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Open access

Nicoleta Dumitru, Mara Carşote, Andra Cocoloş, Eugenia Petrova, Maria Olaru, Andra Caragheorgheopol, Constantin Dumitrache and Adina Ghemigian

Abstract

Introduction: Current studies support the implication of metabolic changes associated with type 2 diabetes in altering bone metabolism, structure and resistance.

Objective: We conducted a cross-sectional study on postmenopausal women aimed to analyze the differences in metabolic and bone profile in patients with and without type 2 diabetes

Methods: We analyzed the metabolic and bone profile in postmenopausal women with and without type 2 diabetes(T2DM). Clinical, metabolic, hormonal parameters, along with lumbar, hip and femoral bone mineral density (BMD) and trabecular bone score (TBS) were evaluated.

Results: 56 women with T2DM(63.57±8.97 years) and 83 non-T2DM (60.21±8.77 years) were included. T2DM patients presented a higher value of body mass index (BMI) and BMD vs. control group (p 0.001; p=0.03-lumbar level, p=0.07-femoral neck and p=0.001-total hip). Also, BMI correlated positively with lumbar-BMD and glycated hemoglobin (HbA1c) (r=0.348, p=0.01; r=0.269, p=0.04), correlation maintained even after age and estimated glomerular filtration rate (eGFR) adjustment (r = 0.383, p = 0.005; r=0.237, p=0.08). Diabetic patients recorded lower levels of 25(OH)D(p=0.05), bone markers (p ≤0.05) and TBS(p=0.07).

For the entire patient group we found a negative correlation between HbA1clevel and bone markers: r =-0.358, p = 0.0005-osteocalcin, r =-0.40, p = 0.0005-P1NP, r =-0.258, p = 0.005-crosslaps.

Conclusions: Our results indicate the presence of altered bone microarchitecture in T2DZ patients according to the TBS score, combined with lower levels of bone markers, with a statistically significant negative correlation between HbA1c level and bone markers.

Open access

Romeo-Gabriel Mihăilă

Abstract

Introduction: The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose.

Methods: This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms “liver stiffness” and “hepatitis C”.

Results: The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds can not be used on any other elastographic machine. The higher the liver’s stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥15 cm for patients with a value of liver stiffness <17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline.

Conclusion: Liver stiffness provides clues about the severity and evolution of liver disease.

Open access

Hilal Yücel, Abitter Yücel, Hamdi Arbağ, Erkan Cure, Mehmet Akif Eryilmaz and Ahmet Bedri Özer

Abstract

Introduction: It is known that hyperlipidemia reduces hearing functions. In this study, we aimed to study the effect of antihyperlipidemic drugs on hearing functions and tinnitus.

Methods: Eighty-four patients aged 18 to 84, who were diagnosed with hyperlipidemia and started treatment with the statin group (atorvastatin 20 mg and 40 mg, rosuvastatin 10 mg and 20 mg, and simvastatin 20 mg) of antihyperlipidemic drugs, were included in this study. All patients underwent pure-tone audiometry before starting treatment with antihyperlipidemic drugs. Patients with tinnitus were evaluated by Tinnitus Severity Index and Visual Analogue Scale. In the 6th month of the therapy, otologic examination, pure-tone audiometry and tinnitus evaluation of the patients were repeated.

Results: No significant difference was found in the pure-tone averages of the patients before and after statin use (p>0.05). However, it was found in the audiometry that, after statin use, all drugs caused to statistically significant decrease in the hearing thresholds at 6000 Hertz (p<0.05). Also, strongly increase was found in the Speech Discrimination percentages after treatment in patients using rosuvastatin 10 mg (p= 0.022). A significant decrease was found in the tinnitus frequency, duration, severity and degree of annoyance in patients using rosuvastatin 10 mg and 20 mg (p<0.05).

Conclusion: Statin group of drugs can have a positive effect on the hearing functions and subjective tinnitus. In particular, it is seen that rosuvastatin group of statins has a more notable effect on tinnitus. It was considered that further studies with larger patient groups are needed.

