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JRPMS 2019

Review Article JRPMS, Vol 3, No 1, March 2019, p.1-4
Hypergravity and its effects on bones and the musculoskeletal system: a narrative review
Chrysoula Argyrou, George I. Lambrou
Keywords: Hypergravity, Microgravity, Space, Bone cells, Musculoskeletal
The entrance of mankind into the Space Age, accomplished by the second half of the 20th century, and the advances in modern physics have completely transformed the way we perceive the role of gravity. The musculoskeletal system is long known to be heavily affected by the gravitational forces, resulting in marked loss in bone mineral density in the setting of microgravity. The meticulous study of the underlying pathophysiologic mechanisms is pivotal in order to identify possible therapeutic targets for the management of the microgravity-induced changes in bone physiology during spaceflight missions, as well as the osteopenia induced changes in the setting of osteoporosis affecting a vast majority of elder individuals. In the present bibliographic narrative review, the importance of mechanisms employed by cells in order to perceive and respond to altered gravity are discussed. Current in vitro and in vivo studies focusing on the effect of hypergravity on the musculoskeletal system are also presented. Overall, the variability in study design of the available published data makes the deduction of safe conclusions rather challenging and uncertain. It is important that future studies address the matter by employing similar research methodology and study design in order to increase the comparability of their results.
Mini Review JRPMS, Vol 3, No 1, March 2019, p.5-8
The effects of radiation therapy in musculoskeletal system of children
Christina K. Lappa
Keywords: Childhood cancer, Radiation therapy, Musculoskeletal, Early and late effects
This review summarizes the literature investigating the radiotherapy related early and late musculoskeletal abnormalities in children, concerning non-malignant conditions and secondary malignancies. We searched the PubMed for English written articles and 10 relevant articles were found published between 1992 and 2015. We found that the late musculoskeletal effects were the more frequent among the survivors of childhood cancer, that they occurred more in children who have been irradiated for cranial or abdominal tumors and they were age and dose related. Further research with larger clinical trials examining the radiation dose, especially in younger children, should be done, to refine radiation dose protocols and also annual screening for high risk survivors should be recommended.
Review Article JRPMS, Vol 3, No 1, March 2019, p.9-16
Dental implants in patients with oral autoimmune diseases
Theodora S. Tounta
Keywords: Oral autoimmune diseases, Dental implants, Lichen planus, Pemphigus, Peri-implantitis
Oral mucosal autoimmune diseases include a variety of disorders, like oral lichen planus (OLP), pemphigus vulgaris (PV), mucous membrane (MMP) and bullous pemphigoid (BP), epidermolysis bullosa acquisita (EBA), systemic lupus erythematosus (SLE) and Sjögren syndrome (SS) and can cause painful erosions, blisters and ulceration at the oral epithelium. Such diseases complicate dental hygiene and can lead to tooth loss. When natural teeth are missing, dental implants can improve quality of life for these patients. Osseointegration is necessary for dental implant success and is not contraindicated for patients with oral mucosal autoimmune diseases. However, the clinical dentist must consider the possible impact of oral autoimmune diseases on the oral epithelium that might affect implant success, also due to the difficulty of everyday oral hygiene, leading to bone absorption around the implant. Moreover, medication approved for the therapy of such diseases, such as corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs (NSAIDs) could provoke osseointegration, as it compromises bone quality and affects the patient’s general health. However, the impact of these drugs on implant surgery depends on dose and duration of the drug and usually dental implantation is possible.
