Infliximab rescue therapy in a patient with acute severe ulcerative colitis and coronavirus disease 2019 followed by Escherichia coli 0157:H7 infection: a case report

The management of patients with acute severe ulcerative colitis and SARS-CoV-2 presents a clinical challenge. We report on the first case of a patient with acute severe ulcerative colitis and mild coronavirus disease 2019 (COVID19) who received rescue infliximab therapy, followed by a relapse caused by enterohemorrhagic Escherichia coli 0157:H7. The treatment challenges we faced were biologic therapy administration during active COVID-19, about which little was known at the time, and how to treat EHEC due to the risk of hemolytic uremic syndrome. Acute severe ulcerative colitis was treated with rescue infliximab therapy, and enteric infection with an antibiotic, both with satisfactory clinical response. The decision to induce biologic therapy for inflammatory bowel disease relapse in SARS-CoV-2-positive patients should be made on a caseto-case basis and should be driven by the dominant disease. Our patient tested positive for SARS-CoV-2, but actually had mild disease. At the same time, she had acute severe ulcerative colitis, so we started anti-tumor necrosis factor therapy despite serological tests and the recommendation to delay biological therapy administration for two-weeks. Second, due to severity of the first flare, COVID-19, and the patient’s general condition, we opted for an antibiotic treatment of Escherichia coli 0157:H7 while monitoring the parameters of potential hemolytic uremic syndrome developmen

Antimicrobial resistance of H. pylori to the outcome of 10-days vs. 7-days Moxifloxacin based therapy for the eradication: a randomized controlled trial

<p>Abstract</p> <p>Introduction</p> <p>Antibiotic resistance decreases success of Helicobacter pylori (Hp) eradication. Recently published results show low rate of resistance and better compliance with moxifloxacin based regiments.</p> <p>Aims&methods</p> <p>Whether 7 days moxifloxacin with lansoprasole and amoxycillin can be compared with 10 days moxifloxacin with lansoprasole and amoxycillin according to moxifloxacin resistance. Patients with non-ulcer dyspepsia who had culture and histology positive Hp infection (n = 150) were randomly assigned into two groups. The first group (n = 75) received moxifloxacin 400 mg/d during 7 days and the other (n = 75) received moxifloxacin 400 mg/d during 10 days. All patients received amoxycillin 1 g twice daily, lansoprasole 30 mg twice daily. All Hp cultures were tested for sensitivity to moxifloxacin.</p> <p>Results</p> <p>138 patients (92%) completed the study, 68 in the first group and 70 in the second. Eradication rates were 84% (57/68) and 76% (57/75) in the 7 days moxifloxacin group and 90% and 84% in the second group (63/70, 63/75) according to the PP and ITT analysis; p = n.s. Among 129 patients (86% of study group), 6% of strains were primary resistant to moxifloxacin.</p> <p>Eradication of moxifloxacin sensitive/resistant strains was 98%/66%, p < 0.05</p> <p>Conclusion</p> <p>According to our results we recommend 7 days moxiflixacin based triple therapy.</p

Kako terapijski postupiti kod ciste koledokusa?

We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fibrosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic inflammation of the biliary system even cholangiocarcinogenesis. Our findings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. In our patient, timely choledochocele resection would have certainly contributed to the reduction of subsequent complications, as well as to obviating repeated invasive diagnostic and surgical procedures.Opisan je slučaj bilijarne ciste tip II. koja je u naše bolesnice usprkos svojoj a priori dobroćudnoj naravi bila uzrokom brojnih komplikacija poput ponavljajućih kolangitisa i pankreatitisa s posljedičnom jetrenom cirozom te potencijalnom opasnošću od perforacije koledohocele. Usprkos svojoj dobroćudnoj naravi bilijarne/koledohalne ciste mogu uzrokovati mnogobrojne poremećaje poput kolestaze s kolangitisom, pankreatitisom i bilijarnom sepsom, a s obzirom na kroničnu upalu bilijarnog sustava mogu pogodovati i nastanku kolangiokarcinoma. Iz primjera naše bolesnice može se zaključiti kako u određenom broju slučajeva čak i ovaj tip bilijarne ciste (prema dostupnoj literaturi najmanje zastupljen i najbenigniji tip) treba razmotriti s kirurškog aspekta, jednako kao i bilijarnu cistu tip I. Naime, pravodobna resekcija odnosno ekscizija bilijarne ciste u naše bolesnice svakako bi smanjila gore spomenute komplikacije, a isto tako i opetovane invazivne dijagnostičke i kirurške zahvate kojima je bolesnica bila višestruko podvrgnuta

Neuroleptici, donji jednjačni i pilorički sfinkter, sustav dušik oksida i pentadekapeptid BPC 157

It is not known how dopamine antagonists, L-NAME, L-arginine and stable gastric pentadecapeptide BPC-157 would interact with lower esophageal and pyloric sphincter pressure in rats (LES, PS). We revealed a fall in pressure within LES and PS as an indicative class effect of peripherally and centrally acting antipsihotics. In addition, given intraperitoneally alone and/or combined, all agents once daily through seven days, last application 24h before pressure assessment, BPC-157 mostly dose-dependently, counteracts all pressure falls induced by all antipsihotics; L-NAME induced a marked fall in both sphincters and worsened haloperidol and domperidone-failure; Larginine induced a smaller fall in both sphincters, but reversed L-NAME effect, and partly counteracted dopamine antagonists failure effect (haloperidol (LES)) as well as worsening of both haloperidol (LES) and domperidone (PS)- failure induced by L-NAME. Additional counteracting effect of BPC-157 was general, including all pressure decrease otherwise induced by L-NAME or Larginine, as well as complete counteraction of both spihnicters pressure worsening of haloperidol and domperidone (PS)-failure otherwise induced by L-NAME administration. In conclusion, counteracting potential of BPC-157 (as well as counteracting potential of L-arginine) can be against the conditions of dopamine receptor blockade and NOS-blockade

What is the Right Therapeutic Approach to Biliary Choledochal Cyst?

We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fibrosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic inflammation of the biliary system even cholangiocarcinogenesis. Our findings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. In our patient, timely choledochocele resection would have certainly contributed to the reduction of subsequent complications, as well as to obviating repeated invasive diagnostic and surgical procedures