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Lluís N, Asbun H, Basso S, Corzo-Zamora N, Gelrud A, Guzmán-Calderón E, Lozada-Hernández EE, Mancilla C, Mansilla-Vivar R, Pasqua AV, Peláez-Luna M, Roig GVG, Zapater P, Lluís F, Vaquero E, Ramia JM, Madaria ED. Survey on initial management of acute pancreatitis in Latin America. Gastroenterol Hepatol 2023; 46:603-611. [PMID: 36731725 DOI: 10.1016/j.gastrohep.2023.01.011] [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: 09/27/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region. PARTICIPANTS AND METHODS We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world. RESULTS The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33-47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001). CONCLUSIONS Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Sandra Basso
- Department of Gastroenterology, Bonorino Udaondo Hospital, Buenos Aires, Argentina
| | - Natalia Corzo-Zamora
- Department of Gastroenterology, Bolivian Japanese Bolivian Gastroenterological Institute, Cochabamba, Bolivia
| | - Andrés Gelrud
- Pancreatic Disease Center, Interventional Endoscopy, Miami Cancer Institute, Gastro Health, Miami, FL, USA
| | - Edson Guzmán-Calderón
- Gastroenterology Unit, Edgardo Rebagliati Martins National Hospital, Anglo-American Clinic, and School of Medicine of the Peruvian University of Applied Sciences, Lima, Peru
| | - Edgard E Lozada-Hernández
- General Surgery, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajío, Guanajuato, Mexico
| | - Carla Mancilla
- Gastroenterology Section and Critical Care Unit, University of Chile Clinical Hospital, Santiago, Chile
| | - Rodrigo Mansilla-Vivar
- Digestive Endoscopy Unit, Puerto Montt Hospital, Puerto Montt, Chile; University San Sebastian, Chile
| | - Analía V Pasqua
- Department of Gastroenterology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mario Peláez-Luna
- Research Division, School of Medicine, National Autonomous University of Mexico, Mexico; Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Pedro Zapater
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Lluís
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Eva Vaquero
- Gastroenterology Department, Hospital Clínic, University of Barcelona, CIBERehd IDIBAPS, Barcelona, Spain
| | - José Manuel Ramia
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; Department of Surgery, Dr. Balmis General University Hospital, Alicante, Spain
| | - Enrique de Madaria
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain; Department of Gastroenterology, Dr. Balmis General University Hospital, Alicante, Spain
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Lluís N, Asbun H, Besselink MG, Capurso G, Garg PK, Gelrud A, Khannoussi W, Lee HS, Leppäniemi A, Löhr JM, Mahapatra SJ, Mancilla C, van Santvoort HC, Zapater P, Lluís F, de Madaria E, Ramia JM. International multidisciplinary survey on the initial management of acute pancreatitis: Perspective of point-of-care specialists focused on daily practice. J Hepatobiliary Pancreat Sci 2023; 30:325-337. [PMID: 35716156 DOI: 10.1002/jhbp.1201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/17/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The initial management of patients with acute pancreatitis impacts both morbidity and mortality. Point-of-care decisions have been reported to differ from clinical guideline recommendations. METHODS An online anonymous questionnaire was distributed through scientific associations and social media using REDCap. Multivariable logistic regression was used to identify the characteristics of participants associated with compliance with the recommendations. RESULTS A total of 1054 participants from 94 countries completed the questionnaire; median age (IQR) was 39 (32-47) years; 30.7% were women. Among the participants, 37% opted for nonmoderate flow of i.v. fluid, 31% for fluid type other than Ringer's lactate; 73.4% were in favor of nil per os to patients who could eat, 75.5% for other than enteral feeding to patients with oral intolerance; 15.5% used prophylactic antibiotic in patients with severe acute pancreatitis, 34.1% in necrotizing acute pancreatitis, and 27.4% in patients with systemic inflammatory response syndrome; 27.8% delayed cholecystectomy after biliary acute pancreatitis. Participants with publications in PubMed on acute pancreatitis showed better compliance (OR, 1.62; 95% CI: 1.15-2.32; P = .007) with recommendations of the clinical guidelines. CONCLUSIONS Feeding and nutrition require the greatest improvement efforts, but also the use of prophylactic antibiotics and timing of cholecystectomy should be improved.
