Management of abdomen hydatidosis after rupture of a hydatid splenic cyst: a case report

We present a case of multiple hydatidosis in an 8-year-old boy that resulted from a ruptured hydatid cyst of the spleen and spread into the peritoneal cavity. We also present a new approach for managing these difficult and high-risk cases

Alterations of gut microbiome following gastrointestinal surgical procedures and their potential complications

Intestinal microorganisms play a crucial role in shaping the host immunity and maintaining homeostasis. Nevertheless, alterations in gut bacterial composition may occur and these alterations have been linked with the pathogenesis of several diseases. In surgical practice, studies revealed that the microbiome of patients undergoing surgery changes and several post-operative complications seem to be associated with the gut microbiota composition. In this review, we aim to provide an overview of gut microbiota (GM) in surgical disease. We refer to several studies which describe alterations of GM in patients undergoing different types of surgery, we focus on the impacts of peri-operative interventions on GM and the role of GM in development of post-operative complications, such as anastomotic leak. The review aims to enhance comprehension regarding the correlation between GM and surgical procedures based in the current knowledge. However, preoperative and postoperative synthesis of GM needs to be further examined in future studies, so that GM-targeted measures could be assessed and the different surgery complications could be reduced

Unraveling the intricate dance of the Mediterranean diet and gut microbiota in autoimmune resilience

The nutritional habits regulate the gut microbiota and increase risk of an autoimmune disease. Western diet is rich in sugars, meat, and poly-unsaturated fatty acids, which lead to dysbiosis of intestinal microbiota, disruption of gut epithelial barrier and chronic mucosal inflammation. In contrast, the Mediterranean Diet (MedDiet) is abundant in ω3 fatty acids, fruits, and vegetables, possessing anti-inflammatory properties that contribute to the restoration of gut eubiosis. Numerous studies have extensively examined the impact of MedDiet and its components on both health and various disease states. Additionally, specific investigations have explored the correlation between MedDiet, microbiota, and the risk of autoimmune diseases. Furthermore, the MedDiet has been linked to a reduced risk of cardiovascular diseases, playing a pivotal role in lowering mortality rates among individuals with autoimmune diseases and comorbidities. The aim of the present review is to specifically highlight current knowledge regarding possible interactions of MedDiet with the patterns of intestinal microbiota focusing on autoimmunity and a blueprint through dietary modulations for the prevention and management of disease’s activity and progression

COVID-19 on the spectrum: a scoping review of hygienic standards

The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic

Abscess formation of a spherical-shape duplication in the splenic flexure of the colon: case report and review of the literature

Gastrointestinal tract duplications are rare congenital malformations that may occur anywhere in the alimentary tract from the mouth to the anus, and vary greatly in presentation, size, location, and especially in symptoms. We present a case of an infected spherical colonic duplication, in a 20-day-old baby, located at the splenic flexure of the colon. The prominent symptom was acute abdomen, accompanied by bilious vomiting, intestinal obstruction, and high fever. We present this case, due to atypical clinical presentation and the inability of the imaging modality to establish the diagnosis preoperatively

Investigation of possible interplay among visceral adipose tissue, atherosclerosis and the inflammation markers in patients on chronic hemodialysis

