Showing papers in "Folia Medica in 2014"

Surgical Site Infection In Orthopaedic Surgery: Correlation Between Age, Diabetes, Smoke And Surgical Risk.

Abstract: Introduction Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is essential so that strategies to prevent these potentially devastating infections can be developed. We have conducted this study to determine the possible risk factors for the surgical site infections. Objectives We aimed at finding exhaustive evidence concerning the potential risk factors for infections in orthopaedic surgery. Patients and methods Between October 2009 and December 2011, we identified 84 patients with a superficial and/or deep surgical site infection and compared them with 203 uninfected patients (control group), taken out from a series of 486 patients. We considered the following risk factors: diabetes, BMI >30, ASA Score of 3 or 4, smoking and age. Results The most frequently performed operations of the 287 examined patients were the knee and hip arthroplasties (n = 32, 11.14%) and open fracture reductions (n = 178, 62.02%). Staphylococcus Aureus was the most common identified pathogen (n = 63, 75%). The analyses (preoperative and postoperative) of the infected patients showed them to have significantly high serum glucose levels in comparison with the control group (odds ratio = 8.7). We found a significant high rate of infection in patients smoking for more than 20 years (67 patients, 79.7%). The remaining variables (BMI, OR = 2.21; ASA score, OR = 1.3) showed no significant differences between the study group and controls. We also found a correlation between > 65-year-old patients and infections at the surgical site (61 patients, 72.6%). Conclusion We found that there was correlation between diabetes, smoking and age as risk factors with the development of infection at the surgical site; other variables such as the ASA score and BMI are not relevant here (contrary to what is reported in literature). We believe that postoperative results can be improved considerably with a properly conducted antibiotic treatment, stringent glycemic control (achievable only with careful multidisciplinary management) and good compliance of patients.

Noise exposure during pregnancy, birth outcomes and fetal development: meta-analyses using quality effects model.

Abstract: BACKGROUND: Many women are exposed daily to high levels of occupational and residential noise, so the effect of noise exposure on pregnancy should be considered because noise affects both the fetus and the mother herself. However, there is a controversy in the literature regarding the adverse effects of occupational and residential noise on pregnant women and their fetuses. AIM: The aim of this study was to conduct systematic review of previously analyzed studies, to add additional information omitted in previous reviews and to perform meta-analyses on the effects of noise exposure on pregnancy, birth outcomes and fetal development. MATERIAL AND METHODS: Previous reviews and meta-analyses on the topic were consulted. Additionally, a systematic search in MEDLINE, EMBASE and Internet was carried out. Twenty nine studies were included in the meta-analyses. Quality effects meta-analytical model was applied. RESULTS: Women exposed to high noise levels (in most of the studies ≥ 80 dB) during pregnancy are at a signifi cantly higher risk for having small-for-gestational-age newborn (RR = 1.19, 95% CI: 1.03, 1.38), gestational hypertension (RR = 1.27, 95% CI: 1.03, 1.58) and infant with congenital malformations (RR = 1.47, 95% CI: 1.21, 1.79). The effect was not signifi cant for preeclampsia, perinatal death, spontaneous abortion and preterm birth. CONCLUSION: The results are consistent with previous fi ndings regarding a higher risk for small-for-gestational-age. They also highlight the signifi cance of residential and occupational noise exposure for developing gestational hypertension and especially congenital malformations.

Subgingival microbial profile and production of proinflammatory cytokines in chronic periodontitis.

Abstract: This review examines literature data concerning the bacterial findings in chronic periodontitis depending on pocket depth, and presents the latest published information on the presence of proinflammatory factors in periodontal environment. It has been found that chronic periodontitis affects as much as 80% of the middle-aged population; by comparison, the prevalence of aggressive periodontitis reaches up to 1-1.5%. It is accepted that this social disease is multifactorial in etiology, but the evidence in the literature suggests that the levels of specific Gram-negative organisms in subgingival plaque biofilm play a major role in the initiation and progression of the disease. Of the many bacterial species inhabiting the periodontal environment, three types--Porphyromonas gingivalis (PG), Treponema denticola (TD), Tannerella forsythia (TF)--are strongly associated with the initiation and progression of periodontitis. Microbiological studies suggest that Porphyromonas gingivalis should be considered a major etiologic agent. Currently, Porphyromonas gingivalis is strongly associated with the pathogenesis of chronic periodontitis. On the other hand, the presence of Aggregatibacter actinomycetemeomitans in patients with chronic periodontitis may be related to the severity of the disease and thus modify the therapeutic plan. The increased amount of periodontal pathogens in the subgingival area can activate a cascade of defense mechanisms of the body associated with the production of factors causing inflammation and destruction, which suggests a correlation between the bacterial findings and the body response implemented by enhancing the local cytokine expression. Studies in the literature show that the presence of certain micro-organisms in the periodontal environment is associated to increased levels of proinflammatory cytokines in the gingival fluid and gingival tissue. These levels have been associated with destructive tissues response. There is little evidence in the literature on the correlation of the levels of periodontal pathogens of sites with different pocket depth with periodontal disease activity defined by the degree of the proinflammatory cytokine expression such as tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6).

