Volume 9, Issue 1

We used mathematical modeling in order to determine the pharmacodynamic relationship between antihypertensive drugs atenolol and valsartan, by evaluating their effects on heart rate (HR), systolic blood pressure (SP) and diastolic blood pressure (DP). A group of twelve healthy male volunteers received a single oral dose of 100 mg of atenolol and 160 mg of valsartan, both separately and in combination. Pharmacokinetic (PK), pharmacokinetic/pharmacodynamic (PK/PD) and pharmacodynamic (PD) systems were proposed and PD model of atenolol and valsartan concentration-time profiles and PK/PD model of blood pressure and heart rate effects after administration of single doses of atenolol and valsartan and their combination were constructed. Parameters of PD system, such as gain and mean effect time, were obtained by analysis of PK and PK/PD systems. Modeling of PK and PK/PD systems and their analysis to obtain the PD results could considerably change the view o treatment of individual diseases in terms of greater knowledge of pharmacokinetics and pharmacodynamics of drugs.

Dilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.

Cardiovascular disease (CVD) remains the leading cause of mortality in developed countries. According to the 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, family history is a cornerstone for risk stratification of CVD. First-degree relatives are persons in whom CVD should be assessed and targeted intervention should be performed. The aims of this pilot study were (i) to determine risk factors (RFs) for cardiovascular disease (CVD) in a group of first-degree relatives of patients with CVD at baseline and after 1 year, (ii) to measure adipocyte fatty acid-binding protein (A-FABP) levels as a potential connecting link between metabolic disease and atherosclerosis, and (iii) to determine the impact of targeted intervention on these parameters. The study comprised 62 asymptomatic subjects (41 males; mean age of 53.8±8.3 years). Preventive examinations and interventions were carried out at baseline and at 1-year follow-up to assess RFs and evaluate A-FABP levels. At 1 year, males had significantly lower levels of cholesterol (median 5.18 vs 4.67, p=0.005), HDL (median 1.24 vs 1.14, p=0.021), LDL (median 3.08 vs 2.46, p=0.021), ApoB (median 0.99 vs 0.82, p=0.012) and A-FABP (median 19.84 vs 16.73, p = 0.015). In females after 1 year, only significantly lower levels of fibrinogen (median 3.10 vs 2.79, p=0.043) were found. All subjects were clinically examined or contacted by phone after a mean of 36.7 months (range, 11–55). Over that time, no serious complications were noted. In males, intervention for RFs leads to lower levels of A-FABP as a potential RF linking metabolic syndrome to atherosclerosis.

Right Ventricular (RV) rupture is a rare and dangerous complication of acute myocardial infarction. There are limited reports on RV free wall rupture. In this paper we describe the outcome of an autopsy case of cardiac death by rupture of the free wall of the right ventricle in a 51-year-old man with coronary artery disease and hypertrophic-sclerotic cardiomyopathy.

We have described a rare case of Takotsubo cardiomyopathy in pregnancy, which is presented with cardiac arrest (ventricular fibrillation) at onset. In this case, the transient left ventricular ballooning in absence of coronary artery disease, produced a severe impairment of cardiac function with typical echocardiographic and electrocardiographic findings. There were complications in the form of ventricular fibrillation, with recurrence due to possible Takotsubo cardiomyopathy and new malignant heart rhythm disorder that increases the mortality rate compared with the first attack of Takotsubo cardiomyopathy. Due to presented symptoms the patient has opted for the implantation of cardioverter defibrillator.

The restoring of motor functions in adults through brain-computer interface applications is widely studied in the contemporary literature. But there is a lack of similar analyses and research on the application of brain-computer interfaces in the neurorehabilitation of children. There is a need for expanded knowledge in the aforementioned area. This article aims at investigating the extent to which the available opportunities in the area of neurorehabilitation and neurological physiotherapy of children with severe neurological deficits using brain-computer interfaces are being applied, including our own concepts, research and observations.

