The Evaluation of Diagnostic Role of Cardiac Troponin T (cTnT) in Newborns with Heart Defects

Heart diseases are a significant cause of morbidity and mortality in newborns. Diagnostic methods are often not sufficient or, in many cases, cannot be used. There is a great advance in medical knowledge concerning biomarkers in the diagnosis of circulatory system in adult patients. Among them, cardiac troponins play the main role. In current literature, there is not enough data concerning the possibility of using them in neonatal cardiac diagnostics. Aim of the Study. To evaluate diagnostic usefulness of cTnT in correlation with other markers of circulatory failure and myocardial damage in newborns with heart defects. Patients and Methods. The study involved 83 newborns up to 46 weeks of postmenstrual age. The exclusion criteria were severe perinatal asphyxia and presence of severe noncardiac diseases. Patients were divided into 2 main groups: group I—54 patients with congenital heart defects (CHDs), and group II (control)—29 healthy neonates. All patients underwent detailed examination of circulatory system. Cardiac troponin T (cTnT) concentrations were evaluated by Roche CARDIAC T Quantitive test. Results. Performed studies revealed that cTnT levels in newborns with heart pathology were significantly higher than in healthy ones. However, cTnT concentrations in patients with CHD did not correlate with clinical symptoms of heart failure, nor with echocardiographic markers of LV function. Type of heart defect did not influence cTnT levels as well. Only hemodynamic significance evaluated by echocardiography influenced the cTnT levels with statistical significance. Conclusions. (1) Statistically significant differences in cTnT levels between newborns with heart defects and healthy subjects were shown. (2) CTnT levels in newborns with heart defects refer only to hemodynamic significance of the defect

Remodeling i wsteczny remodeling lewego przedsionka u chorych z niewydolnością nerek

Cardiovascular diseases compose a kind of con­tinuum initiated by cardiovascular risk factors in consequence leading to the development of atherosclerosis, infarct and secondary heart failure. This sequel effecting in death has been proposed in 1991 by Dzau and Braunwald as a concept of lethal cardiac chain. In this process cardiovascular risk factors, such as elevated cholesterol, hypertension, diabetes mellitus, cigarette smoking and end-stage renal disease (ESRD) are now known to promote oxidative stress and to cause endothelial dysfunction, initiating a cascade of events, including alterations in vasoactive mediators, inflammatory responses, and cardiac and vascular remodeling, that culminates in target-organ pathology. However, research concerning reverse process, which can be present due to disappearing of causative factors is not numerous and but rather incomplete. Left atrium (AL) dilatation is a hallmark of LA structural remodeling in ESRD. Biomarker of these changes is left atrium volume index (LAVI). Left atrium remodeling refers to a time-dependent adaptive regulation of cardiac myocytes in order to maintain homeostasis against external stressors. LA enlargement is accompanied by impairment of the LA hemodynamic performance. Renal transplantation (RT) is a potentially allowing intervention reversal or at least the inhibition of adverse changes dependent to cardiac remodeling. Research has shown that observed after RT is to reduce the planimetric parameters and LA volume. Parameters showing LA hemodynamic activity as: LAEF, LAAE and LAIE improving already during the short observation while LAPE is reduced. LAFS behaves differently because although much greater at the end of follow-up, its growth is largely due to the relatively slow improvement in the long for perspective, while a shorter period after RT changes are not yet significant. LA remodeling as an effect of atrial uremic cardiomyopathy is in fact an exemplum of complex cardiomyopathy with elements characteristic for congestive and infiltrative cardiomyopathy, because early LAVI reduction after RT mainly depends on changed hemodynamic conditions, whereas the main reason for further late decreasing of LAVI value is related rather to resolution of uremic toxaemia. Improvement of LA structural and functional properties after RT is a continuous and prolonged process.Choroby układu sercowo-naczyniowego stanowią swoistą kontynuację przemian zapoczątkowanych przez zadziałanie czynników ryzyka sercowo-naczyniowego prowadzących w konsekwencji do rozwoju miażdżycy, zawału i, wtórnie, niewydolności serca. Sekwencję tych procesów, powodującą w końcu śmierć organizmu, przedstawili po raz pierwszy w 1991 roku Dzau i Braunwald jako koncepcję letalnego łańcucha kardiologicznego. W procesie tym czynniki ryzyka sercowo-naczyniowego, takie jak podwyższone stężenie cholesterolu, palenie tytoniu, nadciśnienie tętnicze, cukrzyca, a także schyłkowa niewydolność nerek (ESRD), których wspólnym patogenetycznym mianownikiem jest stymulowanie stresu oksydacyjnego oraz dysfunkcja śródbłonka, inicjują kaskadę wydarzeń, włączając w to zaburzenia aktywności mediatorów naczyniowych, odpowiedzi zapalnej, a także niekorzystnej przebudowy serca i naczyń, czyli remodelingu, co prowadzi do uszkodzenia narządów docelowych. Nieliczne i niekompletne są natomiast badania nad możliwością zjawiska odwrotnego, które może wystąpić w konsekwencji ustąpienia czynnika sprawczego. Powiększenie jamy jest kluczowym przejawem remodelingu lewego przedsionka (LA) u chorych na ESRD. Biomarkerem tych zmian jest wskaźnik objętości LA (LAVI). Remodeling LA to zależna od czasu reakcja adaptacyjna miocytów służąca utrzymaniu dotychczasowej równowagi mimo działania niekorzystnych czynników stresujących. Powiększeniu jamy LA towarzyszy upośledzenie jego czynności hemodynamicznej. Transplantacja nerek (RT) jest interwencją potencjalnie umożliwiającą odwrócenie, a przynajmniej zahamowanie niekorzystnych przemian zależnych od remodelingu serca. Jak wykazano w badaniach, po RT obserwuje się zmniejszenie zarówno parametrów planimetrycznych, jak i objętościowych LA. Parametry obrazujące hemodynamiczną czynność przedsionka, takie jak LAEF, LAAE oraz LAIE, poprawiają się już w czasie krótkoterminowej obserwacji, natomiast LAPE ulega obniżeniu. Inaczej jest w przypadku LAFS — choć zdecydowanie się zwiększa po zakończeniu obserwacji, to swój wzrost zawdzięcza głównie stosunkowo powolnej poprawie w dłuższej pespektywie, podczas gdy w krótszym okresie po RT zmiany nie są jeszcze znamienne. Remodeling LA, będący przejawem przedsionkowej kardiomiopatii mocznicowej, jest przykładem kardiomiopatii złożonej z elementami kardiomiopatii rozstrzeniowej oraz infiltracyjnej, gdyż wczesne zmniejszenie wielkości LAVI po RT bardziej zależy od zmieniających się warunków hemodynamicznych, natomiast przyczyn dalszej późnej redukcji wielkości LAVI należy upatrywać raczej w ustąpieniu związanej z mocznicą toksemii. Poprawa własności elastycznych aorty po RT jest procesem ciągłym i długotrwałym