Oocyte and embryo vitrification in the IVF laboratory: a comprehensive review.

Abstract: Vitrification is an excellent tool in the IVF laboratory, enabling options and offering flexibility in assisted reproduction. The technology of cryopreservation has been underway since the early 20th century. The advent of vitrification has advanced the expectations in routine clinical practice in the IVF laboratory presenting impressive results both in post-thaw survival, and in clinical pregnancy rates, as well as significantly enhancing clinical results on preimplantation genetic diagnosis (PGD). Contradicting opinions have been published recently on the limitations and potential that vitrification has in the laboratory, as well as on the optimal approach to employ vitrification in IVF. This review aims to present a comprehensive analysis of the practical aspects of vitrification including concerns and options regarding its use on oocytes and embryos while comparing it with the traditional "slow-freezing" cryopreservation technique.

Efficiency of nonsurgical periodontal therapy in moderate chronic periodontitis.

Abstract: Introduction Chronic periodontitis is defined as an inflammatory disease of the supporting tissues of teeth caused by microorganisms in the dental biofilm, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation and gingival recession. Treatment of chronic periodontitis aims at arresting the inflammation and stopping the loss of attachment by removal and control of the supra- and subgingival biofilm and establishing a local environment and microflora compatible with periodontal health. The AIM of this study was to evaluate the effectiveness of non-surgical therapy (scaling and root planning) in the treatment of moderate chronic periodontitis. Materials and methods The study included 30 patients aged between 33 and 75 years, of which 46.7% women and 53.3% men, diagnosed with moderate and, at some sites, severe periodontitis. They were treated with non-surgical periodontal therapy methods (scaling and root planning and curettage if indicated). Additionally, chemical plaque control with rinse water containing chlorhexidine was applied. The diagnostic and reassessment procedures included measuring the periodontal indices of 601 periodontal units before and after the therapy. The indices measured were the papillary bleeding index (PBI), the hygiene index (HI), the probing pocket depth (PPD) and the clinical attachment level (CAL). Results Significant reduction of plaque and gingival inflammation was found in all treated patients; we also found a statistically significant reduction of periodontal pockets with clinically measured depth 5 mm did not show statistically significant lower incidence rates probably due to the initially small percentage of deep pockets in the patients studied. There was a statistically significant reduction of all sites with attachment loss, the highest significance found at sites where the attachment loss was greater than 5 mm. Conclusion The results of the study suggest that nonsurgical periodontal therapy is effective in managing the moderate chronic periodontitis. Given a good patient compliance, the antimicrobial periodontal therapy can be quite efficient in arresting the inflammatory process and reducing the depth of periodontal pockets; it can also achieve a stable attachment loss level and obviate the need to use a surgical periodontal treatment modality.

Adaptive maternal immune deviations as a ground for autism spectrum disorders development in children

Abstract: Autism is a vexed problem today. Overall, there is a high frequency of birth children (1:80 - 1:150) with late diagnosed autism spectrum disorders (ASD) and this trend is getting progressively stronger. The causes for the currently increased frequency of ASD and the pathogenesis of ASD are not fully understood yet. One of the most likely mechanisms inducing ASD may be a maternal immune imprinting. This phenomenon is based on transplacental translocation of maternal antibodies of IgG class and, as a consequence, on the epigenetic "tuning" of immune system of the fetus and child. This mechanism provides development of child's anti-infection resistance before meeting with microorganisms, but it can be also a cause of inborn pathology including the ASD appearance. The quantitative changes in maternal blood serum autoantibodies depend on a specific microbial population, or are induced by environmental chemical pollutants in association with some individual features of the maternal metabolism. These immune changes are adaptive in most cases for the maternal organism, but can be pathogenic for the fetus in some cases. We discuss in the present paper the possibilities to predict the risk from abnormal development of nervous system in fetus and early diagnosis of ASD in high-risk group of children.

Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis.

