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Medicina, Volume 55, Issue 1 (January 2019)

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Cover Story (view full-size image) Childhood obesity is a serious global public health challenge. Physical activity may be of [...] Read more.
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Open AccessArticle
The Associations between Body Mass Index of Seven- and Eight-Year-Old Children, Dietary Behaviour and Nutrition-Related Parenting Practices
Received: 21 November 2018 / Revised: 11 January 2019 / Accepted: 17 January 2019 / Published: 21 January 2019
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Abstract
Background and objective: Body mass index (BMI) is one of the key indicators used to measure the growth of children. It could be affected by the children’s nutrition, which is essential for the proper development of the child. Nutrition of children could [...] Read more.
Background and objective: Body mass index (BMI) is one of the key indicators used to measure the growth of children. It could be affected by the children’s nutrition, which is essential for the proper development of the child. Nutrition of children could be affected by many environmental factors, for example, the socioeconomic environment of the family. The aim of this study was to identify the associations between the BMI of seven- and eight-year-old children, dietary behaviour and nutrition-related parenting practices. Materials and Methods: The study was carried out as part of the World Health Organization European Childhood Obesity Surveillance Initiative (WHO COSI). Data were collected using two instruments: objective anthropometric measurements and a questionnaire. The target participant group was 3969 Lithuanian first-formers. Factor analysis was used to summarise questions from the family form. Linear regression analysis was used to identify the associations between various factors and the BMI value of the children. The association between two groups of factors was analysed using Spearman correlation. Results: Factors of dietary behaviour like unhealthy food and proteins were significantly positively associated with BMI in children, while consumption of plant-based, dairy and confectionery items was significantly negatively associated with BMI. Factors of nutrition-related parenting practices like control of unhealthy food, food as a reward or punishment, and mealtime were significantly positively associated with BMI, while encouragement, pressure to eat, and liberal attitude were significantly negatively associated with BMI. The strongest associations were between control of unhealthy food and unhealthy food; cost of and preferences for food and plant-based food; variety of food and proteins; variety of food and plant-based food compared to other associations. Conclusions: The dietary behaviour and nutrition-related parenting practices were associated with BMI in children. Full article
Open AccessArticle
Effects of Zumba® and Aquagym on Bone Mass in Inactive Middle-Aged Women
Received: 20 November 2018 / Revised: 22 December 2018 / Accepted: 22 December 2018 / Published: 21 January 2019
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Abstract
Background and objectives: Regular exercise may stimulate bone formation and reduce the loss of bone mass in premenopausal women. This study aims to evaluate the effect of high-impact physical activity (Zumba®) and low-impact physical activity (Aquagym) on bone mass in [...] Read more.
Background and objectives: Regular exercise may stimulate bone formation and reduce the loss of bone mass in premenopausal women. This study aims to evaluate the effect of high-impact physical activity (Zumba®) and low-impact physical activity (Aquagym) on bone mass in inactive middle-aged women. Materials and methods: Fifty-five healthy inactive women (30–50 years old) were recruited in Spain in 2016 and were randomly allocated into one of three groups: High impact group (HIG: n = 15), low impact group (LIG: n = 12) and control group (CG: n = 28). HIG and LIG were recruited from Madrid and the CG from Toledo. HIG and LIG completed a 12-week intervention program with three 40′ sessions per week of Zumba® or Aquagym; respectively. Dual energy X-ray absorptiometry (DXA) measured bone mineral content (BMC) and areal bone mineral density (aBMD) at total body less head (TBLH), lumbar spine and right hip. Results: Post-intervention adjusted data showed no significant differences in BMC between any of the groups nor in aBMD between HIG and LIG. Interestingly; significant differences for the HIG vs. CG were found in the change in total hip aBMD (1.76% vs. −0.44%), femoral neck aBMD (1.80% vs. −2.71%), and intertrochanter aBMD (2.03% vs. −0.50%). Moreover, significant differences for the LIG vs. CG were also found in the change in femoral neck aBMD (−0.54% vs. −2.71%). Conclusions: The regular practice of Zumba® and Aquagym might reduce the progressive deterioration of bone mass in inactive middle-aged women Full article
Open AccessEditorial
Acknowledgement to Reviewers of Medicina in 2018
Published: 20 January 2019
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Abstract
Rigorous peer review is the cornerstone of high-quality academic publishing [...] Full article
Open AccessArticle
Extent and Predictors of Poor Glycaemic Control among Elderly Pakistani Patients with Type 2 Diabetes Mellitus: A Multi-Centre Cross-Sectional Study
Received: 26 September 2018 / Revised: 3 December 2018 / Accepted: 9 January 2019 / Published: 17 January 2019
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Abstract
Objectives: This study aimed to explore the relationship between glycaemic control and factors that may influence this among elderly type 2 diabetes mellitus (T2DM) patients in Lahore, Pakistan. Methods: This descriptive, cross-sectional study was conducted at the Jinnah and Sir Ganga Ram Hospitals, [...] Read more.
