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 »

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 »

Pregnant women with pre-existing diabetes mellitus type 2 differ from those with diabetes mellitus type 1

Background: Type 2 diabetes has reached epidemic proportions in recent years. The aim of this study was to compare perinatal outcomes in type 2 and type 1 diabetic patients. Materials and Methods: Maternal and fetal outcomes were compared between 62 pregnant women with type 2 pregesta- tional diabetes mellitus and 448 pregnant women with type 1 diabetes who delivered in the University Hospital of Warsaw from 2000 to 2011. Results: Women with type 2 diabetes were older, more overweight prior to pregnancy (BMI 29.3 vs 24.2 kg/m2, p<0.0001), gained less weight during pregnancy and presented with hypertension during pregnancy. The patients with type 2 diabe- tes exhibited lower 1-hour postprandial glycemia levels (104.7 vs 117.4 mg/dL, p<0.001) in the 3rd trimester and lower mean glycemia levels during labor (89.9 vs 107.8 mg/dL, p<0.001). The durations of the pregnancies of these patients were significantly longer (37.1 vs 36.3 weeks, p<0.05). Neonates of mothers with type 2 diabetes were significantly less likely to exhibit low 1st-minute Apgar scores (3.6% vs 18.1%, p<0.05). Conclusions: Pregnant women with type 2 diabetes mellitus present with more risk factors for metabolic syndrome such as hypertension and obesity and exhibit better metabolic control during the 3rd trimester of pregnancy. Read full text »

The use of smart glasses in healthcare – review

Aim. Nowadays technical innovations appear rapidly. One of new possibilities is smart glasses – wearable compu- ting devices wore as standard glasses. Although most smart glasses were not initially targeted at healthcare, they have been already implemented in multiple different medical applications across different specialties. In general such devices can be utilized whenever a screen or external monitor is already required. Head mounted displays can be implemented for very basic purposes such as education, simulation, live streaming of visualized data (i.e. vital signs, imaging studies, tests results, etc)., to more interactive functions such as video recording and digital photo documen- tation, for telemedicine, telementoring and many others. Ultimately smart glasses would implement artificial intelligence engines in the daily clinical practice and several other promising application for the future. Digital health is already growing exponentially, and with no doubt, the market for smart glasses in healthcare will grow accordingly in the very near future. The aim of this paper is to analyze current possible applications of smart glasses in patient care as well as the advantages and drawbacks of this kind of devices in everyday clinical practice. Read full text »

Demographic features of type 2 diabetes patients are associated with diabetes control in terms of primary health care

Aim. The aim of this study was to evaluate the association between selected demographic features of type 2 diabetes (T2D) patients and glycemia control expressed as the percentage of glycated hemoglobin (HbA1c) in the period of publishing the first diabetes treatment guidelines for general practitioners (GPs). Material and method. Medical records of 209 patients with type 2 diabetes (84 men and 125 women) aged from 22 to 87 years (mean age 65.8 years) from two general practitioners’ (GPs) practices in 2009 and 2010 were retrospec- tively assessed. Analysis of HbA1c was performed using high performance liquid chromatography (HPLC). Results. In regard to 2010 significantly higher mean percentage of HbA1c was found: in men compared to women (7.9±1.9% vs 7.1±1.1%); in patients <70 years of age compared to ≥70 years of age (7.7±1.8% vs 7.0±0.9%); in the population <70 years of age – in men compared to women (8.2±2.0% vs 7.2±1.3%) and in the group of men <70 years of age compared with ≥70 years of age (8.2±2.0% vs 7.0±1.1%). Among the 66 patients analyzed in both years, lower mean percentage of HbA1c was demonstrated in the group <70 years of age in 2009 compared to 2010 (7.3 ± 1.1% vs 7.8 ± 1.5%). By contrast, regarding 2010 patients <70 years of age had a higher HbA1c than those ≥70 years of age (7.8 ± 1.5% vs 7.1 ± 0.9%). Discussion and conclusions. Demographic features of patients with type 2 diabetes treated in primary care are associated with glycemia control. GPs should take into consideration patients’ demographic characteristics, especially being a younger men, when planning treatment of type 2 diabetes. Read full text »

Effect of Left Ventricular Systolic Dysfunction on Renal Transplantation Outcomes- A Paired Kidney Analysis

Background: Reduced left ventricular ejection fraction (LVEF) is thought to be a rel-ative contraindication for kidney transplantation (KT). It is not clear how to manage congestive heart failure (CHF) due to left ventricular systolic dysfunction in patients with end-stage renal disease (ESRD). Material and Methods: A total of 21 kidney recipients transplanted between 2011 and 2013 who had LVEF <55% were ana-lysed in this retro- spective single-centre study. This group was compared with 21 patients with LVEF ≥ 55% who had received another kidney from the same de-ceased donor. The mean duration of follow-up was 32Ī10 months. Results: Con-cerning post – transplant characteristics there were no significant differences be-tween groups regarding rate of urinary tract infection after transplantation, level of serum creatinine at 12 months post KT, patient survival and subjective opinion of patient about their ability to physical effort at the end of follow up comparing to pre-transplant condition. In the group with reduced EF there were more incidences of delayed graft func- tion(28.8% vs 14.3%, p=0.29)and lower rate of graft survival( 85.7% vs 100%, p=0.23) but the differences did not reach statistical significance. Conclusion: Reduced EF should not exclude patients from consideration for KT, however greater caution is recommended.
Read full text »