Possible Biomarkers in Blood for Crohn’s Disease: Oxidative Stress and MicroRNAs—Current Evidences and Further Aspects to Unravel

Crohn’s disease (CD) is an inflammatory disorder characterised by a transmural inflammation of the intestinal wall. Although the physiopathology of the disease is not yet fully understood, it is clear that the immune response plays an important role in it. This hyperreactive immune system is accompanied by the presence of unregulated reactive oxygen species (ROS). These elements are modulated in normal conditions by different elements, including enzymes that function as antioxidant defences preventing the harmful effects of ROS. However, in CD there is an imbalance between ROS production and these antioxidant elements, resulting in oxidative stress (OxS) phenomena. In fact, now OxS is being considered more a potential etiological factor for Crohn’s disease rather than a concomitant effect in the disease. The persistence of the OxS can also be influencing the evolution of the disease. Furthermore, the epigenetic mechanisms, above all microRNAs, are being considered key elements in the pathogenesis of CD. These elements and the presence of OxS have also been linked to several diseases. We, therefore, describe in this review the most significant findings related to oxidative stress and microRNAs profiles in the peripheral blood of CD patients

Produksi Nata Fruticans Dari Nira Nipah

Nipah (Nypa fruticans Wurmb.) menghasilkan nira yang dapat diperoleh melalui penyadapan tandan buah. Dalam keadaan segar nira nipah memiliki rasa manis karena mengandung gula yang cukup tinggi. Cairan ini merupakan media yang subur bagi pertumbuhan mikroorganisme, sehingga nira nipah berpotensi digunakan sebagai bahan baku untuk menghasilkan produk melalui proses fermentasi seperti nata. Nata merupakan jenis pangan yang dikelompokkan sebagai makanan penyegar atau pencuci mulut. Percobaan produksi nata fruticans dilakukan melalui proses fermentasi nira nipah yang masih segar dengan perlakuan penambahan gula 0, 50, 75 dan 100 g per liter nira nipah. Produksi nata fruticans dari nira nipah segar yang ditambahkan gula pada berbagai kadar diperoleh rendemen antara 76,52%-90,97% atau rata-rata 86,05%. Penambahan gula pada nira nipah segar berpengaruh tidak nyata terhadap rendemen produksi nata fruticans. Penggunaan nira nipah segar dengantanpa penambahan gula menghasilkan nata fruticans dengan rendemen rata-rata 83,74%

Role of oxidative stress and antioxidant enzymes in Crohn’s disease,”

Abstract There is increasing interest in oxidative stress being a potential aetiological factor and/or a triggering factor in Crohn's disease, rather than a concomitant occurrence during the pathogenesis of the disease. Recent research has shown that the immune mononuclear cells of Crohn's disease patients are induced to produce hydrogen peroxide (H 2 O 2 ). Similarly, the regulation of antioxidant enzymes during disease in these cells has been unravelled, showing that SOD (superoxide dismutase) activity and GPx (glutathione peroxidase) activity is increased during active disease and returns to normal in remission phases. However, catalase remains constantly inhibited which supports the idea that catalase is not a redox-sensitive enzyme, but a regulator of cellular processes. ROS (reactive oxygen species) can be produced under the stimulus of different cytokines such as TNFα (tumour necrosis factor α). It has been shown in different experimental models that they are also able to regulate apoptosis and other cellular processes. The status of oxidative stress elements in Crohn's disease and their possible implications in regulating cellular processes are reviewed in the present paper

The Harvey-Bradshaw Index Adapted to a Mobile Application Compared with In-Clinic Assessment: The MediCrohn Study

Objectives: Mobile apps are useful tools in e-health and self-management strategies in disease monitoring. We evaluated the Harvey-Bradshaw index (HBI) mobile app self-administered by the patient to see if its results agreed with HBI in-clinic assessed by a physician. Methods: Patients were enrolled in a 4-month prospective study with clinical assessments at months 1 and 4. Patients completed mobile app HBI and within 48 h, HBI was performed by a physician (gold standard). HBI scores characterized Crohn's disease (CD) as remission <5 or active ≥5. We determined agreement per item and total HBI score and intraclass correlation coefficients (ICCs). Bland-Altman plot was performed. HBI changes in disease activity from month 1 to month 4 were determined. Results: A total of 219 patients were enrolled. All scheduled assessments (385 pairs of the HBI questionnaire) showed a high percentage of agreement for remission/activity (92.4%, κ = 0.796), positive predictive value (PPV) for remission of 98.2%, and negative predictive value of 76.7%. High agreement was also found at month 1 (93.15%, κ = 0.82) and month 4 (91.5%, κ = 0.75). Bland-Altman plot was more uniform when the HBI mean values were <5 (remission). ICC values were 0.82, 0.897, and 0.879 in all scheduled assessments, 1 and 4 months, respectively. Conclusions: We found a high percentage of agreement between patients' self-administered mobile app HBI and in-clinic physician assessment to detect CD activity with a remarkably high PPV for remission. The mobile app HBI might allow a strict control of inflammation by remote monitoring and flexible follow-up of CD patients. Reduction of sanitary costs could be possible

Should inflammatory bowel disease clinicians provide their patients with e-Health resources?: patients' and professionals' perspectives