Objectives: This study aimed to explore the relationship between glycaemic control and factors that may influence this among elderly type 2 diabetes mellitus (T2DM) patients in Lahore, Pakistan. Methods: This descriptive, cross-sectional study was conducted at the Jinnah and Sir Ganga Ram Hospitals, Lahore using convenience sampling techniques between 1 December 2015 and 28 February 2016. The sample consisted of elderly (>65 years) T2DM patients. Glycaemic values and patient characteristics were obtained from medical charts. Consenting patients were interviewed to complete the Barthel Index, Lawton Instrumental Activities of Daily Living Scale, Clinical Frailty Scale, Iowa Pain Thermometer Scale, Geriatric Depression Scale, Montreal Cognitive Assessment tool, Mini Nutritional Assessment Scale—Short Form and Self Care Inventory—Revised Version. Multiple logistic regression analysis was carried out to determine the predictors of poor glycaemic control. Results: A total of 490 patients were approached and 400 agreed to participate. Overall, nearly one-third (32.2%, n = 129) of patients had glycated haemoglobin (HbA1c) at the target level. Fasting and random plasma glucose levels were within the target range to much the same extent; (36.8%, n = 147) and (27%, n = 108), respectively. HbA1c levels were also higher in patients with co-morbidities (67.4%, n = 229) with diabetes-related complications (73.5%, n = 227). Significant predictors of impaired glycaemic control (HbA1c) included poor diabetes self-care (adjusted odds ratio (AOR) 0.96; 95% confidence interval (CI) 0.95, 0.98), not being prescribed oral hypoglycaemic agents (OHA) (AOR 6.22; 95% CI 2.09, 18.46), regular hypoglycaemic attacks (AOR 2.53; 95% CI 1.34, 4.81) and falling tendency (AOR 0.19; 95% CI 0.10, 0.36). Conclusions: Poor glycaemic control prevailed among the majority of elderly Pakistani diabetic patients in this study. Triggering factors of poor glycaemic control should be taken into consideration by the healthcare professionals in targeting multifaceted interventions to achieve good glycaemic control. Full article
Open AccessArticle
Identification of Prognostic Biomarker Signatures and Candidate Drugs in Colorectal Cancer: Insights from Systems Biology Analysis
Received: 30 November 2018 / Revised: 23 December 2018 / Accepted: 14 January 2019 / Published: 17 January 2019
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Abstract
Background and objectives: Colorectal cancer (CRC) is the second most common cause of cancer-related death in the world, but early diagnosis ameliorates the survival of CRC. This report aimed to identify molecular biomarker signatures in CRC. Materials and Methods: We analyzed [...] Read more.
Background and objectives: Colorectal cancer (CRC) is the second most common cause of cancer-related death in the world, but early diagnosis ameliorates the survival of CRC. This report aimed to identify molecular biomarker signatures in CRC. Materials and Methods: We analyzed two microarray datasets (GSE35279 and GSE21815) from the Gene Expression Omnibus (GEO) to identify mutual differentially expressed genes (DEGs). We integrated DEGs with protein–protein interaction and transcriptional/post-transcriptional regulatory networks to identify reporter signaling and regulatory molecules; utilized functional overrepresentation and pathway enrichment analyses to elucidate their roles in biological processes and molecular pathways; performed survival analyses to evaluate their prognostic performance; and applied drug repositioning analyses through Connectivity Map (CMap) and geneXpharma tools to hypothesize possible drug candidates targeting reporter molecules. Results: A total of 727 upregulated and 99 downregulated DEGs were detected. The PI3K/Akt signaling, Wnt signaling, extracellular matrix (ECM) interaction, and cell cycle were identified as significantly enriched pathways. Ten hub proteins (ADNP, CCND1, CD44, CDK4, CEBPB, CENPA, CENPH, CENPN, MYC, and RFC2), 10 transcription factors (ETS1, ESR1, GATA1, GATA2, GATA3, AR, YBX1, FOXP3, E2F4, and PRDM14) and two microRNAs (miRNAs) (miR-193b-3p and miR-615-3p) were detected as reporter molecules. The survival analyses through Kaplan–Meier curves indicated remarkable performance of reporter molecules in the estimation of survival probability in CRC patients. In addition, several drug candidates including anti-neoplastic and immunomodulating agents were repositioned. Conclusions: This study presents biomarker signatures at protein and RNA levels with prognostic capability in CRC. We think that the molecular signatures and candidate drugs presented in this study might be useful in future studies indenting the development of accurate diagnostic and/or prognostic biomarker screens and efficient therapeutic strategies in CRC. Full article
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Open AccessCase Report
Acute Proximal Myopathy in a Young Male—A Case of Infectious Myositis
Received: 23 December 2018 / Accepted: 14 January 2019 / Published: 17 January 2019
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Abstract
Background and objectives: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in [...] Read more.
