Hippokratia最新文献

Background: The ever-increasing sport level makes every single detail of the athlete's cardiorespiratory profile count, and therefore, it is deemed crucial to clarify how the anterior cruciate ligament (ACL) reconstruction (ACLR) affects the energy economy of an athlete compared to the ACL-deficient and healthy subjects. The purpose of this review was to systematically analyze the studies investigating the correlation between the energy-oxygen cost in patients following ACLR in unreconstructed and intact ACLs.

Methods: We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Cochrane, and Google Scholar databases were searched, and eight articles describing miscellaneous methods for the assessment of oxygen consumption in patients with ACL deficiency or ACL reconstructed knees were included.

Results: In total, 285 subjects were recorded with a mean age of 29.61 years. The type of exercise the patients were subjected to varied among the studies, including one-leg cycling, exercise in the closed kinetic chain, walking, jogging, or running at various speeds, and treadmill inclinations. The energy expenditure of an ACL-deficient patient is considerably higher than a healthy subject. Additionally, chronicity of the ACL tear is not correlated with energy expenditure. ACL deficiency leads to higher energy consumption, not only during walking but during jogging as well. ACLR could improve the efficiency of walking by lowering the energy demands. After ACLR, professional soccer players' aerobic capacity (VO₂max) is improved significantly.

Conclusions: ACL insufficiency affects substantially the metabolic energy costs, resulting in increased energy expenditure. According to current literature, ACLR can help to partially reverse this condition, as significant improvements and a more efficient, energy-wise, locomotion are expected. However, further research is necessary to clarify if ACLR can completely normalize energy expenditure again. HIPPOKRATIA 2023, 27 (4):119-125.

Background: Statin regimens are essential for managing lipids and preventing cardiovascular diseases, both in primary and secondary prevention, alongside lifestyle changes. There are, however, some side-effects associated with statin intake, such as an elevation of (CK) and myopathy.

Case description: This case describes a coronary patient with high low-density lipoprotein cholesterol (LDL-C) who was undertreated due to elevated creatine kinase (CK) levels and myopathy initially linked to statin use. A proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) replaced statin therapy; however, the existence of persisting/recurrent symptoms or CK elevation posed the need for further investigation. A neurological examination, an electromyography (EMG), and a nerve conduction study (NCV) revealed an underlying sensorimotor polyneuropathy, probably Charcot-Marie-Tooth disease.

Conclusions: Persistent muscle symptoms in patients receiving statins should not be always attributed solely to statin intake. Further neurological evaluation could reveal underlying hereditary sensorimotor polyneuropathies. PCSK9i could serve as the therapy of choice in such cases, as additional drug-induced myopathy could pose severe problems for those patients. HIPPOKRATIA 2023, 27 (4):155-157.

Background: This study aimed to identify the risk factors of recurrence following surgical excisional procedures for cervical intraepithelial lesions (CIN).

Methods: We conducted a retrospective cohort study of women with cervical pathology treated surgically over seven years. All patients with surgical interventions of the cervix were recorded and analyzed according to the recurrence following their primary treatment. We utilized the Chi-square test and the multivariate regression analysis to identify recurrence risk factors. We also employed the Kaplan-Meier survival analysis for disease recurrence.

Results: In total, 83 patients were reported; 81 (97.6 %) were treated with loop electrosurgical excision, and two (2.4 %) with cold knife conization. The histopathological results of the treatment approach showed one case (1.2 %) of low-grade intraepithelial lesions, 70 (84.4 %) high-grade intraepithelial lesions (HSIL), five (6 %) with IA1, and two (2.4 %) with IA2, cervical cancer, while in five patients (6 %) the results were negative for cervical pathology. Recurrence was diagnosed in 23 cases (27.7 %), and HSIL was diagnosed in 10 patients (12 %). The median time of recurrence was 11.6 months. Positive endocervical margins [odds ratio (OR): 52.478; 95 % confidence interval (CI): 8.315-331.203; p <0.001], excision of the cone in multiple specimens (OR: 8.793; 95 % CI: 1.854-41.693; p =0.006), and depth of cone less than one cm (OR: 21.225; 95 % CI: 3.176-141.863; p =0.002) were identified as independent risk factors for recurrence.

