Pre-treatment sarcopenic assessments as a prognostic factor for gynaecology cancer outcomes: systematic review and meta-analysis.

INTRODUCTION: Gynaecology cancers, including ovarian (OC), endometrial (EC), and cervical (CC), are prevalent with high mortality. Sarcopenia is found in 38.7% of cancer patients, adversely affecting prognosis. Computed tomography (CT) is performed routinely in oncology, yet CT assessments of sarcopenia are not commonly used to measure prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic potential of pre-treatment sarcopenia assessments on overall survival (OS) and progression free survival (PFS) in gynaecology cancer. METHODOLOGY: Four electronic databases were systematically searched from 2000 to May 2020 in English: Ovid Medline, EMBASE, Web of Science, and CINAHL plus. Titles and abstracts were screened, eligible full-texts were reviewed, and data from included studies was extracted. Meta-analyses were conducted on homogenous survival data, heterogenous data were narratively reported. RESULTS: The initial search yielded 767 results; 27 studies were included in the systematic review (n = 4286), all published between 2015 and 2020. Meta-analysis of unadjusted results revealed a negative effect of pre-treatment sarcopenia on OS in OC (HR: 1.40, 1.20-1.64, p < 0.0001) (n = 10), EC (HR: 1.42, 0.97-2.10, p = 0.07) (n = 4) and CC (HR: 1.10, 0.93-1.31, p = 0.28) (n = 5), and a negative effect on PFS in OC (HR: 1.28, 1.11-1.46, p = 0.0005) (n = 8), EC (HR: 1.51, 1.03-2.20, p = 0.03) (n = 2) and CC (HR: 1.14, 0.85-1.53, p = 0.37) (n = 2). Longitudinal analysis indicated negative effects of muscle loss on survival. Overall, there was a high risk of bias. CONCLUSION: Pre-treatment sarcopenia negatively affected survival in gynaecology cancers. Incorporating such assessments into cancer management may be beneficial. Heterogeneity in sarcopenia assessments makes data interpretation challenging. Further research in prospective studies is required.

The global effect of extreme weather events on nutrient supply: a superposed epoch analysis.

BACKGROUND: To date, the effects of extreme weather events on nutrient supply within the population have not been quantified. In this study, we investigated micronutrient, macronutrient, and fibre supply changes during 175 extreme weather events within 87 countries in the year that a major extreme weather event occurred, with a targeted focus on low-income settings. METHODS: We collected data from the International Disasters Database and the Global Expanded Nutrient Supply model for the period 1961-2010, and applied superposed epoch analysis to calculate the percentage change in nutrient supply during the year of an extreme weather event relative to its historical context. We composited globally and by subgroup (EU, landlocked developing countries, least developed countries, low-income food deficit countries, and net food-importing developing countries). Lastly, we reported nutrient supply changes in terms of recommended dietary allowance for children aged 1-3 years. FINDINGS: Globally, all micronutrient supplies had a modest negative percentage change during the year of an extreme weather event; of these effects, those that reached an α=0·05 significance level included calcium, folate, thiamin, vitamin B6, and vitamin C, with nutrient supply changes ranging from -0·40 to -1·73% of the average supply. The effect of an extreme weather event was especially magnified among landlocked developing countries and low-income food deficit countries, with significant nutrient supply changes ranging from -1·61 to -7·57% of the average supply. Furthermore, the observed nutrient supply deficits in landlocked developing countries constituted a large percentage (ranging from 1·95 to 39·19%) of what a healthy child's sufficient average dietary intake should be. INTERPRETATION: The global effects of extreme weather events on nutrient supply found in this study are modest in isolation; however, in the context of nutrient needs for healthy child development in low-income settings, the effects observed are substantial. FUNDING: Australian-American Fulbright Commission.

Signalling of information that is neither cryptic nor private.