Background and objectives: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context. Case Presentation: A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months. Discussion and Conclusion: Bacterial myositis is most often due to Staphylococcus aureus (70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening. Full article
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Open AccessArticle
Pulmonary Endarterectomy in Latvia: A National Experience
Received: 26 September 2018 / Revised: 9 January 2019 / Accepted: 10 January 2019 / Published: 15 January 2019
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Abstract
Background and objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a hemodynamic state characterized by chronic obstruction in pulmonary circulation. The treatment of choice is pulmonary endarterectomy (PEA). The aim of our study was to compile and analyze the data of a small, national [...] Read more.
Background and objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a hemodynamic state characterized by chronic obstruction in pulmonary circulation. The treatment of choice is pulmonary endarterectomy (PEA). The aim of our study was to compile and analyze the data of a small, national center, which has not yet been done in the Baltic states. Materials and methods: The data of Latvian CTEPH registry in timeframe from 1 September 2007 to 31 December 2016 was retrospectively analyzed and all patients who underwent PEA were included. Results: PEA was done for 7 patients. The in-hospital mortality was 14%. The 3-year survival rate was 86%. The procedure restored pulmonary blood pressure to normal values for three of the patients (42%). The remaining four patients (57%) had persistent pulmonary hypertension (mPAP > 30 mmHg), which required continuous therapy. There was a comparable decline in mean mPAP compared to baseline, 53.4 ± 14.4 mmHg to 44.3 ± 30 mmHg, respectively. At 12-month follow-up, there was a significant improvement in functional capacity, as seen by increased 6-min walk test distance and shifts in New York Heart Association functional class. Conclusions: Only 16% of all prevalent Latvian CTEPH patients have underwent PEA in the course of nine years, despite it being the treatment of choice for CTEPH. As PEA and other emerging treatment options, such as balloon pulmonary angioplasty, can only be done in expert centers, numerous organizational, logistical, and economic issues arise for patients of smaller countries, where such centers have not yet been created due to lack of experience and limited amount of patients. Full article
Open AccessArticle
Digenic Inheritance of LAMA4 and MYH7 Mutations in Patient with Infantile Dilated Cardiomyopathy
Received: 23 November 2018 / Revised: 9 January 2019 / Accepted: 10 January 2019 / Published: 15 January 2019
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Abstract
Background and objectives: Dilated cardiomyopathy (DCM) is a rare cardiac disease characterised by left ventricular enlargement, reduced left ventricular contractility, and impaired systolic function. Childhood DCM is clinically and genetically heterogenous and associated with mutations in over 100 genes. The aim of [...] Read more.
Background and objectives: Dilated cardiomyopathy (DCM) is a rare cardiac disease characterised by left ventricular enlargement, reduced left ventricular contractility, and impaired systolic function. Childhood DCM is clinically and genetically heterogenous and associated with mutations in over 100 genes. The aim of this study was to identify novel variations associated with infantile DCM. Materials and Methods: Targeted next generation sequencing (NGS) of 181 cardiomyopathy-related genes was performed in three unrelated consanguineous families from Saudi Arabia. Variants were confirmed and their frequency established in 50 known DCM cases and 80 clinically annotated healthy controls. Results: The three index cases presented between 7 and 10 months of age with severe DCM. In Family A, there was digenic inheritance of two heterozygous variants: a novel variant in LAMA4 (c.3925G > A, p.Asp1309Asn) and a known DCM mutation in MYH7 (c.2770G > A; p.Glu924Lys). The LAMA4 p.Asp1309Asn variant was predicted to be likely pathogenic according to international guidelines. The other two families had no identifiable potentially deleterious variants. Conclusions: Inheritance of two genetic variants may have a synergistic or dose effect to cause severe DCM. We report of a novel p.Asp1309Asn variation associated with DCM. Targeted NGS is useful in the molecular diagnosis of DCM and to guide whole-family management and counselling. Full article
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Open AccessArticle
Associations between Red Blood Cell Transfusions and Necrotizing Enterocolitis in Very Low Birth Weight Infants: Ten-Year Data of a Tertiary Neonatal Unit
Received: 11 December 2018 / Revised: 10 January 2019 / Accepted: 10 January 2019 / Published: 15 January 2019
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Abstract
Background and Objective: Necrotizing enterocolitis (NEC) remains an important cause of mortality in preterm neonates. There are many risk factors for NEC; however, probably the most controversial one is red blood cell transfusions (RBCT). The data concerning the link between NEC and [...] Read more.