Review Article JRPMS, Vol 3, No 1, March 2019, p.17-25
Signaling pathways that overactivate metabolism and drive neoplasia, in rhabdomyosarcoma
Christos P. Tselios, George I. Lambrou
Keywords: Signaling, Pathway, Metabolism, Neoplasia, Rhabdomyosarcoma
The functional status of a cell is expressed in its metabolic activity. Cancer cells differ from normal cells through unlimited cell division, and show a greater need for energy for their rapid growth and duplication. Thus, cancerassociated metabolic alterations, i.e. metabolic over-activation through signaling pathways alterations, have emerged as a cancer hallmark. Rhabdomyosarcoma (RMS) is a myogenic tumor classified as the most frequent soft tissue sarcoma affecting children, adolescents and adults. Signaling pathway alterations present in this cancer can be related to increased metabolic activity and drive neoplasia. In this review first of all, we would like to enlighten cancer and particular RMS metabolism. Further, we aim to summarize several pathways related to oncogenic drivers affecting metabolism of RMS cells in order to simulate them (in other studies) with a system biology approach. The understanding of the common mechanisms that transform physiological cells to malignant may reveal novel therapeutic targets and strategies that may improve the currently poor outcome for patients with RMS.
Mini Review JRPMS, Vol 3, No 1, March 2019, p.26-31
The role of the calcium intake in the development of cardiovascular calcification
Evaggelia E. Pitaraki
Keywords: Calcium intake, Dietary calcium, Supplemental calcium, Cardiovascular calcification, Cardiovascular disease (CVD) risk
Calcium covers a wide range of body functions. Adequate calcium intake is critical for skeletal health. Dietary calcium intake is considered safe, while supplemental calcium raises concerns, regarding cardiovascular health. Calcium can be administered alone or in combination with vitamin D. Supplemental calcium can be provided if people cannot meet their dietary needs or as a prescription in patients receiving medication for osteoporosis. The last ten years, a major research debate has been ongoing, regarding the possible relationship between calcium intake and cardiovascular risk. Possible mechanisms have been investigated, concerning the possible effect of calcium supplementation on cardiovascular calcifications. Further analysis is needed regarding levels of calcium intake that could possibly promote calcifications. It is also significant to evaluate the effect of the duration of supplemental calcium administration and the possible protective effect of concomitant administration of vitamin D supplementation. Until there are clinical studies to address those hypotheses, the current recommendations include that calcium (dietary and supplemental) can be given safely, within normal limits, to all healthy people and patients, possibly excluding those with chronic kidney disease.
Review Article JRPMS, Vol 3, No 2, June 2019, p.45-51
The role of miRNAs in ankylosing spondylitis: a narrative review
George E. Diakos, George I. Lambrou
Keywords: Ankylosing spondylitis, microRNAs, HLA-B27, SNPs
Ankylosing Spondylitis (AS) is a chronic, autoimmune inflammatory disease mainly affecting the axial skeleton and it might lead to functional and structural impairments and cause severe disability, thus, jeopardize quality of life. The last two decades, the potential role of miRNAs in the pathogenesis of AS has been under investigation in numerous studies. The aim of this article is to review the available literature on the involvement of miRNAs in AS pathogenesis. An electronic literature search was conducted by two independent researchers up to 2013. Titles and abstracts of papers were validated by the authors for further inclusion in the present work. At the end, full texts of the included articles were retrieved. SNPs of miRNAs lead to an overexpression of pro-inflammatory cytokines. Deregulated miRNAs enhance the production of pro-inflammatory cytokines, suppress autophagy in T peripheral cells of the blood. MiRNAs through a vast number of research have a potential correlation with AS pathogenesis. Because of their stable structure which easily could be extracted from cells of blood samples, the different expressed levels of miRNAs in peripheral blood and tissues from the joints could be used as potential biomarkers of the activity and the efficacy of the treatment in AS.
Case Report JRPMS, Vol 3, No 2, June 2019, p.52-59
Multiple vertebral fractures in a liver transplant recipient with HCV cirrhosis: A case report
Elpida E. Ntofi, Symeon T. Tournis
Keywords: HCV cirrhosis, Orthotopic liver transplantation, Osteoporosis, Multiple vertebral fractures, Zolendronic acid
Cirrhosis is a known major risk factor for osteoporosis. The already compromised bone health of cirrhotic patients tends to deteriorate further after liver transplantation, mainly as a result of immunosuppressive treatment. This case report describes a 63-year-old man who presented with multiple vertebral fractures and severe osteoporosis, one year after orthotopic liver transplantation (OLT) because of end-stage HCV cirrhosis. At his initial consultation, the patient was taking everolimus and mycophenolate, while previously the immunosuppressive regimen included corticosteroids. We present follow-up data of the patient after anti-osteoporotic treatment, including consecutive measurements of bone mineral density, vertebral morphometry, biomarkers of bone turnover and related hormones. Two years after OLT, during which he followed treatment with calcium, vitamin D supplements and zolendronic acid (intravenous infusion of 5mg once a year), the patient showed remarkable improvement in bone densitometry, hormones and biomarkers of bone metabolism, with the exception of persistent secondary hyperparathyroidism. As the survival rates of liver transplant recipients improve, osteoporosis constitutes an important long-term complication among these patients. Consequently, prompt diagnosis and treatment of osteoporosis in cirrhotic and liver transplanted patients is crucial, with biphosphonates, and in particular zolendronic acid, a potent possible first-line therapeutical option.
