the safest drug. Given the quality of the available data, it is still necessary to continuously update the information, as well as to promote observational studies of cohorts of pregnant patients and men of childbearing age, including prospective studies, in order to generate more scientific evidence.
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Affiliation(s)
- Olatz Ibarra Barrueta
- Servicio de Farmacia, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, España
| | - Estela García Martín
- Servicio de Farmacia, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.
| | - Piedad López Sánchez
- Servicio de Farmacia, Hospital General de Tomelloso, Tomelloso (Ciudad Real), Spain
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Viedma-Martínez M, Gallo-Pineda G, Jiménez-Gallo D. Practical Guide to New Treatments for SARS-CoV-2 Infection in Dermatology Patients Being Treated With Common Immunomodulators. Actas Dermosifiliogr 2023; 114:49-53. [PMID: 35963337 DOI: 10.1016/j.ad.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023] Open
Abstract
Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology.
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Viedma-Martínez M, Gallo-Pineda G, Jiménez-Gallo D. [Translated article] Practical Guide to New Treatments for SARS-CoV-2 Infection in Dermatology Patients Being Treated With Common Immunomodulators. Actas Dermosifiliogr 2023; 114:T49-53. [PMID: 36368577 DOI: 10.1016/j.ad.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology.
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Sicilia B, García-López S, González-Lama Y, Zabana Y, Hinojosa J, Gomollón F. GETECCU 2020 guidelines for the treatment of ulcerative colitis. Developed using the GRADE approach. Gastroenterol Hepatol 2021; 43 Suppl 1:1-57. [PMID: 32807301 DOI: 10.1016/j.gastrohep.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Since the first edition of the Guidelines was published in 2013, much information has been generated around the treatment of ulcerative colitis, and new drugs and action protocols have been introduced. Clinical practice has changed substantially, warranting new approaches and a comprehensive review and update of the evidence. MATERIAL AND METHODS Once again, we used the GRADE approach, supported by an electronic tool (https://gradepro.org). The clinical scenarios are the same as in the previous version (induction and maintenance in severe and mild-moderate flare-ups), as are the variables and their evaluation. However, in the updated guidelines, three questions have been deleted, 14 added and 30 maintained, making a total of 44 clinical questions. After an exhaustive review of the evidence, the recommendations are now updated. RESULTS Of the 44 questions analysed, no recommendation could be established in two due to the very low quality of the evidence, while in the other 42, based on different degrees of quality of evidence, recommendations were made according to the GRADE system. In 25 of these questions the final recommendation is strongly in favour, in six strongly against, in seven weakly in favour and in four weakly against. According to the scenarios and recommendations, six algorithms are proposed as a simple guide for practical decision-making. CONCLUSIONS The aim of this update of the 2013 guidelines is to provide answers, based on the GRADE approach, to the different questions we ask ourselves daily when deciding the most appropriate treatment for our patients with ulcerative colitis in the different clinical scenarios.
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Affiliation(s)
- Beatriz Sicilia
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Burgos, España
| | - Santiago García-López
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, España.
| | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Yamile Zabana
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo Hospital Universitario Mútua Terrassa Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Joaquín Hinojosa
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital de Manises, Valencia, España
| | - Fernando Gomollón
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Instituto de Investigaciones Sanitarias de Aragón, Hospital Clínico Universitario Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Zaragoza, España
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Almorza Hidalgo T, García González AJ, Castañeda S, Tomero EG, Pablos Álvarez JL. Cogan syndrome: Descriptive analysis and clinical experience of 7 cases diagnosed and treated in two third level hospitals. ACTA ACUST UNITED AC 2021; 17:318-21. [PMID: 32571733 DOI: 10.1016/j.reuma.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. MATERIALS AND METHODS Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. RESULTS Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. CONCLUSION The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS.
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Millán-Longo C, Peiteado D, Schlincker A, Hidalgo V, Pieren A, Balsa A, de Miguel E. Use of Immunomodulatory Drugs at a Uveitis Clinic. Reumatol Clin (Engl Ed) 2019; 15:271-276. [PMID: 29132749 DOI: 10.1016/j.reuma.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis.