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Affiliation(s)
- Nuria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Andres Gelrud
- Pancreatic Disease Center, Interventional Endoscopy, Miami Cancer Institute, Gastro Health, Miami, Florida, USA
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco.,Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed The First University, Oujda, Morocco
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ari Leppäniemi
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Carla Mancilla
- Gastroenterology Section and Critical Care Unit, University of Chile Clinical Hospital, Santiago, Chile
| | - Hjalmar C van Santvoort
- Department of Surgery, UMC Utrecht Cancer Center and St Antonius Hospital Nieuwegein: Regional Academic Cancer Center Utrecht, Utrecht, The Netherlands
| | - Pedro Zapater
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Felix Lluís
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Enrique de Madaria
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,Department of Gastroenterology, General University Hospital of Alicante, Alicante, Spain
| | - José Manuel Ramia
- Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.,Department of Surgery, General University Hospital of Alicante, Alicante, Spain
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Espino A, Vargas JI, Mancilla C, Muñoz P, Martínez W, Menéndez A, Jara D, Mansilla R, Schiappacasse G, Santamarina M, Huete Á, Candia R, Silva F, Castillo C, Richter H, Mejía R, Vial P, Robles I, Martínez J, Jarufe N, Briceño E, Lembach H, Zoroquiain P, Roa JC, Walker K, Torres J, Carreño L, Castiblanco A, Fernández W, Ríos Á, Chandia J, Ayala MJ, Rojas T, Verdugo J, Berger Z. [Chilean consensus on diagnosis and management of pancreatic cystic neoplasms]. Rev Med Chil 2021; 149:1773-1786. [PMID: 35735345 DOI: 10.4067/s0034-98872021001201773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022]
Abstract
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
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Affiliation(s)
- Alberto Espino
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Ignacio Vargas
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carla Mancilla
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Pablo Muñoz
- Departamento de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Waldo Martínez
- Cirugía Digestiva, Clínica Colonial, Huechuraba, Santiago, Chile
| | | | | | - Rodrigo Mansilla
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Puerto Montt, Chile
| | - Giancarlo Schiappacasse
- Departamento de Radiología, Facultad de Medicina, Universidad de Desarrollo, Santiago, Chile
| | - Mario Santamarina
- Departamento de Radiología, Hospital Naval Almirante Nef, Viña del Mar, Valparaíso, Chile
| | - Álvaro Huete
- Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Candia
- Departamento de Gastroenterología, Hospital Clínico UC-Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Silva
- Hospital Regional de Coyhaique, Coyhaique, Chile
| | - Cecilia Castillo
- Cirugía Endoscópica, Hospital Clínico San Borja Arriarán; Endoscopía, Clínica Alemana de Santiago, Santiago, Chile
| | - Hugo Richter
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Mejía
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Vial
- Departamento de Gastroenterología, Clínica Alemana de Santiago, Santiago, Chile
| | | | - Jorge Martínez
- Departamento de Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Berger Z, Mancilla C, Tobar E, Morales MP, Baró M, Carrasco M, Cordero J, Cruz R, Cruz R, Lara C, Ledesma S, Ramírez G, Sierralta A, Godoy L, Valdés E. Acute pancreatitis in Chile: A multicenter study on epidemiology, etiology and clinical outcome. Retrospective analysis of clinical files. Pancreatology 2020; 20:637-643. [PMID: 32386970 DOI: 10.1016/j.pan.2020.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epidemiology of acute pancreatitis (AP) is variable in different geographical regions. OBJECTIVES To compare etiology and severity of AP to published data from South America and the rest of world, study impact of demographical factors and treatment on its outcome in Chilean hospitals. METHODS Multicenter observational study. Data of consecutive patients with AP were collected at the moment of discharge from 11 centers and retrospectively analyzed. RESULTS Data of 962 patients were included in the analysis, 447 men and 515 women. Mean age was 48,2 years. Biliary etiology was significantly more frequent in women (70%) than in men (52%). Conversely, alcohol was responsible for about 17% of AP in men but exceptional in women. Mild AP was seen in 73.4%, moderately severe in 14.1% and severe in 13%. The overall mortality was 2.5% (24 of 962): 0.3%, 3.1% and 15.1% in mild, moderately severe and severe cases, respectively. No difference was found in the mortality and severity of biliary versus alcoholic AP, while hypertriglyceridemia induced AP was more severe, without increased mortality. Severity and mortality increased with age. ERCP was performed in 16% of biliary pancreatitis. Adherence to main guidelines was heterogeneous: more than half of mild AP patients were admitted to critical care units and antibiotics were used in about 25% them. CONCLUSION This is the first multicenter study in Chile on AP. When compared to literature, we found similar severity distribution and an acceptably low mortality. Biliary etiology was dominant, but alcohol was also important in men.