Obesity per se has been recognized as a chronic disease and the deleterious effects on kidney outcome have been well proved in chronic kidney disease (CKD) patients. Paradoxically the survival in overweight or obese CKD patients undergoing maintenance hemodialysis (HD) opposed compared with the general population .Obesity has been shown to represent an important modifier of cardiovascular risk factors such as hypertension, left ventricular mass index, insulin resistance (10) as well as of cardiovascular risk per se in CKD patients (5.6).The association between under nutrition and adverse cardiovascular outcome in dialysis patients, which stands in contrast to that seen in non-ESRD(end stage renal disease) individuals, has been referred to as ‘reverse epidemiology’. Analysis of possible modifiers is considered essential in observational studies of the relationship between potential novel risk factors and clinical outcomes (10,215). Therefore, with the present study we sought to investigate the interaction of certain adipokines with levels of body mass index (BMI) and inflammatory markers for predicting all-cause mortality in a cohort of HD patients. Epidemiological evidence has shown conflicting results regarding the association between levels of adiponectin and occurrence of adverse outcomes in end-stage renal disease (ESRD) patients. Recent published data in hemodialysis (HD) patients pointed to non-linear associations between this adipokine and prognosis rendering the clinical application of the observed associations impractical. 60 patients (mean age 64±13 years, 39 men) with ESRD on maintenance HD followed up for 4.5 years represented the prospective study cohort.Measurements of adipokines, cytokines, CD40L and adhesion molecules as well as other biochemical markers were assessed and choose to present the most representative results. Associations between plasma adiponectin levels and BMI with all-cause mortality were assessed taking into account the assumption of non-linear correlations. Furthermore, the association between adiponectin, BMI and serum levels of interleukin-10 (IL-10) and interleukin-6 (IL-6) with survival was determined also cross-sectionally. The primary study end-point was death from any cause. Data are presented as percentages for categorical data, as means ± standard deviation (SD) for continuous variables that were normally distributed and as medians with interquartile range (IQR) for non-normally distributed data (adiponectin, IL-10, IL-6, triglyceride levels and duration of HD). Normal distribution was tested using the Kolmogorov- Smirnov test. Between groups comparisons were made with chi-square test, unpaired Student’s t-test and Mann-Whitney U-test as appropriate. All correlation analyses was performed my means of Spearman’s (co-efficient rho). Non-linear survival modeling showed that there was a U-shaped association of BMI with all-cause mortality whereas for plasma adiponectin levels the association was an inverse U-shaped association. Using a BMI of 24 Kg/m2 as a cut-off, an interaction effect of BMI on the association between adiponectin and mortality was observed (p=0.045). In participants with BMI ≥24 Kg/m2 each 15 μg/ml increase in plasma adiponectin levels was associated with a decreased hazard of death (HR 0.57 95%CI 0.32-0.99) in unadjusted analysis. In HD patients with BMI<24 Kg/m2 no significant association was observed between adiponectin and mortality (p=0.989). Cross-sectional analysis showed that in the sub-group of patients in whom the protective effect of adiponectin was observed (BMI≥24 Kg/m2), a positive linear association existed between adiponectin and IL-10 levels (r=0.345, p=0.027) as well as a negative association with IL-6 levels (r=-0.322, p=0.040). No association was observed in patients with BMI<24 Kg/m2 neither with IL-10 nor with IL-6. Obesity possibly modifies the effect of adiponectin on all-cause mortality in HD patients thus explaining the published conflicting results in recent literature regarding the association of plasma adiponectin levels and mortality in chronic kidney disease patients.