Background and Objective: Necrotizing enterocolitis (NEC) remains an important cause of mortality in preterm neonates. There are many risk factors for NEC; however, probably the most controversial one is red blood cell transfusions (RBCT). The data concerning the link between NEC and RBCT has been conflicting. Therefore, we aimed to analyze the association between NEC and RBCT in Neonatal Intensive Care Unit (NICU) at the Hospital of Lithuanian University of Health Sciences. Materials and Methods: We used the Very Low Birth Weight (VLBW) Infants database to match all infants with ≥2a Bell’s stage NEC admitted between 1 January 2005 and 31 December 2014 (n = 54) with a control group (n = 54) of similar gestational age and birth weight and without NEC. We analyzed the charts of these infants and performed statistical analysis on 20 clinical variables including RBCT. Results: The main clinical and demographic characteristics did not differ between the two groups. All variables associated with RBCT (receipt of any RBCT, the number of transfusions and the volume transfused in total) were significantly higher in the NEC group both before the onset of NEC and throughout the hospitalization. RBCT increased the odds of NEC even after adjustment for confounding factors. In addition, we found that congenital infection was more abundant in the NEC group and increased the odds of NEC 2.7 times (95% confidence interval CI (1.1, 6.3), p = 0.024). Conclusions: A higher number and the total volume of RBCT are associated with an increased risk of NEC in VLBW infants. The presence of congenital infection might identify the infants at risk. Full article
Open AccessArticle
The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting
Received: 22 October 2018 / Revised: 8 January 2019 / Accepted: 10 January 2019 / Published: 15 January 2019
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Abstract
Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: [...] Read more.
Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) <2.0, decreased in case of INR >3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of ≥65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of ≥65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care. Full article
Open AccessArticle
Pacing of Women and Men in Half-Marathon and Marathon Races
Received: 4 November 2018 / Revised: 17 December 2018 / Accepted: 9 January 2019 / Published: 14 January 2019
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Abstract
Background and objective: Half-marathon is the most popular endurance running race in terms of number of races and runners competing annually; however, no study has compared pacing strategies for this race distance with marathon. The aim of the present study was to [...] Read more.
Background and objective: Half-marathon is the most popular endurance running race in terms of number of races and runners competing annually; however, no study has compared pacing strategies for this race distance with marathon. The aim of the present study was to profile pacing in half-marathon, compare half-marathon and marathon for pacing, and estimate sex differences in pacing. Materials and methods: A total of 9137 finishers in the half-marathon (n = 7258) and marathon race (n = 1853) in Ljubljana 2017 were considered for their pacing in five race segments (0–23.7%, 23.7–47.4%, 47.4–71.1%, 71.1–94.8%, and 94.8–100% of the race. Results: Half-marathon runners followed a positive pacing with every segment being slower than its previous one without the presence of an endspurt. Compared to marathon (where the average percent of change in speed (ACS) was 5.71%), a more even pacing was observed in half-marathon (ACS = 4.10%). Moreover, women (ACS = 4.11%) had similar pacing as men (ACS = 4.09%) in half-marathons. Conclusions: In summary, running a half-marathon followed a unique pattern that differentiated this race distance from marathon, with the former showing a more even pacing with an absence of endspurt, and sex difference compared to the latter. Consequently, runners should be advised to adopt a less variable pacing when competing in a half-marathon, regardless of their sex. To the best of our knowledge, the more even pacing in half-marathon, than in marathon, was a novel finding, as it was the first study to compare the two race distances for this characteristic. Full article
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Open AccessArticle
Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals
Received: 2 November 2018 / Revised: 27 December 2018 / Accepted: 3 January 2019 / Published: 14 January 2019
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Abstract
Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on [...] Read more.
Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on the inpatient outcomes of bipolar disorder patients. Methods: We used Nationwide Inpatient Sample from the US hospitals and identified cases with bipolar disorder and comorbid BPD (N = 268,232) and controls with bipolar disorder only (N = 242,379), using the International Classification of Diseases, 9th Revision, and Clinical Modification codes. We used multinomial logistic regression to generate odds ratios (OR) and evaluate inpatient outcomes. Results: The majority of the bipolar patients with BPD were female (84.2%), Caucasian (83.1%) and 18–35 years age (53.9%). Significantly longer inpatient stays, higher inpatient charges, and higher prevalence of drug abuse were noted in bipolar patients with BPD. The suicide risk was higher in bipolar patients with BPD (OR = 1.418; 95% CI 1.384–1.454; p < 0.001). In addition, utilization of electroconvulsive treatment (ECT) was higher in bipolar patients with comorbid BPD (OR = 1.442; 95% CI 1.373–1.515; p < 0.001). Conclusions: The presence of comorbid BPD in bipolar disorder is associated with higher acute inpatient care due to a longer inpatient stay and higher cost during hospitalization, and higher suicide risk, and utilization of ECT. Further studies in the inpatient setting are warranted to develop effective clinical strategies for optimal outcomes and reduction of suicide risk in bipolar patients with BPD. Full article
Open AccessArticle
Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators
Received: 18 December 2018 / Revised: 8 January 2019 / Accepted: 9 January 2019 / Published: 14 January 2019
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Abstract
Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators [...] Read more.
Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer–Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient–physician shared decision-making. Full article
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Open AccessReview
Pediatric Celiac Disease in Central and East Asia: Current Knowledge and Prevalence
Received: 12 December 2018 / Revised: 31 December 2018 / Accepted: 3 January 2019 / Published: 12 January 2019
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Abstract
The current prevalence of pediatric Celiac Disease (CD) is estimated to be around 1% in the general population, worldwide. However, according to the geographic area, a great variability of CD prevalence has been described. Whereas a number of studies are available from Europe, [...] Read more.
The current prevalence of pediatric Celiac Disease (CD) is estimated to be around 1% in the general population, worldwide. However, according to the geographic area, a great variability of CD prevalence has been described. Whereas a number of studies are available from Europe, North and South America, Australia, South-West Asia, and North Africa, the knowledge and awareness of CD in large parts of the remaining world areas is definitively poor. In several countries of Central and East Asia, the consumption of wheat is consistent and/or has significantly increased in recent decades, and CD is supposed to be underdiagnosed in children. In this mini-review, we aimed to summarize the current knowledge about the prevalence of pediatric CD in Central and East Asia, paying attention to the HLA-DQ immunogenetic background as well. Indeed, CD is likely not to be as uncommon as previously or currently thought in countries like Russia, Kazakhstan, and China, in addition to India, where pediatric CD has been clearly showed to be quite prevalent. Therefore, there is an urgent need for population-based studies on the prevalence of CD in those countries, especially in children, in order to increase the awareness of this disease and to improve the diagnostic strategy in these areas. Full article
(This article belongs to the Special Issue Advances in Celiac Disease)
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Open AccessArticle
Evaluation of Turmeric Nanoparticles as Anti-Gout Agent: Modernization of a Traditional Drug
Received: 21 November 2018 / Revised: 30 December 2018 / Accepted: 4 January 2019 / Published: 11 January 2019
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Abstract
Background and objectives: Turmeric has assisted in the control of inflammation and pain for decades and has been used in combination with other nutraceuticals to treat acute and chronic osteoarthritis pain. Recently, the effect of turmeric, turmeric extract, or curcuminoids on musculoskeletal [...] Read more.
Background and objectives: Turmeric has assisted in the control of inflammation and pain for decades and has been used in combination with other nutraceuticals to treat acute and chronic osteoarthritis pain. Recently, the effect of turmeric, turmeric extract, or curcuminoids on musculoskeletal pain, either by themselves or in conjunction with other substances, has been reported. The aim of this study was to develop and characterize turmeric nanoparticles (T-NPs) for various parameters, both in vitro and in vivo. Materials and Methods: The T-NPs were successfully synthesized and characterized using particle size analysis, solubility improvement, SEM, EDX, X-ray diffraction, and in vivo antigout activity in mice model. Results: The T-NPs were of about 46 nm in size with a positive zeta potential +29.55 ± 3.44 and low polydispersity index (PDI) (0.264). Furthermore, the diseased mice, with induced gout via monosodium urate crystals, were treated with 5, 10, and 20 ppm T-NPs, administered orally, and the anti-gout potential was observed through measurement of joint diameter and changes in biochemical parameters, including lipid profile, renal function test, and liver function tests which significantly reduced the levels of these biochemical parameters. Conclusions: Uric acid levels were significantly reduced after the treatment with T-NPs. indicating that T-NPs show superior potential against gout management. Thus, T-NPs can be developed as an efficient antigout agent with minimum toxicities. Full article
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Open AccessCase Report
A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum
Received: 19 October 2018 / Revised: 20 December 2018 / Accepted: 8 January 2019 / Published: 10 January 2019
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Abstract
Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our [...] Read more.
Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our emergency room with the chief complaint of lower abdominal pain. Computed tomography imaging revealed a dilated cecum and presence of free air. With a preoperative diagnosis of perforation of the cecum; an urgent surgery was conducted. Intraoperative findings revealed an ischemic change of the cecum and a laparoscopic-assisted ileocecal resection was performed. The pathological findings showed transmural ischemic change on the anti-mesenteric side of the cecum, and the diagnosis of ICN was achieved. Preoperative diagnosis of ICN is difficult because of its non-specific radiological features. In patients with right lower abdominal pain, ICN should be considered as a differential diagnosis especially if the patient has a comorbidity causing hypotension attack. Full article
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Open AccessArticle
Polymorphisms of ABCG2 and SLC22A12 Genes Associated with Gout Risk in Vietnamese Population
Received: 24 October 2018 / Revised: 13 December 2018 / Accepted: 3 January 2019 / Published: 7 January 2019
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Abstract
Background and objective: Gout is a common form of inflammatory arthritis caused by the crystallization of uric acid. Previous studies have demonstrated that the genetic predisposition of gout varies in different ethnic populations. However the association study of genetic variants with gout remains [...] Read more.
