Mastication inefficiency due to diminished or lack of occlusal support is associated with increased blood glucose levels in patients with type 2 diabetes.

BACKGROUND: It has been shown that mastication may contribute to a lower risk of diabetes, and occlusal support reduced the risk of diabetes by improving glucose metabolism after meals. However, the relationship between inefficient mastication and blood glucose levels in patients with type 2 diabetes (T2D) remains unclear. This retrospective study, therefore, aimed to investigate the association between mastication inefficiency due to diminished occlusal support and blood glucose control in subjects with T2D. METHODS: Ninety-four subjects (mean of 54.9 years) were recruited in this study. Subjects with at least 1-year T2D medical history and current medications for T2D were included. Subjects were divided into 2 groups: The control group (41 subjects) included Eichner group A (4 occlusal functional areas in the posterior area). The test group (53 subjects) included Eichner group B (1-3 occlusal functional areas) and group C (no natural occlusal contact). Blood glucose level was significantly lower in the control group participants than in the test group. Subject(s) showing diminished or lack of occlusal support and requiring a fixed restoration were treated with an implant-supported fixed restoration. These groups' levels of glycated hemoglobin (A1c) were compared using the independent student t-test. RESULTS: Blood glucose level was significantly lower in the control group (7.48) as compared to those in the test group (9.42). The mean differences between the two groups were 1.94 ± 0.39 (p = 0.0001). Differences in white blood cell counts and body mass index (BMI) were not statistically significant between groups. Blood glucose levels could be reduced (from A1c 9.1 to 6.2) following a fixed implant-supported restoration in T2D patients with diminished occlusal support. CONCLUSION: The results suggested that masticatory inefficiency due to diminished dental occlusion was associated with an increase in poor controlled-blood glucose levels among T2D patients.

Diastolic dysfunction and contrast-induced nephropathy in patients undergoing coronary angiography.

OBJECTIVES: It has been demonstrated that decreased left ventricular ejection fraction (LVEF) is associated with an increased risk of contrast-induced nephropathy (CIN). In this study, we aimed to assess whether there is a relationship between left ventricular (LV) diastolic dysfunction and renal function decline after coronary angiography (CAG). PATIENTS AND METHODS: The study consisted of two groups: group I, patients with normal diastolic function; group II, patients with cardiac symptoms and abnormal diastolic function. Serum creatinine (Crea) and glomerular filtration rates (GFR) were measured before and after 48 h of CAG. RESULTS: After the procedure, serum Crea values were higher in group II compared with group I (p = 0.051). Postprocedural 48-h GFR values determined by Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations were lower in group II compared with group I (p = 0.016 and p = 0.003, respectively). Delta (Δ) ΔCrea and ΔGFR determined by the Cockcroft-Gault and MDRD equations were statistically higher in group II than in group I (p = 0.005, p = 0.052, p = 0.030). The presence of higher age (p = 0.025), E/E' lateral ratio (p = 0.030), and left atrial volume index (p = 0.05) were independent predictors of worsening renal function. CONCLUSION: The presence of diastolic dysfunction may play a role in determining the risk of CIN in patients with normal LVEF.

Intracavitary cardiac hydatid cysts with a high risk of thromboemboli. Invasive nature of cardiac echinococcosis.

