Small States in the Rearview Mirror: Legitimacy in the Management of Economy and Society

Small States in World Markets is about political efficacy and legitimation rather than scoring who is ahead in the economic sweepstakes. Its case for democratic corporatism rests on norms, particularly stability, rather than on narrow measures of economic efficiency. But stability and the efficacious management of the economy and social problems requires a degree of technocracy that undermines the legitimacy of the management process itself by helping to produce populist revolts

Inflammatory bowel disease course in liver transplant versus non-liver transplant patients for primary sclerosing cholangitis: LIVIBD, an IG-IBD study

Background: Data regarding the effect of orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD) course are scarce and conflicting. Aims: To compare the incidence of refractory IBD in two groups (OLT and non-OLT) of patients affected by IBD and PSC. Methods: An observational, multicentre, cohort retrospective study was conducted by the Italian Group for the study of IBD in Italy. The primary outcome was the need for biologic therapy or bowel resection for medically refractory IBD or hospitalization due to IBD relapse during the follow-up. Secondary outcomes were rate of colonic dysplasia, colorectal cancer, other solid tumours, lymphoma. Results: Eighty-four patients were included in the study. The primary outcome was not different between OLT and non-OLT groups (11/27, 40.7%, versus 20/57, 35.1%, respectively, p = 0.62). The lymphoma and other tumours (thyroid cancer, kidney cancer, ileal tumour, ovarian cancer, cervical cancer) rates were significantly higher in the OLT group (p = 0.04 and p = 0.005, respectively), at the limit of statistical significance for high-grade colonic dysplasia (p = 0.06). Conclusion: OLT in patients affected by IBD and PSC is not a risk factor for a more severe IBD course, but it is associated with a higher occurrence of cancer

Desloratadine 5 mg once daily improves quality of life in chronic idiopathic urticaria

Aim. Desloratadine (DL) is an effective treatment for chronic idiopathic urticaria (CIU) symptoms, but there is little information about its impact on patients' perceived general wellbeing. The primary objective was to measure the effect of DL on the quality of life (QoL) of CIU patients, using the Dermatology Life Quality Index (DLQI). Secondary objectives were: evaluation of the effects of DL on pruritus and number of hives, sleep and daily activities, overall CIU condition, and assessment of therapeutic response. Safety and tolerability of DL were also evaluated. Methods. Two-hundred and fifty-five patients, aged 18-79 years and with moderate to severe CIU, were treated with DL 5 mg once daily for 28 days. Patients recorded signs and symptoms scores daily, and completed the DLQI questionnaire at baseline and on treatment days 7, 14, 21 and 28. Patients and investigators jointly evaluated overall CIU condition and therapeutic response at days 14 and 28. Results. After 28 days of treatment, DL significantly reduced mean overall DLQI score from 9.4 (±5.4) at baseline to 3 (±4.1) (-66.1%; P<0.001), with no significant differences between moderate and severe patients. Improvement in QoL was significant (P<0.001) at all time points and for all DLQI domains. All signs and symptoms scores were significantly correlated with DLQI score. Conclusion. Treatment with DL 5 mg for 4 weeks significantly improves symptoms and QoL in patients with CIU, irrespective of disease severity, and with a rapid onset of action