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Journal Article 2016; 37(7): 478-484 PubMed PMID: 28326741 Citation  Keywords:  Adult, Anxiety Disorders:etiology, Child, Child Abuse, Depression:etiology, Depressive Disorder:etiology, Female, Health Surveys, Humans, Life Change Events, Male, Risk Factors, Substance-Related Disorders,.   

OBJECTIVES: The childhood adversities model is generally accepted as a predictor of adult psychopathology vulnerability. It stems from child development theories, but the question remains as of how well solid research supports it. The aim of this article is to give a review of the studies concerning childhood adversities and their impact on the development of anxiety disorders and major depressive disorder in adulthood.

METHOD: A computerized search of the MEDLINE database of publications up to 31 March 2016 was done, using the keywords "childhood adversities, abuse, maltreatment, bullying" and "anxiety disorders, depressive disorder". No backward time constraints were used. Non-original studies, conference abstracts, books and book chapters, commentaries, and dissertations were excluded.

RESULTS: The influence of childhood adversities on later age psychopathology is examined in five categories: the negative family atmosphere, abuse, loss of a close person, the social difficulties, and problems at school (including, most importantly bullying). The majority of studies confirmed the connection between childhood adversities and anxiety and depression disorders in adulthood. The character of the adversities is not, apparently, a specific predictor for a concrete psychopathology. Multiple adversities are more frequently connected with depressive and anxiety disorders in adulthood, cumulating together in broader adverse context.

CONCLUSION: Childhood adversities were found to increase vulnerability to the distress, depression, fear and anxiety later in the life. However, specific correlations between a given childhood adversity and a specific form of depression or anxiety disorder were either not found or weak. This is in line with the generally accepted view considering each of these factors a non-specific stressor increasing vulnerability to mood and affect disorders later in life....

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Case Reports 2016; 37(7): 473-477 PubMed PMID: 28326740 Citation  Keywords:  Abortion, Habitual:therapy, Adult, Enoxaparin:administration & dosage, Female, Humans, Pregnancy, Pregnancy Outcome, Sildenafil Citrate:administration & dosage, Treatment Outcome,.   

OBJECTIVES: Does addition of Intralipid to sildenafil and enoxaparin immunotherapy improve pregnancy outcome?

MATERIALS AND METHOD: Report of a striking case of a patient with history of 4 recurrent pregnancy losses (RPL) and IVF failures.

RESULTS: Adding of Intralipid resulted in giving birth to a healthy male baby in the 3th IVF cycle.

CONCLUSION: Combination therapy that includes Intralipid may generate successful IVF outcome, although this problem merits further study, especially regarding safety issues....

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Case Reports 2016; 37(7): 469-472 PubMed PMID: 28326739 Citation  Keywords:  Adolescent, Adrenal Insufficiency:diagnosis, Female, Hormone Replacement Therapy, Humans, Hyponatremia:diagnosis, Hypopituitarism:blood, Pituitary Diseases:complications, Pituitary Gland:metabolism, Seizures:complications, Sodium:blood, Treatment Outcome,.   

: Pituitary stalk interruption syndrome (PSIS) is a congenital disease with isolated growth hormone deficiency (GHD) or multiple anterior pituitary hormone deficiencies (MPHD). The typical clinical manifestations of PSIS are growth retardation, hypoglycemia or delayed pubertal development. However, few reports showed cases of PSIS were diagnosed with acute epileptic seizures accompanied by hyponatremia. Here, we report an 18-year-old female presenting with episodes of intermittent seizures for 13 years. The electrolyte examination on many occasions has shown hyponatremia, even as low as 99.9 mmol/L. However, the cause of hyponatremia has not been further discussed. The patient had short stature and no pubertal development. The laboratory tests revealed growth hormone deficiency, secondary adrenal insufficiency, hypothyroidism and hypogonadotropic hypogonadism. MRI showed an ectopic hyperintense signal of the posterior pituitary and no visible anterior pituitary gland or stalk. The hormone replacement therapy helped to raise the sodium concentration to a normal level and in the termination of seizures....

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Journal Article 2016; 37(4): 337-342 PubMed PMID: 27857052 Citation  Keywords:  Aged, Aged, 80 and over, Atrial Fibrillation:blood, Case-Control Studies, Cohort Studies, Female, Heart Failure:blood, Humans, Hyperthyroidism:blood, Hypothyroidism:blood, Male, Middle Aged, ROC Curve, Thyroid Function Tests, Thyrotropin:blood, Thyroxine:.   

OBJECTIVE: To fully investigate the thyroid hormonal function in patients with the most common arrhythmia - atrial fibrillation.

