Volume 6, Issue 4

Metabolic syndrome is a clinical term encompassing risk factors (obesity, insulin resistance, dyslipidemia and hypertension), which yield an increased risk for the development of diabetes mellitus type 2 and cardiovascular disorders in adolescence. Two sets of criteria for diagnosing metabolic syndrome were applied, the criteria for adults, specifically adapted for children, and the criteria defined by the International Diabetes Federation (IDF). A reliability analysis was conducted; sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of applying certain criteria of both definitions of metabolic syndrome. Metabolic syndrome in adolescents was diagnosed much more frequently using the specific criteria (41%) in comparison to the IDF criteria (22%). Using the specific criteria for children and adolescents, it was established that the HDL cholesterol was the most specific and had the largest PPV. Using the IDF criteria for diagnosing metabolic syndrome, the reliability analysis established that the highest PPV was recorded with the elevated level of triglycerides. The specific criteria have been found to be more efficient in diagnosing metabolic syndrome in adolescents. The highest predictive value was displayed by dyslipidemic disorders, hypertriglyceridemia and hypo HDL cholesterolemia.

We report on two cases of spontaneous pneumomediastinum and pneumopericardium, in one case associated with pneumorrhachis, occurring in two children suffering from the novel influenza H1N1 virus infection. At the admission both children presented with fever, violent dry cough, dyspnea and tachypnea. Radiological studies showed sizeable pneumomediastinum and pneumopericardium in both patients. One of the patients also a pneumorrachis. Children were initially treated by intravenous broad-spectrum antibiotics, antipyretics and a cough sedative. Oral Oseltamivir (60 mg twice daily for 5 days) was administered after the diagnosis of influenza A (H1N1) virus infection. Patients’ clinical condition quickly improved and children were discharged with a partial resolution of their radiological findings. Although these conditions are usually self-limiting and without respiratory or systemic consequences, their prompt recognition in children with H1N1 influenza virus infection is essential to establish fast and adequate therapy mainly related to the control of cough and the commencement of antiviral treatment.

Ascariasis is a helminthic infection of global distribution, and intestinal obstruction is its most common gastrointestinal complication. This is a case of a 7-year-old boy admitted to Pediatric Surgery because of intestinal obstruction caused by ascariasis. On admission, the patient presented with colicky abdominal pain, bile-stained vomiting and meteorism. On physical examination, the patient was thin, pale, and dehydrated. An abdominal examination showed distention and diffuse tenderness. After admission, the patient had fecal vomiting and expulsion of worms through the mouth. Laboratory-test results showed leucocytosis, eosinophilia, hypoalbuminaemia, and hypochloremia. Abdominal radiographs and ultrasound studies were indicative of small-bowel obstruction due to roundworms, which led to the performance of an exploratory laparotomy. On bowel exploration, an intraluminal mass, 10 by 6 cm in diameter, consisting of roundworms in the middle third of the ileum was found. A longitudinal enterotomy was performed, and the worms were meticulously extracted manually. Postoperatively, broad-spectrum antibiotics and antihelminthic drugs were administered. Our case of intestinal obstruction caused by ascariasis is the first to be reported in Serbia, according to the Serbian literature.

Gastrointestinal autonomic nerve tumors form an uncommon subcategory of stromal tumors of the intestinal tract although their histologic appearance is similar to other gastrointestinal stromal tumors. Our aim was to evaluate our experience in the diagnosis and therapy of these kinds of tumors. Two patients were admitted to the Pediatric Surgery Clinic in Niš with abdominal pain and a palpable mass in the abdomen. After excision, the tumor tissue was sampled, sent for histopathological diagnosis, and examined by light microscopy, immunohistochemistry, and electron microscopy. Postoperatively, both patients recovered without complications. The patient with the tumor bulk in the mesentery of the small bowel had no evidence of tumor progression 6 years after surgery. In the second case, a giant tumor was present along the greater curvature of gaster. Even with a tumor of this size, there were no signs of progression 10 years after surgery. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the curative approach to date, and long-term survival is possible even with large tumors.

The purpose was to determinate possible factors associated with psychosocial health through self-perceived health and psychological well-being among Serbian schoolchildren and adolescents. A cross-sectional study. The study is based on the 2006 National Health Survey of the population of Serbia. A total of 2,721 schoolchildren and adolescents were included. Face-to-face questionnaire and self-administered questionnaire were used for collection of data. For the assessment of psychosocial health we created two indicators (varibles): Self perceived health (using the categorical principal components), and Psychological well-being (using reliability analisys). Data were analyzed using descriptive statistics, Pearson’s correlation coeficient and categorical regression. Self-perceived health was found to have a positive association with gender, age, objective and subjective socioeconomic status. Psychological well-being was associated with gender, age, social support, objective and subjective socioeconomic status. Age group was strongly associated with self-perceived health and psychological well-being. Older respondents and female perceived their health to be better than others. Male and respondents in age group 7–11 had higher levels of psychological well-being. Results show that both demographic and socioeconomic variables have an important influence on schoolchildren and adolescent self-perceived health and psychological well-being.

