Infective endocarditis caused by dental problems correlated with bicuspid aortic valve

Abstract:The aim of the study was to emphasize the importance of prophylaxis of infective endocarditis. Also, the influence of heart failure and bacterial etiology on the treatment was analyzed. This study presents a case report of a patient who was suffering from IE. He was treated in the Cardiology Ward at the Medical University of Lublin. 47-year-old man has resected his tooth in a dental surgery. After a few days at home, he presented non-specific symptoms like fever and chest pain. Bicuspid aortic valve was diagnosed at the Cardiology Ward. Furthermore, vegetation on aortic valve was recorded in echocardiography. That is why IE diagnosis was made. After the therapy with Vancomycin, vegetation on aortic valve was still present. Regurgitation in 3rd state was developed by the patient. New valve was implanted. A few days after operation the patient had subfebrile state. He was treated with Vancomycin and Clindamycin. Currently, he is receiving ciprofloxacin as prophylaxis of IE. Heart failure is a risk factor of IE. These patients should get antibiotic prophylaxis before dental surgery. Patients with heart defect can develop more severe type and treatment in these cases is more difficult. Everyone should undergo non-specific prophylaxis of infective endocarditis. Read full text »

How stress and anti-stress remedies influence bone health

Abstract:Various factors affect the increased risk of skeletal system disorders in the modern society. Chronic stress can be regarded as one of the causes of greatest importance. Epidemiological studies conducted by the World Health Organization (WHO) indicate that the level of stress in the society is constantly increasing. This phenomenon is particularly apparent in developed countries. Bone tissue loss affects not only the elderly, but also people of younger age. Studies have shown reduced bone mineral content (BMC) and bone mineral density (BMD) in people exposed to chronic stress and suffering from depression. These facts can be explained through the mechanism of action of glucocorticoids (GCs) on the bone. It reduces the content of inorganic substances in the bone, thereby weakening its strength. Additionally, important factors causing BMC and BMD to decrease include usage of drugs such as antidepressants, as well as addictions such as smoking. Metyrapone, an inhibitior of cortisol synthesis, has been found to increase serum BMC and osteocalcin (OC) levels and to promote bone formation. Moreover, Alzheimer’s disease (AD) patients using rivastigmine arebe at lower risk of developing hip fracture. Read full text »

Understanding tokophobia phenomenon as a key to proper management

Abstract: Tokophobia also known as fear of childbirth (FOC) becomes a frequent psychiatric indication to Caesarean section which makes it a rising problem of current obstetrics. Patients with FOC may suffer from additional psychiatric conditions such as depression. Women with higher risk of developing tokophobia are those with immense levels of fear of pain, young, with low educational level, poor socio-economic status, low self-esteem and lack of proper knowledge concerning peripartum period. History of unfortunate events during previous deliveries or illness of the older child are also associated with more frequent occurrence of FOC. Adequate management of FOC focuses on implementing psychotherapy. Symptoms of FOC can be decreased by means of qualified and trustworthy medical staff during labor or support from a closely related person. Secondary tokophobia can be prevented by minimalisation of negative experience during the first birth. If tokophobia is the symptom of depression, the underlying illness should be treated. Tokophobic patients are more prone to experience higher levels of pain during labor, which makes peripartum pain management harder for clinicians. FOC is one of the main reasons for performing caesarean delivery on maternal request (CDMR), which may lead to post-operative complications. Research shows that FOC is related to anxiety concerned with lower self-esteem due to changes occurring in women’s body during pregnancy and delivery. Learning and understanding the reasons behind tokophobia might lead to reducing the number of patients suffering from this condition and in consequence minimalizing the number of performed CDMR. Read full text »

Microcephaly associated with Zika virus infection – prevention, diagnosis and treatment

Background: Zika virus (ZIKV) is a mosquito-borne flavivirus, first identified in Uganda in 1947 in monkeys by researchers monitoring yellow fever. Later virus was identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of ZIKV disease have been recorded in Africa, the Americas, Asia and the Pacific. From the 1960s to 1980s, human infections were found across Africa and Asia, typically accompanied by mild illness. The first large outbreak of disease caused by Zika infection was reported from the Island of Yap (Federated States of Micronesia) in 2007. The next epidemic of ZIKV infection was reported in 2015 in South and Central America and the Caribbean. Read full text »

Meckel’s diverticulum resection as a part of Emergency General Surgery – single centre experience in years 2006-2014.

Background: An emergency surgery is a medical procedure that must be performed immediately to solve the patients’ health problem successfully. A delay of this medical procedure could result in a death or a permanent impairment of the health. An emergency surgery can be also defined as a surgery which is required to be performed in case of an acute threat to life of an organ, limb or tissue caused by an external trauma, acute disease process, acute exacerbation of a chronic disease process or complication of a surgical or other interventional procedure. Scott and co-workers [1] analysed 3.1 million of patients admitted to the hospital due to acute indication and they reported that emergency general surgery (EGS) represents 11% of admissions. EGS includes: cute appendicitis, peritonitis, bowel obstruction, acute mesenteric ischemia, gastrointestinal perforation or bleeding, acute cholecystitis, irreducible or incarcerated hernias, injuries after accidents e. g. organ fractures, intentional ingestion of foreign bodies or poisonous substances. Read full text »

