BACKGROUND The protein thioredoxin-1 (TRX-1) has anti-oxidative, anti-inflammatory and anti-apoptotic effects, and it has been related to the regulation of ageing and different diseases. TRX-1 in periodontitis has been scarcely studied, and the results in humans and in mice are contradictory. In three small studies with humans (the highest with 96 subjects), it was found that patients with periodontitis, compared to periodontally healthy subjects, showed a higher expression of TRX-1 or of the TRX-1 gene in saliva. However, in one study with mice, it was found that mice with periodontitis, compared to periodontally healthy mice, showed a lower expression of TRX-1 in the periodontal tissues. AIM To explore the possible association of salivary TRX-1 concentrations with periodontitis and its severity, and of determining the capability of salivary TRX-1 concentrations to predict the diagnosis of periodontitis in a larger sample size study. METHODS Salivary TRX-1 concentrations were measured in subjects with and without periodontitis in this observational and prospective study. Criteria to establish periodontal health were the nonexistence, or existence in less than 10% of sites, of bleeding on probing, and the nonexistence of interproximal attachment and bone loss. Criteria to establish localized gingivitis were the existence of bleeding between 10%-30% of sites, and the nonexistence of interproximal attachment and bone loss. Criteria to establish periodontitis were the existence of interproximal attachment or bone loss. We carried out a multivariate logistic regression analysis to determine the variables associated with periodontitis, a correlation analysis to determine the possible association between salivary TRX-1 concentrations and periodontitis severity, and a receiver operating characteristic (ROC) analysis to determine the capability of salivary TRX-1 concentrations to predict the diagnosis of periodontitis. RESULTS A total of 144 subjects (58 with periodontitis and 86 without periodontitis) were included. Low salivary TRX-1 concentrations showed an association with periodontitis (P = 0.04) according to regression analysis, an association with periodontitis severity (rho = -0.47; P < 0.001) according to correlation analysis, and an area under curve of 75% (95%CI: 67%-82%; P < 0.001) for periodontitis diagnosis according to ROC analysis. CONCLUSION Novel findings of this study were the association of low salivary TRX-1 concentrations with periodontitis and its severity, and the capacity of salivary TRX-1 concentrations to help in the periodontitis diagnosis.

Background: Sirtuin-1 (SIRT-1) is one enzyme that has anti-oxidative, anti-inflammation and anti-apoptosis effects, and it is involved in regulating aging and in different age-associated disorders. Salivary SIRT-1 concentrations in periodontitis patients have been scarcely studied and only in studies with small sample sizes (the highest with 83 subjects). There were no differences in salivary SIRT-1 concentrations between periodontitis patients and periodontally healthy subjects in any of those studies. The aims of our study were to compare salivary SIRT-1 concentrations in subjects with periodontitis and those without it in a study with a larger sample size to determine whether there exists an association between salivary SIRT-1 concentrations and the presence of periodontitis and to analyze the potential capability of salivary SIRT-1 concentrations for periodontitis diagnosis. Material and Methods: In this cross-sectional study, salivary SIRT-1 concentrations were measured in subjects with and without periodontitis. To determine that variables were associated with periodontitis, a multivariate logistic regression analysis was carried out. To determine the capability of salivary SIRT-1 concentrations to diagnose periodontitis, a receiver operating characteristic (ROC) analysis was carried out. Results: We included 144 subjects (85 without periodontitis and 59 with periodontitis). Salivary SIRT-1 concentrations < 1.2 ng/mL were associated independently with periodontitis (OR = 2.84; 95% CI = 1.075-7.506; p = 0.04) in the regression analysis. The salivary SIRT-1 concentration showed an area under curve of 74% (95% CI = 66-86%; p < 0.001) for periodontitis diagnosis in the ROC analysis. Conclusions: Our study had the highest sample size reporting salivary SIRT-1 concentrations in patients with periodontitis. We found that low salivary SIRT-1 concentrations could be associated with the presence of periodontitis. In addition, they could play a role in periodontitis diagnosis as an adjunct to other markers given that their diagnostic capability is not high. However, given the limitations of our study, further investigations are necessary to confirm these preliminary findings.

