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Ribaldone DG, Testa G, Verstockt B, Molnar T, Savarino E, Schmidt C, Vieujean S, Teich N, Meianu C, Juillerat P, Grellier N, Lobaton T. Treatment of antibiotic refractory chronic pouchitis with JAK inhibitors and S1P receptor modulators: an ECCO CONFER Multicentre Case Series. J Crohns Colitis 2023:jjad194. [PMID: 37965867 DOI: 10.1093/ecco-jcc/jjad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIMS Data regarding effectiveness and safety of JAK inhibitors and S1P receptor modulators in antibiotic refractory chronic pouchitis (CARP) are lacking. METHODS This ECCO-CONFER project retrospectively collected JAK inhibitors or S1P receptor modulators treatments for CARP with at least 3-months follow up. The outcomes included corticosteroid and antibiotics-free clinical response and remission at three and twelve months, trend in mPDAI, endoscopic PDAI, CRP and calprotectin. RESULTS Seventeen treatments in 15 patients were collected. Previous pouchitis treatments included infliximab (5/15), adalimumab (4/15), vedolizumab (9/15), and ustekinumab (5/15). Pooling data on JAK inhibitors (8 tofacitinib, 1 filgotinib and 6 upadacitinib), after 3 months (T3), steroid and antibiotics-free clinical response was achieved in 53.3% (8/15), steroid and antibiotics-free clinical remission was achieved in 40% (6/15). Of the patients with at least 12 months of follow-up, steroid and antibiotics-free clinical response was achieved in 50% (3/6) and remission in one patient (16.7%), endoscopic response in 50% (3/6), endoscopic remission in 50% (3/6). Of the two ozanimod treatments at T3, steroid and antibiotics-free clinical response was achieved in one patient, without remission; both discontinued ozanimod before T12. No side effects reported. CONCLUSIONS Small molecules may represent a suitable option for CARP refractory to multiple biologics, deserving further investigation.
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Affiliation(s)
| | - Giulia Testa
- Gastroenterology-U, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Carsten Schmidt
- Medical Clinic II, Hospital Fulda, Fulda, Germany
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Niels Teich
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
- Gastroenterology Practice, Leipzig, Germany
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Department of Gastroenterology, Bern University Hospital
- Crohn and Colitis Center, Gastro-enterologie Beaulieu SA, Lausanne, Switzerland
| | - Nathan Grellier
- Hepato-Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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Meianu C, Andrei S, Diculescu M, Longrois D, Guinot PG, Droc G. Rotational Thromboelastometry Coagulation Parameters (ROTEM®) May be Discriminative for Active Inflammatory Bowel Disease: A Prospective Observational Study. J Gastrointestin Liver Dis 2023; 32:298-305. [PMID: 37774216 DOI: 10.15403/jgld-4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/13/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is associated with increased risk of thromboembolic events. The rotational thromboelastometry (ROTEM®) is a validated integrative assessment of coagulation, but it has never been studied in IBD patients. METHODS We performed a monocentric prospective observational study in a national tertiary center. Adult IBD patients underwent ROTEM® analysis on admission to our IBD Department. Parameters evaluated with ROTEM® tests (INTEM, EXTEM and FIBTEM) were clotting time (CT), the time of clot formation (CFT), clot firmness amplitude after 5 and 10 minutes (A5 and A10) and maximum clot firmness (MCF). ROC curves were performed in order to evaluate the ability of ROTEM® to predict active IBD. RESULTS Several ROTEM® parameters were significantly associated with active IBD compared to patients in remission, towards a hypercoagulable status for patients with active disease: CT, CFT, A5, A10, MCF. ROC analysis demonstrated that parameters related to clot robustness showed a very good prediction ability of active IBD (AUC >0.8): A5, A10, MCF in INTEM (p<0.001), in EXTEM (p<0.001) and MCF in FIBTEM (p<0.001). ROTEM® parameters showed high correlations with inflammation markers as C-reactive protein (CRP) and faecal calprotectin (FC). CONCLUSIONS Our study showed that ROTEM® parameters are modified in patients with active IBD, being correlating with inflammation markers and demonstrating a high prediction ability of active IBD. Future research is needed to validate ROTEM® as a method to discriminate patterns of active IBD and to guide anticoagulant therapy in patients with active IBD.
