Obesity, diabetes and zinc: A workshop promoting knowledge and collaboration between the UK and Israel, November 28–30, 2016 – Israel

Sponsored by the Friends of Israel Educational Foundation (FIEF) and Ben-Gurion University of the Negev and supported by the EU COST action Zinc-Net (COST TD1304), a three-day collaborative UK-Israel workshop was organized by Drs Assaf Rudich, Imre Lengyel and Arie Moran. Participants from the UK and Israel met at the Desert Iris Hotel, Yeruham, Israel between the 28-30th of November 2016 for in-depth discussions, rather than a lecture series, to set the stage for future collaborative grants and projects on diabetes and zinc. Two days of formal scientific sessions with dynamic and wide-ranging discussions was followed by a day of touring and informal networking in the Negev area. This format was previously recognized by our sponsors as both effective and enjoyable and all participants agreed at the end of the meeting that the 3-days provided an excellent basis for future scientific collaboration. The discussions were centered on diabetes and obesity, already at pandemic levels, and zinc homeostasis which is related to the clinical issues and themes of the meeting. The free-flowing discussions were based on short presentations setting the scene for the six main topics: ‘Diabetes and zinc transporters’, ‘Nutrition related factors’, ‘Biomarkers’, ‘Clinical epidemiology’, ‘the Microbiome and diabetes’, and ‘Related diseases’. The abstract style summary of the sessions is followed by the major discussion points raised by the Authors and other participants (UK: Patrik Rorsman, Oxford University; Alan Stewart, University of St Andrews and Israel: Assaf Rudich, Idit Liberty, Rahel Gol, Guy Las and Amos Katz, Ben-Gurion University; Sarah Zangen, Haddassa University). We hope that readers will find this discourse stimulating and some of the ideas might make their way into their research efforts

Harnessing SmartPhones to Personalize Nutrition in a Time of Global Pandemic

The soar in COVID-19 cases around the globe has forced many to adapt to social distancing and self-isolation. In order to reduce contact with healthcare facilities and other patients, the CDC has advocated the use of telemedicine, i.e., electronic information and telecommunication technology. While these changes may disrupt normal behaviors and routines and induce anxiety, resulting in decreased vigilance to healthy diet and physical activity and reluctance to seek medical attention, they may just as well be circumvented using modern technology. Indeed, as the beginning of the pandemic a plethora of alternatives to conventional physical interactions were introduced. In this Perspective, we portray the role of SmartPhone applications (apps) in monitoring healthy nutrition, from their basic functionality as food diaries required for simple decision-making and nutritional interventions, through more advanced purposes, such as multi-dimensional data-mining and development of machine learning algorithms. Finally, we will delineate the emerging field of personalized nutrition and introduce pioneering technologies and concepts yet to be incorporated in SmartPhone-based dietary surveillance

Empirical Anthelmintic Therapy for Patients with Eosinophilia in Nepal: A Prospective Cohort Study

Eosinophilia is common in low-resource countries and usually implies helminthiasis. Since helminthiasis is a common cause of eosinophilia and its diagnosis is cumbersome, we hypothesized that broad-spectrum anthelmintic therapy may decrease the eosinophil count and eventually cure helminthiasis, whether microbiologic diagnosis is established or not. We recruited patients with eosinophilia aged 5 years and older who presented to Dhulikhel hospital, Nepal. Patients were treated with albendazole and ivermectin. A stool sample for microscopy was obtained. Of a total of 113 patients, 106 had a follow-up visit and 56 were classified as responders to treatment (defined as a decrease in eosinophil count to below 500 cells/µL, or an absolute decrease of more than 1000 cells/µL). For all patients, we found an absolute decrease in the eosinophil count and for the responding group (more than 50% of the whole cohort), the eosinophil count decreased substantially. All stool samples were negative. The reason for a lack of response in the remaining patients is unclear. In order to ascertain whether eosinophilia should be an indication for anthelmintic treatment, a randomized controlled study of empirical treatment after a thorough microbiologic workup is needed

The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study.

