Cyclosporine (CsA) and MTX are commonly used for GVHD prophylaxis in pediatric allo-SCT. Mucositis and hepatic toxicity frequently restrict the delivery of the fourth dose of MTX. Folinic acid (FA) ...may ameliorate MTX toxicity. We conducted a retrospective chart review of all pediatric patients who received CsA and MTX for GVHD prophylaxis from January 2000 to July 2010. Patients treated before July 2007 (N=29) did not receive FA and those treated from July 2007 onward did receive FA (N=18). Patients who received FA were significantly more likely to receive day +11 MTX (odds ratio (OR) 10.42, 95% confidence interval (CI): 1.21-262.27) but there was no significant difference in Grade III-IV GVHD between the two groups (OR 1.15, 95% CI: 0.08-18.14). FA did not impact relapse-free survival (RFS) (P=0.82). Increased likelihood of receiving day +11 MTX suggests that FA ameliorates MTX toxicity, such as severe mucositis. FA administration for MTX GVHD prophylaxis should be studied in a prospective, randomized fashion.
Atrophic gastritis as a cause of hyperhomocysteinaemia Santarelli, L.; Gabrielli, M.; Cremonini, F. ...
Alimentary pharmacology & therapeutics,
January 2004, 2004, 2004-Jan-01, 2004-01-00, 20040101, Letnik:
19, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Summary
Background : Hyperhomocysteinaemia is an independent risk factor for atherosclerosis. It is often related to low levels of vitamin B12 and/or folate, enzymatic co‐factors of methionine ...metabolism. Atrophic gastritis, often caused by Helicobacter pylori infection, may impair vitamin absorption.
Aim : To assess whether the presence of atrophic gastritis is associated with hyperhomocysteinaemia via deficiency of its vitamin co‐factors.
Methods : Thirty‐one patients with atrophic gastritis were recruited. The control group consisted of 28 patients with non‐atrophic gastritis, matched with patients for sex, age and body mass index. The presence and degree of gastric atrophy were assessed by histology. H. pylori infection was assessed by histology/serology. Blood samples were collected for the measurement of homocysteine, vitamin B12 and folates.
Results : Multiple logistic regression analysis showed that atrophic gastritis (odds ratio, 5.3; 95% confidence interval, 1.23–25.26; χ2 = 5.2; P = 0.01) and low vitamin B12 (odds ratio, 3.7; 95% confidence interval, 1.03–22.08; χ2 = 3.6; P < 0.05) were both predictors of hyperhomocysteinaemia. None of the other variables considered in the analysis, including H. pylori status, showed a significant association with hyperhomocysteinaemia.
Conclusions : The present study suggests that atrophic gastritis, rather than H. pylori infection per se, may be a contributing factor to hyperhomocysteinaemia, possibly via vitamin B12 malabsorption.
Treatment of H. pylori Infection: A Review CANDELLI, Marcello; NISTA, Enrico C; CARLONI, Emilia ...
Current medicinal chemistry,
01/2005, Letnik:
12, Številka:
4
Journal Article
Recenzirano
Helicobacter pylori infection has been indicated as the main pathogenic factor in the development of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although the vast majority of ...infected subjects do not carry but a mild, asymptomatic gastritis, still there are some cases in which the eradication of the infection appears mandatory. This review addresses current anti-Helicobacter regimens and pharmacological resources, and highlights the pros and cons of each of them, according to the most recent and reliable clinical trials. Also, basic recommendations are given, regarding treatment choice in the event of the failure of a first or second line eradicating strategy, and about the implementation of standard regimens with newer antibacterial devices as probiotics.
In the last years, a considerable number of studies have been performed on the correlation between
Helicobacter pylori infection and ischaemic heart disease. The reason is the supposed role of some ...chronic infections in the genesis and development of vessel wall injury and atheromatous plaque, as already reported for
Chalmydia pneumoniae and herpes viruses. While this association may be theoretically conceivable, it still remains debated from a practical point of view. Epidemiological and animal studies as well as some eradicating trials gave conflicting results, while studies investigating the specific molecular mimicry mechanisms induced by
H. pylori strongly support the association. Moreover, none of the studies performed so far did take into account the effect of the genetic susceptibility to develop ischaemic heart disease or to respond to
H. pylori infection. In particular, while the exposure to some known risk factor for atherosclerosis should lead to develop ischaemic heart disease, no condition or exposure, either individual or in combination, completely explains the occurrence and the progression of the disease, as many patients develop ischaemic heart disease in the absence of any risk factor. Based on these concepts, can we state that
H. pylori infection may cause the same effect in patients with ischaemic heart disease as in healthy subjects? Further studies are needed in order to clarify this issue.
