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- Acute Campylobacter spp. gastroenteritis in the Pediatric Emergency Department of a level II hospitalPublication . Sá, Liliana; Pinheiro, Teresa; Silva, Joana; Pedrosa, Adriana; Soares, Laura; Costa, Miguel; Rocha, CristinaIntroduction: Campylobacter spp. is the main cause of pediatric acute bacterial gastroenteritis (ABG) in the European Union, with greater incidence in children under five years old. Most patients present complete recovery within days of infection, with no associated comorbidities. Antibiotic therapy should be reserved for severe cases. Objectives: The aim of this study was to investigate the epidemiology, symptoms, treatment, and complications of Campylobacter spp. infection in pediatric patients with ABG. Material and methods: Case-by-case review of the clinical records of patients evaluated in the Pediatric Emergency Department of a level II hospital with a diagnosis of ABG and Campylobacter spp. isolated from stool samples over a five-year period (2013-2017). Results: Of the 1990 stool tests performed, 637 (32%) were positive for the presence of bacteria. Campylobacter spp. was identified in the samples of 459 patients (72%). Eighteen patients were excluded for insufficient data, making up a final sample of 441 patients, with a mean age of three years old. Clinically, patients presented with aqueous diarrhea (59.6%), bloody diarrhea (43.8%), bloody and mucus diarrhea (15.4%), mucus diarrhea (3.9%), vomiting (36.3%), abdominal pain (24.3%), fever (63%), seizures (0.9%), and rash (0.2%). Eighty-nine patients were hospitalized. Eleven patients received antibiotic therapy. Discussion: This study represents the largest national case-by-case review of ABG by Campylobacter spp. in the pediatric population. Campylobacter was the main bacteria identified, mostly associated with self-limited disease. Conclusion: A judicious use of stool tests allows etiological identification in ABG. The growing number of cases of ABG by Campylobacter spp. reinforces the need for better hygiene procedures.
- Hepatic immune-mediatedadverseeffects of immune checkpoint inhibitors: analysis of real-life experiencePublication . Silva, Joana; Falcão, Daniela; Cardoso, Cláudia; Pires, Ana Luísa; Araújo, António; Castro-Poças, FernandoIntroduction and objectives: Immune Checkpoint Inhibitors (ICI) have shifted the paradigm of cancer therapy treatment. Despite their efficacy, ICIs may induce immune-related adverse events (irAE), which can affect various organs, namely the liver. This study intends to perform a comprehensive clinical description of the hepatic irAEs associated with ICI in a Portuguese population of a tertiary hospital centre. Materials and methods: A retrospective analysis of patients who developed immune-mediated liver injury (IMLI), among a cohort of patients treated with ICIs between March 15th of 2015 and December 15th of 2019 in a tertiary hospital. We used both Common Terminology Criteria for Adverse Events (CTCAE) and Drug-Induced Liver Injury Network (DILIN) criteria to define liver injury. Results: Among 151 patients, eight (5.3%) patients developed liver injury grade ≥3, of which five had hepatic metastasis. As such, only 3 cases were classified as IMLI. All IMLI presented with cholestasis pattern; the median duration from ICI initiation to IMLI was 84 days and/or 4 ICI cycles; one patient registered IMLI one month after nivolumab suspension; all were treated with steroids and one was successfully submitted to ICI re-challenge; a favourable outcome was seen in all patients; the median time to hepatic biochemistries normalization was 150 days. Among 10 patients with previous hepatic conditions, only one developed liver injury grade 2. Conclusions: Clinically significant ICI-related hepatotoxicity was uncommon; Immune-mediated liver injury may present a cholestatic pattern predominance. There was a low rate of liver injury of any kind in patients with previous hepatic disease while on ICI.