Hospital de Basurto

Early diagnosis of premalignant gastric condition, such as chronic atrophic gastritis and intestinal metaplasia, allow us to assess and stratify the risk of gastric cancer. Gastric mucosal cleaning, mucosal exploration, photo-documentation, and advanced technologies like optical enhancement, electron chromoendoscopy and magnification endoscopy improve lesion detection rates. This study compares the detection rate of premalignant gastric lesions between biopsies guided Electron chromoendoscopy combined with optical enhancement and magnification endoscopy versus random biopsies (Sydney Protocol) with optical enhancement. This is a prospective, observational, blinded comparative study. Outpatients were divided into two groups: group 1 (162 patients), biopsies were performed either under Electron chromoendoscopy combined magnification endoscopy guidance; and group 2 (160 patients), biopsies were performed under blinded mapping (updated Sydney system) with optical enhancement. The following clinical outcomes were assessed in each group: age, gender, adequate gastric clearance rate, gastric atrophy rate, intestinal metaplasia rate. A total of 322 patients were randomized, where 76 were excluded from the study. Detection rate for Intestinal metaplasia was significantly higher with Electron chromoendoscopy combined with optical enhancement and magnification endoscopy (37.6% versus 23.7%; p < 0.0001). Extensive Intestinal metaplasia was significantly more prevalent with Electron chromoendoscopy combined magnification endoscopy compared to mapping with optical enhancement (p = 0.029; p = 0.048, respectively). Electron chromoendoscopy combined with optical enhancement and magnification endoscopy demonstrated a comparative superiority over Sydney System random biopsy protocol in the identification of patients with premalignant gastric conditions. By enabling more precise endoscopic targeting, directed biopsies help reduce sampling error; however, in high-risk populations, a complementary approach integrating both targeted and systematic random biopsies remains advisable to optimize diagnostic accuracy.

The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids. This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes. In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%-5.8%, p = 0.043), and high risk to self also rose notably (19.5%-31.7%, p < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%-16.8%, p < 0.001). Diagnostically, eating disorders increased (3.7%-10.0%, p = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%-7.4%, p = 0.049). Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.

Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenously or subcutaneously administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of intravenous (IV) versus subcutaneous (SC) TCZ has been performed in patients with GCA-related aortitis. The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions. This was a multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 American College of Rheumatology criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect. Of 196 patients (148 women; mean age 69.8 ± SD 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and markers of inflammation were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; P < 0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms. In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission, whereas no significant differences were observed between both routes regarding imaging remission.

Abstract Background: Serrated polyposis syndrome, the most prevalent colonic polyposis, confers an increased colorectal cancer risk. Guidelines recommend close colonoscopy surveillance, but recent data suggest low neoplasia rates, supporting longer colonoscopy intervals. Aims: Compare advanced neoplasia incidence between two- and three-year surveillance. Methods: A multicentre, randomized noninferiority trial was performed (May 2021–November 2024) in six Spanish hospitals. Patients meeting 2019 serrated polyposis syndrome WHO criteria I or II, with no advanced polyps and &lt;5 relevant polyps at their previous colonoscopy, were randomized to surveillance at two or three years. The primary endpoint was advanced neoplasia incidence. Results: A total of 131 patients with serrated polyposis syndrome were included (47.3% women; mean age 66.1). Seventy-two were assigned to 2-year and 59 to 3-year colonoscopy. Among 771 resected lesions, 2.4% were advanced adenomas or advanced serrated polyps; no colorectal cancer was detected. The proportion of patients with advanced neoplasia in the surveillance colonoscopy was 6.9% (2-year) vs 13.6% (3-year), with no statistical difference (p=0.208) but with a risk difference of +6.7% (95% CI: –4.1% to 17.5%) exceeding the pre-specified non-inferiority margin of +10%. Time since serrated polyposis syndrome diagnosis &lt;3 years was associated with advanced neoplasia (OR: 4.4; 95% CI: 1.52-14.75; p=0.024). Conclusions: In patients with serrated polyposis syndrome, extending colonoscopy surveillance intervals to three years was not shown to be non-inferior to a two-year interval for advanced neoplasia incidence. The early years of follow-up after serrated polyposis syndrome diagnosis was identified as a risk factor for advanced neoplasia. Clinical trial registry : ClinicalTrials.gov (NCT04906343). Date: 5-10-2021.