Refractory Pseudomonas aeruginosa infections treated with phage PASA16: A compassionate use case series.

BACKGROUND: A growing number of compassionate phage therapy cases were reported in the last decade, with a limited number of clinical trials conducted and few unsuccessful clinical trials reported. There is only a little evidence on the role of phages in refractory infections. Our objective here was to present the largest compassionate-use single-organism/phage case series in 16 patients with non-resolving Pseudomonas aeruginosa infections. METHODS: We summarized clinical phage microbiology susceptibility data, administration protocol, clinical data, and outcomes of all cases treated with PASA16 phage. In all intravenous phage administrations, PASA16 phage was manufactured and provided pro bono by Adaptive Phage Therapeutics. PASA16 was administered intravenously, locally to infection site, or by topical use to 16 patients, with data available for 15 patients, mainly with osteoarticular and foreign-device-associated infections. FINDINGS: A few minor side effects were noted, including elevated liver function enzymes and a transient reduction in white blood cell count. Good clinical outcome was documented in 13 out of 15 patients (86.6%). Two clinical failures were reported. The minimum therapy duration was 8 days with a once- to twice-daily regimen. CONCLUSIONS: PASA16 with antibiotics was found to be relatively successful in patients for whom traditional treatment approaches have failed previously. Such pre-phase-1 cohorts can outline potential clinical protocols and facilitate the design of future trials. FUNDING: The study was funded in part by The Israeli Science Foundation IPMP (ISF_1349/20), Rosetrees Trust (A2232), United States-Israel Binational Science Foundation (2017123), and the Milgrom Family Support Program.

Adolescent Immigration and Type-2 Diabetes.

PURPOSE OF REVIEW: Type-2 diabetes (T2D) in children and adolescents has become an increasingly important public health concern, currently accounting for nearly half of all diabetes cases in this age group in some countries. With immigration growing worldwide, immigrants as a subpopulation warrant special attention. Although the association of immigration and T2D has been explored in older persons, few studies have examined it in adolescent immigrants. RECENT FINDINGS: Of 64 studies, only 8 were relevant and elaborated on in this review. Our findings show that adolescent immigrants to Western countries seem to benefit an overall favorable metabolic profile that is associated with lower odds to dysmetabolism. However, this protective effect wanes over time with longer years of residency and plateaus at approximately a decade from arrival. As immigration becomes a global phenomenon, pediatric T2D in these special populations has major public health and socioeconomic implications. Improving immigrants' access to healthcare, healthcare education and utilization, and specific cultural programs for prevention and treatment of T2D are important to ensure the accessibility of preventive medical services to young immigrants. Further research should be considered to help identify at-risk youth.