Acta Medica Academica

The More Intensive the Diagnostic Workup, the More Likely It Is That the Cause of Coccygodynia Can Be Clarified

Josef Finsterer — 2023-12-30

No abstract available.

Influence of Minimal Residual Disease at Day 15 of Induction Therapy on Survival of Children with Acute Lymphoblastic Leukemia

Jelica Samardžić-Predojević — 2023-12-30

Objective. The aim of the study was to evaluate the impact of minimal residual disease (MRD) on day 15 of induction therapy (d15) on the treatment outcome in children with acute lymphoblastic leukemia (ALL).

Materials and Methods. The study included 74 patients (1-18 years) with ALL, who were treated at the Pediatric Clinic of the University Clinical Center Banja Luka from January 2011 to May 2021. All patients were treated according to ALL IC-BFM 2009 protocol. MRD on bone mar- row was assessed d15, using the multiparameter flow cytometry method (FCM).

Results. Of all, 59.46% of patients had MRD d15 0.1−10%, MRD<0.1% had 18.92% of patients, and 21.62% had MRD >10%. Patients with the lowest MRD had the highest 5-year overall survival (OS) and event-free survival (89.5% and 91% respectively) and the lowest cumulative risk for relapse or death (9.7% and 8.1%), in contrast to patients with MRD>10% in whom OS was 80.0%, and the risk of recurrence is 20%. Predicted MRD d15 was significantly associated with prednisone response assessed in the peripheral blood on day 8 (P<0.001) and statistically significantly positive correlation (r=0.498; P<0.001) was found.

Conclusion. MRD measurement d15 has a great prognostic significance for patients in the standard and high risk groups, but not for patients in the intermediate risk group. The introduction of additional testing is necessary for better identification of patients with an increased risk of disease recurrence.

Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: a Single-center Experience

Ana Đordević — 2023-12-30

Objectives. Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The incidence and etiology of pediatric cancer-related thrombosis is still not well understood. The aim of this study was to evaluate the preva- lence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inher- ited thrombophilia in the development of thrombosis in a pediatric oncology population.

Patients and Methods. Forty-seven children (36 treated for hematological malignancies and 11 for solid tumors) with a median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden (G1691A), prothrombin G20210A, and methy- lenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis.

Results. Four (8.5%) patients were heterozygous for Factor V Leiden, 3 (6.4%) were heterozygous for prothrombin G20210A mutation, and 3 (6.4%) were homozygous for MTHFR C677T mutation. All patients had implanted central venous catheters. Four (8.5%) children had documented thrombosis, three of which were in the upper venous system. Two of the four patients with thrombosis had Factor V Leiden heterozygosity.

Conclusions. Thrombosis is an important complication of childhood cancer. The risk of thrombosis may be increased in patients with Factor V Leiden. In the absence of consensus guidelines, our results support the recommendation for thrombophilia screening in children with cancer.

Investigation of Correlation between Resistance to Diazepam and Expression of Inflammatory Markers in The Peripheral Blood of Patients with Status Epilepticus

Corry Novita Mahama — 2023-12-30

Objective. This study investigated several inflammatory markers’ gene and protein expression in status epilepticus (SE) and their correlation with diazepam resistance.

Materials and Methods. Peripheral blood samples were collected from 18 adult patients with SE in Cipto Mangunkusumo Central Hospital, consisting of 12 diazepam-responsive and six diazepam-resistant samples, within 72 hours of the onset of the seizure. We collected baseline demographic and clinical data from each subject. Peripheral blood mononuclear cells (PBMCs) were isolated, cultured, stimulated with lipopolysaccharide (LPS) 1 mg/ml, and harvested for RNA isolation. The RNA was used to determine the expression of Human Mobility Group Box 1 (HMGB1), Inter- leukin-6 (IL-6), IL-10, Toll-like Receptor 4 (TLR4), and Glial fibrillary acidic protein (GFAP). In addition, we performed serum protein assay of HMGB1, IL-6, IL-10, TLR4, and GFAP to compare with gene expression.

Results. We found a significant differ- ence between the responsive and resistant groups for serum HMGB1 and IL-6 concentration. The mRNA expression of HMGB1 and IL-6 was significantly higher in LPS-stimulated samples in the responsive but not in the resistant groups. The ratio of IL-6 to IL-10 showed a significant difference between LPS and control in the responsive group. Diazepam response was significantly correlated with seizure duration and serum protein concentration of HMGB1.

Conclusion. HMGB1 was highly expressed in the resistant group and strongly correlated with diazepam response, and there was a significant increase in HMGB1 mRNA expres- sion in response to LPS stimulation. These findings suggest that targeting HMGB1 may be a promising therapeutic strategy and that HMGB1 levels could be a valuable biomarker for predicting diazepam resistance in SE.

The Effects of Helichrysum italicum Extract on the Extracellular Matrix of the Skin

Erkin Pekmezci — 2023-12-30

Objective. An in-vitro study was performed to investigate the molecular basis of the wound healing and skin protective features of Helichrysum italicum (HI), a medicinal plant from the Mediterranean basin.

