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SummaryBackgroundObeticholic acid (OCA) and fibrates are second‐line therapies for patients with primary biliary cholangitis (PBC) with an inadequate response to ursodeoxycholic acid (UDCA).AimTo know whether OCA and fibrates, administered together in combination with UDCA, have additive beneficial effects in patients with difficult‐to‐treat PBC.MethodsPBC patients treated for ≥3 months with UDCA, OCA and fibrates (bezafibrate or fenofibrate) due to failure of either second‐line therapy were included in a multicentre, uncontrolled retrospective cohort study. Changes in biochemical liver tests and pruritus were analysed using a generalised linear mixed‐effect model.ResultsAmong 58 patients included, half received OCA as second‐line and fibrates as third‐line therapy (Group OCA‐Fibrate), while the other half had the inverse therapeutic sequence (Group Fibrate‐OCA). The mean duration of triple therapy was 11 months (range 3‐26). Compared to dual therapy, triple therapy was associated with a significant gain in alkaline phosphatase (ALP) reduction: 22% per first year (95% CI 12%‐31%), an effect that was stronger in OCA‐Fibrate than in Fibrate‐OCA group. Triple therapy was associated with a 3.4 (95% CI 1.4‐8.2) odds ratio (OR) of reaching normal ALP and with a significant decrease in gamma‐glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin. The ORs of achieving the Paris‐2 and Toronto criteria of adequate biochemical response were 6.8 (95% CI 2.8‐16.7) and 9.2 (95% CI 3.4‐25.1) respectively. Finally, triple therapy significantly improved pruritus in OCA‐Fibrate but not in Fibrate‐OCA group.ConclusionsTriple therapy with UDCA, OCA and fibrates is able to normalise biochemical liver tests and improve pruritus in patients with difficult‐to‐treat PBC.

Objectives: Coronavirus disease 2019 (COVID-19) was first discovered in Wuhan, China, in December 2019, and soon spread around the entire world. As no effective treatment is known, prediction of disease severity is very important in order to estimate a patients outcome. Aim of this study was to evaluate routine hematology parameters in time after admission. Methods: Data from routine blood analyses from confirmed COVID-19 cases admitted to the University Hospital of Leuven in Belgium were collected. COVID-19 patients (n = 197) were assigned to three groups: a 'non-ICU' group, a 'ICU' group and a 'deceased' group. A control group of 60 Influenza A (non-COVID-19) patients was also included. The parameters evaluated were platelet count (PLT, 10 9 /L), hemoglobin concentration (Hb, g/dL), leukocyte count (LEU, 10 9 /L), neutrophil count (NEU, %), eosinophil count (EO, %), lymphocyte count (LYM, %) and monocyte count (MONO, %). Results: Deceased COVID-19 patients had significant lower platelet count, higher leukocyte/ neutrophil count, and lower eosinophil/lymphocyte/monocyte count compared to recovered patients. Especially lymphocyte count showed important differences; they were significantly lower between day 9 and 12 after admission making this time window important in predicting clinical worsening of a patient. Conclusion: Patients with COVID-19 with poor outcome showed significant differences in results of routine hematological parameters compared with patients that recovered. Especially lymphocyte count can be helpful in the prediction of a patients outcome.

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Recent advancements in sequencing technologies and metagenomic studies have increased the knowledge of the virosphere associated with honey bees tremendously. In this study, viral-like particle enrichment and deep sequencing was deployed to detect viral communities in managed Belgian honey bees. A substantial number of previously undescribed divergent virus genomes was detected, including a rhabdovirus and a recombinant virus possessing a divergent Lake Sinai Virus capsid and a Hepe-like polymerase. Furthermore, screening > 5,000 public sequencing datasets for the retrieved set of viral genomes revealed an additional plethora of undetected, divergent viruses present in a wide range of Hymenoptera species. The unexpected high number of shared viral genomes within the Apidae family and across different families within the order Hymenoptera suggests that many of these viruses are highly promiscuous, that virus sharing within and between Hymenoptera families occurs frequently, and that the concept of species-specific viral taxa inside the Hymenoptera should be revisited. In particular, this estimation implies that sharing of several viral species, thought to be specific for bees, across other eukaryotic taxa is rampant. This study provides important insights on the host taxonomical breadth of some of the known “bee viruses” and might have important implications on strategies to combat viruses that are relevant to pollinators.

Cladophialophora bantiana is a neurotropic dematiaceous fungus which rarely causes disseminated disease. We report a case of proven C. bantiana osteomyelitis in a renal transplant recipient, complicated with probable cerebral disease. Stable disease was reached after combined antifungal therapies, immune enhancement and amputation of the infected lower limb.

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