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Affiliation(s)
- Corina Meianu
- Department of Gastroenterology, Fundeni Clinical Institut, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
| | - Stefan Andrei
- University of Medicine and Pharmacy Carol Davila Bucharest Romania; Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania; Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, University of Burgundy Franche Comté, Dijon, France
| | - Mircea Diculescu
- Department of Gastroenterology, Fundeni Clinical Institut, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Dan Longrois
- Anaesthesiology and Critical Care Department, Bichat-Claude Bernard Hospital, Université Paris Cité, INSERM1148, Paris, France
| | - Pierre Gregoire Guinot
- Anaesthesiology and Critical Care Department, Dijon Bourgogne University Hospital, University of Burgundy Franche Comté, Dijon, France
| | - Gabriela Droc
- University of Medicine and Pharmacy Carol Davila Bucharest Romania; Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
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Stroie T, Preda C, Meianu C, Istrătescu D, Manuc M, Croitoru A, Gheorghe L, Gheorghe C, Diculescu M. Fatigue Is Associated with Anxiety and Lower Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Remission. Medicina (B Aires) 2023; 59:medicina59030532. [PMID: 36984533 PMCID: PMC10058711 DOI: 10.3390/medicina59030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable course and a remitting–relapsing evolution. Fatigue is a frequent complaint in patients with IBD, affecting approximately half of the newly diagnosed patients with IBD. The aim of this study was to analyze fatigue in patients with IBD in remission. Materials and Methods: One hundred nineteen consecutive outpatients diagnosed with IBD for over 3 months that were in corticosteroid-free clinical and biochemical remission at the time of assessment were included in this cross-sectional study. Out of them, 72 (60.5%) were male; the median age was 39 years (IQR 30–47). Seventy-seven patients (64.7%) were diagnosed with Crohn’s disease and forty-two (35.3%) with ulcerative colitis, with a median disease duration of 6 years (IQR 2–10). Fatigue, health-related quality of life (HR-QoL), anxiety and depression were evaluated using the following self-administered questionnaires: FACIT Fatigue, IBDQ 32 and HADS. Results: The mean FACIT-Fatigue score was 41.6 (SD ± 8.62), and 38.7% of patients were revealed as experiencing fatigue when a cut-off value of 40 points was used. The mean IBDQ 32 score was 189.4 (SD ± 24.1). Symptoms of anxiety and depression were detected in 37% and 21% of the patients, respectively. In the multivariate analysis, fatigue was significantly associated with lower HR-QoL (OR 2.21, 95% CI: 1.42–3.44, p < 0.001), symptoms of anxiety (OR 5.04, 95% CI: 1.20–21.22, p = 0.008), female sex (OR 3.32, 95% CI: 1.02–10.76, p = 0.04) and longer disease duration (OR 1.13, 95% CI: 1.01–1.27, p = 0.04). Conclusions: Fatigue is highly prevalent even in patients with inactive IBD and is correlated with lower HR-QoL and anxiety, as well as with clinical factors such as longer disease duration and female sex.
