(searched for: doi:10.17352/2455-2283.000100)
Published: 18 April 2022
Archives of Clinical Gastroenterology, Volume 8, pp 008-019; https://doi.org/10.17352/2455-2283.000106
Celiac disease is an immune-mediated enteropathy, caused (in genetically predisposed or susceptible individuals) by the ingestion of gluten, the complex of water-insoluble proteins found in cereal grains such as wheat, rye and barley. In terms of terminology, it is the complex natural history and extremely polymorphous clinical presentation that has created some confusion. In fact, to date, at least three different forms of celiac disease are known, in addition to the simple non-celiac gluten sensitivity, since in common clinical practice most patients do not present the classic symptoms such as malabsorptive syndrome with diarrhoea, steatorrhoea, weight loss and nutritional deficiency, but rather an anaemia, asthenia, meteorism, abdominal tension, osteoporosis and infertility, thus painting an extremely varied and complex symptomatic picture that is linked to enteric microbiota and microbiome issues. Celiac disease affects the mucosa of the small intestine, while it generally spares the submucosa, muscolaris propria and serosa; if the disease does not involve the whole of the small intestine but only part of it, it is usually more serious in the proximal than the distal tract. The simultaneous presence of shortened villi, crypt hyperplasia, the abnormal cytological appearance of the absorbent surface and increased lamina propria cells is required for the diagnosis of celiac disease. Based on these findings, several forms of celiac disease have been identified in the clinic: typical, atypical (and in turn silent, latent, and potential), and sensitive non-celiac. Based on these considerations a specific diagnostic scheme is suggested to frame the celiac universe more functionally and structurally (so-called Diagnostic Scheme for Celiac Disease and Nonceliac Gluten Sensitivity, DSCNC), identifying at least eight clinical hypotheses based on the serological, genetic, bioptic and allergological tests suggested). From a pharmacological and integrative point of view, the protocols shared by the scientific community remain in place: gluten-free diet, vitamin and salt supplementation if appropriate, pharmacological therapy (antibiotics, antihistamines, corticosteroids and immunosuppressants) if necessary, also in the future with the majority orientation oriented towards oral glutenase able to counteract the effects of gliadin in sensitive subjects, the use of larazotide acetate to remedy the increase in intestinal permeability and tTG inhibitors to reduce the toxic effects of gluten intake. The state of the art on celiac disease is not yet able to explain the precise aetiology and atypical forms of the disease, as well as the real impact of genetic predisposition on clinical manifestations. Research continues and seems to point the way to a complete resolution of this enteropathy that has been so prevalent over the last two decades.
Published: 30 March 2022
Archives of Community Medicine and Public Health, Volume 8, pp 041-051; https://doi.org/10.17352/2455-5479.000172
Ostomy patients are subject to significant negative psychological impact, affecting their quality of life in all respects (physical, psychological, social, economic, and spiritual), especially if they are not properly constructed or if there are complications during the recovery phase. In the light of published research and studies, the main problems are as follows: a) alteration of body image; loss of sphincter control; b) odor, leakage, and complications related to the stoma; c) impairment of sexuality; d) alteration of nutrition and sleep; e) anxiety, depression, and loneliness; embarrassment and shame; f) loss of control of the situation; drop in self-esteem; g) rejection; h) stigmatization; i) disinvestment in social activities; l) abandonment of work and sports activities; isolation; m) difficulties in couple relationships and social contacts. The psychological problems caused by ostomy can be avoided, or at least contained, by comprehensive care of the patient, both before and after the operation. In addition to purely technical care, teaching, accompaniment and constant support are the main components of care that can make a difference to how the patient will accept his or her ostomy. Setting the care only on the management of the physical dimension will hardly allow the person to integrate the ostomy into his life. The present work proposes a specific protocol of psychological intervention (Perrotta-Guerrieri Psychological Care for Ostomy Patients, PCOP), for all the clinical phases (pre-operative, operative, post-operative, follow-up) and a specific questionnaire (Perrotta-Guerrieri Psychological Care for Ostomy Patients Questionnaire - first version, PCOP-Q1) to be submitted to the patient which investigates the 9 subjective functions (physical, psychological, sexual, emotional, sentimental, work, family and social), in 45 items with a response on L1-5 scale, for the study of quality of life in the ostomised patient.
