Systemic Disease In Patients Research Articles

Deranged Liver Biochemistry in a Non-Liver Intensive Care Unit: A Prospective Study

Introduction: Common indications for admission to a liver intensive care unit (LICU) are often due to complications of an underlying chronic liver disease or to an acute insult to the liver either by bacterial or viral infections, alcohol or drugs. Secondary or acquired liver injury occurs in patients with systemic disease in patients who are admitted to a non-LICU setting. These patients are often hemodynamically unstable with multiorgan failure. The aim of the study was to understand the pattern of liver injury in patients admitted to a non-LICU for issues unrelated directly to the liver. Materials and Methods: Patients admitted to medical, neuro and cardiac ICU of the institution were included. All patients had liver biochemistry at admission. R factor (RF) criteria (alanine aminotransferase: S. Alkaline phosphatase ratio) was used for stratifying the liver injury as hepatocellular (HC) (RF-HC; ≥5), cholestatic (RF-C; ≤2) and mixed type (RF-HC+C; 2–5). Patients were followed up in the ICU until discharge. Statistical Analysis: SPSS v26 (IBM Corp.) was used for analysis. Chi-square test was done for categorical variables and Fisher’s exact test, when the expected frequency in the contingency table was <5 in more than 25% of the cells. P < 0.05 was considered as statistically significant. Results: 108 (43.9%) of 246 admissions had liver injury (43.9%). The elevation in liver enzymes were <2 times the upper limit of normal range. There were no significant differences in enzyme elevations in the 3 ICUs. The most common type of liver injury was RF-C (67; 62%) followed by RF-HC+C (34; 31.5%) and RF-HC (7; 6.48%). There was no difference in the disease specific liver injury. Patients with RF-C needed significantly more inotrope support (P = 0.001); 76% survived (P = 0.023). Those with RF-HC required hemodialysis (P = 0.001) with poor survival outcome (42.9%). Conclusions: Liver enzymes are not significantly elevated in non-LICU patients. RF criteria is useful in not only predicting the type of liver injury but also predicting the likely outcome.

Prevalence of oral diseases and their correlations with systemic diseases in patients attending the family medicine and specialties clinic Q12 of ISSSTE

Prevalence of oral diseases and their correlations with systemic diseases in patients attending the family medicine and specialties clinic Q12 of ISSSTE

Manifestaciones neurológicas de enfermedades sistémicas: aspectos claves para el clínico

The nervous system interacts with all other systems in the human body on a continuous ba-sis. It’s not uncommon for a disease to exhibit neurological symptoms that are not solely at-tributable to a primary nervous system disorder, but, rather, to the intricate relationships the nervous system has with other organs. This article reviews how diverse gastrointesti-nal, endocrine, rheumatic, kidney, heart, and other affections manifest in the neurological system. Key points, frequent symptoms, and signs are thus summarized to provide a com-prehensive understanding of the relationship between systemic diseases and neurological symptoms. Emphasizing the clinical presentation of a selected group of conditions, it is hoped that clinicians can better recognize the potential for neurological symptoms in pa-tients with systemic diseases, and the potential for systemic diseases in patients exhibiting neurological symptoms, leading to earlier diagnosis and improved outcomes.

The relationship between optic nerve sheath diameter measurements and serum ammonia level and systemic diseases in patients followed in the ICU

The relationship between optic nerve sheath diameter measurements and serum ammonia level and systemic diseases in patients followed in the ICU

Aggressive course of atherosclerosis in hyperlipoproteinemia (a): a case series

Currently, worldwide interest in lipoprotein(a) (LP(a) as one of the most important markers of premature and aggressive atherosclerosis is steadily growing. This trend is due to both the new data on the pathogenesis of hyperlipoproteinemia (a) and the development of novel treatment methods in the near future. The variety of clinical manifestations of atherosclerosis associated with high LP(a) concentrations leads such patients to specialists of various profiles. The aim of this paper was to demonstrate, using examples from the practice of two lipid centers in Krasnodar, the diversity of clinical scenarios of atherosclerosis as a systemic disease in patients with very high LP(a) levels, as well as to highlight the current and future options for the treatment of hyperlipoproteinemia (a).