BACKGROUND:Compared with conventional colonoscopy, computer-assisted adenoma detection (CADe) colonoscopy and Endocuff-Vision (EV) have been shown to increase the adenoma detection rate (ADR). However, the evidence for whether their combination further increases the ADR compared with that of EV alone is limited. The aim was to compare the combination of CADe and EV, with EV alone. METHODS:In all, 696 patients were randomized 1:1 to receive either CADe (ENDO-AID [OIP-1]) plus EV or EV alone at a tertiary care hospital. The primary outcome was the ADR. The secondary outcomes included the advanced ADR and the number of adenomas per colonoscopy (APC). Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. RESULTS:In the ITT analysis, the ADR was 54.6% and 51.1% in the combination and EV groups, respectively (OR 1.15, 95% CI (0.85-1.55)). In the PP analysis, the ADRs were 58.7% and 56.6%, respectively (OR 1.09, 95% CI (0.79-1.52)), for the combination and EV groups. The ADR in the proximal colon was significantly greater in the combination group than in the EV group (39.6% vs. 30%; P=0.015). The APC value was significantly greater in the combination group than in the EV group (mean: 1.7, SD: 2.34 vs. mean: 1.31, SD: 1.92; P=0.029), which was primarily due to increased detection of flat diminutive adenomas. CONCLUSIONS:Compared with EV alone, colonoscopy assisted by both ENDO-AID (OIP-1) and EV does not significantly increase the ADR. However, this combination may be beneficial for the detection of proximal and diminutive flat adenomas (NCT05141773).

INTRODUCTION:Proper bowel preparation is crucial for increasing the adenoma detection rate. A novel application based on the use of a convolutional neural network can differentiate between adequate and inadequate bowel preparation on the basis of images of rectal effluents taken before the examination. The aim of this study was to evaluate whether a software-driven approach improves colon cleansing quality during colonoscopies compared with standard care. METHODS:A multicenter randomized controlled trial was conducted. Consecutive patients were assigned to a standard-care group or an intervention group. The latter group was trained to use a web application linked to a convolutional neural network, enabling them to send an image of their most recent rectal effluent and receive feedback on the adequacy of their bowel preparation. Patients were instructed to follow the recommendations provided by the platform. RESULTS:Overall, 774 patients were eligible and randomized . The intention-to-treat analysis revealed statistically significant differences in bowel cleansing quality in favor of the intervention group (91% vs 84.2%, OR 1.88, 95% CI [1.21-2.93], P = 0.005). The right and left colon exhibited better cleansing in the intervention group (90.4% vs 84.8%, P = 0.016 and 95.3% vs 91.5%, P = 0.03, respectively). In the per-protocol analysis, bowel cleansing quality was also significantly higher in the intervention group, both overall (93.3% vs 85.6%, OR 2.34 (1.36-4.02), P = 0.002) and by segment. When aiming for excellent bowel preparation (>7), cleansing was significantly better in the intervention group overall and by segment. DISCUSSION:A software application-driven colon cleansing process improves preparation quality in outpatients (NCT05871814).

BACKGROUND:Periodontitis consists of a chronic inflammatory disease of the periodontal tissue. In addition to inflammation, oxidation is also involved in periodontitis. Glutathione peroxidase (GPx) is an antioxidant enzyme. There are 8 forms of GPx (GPx 1-8) and GPx-1 is the most abundant. The comparison of salivary GPx-1 levels in patients with periodontitis and periodontally healthy subjects has been explored in small sample size studies (the largest including 101 subjects) and the results are contradictory. AIM:To compare salivary GPx-1 concentrations in subjects with and without periodontitis in a study with a larger sample size. In addition, novel aims were exploring the possible association of salivary GPx-1 concentrations with periodontitis by a regression analysis and determining the capability of salivary GPx-1 concentrations to predict the diagnosis of periodontitis by a receiver operating characteristic (ROC) analysis. METHODS:Observational and prospective study including subjects with and without periodontitis. Salivary samples were taken to determine GPx-1 concentrations. A multivariate logistic regression analysis was performed to determine whether salivary GPx-1 levels were independently associated with periodontitis. A ROC analysis was carried out to determine the capability for the diagnosis of periodontitis by salivary GPx-1 concentrations. RESULTS:We found lower salivary GPx-1 concentrations in 57 subjects with periodontitis than in 86 without periodontitis. We found that salivary GPx-1 concentrations showed an area under the curve for periodontitis diagnosis of 76% (95%CI: 68%-83%; P < 0.001) in ROC analysis, and that salivary GPx-1 levels < 1214 pg/mL showed an independent association with periodontitis (odds ratio: 6.25; 95%CI: 2.844-13.717; P < 0.001) in regression analysis. CONCLUSION:To our knowledge, our series has the largest sample size on salivary GPx-1 concentrations in periodontitis. Novel findings of our study were that salivary GPx-1 levels were able to diagnose periodontitis and were independently associated with periodontitis. However, our preliminary study has some limitations as there were significant differences in age between subjects with and without periodontitis, other antioxidant enzymes or total antioxidant capacity were not assessed, other biological samples were not analyzed, and GPx-1 genetic variations were not studied. Nevertheless, we think that the results of our study could encourage further research on the role of salivary biomarkers concentrations (as GPx-1) in the management of periodontitis.

A male term neonate had a parchment-like surface membrane covering the whole body. Due to suspicion of collodion baby, he was admitted 19 hours post birth for monitoring and observation. Preventive treatment for keratitis and synechiae and conservative measures were initiated, with temperature control and high humidity in the incubator, aseptic measures and intense hydration with emollients. Collodion baby is a rare dermatosis (incidence: 1/50 000-100 000). It requires adequate diagnosis and management, given the severe changes in the skin barrier, and be associated with complications such as dehydration, hypothermia or skin infection.

Elderly patient population are growing in acute cardiac care setting. Frailty syndrome worsens outcomes in cardiovascular patients. However, frailty is not routinely detected in patients admitted into the acute cardiac care unit (ACCU) . Systematic frailty screening can be useful for better risk stratification in patients. To assess the prevalence and prognostic impact of frailty in elderly patients in the ACCU. Patients older than 65 years admitted to the ACCU for 3 consecutive months was studied and followed up for 22 months. Demographics and clinical variables, geriatric tests and scales, in-hospital complications and mortality and at 22 months follow-up were collected. 105 patients, mean age 78±7 years, 66% men were included. The most frequent admission diagnoses were acute coronary syndrome (29.5%), atrioventricular block (24.8%), acute heart failure (15.25%) and post-structural heart intervention (14.3%). Patients were classified frail 22.9%, pre-frail 42.9%, and robust 34.3%. Compared with robust patients, frail patients were older (80.7±6.7 vs 77.8±7.03 years; p = 0.014), more frequently female (82.9 vs 58.6%; p = 0.014), had lower Hb level on admission (11.71±1.82 vs 13.53±1.83 gr/dl; p = 0.001) and higher score on the CHA2DS2-Vasc scale (p = 0.002). Frailty was associated with polypharmacy (91.7 vs 25.7%; p = 0.001), dependency (83.3 vs 26.1%; p = 0.001), cognitive impairment (31.8 vs 2.9%; p = 0.001), nutritional risk (78.3 vs 37.1%; p = 0.004), depression (50 vs 6.1%; p = 0.001) and worse score in perceived quality of life (0.77 vs 0.54; p = 0.001). No differences were found in diagnostic and therapeutic management and length of hospital stay between group patients. However, frail patients group shown higher rate of complications such as heart failure (50% vs 2.8%; p = 0.0001), acute renal failure (25% vs 0%; p = 0.006) and phlebitis (0% vs 12.5%; p = 0.03). Frail patients had a higher rate of in-hospital mortality (20% vs 0%; p = 0.017). Mortality rate at 22-month follow-up was 33.3% for frail patients, 29.5% for pre-frail patients, and 5.6% for robust patients. Analysis of survival probability using the Kaplan-Meier actuarial method showed a higher risk of mortality among frail patients [Hazard ratio: 7.42 (95% CI: 2.43 – 22.68)] and pre-frail patients [Hazard ratio: 5.9 (95% CI: 2.41 – 14.48)] compared with robust patients (figure 1). In our study, frailty was present in about one in five patients admitted to the UCCA. It was associated with higher incidence of in-hospital complications and mortality. Frail and pre-frail patient showed worse long-term outcome. Early detection of frailty provides significant information to risk stratification on elderly UCCA patients. Frailty syndrome is reversible. Special nursing and multidisciplinary care plans are needed to modify it.Kaplan-Meier survival analysis

OBJECTIVE:It has been found that patients with chronic periodontitis showed higher salivary concentrations of reactive nitrogen species than healthy subjects. However, only a study of elderly Koreans has reported that high salivary reactive nitrogen species concentrations are associated independently with periodontitis. The objective of the present study was to determine whether salivary nitrite concentrations are associated with periodontitis-controlling risk factors in other populations (such as a European population). METHOD AND MATERIALS:This was a prospective and observational study carried out in a dental clinic including European subjects without periodontitis (including subjects with periodontal health or with localized gingivitis in 30% sites) or with periodontitis (thus, with loss of periodontal tissue). The levels of nitrite in saliva were assessed using the Griess method. A multivariate regression analysis was performed to determine that variables were associated independently with periodontitis. To determine the association between salivary malondialdehyde levels and the severity of periodontitis, Spearman rho correlation coefficient was used. A receiver operating characteristic analysis with salivary nitrite levels and periodontitis diagnosis was performed. RESULTS:Subjects with periodontitis (n = 54) in comparison to subjects without periodontitis (n = 30) had higher salivary nitrite levels (P = .003), a higher rate of arterial hypertension history (P = .02), and were older (P .001). Nevertheless, differences between subjects with and without periodontitis in other variables were not found. A positive correlation was found between salivary nitrite levels and periodontitis severity (rho = 0.23; P = .04). Multiple logistic regression analysis showed that elevated salivary nitrite levels > 209 nmol/mL were associated with periodontitis, controlling for arterial hypertension history and age (OR = 10.212; 95% CI = 2.665 to 39.128; P = .001) and controlling for diabetes mellitus and smoking (OR = 8.793; 95% CI = 3.038 to 24.450; P .001). The area under the curve for periodontitis diagnosis by salivary nitrite levels was 69% (95% CI = 58% to 79%; P .001). The selected point of salivary nitrite levels > 209 nmol/mL for periodontitis diagnosis had 72% sensitivity (58% to 84%), 77% specificity (58% to 90%), a 3.1 positive likelihood ratio (1.6 to 6.1), 0.4 negative likelihood ratio (0.2 to 0.6), 85% positive predictive value (74% to 92%), and 61% negative predictive value (49% to 71%). CONCLUSIONS:Salivary nitrite concentrations could be associated independently with periodontitis, could be associated with periodontitis severity, and could help in periodontitis diagnosis in a European population according to the results of this preliminary study. (Quintessence Int 2025;56:100-107; doi: 10.3290/j.qi.b5872791).

Background/Objectives: Patients with periodontitis have been found to have higher salivary concentrations of malondialdehyde, a biomarker of lipid hyperoxidation, compared to healthy subjects. However, the association between salivary malondialdehyde levels and periodontitis, independently of other risk factors, has not been analyzed. Therefore, the novel objective of our study was to explore this possible association by performing a logistic regression analysis. Material and Methods: This observational, prospective study was carried out in a private dental practice. Salivary malondialdehyde levels were measured in subjects with periodontitis (characterized by periodontal tissue loss) and in subjects without periodontitis (either periodontally healthy or with localized gingivitis in <30% of sites). A multivariate regression analysis was carried out to determine the factors associated with periodontitis. Variables with a p-value ≤ 0.05 in the comparison between subjects with and without periodontitis were included in the regression analysis. Results: A total of 119 subjects were included, 63 with periodontitis and 56 without (35 periodontally healthy subjects and 21 patients with localized gingivitis). In the multiple binomial regression analysis, salivary malondialdehyde levels > 0.77 nmol/mL were identified as a predictor of periodontitis (p = 0.03), after controlling for age (p < 0.001), diabetes mellitus (p = 0.81), arterial hypertension (p = 0.43), smoking status (never smoked p = 0.08), and cardiovascular disease (p = 0.88). Conclusions: To our knowledge, this is the first study to report that salivary malondialdehyde levels are associated with periodontitis, independently of other known risk factors.