Published: 21 October 2021
Journal: Open Journal of Trauma
Open Journal of Trauma pp 019-036; https://doi.org/10.17352/ojt.000038
The spleen is an organ commonly injured in abdominal trauma of the upper left quadrant and until just under two decades the first choice was always splenectomy; however, based on new research and clinical experience, there is a tendency to preserve the spleen as much as possible, precisely because of its immune function and risk of infection. On the basis of the trauma and of the patient’s anamnesis, after an objective examination, the primary ABCDE evaluation, the Eco-FAST, and if necessary also the CT scan (with contrast), it is possible to choose between surgical (OM) and non-surgical (NOM) management: in the first hypothesis are included total or partial splenectomy surgery, raffia, direct hemostasis through drugs or devices with hemostatic-adhesive action, and laparoscopy; in the second hypothesis are included treatments such as controlled nutrition, rest, anticoagulant drug therapy (and antibiotic, if necessary), and angioembolization (exclusive or accessory to a NOM). In particular, in the last few years, a dual interpretation has emerged on the findings necessary to favour splenectomy (total or partial) over angioembolization. From the best clinical practice emerges therefore the answer to the question at hand, namely that the patient is a candidate for angioembolization if 1) is hemodynamically stable (with systolic blood pressure > 90 mmHg, heart rate < 100 bpm, and transfusion of < 3 units of blood in 24 hours) or stabilizable (positive response to rapid infusion of 1000-2000 cc of crystalloids-Ringer Lactate-with restoration of blood pressure and heart rate values in the range of hemodynamic stability); 3) there is no open trauma to the abdomen or evidence of vasoconstriction (cold, sweaty skin, decreased capillary refill) or obvious intestinal lesions or perforative peritonitis or high-grade lesions to the spleen or peritoneal irritation or signs of exsanguination or contrast blush or effusion (exceeding 300ml) detected by Eco-FAST. This preference is optimal concerning both the risks of postoperative infection and immunological risks; finally, age and head trauma, compared to the past, seem to be no longer discriminating conditions to favour splenectomy regardless. Splenic immune function is thought to be preserved after embolization, with no guidelines for prophylactic vaccination against encapsulated bacteria. Other clinical signs finally, however, might argue for discontinuation of NOM treatment in favour of a surgical approach: 1) need to transfuse more than 3 units of blood or simply the need for transfusion in 24 hours to maintain a maximum systolic blood pressure greater than 90 mmHg, correct anaemia less than 9 g/100 ml, or a hematocrit less than 30%; 2) persistence of paralytic ileus or gastric distension beyond 48 hours (despite a nasogastric aspiration); 3) increased hemoperitoneum (on ultrasound or CT); 4) aggravation of the lesion evidenced by ultrasound and/or CT (so-called “expansive” lesions); and 5) subsequent appearance of signs of peritoneal irritation. A complete understanding of post-embolization immune changes remains an area in need of further investigation, as do the psychological and mental health profiles of the surgical patient.
Published: 18 October 2021
Journal: Annals of Psychiatry and Treatment
Annals of Psychiatry and Treatment pp 088-095; https://doi.org/10.17352/apt.000035
Purpose: Starting from the classic definition of “demonic possession” (as a psychophysical condition in which a person becomes the victim of a supernatural being of demonic origin), the present research, starting from the study published in 2019 on the proposed clinical classification of this particular phenomenon, is aimed at confirming the theoretical assumption of psychopathological origin, refuting the assumptions of the most significant analytical orientations, such as the ethnopsychiatric, the socio-anthropological, the cultural, the religious and the esoteric, to reaffirm the accuracy of the theoretical approach of the multifactorial model proposed in the previous research. Methods: Clinical interview, based on narrative-anamnestic and documentary evidence and the basis of the Perrotta Human Emotions Model (PHEM) concerning their emotional and perceptual-reactive experience, and administration of the battery of psychometric tests published in international scientific journals by the author of this work: 1) Perrotta Integrative Clinical Interviews (PICI-2), to investigate functional and dysfunctional personality traits; 2) Perrotta Individual Sexual Matrix Questionnaire (PSM-Q), to investigate the individual sexual matrix; 3) Perrotta Affective Dependence Questionnaire (PAD-Q), to investigate the profiles of affective and relational dependence; 4) Perrotta Human Defense Mechanisms Questionnaire (PDM-Q), to investigate the defence mechanisms of the Ego. Results: The preliminary results of the interviews and the anamnestic form would suggest that the phenomenon of demonic possession has a greater tendency to manifest itself in the female group, in the juvenile group (and tends to decrease but not to disappear with the advancement of age) and in the group geographically originating in the centre-south of Italy (due to greater religious influences, popular beliefs and ancestral fideistic representations). Moreover, the subsequent findings would lead to deduce with almost total certainty, concerning the selected sample, that the phenomenon of demonic possession has an absolute prevalence in the believing population, faithful or in any case trusting in the existence of paranormal phenomena per se, even in the absence of objective and/or scientific evidence. Based on the PICI-2 it emerged that the primary emerging disorder turns out to be alternatively the delusional disorder, the dissociative disorder and the obsessive disorder; followed, as secondary disorders, by the delusional disorder (if it is not considered as primary disorder), the schizoid disorder, the borderline disorder and the psychopathic disorder. Even the analysis of functional traits has reported the marked dysfunctional tendency of the classes that refer to self-control, sensitivity, Ego-ID comparison, emotionality, ego stability, security and relational functionality, reaffirming here too the marked dysfunctional tendency of the clinical population. According to the PSM-Q, more than 1/4 of participants present a lack of acceptance of their sexual orientation and a marked tendency to chronicle feelings of shame into dysfunctional sexual behaviours of avoidance or hypersexuality. Still, nine in ten reports having experienced severe psychological or physical abuse at a young age, or intraparental relational imbalance, or otherwise a sexual upbringing that was not open and lacked free communication. According to the PDM-Q, 37.2% are affected by affective dependence, with a greater emphasis on types I (neurotic), V (borderline), III (histrionic), and VII (psychotic) in that order of descent. Finally, the PDM-Q reveals the widespread psychopathological tendency of the ego function framework for the mechanisms of isolation, denial, regression, reactive formation, denial, projection, removal, withdrawal, instinct, repression, and idealization. Conclusions: The present research demonstrates beyond any reasonable doubt the psychopathological nature of the phenomenon of demonic possession, which deserves to be treated pharmacologically and with a psychotherapeutic approach (preferably cognitive-behavioural and/or strategic), according to the symptoms manifested and the severity of the morbid condition.