Abstract: UNLABELLED The AIM of this study was to analyse the results of the surgery and compare the outcomes of unicondylar knee arthroplasty and high tibial osteotomy performed in isolated gonarthrosis. PATIENTS AND METHODS Between 2007 and 2011, 65 patients were implanted a partial knee endo-prosthesis in the Clinic of Orthopedics and Traumatology. Men were 23 (35.4%) and women were 42 (64.6%). High tibial osteotomy was performed to manage the unicompartmental gonarthrosis in 92 patients (47 men and 45 women) for 13 years between 1975 and 1987. These two modalities were used only in cases in which one of the knee joint compartments was affected. Clinical, para-clinical, functional tests and radiographic examination were conducted of the affected knee joint. RESULTS The results of the study were assessed by the rating system proposed by the Knee Society and modified by John Insall. At four-year follow-up study the outcomes of the partial prosthesis were assessed as excellent in 85.13%, good--in 13.11% and satisfactory in 1.77% of patients. After high tibial osteotomy the results were considered very good in 54.18% of patients, good--in 32.29%, satisfactory--in 6.25%, and poor--in 7.8%. CONCLUSIONS Partial knee arthroplasty is a resurfacing procedure, while high tibial osteotomy is used only to slow the overall degenerative process with gradual progressive exacerbation of osteoarthritis with age. The results after prosthetic treatment had a better dynamics than that in high tibial osteotomy.

Brain-Derived Neurotrophic Factor and Its Serum Levels in Schizophrenic Patients

Abstract: Introduction Neurotrophins have an important role in regulating the development and maintenance of the peripheral and central nervous systems' function. Thus, the neurotrophin hypothesis of schizophrenia has postulated that the changes in the brain of schizophrenic patients are the result of disturbances of developing processes involving these molecules. Aim We analyse in the present study the changes in the serum levels of brain-derived neurotrophic factor (BDNF) in schizophrenic patients as possible epiphenomena of underlying alterations of the neurotrophic factor in central nervous system, reflecting its role in the pathophysiology of schizophrenia. Patients and methods Twenty-one schizophrenic patients satisfying the DSM-IV criteria for diagnosis of schizophrenia were enrolled in the study. The control group consisted of 28 age-matched mentally healthy subjects. Serum BDNF levels were determined in patients and normal controls using ELISA (Chemicon International, USA & Canada). The data were analyzed statistically with Student's t- test in SPSS 9.0. Results The serum BDNF levels were lower in the schizophrenic patients than in the control subjects, reaching statistically significant difference (t = 2.72, p = 0.009). Female patients had lower serum BDNF levels than the male patients but the difference fell short of statistical significance (t = 0.1, p = 0.9). Conclusions The BDNF reduction in serum indicates a potential deficit in neurotrophic factor release in patients with schizophrenia and support the concept that BDNF might be associated with schizophrenia.

Memory effects of Aronia melanocarpa fruit juice in a passive avoidance test in rats.

Abstract: AIM: To study the effect of Aronia melanocarpa fruit juice on memory in male Wistar rats. MATERIALS AND METHODS: The juice was administered orally for 7, 14, 21 and 30 days at doses of 2.5 ml/kg, 5 ml/kg and 10 ml/ kg. Memory was assessed in the one-way passive avoidance task (step through) which consisted of one training session and two retention tests (3 hours and 24 hours after training). The variables measured were the latency time to step into the dark compartment of the apparatus and the learning criterion (remaining in the illuminated compartment for at least 180 sec). RESULTS: Oral administration of Aronia melanocarpa fruit juice for 7 and 14 days resulted in a dose-dependent tendency to increase the latency time and the learning criterion compared to saline-treated controls but the effect failed to reach statistical signifi cance. After 21 days of treatment, the juice dose-dependently prolonged the latency time at the retention tests, the effect being signifi cant at doses of 5 ml/kg and 10 ml/kg. Applied for 30 days, the juice in all the tested doses increased signifi cantly the latency time at the retention tests and the dose of 10 ml/kg signifi cantly increased the percentage of rats reaching the learning criterion. CONCLUSION: These fi ndings suggest that Aronia melanocarpa fruit juice could improve memory in rats. The effect is probably due to the polyphenolic ingredients of the juice which have been shown to be involved in learning and memory processes.

Influence of serum levels of thyroid-stimulating hormone and anti-thyroid peroxidase antibodies, age and gender on depression as measured by the Zung Self-Rating Depression Scale.

Abstract: UNLABELLED The AIM of the present study was to explore the level of depression in the respondents using the Zung self-rating depression scale (SDS) and find a correlation with the levels of the thyroid-stimulating hormone (TSH) and the anti-thyroid peroxidase antibodies (anti-TPO), the age and gender of the participants. PATIENTS AND METHODS 2401 subjects aged 20-84 yrs were included, 1344 of them female aged 48.7 +/- 14.4 yrs and 1057 male, aged 46.5 +/- 14.5 yrs (p < 0.001). All participants completed the Zung SDS questionnaire and a depressive score was calculated and interpreted as follows: less than 49 points--no depression, between 50 and 59 points--mild depression, between 60 and 69 points--moderate depression and more than 69 points-- severe depression. Body height and weight were measured and serum TSH and Anti-TPO were determined. RESULTS SDS was higher in the females (47.6 +/- 9.7 vs. 41.7 +/- 8.6, p < 0.001) and correlated with the subjects' age (Spearman's rho(female) = 0.447, p < 0.001, P(male) = 0.402, p < 0.001). Depression was more prevalent in the females (all p < 0.001) with hypothyroidism than in the euthyroid subjects (odds ratio 1.8, 95% CI 1.15-2.80, p < 0.011). The odds ratio for depression was 3.47 (2.64-4.57) for the female gender and the risk of depression increased by 6% (5 - 7) with each added year of age. The anti-TPO, BMI and waist circumference did not influence the regression models. CONCLUSION The depressive score was higher in the females and increased with age. Hypothyroidism determined a higher risk of depression in the females.

