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Introduction: Lipoprotein (a) [Lp(a)] is a marker for cardiovascular disease, involved in pathogenesis and progression of atherosclerosis. In selected high-risk patients, lipoprotein-apheresis could optimize secondary prevention and improve prognosis. Aim: We presented the case of a 49-year-old man with high lipoprotein (a) levels and recurrent cardiac adverse events, despite maximal pharmacological therapy. Case report: Four years before the admission at our Centre, he presented an anterior STEMI, treated with angioplasty and implantation of a drug eluting stent on left anterior descending artery, at the age of 47 years, in September 2012; one month later, the patients presented a new episode of angina, and exams showed a critical stenosis in the right coronary artery, treated by angioplasty and implantation of drug eluting stent. Because of high Lp(a) plasma levels, patient was subsequently on regularly 7-10 day lipoprotein apheresis. Results and discussion: A thrombophilic screening was performed, showing the simultaneous presence of heterozygous V Leiden mutation and prothrombin G20210A mutation. He referred to our Centre in order to optimize therapy; we performed an endothelial function assessment showing a severe dysfunctional pattern. Because of these findings, we prescribed dual antiplatelet therapy, and we added omega-3 fatty acids and association with nicotinic acid/laropiprant. According with current guidelines, considering the high risk of bleeding, we preferred not to administer anticoagulant therapy. At 6-month and 1-year follow up the patient continued lipoprotein apheresis and was asymptomatic for other cardiovascular events. Conclusions: The assessment for the eventual presence of thrombophilia might become a useful tool in clinical practice for high-risk selected patients.

Chagas disease is a public health problem in Latin America and its treatment is based on the use of benznidazole or nifurtimox compounds. Both present problems such as resistance, inefficiency in chronic infection and cytotoxic effects. New compounds such as posaconazole and amiodarone have been tested against T. cruzii and shown to be effective. In addition, new molecules have been synthesized and tested against T. cruzii. Because this protozoan is highly pathogenic, even with a number of cases of accidental laboratory infections, few laboratories located outside Latin America are authorized to work with its infective developmental stages. On the other hand, Trypanosoma dionisii is a non-pathogenic protozoan phylogenetically related to T. cruzii and that shares similar strategies to complete its life cycle in mammalian cells in vitro. Here, we describe a comparative analysis of the sensitivity of both parasites to benznidazole, posoconazole and amiodarone. We also analyzed the morphological effects of these compounds on both Trypanosoma species using electron microscopy. Our results show that T. dionisii is more sensitive to the compounds tested than T. cruzii. They also support a previous suggestion that it may constitute an excellent model for large scale screening of compounds against T. cruzii.

Ginseng extracts are often used as adaptogen to improve mental performances and well being, helping to overcome stress. Thus, in our times a lot of ginseng extracts are continuously produced and sold into commercial channels. Both Asian and Korean red ginseng (Panax ginseng) and American ginseng (Panax quinquefolius) are the most extensively used and researched. Both Panax ginseng and Panax quinquefolium contain different types of saponins, also known as ginsenosides, which are the substances that give ginseng medicinal properties. Human and animal studies showed that ginseng extracts can also have hypoglycemic effects. The mechanisms by which ginseng reduces blood glucose levels are unclear; some mechanisms have been proposed to explain its hypoglycemic effect, especially modulating effects on insulin sensitization and/or insulin secretion and regulating actions on digestion and intestinal absorption. We describe a case of hypoglycemia by ginseng in type 2 diabetic patient treated with oral hypoglycemic agents. Although, in order to provide better assessments of a sure anti-diabetic efficacy of ginseng, larger and longer randomized controlled clinical trials will be required, in our case we think that we have enough evidence to believe that the cause of hypoglycemia was ginseng. Obviously, this report should not be taken as a proof of the hypoglycemic effect of ginseng, nor it wants to be a suggestion to use ginseng in the treatment of diabetes; instead, it wants to be an alert for patients and clinicians to avoid hypoglycemia in daily clinical practice.

Background: Various studies examined the effect of birth order. First born children show usually better cognitive performance than their later born siblings. Studies on emotional aspects yield heterogeneous results, sometimes in favour of first born, sometimes in favour of later born children. Studies comparing only-children with children with siblings are rare. Method: An internet survey was performed in 508 Polish and 500 German subjects. Only-children, first born, middle born and latest born children were compared regarding body mass index, depression, anxiety and partnership. Results: No differences among first born, middle born and latest born children were detected. Only-children reported significantly less symptoms of social phobia than first born children (z=0.50, p< 0.01). Conclusions: Except for suicidality, the results of this study question the sense of further investment in studying effects of birth order. In contrast, examining differences between only-children vs. children having siblings seems to have the potential to yield interesting and new results. Optimally, such research would combine self-report measures with reports from others, such as parents, teachers or clinicians.

