Microbial Community of Small Intestine in Acute Severe Pancreatitis Patients: a Pilot Study

Purpose of the study: to describe the composition of the microbiota of the initial sections of the small intestine in patients with severe necrotizing acute pancreatitis.Objectives of the studyDetermine the composition of the microbiota of the initial sections of the small intestine upon admission to the ICU;Determine the differences in the composition of the microbiota of the initial sections of the small intestine, depending on the timing of the onset of the disease.IntroductionDisturbance of intestinal homeostasis is a leading factor in the pathogenesis and progression of systemic inflammation in patients with severe acute pancreatitis. The development of systemic complications occurs due to both mesenteric hypoperfusion and dysregulation of intestinal motility, and the destruction of the intestinal barrier, with the translocation of bacterial bodies and their substrates. Which increases the risk of developing POI and increasing mortality. With the advent of methods for high-throughput sequencing of microbiome samples - for example, in the 16S rRNA format - the possibilities for studying the structure of microbial communities have significantly expanded. In this regard, there is more and more evidence of the relationship between the state of human health and microflora inhabiting various parts of the body.Materials and methodsThe study included 7 patients with a diagnosis of severe necrotizing acute pancreatitis (6 men, 1 woman), the mean age was 54.1 ± 14.4 years. The patients were divided into two groups. Group 1 (n = 4) included patients admitted 2-4 days after the onset of a pain attack. Group 2 (n = 3) - patients admitted no later than 24 hours from the onset of the disease. The bacterial composition of jejunal wash samples was studied using 16S RNA sequencing. The severity of the condition was assessed using the integral scales APACHE II, SOFA, SAPS II. In patients of the main group, APACHE II was 22 ± 2.83 points (18; 24), SOFA - 6.8 ± 0.5 points (6; 7), SAPSII - 32.9 ± 6.4 points (24.7; 40), in patients of the comparison group, APACHE II is 18.0 ± 3.7 points (12; 22), SOFA - 4.0 ± 2.6 points (2; 7), SAPSII - 24.4 ± 5.0 points (20.9; 30.1).Material was collected at the time of installation of a sterile multifunctional intestinal catheter for Treitz’s ligament, no later than 12 hours from the moment of admission to the ICU. At the time of sampling, patients were not receiving antibiotic therapy.ResultsA more severe course was associated with a reduced representation in the microbiome of the species Nesseria mucosa and Parvimonas micra inhabiting the mucosal layer, as well as Megasphaera micronuciformis. The share of Streptococcus genera (S. rubneri / parasanguinis / australis species) and Actinomyces and a number of genera from the Enterobacteriaceae family in such patients, on the contrary, was higher.Interest disclosureSample preparation, sequencing and analysis of these microbiome samples was carried out by Knomics LLC during a commercial project for VneshPromFarm LLC, the manufacturer of saline electrolyte solution (SES).

C’è dolore e dolore: l’osteoma osteoide

A 5-year-old boy with one-month history of atraumatic pain in his left leg was taken to the ED for a severe pain attack. A femoral osteoid osteoma was eventually diagnosed after the performance of a CT scan

C'è dolore e dolore: l'osteoma osteoide

A 5-year-old boy with one-month history of atraumatic pain in his left leg was taken to the ED for a severe pain attack. A femoral osteoid osteoma was eventually diagnosed after the performance of a CT scan.

Successful Treatment of Airplane Headache with Rizatriptan: Case Report

Optimal management of airplane headache (AH) is still unresolved. A female, 53 years, complained of severe short-lasting jabbing pain attacks over the forehead and in the eyebrows, mainly on the left side, that occur during take-off and landing. Neurological, opthalmological, and otolaryngological examinations and brain MRI were normal. It was diagnosed as AH. The patient was recommended to take 10 mg rizatriptan 30 min before the flight. It resulted in a complete absence of headache during the take-off and significant decrease of pain intensity during the plane descending. Based on the flight duration (about 2.5 h) and rizatriptan pharmacokinetics, the patient was recommended to take a second dose of rizatriptan 10 mg 1 h before flight ending. The patient reported a complete absence of pain attacks during the next flights. The effectiveness of AH pain attack prevention is based on the pharmacokinetic properties of the drug, time of pain onset during flight, and the flight duration.

LOW BACK PAIN

Low back pain is the most common symptom found in the primary health care and is the number one cause of disability throughout worldwide. It is estimated that around 60 – 80% the world population will experience back pain during their lifespan. There are three different source of pain in the spine: axial-lumbosacral, radicular and reffered pain. All of these source brings different clinical presentations. Low back pain could be classified as acute, subacute and chronic low back pain. The pain could be nociceptive or neuropathic, the most common symptoms reported are “pressure pain” and “pain attack”. The physician should be aware of “red flags” symptoms that lead into more serious condition beside back pain and, therefore the patient has to be investigated to further examination whenever these symptoms present. The management of low back pain consist of severe modalities, both therapeutic and rehabilitative procedure. Oftentimes, the management needed multidisciplinary approach. It is important to general practitioners to identify and treat low back pain appropriately to reduce the burden of the disease and to prevent the disabilties caused by this condition.

