Search

Malaltia de Crohn; Factors predictius; Ustekinumab Enfermedad de Crohn; Factores predictivos; Ustekinumab Crohn’s disease; Predictive factors; Ustekinumab Ustekinumab has shown efficacy in Crohn’s Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients’ data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index ≤ 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission. This work was supported by Janssen-Cilag Spain. This sponsor had a partial role in study design, analysis, and interpretation of data.

[Abstract] A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) α-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions. Ministerio de Economía y Empresa; IDI-20151125 Ministerio de Ciencia, Innovación y Universidades; SAF SAF 2017-87846-R

Introduction: The socioeconomic burden of irritable bowel syndrome with constipation (IBS-C) has never been formally assessed in Spain. Patients and methods: This 12-month (6-month retrospective and prospective periods) observational, multicentre study assessed the burden of moderate-to-severe IBS-C in Spain. Patients were included if they had been diagnosed with IBS-C (Rome III criteria) within the last 5 years and had moderate-to-severe IBS-C (IBS Symptom Severity Scale score [IBS-SSS] >= 175) at inclusion. The primary objective was to assess the direct cost to the Spanish healthcare system (HS). Results: A total of 112 patients were included, 64 (57%) of which had severe IBS-C at inclusion. At baseline, 89 (80%) patients reported abdominal pain and distention. Patient quality of life (QoL), measured by the IBS-C QoL and EQ-5D instruments, was found to be impaired with a mean score of 59 and 57 (0100, worst-best), respectively. Over the 6-month prospective period the mean IBS-C severity, measured using the IBS-SSS showed some improvement (315234 [0500, bestworst]). During the year, 89 (80%) patients used prescription drugs for IBS-C, with laxatives being the most frequently prescribed (n = 70; 63%). The direct cost to the HS was (sci)1067, and to the patient was (sci)568 per year. The total direct cost for moderate-to-severe IBS-C was (sic)1635. Discussion: The majority of patients reported continuous IBS-C symptoms despite that 80% were taking medication to treat their IBS-C. Overall healthcare resource use and direct costs were asymmetric, with a small group of patients consuming the majority of resources. (C) 2018 Elsevier Espana, S.L.U. All rights reserved.

Resumen Pacientes con enfermedad celiaca del adulto de reciente diagnostico fueron evaluados con los test GSRS y PGWBI con el objetivo de valorar las alteraciones psicologicas que presentan, su relacion con la sintomatologia gastrointestinal y su evolucion despues de la instauracion de dieta sin gluten. Previo asesoramiento nutricional los pacientes iniciaron dieta sin gluten y 6 meses despues fueron reevaluados. Las variables cuantitativas se expresan como medianas y percentil 25-75. Resultados Se incluyeron 21 pacientes, 17 mujeres y 4 hombres, edad 43 anos (31-47). La histologia fue compatible con lesion Marsh I en 6 casos, Marsh IIIa en 6 y Marsh IIIb en 9. Basalmente 8 pacientes presentaban distres psicologico severo, 4 distres moderado y 9 no presentaban distres. La puntuacion GSRS fue 34 (17-43) y el PGWBI 64 (48-87), objetivando la correlacion significativa entre los 2 indices (rho = –0,58, p = 0,006). A los 6 meses 3 pacientes tenian distres psicologico severo, 5 distres moderado, 9 no presentaban distres y 4 presentaban bienestar psicologico, la puntuacion GSRS del 6.° mes fue 13 (8-17) y el PGWBI 83 (68-95) (p Conclusiones Los pacientes con enfermedad celiaca presentan alteraciones psicologicas cuya intensidad esta relacionada con la sintomatologia gastrointestinal, que mejoran despues de la instauracion de DSG.

Resumen Objetivo Valorar los recursos disponibles en los hospitales comarcales catalanes para la asistencia urgente de la hemorragia digestiva alta. Metodo Se analiza una encuesta enviada a 32 hospitales, sobre la existencia, composicion y recursos del turno de guardia (TDG) de endoscopia, referida al ano 2009. Resultados Respondieron 24 centros, que cubrian la asistencia de 3.954.000 habitantes. Tenian TDG 12 hospitales. No disponian de TDG en su centro de referencia 1.483.000 habitantes. Los centros con TDG tenian mas camas y cubrian mas poblacion. Los TDG estaban formados por 4,5 endoscopistas (rango 2-11), que cubrian 82,1 (33,2-182,5) guardias/ano. Diecisiete centros reportaban 1.571 episodios (51 por centro, rango 3-280, 39,68/100.000 hab.). Los centros con TDG reportaban mas casos (76 vs. 43, p = 0,047). Los que no disponen de TDG derivaron mas pacientes (147 vs . 17, p= 0,001). Los pacientes en urgencias estaban a cargo de medicina interna en 4 centros, de cirugia en 14 y repartidos entre ambos servicios en 6. Si ingresaban, quedaron a cargo de Digestivo solo en 6 hospitales. Los recursos mas utilizados eran la ligadura en la hemorragia varicosa y las terapias de inyeccion en la no varicosa. Un 21% de centros no realizaban tratamiento combinado. Conclusiones Una proporcion significativa de la poblacion no dispone de endoscopista de guardia en su centro de referencia. La constitucion de TDG en hospitales comarcales supone importantes cargas asistenciales. La coordinacion entre profesionales y centros permitiria la aplicacion eficiente de los recursos terapeuticos y el establecimiento de TDG en centros que no tienen.

To evaluate the resources available in Catalan regional hospitals for the emergency care of upper gastrointestinal hemorrhage.We analyzed a survey sent to 32 hospitals on the availability, composition and resources of a duty endoscopy service for the year 2009.Responses were obtained from 24 centers, covering 3,954,000 inhabitants. Duty endoscopists were available in 12 hospitals. A total of 1,483,000 inhabitants were unable to access a duty endoscopist in the referral center. Centers with duty endoscopists had more beds and had a larger catchment area. Duty services were composed of 4.5 endoscopists (range 2-11), covering 82.1 (33.2-182.5) duty shifts/year. Seventeen centers reported 1,571 episodes (51%, range: 3-280, 39.68/100,000 inhabitants). Centers with a duty service reported a greater number of cases (76 vs. 43, p=0.047). Centers without this service referred a greater number of patients (147 vs. 17, p=0.001). Patients in the emergency department were under the care of the internal medicine department in four centers, the surgery department in 14 centers and under the care of both departments in six. Admitted patients were under the care of the gastroenterology department in only six hospitals. The most widely used procedures were ligation of varicose bleeding and injection therapies in non-varicose bleeding. Twenty-one percent of centers did not perform combined treatment.A significant proportion of the population does not have access to a duty endoscopist in referral centers. Duty shifts represent significant workload in regional hospitals. Coordination among health professionals and centers would allow the efficient application of therapeutic resources and a duty endoscopy service to be established in centers lacking this resource.