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Volumen 43 (2022): Heft 3 (November 2022)

Volumen 43 (2022): Heft 2 (July 2022)

Volumen 43 (2022): Heft 1 (March 2022)

Volumen 42 (2021): Heft 3 (December 2021)

Volumen 42 (2021): Heft 2 (October 2021)

Volumen 42 (2021): Heft 1 (April 2021)

Volumen 41 (2020): Heft 3 (November 2020)

Volumen 41 (2020): Heft 2 (September 2020)

Volumen 41 (2020): Heft 1 (June 2020)

Volumen 40 (2019): Heft 3 (December 2019)

Volumen 40 (2019): Heft 2 (October 2019)

Volumen 40 (2019): Heft 1 (May 2019)

Volumen 39 (2018): Heft 2-3 (December 2018)

Volumen 39 (2018): Heft 1 (July 2018)

Volumen 38 (2017): Heft 3 (December 2017)

Volumen 38 (2017): Heft 2 (September 2017)

Volumen 38 (2017): Heft 1 (March 2017)

Volumen 37 (2016): Heft 2-3 (November 2016)

Volumen 37 (2016): Heft 1 (June 2016)

Volumen 36 (2015): Heft 3 (December 2015)

Volumen 36 (2015): Heft 2 (December 2015)

Volumen 36 (2015): Heft 1 (May 2015)

Volumen 35 (2014): Heft 3 (December 2014)

Volumen 35 (2014): Heft 2 (October 2014)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1857-8985
Erstveröffentlichung
08 Sep 2014
Erscheinungsweise
2 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 42 (2021): Heft 2 (October 2021)

Zeitschriftendaten
Format
Zeitschrift
eISSN
1857-8985
Erstveröffentlichung
08 Sep 2014
Erscheinungsweise
2 Hefte pro Jahr
Sprachen
Englisch

Suche

16 Artikel
Uneingeschränkter Zugang

Grief: Aetiology, Symptoms and Management

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 9 - 18

Zusammenfassung

Abstract

Grief is a process provoked as a response to different losses, such as death, loss of job, relationship breakdown, some unexpected life events and changes, etc. The experiences of loss and bereavement are very individual. Even though loss is expected, the person feels traumatized, especially if death is provoked by violence, natural disasters, or war. This pandemic, like other disasters (wars, tsunami, earthquakes, floods, etc.) has provoked intensive reactions of grief, reactions that could persist for years. The core symptoms of grief are described in the ICD-11 and DSM-5 manuals.

The term “complicated grief” in the medical sense refers to a superimposed process that alters grief and modifies its course for the worse. Prolonged grief disorder (PGD) is characterized by normal grief symptoms, but these are symptoms that remain too intense for too long of a period.

This article is a review of the manifestations and duration of grief in different occasions, and it is based on over 50 published papers, and discoveries in the Medline and Psych-Net databases.

Commonly described reactions to grief are: shock, disbelief or denial, a high level of anxiety, distress, anger, sadness, insomnia, and a loss of appetite. As predictors for a high/slow decreasing trajectory of grief process are: female gender, reported symptoms of depression before the traumatic event, and higher scores on avoidance. However, grief is transient, even as we are is in the midst of its clutches. People should expect to fluctuate between moments of sadness and mourning, and moments of acceptance, or even happiness for being alive. Researchers suppose that when a crisis passes; most people will be able to bounce back and move on with their lives.

Schlüsselwörter

  • grief
  • bereavement
  • mourning
  • stress
  • traumatic events
Uneingeschränkter Zugang

In Memoriam Acad. Prof. Dr. Momir Polenakovic

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 19 - 23

Zusammenfassung

Uneingeschränkter Zugang

“Life is a Great Illusion, Achievements Stay Forever!” Momir H. Polenakovic (1939–2021)

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 25 - 26

Zusammenfassung

Uneingeschränkter Zugang

In Memoriam Academic Momir Polenakovic, Pediatric Nephrology, Rare Diseases and Publishing in Macedonia

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 27 - 29

Zusammenfassung

Uneingeschränkter Zugang

“Life is a Great Illusion, Achievements Stay Forever!” Momir H. Polenakovic (1939–2021)

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 31 - 32

Zusammenfassung

Uneingeschränkter Zugang

In Memoriam: Momir Polenakovic

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 33 - 34

Zusammenfassung

Uneingeschränkter Zugang

New DXA Diagnostic Indexes of Abdominal Obesity

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 37 - 50

Zusammenfassung

Abstract

Aim: Cushing’s syndrome (CS) is associated with weight gain and extreme central, visceral, abdominal obesity which is confirmed with dual-energy X-rays absorptiometric (DXA) diagnostic cut-off point (CP) values of central obesity indexes (COI), determined as an android to gynoid tissue and fat mass ratios. These best differentiate CS from non-CS obese women matched with CS according to their age and BMI. The aim of this study was to determine the CP values of new DXA indexes of central, abdominal obesity as a ratio of android and trunk to legs as well as trunk and legs to total tissue and fat mass that best differentiate CS and matched non-CS obese women in order to confirm central abdominal obesity, and to determine their normal CP values that best differentiate healthy non-obese women from CS and non-CS obese women, and to exclude abdominal obesity completely.