A Model-Based Meta-Analysis Evaluating Gender Differences on Blood Flow Responses to Brachial Artery Infusions of Acetylcholine, Albuterol, ATP, Bradykinin, Estradiol, Glyceryl Trinitrate, L-NMMA, Nevibolol, Norepinephrine, Sodium Nitroprusside, Substance P, and Verapamil

Background: Venous occlusion plethysmography (VOP) is a methodology that was originally reported in the literature by A.W. Hewlett and J.G. Van Zwaluwenburg in 1909 [1]. The technique describes an approach to measure blood flow based from factors affecting the forearm vasculature. Since the methodology has been formally presented in the published literature, countless of articles have documented the clinical utility of VOP and is currently the key method for evaluating the physiological responses to various doses of drugs modulating the cardiovascular system. Throughout this time, physicians and scientists evaluating the mechanisms of vasodilation and vasoconstriction have used various compounds to test arterial response based on endothelial dependence (e.g. Acetylcholine or Bradykinin), endothelial independence (e.g. Sodium Nitroprusside or Glyceryl Trinitrate), or other mechanisms like the calcium channel blocking effects of drugs (e.g. Verapamil). Read full text »

Living kidney donor with expanded criteria for qualification – a case report

Background: Nowadays, kidney transplantation is the best way of treatment of end-stage renal failure (1). Results of transplantation of organs procured from living donors are much better in comparison to those from deceased donors (2). Benefits of living donation include not only better graft survival and reduced number of episodes of rejection, but also shorter dialysis time and greater chance for preemptive transplantation (meaning that the recipient remains in pre-dialyses period). Fewer rejection episodes imply the possibility of reducing immunosuppression and therefore, lower incidence of associated complications. Beside the obvious improvement in recipients’ quality of life, the possibility of pre-emptive transplantation significantly reduces the cost of end-stage renal disease treatment in relation to possible avoidance of renal replacement therapy by hemodialysis. In addition, scheduled and controlled character of the procedure improves its safety and reduces the relative length of hospital stay and absence from work due to illness. Read full text »

A Clinical Trial Simulation Evaluating Epinephrine Pharmacokinetics at various Dosing Frequencies during Cardiopulmonary Resuscitation

Background: This article seeks to identify if differences exists in epinephrine blood levels in virtual patients who are administered epinephrine at a dosing interval of either 3-minutes or 5-minutes. According to the most recent, 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) epinephrine remains the primary drug of choice during resuscitation with a fixed dose of 1mg for Adult Advanced Cardiovascular Life Support (ACLS) every three to five minutes [1]. Do differences exist in epinephrine kinetics during simulated CPR scenarios in virtual adult patients of varying health backgrounds? This article will used published population pharmacokinetic parameters and dosing simulations will be conducted according to the 2015 AHA adult guidelines. Prior to the pharmacokinetic simulations, this article will review the reported sources of variability influencing epinephrine pharmacokinetics. Read full text »

FINDRISC scale as a common tool to assess the risk of diabetes type 2

Background: The aim of the study was to evaluate the risk of developing type 2 diabetes among middle-aged and elderly with the use of FINDRISC scale. Material and methods: The study involved 200 people. Those participating in the study were given the form representing the scale of developing diabetes risk, based on FINDRISC scale and classified into one of five groups of risk of developing type 2 diabetes within 10 years. Results: 47% of examined patients are of a moderate, high or very high risk of developing diabetes type 2. There was no significant difference between men and women. The correlation between age and the risk of developing diabetes type 2 appeared insignificant. The correlation between BMI and the risk as well as waist circumference and the risk appeared to be high, positive. Conclusions: FINDRISC scale is a simple tool to rank the risk of developing diabetes in the general popula- tion, among the overweight or obese patients having positive family history of developing diabetes. Read full text »

The Prevalence Of Mycoplasma In Pregnant Women’s Genital Tracts Delivering In TERTIARY Hospital

Background: The aim of this study was to evaluate the prevalence of Mycoplasma hominis and Ureaplasma urealyticum among pregnant women and an attempt to identify risk factors for maternal infection and assessment of the impact of infection on perinatal outcomes. Material and methods: Patients included into the analysis were divided into 2 groups. The first group consisted of 97 (78.9%) women who had not isolated the strains of Mycoplasma, and the second group of 26 (21.1%) women who had isolated a strain of Mycoplasma. Results: Women who had isolated strains of Mycoplasma were significantly younger (p=0.0031), less frequently completed higher education (p=0.0163), less frequently were married (p=0.0061). Women who were not classified with Mycoplasma were more frequently multiparas (p=0.012) and were more likely to have previous caesarean birth (p=0.022). The groups did not differ significantly in terms of gestational age at birth, the incidence of premature rupture of membranes, intrauterine infection, the percentage of women who gave birth vaginally, the birth weight of newborns and the condition of the newborns after delivery. The neonatal respiratory support type nCPAP was more frequently applied to the babies born to mothers who had isolated Mycoplasma. Conclusions: Based on the survey results and data from the world literature, it can be concluded that women with pre-term labour and PROM should be tested for Mycoplasma colonization and the newborn should be observed primarily in terms of complications caused by respiratory tract. Colonization with Mycoplasma in term pregnancy does not impact significantly maternal and neonatal outcome. Read full text »