Gestational diabetes mellitus: why screen and how to diagnose

Hippokratia 2010; 14(3): 151-154

T. Karagiannis, E. Bekiari, K. Manolopoulos, K. Paletas, A. Tsapas

Abstract

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM and their offspring have an increased risk of developing type 2 diabetes mellitus in the future. The global incidence of GDM is difficult to estimate, due to lack of uniform diagnostic criteria. Various diagnostic criteria have been proposed. The benefit of treating GDM has also been controversial. The clinical significance of treating maternal hyperglycemia was made evident in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The HAPO study demonstrated that there is a continuous association of maternal glucose levels with adverse pregnancy outcomes and served as the basis for a new set of diagnostic criteria, proposed in 2010 by the International Association of Diabetes and Pregnancy Groups (IADPSG). According to these criteria the diagnosis of GDM is made if there is at least one abnormal value (?92, 180 and 153 mg/dl for fasting, one-hour and two-hour plasma glucose concentration respectively), after a 75 g oral glucose tolerance test (OGTT).

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Insomnia symptoms among Greek adolescent students with excessive computer use

Hippokratia 2010; 14(3):203-207

KE. Siomos, D. Braimiotis, GD. Floros, V. Dafoulis, NV. Angelopoulos

Abstract

Background: The aim of the present study is to assess the intensity of computer use and insomnia epidemiology among Greek adolescents, to examine any possible age and gender differences and to investigate whether excessive computer use is a risk factor for developing insomnia symptoms.
Patients and Methods: Cross-sectional study of a stratified sample of 2195 high school students. Demographic data were recorded and two specific questionnaires were used, the Adolescent Computer Addiction Test (ACAT) and the Athens Insomnia Scale (AIS).
Results: Females scored higher than males on insomnia complaints but lower on computer use and addiction. A dosemediated effect of computer use on insomnia complaints was recorded. Computer use had a larger effect size than sex on insomnia complaints. Duration of computer use was longer for those adolescents classified as suffering from insomnia compared to those who were not.
Conclusions: Computer use can be a significant cause of insomnia complaints in an adolescent population regardless of whether the individual is classified as addicted or not.

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P2X7 receptor at the heart of disease

Hippokratia 2010; 14(3):155-163

Ei. Vasileiou, RM. Montero, CM. Turner, G. Vergoulas

Abstract

Purinergic signaling is a crucial component of disease whose pathophysiological basis is now well established. This review focuses on P2X7, a unique bifunctional purinoreceptor that either opens a non selective cation channel or forms a large, cytolytic pore depending on agonist application and leading to membrane blebbing and to cell death either by necrosis or apoptosis.Activation of P2X7 receptor has been shown to stimulate the release of multiple proinflammatory cytokines by activated macrophages, with the IL-1b to be the most extensively studied among them. These findings were verified by the use of knockout P2X7 (-/-) mice. Update information coming from all fields of research implicate this receptor at the very heart of diseases such as rheumatoid arthritis, multiple sclerosis, depression, Alzheimer disease, and to kidney damage, in renal fibrosis and experimental nephritis. Clinical studies are currently underway with the newly developed selective antagonists for P2X7 receptor, the results of which are eagerly anticipated. These studies together with data from in-vivo experiments with the P2X7 knockout mice and in-vitro experiments will shed light in this exciting area.

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Collagenous and non-collagenous biochemical markers of bone metastases from prostate cancer

Hippokratia 2010; 14(3):164-169

A. Zafeirakis

Abstract

The importance of the bone microenvironment to the pathophysiology and morbidity associated with prostate cancer bone metastasis is becoming increasingly apparent. Significant alterations take place in the microenvironment of bone, which disturb the normal coupling that exists between bone resorption and bone formation. Consequently, a better understanding of the mechanisms that interact at the molecular level will definitely result in more effective therapy for patients with this devastating complication of prostatic carcinoma. This review will discuss the diagnostic and predictive implications of various collagenous and non-collagenous bone markers, along with the novel markers of osteoclastogenesis and other matrix enzymes such as metalloproteinases and growth factors responsible for the complex biochemical mechanisms that upregulate bone resorption/formation during the development of metastasis. Further prospective studies are needed to determine whether any of these markers measured longitudinally in prostate cancer patients without bone scan evidence of skeletal disease will ultimately predict those patients who will develop bone metastases from their malignancy. Nonetheless, from the clinical point of view it is important to know that these novel markers carry the potential to provide meaningful information for daily practice by using upper normal reference values as cut-offs for identifying patients with an increased risk of developing progressive bone disease or skeletal related events.

