Higher S2PLIT-UG scores at index admission are associated with a higher functional disease burden and increased biomarkers of myocardial injury and ventricular overload among patients with acutely decompensated heart failure

Goals: Outcomes following acutely decompensated heart failure (ADHF) are poor and associated with increased mortality and morbidity. Various risk stratification systems have been developed in the past to predict mortality and rehospitalizations in this population. The S2PLiT-UG score was recently introduced to stratify ADHF patients in three risk categories in respect to all-cause mortality during 1-year post-discharge period.1 I n t his w ork, w e a imed to d etermine a ssociations o f S 2PLiT-UG score with functional disease burden estimated by NYHA class and biomarkers including high sensitivity cardiac troponin I (hs-cTnI), NT-proBNP and C-reactive protein (CRP). Patients and Methods: A cohort of 106 consecutive ADHF patients enrolled at the Cardiology Department during 2018-2019 were included in the study. S2PLiT-UG score calculation and laboratory analyses were performed for each patient at index admission. Results: Fifty-six (52.8%) patients were designated as low, 24 (22.6%) as intermediate, and 26 (24.6%) as high risk according to S2PLiT-UG score stratification. Patients significantly differed (p=0.021) in respect to their NYHA class with mean values of 2.85±0.57, 3.10±0.61, and 3.33±0.56 for low, intermediate, and high-risk group, respectively. Troponin values were significantly higher in high risk compared to intermediate and low-risk groups (148.4±72 vs. 68.2±48 vs. 42.2±24 ng/L; p=0.025, respectively). Similarly, NT-proBNP levels were highest in the high-risk group (13740±7884 pg/mL) followed by intermediate (7811±5668 pg/mL) and low-risk group (4195±1632 pg/mL), p=0.002. Finally, CRP values differed across groups with the high-risk group exhibiting highest CRP value (21.8±14.8 mg/L) compared to intermediate and low-risk group (17.5±15.8 and 12.2±11.3 mg/L, respectively), however, this result was not significant (p=0.327). S2PLiT-UG score positively correlated with NYHA class (r=0.300, p=0.004), hs-cTnI (r=0.303, p=0.009), NT-proBNP (r=0.353, p=0.001) and CRP (r=0.203, p=0.069). Conclusion: Among ADHF patients, higher S2PLiT-UG score values, calculated at index admission, are associated with higher functional disease burden and increased levels of circulating biomarkers reflecting myocardial injury and ventricular overload, but not systemic inflammation

Uspješno liječenje embolije bubrežne arterije čak 48 sati nakon ispada

Renal artery embolism is a disease that is easily missed due to its infrequent and nonspecific presentations. Although early diagnosis and optimal thrombolytic treatment can sometimes restore renal function, therapeutic guidelines have not yet been established. However, early anticoagulant therapy is beneficial and selective infusion of lytic agents into renal artery has been reported with increasing frequency and efficacy if used in the early stage. We report that intra-arterial thrombolytic therapy with low dose of 35 mg recombinant tissue plasminogen activator (t-PA) may be an effective and safe strategy for the treatment of renal artery embolism, despite the period of ischemia being longer than 48 hours.Embolija bubrežne arterije je bolest koja se lako previdi zbog rijetke pojavnosti i nespecifične prezentacije. Iako rana dijagnoza i optimalno trombolitičko liječenje ponekad može vratiti bubrežnu funkciju, terapijske smjernice još nisu uspostavljene. Međutim, rana primjena antikoagulantne terapije je korisna, a o selektivnoj infuziji litičkih sredstava u bubrežne arterije, ako se primijeni u ranom stadiju, sve se češće izvješćuje u smislu povećanja njene učinkovitosti. Mi smo opisali kako intraarterijska trombolitička terapija s niskim dozama od 35 mg rekombinantnog tkivnog aktivatora plazminogena (t-PA) može biti učinkovita i sigurna strategija za liječenje embolije bubrežne arterije unatoč tomu što je razdoblje ishemije bilo duže od 48 sati

