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.
NSAID-induced ischemic colitis Sierra Gabarda, Olivia; Espinosa Pérez, María; Casas Deza, Diego ...
Revista española de enfermedades digestivas,
05/2022, Volume:
114, Issue:
5
Journal Article
Peer reviewed
Open access
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.
•This is the largest study assessing the efficacy of LPV/r against SARS-CoV-2.•The overall use of LPV/r was not associated with lower mortality in CoVID19 patients.•The early use of LPV/r (median 5 ...days) showed no benefit either.
This study compared short-term effectiveness of proton pump inhibitors (PPI), swallowed topical corticosteroids (STC), and dietary therapies in reversing clinical and histological features in ...pediatric patients with eosinophilic esophagitits (EoE). Determinants for treatment choice and PPI therapy effectiveness were also assessed. A cross-sectional study analysis of patients under 18 years old recruited onto the multicenter EoE CONNECT registry was performed. Clinico-histological response was defined as symptomatic improvement plus a peak eosinophil count below 15 per high-power field after treatment. Effectiveness of first-line options used in monotherapy was compared. Overall, 393 patients (64% adolescents) receiving PPI, STC, or dietary monotherapy to induce EoE remission were identified. PPI was the preferred option (71.5%), despite STC providing the highest clinico-histological response rates (66%) compared to PPI (44%) and diet (42%). Logistic regression identified fibrotic features and recruitment at Italian sites independently associated to first-line STC treatment; age under 12 associated to dietary therapy over other options. Analysis of 262 patients in whom PPI effectiveness was evaluated after median (IQR) 96 (70–145) days showed that this effectiveness was significantly associated with management at pediatric facilities and use of high PPI doses. Among PPI responders, decrease in rings and structures in endoscopy from baseline was documented, with EREFS fibrotic subscore for rings also decreasing among responders (0.27 ± 0.63
vs.
0.05 ± 0.22,
p
< 0.001).
Concl
usion
: Initial therapy choice for EoE depends on endoscopic phenotype, patient’s age, and patients’ origin. High PPI doses and treatment in pediatric facilities significantly determined effectiveness, and reversed fibrotic endoscopic features among responders.
What is Known:
• Proton pump inhibitors are widely used to induce and maintain remission in EoE in real practice, despite other first-line alternative therapies possibly providing higher effectiveness.
What is New:
• Proton pump inhibitors represent up to two-thirds of first-line monotherapies used to induce EoE remission in pediatric and adolescent patients with EoE. The choice of STC as first-line treatment for EoE was significantly associated with fibrotic features at baseline endoscopy and recruitment in Italian centers; age less than 12 years was associated with dietary therapy.
• PPI effectiveness was found to be determined by use of high doses, attendance at pediatric facilities, presenting inflammatory instead of fibrotic or mixed phenotypes, and younger age. Among responders, PPI therapy reversed both inflammatory and fibrotic features of EoE after short-term treatment.
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 Calmarza, Pilar; Sanz París, Alejandro; Prieto López, Carlos ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2018-Apr-05, Volume:
35, Issue:
4
Journal Article
Open access
apart from the known effects of vitamin D on phospho-calcium homeostasis, in recent years there is great interest in its extrabone effects.
to know the concentration of 25-hydroxyvitamin D (25OH D) ...in newly diagnosed patients of cancer and to verify if there are differences between the different types of cancer.
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.
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).
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 granrelevancia sus efectos extra-óseos.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 pre-operatoria. Se revisaron 139 historias clínicas obteniéndose 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 cáncercolorrectal (CCR), 35 cáncer de cabeza y cuello (C y C) y 6 cáncer de otro tipo. La concentración media de 25(OH) D fue de 50,41 nmol/l (IC al 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 déficitestadísticamente 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) D (p<0,01).Conclusiones: Hay una alta prevalencia de déficit de Vitamina D en lospacientes recién diagnosticados de cáncer (sobre todo en CCR y C y C),debiendo priorizarse 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.
NSAID-induced ischemic colitis Moms, Eva Sierra; Perez, Maria Espinosa; Gonzalez, Javier Alcedo ...
Revista española de enfermedades digestivas,
05/2022, Volume:
114, Issue:
5
Journal Article
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