Treatment Of Chronic Patients Research Articles

Long-term Efficacy and Safety of Sodium Oxybate in Treating Alcohol Use Disorder: A Systematic Review and Meta-Analysis.

Worldwide, three million deaths each year are reported due to the harmful use of alcohol. To date, only a few drugs have been approved for the treatment of Alcohol Use Disorder (AUD). This systematic review and meta-analysis aim to assess the long-term efficacy and safety of sodium oxybate (SMO) treatment in patients with AUD. We followed the PRISMA statement guidelines and searched PubMed and ISI Web of Science to retrieve the studies of interest. In total, 13 studies on long-term (>12 weeks) SMO administra- tion in patients with AUD were included in this systematic review, and 7 were included in the meta- analysis. Overall, the abstinence rate after 12 weeks of treatment was similar in the SMO and placebo groups, while it was significantly in favour of SMO compared to Naltrexone (NTX). The completion rate was similar in all three conditions. Mean corpuscular volume (MCV) levels favoured SMO over NTX, while Alcohol Craving Scale (ACS) scores did not favour SMO. The incidence of adverse reactions varied widely between studies. SMO in the chronic treatment of patients with AUD showed no superiority to placebo in our analysis of published RCTs, although many observational studies reported its beneficial effect in the long term. On the contrary, SMO was superior to NTX treatment on abstinence. The rate of study completion was similar in the three groups. Safety was not an issue in any of the studies included. Further studies are needed to better assess SMO efficacy and safety in the long term.</p>.

The effects of gastrointestinal diet therapy for chronic pathologies of the digestive system in cats

Gastroeintestinal diseases are one of the most common groups of diseases among small domestic animals. The gastro-intestinal tract includes the oral cavity, pharynx, esophagus, stomach, pancreas, small intestine and large intestine. General signs of digestive system disorders in cats with diseases of the digestive tract are vomiting, regurgitation, capricious appetite, as well as various defecation disorders: diarrhea, coprostasis, various inclusions in feces (blood, mucus). Diseases of the gastrointestinal tract of a chronic nature often involve the manifestation of symptoms on an ongoing basis or are recur-rent in nature. Chronic gastritis, enteropathy, pancreatitis require specialized diets that normalize the functioning of the digestive tract and help improve digestive function. These therapeutic complete diets are presented in ready-made feeds in dry (pellets) and wet (pates, pouches) variations from many manufacturers of industrial feeds. Dietary therapy is required long-term or lifelong; during remission it is the basis in the treatment of chronic patients. The compositions of these diets take into account the physiological and specific needs of the animal, and are also developed on the basis of easily digestible ingredients and a reduced amount of fat, but completely replenishing the required amount of calories.

Infection risk in patients with autoimmune cytopenias and immune dysregulation treated with mycophenolate mofetil and sirolimus.

Autoimmune cytopenias (AICs) are a group of disorders characterized by immune-mediated destruction of blood cells. In children, they are often secondary to immune dysregulation that may require long-lasting immunosuppression. Mycophenolate mofetil and sirolimus represent two well-tolerated options to treat these disorders, often as a steroid-sparing option. However, no data are available on the infection risk for patients undergoing long-lasting treatments. The rate of severe infective events was calculated in episodes per 100 persons/months at risk (p/m/r) documented by the analysis of hospitalization charts between January 2015 and July 2023 of patients treated with mycophenolate mofetil or sirolimus given for isolated AIC or AICs associated with autoimmune lymphoproliferative syndrome (ALPS)/ALPS-like syndromes in two large Italian pediatric hematology units. From January 2015 to July 2023, 13 out of 96 patients treated with mycophenolate mofetil or sirolimus developed 16 severe infectious events requiring hospitalization. No patients died. Overall infection rate was 0.24 person/*100 months/risk (95% CI 0.09-0.3). Serious infectious events incidence was higher in patients with ALPS-like compared to others (0.42 versus 0.09; p = 0.006) and lower in patients who underwent mycophenolate treatment alone compared to those who started sirolimus after mycophenolate failure (0.04 versus 0.29, p = 0.03). Considering only patients who started treatment at the beginning of study period, overall cumulative hazard was 18.6% at 60 months (95% CI 3.4-31.4) with higher risk of infectious events after 5 years in ALPS-like patients (26.1%; 95% CI 3.2-43.5) compared to other AICs (4%; 95% CI 0-11.4; p = 0.041). To the best of our knowledge, this is the first study to describe the infectious risk related to mycophenolate and sirolimus chronic treatment in patients with AICs and immune dysregulation. Our data highlight that infection rate is very low and mainly related to the underlying hematological condition. Mycophenolate and sirolimus represent a safe immunosuppressive therapy in AICs and immune dysregulation syndromes.

