Drug intoxications and their treatment

Introduction: Although drugs are used for prevention, amelioration or treatment of certain diseases, they represent a certain risk for those who use them. The consumption of drugs has grown tremendously and continues to grow worldwide, so it is virtually impossible not to overuse drugs and self-medication, generating a range of negative effects, represented by adverse reactions, drug poisoning, which complete a new disease of civilization - „drug disease". Purpose and objectives: Achieving a complex study on the epidemiology, clinical manifestations, diagnosis and principles of treatment of drug intoxication. Patients: This study included 2260 patients’ data files with diagnosis of drug intoxications during the years 2011, 2012, 2013. Methods: Findings of epidemiological characteristics, etiology, clinical features of acute drug intoxication addressed to the Republican Center of Toxicology. Evaluating statistics for 3 years and highlighting the prevalence of drugs, age and sex more frequently involved in drug intoxication. Results: During the years 2011-2013 were recorded 2260 cases of intoxications. Every year their number is constantly growing (666 cases in 2011,744 cases in 2012 and 850 in 2013). Men frequently suffer from poisoning (due to alcohol consumption), but in 2013 the number is equivalent to that of women. Drug intoxications are found more frequently in women (185 cases in 2013). The highest rate of drug poisoning was represented by neuroleptics, antihistamines and benzodiazepines. We observed a significant increase of intoxications with NSAD in the years 2011, 2012. Serious complications or deaths were not recorded, due to qualified therapeutic care and resuscitation. The causes of drug intoxications are evident for our country. Most of the patients lack financial resources, don’t seek specialized medical services and have free access to drugs, this facts increasing the rate of self-treatment, that include multiple risks for their life. A significant part of drug intoxications were due to suicide. Conclusion: Drug poisoning is the result of self-management and uninformed use of drugs, frequently for suicide. There should be a culture of drug use and fastest possible resolution of the serious consequences that involve them. This problem should include a multidisciplinary approach, both therapeutic as well as psychosocial

Curriculum for diagnostic endoscopic ultrasound training in Europe : European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

n/a

Natural History and Outcome of Hepatic Vascular Malformations in a Large Cohort of Patients with Hereditary Hemorrhagic Teleangiectasia

BACKGROUND: Hereditary hemorrhagic telangiectasia is a genetic disease characterized by teleangiectasias involving virtually every organ. There are limited data in the literature regarding the natural history of liver vascular malformations in hemorrhagic telangiectasia and their associated morbidity and mortality. AIM: This prospective cohort study sought to assess the outcome of liver involvement in hereditary hemorrhagic telangiectasia patients. METHODS: We analyzed 16 years of surveillance data from a tertiary hereditary hemorrhagic telangiectasia referral center in Italy. We considered for inclusion in this study 502 consecutive Italian patients at risk of hereditary hemorrhagic telangiectasia who presented at the hereditary hemorrhagic telangiectasia referral center and underwent a multidisciplinary screening protocol for the diagnosis of hereditary hemorrhagic telangiectasia. Of the 502 individuals assessed in the center, 154 had hepatic vascular malformations and were the subject of the study; 198 patients with hereditary hemorrhagic telangiectasia and without hepatic vascular malformations were the controls. Additionally, we report the response to treatment of patients with complicated hepatic vascular malformations. RESULTS: The 154 patients were included and followed for a median period of 44 months (range 12-181); of these, eight (5.2%) died from VM-related complications and 39 (25.3%) experienced complications. The average incidence rates of death and complications were 1.1 and 3.6 per 100 person-years, respectively. The median overall survival and event-free survival after diagnosis were 175 and 90 months, respectively. The rate of complete response to therapy was 63%. CONCLUSIONS: This study shows that substantial morbidity and mortality are associated with liver vascular malformations in hereditary hemorrhagic telangiectasia patients

Extensive preoperative workup in diffuse esophageal leiomyomatosis associated with Alport syndrome influences surgical treatment: A case report

Introduction: Diffuse esophageal leiomyomatosis is a rare disease. Misdiagnosis is frequent and previous surgeries can complicate surgical management. The only treatment described for severe symptomatic cases is esophagectomy. Presentation of case: We describe a case of diffuse esophageal leiomyomatosis associated with Alport syndrome in a 21 year-old female where endoscopic ultrasonography (EUS) with concomitant fluoroscopy and 3D-gastric computed tomography (3D-GCT) modified surgical management. Discussion: The diagnosis of diffuse esophageal leiomyomatosis is difficult but can be greatly facilitated by extensive endoscopic and radiologic workup. Esophagectomy should only be entertained after complete anatomic mapping of the lesions, especially after previous surgeries. Conclusion: EUS and 3D-GCT should strongly be considered as part of routine preoperative workup in these patients

Chronic Genotype 3 Hepatitis E in Pregnant Woman Receiving Infliximab and Azathioprine

Acute hepatitis E virus infection during pregnancy has a high fatality rate in developing countries. Little data are available on chronic infection in pregnant women. We report a case of chronic hepatitis E during treatment with infliximab and azathioprine, without adverse event during pregnancy and with spontaneous resolution after delivery

Value of contrast-enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta-analysis

Background: Current imaging modalities are limited in their ability to distinguish pancreatic cancer (PC) from non-neoplastic pancreatic lesions. The diagnostic use of contrast-enhanced endoscopic ultrasonography (CE-EUS) has increased, and its utility has been reported. Recently, contrast-enhanced harmonic EUS (CH-EUS) was reported to facilitate imaging of parenchymal perfusion and microvessels in pancreatobiliary diseases, leading to a high diagnostic accuracy for PC. The present meta-analysis aims to investigate the usefulness of CH-EUS with enhancement pattern for PC diagnosis. Methods: A systematic meta-analysis of all potentially relevant articles identified in PubMed, the Cochrane library, and Medline was carried out. Fixed-effects or random-effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence interval (CI). Results: The study enrolled 887 patients from nine eligible studies. Pooled estimates of sensitivity and specificity were 93% (95% CI, 0.91\u20130.95) and 80% (95% CI, 0.75\u20130.85), respectively. Subgroup analyses were carried out on the main results after excluding two outliers. Area under summary receiver operating characteristics curve was 0.97. No publication bias was found using funnel plots. No significant relationship was found between the diagnostic odds ratios and the characteristics of the studies including continent and contrast agent. Conclusions: This meta-analysis showed that CH-EUS with qualitative analysis of enhancement pattern is useful for the diagnosis of PC, and has high sensitivity and accuracy, regardless of the type of contrast agent used. This modality may provide improved diagnostic accuracy for PC in clinical practice