Incretins in type 2 diabetes mellitus: cardiovascular and anti-atherogenic effects beyond glucose lowering

Hippokratia. 2012; 16 (2):100-105

M. Psallas, C. Manes

Abstract

Type 2 diabetes mellitus is the most outspreading disease of the western world and it provides cardiovascular disease. During the past decade new drug categories were added to the already existing ones. Perhaps, the most outstanding, as promising, too, are glucagon-like peptide-1(GLP-1) analogues, which pinpointed at the incretin hormone system, targeting mainly at the postprandial hyperglycemia.It seemed that these novel drugs have beneficial effects on ischemic heart, heart failure,blood pressure, even on lipids and body weight in type 2 diabetics, considering them not only as another glucose lowering agent. A lot of recent studies investigate the potential relationship between GLP-1 and its possible cardioprotective and anti-atherogenic effects in type 2 diabetes and the present review discusses these effects of GLP-1.

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Thyroid surgery with harmonic focus, ligasure precise and conventional technique: a retrospective case-matched study

Hippokratia. 2012; 16(2):154-159

A. Bove, IG. Papanikolaou, G. Bongarzoni, PA. Mattei, H. Markogiannakis, M. Chatzipetrou, V. D' Addetta, RM. Di Renzo, M. Fiordaliso, L. Corbellini

Abstract

Background:New surgical technologies have been introduced in thyroid surgery, to achieve vessel sealing and hemostasis. The aim of the study was to examine their effectiveness and compare the outcome of total thyroidectomy using the Harmonic Focus™, the LigaSure® Precise and the conventional technique of suture ligation.
Methods: A retrospective case-matched study of all total thyroidectomies between October 2008 through May 2010 was conducted. Patients (n=240) underwent total thyroidectomy using three different methods; the Harmonic Focus™ (Group F, n=80), the LigaSure Precise® (Group L, n=80) and the conventional technique of suture ligation (Group C, n=80).
Results: No significant differences were identified between the 3 groups in terms of demographics, thyroid gland weight, pathologic diagnosis, preoperative and postoperative calcium levels, postoperative complications, duration of hospital stay, and final outcome. The operative time was shorter with Harmonic Focus™ by about 15%. Statistical analysis revealed a statistically significant difference between operations with F (62.7±14.1 minutes) and C (72.7±13.6minutes) with (p=0.019).
Conclusions: Both devices were safe and efficient. A significant reduction of the operative time was found with Harmonic Focus™ compared to the other two techniques with no statistically significant differences in postoperative complications in the 3 groups.

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The new biology: a bridge to clinical cardiology

Hippokratia. 2012; 16(2):106-112

GE. Louridas, KG. Lourida

Abstract

The recent advances in the biological research have produced new biological disciplines with clinical applications in medicine and cardiology. The integration of multilevel biological data and the connection with the clinical practice reveal the potential of personalized medicine and nanotechnology with future implications for prognosis, diagnosis and management. In the post-genomic time period the new disciplines, systems biology, synthetic biology and translational medicine are emerging as significant research areas in biology and medicine with extension in the field of clinical medicine and cardiology. These disciplines, with their predictive, preventive and therapeutic potential, are formulating the concept of personalized management, with patient's energetic involvement and participation in the diagnosis and treatment. Personalized medicine and cardiology, using biomarkers as health and disease indicators, encourage drug development and direct towards a better molecular comprehension of disease processes.

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Pulmonary microvascular permeability and gas exchange in patients with syndrome X

