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Archive for the ‘Current Awareness’ Category

What’s New in UpToDate

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Prevention of graft reinfection in HCV-infected patients undergoing liver transplantation
In the absence of viral suppression or clearance of chronic hepatitis C virus (HCV) in patients who undergo liver transplantation, the new liver is almost always reinfected. In an open-label study, 16 HCV genotype 1-infected patients undergoing their first liver transplantation from an uninfected donor received a single dose of ledipasvir-sofosbuvir the day they arrived at the hospital for transplantation and once daily for four weeks postoperatively [1]. The sustained virologic response rate 12 weeks after completion of treatment was 88 percent, suggesting that an abbreviated perioperative course of direct-acting antiviral (DAA) treatment can prevent reinfection of the graft. Additional studies are warranted to confirm the efficacy and safety of this approach in other HCV-infected populations and with other DAA regimens.
See ‘Recurrence of hepatitis C virus infection following liver transplantation’, section on ‘Perioperative therapy’.
1. Levitsky J, Verna EC, O’Leary JG, et al. Perioperative Ledipasvir-Sofosbuvir for HCV in Liver-Transplant Recipients. N Engl J Med 2016; 375:2106.
 
Early introduction of egg for the prevention of egg allergy
Four recent randomized trials have examined introduction of egg for the prevention of egg allergy, with variable success. These studies are the Prevention of Egg Allergy with Tiny Amount Intake (PETIT) trial [2], the Starting Time of Egg Protein (STEP) trial [3], the Beating Egg Allergy Trial (BEAT) [4], and the Hen’s Egg Allergy Prevention (HEAP) trial [5]. Each trial enrolled a slightly different population and introduced different doses and forms of egg at ages ranging from 4 to 6 months. The most successful trial (PETIT) involved infants with eczema given a low dose of heated egg starting at 6 months of age, which resulted in egg allergy at 12 months in 8 and 38 percent in the treatment and placebo groups, respectively. The other trials that used pasteurized raw egg and started dosing as early as 4 months were negative. Further studies are needed to determine the optimal timing, patient population, and form of egg to introduce.
See ‘Introducing highly allergenic foods to infants and children’, section on ‘Introduction in a high-risk population’.
2. Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. Lancet 2016.

3. Palmer DJ, Sullivan TR, Gold MS, et al. Randomized controlled trial of early regular egg intake to prevent egg allergy. J Allergy Clin Immunol 2016.

4. Tan JW-L, Valerio C, Barnes EH, et al. A randomized trial of egg introduction from 4 months of age in infants at risk for egg allergy. J Allergy Clin Immunol 2016.

5. Bellach J, Schwarz V, Ahrens B, et al. Randomized placebo-controlled trial of hen’s egg consumption for primary prevention in infants. J Allergy Clin Immunol 2016.

 
Donor fecal microbiota transplant for recurrent Clostridium difficile infection
Strong evidence to support fecal microbiota transplant (FMT) in patients with recurrent Clostridium difficile infection (CDI) has been lacking. In a randomized trial, patients with three or more recurrences of CDI who had received vancomycin for their most recent acute episode were assigned to FMT administered by colonoscopy with donor stool or their own stool (as a control) [6]. Patients who received donor FMT achieved higher clinical cure rates (92 versus 63 percent). These data support our recommendations to treat patients with recurrent CDI despite multiple courses of antibiotic therapy with donor FMT.
See ‘Fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection’, section on ‘Colonoscope’.
6. Kelly CR, Khoruts A, Staley C, et al. Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial. Ann Intern Med 2016; 165:609.

Current Awareness: Zetoc & JournalTOCs

Unfortunately, NHS Athens users will no longer have access to Zetoc (the table of contents alerting service) from 1st April 2012. This is the message on the NHS Evidence website:

“Regrettably access to Zetoc will cease on the 31st March 2012 due to a change in the terms and conditions for access to Zetoc which the NHS cannot comply with. NHS Athens users will lose access to Zetoc from 1st April 2012 onwards.”

A good alternative to Zetoc is JournalTOCs.

This can be used to set up alerts to journal table of contents, and keyword searches.

Register for a free account and then select the journal(s) from which you wish to receive tables of contents.

If you don’t have the time to do this, then the Warner Library can also set up alerts for MEHT staff . Contact Zena Woodley to arrange this (ext 4310 or zena.woodley@meht.nhs.uk)

JournalTOCs is included in the Warner Library’s free training course:

Keeping up to Date: RSS, Blogs, Wikis and More!

This course covers using internet technologies to keep up to date with professional developments and discussion.  Dates can be found on the training page.