Gastroent Hepat Barc
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Gastroent Hepat Barc · Dec 2011
Case Reports[Fatal rickets in the fetus and undiagnosed maternal celiac disease].
Celiac disease is a relatively frequent enteropathy associated with a wide range of clinical manifestations, due in part to malabsorption. In women, it has been associated with obstetric and gynecological alterations such as repeated miscarriages, intrauterine growth delay, premature delivery, and low birth weight. We present the case of a woman with undiagnosed celiac disease who gave birth to a stillborn foetus via normal delivery after 34 weeks of gestation. ⋯ In the medical literature congenital rickets secondary to maternal celiac disease due to malabsorption is rare. We discuss the current knowledge on maternofoetal phospho-calcium metabolism and relate active celiac disease with severe hypocalcaemia during pregnancy and fatal rickets in the foetus. We recommend screening for celiac disease in pregnant women with signs of malabsorption or impaired fetal development.
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Gastroent Hepat Barc · Aug 2011
Review[Antiplatelet agents and proton pump inhibitors. How can the risk-benefit balance be optimized in patients at risk for cardiovascular disease and gastrointestinal bleeding?].
Antiplatelet agents are routinely used in both primary and secondary prevention of cardiovascular events. The development of new antiplatelet agents and the strong growth of interventional cardiology have led to this therapy being more widely prescribed and for longer periods. ⋯ This review provides specific management recommendations and highlights important practical aspects related to antiplatelet therapy, including the interaction between clopidogrel and proton pump inhibitors. The benefits and hazards in distinct clinical settings are outlined within the context of optimizing the balance between the cardiovascular benefits and bleeding risk of antiplatelet therapy.
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Gastroent Hepat Barc · Apr 2011
[Alleged malpractice claims related to gastrointestinal endoscopy. Analysis of casuistics over 22 years].
We reviewed the records of patients filing alleged malpractice claims related to gastrointestinal endoscopy to the Professional Responsibility Section of the Medical Council of Catalonia from 1987 to 2009 to determine the frequency of medical errors or substandard care in the practice of this procedure and the result of complaints according to whether malpractice might have been involved or not. There were a total of 66 complaints, 46 (70%) after colonoscopy, 12 (18%) after endoscopic retrograde cholangiography and eight (12%) after gastroscopy. In 18 (27%) cases, we considered malpractice to have been probable, due to lack of informed consent in four, delayed treatment of complications in six, substandard sedation in five, misdiagnosis in two and substandard practice in one, which would justify the complaints. ⋯ There were a greater number of complaints in private clinics than in public hospitals. Endoscopists with more than one complaint were more frequently found guilty or reached an out-of-court settlement than those with only one complaint against them (100% versus 28%). Analysis of complaints of alleged malpractice is useful to identify areas requiring improved patients safety and to reduce the number of these complaints.