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Screening for prostate cancer: a controversy or fact

Hippokratia 2010; 14(3):170-175

S. Stavridis, S. Saidi, Lj. Lekovski, S. Dohcev, G. Spasovski

Abstract

Background: Adenocarcinoma of the prostate is the most frequent malignancy in men and the second leading cause of death in the male population worldwide. The screening for prostate cancer allows early diagnosis of prostate malignancy before the individual presents with symptoms. The early stage of the disease is easier to manage by different therapeutic modalities.
Aim: The aim of this review is to evaluate the reasons and facts for enthusiasm and positive approach towards the clinical decision about whether to screen or not male patients for early detection of prostate cancer.
Methods: We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings were summarized. We analyzed the methods and schedule of screening, as well as advantages and disadvantages of the prostate cancer screening.
Results: There were more than a hundred studies on prostate cancer screening performed but only a few are eligible for a decisive conclusion concerning the prostate cancer screening issue. We reviewed the screening methods, the schedule of screening, the advantages and disadvantages of prostate cancer screening.
Conclusion: The role for prostate cancer screening is not established yet. Definite proof of screening should be assumed as a decrease in the death rate of that cancer due to screening activity.

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Long-term outcome after implantation of prosthetic disc nucleus device (PDN) in lumbar disc disease

Hippokratia 2010; 14(3):176-184

P. Selviaridis, N. Foroglou, A. Tsitlakidis, A. Hatzisotiriou, I. Magras, I. Patsalas

Abstract

Background: The prosthetic disc nucleus (PDN) device offers an adjunct treatment for patients with degenerative disc disease and herniation, who necessitate surgical intervention, avoiding total-disc replacement or fusion. This prospective, clinical study aimed to gauge the long-term effectiveness of microdiscectomy followed by PDN implantation in relieving pain and improving functional status in patients with symptomatic degenerative lumbar disc disease and herniation.
Methods: Ten patients with a) at least 6 months low back pain and/or sciatica resistant to conservative treatment and b) radiologically documented degenerative lumbar disc disease and herniation have been selected. Follow-up at 6 weeks, 3, 12, 48, and 96 months postoperatively included physical examination, radiological investigation (plain and dynamic radiographs and magnetic resonance imaging), and self-completion of outcome scales (visual analogue, Oswestry, and Prolo functional status). Short Form-36 version 2 Health Survey patient profile at 96 months completed the image of health related quality of life.
Results: Patients? mean follow-up was 100.6 months. Significant improvements in Oswestry, Prolo, and VAS scores were documented (p: 0.004 in all scales at 48 months). Generic health status was rated within the average lumbar disease population (46.3?6.8 for physical component summary and 45.2?9.6 for mental component summary). Lumbar spine range of motion (20.2?11.8 at 96 months) was restricted in relation to normal, but maintained considerable mobility. Treated disc height increased postoperatively (p:0.002) and its maintenance could also be documented in all cases. Disc height at the level above did not show any significant modification. All postoperative MRI showed a non-clinically significant high signal of end-plate on T2 sequences. Clinically relevant complications included one case of pulmonary thrombosis and one case of device extrusion, which was subsequently explanted.
Conclusions: After implantation, most patients continue to enjoy significant pain relief, a considerable amount of mobility is conserved and the disease specific functional outcome is excellent and remains for long, although it could not be supported that the generic health related quality of life is that of the general population.

