Haematological and biochemical blood study in baby alpaca with diarrhoea

The aim of this study was to determine the haematological value and biochemical blood in baby alpacas with enteric disorder. A total of 30 blood and serum samples were collected from alpacas of 1 month old with diarrhoea and 5 blood samples of clinically healthy baby alpacas (controls). The animals were from communities in the central Andes from Peru. About haematology were determined haematocrit, haemoglobin concentration, red blood count and white blood count that were not significantly different between control animals and animals with diarrhoea. Moreover, biochemical blood parameters as total protein, albumin and calcium decrease significantly (p<0.05). We conclude that our results could be considered as factors in the mortality of baby alpaca by infectious diarrhoea.

A metagenomic comparison of endemic viruses from broiler chickens with runting stunting syndrome and from normal birds

Runting-stunting syndrome (RSS) in broiler chickens is an enteric disease that causes significant economic losses to poultry producers worldwide due to elevated feed conversion ratios, decreased body weight during growth, and excessive culling. Of specific interest are the viral agents associated with RSS which have been difficult to fully characterise to date. Past research into the aetiology of RSS has implicated a wide variety of RNA and DNA viruses however, to date, no individual virus has been identified as the main agent of RSS and the current opinion is that it may be caused by a community of viruses, collectively known as the virome. This paper attempts to characterise the viral pathogens associated with 2 – 3 week old RSS-affected and unaffected broiler chickens using next-generation sequencing and comparative metagenomics. Analysis of the viromes identified a total of 20 DNA & RNA viral families, along with 2 unidentified categories, comprised of 31 distinct viral genera and 7 unclassified genera. The most abundant viral families identified in this study were the Astroviridae, Caliciviridae, Picornaviridae, Parvoviridae, Coronaviridae, Siphoviridae, and Myoviridae. This study has identified historically significant viruses associated with the disease such as chicken astrovirus, avian nephritis virus, chicken parvovirus, and chicken calicivirus along with relatively novel viruses such as chicken megrivirus and sicinivirus 1 and will help expand the knowledge related to enteric disease in broiler chickens, provide insights into the viral constituents of a healthy avian gut, and identify a variety of enteric viruses and viral communities appropriate for further study.

Caracterização do índice de biofilme oral em doentes internados no serviço de cuidados intensivos 1 do Centro Hospitalar do Porto