Open access

Stamatis S Papadatos, Stamatis J Karakatsanis, George Deligiannis and Eleni Gatsa

Abstract

Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy syndrome resulting from decrease or absence of “a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13” (ADAMTS13). TTP has been characterized by the classical pentad of thrombocytopenia, hemolysis, fever, renal injury and neurological deficits, yet the patient may present with any atypical symptom related to microthrombi formation in the microcirculation. Here we present a rare case of a young patient with retrosternal chest pain and myocardial injury as the first manifestation of TTP.

Open access

Theodor Voiosu, Andrei Voiosu, Andreea Benguş and Bogdan Mateescu

Abstract

Background: Endoscopic retrograde cholangiopancreatography has evolved significantly in recent years. The increase in complexity and range of applications has not been adequately reflected in an improvement of training methods for ERCP, with many endoscopists failing to meet required performance standards during their training period and limited available data on their performance immediately after completing training. We aimed to analyze the performance of an independent operator from a developing country after the completion of formal training with regard to procedure and patient-related outcomes. Methods: We conducted an observational study of ERCPs performed by a young endoscopist from a referral center. Data about the procedure, cannulation technique (including use of precut), trainee involvement and procedure-related outcomes was retrieved and analyzed from a prospectively maintained database on quality in ERCP (the QUASIE initiative). Results: Data from 679 consecutive ERCPs conducted or supervised by one endoscopist with < 200 independent procedures prior to the study period were included in the final analysis. Cannulation rates significantly improved over time, from 90% to 96% (p=0.016). Use of precut techniques changed significantly over time, with an initial increase followed by a subsequent decrease as overall cannulation rates improved. Trainee involvement was significantly associated with prolonged cannulation times (p=0.003) and use of precut (p=0.001), but did not impact on technical success or patient safety. Conclusions: Independent practice of ERCP after the training period is characterized by on-going changes in technique, especially with regard to cannulation and use of precut, showing significant improvements in performance over time.

Open access

Stamatis Karakonstantis, Niki Gryllou, George Papazoglou and Charalampos Lydakis

Abstract

Introduction: Eosinopenia has been previously investigated as a marker to differentiate infectious from non-infectious diagnoses and as a prognostic marker. Most previous studies were conducted in intensive care unit patients. Our study focuses on the value of eosinopenia in patients admitted to the Internal Medicine department. Methods: We retrospectively analyzed 271 consecutive patients with infection and 31 patients presenting with fever or inflammatory syndrome and a non-infectious diagnosis. We evaluated and compared the following markers for differentiating infectious from non-infectious diagnoses: eosinophil count [EC], CRP, WBC and neutrophil-to-lymphocyte count ratio [NLCR]. We also evaluated the value of eosinopenia as a monitoring parameter in patients with infections. Results: Eosinopenia at admission was found in 71% of patients with infection compared to 32% in the non-infection group. EC and NLCR were moderate markers for discriminating infection from non-infection, with an area under the receiver operating characteristic curve of 0.789 and 0.718 respectively. Significant eosinopenia (≤10/ul) had a high specificity (90%) for diagnosing infections. High EC at admission (>400/ul) was rare in the infection group (1.5%) but not uncommon in the non-infection group (25.8%). Persistent eosinopenia was noted in non-survivors, compared to the rapid normalization of EC in survivors. Conclusions: Among patients presenting with fever and/or high inflammatory markers a low EC is supportive of infection, while a high EC may suggest non-infectious diagnoses. The persistence/resolution of eosinopenia may be a useful monitoring parameter to predict response to therapy.

Open access

Pooneh Pashapour, Samad Ghaffarii and Ahmad Separham

Abstract

Introduction: One of the inflammatory factors affecting the prognosis of myocardial infarction is the high level of neutrophil count in blood. In this study, we investigated the relationship of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in peripheral blood with ST-segment resolution and clinical outcomes of patients with ST-elevation myocardial infarction (STEMI) receiving thrombolytic therapy.

