Aim: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. Methods: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cell/mm3, and empirically treated with cefotaxime. Results: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. Conclusion: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated. © 2008 WJG. All rights reserved

Amyloidosis is an important cause of infiltrative cardiomyopathy and is often diagnosed lately in the course of the disease; radiolabeled bisphosphonates bone scan is highly sensitive in detecting transthyretin (TTR) cardiac amyloidosis; data on the true prevalence of cardiac involvement in TTR amyloidosis are lacking. The aim of the present retrospective observational, monocentric study was to estimate the prevalence of positive bone scan suspect for TTR cardiac amyloidosis in the population of Piedmont -a region in the north-west of Italy -retrospectively assessing unexpected cardiac emissions in bone scan scintigraphy among an all-comers population who underwent a bone scan at San Luigi Gonzaga University Hospital between January 2015 and May 2020. ECG, echocardiography and clinical status of patients with positive cardiac emission have been collected in order to better characterize their clinical features.Background. Amyloidosis is a group of diseases characterized by deposition in human tissues of protein aggregates [1]. A subtype of amyloidosis is characterized by accumulation of transtyretin (TTR), either in its natural (wild type ATTR amyloidosis, ATTRwt) or mutated (hereditary ATTR amyloidosis, hATTR) form. In this disease TTR tetramer, mutated or natural with age, becomes instable and dissociates into single monomers [2]. Clinically, the disease causes heart failure, orthostatic hypotension, neurological and autonomic dysfunctions, renal insufficiency, carpal tunnel syndrome and lumbar spinal stenosis [3].

Automated cell counters not only have a good diagnostic accuracy, but are also very effective in monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP.

In both alcoholics and cirrhotics, we found a significant increase of plasma-aromatic amino acid and methionine levels, whereas glutathione was significantly reduced. The erythrocytes of these patients showed a significant increase of cysteine, glutamic acid, and glycine; gamma-glutamylcysteine was normal; and glutathione and other free amino acids were significantly decreased. Data suggest that, independent of liver cirrhosis, ethanol abuse affects the metabolism of amino acids and glutathione in both the plasma and the erythrocytes.