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The COVID-19 pandemic caused by SARS-CoV-2 has led to a wide range of clinical presentations, with respiratory symptoms being common. However, emerging evidence suggests that the gastrointestinal (GI) tract is also affected, with angiotensin-converting enzyme 2, a key receptor for SARS-CoV-2, abundantly expressed in the ileum and colon. The virus has been detected in GI tissues and fecal samples, even in cases with negative results of the reverse transcription polymerase chain reaction in the respiratory tract. GI symptoms have been associated with an increased risk of ICU admission and mortality. The gut microbiome, a complex ecosystem of around 40 trillion bacteria, plays a crucial role in immunological and metabolic pathways. Dysbiosis of the gut microbiota, characterized by a loss of beneficial microbes and decreased microbial diversity, has been observed in COVID-19 patients, potentially contributing to disease severity. We conducted a comprehensive gut microbiome study in 204 hospitalized COVID-19 patients using both shallow and deep shotgun sequencing methods. We aimed to track microbiota composition changes induced by hospitalization, link these alterations to clinical procedures (antibiotics administration) and outcomes (ICU referral, survival), and assess the predictive potential of the gut microbiome for COVID-19 prognosis. Shallow shotgun sequencing was evaluated as a cost-effective diagnostic alternative for clinical settings. Our study demonstrated the diverse effects of various combinations of clinical parameters, microbiome profiles, and patient metadata on the precision of outcome prognostication in patients. It indicates that microbiological data possesses greater reliability in forecasting patient outcomes when contrasted with clinical data or metadata. Furthermore, we established that shallow shotgun sequencing presents a viable and costeffective diagnostic alternative to deep sequencing within clinical environments. [ABSTRACT FROM AUTHOR]

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Nonsteroidal anti-inflammatory drugs (NSAIDs) show high efficacy in anti-inflammatory and analgesic therapy and are the most widely used drugs worldwide. In addition to their efficacy, the widespread use of NSAIDs has been fostered by their wide availability, especially as some are available without a prescription. Unfortunately, this group of drugs is also fraught with adverse effects, including serious ones. Due to the widespread use of NSAIDs, updated data on this group of drugs is critical for practitioners to make the right therapeutic decisions. Each patient requires individualised therapy because, in the case of NSAIDs, the choice of a specific drug, in relation to the type and nature of pain and potential adverse effects, is very important. Over the years, attempts have been made to develop an algorithm for the selection of NSAIDs according to the risk of developing complications associated with drugs of this group in individual cases, taking into account the so-called, golden mean' of NSAIDs and the knowledge of interactions between some NSAIDs and cardioprotective acetylsalicylic acid. This study is another attempt to summarise this issue. With the current state of knowledge, resulting primarily from the publication of the large PRECISION study, which is limited to only three molecules, there remains the fundamental question of expanding the knowledge to include such commonly used drugs as diclofenac, ketoprofen, meloxicam and etoricoxib. In addition to the results of the PRECISION study, this version includes a study by an expert group on other NSAIDs on the Polish market and presents an algorithm for selecting NSAIDs according to individual gastroenterological and cardiovascular risk. [ABSTRACT FROM AUTHOR]

Introduction: Although the phenomenon of cytokine storm is well described in patients with severe COVID-19, little is known about the role of the immune system in asymptomatic patients, especially in the group with autoimmune diseases, such as inflammatory bowel disease (IBD). Aim: To assess the stimulation of the immune system expressed through the production of cytokines in IBD patients with asymptomatic COVID-19. Material and methods: This is a multi-centre, prospective study in which the concentration of many cytokines (IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IL-23, IFN-γ, TNF-α, TNF-β) was assessed in patients with IBD and asymptomatic SARS-CoV-2 infection diagnosed by serological tests. Results: In the group of patients with a recent SARS-CoV-2 infection, defined as positive antibodies in the IgA + IgM class, a higher percentage of patients with the presence of interleukin (IL) 2 (IL-2) was found. No association with other cytokines or effects of IBD activity or treatment was found. However, the effect of the applied treatment on the concentration of some cytokines was found: a negative association of infliximab, vedolizumab, and prednisone with IL-2, a positive correlation of steroids, thiopurines with IL-10, and in the case of tumor necrosis factor-α (TNF-α), negative with infliximab, and positive with vedolizumab. Conclusions: The increased concentration of IL-2 may result from its regulatory role in inhibiting excessive activation of the immune system; however, considering the studies of patients with severe COVID-19, its role in the initial phase of SARS-CoV-2 infection requires further research. [ABSTRACT FROM AUTHOR]