Introdução: A cavidade oral de um doente que esteja internado num serviço hospitalar apresenta uma flora diferente das pessoas saudáveis. Ao fim de 48 horas de internamento, a flora apresenta um maior número de microrganismos que rapidamente podem ser responsáveis por aparecimento de infeções secundárias, tais como pneumonias, resultante à proliferação bactérias que lhe está associada. Este risco é ainda superior em doentes críticos. Nesta população torna-se fundamental a implementação de um efetivo protocolo de higiene oral, procurando controlar ao máximo o desenvolvimento do biofilme oral. Objetivo: Avaliar o índice de biofilme oral dos doentes na admissão a um serviço de Cuidados Intensivos, procedendo á sua reavaliação após 7 dias de internamento e, procurando deste modo avaliar a eficácia de higienização oral efetuada no Serviço. Materiais e Métodos: Estudo prospetivo, institucional, descritivo, analítico e observacional realizado no Serviço de Cuidados Intensivos do CHP. Foram envolvidos no estudo doentes com mais de 18 anos, e com um tempo de internamento igual ou superior a 7 dias. Procedeu-se à colheita de dados demográficos, motivo de admissão, tempo de internamento, medicação prescrita, tipo de alimentação efetuada no serviço, necessidade ou não de suporte respiratório e qual o tipo de higiene realizada no serviço. Foi avaliado o índice de higiene oral simplificado de Greene & Vermillion (IHO-S) nas primeiras 24h e 7 dias após a 1ª avaliação. O IHO-S é um indicador composto que avalia 2 componentes, a componente de resíduos e a componente de cálculo, sendo cada componente avaliada numa escala de 0 a 3. São avaliadas 6 faces dentárias que são divididas em 3 porções clínicas (porção gengival, terço médio e porção oclusal). No final de cada avaliação é calculado o somatório do valor encontrado para cada face, sendo este total dividido pelo nº de faces analisadas. O cálculo do IHO-S por indivíduo corresponde à soma das componentes. Resultados: Foram avaliados 74 doentes, tendo-se excluído 42 por não terem a dentição mínima exigida. Os 32 doentes que completaram o estudo apresentaram uma idade média de 60,53 ± 14,44 anos, 53,1% eram do género masculino, e na sua maioria pertenciam a pacientes do foro médico e cirúrgico (37,5,5%). Os doentes envolvidos no estudo tiveram uma demora média de 15,69±6,69 dias de internamento, tendo-se verificado que 17 dos pacientes (53,1%) estiveram internados mais de 14 dias no Serviço de Cuidados Intensivos 1. Relativamente às características particulares da amostra verificou-se que durante o período de avaliação a maioria dos doentes estiveram sedados (75%), sob suporte ventilatório (81,3%) e a fazer suporte nutricional por via entérica por sonda nasogástrica (62,6%). O IHO-S inicial foi de 0,67±0,45tendo-se verificado um agravamento significativo ao fim de sete dias de internamento 1,04±0.51 (p<0,05).Este agravamento parece estar fundamentalmente dependente dos maus cuidados orais prestados aos doentes, não se tendo observado qualquer diferença significativa resultante dos aspetos particulares avaliados, com exceção para a nutrição entérica versus a soroterapia. Discussão e Conclusão: Apesar de vários estudos evidenciarem a necessidade de um boa higiene oral para evitar a proliferação bacteriana e o risco de infeção nosocomial, muitas das instituições de saúde continuam a não valorizar esta prática. Neste estudo observa-se que os doentes na admissão apresentam um bom índice de higiene oral tendo-se contudo observado um agravamento significativo ao fim de uma semana de internamento. Embora este agravamento possa não ser importante para o doente com uma semana de internamento ele poderá ser indicativo de um risco acrescido para infeções nosocomiais em doentes com internamentos mais prolongados, necessitando estes doentes de uma higiene oral mais eficaz.

Impact of Cryptosporidium spp. interaction with co-occurring microorganisms on moderate-to-severe diarrhea in the developing world

Diarrheal illness is responsible for over a quarter of all deaths in children under 5 years of age in sub-Saharan Africa and South Asia. Recent findings have identified the parasite Cryptosporidium as a contributor to enteric disease. We examined 9,348 cases and 13,128 controls from the Global Enteric Multicenter Study to assess whether Cryptosporidium interacted with co-occurring pathogens based on adjusted odds of moderate-to-severe diarrhea (MSD). Cryptosporidium was found to interact negatively with Shigella spp., with multiplicative interaction score of 0.16 (95% CI: 0.07 to 0.37, p-value=0.000), and an additive interaction score of -9.81 (95% CI: -13.61 to -6.01, p-value=0.000). Cryptosporidium also interacted negatively with Aeromonas spp., Adenovirus, Norovirus, and Astrovirus with marginal significance. Odds of MSD for Cryptosporidium co-infection with Shigella spp., Aeromonas spp., Adenovirus, Norovirus, or Astrovirus are lower than odds of MSD with either organism alone. This may reduce the efficacy of intervention strategies targeted at Cryptosporidium.

Ácidos orgânicos e probiótico na redução da colonização de Salmonella enterica Heidelberg em frangos de corte