Hippokratia 2012; 16 (2): 113-117

G. Durmus-Altun, SA. Vardar, YS. Salihoglu, M. Aktoz, B. Dirlik, A. Altun

Abstract

Aim: This clinical study was planned to assess pulmonary microvascular permeability in patients with Syndrome X (SX) by using a functional imaging tool, technetium 99m-diethyltriaminepentaaceticacid (99m Tc-DTPA) lung clearance scintigraphy, and the pulmonary functions test, which includes diffusion capacity of the lung for carbon monoxide (DLCO).
Methods: The study population consisted of 22 non-smoker subjects divided into two groups. First group comprised 12 patients (4 male, 8 female, mean age: 48±4 years, range 36 to 65) with SX. Ten healthy subject (4 men, 6 female, mean age: 45±3 years, range 34 to 58) were served as control group. Volumetric pulmonary functions, including DLCO were also performed before lung scintigraphy. Alveolar epithelial ermeability was assessed by measuring the pulmonary clearance of an inhaled 99mTc-DTPA using a gamma camera.
Results: Spirometric data was comparable in both groups. Although volumetric pulmonary measurements were similar, DLCO values of SX patients were lower than those in control 20.9±1.7 ml/min/mmHg vs. 27.8±1.3 ml/mi /mmHg, p=0.002). The mean clearance rate of 99mTc-DTPA in control subjects was 106±6 min, and this value was lower than patients with SX (179±19 min; p=0.0001).
Conclusion: We conclude that lung is a target organ for SX. The pulmonary gas exchange and microvascular permeability, which is measured by 99mTc-DTPA scintigraphy, are restricted without change of volumetric pulmonary functions in patients with SX.

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Serum antioxidant status among young, middle-aged and elderly people before and after antioxidant rich diet

Hippokratia 2012; 16(2):118-123

E. Limberaki, Ph. Eleftheriou, E. Vagdatli, V. Kostoglou, Ch. Petrou

Abstract

Background: The influence of factors such as age, sex, life style and smoking on oxidative stress status of the organism remains unclear. There is evidence that dietary intake of antioxidants is thought to enforce the organism ability to counteract free radicals. Administration of synthetic antioxidants as dietary supplements does not seem to have the same beneficial effect as consumption of the same antioxidants as part of food ingredients. This work focuses on the investigation of age and diet effects on oxidative stress and examines the hypotheses of their significant influence.
Methods: Blood samples of 146 volunteers, were collected and allocated in three age groups. All volunteers completed a questionnaire concerning home and working environmental conditions, special habits and dietary preferences. We implemented a thirty days diet rich in antioxidants in 55 volunteers. Antioxidant activity was estimated before and after the special diet by measuring the in!uence of serum in oxidation of ABTS by the ferryl myoglobinhydrogen peroxide system.
Results: Our finndings showed unexpected lower serum total antioxidant capacity (TAC) in younger people (ages 18-35 yrs) 79%, compared to middle aged and elderly individuals and a large increase 62% in serum TAC of all age-groups after the one-month special diet.
Conclusions: These results imply that a diet rich in antioxidants based on antioxidant rich food consumption and not on single antioxidants administration, can increase the antioxidant status of the organism and other better health. The total serum antioxidant status increases with age and this fact should be taken into account when TAC is measured in different diseases.

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The attitudes of surgeons concerning preoperative smoking cessation: a questionnaire study*

Hippokratia 2012; 16(2):124-129

O. Ozturk, I. Yilmazer, A. Akkaya

Abstract

Background: The purpose of this study was to evaluate the attitudes and behavior of surgeons regarding preoperative smoking cessation.
Methods: A total of 109 anonymous questionnaires were distributed to non-vascular surgeons in our hospital, inquiring about their smoking attitudes, their smoking cessation advice practices, whether they appreciated the benefits of preoperative smoking cessation, and their knowledge of smoking cessation methods.
Results: Eighty questionnaires (from 51 resident doctors and 29 academic staff) were returned (response rate: 73.40%). Of the surgeons, 17.50% were current smokers. Although 40% of the surgeons surveyed believed that preoperative smoking cessation reduces postoperative complications, 31.2% of the surgeons (25/63) had given smoking cessation advice at least to 1 patient in the last month. Most of the resident doctors (39.2%) advised smoking cessation within a month; prior to surgery however, the academic staff (27.6%) advised cessation immediately before the operation (p=0.038). There was a significant difference between academic sfaff and resident doctors concerning the method to increase a patient's chance of quitting (p=0.045), even among current smokers (p=0.049).
Conclusion: The surgeons who participated in the questionnaire were aware that smoking cessation improves outcome, but most of them did not appreciate that providing brief advice, referring to cessation services, or prescribing nicotine replacement therapy (NRT) may be of benefit in helping patients to quit. It is necessary to educate surgeons about the scale of the benefit and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke.

