Hippokratia最新文献

Introduction: In oral and maxillofacial surgery, hard tissue augmentation is provided by materials that accelerate the healing, act as a template for reconstructing bony defects, and stimulate bone production and growth. This study investigated the effects of biocompatible carriers containing active vitamin D and platelet-rich plasma (PRP) on bone defects created in rat calvaria.

Material and methods: This experimental animal study utilized fifty-two male Sprague Dawley rats divided into six groups and conducted histopathological, microtomographic, and biochemical comparisons by adding vitamin D, which has an accelerating effect on bone development. We examined the calvarial defects, sacrificing the rats in equal numbers (eight in each group and four to obtain PRP) at the first, second, fourth, and eighth weeks. The newly formed bone was assessed using histopathologic, microtomographic, and macroscopic methods as well as the biochemical analysis performed in the plasma samples. Expression of fibroblast growth factor 23 (FGF23), vitamin D receptor (VDR), and receptor activator of nuclear factor-kappa B (RANK), which determine bone formation, were investigated. The amounts of ossification, bone volume, and mineral densities were significantly higher in the fourth and eighth weeks as the biocompatible material was delivered with calcitriol.

Results: The histological and macroscopic examinations revealed that the defect area shrank and was colonized with new cells in the "calcitriol + chitosan + PRP" group. The expression of RANK, FGF23, and VDR antibodies was more intense in the "calcitriol + chitosan + PRP" group than in other groups of the experiment and controls.

Conclusion: Active vitamin D, PRP, and chitosan formulation positively contributed to the repair of bone defects and induced remarkable clinical improvement. This new delivery approach could be promising for healing bone defects following surgical operations in hard bony tissues. HIPPOKRATIA 2023, 27 (2):48-56.

Background: Problematic internet use among university students is a rising phenomenon with repercussions worldwide. We aimed to determine the association between time spent online, loneliness, and mental health.

Methods: We conducted an online cross-sectional study using self-administered questionnaires on demographics, frequency of internet use as assessed by the Internet Addiction Inventory (IAT), depressive symptoms as reported by answering the Beck Depression Inventory (BDI), loneliness as depicted by the UCLA Loneliness scale, and general psychopathology on the self-reported General Health Questionnaire-28 (GHQ-28) scale. We performed statistical analysis using the IBM SPSS for Windows, Version 25.0.

Results: The mean age (n =294, 62.9 % female) was 23.19 ± 6.454 years. One-third (33.3 %) and 8.2 % were mildly and moderately addicted to the Internet, respectively. There was no participant with severe dependence. Nearly one-quarter (24.5 %) of participants reported mild, 10.6 % moderate, and 3.3 % severe depression and 44.8 % reported moderate and 11.9 % a moderately high degree of loneliness. Four in ten (41.8 %) of participants self-reported mental health problems. Mean IAT, BDI, UCLA Loneliness, and GHQ-28 score differences were statistically significant between IAT categories across all questionnaires. Correlations between the scales were statistically significant, and a binary logistic regression model revealed that the level of self-reported depressive symptoms, loneliness, and general psychopathology scores could predict internet use.

Conclusions: In our student sample, mental health problems were present in approximately 40 % of participants. They were significantly correlated with problematic internet use, thus complicating the development of essential communication skills in young adults. The higher the internet use, the greater the loneliness felt. Future studies should be more extensive, focusing on the relation of internet use with the type of use, family history of psychopathology, use of substances, and impulsivity. HIPPOKRATIA 2023, 27 (2):31-36.

Background: Laryngotracheobronchial anomalies in children are rare, and their clinical manifestations are diverse. In this study, we report the clinical aspects and prevalence rates of tracheal bronchus (TB) and congenital subglottic stenosis (CSS) in a select group of patients at our institution and briefly review and discuss the literature to draw attention to these rare anomalies.

Case series: We retrospectively reviewed the clinical records of 249 children for whom senior surgeons performed rigid bronchoscopy for suspected or confirmed food choking or foreign body aspiration in children between August 2013 and January 2020. Bronchoscopic findings and demographics of the patients with laryngotracheobronchial anomalies were documented. Four among the 249 patients (1.6 %) had right-sided TB (two males aged 24 and 42 months and two females aged 14 and 60 months), while three (1.2 %) had grade 1 CSS (one male aged eight months and two females aged 11 and 13 months). There was no previous history of endotracheal intubation for any subglottic stenosis (SS), though all three patients were admitted with sudden onset of respiratory difficulty. One of the TB cases had congenital cardiac anomalies, and two were symptomatic before their admission to the emergency department.

Conclusions: The prevalence of CSS and TB in the healthy population is low. Physicians dealing with the pediatric airways should consider such anomalies for prompt diagnosis, proper instrumentation, management, and follow-up of these cases. Our data also correlate with previous data, indicating that these anomalies' prevalence rates have not increased during the last few decades. HIPPOKRATIA 2023, 27(2):59-63.

Introduction: Hospitalizations of patients with atrial fibrillation (AF) lead to an explosion of expenditure on the public health system or private health expenses in family budgets. This study aims to estimate the duration and the cost of hospitalization for the public health system or the private cost to patients hospitalized after an AF episode.