Material and Methods: DXA indexes of abdominal obesity, calculated as а ratio of regional body fat and tissue mass compartments android to legs (A/L), trunk to legs (Tr/L), trunk to total (Tr/To) and legs to total (L/To) values were determined among 4 groups. Each group consisted of 18 women: 1st group of CS, 2nd group of obese women (O1) not different according to their age and BMI from CS, 3rd group of obese women (O2) with higher BMI of 35 ± 1.2 kg and a 4th group of non-obese, healthy women (C) with a normal BMI. Diagnostic accuracy (DG) of CP values of DXA indexes of abdominal obesity and indexes of normal body fat distribution (BFD) were determined.

Results: A/L, Tr/L, Tr/To, and L/To DXA indexes were significantly different between CS and O1 as well as between non-CS women O2 compared to O1 and C. These indexes had a highly significant correlation among each other and also in relation to their BMI (p < 0.0001). A/L-Tm CP value of 0.3 best differentiated the CS from group O1, with the highest DG of 100 % and an A/L-Fm CP value of 0.26 differentiated them with a DG of 94.44% and sensitivity of 100 %. An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 best differentiated CS and C as well as O2 and C for the highest DG of 100 %.

Conclusions: DXA indexes A/L, Tr/L, Tr/To and L/To values were significantly different among the four groups. These values correlated significantly among them and with their BMI in non-CS groups, thus confirming a BMI increase association with a more pronounced abdominal BFD. An A/L-Tm CP value of 0.3 and an A/L-Fm CP value of 0.26 were discovered as the best DXA diagnostic indexes of extreme abdominal obesity in CS and these could also be used in discovering abdominal BFD in non-CS obese women with metabolic syndrome (MS). An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 were discovered as the best DXA diagnostic indexes of normal BFD which completely excluded abdominal obesity.

Schlüsselwörter

  • DXA
  • abdominal obesity
  • DXA obesity indexes
  • cut-off point values
Uneingeschränkter Zugang

Enriching Human-Robot Interaction with Mobile App in Interventions of Children with Autism Spectrum Disorder

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 51 - 59

Zusammenfassung

Abstract

Introduction: Autism spectrum disorder (ASD) is a group of complex lifelong neurodevelopmental disorders, characterized by difficulties in social communication and stereotyped behaviours. Due to the increasing number of children with ASD, it is important to continue developing interventions as well as invent new ones. Human-robot interaction can contribute to better outcomes for these children. There are several robots such as Nao, Kaspar, ZENO, Probo, ZECA, etc. which are used in autism interventions. Many mobile and web applications are in constant growth, too. They target skills such as collaboration, social skills, language skills, social competence, and communication.

Aim: To explore the usability of the humanoid robot Kaspar and a complementary app in interventions of children with ASD.

Sample: 20 children with ASD, aged between 23 and 76 months old.

Method: As an added intervention for this group of children, we used the robot Kaspar and its complementary app. Kaspar is a child-sized humanoid robot that uses bodily expressions, facial expressions, gestures, and pre-recorded speech to interact with a human.

Results: This intervention achieved certain positive shifts in eight of the eleven measured developmental domains, such as communication functions and means, turn taking, imitation, language skills, play, attention and daily life skills. The three categories that had inconsiderable improvement are vocalization and speech, cause and effect and coping skills.

Conclusion: Based on the measurements before and after the use of Kaspar and its complementary app, there is improvement, primarily in the domains of language, imitation and communication skills and attention.

Schlüsselwörter

  • autism spectrum disorder
  • children
  • robot and mobile app intervention
Uneingeschränkter Zugang

Prevalence and Predictors of Impaired Glucose Tolerance and Diabetes Mellitus Type 2 in Patients with Polycystic Ovary Syndrome

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 61 - 70

Zusammenfassung

Abstract

Aim: To estimate the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DMT2), as well as the predictors for glucose abnormalities in women with polycystic ovary syndrome (PCOS).

Material and methods: A cross-sectional study with 80 consecutive patients with newly diagnosed PCOS who underwent the standard 75g oral glucose tolerance test (OGTT) and the measurement of sex steroid hormone and lipid profile.