Ο ρόλος της παχυσαρκίας γενικά και του λιπώδους ιστού ειδικότερα έχει αρκετά χρόνια που μελετάται στον γενικό πληθυσμό καθώς έχει αναγνωριστεί ως χρόνια νόσος. Οι ασθενείς όμως με ΤΣΧΝΝ σε θεραπεία υποκατάστασης αποτελούν έναν ιδιαίτερο πληθυσμό όπου πολλά επιδημιολογικά δεδομένα φαίνονται να ανατρέπονται. Η επιβίωση των υπέρβαρων ή παχύσαρκων ασθενών φαίνεται να μην ακολουθεί την πεπετημένη.Το παράδοξο της παχυσαρκίας ως φαινόμενο με όλες τις πτυχές της παθοφυσιολογίας του βρίσκεται συνεχώς υπό μελέτη. Η παχυσαρκία per se έχει δειχθεί ότι αντιπροσωπεύει έναν σημαντικό τροποιητή των παραγόντων καρδιαγγειακού κινδύνου όπως η υπέρταση,η υπερτροφία της αριστερής κοιλίας, η αντίσταση στην ινσουλίνη όπως και ο καθεαυτού καρδιαγγειακός κίνδυνος στους ασθενείς με ΤΣΧΝΝ. Η συσχέτιση μεταξύ της κακής θρέψης και της δυσμενούς καρδιαγγειακής έκβασης στους αιμοκαθαιρόμενους αναφέρεται ως ανάστροφη επιδημιολογία. Η ανάλυση πιθανών ρυθμιστών αυτής της σχέσης θεωρείται ουσιώδης στις στην διαξαγωγή μελετών για δυνητικά νέους παράγοντες κινδύνου και κλινικών αποτελεσμάτων. Ως εκ τούτου με αυτή τη μελέτη επιδιώχθηκε να μελετηθεί η αλληλεπίδραση κάποιων αντιποκινών με τα επίπεδα του ΔΜΣ και δεικτών φλεγμονής ως προς την πρόγνωση της ολικής θνητότητας σε ομάδα αιμοκαθαιρομένων ασθενών. Υπάρχουν αντικρουόμενες μελέτες που αφορούν τη συσχέτιση της αντιπονεκτίνης με την ύπαρξη δυσμενών αποτελεσμάτων σε ασθενείς με ΤΣΧΝΝ. Πρόσφατα στοιχεία αναφέρουν μια μη γραμμική σχέση αυτής της αντιποκίνης με την πρόγνωση καθιστώντας έτσι αδύνατη την κλινική εφαρμογή των παρατηρήσεων. Την ομάδα μελέτης αποτέλεσαν 60 ασθενείς μέσης ηλικίας 64 ± 13 έτη, 39 άνδρες και 21 γυναίκες, με ΤΣΧΝΝ υπό αιμοκάθαρση και παρακολουθήθηκαν για 4,5 έτη. Προσδιορίστηκαν αντιποκίνες, προ και αντι-φλεγμονώδεις κυτταροκίνες, CD40L και μόρια προσκόλλησης όπως και άλλοι βιοχημικοί δείκτες οι οποίοι μετά την στατιστική επεξεργασία τους επιλέχθηκε η αντιπροσωπευτικότερη παρουσίαση τους. Οι σχέσεις ανάμεσα στα επίπεδα της αντιπονεκτίνης και του ΔΜΣ με την ολική θνητότητα αξιολογήθηκαν λαμβάνοντας υπόψη την υπόθεση της μη γραμμικής συσχέτισης. Επιπλέον οι σχέσεις των παραπάνω και με τις IL-10 και IL-6 προσδιορίστηκαν και σε επίπεδο συγχρονικής ανάλυσης (cross-sectional). Το βασικό καταληκτικό σημείο της μελέτης ήταν ο θάνατος από πάσης φύσης αιτία. Τα στοιχεία παρουσιάζονται με ποσοστά για κατηγορικά δεδομένα, ως μέση τιμή ± σταθερή απόκλιση (SD) για συνεχείς μεταβλητές που ακολουθούσαν την κανονική κατανομή και ως διάμεση τιμή με ενδοτεταρτημοριακό πλάτος (IQR) για συνεχείς μεταβλητές που δεν ακολουθούσαν την κανονική κατανομή (αντιπονεκτίνη, IL-10, IL-6, τριλγυκερίδια και διάρκεια αιμοκάθαρσης). Η κανονική κατανομή των μεταβλητών ελέγχθηκε χρησιμοποιώντας τη δοκιμασία Kolmogorov- Smirnov. Η σύγκριση μεταξύ των ομάδων έγινε με τη δοκιμασία χ2, δοκιμασία unpaired Student’s t-test και δοκιμασία Mann-Whitney U-test αναλόγως με το είδος της μεταβλητής και την κανονικότητα της κατανομής της. Όλες οι συσχετίσεις έγιναν με τη μέθοδο γραμμικής συσχέτισης κατά Spearman και εκφράσθηκαν ως παράγοντας rho (ρ). Το μη γραμμικό μοντέλο επιβίωσης έδειξε την ύπαρξη σχέσης του ΔΜΣ με την ολική θνητότητα σχήματος U ενώ της αντιπονεκτίνης σε σχήμα ανεστραμμένου U. Αν χρησιμοποιηθεί ο ΔΜΣ 24 kg/m² ως cutoff ,παρατηρείται αλληλεπίδραση του με τη σχέση της αντιπονεκτίνης και πρόγνωσης. (p=0.045). Μια αμβλυμένη προστατευτική δράση της αντιπονεκτίνης παρατηρήθηκε σε ασθενείς με ΔΜΣ24 kg/m2. Σε ασθενείς με ΔΜΣ ≥ 24 Kg/m2, τα επίπεδα αντιπονεκτίνης συσχετιζόταν με τα επίπεδα IL-10 (Spearman’s rho 0.345, p=0.027). Αντιθέτως σε ασθενείς με ΔΜΣ <24 Kg/m2, τα επίπεδα αντιπονεκτίνης δεν συσχετίσθηκαν με τα επίπεδα IL-10 (Spearman’s rho -0.058, p=0.814) ούτε ανιχνεύθηκε σημαντική διαφορά (Mann-Whitney U-test, p=0.487) στα επίπεδα IL-10 μεταξύ ασθενών με υψηλά (IL-10: 6.9 pg/ml IQR 6.7-8.8 pg/ml) και χαμηλά (IL-10: 7 pg/ml IQR 4.9-7.7 pg/ml) επίπεδα αντιπονεκτίνης. Η συσσώρευση σπλαχνικού λιπώδους ιστού πιθανώς τροποποιεί τη δράση των αντιποκινών (αντιπονεκτίνη) στην ολική θνητότητα αιμοκαθαιρομένων με χρόνια μικροφλεγμονή και ως εκ τούτου στηρίζεται η θεωρία ότι η διαφορετική επίδραση της αντιπονεκτίνης στην επιβίωση των αιμοκαθαιρομένων πιθανόν έγκειται στην σχέση σπλαγχνικού λιπώδους ιστού – φλεγμονής και μπορεί να εξηγεί τα αντιφατικά αποτελέσματα στην πρόσφατη βιβλιογραφία όσον αφορά αυτή τη σχέση στους ασθενείς με ΤΣΧΝΝ

