Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva

Introduction: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. Objective: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. Material and methods: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. Results: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. Conclusions: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

Diarrea crónica por Salmonella typhimurium en paciente inmunocompentente

La diarrea crónica de origen infeccioso en pacientes inmunocompetentes es un cuadro poco frecuente en países desarrollados, aunque ciertos patógenos, generalmente parásitos (Giardia lamblia, Isospora belli, Cryptosporidium, Cyclospora, Strongyloides, Ameba, Trichuris y Schistosoma) y algunas bacterias (Aeromonas, Plesiomonas, Campylobacter, Clostridium difficile, Salmonella o Mycobacterium tuberculosis) pueden ser causantes de diarrea persistente. Se presenta un caso de un paciente que presentó Salmonella typhimunium en el coprocultivo y se recuperó tras tratamiento con levofloxacino durante 7 días.

Biological and chemical strategies for the recovery of precious and rare metals as nanoparticles

Tese de Doutoramento, Ciências do Mar da Terra e do Ambiente, Ramo: Ciências e Tecnologias do Ambiente, Especialidade em Biotecnologia, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2016

Sorological evaluation of commercial vaccines against enterotoxemia in goats.

Enterotoxemia in sheep and in goats is caused by the effects of the epsilon toxin of C/ostridium perfringens type D, being considered the main infectious cause of mortality in those animal species. The main prophylactic measures include adequate nutritional management and vaccination of ali animais using vaccines of high immunogenic power. Six commercial vaccines containing in its formulation the epsilon toxoid of C. perfringens type D were sorogically evaluated. Eighty four female goat kids, whose mothers had no previous vaccination history against clostridioses were used. They were divided into six groups of 14 animais each. The animais of the control group didn't receive any vaccine dose and the animais from the groups 1 to 5 received two vaccine doses, The first vaccine dose was applied at 45 days of life (day zero) and the second dose at 75 days (30 days after the first dose). Blood samples were collected from the goat kids at the days zero, 30, 60, 90, 120 and 150 after the beginning of the experiment, in order to evaluate the immunologic response. The Indirect ELlSA technique was used for the quantification of the antibodies against epsilon toxin in the samples of blood serum of the animais. In day zero, no animal presented titre considered protector. The largest number of animais considered protected was found at day 60, in response to the two initial doses of the vaccine (days O and 30, first and second doses, respectively). Only tive animaIs which received the vaccine 1 and one animal which received the vaccine 3 stayed wilh titres of antibodies considered up to 150 days after the first vaccine dose. Based on the results, it was concluded lhat the evaluated vaccines showed small amount of epsilon toxoid in the commercial formulations, a crucial fact for lhe low efficiency of. the vaccines. For commercial reasons, the vaccines against the clostridioses present versatile formulations, with several toxoid types, used for various animal species, which certainly contributed to reduce their effectiveness in preventing the iIInesses caused by the clostridia or their toxins.

Effect of room temperature transport vials on DNA quality and phylogenetic composition of faecal microbiota of elderly adults and infants

Background: Alterations in intestinal microbiota have been correlated with a growing number of diseases. Investigating the faecal microbiota is widely used as a non-invasive and ethically simple proxy for intestinal biopsies. There is an urgent need for collection and transport media that would allow faecal sampling at distance from the processing laboratory, obviating the need for same-day DNA extraction recommended by previous studies of freezing and processing methods for stool. We compared the faecal bacterial DNA quality and apparent phylogenetic composition derived using a commercial kit for stool storage and transport (DNA Genotek OMNIgene GUT) with that of freshly extracted samples, 22 from infants and 20 from older adults. Results: Use of the storage vials increased the quality of extracted bacterial DNA by reduction of DNA shearing. When infant and elderly datasets were examined separately, no differences in microbiota composition were observed due to storage. When the two datasets were combined, there was a difference according to a Wilcoxon test in the relative proportions of Faecalibacterium, Sporobacter, Clostridium XVIII, and Clostridium XlVa after 1 week's storage compared to immediately extracted samples. After 2 weeks' storage, Bacteroides abundance was also significantly different, showing an apparent increase from week 1 to week 2. The microbiota composition of infant samples was more affected than that of elderly samples by storage, with significantly higher Spearman distances between paired freshly extracted and stored samples (p

Effetto sul microbiota intestinale della sostituzione dei nitriti con antiossidanti naturali in salami sperimentali

Recentemente il consumo di carne ha attirato l'attenzione per motivi salutistici, ambientali ed etici; pertanto è sempre più urgente considerare formulazioni di prodotti a base di carne più salutari e sostenibili inclusi in una dieta sana e nutriente. In questa tesi sono stati valutati gli effetti in vitro sul microbiota intestinale umano di salami riformulati sostituendo i nitriti con acido ascorbico e antiossidanti vegetali. A questo scopo è stato utilizzato il modello intestinale in vitro MICODE, nella versione che include la digestione gastro-duodenale seguita dalla fermentazione colonica. Gli effetti sul microbiota intestinale sono stati valutati attraverso tecniche di analisi quantitativa Real Time qPCR in base agli shift di alcune popolazioni microbiche, sia quelle benefiche (come Lactobacillales, Bifidobacteriaceae, Clostridium gruppo IV), sia quelle opportuniste (come Enterobacteriaceae, Clostridium gruppo I) e infine il rapporto Firmicutes/Bacteroidetes (importante indice di eubiosi del microbiota intestinale dell’ospite). Inoltre, sono state analizzate, tramite SPME-GC-MS, le molecole volatili prodotte in seguito alla fermentazione colonica, sia positive, come gli SCFA, sia negative, come fenolo e cresolo. I risultati ottenuti hanno mostrato che le formulazioni innovative promuovono una generale eubiosi del microbiota intestinale e una riduzione di popolazioni microbiche negative, in confronto ai controlli. Inoltre, l’analisi del volatiloma evidenzia una maggiore produzione di molecole benefiche e una maggiore riduzione delle molecole negative per l’ospite. Sebbene le formulazioni innovative non abbiano dato benefici nettamente superiori a quelli dei controlli, i risultati ottenuti sono promettenti, in quanto gli antiossidanti utilizzati in sostituzione hanno dato risultati comparabili a quelli ottenuti con il formulato tradizionale.