Results: According to the results from the OGTT, 63% had a normal test (NT), 23% had IGT, and 9% had DMT2. The NT group was younger with lower BMI than IGT and DMT2 groups (25.1 ± 7.3, 31.5 ± 6.5, 37.4 ± 4.0 years, and 29.1 ± 8.3 kg/m2, 31.7 ± 4.6 kg/m2, and 34.5 ± 5.6 kg/m2, respectively). The testosterone levels were highest in the group with a normal test (2.7 ± 0.8 nmol/l) and lowest in the DMT2 group (1.9 ± 0.8 nmol/L), with statistical significance. The sex hormone bounding globulin (SHBG) levels were low in all three groups, with statistically significant differences between NG and IGT, and the NT and DMT2 groups. The multivariate linear regression model identified age, BMI, SHBG and testosterone as major independent predictors for abnormal glucose metabolism.

Conclusion: It seems that the prevalence of IGT and DMT2 among PCOS women in our country is not as high as in Western countries. Age, BMI, and SHBG increase the risk for the development of IGT and DMT2. Thus, close monitoring of older, obese women with low SHBG is needed because of the higher risk for the development of IGT and DMT2 in such patients.

Schlüsselwörter

  • polycystic ovary syndrome
  • OGTT
  • IGT
  • DMT2
  • testosterone
Uneingeschränkter Zugang

High Risk Percutaneous Coronary Intervention of Left Main Bifurcation Stenosis in a Peritoneal Dialysis Patient

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 71 - 78

Zusammenfassung

Abstract

Complex coronary artery disease is the leading cause of death in patients with end-stage renal disease. We report a case of a patient on peritoneal dialysis, preloaded with Prasugrel and acetylsalicylic acid as а potent dual antiplatelet therapy (DAPT). The patient underwent a high-risk percutaneous coronary intervention (PCI) due to bifurcation stenosis of the left main stem branch. A “double kiss crush” bifurcation stenting technique was performed. This case provides additional data about the treatment of this group of patients, a group that is often excluded from randomized control trials, but is frequently encountered in cardiovascular practice. Furthermore, it helps to advance PCI treatment along with exploring the safety of potent DAPT in a group that is susceptible to both ischemia and bleeding, thus presenting a great challenge in the decision for treatment.

Schlüsselwörter

  • Left main bifurcation stenosis
  • high risk percutaneous coronary intervention
  • Prasugrel
  • optical coherence tomography
  • end stage renal diseases
  • peritoneal dialysis
Uneingeschränkter Zugang

Leptin, Obesity Parameters, and Atopy Among Children with Asthma

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 79 - 88

Zusammenfassung

Abstract

Leptin, as a major adipokine, positively correlates with the body’s fat, while atopy is an important feature in the development of childhood asthma. We aimed to evaluate the relationship between leptin, parameters of obesity, and atopy in children with asthma. The study included 112 children (73 boys, 39 girls, mean age 11.1±2.4). 41 were overweight, 38 had asthma and a normal body mass index (BMI), and 33 were overweight asthmatics. Serum leptin levels, BMI, waist circumference (WC), and waist to hips ratio (WHR) were measured. Skin prick test (SPT)/CAP, total serum IgE, fractional exhaled nitric oxide (FeNO), and pulmonary function tests were performed. In asthmatic children, serum leptin median level was 9.2±16.2 ng/ml, in overweight children was 30.6±21.6 ng/ml, and in overweight asthmatics was 31.1±20.3 ng/ml with a significant difference between the groups (p=0.0374), yet with a significantly lower median level in the group of children with asthma compared to the overweight children: with asthma (p=0.00001) and without asthma (p=0.00001). In the three groups of patients, BMI and WC displayed a significant positive correlation with leptin (for BMI r=0.652 vs. r=0.530 vs. r=0.563, respectively and for WC r=0.508 vs. r=0.426 vs. r=0.527, respectively). No significant correlations of leptin within atopy parameters (Eo, IgE, SPT/CAP, FeNO) in all three analyzed groups (p>0.05) was detected.

Conclusion: Atopy was not confirmed as an underlying mechanism of the association between asthma and being overweight. Leptin had a significant linear correlation as a parameter of central obesity with BMI and WC in all three groups, but not with WHR.

Schlüsselwörter

  • Asthma
  • body mass index
  • children
  • obesity
  • overweight
  • leptin
Uneingeschränkter Zugang

Cancer – Associated Thrombosis – A Study of Cases

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 89 - 97

Zusammenfassung

Abstract

Research shows that the presence of cancer increases the likelihood of developing venous thromboembolism (pulmonary thromboembolism and deep vein thrombosis) from as much as fourfold up to sevenfold. It is imperative that after early diagnosis we treat cancer-associated thrombosis with grave seriousness in order to reduce its morbidity and mortality.