BACKGROUND:Lower salivary uric acid concentrations, the most abundant antioxidant agent in saliva, have been observed in patients with periodontitis compared to individuals with periodontal health. However, the independent association of salivary uric acid levels with periodontitis, accounting for other risk factors, as well as its association with periodontitis severity, has not been investigated. AIM:To the independent association of salivary uric acid levels with periodontitis and the association of salivary uric acid levels with the severity of periodontitis. METHODS:This observational and prospective study measured salivary uric acid levels in subjects with periodontitis (characterized by periodontal loss of tissue) and in subjects without periodontitis (periodontal health or localized gingivitis in < 30% of sites). Multivariate regression analysis was performed to determine independent factors associated with periodontitis. Spearman's rho correlation coefficient was used to assess the relationship between salivary uric acid levels and periodontitis severity. A receiver operating characteristic analysis was carried out to evaluate the diagnostic performance of salivary uric acid levels in periodontitis, reporting the area under curve (AUC) and its 95%CI. RESULTS:We included 121 subjects, 61 of them with periodontitis and 60 without periodontitis (39 with periodontal health and 21 with local gingivitis). Subjects with periodontitis compared to those without periodontitis were older (P < 0.001), had higher salivary uric acid levels (P = 0.002), higher rate of arterial hypertension history (P = 0.001) and higher rate of never-smoker history (P < 0.001). The AUC for periodontitis diagnosis by salivary uric acid levels was 66% (95%CI: 57%-75%; P < 0.001) and the better cut-off point was 111 nmol/mL. Multiple logistic regression analysis showed an independent association of salivary uric acid levels < 111 nmol/mL (OR = 6.14; 95%CI: 2.015-18.721; P = 0.001) with periodontitis after controlling for age, never-smoker history and arterial hypertension. A negative correlation of salivary uric acid levels and periodontitis severity was observed (rho = -0.32; P < 0.001). CONCLUSION:The two novel findings of our research were, first, that low salivary uric acid concentrations are independently associated with periodontitis, even after accounting for established risk factors. Second, salivary uric acid levels show a negative correlation with periodontitis severity.

OBJECTIVE:Different studies have determined blood linezolid concentrations. However, the largest studies reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients account for less than 60 patients. Thus, the objective of our study was to determine what factors were associated with subtherapeutic linezolid concentrations in critically ill patients in a larger series of patients. DESIGN:Historical cohort study. SETTING:One Spanish Intensive Care Unit. PATIENTS:Critically ill adult patients who received linezolid due to suspected or confirmed infection by multidrug-drug-resistant Gram-positive bacteria during 2022 and 2023. INTERVENTIONS:Blood samples were collected to determine linezolid concentrations (Cmin) immediately before dosing after at least 48 h from starting linezolid therapy. MAIN VARIABLE OF INTEREST:Subtherapeutic linezolid concentrations. RESULTS:We included a total of 168 patients. We found 79 (47.0%) patients with and 89 (53.0%) patients without subtherapeutic linezolid concentrations. Multiple logistic regression showed that linezolid continuous infusion (OR = 0.192; 95% CI = 0.053-0.694; P = .01) and older age (OR = 0.952; 95% CI = 0.926-0.980; P = .001) were associated with lower risk of subtherapeutic linezolid concentrations. CONCLUSIONS:As far as we know, this is the largest study reporting data on factors associated with subtherapeutic linezolid concentrations in critically ill patients. To our knowledge, our study is the first to report that linezolid continuous infusion was independently associated with lower risk of subtherapeutic linezolid concentrations in critically ill patients.

Background: Tyrosine, a non-essential amino acid involved in protein biosynthesis, can undergo oxidative modification upon exposure to reactive species like the peroxynitrite radical (ONOO-), resulting in the formation of 3-nitrotyrosine (3-NT). High concentrations of 3-NT have been found in the periodontal tissues of rats with periodontitis and in one study involving twelve patients with periodontitis; further, a correlation between 3-NT concentrations in periodontal tissues and clinical indices of periodontitis was found in 24 patients with periodontitis. The objectives of our study were to compare salivary 3-NT concentrations in subjects with and without periodontitis, to determine whether an association exists between salivary 3-NT concentrations and periodontitis, and to evaluate the potential of salivary 3-NT concentrations for the diagnosis of periodontitis. Material and Methods: This prospective study involved the measurement of salivary 3-NT concentrations in individuals diagnosed with periodontitis-defined by the presence of periodontal tissue loss-and in individuals without periodontitis, characterized by either periodontal health or localized gingivitis affecting fewer than 30% of sites. A total of 66 participants without periodontitis and 60 with periodontitis were included. To identify variables independently linked to periodontitis, multivariate logistic regression was applied. Additionally, a receiver operating characteristic (ROC) analysis was carried out to assess the ability of salivary 3-NT levels to discriminate between the two groups. Results: Multivariate logistic regression analysis showed that the variables independently associated with periodontitis were salivary 3-NT concentrations > 4.25 ng/mL (OR = 3.22; 95% CI = 1.180-8.789; p value = 0.02), age (years) (OR = 1.12; 95% CI = 1.064-1.168; p value < 0.001), and being a never smoker (OR = 0.36; 95% CI = 0.129-0.989; p value = 0.048). The area under the curve (AUC) of salivary 3-NT concentrations for the diagnosis of periodontitis was 62% (95% CI = 53-70%; p value = 0.02). Conclusions: Our findings showed that salivary 3-NT concentrations were higher in subjects with periodontitis than in those without, that there is an association between high salivary 3-NT concentrations and periodontitis, and that salivary 3-NT concentrations may be useful for diagnosing periodontitis.