Current Insights in Microbiome Shifts in Sjogren’s Syndrome and Possible Therapeutic Interventions

Sjogren’s syndrome (SS) is an autoimmune disease, among the most common ones, that targets mainly the exocrine glands as well as extra-glandular epithelial tissues. Their lymphocytic infiltration leads to manifestations from other organs (e.g., kidneys, lungs, liver, or thyroid), apart from sicca symptoms (xerostomia and keratoconjunctivitis). SS is more prevalent in women than in men (9:1). Moreover, p.SS patients are in increased risk to develop lymphoma. Certain autoantibodies (e.g., antibodies against ribonucleoprotein autoantigens Ro-SSA and La-SSB) are ultimate hallmarks for the disease. It was not known until recently that culture-independent techniques like next-generation sequencing (NGS) facilitate the study of the microbe communities in humans and scientists achieved to define the outlines of the microbiome contribution in health and disease. Researchers have started to investigate the alterations in diversity of the oral, ocular, or intestinal microbiota in SS. Recent studies indicate that dysbiosis may play a significant role in SS pathogenesis. At the same time, the cause or effect is not clear yet because the dysfunction of salivary glands induces alterations in oral and intestinal microbiome which is linked to worsen of symptoms and disease severity. If the human microbiome proves to play a key role in pathogenesis and manifestation of SS, the next step could be new and promising therapeutic approaches such as probiotics or prebiotics. This mini review focuses on the alterations of microbiome of SS patients, their connection with immune tolerance and new therapeutic strategies involving diet manipulation toward future personalized medicine

Towards Advances in Medicinal Plant Antimicrobial Activity: A Review Study on Challenges and Future Perspectives

