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.

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.

Assessment of Luteal Function Using Rectal Palpation, B-Mode Ultrasonography, and Progesterone Determination to Improve Recipient Selection in Embryo Transfer Programs.

Proper selection of recipients determines the success of embryo transfer (ET) programs. Therefore, the objectives of this study were to assess the accuracy of rectal palpation (RP) in selecting recipients according to the size and firmness of their corpus luteum (CL) compared to ultrasonography (US) and progesterone determination (P4); to check if US or P4 provide additional information to RP with regard to selecting animals with higher odds of maintaining the pregnancy; and to verify the reliability of the presence of a cavity and the volume of the CL within the ovary (%CLOV) as predictors of the ET outcome. In Experiment 1, measurements for the largest and minor diameter (LADCL and MIDCL), CL area, and P4 at ET day were collected, as well as the RP score, in 94 heifers. In Experiment 2, measurements for the LADCL, MIDCL, CL volume, %CLOV, and presence of a cavity were collected, as well as data about the procedure and metabolic markers, in 108 heifers. No differences were found in Experiment 1, whereas in Experiment 2, just a tendency was observed for the variable of veterinarian. Consequently, these results suggest that RP and US are useful methods to select recipients with, that US and P4 do not offer additional data to use to select animals with higher odds of maintaining pregnancy, and that neither %CLOV nor cavitary CL were good indicators for pregnancy rates.

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.

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.

Hemorragia digestiva alta secundaria a sobreingesta de inhibidores selectivos de la recaptación de serotonina y antiinflamatorios no esteroideos / Upper gastrointestinal bleeding due to overdose of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs

No disponible

No siempre es una enfermedad de Crohn: amebiasis como diagnóstico diferencial de la enfermedad inflamatoria intestinal / It is not always Crohn's disease: Amebiasis as a differential diagnosis of inflammatory bowel disease

No disponible

Síndrome de Zieve, una entidad infradiagnosticada / Zieve's syndrome, an underdiagnosed entity

No disponible

Pioderma gangrenoso bilateral asociado a colitis ulcerosa y proctocolectomía restauradora / Bilateral pyoderma gangrenosum associated with ulcerative colitis and restorative proctocolectomy

No disponible

[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.

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

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

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 signifi cantly 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

Benchmarking welfare indicators in 73 free-stall dairy farms in north-western Spain.

The aim of this study was to describe the status of body condition score (BCS), hock injuries prevalence, locomotion and body hygiene score as animal welfare measures in 73 free-stall dairy cattle farms in Lugo (Spain). A benchmarking process was established across farms: (1) the animal-based indicators were ordered from low to high values; (2) The farms were classified into three categories based on the number of indicators within less than the 25th percentile, 25th to 75th percentile and above the 75th percentile. The median prevalence of unsuitable BCS, hock injuries and clinical lameness was (median (range)) 51.7 per cent (13.3 to 89.5 per cent), 40.0 per cent (7.0per cent to 100 per cent) and 9.0 per cent (0per cent to 60.0 per cent) respectively. The dirtiness of the cow's coat had a high prevalence (73.0 per cent (37.5per cent to 100 per cent)). Most farms did not display consistently good or poor animal-based indicators and each farm had its own set of strong and weak points. Moreover, facilities design and management practices were described to understand source of the observations made of the cows. The incidence of overstocking was 31.5 per cent for stalls and 26.0 per cent for headlocks. The front lunge space was reduced (<90 cm) on most dairies (90.4 per cent). Signs of poor natural ventilation (cobwebs or humidity on the roof) and ammonia odour were observed on 32.8 per cent and 85.0 per cent of the barns totally closed or with a side openingless than 50 per cent of the wall height. The milking parlour was designed with two or more turns more than 90° (9.3 per cent), and failed to allow cows to see the parlour before entering (45.2 per cent). On 52.0 per cent of dairies, more than 15 per cent of the cows had to be forcefully moved into the milking parlour. In conclusion, there was a big variation in the animal welfare levels within and across farms and they could benefit from others by changing management practices related to facilities and herds.

Photosensitive azobispyridine gold(I) and silver(I) complexes.

