[Utilization of Upadacitinib in the treatment of Crohn's disease: a report on two clinical cases]. / Utilización de Upadacitinib en el tratamiento de la enfermedad de Crohn: reporte de dos casos clínicos.

Crohn's disease (CD) is a chronic, progressive inflammatory disease with complications that impact the well-being of patients. The therapeutic advances achieved in recent decades, especially through the advent of biological therapy, have allowed for a transformation in the approach and management of CD, thereby modifying the course of this disease. However, a significant number of patients do not experience a satisfactory response to these drugs or lose it during the course of the disease. In this scenario, a viable alternative is to switch medications. Upadacitinib, a novel Janus kinase inhibitor, has emerged as a promising strategy for the management of CD. We presented two cases of patients with CD refractory to conventional therapy and biological therapy, who responded successfully to treatment with upadacitinib.

Evaluation of the sensitivity and specificity of sigmoidoscopy in comparison to colonoscopy regarding the detection of intestinal inflammatory activity in the follow-up of patients with ulcerative colitis. / Evaluación de la sensibilidad y especificidad de la sigmoidoscopia en comparación con la colonoscopia en la detección de actividad inflamatoria intestinal en el seguimiento de pacientes con colitis ulcerosa.

INTRODUCTION: Ulcerative colitis (UC) is a chronic disease characterized by periods of inflammatory activity and remission, which vary from the rectum to the proximal colon. Currently, mucosal healing is a long-term goal in the management of inflammatory bowel disease, with colonoscopy and sigmoidoscopy being the recommended tools for evaluation. OBJECTIVE: To assess the effectiveness of both examinations in determining the presence of inflammatory activity in the follow-up of patients with UC. METHODS: Retrospective observational study analyzing colonoscopies performed as part of the follow-up of UC patients between January 2021 and July 2023 by gastroenterologists from the Inflammatory Bowel Disease Program at the Clínica Universidad de los Andes. The study compared endoscopic and histological activity observed in the rectosigmoid region with that found in the rest of the colon. Sensitivity and specificity were determined using concordance and correlations tests. RESULTS: A very good concordance and correlation were observed regarding endoscopic findings, with a Kappa index of 0.97 and a Spearman coefficient of 0.97. The Positive Predictive Value (PPV) of sigmoidoscopy for endoscopic activity was 1, and the Negative Predictive Value (NPV) was 0.96. In relation to histological activity, the concordance had a Kappa index of 0.93 and a Spearman coefficient of 0.93, with a PPV of sigmoidoscopy for histological activity being 1 and an NPV of 0.91. CONCLUSION: This cohort suggests that sigmoidoscopy is a cost-effective option for evaluating mucosal healing in UC patients in symptomatic and biomarker remission. However, complete colonoscopy should be considered in cases of discrepancies with the clinical picture or in colorectal cancer surveillance.

Occurrence of parasitism promoted by Myzobdella lugubris Leidy, 1851 (Annelida: Piscicolidae) in Callinectes bocourti (Crustacea: Portunidae): A report of invasive leech in Brazilian Amazon province.

This study reports the presence of high parasitic load by Myzobdella lugubris Leidy, 1851 in the swimming crab Callinectes bocourti A. Milne-Edwards, 1879 from Amazon mangrove. We sampled the swimming crabs using a baited trap, between January and June 2023, in Santa Maria River, located in the municipality of Curuçá, state of Pará, Brazil (geographical coordinates 0°40'3.705"S, 047°54'43.405"W). After sampling, each swimming crab was individually placed in plastic containers for the count of leeches per individual. In the laboratory, the specimens were sexed, measured (parasite and host) and fixed in 70% alcohol. For the leech species identification, macroscopic techniques were combined with light microscopy (LM) and scanning electron microscopy (SEM). We examined 86 specimens of C. bocourti (75 males and 11 females) in a ratio of 1 M:0.14 F, all infested with leeches. In total, 186 leech specimens were collected, ranging from 1 to 21 leeches per host. Leeches oviposited the cocoons in greater quantities in ventral area of swimming crab carapace (32%), followed by dorsal area of carapace (29.09%), chelipeds (24.34%) and ambulatory legs (14.57%). The presence of M. lugubris is a risk to the health of the host, once it may transmit a range of diseases to aquatic organisms, and subsequently risk to human health.

Treatment with hyperbaric oxygen in a Crohn`s disease patient.

Despite advances in the treatment of inflammatory bowel disease, particularly with biological therapies and new small molecules, a significant gap still exists in achieving persistent remission from a symptomatic, biomarker, and endoscopic perspective. In this context, hyperbaric oxygen therapy (HBOT) is considered as a therapeutic strategy. This approach has also been suggested for managing ischemic ulcers located at anastomotic sites. In this clinical case, we describe the clinical and endoscopic evolution of a challenging-to-manage Crohn's disease (CD) patient with an ischemic ulcer at the ileo-rectal anastomosis who underwent HBOT.

Corticoides en la enfermedad inflamatoria intestinal: ¿siguen siendo una opción terapéutica? / Corticosteroids in inflammatory bowel disease: Are they still a therapeutic option?

