Alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis.

BACKGROUND: In patients with ulcerative colitis (UC), alterations of the intestinal microbiota, termed dysbiosis, have been postulated to contribute to intestinal inflammation. Fecal microbiota transplantation (FMT) has been used as effective therapy for recurrent Clostridium difficile colitis also caused by dysbiosis. The aims of the present study were to investigate if patients with UC benefit from FMT and if dysbiosis can be reversed. METHODS: Six patients with chronic active UC nonresponsive to standard medical therapy were treated with FMT by colonoscopic administration. Changes in the colonic microbiota were assessed by 16S rDNA-based microbial community profiling using high-throughput pyrosequencing from mucosal and stool samples. RESULTS: All patients experienced short-term clinical improvement within the first 2 weeks after FMT. However, none of the patients achieved clinical remission. Microbiota profiling showed differences in the modification of the intestinal microbiota between individual patients after FMT. In 3 patients, the colonic microbiota changed toward the donor microbiota; however, this did not correlate with clinical response. On phylum level, there was a significant reduction of Proteobacteria and an increase in Bacteroidetes after FMT. CONCLUSIONS: FMT by a single colonoscopic donor stool application is not effective in inducing remission in chronic active therapy-refractory UC. Changes in the composition of the intestinal microbiota were significant and resulted in a partial improvement of UC-associated dysbiosis. The results suggest that dysbiosis in UC is at least in part a secondary phenomenon induced by inflammation and diarrhea rather than being causative for inflammation in this disease.

omega-3 Fatty acids infusions as adjuvant therapy in rheumatoid arthritis.

BACKGROUND: The present study investigated the efficacy and safety of parenteral omega-3 fatty acids (omega-3 FA) in patients with active rheumatoid arthritis (RA). METHODS: We performed a double-blind, randomized, placebo-controlled study in 23 patients with moderate to severe RA. Patients received either 0.2 g of fish oil emulsion/kg (active) or 0.9% saline (placebo) infusion intravenously for 14 consecutive days, followed by 20 weeks of 0.05 g of fish oil/kg (active) or paraffin wax (placebo) ingested orally as capsules. A decrease in swollen and tender joint counts was the primary efficacy measure. RESULTS: At baseline, both swollen and tender joint counts were not significantly different between patients in the treatment and placebo groups. Twenty patients completed the infusion portion of the study, and 13 completed the oral portion. Swollen joint count was significantly lower in the omega-3 FA group compared with the placebo group after 1 week of infusion (P = .002) as well as after 2 weeks of infusion (P = .046). Tender joint count also tended to be lower in the omega-3 FA group, although this did not reach statistical significance. Both swollen and tender joint counts were significantly lower in the omega-3 FA group compared with the placebo group during and at the end of oral treatment. CONCLUSION: Our pilot study indicates that parenteral omega-3 FAs are well tolerated and improve clinical symptoms of RA. Subsequent oral administration of omega-3 FAs may prolong the beneficial effects of the infusion therapy. These results warrant validation in larger multicenter studies.

Case report: Hyperbaric oxygen in the treatment of puff adder (Bitis arietans) bite.

INTRODUCTION: The puff adder (Bitis arietans) is a venomous viper mainly found in sub-Saharan Africa. Due to its common occurrence and potent venom, it is considered to be the most dangerous snake in Africa, responsible for most snakebite fatalities there. Puff adder bites outside Africa are rare and involve captive vipers. We present the unusual case of puff adder envenomation in an Austrian man. CASE REPORT: A 26-year-old Austrian man was bitten by a puff adder that he kept illegally in his home. On admission he showed signs of local and systemic toxicity. He was stabilized with antivenom, intravenous fluids, catecholamines and packed platelets. Hyperbaric oxygenation was begun due to incipient compartment syndrome on the second day and continued until the eleventh day, when the patient had recovered completely and could be discharged. DISCUSSION: The venom of Bitis arietans can cause serious systemic and local complications. Our patient suffered from both. Systemic signs included hemodynamic as well as hemostaseologic impairment. Local effects included swelling and incipient compartment syndrome. Systemic and local treatment, including hyperbaric oxygenation, effected a full recovery. We suggest that, whenever feasible, hyperbaric oxygenation should be considered as adjunct treatment in snake bites to avert adverse outcomes.