Neurotoxicity that May Mimic Progressive Multifocal Leukoencephalopathy in Patient with Transplanted Kidney

We present the 55-year old woman who has had kidney transplantation three times. She has been treated with immunosuppressive therapy and lamivudine for hepatitis B and C. Nine years after the last transplantation she showed neurological symptoms that presented in the form of confusion and epileptic seizures of the grand mal type. A brain MRI showed large oval zones of hyperintense MR signal in T2- weighted image and hypointense in T1- weighted image around the frontal horns of the lateral ventricles, bilaterally and in both cerebellar hemispheres. After reduction in immunosuppression and the exclusion of lamivudine from therapy, the patient was stable with normal neurological status during the course of next five years. We start from the assumption that the concomitant use of cyclosporin with mycophenolate mofetil and lamivudine, despite normal concentrations of cyclosporin, might cause the accumulation of toxic metabolites and lead to neurotoxicity that mimics PML in a chronic viral environment

Remineralizing amorphous calcium phosphate based composite resins: the influence of inert fillers on monomer conversion, polymerization shrinkage, and microhardness

AIM: To determine if the addition of inert fillers to a bioactive dental restorative composite material affects its degree of conversion (DC), polymerization shrinkage (PS), and microhardness (HV). METHODS: Three amorphous calcium phosphate (ACP)-based composite resins: without added fillers (0-ACP), with 10% of barium-glass fillers (Ba-ACP), and with 10% of silica fillers (Si-ACP), as well as commercial control (Ceram•X, Dentsply DeTrey) were tested in laboratory conditions. The amount of ACP (40%) and the composition of the resin mixture (based on ethoxylated bisphenol A dimethacrylate) was the same for all ACP materials. Fourier transform infrared spectroscopy was used to determine the DC (n = 40), 20 min and 72 h after polymerization. Linear PS and Vickers microhardness (n = 40) were also evaluated. The results were analyzed by paired samples t test, ANOVA, and one-way repeated measures ANOVA with Student-Newman-Keuls or Tukey’s post-hoc test (P = 0.05). RESULTS: The addition of barium fillers significantly increased the DC (20 min) (75.84 ± 0.62%) in comparison to 0-ACP (73.92 ± 3.08%), but the addition of silica fillers lowered the DC (71.00 ± 0.57%). Ceram•X had the lowest DC (54.93 ± 1.00%) and linear PS (1.01 ± 0.24%) but the highest HV (20.73 ± 2.09). PS was significantly reduced (P < 0.010) in both Ba-ACP (1.13 ± 0.25%) and Si-ACP (1.17 ± 0.19%) compared to 0-ACP (1.43 ± 0.21%). HV was significantly higher in Si-ACP (12.82 ± 1.30) than in 0-ACP (10.54 ± 0.86) and Ba-ACP (10.75 ± 0.62) (P < 0.010). CONCLUSION: Incorporation of inert fillers to bioactive remineralizing composites enhanced their physical-mechanical performance in laboratory conditions. Both added fillers reduced the PS while maintaining high levels of the DC. Silica fillers additionally moderately improved the HV of ACP composites

THROMBOPROPHYLAXIS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ADMITTED IN UNIVERSITY HOSPITAL SPLIT, CROATIA, DUE TO THE ISCHAEMIC STROKE IN RELATION TO THROMBOEMBOLIC AND BLEEDING RISK