Abstract Background Anti-TNF drugs are effective treatments for the management of Inflammatory Bowel Disease (IBD), yet treatment failure is common. Monitoring drug levels and their antibodies (ATIs) can be useful to optimize the management of patients. In addition, the HLA-DQA1*05 gene has been recently related as a possible marker of immunogenicity and loss of response to anti-TNF therapy.The aim of this study was to evaluate the clinical impact of determining adalimumab (ADA) levels and anti-adalimumab ATIs in patients with IBD, and the influence of the HLA-DQA1*05 allele on the response and maintenance of adalimumab treatment in this population. Methods This observational, multicentric and prospective study enrolled patients who started treatment with ADA from October 2020 to October 2022. Demographic data and IBD characteristics were recorded. Clinical Activity Index (Harvey Index and Parcial Mayo Score) and C reactive protein(CRP), faecal calprotectin (FC), endoscopy or radiological activity, Global Physician Assesment (GPA) and PRO (by IBDQ-9) were prospectively collected at baseline and at the same time that ADA levels: week 4, 10, 30 and 12 months. HLA-DQA1*05 was genotyped at baseline. Pearson coefficient was used to assess the correlation between ADA levels and activity disease at different points Results We included 131 (age 42±17 years, 56% female) IBD patients (78% Crohn`s Disease, 21% Ulcerative Colitis and 1% Indeterminate colitis) who started treatment with ADA (80% were naïve to anti-TNF and 57% started ADA combined with immunomodulator treatment). At baseline, 81% had an active disease (Global Physician Assesment=1), 49% had CRP >5 mg/L and 77% had FC > 150 mg/kg. PRO at baseline was 63±9.1. HLA was determined in 99 patients, of whom 42 (42%) were HLA-DQA1*05 positives. We found a positive correlation between PRO score and Hb levels and albumin, meanwhile a negative correlation with FC and CRP at week 0. No correlation with ADA levels or ATIs was established. Patients HLA-DQA1*05 positive had not more adverse reaction or ATIs during the observational period. Patients with ADA serum concentration >7µg/mL at week 4 had CRP <5mg/dL at week 4 (p=0.04) and at week 10 (p=0.01). Patients with ADA serum concentration >7µg/mL at week 10 had more stable disease (PGA =0) and CRP <5mg/L, FC <150 mg/kg at week 10 (p<0.05), CRP <5mg/L at week 30 (p<0.05) and FC <150 mg/kg at 12 months. Conclusion Early Drug level monitoring of Adalimumab (after induction) may improve the management of IBD patients. Our study shows that ADA levels >7 µg/mL is associated with a better clinical response in short and long-term, independent of HLADQA1*05.

Background: Various predictive models have been published to identify outpatients with inadequate colonic cleansing who may benefit from intensified preparations to improve colonoscopy quality. The main objective of this study was to compare the accuracy of three predictive models for identifying poor bowel preparation in outpatients undergoing colonoscopy. Methods: This cross-sectional study included patients scheduled for outpatient colonoscopy over a 3-month period. We evaluated and compared three predictive models (Models 1–3). The quality of colonic cleansing was assessed using the Boston Bowel Preparation Scale. We calculated the area under the curve (AUC) and the corresponding 95% confidence interval for each model. Additionally, we performed simple and multiple logistic regression analyses to identify variables associated with inadequate colonic cleansing and developed a new model. Results: A total of 649 consecutive patients were included in the study, of whom 84.3% had adequate colonic cleansing quality. The AUCs of Model 1 (AUC = 0.67, 95% CI [0.63–0.70]) and Model 2 (AUC = 0.62, 95% CI [0.58–0.66]) were significantly higher than that of Model 3 (AUC = 0.54, 95% CI [0.50–0.58]; p < 0.001). Moreover, Model 1 outperformed Model 2 (p = 0.013). However, the new model did not demonstrate improved accuracy compared to the older models (AUC = 0.671). Conclusions: Among the three compared models, Model 1 showed the highest accuracy for predicting poor bowel preparation in outpatients undergoing colonoscopy and could be useful in clinical practice to decrease the percentage of inadequately prepared patients.