Pediatric Lymphoma Complicated by Intussusception

Intestinal intussusception is rare in children over the age of 6 years and, in most cases, is due to the presence of anatomical reasons. Tumors of the gastrointestinal tract are one of the etiological factors in the development of ileus in older children. The paper presents the case of a 7-year-old child who was admitted to the clinic with the abdominal pain syndrome that resolved on its own. With a repeated pain attack, intestinal intussusception was diagnosed, the patient was urgently operated. Laparoscopic complete reduction of intussusception failed, which required conversion of the access. After straightening the intussusception of the small intestine, there was detected a tumor of the ileum, which practically blocked the intestinal lumen. The segment of the intestine with the tumor was resected with an end-to-end anastomosis. In the postoperative period, the patient was diagnosed with intestinal lymphoma based on the test studies of the operating material. After stabilizing the condition, the child was transferred to an oncological center.

EVALUATING THE EFFECTIVENESS OF PRIMARY ANALGESIC AND SUBSEQUENT COMBINED MET–THERAPY IN RENAL COLIC THERAPY

Renal colic is an acute pathological symptom complex, which, despite all the achievements of medicine, demonstrates constant occurrence rate of about 12% in the human population. This condition is characterized by a pronounced sudden pain attack, which causes significant suffering to the patient. Therefore, the search for effective and safe methods of analgesia and the search for ways to correct urinary obstruction as a cause of pain are of great clinical importance. The aim of the study was to assess the effectiveness of analgesic and combined lithoeradicative therapy to improve the management of patients with acute attack of renal colic. The clinical study included 228 individuals admitted to the hospital with a diagnosis of renal colic. At the first stage, they were divided into three groups to assess the effectiveness of the pharmacological management of primary analgesia. At the second stage, 96 patients were examined, and then divided into 2 subgroups in order to assess the effectiveness of medical expulsive therapy in its mono–variant and in combination with spasmolytics. The results obtained demonstrated that during the primary analgesic therapy of renal colic, non–steroidal anti–inflammatory drugs have advantages over the opioid group that is manifested by a stronger analgesic effect and less severe adverse reactions. Diclofenac showed the best results in pain relief, superior to other drugs by 5–7%. When evaluating the effectiveness of combined medical expulsive therapy, the data obtained indicate an increase in the chances of calculi passage by 11% in the group, which received drotaverine additionally to the therapeutic scheme, and, consequently, a decrease in the number of patients requiring further surgery. This group also demonstrated a pain reduction by 6–7%. Summarizing the data obtained, we can recommend the administration of diclofenac in a dose of 75 mg for primary analgesia of renal colic, and when conducting medical expulsive therapy, combine α–blockers and spasmolytics should be applied. This will lead to improved clinical results in patients with renal colic.

Pain, Expression, and Sympathy

Chapter 5 provides a discussion of one scene in Sophocles’ play: Philoctetes’ pain attack in light of Herder’s theory of the origin of language. The interpretation focuses on Philoctetes’ cries of pain and how they constitute the possibility of sympathy for the pain of the other. The problem of the possibility, or impossibility, of sympathy conjures Stanley Cavell’s notion of “acknowledgment.” The chapter turns to Cavell as a philosopher who brings the problem of pain together with that of language and sympathy, using the implications of skepticism to put forth his own approach to the possibility, or impossibility, of knowing the other’s pain. It ends with a discussion of André Gide’s Philoctetes and with Werner Hamacher’s philosophy of language.

Familial periodicity in a multigenerational family of cluster headache: A case report

I describe an unusual phenotypic phenomenon in two members of a multigenerational family of cluster headache (CH) with anticipation features. The index case, a 44-year-old woman, and her sister, a 40-year-old woman, have a CH phenotype with atypical features as the burning of the nose. Besides identically circadian and circannual features, they present distinct chronobiological features with the onset of the episodic pain attack every third day between them. I propose to entitle this clinical feature “familial periodicity” because of the remarkable phenotypic correlation and probably a similar genotype in the two sisters. Pathophysiologically, this phenomenon may be the result of the dysfunction of the suprachiasmatic nucleus of the hypothalamus on a genetic basis. This is the first case of familial periodicity, which allows extending the clinical spectrum of CH.

Genetic Background and Clinical Characters of Pediatric Chronic Pancreatitis: Data and Implications from the East

Background.The clinical pattern and genetic background of juvenile idiopathic chronic pancreatitis (ICP) are yet unclear.Methods. A retrospective study of 73 Chinese juvenile ICP patients was performed, and genetic tests were carried out to detect relevant mutations using direct sequencing technique and high-resolution melting technique. Subjects without pancreatitis served as controls.Results.The SPINK1 c.194+2T>C variant was present in 56.16% and 42.00% of juvenile and adult ICP patients, respectively (p=0.020), but was not present in any of the control subjects. Thirty-four (46.58%) of the 73 juvenile ICP patients were male, and a significantly higher ratio of male patients in the adult group was identified (46.58% versus 64.00%,p=0.022). Although most of the juvenile patients presented with abdominal pain (70/73, 95.89%), the patterns of pain attack are significantly different in patients with or without SPINK1 c.194+2T>C mutation. Patients carrying the mutation are more likely to present with recurrent acute pancreatitis (70.70%).Conclusions.The main symptom of pediatric ICP was abdominal pain. SPINK1 c.194+2T>C mutation had a higher occurrence in juvenile ICP patients than in adult group and typically presented with recurrent acute pancreatitis. There may be unidentified factors that lead to a greater incidence rate of ICP in adult male population.