How to dramatically reduce dehydration-related readmission in patients undergoing restorative surgery with diverting ileostomy for ulcerative colitis.

BACKGROUND: Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications. METHODS: The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board. RESULTS: Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%). CONCLUSIONS: This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential.

Nerve ultrasound in Friedreich's Ataxia: enlarged nerves as a biomarker of disease severity.

OBJECTIVE: In Friedreich's ataxia research, the focus is on discovering treatments and biomarkers to assess disease severity and treatment effects. Our study examines high-resolution nerve ultrasound in these patients, seeking correlations with established clinical markers of disease severity. METHOD: Ten patients with Friedreich's Ataxia underwent a comprehensive clinical assessment with established scales (SARA, FARS, mFARS, INCAT, ADL 0-36, IADL). Additionally, they underwent nerve conduction studies and high-resolution nerve ultrasound. Quantitative evaluation of nerve cross-sectional area, conducted at 24 nerve sites using high-resolution nerve ultrasound, was compared with data obtained from 20 healthy volunteers. RESULTS: All the patients had a severe sensory axonal neuropathy. High-resolution nerve ultrasound showed significant increase, in cross sectional area, of median and ulnar nerves at the axilla and arm. The cumulative count of affected nerve sites was directly associated with clinical disability, as determined by SARA, FARS, mFARS, ADL 0-36, and INCAT score, while displaying an inverse correlation with IADL. CONCLUSIONS: Our study shows that high-resolution ultrasound reveals notable nerve abnormalities, primarily in the upper limbs of patients diagnosed with Friedreich's Ataxia. The observed correlation between these nerve abnormalities and clinical disability scales indicates the potential use of this technique as a biomarker for evaluating disease severity and treatment effects. SIGNIFICANCE: Nerve Ultrasound is a potential biomarker of disease severity in Friedreich's Ataxia.

Analysis of response of severe eosinophilic asthmatic patients to benralizumab

Introduction Clinical trials and real-life studies have been published showing effectiveness of benralizumab in severe eosinophilic asthmatic patients. The aim of the present study is to describe super-responders to benralizumab in a series of 79 patients who completed at least 1 year of treatment, and to compare super-responders with non super-responders. Methods This is a multicenter study of the Register of Severe Asthma of the Region of Murcia (RE-ASGRAMUR) Group performed in eight hospitals under the conditions of routine clinical practice. Patients with zero exacerbations and no oral corticosteroid therapy for asthma were considered super-responders. We analyzed clinical, functional, and inflammatory parameters of selected patients. Results In all, 50 of the 79 patients (63%) met the super-responder criteria. In addition, 36% of the patients (26/71) were considered as complete responders to treatment (super--responder + Asthma Control Test [ACT] ≥ 20 + forced expiratory volume in 1 s [FEV1] ≥ 80%). The super--responders were significantly older in age (P = 0.0029), had higher eosinophils count (P = 0.0423), higher proportion of nasal polyps (P = 0.036), and they had less severe disease at baseline. After 1 year of treatment, the super-responders had higher levels of ACT questionnaire (23 vs 19, P = 0.0007) and better percentage of FEV1 (83 vs 75, P = 0.0359). Conclusion Almost two of the three patients treated with benralizumab were super--responders after 1 year of treatment and 36% had a complete response. Super-responders were associated with older age, higher eosinophils count, had nasal polyposis as comorbidity, and had less severe disease at baseline. This data illustrated the good real-life response of patients with severe eosinophilic asthma to the treatment with benralizumab (AU)

Buscando la mejor "evidencia" en Alergología / Searching for the best evidence in allergology

La Alergología Clínica y las ciencias médicas generan día a día preguntas a los que las practicamos. Para responder a estas preguntas existen distintos tipos de fuentes; sin embargo, estamos obligados a buscar la mejor información posible para resolverlas. Los tiempos en los que vivimos y desarrollamos la profesión médica exigen información de calidad dado el mar de datos disponibles en las fuentes a nuestra disposición; de entre todas las conocidas, es Internet la que mayor volumen nos ofrece. El adecuado manejo de este recurso nos permitirá acceder a información que debería ser por regla general basada en la evidencia. El objetivo de este artículo es proponer una guía de recursos web de utilidad para la práctica diaria en alergología.(AU)

Clinic Allergology and medical sciences practice are constant generators of questions. To answer these questions there are multiple sources; however, we most search for the best possible information. Times we are living in and practice medical profession require high quality information because of the great sea of data we find in the available sources; from all of these, internet is the one that offers a great volume of information. An appropriate use of this resource will allow us to achieve information that should be always evidence based medicine. The objective of this article is to propose a guide of web resources useful in daily Allergology practice. (AU)