Immune mediated colitis: a surgical perspective

Background

This study aims to review and summarize the current up to date literature that explore the current treatment approaches to immune mediated colitis and the role of surgical specialties in the landscape of management.

Methods

A narrative review of papers was performed following a literature search through Medline, EMBASE and Cochrane Central databases pertaining to immune mediated colitis as an adverse event of cancer immunotherapy.

Results

Current guidelines for the diagnosis and treatment of immune mediated colitis mirror the approach to the workup of inflammatory bowel disease and guided by treating oncology and gastroenterology specialties. Immune mediated colitis however relies on surgical specific skills as a consequence of obtaining a diagnosis as well as in the management of complications that may arise.

Conclusion

Immune mediate colitis management has largely been under the purview of medical specialties. This review explores the current landscape of managing immune mediated colitis from a surgical perspective and highlights key areas in which surgeons can engage in the multidisciplinary care of this condition. To facilitate prompt diagnosis and management of immune-mediated colitis, there is an increasing necessity for surgeons to become familiar with the latest multidisciplinary approaches and recommendations.     

Efficacy of Jessener solution versus intralesional steroid in treatment of alopecia areata

Background

Alopecia areata is an autoimmune condition that causes non-scarring hair loss. To date, there is no single cure and treatment remains challenging.

Objectives

To evaluate the efficacy of Jessener solution versus intralesional steroid in treatment of Alopecia Areata.

Methods

This study included 40 patients who presented with multifocal patchy alopecia areata (AA). For each patient, three patches were randomly selected to be treated one with intralesional steroid, another with topical Jessner solution and the third with normal saline. Three sessions were done 3 weeks apart and were followed up for 3 months. Response was assessed clinically and by trichoscope.

Results

Fifteen percent of patches coated with Jessner or injected with steroids showed an excellent response while 20% of patches coated with Jessner and 32.5% patches injected with steroids showed a good response. A significant difference was observed between the three modalities of treatment regarding the prognostic score for response (p < 0.001) as patches coated with Jessner and those steroid injected showed a significant higher response rate than patches injected with saline (p < 0.001) while no significant difference was reported between patches either treated with Jessner or steroids (p > 0.05).

Conclusion

Jessners solution can be a novel and feasible and well tolerated modality of treatment for patients suffering from alopecia areata.     

The Delirium Interview as a new reference standard in studies on delirium assessment tools

Background

The reference standard in studies on delirium assessment tools is usually based on the clinical judgment of only one delirium expert and may be concise, unstandardized, or not specified at all. This multicenter study investigated the performance of the Delirium Interview, a new reference standard for studies on delirium assessment tools allowing classification of delirium based on written reports.

Methods

We tested the diagnostic accuracy of our standardized Delirium Interview by comparing delirium assessments of the reported results with live assessments. Our reference, the live assessment, was performed by two delirium experts and one well-trained researcher who registered the results. Their delirium assessment was compared to the majority vote of three other independent delirium experts who judged the rapportage of the Delirium Interview. Our total pool consisted of 13 delirium experts with an average of 13 ± 8 years of experience.

Results

We included 98 patients (62% male, mean age 69 ± 12 years), of whom 56 (57%) intensive care units (ICUs) patients, 22 (39%) patients with a Richmond Agitation Sedation Scale (RASS) < 0 and 26 (27%) non-verbal assessments. The overall prevalence of delirium was 28%. The Delirium Interview had a sensitivity of 89% (95% confidence interval [CI]: 71%–98%) and specificity of 82% (95% CI: 71%–90%), compared to the diagnosis of an independent panel of two delirium experts and one researcher who examined the patients themselves. Negative and positive predictive values were 95% (95% CI: 86%–0.99%), respectively, 66% (95% CI: 49%–80%). Stratification into ICU and non-ICU patients yielded similar results.

Conclusion

The Delirium Interview is a feasible reference method for large study cohorts evaluating delirium assessment tools since experts could assess delirium with high accuracy without seeing the patient at the bedside.