Conclusions: Positive endocervical margins, multiple loop passes, and depth of the cone less than one cm were the most significant risk factors for recurrence. HIPPOKRATIA 2023, 27 (4):132-140.

Background: Elabela/toddler (ELA-32) is a recently identified endogenous apelin receptor ligand. ELA levels are known to rise in heart failure (HF) patients. However, the association between elevated ELA levels and prognosis in these patients remains unknown. We aimed to investigate whether ELA plasma levels are correlated with prognosis in heart failure patients with reduced ejection fraction (HFrEF).

Methods: This case-control cross-sectional study enrolled 150 patients, including 73 HFrEF patients and 77 age- and gender-matched healthy volunteers. We collected a blood sample at hospital admission to measure ELA-32 levels. The study endpoint was cardiovascular mortality or HF-related hospitalization. We followed up all patients in the study for a mean of 7.48 ± 2.73 months.

Results: In patients with HFrEF, ELA-32 levels were higher than those in controls. The levels of ELA-32 showed a significant increase at advanced New York Heart Association stages. In the receiver operating characteristics curve analysis, a cut-off value of the serum ELA-32 level of 8.25 ng/mL showed a sensitivity of 76 % and specificity of 82 % for predicting the study endpoint [area under the curve: 0.84; 95 % confidence interval (CI): 0.72-0.98; p <0.001]. Cardiovascular mortality (p =0.042) and HF-related hospitalization (p <0.001) were statistically more significant in patients with ELA-32 levels greater than 8.25. Age [Hazard ratio (HR) =1.023; 95 % CI: 0.964-1.230, p =0.039], N-terminal pro-brain natriuretic peptide (HR =1.300; 95 % CI: 1.017-1.874, p =0.017), left ventricular end-diastolic volume (HR =1.142; 95 % CI 1.022-1.547, p =0.028), and ELA-32 ≥8.25 (HR =2.556; 95 % CI: 1.078-3.941, p <0.001) remained independently associated with the risk of study endpoint.

Conclusion: For the first time, HF-related hospitalizations and cardiovascular mortality are independently associated with increased ELA-32 levels in patients with HFrEF. HIPPOKRATIA 2023, 27 (4):126-131.

Background: Head and neck surgery is considered high-risk for difficult intubation and accidental extubation. Laryngomicroscopy implies surgical manipulations at the level of the vocal cords. Also, this type of surgery demands a particular position for the patient during the whole surgical intervention. All of this makes accidental extubation even more possible.

Methods: We included a total of 100 patients scheduled for laryngomicroscopy in the study. We have assessed patients' general and clinical data and provided necessary measurements. After the intubation, we documented the depth of the endotracheal tube at the level of the upper incisors and repeated the measurement after the surgical intervention. We recorded all possible difficulties encountered by the surgeon.

Results: We found a significantly more frequent tube dislocation in patients from the difficult intubation group, with χ² =6.632, p =0.010. Inter-incisor gap (IIG) and modified Mallampati score showed statistical significance regarding tube dislocation, with p values of 0.002 and 0.047, respectively. There was statistical significance between tube dislocation and difficulties experienced by surgeons, with χ² =13.504 and p =0.001. According to the area under the curve (AUC) at the Receiver operating characteristic (ROC) curve, the cut-off value for significant tube dislocation was 1.15 cm. When we divided the enrolled patients into two groups, below and above the cut-off value, the IIG maintained statistical significance with a cut-off value of 5.25 cm.

Conclusions: Modified Mallampati score and IIG are considered valuable parameters for rapid preoperative risk assessment of possible accidental extubation. The final depth of the endotracheal tube should be about two cm deeper than necessary, as long as there is adequate ventilation on both sides of the lungs. Difficult intubation undoubtedly represents a risk for accidental extubation occurrence. HIPPOKRATIA 2023, 27 (4):141-147.