Prevalence of Nonadherence to Medications among Geriatric Patients in Al-Madinah Al-Munawara City's Hospitals, Kingdom of Saudi Arabia.

Medication adherence is a major component in the treatment of chronic patients, especially the older adults. It acts as an essential part of a successful therapeutic outcome, increasing treatment benefits, and decreasing hospital admissions, health care utilization, and cost. Limited research regarding medication adherence has been conducted nationwide; however, data among the older adults is sparse due to the lack of research on this topic. Therefore, this study aimed to determine the prevalence of medication nonadherence among older adults' Saudi patients with chronic diseases living in Al-Madinah Al-Munawwarah city. A cross-sectional study was conducted on outpatient older patients with chronic diseases who visited clinics at different hospitals in Al-Madinah Al-Munawwarah city, from March until December 2022. The questionnaire was published in a conversational Arabic dialect. The adherence level was measured by the Adherence to Refills and Medications Scale (ARMS) and the reasons for medication nonadherence were collected by using the Cluig scale. 65.1% of females and 34.9% of males have participated in this study. According to the ARMS scale, 67.9% of patients had poor medication adherence and 32.1% had good medication adherence. Poor adherence was higher in females compared to males, with a p value = 0.018. For educational level, the ARMS score in graduates was higher than patients who finished middle school and illiterate patients. Based on the Cluig scale, the most common reasons for medication nonadherence were forgetfulness, feeling well, polypharmacy, and subsequent avoidance of side effects. The findings indicate the gender-based differences in the factors that associated with medication nonadherence among older adults. Medication adherence is crucial especially among older adults to improve clinical outcomes. The current results highlight the prevalence of medication adherence among the older adult population. This result shows the gender-based differences in the factors associated with medication nonadherence among the older adult population.

Effects of COVID-19 Pandemic and Post-Vaccination Period on Gastroenterology Practice in Turkey.

The sudden and intense burden due to the novel coronavirus (coronavirus disease 2019) pandemic has changed the priority of many health services. The highly contagious new variants and vaccination services have greatly impacted the daily practice of gastroenterologists. In the present study, we tried to evaluate the change in the daily practice of Turkish gastroenterologists in the coronavirus disease 2019 pandemic and the post-vaccination periods. A questionnaire was prepared using Google forms and sent online to 214 gastroenterologists registered with the Turkish Gastroenterology Association. Approximately half of the gastroenterologists moved their endoscopy unit or gastroenterology clinic to another location in the hospital during the pandemic and about one-third of the endoscopy units were completely closed. About 56% of the respondents reported the interruption of endoscopic procedures and inpatient services. In total, 85% of gastroenterologists thought that follow-up and treatment of chronic patients were disrupted due to patients obtaining their medicine directly from pharmacies. After the first case in Turkey, 74% of gastroenterologists worked in coronavirus disease 2019 patient care services, 28% of gastroenterologists were infected with coronavirus disease 2019, and 3% believed they had a cross-infected patient(s). A total of 78% of gastroenterologists reported that patient management became difficult due to the change in the priority of other departments, and 60% of gastroenterologists confirmed that they experienced a decrease in income. In the post-vaccination period, 70% of gastroenterologists returned to their pre-pandemic working schedule and 31% noticed an increase in endoscopic cancer detection. Prolongation of the pandemic has seriously damaged the practice of gastroenterology and multidisciplinary patient management.

