Non-invasive imaging of diabetic vascular disease

A high proportion of diabetic subjects are referred with atherosclerotic disease and higher risk for cardiovascular events. Rapid expansion of the use of non-invasive coronary and peripheral arteries imaging, facilitated by technological advances, have found diagnostic and prognostic roles in this population. This review, which includes important and actual works, guidelines, and algorithms on cardiovascular disease in the diabetic population, indicates mandatory screening for arterial disease in these patients in light of their appropriate management. Nuclear Med Rev 2010; 13, 1: 39–4

Utility of Combined Echocardiography and Lung Ultrasound for Coronavirus Disease-19 Intensive Care Unit Patients: Case Series

BACKGROUND: A little evidence existed for ultrasound evaluation of coronavirus disease (COVID)-19 patients. AIM: We aimed to present combined transthoracic echocardiography and lung ultrasound in 17 COVID-19 patients in the intensive care unit (ICU). METHODS: Patients were on age 57 + 14 years, 9 on mechanical ventilation and 8 on oxygen support, with average 1.2 comorbidities per patient. Ultrasound was performed by a single experienced sonographer and an assistant. RESULTS: Impaired left ventricular ejection fraction (EF) was found in 2 patients (pts) of them (11.8%) and diastolic dysfunction in 7 (41.2%), which was significantly higher in those ones with comorbidities. In 2 pts (11.8%), the presence of pulmonary hypertension with enlarged right ventricle was found. Later one pulmonary thromboembolism was confirmed in them with computed tomography angio. B-lines were found in 8 pts (47.1%), finding that was significantly higher in pts on mechanical ventilation, but not in relation with decreased EF. In one pt (0.6%), pleural effusion was found, but in none of them lung consolidation. CONCLUSIONS: Our findings revealed that combined echocardiography and lung ultrasound in COVID-19 ICU pts have been an accurate method for diagnosing right and left ventricular function and should be a useful one for guiding of their treatment and prognosis

Venous Thromboembolism – Current Diagnostic and Treatment Modalities

BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality.AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE.RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE. Novel oral anticoagulants seem to have some advantages in the treatment of this disorder. Rivaroxaban has been approved widespread, for use as a single-drug approach of VTE.CONCLUSION: Both guidelines are almost similar and good basis for evidence-based treatment of this disorder

Prevalence of risk factors and asymptomatic carotid atherosclerosis in diabetic patients screened for silent myocardial ischemia by SPECT myocardial imaging

BACKGROUND: The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients. MATERIAL AND METHODS: 60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients. RESULTS: 51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1−5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9–3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7−3.6). CONCLUSIONS: Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..

Recurrent myocardial infarction in a young football player with antithrombin III deficiency

Acute myocardial infarction is a rare condition in young athletes. One of the causes could be a hypercoagulable state due to congenital antithrombin III deficiency, together with a prothrombotic state soon after strenuous physical training. We present the case of myocardial reinfarction in young football player with antithrombin III deficiency, treated with primary percutaneous coronary intervention and drug eluting stent, as well as the functional repercussions of continuous intensive physical activity

Post-COVID-19 plućna embolija i Takotsubo kardiomiopatija koja se prikazala kao infarkt miokarda s neopstruktivnim koronarnim arterijama – prikaz slučaja

SUMMARY Venous thromboembolism (VTE) remains a major diagnostic and treatment challenge in COVID-19 patients. Early diagnosis is essential, since anticoagulant treatment determines patient outcomes. Pulmonary embolism is a frequent complication of COVID-19 infection that has important prognostic implications. Over 60% of PE episodes occur during the first 90 days after the discharge, where properly selected thromboprophylaxis is prognostically essential. Recurrent embolisms and fatal outcomes can be prevented with timely diagnosis and treatment. Takotsubo cardiomyopathy is one the causes of myocardial infarction with non-obstructive coronary arteries with generally good prognosis. We present a case of high-risk PE in a post-COVID-19 infection patient additionally complicated by Takotsubo cardiomyopathy.Venska tromboembolija (VTE) i dalje je veliki dijagnostički i terapijski izazov u bolesnika s bolešću COVID-19. Rano je postavljanje dijagnoze ključno jer primjena antikoagulantne terapije određuje ishode. Plućna embolija (PE) česta je komplikacija infekcije virusom uzročnikom bolesti COVID-19 te ima važne implikacije za prognozu bolesti. Više od 60 % epizoda PE-a događa se u prvih 90 dana nakon otpusta iz bolnice, pri čemu je pravilno izabrana tromboprofilaksa od ključne važnosti za prognozu. Opetovane pojave embolije i smrtni ishodi mogu se spriječiti pravodobnom dijagnozom i liječenjem. Takotsubo kardiomiopatija jedan je od uzroka infarkta miokarda s neopstruktivnim koronarnim arterijama, a prognoza je najčešće dobra. Predstavljamo slučaj visokorizične PE u post-COVID-19 bolesnice, dodatno zakomplicirane pojavom Takotsubo kardiomiopatije

Nawracający zawał serca u młodego piłkarza z niedoborem antytrombiny III

Ostry zawał serca jest stosunkowo rzadko obserwowanym schorzeniem u młodych sportowców. Jedną z przyczyn rozwoju zawału serca w tej grupie chorych może być stan nadmiernej krzepliwości krwi wtórny do wrodzonego niedoboru antytrombiny III w połączeniu ze stanem prozakrzepowym, który pojawia się wkrótce po dużym wysiłku fizycznym. W niniejszej pracy opisano przypadek kliniczny kolejnego zawału serca u młodego piłkarza z niedoborem antytrombiny III, leczonego za pomocą pierwotnej przezskórnej angioplastyki wieńcowej połączonej z implantacją stentu uwalniającego lek oraz następczym funkcjonalnym ograniczeniem intensywności wysiłku fizycznego

Direct Oral Anticoagulants or Standard Anticoagulant Therapy in Fragile Patients with Venous Thromboembolism

Background The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age ≥ 75 years and/or creatinine clearance levels ≤ 50 mL/min and/or body weight ≤ 50kg) with venous thromboembolism (VTE) has not been evaluated. Methods We used the RIETE database to compare the rates of the composite of VTE recurrences or major bleeding during anticoagulation in fragile patients with VTE, according to the use of DOACs or standard anticoagulant therapy. Results From January 2013 to April 2018, 24,701 patients were recruited. Of these, 10,054 (41%) were fragile. Initially, 473 fragile patients (4.7%) received DOACs and 8,577 (85%) low-molecular-weight heparin (LMWH). For long-term therapy, 1,298 patients (13%) received DOACs and 5,038 (50%) vitamin K antagonists (VKAs). Overall, 95 patients developed VTE recurrences and 262 had major bleeding. Patients initially receiving DOACs had a lower rate of the composite outcome (hazard ratio [HR]: 0.32; 95% confidence interval [CI]: 0.08-0.88) than those on LMWH. Patients receiving DOACs for long-term therapy had a nonsignificantly lower rate of the composite outcome (HR: 0.70; 95% CI: 0.46-1.03) than those on VKAs. On multivariable analysis, patients initially receiving DOACs had a nonsignificantly lower risk for the composite outcome (HR: 0.36; 95% CI: 0.11-1.15) than those on LMWH, while those receiving DOACs for long-term therapy had a significantly lower risk (HR: 0.61; 95% CI: 0.41-0.92) than those on VKAs. Conclusions Our data suggest that the use of DOACs may be more effective and safe than standard therapy in fragile patients with VTE, a subgroup of patients where the risk for bleeding is particularly high

The Effects of Bariatric Surgery on Vitamin B Status and Mental Health

Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer’s disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes