Hippokratia最新文献

Background: Eosinophilia is frequent in pediatrics and concerns regarding its etiology are often raised. Pediculosis capitis is a common ectoparasitic disease in children but is not traditionally associated with changes in laboratory parameters.

Case description: We present the case of a healthy, 9-year-old girl who presented with abdominal pain and a history of loose stools (2-3) in the preceding week. Laboratory investigations showed leukocytosis with significant eosinophilia. A thorough investigation concerning the most common causes of eosinophilia was negative. Detailed physical examination and history revealed a persistent scalp infestation with head lice. Successful pediculosis management coincided with the gradual resolution of eosinophilia without recurrence until the most recent follow-up visit twelve months later.

Conclusions: The presented case indicates a possible association between eosinophilia and pediculosis capitis, which was not previously displayed, but also highlights the importance of detailed history and clinical examination. Research focusing on the systematic effects of pediculosis capitis in children could clarify whether it can represent a frank cause of eosinophilia. HIPPOKRATIA 2023, 27 (2):112-114.

Background: To assess the feasibility of using T2 relaxation time mapping at 3 Tesla (3T) magnetic resonance imaging (MRI) for detection and classification of lumbar intervertebral disc degeneration, introducing an objective model of disc segmentation for accurate disc assessment.

Materials and methods: The present study is a single-center prospective evaluation including 185 lumbar intervertebral discs from a cohort of 37 patients with chronic lower back pain. For the quantitative classification of disc degeneration, three regions of interest (ROIs) were drawn on T2 maps, and the Pfirrmann grading system was used for qualitative assessment. Intergroup evaluation was performed with paired t-tests. Analysis of variance (ANOVA) was used to compare the mean value of T2 mapping, and Tukey's multiple comparison test was applied to determine differences in mean values of T2 mapping among the Pfirrmann categories.

Results: The ANOVA test analysis of ROIs showed that there is a statistically significant difference (p <0.001) among average T2 relaxation time mapping values in different Pfirrmann score groups, and Tukey's multiple comparison tests revealed that mean values of T2 map among the different grades of Pfirrmann differ from the rest (p <0.001) except grade V. Paired t-tests revealed significant differences in mean values of T2 map between different ROIs.

Conclusion: This study showed that quantitative T2 mapping of the lumbar intervertebral discs at 3T MRI may overcome the subjective element of qualitative classification systems for degenerative intervertebral disc disease. Also, a new template of disc segmentation with more ROIs would be more sensitive for the assessment of disc degeneration. HIPPOKRATIA 2023, 27 (2):75-81.

Background: Dog bite injuries commonly fall under the radar of the public health surveillance systems. Nevertheless, these incidents may result in emotional distress, disfigurement, functional deficit, or exposure to zoonotic agents and therefore may have a considerable impact on public health.

Methods: A pilot surveillance scheme was launched in Greece to assess the epidemiology of dog bite injuries. Physicians in hospital-based emergency room departments and primary health care centers were required to report bite cases via a reporting form. The collected data were analyzed cross-sectionally.

Results: From January to June 2023, 1,656 dog bite victims attended the healthcare settings in Greece. The rate was estimated at 15.8 cases per 100,000 population. The frequency of healthcare visits varied significantly among the regions (p <0.0001), ranging from 0.9 to 45.2 per 100,000 inhabitants. The median number (interquartile range in brackets) of visits concerning dog bite victims for the examined period per reporting hospital was nine (2, 21) and per reporting health center three (1, 10), respectively. The ownerless-to-owned dogs ratio was almost equal (1.04). According to the Abbreviated Injury Scale, 67.3 % of the injuries were classified as minor, 27.7 % as moderate, 4.9 % as serious, and 0.1 % as critical. The lower limb was the most frequently affected anatomical site (50.6 %). Head/neck injuries were associated with younger patients (p <0.0001). Macroscopic tissue loss occurred in 11.9 % of the cases, with the majority presenting areas of damaged or missing skin (50.9 %); partially or completely amputated hand digits occurred in nine of these cases (8.5 %). Among dog bite victims, 2.8 % were hospitalized (inpatients), and 1 % were referred to other hospitals.

Conclusions: Dog bite surveillance offers important epidemiological information on the respective traumatic impact. HIPPOKRATIA 2023, 27 (2):82-88.

Background: Gitelman syndrome (GS) is a rare autosomal recessive salt-losing tubulopathy. Mutations in the SLC12A3 gene encoding the renal thiazide-sensitive Na/Cl cotransporter in the distal renal tubule, cause GS. Identifying biallelic inactivating mutations in the SLC12A3 gene is the most common finding in GS, while the detection of renal calculi is relatively rare.

