Leptin as a cardiovascular risk factor

Hippokratia 2007; 11 (4): 163-170

G. Efstratiadis, C. Nikolaidou, G. Vergoulas

Abstract

The role of leptin in humans is not yet precisely established. Nevertheless there is increasing evidence revealing that this molecule is involved in the pathogenesis of atherosclerosis as an independent risk factor. From another point of view, however, leptin is allready related to known traditional risk factors for accelerated atherogenesis, like obesity.
We herein provide the experimental and clinical data concerning the association between leptin and atherosclerotic
disease. Vascular stiffness and calcification, immune responce regulation, fibrinolysis, and oxidative stress, are the main fields to be investigated in relation to leptin in the present study.
Additionally the discription of the main characteristics of leptin and its receptors is included in the introduction of this article, whereas in the end the main clinical data suggesting that this molecule represents an interesting risk facto for atherosclerotic disease are provided.

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Hearing aids: Quality of life and socio-economic aspects

Hippokratia 2007; 11 (4):183-186

E. Tsakiropoulou, I. Konstantinidis, I. Vital, S. Konstantinidou, A. Kotsani

Abstract

Objective: Hearing loss can significantly impair patient's quality of life, affecting communicative behavior, emotional and social function. This study assesses the impact of hearing aids on the quality of life of patients in a rural area and its correlation with socio-economic factors.
Materials - methods: Thirty patients (18 male, 12 female), with bilateral sensorineural hearing loss of variable etiology, using hearing aid for at least five years, were enrolled in this study. Mean age of subjects was 74 years. This study used the Glasgow Benefit Inventory (GBI) to quantify the changes in quality of life. Patients were divided in above and below criterion group. The criterion used was the median of the air contaction threshold improvement. The binaural use and the type of hearing aids were recorded and correlated with the type of social security service of patients.Results: E ighty per cent of patients reported significant benefit from the hearing aid use. The majority of patients (90%) used one hearing aid (mean GBI total score 35) and only 10% had binaural hearing aid (mean GBI total score 45). The majority of patients used analog hearing aid (56.5%) while 43.5% used digital hearing aid. Interestingly, it was found that patients did not attend appointments for hearing aids maintenance with a mean follow up of 2.5 years.
Conclusion: This study demonstrates a trend of better quality of life for patients with bilateral hearing loss and binaural hearing aid use. The type of hearing aid is related to the funding from their social security service. Therefore more patients are using analog hearing aids, as they are less expensive than the digital hearing aids.

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Contributions of signal analysis to the interpretation of spirometry

Hippokratia 2007; 11 (4): 187-195

A. Anogeianaki, N. Negrev, G. Ilonidis

Abstract

Aim: Chronic Obstructive Pulmonary Disease (COPD) is taking on catastrophic proportions. However, there is still a need for more objective and quantitative methods for its diagnosis and stratification. The present study explores the effectiveness of signal analysis methodologies as the means to increase the effectiveness of spirometry in diagnosing and stratifying COPD. Methods: Since expiratory flow at the mouth results from converging airflows, it is possible to use signal analysis to identify changes in the characteristics of airflow along the respiratory tree. This was achieved by non-invasively identifying alterations in the frequency spectrum of the Forced Expiratory Flow (FEF) curve of 108 patients (49 men and 59 women, 12???75 yrs of age) presenting with (a) clinically and spirometrically normal respiratory profile, (b) COPD, (c) restrictive lung disease and (d) interstitial fibrosis. Fundamental to the study design was the notion that the characteristics of the expiratory output of the respiratory system are determined by the bronchial tree and the upper respiratory tract
Results: A number of quantitative measures for the power spectrum of the FEF curve were identified, which permit the definition of specific rules and allow for the accurate classification of, at least, the basic types of respiratory disease. Conclusions: (a) It is for the first time that airflow resonances are identified in the sub-audible (< 20 Hz) range of the power spectrum of the FEF curve. (b) COPD patients present with FEF curves which have different power spectral characteristics from those of healthy individuals (p < 0.01), at frequencies lower than 3.66 Hz. (c) In COPD, in restrictive lung disease and in interstitial fibrosis, the lower resonant frequencies of the spectrum of the FEF curve predominate.

