Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Fecal microbiota transplantation in recurrent Clostridium difficile infection: the first prospective study of 30 patients in Romania

Introduction: The infection with Clostridium difficile has increased in incidence worldwide and it raises many problems with regard to therapy, resistance to treatment and especially recurrence. Recurrence is frequent in patients treated for Clostridium difficile infection, requiring vancomycin by mouth, with limited alternatives. The literature shows that one of the most efficient treatment methods in Clostridium difficile infection is the transplantation of gut microbiota, also known as fecal microbiota transplantation. Aim: We present our results following FMT performed in patients with recurrent Clostridium difficile infection, and propose a simple and effective protocol for fecal microbiota transplantation. Study design: The study was prospective. The phases of the FMT procedure: assessment of patient eligibility, patient’s consent, identification and screening of donors, discontinuation of antibiotics (vancomycin, metronidazole) 3 days prior to the procedure. Methods: Between 2013 and 2015, FMT was performed in 30 patients with recurrent Clostridium difficile infection, by direct infusion of extensively processed donor fecal matter via colonoscopy. We followed up the patients for 12 months. Results: Immediate post-transplantation outcome in what concerns stool frequency during the follow-up period (7 days) was encouraging in 93.33% of patients. The donors were healthy individuals (53% 1st degree relatives), previously screened for possible infections and infestations. This result was sustained at 6-month and 12-month follow-up. Post-transplantation recurrence occurred in 6.67% (2 patients), which responded well to treatment and did not require a new vancomycin course. Conclusions: Fecal microbiota transplantation via colonoscopy is effective, safe, easy to perform, it yields lasting results and is therefore a good option for recurrent or treatment-resistant Clostridium difficile infection

The influence of pH and the source of nitrogen on the mycelial growth of the Pleurotus ostreatus mushrooms

Pleurotus ostreatus mushrooms (popularly called phage trout or oyster mushroom) are edible flora mushrooms under natural conditions, created spontaneous by beech wood waste, from which he also received the popular name of "Trout phage". Cultivation in artificial conditions required a long work of research and selection carried out in different countries around the world to adapt to the growing conditions in artificially climate, with making a substrate of culture optimal to obtain yields bigger per unit area, in terms of profitability. Pleurotus ostreatus mycelium development requires a rich material in polysaccharides and lignin, sufficiently low in essential minerals and without having been previously attacked by bacteria (decomposed). Compared with mineral sources, organic nitrogen sources have a particular influence on mycelial growth. Thus, the addition of barley flour or malt fangs is favorable. In contrast to the genus Agaricus mushroom, at Pleurotus species the nutrient medium does not require a fence part (fermentation) of the transformed microorganisms or partially hydrolysed by physico-chemical processes. Pleurotus ostreatus mycelium growth is carried out at pH values between 5 and 6.5 the limits being from 4.2 to 7.5. A highly acidic pH (pH 4) stops the growth of mycelium. Increasing the pH of 4 to 6.5 has a positive influence on the growth of mycelium, unlike higher values, ie pH neutral or slightly alkaline (pH 7-8), when the mycelium growth is again partially inhibited. With regard to sources of nitrogen, it has been found that the addition of albumin, in the form of soybean meal, reduces the mycelium growth and delay the production of mushrooms

Rapid Recovery of a Rectovaginal Fistula with Infliximab in a Patient with Crohn&apos;s Disease

Abstract We present the case of a female patient diagnosed with colonic Crohn&apos;s disease, having a clinical evolution with many recurrences and in whom conventional therapy had failed. The patient was admitted in our department 4 years after the onset of the disease, with an altered general state, diarrhea, malnutrition, fever and fecaloid vaginal discharge. Investigations classified the patient in a severe activity flare of Crohn&apos;s disease (CDAI 329), complicated with a rectovaginal fistula. Infliximab therapy was initiated. The evolution was rapidly favorable and the fistula closed after 4 weeks of therapy

Food quality of some vegetables and fruits juices

Fruits and vegetables juices are those drinks which are obtained by mechanical procedures (pressing, centrifugation) or by diffusion and which are conserved using different methods (concentration, chemical conservation, pasteurization). The juices with pulp or the nectars preserve the nutritional value of the products from which they come, but they are exposed to sedimentation. Five types of juices with pulp obtained from apples, pears, carrots, tomatoes and a blend (1:1:1 apples, pears, carrots) were analyzed regarding the efficiency of converting in juice, acidity, sugars, the content of C vitamin, nitrates and nitrites. The efficiency in juice for all the utilised variants was within the values found in the speciality literature. The results regarding the acidity and C vitamin revealed smaller values of those characteristics in natural juices with pulp in comparison with the similar juices from the supermarket for with those characteristics are adjusted