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Affiliation(s)
| | - Diana Peiteado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | | | - Ventura Hidalgo
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - Amara Pieren
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Eugenio de Miguel
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
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Noguera-Morel L, Knöpfel N, Torrelo A, Hernández-Martín A. A Retrospective Study of Systemic Treatment of Severe Atopic Dermatitis With Azathioprine: Effectiveness and Tolerance in 11 Pediatric Patients. Actas Dermosifiliogr (Engl Ed) 2018; 110:227-231. [PMID: 30376955 DOI: 10.1016/j.ad.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically affects children. Severe forms may have a profound effect on patients' quality of life. Some forms are resistant to conventional treatment and require the use of systemic immunosuppressants such as azathioprine (AZA) to adequately manage the disease. OBJECTIVE To evaluate the effectiveness and tolerance of AZA in children with severe AD. PATIENTS AND METHODS We performed a retrospective study of children with severe AD treated with AZA between January 2007 and May 2017. RESULTS We reviewed the cases of 11 patients (6 boys and 5 girls) with a mean age of 13 years (range, 8-18 years). The mean (SD) age at start of treatment was 10.9 (2.2) years (95% CI 8.6-13.1). The mean initial dosage of AZA was 1.8 (0.2) mg/kg/d. We evaluated treatment response after 4 weeks, 12 to 16 weeks, and 6 months. Mean treatment duration was 10.8 (5.7) months. Treatment had to be suspended in 2 patients because of adverse effects. Seven of the 9 remaining patients presented complete or almost complete clearance of the AD after 6 months of treatment. CONCLUSION In our experience, AZA is well tolerated and may be considered as a treatment option in children with severe AD resistant to conventional treatment.
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Affiliation(s)
- L Noguera-Morel
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - N Knöpfel
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Torrelo
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Hernández-Martín
- Departamento de Dermatología, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Díaz-Ramírez GS, Marín-Zuluaga JI, Donado-Gómez JH, Muñoz-Maya O, Santos-Sánchez Ó, Restrepo-Gutiérrez JC. Characterization of patients with autoimmune hepatitis at an university hospital in Medellín-Colombia: cohort study. Gastroenterol Hepatol 2017; 41:87-96. [PMID: 29126693 DOI: 10.1016/j.gastrohep.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/17/2017] [Accepted: 09/15/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Autoimmune hepatitis is a chronic liver disease that impacts on morbidity and mortality of patients. Few epidemiological data exist of this in Latin America and Colombia. OBJECTIVES The aim of this study is to describe the demographic, clinical and laboratory characteristics of the patients; the treatment and the response to it, the evolution and course of the disease, requirement of liver transplantation and mortality. METHODS Historical cohort study that include patients attended at an University Hospital in Medellin, Colombia between January 2010 and December 2016 with ≥16 years age at the time of diagnosis of autoimmune hepatitis. Data collection was done from the review of medical records. Statistical analysis was performed using SPSS version 20. RESULTS The study included 278 patients, 90% of the patients were women, the median age at diagnosis was 50 years. 37.8% were cirrhotic at the time of diagnosis. The biochemical remission was 85%. In patients who developed cirrhosis it was found a higher proportion of men (21.2 vs. 7.8%, p=.027), a greater frequency of overlap autoimmune-primary sclerosant cholangitis (6.0 vs. 0% p=.006) and a greater frequency of non-response to treatment (12.1 vs. 1.6%, p=.004). CONCLUSION Autoimmune hepatitis is not a rare disease in Colombian population; it predominates in women but has a less favourable course in men. An important number of patients are cirrhotic at the time of diagnosis, the response to treatment and complications in our population are similar to those described worldwide.