It is commonly assumed that in order for animal signals to be advantageous, the information being signalled could not have been obtained otherwise, and is therefore 'cryptic' or 'private'. Here, we suggest a scenario in which individuals can gain an advantage by signalling 'public' information that is neither cryptic nor private. In that scenario, signalling increases the efficiency with which that 'public' information is transmitted. We formalize our idea with a game in which offspring can signal their condition to their parents. Specifically, we consider a resource-strapped parent who can only invest in one of its two offspring, and we allow offspring the chance to influence parental investment through a signal. A parent in the game seeks to invest in the higher-quality offspring, which it could identify either through a publicly available cue, such as body size, or by relying on a signal provided by the offspring. We find that if the signal can convey information about offspring quality more efficiently than cues, then signalling of condition between offspring and parents can be favoured by selection, even though parents could potentially have acquired the same information from the cue. Our results suggest that the biological function of signals may be broader than currently considered, and provide a scenario where low cost signalling can be favoured. More generally, efficiency benefits could explain signalling across a range of biological and economic scenarios.

Determinantes sociales y conductuales en salud nutricional: evidencia para Chile / Social and behavioral determinants on nutritional health: evidence for Chile

Due to the nutritional transition in the last decades, the risk factors linked to food nutrition are in the spotlight of public policy and reduction of their prevalence is a key goal in the public health promotion strategies involving food security and nutrition (FSN). Understanding the factors underlying poor nutrition status is a must in order to execute successful policy interventions in the general population. This paper analyses the impact that social and individual behavior variables have on the risk factors linked to poor nutrition (obesity, high levels of cholesterol, glycaemia and sodium) using data from the National Health Survey 2009-2010 using a Seemingly Unrelated Equations (SUR) approach in order to have a consistent estimation outcome. Findings suggest that variables linked to social environment and individual behavior have a significant impact on the food-related health risk factors, taking account for social, demographic, genetic and economic controls. Unsurprisingly, when people underestimate their nutritional status, it conduces to a greater health risk, explaining up to 6 cms of abdominal girth and 3 points of the BMI index. Also, an insecure neighborhood and weak social networks explain part of the health risk. These results are a starting point to discuss the design of public policy regarding health and nutrition in order to promote the food security especially regarding information and education programs, where there is the possibility to strengthen the social support networks.

Los factores de riesgo a la salud asociados con la alimentación son un foco clave en las estrategias de promoción de la salud y de seguridad alimentaria y nutricional en Chile (SAN). Este artículo entrega un análisis de los efectos que variables conductuales y sociales tienen sobre los factores de riesgo asociados a una mala nutrición (obesidad, altos niveles de colesterol, glicemia elevada y altos niveles de sodio), en base a la Encuesta Nacional de Salud 2009-2010 utilizando una estimación por regresiones aparentemente no relacionadas (SUR). Los resultados revelan que las variables asociadas a aspectos conductuales y sociales tienen un impacto significativo en los factores de riesgo de salud alimentaria, controlando por variables demográficas, genéticas y socioeconómicas. Destaca el efecto de la subestimación de las personas respecto a su estado nutricional, que puede explicar hasta 6 cm de circunferencia abdominal y 3 puntos en el IMC. Asimismo, las redes de apoyo social y económico a nivel individual juegan un rol fundamental. Los resultados entregados son un insumo relevante para la discusión sobre los mecanismos que la política pública debiese tener a fin de promover la seguridad alimentaria y nutricional, en particular al diseñar programas de educación e información a la población, donde existe la posibilidad de fortalecer las redes de apoyo existentes.

Interpretación de la densitometría ósea / Interpretation of bone mineral densitometry

La densitometría ósea es la técnica diagnóstica de elección en el estudio de la osteoporosis que en el momento actual aporta ventajas sobre las otras pruebas existentes.ResumenSe trata de una técnica con buenos resultados de precisión y fiabilidad, pero cuyo mayor rendimiento práctico se consigue en las personas con mayor riesgo de fracturas, lo que determina sus indicaciones y la no realización de cribado en la población general.ResumenLa interpretación de sus resultados está marcada por los criterios diagnósticos de la OMS, que a través de la T-Score permiten estratificar el riesgo de fractura, y por las limitaciones del propio método, entre los que destaca la baja capacidad predictiva de fractura a nivel individual (AU)

Bone mineral densitometry (BMD) is the diagnostic technique of choice in the study of osteoporosis at present and has advantages over other existing methods.AbstractThis is a technique with good results for precision and reliability, however, its best practical performance is achieved in those having increased risk of fractures, which determine their indications, and not carrying out screening in the general population.AbstractThe interpretation of its results is marked by the WHO diagnostic criteria, which, using the T-Score, makes it possible to stratify the risk of fracture, and by the limitations of the method, among them the low predictive ability of the individual fracture (AU)

Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication.