AimsPatients’ perception of their cleansing quality can guide strategies to improve cleansing during colonoscopy. There are no studies assessing the agreement between the quality of cleansing perceived by patients and cleansing quality assessed during colonoscopy using validated bowel preparation scales. The main aim of this study was to compare the cleansing quality reported by patients with the quality during colonoscopy using the Boston Bowel Preparation Scale (BBPS).Patients and methodsConsecutive patients referred to an outpatient colonoscopy were included. Four drawings representing different degrees of cleansing were designed. Patients chose the drawing that most resembled the last stool. The predictive ability of the patient's perception and agreement between the patient's perception and the BBPS were calculated. A BBPS score of <2 points in any segment was considered inadequate.ResultsSix hundred and thirty-three patients were included (age: 62.8±13.7 years, male: 53.4%). Overall, 107 patients (16.9%) had inadequate cleansing during colonoscopy, and in 12.2% of cases, the patient's perception was poor. The patient's perception compared to the quality of cleanliness during colonoscopy presented a positive and negative predictive value of 54.6% and 88.3%, respectively. The agreement between patient perception and the BBPS was significant (P<0.001), although fair (k=0.37). The results were similar in a validation cohort of 378 patients (k=0.41).ConclusionsThe cleanliness perceived by the patient and the quality of cleanliness using a validated scale were correlated, although fair. However, this measure satisfactorily identified patients with adequate preparation. Cleansing rescue strategies may target patients who self-report improper cleaning.Registration number of the trial: NCT03830489.

Abstract Background While anti-TNF drugs effectively manage Inflammatory Bowel Disease (IBD), treatment failure rates exceed 40%. Monitoring drug levels, antibodies (Abs), and HLA-DQA1*05 allele typing could optimize patient care. The aim of this study is to evaluate the clinical impact of Infliximab (IFX) and Abs monitoring in IBD patients and to understand the influence of the HLA-DQA1*05 allele on IFX treatment response and maintenance. Methods We conducted a multicenter, observational study involving patients initiating IFX treatment between October 2020 and October 2022. Demographic, clinical, analytical, and endoscopic data, along with disease activity indicators, were prospectively collected. IFX and Abs levels were measured at weeks 6, 14, 30, and 12 months. HLA-DQA1*05 genotyping was performed at baseline. Statistical tests assessed correlations between IFX levels and disease activity. Results Ninety-three IBD patients (45±17 years, 46% female) initiated IFX treatment, mostly anti-TNF naïve (90%). At baseline, 91% had an active disease (GPA = 1) and 85,7% a FC > 150 mg/kg. PRO at baseline was 59.22±8.72. Median follow up was 15 months. HLA was determined in 91 patients, of whom 35 (38.5%) where HLA-DQA1*05 positive. IFX levels > 7 µg/mL correlated with improved disease outcomes in week 6, 14 and 30. In this way, IFX levels > 7 µg/mL in week 6 were associated with CRP < 5 mg/L (p = 0.008), FC <150 mg/kg (p = 0.011) and GPA = 0 (p = 0.0016) in week 6 and with GPA = 0 (p = 0.042) in week 14. IFX levels > 7 µg/mL in week 14 were associated with GPA = 0 (p = 0,001) and FC <150 mg/kg (p = 0,0015) in week 14 and with GPA = 0 (p = 0,019) and FC <150 mg/ kg (p = 0,027) in week 30. IFX levels > 3 µg/mL at 12 months follow-up were associated with FC < 150 mg/kg (p = 0,001). PRO was used to evaluate patients’evolution, and progressive improvement in scores at weeks 0, 14 and 30 was observed (p > 0.001). IFX levels > 7 µg/mL at week 14 were associated with a better PRO score at week 14. Discontinuation (40%) within the first year linked to higher CRP and FC at week 0 and active disease at weeks 6, 14, and 30. Conclusion Early IFX monitoring at weeks 6 and 14 optimizes IBD management. IFX levels > 7 µg/mL indicate better short and long-term clinical outcomes and drug durability, irrespective of HLA-QDA1*05 status.

