Current knowledge about the connection between health status and gut microbiota from birth to elderly. A narrative review

The human body is colonized from the birth by a large number of microorganisms. This will constitute a real “functional microbial organ” that is fundamental for homeostasis and therefore for health in humans. Those microorganisms. The microbial populations that colonize humans creating a specific ecosystem they have been collectively referred to as “human microbiota” or “human normal microflora”. The microbiota play an important pathophysiological role in the various locations of the human body. This article focuses on one of the most important, that is the enteric microbiota. The composition (quantitative and qualitative) of microbes is analyzed in relation to age and environment during the course of human life. It also highlights eubiosis and dysbiosis as key terms for its role in health and disease. Finally, it analyzes its bi-directional relationship with the microbiota of the lungs, skin and that of the brain, and consequently for the whole central and peripheral nervous system for the maintenance of health in the human body

The role of PIAS3, p-STAT3 and ALR in colorectalcancer: new translational molecular features for an old disease

OBJECTIVE: Human colorectal cancer (CRC) is characterized by a sequence of biological events that determine its induction and progression. Gut microbiota has an impor-tant role in this multistep model of carcinogen-esis, as well as constitutive activation of Signal Transducer and Activator Factors 3 (p-STAT3) and Protein Inhibitor of Activated STAT3 (PIAS3), which negatively controls STAT3. It has been re-ported that a liver growth factor, the Augmenter of Liver Regeneration (ALR), an anti-apoptotic, anti-metastatic factor, exerts protective/cell sur-vival and anti-metastatic activities and has been detected highly expressed in neoplastic cells. PATIENTS AND METHODS: To evaluate, by immunohistochemistry, p-STAT3, PIAS3 and ALR expression in neoplastic human tissues from CRC patients, grouping the data in accord-ance with the histological alterations (G1, G2 and G3) and metastasis presence. Western blot (WB) analysis of ALR was also determined in ne-oplastic and surrounding tissues. Finally, cell proliferation (Ki-67) and apoptosis (Bcl-2) were determined. RESULTS : Colon cancer tissue samples showed: (1) ALR and p-STAT3 strongly over-ex-pression in 100% of G1 tissue samples, reducing in G2 and G3 tissue samples; (2) PIAS3 immuno-logical determination was poorly expressed in G1 tissue samples and highly expressed in the 100% of colorectal tissues from group G2 and G3. Ki-67 progressively increases with the im-portance of the anatomic-pathological altera-tions and Bcl-2 resulted higher in G3 tissue sam-ples compared to G1 neoplastic tissues. WB data evidenced, in neoplastic tissues, compared to the tumour-surrounding tissues, ALR over-ex-pressed in G1 neoplastic tissues and down-ex-pressed in G3 neoplastic tissues.CONCLUSIONS: Our data demonstrate a dif-ferent dynamism of the investigated factors in relation to the severity of CRC histological find-ings. We hypothesize that the positive expres-sion of ALR and p-STAT3 in the neoplastic tis-sue samples from CRC G1 group, associated to the absence of PIAS3, could be useful marker to identify an early stage of the disease. Based on these data and on our previous studies on gut microbiota in precancerous intestinal lesions, we are confident that, after microbial priming, a cascade of molecular events is started. So, the detectable molecules acting in these initial steps should be considered for the study of CRC progression and therapy

Survey on worldwide trauma team activation requirement

PURPOSE : trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level. METHODS : A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. RESULTS : The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income. CONCLUSIONS : The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.http://link.springer.com/journal/68am2022Surger

