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Journal Article 2013; 34(7): 585-589 PubMed PMID: 24464000 Citation  Keywords:  Cardiovascular Diseases:epidemiology, Contraceptives, Oral, Combined:administration & dosage, Female, Humans, Risk Factors,.   

trong>:trong> The use of combined oral contraceptives (COCs) is associated with approximately 2-fold and over 4-fold increased relative risks of arterial and venous thromboembolic events, respectively. The highest risk of venous thromboembolism occurs in the first year of use (OR: 4.17) and is reduced to 2.76 over baseline risk after 4 years of therapy. The risk of myocardial infarction does not correlate to the length of therapy and disappears after treatment termination. Most of women, using COCs, have low absolute cardiovascular risks and benefits outweigh the risk associated with this method of birth control. However, in some cases, COCs may be contraindicated due to excessively increased cardiovascular risks. Current users of COCs, older than 35 years, appear to show an estimated 2.5-fold and 10-fold increased risk of venous thromboembolism in comparison to younger than 35 years COCs non-users and users, respectively. COCs users, who are current smokers, have 10-fold increased risk of myocardial infarction, whereas the risk of stroke increases nearly 3-fold. The presence of poorly controlled hypertension is associated with approximately 3-fold increased risks of myocardial infarction and ischemic stroke, while the risk of haemorrhagic stroke rises 15-fold. In women suffering from hypertension, discontinuation of COCs may improve blood pressure control. Women, who had their blood pressure measured before COCs use, have 2-2.5-fold decreased risk of myocardial infarction and ischaemic stroke. In women with multiple cardiovascular risk factors the use of progestogen-only contraceptives (POCs) should be considered. POC therapy is associated with substantially less risk of cardiovascular events than COCs.

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Journal Article 2013; 34(7): 655-659 PubMed PMID: 24463999 Citation  Keywords:  Contraception, Postcoital:utilization, Female, Health Knowledge, Attitudes, Practice, Health Services Accessibility:statistics & numerical data, Humans, Lithuania, Nonprescription Drugs:therapeutic use, Poland, Students:statistics & numerical data, Survey.   

OBJECTIVES: To compare usage patterns, accessibility and knowledge about over-the counter (OTC) emergency contraception (EC) in comparison to prescription-only EC.

DESIGN AND SETTING: Self-designed, paper-based validated questionnaires containing 26 questions were distributed among students and high school pupils in Poland (PL) - 1000 questionnaires and in Lithuania (LT) - 650. In Lithuania EC is available OTC, whereas in Poland EC is a prescription-only drug. Statistical analysis was performed using SAS software with p<0.05 considered significant.

RESULTS: 74.01% of Poles and 70.89% of Lithuanians reported a history of sexual activity. About one third of the respondents in both countries used EC at least once in a lifetime (PL: 29.01%, LT: 32.2%; p>0.05). The main reason for EC usage in both countries was a broken condom (PL: 60.63%, LT: 57.66 %; p>0.05). In case of emergency more than half of the questioned women in both countries would use EC pill. The knowledge about EC was significantly lower in Poland (PL median - 8 out of 16; LT - 10 out of 16 true/false statements; p<0.01).

CONCLUSIONS: Over-the-counter availability of EC does not cause repetitive or increased usage. Moreover, an easier access to EC improves patients' knowledge about the drug....

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Case Reports 2013; 34(7): 693-700 PubMed PMID: 24463998 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Aged, Endocrine System Diseases:blood, Female, Genetic Diseases, Inborn:blood, Glucocorticoids:therapeutic use, Humans, Hydrocortisone:blood, Hypoglycemia:blood, Hyponatremia:blood, Male, Middle Aged, Prednisone:therapeu.   

OBJECTIVES: Adult idiopathic isolated ACTH deficiency (AIIAD) is an underestimated disorder which is frequently misdiagnosed. We presented 3 new Chinese AIIAD cases, summarized their clinical characteristics and analyzed the available literature.

METHODS: Three cases of AIIAD managed in Chinese PLA General Hospital during the period 1998-2003 were retrospectively identified. We have collected information on clinical presentation, laboratory findings and treatment response. The clinical characteristics were summarized and pertinent literatures were analyzed.

RESULTS: Our 3 cases with AIIAD aged 52-68 years old were misdiagnosed for a long period of time. Clinical features of AIIAD were summarized by reviewing the limited literature: 1. Most patients were over 40 years; 2. Clinical presentations were insidious; 3. Usually no pigmentation; 4. Hypogonadism and amenorrhea could present; 5. mild hypoglycemia, hyponatremia, normal-high potassium, mild anemia, lymphocytosis and eosinophilia could present; 6. With low or absent cortisol, normal secretion of pituitary hormones other than ACTH; 7. High prevalence of thyroid disorder; 8. Usually present concomitantly with other autoimmune disease, which usually disappeared on steroid replacement; 9. Absence of structural pituitary defects except for empty sella; 10. No evidence in any infiltration, trauma, surgery, infectious or radiotherapy, or glucocorticoid medication; 11. No growth abnormalities.