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A perspective from the practice of swaddling by Turkish mothers

Hippokratia 2012; 16(2):130-136

AE. Yilmaz, NS. Unsal, N. Celik, M. Karabel, EA Keskin, S. Tan, S. Aldemir

Abstract

Aim: The purpose of this study was to investigate the practice of swaddling by Turkish mothers residing in different areas of the country (rural or urban), and determine to their level of knowledge on its positive and negative effects on children's health.
Material and Methods: A total of 632 mothers with an infant aged 0-3 months who presented to our University Hospital volunteered their participation and 598 mothers were included in the study. The study was based on a questionnaire form given to the mothers.
Results:Two hundred eighty three (283) mothers swaddled their infants (47.3 %), while 315 mothers did not swaddle (52.7%). The mothers that swaddled their baby cited tradition ("That's what I learned from my elders") as the most common reason (38%) for swaddling. The most important reason (32%) for not swaddling was the mothers' belief "that it would prevent normal development".
Conclusion: In Turkey, the swaddling tends to decrease with the increase of maternal education level and socio-economic situation. The level of Turkish mother's knowledge about beneficial and adverse effect of swaddling were insuficient. We think that the information about properly swaddling should be given to mothers In order to benefit from it's positive effects and at the same time and avoid its adverse effects.

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Association of glomerular ltration rate and inflammation with left ventricular hypertrophy in chronic kidney disease patients

Hippokratia 2012; 16(2):137-142

E. Dervisoglu, G. Kozdag, N. Etiler, B. Kalender

Abstract

Background: Although left ventricular hypertrophy (LVH) is an independent predictor of mortality in patients with end stage renal disease, few have examined its prevalence before the initiation of dialysis. !e aim of this study was to investigate the relationship between LVH, estimated glomerular filtration rate (GFR), and inflammatory markers in patients with chronic kidney disease (CKD).
Methods: Forty-one CKD patients (18 women, 23 men, mean age 53±17 years) with an estimated GFR between 15 and 59mL/min (mean 34.2 mL/min) were enrolled and the following tests performed: routine serum biochemical analyses, high sensitivity C-reactive protein (hs-CRP), fibrinogen, ferritin, and homocysteine, and left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and left ventricular fractional shortening (LVFS).
Results: LVH was diagnosed in 32/41 patients (78%). CKD patients with LVH (n=32) had signicantly higher hs-CRP (p=0.012), fibrinogen (p=0.031), and lower serum albumin (p=0.028) levels than those without LVH (n=9). In all patients, LVMI correlated positively with hs-CRP (r=0.483, p=0.002) and serum fibrinogen (r=0.426, p=0.015). Estimated GFR correlated positively with LVEF (r=0.414, p=0.007) and LVFS (r=0.376, p=0.018).
Conclusions: Important positive associations exist between markers of inflammation and LVMI in patients with CKD. In addition to hs-CRP, elevated fibrinogen may portend the development of LVH in patients with CKD who are not yet on dialysis.

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A comparison of the effects of losartan and ramipril on blood pressure, renal volume and progression in polycystic kidney disease: A 5-Year follow-up

Hippokratia 2012; 16(2):143-148

S. Ulusoy, G. Ozkan, P. Kosucu, K. Kaynar, I. Eyuboglu

Abstract

Background: The major cause of hereditary renal failure is autosomal dominant polycystic kidney disease (ADPKD). Many factors affect renal progression in these patients. Among these, hypertension and an increase in renal volume are interrelated in terms of their effects on renal progression. We aimed to investigate the effects of losartan and ramipril on renal volume and progression in patients with ADPKD.
Materials and Methods: Data from 18 hypertensive patients with ADPKD were evaluated. Eleven of the 18 hypertensive patients were on losartan and 7 on ramipril treatment. Demographic parameters, use of antihypertensives and other medications, the course of blood pressure (BP), biochemical parameters, creatinine clearance (CrCL), findings at computed tomography and renal volume were recorded at baseline and at 1 and 5 years.
Results: Target BP values were maintained over 5 years. The annual decrease in CrCL was 1.33 mL/min in the losartan group compared with 6.59 mL/min in the ramipril group. There was no significant difference between the groups in terms of annual decrease in CrCL. Annual increase in renal volume was 252.04 cm³ in the losartan group and 167.36 cm³ in the ramipril group. There was no significant difference between the groups in terms of the increase in renal volumes at 1 and 5 years.
Conclusion: Our study demonstrated that losartan and ramipril provided effective BP control. In addition, the results of our study demonstrated that despite the increase in renal volume, losartan and ramipril may have regressed renal progression via other factors.

