Early discontinuation of biological therapy among inflammatory bowel disease patients in Bahrain: Real world experience.

Background: Despite the effectiveness of several biological agents in the treatment of inflammatory bowel disease (IBD), some patients respond better than others. Such discrepancies are often evident early in the treatment course. The aim of this study is to identify the risks and assess the rate of early biological discontinuation (BD) among IBD patients. Methods: In this retrospective cohort study conducted in Bahrain all IBD patients who were administered biological agents between June 2009 and June 2019 were included. Medical records were reviewed to collect study data and confirm IBD diagnoses. Early discontinuation of biological agents was defined by discontinuation of a biological agent (within 6 months from administration). Montreal classification was used to classify Crohn's disease and ulcerative colitis (UC) according to location and extension, respectively. Results: Ineffectiveness was the most common reason for early BD. Early BD was not related to the type of IBD, biological agent used, or to most patient-related factors (such as gender and family history). Patient age at index biological initiation was the only independent significant predictor of early BD (P = 0.045, adjusted odds ratios (95% CI): 1.06 (1.001-1.116)] even after correction of two significant factors: comorbid diabetes and marked weight loss at diagnosis. Conclusion: The older the IBD patient at the time of biological therapy initiation, the higher the incidence of early BD. Therefore, caution and close follow-up are required for biological therapy among elderly patients to assess effectiveness and adverse drug reactions.

Transarterial embolization of acute carotid blowout syndrome postneck dissection.

Carotid blowout syndrome is described as rupture of the carotid artery most commonly following head and neck dissection. It is an uncommon complication that can be fatal if not diagnosed and managed promptly. This report will discuss the case of a 45-year-old male, who developed carotid blowout syndrome following receiving several therapies for his laryngeal cancer. It will include how careful assessment of the patient's current state and taking into consideration his previous history and risk factors can lead to a case-tailored management plan to be performed in a timely manner, maximizing the chances of a successful life-saving procedure.