Materials and Methods. A dermal fibroblast cell line culture was treated with HI hydro-alcoholic extract to detect the gene expression levels of three selected primers: FGF-2, HAS-2 and MMP-9. Cell proliferation assay was performed using a XTT reagent. RNA isolations were carried out from both the extract treated study cell group and the control cell group using a TRI reagent. GAPDH was used as the reference gene. Gene expressions were determined by real time RT-qPCR. The results were represented as ‘Target/GAPDH Fold Change’. Statistical evaluation was performed by Student’s t test.

Results. HI extract caused statistically significant upregulation of FGF-2 (P=0.0473) and HAS-2 (P=0.0335) gene expressions compared to the untreated control cells. The treatment ended with 1.74 and 3.10 fold changes for FGF-2 and HAS-2, respectively.

Conclusion. In general, it may be considered that HI has certain anabolic effects on the extracellular matrix of the skin because of the significant increases it causes in FGF-2 and HAS-2. Therefore, it may have a promising future in anti-aging studies and cosmetic dermatology. The results obtained in this study may also partially explain the molecular basis of the health benefits of HI on skin, including improvement in wound healing, and protection against the detrimental effects of ultraviolet exposure.

Animal Model of Cisplatin-Induced Oral Mucositis: Dose Optimization

Oke Kadarullah — 2023-12-30

Objective. The present study aimed to develop and validate an animal model of chemotherapy-induced oral mucositis due to cisplatin administration.

Materials and Methods. Oral mucositis was induced in Wistar rats by cisplatin. Twenty healthy male Wistar rats were divided into four groups: a control group, and cisplatin 3 mg/kgBW (D1), cisplatin 5 mg/kgBW (D2), and cis- platin 6 mg/kgBW groups (D3). The D1, D2, and D3 groups received the cisplatin intraperitoneally on days 1, 3, and 5, whereas the control group did not receive anything. On day 7 and day 14 the entire experiment was terminated in all groups and the changes in body weight, oral mucositis grades, and histopathological scores were evaluated.

Results. Cisplatin administration created a strong oral mucositis effect on groups D2 and D3. All the cisplatin doses decreased the rats’ body weight by day 14. The worst oral mucositis grades and histopathological scores resulted from the administration of cisplatin at a dose of 5 mg/kgBW.

Conclusions. In conclusion the cisplatin 5 mg/kgBW administered on days 1, 3, and 5 by intraperitoneal administration was the optimum dose to induce oral mucositis.

A Comparison of Cathelicidin Levels in the Skin of Leprosy Patients and Their Household Contacts

Fifa Argentina — 2023-12-30

Objective. This study aimed to compare cathelicidin levels in the skin of leprae patients and leprae contacts.

Patients and Methods. This research is an analytic observational study with a cross-sectional approach. Fifty-four research subjects participated in this study. They consisted of leprae patients, household contacts, and healthy individuals. Cathelicidin levels were measured using the ELISA method. Data analysis was carried out with the help of SPSS software, and univariate and bivariate analysis was conducted.

Results. Cathelicidin levels in the leprae group (256.8±22.9 pg/ml) were higher than in the contact group (25.9±2.7 pg/ml). Likewise, the contact group had higher cathelicidin levels than healthy controls (1.4±0.1 pg/ml). Statistically, there were differences in cathelicidin levels between groups, P<0.050.

Conclusion. Cathelicidin levels in leprae patients were higher than those in household contacts.

The Relative Role of Family Affluence and Social Support on Depression and Selfesteem among Adolescents in Nigeria: a Cross-sectional Study

Bassey Edet — 2023-12-30

Objectives. To assess the relative importance of social support and family affluence in depression and self-esteem among ado- lescents in Calabar, Nigeria.

Methods. This cross-sectional study was conducted among adolescent students in Calabar, Nigeria. Using stratified random sampling, 332 students were selected for participation. The Family Affluence Scale (FAS), Oslo Social Support Scale (OSS), Becks Depression Inventory (BDI) and Rosenberg Self-Esteem Inventory (RSES) were administered. To facilitate comparisons, the sample was divided into four groups: those with low OSS and low FAS scores, those with low OSS and high FAS scores, those with high OSS and low FAS scores, and those with high scores in both OSS and FAS. Groups were com- pared using the Kruskal-Wallis Test. Linear regression analysis was conducted to determine the predictors of depression and self-esteem. All analyses were performed using IBM SPSS version 21.

Results. Respondents with low levels of social support, irrespective of family affluence, had significantly higher depression scores and significantly lower self-esteem scores (P< 0.05). In linear regression analyses, social support (95%CI [-1.35,-0.58]) and female gender (95%CI [1.49,5.29]) emerged as predic- tors of depression, while social support (95%CI [0.25,0.64]) and age (95%CI [-0.79,-0.11]) emerged as predictors of self-esteem. Affluence did not predict depression or self-esteem.