Non-Contact Atrial Fibrillation Detection From Face Videos by Learning Systolic Peaks.

We propose a non-contact approach for atrial fibrillation (AF) detection from face videos. Face videos, electrocardiography (ECG), and contact photoplethysmography (PPG) from 100 healthy subjects and 100 AF patients are recorded. Data recordings from healthy subjects are all labeled as healthy. Two cardiologists evaluated ECG recordings of patients and labeled each recording as AF, sinus rhythm (SR), or atrial flutter (AFL). We use the 3D convolutional neural network for remote PPG monitoring and propose a novel loss function (Wasserstein distance) to use the timing of systolic peaks from contact PPG as the label for our model training. Then a set of heart rate variability (HRV) features are calculated from the inter-beat intervals, and a support vector machine (SVM) classifier is trained with HRV features. Our proposed method can accurately extract systolic peaks from face videos for AF detection. The proposed method is trained with subject-independent 10-fold cross-validation with 30 s video clips and tested on two tasks. 1) Classification of healthy versus AF: the accuracy, sensitivity, and specificity are 96.00%, 95.36%, and 96.12%. 2) Classification of SR versus AF: the accuracy, sensitivity, and specificity are 95.23%, 98.53%, and 91.12%. In addition, we also demonstrate the feasibility of non-contact AFL detection. We achieve good performance of non-contact AF detection by learning systolic peaks. non-contact AF detection can be used for self-screening of AF symptoms for suspectable populations at home or self-monitoring of AF recurrence after treatment for chronic patients.

Detection of Cardiovascular Disease Based on PPG Signals Using Machine Learning with Cloud Computing

Hypertension is the main cause of blood pressure (BP), which further causes various cardiovascular diseases (CVDs). The recent COVID-19 pandemic raised the burden on the healthcare system and also limits the resources to these patients only. The treatment of chronic patients, especially those who suffer from CVD, has fallen behind, resulting in increased deaths from CVD around the world. Regular monitoring of BP is crucial to prevent CVDs as it can be controlled and diagnosed through constant monitoring. To find an effective and convenient procedure for the early diagnosis of CVDs, photoplethysmography (PPG) is recognized as a low-cost technology. Through PPG technology, various cardiovascular parameters, including blood pressure, heart rate, blood oxygen saturation, etc., are detected. Merging the healthcare domain with information technology (IT) is a demanding area to reduce the rehospitalization of CVD patients. In the proposed model, PPG signals from the Internet of things (IoT)-enabled wearable patient monitoring (WPM) devices are used to monitor the heart rate (HR), etc., of the patients remotely. This article investigates various machine learning techniques such as decision tree (DT), naïve Bayes (NB), and support vector machine (SVM) and the deep learning model one-dimensional convolutional neural network-long short-term memory (1D CNN-LSTM) to develop a system that assists physicians during continuous monitoring, which achieved an accuracy of 99.5% using PPG-BP data set. The proposed system provides cost-effective, efficient, and fully connected monitoring systems for cardiac patients.

Health Care Professionals' Perspectives on the Uses of Patient-Generated Health Data.

Integration of digital self-management solutions into health care processes requires the involvement of health care professionals in the adoption and use of the solutions as part of the care pathway. We conducted 23 interviews with diverse profiles of health care professionals participating in the treatment of chronic patients in three different countries. Our results indicate that health care professionals appeared relatively motivated at the prospect of having access to patient-generated data. Nevertheless, they appeared less confident in weighing what types of data could be collected efficiently through mobile devices and how it could be presented in ways that would provide value to the care process. Our results identify four broad categories for how patient-generated health data could be useful: monitoring, prevention, research, and transparency of condition parameters.

Peritoneal dialysis for refractory heart failure: A single-center experience.