Endoscopic diagnosis of intramural hematoma in the colon sigmoideum in a child with high titer inhibitory hemophilia A.

Abstract: Lower gastrointestinal bleeding is a rare condition in childhood pathology. The incidence of this disorder in the general population of Bulgarian children is unknown. We report a case of a 7-year-old child with diagnosed hemophilia A and high titer of factor VIII inhibitor; the patient was admitted into the Department of Pediatrics and Medical Genetics for rectorrhagia after falling onto his buttocks while playing. Colonoscopy showed submucosal hematoma 25 cm from the anocutaneous line occluding the intestinal lumen with a lesion of the overlying mucosa as long as 20 mm. If a patient presents with rectorrhagia, timely and carefully planned colonoscopy could identify the source of bleeding, determine the severity of bleeding and the size of hematoma, and assess the need for surgical intervention. The reported case supports the modern view that patients with inhibitor hemophilia should not be denied interventional procedure or surgical intervention for fear of uncontrolled bleeding.

Clinical Investigations: Lash Ptosis As A Characteristic Sign Of Floppy Eyelid Syndrome

Abstract: AIM To find a correlation between the floppy eyelid syndrome and the clinical sign of lash ptosis and loss of eyelash parallelism and develop an algorithm for early diagnosis. MATERIALS AND METHODS This is a prospective case-control study including 97 consecutive patients diagnosed with floppy eyelid and 81 healthy sex- and age-matched controls. The study was conducted in Professor Pashev Eye Hospital, Sofia between January 2011 and December 2012. The clinical sign of lash ptosis and loss of eyelash parallelism was investigated in two stages. The condition was graded using a specially designed algorithm. RESULTS Lash ptosis and loss of eyelash parallelism was documented in all 97 (100%) patients with floppy eyelid and only in 8 patients (9%) in the control group. Statistical analysis of the results showed a very strong association between this sign and the floppy eyelid syndrome (p <0.0001), and a correlation between the degree of lash ptosis and stage of the disease (p < 0.001). CONCLUSION The clinical sign of lash ptosis and loss of eyelash parallelism is characteristic for the syndrome. Recognizing this sign during a routine eye examination can facilitate a timely diagnosis of the frequently overlooked and improperly treated disorder of floppy eyelid.

Experimental study on the role of 5-HT2 serotonin receptors in the mechanism of anti-inflammatory and antihyperalgesic action of antidepressant fluoxetine.

Abstract: INTRODUCTION Fluoxetine is an antidepressant that has anti-inflammatory and antihyperalgesic effects in experimental models of pain and inflammation. The AIM of the present study was to determine the role of 5-HT2 receptors in the mechanism of anti-inflammatory and antihyperalgesic action of fluoxetine after single and repeated administration of the drug. MATERIALS AND METHODS 40 male Wistar rats were randomly divided in five groups (n = 8) treated for 14 days with saline (control), diclofenac (positive control), fluoxetine, cyproheptadine (5-HT2 antagonist), and fluoxetine + cyproheptadine, respectively. We used the experimental model of inflammation induced by intraplantar injection of carrageenan and nociceptive test with mechanical pressure on the inflamed hind paw. RESULTS Single and repeated administration of fluoxetine showed that it had significant anti-inflammatory and antihyperalgesic effects when compared with the control (p < 0.05). Cyproheptadine did not change significantly the anti-inflammatory effect of fluoxetine in the first 4 hours, after a single administration. At 24 hours the combination did not differ statistically when compared with the control. Cyproheptadin did not change significantly the anti-inflammatory effect of fluoxetine after repeated administration. After prolonged treatment the group that received fluoxetine + cyproheptadine showed a statistically significant increase in paw pressure to withdraw the hind paw compared with that treated with fluoxetine alone (p < 0.05). CONCLUSIONS Fluoxetine has anti-inflammatory and antihyperalgesic effects in the carrageenan model of inflammation. 5-HT2 receptor mediated its anti-inflammatory effect in single dose treated animals. Spinal 5-HT2 receptors are involved in the antihyperalgesic effect of fluoxetine after repeated administration.

