Clinical Implications of Dietary Probiotic Supplement (Associated with L-Glutamine and Biotin) in Ulcerative Colitis Patients' Body Composition and Quality of Life.

Patients with ulcerative colitis (UC) are reported to have changes in body structure, with negative impact on the course of disease. This study explored the effects of a standardized nutritional supplement containing five bacterial strains of at least five billion bacteria (Bifidobacterium infantis, Bifidobacterium animalis, Lactobacillus bulgaricus, Lactobacillus helveticus, and Enterococcus faecium), L-glutamine, and biotin on the body composition and quality of life of patients with UC. Ninety-three patients over 18 years of age with a confirmed diagnosis of UC, for whom body composition could be accurately determined, were included in this observational follow-up randomized study. These patients were split into two groups: UC-P (44 patients with dietary counselling and supplement with probiotics) and UC-NP (49 patients with dietary counselling, without supplement). Body composition was assessed using the multifrequency bioelectrical impedance device, and the quality of life related to UC was evaluated by applying the short inflammatory bowel disease questionnaire (SIBDQ). The results showed that the average value of muscular mass (MM) and sarcopenic index (SMI) significantly increased (p = 0.043, respectively, p = 0.001) and a large fraction (p = 0.001) of patients had their SMI levels normalized in the UC-P group compared with UC-NP group. The extracellular water to total body water ratio (ECW/TBW) also had significantly different mean values (p = 0.022), favoring the UC-P group. By testing the differences between the average values of body composition parameters before and after treatment, we obtained significant results in body mass index (BMI) (p = 0.046), fat free mass (FFM) (p < 0.001), and ECW/TBW ratio (p = 0.048). The SIBDQ total score increased significantly (p < 0.001) in the UC-P group and was more strongly associated with changes in body parameters. Supplementation with probiotics associated with L-glutamine and biotin can improve body composition parameters, which in turn implies an increase in the overall quality of life of patients with UC.

Probiotics and the microbiota-gut-brain axis: focus on patients with depression. A review of current research.

This review covers recent data on the relationship between major depressive disorder (MDD) and faecal microbiome and examines the co-relations between the use of probiotics and changes in psychiatric state. We conducted a thorough search of academic databases for articles published between 2018 and 2022, using specific keywords and previously established inclusion/exclusion criteria regarding faecal microbiota, depressive disorder, and probiotics. Of 192 eligible articles (reviews, original papers, and clinical trials), we selected 10 that fully met our criteria and performed a careful review to determine any correlation between microbiome, probiotic treatment, and depression. All patients were adults (mean age, 36.8), with at least one MDD episode and onset of depression during adolescence (duration of 31.39 years of depressive episodes). We found mixed but mostly positive results regarding the influence of probiotic/prebiotic/postbiotic effects on depression. We could not identify the precise mechanism of action that led to their improvement. Antidepressants did not alter the microbiota, according to studies that evaluated this aspect. Probiotic/prebiotic/postbiotic treatments were proven to be safe, with few and mild side effects. Probiotics seemingly could be beneficial in patients with depression, as evidenced by well-established depression scales. Based on this finding and the high tolerability and safety of probiotics, no caveats against their routine use can be made. Some unmet needs in this field include determination of the dominant type of microbiota in specific patients with depression; study of microbiome-directed/driven treatment regarding dose and duration adjustments; and multiple versus single strain treatments.

Multimodality Imaging Diagnosis in Infective Endocarditis.

Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.

Psychosocial profile of the patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a chronic, disabling entity of unknown aetiology, with negative impact on the patient's life, including psychological patterns. This study assessed multiple psychosocial factors (satisfaction with life, coping mechanisms, emotional profile, mental recognition of the disease and cognition schemes related to patients' demographic characteristics, clinical picture, form and duration of the disease, therapeutic plans) in IBD patients vs. a healthy group. This non-interventional study comprised 60 participants who attended for medical advice/check-up as an ambulatory visit or during hospitalization. The patients completed questionnaires after receiving explanations from the psychologist. Statistical analyses (Kolmogorov-Smirnov test, Independent-Samples t-test, One-Way ANOVA and Post Hoc Multiple Comparisons) were conducted using IMB for the Social Sciences (SPSS), version 20 (P≤0.05). IBD patients (G1) are more hostile when compared to the healthy group (G2). Those who experience abdominal pain are more likely to use active coping mechanisms and those who experience fatigue are more likely to use acceptance, emotional venting, behavioural disengagement and mental disengagement. G1 have higher levels of others-downing vs. G2. Regarding negative emotions, IBD patients generally experience more negative emotions compared to healthy participants (who have higher levels of life satisfaction). Regarding the perception of illness, there are no differences between patients in terms of illness coherence, personal or treatment control, consequences, timeline, or emotional representations. Results indicate that psychological factors and different characteristics of IBD patients play a relevant role in the way these patients deal with their disease.

COX-2 and Ki-67 immunohistochemical markers in the assessment of long-standing ulcerative colitis associated dysplasia.

INTRODUCTION: Malignancy in LUC (long-standing ulcerative colitis) presumably evolves through a chronic inflammation-dysplasia-adeno-carcinoma sequence in which a multitude of yet not fully understood factors takes part. AIM: To assess ulcerative colitis (UC) associated dysplasia and to distinguish regenerative changes from premalignant ones using immunohistochemical (IHC) markers. MATERIALS AND METHODS: We studied 80 LUC biopsy specimens: 20 high-grade dysplasia (HGD), 20 low-grade dysplasia (LGD), 20 indefinite for dysplasia, 20 regenerative atypia. We used anti-COX-2 and Ki-67 antisera (Dako, Carpinteria, USA) to perform immunohistochemical staining by the labeled Streptavidin-Biotin method, and then assessed and graded staining intensity and distribution using previously described scoring systems. Statistical analysis was made using chi-square test and SPSS application. A p-value <0.05 was considered significant. RESULTS: In LGD, most of the cases had middle and top Ki-67 localization of the staining. For HGD, we found to be characteristic the top and surface staining of the crypts and no case of basal immunostaining. COX-2 immunostaining was positive (total score >=3) in 72.5% of all the UC cases studied. In non-dysplastic lesions (regenerative atypia), COX-2 expression was negative and as the pathologic process progressed towards dysplasia/malignant transformation, COX-2 expression became positive with a progressive increase of the total score. CONCLUSIONS: A combination of enhanced colonoscopic surveillance and IHC markers those are more sensitive for dysplasia might be the optimal way to manage the increased colorectal cancer (CRC) risk in LUC patients. Further studies to find additional prognostic parameters will provide valuable insights into the behavior of LUC.