Background and objective: Gout is a common form of inflammatory arthritis caused by the crystallization of uric acid. Previous studies have demonstrated that the genetic predisposition of gout varies in different ethnic populations. However the association study of genetic variants with gout remains unknown in the Vietnamese population. Our study aimed to assess the relationship between polymorphisms in ABCG2 and SLC22A12 and gout susceptibility in Vietnamese. Materials and methods: Genomic DNA was extracted from blood of a total of 170 patients with gout and 351 healthy controls. We genotyped single nucleotide polymorphisms (SNPs): rs72552713, rs12505410 of the ABCG2 gene and rs11231825, rs7932775 of the SLC22A12 gene using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) and then confirmed 10% of randomly selected subjects by Sanger sequencing. Results: Three SNPs (rs72552713 and rs12505410 and rs11231825) were in accordance with Hardy–Weinberg Equilibrium (HWE) (p > 0.05) while rs7932775 was not (p < 0.05). For rs72552713, CT genotype was significantly different between gout patient and control groups (p < 0.001) and the T allele was associated with an increased risk of gout (OR = 21.19; 95% CI: 3.00–918.96; p < 0.001). Serum uric acid and hyperuricemia differed significantly between CC and CT genotype groups (p = 0.004 and 0.008, respectively). For rs11231825, a protective effect against gout risk was identified in the presence of the C allele when compared with the T allele (OR = 0.712; 95% CI: 0.526–0.964 p = 0.0302). In contrast, no significant difference of allele frequencies between gout patients and controls was detected for rs12505410 (p > 0.05). However, significant differences in serum uric acid and systolic blood pressure were obtained among gout patients. Conclusion: Our results suggest that ABCG2 rs72552713 and SLC22A12 rs11231825 are likely associated with gout in the Vietnamese population in which T allele may be a risk factor for gout susceptibility. Full article
Open AccessArticle
Association between Physical and Motor Fitness with Cognition in Children
Received: 7 November 2018 / Revised: 12 December 2018 / Accepted: 26 December 2018 / Published: 4 January 2019
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Abstract
Background and objective: There is an increased interest in exploring the association between fitness components with cognitive development in children in recent years. One of the scopes is to find the best exercise prescription to enhance health and cognition. Most of the studies [...] Read more.
Background and objective: There is an increased interest in exploring the association between fitness components with cognitive development in children in recent years. One of the scopes is to find the best exercise prescription to enhance health and cognition. Most of the studies so far have focused on cardiorespiratory fitness with little evidence on other fitness components. The present study aimed to explore the association between physical fitness (PF) and motor fitness (MF) with cognitive performance in children. Methods: Two hundred and six schoolboys (11.0 ± 0.8 y) underwent a battery of tests to measure information processing speed (i.e., simple and choice reaction time) and inhibitory control (i.e., Simon task). PF components (i.e., flexibility, muscular strength, and endurance) and MF components (speed and agility) were measured. Results: Multiple linear regression analysis adjusted for potential confounders (i.e., age, socioeconomic status, %fat and physical activity) revealed no relationship between flexibility, speed, muscular strength, and endurance with either information processing tasks or inhibitory control tasks. However, a positive association was observed between agility with both congruent reaction time and incongruent reaction time. Conclusions: No relationship was observed between the underlying fitness components with either information processing or inhibitory control. However, an association was observed between agility with inhibitory control. Full article
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Open AccessArticle
Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?
Received: 29 September 2018 / Revised: 28 December 2018 / Accepted: 31 December 2018 / Published: 4 January 2019
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Abstract
Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the [...] Read more.
Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 patients were retrospectively reviewed and the predictive factors of postoperative IAA were investigated. In addition, patients were divided into complicated appendicitis (CA) and simple appendicitis (SA) and perioperative factors of two groups were compared. Results: One hundred and forty-seven patients were diagnosed with CA, while the other 69 patients were diagnosed with SA. Sixteen patients developed postoperative IAA in the CA group, while no patients in the SA group did. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p < 0.001), operation time more than 120 min (p = 0.023) and placement of a drainage tube (p < 0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427, 95% CI: 1.586–18.57). Conclusions: IAA developed predominantly in patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding. Full article
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Open AccessArticle
Demographic Variation in the Frequency of Gliomas in Florida
Received: 28 November 2018 / Revised: 26 December 2018 / Accepted: 26 December 2018 / Published: 4 January 2019
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Abstract
Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. [...] Read more.
Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. However, such analyses did not include demographic data specific to the state of Florida. This study assessed the association between race and glial vs. non-glial Central Nervous System (CNS) cancers in Florida, USA. Materials and Methods: This case-control study utilized the Florida Cancer Data Registry (FCDS), in which race was considered the exposure and development of glioma as the measured outcome. The sample was comprised of patients in Florida diagnosed with brain tumors from 1981 to 2013. Relative racial frequencies were compared between patients with glial brain tumors and those with other CNS tumors. Data was analyzed using logistic regression in order to determine any associations between race and frequency of diagnosis adjusting for several confounders (age, sex, smoking status, year of diagnosis, and insurance status). Results: Between 1981 and 2013 a total of 14,092 patients meeting the inclusion and exclusion criteria were diagnosed in Florida with a primary brain tumor. Being of non-white race was associated with 60% decreased odds of glioma diagnosis compared to the reference white population (adjusted OR 0.4, 95% CI 0.34–0.47). Secondary findings include associations between increasing age and male sex with increased odds of glioma diagnosis. Decreased adjusted odds of glioma diagnosis were found with former smoking status (reference non-smokers), diagnosis between 2001 and 2010 (reference 1981–1990), and Medicaid or Medicare insurance (reference private insurance). Hispanic ethnicity, current smoking status, no insurance/self-pay, and geographical location (urban vs. rural) all had no association with glioma diagnosis. Conclusions: These findings are consistent with and help reinforce previous studies utilizing national databases (SEER) which also showed increasing odds of glioma diagnosis in older white males. Various potential explanations for these findings include genetic predisposition, lifestyle and behavioral factors, and socioeconomic status, including access to healthcare. Future research aims at identifying potential genetic etiologies. Full article
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Open AccessArticle
Inflammatory Cytokine and Chemokine Patterns in Paediatric Patients with Suspected Serious Bacterial Infection
Received: 19 November 2018 / Revised: 13 December 2018 / Accepted: 24 December 2018 / Published: 3 January 2019
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Abstract
Background and objectives: In children, acute infection is the most common cause of visits to the emergency department. Although most of them are self-limiting, mortality due to severe bacterial infections (SBI) in developed countries is still high. When the risk of serious bacterial [...] Read more.
Background and objectives: In children, acute infection is the most common cause of visits to the emergency department. Although most of them are self-limiting, mortality due to severe bacterial infections (SBI) in developed countries is still high. When the risk of serious bacterial infection is too high to ignore, yet too low to justify admission and hospital observation, clinicians try to improve diagnostic accuracy by performing various laboratory tests. The aim of the study was to investigate whether an early inflammatory cytokine and chemokine panel can add information in diagnostics of SBI and assessment of efficacy of early therapies in hospitalized children with fever. Methods: This study included 51 children with febrile infections that were admitted to the emergency department (ED). Clinical examination and microbiological and radiological tests were used as reference standards for the definition of SBI. Study population was categorized into two groups: (1) patients with SBI (n = 21); (2) patients without SBI (n = 30). Inflammatory cytokine and chemokine panels were analyzed from the first routine blood samples at hospital admission and after 24 h. Results: Out of 12 cytokines and chemokines, only Eotaxin and granulocyte colony-stimulating factor (G-CSF) had statistically significant differences between groups at the time of inclusion. Receiver operator characteristic analysis to predict SBI showed an area under the curve (AUC) of 0.679 for G-CSF. Conclusions: Analysis of inflammatory cytokine profiles may provide additional information in early diagnostics of SBI. Full article
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Open AccessArticle
Modulation of Renal Insulin Signaling Pathway and Antioxidant Enzymes with Streptozotocin-Induced Diabetes: Effects of Resveratrol
Received: 19 October 2018 / Revised: 7 December 2018 / Accepted: 26 December 2018 / Published: 31 December 2018
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Abstract
Background and objectives: Diabetes mellitus is a disease of insulin deficiency or its inability of usage by the target tissues leading to impairment of carbohydrate, lipid, and protein metabolisms. Resveratrol, having robust anti-inflammatory and anti-oxidant properties, has a high potential to treat or [...] Read more.
