Hospital of the Brothers of St. John of God

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the most aggressive malignancies with a very poor prognosis. Currently, there is no standardized therapeutic approach for third-line systemic treatment. The aim of this retrospective/prospective study was to evaluate survival outcomes in patients treated in the third-line setting and to analyze the impact of nutritional and inflammatory biomarkers on overall survival (OS) and progression-free survival (PFS). The analysis retrospectively and prospectively included 95 patients with mPDAC treated with third-line systemic therapy. Data were collected from the Slovak Pancreas Registry. Data were collected from 13 hospitals. Baseline chemotherapy regimens, ECOG, nutritional, and inflammatory parameters were recorded and used to calculate prognostic scores (PNI, CRP, NLR, SII, SIRI, GPS). Their association with OS and PFS was analyzed using the log-rank test and Kaplan-Meier survival analysis. The most frequently used regimen was FOLFOX/CAPOX (56 patients), followed by nanoliposomal irinotecan (nal-IRI, 24 patients) and capecitabine (11 patients). The median OS was 5.55 months and the median PFS was 3.29 months. A PNI > 40.5 was significantly associated with longer OS (6.34 vs. 3.32 months, p=0.001) and PFS (3.71 vs. 2.76 months, p=0.009). Lower GPS scores were significantly associated with improved OS (p=0.006) and PFS (p=0.027). Other inflammatory markers (NLR, SIRI, SII, CRP) did not show a statistically significant impact on OS or PFS. Third-line systemic therapy may offer clinical benefit in selected mPDAC patients, particularly in those with favorable nutritional-inflammatory profiles. The Prognostic Nutritional Index (PNI) and Glasgow Prognostic Score (GPS) appear to be potentially useful tools for identifying candidates suitable for further systemic treatment. However, further prospective studies are needed to confirm these findings.

Statins, or HMG-CoA reductase inhibitors, represent one of the most extensively researched and frequently prescribed pharmacological agents, primarily utilized to reduce cardiovascular risk through the modulation of serum cholesterol levels. Although their efficacy in reducing global mortality and cardiovascular events is well-established, genetic variability persists among different populations which may predispose patients to dose-related adverse effects and reduced efficancy of statin therapy. This heterogeneity has driven a shift in the scientific landscape toward exploring common genetic polymorphisms within the genes encoding genes involved in pharmacodynamic pathways. This review aims to provide a comprehensive analysis of clinically significant polymorphisms within the pharmacodynamic pathways of statins. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, and the Cochrane Library were searched for peer-reviewed publications from 2021 to 2025. Following a rigorous selection process based on Evidence-Based Medicine (EBM) criteria. Conclusions: Despite rapid progress in the field of pharmacogenomics, the role of genetic polymorphisms among genes involved in pharmacodynamic pathways of statin therapy still requires more research in order to establish robust evidence of their role in the overall lipid-lowering efficacy of statins.

Abstract Background Cytomegalovirus (CMV) colitis mimics acute IBD flares, making it a critical differential diagnosis in acute severe colitis (ACS). Therefore, it’s an important differential diagnosis in patients with ACS. Prevalence ranges from 10 to 30% in steroid-refractory ulcerative colitis (UC).1,2 Corticosteroids are identified as risk factors for CMV colitis. Evidence for biologics and small molecules remains conflicting or absent.1 This study aimed to evaluate demographic data of CMV colitis in a central European inflammatory bowel disease (IBD) cohort. Methods We conducted a retrospective analysis of 110 colon biopsy samples of IBD patients with clinical suspicion of CMV colitis at our IBD center between 2020 and 2024. All biopsies were obtained from the most inflamed colonic segments during diagnostic colonoscopy. CMV testing including immunohistochemistry (IHC) and quantitative tissue PCR (qPCR) was performed at the affiliated pathology and virology departments. CMV positivity was defined as IHC+/qPCR-, IHC-/qPCR+ or IHC+/qPCR+.3 Results A total of 110 IBD patients with clinical suspicion of CMV colitis were included. The median age was 43.5 years [IQR 36-57]. Gender distribution was nearly equal: 50.9% male (56/110) and 49.1% female (54/110). The majority had UC 75.5% (83/110), followed by Crohn’s colitis (CC) 23.6% (26/110), and colitis indeterminata (1/110). The overall prevalence of CMV colitis was 16.4% (18/110). Among CMV-positive cases 94.4% (17/18) had UC and 5.6% (1/18) had CC. Among the 18 CMV-positive patients, current immunosuppressive therapy included systemic glucocorticoids (GC) 33.3% (6/18), VDZ 27.8% (5/18), Updadacitinib (UPA) 22.2% (4/18), Ustekinumab (UST) 11.1% (2/18), Adalimumab (ADA) 5.6% (1/18), Filgotinib (FILGO) 5.6% (1/18), and topical GCs 5.6% (1/18). 94.4% (17/18) of CMV positive patients had a history of prior systemic immunosuppressive therapy. Of those, 6 never received a biologic, 5 received 1 biologic, 3 received 2 biologics, and 4 received ≥3 biologics. 61.1% (11/18) CMV-positive patients had a documented prior episode of CMV colitis. Conclusion The prevalence of CMV-colitis was 16.4% among IBD patients with clinical suspicion, predominantly affecting those with UC (94.4%). Nearly all positive cases had prior or current immunosuppressive exposure, mostly systemic GCs (33.3%), VDZ (27.8%) or JAK inhibitors (UPA/FILGO 27.8%). Notably, 61.1% had a documented prior episode of CMV colitis. These findings highlight, that immunosuppressed patients – particularly those with UC are at elevated risk of a CMV colitis. Further studies are needed to identify IBD patients and immunosuppressive therapies associated with the highest risk of CMV colitis.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection globally, responsible for a wide spectrum of epithelial lesions ranging from benign warts to invasive malignancies of the cervix, vulva, anus, and oropharynx. More than 200 genotypes have been identified, with low-risk types such as HPV-6 and HPV-11 linked to genital warts, and high-risk types, notably HPV-16 and HPV-18, associated with oncogenic transformation. Transmission occurs primarily through direct sexual contact, although nonsexual and vertical routes have been described. The majority of infections remain asymptomatic and transient, yet persistent infection with high-risk genotypes can lead to neoplastic progression. Diagnosis is mainly clinical, supported by histopathology and molecular HPV DNA detection when indicated. Current management focuses on lesion removal through topical agents (podophyllotoxin, imiquimod, sinecatechins) and ablative or surgical techniques, though recurrence remains frequent. Preventive strategies are central to disease control, with prophylactic HPV vaccination demonstrating remarkable efficacy in reducing infection rates and HPV-related disease burden worldwide. The bivalent, quadrivalent, and nonavalent vaccines provide durable protection for at least 10–14 years and are recommended before sexual debut. Expanding global vaccine coverage, combined with continued screening and education, remains vital to reducing HPV-related morbidity and mortality.

