1,721,031 research outputs found
Pain thresholds in women with chronic pelvic pain
No full textPURPOSE OF REVIEW: To update on the latest developments in sensory changes of
female patients with chronic pelvic pain (CPP). CPP is very common, but its
pathophysiology is still controversial. Evaluation of pain sensitivity in painful
and nonpainful areas is key to understanding the underlying peripheral vs.
central contributions to the symptom. This in turn is fundamental to improving
the treatment strategies.
RECENT FINDINGS: We reviewed the experimental studies published over the last
year on pain thresholds to different stimuli measured at both the somatic and
visceral level in women with different forms of recurrent or CPP. The majority of
the studies indicate a pain threshold decrease to most stimuli in skin, subcutis
and muscle in painful pelvic areas, the site of referred pain from pelvic
viscera, as well as a decreased pain threshold in most viscera (colon and urinary
bladder). A significant threshold decrease is also found in deep somatic tissues
(subcutis and muscle) outside the painful zone in the most severe cases,
indicating a state of central sensitization.
SUMMARY: These findings have important implications for clinical practice: pain
threshold measurement in both painful and nonpainful sites could have important
predictive value of the clinical evolution and response to therapy of CPP
The intestinal microbiome and its relevance for functionality in older persons
No full textPURPOSE OF REVIEW:
This article summarizes the advances of research on the role of the intestinal microbiota in influencing sarcopenia, frailty, and cognitive dysfunction in older individuals, and thus its relevance for healthy active ageing.
RECENT FINDINGS:
Age-related alterations of intestinal microbiota composition may negatively influence muscle protein synthesis and function by promoting chronic systemic inflammation, insulin resistance, oxidative stress, and reducing nutrient bioavailability. However, this 'gut-muscle axis' hypothesis is not supported by human data to date. Some observational studies have instead demonstrated that, in older individuals, frailty and Alzheimer-type dementia are associated with fecal microbiota dysbiosis, that is, reduced biodiversity and overexpression of pathobionts. The main possible mechanisms of the 'gut-brain axis' in cognitive function modulation include effects on neurotransmission, neuroinflammation, and amyloid deposition. Conversely, longevity in good health may be associated with the maintenance of a fecal microbiota composition similar to that of healthy young adults. However, the role of gut microbiota as an independent modulator of frailty and cognition still remains uncertain, being influenced by several physiological factors, including diet and exercise.
SUMMARY:
The intestinal microbiome composition represents a possible determinant of functional performance in older people, and a promising target for antiaging therapeutic interventions
Sarcoidosis: Old certainties and new perspectives [La sarcoidosi: Vecchie certezze e nuove prospettive]
No full textIntroduction: Sarcoidosis is the paradigm of the internistic disease. It virtually affects every organ and tissue and is characterized by the presence of noncaseating granulomas. A holistic view is needed for the diagnosis and treatment of the disease. The authors provide an overview on several recently published studies, which pose new perspectives on the approach to the disease. Materials and methods: The authors reviewed the scientific literature focusing on new etiopathogenetic, diagnostic and therapeutic data. Results and discussion: A multimodal approach is appropriate and effective in the diagnosis and treatment of systemic diseases such as sarcoidosis. In this context, the internist plays a key role more than any other specialist
Lp(a) and cardiovascular risk: Investigating the hidden side of the moon
No full textAIMS: This article reports current evidence on the association between Lp(a) and
cardiovascular (CV) disease and on pathophysiological mechanisms. The available
information on therapy for reduction of lipoprotein(a) is also discussed.
DATA SYNTHESIS: Although some evidence is conflicting, Lp(a) seems to increase CV
risk through stimulation of platelet aggregation, inhibition of tissue factor
pathway inhibitor, alteration of fibrin clot structure and promotion of
endothelial dysfunction and phospholipid oxidation. Lp(a) 3.5-fold higher than
normal increases the risk of coronary heart disease and general CV events,
particularly in those with LDL cholesterol ≥ 130 mg/dl. High Lp(a) values
represent also an independent risk factor for ischemic stroke (more relevant in
young stroke patients), peripheral artery disease (PAD) and aortic and mitral
stenosis. Furthermore, high Lp(a) levels seem to be associated with increased
risk of cardiovascular events in patients with chronic kidney disease,
particularly in those undergoing percutaneous coronary intervention.