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Affiliation(s)
- Tudor Stroie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Carmen Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Doina Istrătescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Manuc
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Liana Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Diculescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Stroie T, Preda C, Meianu C, Croitoru A, Gheorghe L, Gheorghe C, Diculescu M. Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Clinical Remission: What Should We Look For? Medicina (Kaunas) 2022; 58:medicina58040486. [PMID: 35454325 PMCID: PMC9028218 DOI: 10.3390/medicina58040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 12/07/2022]
Abstract
Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable evolution that can have a negative impact on patients’ quality of life (QoL). Even though patients in remission have a better QoL compared to patients with active disease, they still have a lower QoL compared to healthy people. The aim of this study is to identify the factors that are associated with a lower QoL in patients with IBD in clinical remission, in a tertiary IBD center in Romania. Materials and Methods: Ninety-seven adult patients with a current diagnosis of IBD for over 3 months who were in clinical remission were enrolled in this study. Pregnant women, patients with ostomy, perianal disease, extraintestinal manifestations or other significant comorbidities were excluded. Out of the 97 patients, 63.9% were men. The median age was 39 years (IQR 29−47), and the median disease duration was 5 years (IQR 2−10). Disease activity was assessed using the SCCAI score for ulcerative colitis and HBI score for Crohn’s disease. Remission was defined for SCCAI score ≤ 1 and HBI score ≤ 4. The health-related quality of life (HR-QoL) was assessed using the IBDQ32 score. FACIT-Fatigue was used to evaluate the level of fatigue. Patients with symptoms of anxiety or depression were identified with the HADS score. Symptoms of anxiety were considered when HADS-A >7 points and symptoms of depression when HADS-D >7 points. Results: Sixty-five patients (67%) were diagnosed with CD and the remaining 32 (33%) with UC. Ninety-three patients (95.9%) were on biological therapy. The mean IBDQ score (total score) was 190.54 points (SD +/− 8.2). The mean FACIT Fatigue score was 42.5 (SD +/− 8.2), with 6.2% of patients suffering from severe fatigue (FACIT Fatigue < 30 points). A total of 33% of patients had symptoms of anxiety and 16.5% of depression. Exposure to more than one biologic therapy (p = 0.02), fatigue (p < 0.001) and symptoms of anxiety (p < 0.001) were associated with a lower HR-QoL in the multivariate analysis. Female patients, patients with Crohn’s disease, patients with anemia and patients with symptoms of depression also had a lower HR-QoL, but this did not reach statistical significance in our study. Conclusions: Exposure to a higher number of biological agents (patients that switched multiple biologics), the presence of fatigue and symptoms of anxiety impair the HR-QoL of patients with IBD in clinical remission. Further studies should assess in a prospective manner whether early identification of these factors with prompt clinical interventions could lead to a better HR-QoL in these patients.
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Affiliation(s)
- Tudor Stroie
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Carmen Preda
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Corina Meianu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania;
- Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Liana Gheorghe
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mircea Diculescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.P.); (C.M.); (L.G.); (C.G.); (M.D.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Gheorghe LS, Preda C, Iliescu L, Istratescu D, Chifulescu AE, Pop CS, Trifan A, Stanciu C, Diculescu M, Voiosu T, Baicus C, Tugui L, Iacob S, Tieranu C, Meianu C, Manuc M. Efficacy and Safety of Ledispavir/Sofosbuvir with or without Ribavirin in patients with Decompensated Liver Cirrhosis and Hepatitis C Infection: a Cohort Study. J Gastrointestin Liver Dis 2020; 29:385-390. [PMID: 32919421 DOI: 10.15403/jgld-2448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Ledipasvir/Sofosbuvir (LDV/SOF) with or without Ribavirin (RBV) has shown good results in terms of efficacy and safety in clinical trials in advanced liver cirrhosis, but real-life data are still needed in order to confirm this profile. We investigated the efficacy and safety of LDV/SOF in a large Romanian population with liver cirrhosis and genotype 1b hepatitis C virus (HCV). METHODS We analyzed a multicentric retrospective cohort enrolling 349 patients with decompensated liver cirrhosis due to HCV who received LDV/SOF±RBV 12/24 weeks (301/48). Patients were included between 2017-2018, all with genotype 1b. Main inclusion criteria were liver cirrhosis and detectable HCV RNA. The cases were followed-up monthly during therapy and 12 weeks after the end of therapy. RESULTS The cohort included 60% females with a median age of 61, 16% interferon (IFN) pre-treated, 53% with comorbidities, 40/53/7 % with Child Pugh A/B/C, 4% with virus B co-infection and 8% with previously treated hepatocellular carcinoma. Mean initial MELD score was 11.92 (6.82÷ 24.5). Six patients were lost during follow-up. Sustained virologic response (SVR) in intention-to-treat was reported in 85.1%. Predictive factors of SVR in decompensated cirrhosis were female gender (p=0.01), advanced age (p<0.001), lower bilirubin levels (p=0.002) and lower CTP score (p=0.02). In patients with CTP score B or C low bilirubin levels (p=0.003), low INR (p<0.001), increased platelet count (p=0.04), low CTP score (p<0.001), lack of encephalopathy (p=0.02), serum albumin >3.5g/dl (p=0.002) predicted improvement of liver function. Serious adverse events were reported in 16/349 (4.6%), most of them due to severe liver decompensation (9/16). CONCLUSIONS LDV/SOF±RBV proved to be highly efficient in our difficult to treat population with 85.1% SVR.