Heart failure (HF) is a disease associated with poor quality of life. Peritoneal dialysis (PD) can be an alternative in the treatment of these patients to overcome fluid overload. The objective of this study is to observe the effects of PD in refractory HF patients. We conducted an observational study including 10 patients with refractory congestive HF. PD started solely for fluid overload. Patients' baseline parameters were compared with follow-up parameters. Median age was 57.5 (44.8-64.3) years. Median left ventricular ejection fraction was 20% (18.8-31.3), and all patients had right ventricular dysfunction. Median estimated glomerular filtration rate was 51.2 (43.8-101.3)ml/min/1.73 m2 . Two patients (20%) died during the follow-up period. New York Heart Association (NYHA) functional class decreased significantly from a median of 4 to 2,1 and 1 in the 3rd, 6th, and 12th months, respectively (p ≤ 0.01 for all from baseline). Number and length of hospitalization decreased significantly after treatment (number from a median of 3 to 0, p=0.013; days from 50.5 to 0, p=0.028). PD significantly reduced NYHA functional class, number and days of hospitalization for HF. It could be a reasonable option in chronic treatment of patients with refractory HF.

Research on Key Technologies of Personalized Intervention for Chronic Diseases Based on Case-Based Reasoning.

In recent years, with the acceleration of industrialization, urbanization, and aging process, the number of patients with chronic diseases in the world is increasing year by year. In China, the number of chronic diseases has increased tenfold in 10 years. The percentage of the disease burden in the whole society accounts for 79.4%. Chronic diseases have become the top killer for Chinese people's health. However, for chronic diseases, prevention is more important than treatment. It is the best way to keep healthy. Therefore, health intervention is the key to prevent chronic diseases. Especially now, with the spread of COVID-19 pandemic, reducing the times of hospital check-ups and treatments for chronic patients is practically significant for releasing the stress on medical staffs and decreasing the rate of transmission and infection of COVID-19. In this paper, case-based reasoning (CBR) technology is used to assist personalized intervention for chronic diseases, and the key technologies of personalized intervention for chronic diseases based on case-based reasoning are proposed. The case organization, case retrieval, and case retention techniques of CBR technology in chronic disease personalized intervention are designed, and the calculation of interclass dispersion is added to the distribution of feature words, which is used to describe the distribution of feature attributes in different categories of cases. It provides an effective method for the establishment of personalized intervention model for chronic disease.

Predictive model of variables associated with health-related quality of life in patients with advanced chronic kidney disease receiving hemodialysis.

Chronic kidney disease (CKD) affects over 10% of the global population. Health-related quality of life (HRQoL) has been identified as a reliable indicator for assessing the effectiveness of treatment in chronic patients, and resilience as a predictor of low levels of stress and higher QoL. The aim of this research is to identify the relationship between HRQoL, resilience, perceived stress, and the different sociodemographic and clinical routine variables of advanced chronic kidney disease (ACKD). Multicenter, cross-sectional, and correlational study with 155 ACKD patients in the Valencian Community (Spain). The measures for the study included the Kidney Disease Quality of Life 36 (KDQOL-36), the Perceived Stress Scale 10 (PSS10), and the Connors-Davidson Resilience Scale (CD-RISC). To identify the variables with predictive power over the scales and subscales of the KDQOL-36, multiple regression analyses were performed. Average participants' age was 67.39, 68.4% were male, 29% diabetic, and 83.2% had undergone arteriovenous vascular access placement with a Charlson Comorbidity Index of 6 (SD = 2.09). The regression models identified that age and resilience explained up to 26.8% of the variance of the KDQOL-36 total score. As for the physical component of QoL, comorbidity with other clinical conditions, resilience, and the presence of diabetes explained 32.1% of its variance. Resilience was identified as one of the most important predictors of HRQoL. Thus, the development of interventions aiming to improve the level of resilience may have a positive impact over the quality of life of patients with CKD.

Проблемы развития домашнего мониторинга состояния здоровья

Due to its rapid development, telemonitoring technologies in the field of healthcare significantly outstripped the possibilities of implementation in real practice. Therefore, there is a need for the active development of this area of prevention and treatment of chronic patients, identifying emerging problems and finding possible solutions. The aim of this work was to assess the status and development prospects of monitoring of patient health in residential settings and analyze the problems of its inclusion in the existing health care system. Based on the analysis of scientific publications and expert assessments, the existing at-home telemonitoring systems, the main pathologies observed, and the organization of medical care for chronic patients under remote monitoring are examined. It was shown that the on-line treatment of monitored patients in the current health care system is very difficult due to its unpreparedness for the introduction of such technologies and the undeveloped concept of clinical and economic efficiency of their use. The article proposes to carry out special training of patients on effective participation in the process of remote monitoring, and it is also proposed to provide in the treatment and prevention institutions the position of a consultant (general practitioner, with an appropriately equipped workstation) for conducting remote patient consultations.