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Twenty four-hour ambulatory blood pressure monitoring and lipid levels before, 3, 6 and 12 months aer the onset of hemodialysis in chronic kidney disease patients: a pilot study

Hippokratia. 2012; 16(2):154-158

AG. Vagiona, SA. Koupidis, P. Passadakis, EL. Thodis, V. Vargemezis

Abstract

Background: Twenty four-hour ambulatory blood pressure (BP) monitoring (ABPM) is being increasingly used to evaluate the effectiveness of antihypertensive medications. We aimed to to investigate the incidence of "non-dippers" in ESRD patients before, as well after the initiation of hemodialysis, to evaluate whether start of hemodialysis is associated with a reduction in the use of antihypertensive drugs, and to correlate 24-hour ABPM with serum lipid levels, the use of lipid-lowering drugs (statins) and the development of the Metabolic Syndrome (MetS) in these patients.
Methods: Thirty patients scheduled to initiate hemodialysis (glomerular filtration rate <15 ml/min/1.73m²) were prospectively recruited. Twenty four-hour ABPM and lipid levels were recorded before (T0), as well as 3 (T1), 6 (T2) and 12 (T3) months after hemodialysis onset.
Results: A progressively significant (p=0.025) decrease in the use of antihypertensive medications was observed in 26 of 30 patients throughout the study, whereas the remaining four patients were not hypertensive during the same period. There was a progressive increase in the use of statins for the management of dyslipidemia (p=0.015). This increase in statin use was coupled with an increase in the prevalence of the MetS in the study population (p=0.040). Patients with daily BP<135/85 mm Hg had a lower incidence of new MetS compared with patients with daily BP >135/85 mm Hg (p=0.053).
Conclusions: Patients initializing hemodialysis demonstrate a progressively increased incidence of dyslipidemia and MetS, as well as a reduction in the use of antihypertensive drugs. Optimal management of BP and dyslipidemias is essential to reduce the high cardiovascular morbidity and mortality rates in this high-risk population.

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Non steroidal antiinflammatory drugs may be harmful to normal kidneys: experimental surgery model*

Hippokratia. 2012; 16 (2): 160-165

E. Hur, E. Duman, D. Bozkurt, E. Sozmen, S. Sen, H. Taskin, O. Timur, SO. Kaya, S. Duman

Abstract

Background and aim: The exact effect of analgesics on normal kidneys is not known yet. We aimed to evaluate the impression of non steroidal antiinflammatory drugs (NSAID) used post-operatively on kidneys, in rat (tracheotomy) model.
Methods: Twenty-five non-uremic male wistar albino rats were included. For 18 rats, tracheotomy was performed and divided into two groups. First group, NSAID (diclofenac 10 mg/kg/day intramuscular (im)) (NSAID, n=8); second group isotonic (im)(Control, n=10) were administered for a week. For third group (Histological control,n=7) in order to evaluate normal histology neither surgery nor medication were applied. At the end (7th day), 24 hours urine collected then, blood samples were taken by intracardiac punction and were sacrified. One of the kidneys fixed for histological evaluation, the other was preserved for the measurements of tissue enzyme levels. Lipid peroxidation products and antioxidant enzyme levels were measured both from plasma and renal tissues. Histologically inflammation, regeneration, degeneration assessed semiquatitativelly and immunohistochemical dyes were applied.
Results: Hemoglobin thiobarbituric acid reactive substance level indicating the increase of lipid peroxidation in NSAID group was higher than control group (673±204 vs.373±27nmol/gHb respectively, p>0.05). Superoxide dismutase (one of the antioxidant enzymes responsible for reduction of reactive oxygen substances) and serum nitrate levels were lower in NSAID groups (700±68 vs.1371±164U/gHb and 26±4.4 vs.50.8±6.8 µmol/mL respectively, p>0.05). Cyclooxygenase-2 expression was disappeared in NSAID group.
Conclusions: NSAIDs mostly used post-operatively for analgesia, may cause unfavorable effects on kidneys by oxidative stress.