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Treatment of intravenous drug users with chronic hepatitis C: Treatment response, compliance and side effects

Hippokratia 2007; 11 (4): 196-198

E. Gigi, E. Sinakos, Th. Lalla, E. Vrettou, E. Orphanou, M. Raptopoulou

Abstract

Backgroung: Although intravenous drug users (IVDUs) comprise the majority of patients with chronic hepatitis C, most of them are excluded from treatment because of concerns about adherence to treatment and side effects.
Material and methods: In this study we retrospectively evaluated safety, compliance to treatment and efficacy of treatment in IVDUs with HCV infection in 163 former IVDUs with chronic hepatitis C, who were not in methadone substitution and were attending our clinics the period 1997-2004. All subjects were HCVRNA (+), had ALT levels >x1.5 UNL and were treated for their HCV infection. Treatment consisted of three different regimens: IFN-?? monotherapy (39.8%), IFN-??/ribavirin combination therapy (30.1%) and pegylated IFN-??/ribavirin combination therapy.
Results: Eighty seven over 163 patients (53.3%) discontinued treatment early due to drug abuse relapse (62%), side effects (32.1%, 10% psychiatric) and 5,7% for other reasons. Eighty precent of those who discontinued treatment had pre-treatment drug abstinence ??? 9 months. Seventy over 76 patients who completed therapy had an end-of-treatment virologic response (ETR, 92%). Fifty four over 76 patients showed sustained virologic response (SVR, 71.05%). ETR and SVR were significantly higher in both combination therapies compared to IFN-?? monotherapy. The most prevalent HCV genotype was 3 (65%) and mild histological lesions were detected in the majority of subjects.
Conclusions: Our findings show that treatment for chronic hepatitis C was reasonably safe and sufficiently effective in our group of non methadone-substituted IVDUs, despite the fact that more than half of them discontinued treatment early and many relapsed to drug abuse. We suggest that the optimal duration of pretreatment abstinence from drug abuse should be > 9 months.

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Changes of serum bone markers in CAPD and hemodialysis patients

Hippokratia 2007; 11 (4): 199-201

D. Yonova, P. Dukova

Abstract

Background: A non-invasive method for evaluation of high-turnover and low-turnover bone diseases is the measurement of certain important serum bone markers such as osteocalcin, procolagen-I-propeptide, dioxypiridinoline, hydroxyproline and alkaline phosphatase. Renal osteodystrophy (ROD) in pre-dialysis and dialysis patients, is manifested in 3 forms: high-turnover ROD, related to secondary hyperparathyroidism; low-turnover ROD and mixed ROD.
Material and methods: Serum levels of intact parathyroid hormone (iPTH), osteocalcin (OC), procolagen-I-propeptide
(PIPC) and dioxypiridinoline (DYP) were measured in 20 patients on hemodialysis (HD) and 20 patients on continuous
ambulatory peritoneal dialysis (CAPD) to assess the prevalence of ROD type in the HD and CAPD groups.
Results: We found lower mean levels of all bone markers in CAPD patients, (iPTH: 219±235 vs. 428±285 pg/ml; p<0.01; OC 10.2±7.5 vs. 21.3±7.2 ng/ml; p<0.01; PIPC 111±57.3 vs. 218±62.4 ng/ml; p<0.01; DYP 7.3±6.4 vs. 55.2±23.3nm/l; p<0.001; AP 164±66 vs. 325±188 U/l; p<0.01) and lower than normal in 11 of them and higher than normal PTH, AP and some of the other serum markers (PICP; DYP) in 14 HD patients.
Conclusions: The lower levels of the investigated serum bone markers in CAPD patients suggest that low-turnover ROD prevails in these patients than in HD pts.

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Keywords: serum bone markers, osteocalcin, procolagen-I-propeptide, dioxipyridinoline, hydroxyproline, alkaline phosphatase, intact parathyroid hormone, high-turnover ROD, low-turnover ROD

Correspoding author: Yonova D, Dialysis Clinic, Med Univ Hosp ”Alexandrovska”, Sofia, Bulgaria; This email address is being protected from spambots. You need JavaScript enabled to view it.

Results of active cycle of breathing techniques and conventional physiotherapy in mucociliary clearance in children with cystic fibrosis

Hippokratia 2007; 11 (4): 202-204

A. Hristara Papadopoulou, J. Tsanakas

Abstract

Aim: The aim of the present study is the comparison of the results of the appliance of two methods of respiratory physiotherapy; the active cycle of breathing techniques in drainage positions and the conventional physiotherapy, regarding their effects on mucociliary clearance in patients with cystic fibrosis.
Material-methods: Thirty-five children teenagers and adults with cystic fibrosis, 8-20 years of age, with mean Schwachman score 78,49 took part in the research. All patients had regular physiotherapeutic control and applied systematically physiotherapy. The same children received two methods of respiratory physiotherapy in a 3-month random order, when they came at the outpatients??? department of the hospital for their regular check-up.
Results: The comparison of the results of the two methods did not show statistical significant difference in sputum quantity, whereas statistical significant difference was noticed in sputum quality after the application of active cycle of breathing techniques.
Conclusions: The application of the active cycle of breathing techniques contributes effectively in the sputum
expectoration from the peripheral bronchopulmonary segments and enhances the mucociliary clearance in children with cystic fibrosis.