Gastroesophageal reflux disease (GERD) is a widespread gastrointestinal disorder with a significant global burden. Its multifactorial etiology is influenced by unmodifiable risk factors such as sex-based differences; men, for instance, show a higher predisposition for more severe complications like esophageal adenocarcinoma. GERDs pathophysiology is heavily connected with mechanical failure of the anti-reflux barrier, a two-component system that consists of the intrinsic lower esophageal sphincter (LES) and the extrinsic crural diaphragm. Interference in the form of hiatal hernia, hypotensive LES pressure or transient LES relaxations leads to reflux. Modern approach highlights the critical role of microscopic mucosal damage, which causes visceral hypersensitivity and allows the distinction of various phenotypes like non-erosive reflux disease and reflux hipersensitivity. Diagnosis is guided by the Lyon Consensus 2.0 using endoscopy, manometry, and impedance-pH monitoring. Treatment is a multi-step process – it includes lifestyle modification, numerous pharmacological agents such as proton pump inhibitors or newer potassium-competitive acid blockers, and, for refractory cases, interventional treatment via laparoscopic Nissen fundoplication, transoral incisionless fundoplication or magnetic sphincter augmentation.

BackgroundThe paucity of data on the knowledge and attitudes of Deaf people towards dementia is well documented, as is the limited access to dementia services in this population due to lack of interpreters and absence of health professionals who use sign language (SL). Therefore, delivering dementia awareness in Deaf people is assumed as a high priority which is also related to the seeking of relevant diagnostic services. Additionally, till now there are almost no screening tools for detecting early dementia signs which are adapted in national SL.MethodTo address this gap, the current Erasmus+ project aims to identify attitudes and knowledge about dementia among the Deaf population using relevant psychometric tools and subsequently create dementia raising awareness seminars, tailored to the cultural background and norms of the Deaf communities in Austria, Germany, Greece, and Italy. Secondly, the only existing Cognitive Screening Test (CST), originally adapted in British SL from Atkinson et al. (2015) for detecting dementia in Deaf older adults will be also adapted in Austrian and Greek SL.ResultInitially, results from the tools measuring dementia attitudes and knowledge will be presented. Afterwards, the design of the structured seminars delivered in Deaf communities will be also displayed. Finally, the adapted versions of the Austrian and Greek CST administered in Deaf older adults in both countries will be available.ConclusionThe final goal is to increase dementia raising awareness seminars in Deaf people from Austria, Germany, Greece and Italy, as well as achieve dementia detection in this population by providing them with diagnostic and care pathways.

Antibody‐drug conjugates (ADCs) and immunotherapy have changed the treatment landscape for locally advanced and metastatic urothelial carcinoma (la/mUC). Clinical trials have demonstrated the superiority of enfortumab vedotin (EV) combined with pembrolizumab (P) over chemotherapy. This retrospective, multicentre Austrian registry analysis evaluated the effectiveness and safety of EV + P in treatment‐naïve la/mUC patients in a real‐world setting. This study included 203 first‐line EV + P treated patients from 20 Austrian centres. The majority were male (77.3%), with a median age of 70 years (range, 26–92), while 33.5% were ≥75 years. Comorbidities were common, with 25.1% having a Charlson Comorbidity Index (CCI) ≥ 5, and 46.3% moderate to severe renal impairment. Among 195 evaluable patients, the objective response rate (ORR) was 63.6% (95% CI, 56.6–70.0), including 21.5% complete responses and 42.1% partial responses. Disease control was achieved in 75.4% (95% CI, 68.9–80.9). Median progression‐free survival (PFS) and overall survival (OS) were not reached after a median follow‐up of 5.8 months. Poor outcomes were associated with ECOG PS >2 (PFS, p = .003; OS, p< .001) and CCI ≥5 (PFS, p = .011; OS, p = .08). EV + P was generally well tolerated; grade ≥3 treatment‐related adverse events occurred in 38.4% of patients and immune‐related adverse events in 19.2%. Limitations of this study include its retrospective design and short follow‐up. These findings support the clinical use of EV + P as first‐line treatment for la/mUC, demonstrating substantial effectiveness and manageable toxicity in a large real‐world population, including elderly and comorbid patients. Extended follow‐up is warranted to determine long‐term survival and predictive markers of response.