Ischemic stroke as a rare cause of seizures in a newborn – case report

Background: Identifying etiology of seizures is the primary clinical objective in the management of neonatal seizures (NS). About 85 % of NS cases occurr as a consequence of a specific, identifiable etiology. Causes of symptomatic NS can be broadly categorized as: hypoxic-ischemic encephalopathy, electrolyte or metabolic disturbances, CNS or systemic infections, developmental defects and acquired structural brain lesions, including hemorrhagic or ischemic stroke. Ischemic stroke is characterized as a sudden focal or generalized brain function disruption, whose symptoms tend to last longer than 24 hours (or cause death) and have no other reason but a vascular one. The reported annual incidence is estimated at one per 4000 live births for neonates. The aim of this case report is to present diagnostic difficulties in case of ischemic stroke in apparently healthy neonate. This case concerns a patient – a full-term male newborn, who was in a good condition in the first 3 days after birth. At the beginning of the 4th day of life 3 episodes of right-sided clonic seizures with right-sided nystagmus occurred and which was the reason for admitting the patient to the Department of Neonate and Infant Pathology. Shortly after arrival the seizures appeared again. Laboratory tests showed slightly lowered glucose level and elevated serum concentration of lactic acid. The ultrasound examination of the head revealed a small right-sided subependymal cyst. The patient’s condition was deteriorating, with recurring righ-sided clonic and tonic seizures accompanied by apnea and desaturation that required resuscitation efforts. Because of worsening state of the patient, CT scan was performed. The CT examination revealed a hypodensic area in the left parietal region and cerebral edema, which indicated a possible ischemic stroke. Conclusions: The absence of visible pathologies in the ultrasound examination of the head does not necessarily indicate a lack of CSN abnormalities. More precise imaging tests are needed to identify the cause of NS

Estimating genomic instability mediated by Alu retroelements in breast cancer

Alu-PCR is a relatively simple technique that can be used to investigate genomic instability in cancer. This technique allows identification of the loss, gain or amplification of gene sequences based on the analysis of segments between two Alu elements coupled with quantitative and qualitative analyses of the profiles obtained from tumor samples, surgical margins and blood. In this work, we used Alu-PCR to identify gene alterations in ten patients with invasive ductal breast cancer. Several deletions and insertions were identified, indicating genomic instability in the tumor and adjacent normal tissue. Although not associated with specific genes, the alterations, which involved chromosomal bands 1p36.23, 1q41, 11q14.3, 13q14.2, occurred in areas of well-known genomic instability in breast and other types of cancer. These results indicate the potential usefulness of Alu-PCR in identifying altered gene sequences in breast cancer. However, caution is required in its application since the Alu primer can produce non-specific amplification