In the food industry, Salmonella sp. and other pathogens represent a major threat as potential causes of foodborne diseases. The Salmonella enterica serovar Heidelberg (SH) has a great importance to public health, being currently the most frequent serotype in the official control analyzes carried out in Brazil’s Southern. In this region are concentrated the largest poultry flocks, contributing over 60 % of Brazilian production of chicken meat. To help prevent and minimize infections by pathogenic bacteria, in addition to attend the standards of biosecurity in the field and good hygiene and sanitizing programs in the industry, there is the possibility to control directly on the poultry breeding. Use of organic acids added in the diet of the fowls has an antibacterial action. In the other hand, the use of probiotics has been shown to prevent enteric diseases. This dissertation was divided into two chapters and aimed to evaluate the quantitative and qualitative reduction of SH in broiler chickens. In the first chapter the aim was to collect information on the prevalence rate of SH strain in broiler chickens. This coefficient was 100 %, being a suitable method for determining the frequency of salmonellosis in broiler chickens. In the second chapter five treatments were evaluated (a positive control and four tests), in order to reduce the colonization of SH in broilers, using organic acids and probiotic during production phase. In SH count related to the colonization of the cecum at 28 days of age differences were observed (p<0,05) among treatments. The Treatment 2 showed a count of 41 most probable number of bacterial cells per gram (MPN/g) with lower counts when compared to the positive control (5.106 MPN/g) and treatment 1 (1.354 MPN/g). The evaluation index of infected birds, there was a difference between treatments. In treatment 2, and treatment 4 reduced 58,34 % and 25 % respectively the number of fowls infected with SH. There was no effect of treatments on the performance. Administration of organic acids and probiotic used in the treatment 2 proved to be an effective tool in the SH control in broilers at 28 days of age.

Tumores do espaço parafaríngeo: experiência de 10 anos do IPO-LFG

Introdução: As neoplasias do espaço parafaríngeo são raras, representando apenas 0,5% dos tumores da cabeça e pescoço. A maioria são benignas, mas uma ampla variedade de patologias benignas e malignas podem ser encontradas neste espaço, o que cria desafios complexos de diagnóstico e tratamento. Objetivo: Descrever e analisar uma série de casos de neoplasias primárias do espaço parafaríngeo tratadas no Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG). Material e métodos: Estudo retrospetivo, com recolha e análise dos dados dos processos clínicos de tumores primários do espaço parafaríngeo, que foram diagnosticados ou referenciados ao IPOLFG entre 1 de Janeiro de 2003 e 31 de Dezembro de 2013. Resultados: Foram incluídos 38 doentes. A idade mediana foi de 52 anos (Âmbito Interquartil: 40-63 anos). Dez (26,3%) doentes eram assintomáticos. O sintoma mais comum à apresentação foi a sensação de corpo estranho orofaríngeo (23,7%) e o achado mais frequente foi um abaulamento orofaríngeo (78,4%). Todos os doentes fizeram exames de imagem pré-operatórios: 94,7% tomografia computorizada e 68,4% ressonância magnética. A citologia aspirativa foi realizada em 39,5%. 31 tumores eram benignos (81,6%), sendo os mais frequentes os adenomas pleomórficos (58,1%). 7 eram malignos (18,4%), com os carcinomas exadenomas pleomórficos (28,6%) e os linfomas (28,6%) sendo os mais comuns. 36 doentes (94,7%) foram submetidos a tratamento cirúrgico primário; os outros 2 doentes (5,3%) receberam tratamento não cirúrgico, com quimioterapia e quimioradioterapia, respectivamente. A abordagem cervical foi a mais utilizada (80%). A mandibulotomia foi necessária em apenas 5,7%. A complicação mais frequente foi a neuropatia de pares cranianos de novo, identificada em 22,2%. Destes, 75% foram sequela da resseção de tumores neurogénicos. Todas as neuropatias que resultaram da resseção de tumores não neurogénicos foram transitórias. O follow-up mediano foi de 6,5 anos. A taxa de recorrência foi de 13,5%. Conclusões: Os tumores do espaço parafaríngeo requerem um elevado índice de suspeição para serem diagnosticados num estadio precoce. A resseção cirúrgica completa é o principal tratamento. A abordagem cirúrgica deve ser selecionada caso a caso, mas a cervical fornece um excelente acesso à maioria dos tumores deste espaço

Efficient and Durable Vaccine against Intimin β of Diarrheagenic E. Coli Induced by Clay Nanoparticles