Inclusion body myositis is a slowly progressive myopathy affecting predominantly the middle-aged and older patient population. It is a major form of the idiopathic inflammatory myopathies which are chronic systemic autoimmune diseases characterized by symmetrical proximal muscle weakness. Unfortunately, there is no effective therapy yet; however, the early diagnosis is essential to provide treatment options which may significantly slow the progression of the disease. In our case-based clinicopathological study the importance of the close collaboration between the clinician and the neuropathologist is emphasised.

One of the territories of dental psychosomatics is the link between personality characterisctics and dental status. The aim of the present study was to survey the relationship between temperament and character factors and dental status in police students. It can be hypothesized, that some temperament factors can increase the risk for dental health problems. After dental screening 792 police students completed the Temperament and Character Inventory (TCI) devised by Cloninger. 57.5% of students rated their own teeth as being in good or very good condition, and only 2.8% as bad condition. In persons rating their dental status as “good”, the average DMFT was 9.23±5.01 (mean±S.D.). In students assessing their own oral health as bad, TCI results showed that a higher percentage of students displayed extravagance, impulsiveness, disorderliness than the overall population. Among the students with good self-assessment but bad teeth, there was a higher percentage of students displaying passivity, low assertiveness, and introversion. The temperament and character factors may have negative consequences for students in an institution which exposes them to high stress level. It may be useful to screen these students using subjective health questionnaires in order to permit more effective efforts to positive health behaviour.

Pancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

Cholesterol gallstone disease is often associated with the metabolic syndrome. Female gender is an unmodifiable risk factor for cholelithiasis and, in its turn, the metabolic syndrome features a sexual dimorphism which warns that a global approach might overlook important discrimination. We carried out a retrospective analytical case-control study in order to perform a comparative analysis between two groups of female patients with metabolic syndrome and gallstones (n=60) or without gallstones (n=65). All the patients were investigated by abdominal ultrasound and met at least three criteria for the diagnosis of metabolic syndrome. Cases and controls were compared regarding anthropometric measurements, a complex lipid profile, and liver function tests. The risks associated with the likelihood of gallstones were estimated by means of cross-tabulation. In order to rank the significant variables we developed a binary logistic regression model which identified lean body weight ≤ 46.44 kg (OR 0.165; 95% CI 0.045–0.611; P = 0.007), total cholesterol ≥ 4.9 mmol/L (OR 15.948; 95% CI 2.700–94.205; P = 0.002), and direct bilirubin > 5.1 µmol/L (OR 0.056; 95% CI 0.013–0.235; P < 0.001), as variables with significant probability of association with the risk of gallstones in women with metabolic syndrome.

The diagnostic and prognostic utility of extremely elevated ferritin values in hospitalized medical patients is lacking. We aimed to determine the clinical significance of ferritin levels ≥ 1000 ng/mL in adults hospitalized in the general medical service. We scanned the hospital laboratory database for ferritin values ≥ 1000 ng/mL, and evaluated the medical history, diagnoses, and survival of patients hospitalized in the general medical service. We compared the characteristics and outcomes of patients with values up-to versus above 2,999 ng/mL. Ferritin samples ranging from 1,003 to 12,170 ng/mL from 422 patients in the lower and 94 in the higher ferritin groups were included. Malignancy, repeat blood transfusions and recent chemotherapy were more prevalent in the higher ferritin group (p=0.003, p=0.002, and p<0.001, respectively). Infection (58.7%), chronic kidney disease (22.0%), and solid or hematological malignancies (21.6% and 17.1%, respectively) were the leading conditions associated with elevated ferritin. One-year survival was low, and significantly lower in patients in the higher ferritin group (10.8% vs. 16.9%, p=0.004). In conclusion, extremely elevated ferritin values in patients admitted to the general medical service are associated with multiplicity of clinical conditions and poor outcome.