We present 14 case reports of patients with cancer-associated thrombosis including thrombosis related to malignant hemopathies.

Schlüsselwörter

  • cancer-associated thrombosis (CAT)
  • malignant hemopathies
  • venous thromboembolism (VTE)
Uneingeschränkter Zugang

Potocki-Lupski Syndrome Dup17p11.2 in a Girl with Hypotonia and Early Behavioural Disturbances

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 91 - 94

Zusammenfassung

Abstract

Potocki-Lupski syndrome (PTLS) is a contiguous gene syndrome caused by duplication of chromosome 17p11.2. PTLS is characterized by hypotonia, failure to thrive, congenital anomalies (particularly of the cardiovascular system), intellectual disability, and behavioural disturbances.

The patient was a full-term baby girl, 2,750 grams at birth, delivered via an uncomplicated vaginal delivery with pronounced hypotonia at birth. Nevertheless, there was failure to thrive (weight 7.6 kg; 2.8 SD). Micrognathia, epicanthal skin folds, and megalocornea were noticeable. There was a harsh continuous systolic murmur, and the ultrasound of the heart revealed a persistent arteriosus duct which was surgically closed. At the age of 18 months, the girl could not sit without support, and she could not utter simple words. The girl is often moody, angry, and aggressive. She is hyperactive and unable to establish contacts with family members. A 17p12-p11.2 microduplication was identified via MLPA.

Muscle hypotonia, congenital heart malformation, failure to thrive, developmental delay, behavioural disturbances (or autism spectrum disorder), and intellectual disability are early signs of PTLS. The presence of PTLS was proven by an MLPA analysis.

Schlüsselwörter

  • Potocki–Lupski syndrome
  • hypotonia
  • cognitive delay
  • behavioural disturbances
  • congenital heart malformation
Uneingeschränkter Zugang

A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 95 - 101

Zusammenfassung

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases.

Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases.

In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up.

We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

Schlüsselwörter

  • COVID-19
  • SARS-CoV-2
  • MIS-C
  • appendicitis
  • pancreatitis
Uneingeschränkter Zugang

Implant Site Guided Bone Regeneration and Pontic Site Ridge Preservation: A Case Report

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 103 - 108

Zusammenfassung

Abstract

Guided bone regeneration (GBR) is a therapeutic modality to achieve bone regeneration with the use of barrier membranes. The use of deproteinized bovine bone material (DBBM) for ridge preservation allows the preservation of the edentulous ridge dimensions. Here, we present a case of horizontal GBR using DBBM and a resorbable membrane, with simultaneous implant placement. Simultaneously, ridge preservation of the pontic area, using DBBM within a “socket seal” procedure was performed. Two implants were places at sites 23 and 26 to support a fixed partial denture (FPD). The mesial implant showed exposed buccal threads, which were then covered with autogenous bone particles and small size granules of DBBM. The collagen membrane was stabilized with periosteal mattress suture. Six months postoperatively, CBCT images revealed a stable buccal bone layer at the implant site, indicating a successful GBR procedure. At this point in time, tooth 24 was atraumatically extracted. A ridge preservation was done utilizing DBBM, and a soft tissue graft form the tuber. A ceramic-metal FPD with excellent “white aesthetics” and a harmonic transition zone to the soft tissue was fabricated. At 3 years follow up, the peri-implant bone levels were stable, and the clinical outcomes were excellent. It is concluded that a GBR procedure, utilizing DBBM and a collagen barrier membrane with simultaneous implant placement, as well as ridge preservation using DBBM, are predictable therapeutic methods. However, gentle manipulation of the soft tissues, and wound stability, with tension-free passive closure of the wound margins are prerequisites for a long-term clinical success.

Schlüsselwörter

  • implants
  • guided bone regeneration
  • ridge preservation
  • deproteinized bovine bone materials
Uneingeschränkter Zugang

Anti-Factor H Antibody-Associated Atypical Hemolytic Uremic Syndrome: A Case Report

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 109 - 115

Zusammenfassung

Abstract

Introduction: Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy, caused by dysregulation of the complement alternative pathway. Deletion of the complement factor H–related genes, CFHR1 and CFHR3, together with the presence of CFH autoantibodies are reported in aHUS patients, representing 10% of cases of patients with aHUS.