Angiotensin Converting Enzyme Inhibitors: Interaction Issues in Patients with Glaucoma and Arterial Hypertension. Review

The purpose of the review is to evaluate the interaction of angiotensin-converting enzyme inhibitors in patients with glaucoma and concomitant arterial hypertension using literature data. Glaucoma is the main cause of blindness and visual impairment, as well as the main cause of irreversible blindness worldwide. Pharmacotherapy, laser or surgical treatments are used to reduce IOP levels, as well as prevent deterioration of visual field defects. However, 40 % of patients develop glaucomatous neuropathy despite ongoing therapy. This prompts the investigation of alternative causes of damage to the optic nerve, and abnormal blood pressure levels, both too low and too high, are considered as a possible risk factor. Arterial hypertension occurs in 48–65 % of patients with glaucoma and is the most common systemic disease in patients with glaucoma. Currently, angiotensin converting enzyme (ACE) inhibitors are considered the “gold standard” in the treatment of arterial hypertension, in the pathogenesis of which activation of the renin-angiotensin system (RAS) plays an important role. The renin-angiotensin system (RAS) is a hormonal system responsible for regulating blood pressure and fluid and electrolyte balance in the body. Local tissue-specific RAS were found, including in the structures of the eyeball: cornea, aqueous humor, iris, ciliary body, vitreous body, retina. These data indicate that the local RAS plays an important role in the regulation of the physiology of the eye and may become a target in the development of new antiglaucoma drugs. Animal studies, as well as studies in various patient groups, show that systemic antihypertensive drugs that inhibit the RAS, such as ACE inhibitors, reduce IOP. These studies support the concept that RAS inhibitory drugs may be potential antiglaucoma drugs in the future, as ACE inhibitors can improve the outflow of intraocular fluid, thereby reducing IOP.

Evaluation of Risk Factors in Patients with Primary Open Angle Glaucoma and Ocular Hypertension

Objective: The purpose of our study was to compare the age, gender, intraocular pressure (IOP), central corneal thickness (CCT), spherical equivalent values, smoking, family history of glaucoma and additional systemic diseases in patients with primary open angle glaucoma (POAG) and patients with ocular hypertension (OHT); and to evaluate the relationships of these factors with each other. Material Methods: 40 patients with POAG, 40 patients with OHT and 40 individuals as control group were included in the study. Age, gender, IOP, CCT, spherical equivalent values, family history of glaucoma, history of consanguineous marriage, smoking, systemic diseases of each subject were recorded. Results: There was no significant difference in gender and average age between the groups (p=0.238 and p=0.51, respectively). IOP values was higher in POAG and OHT groups compared with the control group (p=0.000). CCT was higher in OHT group compared with the other groups (on the right, p=0.001 and p=0.008, respectively; on the left, p=0.013 and p=0.006, respectively). There was no significant correlation between IOP and CCT values. There was no significant difference in mean spherical equivalent values (on the right eye p=0.686; on the left eye p=0.640) . The incidence of diabetes mellitus, hypertension, hyperlipidemia and coronary artery disease was the similar in all groups (p=0.417, p=0.058, p=0.79, p=0.236, respectively). Family history of glaucoma is increased in POAG and OHT group compared with the control group (p=0.000). There was no significant difference in history of consanguineous marriage, smoking and alcohol consumption status among all groups (p=0.899, p=0.492, p=0,899, respectively). Conclusion: High IOP is the most important risk factor in the POAG and OHT groups. Individuals with OHT and thin CCT are at higher risk of developing POAG. The significant presence of a familial history of glaucoma in the POAG and OHT groups indicates that genetic factors could be a significant risk factor. Diabetes, hypertension, and high myopia are factors that increase the risk of glaucoma.

The condition of the oral mucosa and salivary glands against the background of systemic diseases

The purpose of this article is to give a brief overview of the manifestations in the oral cavity of systemic diseases in patients, such as diabetes mellitus, cirrhosis of the liver, peptic ulcer of the stomach and duodenum, iron deficiency anemia, based on domestic and foreign literature data for the last 10 years. The review will focus on diseases affecting the oral mucosa and salivary glands, since these tissues are of the greatest interest to practicing dentists of all profiles. Pathological processes that occur in the human body due to systemic diseases are often manifested through changes in the mucous membrane or organs of the oral cavity and in most cases are the first clinical signs of metabolic disorders, especially in diseases of the digestive, endocrine, hematopoietic systems. The degree of manifestation of somatic pathologies in the oral cavity is directly dependent on the severity of the disease, since the physiological processes in the body acquire a pathological character. This article will be useful for practicing dentists of all specialties, for the formation of clinical thinking.