The aim of this study was to determine the relative contributions of fat mass and lean mass to the variability of bone mineral density (BMD) of the lumbar spine and proximal 1/3 forearm in Bulgarian women. 180 women aged 21 through 76 years participated (mean age 50.8 ± 9.7 years). 130 of them were postmenopausal. Lumbar spine and forearm BMD were measured by dual-energy X-ray absorptiometry, followed by a whole-body scan for body composition examination (Hologic QDR 4500 A device, software version 1.26). The strongest linear correlation was found with body weight (r2=0.231, p<0.001). Using this model, 18.1 % of the variability of lumbar spine BMD was attributable to fat mass and 16.0 % to lean mass. The relative influence of fat mass on L1-L4 BMD was greater than that of lean mass (standardized regression coefficient 0.291 versus 0.199). There were weak correlations of body weight, fat and lean mass with the forearm BMD. Lean mass correlated slightly better (r=0.187, p=0.050) to forearm BMD than fat mass (r=0.162, p=0.055). In conclusion, the differentiation between fat and lean mass does not strengthen the BMD correlations beyond that with total body weight.

Chronic fatigue syndrome (CFS) is characterized by unexplained fatigue lasting for more than 6 months and accompanied by flulike symptoms. It most commonly affects women aged between 30 and 60 years. To date, clear diagnostic criteria allowing for unambiguous diagno-sis of CFS have not been established. We present a case of a 57-year-old woman with chronic fatigue syndrome in order to showcase the symptoms of this condition and propose a diagnos-tic protocol.

We report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.

A 53-year-old immigrant male patient presented with left scrotal swelling with a draining ulcer on the left hemiscrotum. Patient had intentional weight loss, fever and night sweats, cough, headaches, confusion and difficulty with ambulation. Imaging studies revealed innumerable pulmonary nodules, leptomeningeal enhancement of the brain and bilateral epididymo-orchitis. Acid fast bacilli (AFB) smear was positive from the surgical specimen of bilateral epididymis and left testes. Cerebrospinal fluid (CSF) analysis revealed neutrophilic predominant pleocytosis with low glucose and elevated protein. Polymerase chain reaction (PCR) test performed on the CSF and AFB smear of epididymis was positive for Mycobacterium tuberculosis. Though the CSF and sputum AFB smears were negative, cultures subsequently grew mycobacterium tuberculosis. Patient was diagnosed with disseminated tuberculosis. Human deficiency virus test was negative. Patient was successfully treated with anti-tuberculosis therapy. Steroid was used as adjuvant therapy due to presence of tuberculous meningitis.

Severe thermal injury may be complicated by dysfunction of organs distant from the original burn wound, including the liver, and represents a serious clinical problem. Although pathophysiology of burn-induced liver injury remains unclear, increasing evidence implicate activation of inflammatory response, oxidative stress, endothelial dysfunction and microcirculatory disorders as the main mechanisms of hepatic injury. Several studies suggest melatonin as a multifunctional indolamine that counteracts some of the pathophysiologic steps and displays significant beneficial effects against burn-induced cellular injury. This review summarizes the role of melatonin in restricting the burn-induced hepatic injury and focuses on its effects on oxidative stress, inflammatory response, endothelial dysfunction and microcirculatory disorders as well as on signaling pathways such as regulation of nuclear erythroid 2-related factor 2 (Nrf2) and nuclear factor-kappaB (NF-kB). Further studies are necessary to elucidate the modulating effect of melatonin on the transcription factor responsible for the regulation of the pro-inflammatory and antioxidant genes involved in burn injuries.

This article evaluates the authors’ own concept of integrated IT environments for people with disabilities. Increasing numbers of disabled people and elderly people are affected by shortages of medical specialists and limited funding for medical care. Integrated IT environments for people with disabilities — through integration of various technical and medical solutions into one flexible system — are one way to provide increased independence and improved quality of life for disabled, elderly and severely ill people. The aim of this paper is to assess the extent to which the available possibilities in this area are being utilized, including the authors’ own concept. The implications of technological developments are discussed to lay the groundwork for further research.

Every five years or so a case of adult small bowel intussusception secondary to pathologies such as inflammatory fibroid polyp (IFP) appears in English literature. Likewise rare cases of adult colonic intussusception due to a tumour have been reported including, more recently, their successful management by laparoscopic approach. We describe two such cases, one each of small bowel and large bowel intussusception, due to IFP and caecal tumour respectively and discuss their management. We also suggest role of combined laparoscopy/endoscopy in selected cases of colonic resections.