Introduction: There is little data on the development of dermal lesions in patients with inflammatory bowel disease (IBD) treated with anti - tumor necrosis factor-α (anti-TNF-α), while their characteristics, clinical course, and impact on treatment are of great concern., Objectives: The aim of this study is to assess the prevalence, risk factors, and clinical sequelae of dermal lesions in IBD patients treated with anti-TNF-α antibodies., Patients and Methods: This retrospective, single-center study evaluated 541 IBD patients treated with anti-TNF-α drugs and compared them with 688 IBD anti-TNF-α-naïve patients., Results: A significant higher prevalence of dermal lesions was noted during the anti-TNF-α therapy of 30.9% patients versus 16.4% (P <0.001). Risk factors for dermal lesions were higher body mass index (BMI), Crohn's disease located in the small intestine, and longer duration of therapy. Some types of dermal lesions were associated with anti-TNF-α therapy: infusion reactions and injection site reactions, cutaneous infection, psorasiform reactions, and lupus-like symptoms. Dermal lesions (alopecia, lupus-like symptoms, melanoma, and psoriasis) occurred in 5.9% of patients who discontinued or changed anti-TNF-α therapy., Conclusions: We observed a higher prevalence of dermal lesions in patients with IBD undergoing anti-TNF-α therapy, although the development of such lesions rarely necessitated a change in or discontinuation of treatment. Patients with IBD should undergo regular dermatological follow-up, which may improve the detection of dermal lesions. Moreover, biological therapy in IBD patients requires close collaboration with an experienced dermatologist.

Introduction: Inflammatory bowel disease (IBD) patients use a wide variety of immunosuppressive drugs, including biologics, but their effect on SARS-CoV-2 vaccine antibody levels remains a mystery., Aim: We analysed whether the drugs used in the treatment of IBD patients could affect the concentration of SARS-CoV-2 antibodies., Material and Methods: This is a prospective, single-centre evaluation of the persistence of SARS-CoV-2 antibodies after vaccination at various time points: every 2 months throughout the 6 th month after the first dose., Results: We included a total of 346 vaccinated IBD patients in the study. A negative correlation between antibody level and time from full vaccination was confirmed for the following types of therapy: infliximab (rho = -0.32, p < 0.001), adalimumab (rho = -0.35, p = 0.025), and vedolizumab (rho = -0.50, p < 0.001). In the case of other, long-term drug administration, a negative correlation between antibody level and time from full vaccination was confirmed for mesalazine (rho = -0.35, p < 0.001), budesonide (rho = -0.58, p = 0.004), systemic glucocorticoids (rho = -0.58, p < 0.001), and azathioprine (rho = -0.44, p < 0.001)., Conclusions: Due to the immunosuppressive and biological treatment, IBD patients are exposed to a shorter persistence of SARS-CoV-2 antibodies and require booster doses. The role of gastroenterologists in educating patients about the need to continue SARS-CoV-2 vaccination remains crucial., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Termedia.)

Andexanet alfa (AA) is a recombinant inactive analog of human activated factor X (FXa), effectively reversing the effects of its inhibitors - rivaroxaban and apixaban, which are available in Poland. The drug was approved for clinical use registration after the publication of the results of the ANNEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXa Inhibitors 4), in which its efficacy in restoring hemostasis in life-threatening hemorrhages in patients receiving using the aforementioned anticoagulants was demonstrated. Hence, AA is now recommended for patients on apixaban or rivaroxaban therapy with massive and uncontrollable hemorrhages, including hemorrhagic strokes (HS) and gastrointestinal bleeding. Drug-specific chromogenic anti-Xa assays are generally best suited for estimating rivaroxaban and apixaban plasma levels, aside from direct assessment of their concentrations. The absence of anti-Xa activity, determined using these assays, allows us to rule out the presence of clinically relevant plasma concentrations of any FXa inhibitor. On the other hand, the dose of AA should not be modified based on the results of coagulation tests, as it depends solely on the time that elapsed since the last dose of FXa inhibitor and oon the dose and type of FXa inhibitor. AA is administered as an intravenous (i.v.) bolus, followed by an i.v. infusion of the drug. The maximum reversal of anti-Xa activity occurs within two minutes of the end of the bolus treatment, with the continuation of the continuous i.v. infusion allowing the effect to be maintained for up to two hours afterwards. Because anticoagulant activity can reappear after the infusion is completed, it is currently unclear at what point after AA administration FXa inhibitors or heparin should be re-administered. In Poland AA is starting to become available and its urgent need to administer it to patients with severe bleeding on apixaban or rivaroxaban.