Uspješno liječenje embolije bubrežne arterije čak 48 sati nakon ispada

Renal artery embolism is a disease that is easily missed due to its infrequent and nonspecific presentations. Although early diagnosis and optimal thrombolytic treatment can sometimes restore renal function, therapeutic guidelines have not yet been established. However, early anticoagulant therapy is beneficial and selective infusion of lytic agents into renal artery has been reported with increasing frequency and efficacy if used in the early stage. We report that intra-arterial thrombolytic therapy with low dose of 35 mg recombinant tissue plasminogen activator (t-PA) may be an effective and safe strategy for the treatment of renal artery embolism, despite the period of ischemia being longer than 48 hours.Embolija bubrežne arterije je bolest koja se lako previdi zbog rijetke pojavnosti i nespecifične prezentacije. Iako rana dijagnoza i optimalno trombolitičko liječenje ponekad može vratiti bubrežnu funkciju, terapijske smjernice još nisu uspostavljene. Međutim, rana primjena antikoagulantne terapije je korisna, a o selektivnoj infuziji litičkih sredstava u bubrežne arterije, ako se primijeni u ranom stadiju, sve se češće izvješćuje u smislu povećanja njene učinkovitosti. Mi smo opisali kako intraarterijska trombolitička terapija s niskim dozama od 35 mg rekombinantnog tkivnog aktivatora plazminogena (t-PA) može biti učinkovita i sigurna strategija za liječenje embolije bubrežne arterije unatoč tomu što je razdoblje ishemije bilo duže od 48 sati

Clinicopathological Characteristics of BRAF V600E Mutated Melanomas in the Dalmatian Region of Croatia

A high proportion of cutaneous melanomas harbor activating mutations of the BRAF or NRAS genes, which are components of mitogen-activated protein kinase (MAPK) signal transduction pathway. The importance of BRAF V600E mutation in melanoma is not only related to the possibility of the administration of the targeted therapy, but also to the fact that BRAF V600E mutated melanomas have distinct clinicopathological features. We investigated the clini-copathological features of 80 primary skin melanomas with known BRAF V600E mutation status excised in the Dalmatian region of Croatia, with comparison of these features between the mutated and wild-type group. The frequency of BRAF V600E mutation was 47.5%. In comparison with wild-type melanomas, BRAF V600E mutated melanomas were significantly associated with younger age and female sex (P=0.014 and P=0.011, respectively). The mutated melanomas were more often located on the extremities, of a nodular type, ulcerated, and with higher median of mitotic index but without significant difference in comparison with wild-type tumors. There were no differences in the depth of invasion and the presence of lymphovascular invasion, tumor infiltrating lymphocytes, and regression between the investigated groups. The frequency of BRAF V600E mutation in our cohort of primary skin melanomas and the clinicopathological features of mutated tumors were similar to those reported in the literature, except for the higher proportion of women observed in our group with mutation

Adropin - potencijalni čimbenik kardiovaskularne sigurnosti u muškaraca oboljelih od šećerne bolesti tip 2 liječenih liraglutidom

The aim of this study was to determine plasma adropin concentration and parameters of insulin resistance in obese male type 2 diabetes mellitus (T2DM) patients before and after 3-month liraglutide treatment. In this interventional study, we enrolled 15 obese male T2DM patients with body mass index (BMI) >35 kg/m2, uncontrolled disease and HbA1c >7.5%, having previously taken taking two oral antidiabetic drugs. We modified their therapy to metformin and liraglutide for the next three months. After three months of liraglutide treatment, we observed significant decrease in body weight (from 111.5±18.7 kg to 109.2±17.5 kg, p=0.016) and BMI (from 40.9±7.3 to 40.1±7.0 kg/m2, p=0.021). Plasma adropin concentration increased significantly (p=0.003) compared with baseline. Fasting plasma insulin level decreased from 17.79±6.53 to 13.38±3.51 mU/L (p=0.002), fasting plasma glucose level decreased from 8.66±3.07 to 7.41±2.21 mmol/L (p=0.004) and HbA1c decreased from 7.98±0.70% to 7.26±0.36% (p=0.003). Insulin resistance presented as HOMA-IR decreased significantly from 7.30±5.19 to 4.52±2.61 (p=0.002). Systolic blood pressure, lipid status, liver and kidney function improved, but not reaching statistical significance. Treating obese male T2DM patients with liraglutide resulted in a significantly higher plasma adropin concentration, significant weight loss and improved parameters of insulin resistance, i.e. decreased fasting plasma insulin, plasma glucose levels and HOMA-IR.Cilj je bio usporediti plazmatske vrijednosti adropina i parametre inzulinske rezistencije kod pretilih muškaraca koji boluju od šećerne bolesti tip 2 (ŠBT2) prije i nakon 3 mjeseca primjene liraglutida. U ovoj intervencijskoj studiji sudjelovalo je 15 pretilih muškaraca koji boluju od ŠBT2 s indeksom tjelesne mase (ITM) >35 kg/m2, loše reguliranom bolešću i HbA1c >7,5%. Ispitanici su prethodno u terapiji imali dva peroralna antidijabetična lijeka. Nakon uključenja u studiju terapija im je modificirana na metformin i liraglutid tijekom tri mjeseca. Nakon primjene liraglutida kod ispitanika je zamijećeno smanjenje tjelesne mase (sa 111,5±18,7 na 109,2±17,5 kg, p=0,016) i ITM (s 40,9±7,3 na 40,1±7,0 kg/m2, p=0,021), dok su plazmatske vrijednosti adropina bile značajno povišene (p=0,003). Zamijećeno je sniženje vrijednosti inzulina natašte (sa 17,79±6,53 na 13,38±3,51 mU/L, p=0,002), glukoze natašte (s 8,66±3,07 na 7,41±2,21 mmol/L, p=0,004) te HbA1c (sa 7,98±0,70% na 7,26±0,36%, p=0,003). HOMA-IR se značajno smanjio (sa 7,30±5,19 na 4,52±2,61, p=0,002). Također su zabilježene niže vrijednosti sistoličkog arterijskog tlaka, bolji lipidni profil te poboljšanje jetrene i bubrežne funkcije, iako ne statistički značajno. Primjena liraglutida u pretilih muškaraca koji boluju od ŠBT2 rezultira statistički značajno višim razinama plazmatskog adropina, značajnim smanjenjem tjelesne težine i poboljšanjem svih parametara inzulinske rezistencije, tj. sniženjem plazmatskog inzulina i glukoze natašte te nižim HOMA-IR

