Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study.

BACKGROUND: Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP. METHODS: A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts. RESULTS: None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray-Curtis distance. CONCLUSION: Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.

A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based.

Background: Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students. Methods: We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance. Results: We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data. Conclusions: The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence.

[Arg506 --> Gln mutation of coagulation factor V (factor V Leiden) and transient cerebral ischemia at a young age in 3 members of the same family]. / Mutazione Arg506 --> Gln del fattore V della coagulazione (fattore V Leiden) ed ischemia cerebrale transitoria in giovane età in tre membri della stessa famiglia.

The Arg506 --> Gln coagulation factor V mutation (factor V Leiden) is the most frequent inherited abnormality of blood coagulation which predisposes to venous thromboembolism. Its association with an increased risk of arterial thrombosis is uncertain. We describe 3 members of the same family (a woman and her 2 children) who were heterozygous for the Arg506 --> Gln mutation and who presented cerebral transient ischemic attacks (TIA) at a young age. The patients (with the exception of one smoker) had no risk factors for TIA and no abnormality of the coagulation system other than the Arg506 --> Gln mutation. The observation of the mutation and TIA in 3 members of the same family may suggest the hypothesis of an association between the mutation and arterial thrombosis. This hypothesis must be interpreted with caution, due to the absence of objective instrumental findings in patients with TIA and to the high prevalence of the Arg506 --> Gln mutation in the general population.

Mirtazapine in the treatment of essential tremor: an open-label, observer-blind study.

INTRODUCTION: Essential tremor (ET) is the most common movement disorder in the adult population. At present ET treatment shows limited efficacy, particularly in patients with severe and disabling symptoms. This study evaluates the clinical efficacy of mirtazapine in an untreated ET patient population. MATERIALS AND METHODS: 30 ET patients (female/male = 19/11; average age = 71.4 +/- 8.3 years) were examined by clinical criteria, electromyographic (EMG), and apomorphine tests to study the cortical silent period. The patients were all treated with mirtazapine 30 mg daily. RESULTS: Mirtazapine proved to be a good control agent for tremor symptomatology in 23/27 patients (85%) who completed 1 month of treatment, with a marked reduction of tremor; the benefit was maintained during the 12-month follow-up. No significant variation in EMG parameters was observed aside from two prevalent and distinct frequencies of tremors (5-6 Hz and 7-8 Hz) and a group of selected patients whose cortical silent period (SP) was markedly reduced. There were no clinical differences between the two subgroups. All apomorphine-tested patients showed an SP with no significant modifications. CONCLUSIONS: Mirtazapine proved to be an efficacious drug treatment for tremor symptoms in patients suffering from ET. It had limited side effects and excellent overall tolerability, could be used as daily monotherapy, and did not interfere with any of the many other medications being taken simultaneously by the patients.

Asymptomatic carotid bruit as related to single risk factors. A flowmetric study.

The prevalence of asymptomatic carotid bruit is 4 per cent in the general population aged over 40 years. According to most authors, it is an evident risk factor for stroke and myocardial infarction. In the present study the clinical data and Doppler flowmeter analysis of 5 groups of patients are reported. These patients had risk factors for cerebrovascular disease, without cerebral symptoms. An age matched group of healthy control subjects was also studied. The prevalence of haemodynamic stenosis (more than 50 per cent) of carotid artery is significantly higher among subjects with peripheral arteriopathy and arterial hypertension compared with other groups. On the other hand nonhaemodynamic stenosis (below 50 per cent) of carotid artery occurs to the same extent in patients and control groups. The possible implications of these findings on the knowledge of cerebrovascular obstructive disease are discussed.

Transcranial Doppler monitoring of a migraine with aura attack from the prodromal phase to the end.

Transcranial Doppler sonography (TCD) was performed in a case of migraine with aura during the different phases of the attack. In the prodromic period our patient showed a slight central deficit of the seventh right cranial nerve and hypesthesia in her right arm. TCD indicated a remarkable decrease of the mean flow velocity (MFV) of the left middle cerebral artery (MCA). During the headache phase and when the signs and symptoms subsided, TCD showed an increase in MFV of both middle cerebral arteries with normal symmetry. An electroencephalogram (EEG) demonstrated a left temporal disorder. A month later a cranial CT scan, an EEG, and TCD were normal. In our opinion all these findings suggest a focal reduction in cerebral blood flow in the prodromic phase.

Basilar artery migraine: transcranial Doppler EEG and SPECT from the aura phase to the end.

Transcranial Doppler, electroencephalography, and single photon emission computed tomography were performed in a case of basilar migraine during the different phases of the attack. In the aura phase, the patient had bilateral blindness and ataxia. Doppler ultrasound studies showed a reduction in the mean flow velocity of the posterior cerebral arteries, electroencephalography showed slow activity confined to the posterior regions, and single photon emission computed tomography, an area of hypoperfusion in the right parietal and occipital regions. During the headache phase, when the neurological examination was normal, transcranial Doppler showed an increase in the mean flow velocity of both posterior cerebral arteries and the electroencephalogram revealed an increase in the slow activity over the occipital regions. When the pain subsided, the electroencephalogram showed a progressive reduction of the slow abnormalities and transcranial Doppler was reported as normal. After a week, single photon emission computed tomography and cranial magnetic resonance imaging were normal. After a month, a follow-up electroencephalogram was also normal. All these findings indicated a transient focal reduction of cerebral blood flow during the aura phase.

Guillain-Barré polyradiculoneuritis after blood transfusion.

We report the case of a 72 year-old woman who developed acute polyradiculoneuritis 7 days after a series of 4 blood transfusion. While blood transfusion is not listed as an antedecent event of Guillain-Barré syndrome (GBS), GBS following surgical procedures is well known. In the present case the close temporal relationship and the absence of all factors which usually precede the onset of the disease including surgery, suggest a possible role of blood transfusion in the onset of the GBS.

Acute cholangitis induced by carbamazepine.

We report a case of a patient with fever and intrahepatic cholestasis induced by carbamazepine (CBZ). This adverse reaction has been described in only a single case. We observed complete resolution of the hepatic damage once the agent was discontinued. CBZ rechallenge was followed by recurrence of all symptoms and abnormalities. Hepatic function improved again when CBZ was discontinued.

Gabapentin in painful HIV-related neuropathy: a report of 19 patients, preliminary observations.

The objective of this study was to assess the efficacy and safety of Gabapentin as the sole analgesic in patients with HIV-related painful neuropathy. Nineteen patients with HIV-related painful neuropathy were administered Gabapentin. Efficacy was evaluated with two 100-mm Visual Analogue Scales (VAS) (0: no symptom; 100: worst symptom), rating pain and interference of pain with sleep, performed at baseline and monthly intervals. Main Pain VAS score decreased from a baseline of 55.7 +/- 19.1 mm to a final 14.7 +/- 18.6 mm (ANOVA P = 0.0001) and mean Sleep Interference VAS score decreased from a baseline of 60.4 +/- 31.9 mm to a final 15.5 +/- 27.7 mm (ANOVA P = 0.0001). Gabapentin provided significant pain relief in our patients with HIV-associated painful sensory neuropathy.