 62-year-old female with a history of arterial hypertension, attended the emergency department due to pain in the left flank. On physical examination no showed signs of peritoneal irritation. Urinalysis was indicated, that reported microscopic hematuria and negative abdominal ultrasound.

Background and aims: Iron deficiency is one of the most important health issues in adolescents, especially girls. Today, empowerment is considered an effective program to change behavior in chronic disease control. This study was conducted to determine the effect of the family-centered empowerment model on the empowerment indicators of student girls with iron deficiency anemia and their mothers.Methods: This is a two-group semi-experimental study conducted on 60 student girls along with their mothers, who were selected by a two-stage cluster random sampling method. Data was collected using a demographic information questionnaire and an adolescent and mother empowerment questionnaire. The intervention based on the family-centered empowerment model was implemented for the test group, and after 1.5 months, data from both groups were collected and analyzed with chi-square, independent t, and paired t-tests.Results: The results of the independent t-test showed that there was a significant difference between the student girls in the test and control groups after the intervention in terms of empowerment indicators (p < 0.05). The results of the independent t-test showed that there was a significant difference between the mothers in the test and control groups after the intervention in terms of ability indicators (p < 0.05), while before the intervention, this difference was not significant (p > 0.05). Conclusion: The results of the present study showed that the implementation of the family-centered empowerment model not only increased the empowerment indicators of student girls with iron deficiency anemia but also had an effect on the empowerment of their mothers.

Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature. Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications. Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available. Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms

The recent introduction of the miniscrew in orthodontics revolutionized the clinical and biomechanical approach of anchoring. Used as direct or indirect anchoring, the orthodontic micro screws indications field is expanding due to their easy insertion, and their immediate loading ensuring an absolute anchoring. Our objective through this clinical case is to show the effectiveness of these miniscrews in the correction of the uncontrolled loss of anchoring.

Background: C-type natriuretic peptide (CNP) was isolated from porcine brain and is a 22-amino acid peptide which belongs to the natriuretic peptide (NP) family. Even though this peptide shares structural similarity to other endogenous NPs including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) its receptor selectivity is different from other NPs. The present study was undertaken to investigate the expression of C-type natriuretic peptide (CNP) and its specific guanylyl cyclase (GC)-coupled receptor in the granulosa cells of the pig ovarian follicle. Results: Specific 125I-[Tyr0]-CNP(1-22) binding sites were localized in the granulosa cell layer of the ovarian follicle with an apparent dissociation constant (Kd>) and a maximal binding capacity (Bmax) of 1.41±0.39 nM and 2.75±0.65 fmol/mm2 respectively. Binding of 125I-[Tyr0]-CNP(1-22) to these sites was also prevented by atrial natriuretic peptide (ANP(1-28)), brain natriuretic peptide (BNP(1-26)) and des[Gln18,Ser19,Gly20, Leu21,Gly22] ANP(4-23) (C-ANP). Production of 3’,5’-cyclic guanosine monophosphate (cGMP) by particulate GC in the granulosa cell membranes was stimulated by natriuretic peptides (NPs) with a rank order of potency of CNP(1-22)>>BNP(1-26)>ANP(1-28). HS-142-1, a selective antagonist of the two recognized GC-coupled NPRs, inhibited CNP(1-22)-stimulated cGMP production in granulosa cell membranes in a dose-dependent manner. Also mRNAs for all three recognized NPRs were detected in granulosa cells using reverse transcriptase-polymerase chain reaction (RT-PCR). Serial dilution curves of granulosa cell extracts were parallel to the standard curve of synthetic CNP. Conclusion: These results indicate that CNP and its specific receptor are expressed in the granulosa cells of the pig ovary, and suggest that CNP may be a local autocrine and/or paracrine regulator via activation of its specific GC-coupled receptor, NPR-B.

Selective alveolar decortication and periodontal augmentation with a bone graft were the two procedures used for the correction of the skeletal class II malocclusion in the case reported. A 25-year-old male patient presented with a skeletal class II malocclusion with increased bi-maxillary dento-alveolar protrusion, increased overjet, deep bite and imbricated and rotated mandibular incisors with bilateral presence of supernumerary teeth in the maxillary right and left premolar regions. Extraction of supernumerary in the maxillary right and left premolar region, and impacted UL5 was done. Pre-adjusted edgewise appliance, Roth’s prescription (0.022x0.028-inch slot), was bonded and a week later full thickness labial and lingual flaps were reflected in the maxillary and mandibular arches. Circumscribed corticotomy cuts was done and subsequently augmented with a bone graft. Orthodontic treatment was commenced immediately after surgery and orthodontic adjustments were performed every 2 weeks. The entire orthodontic treatment was completed in 9 months. Regional acceleratory phenomenon, triggered by the alveolar decortication, was responsible for the rapid correction of the malocclusion and the augmentation with the bone graft provided adequate bone volume for housing the teeth, thereby decreasing the possibility of subsequent relapse.