Mini Review JRPMS, Vol 3, No 2, June 2019, p.60-66
Impact of subclinical hyperthyroidism on bone
Stavroula Koutroumpi, Theodora Stratigou, Varvara Vlassopoulou
Keywords: Thyroid, Subclinical Hyperthyroidism, Bone Mineral Density, Osteoporosis, Fractures
Normal balance of thyroid hormones plays a key role on skeletal growth and integrity. Overt hyperthyroidism is an established risk factor for osteoporosis and fractures. However, recent studies report that even subclinical hyperthyroidism has a negative impact on bone health. Screening of subjects at risk and consequent treatment to prevent or recover secondary bone loss depends on age, gender, menopausal status, severity and duration of thyroid dysfunction.
Case Report JRPMS, Vol 3, No 2, June 2019, p.67-70
Hypercalcaemia in an idiopathic hypoparathyroidism patient, due to sarcoidosis
Irena Karabella, Maria Meliou
Keywords: Hypercalcaemia, Idiopathic hypoparathyroidism, 1.25(OH)2D3, Sarcoidosis
We report the case of a female 68 years old patient who appeared in the emergency department (ED) with severe weakness, vomiting and mild confusion with onset 5 days before admission. Previous medical history consisted of idiopathic hypoparathyroidism, diabetes mellitus, hypertension, chronic renal disease and an ischemic stroke. She was previously, in other hospital admitted, multiple times due to hypercalcaemia attributed to high doses of per os calcium and vitamin D, and dosage was adjusted. Physical examination in the ED revealed that patient was lethargic but responsive in sample questions. Rest of clinical examination had no significant findings. The laboratory test showed that corrected calcium levels were elevated 13.3mg/dl. Calcium therapy was withheld and patient was treated with intravenous fluids and dieresis. Further clinical investigation and laboratory investigation, showed that 1.25(OH)2 vitD3 was elevated as well as serum ACE. Computing tomography (CT) was performed, revealing thoracic lymphadenopathy. Trans-bronchial biopsy of lymphatic tissue revealed granulomatous disease, compatible with sarcoidosis. Corticosteroid treatment was initiated, with methylprednisolone 32 mg following improvement in calcium levels. Cases of concomitant hypoparathyroidism and sarcoidosis are rare. Treatment of cases of concomitant sarcoidosis and collaboration between specialists.
Review Article JRPMS, Vol 3, No 2, June 2019, p.71-77
Perioperative medication management of patiens with Rheumatoid Arthritis
Konstantina Zoupidou
Keywords: Rheumatoid Arthritis, Perioperative management, DMARDs, TNFα, Glucocorticoids
Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory disease that is characterised by inflammation of the synovial membrane and progressive destruction of articular cartilage and bone. Furthermore, RA is often associated with extra-articular manifestations. A multidisciplinary approach is required for patients with RA in the peri-operative period. This review discusses the pre-operative, peri-operative and post-operative management of patients with RA and attempts to provide plausible answers to challenging questions that arise often when patients with RA undergo surgery. The key issues a physician has to address include controlling disease activity, assisting the wound-healing process by eliminating any delaying factors related to RA and preventing post-operative complications that may occur. The peri-operative care of patients with RA must be (strictly) personalised, given that it has to take into account a wide set of factors such as the type of surgery and the anaesthesia needed, the disease activity, the current medication the patient receives and the risk factors of co-morbidity such as age, smoking and decreased cardiac, renal, pulmonary or peripheral vascular function.