The Retroaortic Left Renal Vein Abnormalities in Cross-Sectional Imaging

Abstract: Objective The normal anatomic course of the left renal vein (LRV) from the kidney to inferior vena cava (IVC) is usually preaortic. It is called retroaortic left renal vein (RLRV) when located between the aorta and vertebra; the circumaortic left renal vein (CLRV) has both a preaortic and retroaortic course. In this study, we aimed to find the incidence and characteristics of LRV abnormalities in routine abdominal CT and MR examinations conducted in our clinic. Materials and methods A total of 2189 abdominal CT and MR examinations, performed between April 2007 and June 2009, were reviewed retrospectively for retroaortic and circumaortic LRV abnormalities. Results LRV abnormalities were detected in 50 (2.3%) examinations. Forty-four of these (2%) were RLRV and 6 (0.3%) were circumaortic LRV abnormalities. Conclusions Preoperative knowledge of LRV abnormalities facilitates the safe performance of surgery and reveals the clinical symptoms. It is easy to see LRV and its drainage way on routine CT and MR imagings.

Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis.

Abstract: In patients with spinal cord injury and multiple sclerosis, deterioration of body composition (changes in bone, fat and muscle mass) is associated with increased risk for diseases such as coronary artery heart disease, non-insulin dependent diabetes mellitus, lipid metabolism abnormalities, and osteoporotic fractures in these patients. Immobility leads to a changing pattern of loading in the paralyzed areas, and secondary alteration in structure. However, bone and soft tissue changes in these patients are usually neglected. The purpose of this article is to update on the pathophysiological mechanisms leading to bone and soft tissue changes, and to increase the awareness of the treating physicians with respect to bone, muscle and fat loss and their consequences aiming to obtain measures to prevent bone and soft tissue loss in these patients.

Dermatoglyphics--a possible biomarker in the neurodevelopmental model for the origin of mental disorders.

Abstract: Introduction Dermatoglyphic pattern formation and differentiation are complex processes which have been in the focus of research interest ever since dermatoglyphics became a science. The patterns' early differentiation and genetic uniqueness as well as the relatively simple methods used to obtain and store fingerprints make it possible to study the relationship between certain dermatoglyphic characteristics and the underlying pathological processes in a number of diseases, including mental disorders. Aim The present review reports published data from fundamental and clinical studies on dermatoglyphics primarily in schizophrenia and bipolar disorder to lend additional support for the neurodevelopmental hypothesis in the etiology of these disorders. Following an analysis of the theories of dermatoglyphics formation and the complex association between ridge patterns and central nervous system in early embryogenesis, an attempt is made to present dermatoglyphics as possible biological markers of impaired neurodevelopment. Conclusions The contradictory data in the literature on dermatoglyphics in mental disorders suggest the need for further studies on these biological markers in order to identify their place in the neurodevelopmental etiological model of these diseases.

Latent Bipolarity In Unipolar Depression: Experimental Findings, Conceptual Analysis And Implications For Treatment Strategies.

Abstract: INTRODUCTION Previous studies have suggested that the two opposite poles of psychomotor disturbances in unipolar depression (UD) - retardation and agitation - require different treatment strategies as the psychomotor overactivation requires an augmentation of the antidepressant therapy with mood stabilizers and/or atypical antipsychotics. OBJECTIVE The aim of the present study was to objectively identify and measure the psycho-motor disturbances in UD using differentiation between activity and reactivity. MATERIAL AND METHODS An equilibriometric movement pattern analysis system that allows differentiation between psychomotor activity and reactivity was applied in 58 unipolar depressive patients and 76 healthy controls. RESULTS Compared to controls, the patients as a group were significantly slower in their psychomotor reactivity. However, the subsequent subgrouping according to the direction of deviation of their objective psychomotor parameters revealed a disinhibition of psychomotor activity and/or reactivity in about one half of them. Such a contradictory combination of clinically manifested depressive mood and subclinically detected manic-like psychomotor overactivation might be regarded as belonging to the bipolar spectrum, since it was admitted that manic psychomotor disinhibition in unipolar depressive patients uncovers a latent bipolarity. CONCLUSION Not only prototypical depressive inhibition, but also prototypical manic-like disinhibition may underlie clinically manifested UD. Since the combination between depressive mood and psychomotor overactivation multiplies the suicidal risk, we may presume that the timely detection of this combination at a subclinical level would contribute to an earlier and more effective suicidal prevention by an objectively-guided optimization of pharmacological treatment.

Clinical And Morphological Improvement Of Lupus Nephritis Treated With Rituximab.