Background and aimsPatients’ perception of their bowel cleansing quality may guide rescue cleansing strategies before colonoscopy. The main aim of this study was to train and validate a convolutional neural network (CNN) for classifying rectal effluent during bowel preparation intake as “adequate” or “inadequate” cleansing before colonoscopy.Patients and methodsPatients referred for outpatient colonoscopy were asked to provide images of their rectal effluent during the bowel preparation process. The images were categorized as adequate or inadequate cleansing based on a predefined 4-picture quality scale. A total of 1203 images were collected from 660 patients. The initial dataset (799 images), was split into a training set (80%) and a validation set (20%). The second dataset (404 images) was used to develop a second test of the CNN accuracy. Afterward, CNN prediction was prospectively compared with the Boston Bowel Preparation Scale (BBPS) in 200 additional patients who provided a picture of their last rectal effluent.ResultsOn the initial dataset, a global accuracy of 97.49%, a sensitivity of 98.17% and a specificity of 96.66% were obtained using the CNN model. On the second dataset, an accuracy of 95%, a sensitivity of 99.60% and a specificity of 87.41% were obtained. The results from the CNN model were significantly associated with those from the BBPS (P<0.001), and 77.78% of the patients with poor bowel preparation were correctly classified.ConclusionThe designed CNN is capable of classifying “adequate cleansing” and “inadequate cleansing” images with high accuracy.

Abstract Background Anti-TNF drugs have proven effective in managing Inflammatory Bowel Disease (IBD), but a significant percentage of patients exhibit primary or secondary non-response. Therapeutic drug monitoring (TDM) is a valuable tool for optimizing patient management. HLA-DQA1*05 gene has been investigated as a potential marker for immunogenicity and loss of response to anti-TNF therapy.This prospective, multicentric study aimed to assess the clinical impact of determining Adalimumab (ADA) levels and anti-adalimumab antibodies (Abs) in IBD patients and the influence of the HLA-DQA1*05 allele on the response and maintenance of ADA treatment over a 24-month follow-up. Methods Patients initiating ADA treatment between October 2020 and October 2022 were enrolled. Demographic data and IBD characteristics were recorded. Clinical Activity Index, C reactive protein (CRP), faecal calprotectin (FC), endoscopy or radiological activity, Global Physician Assesment (GPA) and PRO (by IBDQ-9) were prospectively collected at baseline and at the same time that ADA levels: week 4, 10, 30 and 12 months. HLA-DQA1*05 was genotyped at baseline. Pearson coefficient was utilized to assess correlations between ADA levels and disease activity. Results We included 170 (age 42±17 years, 54% female) IBD patients (74% Crohn`s Disease, 24% Ulcerative Colitis and 2% Indeterminate colitis) who started ADA (85% naïve to anti-TNF). At baseline, 80% had an active disease (GPA=1); CRP and FC were 10.72 ±17.85 mg/L and 568 ±775 µg/g; PRO at baseline was 63±8.6. HLA was determined in 167 patients, of whom 71 (42%) were HLA-DQA1*05 positives. Median follow up was 17 months. No correlation between HLA and drug levels or Abs was founded. ADA levels at the end of induction was correlated with ADA levels during follow up. ADA serum concentration >7 µg/mL at weeks 4 and 10 correlated with improved clinical response at corresponding time points (p<0.001). Patients with ADA levels >7 µg/mL at week 10 demonstrated better disease control at 12 months. 41 patients stopped ADA. It was associated with active disease, low ADA levels, and adverse clinical and laboratory markers. HLA-DQA1*05 positivity did not correlate with adverse reactions or Abs during the observational period. A significative improvement in PROs in patients who started treatment with ADAL (62.73 at baseline and 69.42 at week 30) (p<0.001) was observed. Conclusion Early Drug level monitoring of Adalimumab may improve the management of IBD patients. PCR, CF and GPA at week 10 may predict treatment failure. ADA levels >7 µg/mL is associated with a better clinical response in short and long-term, independent of HLADQA1*05.