BACKGROUND: The recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established. AIM: To compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication. METHODS: One hundred and sixty patients (aged 18-70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20mg b.d. and amoxicillin 1g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire. RESULTS: No dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p=0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups). Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p=0.58; 12% in the once daily group; 32.5% in the twice daily group; p=0.04). CONCLUSIONS: 10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.

Non-photoperiodic factors and timing of breeding in blue tits: impact of environmental and social influences in semi-natural conditions.

The seasonal development of life-history traits is influenced by many environmental factors. The impact of photoperiodic and non-photoperiodic factors on nest building and egg laying has been rarely investigated in non-domesticated avian species for which long term field data sets are available. Former investigations showed that blue tits originating from geographically close populations in the Mediterranean region do not respond in the same way to photoperiodic factors in semi-natural outdoor conditions. Here we show experimentally that nest building and onset of egg laying in captive blue tits is also proximately influenced by non-photoperiodic factors, including aspects related to aviary characteristics and social interactions between birds of the two sexes originating from different local Mediterranean study populations. In two successive experiments, we show that (1) increasing the volume of the aviary advanced the egg laying period of one specific population by almost 1 month, and (2) crossing pairs of birds from different origins strongly reduced the nest building and egg laying behaviours. These results indicate that obtaining biologically relevant breeding results in captivity with wild birds requires the control and experimental manipulation of a wide array of complex environmental cues.

Medical strategies for weight loss in the overweight and obese patient.

In recent years, obesity has become a major public health problem in Western countries. The World Health Organization has defined obesity as a global epidemic of the third millennium. Treatment options for weight management include dietary intervention, physical activity, behavior modification, pharmacotherapy and surgery. However, the complexity of this chronic condition necessitates a coordinated multidisciplinary team-approach to the care of obese patients who fail weight control. The long-term duration of the treatment and the necessity of monitoring compliance and effectiveness should be considered. The objective of this article was to review the major controlled randomized clinical trials dealing with the different medical strategies for weight loss and its maintenance in overweight and obese patients.

Early treatment with ursodeoxycholic acid for cholestasis in children on parenteral nutrition because of primary intestinal failure.

BACKGROUND: There is conflicting evidence as to whether ursodeoxycholic acid (UDCA) reduces the incidence of parenteral nutrition-associated cholestasis. AIM: To investigate the efficacy of UDCA on parenteral nutrition-associated cholestasis in children with intestinal failure due to short bowel syndrome or to other causes. METHODS: Children with cholestasis received 30 mg/kg/day UDCA. Improvement or normalization of parenteral nutrition-associated cholestasis was evaluated at 6 months of therapy and at the last follow-up. In a subgroup of children, serum UDCA levels were measured while receiving UDCA and after 4 weeks withdrawal. RESULTS: Twelve children were treated with UDCA. Full remission or partial improvement of parenteral nutrition-associated cholestasis occurred in 11 of 12 children. In three of four children, withdrawal of UDCA was associated with a rebound rise of cholestasis. Only one of 12 treated children showed no improvement and in this patient, in contrast to four other patients, plasma levels of UDCA did not increase during treatment. CONCLUSIONS: Ursodeoxycholic acid was effective in controlling parenteral nutrition-associated cholestasis. The efficacy of UDCA also in children with short bowel is related to intestinal absorption.

Evidence that blue petrel, Halobaena caerulea, fledglings can detect and orient to dimethyl sulfide.

