Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region.

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

A NEO-PI-R short form for older adults.

This article reports on the construction and examination of a 120 item version (NEO-PI-R-SF) of the Dutch/Belgian NEO-Personality Inventory-Revised (NEO-PI-R). The item selection was based on criteria of appropriateness for older adults and psychometric contribution. The factor structure of the NEO-PI-R-SF proved highly equivalent to the parent instrument, indicating concordant validity. Coefficients alpha were generally lower due to the reduction of items. When assessed in a new sample of older adults (N=794), the factor structure of the NEO-PI-R-SF proved replicable, except for the facet scales A1: Trust and A3: Altruism. Coefficients alpha for the domain scales were satisfactory, while the coefficients alpha for the facet scales were marginal to satisfactory and below those found in two adult samples (N=1305 and N=682). It was concluded that the NEO-PI-R-SF may be a time-saving alternative for research when a fine-grained description of personality among older adults is required.

Transient hypertransaminasemia in paediatric patients with Crohn disease undergoing initial treatment with enteral nutrition.

OBJECTIVES: Total enteral nutrition (TEN) is frequently used as monotherapy in children with Crohn disease to prevent steroid toxicity. Liver disease is a known complication in inflammatory bowel disease, and liver enzymes are regularly obtained in these patients. PATIENTS AND METHODS: Prospective follow-up of liver enzymes was performed in 11 new consecutive patients ages 7.6 to 17.1 years who were primarily treated with TEN for 6 weeks. Liver enzymes were measured before starting TEN and after 3, 6, and 12 weeks. RESULTS: At the beginning of TEN, the mean aspartate aminotransferase (ASAT) was 18.4 U/L and the mean alanine aminotransferase (ALAT) 17.1 U/L. The mean ASAT and ALAT were 202.0 U/L and 269.0 U/L after 3 weeks and 109.6 U/L and 180.9 U/L at 6 weeks. After 12 weeks values decreased to 22.8 U/L (ASAT) and 20.9 U/L (ALAT). Overall, 9 of 11 patients had transient elevated ASAT and 10 patients showed elevated ALAT. Gamma-glutamyl transpeptidase was slightly elevated in 3 patients during therapy, but alkaline phosphatase and bilirubin showed no changes. None of the patients developed liver disease during follow-up, and prolonged clinical remission was achieved in 9 patients. CONCLUSIONS: This study shows that TEN can be associated with transient hypertransaminasemia without evidence of liver disease. We hypothesise that insulin resistance in patients with Crohn disease in combination with standard TEN formulae can result in transient hepatic steatosis causing the hypertransaminasemia. For the clinician it is important to be aware of this benign TEN-associated condition to prevent unnecessary investigations.

Topical silver-impregnated dressings and the importance of the dressing technology.

A wide variety of silver-impregnated wound dressings has become available in recent years. This has given the practitioner choice but little evidence by which an appropriate dressing may be selected. In many instances, the ancillary function(s) of the dressing will become differentiating factors that influence choice. For example, the dressing capacity to manage exudate, maintain an optimum moist environment, reduce or avoid maceration, maintain an intimate contact with the wound bed, promote autolytic debridement, sequester bacteria and bind matrix metallo proteases (MMPs) are some of those functions that are of clinical significance and may dictate choice. In this article we present the evidence for these functions, thereby enabling practitioners to evaluate comparative dressing attributes, and so make an informed choice of which silver dressing best suits the needs of the wound under differing circumstances.

Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody.

Allergic bronchopulmonary aspergillosis (ABPA) can cause severe worsening of the respiratory condition in patients with cystic fibrosis. Treatment can result in steroid dependency and serious adverse events. A dramatic and rapid improvement of respiratory symptoms and lung function after a single dose of anti-IgE antibody (omalizumab) in a 12-year-old girl with cystic fibrosis and ABPA is described. This is the first report of this experimental treatment. It suggests an important role for IgE in the pathogenesis of ABPA and offers new therapeutic possibilities.

Quorum signal molecules as biosurfactants affecting swarming in Rhizobium etli.

Swarming motility is suggested to be a social phenomenon that enables groups of bacteria to coordinately and rapidly move atop solid surfaces. This multicellular behavior, during which the apparently organized bacterial populations are embedded in an extracellular slime layer, has previously been linked with biofilm formation and virulence. Many population density-controlled activities involve the activation of complex signaling pathways using small diffusible molecules, also known as autoinducers. In Gram-negative bacteria, quorum sensing (QS) is achieved primarily by means of N-acylhomoserine lactones (AHLs). Here, we report on a dual function of AHL molecules in controlling swarming behavior of Rhizobium etli, the bacterial symbiotic partner of the common bean plant. The major swarming regulator of R. etli is the cinIR QS system, which is specifically activated in swarming cells by its cognate AHL and other long-chain AHLs. This signaling role of long-chain AHLs is required for high-level expression of the cin and rai QS systems. Besides this signaling function, the long-chain AHLs also have a direct role in surface movement of swarmer cells as these molecules possess significant surface activity and induce liquid flows, known as Marangoni flows, as a result of gradients in surface tension at biologically relevant concentrations. These results point to an as-yet-undisclosed direct role of long-chain AHL molecules as biosurfactants.