Review Article JRPMS, Vol 3, No 2, June 2019, p.78-82
Etiopathogenesis of idiopathic scoliosis
Apostolos M. Papadoudis, Kleopatra L. Skourti
Keywords: Idiopathic, Scoliosis, Pathophysiology, Etiology, Pathogenesis
Scoliosis is a three-dimensional deformity of the spine. The key radiographical tool for diagnosis is the Cobb angle and the most common form is a right thoracic convexity with a compensatory left lumbar convexity. Scoliosis is divided, in terms of etiology, into idiopathic, congenital, and secondary. Research into the etiology of idiopathic scoliosis has focused on multiple areas and a great number of suggestions has been made during the last decades concerning hormones, genetic, metabolic and biomechanical factors. Although a lot of theories have been proposed, none is capable to fully describe the pathophysiology of the disease, underlying the complexity and the multifactorial etiology of the condition. The purpose of this review is to summarize the main concepts of etiology and highlight the pathogenetic theories under research in order to reveal possible “targets” for our efforts to understand, diagnose and treat idiopathic scoliosis.
Mini Review JRPMS, Vol 3, No 3, September 2019, p.83-86
Malignant giant cell tumor of bone
Emmanouil Neonakis, Georgia Antoniou, Ioannis K. Triantafyllopoulos
Keywords: Giant cell tumor, Long bones, Malignant transformation
Giant cell tumors of bone are locally destructive benign entities that occur predominantly in long bones of postpubertal adolescents and young adults. The majority are treated by aggressive curettage or resection. Occasionally, Giant cell tumors of bone may undergo malignant transformation to undifferentiated sarcomas. We report a mini review of malignant GCT of the long bones in order to raise awareness of this entity that may mimic the benign form but is more aggressive with poorer prognosis.
Review Article JRPMS, Vol 3, No 3, September 2019, p.87-95
Risk factors for periprosthetic joint infection following total hip and knee arthroplasty
Argyris Costa Hadjimichael, Athanasios Fotios Foukas, Athanasios Antonopoulos, Olga Savvidou, Panayiotis Papagelopoulos
Keywords: Osteoarthrosis, Total hip replacement, Total knee replacement, Periprosthetic infections, Risk factors
Osteoarthrosis is a common degenerative and progressive disease, involving the articular cartilage as well as the subchondral bone and the soft tissues in the hip and knee. The incidence of hip and knee osteoarthrosis has increased over the last twenty years and is expected to increase even further. Approximately, 40% of men and 47% of women over 65 years old suffer from symptomatic osteoarthrosis that eventually requires surgical treatment by an orthopedic surgeon. In 2010 around 2.5 million patients were operated for total hip replacement and around 4.7 people with knee osteoarthrosis had a total knee replacement in the United States of America. Acute periprosthetic joint infection, with Staphylococcus aureus being the most common and aggressive pathogen is a very threatening complication for the whole health status of the patient. The need for revision procedures due to periprosthetic hip infection is expected to be doubled in 2026 and is already doubled due to periprosthetic knee infection in 2015.The risk factors for hip and knee periprosthetic joint infections appear in the preoperative period, as well as intraoperatively and continue to be harmful both in the postoperative period and after the patient’s discharge from the hospital. The aim of this article is to present the variety of risk factors, associated with periprosthetic infections after total hip and knee replacements. Many risk factors can be controlled with the use of specific preventive and therapeutic interventions by orthopedic surgeons.
Review Article JRPMS, Vol 3, No 3, September 2019, p.96-101
Could treating periodontitis prevent osteoporosis? An update of the last decade
Ioanna Skoufou, Maria Yavropoulou, Christos Zafeiris
Keywords: Chronic periodontitis, Osteoporosis, Risk factors, Bone mineral density
Chronic periodontitis and osteoporosis are both systemic diseases, characterized by bone resorption. Over the last decade, their correlation has been examined closely, mainly to investigate whether they present a risk factor or an indicator for each other. It is their pathogenetic similarities, their numerous common risk factors and their frequent concomitant development that initiated researchers’ interest in the precise association between these two maladies. The present review is aiming to analyse this correlation, laying emphasis on the effects of periodontal status on the skeletal bone mineral density, as suggested by the latest studies. It will also attempt to clarify whether periodontal management could influence the progression or the onset of osteoporosis.