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Affiliation(s)
| | - Juan Ignacio Marín-Zuluaga
- Grupo de Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | - Octavio Muñoz-Maya
- Grupo de Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Óscar Santos-Sánchez
- Grupo de Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Juan Carlos Restrepo-Gutiérrez
- Grupo de Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia
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Rueda-Rueda T, Sánchez-Vicente JL, Moruno-Rodríguez A, Castilla-Martino M, López-Herrero F, Contreras-Díaz M, Molina-Socola F, Sáez-Ortega L, Muñoz-Morales A. Tubulointerstitial nephritis and uveitis syndrome (TINU). Treatment with immunosuppressive therapy. ACTA ACUST UNITED AC 2017. [PMID: 28648690 DOI: 10.1016/j.oftal.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CASE REPORT Two cases of tubulointerstitial nephritis and uveitis are presented. Immunosuppressive therapy was required to control the uveitis. Contrary to that usually described, uveitis became chronic, which made immunosuppressive therapy necessary. Nephritis was successfully treated with steroids. DISCUSSION Tubulointerstitial nephritis and uveitis syndrome is an under-diagnosed disorder and requires clinical suspicion due to there being no specific laboratory study available. Recurrences and relapses of ocular inflammation are common. Immunosuppressive therapy is not often needed.
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Affiliation(s)
- T Rueda-Rueda
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Sánchez-Vicente
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Moruno-Rodríguez
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - M Castilla-Martino
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Contreras-Díaz
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Molina-Socola
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - L Sáez-Ortega
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Muñoz-Morales
- Departamento de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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13
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Chaparro M. Treatment of inflammatory bowel disease: what's new in Digestive Disease Week 2016. Gastroenterol Hepatol 2016; 39 Suppl 1:20-28. [PMID: 27888860 DOI: 10.1016/s0210-5705(16)30171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Inflammatory bowel disease is a chronic disorder of unknown aetiology that results from a pathologic response from both the innate and acquired immune systems, leading to chronic inflammation of the gastrointestinal tract. New drugs have been introduced into the therapeutic armamentarium of inflammatory bowel disease but are not effective in all patients; moreover, among initial responders, there have been reports of loss of response over time. In addition, these drugs sometimes have adverse effects and are often expensive. The present article reviews the studies presented at Digestive Disease Week 2016 that provided new data on the optimisation of currently approved treatments for inflammatory bowel disease, experience with recently approved drugs in clinical practice, and some studies on molecules that are under development for the treatment of these diseases.
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Affiliation(s)
- María Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
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14
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Mier Escurra EA, Díaz Prieto T, Fernández Ortíz SJ, Mier Saad G, Valdes Cepeda A. [Acute colonic pseudo-obstruction (Ogilvie syndrome) post-renal transplant]. Bol Med Hosp Infant Mex 2016; 73:250-255. [PMID: 29421388 DOI: 10.1016/j.bmhimx.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/15/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is a rare gastrointestinal syndrome in children. It is characterized by a marked dilatation of the colon evidenced by imaging and absence of mechanical obstruction. Patients typically present with abdominal pain and distended, tympanic abdomen, with peristalsis present, accompanied by nausea and vomiting. Up to 40% of patients can pass gas and/or have bowel movements. We decide to report this case because this syndrome is very rare in pediatric patients, and no cases have been reported in a post-renal transplant pediatric patient. CASE REPORT 13 year old male patient with past medical history of psychomotor retardation due to perinatal asphyxia and chronic renal failure secondary to bilateral renal hypoplasia. Treated with peritoneal dialysis for one year until kidney transplant was performed. Currently under immunosuppressive regime. He began his condition with mild abdominal pain accompanied by semi-liquid stools, and progressive distention up to 78cm of abdominal circumference in 72hours, so image studies were performed. Managed with prokinetic drugs without any improvement. Two exploratory laparotomies observed flanges, without evidence of any mechanical obstruction. An abdominal magnetic resonance was performed, where important intestinal dilatation was observed with no evidence of mechanical obstruction. Ogilvie Syndrome was diagnosed, so management with neostigmine was established, which led to symptom resolution. CONCLUSIONS This case is reported because this syndrome is very rare in children, there is little clinical suspicion and lack of management guides for diagnosis and treatment in patients of this age.