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Homocystein and carotid atherosclerosis in chronic renal failure

Hippokratia 2007; 11 (4): 205-209

M. Lubomirova, E. Andreev, A. Tzoncheva, J. Petrova, R. Djerassi, B. Kiperova

Abstract

Background: Since total homocystein (Hcy) is markedly elevated in patients with chronic renal failure (CRF), it has been presented as potential factor contributing to the high risk of cardiovascular disease (CVD) in CRF. The aim of the study was to examine the significance of elevated Hcy and other cardiovascular risk factors for carotid atherosclerosis in patients with CRF.
Material and Methdos: Fifty six patients 16-M, 40- F, average age 58±14.55, creatinine clearance 39.19±10.11 ml/min were examined. In addition, 20 control healthy subjects were examined. The association of Hcy levels and classic risk factors for atherosclerosis with common carotid intima-media thickness (IMT) was examined. B-mode ultrasound measurement of carotid IMT was performed in 56 hypertensive pts with CRF (glomerular filtration rate > 20 ml / min and < 90 ml/min), 44 hypertensive pts with normal renal function and 20 healthy volunteers. The mean duration of hypertension was 14±5.12 years.
Results: IMT in all examined hypertensive pts was increased above normal clinical value and significantly higher then in healthy controls (0.75± 0.006/ 0.60±0.1, p<0.001). The carotid IMT was similar between hypertensive pts with CRF and hypertensive pts with normal renal function ( 0.74 ±0.1/ 0.76 ±0.1, p>0.05). Significant predictors for IMT were age (r=0.358, p<0.04), duration of hypertension (r=0.395, p=0.023), diabetes duration (r=0.343, p<0.02), as well as duration of CRF (r=0.324, p<0.006). There was a negative correlation between IMT and glomerular filtration rate assessed by creatinine clearance (r= -0.303, p<0.003). Renal function, described by creatinine clearance was the strongest determinant for Hcy levels ( r =- 0.332, p<0.008). Increased IMT was estimated in pts with CRF compared to healthy controls ( 0.74±0.10 vs 0,59±0.10, p<0.001). We found association between Hcy and carotid IMT ( r=0.344, p<0.015). No consistent association was found between IMT and other specific for CRF cardiovascular risk factors.
Conclusion: The study suggests that patients with mild renal failure have increased IMT of the common carotid artery and that elevated plasma Hcy level in CRF is associated with carotid intima- media thickening.

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Adamantiades - Behcet Disease (ABD) in Northern Greece Patients: Experience from a single center

Hippokratia 2007; 11 (4): 210-215

P. Boura, K. Tselios, P. Skendros, S. Kamali, A. Sarantopoulos, M. Raptopoulou-Gigi

Abstract

Objective - Methods: Adamantiades-Behcet disease (ABD) is a multi-systemic vasculitis of unknown origin, with a characteristic geographic distribution, that affects vessels of all kinds and sizes and is characterized by recurrent mucosal, skin and ocular lesions. In the present study, a series of 36 patients from Northern Greece is analyzed retrospectively in regard to the epidemiological, clinical and immunological parameters. Results: All patients had recurrent oral ulcerations (36/36, 100%), while 23/36 (63.9%) experienced genital ulcerations
and 22/36 (61.1%) developed ocular disease. Skin manifestations were observed in 23/36 patients (63.9%) and pathergy test was found positive in 14/36 patients (38.9%). Other manifestations included central nervous system involvement, recurrent genitourinary inflammations, arthralgias and superficial thrombophlebitis. Laboratory findings were not specific, partly reflecting the severity of inflammation. Ocular disease was more often observed in HLA-B51 (+) patients (20/31, 64.5%) than in HLA-B51 (-) patients. Standard of care (SOC) treatment consisted of cyclosporine A, azathioprine, methylprednisolone and aspirin, whereas refractory disease was treated with intravenous pulses of methylprednisolone and cyclophosphamide. Occasionally, anti-TNF agents (infliximab) were applied to treat refractory ocular disease.
Conclusion: The findings of the present study come in agreement with those reported for other Mediterranean series. HLA-B51 seems to predispose to more severe disease, while early therapeutic intervention is beneficial for these patients.

