Thirty two patients with active Crohn's disease were included in a controlled randomised trial to determine the efficacy and safety of polymeric enteral nutrition compared with steroids, to achieve and maintain clinical remission. The polymeric diet was administered through a fine bore nasogastric tube by continuous, pump assisted infusion (2800 (SEM 120) kcal/day). The steroid group received 1 mg/kg/day ofprednisone. Both treatments were effective in inducing clinical remission: 15 of the 17 patients given steroids and 12 ofthe 15 patients assigned to the polymeric diet went into clinical remission (defined by a Van Hees index <120) within four weeks of treatment. The percentage reduction of the Van Hees index was 34*8 (4.9)% for steroids and 32 3 (5)% for enteral nutrition (mean difference 2-5%; 95% CI -11-8% to +16-8%). Mean time elapsed to achieve remission was similar in both groups (2.0 (1) v 2-4 (1.2) weeks). Tolerance of the enteral diet was excellent. Four patients in the steroid group had mild complications attributable to this treatment. Ten patients (66.6%) in the steroid group and five (41.6%) in the enteral nutrition group relapsed within a year of discharge, but no differences were found in the cumulative probability of relapse during the follow up period. These results suggest that polymeric enteral nutrition is as safe and effective as steroids in inducing short term remission in active Crohn's disease.

Objectives: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. Material and methods: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. Results: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. Conclusions: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.

Well-controlled HIV patients with low Framingham risk score have a high prevalence of subclinical carotid atherosclerosis, and the main risk factors are age and inflammation. These patients are not receiving primary prophylaxis for cardiovascular events according to current guidelines.

Background. The reported prevalence of HIV-associated neurocognitive disorders in HIVpeople depends on the population studied and the methodology used. We analyze the prevalence of neurocognitive impairment (NCI) and associated factors in patients on successful antiretroviral therapy (ART), without comorbidities. Matherial and methods. Cross-sectional observational study in HIV-subjects, ≥18 yearsold, on stable ART and HIV viral load <50copies/mL. Patients with medical or psychiatric comorbidities and substance abuse were excluded. NCI was diagnosed using Frascati criteria, examining seven neurocognitive domains. We analyzed the association between NCI and: HIV-related clinical variables, carotid intima media thickness, bacterial traslocation, and plasma inflammatory biomarkers (soluble CD14, Interleukin-6 [IL-6], and tumor necrosis factor-α). The prevalence of NCI was calculated with a 95%CI. We fitted a logistic regression model to assess the strength of the associations. Results. Eighty-four patients were included with an observed NCI prevalence of 29.8% (95%CI: 21.0-40.2): 19% had asymptomatic neurocognitive impairment; 8.3%, mild neurocognitive disorder; 2.4%, HIV-associated dementia. Delayed recall was the most commonly affected neurocognitive domain (27.4%). People diagnosed at least 10 years ago (OR:6.5, 95%CI: 1.6-21.7) and those with IL-6 levels above 1.8 pg/mL (OR:6.0, 95%CI 1.1-31.3.3) showed higher odds of NCI in adjusted analyses. Participants with carotid plaques had lower scores for delayed recall: −0.9±1.1 versus −0.2±1.1 (p=0.04). Conclusions. Prevalence of NCI is high in otherwise healthy adults with HIV-infection. In this population, more than 10 years since HIV diagnosis and high IL-6 levels are associated with NCI. Delayed recall neurocognitive domain is worse in patients with subclinical atherosclerosis.