Cefacetrile and Rifaximin association might improve first service conception rate and reduce the number of services per conception in cows with clinical endometritis

Clinical endometritis (CE) is a serious disease leading to poor reproductive performances in lactating dairy cows, thus diminishing farm profitability. To preserve optimum reproductive efficiency, various strategies and therapeutic approaches have been proposed to manage cows with CE, often with contradictory results. Thus, investigating new paths to CE treatment is economically important. The aim of the present study was to test the efficacy of three therapeutic protocols on the clinical cure rate of CE, and improvement of reproductive performance. Cows with CE (n=42), 21–38 days in milk (DIM), were assigned to three treatment groups: PGF: cows (n=19) were treated systemically with two doses of d-cloprostenol, a PGF2α analogue, at 14-days intervals; CEFAX: cows (n=10) received an intrauterine infusion of the combined antibiotics Cefacetrile and Rifaximin; and NAX: cows (n=13) received systemic treatment with Ceftiofur crystalline free acid (CCFA). A control group included cows (n=36) free from CE (healthy group: HE). All cows were clinically re-examined after the end of the treatment protocol. The clinical cure rate was 73.7%, 80% and 69.2% in PGF, CEFAX, and NAX groups, respectively (P>0.05). The HE group had a significantly shorter calving to first service interval compared to CEFAX and PGF groups (P<0.05), however the difference was not significant with NAX group. The mean calving to fertilizing service interval (CFI) was slightly higher in all three treatment groups compared to the HE group, however the difference was not significant (P>0.05). CEFAX protocol resulted in shorter but not statistically significant CFI, compared to the PGF and NAX protocols. Services per conception rate were slightly lower (1.7) in the CEFAX group compared to HE (1.75), PGF (1.84) and NAX (2.23) groups, however these differences were not significant. First service conception rate and conception rate at 105 DIM did not differ statistically between the treatment groups. While the difference was not significant, CEFAX protocol had slightly better cure rate for CE, reducing the number of services per conception and boosting the resumption of ovarian activity after calving. Validating these finding on a larger herd size will improve the accuracy of these findings.

Add-On Effect of Honeysuckle in the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Background: The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a global emergency since December 2019. Chinese herbal medicine plays an important role in the treatment of COVID-19. Chinese herbal medicine honeysuckle is an extremely used traditional edible and medicinal herb. Many trials suggest that honeysuckle has obtained a good curative effect for COVID-19; however, no systematic evaluation on the clinical efficacy of honeysuckle in the treatment of COVID-19 is reported. This study aimed to evaluate the efficacy and safety of Chinese herbal medicine honeysuckle in the treatment of COVID-19.Methods: Seven electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biology Medicine) were searched to identify randomized controlled trials (RCTs) of honeysuckle for adult patients (aged ≥ 18 years) with COVID-19. The Cochrane Risk of Bias Tool was applied to assess the methodological quality of trials. Review Manager 5.3 software was used for data analysis.Results: Overall, nine RCTs involving 1,286 patients were enrolled. Our meta-analyses found that combination therapy of honeysuckle and conventional therapy was more effective than conventional therapy alone in lung computed tomography (CT) [relative risk (RR) = 1.24, 95% confidence interval (95%CI) (1.12, 1.37), P < 0.0001], clinical cure rate [RR = 1.21, 95%CI (1.12, 1.31), P < 0.00001], and rate of conversion to severe cases [RR = 0.50, 95%CI (0.33, 0.76), P = 0.001]. Besides, combination therapy can improve the symptom score of fever, cough reduction rate, symptom score of cough, and inflammatory biomarkers (white blood cell (WBC) count; C-reactive protein (CRP)) (P < 0.05).Conclusion: Honeysuckle combined with conventional therapy may be beneficial for the treatment of COVID-19 in improving lung CT, clinical cure rate, clinical symptoms, and laboratory indicators and reducing the rate of conversion to severe cases. Besides, combination therapy did not increase adverse drug events. More high-quality RCTs are needed in the future.

Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency

Background The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and those with renal dysfunction. The purpose of this study was to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction. Methods A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (creatinine clearances [CrCl] >60 mL/min, 30–60 mL/min, and <30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events. Results A total of 446 patients were included, with 278 females and 168 males. The overall clinical cure rate was 86.5% (95% CI, 83.0%–89.4%; n = 386). The clinical cure rate did not vary between genders (odds ratio [OR], 0.6; 95% CI 0.35–1.04; P = .085) or between patients with a CrCl >60 mL/min compared with those with CrCl 30–60 mL/min (OR, 1.01; 95% CI, 0.40–2.44; P = 1). The 1 patient with a CrCl <30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (OR, 0.5; 95% CI, 0.26–0.99; P = .045) or cirrhosis (OR, 0.21; 95% CI, 0.06–0.82; P = .025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n = 9) of patients. Conclusions There was no statistically significant difference in clinical cure with nitrofurantoin between genders or various renal functions.