The increasing incidence of drug- resistant pathogens raises an urgent need to identify and isolate new bioactive compounds from medicinal plants using standardized modern analytical procedures. Medicinal plant-derived compounds could provide novel straightforward approaches against pathogenic bacteria. This review explores the antimicrobial activity of plant-derived components, their possible mechanisms of action, as well as their chemical potential. The focus is put on the current challenges and future perspectives surrounding medicinal plants antimicrobial activity. There are some inherent challenges regarding medicinal plant extracts and their antimicrobial efficacy. Appropriate and optimized extraction methodology plant species dependent leads to upgraded and selective extracted compounds. Antimicrobial susceptibility tests for the determination of the antimicrobial activity of plant extracts may show variations in obtained results. Moreover, there are several difficulties and problems that need to be overcome for the development of new antimicrobials from plant extracts, while efforts have been made to enhance the antimicrobial activity of chemical compounds. Research on the mechanisms of action, interplay with other substances, and the pharmacokinetic and/or pharmacodynamic profile of the medicinal plant extracts should be given high priority to characterize them as potential antimicrobial agents

HIV pre-exposure prophylaxis and its impact on the gut microbiome in men having sex with men

HIV/AIDS still imposes a high epidemiological and societal burden. Together with antiretroviral therapy, pre-exposure prophylaxis (PrEP) represents a fundamental tool in the fight against HIV/AIDS. PrEP is considered effective and safe, even though it may affect organs like the kidney, bone, and liver, as shown by randomized clinical trials (RCTs). These side effects may be mediated by alterations of the gut microbiome. Whilst the impact of the human rectal and vaginal microbiome on HIV prevention has been highly investigated among women, less is known about its effect among men having sex with men (MSM), a vulnerable population at high risk for HIV and disproportionately affected by HIV/AIDS. In the present paper, we will overview the effects of PrEP on the gut microbiota in MSM. Mining PubMed/MEDLINE, we identified three studies that have found significant changes affecting the gut microbiota. However, these shifts in the gut microbiome composition are variable, probably due to methodological differences, even though all studies reviewed in the present overview consistently report aberrations at the level of the gut microbiota. More data are needed, especially concerning the long-term side effects of PrEP: despite the studies included being a high-quality RCT, and two well-designed cross-sectional studies, evidence related to the impact of HIV PrEP on the gut microbiome in MSM is scarce and based on small populations. A better understanding of the interactions between the gut microbiota, sexual orientation/identity, and HIV prevention is expected to improve PrEP adherence and devise strategies to counteract PrEP-related side effects

The Role of the Microbiome in Connective-Tissue-Associated Interstitial Lung Disease and Pulmonary Vasculitis

The microbiome can trigger and maintain immune-mediated diseases and is associated with the severity and prognosis of idiopathic pulmonary fibrosis, which is the prototype of interstitial lung diseases (ILDs). The latter can be a major cause of morbidity and mortality in patients with connective-tissue diseases (CTD). In the present review, we discuss the current evidence regarding microbiome in CTD-ILD and pulmonary vasculitis. In patients with rheumatoid arthritis (RA) the BAL microbiota is significantly less diverse and abundant, compared to healthy controls. These changes are associated with disease severity. In systemic sclerosis (SSc), gastrointestinal (GI)-dysbiosis is associated with ILD. Butyrate acid administration as a means of restoration of GI-microbiota has reduced the degree of lung fibrosis in animal models. Although related studies are scarce for SLE and Sj&ouml;gren&rsquo;s syndrome, studies of the gut, oral and ocular microbiome provide insights into the pathogenesis of these diseases. In ANCA-associated vasculitis, disease severity and relapses have been associated with disturbed nasal mucosa microbiota, with immunosuppressive treatment restoring the microbiome changes. The results of these studies suggest however no causal relation. More studies of the lung microbiome in CTD-ILDs are urgently needed, to provide a better understanding of the pathogenesis of these diseases