Mathematical analysis and simulation of a Hepatitis B model with time delay: A case study for Xinjiang, China.

The incubation period for Hepatitis B virus (HBV) within the human is epidemiologically significant because it is typically of long duration (1.5∼6 months) and the disease transmission possibility may be increased due to more contact from the patients in this period. In this paper, we investigate an SEICRV epidemic model with time delay to research the transmission dynamics of Hepatitis B disease. The basic reproductive number ${\mathcal R}_0$ is derived and can determine the dynamics of the model. The disease-free equilibrium is globally asymptotically stable if ${\mathcal R}_0<1 and="" unstable="" if="" mathcal="" r="" _0="">1$. As ${\mathcal R}_0>1$, the model admits a unique endemic equilibrium which is locally asymptotically stable. The endemic equilibrium is globally asymptotically stable when the vertical transmission is ignored. Numerically, we study the Hepatitis B transmission case in Xinjiang, China. Using the Hepatitis B data from Xinjiang, the basic reproductive number is estimated as 1.47 (95% CI: 1.34-1.50). By the end of 2028, the cumulative number of Hepatitis B cases in Xinjiang will be estimated about 700,000 if there is no more effective preventive measures. The sensitivity analysis of ${\mathcal R}_0$ in terms of parameters indicates prevention and treatment for chronic patients are key measures in controlling the spread of Hepatitis B in Xinjiang.

Immunological exhaustion and functional profile of CD8+ T lymphocytes as cellular biomarkers of therapeutic efficacy in chronic Chagas disease patients

The lack of useful tools for detection the impact of treatment during the follow-up of chronic Chagas disease treated patients difficult the adequate care to the affected population. The objective of this study was to evaluate the functional response of CD8+ T lymphocyte population, critical for the control of Trypanosoma cruzi infection, as a possible cellular biomarker of treated Chagas disease patients. Thus, we analyzed the antigen-specific CD8+ T-cell response before and after benznidazole treatment in asymptomatic (indeterminate) and cardiac chronic Chagas disease patients. A marked dysfunctional process of the CD8+ T cell population was found in patients with an advanced pathology. Thus, the cardiac patients have a higher co-expression of inhibitory receptors and a lower antigen-specific multifunctional capacity compared with that of asymptomatic patients. Remarkably, benznidazole treatment partially reverses this functional exhaustion process of CD8+ T cells in both asymptomatic and cardiac Chagas disease patients. Thus, the co-expression of inhibitory molecules tends to be reduced after benznidazole treatment, mainly in asymptomatic patients, finding a significant drop in the expression of inhibitory receptors such as PD-1 and 2B4. In addition, the multifunctional antigen-specific response of CD8+ T cells is enhanced after treatment in chronic patients. An increase in the subset of cells with cytotoxic capacity and production of the IFN-γ cytokine was also observed in both treated asymptomatic and cardiac chronic Chagas disease patients. The results derived from this study show the improvement of the functional capacity of CD8+ T cells after treatment which could be have a positive effect on parasitic control. In addition, the phenotypic and functional profile of the CD8+ T cells described could serve as a tool for monitoring the impact of benznidazole treatment.

Home management of patients with ischemic heart disease

Chronic pathologies increase constantly as the average life period lengthens. In particular, it has been observed a significant increase in cardiovascular diseases. In the Lombardy Region, this issue has been faced by developing a project for those who are suffering from both single or multi-pathologies. This project called PIC, which stands for "treatment of chronic patients" in Italian, is improving patient adherence to therapies. To meet the needs of these patients, Lombardy's family doctors have joined in cooperatives in order to better help chronic patients by providing a service center and the necessary tools for drafting a detailed individual care plan. The individual care plan is a digital document including a customized planning for each patient. This allows a better monitoring, which results in an effective treatment course.