Examining the Frequency of Systemic Diseases in Patients Referring to the Dental Surgery Department

Background: Considering the relatively high prevalence of systemic diseases, the present study investigated the frequency of systemic diseases in patients referring to the surgery department of the Zahedan Faculty of Dentistry. Methods: In this descriptive-analytical cross-sectional study, 463 patients referring to the surgery department of the Zahedan Faculty of Dentistry in 2021 - 2022 were investigated. The required information, including the type of systemic disease, age, gender, and marital status, was extracted from the patient's medical file and recorded in the designed checklist. Next, the frequency of systemic disease was compared in terms of age, gender, and marital status. Results: The frequency of systemic diseases was obtained at 27.4%. The most common systemic diseases were hypertension (8.6%), diabetes (6.6%), and anemia (4%). The frequency of systemic diseases in terms of gender and marital status did not differ significantly (P = 0.567 and P = 0.193, respectively), while it was significantly higher in those above 45 years of age compared to those younger than 45 (P < 0.001). Conclusions: The prevalence of systemic diseases in patients referring to the surgery department of the Zahedan Faculty of Dentistry is relatively low compared to other studies. Hypertension, diabetes, and anemia had the highest frequency among systemic diseases.

Relationship between C-reactive protein level and periodontitis and systemic diseases.

Periodontitis affects systemic disease risk, although the relationship thereof in the context of different C-reactive protein (CRP) levels is not clear. This study investigated the association of periodontitis with systemic diseases according to high-sensitivity CRP (hs-CRP) level and sought to identify the risk of systemic diseases in patients with periodontitis. We used data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey. In a total of 16,489 subjects, the hs-CRP group was classified into the hs-CRP low-risk group and the hs-CRP high-risk group. Propensity score matching (PSM) is used for 1:1 matching of confounding variables (e.g., age, gender, income, and education) between hs-CRP low-risk and hs-CRP at-risk groups to analyze the final 5316 subjects. The association between general characteristics and prevalence of systemic diseases was analyzed using descriptive statistics and the chi-squared test. The associations between hs-CRP level and systemic and periodontitis were analyzed using logistic regression analyses. Within the hs-CRP group, the presence of periodontitis was associated with a significantly increased prevalence of hypertension, diabetes mellitus, and stroke. In the hs-CRP risk group, periodontitis significantly increased the risk of hypertension and diabetes mellitus by 2.1 and 2.4 times, respectively. The presence of periodontitis significantly increases the prevalence of systemic diseases and more so in individuals with higher hs-CRP levels. This indicates the significance of maintaining oral health in reducing the risk of systemic diseases.

Prevalence of Oral Manifestations of Systemic Diseases in Patients Visiting the Dental Outpatient Department of Sindh, Pakistan

OBJECTIVES The purpose of the study was to evaluate the awareness of oral health workers in identifying the prevalence of oral manifestations of systemic diseases in patients visiting the Dental Out-Patient Department of Sindh, Pakistan. METHODOLOGY A descriptive, cross-sectional survey-based study was conducted in Karachi, Pakistan, from October to December 2021. The study was conducted in various institutes from all over Sindh, Pakistan. An online, well-structured questionnaire was designed using Google Forms and distributed to the participants through social media platforms in the dental community. Using the Open-Epi software regarding a parent article, the sample size of this study was calculated. Keeping the confidence interval at 95% and the desired percentile at 50, the total sample size was calculated to be 100. Around 175 questionnaires were given out to the candidates. RESULTSThe results showed that 81% male and 19% female participated, including 45% postgraduate trainees, 30% house officers, and 25% general dentists. 80% detected 2-3 systemic diseases in a patient, with 75% observing oral manifestations preceding systemic illness diagnosis. The majority favoured treating underlying ailments (75%), and prevalent conditions included hypertension (90%), diabetes (80%), anaemia (75%), and lichen planus (40.7%). CONCLUSION Oral health workers play a vital role in the initial and early identification and multidisciplinary medical management of various systemic diseases. A coordinated approach between physicians and dentists in diagnosing and managing these conditions is necessary to achieve optimal clinical outcomes.