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Homocysteine and its relationship to deep venous thrombosis in patients undergoing total knee or hip arthroplasty

Hippokratia 2010; 14(3):185-188

H. Mouravas, D. Verettas, K. Kazakos, K. Xarhas, N. Panagiotou, P. Ellinas

Abstract

Backround: The role of hyperhomocysteinemia as an independent risk factor for venous thrombosis after lower limb arthroplasty remains questionable. The objective of this study is to determine the relationship between hyperhomocysteinemia and postoperative thromboembolic events in patients undergoing total hip or knee arthroplasty.
Method: Between September 2004 and June 2006, we studied 172 patients (41 male and 131 female) with mean age 70.2 years (48-85). Total plasma homocysteine as well as other thrombophilic agents (proteinC, protein S, Antithrombin III, Lupus anticoagulants, APC-Resistance) were measured preoperatively. Duplex sonography was performed twice postoperatively, on the 7th day (+/-2) and on the 42th day (+/- 2). Spiral CT was performed when pulmonary embolism was suspected.
Results: Four patients developed deep venous thrombosis from which two developed pulmonary embolism. Only one of these four patients had high levels of total plasma homocysteine.
Conclusions: Total plasma homocysteine does not seem to affect the development of deep venous thrombosis in patients undergoing total knee or hip arthroplasty and receive low molecular weight heparine.

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Correlation of depressive symptoms and olfactory dysfunction in patients on hemodialysis

Hippokratia 2010; 14(3):189-192

E. Grapsa, E. Samouilidou, K. Pandelias, C. Pipili, N. Papaioannou, T. Mpakirzi, H. Tzanatos

Abstract

Background and aim: A possible link between depression and olfactory dysfunction has been suggested in the literature, in research projects using the olfactory bulbectomy model. In human studies using a syndrome-oriented approach, such an association has not been reported consistently. The aim of the study was to test the association of olfactory dysfunction with depression using a symptom-oriented approach.
Paients and methods: Twenty eight end-stage renal failure patients took part in this project. The patients? olfactory identification ability was tested with the University of Pennsylvania Smell Identification Test (UPSIT). Immediately before olfactory testing, the subjects completed the Zung self-rating scale, which provides data on symptoms of depression in this group of patients.
Results: The mean value of the number of mistakes made in the olfactory identification ability (UPSIT test) by the total sample was 14.0?4.5, with a range 6-22. Half of the symptoms seem to bear an influence on the olfactory identification performance. Patients experiencing decreased libido and dissatisfaction exhibited significantly reduced olfactory function, as contrasted to those not experiencing these symptoms. The above results remain practically unaltered even after taking into account such probable confounding factors as age, sex, olfactory detection threshold and duration of illness.
Conclusion: These findings support previous evidence indicating that olfactory dysfunction may be related to specific depressive symptoms in humans. The present findings also suggest that the symptom-oriented approach is an effective research tool for the elucidation of such clinical issues. The need for further research in this field is pointed out.

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Nutrition parameters as hemodialysis adequacy markers

Hippokratia 2010; 14(3):187-191

R. Stolic, G. Trajkovic, D. Stolic, V. Peric, G. Subaric-Gorgieva

Abstract

Background and aim: The nutritive status has significant role in improving the quality of life of dialysis patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD.
Methods: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status. One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55?12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ? 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2).
Results: Patients with adequate hemodialysis had been longer on dialysis in correlation with the group of patients with non-adequate hemodialysis (73 ? 56.4 vs. 44 ? 50.1 months; p: 0.004). Group A and group B presented significant differences in the number of leukocytes (p: 0.027), and hemoglobin (p: 0.047), potassium (p: 0.038) and C-reactive protein level (p: 0.048) as well as in serum total protein (69 ? 4.63 vs. 65 ? 5.74 g/L; p < 0.0001) and albumin (38 ? 2.99 vs. 29 ? 4.4 g/L; p: 0.047). Pearson?s correlation of factors that may have impact on hemodialysis adequacy indicated a significant relation between serum total protein and the index of hemodialysis adequacy (r: 0.21; p: 0.0446).
Conclusions: All investigated anthropometric parameters and protein status showed significantly higher values in patients with adequate hemodialysis quality (Group A). The Group B showed higher levels of CRP and lower values of hemoglobin.