We report a case of an apparently well-documented indapamide-induced hyponatremia. The initial diagnosis was made on the basis of dechallenge and rechallenge performed on two occasions. Further course of the disease, which proved inconsistent with our expectations, prompted us to look for another aetiology leading to the final diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) complicated by indapamide treatment.

The aim of this study was to assess the associations of the body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with ischemic heart disease (IHD) and risk factors of IHD in the Lithuanian population aged 25 to 70 years. The cross-sectional health survey was carried out in Kaunas, which is the second largest city in Lithuania, and in five regions randomly selected from the northern, southern, eastern, western and central parts of Lithuania. Data from 2048 subjects (936 men and 1112 women) were analyzed. In both sexes, the odds ratios for reduced high density lipoprotein cholesterol, elevated triglycerides, high fasting blood glucose, and hypertension rose with an increasing quartile of BMI, WC, and WHtR. The likelihood of having IHD was statistically significantly higher in the fourth quartile of these anthropometric measures when compared to the first one. Comparison of the logistic regression models revealed that the models with WHtR best fit the prediction of IHD risk. Compared with BMI and WC, WHtR showed a stronger association with IHD and its risk factors in the Lithuanian adult population.

Patent ductus arteriosus (PDA) is the most prevalent cardiovascular defect and is more often seen in females; premature babies are at increased risk. For both sexes, a relationship exists between the risk of this defect occurring and the higher dimensions of the ductus arteriosus. In this study, we examined the relationship between the dimensions of the ductus arteriosus (diameter, length, capacity) and sex. We analyzed a total of 223 fetuses, 108 males and 115 females, ranging in age from four to eight months of intrauterinal life. All fetuses of normal karyotype were obtained from spontaneous abortions. None of the analyzed specimens demonstrated any visible malformations. The increase in the length and diameters of the ductus is linearly related to gestational age. The volumetric growth of this vessel was dependent on fetal age, according to the exponential function. The large number of analyzed specimens allows reliable determination of the ductus arteriosus dimensions in consecutive months of fetal life. The data obtained could be of prognostic value during echocardiographic follow-up in the fetus. We found that the dimensions analyzed did not differ with regard to sex. It is a contradiction that, more frequently PDA in females is caused with the gender differences in the dimensions of ductus arteriosus.

Fourteen Sprague-Dawley male rats were randomly divided into 2 groups which were given CdCl2 at the doses of 0 and 1.5 mg /kg for 12 weeks. Before sacrifice, microCT scanning were performed on the proximal tibia and urine were collected for cadmium and N-acetyl-beta-D-glucosaminidase assay, then all of rats were sacrificed and blood was collected for biomarkers measurement; bone tissues were collected for bone mass, histology and biomechanical analysis. The cadmium in blood, urine, bone and kidney of rats treated with cadmium was significantly higher than those in the control group. The bone mineral density, and bone mineral ability of rats treated with cadmium were obviously decreased by 20%–50% compared to controls. Bone microstructure index and trabecular separation of rats treated with cadmium were obviously lower (−50%) and significantly higher (+150%) than that in the control group. Bone biomechanical property decreased by 30%–60% in cadmium treated rats compared to control. Tartrate-resistant acid phosphatase 5b and alkaline phosphatase levels of rats treated with cadmium were significantly higher than those in control, but serum osteocalcin level decreased greatly by cadmium. Obvious proximal tubule damage occurred after cadmium exposure. These observations gave clear and comprehensive evidence that cadmium exposure could induce itai-itai-like syndrome in male rats.

The aim was to identify and quantify the association between the use of particular medications during the first trimester of pregnancy and selected congenital abnormalities (CAs) of newborns. Data were from the Czech National Registry of CAs. We used a case-control design, and collected total of 7285 cases and 9143 controls. Thiethylperazine and iron compounds had no effect on development of CAs. Lower odds ratio and potentially protective associations were found between CAs and bioflavonoids, folic acid, progesterone, levothyroxine, and iodine therapy. Since the protective effect of bioflavonoids was not described before, analysis of interaction with other drugs was performed. However, their protective effect was not confirmed and the strongest significant protective effect was detected in combination of bioflavonoids and progesterone. Increased odds ratio were identified for hydroxyprogesterone, phenoxymethylpenicillin, aspirin, paracetamol and valproic acid. The association between paracetamol and congenital foot deformities was not significant, while the same association for the whole group of CAs and deformities of musculoskeletal system had significantly increased odds ratio. Except newly described effect of bioflavonoids, our results are in agreement with risk categories defined by health authorities in USA and Australia, and with results of other studies. According to our results, paracetamol does not influence development of congenital foot deformities.

