Octreotide long-active release in the treatment of gastrointestinal bleeding due to vascular malformations: Cost-effectiveness study.

INTRODUCTION: Gastrointestinal hemorrhage due to vascular malformations has a negative impact on patients´ quality of life and consumes an important quantity of resources. OBJECTIVE: Analyze the cost-effectiveness of long-active releasing octreotide (OCT-LAR) in the treatment of gastrointestinal haemorrhage secondary to vascular malformations. MATERIAL AND METHODS: Retrospective study, including 19 pacients that were treated with mensual injections of OCTLAR between 2008-2013. The number of blood transfusions, hemoglobin levels, hospital admissions and possible side effects during the year before treatment and the year after the start of the treatment were assessed, and cost-effectiveness was analyzed. RESULTS: After the beginning of the treatment with OCTLAR, complete response was observed in 7 patients (36.8 %), partial response in 7 patients (36.8 %) and 5 patients (26.3 %) continued to require admissions, blood transfusions and/or endoscopic treatment. We observed significant reduction in the length of admission per year (in days) before and after the start of the treatment (22.79 versus 2.01 days, p < 0.0001) as well as in the number of blood transfusions administered (11.19 versus 2.55 blood transfusions per year, p = 0.002). The mean haemoglobin levels increased from 6.9 g/dl to 10.62 g/dl (p < 0.0001). We observed reduction of costs of 61.5 % between the two periods (from 36,072.35 € to 13,867.57 € per patient and year, p = 0.01). No side effects related to treatment were described. CONCLUSION: In conclusion, OCT-LAR seems to be a costefficient and safe pharmacological treatment of gastrointestinal haemorrhage secondary to vascular malformations, mainly in patients in whom endoscopic or surgical treatment is contraindicated.

Octreótido de acción prolongada (LAR) en el tratamiento de hemorragia digestiva por lesiones vasculares: estudio de coste-eficiencia / Octreotide long-active release in the treatment of gastrointestinal bleeding due to vascular malformations: cost-effectiveness study

INTRODUCCIÓN: la hemorragia digestiva por lesiones vasculares (HDLV) deteriora la calidad de vida de los pacientes y requiere el consumo de una importante cantidad de recursos. OBJETIVO: analizar la coste-eficiencia de octreótido de depósito (OCT-LAR) en el tratamiento de hemorragia gastrointestinal por lesiones vasculares. MATERIAL Y MÉTODOS: estudio retrospectivo, incluyendo a 19 pacientes que fueron tratados con inyecciones mensuales de OCTLAR entre los años 2008-2013. Se revisaron los requerimientos transfusionales, niveles de hemoglobina, necesidad de ingreso hospitalario y posibles efectos secundarios en el año previo y posterior al inicio del tratamiento, se analizó la coste-eficiencia. RESULTADOS: tras el inicio de OCT-LAR observamos respuesta completa en 7 pacientes (36,8 %), parcial en otros 7 pacientes (36,8 %) y 5 pacientes (26,3 %) siguieron precisando ingresos, trasfusiones de hemoderivados y/o tratamiento endoscópico. Observamos disminución significativa de los días de ingreso al año, antes y después de tratamiento (22,79 vs. 2,01 días, p < 0,0001) y del número de concentrados de hematíes transfundidos (11,19 vs. 2,55 concentrados de hematíes por paciente/año, p = 0,002). La media de hemoglobina mejoró de 6,95 a 10,62 g/dl (p < 0,0001). Observamos una reducción del 61,5 % del coste entre los dos periodos (de 36.072,35 Euros a 13.867,57 Euros por paciente/ año, p = 0,01). No se observaron efectos secundarios asociados al tratamiento. CONCLUSIÓN: en conclusión, OCT-LAR parecer ser un tratamiento farmacológico coste-eficiente y seguro para la hemorragia digestiva secundaria a malformaciones vasculares, especialmente en pacientes no subsidiaros de tratamiento endoscópico o quirúrgico