Efficacy of lymph node dissection for duodenal cancer according to the lymph node station.

Lymph node metastasis (LNM) is associated with poor prognosis in patients with duodenal cancer (DC). However, the efficacy and optimal extent of lymph node (LN) dissection have not been thoroughly discussed. A total of 98 consecutive patients with DC who underwent surgical resection (pancreatoduodenectomy, n = 55; partial resection, n = 32; pancreas-sparing total duodenectomy, n = 9) were retrospectively analyzed. The LN stations located upstream of the lymphatic flow were defined as Np stations according to tumor location, whereas the others were defined as Nd stations. The association between the dissection of each LN station and survival outcome was investigated using the efficacy index (EI; percentage of metastases to lymph nodes in each station multiplied by the 5-year survival rate of metastatic cases). The survival of patients with LNM at the Nd stations (n = 6) was significantly worse than that of patients with LNM only at the Np stations (n = 20) (relapse-free survival, median survival time [MST], 6.0 vs. 48.4 months, p < 0.001; overall survival, MST, 15.1 vs. 96.0 months, p < 0.001). Multivariate analysis identified LNM at Nd stations as an independent prognostic factor for overall survival (hazard ratio 9.92; p = 0.015). The Np stations had a high EI (range, 8.34-20.88), whereas the Nd stations had an EI of 0, regardless of the tumor location. LN dissection of the Np stations contributed to acceptable survival, whereas LNM of the Nd stations led to poor survival, possibly reflecting advanced tumor progression to systemic disease in patients with DC.

Evaluation of The Prevalence of Systemic Disease in Patients Admitted To The Oral And Maxillofacial Radiology Clinic

Amaç: Bu çalışmanın amacı, diş hekimliği fakültesi hastanesine başvuran hastaların sistemik hastalık prevalansının belirlenmesi ve medikal profilinin değerlendirilmesidir. Gereç ve Yöntem: Bu retrospektif çalışmaya, Diş Hekimliği Fakültesi Ağız, Diş ve Çene Radyoloji kliniğine Mart-Eylül 2022 tarihleri arasında çeşitli nedenlerle muayene için başvuran hastalar dahil edildi. Hastaların yaş, cinsiyet gibi demografik bilgileri ve sistemik hastalıkları belirlendi. Sistemik hastalık görülme sıklığı ile cinsiyet ve yaş arasındaki farklılık ki-kare testi ile değerlendirildi. Bulgular: Çalışmada, 14-89 yaş aralığında, 2007 kadın ve 1284 erkek olmak üzere toplam 3291 hasta değerlendirildi. Çalışmaya dahil edilen bireylerden %71.77’sinde (n=2362) sistemik hastalık gözlenmezken, %28.23’ünde (n=929) en az bir tane sistemik hastalık belirlendi. Sistemik hastalık görülme sıklığı, cinsiyetler ve yaş grupları arasında istatiksel anlamda farklılık gösterdi (p&amp;lt;0.05). Sonuç: Çalışma sonuçlarına göre en sık gözlenen hastalık kardiyo-vasküler ve endokrin sistem hastalıklarıdır. Diş hekimleri, bu hastalıklarla ilgili oluşabilecek komplikasyonları önlemek için muayene ve dental tedavi öncesinde ayrıntılı bir anamnez almalıdır.

Peripheral Neuropathy in Sjogren’s Syndrome: A Case Report

We report here a case of peripheral nerve complications of Sjogren’s syndrome in a 45-year-old Chinese man. To our knowledge, there are presently no studies to provide the best treatment for peripheral neuropathy in Sjogren’s syndrome. In our patient, rituximab was particularly effective. However, the mechanism through which rituximab exerts its efficacy in the treatment of neuropathy is unclear. Clinicians should screen other systemic diseases in patients with peripheral neuropathy, and consider Sjogren’s syndrome in the differential diagnosis.