Background and objectives: Diabetes mellitus is a disease of insulin deficiency or its inability of usage by the target tissues leading to impairment of carbohydrate, lipid, and protein metabolisms. Resveratrol, having robust anti-inflammatory and anti-oxidant properties, has a high potential to treat or prevent the pathogenesis of diseases. This study was conducted to reveal the relationship between diabetes-induced oxidative stress and tissue inflammation with changes in main enzymatic antioxidants (cat, sod, gpx, and gst) and the components of the insulin signaling pathway (insulin Rβ, irs-1, pi3k, akt, mtor) in kidney tissues. Additionally, the effects of resveratrol on these parameters were evaluated. Materials and Methods: Male Wistar rats were randomly divided into four groups; (1) control/vehicle; (2) control/20 mg/kg resveratrol; (3) diabetic/vehicle; (4) diabetic/20 mg/kg resveratrol. Gene and protein expressions of antioxidant enzymes and insulin signaling elements were evaluated in renal tissues. Results: Downregulation of antioxidant enzymes’ gene expression in the kidney tissues of diabetic rats was demonstrated and this situation was devoted partially to the reduced gene expression of nfκb. Moreover, the components of renal insulin signaling elements were upregulated at both gene and protein expression levels in diabetic rats, and resveratrol treatment decreased this sensitization towards the control state. Conclusion: Resveratrol partially improved diabetes-induced renal oxidative stress and inflammation due to healing action on renal antioxidant enzymes and insulin signaling pathway components. Full article
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Open AccessArticle
Physical Activity Level Using Doubly-Labeled Water in Relation to Body Composition and Physical Fitness in Preschoolers
Received: 14 November 2018 / Revised: 9 December 2018 / Accepted: 20 December 2018 / Published: 27 December 2018
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Abstract
Background and objectives: There is a lack of studies investigating associations of physical activity level (PAL) and activity energy expenditure (AEE) using the doubly-labeled water (DLW) method with body composition and physical fitness in young children. Thus, we aimed to examine cross-sectional [...] Read more.
Background and objectives: There is a lack of studies investigating associations of physical activity level (PAL) and activity energy expenditure (AEE) using the doubly-labeled water (DLW) method with body composition and physical fitness in young children. Thus, we aimed to examine cross-sectional associations of PAL and AEE with body composition indices and physical fitness components in Swedish preschool children. Materials and methods: PAL was calculated as total energy expenditure measured using DLW divided by the predicted basal metabolic rate in 40 children aged 5.5 (standard deviation 0.2) years. AEE was calculated as total energy expenditure minus basal metabolic rate and the thermic effect of food, and divided by fat-free mass. Body composition was assessed using the 3-component model by combining measurements based on isotope dilution and air-displacement plethysmography. Physical fitness (muscular strength, motor fitness, and cardiorespiratory fitness) was evaluated using the PREFIT test battery. Multiple linear regression models were conducted. Results: PAL and AEE were negatively associated with body mass index, percent body fat, and fat mass index (PAL: standardized β −0.35, −0.41, and −0.45, all p < 0.036; AEE: standardized β −0.44, −0.44, and −0.47, all p < 0.006, respectively). Furthermore, PAL and AEE were positively associated with the standing long jump test (PAL: standardized β 0.37, p = 0.017; AEE: standardized β 0.38, p = 0.014). There were no statistically significant associations found regarding PAL or AEE with fat-free mass index or any other physical fitness test. Conclusions: Greater PAL and AEE at the age 5.5 were significantly associated with body fatness and improved lower-body muscular strength. Therefore, increasing physical activity, and thus energy expenditure, at young ages may be beneficial for preventing overweight/obesity. However, further studies with larger sample sizes are needed to confirm the results. Full article
Open AccessArticle
The Effects of Intravenous Lipid Emulsion Therapy in the Prevention of Depressive Effects of Propofol on Cardiovascular and Respiratory Systems: An Experimental Animal Study
Received: 22 October 2018 / Revised: 27 November 2018 / Accepted: 20 December 2018 / Published: 25 December 2018
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Abstract
Background and objectives: Although there are several hypotheses about the mechanism of action, intravenous lipid emulsion (ILE) therapy has been shown to be effective in the treatment of toxicities due to local anaesthetics and many lipophilic drugs. In this study, we had [...] Read more.
Background and objectives: Although there are several hypotheses about the mechanism of action, intravenous lipid emulsion (ILE) therapy has been shown to be effective in the treatment of toxicities due to local anaesthetics and many lipophilic drugs. In this study, we had hypothesized that ILE therapy might also be effective in preventing mortality and cardiorespiratory depressant effects due to propofol intoxication. Materials and methods: Twenty-eight Sprague-Dawley adult rats were randomly divided into four groups. Saline was administered to the subjects in the control group. The second group was administered propofol (PP group); the third group was administered ILE (ILE group), and the fourth group was administered propofol and ILE therapy together (ILE+PP group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mortality were recorded at 10 time-points during a period of 60 min. A repeated measures linear mixed-effect model with unstructured covariance was used to compare the groups. Results: In the PP group; SBP, DBP, RR, and HR levels declined steadily; and all rats in this group died after the 60-min period. In the ILE+PP group, the initially reduced SBP, DBP, RR, and HR scores increased close to the levels observed in the control group. The SBP, DBP, RR, and HR values in the PP group were significantly lower compared to the other groups (p < 0.01). The mortality rate was 100% (with survival duration of 60 min) for the PP group; however, it was 0% for the remaining three groups. Conclusions: Our results suggest that the untoward effects of propofol including hypotension, bradycardia, and respiratory depression might be prevented with ILE therapy. Full article
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