Improved strategies are urgently required to control infections with enterohemorrhagic Escherichia coli and enteropathogenic E. coli, two dominant zoonotic enteric pathogens responsible for a wide spectrum of illnesses as well as deaths of human being, with tremendous financial cost worldwide. The present study investigates the capacity of two clay nanoparticles (NPs) with opposite surface charges, namely synthetic layered double hydroxide (LDH) and hectorite (HEC) NPs as adjuvants to promote strong immune responses against the infections. Here both LDH and HEC NPs are showed to be able to carry an appreciable amount of Intimin β (1.1 and 4.4 mg per mg clay nanomaterials, respectively) and significantly facilitate antigen uptake by antigen-presenting cells. Remarkably, these clay NPs induce strong antibody and cell-mediated immune responses, which are much higher than that by the potent adjuvant, QuilA. Furthermore, these strong immune responses are well maintained for at least four months in the mouse model, during which there are no changes in histopathology of the animal organs. Collectively these data demonstrate the suitability of LDH and HEC NPs as useful adjuvants in new-generation vaccine formulations to control various infectious diseases.

Climate Clever Beef: options to improve business performance and reduce greenhouse gas emissions in northern Australia

The Rangeland Journal – Climate Clever Beef special issue examines options for the beef industry in northern Australia to contribute to the reduction in global greenhouse gas (GHG) emissions and to engage in the carbon economy. Relative to its gross value (A$5 billion), the northern beef industry is responsible for a sizable proportion of national reportable GHG emissions (8–10%) through enteric methane, savanna burning, vegetation clearing and land degradation. The industry occupies large areas of land and has the potential to impact the carbon cycle by sequestering carbon or reducing carbon loss. Furthermore, much of the industry is currently not achieving its productivity potential, which suggests that there are opportunities to improve the emissions intensity of beef production. Improving the industry’s GHG emissions performance is important for its environmental reputation and may benefit individual businesses through improved production efficiency and revenue from the carbon economy. The Climate Clever Beef initiative collaborated with beef businesses in six regions across northern Australia to better understand the links between GHG emissions and carbon stocks, land condition, herd productivity and profitability. The current performance of businesses was measured and alternate management options were identified and evaluated. Opportunities to participate in the carbon economy through the Australian Government’s Emissions Reduction Fund (ERF) were also assessed. The initiative achieved significant producer engagement and collaboration resulting in practice change by 78 people from 35 businesses, managing more than 1 272 000 ha and 132 000 cattle. Carbon farming opportunities were identified that could improve both business performance and emissions intensity. However, these opportunities were not without significant risks, trade-offs and limitations particularly in relation to business scale, and uncertainty in carbon price and the response of soil and vegetation carbon sequestration to management. This paper discusses opportunities for reducing emissions, improving emission intensity and carbon sequestration, and outlines the approach taken to achieve beef business engagement and practice change. The paper concludes with some considerations for policy makers.

An evaluation of carbon offset supplementation options for beef production systems on coastal speargrass in central Queensland, Australia

In 2014, the Australian Government implemented the Emissions Reduction Fund to offer incentives for businesses to reduce greenhouse gas (GHG) emissions by following approved methods. Beef cattle businesses in northern Australia can participate by applying the 'reducing GHG emissions by feeding nitrates to beef cattle' methodology and the 'beef cattle herd management' methods. The nitrate (NO3) method requires that each baseline area must demonstrate a history of urea use. Projects earn Australian carbon credit units (ACCU) for reducing enteric methane emissions by substituting NO3 for urea at the same amount of fed nitrogen. NO3 must be fed in the form of a lick block because most operations do not have labour or equipment to manage daily supplementation. NO3 concentrations, after a 2-week adaptation period, must not exceed 50 g NO3/adult animal equivalent per day or 7 g NO3/kg dry matter intake per day to reduce the risk of NO3 toxicity. There is also a 'beef cattle herd management' method, approved in 2015, that covers activities that improve the herd emission intensity (emissions per unit of product sold) through change in the diet or management. The present study was conducted to compare the required ACCU or supplement prices for a 2% return on capital when feeding a low or high supplement concentration to breeding stock of either (1) urea, (2) three different forms of NO3 or (3) cottonseed meal (CSM), at N concentrations equivalent to 25 or 50 g urea/animal equivalent, to fasten steer entry to a feedlot (backgrounding), in a typical breeder herd on the coastal speargrass land types in central Queensland. Monte Carlo simulations were run using the software @risk, with probability functions used for (1) urea, NO3 and CSM prices, (2) GHG mitigation, (3) livestock prices and (4) carbon price. Increasing the weight of steers at a set turnoff month by feeding CSM was found to be the most cost-effective option, with or without including the offset income. The required ACCU prices for a 2% return on capital were an order of magnitude higher than were indicative carbon prices in 2015 for the three forms of NO3. The likely costs of participating in ERF projects would reduce the return on capital for all mitigation options. © CSIRO 2016.