Abstract: Aim TO assess the effects of rituximab (RTM) therapy on clinical and morphologic activity of lupus nephritis (LN). Material and methods The study included 45 patients with confirmed diagnosis of systemic lupus erythematosus (SLE), unaffected by previously received standard therapy with glucocorticoids (GCs) and cytostatics. The disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K); to assess the LN activity we used the SLICC RA/RE index. Forty-five patients with LN were given puncture renal biopsy prior to prescribing RTM; 16 patients had repeated renal biopsy 1 year and more after beginning the anti-B-cell therapy. LN was graded histologically in accordance with the WHO classification (2003) with indices of activity (AI) and chronicity (CI). Results The predominant number of patients had class III - IV of LN. The repeated renal biopsies demonstrated that LN had undergone a transition into a more favourable morphologic class, which was associated, in most of these cases, with a positive therapeutic effect. The follow-up dynamics showed a statistically significant reduction of AI (p=0.006), and no statistically significant changes in the CI (p = 0.14). Conclusion The long-term follow-up in the study has showed that repeated courses of anti-B-cell therapy with RTM have a positive effect both on SLE activity and generally on the renal process. The reduction of the morphologic class of LN as assessed in the repeated renal biopsies is a convincing proof for this. Eleven out of 16 patients experienced transition of the morphologic class into a more favourable type, which in most cases was combined with lower AI (p = 0.006). We found no evidence of increase in the CI (p = 0.14).

Behaviour Evaluation Scales For Pediatric Dental Patients - Review And Clinical Experience.

Abstract: The present article makes a review of the relevant literature on the scales used in the assessment of behaviour of pediatric dental patients as well as presents the results we have had of using a modified Kurosu Behaviour Evaluation Scale to assess a study sample. The review makes a critical analysis of current evaluation methods and the design of assessment scales. The assessment tools most commonly used in pediatric dentistry are presented in a chronological order from the past to the present. The clinical study we conducted used a modified Behaviour Evaluation Scale developed by Kurosu for the assessment of the behaviour of children. The study showed that during dental treatment of children in the age range of 6 to 12 years the prevailing objective behaviour characteristics in accordance with Kurosu's behaviour evaluation scale are related to the eyes and the facial expression. The findings from the literature review and the results of our study warrant further studies to develop easy-to-use assessment tools that would enhance the objective assessment of behaviour.

Clear Cell Sarcoma Of Metatarsus.

Abstract: We report a case of clear cell sarcoma in the third metatarsus of the right foot. This type of tumor is very rare and scantily reported in literature. A 42-year-old Caucasian male presented with a nodular ulcerated mass on the dorsal side of the left foot. X-rays demonstrated a nodular solid lesion which dislodged the third metatarsus. A biopsy revealed a neoplastic proliferation with a sarcoma clear cell profile; because of the aggressive nature of this type of neoplasm, we performed a trans-tibial amputation according to Bugess to achieve a better functionality for the patient. The present study underlines clinical, morphological, as well as imaging and therapeutic aspects of a rare neoplasm such as clear cell sarcoma. The location site is also quite unusual - the metatarsus of the foot. The histological and immunohistochemical data were suggestive of the diagnosis of clear cell sarcoma of metatarsus. After MRI and a bone scan, the surgical treatment suggested the extension over the forefoot and the ankle and therefore a trans-tibial amputation was made.

Medical And Surgical Management Of Orbital Cellulitis In Children.

Abstract: Objective The purpose of this study was to identify features of orbital cellulitis that predict response to conservative treatment without surgical intervention and factors associated with a decision for surgery. Patients and methods The medical files of patients diagnosed with orbital cellulitis at a tertiary medical center in central Israel between 1995 and 2010 were reviewed for clinical data, diagnosis, complications, and type of treatment. Comparison was made between patients treated with antibiotics and patients treated with antibiotics and surgery. Results Fifty-one patients (35 male) with a mean age of 6.1 years were identified. Main clinical signs included fever (mean 38.5°C), proptosis (82.3%), extraocular motility restriction (74.5%), and ocular pain (41.1%). Forty-one patients were successfully treated with antibiotics and 10 required endoscopic sinus surgery. On between-group comparison, the surgery group had severe eye pain (p = 0.009), severe proptosis (P = 0.02), longer intravenous antibiotic treatment (13.2 vs. 9.2 days, p = 0.04), and several imaging findings. Additional factors associated with surgical intervention included older children, subperiorbital abscess, larger dimension of the abscess (mean 15 mm), involvement of frontal sinuses and findings of intraorbital air bubbles. There was no visual deterioration in either group and no late sequelae. Conclusion Factors associated with surgery included age older than 9 years, severe ocular pain, severe proptosis, and subperiorbital large abscess. These may be used for early identification of patients at risk of failure of only medical management.

