Hypertensive response to exercise in dipper and non-dipper normotensive diabetics

Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5?±?7 and 10 male) in group 1 and 37 patients (mean age 53.1?±?10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p?=?0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r?=?0.611, p?r?=?0.266, p?=?0.002) and age (r?=?0.321, p?=?0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p?p?=?0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.     

Hemorheological changes with strontium ranelate treatment do not seem to be related to its claimed prothrombotic effects

Strontium ranelate is claimed to be related with increased risk of thromboembolic events. No explanation of this increased incidence of thromboembolism has been identified. However, growing evidence has clearly demonstrated the involvement of blood rheology in any thrombotic process. The aim of this study was to assess hemorheological changes with strontium ranelate treatment in elderly women with osteoporosis. This study was designed in a prospective manner. Twenty-two elderly women diagnosed with osteoporosis were included. During a 2-month treatment period, participants received strontium ranelate 2 g/day. Hemorheological parameters including erythrocyte deformability, erythrocyte aggregation and plasma viscosity were measured before and after 2 months therapy with strontium ranelate. The median age of the patients was 70.0 (range = 65-80) years. After 60 days of treatment, there was no statistically significant change in hemorheological parameters. None of the subjects developed clinical venous thromboembolic event (VTE) during the 2-month period of strontium ranelate treatment. Our study demonstrated that in elderly women, treatment of osteoporosis with strontium ranelate did not change hemorheological parameters over 2 months of time. However, its long-term effects on hemorheologic parameters should be evaluated further with a larger sample.     

Coexistence of osteoporosis (OP) and coronary artery disease (CAD) in the elderly: it is not just a by chance event

Cardiovascular disease (CVD) and OP are common age-related conditions. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CVD. But available data in geriatric population is limited. In this study we aimed to seek the possible relationship between CAD and low bone mineral density (BMD) in a large number of geriatric patients. A total of 2235 patients aged 65 years or more were included in this cross-sectional study. All patients underwent a complete geriatric assessment and evaluated for CAD and cardiovascular risk factors. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femoral neck. BMD results were classified into three groups; normal (T-score: ≥-1.0×S.D.), osteopenia (T-score between -1.0 and -2.5×S.D.), and OP (T-score: ≤-2.5×S.D.). CAD was present in 397 (29.7%) of 1335 patients with OP, in 199 (27.4%) of 726 patients with osteopenia and in 34 (19.5%) of 174 patients with normal BMD. Multivariate regression analysis revealed that presence of OP or osteopenia increased the prevalence of CAD as an independent correlate (OR=1.643; 95% CI=1.068-2.528, p=0.030). This study highlights the need for careful evaluation of elderly patients with low BMD for possible CAD.     

The association between homocysteine (hcy) and serum natural antioxidants in elderly bone mineral densitometry (BMD)

Previous studies showed oxidative stress had an important impact on osteoclastic and osteoblastic functions. Oxidative stress or low levels of antioxidants are supposed to reduce BMD and cause osteoporosis. hcy, gamma glutamyltransferase (GGT), uric acid, albumin and total bilirubin are simple laboratory parameters that are related with oxidative stress. In this study we compare the serum hcy and antioxidant levels in patients with osteoporosis, osteopenia and control subjects. A total of 2190 elderly persons (1348 patients with osteoporosis, 643 patients with osteopenia and 199 control subjects) who were referred to the outpatient clinic of the Department of Internal Medicine, Division of Geriatric Medicine at Hacettepe University Hospital for comprehensive geriatric assessment were included in this cross-sectional study. Mean age of subjects were 72.30±6.34 in osteoporosis group, 71.92±6.90 in osteopenia and 71.86±5.88 in control group (p: 0.260). Multivariate regression analysis revealed that hypertension (HT) (OR: 0.675, 95% CI: 0.534-0.854, p: 0.001), diabetes mellitus (DM) (OR: 1.669, 95% CI: 1.301-2.142, p: <0.001), age (OR: 1.025, 95% CI: 1.006-1.044, p: 0.009), male gender (OR: 0.451, 95% CI: 0.358-0.569, p<0.001), uric acid (OR: 0.893, 95% CI: 0.837-0.952, p: 0.001), hcy (OR: 1.042, 95% CI: 1.023-1.061, p<0.001), albumin (OR: 0.521, 95% CI: 0.376-0.724, p<0.001), GGT (OR: 1.010, 95% CI: 1.003-1.017, p: 0.003), creatinine (OR: 0.630, 95% CI: 0.459-0.864, p: 0.004) were independent variables predicting the occurrence of osteoporosis. This study shows there is an imbalance between natural antioxidative and oxidative markers in patients with osteoporosis. Higher serum uric acid and albumin levels are associated with a lower prevalence of osteoporosis whereas higher hcy and GGT levels are associated lower BMD and higher osteoporosis prevalence.     