INTRODUCTION:Typhoid fever (TF) continues to cause considerable morbidity and mortality in Nepal, but only limited epidemiologic data is available about TF outside Kathmandu. METHODS:As part of an interventional trial, we performed a prospective cohort study of bacteremic TF patients in Dhulikhel Hospital between October 2012 and October 2014. Demographic, epidemiological, clinical, and microbiologic data were recorded. RESULTS:116 bacteremic typhoid patients were included in the study. Most were young, healthy, adults (mean age 27.9±12 years), 41.4% of whom were female. More than 70% of patients were employed in non-manual services or were university students. Salmonella Typhi accounted for 64/115 (55.7%) of all isolates, while Salmonella Paratyphi accounted for 51/115 (44.3%), of which 42 were Paratyphi A and 9 Paratyphi B. A significant proportion of TF cases occurred also during the dry season (48/116, 41.6%). The clinical presentation of Salmonella Typhi and Paratyphi infections was similar, except for a greater proportion of arthralgia in patients with Salmonella Typhi. Most Salmonella Typhi and Paratyphi isolates were resistant to nalidixic acid and susceptible to older antibiotics. One Salmonella Paratyphi isolate was resistant to ceftriaxone. CONCLUSIONS:TF remains common in the Dhulikhel area, even among those with a high level of education. Public health measures aimed at reducing the incidence of TF in the Dhulikhel area are warranted. The relative burden of TF caused by Salmonella Paratyphi is rising; a vaccine with activity against Salmonella Paratyphi is needed. Since Salmonella Paratyphi B was more prevalent in this cohort than in large cohorts of patients from Kathmandu, it is likely that there are significant regional variations in the epidemiology of TF outside Kathmandu

Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults

<div><p>Background</p><p>Emerging resistance to antibiotics renders therapy of Typhoid Fever (TF) increasingly challenging. The current single-drug regimens exhibit prolonged fever clearance time (FCT), imposing a great burden on both patients and health systems, and potentially contributing to the development of antibiotic resistance and the chronic carriage of the pathogens. The aim of our study was to assess the efficacy of combining third-generation cephalosporin therapy with azithromycin on the outcomes of TF in patients living in an endemic region.</p><p>Methods</p><p>An open-label, comparative trial was conducted at Dhulikhel Hospital, Nepal, between October 2012 and October 2014. Only culture-confirmed TF cases were eligible. Patients were alternately allocated to one of four study arms: hospitalized patients received either intravenous ceftriaxone or a combination of ceftriaxone and oral azithromycin, while outpatients received either oral azithromycin or a combination of oral azithromycin and cefexime. The primary outcome evaluated was FCT and the secondary outcomes included duration of bacteremia.</p><p>Results</p><p>105 blood culture-confirmed patients, of whom 51 were treated as outpatients, were eligible for the study. Of the 88 patients who met the inclusion criteria for FCT analysis 41 patients received a single-agent regimen, while 47 patients received a combined regimen. Results showed that FCT was significantly shorter for the latter (95 versus 88 hours, respectively, p = 0·004), and this effect was exhibited in both the hospitalized and the outpatient sub-groups. Repeat blood cultures, drawn on day 3, were positive for 8/47 (17%) patients after monotherapy, versus 2/51 (4%) after combination therapy (p = 0·045). No severe complications or fatalities occurred in any of the groups.</p><p>Conclusions</p><p>Combined therapy of third-generation cephalosporins and azithromycin for TF may surpass monotherapy in terms of FCT and time to elimination of bacteremia.</p><p>Trial registration</p><p>Trial registration number: <a href="https://clinicaltrials.gov/ct2/show/NCT02224040" target="_blank">NCT02224040</a>.</p></div

Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults - Fig 2

<p><b>Kaplan-Meir curve of fever clearance time (FCT) in dual antibiotic therapy versus monotherapy</b>. A. Time to defervescence for the outpatient study arms; B. Time to defervescence for the inpatient study arms; C. Time to defervescence for the two study arms receiving monotherapy versus the two study arms receiving dual therapy. Dashed lines represent monotherapy, continuous lines represents dual therapy.</p

Patient characteristics upon enrollment.

<p>Patient characteristics upon enrollment.</p

Study flow diagram of patients with blood cultures positive for <i>S</i>. Typhi and <i>S</i>. Paratyphi.

<p>Study flow diagram of patients with blood cultures positive for <i>S</i>. Typhi and <i>S</i>. Paratyphi.</p