Misdiagnosed Appendicitis in Children

Background: Appendicitis is the one of the most common emergency abdominal operation in children. It is estimated that appendicitis is diagnosed in about 2 % of children who present to emergency department because of acute abdominal pain1. Timely diagnosis and appendectomy can prevent abscess formation, perforation as well as reducing early and late postoperative complication. Methods: This study is a retrospective review of all children diagnosed with acute appendicitis in our emergency department between January 2015 – 2018. We have compared the clinical features and the results of examinations between two group of patients - those who were diagnosed correctly and have been operated,and those who were misdiagnosed and operated later respectively more than 24 hours after initial control. Results: This study includes fifty-nine children less than sixteen years old, admitted in our clinic and operated due to acute appendicitis. Fifty three (89.9%) of them were hospitalized after the first control, whereas the remining six (10.1 %) were discharged home after the initial control. The misdiagnosed patients were returned in our department less than twenty hours after the first control. Compared with the patients in which the diagnosis was made correctly the misdiagnosed patients in general had lower levels of leukocytes, CRP and temperature. Conclusion: The diagnosis of appendicitis in children can be very difficult because of the atypical features. According to our experience and the data from other studies, still there is not a single test or combination of clinical and laboratory examinations, able to discriminate children with and without acute appendicitis with a high percentage of accuracy

The Diagnostic Value of C-Reactive Protein and Total Leukocyte Count in Patients with Acute Abdominal Pain In Children.

Background: C-reactive protein (CRP) is one of the acute-phase proteins which increases during inflammatory conditions. Nowadays, C-reactive protein (CRP) is a commonly used biomarker especially in emergency department (ED) for diagnostics of febrile and infectious patients. It is almost impossible to distinguish the bacterial from nonbacterial (viral) infection by CRP level only - so the detailed history of onset of disease is very important to establish the diagnosis of bacterial infection as a cause of acute abdominal pain. Objective: The aim of this study was to establish the diagnostic value of leucocyte and CRP count in in diagnosing acute abdominal pain. Material and methods: We retrospectively evaluated 159 patients with acute abdominal pain admitted to the surgical department of the Clinical Hospital of Tetova and PHO “Alba – Med” over a period of 2 yearsrespectively from January 20016 to January 2018. All patients included in this study was aged between five to 15 years old. Results: During the study period there were 158 patients (96 were females and 56 males). All the patients suffered from acute abdominal pain, whereas 45 of them had a surgical condition, respectively in 42 of them acute appendicitis as a cause of pain, Meckel’s diverticulitis, jejunal intussusception and ruptured ovarian cyst in three other patients. In 105 patients nonsurgical condition was the reason of acute abdominal pain. CRP was performed within 24 h after admission in all the patients. In the group of patients with surgical disease in 41 of them (91 %) the value of CRP was more than > 5g/L. Conclusions: According to our experience we conclude that the CRP level is not sufficient to predict patients with acute abdominal pain that require surgical treatment

Surgical Site Infections with MRSA in young Patients

Introduction: Surgical site infections (SSIs) pose a global health concern. While various pathogenic microorganisms can cause SSIs, a predominant causative agent is Staphylococcus aureus, particularly its methicillin-resistant strain (MRSA). MRSA, known for its resistance to multiple antibiotics, significantly complicates treatment options, leading to increased morbidity. In some cases, particularly among patients with pre-existing comorbidities, MRSA infections can prove fatal. Moreover, eradicating MRSA from hospital settings presents a formidable challenge. This study aims to report on two young, otherwise healthy patients who developed MRSA infections in their surgical wounds during hospitalization. Case Descriptions: A 22-year-old female patient developed an MRSA infection following an appendectomy and a 12-year-old male patient exhibited similar complications post-orchiopexy. In both cases, MRSA presence was confirmed through microbiological cultures a few days post-surgery. Repeated cultures indicated successful MRSA eradication after isolation and initiation of targeted antibiotic therapy based on antibiograms. Once their general health stabilized, the patients were discharged and continued outpatient antibiotic treatment for a prescribed duration. Conclusion: These cases emphasize that MRSA infections, typically associated with elderly patients or those with underlying health conditions, can also occur in younger, healthier individuals. Eradicating these infections remains a significant challenge for healthcare facilities encountering MRSA. Keywords: Staphylococcus aureus, Methicillin-resistant, young patients, Surgical site infections

Frequency of Gastrointestinal Diseases in Patients with End-Stage Renal Disease Treated with Long Term Dialysis

