Volumen 17 (2017): Heft 2 (August 2017)

Introduction: There is an increase in level of stress in the general population because of the social, personal and professional demands. Currently, there are only simple tools that can safely measure this stress such as levels of cortisol and heart rate variability (HRV). Objective: To analyze the relationship between salivary cortisol and the cardiac autonomic modulation. Methods: A total of fifty-one male and female subjects between 18 and 40 years old were evaluated. Saliva collection was achieved for the salivary cortisol dosage. The collection was performed through the SalivetteR tube. After this collection, the median cortisol levels (0.24 ug/dl) were analyzed and the volunteers were divided into two groups: i) cortisol below the mediane ii) cortisol above the median. After this division, each group consisted of 25 volunteers and then was verified the following information: age, gender, weight, height, body mass index (BMI), blood pressure. Shortly thereafter was assessment of cardiac autonomic modulation por meio da HRV. The Polar RS800cx heart rate receiver was placed on the chest of the volunteers, in the vicinity of the distal third of the sternum. The volunteers were instructed to remain in rest with spontaneous breathing in dorsal position for 20 minutes. HRV analysis included geometric, time and frequency domain indices. Results: There were no statistical differences for the two groups regarding systolic and diastolic blood pressure, heart rate, RR intervals or linear and frequency indices for the volunteers. In addition, also there was no correlation the cortisol with the analyzed variables (SAP, p=0.460; DAP, p = 0.270; HR, p = 0.360; RR, p = 0.380; SDNN, p = 0.510; rMSSD, p = 0.660; pNN50, p = 0.820; RRtri, p = 0.170; TINN, p = 0.470; SD1, p = 0.650; SD2, p = 0.500; LF [ms²], p = 0.880; LF [nu], p = 0.970; HF [ms²], p = 0.870; HF [nu], p = 0.960; LF/HF, p = 0.380 Conclusion: Heart rate variability autonomic control was unchanged in healthy subjects with physiological distribution of salivary cortisol levels. There was no association between normal salivary cortisol and resting autonomic regulation of heart rate.

Objective: The aim of our study was to determine the relation of particular genetic variants in selected genes (GSTM1, GSTT1 null genotypes; rs1695 GSTP1; rs10735781 EVI5) to the risk of multiple sclerosis (MS) development and find out the possible association with disease disability progression rate. Material and methods: Our study included 202 MS patients and 174 healthy control volunteers. MS patients were divided according to disability progression rate to three groups - slowly progressing, mid-rate progressing and rapidly progressing. All DNA samples were isolated from venous blood. Genotyping was performed by PCR-RFLP and multiplex PCR. Results: Our analysis showed that GSTT1 null genotype (OR 0.56; 95%CI 0.33 -0.95; p=0.04) and GSTM1, GSTT1 double null genotype (OR 0.32; 95%CI 0.14 - 0.74; p=0.006) are potentially protective in relation to MS. We observed similar result in GSTT1 null genotype in association with mid-rate progression (OR 0.48; 95%CI 0.24 - 0.97; p=0.05). Frequency of GSTM1 and GSTT1 double null genotype is significantly lower in subgroup of MS patients with progression rate defined as slow (OR 0.22; 95%CI 0.05 - 0.98; p=0.05) and middle (OR 0.33; 95%CI 0.11 - 0.99; p=0.045). We did not show any significant association of genetic changes rs1695 in GSTP1 and rs10735781 in EVI5 with MS or rate of disease progression. Conclusions: Genetic basis of multiple sclerosis is still not fully elucidated. Further research may clarify our results and confirm the value of studied factors for clinical practice.

The direct oral anticoagulant drugs (DOAC) are generally safe and effective in several clinical settings including acute venous thromboembolic disease, prophylaxis in the postoperative setting, prevention of thromboembolism in patients with non-valvular atrial fibrillation, and in the management of acute coronary syndrome. The relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use of the DOAC. The aim of this work is to propose and summarize periprocedural management of patients treated with the DOAC in dental practice and to inform about the principal specifications of this treatment.

Background: Anti-citrullinated peptides antibodies (ACPA) are specific for rheumatoid arthritis and have been implicated in disease pathogenesis. ACPA examination is a new component of ACR/EULAR 2010 classification criteria for rheumatoid arthritis. ACPA positivity predicts a more erosive disease course with severe joint damage and extra-articular manifestations. Objectives: To evaluate the benefits of ACPA examination in patients with early undifferentiated arthritis and patients with rheumatoid arthritis. Methods: We examined patients with arthritis and tested them for ACPA positivity. In every individual patient we evaluated if ACPA examination was necessary to establish the diagnosis of rheumatoid arthritis, or to change treatment, or if the diagnosis could have been established without ACPA examination (ACR/EULAR 2010 classification criteria was met without ACPA scoring). Results and Conclusions: We examined 833 patients with arthritis. There were 43 patients, or 62 % of a subgroup of 69 who were ACPA positive whose ACPA examination was not needed - ACR/EULAR criteria was met without ACPA scoring. This number represents 5.1 % of the total number examined. There were 15 patients, or 22 % of the subgroup and 1.8 % of the total whose diagnosis was revised to rheumatoid arthritis due to ACPA positivity - ACR/EULAR criteria was met solely with ACPA scoring. There were 11 patients (16 % and 1.3 %) whose medication was changed due to ACPA positivity. ACPA examination is useful in 3,1 % of all examined patients. When we correlate data on ACPA positive patients, 38 % of the patients profit from ACPA examinations. Considering the relatively low price of ACPA testing, this examination should not be excluded.

Introduction: Ureteral stenosis is one of the most commonly reported urological complications after kidney transplantation. Material and methods: This is a retrospective analysis of the risk factors for ureteral stenosis (type of donor, age of donor, presence of interior polar arteria, unilateral dual transplantation, diabetes mellitus of the recipient and the donor, BK positivity, child recipient, cold ischaemia time, and delayed graft function), as well as the causes and types of treating ureteral stenoses. Results: In the group of 278 patients, the occurrence was 7.2 %. The medial of occurrence of ureteral stenoses was 24.6 months. The independent risk factor for ureteral stenosis in our group was the age of the donor ≥ 70 years [HR 6.5833; 95 % CI 2.2448-19,3070 (P = 0.0006)], BK positivity [HR 13.6667; 95 % CI 6.9127-27.0196 (P<0.0001)], cold ischaemia time > 1080 min [HR 4.0368; 95 % CI 1.7250-9,4465 (P = 0.0013)], and diabetes mellitus in the donor’s history [HR 16.2667; 95 % CI 7.8629-33.6525 (P <0.0001)]. The most frequent type of treating the ureteral stenosis in our group was retroureteroneocystostomy. After surgical treatment, we recorded no recurrence of stenosis. Conclusion: In our analysis, the confirmed independent risk factor was diabetes mellitus of the donor. However, further monitoring and analyses of large groups of patients are necessary. Surgical treatment of ureteral stenosis is safe. However, the most important momentum in surgical treatment of ureteral stenosis still remains the surgeon´s experience in the given type of treatment.

Prostate cancer usually metastasis to the regional lymph nodes and can rarely metastases to nonregional supradiaphragmatic lymph nodes. Cervical lymph node metastasis of prostate cancer is extremely rare. However, it should be considered in the differential diagnosis of cervical lymphadenopathy in male patients with adenocarcinoma of unknown primary site. In this report we present a rare case of metastatic prostate adenocarcinoma with left supraclavicular lymphadenopathy as the only clinical presentation with no other evidence of metastasis to the regional lymph nodes or bone metastasis.