The Primary Biliary Cholangitis (PBC) Obeticholic Acid (OCA) International Study of Efficacy (POISE) randomized, double-blind, placebo-controlled trial demonstrated that OCA reduced biomarkers ...associated with adverse clinical outcomes (ie, alkaline phosphatase, bilirubin, aspartate aminotransferase, and alanine aminotransferase) in patients with PBC. The objective of this study was to evaluate time to first occurrence of liver transplantation or death in patients with OCA in the POISE trial and open-label extension vs comparable non-OCA–treated external controls.
Propensity scores were generated for external control patients meeting POISE eligibility criteria from 2 registry studies (Global PBC and UK-PBC) using an index date selected randomly between the first and last date (inclusive) on which eligibility criteria were met. Cox proportional hazards models weighted by inverse probability of treatment assessed time to death or liver transplantation. Additional analyses (Global PBC only) added hepatic decompensation to the composite end point and assessed efficacy in patients with or without cirrhosis.
During the 6-year follow-up, there were 5 deaths or liver transplantations in 209 subjects in the POISE cohort (2.4%), 135 of 1381 patients in the Global PBC control (10.0%), and 281 of 2135 patients in the UK-PBC control (13.2%). The hazard ratios (HRs) for the primary outcome were 0.29 (95% CI, 0.10–0.83) for POISE vs Global PBC and 0.30 (95% CI, 0.12–0.75) for POISE vs UK-PBC. In the Global PBC study, HR was 0.20 (95% CI, 0.03–1.22) for patients with cirrhosis and 0.31 (95% CI, 0.09–1.04) for those without cirrhosis; HR was 0.42 (95% CI, 0.21–0.85) including hepatic decompensation.
Patients treated with OCA in a trial setting had significantly greater transplant-free survival than comparable external control patients.
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Patients with primary biliary cholangitis treated with obeticholic acid in the POISE study had fewer deaths and liver transplants vs comparable patients in the Global PBC and UK-PBC disease registries.
Lactobacilli to prevent traveler's diarrhea? Katelaris, P H; Salam, I; Farthing, M J
The New England journal of medicine,
1995-Nov-16, Letnik:
333, Številka:
20
Journal Article
The causative association between Helicobacter pylori and gastric mucosal inflammation is well established. The inflammatory process leads to the acquisition of mucosa-associated lymphoid tissue ...(MALT) by the stomach. Evidence links H. pylori gastritis with the development of low-grade primary gastric lymphoma with a phenotype specific for lymphoma of MALT type. It is now accepted that primary low-grade MALT lymphomas regress with H. pylori eradication therapy. However, the response of primary, diffuse, large-cell gastric lymphoma to H. pylori eradication therapy is still not established. We report a case of a primary high-grade gastric lymphoma regressing after H. pylori eradication therapy.
Macroamylasaemia is a condition in which serum amylase is elevated in the presence of a low to normal urinary amylase and normal renal function. It is rare but can masquerade as other clinical ...disorders. Discussed here is a case report of a patient who presented initially with abdominal pain (later recognized as being due to gangrenous appendicitis) and in whom there was a very high serum amylase level, leading to an erroneous initial diagnosis and management as acute pancreatitis. The CT scan of the abdomen was normal without any evidence of pancreatitis. Subsequently, the renal amylase:creatinine clearance ratio (Cam/Ccr) was found to be low, being characteristic and diagnostic of macroamylasaemia; the latter was, in turn, the cause for the elevated serum amylase level. The underlying macroamylasaemia had thus masqueraded as pancreatitis. The patient underwent appendicectomy and hence made an excellent recovery. It is vitally important to recognize this condition in order to avoid both an incorrect diagnosis and inappropriate treatment/management.
Summary
Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for ...treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24 h of the onset of diarrhoea, were randomised to receive either ciprofloxacin 500 mg or placebo. Every subject recorded the number and consistency of stools and presence of any other associated symptoms for 72 h or until recovery.
Of 88 subjects enrolled, 83 were evaluable, of whom 45 received ciprofloxacin and 38 placebo. Groups did not differ with regard to duration or severity of diarrhoea at randomisation. Mean (SE) duration of diarrhoea, as assessed by time to the last liquid and last unformed stool, was reduced from 50·4 (4·5) h and 53·5 (4·4) h, respectively, in the placebo group to 20·9 (3·4) h and 24·8 (3·8) h in those receiving ciprofloxacin (p<0·0001). Mean number of liquid stools was reduced from 11·4 (1·2) in the placebo group to 5·0 (0·7) in the ciprofloxacin-treated group (p<0·0001). The cumulative percentages of subjects with no unformed stool after 24 h, 48 h, and 72 h were, respectively, 64%, 82%, and 93% in the ciprofloxacin group and 11%, 42%, and 79% in the placebo group (p<0·0001, p<0·001, and not significant, respectively).
A single 500 mg dose of ciprofloxacin was an effective empirical treatment for reducing the duration and severity of diarrhoea in travellers. The regimen should maximise compliance and reduce the cost and duration of therapy.
Exchange transfusion in severe falciparum malaria Chiodini, P L; Somerville, M; Salam, I ...
Transactions of the Royal Society of Tropical Medicine and Hygiene,
1985, Letnik:
79, Številka:
6
Journal Article
Recenzirano
Three cases of severe falciparum malaria with high parasitaemia, one of them complicated by disseminated intravascular coagulation, were treated with exchange transfusion in addition to conventional ...chemotherapy. All three made a good recovery. There are few previous reports of this treatment which deserves wider attention and further assessment.
Machine Learning (ML) is an Artificial Intelligence (AI) approach that allows systems to adapt to their environment based on past experiences. Machine Learning (ML) and Natural Language Processing ...(NLP) techniques are commonly used in sentiment analysis and Information Retrieval Techniques (IRT). This study supports the use of ML approaches, such as K-Means, to produce accurate outcomes in clustering and classification approaches. The main objective of this research is to explore the methods for sentiment classification and Information Retrieval Techniques (IRT). So, a combination of different machine learning algorithms is used with a dataset from amazon unlocked mobile reviews and telecom tweets to achieve better accuracy as it is crucial to consider the previous predictions related to sentiment classification and IRT. The datasets consist of user reviews ratings and algorithms utilized consist of K-Means Clustering algorithm, Logistic Regression (LR), Random Forest (RF), and Decision Tree (DT) algorithms. The amalgamation of each algorithm with the K-Means resulted in high levels of accuracy. Specifically, the K-Means combined with Logistic Regression (LR) yielded an accuracy rate of 99.98%. Similarly, the K-Means integrated with Random Forest (RF) resulted in an accuracy of 99.906%. Lastly, when the K-Means was merged with the Decision Tree (DT) Algorithm, the accuracy obtained was 99.83%.We exhibited that we could foresee efficient, effective, and accurate outcomes.