Review Article JRPMS, Vol 3, No 3, September 2019, p.102-105
Imaging methods for the control and treatment of sarcopenia
Eleni Gioutlaki, Thomas Karyakatzis, George I. Lambrou
Keywords: Sarcopenia, Quality of life, Body mass composition, Magnetic resonance imaging, DXA
Sarcopenia is a progressive loss of skeletal muscle mass with advancing age. Both imaging and non-imaging methods are used for sarcopenia’s diagnosis. The use of non-imaging techniques refer to the use of SARC-F scale questionnaires and the physical ability tests. On the other hand, from the group of imaging techniques used for sarcopenia’s diagnosis the ones that assess the body mass composition (Body Composition) are: the ultrasound imaging (US), the Dual-energy X-ray absorptiometry (DXA), the computed tomography scan (CT) and the magnetic resonance imaging (MRI). In this review we refer more specific to Magnetic resonance imaging as the specialized imaging method as far as the identification of loss of muscle tissue quality. Sarcopenia is a common disease that has a negative impact on patients’ health, as well as a heavy financial and social burden for the developed world. Today, imaging plays a crucial role in diagnosing patients with sarcopenia.
Review Article JRPMS, Vol 3, No 3, September 2019, p.106-112
The relation of parathyroid hormone and hematologic parameters under erythropoetin administration in hemodialysis patients
Theodora Papachrysanthou, Maria Aktsiali, Ioannis Griveas, Christos Andriopoulos, Panagiotis Sitaras, George I. Lambrou
Keywords: Hemodialysis, End Stage Renal Disease, Erythropoetin, Parathyroid hormone, Hematologic parameters
Hemodialysis has been the principal therapeutic tool for End Stage Renal Disease (ESRD) for decades. ESRD patients are defined as those having Glomerular Filtration Rate (GFR) under 15 ml/min. Loss of renal function can result either as acute kidney failure or gradually, following the natural course of a vascular disease such as hypertension and Diabetes mellitus. Metabolic bone disease is a very common situation for the majority of patients with chronic renal disease due to severe imbalance in bone remodeling as well as mineral homeostasis. The aim of the present study was to investigate the relation of Erythropoetin (Epo) administration in ESRD patients with hematologic factors as well as parathyroid hormone (PTH) levels. A retrospective observational study was conducted in an outpatient Chronic Hemodialysis Unit between January 2015 and December 2016 (24 months). Patients with ESRD were recruited, who had received hemodialysis for at least twelve months. Several hematologic factors as well as PTH levels were evaluated in ESRD patients and the results were compared in order to find the effect of Epo administration on those factors. We have found that Epo significantly affects hematologic factors, but it marginally affects PTH levels. Our study has confirmed that Epo administration has beneficial effects to hematologic parameters, in ESRD patients, yet with marginal effect on PTH and thus its role in bone metabolism needs to be further investigated.
Mini Review JRPMS, Vol 3, No 4, December 2019, p.113-122
Effect of estrogen on bone cells: what is new?
Efthymia Karlafti, Kalliopi Lampropoulou-Adamidou, Symeon Tournis, George Trovas, Ioannis K. Triantafyllopoulos
Keywords: Estradiol, Osteoporosis, Osteoclasts, Osteoblasts, Osteocytes
After the observations of Fuller Albright, that the loss of estrogen in women is related to osteoporosis, many studies have proved the principal role of estrogen in the regulation of bone metabolism in both genders. Apart from studies that have proven the protective effect of sex steroids on bone resorption, later studies have focused on the effect of sex steroids on osteoblasts, osteocytes and bone lining cells. These studies came to the conclusion that sex steroids contribute to bone formation directly and regulate bone adaptation to mechanical load. Further studies will have to be made to help us clarify the mechanisms by which sex steroids affect bone cells and their function, especially regarding bone lining cells.
