Efficacy of switching from infliximab to golimumab in patients with ulcerative colitis in deep remission.

BACKGROUND-AIM: Intravenously administered biologicals are associated with a huge pressure to Infusion Units and increased cost. We aimed to assess the impact of switching infliximab to golimumab in ulcerative colitis (UC) patients in deep remission. Patients and method: In a prospective, single-centre pilot study UC patients on infliximab mono-therapy for = 2 years, whowere in deep remission, consented to switch to golimumab and were followed for 1 year with clinical assessment, serum and faecal biomarkers, work productivity, satisfaction with treatment and quality of life parameters. Endoscopic remission was assessed by colonoscopy at 1 year. Patients fulfilling the same inclusion criteria, who did not consent to switch to golimumab and continued to receive infliximab mono-therapy, for the same period, served as controls. PATIENTS AND METHODS: In a prospective, single-centre pilot study UC patients on infliximab mono-therapy for ≥ 2 years, who were in deep remission, consented to switch to golimumab and were followed for 1 year with clinical assessment, serum and faecal biomarkers, work productivity, satisfaction with treatment and quality of life parameters. Endoscopic remission was assessed by colonoscopy at 1 year. Patients fulfilling the same inclusion criteria, who did not consent to switch to golimumab and continued to receive infliximab mono-therapy, for the same period, served as controls. RESULTS: Between October 2015 and October 2017, 20 patients were recruited; however one patient stopped therapy because of pregnancy. All 19 patients who were switched to golimumab were still in clinical, biomarker and endoscopic remission at 1 year and maintained excellent quality of life without any complications. In the control group, 18 of 19 patients were also in deep remission, since only one patient had a flare which was managed with IFX dose intensification. During a median 3 years extension treatment with golimumab only 2 patients experienced a flare of colitis. CONCLUSIONS: This pilot study indicates that switching from in-fliximab to golimumab in UC patients in deep remission does not compromise treatment effectiveness or the course of disease; golimumab offers a valid alternative to intravenous infliximab infusions during the COVID-19 pandemic.

Increased cardiovascular and renal disease but not reduced life expectancy among diabetic participants in the general Northern Greek population.

We compared life expectancy and causes of death based on death certificates of 269 diabetic participants (group A) and 5659 nondiabetic participants (group B) who died from January 1, 1991 to December 31, 2010, in 3 small towns of Northern Greece. Age at death was significantly (P = .011) higher in group A (77.2 ± 8.7 years) than in group B (75.7 ± 18.9 years). Males with diabetes lived longer with a mean difference of 4.7 (2.8-6.6) years (P < .001), whereas females without diabetes lived longer, with a mean difference of 2.3 (1.1-5.6) years (P = .004). Diabetic participants died more frequently of myocardial infarction (P = .001), chronic renal failure (P < .001), followed by pneumonia (P = .010) and hyperosmolar non-ketotic coma (P < .001). Nondiabetic participants died more frequently of lung cancer (P < .001), old age (P < .001), and car accidents (P = .004). In conclusion, the cardiovascular and renal disease burden among diabetic participants did not reduce life expectancy, especially in men.

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease.

OBJECTIVE: Several factors either predisposing or protecting from the onset of diabetes mellitus type 2 (DM2) have been proposed. Two specific polymorphisms of toll-like receptor 4 (TLR4; Asp299Gly and Thr399Ile) have recently been identified either as candidate protector genes against DM2 and associated neuropathy or risk alleles for the manifestation of diabetic retinopathy. The impact of these alleles on the risk for ischaemic heart disease (IHD) is controversial while their role in diabetes-associated IHD has never been studied. DESIGN AND METHODS: In order to clarify the potential impact of TLR4 polymorphisms on the predisposition for DM2 as well as on diabetes-related IHD vulnerability, the distribution of the mutant TLR4 Asp299Gly and Thr399Ile alleles in 286 DM2 patients and 413 non-DM2 controls with or without IHD, was examined. RESULTS: Mutant alleles were predominantly detected in 79/413 non-diabetic individuals versus 15/286 DM2 patients (P<0.0001). The rates of positivity for mutant alleles were similar among diabetic patients with or without IHD (7/142 vs 8/144, P>0.1), whereas they proved different among non-diabetic individuals with or without IHD (39/145 vs 40/268, P=0.004). Following multivariate analysis, the difference between diabetic and non-diabetic subjects, with regard to TLR4 mutations alone, remained significant (P=0.04). CONCLUSIONS: Mutant TLR4 alleles confer protection against DM2. However, their presence does not seem to play any role, protective or aggravating, in the manifestation of IHD either in diabetic or in non-diabetic individuals.

Clinicopathological differences between right- and left-sided colonic tumors and impact upon survival.

AIM: This study is to analyze the clinicopathological differences between right- and left-sided colonic tumors and to evaluate the impact upon the patient's survival. METHODS: In a period of 5 years (2004-2009), 453 patients were diagnosed with colorectal cancer. RESULTS: From a total of 453 patients diagnosed with colon cancer, 56.5% of them were men, while 43.5% of them were women. Right-sided colonic tumors were diagnosed in 54.53% of the patients compared to the 45.47% of patients with left-sided colonic tumors. The size of colonic tumors is statistically significant greater in right-sided colonic tumors compared to left ones (P < 0.001). Left-sided colon cancer patients identified to have a statistically significant better overall 5-year survival rate compared to right-sided ones (P < 0.001). CONCLUSION: Based upon our results, there is a different biological profile between right- and left-sided colonic tumors.

Influence of tea on intrinsic colour of previously bleached enamel.

Aim of the study was to evaluate the influence of tea applied at various time intervals after bleaching of enamel on intrinsic tooth colour. Ninety bovine specimens were distributed among six groups (A-F, n=15). The samples of group A-D were bleached with the 10% carbamide peroxide (CP) gel VivaStyle for 8 h, followed by storing in artificial saliva for the remaining period of the day. The specimens were removed from the saliva at different intervals (A: 0 min, B: 60 min, C: 240 min) and immersed in freshly prepared black tea for 10 min. Group D (bleaching, no tea), E (no bleaching, but tea) and F (no bleaching, no tea) served as controls. These procedures were repeated for 8 days. Colour was measured at baseline, after each day, and after final cleaning using the CIELab-system. Then Deltab (initial b-value - final reading), DeltaL, and composite colour (DeltaE) were statistically analysed. External bleaching (A-D) led to a distinct whitening effect with lower Deltab- (=reduction in yellow) and higher DeltaL-values (=increase in brightness) compared with controls. The Deltab- and DeltaL-values of the samples A-C were not significantly different from the samples which were bleached only. No significant difference was observed comparing specimens of group A-C. It is concluded that application of tea directly after bleaching with 10% CP does not significantly effect the outcome of a bleaching treatment irrespective of the time interval elapsed between the bleaching procedure and the contact of the tooth surface with tea.