Fecal Microbial Transplantation for Ulcerative Colitis

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Fecal microbial transplantation (FMT) via enema is shown to be effective, tolerable, and feasible for treating children with ulcerative colitis (UC), according to findings from a phase 1 pilot study published in the Journal of Pediatric Gastroenterology and Nutrition.

It involves infusion of human stool from a healthy adult donor into the patient’s intestine and has been proposed as an option for recurrent Clostridium difficile infection and possibly for ulcerative colitis as per Sachin Kunde, MD, MPH, from Spectrum Health Medical Group, Helen DeVos Children’s Hospital in Grand Rapids, Michigan. The procedure may restore ‘abnormal’ bacteria to ‘normal’ in patients with UC.

Ten children, aged 7 to 21 years, who had mild to moderate UC, received freshly prepared fecal enemas daily for 5 days.

The investigators collected data on tolerability, adverse events, and disease activity during FMT and weekly for 4 weeks thereafter. At baseline, pediatric UC activity index ranged from 15 to 65. The investigators considered a reduction in PUCAI by more than 15 to be clinical response, and PUCAI lower than 10 to be clinical remission.

There were no serious adverse events. Self–limiting adverse events were mild cramping, fullness, flatulence, bloating, diarrhea, blood in the stool, and moderate fever. Although 1 child could not retain fecal enemas, average tolerated enema volume in the other 9 children was 165 mL/day.

Clinical response within one week occurred in 7 (78%) of the 9 children, including 3 (33%) who had clinical remission and 6 (67%) who maintained clinical response at 1 month. Compared with baseline, median PUCAI significantly improved after FMT. (Medscape)

Dramatic Rise in Extensively Drug–Resistant Tuberculosis

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Almost half (43.7%) of patients with multidrug–resistant (MDR) tuberculosis in 8 countries studied were resistant to at least 1 second–line drug, and 6.7% had extensively drug–resistant (XDR) tuberculosis, according to a study published online August 30 in The Lancet by Tracy Dalton, PhD, a senior service fellow in the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention in Atlanta, Georgia. MDR tuberculosis is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin. XDR tuberculosis is caused by Mycobacterium tuberculosis strains that are resistant to isoniazid, rifampicin, and at least 1 drug within the fluoroquinolones and 1 antituberculosis injectable drug. Fluoroquinolones and injectable drugs are second–line antituberculosis drugs.

Most international recommendations for tuberculosis control have been developed for (MDR) tuberculosis prevalence of up to around 5%. Yet we now face prevalence up to 10 times higher in some places, where almost half of the patients with infectious disease are transmitting MDR strains of Mycobacterium tuberculosis.

According to data from the World Health Organization, 5.4% of patients with MDR tuberculosis have XDR tuberculosis.

Rise and fall of Nuclear Cardiac Imaging

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The use of nuclear myocardial perfusion imaging declined substantially in a large integrated healthcare system during a recent 5–year period, reports Medpage.

Following an increase in use from 2000 to 2006 at Kaiser Permanente Northern California MPI use dropped by a relative 51% through 2011 according to Edward McNulty, MD, of Kaiser Permanente Medical Center in San Francisco.

Replacement by cardiac CT and stress echocardiography did not explain the pullback from using MPI, the researchers reported March 26 issue of JAMA.

The fact that we observed greater declines amongst lower–risk subsets (outpatients and younger persons) suggests MPI use became more discriminating (used preferentially in higher–risk persons), as per the authors.

Other reasons may be “more recently, factors potentially discouraging use, such as appropriate use criteria, declining reimbursement, radiology benefits managers, and more publicized concerns about the health effects of radiation have emerged.”

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