A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases

Background: Meta-analyses on the effects of probiotics on specific gastrointestinal diseases have generally shown positive effects on disease prevention and treatment; however, the relative efficacy of probiotic use for treatment and prevention across different gastrointestinal diseases, with differing etiology and mechanisms of action, has not been addressed. Methods/Principal Findings: We included randomized controlled trials in humans that used a specified probiotic in the treatment or prevention of Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, Antibiotic Associated Diarrhea, Traveler’s Diarrhea, or Necrotizing Enterocolitis. Random effects models were used to evaluate efficacy as pooled relative risks across the eight diseases as well as across probiotic species, single vs. multiple species, patient ages, dosages, and length of treatment. Probiotics had a positive significant effect across all eight gastrointestinal diseases with a relative risk of 0.58 (95 % (CI) 0.51–0.65). Six of the eight diseases: Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, and Antibiotic Associated Diarrhea, showed positive significant effects. Traveler’s Diarrhea and Necrotizing Enterocolitis did not show significant effects of probiotcs. Of the 11 species and species mixtures, all showed positive significant effects except for Lactobacillus acidophilus, Lactobacillus plantarum, and Bifidobacterium infantis. Across all diseases and probiotic species, positive significant effects of probiotics were observed for all age groups, single vs. multiple species, and treatment lengths

Visual processing in migraine

Background Migraine is a common neurological condition that often involves differences in visual processing. These sensory processing differences provide important information about the underlying causes of the condition, and for the development of treatments. Review of psychophysical literature Psychophysical experiments have shown consistent impairments in contrast sensitivity, orientation acuity, and the perception of global form and motion. They have also established that the addition of task-irrelevant visual noise has a greater effect, and that surround suppression, masking and adaptation are all stronger in migraine. Theoretical signal processing model We propose utilising an established model of visual processing, based on signal processing theory, to account for the behavioural differences seen in migraine. This has the advantage of precision and clarity, and generating clear, falsifiable predictions. Conclusion Increased effects of noise and differences in excitation and inhibition can account for the differences in migraine visual perception. Consolidating existing research and creating a unified, defined theoretical account is needed to better understand the disorder

Bleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillation

International audienceOBJECTIVE: Direct oral anticoagulants have been evaluated in the general population, but proper evidence for their safe use in the geriatric population is still missing. We compared the bleeding risk of a direct oral anticoagulant (rivaroxaban) and vitamin K antagonists (VKAs) among French geriatric patients with non-valvular atrial fibrillation (AF) aged ≥80 years. METHODS: We performed a sequential observational prospective cohort study, using data from 33 geriatric centres. The sample comprised 908 patients newly initiated on VKAs between September 2011 and September 2014 and 995 patients newly initiated on rivaroxaban between September 2014 and September 2017. Patients were followed up for up to 12 months. One-year risks of major, intracerebral, gastrointestinal bleedings, ischaemic stroke and all-cause mortality were compared between rivaroxaban-treated and VKA-treated patients with propensity score matching and Cox models. RESULTS: Major bleeding risk was significantly lower in rivaroxaban-treated patients (7.4/100 patient-years) compared with VKA-treated patients (14.6/100 patient-years) after multivariate adjustment (HR 0.66; 95% CI 0.43 to 0.99) and in the propensity score-matched sample (HR 0.53; 95% CI 0.33 to 0.85). Intracerebral bleeding occurred less frequently in rivaroxaban-treated patients (1.3/100 patient-years) than in VKA-treated patients (4.0/100 patient-years), adjusted HR 0.59 (95% CI 0.24 to 1.44) and in the propensity score-matched sample HR 0.26 (95% CI 0.09 to 0.80). Major lower bleeding risk was largely driven by lower risk of intracerebral bleeding. CONCLUSIONS: Our study findings indicate that bleeding risk, largely driven by lower risk of intracerebral bleeding, is lower with rivaroxaban than with VKA in stroke prevention in patients ≥80 years old with non-valvular AF

Crise epiléptica única: análise dos fatores de risco para recorrência First seizure: analysis of risk factors for recurrence

Estudamos crianças acompanhadas em nosso Ambulatório de Epilepsia Infantil que apresentaram primeira crise epiléptica não provocada no período de setembro/1989 a julho/1996. O tempo médio decorrido entre a crise e a inclusão no estudo foi 16 dias. As variáveis: idade, sexo, tipo e etiologia da crise epiléptica, estado de sono, antecedente de convulsão febril (CF), antecedente de crise não provocada nos familiares próximos (AF), eletrencefalograma (EEG) e tomografia computadorizada (TC) foram avaliadas como fatores de risco para recorrência. Encontramos dois grupos de pacientes, quanto a etiologia das crises: -(a) crises idiopáticas (G-CI) e (b) crises sintomáticas remotas (G-CSR). Este último grupo tinha apenas dois pacientes e foram excluídos. Prosseguimos a análise com os pacientes do G-CI (n=86). Foi observada recorrência em 29 crianças (33%), durante seguimento médio de 2,4 anos. Através de método estatístico, que utilizou o modelo de riscos proporcionados para análise uni e multivariada, observamos que os pacientes com EEG alterado e aqueles com AF positivo tiveram maior risco de recidiva (p < 0,003). Observando a curva de sobrevivência, estimou-se risco de recorrência após primeira crise: 18% no primeiro semestre e 27%, 35%, 38% no primeiro, segundo e terceiro anos, respectivamente.<br>We studied chidren who presented with a first seizure and came to the outpatient clinic for childhood from September/1989 to July/1996. The following risk factors were assessed: age, sex, type and etiology of the seizure, sleep state at time of seizure, family history of seizures, electroencephalogram (EEG) and computerized tomography (CT). Our purpose was to assess the risk factors in univariable and multivariable analisys. We found two groups of patients according to the etiology: (a) idiopathic cases (IC) and (b) syntomatic cases (SC). This last group had only two patients and was excluded from the analisys. We studied only the IC group with 86 patients. Seizure recurrence was observed 29 children (33%), during 2.4 years. Only patients with abnormal EEG and family history for unprovoked seizures had a higher risk of recurrence (p <0.003). .After the first unprovoked seizure estimate of recurrence by survival curves was 18% at first semester, 27% at first year,35% at second year and 38% at third year