European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on 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

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Resultados del programa de diagnóstico precoz de cáncer de colon y recto de les Illes Balears en el Hospital Comarcal de Inca en las dos primeras rondas de su desarrollo en relación a la actividad endoscópica: enero 2015- diciembre 2018

Introduction: Colon cancer is the most frequent cancer in Spain with 39553 new cases per year. It is a type of cancer that can be subjected to screening programs, currently operational in most European countries. Material and methods: The early Illes Balears colon cancer diagnosis program began in January 2015. Aimed at men and women aged 50 to 69 years, asymptomatic and without a family history of colon cancer. It is based on offering the realization of occult blood in immunological feces with subsequent colonoscopy to people with positive results. The Regional Hospital of Inca is the only hospital in Mallorca with this operational program since January 2015. We intend to analyze the results of screening colonoscopies performed in the first two rounds (January-2015 / December 2018). Results: 1006 screening colonoscopies have been performed, detecting 246 advanced adenomas and 57 cases of colorectal cancer. 80% of the CCRs detected correspond to early stages (I and II) with a very good prognosis. Conclusions: The development of the screening program is highly profitable for the health system. It is feasible in the context of the Public Health System of the Balearic Islands. The results help to justify the extension of the program to the rest of the health areas of Mallorca.Introducción: El cáncer de colon es el cáncer más frecuente en España con 39553 casos nuevos al año. Es un tipo de cáncer susceptible de ser sometido a programas de cribado, actualmente operativos en la mayoría de países europeos. Material y métodos: El programa de diagnóstico precoz de cáncer de colon de les Illes Balears, se inició en enero 2015. Dirigido a hombres y mujeres de 50 a 69 años, asintomáticos y sin antecedentes familiares de cáncer de colon. Se basa en ofrecer la realización de sangre oculta en heces inmunológica con colonoscopia posterior a las personas con resultado positivo. El Hospital Comarcal de Inca es el único hospital de Mallorca con dicho programa operativo desde enero 2015. Pretendemos analizar los resultados de las colonoscopias de cribado realizadas en las dos primeras rondas (enero-2015/ diciembre 2018). Resultados: Se han realizado 1006 colonoscopias de cribado, detectando 246 adenomas avanzados y 57 casos de cáncer colorrectal. El 80% de los CCR detectados corresponden a estadíos precoces (I y II) de muy buen pronóstico. Conclusiones: El desarrollo del programa de cribado es altamente rentable para el sistema sanitario. Es factible en el contexto del Sistema Sanitario público de les Illes Balears. Los resultados ayudan a justificar la extensión del programa al resto de áreas sanitarias de Mallorca

Estudios aleatorios al comportamiento de las revistas científicas de ciencias jurídicas declaradas en el Google Académico

Se presenta un análisis aleatorio del comportamiento de la producción y la visibilidad de las revistas científicas sobre ciencias jurídicas, durante el período comprendido entre 2018 y 2022, a partir de un estudio descriptivo y transversal, utilizando Google. Se analizaron variables de producción, por revistas, autores y afiliaciones, así como la red de palabras claves. Se obtuvo una disminución, con una tasa de crecimiento promedio anual negativo de -3,57 %, con un coeficiente de determinación nulo. Se valoran indicadores para dar seguimiento a este estudio preliminar en las ciencias jurídicas que sirvan de herramienta para evaluar su calidad editorial y visibilidad de las revistas de esta subcategoría