MATERIALS AND METHODS: 120 patients (aged 55-85 yrs) with symptoms of congestive heart failure exacerbation and no other concomitant disorders (inclusion criteria: normal cardiac troponin T at admission and 12 hours after, normal renal, hepatic and respiratory function; exclusion criteria: inflammatory state, history of myocardial infarction). Depending on the presence of permanent atrial fibrillation (PAF), patients were divided into two groups: PAF (34 females, 26 males) and regular sinus heart rhythm (43 females, 17 males), the groups did not differ in terms of heart rate, blood pressure, presence of overt/subclinical thyroid dysfunction, and medical therapy used. In all subjects thyroid stimulating hormone, free thyroxine, free triiodothyronine, reverse triiodothyronine were measured; echocardiography was performed.

RESULTS:&nbsp;PAF group showed higher FT4 and rT3 (1.41 vs. 1.27 ng/dl, p=0.0007; 0.61 vs. 0.32 ng/ml, p<0.0001, respectively). With ROC curve analysis the biochemical thyroid related factor of the highest prognostic value for PAF occurrence (with the highest sensitivity and specificity: 77% and 72%, respectively) was rT3 with the cut-off of above 0.3 ng/ml. Also, a positive correlation between rT3 levels and left ventricular posterior wall diameter was observed (Spearman's correlation coefficient 0.33, p=0.0093).

CONCLUSIONS:&nbsp;PAF is another condition where an increase in rT3 is observed. rT3 concentration above 0.3 ng/ml may be a novel biochemical sign associated with the presence of PAF in patients with chronic heart failure....

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Journal Article 2016; 37(4): 325-336 PubMed PMID: 27857051 Citation  Keywords:  Adrenocorticotropic Hormone:metabolism, Adult, Aging:metabolism, Alanine Transaminase:metabolism, Biomarkers:metabolism, C-Reactive Protein:metabolism, Case-Control Studies, Cross-Sectional Studies, Female, Hepatitis C, Chronic:immunology, Humans, Hydroco.   

BACKGROUND:&nbsp;Whilst the hypothalamic-pituitary-adrenal (HPA) Axis is a major stress axis, and is necessarily perturbed in opioid dependency, and stress is a major contributor to aging mechanisms, the HPA axis has not been studied in opioid dependency in an age-dependent manner.

OBJECTIVE:&nbsp;Hypothesis - Differences in age dependent levels of HPA components.

DESIGN:&nbsp;Cross-sectional comparison of general medical and opioid dependent patients (ODP, GMP). Setting - Primary Care. Patients - 51 GMC, 233 ODP. Ages 37.92+1.95 v. 37.12+0.62 years (P - N.S.) and 33.33% v. 71.67% male (p<0.0001). Intervention(s) - Measurement ACTH, cortisol and their ratio (ACR). Main Outcome Measure(s) - Pre-planned analysis ACR.

SECONDARY OUTCOMES:&nbsp;Impact of immune and metabolic markers.

RESULTS:&nbsp;ACTH/cortisol was a negative biomarker for age in female patients. Whilst the mean ACR were not different, the (log) ACTH/cortisol showed a positive relationship with age:sex:status (p=0.0396) and age:status (p=0.0437). The effect of addictive status was confined to hepatitis C (HCV) positive female ODP (p=0.0355), and the age:status interaction was also stronger in female HCV+ (p=0.0075) compared to HCV - (p=0.0667) patients. Multiple regression of ACR against age, status, ALT, CRP, and Globulins confirmed many significant interactions. ACTH/cortisol ratio interacted significantly from p=0.0008 in males and p=0.0079 in females, and in both sexes four terms included addictive status.

CONCLUSIONS:&nbsp;These data establish the ACTH/cortisol ratio as a negative biomarker of aging in females, and show that this decline is more pronounced in ODP an effect which is partly related to HCV seropositivity, immune and metabolic factors. Dementias are one of the most serious health and socioeconomic issues. Multi-infarct dementia (MID) and Alzheimer´s type dementia (AD) exhibit differences in cerebrovascular blood flow velocity profiles and in presence of microemboli, detected by transcranial Doppler sonography....

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Journal Article 2016; 37(4): 318-324 PubMed PMID: 27857050 Citation  Keywords:  Adrenal Cortex Hormones:therapeutic use, Adult, Aged, Aged, 80 and over, Brain Neoplasms:diagnostic imaging, Central Nervous System Neoplasms:diagnostic imaging, Diffusion Magnetic Resonance Imaging, Disease Progression, Female, Humans, Immunocompetence:i.   

OBJECTIVES:&nbsp;The aim of the present study was to evaluate morphological MRI findings in histologically-proven central nervous system lymphoma (CNSL) at time of their first appearance, and to describe dynamic changes on repeat MRI before the diagnosis was histologically proven.

METHODS:&nbsp;We retrospectively evaluated the MRI examinations of 74 patients with histologically-proven CNSL (10 secondary CNSL, 64 primary PCNSL; 10 immunocompromised, 54 immunocompetent). In 43 patients, we evaluated the evolution of CNSL on MRI before the diagnosis was proven.

