[Vaccination for Cirrhosis and Liver Transplant Patients]. / Inmunizaciones en cirrosis y trasplante hepático: Puesta al día.

Patients with cirrhosis and liver transplantation (LT) have a higher risk of infections, complications and death. Vaccines have historically been used to prevent and reduce the risk of complications from viral and bacterial infections. The population with cirrhosis and candidates for LT should be evaluated for immunity against the most relevant immuno-preventable infections, update corresponding immunizations according to the national vaccination program, and inoculate the missing vaccines based on these recommendations. In case of not reaching its inoculation prior to LT, in the post-LT period its vaccination status should be updated. All doctors involved in the health care of these patients must have knowledge about this important topic and be aware of the access and free availability for this population through the presentation of a special form incorporated into the National Immunization Program.

Cross-kingdom microbial interactions in dental implant-related infections: is Candida albicans a new villain?

Candida albicans, an oral fungal opportunistic pathogen, has shown the ability to colonize implant surfaces and has been frequently isolated from biofilms associated with dental implant-related infections, possibly due to its synergistic interactions with certain oral bacteria. Moreover, evidence suggests that this cross-kingdom interaction on implant can encourage bacterial growth, leading to increased fungal virulence and mucosal damage. However, the role of Candida in implant-related infections has been overlooked and not widely explored or even considered by most microbiological analyses and therapeutic approaches. Thus, we summarized the scientific evidence regarding the ability of C. albicans to colonize implant surfaces, interact in implant-related polymicrobial biofilms, and its possible role in peri-implant infections as far as biologic plausibility. Next, a systematic review of preclinical and clinical studies was conducted to identify the relevance and the gap in the existing literature regarding the role of C. albicans in the pathogenesis of peri-implant infections.

Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trial.

BACKGROUND: Patients with inflammatory diseases, such as rheumatoid arthritis, often receive glucocorticoids, but long-term use can produce adverse effects. Evidence from randomised controlled trials to guide tapering of oral glucocorticoids is scarce. We investigated a scheme for tapering oral glucocorticoids compared with continuing low-dose oral glucocorticoids in patients with rheumatoid arthritis. METHODS: The Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial was a double-blind, multicentre, two parallel-arm, randomised controlled trial done at 39 centres from six countries (France, Germany, Italy, Russia, Serbia, and Tunisia). Adult patients with rheumatoid arthritis receiving tocilizumab and glucocorticoids 5-15 mg per day for 24 weeks or more were eligible for inclusion if they had received prednisone 5 mg per day for 4 weeks or more and had stable low disease activaity, confirmed by a Disease Activity Score for 28 joints-erythrocyte sedimentation rate (DAS28-ESR) of 3·2 or less 4-6 weeks before and on the day of randomisation. Patients were randomly assigned 1:1 to either continue masked prednisone 5 mg per day for 24 weeks or to taper masked prednisone reaching 0 mg per day at week 16. All patients received tocilizumab (162 mg subcutaneously every week or 8 mg/kg intravenously every 4 weeks) with or without csDMARDs maintained at stable doses during the entire 24-week study. The primary outcome was the difference in mean DAS28-ESR change from baseline to week 24, with a difference of more than 0·6 defined as clinically relevant between the continued-prednisone group and the tapered-prednisone group. The trial is registered with ClinicalTrials.gov, NCT02573012. FINDINGS: Between Oct 21, 2015, and June 9, 2017, 421 patients were screened and 259 (200 [77%] women and 59 [23%] men) were recruited onto the trial. In all 128 patients assigned to the continued-prednisone regimen, disease activity control was superior to that in all 131 patients assigned to the tapered-prednisone regimen; the estimated mean change in DAS28-ESR from baseline to week 24 was 0·54 (95% CI 0·35-0·73) with tapered prednisone and -0·08 (-0·27 to 0·12) with continued prednisone (difference 0·61 [0·35-0·88]; p<0·0001), favouring continuing prednisone 5 mg per day for 24 weeks. Treatment was regarded as successful (defined as low disease activity at week 24, plus absence of rheumatoid arthritis flare for 24 weeks and no confirmed adrenal insufficiency) in 99 (77%) patients in the continued-prednisone group versus 85 (65%) patients in the tapered-prednisone group (relative risk 0·83; 95% CI 0·71-0·97). Serious adverse events occurred in seven (5%) patients in the tapered-prednisone group and four (3%) patients in the continued-prednisone group; no patients had symptomatic adrenal insufficiency. INTERPRETATION: In patients who achieved low disease activity with tocilizumab and at least 24 weeks of glucocorticoid treatment, continuing glucocorticoids at 5 mg per day for 24 weeks provided safe and better disease control than tapering glucocorticoids, although two-thirds of patients were able to safely taper their glucocorticoid dose. FUNDING: F Hoffmann-La Roche.