Use of short-term breath measures to estimate daily methane production by cattle

Methods to measure enteric methane (CH4) emissions from individual ruminants in their production environment are required to validate emission inventories and verify mitigation claims. Estimates of daily methane production (DMP) based on consolidated short-term emission measurements are developing, but method verification is required. Two cattle experiments were undertaken to test the hypothesis that DMP estimated by averaging multiple short-term breath measures of methane emission rate did not differ from DMP measured in respiration chambers (RC). Short-term emission rates were obtained from a GreenFeed Emissions Monitoring (GEM) unit, which measured emission rate while cattle consumed a dispensed supplement. In experiment 1 (Expt. 1), four non-lactating cattle (LW=518 kg) were adapted for 18 days then measured for six consecutive periods. Each period consisted of 2 days of ad libitum intake and GEM emission measurement followed by 1 day in the RC. A prototype GEM unit releasing water as an attractant (GEM water) was also evaluated in Expt. 1. Experiment 2 (Expt. 2) was a larger study based on similar design with 10 cattle (LW=365 kg), adapted for 21 days and GEM measurement was extended to 3 days in each of the six periods. In Expt. 1, there was no difference in DMP estimated by the GEM unit relative to the RC (209.7 v. 215.1 g CH4/day) and no difference between these methods in methane yield (MY, 22.7 v. 23.7 g CH4/kg of dry matter intake, DMI). In Expt. 2, the correlation between GEM and RC measures of DMP and MY were assessed using 95% confidence intervals, with no difference in DMP or MY between methods and high correlations between GEM and RC measures for DMP (r=0.85; 215 v. 198 g CH4/day SEM=3.0) and for MY (r=0.60; 23.8 v. 22.1 g CH4/kg DMI SEM=0.42). When data from both experiments was combined neither DMP nor MY differed between GEM- and RC-based measures (P>0.05). GEM water-based estimates of DMP and MY were lower than RC and GEM (P<0.05). Cattle accessed the GEM water unit with similar frequency to the GEM unit (2.8 v. 3.5 times/day, respectively) but eructation frequency was reduced from 1.31 times/min (GEM) to once every 2.6 min (GEM water). These studies confirm the hypothesis that DMP estimated by averaging multiple short-term breath measures of methane emission rate using GEM does not differ from measures of DMP obtained from RCs. Further, combining many short-term measures of methane production rate during supplement consumption provides an estimate of DMP, which can be usefully applied in estimating MY.

Evaluation of alpha-synuclein immunohistochemical methods for the detection of Lewy-type synucleinopathy in gastrointestinal biopsies

International audience

Resource use and greenhouse gas emissions from grain-finishing beef cattle in seven Australian feedlots: a life cycle assessment