INTRODUCTION: Gastrointestinal hemorrhage due to vascular malformations has a negative impact on patients' quality of life and consumes an important quantity of resources. OBJECTIVE: Analyze the cost-effectiveness of long-active releasing octreotide (OCT-LAR) in the treatment of gastrointestinal haemorrhage secondary to vascular malformations. MATERIAL AND METHODS: Retrospective study, including 19 pacients that were treated with mensual injections of OCTLAR between 2008-2013. The number of blood transfusions, hemoglobin levels, hospital admissions and possible side effects during the year before treatment and the year after the start of the treatment were assessed, and cost-effectiveness was analyzed. RESULTS: After the beginning of the treatment with OCTLAR, complete response was observed in 7 patients (36.8 %), partial response in 7 patients (36.8 %) and 5 patients (26.3 %) continued to require admissions, blood transfusions and/or endoscopic treatment. We observed significant reduction in the length of admission per year (in days) before and after the start of the treatment (22.79 versus 2.01 days, p < 0.0001) as well as in the number of blood transfusions administered (11.19 versus 2.55 blood transfusions per year, p = 0.002). The mean haemoglobin levels increased from 6.9 g/dl to 10.62 g/dl (p < 0.0001). We observed reduction of costs of 61.5 % between the two periods (from 36,072.35 Euros to 13,867.57 Euros per patient and year, p = 0.01). No side effects related to treatment were described. CONCLUSION: In conclusion, OCT-LAR seems to be a costefficient and safe pharmacological treatment of gastrointestinal haemorrhage secondary to vascular malformations, mainly in patients in whom endoscopic or surgical treatment is contraindicated

Mucormicosis cutánea como complicación poco frecuente de trasplante hepático / Cutaneous mucormycosis as a rare complication of a liver transplantation

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Listeria monocytogenes infection in inflammatory bowel disease patients: case series and review of the literature.

BACKGROUND: Listeria monocytogenes (LM) is a gram-positive intracellular bacillus that in immunodeficient patients, children, geriatric patients, pregnant women, and even in healthy individuals can cause central nervous system infection, bacteremia, and other clinical manifestations, becoming a relevant pathogen. MATERIALS AND METHODS: From the Microbiology Service data of 'Gregorio Marañón' Hospital, we selected all positive biological sample cultures for LM from inflammatory bowel disease (IBD) patients, from January 1986 until January 2011. These cases were included in an SPSS database, analyzing several basal clinical characteristics and factors related to the infection. RESULTS: Three patients diagnosed with IBD had positive cultures for LM during this period. All of them were male, and also all of them had a diagnosis of Crohn's disease. Every patient had a corticosteroid cumulated dose of more than 400 mg (equivalency in methylprednisolone doses), adding anti-tumor necrosis factor-α treatment (certolizumab) in one patient. Prior colonoscopy with biopsy was performed in two patients. Clinical presentation of the infection was bacteremia in two patients, accompanied by central nervous system infection in one patient. One patient had isolated meningoencephalitis. Despite correct empiric treatment, one patient died from a cause related to the infection, that is, rombencephalitis. Increased incidence of LM bacteremia was found in IBD patients, compared with the general population (12.2 bacteremias/100 000 IBD patient-years, compared with 1.6 bacteremias/100 000 person-years), with an odds ratio of 7.4. CONCLUSION: IBD patients may be at risk for more frequent and serious LM infection compared with the general population.

Consorcio microbiano nativo con actividad catalítica para remoción de índigo y surfactantes en agua residual industrial textil a través de una matriz de inmovilización / Microbial consortium native catalytically active for removal of indigo and surfactants in textile industry wastewater through an immobilization matrix

El siguiente estudio tuvo como objetivo aislar seis diferentes cepas bacterianas provenientes de las descargas de agua utilizadas en la tintura de hilo con colorante índigo, que tuviesen capacidad de degradación de compuestos orgánicos del tinte índigo y tres surfactantes de tipo no iónicos. Igualmente, se evaluaron diferentes medios de soporte para inmovilizar las cepas seleccionadas. Las cepas con mejor capacidad de decoloración se combinaron para conformar cuatro consorcios (I, II, III, y IV) con el fin de potenciar el proceso de decoloración, considerando que la sinergia y el complemento de actividades metabólicas de cultivos mixtos dentro de una comunidad microbiana incrementan la eficiencia de remoción de carga orgánica. Los porcentajes de remoción que se alcanzaron fueron 64, 73, 76 y 59 %, respectivamente. Los cultivos individuales no presentaron porcentajes de remoción superiores a los reportados por los consorcios, lo que permite pensar en su utilización para la remoción de tintes índigos en aguas residuales.