Material and methods: Two hundred thirty-five consecutive patients (141 men and 94 women with an average age of 71.91 ± 12.2 years) who presented with AF to the Emergency Department of the General Hospital of Veroia during a single year were studied. We assessed the possible causes of arrhythmia, the duration and outcome of hospitalization, and the cost of hospitalization. We estimated the total cost by adding the price of the drugs used to cardiovert and the money spent on the patient's hospitalization.

Results: The average hospitalization time was 2.37 ± 1.17 days, and the average cost of hospitalization (total cost) was € 488.22 ± 170.34. There was a significant correlation between the severity of the episode and the total cost (r =0.78, p<0.0001), with 87.6 % of the total cost (€ 427.76 ± 135.86) being related to the cost of hospitalization (imaging, laboratory, hospitalization) and the rest to the drug therapy cost. Amiodarone (97 patients, 41.1 %), flecainide (52 patients, 22 %), propafenone (68 patients, 28.8 %), vernakalant (two patients, 0.8 %), and quinidine (eight patients, 3.4 %) were utilized.

Conclusion: The average cost of hospital care in patients with AF is significantly related to the severity of the episode. Effective drug therapy to reduce AF-provoking factors, such as antihypertensive therapy, combined with cardiovascular disease prevention in general, could reduce the morbidity and costs of AF-related hospitalizations. HIPPOKRATIA 2023, 27 (1):18-21.

Aim: Carcinogenesis of colorectal cancer is a process involving genetic mutations and epigenetic alterations in its multiple phases. The most considerable epigenetic alteration occurring in colorectal cancer (CRC) tumorigenesis is the methylation-mediated silencing of tumor suppressor genes. The present study aimed to detect the methylation status of SOX17 and WNT5a promoters in cell-free DNA circulating in plasma of metastatic CRC patients and to investigate potential prognostic correlation.

Methods: A methylation-specific real-time polymerase chain reaction was utilized to investigate the methylation status of genes (SOX17 and WNT5a) promoter in the blood of 85 metastatic CRC patients.

Results: We found the SOX17 promoter methylated in 54/85 (63.5 %) while WNT5a was methylated in 39/85 (45.8 %) samples of the advanced CRC. All control samples were negative for SOX17 and WNT5a promoter methylation. Patients with metastatic CRC and methylated SOX17 and WNT5a promoter status had a significantly poorer outcome than patients with non-methylated ones.

Conclusions: Plasma SOX17 and WNT5a promoter methylation are frequent epigenetic events in advanced CRC. The reported correlations between the methylation status of genes (SOX17 and Wnt5a) promoter and poorer survival in patients with advanced CRC disease agree with the proposed role of SOX17 as a tumor suppressor gene. A more considerable CRC patient cohort is required to research these findings' potential further and investigate whether SOX17 in plasma could serve as a useful prognostic biomarker in metastatic CRC. HIPPOKRATIA 2023, 27 (1):7-11.

Background: End-stage respiratory failure is non-treatable with mechanical ventilation and can be treated with veno-venous extracorporeal membrane oxygenators (VV-ECMO). It can also be used as a bridge to lung transplantation or recovery of lung function. This patient group can suffer from chronic pain, which is further exacerbated by painful procedures required as part of treatment. Pregabalin is licensed for chronic neuropathic pain and generalized anxiety disorder. Thus far, it has not been tried in routine analgesia protocols for pain relief of patients on VV-ECMO.

Case series: We included nine patients aged 17-54 years on VV-ECMO awaiting lung transplantation. Exclusion criteria were acute kidney injury and chronic kidney disease. All patients had morphine patient-control analgesia. In addition, pregabalin 50 mg twice daily was initiated in all patients with dose escalation as required. Pain scores and quality of sleep were evaluated daily. All patients experienced significant pain relief, demonstrated by reduced pain scores after treatment commencement. The mean visual analogue scale score was reduced significantly from 6 ± 2 to 3 ± 1. A significant increase in good-quality sleep duration was recorded from 5 ± 1.7 hours per day before to 8 ± 2.1 hours per day after pregabalin treatment. All patients except for two reported reduced anxiety levels of at least 2 ± 1 scale improvement (p <0.05).

Conclusions: Pregabalin is an efficient analgesic with accompanying anxiolytic effects in this group of patients with unique characteristics such as high analgesia requirements and exacerbated psychological and emotional stress. HIPPOKRATIA 2023, 27 (1):22-24.

Background: Rapunzel syndrome is a rare trichobezoar variant extending from the gastric cavity into the small bowel.

Case description: We report the case of a 22-year-old woman who presented with epigastric pain, nausea, and loss of appetite within the preceding five weeks. She had a palpable mass in the epigastric area with mild localized tenderness. Her abdominal computed tomography scan showed a distended stomach and duodenum, with a heterogeneous solid material, suspicious for a bezoar. Upper gastrointestinal endoscopy revealed a large, densely packed trichobezoar occupying the gastric cavity and extending through the pylorus. Endoscopic removal of the bezoar was unsuccessful. The patient underwent a 6cm-long gastrotomy, and the 150cm-long bezoar, extending from the stomach to the jejunum, was uneventfully removed. The patient was referred postoperatively to a dietitian and psychiatrist for management of her trichotillomania and trichophagia.

Conclusion: Trichobezoars are commonly found in young females with a history of trichotillomania and trichophagia and are associated with psychiatric disorders. HIPPOKRATIA 2023, 27 (1):25-27.