Methods: This cross-sectional study was conducted on the patients referring to the emergency department in Tabriz, Iran who were diagnosed with STEMI and began receiving treatment with reteplase. The patients were asked questions to gather information about their demographic characteristics as well as their risk factors, level of response to thrombolytic therapy, etc. For all of the patients, electrocardiogram (ECG) was recorded and different blood tests were performed upon their admission to the emergency department and the obtained data were fed into SPSS Version 19 to explore the possible relationships among different variables.

Results: The findings of this study revealed that there is no significant relationship between either NLR or PLR of patients suffering from myocardial infarction and their level of response to thrombolytic therapy. Moreover, no significant relationship was observed between NLR or PLR of these patients and their ejection fraction. However, the results indicated that NLR and PLR associated with an increase in the incidence rate of major adverse cardiac events (MACE) in STEMI patients.

Conclusion: The results of this study indicated that NLR and PLR are directly associated with the rate of in-hospital major adverse effects following STEMI irrespective of the ST resolution.

Open access

Mihaela Dobranici, Anamaria Tocitu, Caterina Delcea and Gheorghe-Andrei Dan

Abstract

Left ventricular noncompaction is a rare structural cardiomyopathy that can occur isolated or in relationship with other conditions, mainly with musculoskeletal diseases or congenital heart defects. The association of left ventricular noncompaction and connective tissue disorders, including systemic lupus erythematosus, was scarcely described in the literature. Reported cases are, more likely, cardiomyopathies mimicking left ventricular noncompaction or transient left ventricular noncompaction with ventricular function improving after appropriate treatment.

We present the case of a 23-year-old woman admitted for cardiac evaluation because of ECG abnormalities observed during a routine check-up. Echocardiography showed severe systolic and diastolic dysfunction, diffuse hypokinesis and hypertrabeculation, suggestive of left ventricular noncompaction. Cardiac magnetic resonance imaging confirmed the diagnosis. She later presented with specific clinical and biological parameters and was diagnosed with systemic lupus erythematosus. Corticosteroid and hydroxychloroquine treatment induced general improvement of signs and symptoms, but no recovery of cardiac function.

Open access

Taro Horino, Osamu Ichii and Yoshio Terada

Abstract

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, self-limiting disease characterized by cervical lymphadenopathy and fever. Since KFD was first reported in 1972, the validity of this clinical entity has been controversial and its aetiology remains unknown. Herein, we report a case of a patient with KFD, which was believed to be associated with systemic lupus erythematosus.

Open access

Tarek Samy Abdelaziz and Khaled Marzouk Sadek

Abstract

Introduction: Medication Regimen complexity is an important issue of patients care that needs to be addressed. The aim of this study is the safe reduction of regimens complexities. The effect of this intervention on glycemic control was assessed in this study.

Methods: Seventy eight patients were recruited to the study. The entry criteria were non optimal glycemic, non-adherence (as demonstrated by indirect tools), and polypharmacy. The only intervention was the safe reduction of medication regimen complexity. This was done in view of the best practice guidelines; to ensure that all comorbidities are treated with the optimum number of medications for the optimum duration.

There was no change to hypoglycemic regimen. All patients, whose hypoglycemic regimen has changed after the recruitment, were excluded. The primary outcome measure was the change in HbA1c three months after the intervention.

Results: Reducing medications regimen complexities led to a significant improvement of HbA1c in the after phase compared to the before phase (mean HbA1c in the before phase was 7.7 ±0.43 % compared to 6.93 ±0.4% in the after phase. Mean reduction in the HbA1c was 0.77±0.23%, P values<0.001).

Conclusion: Medications regimen complexity constitutes a burden for patients with diabetes. Reducing such regimens might improve glycemic control in those patients. Further studies are needed to confirm this favourable effect on glycemic control.