Case presentation: We report here on a case of 4-year-old girl with anti-CFH antibody-associated aHUS. The measurement of complement factors and anti-factor H antibodies, was the main guideline for making an accurate diagnosis and providing the appropriate therapy, with the patient responding positively to plasma exchanges (PEs) and cyclophosphamide pulses. We then, one year after disease onset, continued with glucocorticoids and mycophenolate mofetil (MMF), as maintenance therapy. There were no complications during the therapy other than neutropenia. Now, one year after the cessation of the immune suppression therapy, she is in remission with normal kidney function, no signs of hemolysis, normal C3 levels, and normal range proteinuria. The anti-factor H autoantibody titer decreased but still remained positive, the factor H antigen values remained low all throughout. Close follow-up is applied with frequent urine testing and complete blood count with an intention for early detection of relapse of the disease.

Conclusion: The purpose of this case report is to emphasize the value of complement factor measurements and also to separate anti-CFH antibody-associated aHUS as an entity, because immunosuppressive therapy provides an excellent response..

Schlüsselwörter

  • atypical hemolytic uremic syndrome
  • complement factor H autoantibodies
  • plasma exchanges
  • cyclophosphamide
  • mycophenolate mofetil
16 Artikel
Uneingeschränkter Zugang

Grief: Aetiology, Symptoms and Management

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 9 - 18

Zusammenfassung

Abstract

Grief is a process provoked as a response to different losses, such as death, loss of job, relationship breakdown, some unexpected life events and changes, etc. The experiences of loss and bereavement are very individual. Even though loss is expected, the person feels traumatized, especially if death is provoked by violence, natural disasters, or war. This pandemic, like other disasters (wars, tsunami, earthquakes, floods, etc.) has provoked intensive reactions of grief, reactions that could persist for years. The core symptoms of grief are described in the ICD-11 and DSM-5 manuals.

The term “complicated grief” in the medical sense refers to a superimposed process that alters grief and modifies its course for the worse. Prolonged grief disorder (PGD) is characterized by normal grief symptoms, but these are symptoms that remain too intense for too long of a period.

This article is a review of the manifestations and duration of grief in different occasions, and it is based on over 50 published papers, and discoveries in the Medline and Psych-Net databases.

Commonly described reactions to grief are: shock, disbelief or denial, a high level of anxiety, distress, anger, sadness, insomnia, and a loss of appetite. As predictors for a high/slow decreasing trajectory of grief process are: female gender, reported symptoms of depression before the traumatic event, and higher scores on avoidance. However, grief is transient, even as we are is in the midst of its clutches. People should expect to fluctuate between moments of sadness and mourning, and moments of acceptance, or even happiness for being alive. Researchers suppose that when a crisis passes; most people will be able to bounce back and move on with their lives.

Schlüsselwörter

  • grief
  • bereavement
  • mourning
  • stress
  • traumatic events
Uneingeschränkter Zugang

In Memoriam Acad. Prof. Dr. Momir Polenakovic

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 19 - 23

Zusammenfassung

Uneingeschränkter Zugang

“Life is a Great Illusion, Achievements Stay Forever!” Momir H. Polenakovic (1939–2021)

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 25 - 26

Zusammenfassung

Uneingeschränkter Zugang

In Memoriam Academic Momir Polenakovic, Pediatric Nephrology, Rare Diseases and Publishing in Macedonia

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 27 - 29

Zusammenfassung

Uneingeschränkter Zugang

“Life is a Great Illusion, Achievements Stay Forever!” Momir H. Polenakovic (1939–2021)

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 31 - 32

Zusammenfassung

Uneingeschränkter Zugang

In Memoriam: Momir Polenakovic

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 33 - 34

Zusammenfassung

Uneingeschränkter Zugang

New DXA Diagnostic Indexes of Abdominal Obesity

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 37 - 50

Zusammenfassung

Abstract

Aim: Cushing’s syndrome (CS) is associated with weight gain and extreme central, visceral, abdominal obesity which is confirmed with dual-energy X-rays absorptiometric (DXA) diagnostic cut-off point (CP) values of central obesity indexes (COI), determined as an android to gynoid tissue and fat mass ratios. These best differentiate CS from non-CS obese women matched with CS according to their age and BMI. The aim of this study was to determine the CP values of new DXA indexes of central, abdominal obesity as a ratio of android and trunk to legs as well as trunk and legs to total tissue and fat mass that best differentiate CS and matched non-CS obese women in order to confirm central abdominal obesity, and to determine their normal CP values that best differentiate healthy non-obese women from CS and non-CS obese women, and to exclude abdominal obesity completely.

Material and Methods: DXA indexes of abdominal obesity, calculated as а ratio of regional body fat and tissue mass compartments android to legs (A/L), trunk to legs (Tr/L), trunk to total (Tr/To) and legs to total (L/To) values were determined among 4 groups. Each group consisted of 18 women: 1st group of CS, 2nd group of obese women (O1) not different according to their age and BMI from CS, 3rd group of obese women (O2) with higher BMI of 35 ± 1.2 kg and a 4th group of non-obese, healthy women (C) with a normal BMI. Diagnostic accuracy (DG) of CP values of DXA indexes of abdominal obesity and indexes of normal body fat distribution (BFD) were determined.

