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It is common for constipation to occur following severe spinal cord injury (SCI). Although a bowel management program including a high fibre diet is an integral part of rehabilitation, 1 the effect of a high fibre diet on large bowel function in SCI has not been examined. The aims of this study were to assess the nutrient intake of SCI patients, to determine baseline transit time, stool weight and evacuation time and to assess the effect of addition of bran on large bowel function. Eleven subjects, aged 32 ± lO.5 years participated in the study. The level of injury ranged from C 4 to Tl 2 ; only one patient had an incomplete injury. Baseline mean energy intake was 7823± 1443 kJ/d, protein intake 93±21 g/d, carbohydrate intake 209 ± 39 g/d and mean dietary fibre intake 25 ± 8 g/d. Mean baseline stool weight was 128 ± 55 g/d and bowel evacuation time was 13 ± 7.4 min/d. Three subjects who consumed < 18 g dietary fibre/d had low stool weights of 60-70 g/d and two had very delayed transit times that were too slow to enable quantitation. Mean mouth to anus transit time was 51.3±31.2 h, mean colonic transit time 28.2±3.5 h, right colonic transit time 5.9±4.5 h, left colonic transit time 14.5 ± 5.2 h and rectosigmoid colonic transit time 7.9 ± 5.6 h. Following the addition of bran, dietary fibre intake significantly increased from 25 g/d to 31 g/d (P

Cyclophosphamide is a potent cytotoxic agent used in many clinical settings. The main risks of cyclophosphamide therapy include hematological disorders, infertility, hemorrhagic cystitis and malignancies. Gastrointestinal side effects reported to date are often non-specific and not severe. We present the first case of a fatal small bowel enteritis and pan-colitis which appears to be associated with cyclophosphamide. We aim to raise the readers’ awareness of this significant adverse event to facilitate clinical suspicion and early recognition in potential future cases.

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Introduction: Despite highly effective direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection, some patients experience virological relapse.Salvage regimens should include multiple agents to suppress emergence of resistance-associated substitutions (RAS) and minimise treatment failure. The combination of sofosbuvir (SOF) and elbasvir/grazoprevir (ELB/GZR) ±ribavirin (RBV) is an effective retreatment strategy for HCV genotype (GT)1 and 4 infection. We hypothesised that SOF and ELB/GZR (±RBV) would also be an effective salvage regimen for DAA-experienced GT3 patients. Methods:We evaluated the efficacy and safety of SOF/ELB/GZR ± RBV in DAA-experienced participants with chronic HCV infection who had prior relapse. Participants were treated at four hospitals between December 2016 and March 2018 for either 12-or 16-weeks. The primary endpoint was sustained virological response at week 12 post-treatment (SVR12) using intention-to-treat analysis.Results: There were 40 participants included in the analysis. The mean age was 53 years, 53% had GT3, 33% had GT1 infection and 63% had cirrhosis. Fifty-eight percent were treated for 12 weeks, 42% were treated for 16 weeks and 90% received RBV. The SVR12 rate was 98% overall, 100% in non-GT3 participants and 95% in GT3 participants. One GT3 cirrhotic participant relapsed. ELB/GZR was stopped at week 6 in one GT3 cirrhotic participant who switched to SOF/velpatasvir/RBV for a further 12 weeks and achieved SVR12. RBV dose reduction was required in two participants. Treatment was otherwise well tolerated. Discussion:The combination of SOF/ELB/GZR ± RBV is effective and safe for difficult-to-cure patients who relapse after first-line DAA, including those with cirrhosis and GT3 infection. K E Y W O R D S hepatitis C, resistance-associated substitution, retreatment, salvage, virological relapse S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Papaluca T, Sinclair M, Gow P, et al. Retreatment with elbasvir, grazoprevir, sofosbuvir ± ribavirin is effective for GT3 and GT1/4/6 HCV infection after relapse.