A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.

The paper presents the results of study of the antibacterial effect of silver nanoparticles when ingested, on the experimental model of peritonitis and meningoencephalitis in vivo. In conditions of the increasing resistance of bacteria to antibacterial drags, the search of alternative means which will allow to effectively deal with clinically significant microorganisms, is relevant. Such tools are the nanoparticles of metals, particularly the silver nanoparticles. According to results of conducted research, they show quite a high antibacterial and antiviolence activity. The study prove that at intra-cerebral introduction of pathogenic strains of microorganisms (experimental meningoencephalitis), after per oral use of nanosilver - effect didn&#180;t observed; in the group of animals with intra-peritoneal injection (experimental peritonitis) - the signs of inflammation of the peritoneum by microscopic examination didn&#180;t revealed.

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BackgroundAnkylosing spondylitis (AS), which occurs in about 10% of inflammatory bowel disease (IBD) patients[1], is more common in Crohn’s disease and does not correlate with bowel activity[2]. The occurrence of IBD in patients with AS is 4-16%[3-5].ObjectivesTo investigate the patterns of treatment modifications following newly diagnosed AS in patients with IBD or a new IBD diagnosis in patients with AS.MethodsThis is a retrospective observational study that included patients with coexisting IBD and AS that were followed simultaneously by the gastroenterology and the rheumatology departments of the Sheba Medical Center. Patients with a follow-up duration of at least 3 months since the second diagnosis were included.ResultsThe cohort consisted of 68 patients, 41 with a first diagnosis of IBD (fIBD-group) and 27 with a first diagnosis of AS (fAS-group). Patients in the fAS-group were younger (median age of 36 years, inter quartile range (IQR) 25-48 vs. 43 years IQR 35-56, p=0.043), had more Crohn’s disease (92.6% vs. 68.3%, p=0.016), had a shorter interval up to the second diagnosis (median of 3 years, IQR 1-6 vs. 6 years, IQR 2-11.5, p=0.03), and had an increased rate of past/current biologic treatment (81% vs. 51%, p=0.019) compared with the fIBD-group. Therapy modifications rates were 78% in the fIBD-group and 96% in the fAS-group. The most common modification for the fIBD-group was initiation of biologic therapy in 18/32 patients (Adalimumab 44%, Infliximab 33%, Golimumab 5.75%, Etanercept 5.75%, Certolizumab pegol 5.75%, Ustekinumab 5.75%). In the fAS-group, switching biologic agent to Adalimumab or Infliximab (42%) and ceasing NSAIDs (27%) were the most common (Figure 1). At 1-year follow-up there were no significant differences in clinical outcomes (treatment failure, surgery/hospitalization, clinical remission) between fIBD and fAS groups. However, patients in both groups with treatment modifications, had a trend for higher rate of IBD clinical remission than patients without (72% vs. 40%, p=0.066). No difference was found in AS clinical outcome.ConclusionTreatment modifications are common among newly coexisting IBD and AS patients, preferably biologic drug modifications. These modifications may contribute to IBD clinical remission.References[1]Harbord M, Annese V, Vavricka SR, et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease.J Crohns Colitis. 2016;10(3):239-254. doi:10.1093/ecco-jcc/jjv213[2]Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy.Curr Rev Musculoskelet Med. 2011;4(3):123-131. doi:10.1007/s12178-011-9085-8[3]Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management.Gastroenterology. 2021;161(4):1118-1132. doi:10.1053/j.gastro.2021.07.042[4]de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis.Arthritis Res Ther. 2016;18(1):196. Published 2016 Sep 1. doi:10.1186/s13075-016-1093-z[5]Fragoulis GE, Liava C, Daoussis D, Akriviadis E, Garyfallos A, Dimitroulas T. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment.World J Gastroenterol. 2019;25(18):2162-2176. doi:10.3748/wjg.v25.i18.2162Figure 1.Cohort stratification by diagnoses and treatment modificationsAS=ankylosing spondylitis; IBD= inflammatory bowel disease; MTX=methotrexate; 5-ASA=5-aminosalicylic acid; 6-MP=mercaptopurine; NSAIDS= non-steroidal anti-inflammatory drugs.Acknowledgements:NIL.Disclosure of InterestsNone Declared.