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Affiliation(s)
- Erik Antonio Mier Escurra
- Programa Multicéntrico de la Especialidad Médica de Pediatría de la Escuela de Medicina, Tecnológico de Monterrey, Secretaria de Salud de Nuevo León, Monterrey, México.
| | - Talia Díaz Prieto
- Programa Multicéntrico de la Especialidad Médica de Pediatría de la Escuela de Medicina, Tecnológico de Monterrey, Secretaria de Salud de Nuevo León, Monterrey, México
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15
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Restrepo DP, Tamayo A. [Affective syndromes in liver transplant recipients: ¿mediated neurotoxicity immunosuppressive?]. ACTA ACUST UNITED AC 2015; 44:121-7. [PMID: 26578335 DOI: 10.1016/j.rcp.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 10/07/2014] [Accepted: 01/13/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The onset of affective and psychotic in liver transplant patients symptoms, raises the need to explore the possible etiologies of mental symptoms. METHODOLOGY Case report and literature review. RESULTS Four clinical cases of patients undergoing orthotopic liver transplantation, who in the early post transplant showed affective symptoms, delusions and psychomotor agitation for which they needed psychiatric hospitalization and treatment with psychotropic drugs are presented. Three of the patients had clinical improvement and one patient died by suicide. DISCUSSION The development of mental symptoms in the post-transplant period opens the possibility of considering the secondary organic mental disorder a basic condition. CONCLUSIONS The adverse drug reaction may explain affective mental disorders in these four cases were reported.
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Affiliation(s)
- Diana Patricia Restrepo
- Médica Psiquiatra de Enlace, Docente Universidad CES, Estudiante de Maestría en Epidemiología Universidad CES, Medellín, Colombia.
| | - Alejandra Tamayo
- Médica Psiquiatra, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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16
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Chaparro M. [Natural history, complications, safety and pregnancy in inflammatory bowel disease]. Gastroenterol Hepatol 2015; 38 Suppl 1:20-31. [PMID: 26520193 DOI: 10.1016/s0210-5705(15)30016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Numerous studies were presented in Digestive Disease Week 2015 (DDW 2015) on the natural history, complications, and safety of treatments in inflammatory bowel disease (IBD), as well as novel findings on fertility, pregnancy, and breastfeeding. The present article reviews presentations on the natural history of IBD, the risk of complications and their prevention, treatment safety, aspects related to fertility, pregnancy, and breastfeeding, as well as the risk of cancer and its association with IBD and with drugs used in its treatment. In the next few years, more data will become available on treatment safety and the possible complications that can develop in IBD patients due to the disease itself and the drugs employed in its treatment, which will allow measures to be adopted to improve prognosis.
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Affiliation(s)
- María Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España..
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17
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Hevia P, Nazal V, Rosati MP, Quiroz L, Alarcón C, Márquez S, Cuevas K. [Idiopathic Nephrotic Syndrome: recommendations of the Nephrology Branch of the Chilean Society of Pediatrics. Part two]. ACTA ACUST UNITED AC 2015; 86:366-72. [PMID: 26365749 DOI: 10.1016/j.rchipe.2015.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/10/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
Idiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown, and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis. Steroid-resistant nephrotic syndrome represents 10-20% of idiopathic nephrotic syndrome in pediatrics. It has a poor prognosis, and its management is a significant therapeutic challenge. Half of patients evolve to end-stage renal disease within 5 years, and are additionally exposed to complications secondary to persistent NS and to the adverse effects of immunosuppressive therapy. The primary goal of treatment is to achieve complete remission, but even a partial remission is associated with a better renal survival than the lack of response. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric idiopathic nephrotic syndrome. In this second part, handling of steroid-resistant nephrotic syndrome as well as nonspecific therapies are discussed.
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Affiliation(s)
- Pilar Hevia
- Unidad de Nefrología, Hospital San Juan de Dios, Santiago, Chile.