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Affiliation(s)
- Liliana Simona Gheorghe
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Carmen Preda
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Laura Iliescu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Doina Istratescu
- Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest; 4) Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Emergency Universitary Hospital, Bucharest, Romania.
| | - Andreea Elena Chifulescu
- Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest; 4) Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Emergency Universitary Hospital, Bucharest, Romania.
| | - Corina Silvia Pop
- UMF "Carol Davila" Internal Medicine Department, Emergency Universitary Hospital, Bucharest, Romania.
| | - Anca Trifan
- Gr. T. Popa University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Gastroenterol and Hepatol Institute, Iasi, Romania.
| | - Carol Stanciu
- Gr. T. Popa University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Gastroenterol and Hepatol Institute, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Theodor Voiosu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Colentina Hospital, Bucharest, Romania.
| | - Cristian Baicus
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Depart, Colentina Hospital, Bucharest, Romania.
| | - Letitia Tugui
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
| | - Cristian Tieranu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Elias Emergency Hospital, Bucharest, Romania.
| | - Corina Meianu
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania
| | - Mircea Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterol and Hepatol Depart, Clinic Fundeni Institute, Bucharest, Romania.
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Plaisanu C, Baleanu VD, Davitoiu DV, Meianu C, Diculescu M, Ciora CA. Primary Systemic Amyloidosis - an Unusual Cause of Diarrhea. Rev Chim 2019. [DOI: 10.37358/rc.19.9.7531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The amyloidosis is a group of rare diseases caused by extracellular deposition of amyloid. It may affect multiple organs with protean manifestations, thus often causing delayed or incorrect diagnoses. We report a case of gastrointestinal involvement in primary systemic amyloidosis (PSA) in a patient complaining of diarrhea and weight loss. The diagnosis was confirmed by endoscopic biopsies of upper digestive tract and by multidisciplinary evaluation for systemic involvement.
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Preda CM, Meianu C, Sandra I, Becheanu G, Dumbrava M, Manuc M, Diculescu M. Fecal Microbiota Transplantation in Recurrent NAP1/B1/027 Clostridium Difficile Infection (CDI) Resistant to Vancomycin and Metronidazole in a Patient with Ulcerative Colitis (UC): A Case Report. Rev Med Chir Soc Med Nat Iasi 2016; 120:563-567. [PMID: 30044904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Most of the studies showed that IBD patients inflammatory bowel diseases (IBD) with CDI have more of the whole range of short- and long-term worst outcomes than those without CDI. Initial infection with the BI/NAP1/027 epidemic clone was found to be a significant risk factor for relapse. However, current literature is suggesting increasingly that for patients with infections that fail to resolve with traditional antibiotic regimens, FMAT's average cure rate of >90%. We report a case of a 40-year-old man, diagnosed with ulcerative colitis (UC) in 2012 who presented in our clinic for 20 watery stools per day with mucus and blood, hypogastric pain, pyrexia and chills. Rectosigmoidoscopy and histopathological examination diagnosed a ctive lesions of ulcerative colitis with Clostridium difficile toxins A/B enzyme immunoassays (EIA) testing initially negative. The patient was non-responder at day 10 of intravenous (iv) corticotherapy and received induction therapy with Infliximab 5 mg/kg. EIA testing for Clostridium difficile was repeated at day 12 of hospitalization with positive results for toxins A/B, and associated oral therapy with Vancomycin and Metronidazole was initiated without clinical response in day 7, reasons for what intravenously therapy with Tigecycline was started with good response. Patient was discharged after 10 days of Tigecycline, but came back twice for two relapses of Clostridium difficile colitis treated successfully with Tigecycline, reasons for what fecal transplantation was performed in Matei Bals Institute, which induced remission of both CDI and UC.
