Search

BACKGROUND: The efficacy of interferon beta (IFN beta) is well established in relapsing-remitting multiple sclerosis (MS). However, the use of this drug in clinical practice is complex, especially because it is only partially effective, its long term efficacy and side effects are unknown, its efficacy may be abrogated by the development of neutralising antibodies, compliance is variable, and its cost effectiveness is controversial. OBJECTĠVES AND METHODS: This was an observational, retrospective, cross-sectional study including 210 patients with MS under INFβ-1b treatment between 2000 and 2012 with monitor the outcome of therapy in clinical practice and assess the proportion of patients for stopping therapy due to different reasons. RESULTS: During a median treatment period of 12 years, the relapse rate decreased to 41%. Variation of EDSS scale was from 2,06 to 1,80 in RRMS form and from 3,75 to 5,15 for SPMS form. Adverse reactions were injection site reactions, flu-like symptoms, CNS disturbances including depression, leucopenia, elevated liver enzymes and severe hypersensitivity reactions. The drop-out rate was 50%. CONCLUSĠON: IFN beta is effective in reducing the relapse rate in patients with relapsing-remitting MS in routine clinical practice. However, after median treatment duration of 12 years, a percentage of initially relapsingremitting MS patients seem to have ongoing disease activity, presenting as disabling relapses or insidious progression. Further work is needed to identify the potential better treatment perhaps through pharmacogenomic or biomarker studies, paving the way for a tailored, personalized medicine approach. [ABSTRACT FROM AUTHOR]

Background: Due to recent advances in healthcare, more and more teenagers with chronic diseases emerge into adulthood, posing challenges for both pediatric and adult healthcare systems. The transition from pediatric to adult healthcare settings presents a complex and pivotal phase for adolescents managing chronic conditions. This process necessitates collaboration among adolescents, parents, pediatric specialists, and adult healthcare providers., Aims: This study aims to assess the current practices of doctors caring for teenagers with chronic digestive diseases and to identify the needs and barriers experienced by professionals during the transition of their patients., Methods: In order to achieve the aims of this study, we employed a cross-sectional survey study. Pediatric gastroenterologists (PG), general pediatricians (GP), adult gastroenterologists (AG), and primary care physicians (PCP) applied a 20-closed multiple-choice questionnaire., Results: There were 70 responders; 90% did not follow a transition program. The ideal age for beginning the transition was considered 16-17 (51.4%), and the transfer was recommended at 19-20 years of age by 42.9% and at 18 by 45.7%. Regarding the resources, 78.55% required an online platform, 58.55% solicited transition readiness assessments, 51.41% identified online forms distributed through social media, 48.55% selected brochures for patients and families, and a guideline for medical practitioners. Both GPs and PGs (0.836, p<0.05) requested higher numbers of resources. Identified barriers were the absence of a transition expert (65.7%), lack of time for individualized transition programs (61.41%), patients' psycho-emotional attachment to the pediatric team (52.84%), and adolescents' lack of disease knowledge (57.13%)., Conclusions: Investigating the roles and challenges faced by healthcare professionals during the transitional period is crucial for optimizing continuity of care, enhancing patient outcomes, and addressing systemic gaps in healthcare delivery. We identified valuable tools that could be used in transition programs applicable to all institutions caring for adolescents with chronic diseases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Ethics Committee of St. Mary Hospital issued approval (38761/09.11.2020). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Poamaneagra et al.)

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures, a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system that now needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic had been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have had a clear impact on stage migration due to disease progression.

Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.

Background: Helicobacter pylori antibiotic resistance has increased worldwide and affects the effectiveness of current therapies. The recommended first-line empiric treatment should be tailored to the local clarithromycin resistance rate. This study aimed to determine the pediatric patient profile and rate of clarithromycin resistance for patients diagnosed with Helicobacter pylori by gastric biopsy., Methods: We studied 84 positive gastric samples for Helicobacter pylori . Positive results were confirmed by a rapid urease test and histopathological examination, with the type of gastritis established according to the Sydney System. Gastric biopsy samples were stored in RNA saver. Clarithromycin resistance was determined by a real-time polymerase chain reaction-based molecular assay after RNA-DNA extraction., Results: Of the 84 biopsy samples analyzed, 35 (41.6%) were resistant to clarithromycin. Clarithromycin resistance was found mainly in girls (80%) with a mean age of 15 years (range 6-17 years). The history of prior exposure to clarithromycin was 91.6%. The concordance between the histopathological examination and the PCR test was 100%., Conclusions: One in 2.4 children infected with Helicobacter pylori had a strain resistant to clarithromycin. This resistant strain may be a reason for treatment failure in Romanian children, yet this is uninvestigated. The high rate of bacterial resistance to this antibiotic among children indicates the need for susceptibility testing before therapy.