Evolution after Anti-TNF Discontinuation in Patients with Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study

OBJECTIVES:The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed.METHODS:This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included.RESULTS:A total of 1, 055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn''s disease and ulcerative colitis patients, respectively. In both Crohn''s disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn''s disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe.CONCLUSIONS:The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Insulation design of low voltage electrical motors fed by PWM inverters

This paper proposes a model to determine the partial discharge inception voltage of magnet wires, including the effect of elevated temperatures, and shows its applicability to the complete range of wire geometries considered in IEC Standard 60317-13

Foreign Interventions and Abuse of Civilians During the Peruvian Civil War

The international community has a declared intention to protect innocent civilians from direct and deliberate violence in civil conflicts, but its track record of actually doing so is mixed. Using a new monthly time-series data set, we explore the factors associated with variations in the number of civilians killed or wounded by participants in the civil war in Peru during the 1980s and 1990s. We find that an increase in the level of abuse by one side is strongly associated with subsequent increases in the level of abuse by the other. Certain types of foreign intervention had a large and statistically significant impact on the level of abuse; some types of intervention raised the level of violence, but others reduced it

A global analysis of field body temperatures of active squamates in relation to climate and behaviour

AimSquamate fitness is affected by body temperature, which in turn is influenced by environmental temperatures and, in many species, by exposure to solar radiation. The biophysical drivers of body temperature have been widely studied, but we lack an integrative synthesis of actual body temperatures experienced in the field, and their relationships to environmental temperatures, across phylogeny, behaviour and climate.LocationGlobal (25 countries on six continents).TaxaSquamates (210 species, representing 25 families).MethodsWe measured the body temperatures of 20,231 individuals of squamates in the field while they were active. We examined how body temperatures vary with substrate and air temperatures across taxa, climates and behaviours (basking and diel activity).ResultsHeliothermic lizards had the highest body temperatures. Their body temperatures were the most weakly correlated with substrate and air temperatures. Body temperatures of non-heliothermic diurnal lizards were similar to heliotherms in relation to air temperature, but similar to nocturnal species in relation to substrate temperatures. The correlation of body temperature with air and substrate temperatures was stronger in diurnal snakes and non-heliothermic lizards than in heliotherms. Body-substrate and body-air temperature correlations varied with mean annual temperatures in all diurnal squamates, especially in heliotherms. Thermal relations vary with behaviour (heliothermy, nocturnality) in cold climates but converge towards the same relation in warm climates. Non-heliotherms and nocturnal species body temperatures are better explained by substrate temperature than by air temperature. Body temperature distributions become left-skewed in warmer-bodied species, especially in colder climates.Main ConclusionsSquamate body temperatures, their frequency distributions and their relation to environmental temperature, are globally influenced by behavioural and climatic factors. For all temperatures and climates, heliothermic species' body temperatures are consistently higher and more stable than in other species, but in regions with warmer climate these differences become less pronounced. A comparable variation was found in non-heliotherms, but in not nocturnal species whose body temperatures were similar to air and substrate irrespective of the macroclimatic context.<br/