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Affiliation(s)
- Zoltán Berger
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile; Clínica Dávila, Section of Gastroenterology, Recoleta 464, Recoleta, Santiago, Chile.
| | - Carla Mancilla
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - Eduardo Tobar
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - María Paz Morales
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile
| | - Michel Baró
- Hospital Puerto Montt Dr. Eduardo Schütz Schroeder, Department of Medicine, Los Aromos 65, Puerto Montt, Los Lagos, Chile
| | - Mauricio Carrasco
- Hospital Regional Copiapó San José del Carmen Los Carrera, 1320, Copiapó, Atacama, Chile
| | - Julián Cordero
- Hospital Mauricio Heyermann, Angol Ilabaca 752, Angol, Araucanía, Chile
| | - Rodrigo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Ricardo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Christián Lara
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Sergio Ledesma
- Hospital Regional Dr. Leonardo Guzmán, Azapa 5935, Antofagasta, Chile
| | - Gustavo Ramírez
- Hospital San José, Department of Medicine, San José 1196, Independencia, Santiago, Chile
| | - Armando Sierralta
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Luis Godoy
- Hospital Clínico Magallanes, Department of Gastroenterology, Av. Los Flamencos, 01364, Punta Arenas, Chile
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Berger Z, Mancilla C. Racial Differences in Chronic Pancreatitis. An Explanation for South America? Am J Gastroenterol 2017; 112:814-815. [PMID: 28469211 DOI: 10.1038/ajg.2017.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Zoltán Berger
- Department of Internal Medicine, University of Chile, Clinical Hospital, Gastroenterology Section, Santiago, Chile
| | - Carla Mancilla
- Department of Internal Medicine, University of Chile, Clinical Hospital, Gastroenterology Section, Santiago, Chile
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Perez-Cortes E, Islas A, Arevalo J, Mancilla C, Monjaraz E, Salinas-Stefanon E. Modulation of the transient outward current (Ito) in rat cardiac myocytes and human Kv4.3 channels by mefloquine. Toxicol Appl Pharmacol 2015. [DOI: 10.1016/j.taap.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gompertz M, Lara I, Fernández L, Miranda JP, Mancilla C, Watkins G, Palavecino P, Berger Z. [Mortality of acute pancreatitis in a 20 years period]. Rev Med Chil 2014; 141:562-7. [PMID: 24089269 DOI: 10.4067/s0034-98872013000500002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/18/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mortality for acute pancreatitis (AP) in Chile has fluctuated between 7 ana 10% in last years. AIM To evaluate AP mortality over a period of 20 years in a clinical hospital in Santiago, Chile. MATERIAL AND METHODS Review of the database of hospital discharges with the diagnosis of acute pancreatitis, between 1990 and 2010 and the medical records of those patients. Age, gender, length of hospital stay, surgeries, percutaneous interventions and mortality were registered. To compare the evolution of the disease over time, patients were divided in two groups: those hospitalized between 1990 and 1999 and those hospitalized between 2000 and 2010. RESULTS We reviewed the records of 1367 patients with a median age of 48 years (48% men). In the first period, 93 of 637 (14.6%) patients died, whereas in the second period, 22 of 730 patients died (3.0%). In the first and second period, 41.9 and 25.3% of patients were subjected to surgical procedures. The hospital stay was shorter in the second group, compared with the first (14.2 and 25.9 days respectively). CONCLUSIONS There was a decrease in mortality caused by AP in the last 10 years, probably associated with a better interdisciplinary management of these patients.
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Affiliation(s)
- Macarena Gompertz
- Sección de Gastroenterología, Departamento de Medicina Interna, Hospital Clínico, Universidad de Chile, Santiago, Chile
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Gompertz M, Fernández L, Lara I, Miranda JP, Mancilla C, Berger Z. [Bedside index for severity in acute pancreatitis (BISAP) score as predictor of clinical outcome in acute pancreatitis: retrospective review of 128 patients]. Rev Med Chil 2013; 140:977-83. [PMID: 23282769 DOI: 10.4067/s0034-98872012000800002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is essential to optimize management and to improve outcomes. AIM To assess BISAP score as a predictor of severity of AP. PATIENTS AND METHODS Retrospective review of AP patients between January 2009 and December 2010. BISAP, APACHE II and Balthazar scores were calculated. Length of stay, local complications, organ failure and mortality were registered. Accuracy of the scoring system for predicting severity was measured by the area under the receiver operating curve (AUC). RESULTS The medical records of 128 patients, median age 46.5 years (55.5% men), were reviewed. Mean hospital stay was 15 days, 18 patients (14%) had local complications, 7 patients (5.4%) developed organ failure and 2 patients died (1.6%). The AUC for BISAP score to detect organ failure was 0.977 (95% IC 0.947-1.000). A BISAP score > 3 had a sensitivity, specificity, positive and negative predictive value of 71.4, 99.1, 83.3 and 98.3% respectively. An APACHE II score > 8 had a sensitivity and specificity of 71.5 and 86.8% respectively. The figures for a Balthazar score > 6 were 42.8 and 98.3% respectively. There was a significant correlation between BISAP score and length of hospital stay. CONCLUSIONS BISAP score was a useful method for predicting the severity of PA, with the advantage of being simple and based on parameters obtained on the first day of hospitalization. Its sensitivity and specificity were superior to APACHE II and Balthazar score in this cohort.
