White Cross Court Rehabilitation Hospital

Experimental studies have revealed that tea catechins prevent influenza virus infection ; however, the clinical effects have been inconclusive. At the onset of the influenza season, a randomized, double-blind, placebo-controlled study was conducted from December 2005 to March 2006 in Japan. A total of 404 healthy volunteers, 20-65 years of age, were enrolled and randomly assigned to two groups : the catechin group gargling with tea catechin extract solution (approximately 400 μg/mL catechins) or the placebo group gargling without tea catechin extracts. In both groups, gargling was performed three times daily for 90 days. All participants were inoculated with the influenza vaccine before participating in the study. The primary outcome measure was the incidence rate of influenza infection during the study identified by a rapid assay for influenza virus antigens. On an intention to treat basis, 195 participants in the catechin group and 200 in the placebo group who started the intervention were included in the analysis. Of the participants, 6 (1.5%) were infected with influenza. The incidence rate of influenza infection in the catechin group (1.0%, 2 participants) was half that in the control group (2.0%, 4 participants), but not significant between the two groups. We could not find significant effects of gargling with tea catechin on prevention of influenza in the healthy adults inoculated with the influenza vaccine of the 2005-2006 season. However, the effects in more susceptible groups, i.e., those not vaccinated against the influenza virus, children, elderly or immunosuppressed people remain inconclusive.

The objective of this study is to explore the effects of catechin-treated face masks on influenza prevention. We conducted a randomized controlled study in Japan. Participants included workers in a nursing home, a rehabilitation facility, and a hospital. Participants were randomly allocated into the catechin-treated (epigallocatechin gallate-treated) or non-treated face mask groups for 60 days from January to March, 2016. Incidence of laboratory-confirmed influenza infection was measured and compared between groups using Fisher's exact test. Multivariate analysis was performed to calculate adjusted odds ratios (OR) and associated 95% confidence intervals (CI). After the recruitment of participants, 234 participants were eligible for the study (catechin group, n=118; control group, n=116). Six participants in the full analysis set contracted influenza (catechin: 3.39%; 95% CI: 0.95-5.50%; control: 1.72%; 95% CI: 0.21-6.09%), and the incidence between the groups did not differ significantly (P=0.68). Multivariate analysis showed a similar trend (adjusted OR: 2.35; 95% CI: 0.40-13.72; P=0.34). Our results suggest that the use of catechin-treated face masks does not reduce influenza incidence compared with standard masks. Several limitations to the study, such as infection rates and the selected population may be responsible. Future studies will need to resolve these limitations to accurately evaluate these effects.

Background : Tarsal tunnel syndrome is a disease in which the posterior tibial nerve is entrapped in the tarsal tunnel due to variable causes, and is associated with numbness and pain in the plantar region. Detailed imaging is helpful in understanding the pathophysiology of the disease. In this report, we describe an innovative magnetic resonance (MR) imaging technique that is useful for identifying the pathophysiology of tarsal tunnel syndrome and surgical planning.

Introduction Hypochondriasis was included in DSM-III up to DSM-IV TR in the category of „somatoform disorders,” and ICD-10 concurred with this classification. However, in the last editions of the DSM (i.e., 5 and 5TR), this entity has been transformed into „illness anxiety disorder” (IAD) based on its main clinical feature- the fear of having or contracting a serious disease, although no medical evidence to support such an assumption exists. ICD-11 preserves the term „hypochondriasis” but places it between „obsessive-compulsive or related disorders.” Approaching patients with hypochondria or IAD is reputedly difficult due to the difficulty of maintaining a therapeutic relationship, the sensitivity of these patients to medical data that deny their assumptions of being somatically ill, and their tendency to continuously search the information that validates their belief about their own health. Objectives To conduct a literature search to assess the efficacy of psychotherapeutic interventions for patients with IAD. Methods This review included three databases (Google Scholar, PubMed, and Web of Science/Clarivate) that were searched from their inception until June 2024 for papers published in English corresponding to the keywords “hypochondriasis,” or illness anxiety disorder,” and “psychotherapy*.” Results Cognitive-behavioral therapy (CBT) was used successfully in case reports of IAD when integrated into case management. In a clinical trial, CBT plus fluoxetine led to better results than either intervention alone after 24 weeks. Systematic reviews and meta-analyses showed CBT, cognitive therapy, behavioral therapy and behavioral stress management may significantly reduce hypochondriacal symptoms versus waiting list. The therapeutic approach for IAD was focused on restructuring the catastrophic anticipations, exposure to feared stimuli, and learning relaxation techniques, replacing avoidance and reassurance-seeking with adaptive coping skills and problem-solving techniques. Mindfulness-oriented therapy, group therapies, and acceptance and commitment therapies have also been explored in this population, but the level of quality is low. Conclusions CBT remains the only psychotherapy that proved efficacious for patients with IAD, but most of the data retrieved is derived from case reports and small trials. Changes in the terminology and conceptualization of hypochondriasis/IAD may negatively interfere with the possibility of selecting homogenous groups for clinical studies. Disclosure of Interest None Declared