Review Article JRPMS, Vol 3, No 4, December 2019, p.123-128
Positive correlation of different bariatric surgery techniques with low back pain
Athanasios Galanis
Keywords: Low back pain, Bariatric surgery, Obesity, Weight loss
Low back pain is considered a universal and frequent health problem that is closely and causally associated with obesity, a modern era epidemic. The increased mechanical load placed on the spine, the systemic chronic inflammation or the metabolic syndrome are some of the causes of low back pain detected in obese patients that are directly linked to obesity. The aim of this article is to present a mini review of the existing literature regarding the relation between low back pain and different bariatric surgeries which have been shown to be valid methods of weight loss. Several studies in last decade have advocated that weight loss resulting from bariatric surgeries is associated with a lessening in impairment and intenseness of low back pain. The need for further systematic reviews and prospective trials is evident in order to support the claims that bariatric surgeries may prove beneficial to low back pain.
Mini Review JRPMS, Vol 3, No 4, December 2019, p.129-133
The effect of weight loss programs on bone mineral density in early postmenopausal women
Aikaterini A. Kalogeropoulou
Keywords: Early postmenopausal women, Weight loss, Bone mass, Diet, Exercise training
Menopause is an important milestone for the bone mineral density (BMD) of women. During postmenopausal period, levels of estrogen in the body reduce rapidly. Loss of excess weight at this age is important in order to reduce co-morbidities, but it can also deteriorate bone mass and boost the development of osteoporosis. The positive association between body weight or BMI and bone mineral density is well documented. Weight loss can possibly increase bone resorption through various mechanisms. During weight loss in early postmenopausal women, the usual Ca intake (1g/day) is insufficient, as increase the Ca-PTH axis through the reduction of Ca absorption. In cases where weight loss induced by diet is combined with resistance exercise, it can possibly prevent bone loss, since BMD is more closely related to muscle mass rather than to adipose tissue. Last but not least, the history of weight loss at middle age may be an indicator of the risk of hip fracture at a later stage of life, under conditions.
Mini Review JRPMS, Vol 3, No 4, December 2019, p.134-138
Nutritional interventions in children with cerebral palsy: a mini review
Theano Talamagka
Keywords: Nutrition, Cerebral palsy, Nutritional interventions, Childhood malnutrition
The aim of the present study was to review the current knowledge concerning the nutritional status of children with cerebral palsy. The aim was also to summarize the key factors which are responsible for the high prevalence of malnutrition. Significant reductions in anthropometric parameters were found in children with cerebral palsy in comparison to children of normal development. This deviation from typical growth, can be attributed to several factors, such as: inadequate food intake, deficiency of important trace elements (calcium, phosphorus, magnesium, iron) and vitamins (vitamin D, folate, vitamin 12) and reduced dietary density (which depends on dietary factors and mobility). Children with cerebral palsy, manifest nutritional problems and nutritional deficiency, which mainly is due to the inherent problems these children have to acquire dietary factors and their also inherent problematic in their mobility. Thus the present work attempts to provide a short review of the nutritional issues in children with cerebral palsy and the probable nutritional therapeutic interventions.
Mini Review JRPMS, Vol 3, No 4, December 2019, p.139-142
Initial assessment of the trauma patient: a nursing approach
Panagiota Katsaphourou
Keywords: Trauma nurse, Trauma patient, Initial assessment and primary evaluation
This article presents a mini review of a nursing approach to the trauma patient. Trauma injury is one of the leading causes of death and is considered a modern era disease that poses an immense financial, social and even political burden, forcing the topic of death toll due to unsafe state infrastructures into the political agenda. Reviewing articles from various sources and databases written in English and in Greek, we look into the role of the trauma nurse, focusing on the steps that need to be followed during the initial assessment and the primary evaluation of the trauma patient in an attempt to point to the fact that knowledge of protocols, speed and close collaboration can be factors that literally make a difference between life and death on the trauma patient’s life.