Is there any association between childhood trauma and chronic dermatological diseases? A case-control study

Aim: It is known that traumatic experiences in childhood cause many psychosomatic and psychodermatological diseases. Common dermatological diseases bring abaout not only dermatological but also psychosocial problems. In our study, we aimed to investigate association of depression, anxiety and childhood trauma with chronic dermatological diseases.Methods: After power analysis, 76 patients with chronic dermatological diseases (study group) and 75 healthy volunteers (control group) were included in this study. Beck Anxiety Inventory, Beck Depression Inventory and Childhood Trauma Scale (CTQ 28) were administered to these individuals.Results: The anxiety (p=0.001) and depression (p&lt;0.001) levels were higher in the study group than control group. However, there was no difference with CTQ 28 total (p=0.217) and subscales scores (p=0.159, p=0.976, p=0.902, p=0.234 and p=0.267, respectively) between groups. Physical neglect scores differed significantly according to educational status in the patient group (F=3.643, p=0.031). Emotional neglect and total CTQ 28 scores were higher in patients with lichen simplex chronicus (p=0.234).Conclusion: In our study, unlike previous studies, dermatological diseases such as lichen planus, Behçet’s disease, choronic urticaria, vitiligo were included in the study. These group of diseases should be considered because they adversely affect every aspect of patients' lives in almost. Patients should be carefully evaluated for psychiatric support. We think that the detailed investigation of traumatic experiences from both dermatologists and psychiatrists can lead to better results in the treatment of chronic patients by using psychotherapeutic interventions.

The multifaceted angina.

The word angina describes a symptom most of the time, but not exclusively, due to myocardial ischaemia. The first, lucid, description of angina goes back to 1772 when Heberdeen wrote: ‘There is a disorder of the breast… The seat of it, and sense of strangling and anxiety, with which is attended, may make it not improperly be called angina pectoris. Those, who are afflicted with it, are ceased [sic] while they are walking and most particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast, which seems as it would take their breathe away, if it were to increase or to continue; the moment they standstill, all this uneasiness vanishes’.1 The definition used today for angina is not very different.2 Whatever the definition in guidelines or text book, the reality is that angina can be perceived by patients in many different ways. This is because: (i) not all patients with angina are the same (they might have different comorbidities, different perception of pain); (ii) not all the anginal attacks are the same (as they may be precipitated by several different mechanisms); and (iii) not all the ischaemic episodes are the same. The aim of this supplement of the European Heart Journal, the Heart of the Matter is to provide a spectrum of the multiple facets of angina. To this end, a group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy to present and discuss several clinical cases which are all reported in the supplement. It follows that, the symptomatic pharmacological treatment of patients with angina cannot be the same for all patients, instead it has to be personalized. Current clinical guidelines recommend antianginal therapy to control symptoms of angina before considering coronary artery revascularization,3–5 following a categorical first- and second-line approach (Figure 1). Drugs that are classified first line are beta-blockers, calcium channel blockers, and short acting nitrates. The second line are long-acting nitrates, ivabradine, nicorandil, ranolazine, and trimetazidine. Second-line drugs are indicated for patients who have contraindications to first line agents, do not tolerate them or remain symptomatic. This categorical approach has been questioned in the past couple of years.6–10 Newer antianginal drugs, which are classified as second choice, have more evidence-based and more contemporary data to support their use than what is available for the traditional first-choice drugs. Recently, systematic reviews covering 50 years of medical treatment of angina were performed,10 which demonstrated an incredible scarcity of data since only 72 controlled randomized studies comparing two antianginal drugs were identified including a total of 7034 patients since 1964 to the current day.11,12 Furthermore, only 13 studies included between 100 and 300 patients with more than 50 patients per group, a minimum number to perform a meaningful comparison among groups. The results clearly indicate that, from the little data that there is, no superiority of one antianginal agent over another has been shown and equivalence is demonstrated among beta-blockers, calcium antagonists, and If channel inhibitors. This, in turn, suggests that the treatment of chronic patients can be achieved with all the available class of drugs tailoring these to the patients’ characteristics, comorbidities, and to the typology of resulting ischaemia. This is the reason why the authors of the present supplement decided to propose a different, more individualized approach to patients with angina, the so-called ‘Diamond approach to personalized treatment of angina’.10 Open in a separate window Figure 1 Current guideline suggestions for the symptomatic medical treatment of angina pectoris. © LLS 201822.

