<h2>Peak esophageal intraepithelial eosinophil counts</h2>
Most studies use&nbsp;peak esophageal intraepithelial eosinophil counts&nbsp;(eosinophils per high-power field, or EOS/HPF) to determine histologic outcome, using both percent change in peak EOS/HPF as well as proportion of patients achieving a treatment response, as shown below.4

<h3>How treatment responses are classified4</h3>
<ul>
 <li>&lt;1 EOS/HPF
 <ul>
 <li>(Normal biopsy)&nbsp;Considered a&nbsp;complete histological remission</li>
 </ul></li>
 <li>≥1 to &lt;15 EOS/HPF
 <ul>
 <li>(Reduced eosinophilia)&nbsp;Considered the&nbsp;histologic response threshold</li>
 </ul></li>
 <li>≥15 EOS/HPF
 <ul>
 <li>(Persistent eosinophilia)&nbsp;Considered a&nbsp;non-response</li>
 </ul></li>
</ul>

<h2>Peak EOS/HPF is the most common histologic measure of disease severity4</h2>
&lt;1 complete normalization
<h3>Normalized enrichment score</h3>
The&nbsp;Normalized Enrichment Score (NES)&nbsp;is an additional assessment to confirm the diagnosis using gene expression of interest in eosinophilic esophagitis compared with healthy controls.5
<h3>How NES is assessed</h3>
The EoE diagnostic panel, or EDP (shown below), is a molecular diagnostic test that differentiates patients with eosinophilic esophagitis from normal controls based on 94 EoE genes; a heatmap shows which gene transcripts are upregulated (red) relative to normal controls (blue).5

<h2>EoE Diagnostic panel heatmap5</h2>
<ul>
 <li>Patients with EoE&nbsp;</li>
 <li>Normal controls&nbsp;</li>
</ul>

<h2>NES scores appear to normalize in EoE patients after successful treatment6</h2>

<h3>EoE-HSS Composite score</h3>
The&nbsp;Eosinophilic Esophagitis Histologic Scoring System (EoE-HSS)&nbsp;is a scoring system that measures histologic changes in the esophagus beyond eosinophil count, including barrier function and remodeling, grading 8 features of eosinophilic esophagitis to quantify frequency, severity, and extent of abnormalities.7
<h3>How NES is assessed</h3>
Pathologists score histological degree of abnormality (grade) and histological extent of pathologic severity (stage) using a 4-point scale for each feature (0=normal; 3=most severe or extensive). The maximum possible grade or stage score for each biopsy is 24.7

<h3>EoE-HSS Composite scores are more predictive of treatment response than eosinophil count alone4,7</h3>
<ul>
 <li>0 (normal)</li>
 <li>24 (most severe or extensive)</li>
</ul>

References

Measures of Disease Severity in Eosinophilic Esophagitis (EoE)

EOSINOPHILIC-ESOPHAGITIS-EOE

GASTROENTEROLOGY

In this episode, Paivi Hamalainen, Finnish neuropsychologist at Masku Neurological Rehabilitation Centre in Finland talks about the treatment of cognitive impairments of a chronic disease, and what neurologists can learn in order to provide a more holistic approach to treating patients with MS disease.

MULTIPLE-SCLEROSIS

NEUROLOGY

Cognitive training – A curse or a blessing?

What happens when our cognitive&nbsp; functioning is challenged – which is the case for many people living with MS? To shed some light on the impact of cognitive decline and the future perspectives for cognitive rehabilitation in MS, we have the pleasure of having Hanneke Hulst, assistant professor from the MS center in Amsterdam, (Amsterdam UMC – VUmc), in the studio for this episode.&nbsp;October 2020.

Cognitive decline – The invisible burden of MS?

Biomarkers are important in MS, as they can potentially help with diagnosing patients, inform about disease prognosis, and help monitor disease activity and progression. Neurofilament light chain (NfL) is one of the most promising biomarkers in MS, but is it ready for clinical practice? In this episode, Professor of Neurology Finn Sellebjerg will tell us about the potential and limitations of this exciting biomarker.&nbsp;

