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- Is There Evidence of Crohn’s Disease Exclusion Diet (CDED) in remission of active disease in children and adults? A Systematic ReviewPublication . Correia, Inês; Almeida Oliveira, Patricia; Antunes, Maria Da Luz; Raimundo, Maria da Graça; Moreira, Ana CatarinaCrohn’s disease (CD) is an inflammatory bowel disease. Previous research has explored the impact of diet on CD, as specific dietary components can influence gut microbiota and immune responses, contributing to damage in the gastrointestinal tract. The Crohn’s Disease Exclusion Diet (CDED) is based on an exclusion diet; it is a recent dietary approach that is often used alongside partial enteral nutrition (PEN) and aims to induce disease remission by excluding certain dietary components. This study assesses the current evidence for the effectiveness of the CDED + PEN in achieving remission in both children and adults with active CD. Our systematic review followed PRISMA recommendations and was registered in PROSPERO with CRD number 42022335076. The searched databases were PubMed/MEDLINE, Cochrane Library, Scopus, and Web of Science. The included studies were analyzed using Rayyan software, and the risk of bias was assessed with Cochrane RevMan 5.0 software. The primary assessed outcome was clinical remission, evaluated with validated questionnaire scores such as PCDAI, CDAI, or HBI. All analyzed papers yielded promising results. Notably, the CDED + PEN demonstrated better tolerance than exclusive enteral nutrition (EEN), resulting in higher adherence rates. Therefore, the CDED + PEN appears to be a viable alternative for induction remission in active disease for both children and adults with CD.
- Metastatic gastric adenocarcinoma in a grey seal Halichoerus grypus: Clinicopathological and immunohistochemical characterizationPublication . Marques, Gonçalo Nogueira; Marti-Garcia, Bernat; Leal, Miriam Oliveira; Silva, Nuno Urbani Ramos da; Flanagan, Carla Anne; Suárez-Bonnet, Alejandro; Leal, M OliveiraA 33 yr old female grey seal. Halichoerus grypus presented with inappetence and progressive weight loss. Medical management included blood analysis, imaging, and fecal evaluation, along with multimodal supportive therapy, which periodically improved the overall medical condition. Six months after the initial presentation, the clinical condition deteriorated significantly, including severe hyporexia, hematemesis, and marked neutrophilic leukocytosis, which led to the decision to euthanise based on welfare grounds. Necropsy findings included severe thickening of the distal esophagus, cardia, and proximal gastric fundus, as well as multiple nodular to cystic structures over the stomach’s serosa, omentum, and mesentery. Histologically, a mucinous gastric adenocarcinoma was diagnosed, with metastasis to the gastric lymph nodes and prominent carcinomatosis involving the omentum, mesentery, and diaphragm. Immunohistochemically, the gastric adenocarcinoma was positive for cytokeratin AE1/AE3, weakly positive for COX-2 and E-cadherin, and negative for vimentin. The Ki-67 proliferative index was low (0.8). Although rare, this case offers further insights into the clinical presentation, histopathology, and immunohistochemical profile of gastric tumors in pinnipeds.