The effort of the Humane Microbiome Project has led to the awareness that many districts of the human organism, like the skin, gastrointestinal tract, and genitals harbor their normal resident ...microbes. For this reason, the scientific community overcame the dogma that urines are sterile. Instead, the urinary tract hosts many bacteria, the so-called urobiome, that contribute to its homeostasis and pathology. Urobiome seems to be involved in the pathogenesis of the urinary tract infections (UTIs) and its relationship with the gut microbiome is still far from being understood. We describe a case of an emergent urinary condition, the “purple urine bag syndrome” (PUBS) that displayed with a peculiar combination of pathogens: Corynebacterium urealitycum and Enterococcus faecium. Both bacteria have been described as components of the urobiome and the latter is a well-known member of the gut microbiome but also a possible uropathogen. This case report is the starting point to analyze what we know about urobiome, its role in UTIs, and its interactions with the gut microbiome in the socalled “gut-UTIs axis”.
A 7 day treatment scheme based on rabeprazole/levofloxacin/amoxycillin or tinidazole achieved an eradication rate over 90%. However, the combination of drugs and duration of treatment for the correct ...use of levofloxacin in the eradication of are still unclear.
To compare the efficacy and tolerability of rabeprazole/levofloxacin based dual therapies given for 5, 7 or 10 days with rabeprazole/levofloxacin/amoxycillin triple therapy for 7 days.
One hundred and sixty patients with infection documented by the C-urea breath test and histology were included in this prospective, open label study. Subjects were randomized in four groups: (1) levofloxacin (500 mg o.d.), amoxycillin (1 g b.d.) and rabeprazole (20 mg o.d.) for 7 days; (2) levofloxacin (500 mg o.d.) and rabeprazole (20 mg o.d.) for 5 days; (3) levofloxacin (500 mg o.d.) and rabeprazole (20 mg o.d.) for 7 days; and (4) levofloxacin (500 mg o.d.) and rabeprazole (20 mg o.d.) for 10 days. Six weeks after the end of therapy status was checked by using the C-urea breath test.
All patients completed the therapeutic regimens. The eradication rate was not significantly modified by treatment duration in the dual therapy schemes (5 days: 20/40, 50%; 7 days: 28/40, 70%; 10 days: 26/40, 65%). The eradication rate of the 1 week levofloxacin based triple therapy was significantly higher than that observed using any dual therapies (36/40). No major adverse effects were observed.
A rabeprazole/levofloxacin dual eradication regimen is simple and well tolerated but does not achieve an acceptable eradication rate when compared to a 1 week rabeprazole/levofloxacin/amoxycillin triple therapy. The eradication rate did not increase with a longer regimen.
To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for ...hospitalization or home monitoring.
We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.
Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.
We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.
Summary
Background
The ‘immersion’ technique during upper endoscopy allows the visualization of duodenal villi and the detection of total villous atrophy.
Aim
To evaluate the accuracy of the ...immersion technique in detecting total villous atrophy in suspected coeliac patients. The accuracy in diagnosing coeliac disease and the potential cost‐sparing of a biopsy‐avoiding approach, based on selection of individuals with coeliac disease‐related antibodies and on endoscopic detection of absence of villi, were also analysed.
Methods
The immersion technique was performed in 79 patients with positive antibodies and in 105 controls. Duodenal villi were evaluated as present or absent. As reference, results were compared with histology. Diagnostic approaches, including endoscopy with or without biopsy, were designed to investigate patients with coeliac disease‐related antibodies and total villous atrophy. A cost‐minimization analysis was performed.
Results
All patients with positive antibodies had coeliac disease. The sensitivity, specificity, positive and negative predictive values of endoscopy to detect total villous atrophy was always 100%. The sensitivity, specificity, positive and negative predictive values of biopsy‐avoiding or biopsy‐including strategies in diagnosing coeliac disease when villi were absent was always 100%. The biopsy‐avoiding strategy was cost‐sparing.
Conclusions
Upper endoscopy is highly accurate in detecting total villous atrophy coeliac patients. A biopsy‐avoiding approach is both accurate and cost‐sparing to diagnose coeliac disease in subjects with marked duodenal villous atrophy.
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