Results: A/L, Tr/L, Tr/To, and L/To DXA indexes were significantly different between CS and O1 as well as between non-CS women O2 compared to O1 and C. These indexes had a highly significant correlation among each other and also in relation to their BMI (p < 0.0001). A/L-Tm CP value of 0.3 best differentiated the CS from group O1, with the highest DG of 100 % and an A/L-Fm CP value of 0.26 differentiated them with a DG of 94.44% and sensitivity of 100 %. An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 best differentiated CS and C as well as O2 and C for the highest DG of 100 %.

Conclusions: DXA indexes A/L, Tr/L, Tr/To and L/To values were significantly different among the four groups. These values correlated significantly among them and with their BMI in non-CS groups, thus confirming a BMI increase association with a more pronounced abdominal BFD. An A/L-Tm CP value of 0.3 and an A/L-Fm CP value of 0.26 were discovered as the best DXA diagnostic indexes of extreme abdominal obesity in CS and these could also be used in discovering abdominal BFD in non-CS obese women with metabolic syndrome (MS). An A/L-Tn CP value of 0.23 and an A/L-Fn CP value of 0.25 were discovered as the best DXA diagnostic indexes of normal BFD which completely excluded abdominal obesity.

Schlüsselwörter

  • DXA
  • abdominal obesity
  • DXA obesity indexes
  • cut-off point values
Uneingeschränkter Zugang

Enriching Human-Robot Interaction with Mobile App in Interventions of Children with Autism Spectrum Disorder

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 51 - 59

Zusammenfassung

Abstract

Introduction: Autism spectrum disorder (ASD) is a group of complex lifelong neurodevelopmental disorders, characterized by difficulties in social communication and stereotyped behaviours. Due to the increasing number of children with ASD, it is important to continue developing interventions as well as invent new ones. Human-robot interaction can contribute to better outcomes for these children. There are several robots such as Nao, Kaspar, ZENO, Probo, ZECA, etc. which are used in autism interventions. Many mobile and web applications are in constant growth, too. They target skills such as collaboration, social skills, language skills, social competence, and communication.

Aim: To explore the usability of the humanoid robot Kaspar and a complementary app in interventions of children with ASD.

Sample: 20 children with ASD, aged between 23 and 76 months old.

Method: As an added intervention for this group of children, we used the robot Kaspar and its complementary app. Kaspar is a child-sized humanoid robot that uses bodily expressions, facial expressions, gestures, and pre-recorded speech to interact with a human.

Results: This intervention achieved certain positive shifts in eight of the eleven measured developmental domains, such as communication functions and means, turn taking, imitation, language skills, play, attention and daily life skills. The three categories that had inconsiderable improvement are vocalization and speech, cause and effect and coping skills.

Conclusion: Based on the measurements before and after the use of Kaspar and its complementary app, there is improvement, primarily in the domains of language, imitation and communication skills and attention.

Schlüsselwörter

  • autism spectrum disorder
  • children
  • robot and mobile app intervention
Uneingeschränkter Zugang

Prevalence and Predictors of Impaired Glucose Tolerance and Diabetes Mellitus Type 2 in Patients with Polycystic Ovary Syndrome

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 61 - 70

Zusammenfassung

Abstract

Aim: To estimate the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DMT2), as well as the predictors for glucose abnormalities in women with polycystic ovary syndrome (PCOS).

Material and methods: A cross-sectional study with 80 consecutive patients with newly diagnosed PCOS who underwent the standard 75g oral glucose tolerance test (OGTT) and the measurement of sex steroid hormone and lipid profile.

Results: According to the results from the OGTT, 63% had a normal test (NT), 23% had IGT, and 9% had DMT2. The NT group was younger with lower BMI than IGT and DMT2 groups (25.1 ± 7.3, 31.5 ± 6.5, 37.4 ± 4.0 years, and 29.1 ± 8.3 kg/m2, 31.7 ± 4.6 kg/m2, and 34.5 ± 5.6 kg/m2, respectively). The testosterone levels were highest in the group with a normal test (2.7 ± 0.8 nmol/l) and lowest in the DMT2 group (1.9 ± 0.8 nmol/L), with statistical significance. The sex hormone bounding globulin (SHBG) levels were low in all three groups, with statistically significant differences between NG and IGT, and the NT and DMT2 groups. The multivariate linear regression model identified age, BMI, SHBG and testosterone as major independent predictors for abnormal glucose metabolism.