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Prevalence of musculoskeletal disorders in patients with type 2 diabetes mellitus: a pilot study

Hippokratia 2007; 11 (4): 216-218

I. Douloumpakas, A. Pyrpasopoulou, A. Triantafyllou, Ch. Sampanis, S. Aslanidis

Abstract

Background: Diabetes mellitus is associated with a variety of musculoskeletal disorders. The prevalence of connective tissue disorders in these patients has increased in the recent years affecting significantly their quality of life.
Methods - Results: We conducted a pilot study including 208 sequentially selected patients with type 2 diabetes mellitus regularly followed-up at the Diabetes Center of the Hippokration University Hospital. Among the diabetic patients who were screened according to the Short Musculoskeletal Function Assessment Questionnaire for musculoskeletal symptoms and findings, 82.6% were found to exhibit musculoskeletal abnormalities, mainly of the degenerative, noninflammatory type.
Conclusions: Musculoskeletal disorders are a common finding among patients with type 2 diabetes. Obesity and accumulation of abnormally glycosylated byproducts have been proposed as potential pathogenetic mediators of these connective tissue abnormalities. Of particular interest is, however, the common association of osteoarthritis, involving even non-weight bearing joints in patients with type 2 diabetes, indicating a common pathophysiologic mechanism connecting these two clinical conditions.

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The management of hypertension in hemodialysis and CAPD patients

Hippokratia 2007; 11 (4): 171-174

M. Malliara

Abstract

Patients with chronic kidney disease progress to end stage renal disease and about 86% are diagnosed hypertensives.
Hypertension is a risk factor for cardiovascular disease which is the main cause of morbidity and mortality in the dialysis population. Pre and post -dialysis blood pressure values of < 140/90 mmHg are recommended as the optimal blood pressure.
The extra-cellular volume (ECV) expansion is the main pathophysiological determinant of hypertension in dialysis patients. The efforts should be made to correctly estimate and achieve the patients dry body weigh and to limit dietary sodium intake. Angiotensin II receptor antagonists, beta blockers and calcium channel blockers are recommended as first choice drugs. Beta blockers and calcium channel blockers have been associated with reduced cardiovascular mortality and give their protective effects in patients at high risk. Antihypertensive drug therapies can effectively reduce blood pressure and are needed by the vast majority of hemodialysis patients.

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Anesthesia for the elderly

Hippokratia 2007; 11 (4): 180-182

Z. Kanonidou, G. Karystianou

Abstract

Aging is a universal and progressive physiological phenomenon clinically characterized by degenerative changes in both the structure and the functional capacity of organs and tissues.
In general, geriatric patients are more sensitive to anesthetic agents. Less medication is usually required to achieve a desired clinical effect, and drug effect is often prolonged. The most important outcome and overall objective of perioperative care of geriatric population, is to speed recovery and avoid functional decline.
An important principle must be kept in mind when dealing with an elderly patient: Aging involves a progressive loss of functional reserve in all organ systems, to variable extend. Compensation for age-related changes is usually adequate, but limitation of physiological reserve is evident during times of stress such as the perioperative period.

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The role of apoptosis and current therapeutic challenges in myelodysplastic syndromes

Hippokratia 2007; 11 (4): 178-182

M. Diamantidis, S. Dimoudis, Ph. Klonizakis, K. Badekas, K. Koutourli, S. Haralambidou-Vranitsa, E. Ioannidou-Papagiannaki

Abstract

The myelodysplastic syndromes (MDS) remain challenging to the clinician in terms of diagnosis and management. The diagnosis is essentially one of exclusion in first ruling out other disorders that can also cause peripheral blood/bone marrow cell dysplasia and cytopenias. Recent studies implicate extensive apoptosis as the explanation of the paradoxical observation of marrow hyperplasia, but peripheral blood cytopenia. The clonal nature of MDS places it also at continual risk for transformation to acute leukemia. Predicting overall survival as well as the risk of acute myeloid leukaemia (AML) transformation has been improved by the development of the International Prognostic Scoring System (IPSS).
Management of MDS can now be based on the patient???s respective prognostic subgrouping. Low-risk patients should be considered for hematopoietic growth factor singly or in combination, while high-risk patients should be offered AMLinduction therapy or novel therapeutic agents. Common complications are neutropenias with recurrent infections and red cell transfusion dependence. Future advances upon understanding the molecular details of the MDS clone should ultimately improve the care of patients with MDS.

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Intraperitoneal pseudocyst formation: Complication of fungal peritonitis in continuous ambulatory peritoneal dialysis

Hippokratia 2007; 11 (4): 219-220

E. Sahpazova, B. Ruso, D. Kuzmanovska

Abstract

A 14-year-old girl, with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD) the last 4 years, after an episode of Candida albicans was switched to hemodialysis. One month later she came back because of a palpable - painful abdominal mass and abdominal distention. Computed tomography (CT) and ultrasound examination demonstrated a demarkated fluid collection in the lower abdomen and pelvis. The cyst was drained percutaneously and the culture disclosed candida albicans which was treated with fluconasole. Two months later, the girl was admitted again with the same symptoms. An investigative laparotomy was undergone and the cyst was drained again. Fluid cultures were negative. CT abdomen examination six months later was negative for cyst relapse. In conclusion, intraperitoneal pseudocyst is a serious complication of CAPD. Surgical intervention may be preferable to percutaneous drainage.

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