Conclusions. Social support is of greater relative importance in depression and self-esteem in our study. In developing nations with lean resources, enhanced social support might buffer against the effect of low socio-economic status on mental health.

Vitamin D-Binding Protein and the Role of its Gene Polymorphisms in the Mortality of Sepsis Patients

Liliriawati Ananta Kahar — 2023-12-30

Objective. This study aimed to determine the role of vitamin D-binding protein (VDBP) gene polymorphisms (especially at locus rs7041), vitamin D-binding protein levels, and vitamin D levels in mortality in sepsis patients.

Patients and Methods. We performed the analytic observational study with a case-control approach. A total of 80 patients were included in this study, 40 patients were grouped as the case group and 40 patients were grouped as the control group. The patients were diagnosed with sepsis and treated in the Intensive Care Unit (ICU), M. Djamil Hospital, Indonesia. The VDBP rs7041 gene polymorphism was analyzed using the polymerase chain reaction procedure. VDBP and vitamin D levels were examined using the enzyme-linked immunosorbent assay (ELISA) method.

Results. The case group showed lower mean vitamin D and VDBP levels than the con- trol group (P<0.05). There were more variations in the rs7041 gene VDBP (mutant) locus in the case group than in the control group, and this difference was considered statistically significant, P<0.05. The results of this study indicate that the occurrence of polymorphism or variations at locus rs7401 (mutant) causes a decrease in VDBP and vitamin D levels. A decrease in vitamin D levels correlates with the incidence of mortality in sepsis patients.

Conclusion. Polymorphism gene VDBP at locus rs7041 causes a decrease in the production of VDBP, a vitamin D carrier protein.

The Hyoid Bone - the Anatomy of a Small Bone of the Neck in Hellenic and GrecoRoman Medical Literature

Maria Rachi — 2023-12-30

Objectives. To understand the nomenclature of the hyoid bone.

Materials and Methods. Hyoid, a small bone of the neck, is a bony part that is rather difficult to unearth and discover among skeletal remains.

Results. The named was coined by the ancient Greeks, along with its anatomic description. Galen (2nd – 3rd c. AD) and Theophilus Protospatharius (7th century AD), facing religious and social barriers, succeeded in presenting its anatomy and suggesting its probable function in speech and swallowing, regarding the bone as a muscle pillar of the neck area.

Conclusion. Authorities of Hellenic antiquity surprise us with their accuracy and the resilience of their anatomical descriptions.

Toxic Cardiomyopathy in a Young Patient Treated for Her2-Positive Early Breast Cancer: Case Report and Literature Review

Amina Hadžibeganović — 2023-12-30

Objective. We present the case of toxic cardiomyopathy in a healthy thirty-eight-year-old female patient treated for Her2-positive early breast cancer.

Case Report. During the neoadjuvant treatment, the patient received four cycles of AC regimen and four cycles of docetaxel in combination with trastuzumab biosimilar. Two days after she received the ninth dose of trastuzumab biosimilar, she reported feebleness, palpitation, and dyspnoea. A heart ultrasound was performed and was normal without changes in the ejection fraction (EF) compared to previous checks. Three days later she reports worsening of her symptoms that were highly suggestive of heart failure. A cardiologist was consulted who insisted that the patient’s symptoms were the consequence of the disease progression. A CT scan showed signs of heart failure. A heart ultrasound was done and the EF dropped to 30%. Drainage of the right pleural cavity was performed and pharmacotherapy for heart failure was started. The treatment led to clinical improvement, but eighteen months later EF is still not back to normal.

Conclusion. This is a rare case of toxic cardiomyopathy in a young, previously healthy, patient who received anthracyclines followed by trastuzumab biosimilar in combination with taxanes. All the medications this patient received are potentially cardiotoxic. However, the overall presentation is not typical for any of these medications since the patient presented with symptoms and signs of heart failure with significant dilatation of the right atrium, which persists eighteen months after its onset, with only a small increase in the EF. There is also a possibility that the antineoplastic therapy the patient received only facilitated dilatative cardiomyopathy, while the main causative factor was intrinsic or extrinsic.

Coccygeal Disc Disease as a Possible Cause of Coccygodynia

Spyridon P. Galanakos — 2023-12-30

Objective. The aim of the present study was to describe the causes involved in the pathophysiology of coccydynia, emerging from the coccyx or the anatomical tailbone region.

Case Report. We present the case of a 64-year-old man with pain in the coccyx and numbness in the perianal area. After clinical examination and imaging evaluation, including plain X-rays and magnetic resonance, coccygeal disc disease was identified. Other findings, such as tumor and fracture were excluded. We decided to undertake conservative management and the pain was eventually relieved. This is the first case report of coccygodynia and perianal numbness attributed to coccygeal disc disease.

Conclusion. Although there is no standard treatment, coexisting coccygeal disc disease should be always taken into account, with clinical and imaging examinations being considered of major importance to establish both medical diagnosis and treatment.