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Preda CM, Fulger LE, Gheorghe C, Gheorghe L, Manuc M, Negreanu L, Meianu C, Slavulete BI, Diculescu MM. Tuberculin skin test and Quantiferon TB Gold in Romanian BCG vaccinated, immunosuppressed patients with moderate-to-severe Crohn's disease: a comparison with a Hungarian cohort. J Gastrointestin Liver Dis 2016; 25:260-261. [PMID: 27308663 DOI: 10.15403/jgld.2014.1121.252.tbg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Carmen M Preda
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania.
| | | | - Cristian Gheorghe
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea Manuc
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Corina Meianu
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan I Slavulete
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea M Diculescu
- Center of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
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Preda C, Fulger L, Gheorghe L, Gheorghe C, Goldis A, Trifan A, Tantau M, Tantau A, Negreanu L, Manuc M, Cijevschi-Prelipcean C, Iacob R, Tieranu C, Meianu C, Diculescu M. Adalimumab and Infliximab in Crohn's disease - real life data from a national retrospective cohort study. Curr Health Sci J 2016; 42:115-124. [PMID: 30568821 PMCID: PMC6256158 DOI: 10.12865/chsj.42.02.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022]
Abstract
AIM to compare the efficacy and safety of Adalimumab(ADA) and Infliximab(IFX), in a large Romanian population and to identify predictors of response. Methods We performed a national retrospective cohort study including 265 patients (136 ADA, 129 IFX) between 2008-2014. Binary logistic regression was performed with the statistical program Minitab. RESULTS Patients were half women, with a median age of 36, a median disease duration of 2.5 years, 80% received Azathioprine. Mean therapy duration was 20 months in ADA group and 36 months in IFX group. Complete response to Adalimumab respectively Infliximab was recorded in 77%vs.65%, secondary loss of response in 18%vs.28%, statistically comparable. We failed to identify predictors of response. In 79.2%of patients with secondary loss of response to ADA, the dose was escalated, 12.5% were switched to Infliximab. In 70%of patients that lost response to IFX, the dose was increased, 30% were switched to Adalimumab. CONCLUSIONS Adalimumab and Infliximab have similar efficacy, with a complete response rate of~70%. In case of secondary loss of response to IFX, the best solution is to switch to ADA, with 83% response rate, while in case of secondary loss of response to ADA, increasing the dose leads to 84 % response rate.
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Affiliation(s)
- C Preda
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - L Fulger
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - L Gheorghe
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - C Gheorghe
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - A Goldis
- University of Medicine "Victor Babes", Clinic of Gastroenterology, Timisoara
| | - A Trifan
- Clinic County Hospital "Sf.Spiridon", Gastroenterology and Hepatology, Iassy
| | - M Tantau
- Regional Institute of Gastroenterology and Hepatology "O.Fodor", Gastroenterology and Hepatology, Cluj
| | - A Tantau
- Regional Institute of Gastroenterology and Hepatology "O.Fodor", Gastroenterology and Hepatology, Cluj
| | - L Negreanu
- Clinic Universitary Emergency Hospital, Bucharest
| | - M Manuc
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | | | - R Iacob
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - C Tieranu
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - C Meianu
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
| | - M Diculescu
- Clinic Fundeni Institute, Gastroenterology & Hepatology, Bucharest
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10
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Preda CM, Ionescu M, Dumitrascu T, Manuc M, Meianu C, Herlea V. Myofibroblastic Inflammatory Tumor Presenting as Recurrent Acute Pancreatitis and Obstructive Jaundice. J Gastrointestin Liver Dis 2015; 24:273. [PMID: 26405696 DOI: 10.15403/jgld.2014.1121.243.cmp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Carmen-Monica Preda
- Gastroenterology and Hepatology Department, Fundeni Clinical Hospital, Bucharest, Romania.
| | - Mihnea Ionescu
- Surgery Department, Fundeni Clinical Hospital, Bucharest, Romania
| | | | - Mircea Manuc
- Gastroenterology and Hepatology Department, Fundeni Clinical Hospital, Bucharest, Romania
| | - Corina Meianu
- Gastroenterology and Hepatology Department, Fundeni Clinical Hospital, Bucharest, Romania
| | - Vlad Herlea
- Gastroenterology and Hepatology Department, Fundeni Clinical Hospital, Bucharest, Romania
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