Background: Lifestyle changes in Diabetes Mellitus (DM) positively affect blood glucose and all risk factors. This study aims to determine the effect of swimming and running exercises on oxidant-antioxidant and lipid profiles in streptozotocin (STZ)-induced type 1 diabetic and non-diabetic rats.

Methods: We included forty-eight adult male Wistar albino rats in this study, and we randomly classified them into six groups (eight per group). The groups were organized as Control Sedentary, Control Exercise-swimming, Control Exercise-running (CE-r), Diabetes Sedentary (DS), Diabetes Exercise-swimming (DE-s), and Diabetes Exercise running (DE-r). Half of these rats were subjected to experimental diabetes via STZ. We evaluated total oxidant capacity (TOC), total antioxidant capacity (TAC), superoxide dismutase (SOD), and as lipid parameters: high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. The rats were sacrificed at the end of the four weeks.

Results: We found a significant difference between DE-s and DE-r groups in terms of TOC (p =0.043) and SOD (p =0.030). The highest TAC was found in the CE-r group, and the highest TOC was found in the DS group. Exercise significantly reduced LDL levels. There was no significant difference between the DE-s and DE-r groups (p =0.084) for lipid profiles (HDL).

Conclusion: Based on the lower TOC (oxidant) and higher SOD (antioxidant) levels in the diabetic running group, these results suggest that running may be more beneficial than swimming for diabetics. HIPPOKRATIA 2023, 27 (4):148-154.

Background: Cholangiocarcinoma (CCA) may invade the bile duct, causing malignant biliary obstruction, which is mainly treated by percutaneous biliary stenting. Biliary tract infection after stenting is a severe and common complication in the early postoperative period. In this study, we investigated the risk factors predisposing to infection after percutaneous biliary stenting in patients with CCA and its effect on prognosis. Our findings might reference early clinical prevention, diagnosis, and treatment.

Methods: We analyzed retrospective data regarding 337 patients who developed CCA and underwent percutaneous biliary stenting from December 2016 to December 2021. We collected the patients' general characteristics and clinical data utilizing a questionnaire regarding general information designed by the investigator. We performed the t-test and chi-square test to investigate the association between the clinical characteristics and postoperative infection and binary logistic regression to analyze the independent risk factors for patients developing postoperative infections. We used the Cox risk regression to determine each factor's effect on patients' survival status.

Results: Seventy-three cases of postoperative infection occurred in total, with an estimated infection rate of 21.7 %. Logistic regression analysis revealed that age [odds ratio (OR) =1.041, p =0.031], presence of combined gallstones (OR =2.200, p =0.030), stent type (OR =2.607, p =0.003), administration of preoperative prophylactic antibiotics (OR =0.473, p =0.042), presence of intraoperative complications of biliary bleeding (OR =2.452, p =0.017), presence of postoperative biliary pneumoperitoneum (OR =2.355, p =0.013), duration of surgery (OR =1.026, p =0.008), preoperative serum albumin (Alb) (OR =0.946, p =0.005), and preoperative hemoglobin (Hb) (OR =0.964, p =0.014) were the independent factors influencing postoperative infection development. The Cox risk regression analysis showed that infection occurrence was an independent factor influencing patients' survival time (OR =1.041, p =0.031).

Conclusion: Biliary tract infection is the most common complication after biliary interventions, and severe infection may even lead to death. Clinical studies should analyze and evaluate patients' clinical characteristics, perioperative indicators, and relevant serological indicators, identify relevant risk factors, and administer prompt treatment to reduce the chance of infection and improve patients' prognosis. HIPPOKRATIA 2023, 27 (2):89-98.

Background: Spontaneous non-specific pyogenic spondylodiscitis (SNPS) is a rare medical condition, whose optimal treatment remains controversial. We evaluated the multidisciplinary protocol implemented at our department for the conservative treatment of patients with SNPS.

