Rui Morais

High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis

Please cite this article as: Cardoso, H., Vale, A.M., Rodrigues, S., Gonçalves, R., Albuquerque, A., Pereira, P., Lopes, S., Silva, M., Andrade, P., Morais, R., Coelho, R., Macedo, G., High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis, Journal of Hepatology (2016), doi: http://dx.doi.org/10.1016/j.jhep.2016.07.027

Predictive factors of short-term mortality in ischaemic colitis and development of a new prognostic scoring model of in-hospital mortality

Background Ischaemic colitis (IC) is the most common form of intestinal ischaemia with a wide spectrum of severity, with possible risk of death. Objective The purpose of this study was to evaluate predictive factors of in-hospital and short-term mortality, in a cohort of patients with IC. Methods Retrospective analysis of IC cases diagnosed between 2008–2013 in a single tertiary centre, with assessment of factors at the time of diagnosis associated with in-hospital and 90-day mortality. Results Of the 203 patients included (132 women), 47 (23%) died during the follow-up (median: 16 months). There were 21 patients (45%) who died during hospitalization and at 90 days there were 30 deaths (64% of total). In multivariate analysis, need for vasopressor support (odds ratio (OR) 11.21; 95% confidence interval (CI): 2.31–54.24; p = 0.01), Intermediate or Intensive Care Unit (ICU): admission (OR 7.01; 95% CI: 1.48–33.16; p = 0.014) and atrial fibrillation (OR 4.99; 95% CI: 1.1–26.23; p = 0.048) were independently and significantly associated with in-hospital mortality. Using the coefficients of the estimated logistic model, we calculated a scoring model to predict the occurrence of in-hospital mortality. The presence of all three risk factors predicted a probability of death of 32% with an area under the receiver operating characteristic curve (AUROC) of 0.89 (95% CI 0.80–0.98. At 90 days, the presence of chronic kidney disease (OR 7.46; 95% CI: 1.87–29.73; p = 0.002), and male sex (OR 5.85; 95% CI: 1.57–21.83; p = 0.009) were also independently associated with mortality. Conclusions Most deaths in ischaemic colitis occur in the first 90 days after admission, sharing similar risk factors. Assessment of the presence of atrial fibrillation, need of vasopressor support or hospitalization in the intermediate/intensive care unit provides a useful tool to estimate in-hospital mortality and to establish the management for patients admitted for ischaemic colitis.

Clinical features and outcome of acute ischemic proctocolitis

Ischemic injury to the rectum is rare owing to its rich vascular supply, occurring in <6% of the cases of ischemic colitis.1,2 As in ischemic colitis, a spectrum of severity exists and ranges from superficial mucosal ischemia to full-thickness necrosis with perforation.3 Early recognition of this clinical entity is of vital importance in order to avoid complications.1 The authors report a series of 5 cases of acute ischemic colitis with rectum involvement and present review of the literature. In this report, 5 patients were included, 4 man and 1 woman, with a median age of 70 year-old. The prevalence of cardiovascular risk factors was high (80%). All cases were admitted for lower gastrointestinal bleeding. None of the patients were taking nonsteroidal anti-inflammatory drugs in the days before presentation. In all patients who presented with bloody diarrhea, stool cultures (including Escherichia coli O157:H7), stool examination for ova (including Entamoeba histolytica) and parasites and Clostridium difficile toxin assay were obtained, and were negative. In 3 cases, a conservative approach was assumed due to their clinical stability and resolved without complications. The remaining 2 cases required a surgical approach and were admitted to an intensive care unit following surgery. One of these cases required multiple surgical procedures for complications. The median duration of hospitalization was 8 (IQR: 62) days, and all patients survived. The clinical features of each case are summarized in Table 1. A report of each case is described below. The first case concerns to a 70-year-old man, with a medical history of insulin dependent diabetes mellitus, left hemicolectomy for sigmoid adenocarcinoma (15 years before) and peripheral vascular disease requiring ileo-femoral bypass 4 months before. The patient was admitted for bloody diarrhea, nausea and vomiting. Proctosigmoidoscopy was performed and revealed a purplish

An Unexpected Abdominal Radiographic Finding: Chilaiditi Sign

hydration and antibiotherapy, he started to show clinical and renal function improvement. Stool cultures were negative. Nevertheless, 5 days after admission, he complained of epigastric pain, which was moderate, cramping, and nonradiating. The patient maintained 2 loose stools per day but denied nausea, vomiting, or other relevant symptoms. On physical examination, he presented slight epigastric tenderness. Laboratory testing was unremarkable. An abdominal computed tomography revealed a loop of colon between the liver and right hemidiaphragm, consistent with Chilaiditi sign ( Fig. 1 , 2 ). This radiographic finding was initially described by the Greek radiologist Demetrius Chilaiditi in 1910. This condition has an incidence of 0.25–0.28% worldwide, being more frequent in men and the elderly [1] . The etiology can be congenital or acquired. It is usually incidental and asymptomatic; however, when it is associated with gastrointestinal symptoms, such as abdominal pain, constipation, or nausea, it is called Chilaiditi syndrome. Complications of Chilaiditi syndrome include volvulus of the cecum, splenic flexure or transverse colon, cecal perforation, and perforated appendicitis [2] . Chilaiditi syndrome is initially managed conservatively with rest, fluid therapy, and laxatives. Surgical intervention is only indicated when severe complication occurs [1] . In our patient, since other causes of epigastric pain, such as pan

Caught in the act

Representing the Center for Defect Physics (CDP), this document is one of the entries in the Ten Hundred and One Word Challenge. As part of the challenge, the 46 Energy Frontier Research Centers were invited to represent their science in images, cartoons, photos, words and original paintings, but any descriptions or words could only use the 1000 most commonly used words in the English language, with the addition of one word important to each of the EFRCs and the mission of DOE: energy. The mission of the CDP is to enhance our fundamental understanding of defects, defect interactions, and defect dynamics that determine the performance of structural materials in extreme environments.

Pseudolymphomatous nodular lymphoid hyperplasia of small bowel

A 41-year-old woman was referred to the Gastroenterology outpatient clinic due to non-bloody chronic diarrhea with associated iron-deficiency anemia (hemoglobin 8 g/dL). Initial work-up laboratory study revealed marked deficit of all immunoglobulins, especially Ig A (< 8 mg/dL for a normal value of 78—312 mg/dL), consistent with common variable immunodeficiency (CVID). Viral serologies and anti-transglutaminase antibodies were negative. Upper endoscopy revealed multiple small nodules in the duodenal bulb and the second part of duodenum (Fig. 1A). Biopsies showed nodular lymphoid hyperplasia (NLH) with associated duodenitis and presence in the epithelium surface of trophozoites compatible with Giardia lamblia (Fig. 1B).

Loose ends in the eradication of Helicobacter pylori infection

Abstract The eradication of Helicobacter pylori is essential for prevention and treatment of various conditions associated with this infection. However, its effectiveness is limited and influenced by factors linked to the bacteria and the host. In particular, influence of the biotype, smoking, diabetes mellitus, and previous treatment failure in eradication is understudied. Our center proposed to evaluate these aspects in a real life cohort by applying a questionnaire with demographic and lifestyle variables in patients who consecutively underwent urease breath test after the eradication therapy.