CONCLUSION: AIIAD is an unspecified and underestimated condition with much misdiagnosis. We summarized the clinical features to improve the recognition. Indeed, every patient with unexplained hyponatremia and malaise, particularly in patients with autoimmune diseases, needs to be evaluated for the possibility of AIIAD....

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Journal Article 2013; 34(7): 615-617 PubMed PMID: 24463997 Citation  Keywords:  Decision Making, Entropy, Humans, Models, Psychological, Psychophysics, Uncertainty,.   

: Connections between information theory and decision under uncertainty have been attracting attention in econophysics, neuroeconomics and quantum decision theory. This paper proposes a psychophysical theory of Shannon entropy based on a mathematical equivalence of delay and uncertainty in decision-making, and psychophysics of the perception of waiting time in probabilistic choices. Furthermore, it is shown that the well-known Shannon entropy is a special case of the general psychophysical entropy. Future directions in the application of the present theory to studies in econophysics and neuroeconomics are discussed....

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Clinical Trial 2013; 34(7): 687-692 PubMed PMID: 24463995 Citation  Keywords:  Adult, Dose-Response Relationship, Drug, Female, Fetus:blood supply, Hemodynamics:drug effects, Humans, Middle Cerebral Artery:drug effects, Nifedipine:administration & dosage, Obstetric Labor, Premature:diagnostic imaging, Placenta:blood supply, Pregnanc.   

OBJECTIVES: The aims were to assess the placental and fetal circulation during nifedipine tocolysis within the first 48 hours of therapy.

METHODS: Placental and fetal circulation was assessed in Doppler ultrasound examination prior to nifedipine administration and then after 24 and 48 hours. Maternal heart rate and PI in uterine arteries were evaluated as well as FHR, RI and PI of UA and MCA. E/A-wave ratio for A-V valves, MPI and SF were calculated for both ventricles independently. To determine changes over time in all study variable analysis of variance (ANOVA) for repeated measurements followed by Tukey-Kramer's multiple comparison test was used. The effects of additional clinical covariates were checked.

RESULTS: Uterine and umbilical blood flow patterns were not altered significantly during administration of nifedypine tocolysis. While MCA Doppler indicies such as RI and PI were unchanged, the evaluation of MCA PSV revealed a transient significant decrease after 24 hours. A resolution of this distraction was observed within the following 24 hours. No significant changes were observed in direct fetal cardiac function parameters calculated separately for both ventricles.

CONCLUSIONS: The decrease of MCA PSV after 24 hours of treatment was isolated and transient hemodynamic distraction observed during treatment. Neither fetal cardiac parameters nor other Doppler indices were changed. Therefore oral administration of nifedipine seems not to alter uterine nor fetal arterial blood flow pattern seriously. As significant changes were observed by different authors, further studies should be performed to verify the optimal total dose of nifedipine and its influence on hemodynamic conditions....

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Journal Article 2013; 34(7): 643-647 PubMed PMID: 24463994 Citation  Keywords:  Action Potentials:physiology, Adult, Electrophysiology, Female, Humans, Hyperlipidemias:complications, Male, Median Nerve:physiology, Middle Aged, Neural Conduction:physiology, Peripheral Nervous System Diseases:complications, Peroneal Nerve:physiology, S.   

OBJECTIVES: Metabolic disease affect all systems in the body, including the peripheral nervous system, but there is a controversy as whether to consider hyperlipidemia is a cause of peripheral neuropathy. The aim of the present study was to evaluate whether hyperlipidemic subjects with no clinical symptom or sign of peripheral neuropathy showed nerve conduction abnormalities or subclinical peripheral neuropathy according to the universally accepted electrophysiological criteria.

METHODS: The study group consisted from 29 female and 16 male patients (mean age: 47±7) while the control group consisted from 22 female and 10 male healthy volunteer subjects with a mean age of (43±9). All participants underwent an electrographic study in the classical manner described in the literature. Median and ulnar nerves in one upper, peroneal posterior tibial and sural nerves were studied in both lower extremities.

RESULTS: Median nerve 2nd digit-wrist segment sensory nerve conduction velocity were slow and sensory nerve action potential amplitude (SNAP) were low relative to controls. Sural nerve sensory nerve conduction velocity in the lower extremities were low relative to controls.