Cilj rada bio je procijeniti usklađenost propisivanja tromboproilakse u bolesnika s nevalvularnom atrijskom ibrilacijom (nAF) prigodom prijma na liječenje zbog ishemijskog moždanog infarkta sa smjernicama Europskog kardiološkog društva za tromboproilaksu u bolesnika s nAF. U presječno retrospektivno istraživanje je uključeno 327 bolesnika [143 (44 %) muškaraca] s nAF, liječenih zbog ishemijskog moždanog infarkta. Tromboembolijski (TE) rizik procijenjen je sustavom CHA2DS2-VASc, a rizik krvarenja sustavom HAS-BLED. Prije doživljenog ishemijskog moždanog infarkta 98,2 % bolesnika pripadalo je skupini velikog tromboembolijskog rizika. Od tog broja tromboproilaksu je primjenjivalo samo 179 (55 %) bolesnika: 65,5 % bolesnika primjenjivalo je acetilsalicilnu kiselinu, 30,5 % varfarin, a 4 % klopidogrel. Raniji tromboembolijski incident nezavisno je korelirao s primjenom (OR 2,5; 95% CI 1,4-4,5; p=0,003), a neregulirana arterijska hipertenzija s neprimjenjivanjem (OR 0,47; 95% CI 0,25-0,88; p=0,019) varfarina. Od 55 bolesnika koji su ishemijski moždani infarkt doživjeli unatoč primjeni varfarina, u 83,7 % bolesnika vrijednosti protrombinskog indeksa prilikom prijama su bile niže od terapijskih.Autori zaključuju da tromboproilaksa u bolesnika s nAF hospitaliziranih zbog ishemijskog moždanog infarkta nije bila sukladna njihovom tromboembolijskom riziku i trenutnim smjernicama Europskog kardiološkog društva.Aim of the study was to assess the concordance of the thromboprophylactic treatment in patients with nonvalvular atrial ibrillation (nAF) at the time of admission due to ischemic stroke with clinical guidelines of the European Society of Cardiology. Methods: In the cross-sectional study were included 327 patients [143 (44%) males] treated because of ischemic stroke associated with nAF. The index of the thromboembolic risk (TE) has been established by the CHA2DS2-VASc score, whereas the bleeding risk has been assessed by the HAS-BLED score. Results: Before the ischemic stroke, 98.2% of patients belonged to the group of high TE risk. Among these patients only 179 (55%) were received thromboprophylaxis: 67.5% patients acetylsalicylic acid, 30.5% warfarin, and 4% clopidogrel. Previous ischemic stroke was independently correlated with warfarin administration (OR 2.5; 95% CI 1.4-4.5; p=0.003), while poorly controlled arterial hypertension was independently correlated with warfarin non-administration (OR 0.47; 95% CI 0.25-0.88; p=0.019). The 83.7% of 55 patients, who experienced ischemic stroke during anticoagulant treatment, had an INR values lower than therapeutic. Conclusion: Thromboprophylaxis among the patients with nAF admitted because of ischemic stroke did not correlate with their TE risk and contemporary guidelines of the European Society of Cardiology

Influence of Different Types of Fillers on the Degree of Conversion of ACP Composite Resins