Conclusion: It seems that the prevalence of IGT and DMT2 among PCOS women in our country is not as high as in Western countries. Age, BMI, and SHBG increase the risk for the development of IGT and DMT2. Thus, close monitoring of older, obese women with low SHBG is needed because of the higher risk for the development of IGT and DMT2 in such patients.

Schlüsselwörter

  • polycystic ovary syndrome
  • OGTT
  • IGT
  • DMT2
  • testosterone
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High Risk Percutaneous Coronary Intervention of Left Main Bifurcation Stenosis in a Peritoneal Dialysis Patient

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 71 - 78

Zusammenfassung

Abstract

Complex coronary artery disease is the leading cause of death in patients with end-stage renal disease. We report a case of a patient on peritoneal dialysis, preloaded with Prasugrel and acetylsalicylic acid as а potent dual antiplatelet therapy (DAPT). The patient underwent a high-risk percutaneous coronary intervention (PCI) due to bifurcation stenosis of the left main stem branch. A “double kiss crush” bifurcation stenting technique was performed. This case provides additional data about the treatment of this group of patients, a group that is often excluded from randomized control trials, but is frequently encountered in cardiovascular practice. Furthermore, it helps to advance PCI treatment along with exploring the safety of potent DAPT in a group that is susceptible to both ischemia and bleeding, thus presenting a great challenge in the decision for treatment.

Schlüsselwörter

  • Left main bifurcation stenosis
  • high risk percutaneous coronary intervention
  • Prasugrel
  • optical coherence tomography
  • end stage renal diseases
  • peritoneal dialysis
Uneingeschränkter Zugang

Leptin, Obesity Parameters, and Atopy Among Children with Asthma

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 79 - 88

Zusammenfassung

Abstract

Leptin, as a major adipokine, positively correlates with the body’s fat, while atopy is an important feature in the development of childhood asthma. We aimed to evaluate the relationship between leptin, parameters of obesity, and atopy in children with asthma. The study included 112 children (73 boys, 39 girls, mean age 11.1±2.4). 41 were overweight, 38 had asthma and a normal body mass index (BMI), and 33 were overweight asthmatics. Serum leptin levels, BMI, waist circumference (WC), and waist to hips ratio (WHR) were measured. Skin prick test (SPT)/CAP, total serum IgE, fractional exhaled nitric oxide (FeNO), and pulmonary function tests were performed. In asthmatic children, serum leptin median level was 9.2±16.2 ng/ml, in overweight children was 30.6±21.6 ng/ml, and in overweight asthmatics was 31.1±20.3 ng/ml with a significant difference between the groups (p=0.0374), yet with a significantly lower median level in the group of children with asthma compared to the overweight children: with asthma (p=0.00001) and without asthma (p=0.00001). In the three groups of patients, BMI and WC displayed a significant positive correlation with leptin (for BMI r=0.652 vs. r=0.530 vs. r=0.563, respectively and for WC r=0.508 vs. r=0.426 vs. r=0.527, respectively). No significant correlations of leptin within atopy parameters (Eo, IgE, SPT/CAP, FeNO) in all three analyzed groups (p>0.05) was detected.

Conclusion: Atopy was not confirmed as an underlying mechanism of the association between asthma and being overweight. Leptin had a significant linear correlation as a parameter of central obesity with BMI and WC in all three groups, but not with WHR.

Schlüsselwörter

  • Asthma
  • body mass index
  • children
  • obesity
  • overweight
  • leptin
Uneingeschränkter Zugang

Cancer – Associated Thrombosis – A Study of Cases

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 89 - 97

Zusammenfassung

Abstract

Research shows that the presence of cancer increases the likelihood of developing venous thromboembolism (pulmonary thromboembolism and deep vein thrombosis) from as much as fourfold up to sevenfold. It is imperative that after early diagnosis we treat cancer-associated thrombosis with grave seriousness in order to reduce its morbidity and mortality.

We present 14 case reports of patients with cancer-associated thrombosis including thrombosis related to malignant hemopathies.

Schlüsselwörter

  • cancer-associated thrombosis (CAT)
  • malignant hemopathies
  • venous thromboembolism (VTE)
Uneingeschränkter Zugang

Potocki-Lupski Syndrome Dup17p11.2 in a Girl with Hypotonia and Early Behavioural Disturbances

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 91 - 94

Zusammenfassung

Abstract

Potocki-Lupski syndrome (PTLS) is a contiguous gene syndrome caused by duplication of chromosome 17p11.2. PTLS is characterized by hypotonia, failure to thrive, congenital anomalies (particularly of the cardiovascular system), intellectual disability, and behavioural disturbances.