Procellariiform seabirds (the petrels, albatrosses and shearwaters) are recognized for their acute sense of smell. These pelagic seabirds forage over thousands of miles of ocean to find patchily distributed prey resources. Over the past decade, much headway has been made in unravelling the variety of olfactory foraging strategies that Antarctic species employ, and it is becoming clearer that olfaction plays a key role in foraging, particularly for burrow nesting species. Now we are beginning to explore how these behaviours develop in chicks. Procellariiform chicks fledge and survive the open seas without aid or instruction from a parent, but how they are able to accomplish this task is unknown. Here we explore whether chicks leave the nest pre-tuned to olfactory cues necessary for foraging. In this study, we tested the hypothesis that blue petrel chicks (Halobaena caerulea) are able to detect and orient to a foraging cue (dimethyl sulphide, DMS) used by adults without ever having experienced this odour at sea. We first established that chicks could detect DMS at a biologically relevant concentration that they will later naturally encounter at sea (<10 pmol l-1). We then performed preference tests in a Y-maze on a group of birds 1-6 days before they fledged. Sixteen out of 20 fledglings preferred DMS (e.g. DMS+propylene glycol) to a ;control' odour (propylene glycol alone). Our results suggest that chicks can detect and may already recognize DMS as an orientation cue even before they leave the nest to forage for the first time.

Simultaneous pituitary-gonadal recrudescence in two Corsican populations of male blue tits with asynchronous breeding dates.

Animal populations living in geographically variable environments respond to different selection pressures. The adaptive character of the responses to environmental information determines the degree of synchrony of the breeding period with local optimal conditions. An example is provided by two populations of Mediterranean blue tits (Parus caeruleus) in Corsica, breeding in different habitats, with a 1-month difference in the onset of egg laying. This difference in the onset of lay is supposed to be adaptive because, although chicks from both populations are raised mostly on caterpillars, the timing of the appearance of caterpillars is earlier for populations of tits associated with deciduous oak trees than those associated with evergreen oak trees. Here, we show that, despite the difference in the timing of egg laying, males from these two populations start seasonal hypothalamo-hypophysial-testicular development at approximately the same time, in late winter. Specifically, the vernal recrudescence of brain GnRH-I perikarya and fibers, testes volume and song activity began around the same dates and proceeded at the same pace in late winter in both populations. Plasma testosterone and LH levels displayed seasonal variations that were shifted by less than 2 weeks compared to the 1-month difference in egg laying periods. We hypothesize that the strong selection pressures on these two populations to adapt the timing of their breeding seasons to their local environment may have acted mostly on the female egg laying dates, and not so much on the initiation and rate of seasonal recrudescence of the hypothalamo-hypophysial-testicular activity in males.

Probiotics and small bowel mucosa: Molecular aspects of their interactions.

Probiotics are described as "friendly bacteria" that could improve the intestine defense by interacting with the resident microflora. There is a large body of evidence suggesting that consumption of functional food containing probiotics exerts positive effects on human health. Several clinical trials have highlighted the efficiency of probiotics in the prevention and treatment of different gastrointestinal disorders including the prevention of antibiotic associated diarrhea, the remission in patients with inflammatory bowel disease, beneficial effects against Helicobacter pylori infection, positive effects in patients affected by allergies and atopic diseases. The clinical benefits of probiotics use are mainly attributed to their antimicrobial substances production and their positive interactions with the enterocytes to reinforce the intestinal epithelial barrier. Moreover, there is evidence suggesting that probiotics stimulate both specific and non-specific host immune responses. Recently, have been published some experiments performed with the DNA microarray technology which provided a global gene screening of the complex bacteria-host interplay. Nevertheless, the molecular mechanisms by which probiotics enhance the intestinal host defense are still not completely elucidated. Here, we review the experiments and clinical studies to date on the complex mechanisms regulating the communication between probiotics and their hosts.

Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate the feasibility, safety, and clinical impact of push-and-pull enteroscopy (PPE) in patients with suspected or documented small-bowel diseases, in a prospective multicenter trial in three European medical centers. PATIENTS AND METHODS: A total of 100 patients (mean age 56 +/- 16 years; range 13 - 90) were included at the three institutions between July and November 2004. The leading symptoms were: acute recurrent or chronic gastrointestinal bleeding (n = 64), polyposis syndrome (n = 8), chronic abdominal pain (n = 7), chronic diarrhea (n = 7), and others (n = 14). RESULTS: No major PPE-associated complications such as perforation, bleeding, or relevant injury to the small-bowel tissue or mesentery were encountered. Minor complications occurred in 12 %. The mean time required to carry out the procedure from the oral and anal approaches was 75 +/- 19 min (32 - 150 min). The average insertion depths into the small bowel were 200 +/- 70 cm per PPE session (220 +/- 90 cm with the oral approach and 130 +/- 80 cm with the anal approach). The average radiation exposure (including diagnostic and therapeutic interventions) was 2.1 +/- 2.4 min and 155 +/- 159 dGy/cm2. PPE was fully diagnostic in 72 % of cases. The majority of the patients (34 %) were suffering from angiodysplasias; ulcerations and erosions of various etiologies were seen in 16 %, and polyps and tumors in 13 %. The PPE findings played a role in the subsequent treatment in 62 % of the patients. Endoscopic treatments, including argon plasma coagulation, polypectomy, dilation, and foreign-body extraction, were carried out in 42 %. Medical treatment was given in 12 %, and patients were referred for surgery in 8 % of cases. CONCLUSIONS: This prospective analysis shows that PPE is safe and has a high diagnostic and therapeutic yield in patients with suspected or known small-bowel disease.

Effects of Lactobacillus GG on genes expression pattern in small bowel mucosa.

BACKGROUND AND AIMS: Probiotics have been used for cure and prevention of several clinical conditions. However, further insights into the mechanism of action are needed to understand the rationale of their use. The aim of this study was to investigate the influence of Lactobacillus GG on the genetic expression patterns in the small bowel mucosa. METHODS: Six male patients (38+/-5 years) with endoscopically proven oesophagitis were enrolled. All patients were treated for 1 month with esomeprazole and randomised to receive Lactobacillus GG or placebo. After 1 month of treatment, upper endoscopy was repeated. Biopsies of the duodenal mucosa were taken prior to and after the treatment, and the genes expression patterns were assessed using GeneChip Human U133A array. Genes with significant expression changes were selected and analysed to identify specific cellular pathways modified by Lactobacillus GG. To support the array data, 10 target genes were studied using Syber-Green PCR. RESULTS: Microarray analysis showed that Lactobacillus GG administration determined the up- and down-regulation of 334 and 92 genes, respectively. Real-time PCR confirmed the reliability of the analysis. Lactobacillus GG mainly affected the expression of genes involved in immune response and inflammation (TGF-beta and TNF family members, cytokines, nitric oxide synthase 1, defensin alpha 1), apoptosis, cell growth and cell differentiation (cyclins and caspases, oncogenes), cell-cell signalling (ICAMs and integrins), cell adhesion (cadherins), signal transcription and transduction. CONCLUSIONS: These data indicate that administration of Lactobacillus GG is associated with a complex genetic response of the duodenal mucosa, reflected by the up- and down-regulation of several genes involved in specific cellular pathways.

Levofloxacin-based triple therapy vs. quadruple therapy in second-line Helicobacter pylori treatment: a randomized trial.

BACKGROUND: Levofloxacin has been shown to be effective in Helicobacter pylori eradication. Two 10-day levofloxacin-based triple therapies were compared with standard 7- and 14-day quadruple regimens in second-line treatment. METHODS: Two hundred and eighty consecutive patients who failed to respond to standard triple therapy (clarithromycin, amoxicillin, rabeprazole) were randomly assigned to four groups: (1) levofloxacin 500 mg o.d., amoxicillin 1 g b.d., rabeprazole 20 mg b.d. for 10 days (LAR, n = 70); (2) levofloxacin 500 mg o.d., tinidazole 500 mg b.d., rabeprazole 20 mg b.d. for 10 days (LTR, n = 70); (3) tetracycline 500 mg q.d.s., metronidazole 500 mg t.d.s., bismuth salt 120 mg q.d.s., rabeprazole 20 mg b.d. for 7 days (7TMBR, n = 70); and (4) for 14 days (14TMBR, n = 70). Helicobacter pylori status and side-effects were assessed 6 weeks after treatment. RESULTS: The eradication rate was 94% in the LAR group and 90% in the LTR group in both intention-to-treat and per protocol analyses. Helicobacter pylori eradication was achieved in 63 and 69% of the 7TMBR group and in 69 and 80% of the 14TMBR group in intention-to-treat and per protocol analysis, respectively. Side-effects were significantly lower in the LAR and LTR groups than in the 14TMBR group. CONCLUSION: Ten-day levofloxacin-based therapies are better than standard quadruple regimens as second-line option for H. pylori eradication.

