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Open access

Mehran Shokri, Roya Ghasemian, Masomeh Bayani, Parviz Amri Maleh, Masoumeh Kamrani, Mahmoud Sadeghi-Haddad-Zavareh and Soheil Ebrahimpour

Abstract

Background. Measuring the serum and alveolar procalcitonin level as inflammatory marker in the diagnosis of ventilator-associated pneumonia (VAP) has been taken into account. In this study, serum and alveolar procalcitonin levels in patients with suspected VAP and patients with confirmed VAP were compared.

Methods. This cross-sectional study was conducted using 50 intubated intensive care unit (ICU) patients, connected to ventilator, from October 2014 to April 2015. 50 patients with clinical pulmonary infection score ≥6 were divided into two groups. Patients whose bronchoalveolar lavage (BAL) has shown the growth of more than 104 CFU/mL were included in confirmed VAP group and other patients were included in suspected VAP group. Serum and alveolar procalcitonin levels were measured and compared between both groups.

Results. Mean age of patients was 69.10 ± 42.13 with a range of 16-90 years, out of which 23 patients were male (46%) and 27 patients were female (54%). Moreover, patients’ mean clinical pulmonary infection score was reported to be 7.02 ± 1.07. There was a significant relationship between serum and alveolar procalcitonin in suspected patients and patients with an approved form of pneumonia (p = 0.001 and 0.027). Area under the curve for alveolar procalcitonin was 0.683 (sensitivity = 57%; specificity = 80%) and for serum procalcitonin 0.751 (sensitivity = 71%; specificity = 73%) for the diagnosis of VAP.

Conclusion. According to the results of the present study, we can diagnose ventilator-associated pneumonia earlier and more accurately by measuring procalcitonin level (particularly alveolar type) in intensive care unit patients.

Open access

Dimitrios Velissaris, Nikolaos-Dimitrios Pantzaris, Christina Platanaki, Nikolina Antonopoulou and Charalampos Gogos

Abstract

Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

Open access

Vesa Cosmin Mihai, Popa Loredana, Dana Zaha, Moisi Mădălina, Jurca Claudia, Ţica Otilia, Popescu Mircea and Popa Amorin Remus

Abstract

Bihor is a county in north-western Romania with a population of approximately 600000. One (5) study performed at the beginning of this decade addressing diabetes epidemiology in Romania demonstrated a high prevalence of diabetes in Bihor, the cause being the obesity (1) epidemics as consequence of inadequate diet (high lipid content, refined sugars) and physical inactivity. Our study demonstrates the increasing prevalence (4.71% in 2011 vs. 5.24% in 2016) of diabetes in the county. Also by analyzing different epidemiological parameters we determined the profile of the newly diagnosed diabetes patient in Bihor including only the patients diagnosed in 2016 and 2017. The newly diagnosed diabetic patient is more often female than male (52.78% vs. 47.22%), from urban environment (51.84% vs 48.16%), belongs to the age group 47-65 years (57.35%), is obese (54.47%) is affected by hypertension (70.65%), dyslipidemia (72.3%), is smoker in 23.56% of cases and sedentary in 30.50% of cases.

Open access

Delia Tulbă, Marius Balea and Cristian Băicuş

Abstract

Introduction. Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory state mediated by uncontrolled cytokine storm and haemophagocytosis. Although rarely reported, MAS might occur in systemic lupus erythematosus (SLE), notably as an inaugural manifestation. Glucocorticoids (GCs) are the cornerstone of SLE therapy. However, in some cases high doses of GCs are required to achieve remission (i.e. glucocorticoid-resistance), leading to significant side effects.

Case report. A 28-year-old Romani male was admitted to our hospital for polyarthralgia, polyserositis and fatigability. The patient had high-grade fever, jaundice and generalized lymphadenopathy. Laboratory tests revealed severe mixed hemolytic autoimmune anemia, leukopenia, hepatocytolysis, coagulation abnormalities, hypertriglyceridemia, biological inflammatory syndrome, hyperferritinemia and persistent proteinuria of nephritic pattern. Imaging studies showed pleuropericardial effusion, hepatosplenomegaly and polysynovitis. Additional blood tests revealed hypocomplementemia and positive ANA, anti-dsDNA and anti-Sm antibodies. Haemophagocytosis was not identified either on bone marrow or axillary lymph node biopsy specimens. However, SLE-associated MAS seemed to fit this set-up. High-dose corticotherapy (6.5 g methylprednisolone followed by prednisone, 1.5 mg/kg/day after discharge) and intravenous cyclophosphamide were necessary to induce and sustain remission.

Conclusion. MAS is a potentially severe manifestation that should be considered at SLE onset whenever high fever and elevated serum levels of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and procalcitonin are noted. Early diagnosis and prompt treatment lead to remission in two thirds of cases.

Glucocorticoid-resistance leads to the use of high-dose corticotherapy or immunosuppressive agents that could elicit serious side effects. New insights into the molecular mechanisms of glucocorticoid-resistance are needed in order to conceive more adequate GC-therapies.

Open access

Anca Bălănescu, Paul Bălănescu, Valentina Comănici, Iustina Stan, Beata Acs, Laura Prisăcariu, Florin Brezan, Tatiana Ciomârtan and Ioan Gherghina

Abstract

Background and aims. The aim of this study is to assess the lipid profile pattern of pediatric overweight and/or obese patients with Non-Alcoholic Fatty Liver Disease (NAFLD) in relation to IDF Consensus Criteria for Metabolic Syndrome (MetS).