The patient was a full-term baby girl, 2,750 grams at birth, delivered via an uncomplicated vaginal delivery with pronounced hypotonia at birth. Nevertheless, there was failure to thrive (weight 7.6 kg; 2.8 SD). Micrognathia, epicanthal skin folds, and megalocornea were noticeable. There was a harsh continuous systolic murmur, and the ultrasound of the heart revealed a persistent arteriosus duct which was surgically closed. At the age of 18 months, the girl could not sit without support, and she could not utter simple words. The girl is often moody, angry, and aggressive. She is hyperactive and unable to establish contacts with family members. A 17p12-p11.2 microduplication was identified via MLPA.

Muscle hypotonia, congenital heart malformation, failure to thrive, developmental delay, behavioural disturbances (or autism spectrum disorder), and intellectual disability are early signs of PTLS. The presence of PTLS was proven by an MLPA analysis.

Schlüsselwörter

  • Potocki–Lupski syndrome
  • hypotonia
  • cognitive delay
  • behavioural disturbances
  • congenital heart malformation
Uneingeschränkter Zugang

A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 95 - 101

Zusammenfassung

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases.

Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases.

In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up.

We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

Schlüsselwörter

  • COVID-19
  • SARS-CoV-2
  • MIS-C
  • appendicitis
  • pancreatitis
Uneingeschränkter Zugang

Implant Site Guided Bone Regeneration and Pontic Site Ridge Preservation: A Case Report

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 103 - 108

Zusammenfassung

Abstract

Guided bone regeneration (GBR) is a therapeutic modality to achieve bone regeneration with the use of barrier membranes. The use of deproteinized bovine bone material (DBBM) for ridge preservation allows the preservation of the edentulous ridge dimensions. Here, we present a case of horizontal GBR using DBBM and a resorbable membrane, with simultaneous implant placement. Simultaneously, ridge preservation of the pontic area, using DBBM within a “socket seal” procedure was performed. Two implants were places at sites 23 and 26 to support a fixed partial denture (FPD). The mesial implant showed exposed buccal threads, which were then covered with autogenous bone particles and small size granules of DBBM. The collagen membrane was stabilized with periosteal mattress suture. Six months postoperatively, CBCT images revealed a stable buccal bone layer at the implant site, indicating a successful GBR procedure. At this point in time, tooth 24 was atraumatically extracted. A ridge preservation was done utilizing DBBM, and a soft tissue graft form the tuber. A ceramic-metal FPD with excellent “white aesthetics” and a harmonic transition zone to the soft tissue was fabricated. At 3 years follow up, the peri-implant bone levels were stable, and the clinical outcomes were excellent. It is concluded that a GBR procedure, utilizing DBBM and a collagen barrier membrane with simultaneous implant placement, as well as ridge preservation using DBBM, are predictable therapeutic methods. However, gentle manipulation of the soft tissues, and wound stability, with tension-free passive closure of the wound margins are prerequisites for a long-term clinical success.

Schlüsselwörter

  • implants
  • guided bone regeneration
  • ridge preservation
  • deproteinized bovine bone materials
Uneingeschränkter Zugang

Anti-Factor H Antibody-Associated Atypical Hemolytic Uremic Syndrome: A Case Report

Online veröffentlicht: 26 Oct 2021
Seitenbereich: 109 - 115

Zusammenfassung

Abstract

Introduction: Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy, caused by dysregulation of the complement alternative pathway. Deletion of the complement factor H–related genes, CFHR1 and CFHR3, together with the presence of CFH autoantibodies are reported in aHUS patients, representing 10% of cases of patients with aHUS.

Case presentation: We report here on a case of 4-year-old girl with anti-CFH antibody-associated aHUS. The measurement of complement factors and anti-factor H antibodies, was the main guideline for making an accurate diagnosis and providing the appropriate therapy, with the patient responding positively to plasma exchanges (PEs) and cyclophosphamide pulses. We then, one year after disease onset, continued with glucocorticoids and mycophenolate mofetil (MMF), as maintenance therapy. There were no complications during the therapy other than neutropenia. Now, one year after the cessation of the immune suppression therapy, she is in remission with normal kidney function, no signs of hemolysis, normal C3 levels, and normal range proteinuria. The anti-factor H autoantibody titer decreased but still remained positive, the factor H antigen values remained low all throughout. Close follow-up is applied with frequent urine testing and complete blood count with an intention for early detection of relapse of the disease.

Conclusion: The purpose of this case report is to emphasize the value of complement factor measurements and also to separate anti-CFH antibody-associated aHUS as an entity, because immunosuppressive therapy provides an excellent response..

Schlüsselwörter

  • atypical hemolytic uremic syndrome
  • complement factor H autoantibodies
  • plasma exchanges
  • cyclophosphamide
  • mycophenolate mofetil

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