Meta-analysis: the relationship between Helicobacter pylori infection and gastro-oesophageal reflux disease.

BACKGROUND: The relationship between Helicobacter pylori infection and its treatment and gastro-oesophageal reflux disease (GERD) is controversial. AIMS: To establish if H. pylori infection is associated with the presence of GERD and if anti-H. pylori treatment leads to de novo GERD or rebound/exacerbation of GERD. METHODS: A search of MEDLINE and EMBASE databases was made. Pooled odds ratios (OR) were calculated for de novo GERD and rebound/exacerbated GERD after anti-H. pylori therapy in case-control studies and in therapeutic trials. RESULTS: Fourteen case-control studies and 10 clinical trials were included. Among case-control studies, pooled OR for the association between H. pylori negative status and GERD was 1.34 [95% confidence interval (CI) 1.15-1.55]. Among therapeutic trials, pooled OR for the association anti-H. pylori therapy - GERD was 2.54 (95% CI 1.92-3.37). The OR for de novo GERD was 3.25 (95% CI 2.09-5.33), and for rebound/exacerbated GERD was 2.39 (95% CI 1.75-3.34). Associations were higher among Asian studies than among North American and European studies. CONCLUSIONS: This meta-analysis shows significant association between absence of H. pylori infection and GERD symptoms, and a positive association between anti-H. pylori therapy and occurrence of both de novo and rebound/exacerbated GERD. The significance of these associations appears to have been inflated by the effect of single trials and by geographical variations.

Pharmacokinetics of intramuscularly administered biperiden in guinea pigs challenged with soman.

Biperiden is an anticholinergic compound that has demonstrated effectiveness for treating organophosphate-induced seizure/convulsions. The plasma levels of biperiden associated with this efficacy have not yet been defined. In this study, the pharmacokinetics and tissue distribution of biperiden after intramuscular administration of 0.5 mg/kg were conducted while monitoring pharmacodynamic (electroencephalographic) data in soman-exposed guinea pigs. Overall, 59% of the animals had seizures terminated within 30 min of the biperiden administration. The mean time to seizure termination was 15.9 min. The pharmacokinetics of biperiden after i.m. administration to guinea pigs were best described by a one-compartment model with first-order absorption and elimination. The maximal plasma biperiden concentration (34.4 ng/mL) in seizure-terminated animals occurred at 26.3 min. Extensive partitioning into peripheral tissues was noted supporting the relatively large volume of distribution observed. Maximal biperiden concentrations in the cortex and brain stem were found at 30 min and were 2.3 and 1.7 times greater, respectively, than that in plasma. The time for maximal plasma concentration was found to corresponded well with the mean time to seizure termination following drug administration.

Probiotics in antibiotic-associated diarrhoea.

Antibiotic-associated diarrhoea is a common event. In some cases, it could represent a life-threatening event. Clostridium difficile colitis is a further distinct complication of antibiotic administration. Treatment options for antibiotic-associated diarrhoea and Clostridium difficile colitis include supplementation with several types of probiotics, as overviewed in this paper. Three randomised, double-blind, controlled clinical trials show a therapeutic effect of Saccharomyces boulardii in antibiotic-associated diarrhoea. The efficacy of Lactobacillus acidophilus and bulgaricus has also been ascertained in two double-blind controlled studies. Other studies focusing on Lactobacillus as a new preventive agent for antibiotic-associated diarrhoea are not double-blind. Among these, a positive effect of Lactobacillus rhamnosus GG, Bifidobacterium longum and Enterococcus faecium SF68 has been reported. Effectiveness of probiotics in antibiotic-associated diarrhoea has, therefore, a consistent scientific rationale, however few studies have performed an assessment of bacterial recovery in stools, and this approach may be helpful in deciding a more rigorous dose standardisation.