A pesar del desarrollo y de la incorporación de nuevas estrategias terapéuticas, como son la terapia biológica y las moléculas pequeñas, los corticoides aún cumplen un papel importante en la inducción de la remisión de la enfermedad inflamatoria intestinal (EII). Variables como la indicación en el momento apropiado, la dosis correcta, la duración en intervalos adecuados, la seguridad de estos fármacos y las alternativas farmacológicas disponibles deben ser siempre consideradas por el equipo tratante al momento de su indicación en pacientes con EII. Aunque el uso de corticoides es considerado un marcador de calidad de atención en pacientes con EII, en la actualidad el uso de estos fármacos en la práctica clínica de la EII dista mucho de ser el más correcto. Este artículo de revisión no pretende ser solamente una revisión clásica de las indicaciones de los corticoides, sino que explicamos aquí los escenarios en los que en nuestra opinión no serían una opción adecuada para nuestros pacientes, así como los errores más frecuentes que cometemos en nuestra práctica clínica diaria al utilizarlos. (AU)

Despite the development and incorporation of new therapeutic strategies, such as biologic therapy and small molecules, corticosteroids still play an important role in inducting inflammatory bowel diseases (IBD) remission. Variables like indicating the right doses at the right time, in adequate intervals, the security of these drugs and the pharmacological alternatives available must be considered by the providers when they are indicated to patients with IBD. Although the use of corticosteroids is considered as a marker of quality of care in patients with IBD, the use of these drugs in the clinical practice of IBD is far from being the correct one. This review article is not intended to be just a classic review of the indications for corticosteroids. Here we explain the scenarios in which, in our opinion, steroids would not be an appropriate option for our patients, as well as the most frequent mistakes we make in our daily practice when using them. (AU)

A Natural Helper Intervention to Address Disparities in Parent Child-Interaction Therapy: A Randomized Pilot Study.

OBJECTIVE: Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD: Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS: Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS: Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.

Corticosteroids in inflammatory bowel disease: Are they still a therapeutic option? / Corticoides en la enfermedad inflamatoria intestinal: ¿siguen siendo una opción terapéutica?

Despite the development and incorporation of new therapeutic strategies, such as biologic therapy and small molecules, corticosteroids still play an important role in inducting inflammatory bowel diseases (IBD) remission. Variables like indicating the right doses at the right time, in adequate intervals, the security of these drugs and the pharmacological alternatives available must be considered by the providers when they are indicated to patients with IBD. Although the use of corticosteroids is considered as a marker of quality of care in patients with IBD, the use of these drugs in the clinical practice of IBD is far from being the correct one. This review article is not intended to be just a classic review of the indications for corticosteroids. Here we explain the scenarios in which, in our opinion, steroids would not be an appropriate option for our patients, as well as the most frequent mistakes we make in our daily practice when using them.

Anemia en la enfermedad inflamatoria intestinal: un objetivo subestimado / Anemia in inflammatory bowel disease

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Although there are several causes of anemia in IBD, the two most frequent etiologies are iron deficiency anemia and anemia of chronic disease. Despite the high prevalence of anemia in IBD and its significant impact on patient's quality of life, this complication is still underdiagnosed and undertreated by providers. Active screening for anemia, structured assessment, comprehensive management, and multidisciplinary collaboration are needed in IBD patients. The cornerstone of anemia management depends on the underlying etiology along with normalization of inflammatory activity. Although, oral iron is effective for the treatment of mild iron deficiency-related anemia, intravenous iron formulations have a good safety profile and can be used as first-line therapy in patients with active IBD, severe anemia and previous intolerance prior to oral iron. After proper treatment of anemia, careful monitoring is necessary to prevent its recurrence. Herein, we discuss the etiology, screening, diagnosis, therapy selection, and follow-up for anemia in IBD.

[Anemia in inflammatory bowel disease]. / Anemia en la enfermedad inflamatoria intestinal: un objetivo subestimado.

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Although there are several causes of anemia in IBD, the two most frequent etiologies are iron deficiency anemia and anemia of chronic disease. Despite the high prevalence of anemia in IBD and its significant impact on patient's quality of life, this complication is still underdiagnosed and undertreated by providers. Active screening for anemia, structured assessment, comprehensive management, and multidisciplinary collaboration are needed in IBD patients. The cornerstone of anemia management depends on the underlying etiology along with normalization of inflammatory activity. Although, oral iron is effective for the treatment of mild iron deficiency-related anemia, intravenous iron formulations have a good safety profile and can be used as first-line therapy in patients with active IBD, severe anemia and previous intolerance prior to oral iron. After proper treatment of anemia, careful monitoring is necessary to prevent its recurrence. Herein, we discuss the etiology, screening, diagnosis, therapy selection, and follow-up for anemia in IBD.

Anal neoplasia and perianal Crohn's disease: myth or reality?

The association between inflammatory bowel disease (IBD) and anal canal squamous cell carcinoma (SCC) has a low prevalence and is mainly supported by articles that include a series of cases. We describe the clinical, endoscopic and histological findings of a patient with Crohn's disease (CD) who developed SCC while undergoing biological therapy with active disease.