Case presentation: We report the case of a 33-year-old man admitted with recurrent limb weakness for six years. Laboratory tests showed hypokalemic alkalosis, hypocalciuria and renal potassium wasting; serum magnesium and aldosterone were normal, and ultrasound and computed tomography scans showed right-sided renal calculus. A hydrochlorothiazide test was performed, which showed a blunted response to hydrochlorothiazide. Next-generation sequencing identified triple mutations in SLC12A3, including novel splicing heterozygous mutations (c.2285+2T>C). He was administered with oral potassium chloride and spironolactone and maintained mild symptomatic hypokalemia during his follow-up.

Conclusions: The patient was diagnosed with Gitelman syndrome by genetic testing, accompanied by kidney stones. Although kidney stones are rare in Gitelman syndrome, they are not excluded as a criterion. The composition of kidney stones may be of significance for diagnosis and treatment. HIPPOKRATIA 2023, 27 (2):64-68.

Background: L-asparaginase is valuable in treating pediatric acute lymphoblastic leukemia (ALL), yet its use has been associated with lipid profile disturbances.

Methods: We compared the lipid profile [high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, apolipoprotein-α1 (Apo-Α1), apolipoprotein-B100 (Αpo-B100), lipoprotein-α (Lp-α), glucose, amylase, and lipase] between newly diagnosed ALL patients, ALL survivors, and healthy controls. We also assessed alterations of the parameters mentioned earlier during induction and consolidation treatment.

Results: We recorded significant differences in the lipid profile at diagnosis of children with ALL compared to controls (HDL cholesterol, triglycerides, Apo-A1, and Apo-B100 levels). HDL cholesterol, total cholesterol, and Apo-Α1 levels increased significantly during induction at most time points. Levels of Αpo-B100, triglycerides, and Lp-α exhibited a downward trend. During re-induction, no change was observed. During the treatment of high-risk patients, we found no statistically significant difference for any of the examined variables.

Conclusion: To confirm our preliminary results, the role of the administration of L-asparaginase and other medications in the variations in the lipid profile at diagnosis of children with ALL needs to be further elucidated with larger multicentre studies, including more patients from diverse ethnic backgrounds. HIPPOKRATIA 2023, 27 (2):41-47.

Background: The prevalence of malignancies is higher among kidney transplant recipients (KTR) than general population. Although the incidence of renal cell cancer (RCC) after KTR was reported as 0.6 % with a high mortality rate of 13.9 %, none of the guidelines except the European Best Practice Guideline (EBPG) recommends RCC screening based on cost-effectiveness and lack of solid evidence. The EBPG recommends RCC screening in native kidneys (not the allograft) by ultrasonography (USG) every 1-3 years.

Case description: A 55-year-old male patient who had a kidney transplant from a living donor 14 years before, presented with sudden onset uncontrolled hypertension (180/110 mmHg) and rapid deterioration in graft functions (increase in serum creatinine to two-times baseline). Evaluations revealed RCC in the allograft. Abdominal pain, hematuria, fever, weight loss, flu-like syndrome, recurrent urinary tract infections, weakness, hypertension, and allograft dysfunction are reported as the main complaints and signs of RCC in KTR patients. Our patient's findings were hypertension and allograft dysfunction.

Conclusion: It is essential to follow EBPG for KTR and not to forget the annual USG for screening of RCC both in native kidneys and allograft. HIPPOKRATIA 2023, 27 (2):69-71.

Objective: We aimed to evaluate in this study the diagnostic value of the plasmin-α2-plasmin inhibitor complex in patients with malignant tumors and venous thromboembolism (VTE).

Methods: A total of 58 patients with confirmed malignant tumors and VTE were selected, and their plasma samples were collected within 24 hours after VTE diagnosis. We also selected 60 patients with malignant tumors who were hospitalized at the same time and did not have VTE following imaging examination. Their plasma samples were collected within 24 hours after admission and were compared to those of the VTE group concerning the levels of plasmin-α2-plasmin inhibitor (PIC), thrombin-antithrombin complex (TAT), tissue-type plasminogen activator-inhibitor complex (tPAI-C), and thrombomodulin (TM). We used the receiver operator characteristic (ROC) curve to evaluate the diagnostic efficacy of each index regarding malignant tumors accompanied by VTE.

Results: PIC, TAT, and tPAI-C were significantly higher in the group with malignant tumors and VTE compared to the group with malignant tumors without thrombosis (p =0.010, p =0.001, and p =0.003, respectively). In contrast, we found no significant difference in TM levels between the two groups (p =0.483). The area under the curve (AUC) of PIC, TAT, and tPAI-C regarding patients with malignant tumors and VTE was 0.852, 0.636, and 0.655, respectively, demonstrating diagnostic values for those cancer patients suffering VTE. PIC had the highest diagnostic efficiency in those patients with malignant tumors and VTE, while the AUC of TM was 0.537, so its diagnostic value for VTE-complicated malignant tumors was limited.

Conclusion: PIC has a sufficient value for the early diagnosis of VTE in patients with malignant tumors. HIPPOKRATIA 2023, 27 (2):37-40.