Doxycycline is a safe alternative to Hydroxychloroquine + Azithromycin to prevent clinical worsening and hospitalization in mild COVID-19 patients: An open label randomized clinical trial (DOXYCOV)

Objective: We aimed to compare the safety and efficacy of a doxycycline-based regimen against the national standard guidelines (Hydroxychloroquine plus Azithromycin) for the treatment of mild symptomatic COVID-19. Methods: We conducted an open-label, randomized, non-inferiority trial, in Cameroon comparing Doxycycline 100mg, twice daily for 7 days versus Hydroxychloroquine, 400 mg daily for 5 days and Azithromycin 500mg at day 1 and 250mg from day 2 through 5, in mild COVID-19 patients. Clinical improvement, biological parameters and adverse events were assessed. The primary outcome was the proportion of clinical cure at day 3, 10 and 30. Non-inferiority was determined by the clinical cure rate between protocols with a 20 percentage points margin. Results: 194 participants underwent randomization and were treated with Doxycycline (n=97) or Hydroxychloroquine-Azithromycin (n=97). At day 3, 74/92 (80.4%) participants on Doxycycline versus 77/95 (81.1%) on Hydroxychloroquine-Azithromycin -based protocols were asymptomatic (p=0.91). At day 10, 88/92 (95.7%) participants on Doxycycline versus 93/95 (97.9%) on Hydroxychloroquine-Azithromycin were asymptomatic (p=0.44). At day 30 all participants were asymptomatic. SARS-CoV2 PCR was negative at Day 10 in 60/92 (65.2%) participants allocated to Doxycycline and 63/95 (66.3%) participants allocated to Hydroxychloroquine-Azithromycin. None of the participants were admitted for worsening of the disease after treatment initiation. Conclusion: Doxycycline 100 mg twice daily for 7 days is as effective and safe as Hydroxychloroquine-Azithromycin, for preventing clinical worsening of mild symptomatic or asymptomatic COVID-19, and achieving virological suppression

Reintroduction of nitrofurantoin in the treatment of uncomplicated urinary tract infection

The present study was designed to reintroduce an older antimicrobial nitrofurantoin among a group of prescribers and to explore the relationship between the reintroduction and corresponding shift in sensitivity pattern of the microbes. The microbial sensitivity against ciprofloxacin before intervention was 46.6%, which significantly increased after intervention (51.8%). Treatment with nitrofurantoin resulted in a total clinical cure rate of 80.6%, of which rate of clinical cure achieved in expected time was 66.1% and delayed was 14.5%. The rate of total clinical cure with nitrofurantoin corresponded closely with the proportion of urinary isolates sensitive to nitrofurantoin. i.e., 86.3%. This preliminary study revealed that revival might be an effective strategy to increase the sensitivity and to delay the emergence of resistance.

Ultrasonography-Guided Corticosteroid Injection Combined with Versus Without Needle Knife Release of A1 Pulley for Trigger Finger

Background: Although corticosteroid injection remains a common first-line treatment of trigger finger, but not all cases of trigger finger respond the same. This study aims to compare the clinical effectiveness of ultrasonography-guided corticosteroid injection with and without needle knife release of A1 pulley in treating trigger finger. Methods: 49 patients with trigger fingers (55 fingers, thumb) were included in this study. 28 fingers underwent ultrasonography-guided corticosteroid injection plus needle knife release of A1 pulley (combination group), and 27 fingers underwent only ultrasonography-guided needle knife release of A1 pulley (monotherapy group). Visual analogue scale (VAS), Froimson scale, postoperative recurrence rate, and thickness of A1 pulley in pre-operation and follow-up period were recorded. Results: Higher clinical amelioration and clinical cure rate were observed in combination group at 2 weeks after treatment among patients with Froimson scale Grade III and IV (p<0.05). Among Grade IV patients, combination group had narrower thickness of A1 pulley and better pain relief at 2 weeks postoperatively (all p<0.05). There was no significant difference regarding the values of clinical amelioration rate, clinical cure rate, thickness of the A1 pulley, pain relief and recurrence rate between the two groups at 12 week and 6 months postoperatively (all p>0.05). Conclusion: Ultrasonography-guided corticosteroid injection combined with needle knife release of A1 pulley had superiority in early-stage pain relief and narrowing the thickness of A1 pulley than single needle knife release, but its medium and long-term effects were not obvious.