CONCLUSIONS: Lipoprotein (a) (Lp[a]) seems to significantly influence the risk of
cardiovascular events. The effects of statins and fibrates on Lp(a) are limited
and extremely variable. Nicotinic acid was shown effective in reducing Lp(a) but,
due to its side effects and serious adverse events during clinical trials, it is
no longer considered a possible option for treatment. To date, the treatment of
choice for high levels of Lp(a) in high CV risk patients is represented by
LDL-Apheresis. Thanks to innovative technologies, new selectively inhibiting LPA
drugs are being developed and tested
Pulmonary sarcoidosis presenting with miliary opacities
No full textBackground: Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We present the case of a 55-year-old Indian man who presented with dyspnea and low-grade fever. Discussion: Miliary Tuberculosis (TB) was initially suspected, despite the direct microscopic examination from bronchoalveolar lavage was negative for acid-fast bacilli because imaging showed miliary opacities, and transbronchial lung biopsy revealed the presence of typical caseating granulomas. Antitubercular treatment with the classic four-drug regimen was initiated. However, the patient did not improve and cultures were negative for Mycobacterium growth. The diagnosis of sarcoidosis was made only after a negative culture and clinical and histopathological re-evaluation of the case. Conclusion: Although miliary sarcoidosis is rare, physicians should consider sarcoidosis in the differential diagnosis with conditions like tuberculosis, malignancy, and pneumoconiosis when patients present with miliary opacities who do not respond to the traditional treatment
Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution
No full textPurpose of the study: Conventional ultrasound (US) is reliable to reveal the presence of non-alcoholic fatty liver disease (NAFLD), but it is neither sensitive nor specific to reveal fibrosis clues, except in advanced stages where signs of cirrhosis are evident. NALFD fibrosis score is a non-invasive parameter that predicts well the presence of significant fibrosis, but correlations with US parameters are lacking. The aim of this study was, therefore, to compare resistive index of hepatic artery (HARI) of NAFLD patients with different severity degrees of diffuse fatty liver disease vs HARI of controls, and to compare HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls. Methods: This was a spontaneous, no-profit observational study conducted in our US department between December 2013 and July 2014. Patients with NAFLD with different severity of disease and healthy controls were included. Echogenicity and size of liver and spleen, maximum portal vein velocity, RI, peak systolic velocity (PSV), and end diastolic velocity (EDV) of splenic artery, PSV, EDV, and RI of hepatic artery, and NAFLD fibrosis score were acquired and compared between groups. Results: HARI was significantly lower in NAFLD patients than controls (p < 0.0001). A significant difference was also found between the groups of NAFLD severity (p < 0.0001). There was also a difference between HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls (p < 0.0001) with a positive correlation between HARI and NAFLD fibrosis score. Conclusion and discussion: Conventional Doppler US can be helpful to detect NAFLD patients with the risk of fibrous tissue accumulation. HARI tends to exceed the range of controls for patients with NAFLD fibrosis score greater than 0.675. The detection of HARI greater than 0.9 in NAFLD patients, regardless of the US degree of severity of steatosis, might suggest the execution of biopsy to predict the risk of progression to steatohepatitis and fibrous tissue accumulation. Low values of HARI may be expression of lower risk, which does not necessitate any biopsy
Gallbladder infection by trematodes
No full textA 34-year-old-man presented to the emergency department
(ED) because of the persistence of remittent fever (average
temperature 39 C), malaise, jaundice and intense epigastrium pain radiating to the back, lasting 2 weeks. He
reported a history of alcoholic cirrhosis complicated by
ascites and encephalopathy. At home, the patient was
treated regularly with aldosterone antagonists (spironolactone, 100 mg/day) and loop diuretics (furosemide, 25 mg
twice daily). The patient reported having recently made a
journey to China, during which he had eaten typical local
food, such as the ‘‘Yusheng’’, a Chinese raw fish salad
Uric acid and cognitive function in older individuals
Full text linkHyperuricemia has been recognized as an independent cardiovascular risk factor in epidemiological studies. However, uric acid can also exert beneficial functions due to its antioxidant properties, which may be particularly relevant in the context of neurodegenerative diseases. In this paper, we critically revise the evidence on the relationship between serum uric acid levels and cognitive function in older individuals, focusing on the etiology of cognitive impairment (Alzheimer’s disease, Parkinson’s dementia, and vascular dementia) and on the interactive connections between uric acid, dementia, and diet. Despite high heterogeneity in the existing studies, due to different characteristics of studied populations and methods of cognitive dysfunction assessment, we conclude that serum uric acid may modulate cognitive function in a different way according to the etiology of dementia. Current studies indeed demonstrate that uric acid may exert neuroprotective actions in Alzheimer’s disease and Parkinson’s dementia, with hypouricemia representing a risk factor for a quicker disease progression and a possible marker of malnutrition. Conversely, high serum uric acid may negatively influence the disease course in vascular dementia. Further studies are needed to clarify the physio-pathological role of uric acid in different dementia types, and its clinical-prognostic significance
Chest Imaging of Patients with Sarcoidosis and SARS-CoV-2 Infection. Current Evidence and Clinical Perspectives
Full text linkThe recent COVID-19 pandemic has dramatically changed the world in the last months, leading to a serious global emergency related to a novel coronavirus infection that affects both sexes of all ages ubiquitously. Advanced age, cardiovascular comorbidity, and viral load have been hypothesized as some of the risk factors for severity, but their role in patients affected with other diseases, in particular immune disorders, such as sarcoidosis, and the specific interaction between these two diseases remains unclear. The two conditions might share similar imaging findings but have distinctive features that are here described. The recent development of complex imaging softwares, called deep learning techniques, opens new scenarios for the diagnosis and management
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