Gut microbiota in women:The secret of psychological and physical well-being

The gut microbiota works in unison with the host,promoting its health.In particular,it has been shown to exert protective,metabolic and structural functions.Recent evidence has revealed the influence of the gut microbiota on other organs such as the central nervous system,cardiovascular and the endocrine-metabolic systems and the digestive system.The study of the gut microbiota is outlining new and broader frontiers every day and holds enormous innovation potential for the medical and pharmaceutical fields.Prevention and treatment of specific women’s diseases involves the need to deepen the function of the gut as a junction organ where certain positive bacteria can be very beneficial to health.The gut microbiota is unique and dynamic at the same time,subject to external factors that can change it,and is capable of modulating itself at different stages of a woman’s life,playing an important role that arises from the intertwining of biological mechanisms between the microbiota and the female genital system.The gut microbiota could play a key role in personalized medicine.

Venous thromboembolism in patients with inflammatory bowel disease:Focus on prevention and treatment

Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and mortality.The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system,followed by the portal and mesenteric veins.However,other sites may also be involved,such as the cerebrovascular and retinal veins.The aetiology of VTE is multifactorial,including both inherited and acquired risk factors that,when simultaneously present,multiply the risk to the patient.VTE prevention involves correcting modifiable risk factors,such as disease activity,vitamin deficiency,dehydration and prolonged immobilisation.The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial.However,although guidelines recommend thromboprophylaxis for IBD patients,this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients.Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.

Severe Variant of Sickle Cell Intrahepatic Cholestasis a Difficult Approach Diagnosis Clinical Presentation and Outcome in Adult Population in the Congo

Background: There are no consensual diagnosis criteria to make diagnosis of sickle cell intrahepatic cholestasis and identify its 2 variants. Here we delineate the frequency of the complication in its severe form and describe its clinical features. Methods: We included in the study all the patients with sickle cell disease who were presenting fever, jaundice, pain in the upper right quadrant and filling up the biological criteria of the severe sickle cell intrahepatic cholestasis (serum direct bilirubin ≥ 78.5 mg/dL). Patients with evidence of viral hepatitis or gallstones were not included in the study. Results: Sixty-two patients with an average age of 21.5 years (range 18 and 25 years) meet the inclusion criteria, minimum serum direct bilirubin: 82 versus 528 for the maximum. The liver cytolysis was major and ranged from 310 to 1550 UI/L. Forty-nine patients (83.9%) did not develop any organ failure. The symptoms and biological abnormalities resolved with supportive treatment within 7 days. The global lethality was 16.1% associated with liver failure. Conclusion: Severe sickle cell intrahepatic cholestasis is more frequent than we thought and was mainly represented by borderline clinical feature. Early intervention may reduce the progression to organ failure stage and ultimate death.

Anti-TNF alpha in the treatment of ulcerative colitis:A valid approach for organ-sparing or an expensive option to delay surgery?

Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn’t seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.

Chemotherapy for Hepatocellular Carcinoma: Current Evidence and Future Perspectives

Hepatocarcinogenesis is a multistep process,heralded by abnormalities in cell differentiation and proliferation and sustained by an aberrant neoangiogenesis.Understanding the underlying molecular pathogenesis leading to hepatocellular carcinoma is a prerequisite to develop new drugs that will hamper or block the steps of these pathways.As hepatocellular carcinoma has higher arterial vascularization than normal liver,this could be a good target for novel molecular therapies.Introduction of the antiangiogenic drug sorafenib into clinical practice since 2008 has led to new perspectives in the management of this tumor.The importance of this drug lies not only in the modest gain of patients' survival,but in having opened a roadmap towards the development of new molecules and targets.Unfortunately,after the introduction of sorafenib,during the last years,a wide number of clinical trials on antiangiogenic therapies failed in achieving significant results.However,many of these trials are still ongoing and promise to improve overall survival and progression-free survival.A recent clinical trial has proven regorafenib effective in patients showing tumor progression under sorafenib,thus opening new interesting therapeutic perspectives.Many other expectations have been borne from the discovery of the immune checkpoint blockade,already known in other solid malignancies.Furthermore,a potential role in hepatocellular carcinoma therapy may derive from the use of branched-chain amino acids and of nutritional support.This review analyses the biomolecular pathways of hepatocellular carcinoma and the ongoing studies,the actual evidence and the future perspectives concerning drug therapy in this open field.