Grain finishing of cattle has become increasingly common in Australia over the past 30 years. However, interest in the associated environmental impacts and resource use is increasing and requires detailed analysis. In this study we conducted a life cycle assessment (LCA) to investigate impacts of the grain-finishing stage for cattle in seven feedlots in eastern Australia, with a particular focus on the feedlot stage, including the impacts from producing the ration, feedlot operations, transport, and livestock emissions while cattle are in the feedlot (gate-to-gate). The functional unit was 1 kg of liveweight gain (LWG) for the feedlot stage and results are included for the full supply chain (cradle-to-gate), reported per kilogram of liveweight (LW) at the point of slaughter. Three classes of cattle produced for different markets were studied: short-fed domestic market (55–80 days on feed), mid-fed export (108–164 days on feed) and long-fed export (>300 days on feed). In the feedlot stage, mean fresh water consumption was found to vary from 171.9 to 672.6 L/kg LWG and mean stress-weighted water use ranged from 100.9 to 193.2 water stress index eq. L/kg LWG. Irrigation contributed 57–91% of total fresh water consumption with differences mainly related to the availability of irrigation water near the feedlot and the use of irrigated feed inputs in rations. Mean fossil energy demand ranged from 16.5 to 34.2 MJ lower heating values/kg LWG and arable land occupation from 18.7 to 40.5 m2/kg LWG in the feedlot stage. Mean greenhouse gas (GHG) emissions in the feedlot stage ranged from 4.6 to 9.5 kg CO2-e/kg LWG (excluding land use and direct land-use change emissions). Emissions were dominated by enteric methane and contributions from the production, transport and milling of feed inputs. Linear regression analysis showed that the feed conversion ratio was able to explain >86% of the variation in GHG intensity and energy demand. The feedlot stage contributed between 26% and 44% of total slaughter weight for the classes of cattle fed, whereas the contribution of this phase to resource use varied from 4% to 96% showing impacts from the finishing phase varied considerably, compared with the breeding and backgrounding. GHG emissions and total land occupation per kilogram of LWG during the grain finishing phase were lower than emissions from breeding and backgrounding, resulting in lower life-time emissions for grain-finished cattle compared with grass finishing.

The effect of the proton pump inhibitor pantoprazole on the biology of Campylobacter jejuni

Campylobacter is a major cause of acute bacterial gastroenteritis worldwide, with the highest number of infections being attributed to Campylobacter jejuni. C. jejuni is a Gram negative, spiral, motile bacterium that belongs to the campylobacterales order and is related to both Helicobacter spp. and Wolinella sp.. It has long been established that proton pump inhibitors (PPIs) and other benzimidazole derivatives display anti-Helicobacter activity in vitro. PPIs have in the past been shown to affect Helicobacter pylori growth, survival, motility, morphology, adhesion/invasion potential and susceptibility to conventional antibiotics. PPIs are highly effective drugs that are well tolerated, safe for prolonged daily use and are therefore in high demand. Both the PPIs omeprazole and lansoprazole featured in the top ten drugs prescribed in England in 2014. In 2014 Campylobacter was also the most commonly diagnosed gastrointestinal infection in Scotland, in England and Wales and also in Europe. It has previously been generally accepted that patients who are being treated with PPIs are more susceptible to enteric infections such as Campylobacter than people not taking PPIs. The effect of PPI exposure on H. pylori has been investigated rigorously in the past. A single previous study has hinted that PPIs may also be capable of affecting the related organism C. jejuni,but investigations have been extremely limited in comparison to those investigating the effect of PPIs on H. pylori. This study has investigated the in vitro effects of direct contact with PPIs on the biology ofC. jejuni. Exposure to the PPI pantoprazole was found to affect C. jejuni growth/survival, motility, morphology, biofilm formation, invasion potential and susceptibility to some conventional antibiotics. Microarray studies showed that the cmeA and Cj0561c genes were significantly up-regulated in response to pantoprazole exposure and a CmeABC deficient mutant was found to be significantly more susceptible to killing by pantoprazole than was the parent strain. Proteomic analysis indicated that the oxidative stress response of C. jejuni was induced following exposure to sub-lethal concentrations of pantoprazole. C. jejuni gene expression was assessed using qRT-PCR and the genes encoding for thiol peroxidase and GroEL co-chaperonin (both involved in the C. jejuni oxidative stress response) were found to be around four times higher in response to exposure to sub-lethal concentrations of pantoprazole. Experiments using the oxidative stress inhibitors thiourea (a hydroxyl radical quencher) and bipyridyl (a ferrous iron chelator) showed that killing by pantoprazole was not mediated by hydroxyl radical production.

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.

Use of GLP-1 mimetic in type 2 diabetes mellitus: is it the end of fragility fractures?

International audience