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 »

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.
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Heat Stroke. Review

The HS is an acquired disease that cla- ims many lives as they pass the hottest stages of each year, taking a record in each country and sometimes increased mortality figures for this entity associated with hot flashes, which are Frequent daily as a result of natural disasters, pollution, sudden climatic changes, etc.
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Is there a limit for expanding criteria of kidney donors? How far can we go?

Introduction: The lack of organs for transplantation has forced the transplant community to expand the pool of donors. Using expanded criteria donor (ECD) organs is one of the strategies. Although there are organs that do not fit into definition of ECD and remains controversial for transplantation. The aim of this paper is to report the criteria of discharging kidney from transplantation.
Material and methods: 704 patients received cadaveric renal transplants between January 1, 2010 and August 31, 2015. In this time 181 kidneys were discharged from the transplantation – 125 kidneys (63 referred potential donors) were disqu- alified before organ procurement and 56 kidneys were rejected from transplantation during organ storage. Data on donors and preservation parameters were collected. Causes of organ refusal were analysed.
Results: The most common causes of kidney rejection from transplantation was poor donor kidney parameters with pro- bability of kidney irreversible injury (84 kidneys – 46,4%) and malignancy or strong suspicion of malignancy in donor body (44 organs – 24,3%). The next causes of kidneys disqualifications were unsatisfactory parameters during machine per- fusion (20 kidneys – 11%) and hepatitis C virus (HCV) or hepatitis B virus (HBV) infection in donor body with no recipients with negative crossmatch (7 kidneys – 3,9%). The less common causes of kidney rejection from transplantation were anatomical abnormalities (6 organs), nephrolithiasis (5 kidneys) and the others less frequent causes.
Conclusion: Careful kidney selection is recommended in cases of expanded criteria donor kidneys in order to diminish factors that can negatively affect graft function and survival.
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