Man began domesticating animals in Asia and/or northeast Africa somewhere between 8,000 and 5,000 B.C. The Vedic hymns of India, written before 2,000 B.C., indicate that Hindu people used fermented milk products in their diet since prehistoric times [5]. Between 2,000 and 3,000 B.C. a multitude of other civilizations (the Egyptians, Greeks and Romans) left many records to indicate that milk, cheese, and butter were commonly used [6]. As an example, Sumerians crossed expanses of deserts with milk carried in bags made from the stomachs of sheep. The enzymes present in the stomach wall fermented the milk into
Probiotics are living microorganisms which when taken in adequate amount provides benefit to the host. While this beneficial effect was originally thought to stem from improvements in the intestinal microbial balance, there is now substantial evidence that probiotics can also provide benefits by modulating immune functions. Extrapolation of immunomodulatory effects found in the laboratory and in animal studies with outcomes in human trials presents a difficult challenge. Not all probiotics are created equal and the benefits are strain and dose specific. With newer strain-specific clinical trials and meta-analysis of the clinical trials, the beneficial role of probiotics in certain diseases has been evolving. Some uncertainity still exists with probiotics in other diseases with regard to the therapeutic role, strain-specificity, dosage and duration. Identification of clinical characteristics of effective probiotic strains, their mechanisms of action and testing of probiotic-based treatment may provide the true beneficial effect of probiotics in various disorders.
Background Systemic sclerosis (SSc) is a rare, complex, connective tissue disorder. Interstitial lung disease (ILD) is common in SSc, occurring in 35–52% of patients and accounting for 20–40% of mortality. Evolution of therapeutic options has resulted in a lack of consensus on how to manage this condition. This Delphi study was initiated to develop consensus recommendations based on expert physician insights regarding screening, progression, treatment criteria, monitoring of response, and the role of recent therapeutic advances with antifibrotics and immunosuppressants in patients with SSc-ILD. Methods A modified Delphi process was completed by pulmonologists (n = 13) and rheumatologists (n = 12) with expertise in the management of patients with SSc-ILD. Panelists rated their agreement with each statement on a Likert scale from − 5 (complete disagreement) to + 5 (complete agreement). Consensus was predefined as a mean Likert scale score of ≤ − 2.5 or ≥ + 2.5 with a standard deviation not crossing zero. Results Panelists recommended that all patients with SSc be screened for ILD by chest auscultation, spirometry with diffusing capacity of the lungs for carbon monoxide, high-resolution computed tomography (HRCT), and/or autoantibody testing. Treatment decisions were influenced by baseline and changes in pulmonary function tests, extent of ILD on HRCT, duration and degree of dyspnea, presence of pulmonary hypertension, and potential contribution of reflux. Treatment success was defined as stabilization or improvement of signs or symptoms of ILD and functional status. Mycophenolate mofetil was identified as the initial treatment of choice. Experts considered nintedanib a therapeutic option in patients with progressive fibrotic ILD despite immunosuppressive therapy or patients contraindicated/unable to tolerate immunotherapy. Concomitant use of nintedanib with MMF/cyclophosphamide can be considered in patients with advanced disease at initial presentation, aggressive ILD, or significant disease progression. Although limited consensus was achieved on the use of tocilizumab, the experts considered it a therapeutic option for patients with early SSc and ILD with elevated acute-phase reactants. Conclusions This modified Delphi study generated consensus recommendations for management of patients with SSc-ILD in a real-world setting. Findings from this study provide a management algorithm that will be helpful for treating patients with SSc-ILD and addresses a significant unmet need.
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