RESULTS:&nbsp;Primary CNSL was typically localized supratentorially (63%), with multiple (59%) or infiltrative (36%) lesions showing diffusion restriction (98%), often (87%) reaching the brain surface. In approximately 50% of patients, meningeal, ependymal or cranial nerve involvement was found. We detected significant differences in enhancement patterns between immunocompromised and immunocompetent patients; non-homogenous enhancement present in 50% of immunocompromised patients. We did not find any significant differences in MRI appearance between primary and secondary CNSL. Regression was evident after corticosteroid treatment in 52% of patients; however, in 16% of cases overall progression was observed.

CONCLUSION:&nbsp;CNSL generally presents as an infiltrative lesion or multiple homogenously-enhancing lesions of the brain in contact with the brain surface. Involvement of the corpus callosum, cranial nerves, ependyma or meninges is common. No significant differences between primary and secondary CNSL were detected, however differences in enhancement type between immunocompromised and immunocompetent primary CNSL patients were found. We stress the variability of MRI findings in the course of the disease and also the variable response to corticotherapy....

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Journal Article 2016; 37(4): 313-317 PubMed PMID: 27857049 Citation  Keywords:  Adult, Aged, Disorders of Excessive Somnolence:complications, Epilepsy:complications, Female, Humans, Male, Middle Aged, Polysomnography, Sleep Apnea Syndromes:complications, Sleep Deprivation:complications, Sleep Stages, Sleep, REM,.   

OBJECTIVES:&nbsp;Epilepsy and sleep-disordered breathing (SDB) are relatively common disorders. SDB induces repetitive arousals and sleep fragmentation and may cause symptomatic epileptic seizures or hypoxic encephalopathy. Epileptic seizures change sleep architecture with increase of light sleep and reduction of REM sleep, which may lead to central apneas. The aim of this study was to evaluate the relationship between SDB and daytime sleepiness in patients with epilepsy, who underwent polysomnography (PSG) due to problems with breathing during sleep or due to excessive daytime sleepiness.

METHODS:&nbsp;We enrolled 40 patients with epilepsy. Type, etiology of epilepsy and actual antiepileptic therapy was recorded. All of them underwent overnight PSG. Excessive daytime sleepiness (EDS) was assessed by Epworth Sleepiness Scale (ESS).

RESULTS:&nbsp;SDB (apnea-hypopnea index [AHI]<5) was present in 25 patients, 15 patients had no SDB (AHI≥5). EDS was present in 16 patients (40%). ESS significantly correlated with presence of symptomatic epilepsy (r=0.385, p=0.014), presence of SDB (r=0.524, p=0.001), AHI (r=0.416, p=0.003) and duration of REM sleep (r=-0.476, p=0.002). The presence of SDB (beta=0.447, p=0.002) and duration of REM sleep (beta=-0.308, p=0.029) were the only independent variables significantly associated with ESS in regression analysis.

CONCLUSION:&nbsp;SDB has negative influence on quality of sleep and daytime vigility in patients with epilepsy. Sleep fragmentation with the reduction of the REM sleep seems to be the most important mechanism leading to EDS. We suppose that PSG could be beneficial in all patients with epilepsy and EDS....

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Journal Article 2016; 37(4): 308-312 PubMed PMID: 27857048 Citation  Keywords:  Cardiac Surgical Procedures, Child, Child, Preschool, Cicatrix:diagnostic imaging, Coronary Vessel Anomalies:surgery, Echocardiography, Female, Fibrosis, Humans, Infant, Magnetic Resonance Imaging, Male, Myocardium:pathology, Postoperative Complications:d.   

OBJECTIVES:&nbsp;Prognosis of patients with anomalous origin of the left coronary artery from pulmonary artery has dramatically improved as a result of both, early diagnosis and improvements in surgical techniques. Post surgical complications are rare and most patients show quick improvement of the left ventricular performance after repair with complete functional recovery within one year after surgery. Exercise-induced electrocardiographic changes have been found in patients postoperatively and scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation.

METHODS:&nbsp;Authors present 6 cases of anomalous origin of the left coronary artery from pulmonary artery observed at Martin Univesity Hospital and Pediatric Cardiology Clinic over the last eight-year period. In order to assess the presence of myocardial injury, cardiovascular magnetic resonance imaging with late gadolinium enhancement technique was performed in all 6 cases one year after surgical correction.

RESULTS:&nbsp;One patient died 1.5 year after surgical treatment. One year after surgery, the heart size and myocardial functions returned to normal in all patients. Cardiovascular magnetic resonance imaging demonstrated subendocardial late gadolinium enhancement in varios segments of the left ventricle, representing myocardial fibrosis in all patients one year after surgical correction.

CONCLUSION:&nbsp;Because of the presence of scarr tissue, the long term prognosis of these patients remains unclear. The damaged tissue may have arrhythmogenic potential, therefore close follow-up, excercise testing and avoidance of high-level sport activities may be needed....

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