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Affiliation(s)
- Macarena Gompertz
- Sección de Gastroenterología, Departamento de Medicina Interna, Hospital Clínico Universidad de Chile, Santiago, Chile
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Mancilla C, Galvez R, Landskron G, Tobar E, Madrid A. Preliminary report of surface electrogastrography in critically ill septic patients after resuscitation. Crit Care 2012. [PMCID: PMC3363578 DOI: 10.1186/cc10767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sagredo S, Mancilla C, Estuardo N, Poniachik J. Falla hepática fulminante por virus hepatitis B en paciente coinfectado por VIH: un desafío terapéutico. Caso clínico. Rev Med Chil 2011. [DOI: 10.4067/s0034-98872011001000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sagredo S, Mancilla C, Estuardo N, Poniachik J. [Fulminant hepatic failure by hepatitis B virus in a patient with human immunodeficiency virus infection: report of one case]. Rev Med Chil 2011; 139:1336-1339. [PMID: 22286734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infection is a common problem in the world, with an estimated prevalence of up to 8%. We report a 27-year-old man admitted to the intensive care unit with an acute liver failure by HBV. During hospital stay, a co-infection with HIV virus was detected. Treatment with early antiviral therapy was started with emtricitabine, tenofovir and raltegravir, to cover both HBV and HIV. Despite therapy, the patient died two weeks after admission.
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Affiliation(s)
- Susana Sagredo
- Servicio de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Chile
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Mancilla C. Linfoma MALT: aspectos terapéuticos. Medwave 2003. [DOI: 10.5867/medwave.2003.10.2336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Mancilla C. Terapia con proteína C recombinante en sepsis. Medwave 2003. [DOI: 10.5867/medwave.2003.06.2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Mancilla C. Avances en reanimación cardiopulmonar I. Medwave 2002. [DOI: 10.5867/medwave.2002.06.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Poniachik J, Mancilla C, Contreras J, Csendes A, Smok G, Cavada G, Rojas J, Oksenberg D, Burdiles P, Maluenda F, Díaz JC. [Obesity: risk factor for steatohepatitis and hepatic fibrosis]. Rev Med Chil 2002; 130:731-6. [PMID: 12235896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver (NAFL) has been recognized as a cause of chronic liver disease. Its main risk factor is obesity. AIM To describe the clinical and liver pathological findings in a group of patients who underwent surgery as obesity treatment. PATIENTS AND METHODS Sixty eight patients with severe or morbid obesity were subjected to surgery as obesity treatment. Each patient was evaluated with a complete clinical and laboratory medical assessment. A wedge of liver was excised during surgery. Liver biopsies were analyzed without knowledge of clinical and laboratory findings. The presence of steatosis, inflammation (portal or lobular), fibrosis and cirrhosis were recorded in the pathological analysis. Age and body mass index (BMI) were correlated with pathological data. Significance was set at a p value of less than 0.05. RESULTS Ninety one percent of patients had steatosis, 45% inflammation and 47% fibrosis. One patient had cirrhosis (1.4%). There was a statistically significant association between BMI and moderate or severe steatosis (p < 0.03). There was also an association between BMI and portal (p = 0.017) and lobular inflammation (p = 0.034). A BMI over 40 kg/m2 (morbid obesity) was significantly associated with the presence of fibrosis (p = 0.032). Moreover, the presence of moderate or severe steatosis was a risk factor for the development of hepatic fibrosis (p = 0.026). CONCLUSIONS Obesity is a major and independent risk factor for steatohepatitis and fibrosis. The degree of steatosis in the liver biopsy, is a risk factor for the development of fibrosis.
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Affiliation(s)
- Jaime Poniachik
- Centro de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile.
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González-Morán G, Mancilla C. Histomorphometric analysis in the ovary of newly hatched chicks treated with follicle-stimulating hormone during embryonic development. Eur J Morphol 1998; 36:11-8. [PMID: 9526135 DOI: 10.1076/ejom.36.1.11.9027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We studied the histomorphometric changes induced in the left ovary of newly hatched chicks treated with follicle stimulating hormone (FSH) during embryonic development. After FSH treatment the thickness of the ovarian cortex, the number per unit of area and total mass per ovary of germ and pregranulosa cells increased, accompanied by hypertrophy of the pregranulosa cells. The volume of interstitial cell cords, lacunar system, and blood capillaries was increased and modifications in poorly differentiated cells were also observed. The number of interstitial cells and the average volume of interstitial cells also increased, from which we can deduce that these two last events are important in the enlargement of the interstitial cell cords. These findings suggest that the prefollicular ovary is able to respond to FSH, inducing structural changes both in the ovarian cortex as well as in the subcortical medulla.
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Affiliation(s)
- G González-Morán
- Departamento de Biología, Facultad de Ciencias, Universidad Nacional Autónoma de México, México, D. F.
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