The prevalence of the systemic diseases among dental patients in Medenta Oral &amp; Dental Care, Kabul, Afghanistan

To determine the prevalence of systemic diseases in patients looking for dental management in Medenta Oral and Dental Care.: The archived files of 2040 patients looking for dental management in Medenta Oral and Dental Care from 2018-2021 were retrieved and reviewed for systemic diseases. Out of 2040 patients, 1348 patients (67%) had systemic diseases. The most prevalent systemic diseases in descending order were gastro-intestinal disease (14.7%), anemia (14.3%), headaches (11.4%), depression (11.3%), and high blood pressure (5.6%). As the results indicate the prevalence of systemic diseases in dental patients is considerable, especially in women, so the dentists should pay attention while taking patients’ medical history as there could be some diseases or medications that are contraindicated for certain dental procedures or the patient may need special consideration during the treatment process. Hence, detailed and systematic history taking and accurate clinical examinations are required before starting any dental procedure.

68Ga-PSMA PET/CT in early relapsed prostate cancer patients after radical therapy

Biochemical recurrence (BCR) of prostate cancer (PCa) occurs in about 25% of patients treated with radical prostatectomy (RP) and up to 45% in patients who receive external beam radiotherapy (RT). Early diagnosis of PCa recurrence is of high importance for successful salvage therapy. The aim of the present study is to analyze the efficacy of 68 Ga-PSMA PET/CT in detecting the presence of local and/or systemic disease in patients with a history of PCa who have BCR. A total of 52 PCa patients with BCR referred for 68 Ga-PSMA PET/CT were recruited from the American University of Beirut Medical Center between November 2017 and December 2019. We compared the performance of PSMA PET/CT to the results and clinical factors based on follow up: PSA, PSA kinetics, primary treatment, and Gleason score. The relationship between the PET/CT findings and clinical indicators of disease were assessed by univariate and multivariate logistic regression. From a total of 52 patients, 34 (65.4%) had positive PSMA-PET/CT scans. Among those, 8/34 (23.5%) received primary RT. For all patients with a positive PSMA-PET: the detection rate was 2/4 (50%) for PSA < 0.2, 5/10 (50%) for PSA 0.2–0.49, 3/6 (50%) for PSA 0.5–0.99, 6/12 (50%) for PSA 1–1.99, 8/9 (88.9%) for PSA 2–3.99, and 10/11 (90.9%) for PSA 4–10.PSMA-PET/CT positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score and TNM staging. However, it did not show a significant correlation with radiotherapy as primary treatment, ongoing androgen deprivation therapy (ADT), time to relapse, and initial PSA before therapy. In our single center prospective trial, 68 Ga-PSMA PET/CT successfully detected the recurrence of PCa in patients with BCR. Scan positivity was significantly associated with PSA level at time of PET scan, PSA doubling time, Gleason score, and TNM staging. PSMA- PET/CT is a highly promising modality in the work up of patients with PCa in the setting of BCR for earlier detection of disease recurrence.

Prognostic Impact of Positive Peritoneal Lavage Cytology on Resectable Pancreatic Body and Tail Cancer: A Retrospective Study

BackgroundThe prognostic impact of positive peritoneal lavage cytology on pancreatic cancer is unclear. Therefore, this study aimed to evaluate its impact in resectable pancreatic body and tail cancer.MethodsBetween January 2006 and December 2019, 97 patients with pancreatic body and tail cancer underwent peritoneal lavage cytology and curative resection at our institution. We analyzed the impact of positive peritoneal lavage cytology on clinicopathological factors and on the prognosis of pancreatic body and tail cancer.ResultsMalignant cells were detected in 14 patients (14.4%) using peritoneal lavage cytology. In these patients, the tumor diameter was significantly larger (p < 0.001) and anterior serosal invasion (p = 0.034), splenic artery invasion (p = 0.013), lympho-vessel invasion (p = 0.025), and perineural invasion (p = 0.008) were significantly more frequent. The R1 resection rate was also significantly higher in patients with positive peritoneal lavage cytology than in negative patients (p = 0.015). Positive peritoneal lavage cytology had a significantly poor impact on overall survival (p = 0.001) and recurrence-free survival (p < 0.001). This cytology was also an independent poor prognostic factor for recurrence (p = 0.022) and was associated with peritoneal dissemination and liver metastasis.ConclusionsPositive peritoneal lavage cytology is considered to be indicative of more systemic disease in patients with resectable pancreatic body and tail cancer than in patients with negative peritoneal lavage cytology. Early detection of pancreatic cancer before it develops micrometastases is important to improve prognosis, and CY+ patients require more intensive multimodality treatment than standard treatment for resectable pancreatic cancer.

