Band 7, Heft 3

B cell activation factor (BAFF) is a recently discovered member of the TNF ligand superfamily secreted by adipocytes, previously linked to autoimmune and lymphoproliferative disease. The aim of this study was to investigate the relationship between BAFF plasma levels and the non-modified, usual dietary composition as well as obesity-related anthropometric parameters in a cohort of 58 obese and non-obese Central-European Caucasian individuals. We found that BAFF had an independent predictive role for percentage of body fat; moreover, BAFF levels were correlated with waist and hip circumference. BAFF plasma levels were also significantly correlated with investigated dietary composition based on the 7-day food records, as the BAFF levels correlated with the percentage of energy derived from the carbohydrates and with energy derived from the dietary fat. Our results suggest that BAFF may play a role in linking the immune status and metabolic response to diet.

We retrospectively evaluated the rate of renal dysfunction during treatment with liposomal amphotericin B (L-AmB) (3–4 mg/kg, for 7–10 days) in nine consecutive patients with visceral leishmaniasis (VL). During the first week of treatment, 5 patients (56%) experienced transient deterioration of renal function, with a rise in serum creatinine to 1.27–2.44 times the baseline level, and a parallel elevation of uric acid levels without other metabolic or electrolyte disturbances. Serum renal function parameters were restored to normal levels after the completion of therapy, on day 21. These 5 patients had presented with prolonged fever and/or significant spleen enlargement, reflecting high parasite load. This observation suggests that treatment of VL with intermittent L-AmB causes a subclinical tumor lysis-like syndrome, especially in patients with high parasite load.

Posturography is a general term for techniques used to measure postural stability on static or dynamic measuring platforms. The principle of static computerised posturography (SCPG) is the detection of the centre of foot pressure (CFP) in upright stance on a posturography platform. Our communication deals with the importance of SCPG in differential topodiagnosis of vestibular syndromes in neurology. The set of examinations and evaluations carried out was divided among a control group of healthy subjects (77), a group of subjects with peripheral vestibular disorder (159), and a group of subjects with a non-peripheral balance disorder (82). Results obtained through the measurements were evaluated using descriptive statistics procedures and basic numerical and graphic statistical characteristics of the given groups. Our observations demonstrate that posturography is a valuable auxiliary test for balance disorders, especially given the lack of more suitable tests. According to our results, SCPG can be used for a rough differential topodiagnosis of balance disorders in neurology.

Dogs can play an important role in their owners’ lives. As well as providing a source of comfort, emotional support, and entertainment, there is now evidence suggesting that dogs may promote their owners’ health. The mechanisms of these beneficial effects, however, are unclear. The important role of dogs in their owners’ medical emergencies is illustrated by two cases of patients admitted to our intensive care unit, in whom untrained domestic dogs saved lives by alerting the family. Companion dogs may react to emergencies of their owners and save lives. Clarifying how dogs perceive medical emergencies might stimulate design of emergency alarm systems.

International students all over the world meet a lot of stressful situations due to different academic demands, cultural context, language problems and other adaptation difficulties. There is little evidence to explain what stress coping strategies are used by international students to cope with stressful situations and how they are connected to psychological adaptation. So the purpose of this study was to assess associations between psychological adaptation and stress coping strategies in international and domestic students. The study recruited 356 students: 258 host and 98 international students. Stress coping strategies were measured by Coping Orientation of Problem Experience questionnaire. Zung Self-Rating Depression Scale was used to measure depressive symptoms. Stress related health complaints were measured using a scale devised by the authors of this study. The study ascertained that in stressful situations international students used different stress coping strategies when compared to domestic students. Moreover, stress coping strategies used by international and domestic students were differently connected to health outcomes. The study pointed out that by researchers and counselors’ special attention should be given to international students.

Pusher syndrome is classically described as disorder of body orientation in the coronal plane. It is characterized by a tilt towards the contralesional paretic side and a resistance to external attempts to rectify. It occurs mainly in stroke patients, however, non-stroke causes have been described too. In 2010 the concept of the posterior pusher syndrome had been proposed, defined as disturbance of body orientation in the sagittal plane with imbalance, posterior tilt and an active resistance to forward pulling or pushing. The author describes, on the basis of the literature and own research, symptoms and methods of the treatment of the little-known posterior pusher syndrome.

A 28 year-old caucasian lady, with nine years of uncontrolled bronchial asthma, rhinosinusitis and mild upper limb paresthesia, came to our attention to be followed for coeliac disease (CD). She had a biopsy performed elsewhere which proved the diagnosis five years before. Since there was no clinical improvement on a strict gluten-free diet, we re-evaluated the slides of her duodenal biopsies and we found an overestimation of the duodenal lesions due to the wrong orientation of the specimens. Moreover, she had never had positive CD-related antibodies and she was negative for DQ2/DQ8 MHC Class II heterodimers. Months later, she referred she was suffering from diffuse joint pain, epistaxis and a substantial weight loss. A few days later she was hospitalized because of a sudden onset of dyspnea, peripheral edema and pleural effusion. Her echocardiogram showed global left ventricular hypokenesia with an ejection fraction of 24%. The patient was discharged with a diagnosis of dilated cardiomyopathy and NYHA Class II. After a large spectrum of haematological exams, the diagnosis of Churg Strauss Syndrome (CSS), a rare multisystemic small-vessel necrotizing vasculitis, was confirmed by the presence of four/five out of six diagnostic American College of Rheumatology classification criteria (Asthma, Eosinophilia >10%, Neuropathy, Non-fixed pulmonary infiltrates, Paranasal sinus abnormality and Biopsy containing a blood vessel with extravascular eosinophils). Our patient had been under-diagnosed by pulmonologist and by gastroenterologists although she presented the criteria required for CSS diagnosis. Our case report emphasizes that often seemingly unrelated symptoms can be caused by a single rare clinical complex.