Genetic background and T-cell expansion have been confirmed as the most important factors leading to psoriasis susceptibility in the Caucasian population. This study was performed to identify the T-cell receptor Vβ repertoire and HLA-Cw genotype in twenty Mexicans of two different ethnicities with severe chronic plaque-type psoriasis. HLA-Cw typing was performed to detect the allele pattern by SSP-PCR. In parallel, RT-PCR and Western blot were used for the identification of the TCR Vβ expression in peripheral blood cells. We identified a variety of HLA-Cw alleles in this group of patients distinct from the widely known HLA-Cw 0602 Caucasian allele. Moreover, TCR Vβ-2 and Vβ-7 clone-type frequencies were different and statistically significant (P = 0.0280). We speculate that because of diverse genetic backgrounds, the susceptibility to disease and activation of T-cells for a proper immune response could be specific; therefore, the findings might contribute to the elucidation of the pathogenesis in psoriatic Mexican patients.

Previous studies reported controversial results regarding the possible association of recurrent genital herpes during pregnancy with a higher risk of preterm birth/low birth weight in newborns. Thus, birth outcomes of mothers with prospective and medically recorded symptomatic recurrent genital herpes confirmed by serological examination and of mothers without genital herpes were compared in the population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities. Our results showed that of 38,151 newborn infants, 86 (0.23%) had mothers with symptomatic recurrent genital herpes confirmed by serological examination during pregnancy. The rate of preterm births (14.0% vs. 9.2%) was higher in babies born to mothers with symptomatic recurrent genital herpes (OR with 95% CI: 1.7, 1.0–3.1) and this increase showed a trimester dependence with the highest rate in the third trimester (23.5%; OR with 95% CI: 2.6, 1.5–4.5). In conclusion, clinically diagnosed recurrent genital herpes during the third trimester of pregnancy associated with high risk for preterm birth.

To determine the prevalence of high-risk HPV infection before first vaginal intercourse and after initiation of sexual activity in 14-22 years old girls, to find which HPV types occur most commonly. During the gynecologic exam cervical swabs were collected. Specimens were tested using Hybrid Capture 2 DNA test. In positive samples digene HPV genotyping test was performed. Subjects included 264 women, of whom 169 (64.0%) reported previous sexual activity and 95 (36.0%) had not yet had vaginal intercourse. There were 43 cases (16.3%) of high risk HPV, with 39 cases in those reporting sexual activity and 4 in virgins. Single strain HPV infection was detected in 62.8%, two strains in 23.2%, and three strains in 14.0% of subjects. HPV-16 was the most common type (20.9%), next more prevalent types were 18, 56, 31, 33 and 59. HPV-16 or HPV-18 were detected in 39.5% of the subjects. Not a single case was identified containing both types. The prevalence of high-risk HPV is common in sexually active young Lithuanian women. HPV were found in a small percentage of girls who had never had vaginal intercourse. The prevalence of types 16 and 18 among Lithuanian women was higher than in international data.

Genetic variations of the antioxidant enzymes may influence the susceptibility to oxidative stress and consequently the development and progression of diabetic complications. The aim of the current study was to test the association between the −262C/T polymorphism in the catalase gene promoter and carotid atherosclerosis in Slovenian patients with type 2 diabetes. Two-hundred and eighty six diabetics and 150 healthy controls were enrolled in the study. Carotid atherosclerosis was quantified ultrasonographiocally by carotid intima-media thickness (CITM), plaque score and plaque type. Genotypes were determined using the real-time PCR. Fibrinogen concentration showed a borderline statistically significant difference due to catalase genotypes (p=0,05). No difference in clinical characteristics, CIMT, plaque stability or plaque score was observed. Logistic regression model adjusted for age, gender, smoking, BMI, lipid parameters and duration of hypertension and diabetes showed significant association of T allele and lower risk for higher plaque score (OR=0,25; p=0,025). No association with CIMT>1mm and unstable plaques was observed. T allele of −262C/T is associated with lower risk for higher plaque score but it did not affect clinical parameters, CIMT and plaque stability. Whether this polymorphism can be used as a genetic marker for advanced carotid atherosclerosis in diabetic patients needs to be evaluated in the future.

Enterococci are uncommon etiologic agents of central nervous system infections. We describe a case of nosocomial encephalitis and concurrent cerebellitis associated with Enterococcus faecium in a man, with extranodal natural killer/T-cell lymphoma, nasal type, who underwent high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Brain magnetic resonance images showed lesions in the bihemispheral cerebellar cortex with swelling and several small lesions in both cerebral hemispheres. The blood and cerebrospinal fluid cultures were positive for vancomycin-resistant E. faecium. Vancomycin-resistant E. faecium can cause encephalitis and concurrent cerebellitis in an immunocompromised patient who underwent autologous peripheral blood stem cell transplantation.