Material and Methods. We conducted a cross-sectional preliminary study on 45 consecutive pediatric patients. Overweight or obese children aged from 3 to 18 years were included. Standardized measurement of blood pressure and anthropometric parameters were performed. Biological evaluation included inflammatory status, lipid profile, glycemic profile, full blood count and liver function tests. Abdominal ultrasound was performed in all patients.

Results. Prevalence of MetS was 44.4%. A number of 21 patients (46.7%) had NAFLD. MetS patients had higher risk for NAFLD (OR = 9.5, 95% CI = 2.42-37.24). Also patients with positive familial history of type 2 diabetes had a 6.61 fold higher risk for NAFLD (OR = 6.61, 95% CI = 1.74-25.1). We performed a subgroup analysis in patients under ten years old. Patients under the age of ten which had both NAFLD and MetS met more frequently the hypertriglyceride criterion. After adjusting for age and MetS presence, triglyceride levels independently associated with NAFLD (adjusted R square = 0.46, unstandardized B coefficient = 34.51, 95% CI = 4.01-65.02, p = 0.02).

Conclusion. NAFLD obese patients had higher prevalence of MetS, higher BMI and particular lipid profile pattern. Triglyceride levels independently associated with NAFLD after adjusting for age and MetS presence. According to our findings we suggest early triglyceride testing (even below the age of ten) in selected patients.

Open access

Kresimir Kordic, Sime Manola, Ivan Zeljkovic, Ivica Benko and Nikola Pavlovic

Abstract

Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation.

Dissection was the most likely cause of LAD obstruction. To the authors’ best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

Open access

Tica Otilia Anca, Tica Ovidiu, Rosan Larisa, Pantea Vlad, Ignat Romanul Ioana, Sandor Mircea, Sandor-Huniadi Anca, Babes Katalin and Popescu Mircea-Ioachim

Abstract

Atrial fibrillation (AF) is the most common rhythm disorder worldwide, becoming epidemic. Heart failure (HF) is a life-threatening disease and addressing it should be a priority. In this paper, we analyse recent progress on the relationship between HF and AF. The interdependence between AF and HF has not been elucidated and therefore remains an area of interest for research. It is estimated that both the incidence of AF and HF will increase significantly in the next decades worldwide, there will be a significant problem for health systems in several countries. It remains imperative to urgently promote additional research on epidemiology, mechanisms and treatment of AF and HF.

Open access

Mohammad Mostakhdem Hashemi, Nasser Behnampour, Mojgan Nejabat, Afsaneh Tabandeh, Behrouz Ghazi-Moghaddam and Hamid Reza Joshaghani

Abstract

Introduction. Human seminal plasma contains a variety of macro and trace elements including magnesium (Mg), copper (Cu), zinc (Zn), and iron (Fe) that have essential roles in normal functioning of semen and its quality. The imbalance of these elements has been reported in several pathologic and male infertility disorders. Therefore, this study aimed to determine the levels of these elements in seminal plasma samples, their relationships with each other and their impact on sperm motility.

Methods. Overall, 192 males (96 normospermic and 96 asthenospermic males) were enrolled in the study. Semen samples were collected by masturbation and computer-assisted/aided semen analysis of sperm motility was performed. The samples were centrifuged and seminal levels of Mg, Cu, Zn and Fe were measured using atomic absorption spectroscopy.

Results. The levels of Zn did not differ between the two groups, while the levels of Mg, Cu, and Fe were significantly higher in normospermic males. Fe showed a positive correlation with Mg and Cu in asthenospermic group. However, a negative relationship was found between Mg and Fe levels and between Mg and sperm concentration in the normospermic group. Fe levels were higher in the normospermic group compared to the asthenospermic group. Nevertheless, increased Fe levels caused a decrease in most of sperm motility fractions.

Conclusion: Elements play major roles in male fertility and directly affect sperm quality. According to the results of this study, the levels of Zn do not affect the sperm quality and motility, while Fe, Cu and Mg are decreased in males with sperm motility problems. Nevertheless, Fe levels can adversely affect sperm motility in normospermic men.

Open access

Seyed Reza Hosseini, Naghi Baghitabar, Ali Mirzapour, Farshid Oliaei, Hajighorban Nooreddini, Ali Bijani and Simin Mouodi

Abstract

Background. Hyponatremia (HN) can be associated with osteoporosis, falls and bone fractures in the elderly. Recent researches demonstrated different results about the correlation of HN with bone mineral density and bone fractures.

Methods. This analytic research came from the AHAP project in northern IRAN. All people aged 60 years and over were included in the study. Individuals with severe comorbidities and then who had concurrent conditions which could have impact on bone mineral densities (BMD) such as long-term use of steroids, calcium and/or vitamin D supplements, bisphosphonates, calcitonin, thiazides and hormonal medications were excluded.

Results. One thousand and one hundred and thirteen older persons entered in the study. More than 10 percent of the participants had HN (serum Na+ level ≤ 137mEq/L). No significant difference has been observed between hyponatremic and nonhyponatremic individuals about their balance abilities; bone mineral density; incidence of falls and/or bone fracture during the previous 6 months; dependency in activities of daily living; and osteoporosis.

Conclusion. HN was not a prevalent problem in older adults who met the inclusion criteria of this research. No significant difference has been observed between HN and bone mineral density and falls in the elderly.