BACKGROUND AND AIMS: Evidence from rheumatology supports a within-class treatment switch for JAK-inhibitors (JAKi), but data in ulcerative colitis (UC) remain limited. We aimed to assess the effectiveness and safety of initiating a second JAKi in patients with UC previously treated with another JAKi. METHODS: We conducted a multicenter retrospective study, including patients with UC starting a second JAKi after prior JAKi exposure. The primary endpoint was Week 12 steroid-free clinical remission (SFCR-rectal bleeding subscore = 0, stool frequency subscore ≤ 1, and no steroids). RESULTS: We included 243 patients (median follow-up: 38 [21-57] weeks). At Weeks 12, 26, and 52, SFCR was achieved in 116/243 (48%), 120/243 (49%), and 69/243 (28%), respectively. Secondary loss of response to the first JAKi was associated with higher SFCR at Week 12 compared to primary failure (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.11-3.30, P = 0.02). Higher baseline disease activity (OR = 0.68, 95% CI = 0.68-0.55, P < 0.01) and steroid use (OR = 0.23, 95% CI = 0.13-0.42, P < 0.01) had lower odds of Week 12 SFCR. Endoscopic remission occurred in 22/243 (9%) (<Week 26) and 27/243 (11%) (26-78 weeks), and endoscopic improvement in 53/243 (22%) and 45/243 (19%), respectively. Sixty-seven (28%) patients discontinued the second JAKi, mostly due to primary (36/67) or secondary failure (22/67). Sixty-six adverse events (mostly acne and infections) occurred in 56 (23%) patients, without major thromboembolic or cardiovascular events. CONCLUSION: Treatment with a second JAKi is effective and safe in patients with UC already exposed to JAKi. Primary failure to a first JAKi and steroid use at initiation of the second JAKi might reduce the likelihood of success with the second JAKi.

Columbus, Ohio. Crotti Clinic, White Cross Hospital. *Read during the Eighth Annual Congress of Anesthetists, the Associated Anesthetists of the United States and Canada in Joint Meeting with the International Anesthesia Research Society, the Mid-Western Association of Anesthetists and the Eastern Society of Anesthetists, Clinical Congress of Surgeons Week, Congress Hotel, Chicago, Ill. October 14–18, 1929.

Abstract Background A 6-week Crohn’s Disease Exclusive Diet (CDED) combined with 1000kcal Partial Enteral Nutrition (PEN) and CDED alone are comparable in achieving clinical remission in patients with Crohn’s Disease (68% vs 57%, respectively, p = 0.46) suggesting that the CDED is effective without supplemental nutrition1. The exclusion of dairy products from the original CDED, despite the inclusion of dairy-derived ingredients (casein and milk fat) in PEN formulas, appears contradictory. This study aims to test whether the early introduction of dairy products maintains comparable efficacy to standard formula supplementation and to develop a more flexible CDED approach. Methods In this single-center RCT (NCT05606419), adult patients with active CD (Harvey-Bradshaw Index, HBI≥5) on stable therapy for at least 8 weeks prior to enrollment were randomized to receive either CDED plus PEN or CDED coupled with lactose-free, non-ultra-processed dairy products for 6 weeks. PEN and dairy products were incorporated into the recommended diets, each covering 50% of the energy requirements. The primary outcome was clinical response defined as HBI decrease ≥ 3 from baseline after 6 weeks. Secondary outcomes included clinical remission (i.e., HBI &amp;lt;5), changes in inflammatory markers [faecal calprotectin (FC), CRP] and quality of life (IBDQ). Results 21 patients were randomly assigned to either the PEN group (n = 10) or the Dairy group (n = 11). 17 out of 21 patients (9 PEN, 8 Dairy) completed the study (80.9%), showing high or very high adherence, regardless of the study group. In the intention-to-treat (ITT) analysis, clinical response was achieved in 15/21 (71.4%) of the total sample [8/10 (80%) in the PEN vs. 7/11 (63.8%) in the Dairy group, p = 0.635] and 16/21 patients (76.2%) achieved clinical remission at week 6. Among the 76.5% of the as-treated population who had at least one abnormal inflammatory marker at baseline (CRP ≥ 0.5 mg/dL and/or FC ≥ 100 μg/g), complete biochemical remission was achieved in 1/6 (16.7%) of the PEN group and 1/7 (14.3%) of the Dairy group (p = 1.000). FC data was available for 15 patients (8 PEN, 7 Dairy). More patients in the Dairy group achieved ≥ 50% FC drop [3/7 (42.9%) vs.1/8 (12.5%), p = 0.282], although the difference was not significant. IBDQ scores increased significantly in the total sample (p = 0.046), but there were no differences between the intervention groups (p = 0.943). Conclusion The CD-EDEN study suggests that CDED with early dairy introduction may be a viable alternative to CDED with standard formula supplementation, showing comparable clinical response rates and biochemical improvements in both groups. Larger trials are needed to establish non-inferiority and assess long-term efficacy. Reference: 1. Yanai H, Levine A, Hirsch A, et al. The Crohn’s disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn’s disease (CDED-AD): an open-label, pilot, randomised trial. Lancet Gastroenterol Hepatol. Jan 2022;7(1):49-59. doi:10.1016/s2468-1253(21)00299-5 Conflict of interest: Morogianni, Konstantina: Other: Sponsor of Study: Hellenic Group for the Study of IBD Karayiannis, Dimitrios: No conflict of interest Almperti, Avra: No conflict of interest Manolakis, Anastassios: No conflict of interest Viazis, Nikolaos: Nothing to declare Archavlis, Emmanuel: No conflict of interest Mantzaris, Gerassimos: Grant: AbbVie, Ferring, MSD, VIANEX Personal Fees: AbbVie, Aenorasis, BMS, Ferring, Genesis, Inovis, J&amp;J, MSD, Pfizer, Takeda, Mylan, Vianex Other: AbbVie, Aenorasis, Amgen, BMS, Celtrion, CUBE, Falk Pharma, Faran, Ferring, Galenica, Genesis, J&amp;ampJ, MSD, Pfizer, Sandoz, TAKEDA, Vianex, Viatris Zampelas, Antonis: No conflict of interest Poulia, Kalliopi-Anna: No conflict of interest

