Background: Multiple studies have described the effectiveness of ustekinumab (UST) and vedolizumab (VDZ) in patients with Crohn’s disease (CD) failing anti- Tumor necrosis factors (TNFs); however, the effectiveness of VDZ or UST as a third-class biologic has not yet been described. Aims and Methods: In this retrospective multicenter cohort study, we aimed to investigate the effectiveness of VDZ and UST as a third-class biologic in patients with CD. Results: Two-hundred and four patients were included; 156/204 (76%) patients received VDZ as a second- and UST as a third-class therapy (group A); the remaining 48/204 (24%) patients received UST as a second- and VDZ as a third-class therapy (group B). At week 16–22, 87/156 (55.5%) patients and 27/48 (56.2%) in groups A and B, respectively, responded to treatment (p = 0.9); 41/156 (26.2%) and 15/48 (31.2%) were in clinical remission (p = 0.5). At week 52; 89/103 (86%) patients and 25/29 (86.2%) of the patients with available data had responded to third-class treatment in groups A and B, respectively (p = 0.9); 31/103 (30%) and 47/29 (24.1%) were in clinical remission (p = 0.5). Conclusion: Third-class biological therapy was effective in more than half of the patients with CD. No differences in effectiveness were detected between the use of VDZ and UST as a third-class agent.

Autoimmune thyroid diseases (ATDS) are multifactorial conditions that result from genetic predisposition in combination with environmental risk factors. Helicobacter Pylori (HP) infection as an environmental risk factor has been proposed to initiate the antigenic components of the thyroid cell membrane and may play a leading role in the onset of the auto immune diseases such as Hashimoto's thyroiditis (HT).The Aim: To investigate the association between H.P infection and HT and the prevalence of cag. A positive strains H.P in the patients. Methods:The study include 40 female patients with Hashimoto's thyroiditis as a case group and 30 healthy female as control group. HP antigen in stool samples using unamplified enzyme immunoassay and Cag. Ainserum samples using an enzyme linked immunoassay method (ELISA). Anti-thyroid peroxidase antibodies (anti TPO) and thyroid function tests thyroid stimulating hormone (TSH) and thyroxine (T4) were determined. Results:There is statistically significant association between H P and HT (Odd ratio = 8.1, 95% confidence interval: 3-30.1, p<0.001). Also statistically significant association between presence of Cag-A positive strains of HP and HT (odd ratio=5.3, p=0.001). To establish the significant correlation between HP and HT further and more specialized studies are needed. Conclusion:There was a significant association between Hashimoto's thyroiditis and H.P infection and significant prevalence of cag. A positive strain of H.P positive patients and HT

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