The neutral and cationic dinuclear gold(I) compounds [(µ-N-N)(AuR)(2)] (N-N = 2,2'-azobispyridine (2-abpy), 4,4'-azobispyridine (4-abpy); R = C(6)F(5), C(6)F(4)OC(12)H(25)-p, C(6)F(4)OCH(2)C(6)H(4)OC(12)H(25)-p) and [(µ-N-N){Au(PR(3))}(2)](CF(3)SO(3))(2) (N-N = 2-abpy, 4-abpy, R = Ph, Me) have been obtained by displacement of a weakly coordinated ligand by an azobispyridine ligand. The corresponding silver(I) dinuclear [(µ-2-abpy){Ag(CF(3)SO(3))(PPh(3))}(2)] and polynuclear [{Ag(CF(3)SO(3))(4-abpy)}(n)] compounds have been obtained. The molecular structures of [(µ-2-abpy){Au(PPh(3))}(2)](CF(3)SO(3))(2) and [(µ-4-abpy){Au(PMe(3))}(2)](CF(3)SO(3))(2) have been confirmed by X-ray diffraction studies and feature linear gold(I) centers coordinated by pyridyl groups, and non-coordinated azo groups. In contrast the X-ray structure of [(2-abpy){Ag(CF(3)SO(3))(PPh(3))}(2)] shows tetracoordinated silver(I) centers involving chelating N-N coordination by pyridyl and azo nitrogen atoms. The gold(I) compounds with a long alkoxy chain do not behave as liquid crystals, and decompose before their melting point. The soluble gold(I) derivatives are photosensitive in solution and isomerize to the cis azo isomer under UV irradiation, returning photochemically or thermally to the most stable initial trans isomer. The silver(I) derivative [(2-abpy){Ag(CF(3)SO(3))(PPh(3))}(2)] also photoisomerizes in solution under UV irradiation, showing that its solid state structure, which would block isomerization by azo coordination, is easily broken. These processes have been monitored by UV-vis absorption and (1)H NMR spectroscopy. All these compounds are non-emissive in the solid state, even at 77 K.

Ovulation induction in rabbit does submitted to artificial insemination by adding buserelin to the seminal dose.

This study was aimed at determining if a GnRH analogue, buserelin, could be used for ovulation induction in rabbit does submitted to artificial insemination (AI) by intravaginal administration, by adding the hormone to the seminal dose. In a first experiment, 39 secondiparous experimental does (Hyplus strain PS19, Grimaud Frères, France, of about 30 weeks of age) were divided into 3 groups of 13 does each, which at the moment of AI received the following treatments, respectively: (1) control: an intramuscular injection of buserelin (0.8 microg/doe), (2) 8 microg/doe of buserelin added to the insemination dose, and (3) 16 microg/doe of buserelin added to the insemination dose. The experiment was done using 3 consecutive cycles at 42 day-intervals (n = 39). Four does from each of the 3 groups had blood taken at the fourth cycle for LH determination at 0, 60, 90, 120 and 150 min relative to AI. Kindling rates were 82% (28/34), 56% (29/36) and 85% (33/39), respectively for treatments 1, 2 and 3. In the does of groups 2 and 3, LH peaks were detected 60 min after AI, whereas in the does from group 1, the LH peak was detected 90 min after AI. Prolificacy was not different for the 3 treatments (average litter sizes ranged from 10.4 to 10.8). In a second experiment, 3 buserelin concentrations (8, 12 and 16 microg/doe) were used intravaginally and compared with the control treatment (0.8 microg/doe, via intramuscular). This experiment was done using 100 nulliparous rabbit does (Hyplus strain PS19, Grimaud Frères, France, of about 19 weeks of age) (4 groups of 25 does each) located on a commercial farm, to test if the previous results would be confirmed under field conditions. Kindling rates were no different (P < 0.05) for the 4 treatment groups [91.7% (22/24), 79.2% (19/24), 87.0% (20/23) and 87.5% (21/24) respectively for the control, 8, 12 and 16 microg of intravaginal buserelin], however, prolificacy was higher when using the maximal dose of intravaginal buserelin (11.7 vs. 9.4 for the control group). It was concluded that buserelin can be used for ovulation induction in rabbit does when included in the seminal dose, with similar AI results as those obtained when the hormone is administered intramuscularly.