Scleral perforation complicating titanium mesh plaque in orbital blowout fracture

A 27-year-old man who underwent a previous reconstruction surgery for left orbital blowout fracture and recent revision surgery for left cicatricial ectropion was admitted to the ophthalmology outpatient clinic with a 20-mm irregular conjunctival and scleral incision in the left eye at the 6-o'clock position. The scleral and conjunctival incisions were repaired, and during the operation, the anterior end of the titanium mesh plate was visible at the inferior orbital rim. The plastic surgery team removed the irritating end of the plate. Obvious adherence of periocular tissues onto the titanium implant and fibrovascular ingrowth through the implant were seen during this operation. The possible mechanism for the misdirection of the anterior end of the implant might be explained by iatrogenic rotation during the revision of the cicatricial ectropion. To the best of our knowledge, this is the first reported case demonstrating scleral incision caused by an orbital titanium implant.     

The long-term effects of extracorporeal shock waves on the epiphysis of the adolescent rat

Background

Extracorporeal shock waves (ESW) have been successfully used to treat musculoskeletal injuries, tendinopathy, and plantar fasciitis. Different side effects of high-energy ESWT on bones, tendons, nerves, epiphysis, and cartilage have been discussed. Although the effects of ESW on the epiphysis in animal models have been described, no studies have investigated the long-term effect of ESW on the immature epiphysis in an animal model. The purpose of this study was to investigate the long-term effects of ESW on the immature epiphysis in rats.

Methods

Sixteen 4-week old Wistar albino rats, average weight 116.3 grams (109.6–120.2 g) were used for these experiments. The rats were randomly divided into two groups, the ESW 1500 pulses (ESW1500p) group (n = 8) and the ESW 3000 pulses (ESW3000p) group (n = 8). In the ESW1500p group, 1500 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. In the ESW3000p group, 3000 pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. The right knees (n = 16) of the rats in the two groups were used as the controls. The animals were sacrificed after an 8-month follow-up period. Femoral epiphyses were assessed by use of histology. The femoral length (FL), tibial length (TL), and femoral supracondylar medio-lateral width (MLW) were measured.

Results

There was no statistically significant difference between FL, TL, and MLW for the three groups (P > 0.05). The average histological scores were 8.8 (7–10), 17.8 (15–22), and 2.7 (0–4) in the ESW1500p, the ESW3000p groups, and the controls, respectively. The average histological score for the ESW3000p group was significantly higher than those for the ESW1500p group and the controls (P < 0.001). The average histological score for the ESW1500p group was significantly higher than that for the controls (P < 0.001).

Conclusions

The histological findings of this study indicate that ESW increased the cellularity and basophilia of the extracellular matrix (ECM) in the adolescent rat epiphysis and there were no negative effects on extremity measurements in the long term.     

Fatal Fever of Unknown Origin in Acute Cervical Spinal Cord Injury: Five Cases

Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature.

Methods: Case reports of 5 patients with cervical spinal cord injury (SCI).

Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin.

Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal.     

Cardiovascular involvement in Behçet’s disease

Behçet’s disease is a chronic relapsing systemic vasculitis that can involve almost every organ and systems in the body with extremely different diverse manifestations. Cardiovascular involvement is one of these manifestations, the involvement of which might present in various patterns in itself. Cardiovascular involvement is relatively uncommon in Behçet’s disease; however, Behçet’s disease is relatively rather common in certain parts of the world. Therefore, especially in these locations recognizing such miscellaneous presentations are of critical importance, since cardiovascular involvements exceed other presentation in mortality and morbidity rates. Based on these facts, in this review, we summarized the cardiovascular involvements and its different manifestations in Behçet’s disease.