Clostridioides difficile infection (CDI) is a life-threatening disease caused by the Gram-positive, opportunistic intestinal pathogen C. difficile. Despite the availability of antimicrobial drugs to treat CDI, such as vancomycin, metronidazole and fidaxomicin, recurrence of infection remains a significant clinical challenge. The use of live commensal microorganisms, or probiotics, is one of the most investigated non-antibiotic therapeutic options to balance gastrointestinal (GI) microbiota and subsequently tackle dysbiosis. In this review, we will discuss major commensal probiotic strains that have the potential to prevent and/or treat CDI and its recurrence, reassess the efficacy of probiotics supplementation as a CDI intervention, delve into lessons learned from probiotic modulation of the immune system, explore avenues like genome-scale metabolic network reconstructions, genome sequencing, and multi-omics to identify novel strains and understand their functionality, and discuss the current regulatory framework, challenges, and future directions.
Background: Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated.
Objective: We categorized vascular compression based on vessel and location of compression to correlate pain outcomes based on compression type.
Methods: A retrospective video review of 217 patients undergoing endoscopic microvascular decompression for trigeminal neuralgia categorizing vascular compression into 5 distinct types, proximal arterial compression (VC1), proximal venous compression (VC2), distal arterial compression (VC3), distal venous compression (VC4), and no vascular compression (VC5). Vascular compression type was correlated with post-operative pain outcomes at one month (n=179) and last follow up (mean= 42.9 months, n=134).
Results: At one month and longest followup, respectively, pain was rated as “much improved” or “very much improved” in 89% & 69% of patients with VC1, 86.6% & 62.5% of patients with VC2, 100% & 87.5% of patients with VC3 83% & 62.5% of patients with VC4 and 100 &100% of patients with VC5. Multivariate analysis demonstrated VC4 as a significant negative of predictor pain outcomes at one month, but not longest followup, and advanced age as a significant positive predictor.
Conclusions: The degree of clinical improvement in all types of vascular compression was excellent but at longest follow up vascular compression type was not a significant predictor out outcome. However distal venous compression was significantly associated with worse outcomes at one month.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.