The switch to biosimilar infliximab as a cause of treatment cessation in 3 paediatric patients with Crohn’s disease

Discontinuation of treatment in children with inflammatory bowel disease (IBD) in long-term remission remains debatable. The risk of relapse is one of the main concerns in the consideration of reduction or cessation of treatment. In 2017 all paediatric IBD patients treated with originator infliximab at the Department of Paediatric Gastroenterology, Ghent University Hospital, were switched to biosimilar Remsima®. Faecal calprotectin, infliximab through levels and antibodies, white cell count, haemoglobin and C-reactive protein were measured before and after switching to biosimilar. In total 21 IBD patients (3 Ulcerative Colitis – 19 CD) between 7 and 15 years old were switched. Three (14%) patients with CD in clinical, biochemical and histological remission had an unmeasurable through level and antibodies for infliximab, after 22 to 82 months of use. Switching to another treatment or cessation was discussed with patients and parents, all 3 patients decided to stop treatment. All 3 are still in clinical remission 21 to 24 months after treatment stop. Six-monthly follow-up is foreseen

Farmer Behavior and Gastrointestinal Nematodes in Ruminant Livestock—Uptake of Sustainable Control Approaches

Gastrointestinal nematode (GIN) infections are a common constraint in pasture-based herds and cause a decrease in animal health, productivity and farm profitability. Current control practices to prevent production losses of GIN infections in livestock depend largely on the use of anthelmintic drugs. However, due to the continued use of these drugs over more than three decades, the industry is now increasingly confronted with nematode populations resistant to the available anthelmintics. This emerging anthelmintic resistance (AR) in cattle nematodes emphasizes the need for a change toward more sustainable control approaches that limit, prevent or reverse the development of AR. The uptake of diagnostic methods for sustainable control could enable more informed treatment decisions and reduce excessive anthelmintic use. Different diagnostic and targeted or targeted selective anthelmintic control approaches that slow down the selection pressure for anthelmintic resistance have been developed and evaluated recently. Now it is time to transform these insights into guidelines for sustainable control and communicate them across the farmer community. This article reviews the current uptake of such sustainable practices with a focus on farmer's socio-psychological factors affecting this uptake. We investigate communication as a possible tool to change current behavior and successfully implement more sustainable anthelmintic treatment strategies

Daily transcutaneous electrical nerve stimulation at home in a patient with Down syndrome

C

ALS: A Disease of Motor Neurons and Their Nonneuronal Neighbors

Amyotrophic lateral sclerosis is a late-onset progressive neurodegenerative disease affecting motor neurons. The etiology of most ALS cases remains unknown, but 2% of instances are due to mutations in Cu/Zn superoxide dismutase (SOD1). Since sporadic and familial ALS affects the same neurons with similar pathology, it is hoped that therapies effective in mutant SOD1 models will translate to sporadic ALS. Mutant SOD1 induces non-cell-autonomous motor neuron killing by an unknown gain of toxicity. Selective vulnerability of motor neurons likely arises from a combination of several mechanisms, including protein misfolding, mitochondrial dysfunction, oxidative damage, defective axonal transport, excitotoxicity, insufficient growth factor signaling, and inflammation. Damage within motor neurons is enhanced by damage incurred by nonneuronal neighboring cells, via an inflammatory response that accelerates disease progression. These findings validate therapeutic approaches aimed at nonneuronal cells

A case of chronic recurrent multifocal osteomyelitis associated with Crohn's disease

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory bone disease of unknown etiology, most commonly affecting the metaphysis of long bones, especially the tibia, femur and clavicle. The clinical spectrum varies from self-limited uni-or multi-focal lesions to chronic recurrent courses. Diagnosis is based on clinical, radiologic and pathological findings, is probably under-diagnosed due to poor recognition of the disease. A dysregulated innate immunity causes immune cell infiltration of the bones with subsequent osteoclast activation leading to sterile bone lesions. The molecular pathophyiology is still incompletely understood but association with other auto-inflammatory diseases such as inflammatory bowel disease (IBD), psoriasis, Wegener's disease, arthritis and synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is interesting. CRMO can precede the symptoms of the associated disease by several years. The bone remodeling caused by CRMO can cause permanent disability. We report the case of a 10-year-old boy with CRMO in association with Crohn's disease

2-(4-Formyl-2,6-dimeth­oxy­phenoxy)­acetic acid

In the title compound, C11H12O6, the aldehyde group is disordered over two sites in a 0.79:0.21 ratio. The carb­oxy­lic acid chain is found in the [ap,ap] conformation due to two intramolecular O—H⋯O hydrogen bonds