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Lateralized olfactory difference in patients with a nasal septal deviation before and after septoplasty*

Hippokratia. 2012; 16(2):166-169

G. Fyrmpas, M. Tsalighopoulos, J. Constantinidis

Abstract

Background: patients with a smell disorder and less often, healthy people, exhibit an olfactory difference between the two sides of the nose. Higher olfactory thresholds are correlated with the obstructed side of a nasal septal deviation (NSD). With this prospective study we sought to investigate if a NSD compromises the olfactory identification.
Materials and methods: thirty patients with nasal obstruction due to a NSD were recruited. The patients were listed for primary septoplasty with or without radiofrequency reduction of the inferior turbinates. Pre- and postoperatively, patients were assessed by visual analogue scales for symptoms and by the bilateral nasal spirometry (nasal partitioning ratio-NPR) for the side/degree of obstruction. Olfactory identification was tested separately for each nasal cavity by means of the 12 item Sniffin Sticks test (12-SS test) and a 3-point difference between the nasal sides was considered significant.
Results: the mean age of patients (25 males/5 females) was 33 years (range 17-52). No complications or anosmia were reported postoperatively. Subjective hyposmia, nasal obstruction and the NPR were reduced (p<0.001). Significant lateralized differences were present in 20% and 13% of patients before and after septoplasty respectively; the change was not significant (p=0.754). Patients with a significant lateralized olfactory difference had a greater NPR pre- (p=0.031) but not postoperatively (p=0.783). The sides of obstruction and worst olfactory performance did not differ in these patients before surgery. Conclusions: olfactory identification may be compromised on the convex side of a large NSD. Post-operatively, patients exhibit a lateralised smell identification difference as often as healthy people. The effect of a clinically significant NSD on the different aspects of olfactory performance warrants further study.

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An Evaluation of European Countries' Health Systems through Distance Based Analysis

Hippokratia. 2012; 16(2):170-174

V. Jeremic, M. Bulajic, M. Martic, A. Markovic, G. Savic, D. Jeremic, Z. Radojicic

Abstract

Introduction: The issue of evaluating the efficiency of health systems has been elaborated upon frequently. Since "health" is a multi-faceted concept, many variables of different measurement units must be included in its analysis; consequently, this presents a great obstacle for researchers to overcome.
Materials and Methods: A novel statistical approach for evaluating the efficiency of organizational units is here proposed, which can also be easily applied to the health sector. For these purposes, the health status of the 27 countries belonging to the European Union has been examined by employing a statistical Ivanovic-Jeremic Distance Based Analysis (DBA) on various health indicators.
Results: The subsequent outcome of the Distance Based Analysis has shown that Cyprus and Ireland have a most efficient health system sectors. Greece also has exceptional indicators of health service, yet health on the individual level is not comparable.
Limitations: Since it synthesizes many variables into an efficiency score, a DBA can be easily applied to other regions/ countries. However, the choice of input and output variables can be considered to be potential limitations since a different choice of variables may cause different efficiency scores for the countries selected.
Conclusions: A DBA approach contributes significantly to the efficiency in the field of research measurement. This analysis can be additionally performed alongside DEA and SFA methods, as a new measure of efficiency.

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Diagnosis and management of congenital neonatal chylous ascites

Hippokratia 2012; 16(2):175-180

V. Mouravas, O. Dede, H. Hatziioannidis, I. Spyridakis, A. Filippopoulos

Abstract

Background: Congenital chylous ascites is a rare condition that constitutes a challenge for the physician. It is defined as the accumulation of chyle into the peritoneal cavity in infants younger than 3 months. This condition is often refractory to therapy and it is responsible for serious malnutrition and immunological de!ciency because of the loss of proteins and lymphocytes.
Material and methods: Four cases of congenital neonatal chylous ascites, were treated by our staff during the last two years. One case was treated conservatively and three with laparotomy. Two of them had intraabdominal cysts that were excised and one was treated with ligation of the left lumbar lymphatic trunk and cisterna chyli and the use of fibrin glue.
Results: All four cases were treated successfully. On follow up tests no one showed recurrence of the ascites. All children, except the one that treated conservatively and also had other problems due to prematurity, are growing up normally.
Conclusions: Congenital chylous ascites is a complex condition. Its diagnostic evaluation is diffcult and its therapy of long duration. Conservative treatment is in most cases the initial choice, but when it fails, exploratory laparotomy could provide a successful alternative.

