Helicobacter Pylori: A Review of Current Treatment Options in Clinical Practice.

BACKGROUND: When prescribing antibiotics, infection eradication rates, local resistance rates, and cost should be among the most essential considerations. Helicobacter pylori is among the most common infections worldwide, and it can lead to burdensome sequela for the patient and the healthcare system, without appropriate treatment. Due to constantly fluctuating resistance rates, regimens must be constantly assessed to ensure effectiveness. METHODS: This was a narrative review. The sources for this review are as follows: searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Helicobacter pylori, Treatment Options, Clinical Practice. RESULTS: Multiple antibiotics are prescribed as part of the regimen to thwart high resistance rates. This can lead to unwanted adverse reactions and adherence issues, due to the amount and timing of medication administration, which also may contribute to resistance. Single-capsule combination capsules have reached the market to ease this concern, but brand-only may be problematic for patient affordability. Due to the previously mentioned factors, effectiveness and affordability must be equally considered. CONCLUSIONS: This review will utilize guidelines to discuss current treatment options and give cost considerations to elicit the most effective regimen for the patient.

Hyperprolactinemia, Clinical Considerations, and Infertility in Women on Antipsychotic Medications.

Infertility, the inability to establish a clinical pregnancy after 12 months of regular unprotected sexual intercourse, is caused by a wide variety of both male and female factors. Infertility is estimated to affect between 8-12% of couples trying to conceive globally. Female factor infertility can be subdivided into the following broad categories: ovulatory dysfunction, fallopian tubal disease, uterine causes, and oocyte quality. Hyperprolactinemia causes ovulary dysfunction along with other hormonal abnormalities, such as decreased estrogen, which can lead to infertility. In this regard, antipsychotics are commonly used for both schizophrenia and bipolar disorder. The use of these medications can be associated with hyperprolactinemia and hyperprolactinemia associated infertility. Antipsychotic-induced hyperprolactinemia occurs through blockade of D2 receptors on lactotroph cells of the anterior pituitary gland. Discontinuation of the hyperprolactinemia-inducing antipsychotic is an option, but this may worsen the patient's psychosis or mood. If antipsychotics are determined to be the culprit of infertility, the degree of hyperprolactinemia symptoms, length of treatment with the antipsychotic, and risk of relapse should be assessed prior to discontinuation, reduction, or switching of antipsychotic medications. The treatment of a women's mental health and her desire to have children should always be considered as treatment may influence fertility while on the medication.

Central Neuropathic Mechanisms in Pain Signaling Pathways: Current Evidence and Recommendations.

PURPOSE: This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations. RECENT FINDINGS: Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve-glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. CNP is a common complication of SCI and is a prevalent disorder with significant morbidity and disability. Conventional medical treatment is limited in efficacy. Recent studies identified baclofen and ziconotide as possible new therapies, alongside non-medical interventions. Further research into the pathophysiology is required to identify further therapy candidates. A multidisciplinary approach, including psychosocial support, medical and non-medical interventions, is likely needed to achieve therapeutic effects in this difficult to treat syndrome.

Three-dimensional ultrasound imaging.

PURPOSE OF REVIEW: Ultrasound guidance is frequently utilized for needle placement and observation of local anesthetic spread when performing peripheral nerve blocks. Although there is evidence that ultrasound technology can reduce complications, there are limitations to 2-dimensional (2-D) ultrasound. Three-dimensional (3-D) and especially real-time 3-D (4-D) ultrasound may allow for optimized and well tolerated needle positioning and enhanced observation of local anesthetic spread around the target structure. This article reviewed the current literature regarding the use of 3-D and 4-D ultrasound technology in a regional anesthesia setting. RECENT FINDINGS: Several investigations have utilized 3-D ultrasound as a tool to study anatomical spatial relationships, evaluate local anesthetic spread, or optimize nerve block needle or catheter positioning. However, this was mostly achieved by retrospectively generating a 3-D image after the performance of the actual nerve blocks or studying anatomy on volunteers. There are only a few case reports available demonstrating the feasibility of 4-D ultrasound for nerve block performance. SUMMARY: At present, there are limited data regarding the use of 3-D ultrasound and a complete lack of randomized controlled clinical trials evaluating the potential benefits of real-time 3-D (4-D) ultrasound. This may be in part due to technical limitations associated with these techniques.