Comparison of the Bond Strengths of Zinc Phosphate, Glass-Ionomer, and Compomere Cement for Dowel Cementation

Unatoč dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolčića. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolčića cementiranih s trima različitim vrstama cemenata: cink-fosfatnim, stakleno-ionomernim i kompomernim. Prikupljeno je 30 zuba i endodontski preparirano do dubine od 7 mm i ISO promjera 140. Podijeljeni su u 3 skupine od 10 uzoraka. S pomoću triju navedenih vrsta cemenata u njih su cementirani kolčići od čelične žice. Pošto se je cement stvrdnuo, izmjerena je vlačna sila potrebna za izvlačenje kolčića iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175±33,17 N, za stakleno-ionomerni 235,5±46,93 N, a za kompomerni 275,63±96,42 N. Kolčići cementirani kompomerom imaju znatno jaču retenciju od kolčića cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jače retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrješke u radu i razmjerna jeftinoća, te još uvijek u mnogim kliničkim okolnostima ostaje cement izbora.In spite of numerous previous studies, there is no final conclusion on which type of cement is the best for dowel cementation. The purpose of this study was to compare the retention of dowels cemented with three different cement types: zinc phosphate, glass-ionomer, and compomere. Thirty teeth were divided into 3 groups, root-canals were prepared to ISO 140, to 7 mm depth and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. For zinc phosphate it was 175±33.17 N, for glass-ionomer 235.5±46.93 N, and for compomere 275.63±96.42 N. The dowels cemented with compomere had significantly higher tensile strength than those cemented with zinc phosphate or glass-ionomer cement. Glass-ionomer cement had significantly higher tensile strength than zinc phosphate cement. The advantages of zinc-phosphate are its low price and simple usage. Thus, in many clinical situations it may be the cement of choice

Mucositis Grades and Yeast Species

Surgically treated patients with oral, head and neck cancer commonly develop mucositis during additional irradiation therapy. Oral mucosa inflammation other than irradiation is mostly caused by Candida albicans, yeast of Candida genus. This study evaluated possible connection between grades of oral mucositis and oral yeast profile in irradiated patients before, during and after irradiation. In 25 examined patients mucosits grades »0« to »2« before irradiation with 20% positive smears and only two different species of yeasts (C. krusei 4%, C. albicans 16%) during the irradiation changed into »0« to »4« and 36% positive smears with five different species of oral yeasts (C. albicans 12%, C. glabrata 12%, C. parapsilosis 4%, C. guilliermondii 4% and Saccharomyces cerevisiae 4%). Three weeks after irradiation was finished mucositis decreased into »1« to »3« with 20% positive smears and again only two species of yeasts (C. albicans 16%, C. guilliermondii 4%). Mucositis grades was increased significantly (p=0.0037) with changes in fungi profile