Methods: Patients with lumbar or thoracic SNPS, whose treatment was initiated conservatively and had at least six months of follow-up, were enrolled in this retrospective audit study. Patients with specific, postoperative, or iatrogenic spondylodiscitis or necessitating immediate operative treatment were excluded. The location of the infection, initial symptoms, co-morbidities, pathogens, duration of antibiotic treatment, hospitalization and follow-up, and outcome were retrieved. The visual analogue scale (VAS) score was used to register pain improvement after treatment.

Results: Between January 2011 and December 2021, forty-seven patients (male: 26, mean age: 68.5 years) with SNPS (lumbar: 29, thoracic: 18) were hospitalized. The main co-morbidity was diabetes mellitus (23 patients). Pain was the predominant (46 patients), and fever was the second most common (19 patients) symptom. The most frequent causative microorganism was staphylococcus aureus (29 patients); no pathogen was identified in ten patients. The mean hospitalization duration for patients completing their conservative treatment (43/47) was 27 (range: 22-41) days. They received antibiotics for a mean period of 23 days intravenously (range: 21-29), 23.8 days per os (range: 21-35), and 46.8 days in total (range: 42-63). Conservative treatment was discontinued in two females. Two male patients died due to septic shock. The mean follow-up was 11.5 months (range: 6-15). During follow-up, no one developed any neurologic deficit and/or recurrence. There was a significant improvement in the mean VAS, from 8.3 ± 0.8 pre-treatment to 1.6 ± 0.5 at the latest follow-up (p <0.001).

Conclusions: Although treatment is gradually shifting towards surgical intervention, conservative therapeutic management of SNPS patients with antibiotic administration, bed rest, and careful mobilization remains a viable and efficacious option. HIPPOKRATIA 2023, 27 (2):106-111.

Background: Although migraine is among the most common disabling conditions worldwide, it is rarely accurately diagnosed. This study aimed to categorize and compare patients suffering from migraines without aura (MWA) or other types of headaches in primary health care facilities.

Material and methods: We conducted a prospective, cross-sectional, epidemiological, and non-interventional study at 46 primary health care facilities in Bosnia and Herzegovina. The validated Balkan Migraine Screening Questionnaire (BMSQ) was used to classify patients into MWA or non-MWA groups.

Results: The study comprised 1,366 patients categorized into MWA (n =896, 65.6 %) and non-MWA (n =470, 34.4 %) groups. Seven hundred thirty-four patients with MWA were newly identified. The patients in the MWA group were significantly younger, at 49.9 ± 13.7 years, compared to the non-MWA group at 52.0 ± 14.4 years (p =0.008). The MWA group documented less alcohol consumption (11.0 % vs 18.7 % for the non-MWA group, p <0.001) and experienced more severe headaches [headache intensity on Visual Analogue Scale (VAS), with a median score of 7, interquartile range (IQR): 6-8 vs 5 (IQR: 4-7) for the non-MWA group, p <0.001)]. The MWA group had a higher proportion of women (80.1 % vs 64.3 % for the non-MWA group, p <0.001). Compared to the non-MWA group, patients in the MWA group experienced more frequent headache attacks (more than six attacks in the preceding six months: 50.6 % vs 28.1 %, p <0.001), needed additional headache treatment (using two or more classes of antiheadache therapy 41.3 % vs 26.4 %, p <0.001), and had a positive family history of migraine (46.9 % vs 23.0 %, p <0.001). The binomial regression model identified two positive predictors (family history of migraines and headache intensity) and one negative predictor (alcohol consumption) for the BMSQ classification of patients into the MWA group.

Conclusion: More than half the patients in this study were newly classified as having MWA, indicating a high prevalence of undiagnosed migraine. Categorization of patients with headaches is of crucial importance for appropriate treatment and should be utilized in everyday practice in primary health care settings. HIPPOKRATIA 2023, 27 (2):99-105.