DISCUSSION: In this study the hyperlipemic group consisted from subjects with a relatively young age and with not very high serum lipid levels. Finding abnormal nerve conduction in distal sensory nerves in both upper and lower extremities in these hyperlipidemic patients made us think that; aging or uncontrolled hyperlipidemia may make these subjects susceptible to generalized peripheral neuropathy in the future.

CONCLUSION: Hyperlipidemia may affect nerve conduction in peripheral nerves and precede peripheral neuropathy....

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Journal Article 2013; 34(6): 523-528 PubMed PMID: 24378460 Citation  Keywords:  Adult, Aged, Antineoplastic Combined Chemotherapy Protocols:administration & dosage, Cholecalciferol:administration & dosage, Cyclophosphamide:administration & dosage, Dopamine Agonists:administration & dosage, Humans, Male, Melatonin:administration & dos.   

OBJECTIVE: To evaluate the objective clinical response and the safety of the combined administration of somatostatin, melatonin, retinoids, vitamin D3, dopamine subtype 2 receptor (D2R) agonists and low doses of cyclophosphamide, associated with androgen ablation, in patients with a histological diagnosis of prostate adenocarcinoma (Pac).

MATERIALS AND METHODS: The clinical data of 30 patients with non-invasive and metastatic prostate cancer, who attended our institution over a period of more than 5 years, were retrospectively reviewed.

RESULTS: 16 patients satisfied the evaluation criteria. Median age: 64 years. Disease stages: 8 patients (50%) were in Stage II. For advanced stages (Stage IV), secondary lesions were located in the bones and lymph nodes. Taken together, an overall objective response (OR) [Complete response (CR) + Partial Response (PR)] was achieved in 69% of the patients, with 88% of objective clinical benefit [CR+PR+SD]. For local Prostate Cancer group, an OR was achieved in 87.5% of patients (7 cases; 53-98; 95% CI), with CR in 62.5% (5 cases, 31-86; 95% CI). In metastatic disease, the OR was 50% (4 cases; 21-78; 95% CI), with a 20% of CR (2 cases; 7-59; 95% CI) and 75% of clinical benefit.

CONCLUSIONS: This preliminary study shows that patients with early and advanced forms of prostate cancer, not previously treated by surgery and/or chemo-radiotherapy, can achieve a more than positive clinical benefit with the protocol foreseen by the Di Bella Method. Further clinical investigations are strongly recommended....

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Journal Article 2013; 34(6): 518-522 PubMed PMID: 24378459 Citation  Keywords:  Adolescent, Blood Pressure:drug effects, Dose-Response Relationship, Drug, Female, Humans, Hypertension:chemically induced, Infant, Male, Vitamin D:administration & dosage, Vitamin D Deficiency:drug therapy, Vitamins:administration & dosage,.   

OBJECTIVE: The broad spectrum of extraosseal functions of vitamin D has recently been investigated. Although majority of recent studies have documented its hypotensive effect, some older studies warrant the risk of development the juvenile hypertension namely after pulse-fortified D vitamin supplementation during infancy. The aim of this study was to compare of the blood pressure in 13 year old groups of adolescents to the mode of D vitamin supplementation during their infancy.

METHODS: Study group represent 1138 thirteen year old adolescents in complex health care of 21 primary care pediatricians (PCPs). This group was divided into three subgroups according their mode of D vitamin supplementation in infancy. 100 children were given the continuous daily supplementation of AD vitamin 200-400 IU /day - " regular subgroup 0", 933 children were given by bolus doses of D vitamin forte 450 000 IU every three months during first year of life - "fortified subgroup 2", and 105 children given by bolus doses of D vitamin during winter, and continuous daily AD drops during summer - " mixed subgroup 1". D vitamin supplementation was done approximately 13 years before blood pressure study.

RESULTS: The mean systolic blood pressure was 110 mmHg, and mean diastolic one was 70 mmHg in all subgroups, regardless the mode of vitamin D supplementation. There were no statistic differences among subgroups, between girls/ boys, blood pressure levels were in normal limit. Although calculated daily doses of D2 vitamin during infancy exceeded RDA (200-400 IU) four to ten time, no difference in morbidity was found, concerning various chronic diseases (allergy, cardiovascular, renal, etc.). These results are in full accordance to recent knowledge of higher requirement and safety limit during vitamin D application.

CONCLUSION: The mode of D vitamin prophylaxis during infancy (pulse or daily application) has no influence to blood pressure level in early adolescence. No adverse effects have been found despite that the calculated daily dose was exceeded from three to ten times the recommended daily allowance....

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