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The sural sensory/radial motor amplitude ratio for the diagnosis of peripheral neuropathy in type 2 diabetic patients

Hippokratia 2010; 14(3):198-202

N Papanas, G. Trypsianis, G. Giassakis, K. Vadikolias, D. Christakidis, H. Piperidou, G. Efstratiadis, E. Maltezos

Abstract

Background and aim: The diagnosis of peripheral diabetic neuropathy is based on clinical examination. Nerve conduction study (NCS) enables earlier diagnosis, but it is demanding and requires specialised personnel. In an attempt to simplify the procedure, this study aimed to identify a new electrophysiological index, which might correlate with results obtained on standardised NCS in patients with long-standing type 2 diabetes.
Patients and methods: Medical records of type 2 diabetic patients evaluated for neuropathy by NCS were reviewed retrospectively. This analysis included 104 patients (50 men, 54 women) with a mean age of 67.1?5.5 years and mean diabetes duration of 13.1?2.7 years. NCS was performed on radial, ulnar, sural, and peroneal nerves. Neuropathy was defined as impaired NCS. Ratios of neurophysiological parameters from these nerves were calculated and each of them was compared with diagnosis of neuropathy.
Results: The sural sensory/radial motor amplitude ratio had the best combination of sensitivity (85%) and specificity (71%) for neuropathy. It also remained the strongest independent predictor of neuropathy in multivariate regression analysis: low levels of this ratio yielded an odds ratio of 7.7 for neuropathy. Conclusions: The sural sensory/radial motor amplitude ratio has a high sensitivity and a moderately high specificity for the diagnosis of neuropathy, low levels being associated with a nearly eightfold increase in the risk for neuropathy. These results encourage further evaluation of this and other electrophysiological indices to enable wider availability of NCS.

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First body fat percentiles for 607 children from Thessaloniki-Northern Greece

Hippokratia 2010; 14(3):208-211

D. Papandreou, P. Malindretos, I. Rousso

Abstract

Background and Aim: The purpose of this study was to establish for the first time reference curves for body fat levels in a Greek pediatric population aged 7-15y.
Methods: Six hundred and seven (607) children randomly selected from 8 primary and secondary schools from Northern Greece. Percentage body fat was measured by bioelectrical impedance analysis and percentile curves were constructed using the LMS method. All children were measured twice in the morning and the mean number of the two measurements was considered as the percentage of body fat.
Results: The mean number of the percentage body fat for the age group (7-9) was 18.2 ? 5.1 and 18.4 ? 6.1 for boys and girls, respectively. In the second age group (10-12) the girls had higher mean fat levels than boys (22.6 ? 5.8 vs. 20.4 ? 6.2). This increase was continued also in the third age group (13-15) with the girls having higher mean body fat levels (24.2 ? 5.5 vs. 17 ? 5.9). The 85th and 95th percentiles represented the cut-off point for overweight and obesity and it was (26.3, 33.0 and 28.9%) and (34.0, 38.2 and 38.1) for boys for the three age groups (7-9, 10-12 and 13-15), respectively. On the other hand, the girls had higher 85th and 95th percentiles for the same age group (7-9, 10-12, 13-15y) and it was (34.5, 32.9 and 33.6%) and (39.0, 370 and 38.3%), respectively.
Conclusion: Body fat level, which is the component of overweight that leads to pathology, is a better representative over body mass index. These first percentile curves will be at great assistance helping the medical community to identify obesity in these children at early stages and to prevent development at pathological diseases early in their lives.