| | - Vilma Nazal
- Unidad de Nefrología, Hospital Metropolitano La Florida, Santiago, Chile
| | - María Pía Rosati
- Unidad de Nefrología, Hospital San Juan de Dios, Santiago, Chile
| | - Lily Quiroz
- Unidad Nefrología, Hospital de Carabineros, Santiago, Chile
| | - Claudia Alarcón
- Unidad de Nefrología, Hospital Félix Bulnes, Santiago, Chile
| | - Sonia Márquez
- Unidad de Nefrología, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Karen Cuevas
- Unidad de Nefrología, Hospital San Juan de Dios, Santiago, Chile
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Palmero-Fernández L, Santos-Bueso E, Fraile-Maya J, Sáenz-Francés F, Martínez-de-la-Casa JM, García-Feijóo J, García-Sánchez J. [Optic neuropathy in a case of recurrent idiopathic hypertrophic pachymeningitis unresponsive to steroids and immunosuppressants]. ACTA ACUST UNITED AC 2014; 90:97-101. [PMID: 25443460 DOI: 10.1016/j.oftal.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/26/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022]
Abstract
CASE REPORT A 38-year-old female patient with bilateral papilledema who presented with loss of vision in her left eye. The Magnetic Resonance Imagining (MRI) showed thickening of the dura mater, and the intracranial pressure was elevated. A cancer, infectious, and autoimmune origin was ruled out. DISCUSSION The initial response to high doses of corticoids was satisfactory, with disappearance of the optic disc enema, with visual acuity and an improvement in the MRI. However, after one year without treatment she had a new outbreak of the disease. Despite renewed treatment with corticoids and azathioprine, the patient developed a left optic neuropathy and irreversible visual loss.
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Affiliation(s)
- L Palmero-Fernández
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - E Santos-Bueso
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - J Fraile-Maya
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - F Sáenz-Francés
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - J M Martínez-de-la-Casa
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - J García-Feijóo
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | - J García-Sánchez
- Servicio de Oftalmología, Departamento de Neuroftalmologia. Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
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Cavallasca JA, Costa CA, Maliandi Mdel R, Contini LE, Fernandez de Carrera E, Musuruana JL. Severe infections in patients with autoimmune diseases treated with cyclophosphamide. ACTA ACUST UNITED AC 2015; 11:221-3. [PMID: 25455720 DOI: 10.1016/j.reuma.2014.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/24/2014] [Accepted: 09/19/2014] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Infectious diseases are a significant cause of morbidity and mortality in patients with connective tissue diseases. Corticosteroids and immunosuppressive drugs, such as cyclophosphamide (CYC), increases the risk of infections. The objective of this study was to estimate the incidence rates of severe infections in patients who received treatment with CYC. PATIENTS AND METHODS The records of 60 patients with systemic autoimmune diseases who received treatment with CYC were retrospectively reviewed. We evaluated the rate of severe infections that occurred during CYC therapy and the 3 subsequent months. RESULTS Systemic lupus erythematosus was the most common disease, and diffuse proliferative glomerulonephritis the most frequent indication. Severe infection occurred in 9 patients (15%). Community acquired pneumonia was the most frequent infection with 3 cases (33%) followed by Herpes Zoster with 2 reports (22%). The cumulative dose of corticosteroid was the only significant risk factor for infection 32.8±16.7 vs. 20.1±15.3 P=.007. CONCLUSION The use of lower doses of corticosteroids and an aggressive management of infectious complications, allows for an acceptable safety profile in patients treated with CYC.
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20
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Chaparro M. [What useful developments for my inflammatory bowel disease practice have come from Digestive Disease Week 2014?]. Gastroenterol Hepatol 2014; 37 Suppl 3:22-30. [PMID: 25294263 DOI: 10.1016/s0210-5705(14)70080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objective of this article is to summarize reports presented at Digestive Disease Week 2014 that relate to fertility and pregnancy, inflammatory bowel disease in elderly patients, the risk of cancer and its relationship to treatment and finally, developments regarding psychological aspects that may affect patients with inflammatory bowel disease. Studies were selected at the discretion of the author, mainly considering those with conclusions that can be applied immediately to clinical practice. Using anti-TNF drugs during pregnancy is safe in the short term. This currently seems to be true for the medium and the long term. To limit fetal exposure, the mother can safely stop taking the anti-TNF drugs in the second trimester of the pregnancy if she is in remission. Elderly patients with inflammatory bowel disease require stricter monitoring than younger patients due to the risk of complications, especially infections associated with the disease and treatments. The effect of inflammatory bowel disease and the drugs for its treatment on the risk of development is still not well established, but the magnitude of the effect seems possibly lower than previously described. The causal link between psychological factors and the occurrence of IBD relapse is by no means established.
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Affiliation(s)
- María Chaparro
- Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Madrid, España; Instituto de Investigación Sanitaria Princesa (IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD).
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