Arachnoid cyst in a patient with psychosis: Case report

<p>Abstract</p> <p>Background</p> <p>The aetiology of a psychotic disturbance can be due to a functional or organic condition. Organic aetiologies are diverse and encompass organ failures, infections, nutritional deficiencies and space-occupying lesions. Arachnoid cysts are rare, benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid (CSF). In most cases they are diagnosed by accident. Until recently, the coexistence of arachnoid cysts with psychiatric disturbances had not been closely covered in the literature. However, the appearance of some references that focus on a possible link between arachnoid cysts and psychotic symptoms has increased the interest in this subject and raised questions about the etiopathogeny and the therapeutic approach involved.</p> <p>Clinical presentation</p> <p>We present the clinical report of a 21-year-old man, characterised by the insidious development of psychotic symptoms of varying intensity, delusional ideas with hypochondriac content, complex auditory/verbal hallucinations in the second and third persons, and aggressive behaviour. The neuroimaging studies revealed a voluminous arachnoid cyst at the level of the left sylvian fissure, with a marked mass effect on the left temporal and frontal lobes and the left lateral ventricle, as well as evidence of hypoplasia of the left temporal lobe. Despite the symptoms and the size of the cyst, the neurosurgical department opted against surgical intervention. The patient began antipsychotic therapy and was discharged having shown improvement (behavioural component), but without a complete remission of the psychotic symptoms.</p> <p>Conclusion</p> <p>It is difficult to be absolutely certain whether the lesion had influence on the patient's psychiatric symptoms or not.</p> <p>However, given the anatomical and neuropsychological changes, one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation. This raises substantial problems when it comes to choosing a therapeutic strategy.</p

Population genomics of <i>Escherichia coli</i> in livestock-keeping households across a rapidly developing urban landscape

Quantitative evidence for the risk of zoonoses and the spread of antimicrobial resistance remains lacking. Here, as part of the UrbanZoo project, we sampled Escherichia coli from humans, livestock and peri-domestic wildlife in 99 households across Nairobi, Kenya, to investigate its distribution among host species in this rapidly developing urban landscape. We performed whole-genome sequencing of 1,338 E. coli isolates and found that the diversity and sharing patterns of E. coli were heavily structured by household and strongly shaped by host type. We also found evidence for inter-household and inter-host sharing and, importantly, between humans and animals, although this occurs much less frequently. Resistome similarity was differently distributed across host and household, consistent with being driven by shared exposure to antimicrobials. Our results indicate that a large, epidemiologically structured sampling framework combined with WGS is needed to uncover strain-sharing events among different host populations in complex environments and the major contributing pathways that could ultimately drive the emergence of zoonoses and the spread of antimicrobial resistance

Helminth Communities of Owls (Strigiformes) Indicate Strong Biological and Ecological Differences from Birds of Prey (Accipitriformes and Falconiformes) in Southern Italy

We compared the helminth communities of 5 owl species from Calabria (Italy) and evaluated the effect of phylogenetic and ecological factors on community structure. Two host taxonomic scales were considered, i.e., owl species, and owls vs. birds of prey. The latter scale was dealt with by comparing the data here obtained with that of birds of prey from the same locality and with those published previously on owls and birds of prey from Galicia (Spain). A total of 19 helminth taxa were found in owls from Calabria. Statistical comparison showed only marginal differences between scops owls (Otus scops) and little owls (Athene noctua) and tawny owls (Strix aluco). It would indicate that all owl species are exposed to a common pool of 'owl generalist' helminth taxa, with quantitative differences being determined by differences in diet within a range of prey relatively narrow. In contrast, birds of prey from the same region exhibited strong differences because they feed on different and wider spectra of prey. In Calabria, owls can be separated as a whole from birds of prey with regard to the structure of their helminth communities while in Galicia helminths of owls represent a subset of those of birds of prey. This difference is related to the occurrence in Calabria, but not Galicia, of a pool of 'owl specialist' species. The wide geographical occurrence of these taxa suggest that local conditions may determine fundamental differences in the composition of local communities. Finally, in both Calabria and Galicia, helminth communities from owls were species-poor compared to those from sympatric birds of prey. However, birds of prey appear to share a greater pool of specific helmith taxa derived from cospeciation processes, and a greater potential exchange of parasites between them than with owls because of phylogenetic closeness

Differences in Efficacy and Safety of Pharmaceutical Treatments between Men and Women: An Umbrella Review

Being male or female is an important determinant of risks for certain diseases, patterns of illness and life expectancy. Although differences in risks for and prognoses of several diseases have been well documented, sex-based differences in responses to pharmaceutical treatments and accompanying risks of adverse events are less clear. The objective of this umbrella review was to determine whether clinically relevant differences in efficacy and safety of commonly prescribed medications exist between men and women. We retrieved all available systematic reviews of the Oregon Drug Effectiveness Review Project published before January 2010. Two persons independently reviewed each report to identify relevant studies. We dually abstracted data from the original publications into standardized forms. We synthesized the available evidence for each drug class and rated its quality applying the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Findings, based on 59 studies and data of more than 250,000 patients suggested that for the majority of drugs no substantial differences in efficacy and safety exist between men and women. Some clinically important exceptions, however, were apparent: women experienced substantially lower response rates with newer antiemetics than men (45% vs. 58%; relative risk 1.49, 95% confidence interval 1.35–1.64); men had higher rates of sexual dysfunction than women while on paroxetine for major depressive disorder; women discontinued lovastatin more frequently than men because of adverse events. Overall, for the majority of drugs sex does not appear to be a factor that has to be taken into consideration when choosing a drug treatment. The available body of evidence, however, was limited in quality and quantity, confining the range and certainty of our conclusions