NSAID-induced ischemic colitis.

We present the case of a 38-year-old man with no previous medical history who went to the emergency department due to abdominal pain and diarrheal stools with blood of 24 hours of evolution. The patient reports consumption of anti-inflammatories the previous days due to back pain.

Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents: data from the ENEIDA registry.

Background: Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF. Objectives: To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. Design: Retrospective observational study. Methods: Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). Results: Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. Conclusion: The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.

OBJECTIVES: To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. DESIGN: Retrospective observational study. METHODS: Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). RESULTS: Overall, 473 UC patients were included (330 IVi, 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4%, in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. CONCLUSION: The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.

Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents. Data from the ENEIDA registry Background: Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC), but little is known when it is used as the second anti-TNF.

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.

BACKGROUND: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. METHODS: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. RESULTS: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. CONCLUSION: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

Improving prediction of COVID-19 mortality using machine learning in the Spanish SEMI-COVID-19 registry.

COVID-19 is responsible for high mortality, but robust machine learning-based predictors of mortality are lacking. To generate a model for predicting mortality in patients hospitalized with COVID-19 using Gradient Boosting Decision Trees (GBDT). The Spanish SEMI-COVID-19 registry includes 24,514 pseudo-anonymized cases of patients hospitalized with COVID-19 from 1 February 2020 to 5 December 2021. This registry was used as a GBDT machine learning model, employing the CatBoost and BorutaShap classifier to select the most relevant indicators and generate a mortality prediction model by risk level, ranging from 0 to 1. The model was validated by separating patients according to admission date, using the period 1 February to 31 December 2020 (first and second waves, pre-vaccination period) for training, and 1 January to 30 November 2021 (vaccination period) for the test group. An ensemble of ten models with different random seeds was constructed, separating 80% of the patients for training and 20% from the end of the training period for cross-validation. The area under the receiver operating characteristics curve (AUC) was used as a performance metric. Clinical and laboratory data from 23,983 patients were analyzed. CatBoost mortality prediction models achieved an AUC performance of 84.76 (standard deviation 0.45) for patients in the test group (potentially vaccinated patients not included in model training) using 16 features. The performance of the 16-parameter GBDT model for predicting COVID-19 hospital mortality, although requiring a relatively large number of predictors, shows a high predictive capacity.

[Vitamin D levels in patients with recent cancer diagnosis]. / Niveles de vitamina D en pacientes recién diagnosticados de cáncer.

INTRODUCTION: apart from the known effects of vitamin D on phospho-calcium homeostasis, in recent years there is great interest in its extrabone effects. OBJECTIVES: to know the concentration of 25-hydroxyvitamin D (25[OH] D) in newly diagnosed patients of cancer and to verify if there are differences between the different types of cancer. MATERIAL AND METHODS: cross-sectional study of a cohort of recent diagnosed cancer patients who were referred to Endocrinology consultation for a nutritional pre-surgery evaluation. One hundred and thirty-nine medical histories were reviewed. The socio-demographic and biometric data and 25(OH) D concentration were collected. RESULTS: seventy-one of 139 patients had urological cancer, 27 had colorectal cancer (CRC), 35 had head and neck cancer and six, other types of cancer. The mean concentration of 25(OH) D was 50.41 nmol/l (95% CI = 46.67-54.14); 57.97% of patients showed vitamin D deficiency (< 50 nmol/l) and 21.74%, insufficiency (50-75 nmol/l). We found a statistically significant higher prevalence of deficiency (p < 0.01) in head and neck cancer compared to urological cancer: 68.57% and 49.29%, respectively. Year season significantly modifies 25(OH) D concentration (p < 0.01). CONCLUSIONS: there is a high prevalence of vitamin D deficiency among recent diagnosed cancer patients (especially in CRC and head and neck cancer). The use of reference values adjusted by year season could improve the study of 25(OH) D concentrations.

Introducción: aparte de los conocidos efectos de la vitamina D sobre la homeostasis fosfo-cálcica, en los últimos años están cobrando gran relevancia sus efectos extraóseos.Objetivos: conocer la concentración de 25(OH) vitamina D en pacientes recién diagnosticados de cáncer y comprobar si existen diferencias entre los distintos tipos de cáncer.Material y métodos: estudio transversal de una cohorte de pacientes recién diagnosticados de cáncer que fueron remitidos a Consultas Externas de Endocrinología para una valoración nutricional preoperatoria. Se revisaron 139 historias clínicas y se obtuvieron los datos sociodemográficos, biométricos y la concentración de 25(OH) vitamina D de los pacientes.Resultados: de los 139 pacientes, 71 padecían cáncer urológico; 27, cáncer colorrectal (CCR); 35, cáncer de cabeza y cuello (C y C); y seis, cáncer de otro tipo. La concentración media de 25(OH) vitamina D fue de 50,41 nmol/l (IC 95% = 46,68-54,14). El 57,97% presentó déficit de vitamina D (< 50 nmol/l) y un 21,74%, insuficiencia (50-75 nmol/l). Hallamos una mayor prevalencia de déficit estadísticamente significativa (p < 0,01) en el C y C frente al cáncer urológico: 68,57% y 49,29% respectivamente. La estación del año modifica de manera significativa la concentración de 25(OH) vitamina D (p < 0,01).Conclusiones: hay una alta prevalencia de déficit de vitamina D en los pacientes recién diagnosticados de cáncer (sobre todo en CCR y C y C); por ello, se debe priorizar la corrección de los niveles de 25(OH) vitamina D en estos pacientes. La utilización de valores de referencia ajustados según la estación del año podría mejorar la interpretación de resultados.