A promising biomarker in MS: Neurofilament light chain

<h2>WHY IS IT IMPORTANT TO ASSESS MULTIPLE DISEASE DOMAINS IN EoE?</h2>

Outcomes from different disease domains may be discordant with one another14
<ul>
 <li>Symptoms may persist and fibrotic changes may still occur despite histologic remission 9,15,16</li>
 <li>Symptoms may not be present despite endoscopic and histologic evidence of inflammation3</li>
 <li>Subtle esophageal findings of EoE may not be recognized by the less-experienced endoscopist and routine endoscopic findings alone may not detect sections of reduced luminal diameter and microscopic inflammation, thereby requiring additional histologic assessments 9,14,15,17,18</li>
 <li>EoE specific QoL assessments may not correlate with mild forms of endoscopic features of EoE and basal layer hyperplasia, thus requiring confirmation from endoscopic and histologic findings 3</li>
</ul>

black

<table border="1" cellpadding="1" cellspacing="1" style="width: 100%;">
 <tbody>
 <tr>
 <td style="text-align: center; background-color: rgb(91, 37, 148);">&nbsp; Comprehensive assessment using symptoms and QoL, histology, and endoscopy, enables an individualized, patient-centric approach to the management of EoE7,9,11,15</td>
 </tr>
 </tbody>
</table>

Importance of assessing key disease domains in EOE

<ul>
 <li>
 Median diagnostic delay of EoE is&nbsp;1-2 years&nbsp;in children, and increases with age1</li>
 <li>
 Every year of symptoms before diagnosis Increases the chance of fibrostenosis by&nbsp;5%2*</li>
</ul>
Early diagnosis and intervention may improve QoL of children with EoE and reduce progression of disease&nbsp;3-5

Unmasking the Hidden Symptoms!&nbsp;Gain critical insights into the often-overlooked signs of eosinophilic esophagitis (EoE) in children, understand the underlying pathophysiology, and explore cutting-edge diagnostic and treatment options.

This must-read content will equip you with the knowledge to better identify and manage EoE, ensuring improved outcomes for your pediatric patients.

EOE Pediatric - Unmasking the Hidden Symptoms

TYPE-2-DIABETES

DIABETES

The SoliRam observational study

Prof. Abdulrahman A. Alshaikh, Professor Physician &amp; Endocrinologist at KAU &amp; DSFH, Chairman of Saudi Scientific Diabetes Society, Saudi Arabia, presents iGlarLixi safety and effectiveness in adults with T2D who fast during Ramadan in Gulf region (SoliRam study sub-analysis).

<h2>The burden associated with insulin self-management is high and&nbsp;People With Diabetes are responsible&nbsp;for most of their daily regimen</h2>

HCP, healthcare professional; PWD, person with diabetes. Diabetes UK. Diabetes Education and Self-Management. Available at: <a href="https://www.diabetes.org.uk/professionals/resources/shared-practice/diabetes-education#:~:text=Use%20the%20following%20resources%20and,year%20with%20a%20healthcare%20professional" target="_blank">https://www.diabetes.org.uk/professionals/resources/shared-practice/diabetes-education#:~:text=Use%20the%20following%20resources%20and,year%20with%20a%20healthcare%20professional</a>&nbsp;(last accessed September 2023)

<h2>With this&nbsp;high burden&nbsp;on the individual with diabetes, concordance to insulin therapies remains low</h2>
People with T2D may be likely to&nbsp;miss, mistime or reduce&nbsp;their basal insulin doses

A large proportion of missed or mistimed basal insulin doses were reported as&nbsp;unintentional, 
 whereas the majority of reduced basal insulin doses were reported as intentional

The GAPP2 study was an online multinational cross-sectional study of people with T2D currently treated with basal insulin (N=3,042), and HCPs involved in the care of such people. Basal insulin concordance patterns were evaluated with respect to three types of dosing irregularity: missed, mistimed [±2 hours from prescribed time], and reduced dose over the last 30 days. A total of 3,042 people with T2D treated with basal insulin analogs and 1,222 prescribers completed the full survey. GAPP2, Global Attitude of Patients and Physicians 2. Brod M, et al. Curr Res Med Opin 2012;28:1933–46.

<h2>Multiple barriers&nbsp;exist to facilitate and maximize concordance to basal insulin therapy</h2>

Psychological burden on people with diabetes

Little understanding of impact of insulin and 
 lifestyle on glycemic variability

Feelings of guilt and embarrassment, and 
 perception as a burden on the system

Time burden regarding dosing 
 and recording

Physicians do not know the extent of glycemic 
 variability’s impact on a person’s daily life

Lack of data sharing with healthcare provider 
 owing to fears of judgement

Struggle with injections (missed doses)

Time spent during consultation&#xb;is generally low

Reference

INTEGRATED-DIABETES-CARE

The burden associated with insulin self-management

TYPE-1-DIABETES

T1DM Mini-Series: The main challenge for the kids and adolescents with T1

Prof. Thomas Danne, Diabetes Center for Children and Adolescents, Children’s Hospital on the Bult, Hannover Germany, provides insights into T1DM treatment in a set of mini-series. This video is focusing on the main challenge for the kids and adolescents with Type 1.

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