The kelp macrocystis pyrifera as nutritional supplement for goats

The present study was aimed to evaluate Macrocystis pyrifera (MP) meal as a nutritional supplement for goats. There is an increasing interest to look at nutritional alternatives to guarantee a continuous supply of good quality forage for goats, in many communities around the world. Given its abundance and chemical composition, the algae M. pyrifera is an important potential resource as animal feed. Three diets with 10, 20, and 30% of MP meal concentrations and a control diet, with no algae, were evaluated. Four rumen cannulated goats, housed individually in metabolism cages, were used. The experimental design was a 4 x 4 Latin-Square. Feed and water intake, excreted urine and faeces, were measured. Digestibility in vivo, dry matter (DM) disappearance, and the metabolic variables of pH and ammoniacal nitrogen in the rumen, were determined. There was no significant difference in the feed intake but there was in water intake and urine excreted. No significant difference in digestibility in vivo among diets (P>0.05) was found. A significant difference (P<0.05) for degradability in situ was found for the algae diets containing 10 and 30 percent MP concentrations at 96 hours of sampling (78.3 and 82.2 percent). The raw algae in situ digestibility was 77 percent. A potential degradability of 87.3 percent was obtained with 30 percent MP diet. The highest effective degradation was obtained at an estimated rate of 0.02 h-1. Ruminal pH was higher (P<0.05) in all MP treatments (10 percent MP: 6.83, 20 percent MP: 6.85, 30 percent MP: 6.91). As suggested by the results, M. pyrifera represents a good unconventional feeding as a nutritional supplement for goats.

El objetivo de este trabajo fue evaluar Macrocystis pyrifera (MP) como suplemento alimenticio para cabras. Hay un interés creciente en buscar alternativas alimenticias para garantizar el suministro continuo de forraje de buena calidad para cabras en muchas comunidades del mundo. Dada su abundancia y composición química, el alga M. pyrifera es un recurso potencial importante como pienso para ganado. Se evaluaron tres dietas con concentraciones de 10, 20, y 30 por ciento de harina de MP, y una dieta control, sin las algas. Se utilizaron cuatro cabras canuladas dispuestas individualmente en jaulas metabólicas. El diseño experimental fue un Cuadrado Latino 4 x 4. El alimento y agua consumidos, la orina y las heces excretadas fueron medidas. Se determinaron la digestibilidad in vivo, la desaparición in situ de la materia seca y las variables metabólicas pH y nitrógeno amoniacal en rumen. No se encontró diferencia significativa en el alimento consumido, ni en la digestibilidad in vivo entre las dietas (P>0,05), pero si hubo diferencia significativa en el consumo de agua y la orina excretada (P<0,05). Se encontró diferencia significativa (P<0,05) para la digestibilidad in situ en las dietas que contenían el 10 y 30% del alga a la hora 96 del muestreo (78,3 y el 82,2 por ciento). La digestibilidad in situ del alga fue de 77 por ciento. Se obtuvo una degradabilidad potencial de 87,3 por ciento con la dieta que contiene 30 por ciento de MP. La mayor degradación efectiva se obtuvo a una tasa estimada de 0,02 h-1. El pH ruminal fue más alto (P<0,05) en todos los tratamientos con MP (10 por ciento de MP: 6,83, 20 por ciento de MP: 6,85, 30 por ciento de MP: 6,91). Los resultados obtenidos sugieren que M. pyrifera representa un buen suplemento nutricional no convencional para cabras.