A combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 was compared to placebo for relief of symptoms of irritable bowel syndrome (IBS). A total of 113 subjects at 3 clinical sites were randomised in a 2:1 ratio and followed for 12 weeks. Subjects ingested either 2 capsules of active study product, containing 50×10 cfu of live organisms, or 2 placebo capsules daily. Endpoints included improvement in abdominal pain, days of pain, distention, stool consistency and frequency, quality of life (QOL), and adequate relief (AR) of IBS symptoms. IBS subtypes constipation (IBS-C), diarrhoea (IBS-D), and mixed (IBS-M) were evaluated separately; the effect of gender was also examined. For all efficacy endpoints improvement of 30% or more vs placebo was considered clinically significant. With the exception of pain intensity and AR, the endpoints demonstrated a therapeutic advantage of active over placebo for IBS symptoms in at least some subject subgroups. The IBS-D and female subgroups showed the largest and most consistent effects. Stool frequency and consistency were evaluated in the IBS-C and IBS-D subgroups, and improvement of active vs placebo was noted in both. QOL improvement was seen overall and in specific domains. Adverse events (AEs) were limited to 7 subjects; all were of mild or moderate intensity except one, severe cramping. Four AEs in the same subject in the placebo group were judged to be related to study product; these resolved by the end of study. There were no serious AEs.

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Introduction: Information on the prevalence of keratinophilic fungi in West Indies is scanty. Occurrence of keratinophilic fungi in soils of St. Kitts and Nevis has not been investigated previously. Methodology: The prevalence of keratinophilic fungi was investigated in 108 samples of soils of varying habitats from St. Kitts and 55 such samples from Nevis by hair-baiting technique. Fungal growths appearing on the hair baits after four to eight weeks of incubation at room temperature were microscopically examined and cultured on mycological media. Cultures were identified on the basis of colonial and microscopic features. Results: Forty-nine (45%) of the samples from St. Kitts and 38 (69%) from Nevis were positive for keratinophilic fungi. Microsporum gypseum complex, a well-known geophilic dermatophyte, was the most frequently recovered species being present in 15.7% of soils of St. Kitts and 40% of soils of Nevis. The next commonest species recovered was Chrysosporium indicum, represented by 15 (13.9%) isolates from St. Kitts and seven (12.7%) isolates from Nevis. Other infrequently isolated keratinophilic species included Chrysosporium tropicum, Chrysosporium keratinophilum, and unidentified Chrysosporium species. Conclusions: This study is the first of its kind in the islands of St. Kitts and Nevis. A high incidence of M. gypseum complex in the soil of these islands is a noteworthy finding of public health significance.

Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique developed to manage gastric outlet obstruction (GOO). It involves creating a fistula between the stomach and the proximal small bowel using an electric cautery-enhanced lumen-apposing metal stent (ECE-LAMS) with EUS guidance. We aimed to publish our experience in improving teaching of this technique to practicing endoscopists with a wide range of experience by comparing the outcomes before and after standardization of procedural steps. Methods All EUS-GEs performed for inoperable GOO at a single institution from 2014 to 2021 were retrospectively analyzed. The technique was taught by one experienced endoscopist with prior expertise. Five advanced endoscopists with prior EUS and ECE-LAMS placement experience participated. The impact of standardization on outcomes (clinical and technical success, length of stay [LOS], procedure time, and adverse events [AEs]) was compared. Results A total 41 EUS-GEs were performed (5 before and 36 after standardization) by endoscopists with practice experience ranging from 2 to 13 years. The patient population was similar in age and sex. Standardization was associated with significantly higher rates of technical success (100 % vs 60 %, P = 0.01) and lower peri-procedural AEs (2.8 % vs 40 %, P = 0.03). Two AEs in the pre-standardized group were gastric perforation and gastrocolic fistula creation. One AE in the post-standardized group was gastric perforation. Procedure time, clinical success, and LOS showed improvement, although it was not statistically significant. Conclusions Teaching EUS-GE after standardizing the procedure was associated with a significant increase in technical success and a decrease in AEs irrespective of prior total experiences.