Kompozitnim materijalima koji sadržavaju amorfni kalcijev fosfat (ACP) kao aktivni remineralizirajući sastojak dodana su inertna punila kako bi se smanjilo njihovo polimerizacijsko skupljanje i poboljšala mehanička svojstva. Svrha: Svrha istraživanja bila je ispitati utjecaj dodavanja različitih vrsta silaniziranih anorganskih punila na stupanj polimerizacije (SP) kompozita temeljenih na ACP-u. Materijal i postupci: Testirano je sedam ACP-kompozita: ACP-kontrola (40 % ACP, 60 % smola) i šest koji su sadržavali 40 posto ACP-a, 5 posto ili 10 posto neaktivnih punila i 55 posto ili 50 posto smole. U kompozitne materijale uključena su silika-punila (12nm; 4 – 6% silanizacija) te barijeva (0,77μm; 6% silanizacija) ili stroncijeva staklena punila (0,99μm; 3,2% silanizacija). Nanohibridni kompozit CeramX (Dentsply DeTrey, Njemačka) također je služio kao kontrolni materijal. Kompozitni uzorci (10/ispitnoj skupini) polimerizirani su 40 sekundi uređajem Bluephase C8 (Ivoclar Vivadent, Liechtenstein). Stupanj polimerizaciuje određen je Fourier transform infracrvenom spektroskopijom (System 2000 FTIR spectrometer; Perkin Elmer, Velika Britanija) 20 minuta i 72 sata nakon polimerizacije. Rezultati: Dodavanje 10 posto silika-punila (74,14% i 75,90%) i 5 posto stroncijevih staklenih punila (76,23% i 76,29%) nije štetno utjecalo na stupanj polimerizacije ACP-kompozitnih smola. Kod obaju kompozitnih materijala s dodanim barijevim punilima smanjio se SP u odnosu na ACP-kontrolu. Kako se i očekivalo, ACP-kontrola s najmanjim volumenom punila zadržala je najviši SP (75,38% i 76,05%), a CeramX je imao statistički najniži (56,87% i 57,97%). Zaključak: Iako je primjesa određenih punila pridonijela smanjenju stupnja polimerizacije ACP-kompozitnih smola, uzimajući u obzir da je ipak uvelike nadmašen stupanj polimerizacije komercijalno dostupnog kontrolnog materijala, može se zaključiti da neće izazvati neželjene učinke povezane s niskim SP-om.In order to diminish the polymerization shrinkage and improve mechanical properties of the composite materials containing amorphous calcium phosphate (ACP) as an active remineralizing ingredient, inert fillers were introduced into formulation. Purpose: The aim of the study was to examine the influence of the addition of different types of silanized inorganic fillers on the degree of conversion (DC) of the ACP based composites. Material and Methods: Seven ACP composites were tested: ACP control (40% ACP, 60% resin) and six composites containing 40% ACP, 5% or 10% non-releasing fillers and 55% or 50% resin. Silica fillers (12nm; 4-6% silanization), barium (0.77μm; 6% silanization) or strontium glass fillers (0.99μm; 3.2% silanization) were included into the pastes. Nanohybrid composite CeramX (Dentsply DeTrey, Germany) also served as a control. Composite specimens (10/experimental group) were polymerized for 40 sec by Bluephase C8 curing unit (Ivoclar Vivadent, Liechtenstein). The DC was determined by Fourier- transform infrared spectroscopy (System 2000 FTIR spectrometer; Perkin Elmer, UK) 20 min and 72 h after polymerization. Results: The addition of 10% of silica (74.14% and 75.90%) and 5% of strontium glass fillers (76.23% and 76.29%) did not have a detrimental influence on the DC of ACP composite resins. Both composites with added barium fillers showed the reduction in DC when compared to the ACP control. As expected, the ACP control with the lowest filler volume retained the highest conversion rate (75.38% and 76.05%), and CeramX had significantly lowest DC (56.87% and 57.97%). Conclusions: Even though the admixture of certain fillers yielded decrease of the DC of ACP composite resins, and considering the fact that it still greatly exceeded the DC of the commercial control, it might be concluded that they will not cause adverse effects associated with low DC

A new gastric juice peptide, BPC - an overview of stomach (stress) organoprotection hypothesis and BPC befitial effects

The possibility that the stomach affected by general stress pathology initiates a conteracting response has not been considered in the stress theory until recently. In this, the stomach as the most sensitive part of gastrointestinal tract, the largest neuroendocrine organ in the body, has been suggested to be a crutial point, from where a full stress response against all noxius stress pathology could be purposefully initiated, mediated and organized. The end result would be a strong protection of all organs invaded by "stress". Consistent with this assumption, this coping response is best explained in terms of "organoprotection" and endogenous organoprotectors (e.g. prostaglandins, somatostatin, dopamine) are proposed as mediators. Such an endogenous counteraction could even be afforded by their suitable application. According to this concept, a new gastric juice peptide, M.W. 40, 000, named BPC, was recently isolated. In this, a 15 amino acid fragment (BPC 157) tought to be essential for this activity was fully characterized and effectively investigated. As it had previously been demonstrated for many organoprotective agents using different models of various tissue lesions, despite the poorly understood final mechanism, practically all organ systems appear to be included into BPC beneficial activity. Relative to the reference standards, these effects have been achieved in many species using very low dosages (mostly ug and ng/kg range) after intraperitoneal, intragastrical as well as intramucosal (local) application. The effect was obvious already after one application. A long lasting activity was also demonstrated. Likewise, it was highly efficacious when applied in many experiments simultaneously with noxious agent or in the already established damage conditions, as well as chronically during a prolonged period. Therefore, it seems that BPC treatment does not share any of the so far known limitations for "conventional organoprotectors". No influence on different basal parameters and no toxicity were observed. Thus, whether these findings would provide a purposeful breakthrough into the stress thepry and whether BPC, as a likely endogenous free radical scavenger and organoprotection mediator, would be a useful prototype of a new class of drugs, organoprotective agents, remains to be seen