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Weaver syndrome associated with bilateral congenital hip and unilateral subtalar dislocation

Hippokratia 2010; 14(3):212-214

P. Mikalef, T. Beslikas, I. Gigis, I. Bisbinas, T. Papageorgiou, I. Christoforides

Abstract

Background: Weaver syndrome is a congenital paediatric syndrome characterized by mental, respiratory and musculoskeletal manifestations. The coexisting deformities of the skull, the face, fingers and toes are typical. We report a case of a girl with Weaver syndrome associated with rare bilateral congenital dislocation of the hips associated with congenital hypoplastic talus and subtalar dislocation of her ankle joint.
Case Report: A 3-year old girl was admitted in our department with typical manifestations of Weaver syndrome, associated with congenital dislocation of bilateral hips, hypoplastic talus and subtalar dislocation of her right ankle. She was in pain while standing upright and incapable of independent walking. Both hips were treated operatively with open reduction and bilateral iliac osteotomy. Two years afterwards she had an open reduction of her talus and extraarticular arthrodesis of her subtalar joint in her right ankle. Six years postoperatively after the hip operations and four years after the ankle operation the girl is ambulant with a painless independent and unaided walking with a mild limp and full range of movements in all the operated joints.
Conclusions: We suggest that children with Weaver syndrome and disabling musculosceletal deformities, particularly affecting their ability to stand up and walk should be treated early, before bone maturity, in order to achieve the best potential musculoskeletal as well as developmental outcome.

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Effective treatment of antiphospholipid syndrome with plasmapheresis and rituximab

Hippokratia 2010; 14(3):215-216

G. Tsagalis, E. Psimenou, L. Nakopoulou, A. Laggouranis

Abstract

With the exception of the catastrophic antiphospholipid syndrome (APS), the management of patients with APS has been largely supportive aiming at avoiding a recurrent thrombotic event; it is noteworthy that data concerning therapy targeting the triggering factor (the antiphopsholipid antibodies) are scarce. We report a case of APS manifested as recurrent fetal losses, ischemic stroke and renal dysfunction with concomitant nephrotic syndrome successfully treated with the combination of plasmapheresis and anti-CD20 antibody.

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Unicystic ameloblastoma of the maxillary sinus: Pitfalls of diagnosis and management

Hippokratia 2010;14(3):217-220

P. Pitak-Arnnop, A. Chaine, K. Dhanuthai, JC. Bertrand, C. Bertolus

Abstract

Background: Ameloblastoma is a common odontogenic tumor of the jaws that comprises 3 variants: conventional (solid), unicystic and peripheral ameloblastomas. Unicystic ameloblastoma (UA) in the maxillary sinus is very rare. With a secondary infection, the clinical features may lead to incorrect diagnosis and treatment.
Patients and Methods: A 19-year-old man was referred for the management of sinusitis and a mass at the right cheek. A few weeks earlier, the patient presented with acute cellulitis at the same area and underwent an incision and drainage in a primary care unit without any appropriate investigation. A radiographic examination revealed a massive lesion in the right maxillary sinus. An unerupted tooth within the lesion was found at the level of the orbital floor. Results: The patient was successfully treated by enucleation of the tumor and curettage. The specimen was sent for histopathological examination, and the definite diagnosis was UA. The patient has been followed-up periodically for 5 years without recurrence.
Discussion: This case report suggests that primary care doctors should pay attention to differential diagnosis of orofacial lesions. It is therefore of great benefit to organize continuing education for general physicians who initially meet oral disease patients as a ?gate keeper?. Errors of clinical diagnosis and management of orofacial lesions would be minimized. Pitfalls of diagnosis and management of UA in the maxillary sinus were briefly reviewed.

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Electrocardiographic findings compatible with Brugada syndrome in a patient with febrile respiratory infection

Hippokratia 2010; 14(3):221-223

K. Tsarouhas, P. Papalexis, I. Kafantaris, Ch. Tsitsimpikou, S. Vavetsi, E. Rentoukas

Abstract

Brugada syndrome is an inherited autosomal dominant-type disease characterized by ST-segment abnormalities and increased fatal ventricular tachyarrhythmias. We hereby present a 57-years-old patient with no symptoms or history of cardiovascular disease, diagnosed with febrile respiratory infection (39?C). Electrocardiographic (ECG) findings were typical of Brugada-like type I syndrome that gradually turned to Brugada type II and III, following fever remission, and finally became normal. Other clinical evaluation tests (echocardiographic evaluation, treadmill stress test, Holter ECG, procainamide provocation test) did not relate to Brugada syndrome.

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