The relationship between gut microbiota and spontaneous bacterial peritonitis in patients with liver cirrhosis - a literature review

Gut microbiota is an essential component in the pathogenesis of liver cirrhosis and its complications. There is a direct relationship between the gut and the liver called the gutliver axis through which bacteria can reach the liver through the portal venous blood. However, it remains unclear how bacteria leave the intestine and reach the fluid collection in the abdomen. A series of mechanisms have been postulated to be involved in the pathogenesis of spontaneous bacterial peritonitis (SBP) and other complications of liver cirrhosis, including bacterial translocation, bacterial overgrowth, altered intestinal permeability and dysfunctional immunity. The hepatic function may also be affected by the alteration of intestinal microbiota composition. Current treatment in SBP is antibiotic therapy, but lately, probiotics have been the useful treatment suggested to improve the intestinal barrier and prevent bacterial translocation. However, studies are contradictory regarding their usefulness. In this review, we will summarize the literature data on the pathogenesis of spontaneous bacterial peritonitis concerning the existence of a relationship with the microbiota and the useful use of probiotics

Current pharmacological treatment of painful diabetic neuropathy: A narrative review

Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice

The role of Bosniak classification in the assessment of renal cystic masses and in the therapeutical protocol

One of the most frequent kidney pathologies encountered in daily practice is represented by the presence of renal cysts. Most of them are asymptomatic and are found accidentally during periodical check-ups because they don’t have clinical signs until they grow and compress the surrounding organs. We have reviewed the current data regarding this pathology, in order to underline the risk of malignant transformation and its impact on the patient’s life. It is estimated that the prevalence rate of renal cysts in the general population is approximately 10% and it increases with age.Imaging investigations, such as contrast tomography or magnetic resonance imaging, are essential for establishing the cysts characteristics, especially when ultrasonography raises the suspicion of a modified renal cyst, as well as in guiding the therapeutical protocol. The Bosniak classification is based on contrast tomography scans and has allowed the standardization of the kidney cysts, considering their characteristics. More attention should be given to Bosniak IIF and III cystic renal masses, which contain thickened walls and more septa, but no enhanced nodules/soft tissue components, because more than half of these cysts can have a malignant component

Experimental Models in Sexual Medicine: Eight Best Practices

The experimental study of sexual response and problems in the mentally ill draws on the same principles and procedures common to other fields of experimental investigation. At the same time, this field presents several special challenges to investigators, including examining matters that are both private (sexuality) and stigmatizing (mental illness). In this chapter, we discuss a number of ideas that will help ensure high-quality research in the field by identifying eight best practices, beginning with posing research questions and ending with drawing appropriate conclusions. Within this discussion, examples are included so the strengths and limitations of the experimental research process become apparent. In addition, we discuss several caveats so as to steer investigators away from some of the more common pitfalls in research implementation. Although this chapter does not attempt to provide an exhaustive review of issues related to experimental research methodology, investigators might want to consider the best practices herein, along with concepts presented in Chap. 4, as an initial step toward transforming ideas into solid research protocols relating sexual dysfunction to mental illness

Cross Cultural Research: Opportunities and Strategies for Discovery

Although cross-cultural research is currently being conducted in many countries, on many subcultures, and by many research groups, much of this research either is not visible to the practitioner or does not specifically inform the practitioner as to how it might affect healthcare provider–client interactions. We argue for the need to include culturally relevant variables in standard research protocols, delineating research that addresses the healthcare experiences of cultural subsets from research designed to understand basic issues, attitudes, and differences within those cultural subsets. Finally, we offer ways in which various types of research investigations might be implemented within clinic settings and through various kinds of international collaborations