Hydatid cysts are a serious health problem in many countries that raise farm animals, and they usually involve the liver and lungs. Although cardiac involvement is a rare manifestation of hydatid cyst disease, its early diagnosis and surgical management are crucial. Patients with cardiac hydatidosis may develop acute life-threatening complications secondary to their invasion of surrounding cardiac structures, such as cyst rupture together with systemic and pulmonary dissemination. Therefore, surgical excision is the definitive method of treatment for cardiac hydatid cysts in order to prevent these potential life-threatening complications, even for asymptomatic patients. Herein, we report the case of a 36-year-old man who initially presented with pleuritic chest pain, hemoptysis, and dyspnea. This was followed by the revelation of multiple cardiopericardial hydatid cysts which were discovered via transesophageal echocardiography and multislice computed tomography. In this case, there was a higher risk of cyst rupture and thromboembolism during systemic and pulmonary circulation due to the invasive nature of the cysts which were located in the left atrium as well as between the pulmonary artery and aorta. The patient successfully underwent the removal of the multiple cardiac cysts under cardiopulmonary bypass by taking into account their relationship with the surrounding cardiac structures and the potential risk of local, systemic, and pulmonary dissemination. A pathological evaluation of the surgical specimens confirmed the diagnosis of cardiac echinococcosis and the aggressive nature of the cardiopericardial hydatid cysts by demonstrating their myocardial invasion.

Aortic elastic properties are impaired in patients with Graves' ophtalmopathy.

BACKGROUND: Aortic elastic properties have been shown to be an important predictor of cardiovascular morbidity and mortality. Hyperthyroidism was shown to be an important cause of impaired aortic elastic properties both due to the direct effect of the thyroid hormones on the aorta and also due to modulating effects of thyroid hormones on the vascular renin angiotensin system. However, there is no study investigating the aortic elastic properties in Graves's patients who were euthyroid. The goal of the present study was to investigate the aortic elastic properties of patients with Graves' Ophtalmopathy (GO) who had been euthyroid for at least 3 months. PATIENTS AND METHODS: A cross-sectional study was performed on 47 GO patients and 27 controls. Aortic-diastolic and aortic-systolic diameters, aortic strain, aortic distensibility, and aortic stiffness indices were calculated from the diameter of the thoracic aorta as measured by transthoracic echocardiography. RESULTS: The aortic stiffness index was markedly increased (31 ± 26 vs. 17 ± 8.9; p = 0.015) and aortic strain was markedly reduced (20.3 ± 10 % vs. 25.9 ± 12 %; p = 0.046) in the GO group relative to the control group. Aortic distensibility was statistically significantly decreased in the GO group as compared to the control group (9.5 ± 5.7 10(-3)/kPa vs. 13.5 ± 7.1 10(-3)/kPa; p = 0.022). Weak correlations were detected between GO severity and aortic distensibility (r = -0.333, p = 0.011) as well as the aortic stiffness index (r = 0.266, p = 0.044). CONCLUSIONS: Aortic elastic properties were impaired in patients with GO. Therefore, patients with GO, especially those with severe manifestations of the condition, should be followed closely with regard to the occurrence of future cardiovascular events.

Rare mechanical complication of myocardial infarction: isolated right ventricle free wall rupture.

Rupture of the left ventricular free wall is a dramatic complication of acute myocardial infarction (MI) and occurs in about ten percent of patients with fatal acute MI. However, there are limited reports about right ventricular free wall rupture due to MI. In this case report, a patient with isolated right ventricular rupture following MI that was visualised with real-time transthoracic echocardiography is discussed for the first time in the literature.

Aortic valve endocarditis with aortic wall thickening requires close follow-up for a possible abscess formation.

A 67-year-old woman was admitted with aortic valve endocarditis and aortic wall thickening (AWT). Physical examination and laboratory findings yielded infective endocarditis. Echocardiography revealed several small vegetations on the aortic valve, leading to moderate aortic insufficiency together with a small ventricular septal defect. We also became aware of the AWT on and over the aortic root by transesophageal echocardiography (Figure 1). At the one month follow-up period, we also noticed an abscess formation originating from the AWT, which grew into a mature abscess form, day by day (Figure 2). The aortic valve endocarditis, with destruction of the aortic annulus and abscess formation, in this patient, is considered as a grave condition which, essentially, requires an aggressive combined surgical and medical approach. We would like to intimate here with this patient that AWT needs to be considered seriously important in aortic valve endocarditis and, even if the detected vegetations are small, a close follow-up for a possible abscess formation is essential.