The Structure of Trauma Patients, its Management and Health Care in the University Hospital of Alexandroupolis

Abstract: OBJECTIVE: The present study was designed to describe the patterns of trauma patients using a newly-introduced trauma registry, as well as retrospectively assess the management and outcome facts of these patients. MATERIALS AND METHODS: The study included 2346 patients (62.15% male) with a mean age of 34.06 +/- 23.77 years. Of these patients, 355 were multiple trauma patients. Privately owned vehicles were used as a mode of transportation for most of the trauma patients (96.65%). Data regarding patient demographics, arrival at the Emergency Department, mechanism of injury, injury severity, anatomical location and type of injury were collected and analyzed. RESULTS: Falls were the most prevalent mechanism of injury, accounting for 62.19% of the total admitted cases, with other causes (that also included occupational accidents and machinery trauma) being the second most prevalent, and MVAs--the third with a rate of 11.46%. The most commonly injured body regions were the extremities (50.26%), the head (42.50%), and the torso (19.39%). Fractures represented 11.46% of the injuries, while open wounds were much more frequent (29.41%). The mean abbreviated injury severity (AIS) score was 1.78 +/- 1.48 for all admitted patients and 3.56 +/- 1.02 for multiple trauma patients. A multi-disciplinary approach was required for 23% of the multiple trauma patients. The clinic admission rate for the whole patient sample was 13.55% and 48.96% for multiple trauma patients. The mean duration of stay for all clinic admissions was 2.7 days and 2.9 days for multiple trauma patients. CONCLUSIONS: With the epidemiology of trauma in Greece being rather poorly investigated, the present study manages to identify the major epidemiological patterns of trauma cases presenting to a tertiary regional hospital and addresses the need for development and implementation of injury prevention activities and policies. Language: en

Modern Imaging Modalities in the Assessment of Acute Stroke

Abstract: The aim of this review was to present the modern concepts of diagnostic imaging in acute stroke. Neuroimaging in acute stroke aims at diagnosing the condition as early as possible and assessing the extent of parenchymal perfusion and the intracranial vessels patency. A modern approach would involve a combination of various imaging modalities as multidetector computed tomography and high field magnetic resonance imaging. A non-enhanced computed tomography (CT) is used to detect hemorrhage or to identify early signs of ischemic stroke. CT angiography finds evidence of intravascular thrombi or significant stenoses, and CT perfusion displays brain tissue at risk of irreversible alterations that can be salvaged therapeutically. Magnetic resonance imaging (MRI) is a more sensitive modality than CT in diagnosing acute brain ischemia. MR diffusion-weighted imaging is more sensitive than conventional MR sequences in hyperacute stage. MR angiography as a non-invasive and non-ionizing imaging method is used as an alternative modality to CT angiography. To find brain tissue at risk diffusion- and perfusion-weighted magnetic resonance imaging modalities are used. The authors present briefly the modern neuroimaging modalities used in patients with transient ischemic attack, minor stroke and venous infarction. By combining different imaging techniques in a multimodal approach we can acquire the information necessary for therapeutic planning and differentiate patients who need thrombolysis.

Salivary α-Amylase And Chromogranin A In Anxiety-Related Research.

Abstract: Salivary α-amylase (sAA) and chromogranin A (sCgA) are at the forefront of current biochemical research on anxiety. Their use is being driven by the sudden surge of interest in "salivaomics," a new field in medicine studying saliva's genetic code, proteome and methabolom. Interestingly, it is not the primary functions of the enzyme and the protein, but the ingenious capture of their secondary ones (maintenance of the acid-alkaline balance and bactericidal / antifungal action) that allows for a swift, precise and pain-free measurement under physical and mental duress. Upon stimulation, sAA and sCgA are almost simultaneously released. Studying them allows a closer look at the autonomic nervous system (ANS) as opposed to the hypothalamic-pituitary-adrenal axis (HPA), which involves a long cascade of complex, hard to measure and interpret bio-chemical reactions.

World, Time And Anxiety. Heidegger's Existential Analytic And Psychiatry.

Abstract: Martin Heidegger was one of the most influential but also criticized philosophers of the XX century. With Being and Time 1927 he sets apart his existential analytic from psychology as well as from anthropology and from the other human sciences that deny the ontological foundation, overcoming the Cartesian dualism in search of the ontological unit of an articulated multiplicity, as human being is. Heidegger's Dasein Analytic defines the fundamental structures of human being such as being-in-the-world, a unitary structure that discloses the worldhood of the world; the modes of being (Seinsweisen), such as fear (Furcht) and anxiety (Angst); and the relationship between existence and time. In his existential analytic, anxiety is one of the fundamental moods (Grundbefindlichkeit) and it plays a pivotal role in the relationship of Dasein with time and world. The paper firstly focuses on the modes of being, underlining the importance of anxiety for the constitution of human being; secondly, it shows the relationship between anxiety and the world, and anxiety and time: rejecting both the Aristotelian description of time, as a sequence of moments that informs our common understanding of time, and the Augustine's mental account of inner time, Heidegger considers temporality under a transcendental point of view. Temporality is ek-static, it is a process through which human being comes toward and back to itself, letting itself encounter the world and the entities. The transcendental interpretation of time provided by Heidegger may give its important contribution to psychopathology.