Sinusitis is a frequent complication of respiratory tract infections. Probiotics are perceived to be useful in infections, allergies, and inflammations. Our prospective trial stratified 204 children with recurrent rhinosinusitis by age (2–11 years, 54m:64f; 12–18 years, 39m:47f) and assigned them to standard treatment (antibiotics, anticongestants) or additional 60 days Symbioflor-1 (SF1; Enterococcus faecalis 1.5–4.5x107 CFU). The number of sinusitis episodes was lower in SF1-treated patients (2.52±0.91) than among controls (3.27±1.36; p=0.01). Mean duration of the first sinusitis episode was 11.9±8.6 days with SF1, whereas it was 16.1±12.9 days in the younger controls (p=0.023) and 9.86±5.05 days in the elder controls (n.s.). Duration of subsequent sinusitis episodes was also shorter in SF1 patients (15.2±13.6 days) compared with controls (22.7±14.8 days; p=0.030). No adverse events were observed. Probiotic Enterococcus faecalis adjuvant to conventional therapy can reduce the number and duration of rhinosinusitis episodes in children and adolescents.

Distal trisomy 10q is a well delineated but a rare syndrome with characteristic phenotypic features. We present clinical and cytogenetic data on a 7 day-old girl with distal 10q trisomy (10q24→qter), due to maternal t(10;22) reciprocal translocation. Her karyotype showed an unbalanced translocation between chromosomes 10 and 22, resulting in trisomy of the distal part of the long arm of chromosome 10q24.

Regular food consumption plays a critical role in normal glucose homeostasis. Today, a few studies have evaluated the level of fasting glucose in individuals who skip breakfast, which should theoretically lead to a lack of supplementary energy and thereby increase the risk for subsequent hypoglycemia. The prevalence of suspected habitual skipping breakfast (SHSB) (at least three times weekly) was evaluated with a simple question, along with measurement of fasting plasma glucose level and assessment of cardiovascular and lifestyle risk factors in a cross-sectional study of 2,331 asymptomatic adults who had never been treated with insulin or oral anti-diabetic drugs. The overall prevalence of SHSB was 16.3% (20.1% for men and 9.4% for women, P<0.0001, χ2-test). Compared with a normal fasting glucose level, an impaired fasting glucose (IFG) level (100–125 mg/dl), but not high fasting glucose (≥126 mg/dl), was significantly associated with SHSB, and this association remained after adjustment for relevant confounders [odds ratio (95% CI): 1.75 (1.33–2.30) and 2.10 (0.93–4.71), respectively]. Age (inversely), current smoker, late dinner just before sleeping, infrequent exercise, and high C-reactive protein (≥1.8 mg/L) were independently associated with SHSB. In a subgroup of subjects who underwent a 75g-oral glucose tolerance test (n = 1,315), isolated IFG (n = 272) was solely significantly associated with SHSB. Our results suggest that IFG, subtle inflammatory state, and high-risk lifestyle factors for diabetes and cardiovascular disease may have an association in asymptomatic adults who habitually skip breakfast.

The topic of large mucoid plug of tracheobronchus simulating a tumor lacks scientific research and publication. We report such a case presenting as a pseudo-tumor in an elderly population. The plug was easily removed with a flexible bronchoscope. Microscopically, neither malignant cells nor microbial agents were present in the mucoid plug, confirming the diagnosis of a mucoid pseudotumor. If a collection of mucus, indistinguishable from a true tumor, is detected in the tracheobronchial tree particularly on CT scan, we should consider performing bronchoscopy, as such tracheobronchial mucoid pseudotumor may be distinguished from true tumors by this procedure.

Patients with EuroSCORE <2 are usually considered to have a low surgical risk and the lowest mortality. In our study preoperative factors in a group of 250 consecutive low-risk patients (EuroSCORE<2), who underwent first isolated coronary artery by-pass surgery during 1999 and 2000., were analyzed. Cumulative follow-up period was 1178.48 patient-years and the primary clinical outcome was all-cause mortality. Patients’ average age was 59.2±7.5 yr. The following preoperative risk factors of increased 5-year mortality were identified: older age (P<0.001), smoking, prior non-recent myocardial infarction and reinfarction, anteroseptal localization of myocardial infarction (P<0.001), poor ejection fraction<=35% (P<0.001), dilatative cardiomyopathy (P<0.001), wall motion systolic index 〉2 (P<0.001), left atrial dilatation (P<0.001), mitral regurgitation more than 2+ (P<0.001), presence of left main disease, triple vessel coronary artery disease (P<0.001), absence of collaterals (P<0.001) and presence of more than 3 distal anastomoses. Through the present study it has been shown that it is possible to identify a subgroup of patients with low operative mortality and excellent 5-year survival after surgical treatment for coronary artery bypass surgery using preoperative clinical, echocardiographic, coronarographic and intraoperative data, even in difficult conditions of the civil war in the region.