Metastatic tumors of the pituitary are uncommon and usually asymptomatic. They are often incidental findings from imaging workups for other medical issues or from the assessment of primary tumors in other locations. Diabetes insipidus is the most common symptom resulting from pituitary tumors, including pituitary metastases. A 56-year-old woman with primary lung adenocarcinoma underwent video-assisted thoracic bilobectomy. Regular follow-up was unremarkable until 15 months after surgery, when she presented with polyuria and polydipsia suggestive of diabetes insipidus. A pituitary mass was found on brain magnetic resonance imaging; the diagnosis of lung adenocarcinoma metastasized to the pituitary was confirmed by trans-sphenoidal surgery and biopsy of the pituitary mass. Diabetes insipidus and hormonal profiles are the key to recognize the existence of pituitary metastases, and patients with primary lung cancers presenting with diabetes insipidus should be evaluated for pituitary metastases.

Subcutaneous sarcoidosis (SS) is an unusual and specific subtype of nodular sarcoidosis 1. The presence of SS with no elements of systemic manifestations is a rare condition: it is reported only in 1.4% to 6% of patients with systemic sarcoidosis, with the trunk being the most predilected area. Such cases with rare presentation are challenging for physicians because it can mimic several chronic infections, amyloidosis, hypothyroidism, lysosomal storage diseases and other conditions. Typical imaging (specially bilateral hilar adenopathies), histological exam and laboratory findings are the baseline to establish the diagnosis of sarcoidosis. In our case, the presence of subcutaneous manifestations avoided the performance of invasive procedures to get confirmation from other target organs: The epithelioid cells granulommas in subcutaneous fat and the representative radiological images were enough features to make the certain diagnosis. The first-line therapy for SS is oral steroids (20–40 mgr/day) with responses observed only 4–8 weeks after initiation of the treatment2. Prognosis of SS is good with spontaneous remission in some cases; however, when granulommas or fibrosis involves vital organs sarcoidosis can be life-threatening. Physicians should consider diagnosis of SS in patients with clinical suspicious history as sometimes skin manifestations are the first sign of systemic presentation of disease

Hip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

Apelin (AP) and leptin (LEP) are adipokines with vasomotor actions. Taking into account the published data on the role of obesity in the development of pulmonary hypertension, we studied the implications of apelin on leptin relaxing effects on isolated rat pulmonary arteries. LEP had vasodilatatory effects on phenylephrine-precontracted rat pulmonary arteries from normal and ovalbumin-sensitized rats, but not on rats with monocrotaline-induced pulmonary hypertension. AP13 pretreatment increased LEP effects by one-half. Our studies revealed the existence of synergistic favorable effects of these adipokines on pulmonary vessels.

We aim to define the prevalence of nephrolithiasis, the impact of anatomic and metabolic factors to stone formation and prognosis of patients with autosomal dominant polycystic kidney disease in Albania. We included 200 patients with autosomal dominant polycystic kidney from 2002 to 2009. The patients underwent X-ray, renal ultrasonography. We performed the metabolic evaluation of blood and urine. Survival times were calculated as the time to dialysis, transplantation, or death. Kaplan-Meier product-limit survival curves were constructed. Log rank test was used to compare the survival curves. Nephrolithiasis was present in 116 of our patients with autosomal dominant polycystic kidney disease (58%), with a mean age 46.4±5.7 years. Sixty five patients with kidney stones (56%) were women. The stones were composed primarily of urate (47%) and calcium oxalate (39%), and other compounds 14%. In 40% of patients the presence of stones was associated with a history of urinary tract infections and flank pain. In our study the prevalence of nephrolithiasis is 58%, higher than it reported in literature. Except anatomic and metabolic factors, there are other contributor factors to stone formation in our patients such socioeconomic status of patients, geographic zones and dietary habits.

Some decades ago being a medical doctor was characterized unambiguously as a profession that offers help and serves the patients’ needs during medical treatment. In today’s society, this image of the medical profession has been substantially changed. The present paper aims to examine medical career choice motivations and preferences of choosing speciality, in the light of current social and economic changes in Hungary. The study was carried out by using a voluntary, self-administrated, questionnaire among first-year medical students and resident doctors in four medical faculties in Hungary. The career choice motivations of the first-year medical students and resident doctors are similar and match to the traditional health profession career choice motivations. Nevertheless the first-year students consider high income as one of the most important factors. They appear more conscious and more ambitious regarding their future speciality choice. The Hungarian health care system and medical education must be prepared for the presence of students that are aware of the high market value of a medical diploma, have excellent language skills, and consider migration as one main factor in their motivation when choosing a medical profession.