Results from the first English stool bank using faecal microbiota transplant as a medicinal product for the treatment of Clostridioides difficile infection.

BACKGROUND: Faecal Microbiota Transplant (FMT) has improved outcomes for the treatment of Clostridioides difficile infection (CDI) compared to antibiotic therapy. FMT is classified as a medicinal product in the United Kingdom, similar to the USA and Canada, limiting supply via stool banks without appropriate licencing. In the largest UK cohort to date, we describe the clinical outcomes for 124 patients receiving FMT for recurrent or refractory CDI and present a framework to produce FMT as a licenced medicinal product. METHODS: Anonymous unrelated healthy donors, screened via health assessment and microbiological testing donated stool. In aerobic conditions FMT aliquots were prepared for immediate use or frozen storage, following a production framework developed to comply with Good Manufacturing Practice. Outcome measures were clinical response to FMT defined as resolution of diarrhoea within seven days and clinical cure defined as response without diarrhoea recurrence at 90 days. FINDINGS: Clinical response was 83·9% (95% CI 76·0%-90·0%) after one treatment. Clinical cure was 78·2% (95% CI 67·4%-89·0%) across the cohort. Refractory cases appeared to have a lower initial clinical response rate compared to recurrent cases, however at day 90 there were no differences observed between these groups. INTERPRETATION: The methodology developed here enabled successful licencing of FMT by The Medicines and Healthcare products Regulatory Agency as a medicinal product. This has widened the availability of FMT in the National Health Service via a stool bank and can be applied in other centres across the world to improve access to safe and quality assured treatments.

[Distribution of adipose tissue and insulin serum levels in women with gestational diabetes]. / La distribución del tejido adiposo y los niveles séricos de insulina en la mujer obesa que desarrolla diabetes mellitus gestacional.

Obesity has been mentioned as a major risk factor to develop gestational diabetes mellitus (GDM). In this work the main purpose was to compare the distribution of body fat tissue and insulin serum levels in obese women suffering GDM. Twenty obese pregnant patients, ten with GDM and ten non-diabetic control subjects were selected. To define the body fat distribution the following anthropometric indexes were performed: subscapular/triceps skinfold index (STI) during pregnancy (24-28 weeks) and STI plus waist/hip ratio (WHR) in postpartum (6 weeks). The two obese groups were evaluated through an oral glucose tolerance test, taking blood at 0, 60, 120 and 180 minutes; after centrifugation glucose serum levels were measured immediately by the glucose oxidase technique and the rest of the sample was kept frozen at -20 degrees C until insulin determinations by radioimmunoassay. The ten patients with GDM presented upper body fat, segment distribution, while among those without GDM, only six had this last feature and four were found with lower body fat segment distribution (p < 0.047). Insulin serum levels in GDM group were higher than in women without GDM (p < 0.01). The STI during and after pregnancy correlated positively (r = 0.77, p < 0.00003) and also with WHR (r = 0.61, p < 0.0001). There was correlation between STI and WHR both measured in postpartum (r = 0.52, p < 0.0007).

Bone mineral density in patients with pancreatic insufficiency and steatorrhea.

OBJECTIVES: Low bone mineral density (BMD) has been demonstrated in some patients with chronic intestinal disorders accompanied by diarrhea and malabsorption. However, very few studies have evaluated BMD in patients with pancreatic insufficiency due to cystic fibrosis. Our aim was to assess the prevalence and severity of bone loss in a cohort of patients with pancreatic insufficiency as a consequence of chronic pancreatitis. METHODS: Fourteen patients with chronic pancreatitis were studied. All of them presented with severe pancreatic insufficiency (secretin test: bicarbonate < or = 40 mEq/L) and steatorrhea (fecal fat > 7 g/day) and had been abstinent from alcohol for a median of 2.5 yr (range 1-15 yr). BMD was measured with a total-body scanner for dual-energy x-ray absorptiometry. Results were expressed as T-score (number of SD by which a patient density differs from the mean of sex-matched 30-yr-old healthy controls) in lumbar spine (L2-L4) and femoral neck. Total serum calcium, 25-(OH)D3, alkaline phosphatase, and midmolecular parathyroid hormone were determined. RESULTS: Ten patients demonstrated osteopenia (T-score -1 to -2.5) in the lumbar spine and in the femoral neck. Three patients displayed osteoporosis (T-score < -2.5) in the lumbar spine and two in the femoral neck. Mean T-scores (+/- SEM) were -1.44 +/- 0.37 in the lumbar spine and -1.79 +/- 0.27 in the femoral neck. Total and ionic serum calcium, serum parathyroid hormone, and alkaline phosphatase were in the normal range in all patients. Serum 25-(OH)D3 was below normal range in 7 of 12 patients. T-scores of patients with pancreatitis of alcoholic etiology (n = 10) were similar to those of nonalcoholic patients (n = 4). BMD did not correlate with age, bicarbonate secretion, fecal fat excretion, stool volume, parameters of mineral metabolism, duration of alcoholism, or mean alcohol intake. CONCLUSIONS: Most patients with pancreatic insufficiency as a consequence of chronic pancreatitis exhibit osteopenia, and some show evidence of osteoporosis. Identifying the intimate mechanisms for low BMD are beyond the limitations of the present study. More in-depth metabolic studies are necessary to define the pathogenic mechanism of osteopenia associated with chronic pancreatic disorders.