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Perforated endometrial appendicitis in pregnancy

Hippokratia 2012; 16(2):181-183

E. Giorgakis, V. Karydakis, A. Farghaly

Abstract

Background: Endometriosis is a common disorder in women of reproductive age. A rare localization is the appendix, which, in most cases, is an incidental finding during appendectomies. The incidence of symptomatic appendiceal endometriosis or endometrial appendicitis might be increased in pregnancy. Moreover, endometrial appendicitis in pregnancy is more likely to present in an advanced stage, given the physiologic changes characterizing the gravid abdomen.
Materials and Methods: Description of a case of a pregnant woman presenting to the A&E with acute peritonitis attributable to advanced appendicitis. She underwent emergency laparotomy with appendectomy. The biopsy specimen was examined by the pathology laboratory of the same hospital.
Results: The laparotomy revealed perforated appendicitis. The histopathology report described acute endometrial appendicitis.

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Diagnosis of dialysis leak in children on peritoneal dialysis using radionuclide technique

Hippokratia. 2012; 16(2):184-186

EM. Sahpazova, D Kuzmanovska, A. Bogdanovska

Abstract

Dialysis leak from the peritoneal cavity into various tissue planes, most often into subcutaneous tissue around a previous surgical incision or trough umbilical hernia is known complication of continuous ampulatory peritoneal dialysis (CAPD). This complication leads to bed ultrafiltration and compromise the peritoneal dialysis. Usually computed tomogtaphy (CT) makes the diagnosis of dialysate leakage. However there are other techniques that have been shown useful in particulars occasions. Peritoneoscintigraphy is an underestimated noninvasive technique for diagnosis of dialysate leakage. We refer a 9-year-old girl who was on CAPD for 2 years and presented with genitals oedema and failure of ultrafiltration. Using peritoneoscintigraphy we diagnosed leakage of dialysate in subcutaneous tissue through umbilical hernia. CT has proved this finding. We conclude that the peritoneoscintigraphy is an instrumental technique to identify the causes of genital edema in patients on peritoneal dialysis.

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Is hypertension a manifestation of the nutcracker phenomenon/syndrome? Case report and brief review of the literature

Hippokratia.2012; 16(2):187-189

A. Mazarakis, G. Almpanis, N. Tragotsalou, D. Karnabatidis, C. Fourtounas

Abstract

Hypertension has been rarely reported in patients with the nutcracker phenomenon/syndrome. We describe a young male adult where a computed tomography angiography provided evidence of left renal vein dilatation, probably due to its compression through the angle between the aorta and the superior mesenteric artery, during the evaluation for secondary hypertension. As there were no other signs for secondary hypertension, we proceeded with a venography of the inferior vena cava and the renal veins that revealed mild anatomical findings compatible with the so called nutcracker phenomenon/syndrome. Blood levels of renin and aldosterone and renocaval pressure gradient from these sites were between normal limits. As there were coexisting anatomical and clinical findings (hypertension), nutcracker syndrome might have been claimed. However, no causal links could be established and these findings should be considered only as a coincidence.

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An unusual characteristic "flower-like" pattern: flash suppressor burns

Hippokratia. 2012; 16(2):189-190

Altun Gurcan

Abstract

The case on contact shots from firearms with a flash suppressor is rare. When a rifle fitted with a flash suppressor is fired, the emerging soot-laden gas in the barrel escapes from the slits of the flash suppressor. If the shot is contact or near contact, the flash suppressor will produce a characteristic "flower-like" pattern of seared, blackened zones around the entrance. This paper presents the injury pattern of the flash suppressor in a 29-year-old man who committed suicide with a G3 automatic infantry rifle.

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