[Abstract] Introduction: The internet is emerging as a source of information for patients with inflammatory bowel disease (IBD). However, it is not always reliable and may cause anxiety. We aim to assess patients' information habits and patients' and professionals' perceptions of a national website integrated as an educational resource for the IBD unit. Methods: Patients aged 18-65 years, comfortable with the internet, and attending follow-ups at participating IBD units (March-June 2019) and their professionals were invited to evaluate a recommended website through an online survey. Results: Three hundred eighty-nine patients and 95 professionals completed the survey. The internet (n = 109; 27.4%) was the second preferred source of information after the health care team (n = 229; 57.5%). Eighty percent of patients searched the internet for information on their disease and 28.6% did so at least once a week (n = 114), especially newly diagnosed ones (<2 years). Patients valued a website recommended by their professional (n = 379; 95.2%) and endorsed by the National Working Group (n = 377; 94.7%). They would attend online educational initiatives on the website (n = 279; 70.1%) and complete periodical surveys to improve its usefulness (n = 338; 84.9%). According to IBD professionals, this type of website is the best patient source of supplementary information (n = 76; 80%) and they "prescribe" it to most patients (67.0 ± 25.2%), especially the newly diagnosed patients (52.7 ± 26.5%). It effectively integrates routine face-to-face education (n = 95; 100%). Conclusions: Patients of IBD units, especially newly diagnosed ones, appreciate a trusted e-Health resource to back up professional information. The favorable opinion of patients and professionals will allow its use in training interventions

Antisèptics i desinfectants

Centres sanitaris; Desinfecció; HigieneHealth centers; Disinfection; HygieneCentros sanitarios; Desinfección; HigieneL’actualització que han fet els autors d’aquesta segona edició d’Antisèptics i desinfectants ha comportat un treball rigorós i complex en el qual s’ha combinat la informació científica disponible sobre els diversos productes i tècniques amb l’experiència dels professionals que desenvolupen la seva activitat als nostres hospitals, per la qual cosa s'espera que el producte final sigui realment d’utilitat i respongui als interrogants que el dia a dia ens posa sobre la taula.This update of the second edition of Antiseptics and Desinfectants has resulted a complex and rigorous work which combine the available scientific information on various products and techniques with the experience of professionals who develop their activity in hospitals, so it is expected that the final product will be really helpful and it will answer daily questions.La actualización que han hecho los autores de esta segunda edición de Antisépticos y desinfectantes ha supuesto un trabajo riguroso y complejo en el que se ha combinado la información científica disponible sobre los diversos productos y técnicas con la experiencia de los profesionales que desarrollan su actividad en nuestros hospitales, por lo que se espera que el producto final sea realmente de utilidad y responda a los interrogantes que el día a día nos pone sobre la mesa

El registro ENEIDA (Estudio Nacional en Enfermedad Inflamatoria intestinal sobre Determinantes geneticos y Ambientales) de GETECCU: diseno, monitorizacion y funciones

El registro ENEIDA, promovido por el Grupo Espa ̃nol de Trabajo en Enfermedad deCrohn y Colitis Ulcerosa (GETECCU), fue creado en 2005 por un grupo de gastroenterólogosinteresados en mejorar el manejo de los pacientes con enfermedad inflamatoria intestinal. Losobjetivos principales del registro fueron facilitar la recogida de datos clínicos de interés parala práctica clínica asistencial, así como la elaboración de estudios colaborativos a partir dedatos clínicos y muestras biológicas. En sus 15 a ̃nos de existencia, ENEIDA ha evolucionado enmúltiples aspectos, desde su contenido o su soporte tecnológico hasta el número de centrosparticipantes, para convertirse en uno de los registros de referencia para el estudio y cuidadode los pacientes con enfermedad inflamatoria intestinal, con una producción científica continua y de alta calidad que lo ha situado como ejemplo de explotación científica colaborativa en elámbito internacional. En este artículo se revisan los objetivos, el dise ̃no, las característicasestructurales, la monitorización y la explotación científica del registro ENEIDA

Antitumor Necrosis Factor Agents to Treat EndoscopicPostoperative Recurrence of Crohn’s Disease: A Nationwide Study With Propensity-Matched Score Analysis

INTRODUCTION:Patients with Crohn's disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR.METHODS:Multicenter, retrospective, study of patients with Crohn's disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively.RESULTS:A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13-54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04-4.46; P = 0.03, and OR 2.34, 95% CI 1.18-4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65-6.05; P < 0.01, and OR 2.01, 95% CI 1.05-3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis.DISCUSSION:In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.Fiorella Canete received a research grant from the Societat Catalana de Digestologia

Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents

This is the peer reviewed version of the following article: Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents. Journal of Gastroenterology and Hepatology (2020): 29 April, which has been published in final form at https://doi.org/10.1111/jgh.15084. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionsBiological therapies may be changing the natural history of inflammatory bowel diseases, reducing the need for surgical intervention. We aimed to assess whether the availability of anti‐TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC). Methods Retrospective, cohort study of patients diagnosed within a 6‐year period before and after the licensing of anti‐TNFs (1990‐1995 and 2007‐2012 for CD; 1995‐2000 and 2007‐2012 for UC) were identified in the ENEIDA Registry. Surgery‐free survival curves were compared between cohorts. Results A total of 7,370 CD patients (2,022 in Cohort 1 and 5,348 in Cohort 2) and 8,069 UC patients (2,938 in Cohort 1 and 5,131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post‐biological cohorts. The cumulative probability of surgery was lower in CD following anti‐TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3 and 5 years, respectively p<0.0001), though not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3 and 5 years, respectively; p=0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high‐volume IBD centres (in both CD and UC) and immunosuppressant use (in CD) were protective factors. Conclusions Anti‐TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in U