The aim of this study was isolate six different bacterial strains from water discharges used in dyeing yarn with indigo, capable of degradation of organic compounds with indigo dye and three type nonionic surfactants. Similarly, various supporting media were evaluated for immobilizing the selected strains. Strains with better capacity were combined to form four consortia (I, II, III, and IV) in order to enhance the bleaching process, whereas synergy and complement metabolic activities of mixed cultures within a community increase microbial removal efficiency of organic load. Removal percentages were achieved which were 64, 73, 76 and 59%, respectively. Individual cultures showed no higher than rates reported by consortia removal, which suggests in its use for the removal of indigo dyes in wastewater.

Glucose-methanol co-utilization in Pichia pastoris studied by metabolomics and instationary ¹³C flux analysis.

BACKGROUND: Several studies have shown that the utilization of mixed carbon feeds instead of methanol as sole carbon source is beneficial for protein production with the methylotrophic yeast Pichia pastoris. In particular, growth under mixed feed conditions appears to alleviate the metabolic burden related to stress responses triggered by protein overproduction and secretion. Yet, detailed analysis of the metabolome and fluxome under mixed carbon source metabolizing conditions are missing. To obtain a detailed flux distribution of central carbon metabolism, including the pentose phosphate pathway under methanol-glucose conditions, we have applied metabolomics and instationary ¹³C flux analysis in chemostat cultivations. RESULTS: Instationary ¹³C-based metabolic flux analysis using GC-MS and LC-MS measurements in time allowed for an accurate mapping of metabolic fluxes of glycolysis, pentose phosphate and methanol assimilation pathways. Compared to previous results from NMR-derived stationary state labelling data (proteinogenic amino acids, METAFoR) more fluxes could be determined with higher accuracy. Furthermore, using a thermodynamic metabolic network analysis the metabolite measurements and metabolic flux directions were validated. Notably, the concentration of several metabolites of the upper glycolysis and pentose phosphate pathway increased under glucose-methanol feeding compared to the reference glucose conditions, indicating a shift in the thermodynamic driving forces. Conversely, the extracellular concentrations of all measured metabolites were lower compared with the corresponding exometabolome of glucose-grown P. pastoris cells.The instationary ¹³C flux analysis resulted in fluxes comparable to previously obtained from NMR datasets of proteinogenic amino acids, but allowed several additional insights. Specifically, i) in vivo metabolic flux estimations were expanded to a larger metabolic network e.g. by including trehalose recycling, which accounted for about 1.5% of the glucose uptake rate; ii) the reversibility of glycolytic/gluconeogenesis, TCA cycle and pentose phosphate pathways reactions was estimated, revealing a significant gluconeogenic flux from the dihydroxyacetone phosphate/glyceraldehydes phosphate pool to glucose-6P. The origin of this finding could be carbon recycling from the methanol assimilatory pathway to the pentose phosphate pool. Additionally, high exchange fluxes of oxaloacetate with aspartate as well as malate indicated amino acid pool buffering and the activity of the malate/Asp shuttle; iii) the ratio of methanol oxidation vs utilization appeared to be lower (54 vs 79% assimilated methanol directly oxidized to CO2). CONCLUSIONS: In summary, the application of instationary ¹³C-based metabolic flux analysis to P. pastoris provides an experimental framework with improved capabilities to explore the regulation of the carbon and energy metabolism of this yeast, particularly for the case of methanol and multicarbon source metabolism.