RESUMEN
Background/Objectives: To determine the prevalence of amyloidosis through the analysis of synovial tissue and transverse carpal ligament (TCL) in patients undergoing surgery for carpal tunnel syndrome (CTS), detect predictive factors for the presence of amyloid, and assess cardiac involvement degree. Methods: A prospective study with longitudinal cohort follow-up at a teaching hospital. Patients undergoing CTS surgery from 1 January 2019 to 31 May 2021 were included. Samples from synovial and TCL tissues were examined for amyloid presence. Multivariate analysis was used to detect predictive factors of the presence of amyloid. Patients with amyloid underwent echocardiography, laboratory analyses, and scintigraphy. Results: Two hundred and forty-six patients were included. The prevalence of amyloid was 11.4% in TCL and 12.6% in synovial tissues. Age (p = 0.035; OR 1.123), bilateral CTS symptoms (p = 0.022; OR 3.647), and trigger finger (p < 0.001; OR 3.537) were predictors of the presence of amyloid. Seventeen patients were diagnosed with transthyretin amyloidosis (ATTR) located in the carpus (no scintigraphic cardiac uptake or grade 0), one with light chain amyloidosis, eight with ATTR with cardiac involvement (grades 2-3), and five with ATTR in the carpus and scintigraphic uptake grade 1 (with normal echocardiogram and blood and urine tests). Conclusions: We detected amyloid in 12.6% of unselected consecutive patients who underwent CTS surgery. Biopsy in patients with CTS for amyloid detection, especially in elderly patients with bilateral symptoms and trigger finger, may be useful for the early diagnosis of amyloidosis, primarily due to transthyretin.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Prevalencia , Endoscopía , Medición de Riesgo , Anciano Frágil , Endoscopía del Sistema Digestivo , España , Gastroenterología , Enfermedades GastrointestinalesRESUMEN
En los últimos años se han producido avances en el manejo de la hemorragia digestiva alta no varicosa que han permitido disminuir la recidiva hemorrágica y la mortalidad. El presente documento de posicionamiento de la Societat Catalana de Digestologia es una actualización de las recomendaciones basadas en la evidencia sobre el manejo de la hemorragia digestiva por úlcera péptica
In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer
Asunto(s)
Humanos , Hemorragia Gastrointestinal/terapia , Úlcera Péptica Hemorrágica/terapia , Pautas de la Práctica en Medicina , Práctica Clínica Basada en la Evidencia , Endoscopía Gastrointestinal , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Pronóstico , Infecciones por Helicobacter/tratamiento farmacológico , Soluciones Esclerosantes/administración & dosificaciónRESUMEN
In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer.
Asunto(s)
Técnicas Hemostáticas , Úlcera Péptica Hemorrágica/terapia , Antiinflamatorios no Esteroideos/efectos adversos , Antiulcerosos/uso terapéutico , Anticoagulantes/efectos adversos , Biomarcadores/sangre , Terapia Combinada , Comorbilidad , Contraindicaciones de los Medicamentos , Soluciones Cristaloides , Manejo de la Enfermedad , Endoscopía Gastrointestinal , Transfusión de Eritrocitos , Eritromicina/uso terapéutico , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Humanos , Hipotensión/etiología , Hipotensión/terapia , Intubación Gastrointestinal , Soluciones Isotónicas/uso terapéutico , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Úlcera Péptica Hemorrágica/sangre , Úlcera Péptica Hemorrágica/etiología , Examen Físico , Recurrencia , Factores de Riesgo , Vitamina K/uso terapéuticoRESUMEN
El programa de «Elaboración de guías de práctica clínica en enfermedades digestivas, desde la atención primaria a la especializada» es un proyecto compartido por la Asociación Española de Gastroenterología (AEG), la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) y el Centro Cochrane Iberoamericano (CCI). Presentamos la actualización de la guía sobre el manejo de la dispepsia que se publicó en el año 2003. En su elaboración se han tenido en cuenta los criterios esenciales contemplados en el instrumento Appraisal of Guidelines, Research and Evaluation for Europe (AGREE). Para clasificar la evidencia científica y fuerza de las recomendaciones se ha utilizado el sistema Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE)(AU)
The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations(AU)
Asunto(s)
Humanos , Dispepsia/terapia , Protocolos Clínicos , Guías de Práctica Clínica como Asunto , Dispepsia/diagnóstico , Dispepsia/economía , Planificación de Atención al Paciente , Helicobacter pylori/patogenicidad , Factores de Riesgo , Medicina Basada en la Evidencia , Atención Ambulatoria/normas , Atención a la Salud/normasRESUMEN
The "Preparation of Clinical Practice Guidelines in Digestive Diseases, from Primary Care to Specialist Care" Program, is a joint project by the Spanish Gastroenterology Association (AEG), the Spanish Society of Family and Community Medicine (SEMFyC), and the IberoAmerican Cochrane Center (CCI). We present the update of the Guidelines on the Management of Dyspepsia, which was published in 2003. The essential criteria provided in the AGREE (Appraisal of Guidelines, Research and Evaluation for Europe) Instrument were taken into account in the preparation of this document. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to classify the scientific evidence and strengthen the recommendations.
Asunto(s)
Dispepsia/diagnóstico , Dispepsia/terapia , Algoritmos , HumanosRESUMEN
La unidad de atención continuada y hospital de día permite el manejo ambulatorio de los pacientes con una enfermedad digestiva. Objetivo: Disminuir los ingresos hospitalarios y el número de pacientes con una enfermedad digestiva que acude a urgencias. Material y métodos: Los pacientes se atienden según dos niveles asistenciales: a) atención continuada, en que se visitan de forma urgente los pacientes con una descompensación aguda de su enfermedad digestiva, y b) atención programada, en que se realizan procedimientos que por su complejidad requieren personal de enfermería, sin ser necesario el ingreso hospitalario. Resultados: En el período comprendido entre 1995 y 2005 se ha pasado de realizar 118 visitas en atención continuada en 1995 a 784 en 2005. En atención programada las paracentesis han aumentado de 237 en 1995 a 687 en 2006 y las infusiones de hierro intravenoso de 111 en 2004 a 519 en 2006. El número de ingresos hospitalarios pasó inicialmente de 605 en 1995 a 430 en 2000, para posteriormente aumentar. El número de pacientes con una enfermedad digestiva que acudió a urgencias disminuyó un 75% estos años. Conclusiones: La unidad de atención continuada y hospital de día permite una disminución inicial del número de ingresos en el área de hospitalización convencional y en el porcentaje de pacientes con patología digestiva que acuden a urgencias
The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. Aim: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. Material and methods: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. Results: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. Conclusions: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department
Asunto(s)
Humanos , Centros de Día/métodos , Continuidad de la Atención al Paciente/organización & administración , Enfermedades Gastrointestinales/terapia , Centros de Día/métodos , Paracentesis/enfermería , Atención de Enfermería/métodos , Educación del Paciente como Asunto/métodos , Interferones/administración & dosificación , Ribavirina/administración & dosificaciónRESUMEN
UNLABELLED: The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. AIM: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. MATERIAL AND METHODS: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. RESULTS: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. CONCLUSIONS: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department.