Background: Gastrointestinal complications are frequent in patients with renal disease and are responsible for substantial morbidity and mortality among these patients in developing countries. Many times, these patients are subjected to endoscopic evaluation and mucosal biopsies are taken for definitive diagnosis. Long before the routine uses of dialysis, patients dying of uremia were found to have a high incidence of gastrointestinal abnormalities (1). Matherials and methods: The survey included 240 persons; 120 of them were dialysis patients, while the remaining 120 were healthy individuals who served as a control group. 54 (45%) of the patients with hemodialysis were females while 66 (55%) of them were males with mean age: 58.20 ± 18.00 years. These patients had been in dialysis for more than 12 years at the Clinic for Nephrology in Skopje and the Clinical Hospital in Tetovo. Results: Gastrointestinal complications were present in 20 (37.0%) out of 54 females while 26 (39.4%) out of 66 males presented with duodenal bulbar ulcers. 84 patients [(females-38/54 (70.4%) and males-46/66 (85.2%)] of the total number of 120 examined patients were found to have chronic gastritis. In conclusion, we found that the incidence of PUD was more than 10 times higher in CKD patients than in those without CKD over a 3-year period between 2008-2010. CKD patients receiving HD, NSAID, or clopidogrel had an increased risk of PUD, compared to CKD patients not receiving these treatments

Gastro-Oesophageal Reflux, some data on Diagnosis and Clinical Evaluation

Treatment of gastro-oesophageal reflux involves number of therapeutic measures that eventually conclude with surgical treatment. It should be noted that surgical treatment should be the last resort to be used to treat this pathology, due to the complications and recurrences that this surgery may give. This study included 59 children operated for gastro-oesophageal reflux with the laparoscopic method and for the same period 14 children operated with the open method. By gender in these two groups the study involves 34 males and 25 females in the first group of laparoscopic methods and 8 males and 6 females in the open method group. The average age of the treated children was 13.21 and 12.56 years old in the laparoscopic method, 7.34-year-old males and 8.15-year-olds in the open method. Children after being diagnosed by radiology, pharmacology and after having received a proton pump prolonged long-term treatment for indications, were planned for intervention. Prior to the intervention, the child is evaluated in all respects and is subject to the full anesthetic protocol. Including biochemical balance, complete blood, cholesterol, blood group. The child is treated with general anesthesia with endotracheal intubation using as anesthetic inhaler and intravenous subjects. Gastro-oesophageal reflux at childhood is a disease that has long been given particular attention, by both, pediatricians and pediatric surgeons. A pathology that in its benign form, that is non-pathological reflux captures, a very large percentage of children in the first year of life where, according to some studies, appears in 50% of cases with a maximum prevalence rise in the 4th month of life, in our results this aspect is not vulnerable, because we have only studied children who have been subjected to intervention. So are those children who have gone through all the main links of diagnosis and conservative treatment

Management of Perforated Sigmoid Diverticulitis with Associated Retroperitoneal Abscess and Generalized Peritonitis

Introduction: Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey. The article aims to show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV, according to Hinchey. Case report: A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery. Conclusion: While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival

Pre-Chemistry Concepts and Medical Therapy among the Ancient Physicians through the Pre-Socratic Philosophers

Chemistry as experimental science it began only in the seventeenth century, when it began to analyze the matter and its transformations with scientific method, moving away from being one of the alchemy doctrines. Previously the ancient pre-Socratic philosophy through observation for nature is concerned with the laws that govern it and the property of matter. Later the Hellenistic Alexandrian culture took possession of the Hermetic doctrines of the Egyptians, mixing them, with the pre-Socratic thought and Gnosticism. In this historical moment, therefore, there would have been a fusion between the Greek philosophical patrimony and the influences on medicine. The Hermetic gnosis evolved over time to become later in alchemy and then in the birth of chemical science. Many doctors are wandering philosophers who deal with cosmogony to understand the body and the diseases and discover new healing drug for treatment and thus they were the first chemist therapists