Postoperative Ustekinumab Drug Levels and Disease Activity in Patients with Crohn's Disease.

AIMS: This study investigated how post-operative ustekinumab levels relate to surgery type, endoscopic, biochemical, and clinical outcomes in patients with Crohn's Disease. METHODS: A retrospective study of patients with Crohn's Disease with a disease-related operation between 2016 and 2022 assessed outcomes based on ustekinumab levels. Patients were included if they had an ustekinumab trough level within two years post-operatively. Patients were separated into groups based on whether their ustekinumab trough levels were adequate, defined as ≥ 4 µg/mL, or suboptimal < 4 µg/mL. A subset of patients with ustekinumab levels taken within two years both before and after surgery was compared to non-surgical treatment-escalated controls outside the initial patient set. Harvey-Bradshaw index was used to evaluate clinical disease activity. Rutgeert's and Simple Endoscopic Score for Crohn's Disease was used to evaluate endoscopic disease activity. C-reactive protein and fecal calprotectin values were collected to evaluate the molecular inflammatory disease state. CBC data were used to evaluate anemia. RESULTS: Forty-four patients were identified, which had ustekinumab levels after Crohn's Disease-related surgery. Twelve of these patients had pre-operative levels and were compared to 26 non-surgical treatment-escalated controls. No relationship between ustekinumab levels and endoscopic or clinical disease activity post-operatively was found. This also held true when looking at different surgery types. Adequate levels of ustekinumab post-operatively yielded lower risk of anemia. Surgery itself did not have an impact on ustekinumab levels. CONCLUSIONS: This study provided new insights into how post-operative ustekinumab levels impact several factors in patients having undergone Crohn's disease-related surgery.

Self-Supported Mn-Ni3Se2 Electrocatalysts for Water and Urea Electrolysis for Energy-Saving Hydrogen Production.

Recently, there has been a huge research interest in developing robust, efficient, low-cost, and earth-abundant materials for water and urea electrolysis for hydrogen (H2) generation. Herein, we demonstrate the facile hydrothermal synthesis of self-supported Mn-Ni3Se2 on Ni foam for overall water splitting under wide pH conditions. With the optimized concentration of Mn in Ni3Se2, the overpotential for hydrogen evolution, oxygen evolution, and urea oxidation is significantly reduced by an enhanced electrochemical active surface area. Different electronic states of metal elements also produce a synergistic effect, which accelerates the rate of electrochemical reaction for water and urea electrolysis. Owing to the chemical robustness, Mn-doped Ni3Se2 shows excellent stability for long time duration, which is important for its practical applications. A two-electrode electrolyzer exhibits low cell voltages of 2.02 and 1.77 V for water and urea electrolysis, respectively, to generate a current density of 100 mA/cm2. Finally, the prepared nanostructured Mn-Ni3Se2@NF acts as an electrocatalyst for overall water splitting under wide pH conditions and urea electrolysis for energy-saving hydrogen production and wastewater treatment.

Klebsiella pneumoniae Infection as a Mimicker of Multiple Metastatic Lesions.

We describe the case of a 42-year-old man with cirrhosis who presented with fever and imaging concerning for metastatic disease from suspected renal cell carcinoma. He had a right renal mass with multiple pulmonary masses and underwent a lung biopsy and oncology consultation. Blood cultures revealed Klebsiella pneumoniae, and all the lesions disappeared after intravenous (IV) antibiotics. Our case attempts to increase awareness of this unique presentation of invasive Klebsiella infections and discusses host factors that can predispose to this condition.

Current Therapies and Drug Development Pipeline in Lewy Body Dementia: An Update.

The term Lewy body dementia refers to either of two related diagnoses: dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). Clinical management of Lewy body dementia is challenging. The current treatment options focus on relieving symptoms; no disease-modifying therapies are available. There are currently no US Food and Drug Administration (FDA) approved drugs for the treatment of DLB, and there are only a few for PDD. Cholinesterase inhibitors are shown to be beneficial in improving cognitive symptoms in Lewy body dementia. Rivastigmine was approved by the FDA to treat PDD. Donepezil was approved in Japan as a treatment for DLB. Levodopa may provide modest benefit in treating motor symptoms and zonisamide in adjunct to low-dose levodopa helps with parkinsonism. Treatment of autonomic symptoms are based on symptomatic treatment with off-label agents. Our main objective in this article is to present an overview of the current pharmacological options available to treat the clinical features of DLB and PDD. When evaluating the existing management options for Lewy body dementia, it is difficult to fully separate PDD from DLB. However, we have attempted to identify whether the cited studies include patients with PDD and/or DLB. Moreover, we have provided an overview of the current drug pipeline in Lewy body dementia. All currently active trials are in phase I or II and most are focused on disease modification rather than symptomatic treatment. Phase II trial results for neflamapimod show promising results. Due to heterogeneity of symptoms and underlying pathophysiology, there is a need for new biomarker strategies and improved definitions of outcome measures for Lewy body dementia drug trials.

Safety of Percutaneous Endoscopic Gastrostomy Placement in Patients With SARS-CoV-2 Infection.

Background: Coronavirus disease 2019 (COVID-19) can lead to ventilator-dependent chronic respiratory failure and a need for tube feeding. Percutaneous endoscopic gastrostomy (PEG) placement provides more sustainable longer-term enteral access with fewer side effects compared to the long-term nasogastric tube placement. Bleeding is a recognized complication of PEG placement, and many COVID-19 patients are on antiplatelets/anticoagulants, yet minimal data exist on the safety of PEG tube placement in this context. Methods: A retrospective chart review identified patients who underwent PEG placement between January 2020 and January 2021 at a single institution. Success was defined as PEG placement and use to provide enteral nutrition with no complications requiring removal within 4 weeks. Results: Thirty-six patients with and 104 age- and sex-matched patients without COVID-19 infection were included. More COVID-19 patients were obese, on anticoagulants, had low serum albumin levels and had a tracheostomy in place. Of those patients, 8.3% with COVID-19 developed PEG-related complications compared to 16.3% without (P = 0.28). PEG success rates in patients with and without COVID-19 were similar at 97.2% and 92.3%, respectively (P = 0.44). Conclusion: PEG tube placement is comparatively safe in COVID-19 patients who need long-term enteral access.

Polypoid Gastric Adenomyoma: A Rare Cause of Bleeding Treated With Polypectomy.

Gastric adenomyoma is a rare tumor composed of smooth muscle fibers and glandular tissue. Usual presentations include nausea, bloating, and gastric outlet obstruction. We describe a case of a 60-year-old woman who presented with abdominal pain and melena. Endoscopy showed a 1.5 cm polyp in the stomach body that was resected using snare polypectomy. Biopsy showed glands mixed with fibromuscular tissue consistent with gastric adenomyoma. We conclude that gastric adenomyoma, although rare, may present as a bleeding polyp in the stomach body and may be treated with excisional polypectomy.

Factors Affecting Compliance to Antihypertensive Treatment among Adults in a Tertiary Care Hospital in Mumbai.

BACKGROUND: Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. OBJECTIVES: To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. SETTINGS AND DESIGN: A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. SUBJECTS AND METHODS: It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. STATISTICAL ANALYSIS: Data were entered into MS Excel 2007 and analyzed using SPSS 20. RESULTS: Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose - forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. CONCLUSION: Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.