[Incidence of oral cancer in AIDS patients at the "20 de Noviembre" Regional Hospital, ISSSTE]. / Incidencia de cáncer oral en pacientes con SIDA en el Hospital Regional "20 de Noviembre", ISSSTE.

Ever since its initial outbursts in high-risk groups, AIDS has had an appalling impact within the oncological sphere, since it combines opportunistic pathologies with the occurrence of malignancies caused by loss of defensive cells, thus allowing abnormal or cancerous cells to multiply. This paper conveys some recent concepts on AIDS, as well as a study undertaken at the "20 de Noviembre" Hospital, aimed at identifying the most common opportunistic diseases which often occur in the oral cavity upon contracting AIDS.

[Current use of miniplates in maxillofacial surgery. Review of the literature]. / Uso actual de las miniplaces en cirugía maxilofacial. Revisión de la literatura.

Some of the European countries have advocated the use of monocortical screw miniplates for osteosynthesis in the craniofacial areas and there are several advantages over the wired osteosynthesis. The advantages and different applications of the miniplates in maxillofacial surgery are presented.

[Radiology of the temporomandibular joint]. / Radiología de la articulación temporomandibular.

Different radiological techniques have been developed through the years within the realm of studies on the temporomandibular joint, which have implemented significant improvements in diagnosis by professionals in stomatology. Some of the most modern radiographical techniques, such as computerized tomography (CT) or magnetic resonance image (MRI) are not yet regularly used in our country for the diagnosing of temporomandibular dysfunctions. However, it is quite possible that in the near future, this type of techniques may be more widely handled, with resultant benefits for ailing patients.

Cutaneous metastatic Crohn's disease: treatment with metronidazole.

A 55-yr-old man with ileocolic Crohn's disease developed granulomatous dermatitis in the malar region. He was treated with metronidazole 1.5 g/day for 1 month, with remission of the skin lesion after 10 days.

[Celiac disease, histocompatibility antigens and immunologic status]. / Enfermedad celíaca, antígenos de histocompatibilidad y estado inmunitario.

Researched from immunologic and genetic point of view, 40 patients with Celiac Diseases confirmed and under-treatment. The results were compared with a group of 257 healthy people. The immunologic studies: leucocytes and lymphocytes in blood, the subpopulation of lymphocytes T and B, The immune-reaction studies of immunoglobulin Ig G, Ig M, Ig A and component C III complement didn't show difference between the comparative groups justified perhaps because the group of patients were under-treatment. In the antigen erythrocyte A B O and RHO (A), we can only in those assert that there is an increase of A and B group between the patients than who have O, and they were less exposed to get the disease. Between the histocompatibility antigen, the low presence of A9 B5 B7 BW16 antigen in Celiac patients could be a sign of protection against the disease, contrarily the presence of A1 B8 Dr3 Dr7 could indicate the high risk to get the disease. These finding confirm that the antigen group connected with the major System of histocompatibility, showed the susceptibility to suffer the disease.

Enfermedad celíaca, antígenos de histocompatibilidad y estado inmunitario. / [Celiac disease, histocompatibility antigens and immunologic status]

Researched from immunologic and genetic point of view, 40 patients with Celiac Diseases confirmed and under-treatment. The results were compared with a group of 257 healthy people. The immunologic studies: leucocytes and lymphocytes in blood, the subpopulation of lymphocytes T and B, The immune-reaction studies of immunoglobulin Ig G, Ig M, Ig A and component C III complement didnt show difference between the comparative groups justified perhaps because the group of patients were under-treatment. In the antigen erythrocyte A B O and RHO (A), we can only in those assert that there is an increase of A and B group between the patients than who have O, and they were less exposed to get the disease. Between the histocompatibility antigen, the low presence of A9 B5 B7 BW16 antigen in Celiac patients could be a sign of protection against the disease, contrarily the presence of A1 B8 Dr3 Dr7 could indicate the high risk to get the disease. These finding confirm that the antigen group connected with the major System of histocompatibility, showed the susceptibility to suffer the disease.