Abstract Introduction Decompensated heart failure is a common acute presentation to hospital among the frail older population where treatment often involves intravenous furosemide. Whilst this is effective in inducing a diuresis, it can be associated with negative effects of hospital stay such as hospital-associated infections and deconditioning. Continuous subcutaneous infusion (CSCI) of furosemide is well-established as a palliative treatment for end-stage heart failure and there is growing evidence that CSCI Furosemide is as safe and effective as intravenous in the management of acute episodes of decompensation, whilst preventing hospital admission. This study retrospectively assesses the use and effectiveness of CSCI Furosemide for patients under York Virtual Frailty Ward. Methods 10 episodes of care using CSCI of furosemide were identified between November 2023 and May 2025. Included care episodes were those where patients received CSCI Furosemide, had a diagnosis of end stage heart failure and were housebound (CFS ≥6). All individuals received either 160 mg or 230 mg of CSCI Furosemide over a minimum treatment course of 48 hours. Patient records were reviewed to assess weight change and symptom burden pre- and post-CSCI Furosemide. Bed days saved by preventing hospital admission were calculated. Results The average weight loss through treatment was 0.83 kg/24 hours. All patients reported an improvement in symptom burden (oedema/mobility/breathing/fatigue). Two patients experienced a mild localised skin reaction, but treatment was able to continue safely with modifications. 40 bed days were found to have prevented through this community treatment. Conclusion This study demonstrates that CSCI is an effective treatment for management of decompensated heart failure of frail older individuals in the community. Although mild adverse effects may occur, they were short lived and did not prevent the treatment continuing. CSCI Furosemide offers benefits beyond its intended use including reducing risk of hospital-acquired harm and prevention of hospital bed days in an already strained system.

OBJECTIVES: To identify the rate and predictors of successful antitumor necrosis factor (TNF) dose deescalation in patients with inflammatory bowel disease (IBD). METHODS: This multicenter retrospective cohort study collected data from consecutive IBD patients followed at referral centers in Greece and Turkey, who had received intensified anti-TNF regimens due to secondary loss of response. Clinical response, steroid-free clinical remission, biochemical response, or mucosal healing were evaluated at 3 and 6 months following dose escalation. Multivariate analysis was used to identify predictors of successful dose deescalation. RESULTS: A total of 1129 patients were included [Crohn's disease: n = 743; ulcerative colitis: n = 386; infliximab (IFX): n = 650; adalimumab (ADA): n = 471; and golimumab (GOL): n = 8]. The median interquartile range (IQR) duration of anti-TNF treatment before escalation was 13.0 (6.0-36.0) months. After a median (IQR) of 16.0 (8.0-36.0) months of intensified therapy, 283 (25.1%) patients were successfully deescalated to standard anti-TNF dosing, 340 (30.1%) remained on the intensified regimen, and 506 (44.8%) were switched to a different agent - either another anti-TNF ( n = 111, 21.9%) or a biologic with a different mechanism of action ( n = 395, 78.1%). Predictors of successful deescalation included the concomitant use of steroids and the type of anti-TNFa agent used (IFX vs. ADA/GOL). Negative predictors included the presence of extraintestinal manifestations, prior anti-TNF exposure (i.e. ADA followed by IFX and vice versa), and longer duration of anti-TNF therapy before escalation. CONCLUSION: One quarter of IBD patients requiring intensified anti-TNFa therapie were successfully deescalated to standard dosing, after a median of 16.0 (IQR: 8.0-36.0) months.