Acceptance of ICTs for health and/or Physical Activity Monitoring in Patients with Chronic Diseases

Physical activity (PA) is a cornerstone of medical treatment in chronic patients but difficult to maintain over the long term. The Information and Communication Technologies (ICTs) offer new possibilities to provide support for patients and to monitor PA. The aim of this study was to assess the knowledge about, the use of and the interest in ICTs for health and PA monitoring, and to evaluate the influence of gender, age and socio-professional category on ICT acceptance. A survey on ICT’s knowledge, use and acceptance was specifically elaborated for this study. Patients participating in a supervised PA training program completed this survey during a face-to-face visit. Seventy-eight patients between 45 and 79 years old were surveyed. Most of them had access to the Internet (92%) and owned a smartphone (69%). Age was the major factor influencing access to and technical knowledge about ICTs. Half of the patients were in favor of using ICTs for health and PA monitoring. The factors that conditioned this acceptance were to be young, highly educated, and to have already used ICTs. The other half of the patients were opposed to ICTs because of the complexity and constraints of these technologies, and because they worried about the lack of data security. These results emphasize the need to know more about the profile of the patients in order to propose the relevant personalized PA support.

Oral corticosteroid-dependent asthma: current knowledge and future needs.

To discuss the current use of oral corticosteroids (OCS) as a chronic treatment in patients with severe asthma and as a rescue treatment for patients presenting with acute exacerbations. Airways disease is responsible for the bulk of OCS use in the community and considerable OCS-associated morbidity. I speculate that the key mechanism leading to a beneficial effect in these situations is depletion of circulating eosinophils resulting in a reduced response to potentially inhaled corticosteroid unresponsive recruitment signals to the airway mucosa. This effect is shared by anti-IL-5 biological agents, which have emerged as highly effective OCS-sparing agents. Mitigation of the adverse effects of OCS might also result from a better appreciation of features associated with a response to OCS and targeted, biomarker-directed use. Longer term, there are real prospects that chronic and acute OCS use in asthma will be replaced by biological agents targeting eosinophilic airway inflammation more specifically and safely.

SMJERNICE ZA KLINIČKU PREHRANU KOD UPALNIH BOLESTI CRIJEVA

Diet therapy and clinical nutrition have a significant place in the treatment of patients with inflammatory bowel disease (IBD). Nutritional support is an important component of medical therapy in patients with IBD, and in-cludes the prevention and treatment of all forms of malnutrition. Confirmed malnutrition in patients with in-flammatory bowel disease should be treated adequately as it exacerbates prognosis, degree of complications, mortality and quality of life of a patient. Enteral nutrition is an extremely important part of nutritional therapy in inflammatory bowel diseases, and in some situations it has the meaning of primary therapy. Parenteral nutri-tion has its place in nutrition therapy of inflammatory bowel disease, both in acute and chronic treatment of patients with short bowel syndrome. Representatives of the Croatian Society of Clinical Nutrition Croatian Medical Association, Croatian Society of Mucosal Immunology Croatian Medical Association, Croatian Socie-ty of Gastroenterology and Croatian Society of Nutritionists and Dietitians participated in the development of these guidelines. They are evidence-based, according to the GRADE (Grading of Recommendations, Assess-ment, Development and Evaluation) system which, with the strength of evidence, also describes the level of recommendation. The basic conclusions of these guidelines relate to the assessment of malnutrition in this group of patients, the determination of nutritional needs, the replacement of key nutrients and pharmaconutri-ents, the application of various artificial nutrition modalities and the specificities of perioperative nutrition.