TAMI-05. FATTY ACID SYNTHESIS IS REQUIRED FOR HER2+ BREAST CANCER BRAIN METASTASIS

Abstract Brain metastases are refractory to therapies that control systemic disease in patients with human epidermal growth factor receptor 2-positive breast cancer and the brain microenvironment contributes to this therapy resistance. Nutrient availability can vary across tissues, therefore metabolic adaptations required for brain metastatic breast cancer growth may introduce liabilities that can be exploited for therapy. Here we assessed how metabolism differs between breast tumors in brain versus extracranial sites and found that fatty acid synthesis is elevated in breast tumors growing in the brain. We determine that this phenotype is an adaptation to decreased lipid availability in the brain relative to other tissues, resulting in site-specific dependency on fatty acid synthesis for breast tumors growing at this site. Genetic or pharmacological inhibition of fatty acid synthase reduces human epidermal growth factor receptor 2-positive breast tumor growth in the brain, demonstrating that differences in nutrient availability across metastatic sites can result in targetable metabolic dependencies.

Abstract 90: Fatty acid synthesis is required for breast cancer brain metastasis

Abstract Brain metastases are refractory to therapies that otherwise control systemic disease in patients with human epidermal growth factor receptor 2 (HER2+) breast cancer, and the unique brain microenvironment contributes to this therapy resistance. Nutrient availability can vary across tissues, therefore metabolic adaptations required for breast cancer growth in the brain microenvironment may also introduce liabilities that can be exploited for therapy. Here, we assessed how metabolism differs between breast tumors growing in the brain versus extracranial sites and found that fatty acid synthesis is elevated in breast tumors growing in the brain. We determine that this phenotype is an adaptation to decreased lipid availability in the brain relative to other tissues, which results in a site-specific dependency on fatty acid synthesis for breast tumors growing at this site. Genetic or pharmacological inhibition of fatty acid synthase (FASN) reduces HER2+ breast tumor growth in the brain, demonstrating that differences in nutrient availability across metastatic sites can result in targetable metabolic dependencies. Citation Format: Gino B. Ferraro, Ahmed Ali, Alba Luengo, David P. Kodack, Amy Deik, Keene L. Abbott, Divya Bezwada, Landry Blanc, Brendan Prideaux, Xin Jin, Jessica M. Possada, Jiang Chen, Christopher R. Chin, Zohreh Amoozgar, Raphael Ferreira, Ivy Chen, Kamila Naxerova, Christopher Ng, Anna M. Westermark, Mark Duquette, Sylvie Roberge, Costas A. Lyssiotis, Dan G. Duda, Todd R. Golub, Shawn M. Davidson, Dai Fukumura, Véronique A. Dartois, Clary B. Clish, Matthew G. Vander Heiden, Rakesh K. Jain. Fatty acid synthesis is required for breast cancer brain metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 90.

FATTY ACID SYNTHESIS IS REQUIRED FOR BREAST CANCER BRAIN METASTASIS.

Brain metastases are refractory to therapies that control systemic disease in patients with human epidermal growth factor receptor 2 (HER2+) breast cancer, and the brain microenvironment contributes to this therapy resistance. Nutrient availability can vary across tissues, therefore metabolic adaptations required for brain metastatic breast cancer growth may introduce liabilities that can be exploited for therapy. Here, we assessed how metabolism differs between breast tumors in brain versus extracranial sites and found that fatty acid synthesis is elevated in breast tumors growing in brain. We determine that this phenotype is an adaptation to decreased lipid availability in brain relative to other tissues, resulting in a site-specific dependency on fatty acid synthesis for breast tumors growing at this site. Genetic or pharmacological inhibition of fatty acid synthase (FASN) reduces HER2+ breast tumor growth in the brain, demonstrating that differences in nutrient availability across metastatic sites can result in targetable metabolic dependencies.