@article {8494, title = {Thalidomide for inflammatory bowel disease: Systematic review.}, journal = {Medicine (Baltimore)}, volume = {95}, year = {2016}, month = {2016 Jul}, pages = {e4239}, abstract = {

BACKGROUND: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases.

METHODS: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events.

RESULTS: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3\%) patients. Clinical remission was achieved in 220/427 (51.5\%) cases. Maintenance of remission was reported in 128/160 (80.0\%) patients at 6 months and in 96/133 (72.2\%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7\%) patients. Fistulas improved in 49/81 (60.5\%) cases and closed in 28/81 (34.6\%). Endoscopic improvement was observed in 46/66 (69.7\%) and complete mucosal healing in 35/66 (53.0\%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3\%) adverse events and were the most frequent cause of drug withdrawal.

CONCLUSION: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments.

}, issn = {1536-5964}, doi = {10.1097/MD.0000000000004239}, author = {Bramuzzo, Matteo and Ventura, Alessandro and Martelossi, Stefano and Lazzerini, Marzia} } @article {3583, title = {Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.}, journal = {BMC Health Serv Res}, volume = {14}, year = {2014}, month = {2014}, pages = {327}, abstract = {

BACKGROUND: The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.

METHODS: Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).

RESULTS: Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1\%) when no X-ray was provided to 16/42 (38\%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3\%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 {\textpm} 21.8 minutes with remote X-ray consultation, compared to 56.2 {\textpm} 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 {\textpm} 0.37 vs 9.91 {\textpm} 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 {\textpm} 0.32 vs 9.92 {\textpm} 0.31; p = 0.88).

CONCLUSIONS: Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

}, keywords = {Adolescent, Child, Child, Preschool, Computers, Handheld, Decision Making, Fractures, Bone, Humans, Infant, Infant, Newborn, Italy, Prospective Studies, Remote Consultation, Teleradiology, Time Factors}, issn = {1472-6963}, doi = {10.1186/1472-6963-14-327}, author = {Zennaro, Floriana and Grosso, Daniele and Fascetta, Riccardo and Marini, Marta and Odoni, Luca and Di Carlo, Valentina and Dibello, Daniela and Vittoria, Francesca and Lazzerini, Marzia} } @article {1816, title = {Thromboembolism in pediatric inflammatory bowel disease: systematic review.}, journal = {Inflamm Bowel Dis}, volume = {17}, year = {2011}, month = {2011 Oct}, pages = {2174-83}, abstract = {

BACKGROUND: Several studies suggest an increased risk of venous and arterial thromboembolism (TE) in adults with inflammatory bowel disease (IBD) compared to the general population. We performed a systematic review of studies on incidence and characteristic of TE in children with IBD.

METHODS: We searched Medline, LILACS, EMBASE, POPLINE, CINHAL, and reference lists of identified articles, without language restrictions, in August 2010.

RESULTS: Population studies suggest that there is an increased risk of TE in children with IBD compared to controls. TE occurred in children with IBD in all age ranges, mostly (82.8\%) during active disease, and more frequently in children with ulcerative colitis (odds ratio [OR] 3.7, 95\% confidence interval [CI] 1.8-7.6). At least one specific risk factor for TE was recognized in 50\% of cases; two risk factors were present in 24\%. Out of 92 published cases of TE in children with IBD, 54.3\% occurred in cerebral site, 26\% in the limbs, 13\% in the abdominal vessels, and the remaining in the retina and lungs. After a first episode of TE, an early recurrence was observed in 11.4\% of children, a late recurrence in 10\%. A number of different therapeutic schemes were used. Overall mortality was 5.7\% and was mostly associated with cerebral TE.

CONCLUSIONS: Population studies are needed to clarify the risk of TE in children with IBD, the relative weight of other risk factors, the characteristics of the events, and to define guidelines of therapy and prophylaxis.

}, keywords = {Adult, Child, Humans, Inflammatory Bowel Diseases, Risk Factors, Thromboembolism}, issn = {1536-4844}, doi = {10.1002/ibd.21563}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Maschio, Massimo and Martelossi, Stefano and Ventura, Alessandro} }