Validating a short Bulgarian version of a psychometric instrument for multidimensional noise sensitivity assessment.

Abstract: BACKGROUND Noise sensitivity (NS) is a key construct in the fields of hygiene, planning and occupational medicine. It refers to a personality trait representing the reactivity to noise and is associated with various psycho-physiological health outcomes. AIM This study aimed to develop a shorter version of the original Noise Sensitivity Questionnaire (NoiSeQ), retaining its dimensions and assess its validity and reliability. METHODS A test-retest study was carried out in a convenience sample of 56 participants. A short 15-item form of the original NoiSeQ (NoiSeQSF) questionnaire was developed and then administered. All major analyses were based on the coefficient of equivalence and stability, the generalizability theory and linear regression. RESULTS Relative (rho = 0.83) and absolute ((phi = 0.80) G coefficients for global NS exceeded the lower reliability limit according to G- and D-studies. Sleep subscale can readily be used to assess sleep-related NS (rho = 0.76/phi = 0.75). Moreover, NoiSeQSF predicted some cardiac symptoms (with age of participants as a moderator factor), which demonstrated nomological validity. CONCLUSION NoiSeQSF is a reliable estimate for global NS and NS related to sleep quality. It might prove useful to experts in environmental hygiene, urban planning and occupational diseases when dealing with noise-impaired occupational, social or psycho-physiological functioning.

Investigation Of Chromium-Cobalt Coated Scaffolds On Cell Cultures In Vitro.

Abstract: Introduction The use of diverse materials for medical purposes is continuously expanding. The modification of materials which are routinely applied in medical practice as well as the development and introduction of new materials require studies on their biological activity. The first steps in this process are the preliminary short-term screening tests for cytotoxicity and biocompatibility performed on cell cultures. Methods Coating of stainless steel (316 L) scaffolds with chromium-cobalt was performed by electroplating using the non-standard electrolyte Chromispel. The process was carried through at different cathode current densities and deposition times. The modified surface of the metal scaffolds was studied for cytoxicity and cell vitality on the serum-free McCoy-Plovdiv and the immortalized PDL cell cultures. Results Our results indicate no cytotoxic effect of the coated metal scaffolds. Even more, three of the samples stimulated the proliferation and growth of McCoy-Plovdiv cells. Conclusion We have strong reasons to believe that chromium-cobalt coatings are promising for future studies and reliable for medical purposes.

Association of eosinophilic fasciitis with morphea.

Abstract: Eosinophilic fasciitis is a rare inflammatory disease of unknown etiology, described for the first time by Shulman in 1974. The disease presents with induration of the skin, connective tissue and the underlying muscle fascia, sometimes accompanied by myalgia, most commonly in the lower extremities. Unlike scleroderma, it presents with absence of visceral organ involvement and Raynaud's phenomenon. Hypergammaglobulinemia and eosinophilia have been reported. Eosinophilic fasciitis is often associated with hematological disorders--there are reports of combinations with other autoimmune diseases such as systemic sclerosis, systemic lupus erythematosus, Hashimoto thyroiditis, Sjogren syndrome, vitiligo, etc. Occurrence of morphea, in the course of eosinophil fasciitis is considered a rarity. We have observed such a case with the simultaneous presence of both types of lesions. A 20-year-old female patient is reported, wherein the clinical picture developed for 6 months. The initial erythematous edema and subsequently the livedo-like painful plaques in both lower legs gradually swell, thicken and hyperpigment. Almost simultaneously with these complaints small brown livid body plaques emerged. The patient was diagnosed based on history, clinical picture, peripheral eosinophilia and histological findings from the affected areas. There was no systemic involvement and accompanying hematologic or other disease. Therapeutic management and significant clinical improvement were achieved using systemic corticosteroid therapy combined with methotrexate.

Myxopapillary ependymoma of filum terminale.

Abstract: We report a case of 56-year-old patient suffering from myxopapillary ependymoma of filum terminale at the level of the fifth lumbar vertebra. The patient presented with progressive complaints of permanent pain in the anal and sacral region with duration of 8 months. When sneezing or attempting to do brisk movements, the pain irradiated to the posterior surface of the right thigh. Vertebral syndrome was absent. Neurological examination demonstrated no other abnormalities. Magnetic-resonance imaging showed intradural tumor of cauda equina at the level of the fifth lumbar vertebra. The present article discusses the role of MRI in the diagnosis of clinical cases presenting with atypical lumboradiculalgia. We have put an emphasis on the early diagnosis of myxopapillary ependymoma of filum terminale which has an impact on the surgical strategy and postoperative outcome.

Snake venom poisoning in the Plovdiv region from 2004 to 2012

Abstract: INTRODUCTION: Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. MATERIALS AND METHODS: We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. RESULTS: We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes)--mild to medium intensity with predominantly local toxic syndrome. CONCLUSIONS: The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised. Language: en