Comparing Several Treatments with Antibiotics for CommunityAcquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: We aimed to review relevant randomized controlled trials to assess the relative clinical effects of antibiotic treatment of patients with community-acquired pneumonia (CAP). Methods: In this meta-analysis, we identified relevant studies from PubMed, Cochrane, and Embase using appropriate keywords. Key pertinent sources in the literature were also reviewed and all articles published through Oct 2019 were considered for inclusion. For each study, we assessed the risk ratios (RRs) or mean difference combined with the 95% confidence interval (CI) to assess and synthesize outcomes. Results: Overall, 36 studies were consistent with the meta-analysis, involving 17,076 patients. There was no significant difference in the mortality after subgroup analysis: individualized treatment vs. standard treatment; β-lactams plus macrolides vs. β-lactam and/or fluoroquinolone; ceftaroline fosamil vs. ceftriaxone; combination therapy vs. monotherapy or high-dose vs. low-dose. The drug-related adverse event incidence was significantly higher in the ceftriaxone group than in the other drug groups (P<0.05) and also higher in the tigecyline group than in the levofloxacin group (P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the test-of-cure (TOC) visit in the clinically evaluable population, modified intent-to-treat efficacy (MITTE) population, microbiologically evaluable (ME) population and the microbiological MITTE (mMITTE) population (all P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the TOC visit in the mMITTE population of Gram positiveStreptococcus pneumoniae (P<0.05) and multidrug-resistant S. pneumoniae (P<0.05). Conclusion: There was a limited number of included studies in the subgroup analysis, but it will still be necessary to conduct more high-quality randomized controlled trials to confirm the clinical efficacy of different antibiotics used to treat CAP.

Outpatient therapy with piperacillin/tazobactam using elastomeric pumps in patients with Pseudomonas aeruginosa infection

The aim of this study was to evaluate the efficacy and safety of outpatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps and to evaluate the economic impact compared with conventional hospital treatment in patients with Pseudomonas aeruginosa (PA) infections. This is an observational study. Patients with PA infection treated with continuous piperacillin-tazobactam infusion using elastomeric pumps in our hospital between January 2015 and December 2017 were included. Primary outcomes were mortality during antibiotic treatment and mortality at 30 days. Secondary outcomes were reinfection or relapse at 30 days and clinical cure rate. The cost of each episode was compared with theoretical cost of the same treatment using conventional hospitalization. 35 patients were included. One patient (2.9%) died during the treatment. Overall 30-day mortality was 5.7%. No death was related to infection by PA. One patient (2.9%) had a reinfection at 30 days. Cure was achieved in 93% of patients at the end of treatment. There were no severe complications related to elastomeric pumps. Treatment cost with outpatient antimicrobial therapy was 67% lower than theoretical cost with conventional hospital treatment. Oupatient antimicrobial therapy with piperacillin-tazobactam in continuous infusion using elastomeric pumps in patients with PA infections is safe and effective with lower costs.

Clinical manifestations and outcomes of pulmonary tuberculosis in patients with different genotypes of the pathogen

Objective: to study the clinical manifestations and effec- tiveness of treatment of patients with pulmonary tubercu- losis with different genotypes of M. tuberculosis. Materi­ als and methods. Clinical and microbiological data of 120 patients were stratified on the M. tuberculosis epidemic variants: subtypes of Beijing CC2 / W148, CC1, other sub- types of Beijing, and other genotypes other than Beijing (nonBeijing). The DNA of M. tuberculosis strains obtained were genotyped by RD 105/207 for Beijing genotype iden- tification. The CC2/W148 subtype was identified by the presence of a specific deletion in the kdpD gene, the CC1 subtype was done by the SNP in the pks17 gene. Results. It was found that in tuberculosis caused by the CC2/W148 subtype of the Beijing genotype, multiple and broad drug resistance occur in 87.5% of patients. The CC2/W148 ge- no type contributes to the chronization of the tuberculosis process, the formation of fibrous-cavernous tuberculo- sis. Miliary tuberculosis is more common (37.5%) among newly diagnosed patients with CC2/W148 than in other genotypes (15.7%), which is also associated with a high incidence of concomitant HIV infection (56.3%). Total lung tissue damage in patients with infiltrative tuberculosis is observed in 41.7% of patients with the CC2/W148 MBT subtype. The clinical cure rate in patients with CC2/W148 is significantly lower (18.7% compared to 47.4%) than in tuberculosis caused by other genotypes. Conclusion. The results obtained indicate the presence of clinical features of tuberculosis caused by the w148 / CC2 subtype of the Beijing genotype, and the expediency of further study of the clinical, radiological and microbio- logical characteristics of the tuberculosis process caused by MBT of different subtypes of the Beijing genotype and non-Beijing genotypes.