Metabolic syndrome severity score: range and associations with cardiovascular risk factors

Introduction: Metabolic Syndrome Severity Score (MSSS) is a new clinical prediction rule (CPR) for diagnostic and therapeutic decisions and employs available components (sex, age, race, systolic blood pressure, waistline circumference, high-density lipoprotein, triglycerides and fasting blood glucose). The aim of our work was to perform cross-sectional pilot trial on middle-aged healthy volunteers and patients with metabolic syndrome (MetS) with and without type 2 diabetes mellitus (T2DM) for studying feasibility and implementation of MSSS and its associations with cardiovascular risk factors.Material and methods: We approached 64 eligible participants from Bulgaria. The MSSS values, together with demographic, anthropometric, medical history, laboratory findings, CVD risk factors, QRISK2 score for 10-year cardiovascular risk and predicted heart age, were analysed. Descriptive statistics with tests for comparison (e.g., t-test, c2) between groups as well as ANOVA and logistic regression were applied. Results: We analysed data from 56 participants (aged 50.11 ±3.43 years). The MSSS was higher in MetS patients (including 6 T2DM patients) than in controls (n = 29; 51.8%) presented as percentiles (69.97% and 34.41%, respectively) and z-scores (0.60 and –0.45, respectively) (p < 0.05). The logistic regression model of MSSS indicated a positive association with MetS/T2DM cases (correctness > 85%, p < 0.01). For further validation purposes, positive correlations of MSSS with CVDrisk factor as diastolic blood pressure (Rho = 0.399; p < 0.003) and QRISK2 score (Rho = 0.524; p < 0.001) or predicted heart age (Rho = 0.368; p < 0.007) were also found.Conclusions: The pilot study of MSSS in Bulgaria indicated feasibility and consistency of its implementation among patients with metabolic syndrome and/or T2DM and healthy volunteers

Контраст-индуцирана енцефалопатия – рядко усложнение на коронарната ангиография: клиничен случай

Контраст-индуцираната енцефалопатия (КИЕ) е рядко наблюдавано усложнение на контраст-медиираните ендоваскуларни терапевтични и диагностични процедури, протичащо с възвратими, разнородни и неспецифични неврологични симптоми. По литературни данни честотата на КИЕ варира между 0,3% и 2%, а рискът за възникване зависи от типа на процедурата, придружаващите заболявания на пациента и вида на използваната контрастна материя. Към момента не е дефинирана точната доза на контраста, която закономерно да води до неврологичните усложнения, но повечето проучвания приемат 200 мл. като максимално безопасна доза за избягване на невротоксичност. Клинично КИЕ се представя с хетерогенни неврологични симп томи, остро началото обикновено и пълно възстановяване до 72 ч. след началото на симптомите. Диагнозата на КИЕ обаче често е предизвикателство, а провеждането на компютърна томография на главен мозък (КТ на ГМ) не винаги е достатъчно информативно, тъй като при част от пациентите не се откриват абнормности при компютър-томографско изследване. Представяме клиничен случай на 81-годишна полиморбидна пациентка с придружаваща дългогодишна артериална хипертония и бъбречно увреждане, при която 12 часа след проведена коро нарография, клинично се наблюдава пароксизмално състояние, а проведеният КТ е с данни за екстравазация на контрастна материя

Early neurological and cognitive impairments in subclinical cerebrovascular disease

Background: The subclinical cerebrovascular disease (SCVD) is an important public health problem with demonstrated prognostic significance for stroke, future cognitive decline, and progression to dementia. The earliest possible detection of the silent presence of SCVD in adults at age at risk with normal functioning is very important for both clinical doctors and scientists.Materials and Methods: Seventy-seven adult volunteers, recruited during the years 2005–2007, with mean age 58.7 (standard deviation 5.9) years, were assessed by four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB)-Eclipse cognitive assessment system. We used a questionnaire survey for the presence of cerebrovascular risk factors (CVRFs) such as arterial hypertension, smoking and dyslipidemia, among others, as well as instrumental (Doppler examination) and neurological magnetic resonance imaging (MRI) procedures. Descriptive statistics, comparison (t-test, Chi-square) and univariate methods were used as followed by multifactor logistic regression and receiver operating characteristics analyses.Results: The risk factor questionnaire revealed nonspecific symptoms in 44 (67.7%) of the subjects. In 42 (64.6%) of all 65 subjects, we found at least one of the conventional CVRFs. Abnormal findings from the extra- and trans-cranial Doppler examination were established in 38 (58.5%) of all studied volunteers. Thirty-four subjects had brain MRI (52.3%), and abnormal findings were found in 12 (35.3%) of them. Two of the four subtests of CANTAB tool appeared to be potentially promising predictors of the outcome, as found at the univariate analysis (spatial working memory 1 [SWM1] total errors; intra-extra dimensional set 1 [IED1] total errors [adjusted]; IED2 total trials [adjusted]). We established that the best accuracy of 82.5% was achieved by a multifactor interaction logistic regression model, with the role CVRF and combined CANTAB predictor “IED total ratio (errors/trials) × SWM1 total errors” (P = 0.006).Conclusions: Our results have contributed to the hypothesis that it is possible to identify, by noninvasive methods, subjects at age at risk who have mild degree of cognitive impairment and to establish the significant relationship of this impairment with existing CVRFs, nonspecific symptoms and subclinical abnormal brain Doppler/MRI findings. We created a combined neuropsychological predictor that was able to clearly distinguish between the presence and absence of abnormal Doppler/MRI findings. This pilot prognostic model showed a relatively high accuracy of >80%; therefore, the predictors may serve as biomarkers for SCVD in subjects at age at risk (51–65 years)

Descrição e análise do uso de um instrumento de coordenação em um instituto público de pesquisa em biomedicina Cooperative health research networks: a description and analysis of a coordination tool in a public biomedical research institute

O objetivo deste artigo é descrever e analisar a dinâmica de redes cooperativas de pesquisa em saúde como principal instrumento de coordenação de um programa de desenvolvimento tecnológico em saúde em uma instituição pública de pesquisa. Iniciamos com algumas considerações metodológicas sobre as técnicas utilizadas no levantamento, sistematização e análise dos dados. Em seguida fazemos uma breve exposição conceitual sobre as redes cooperativas, acompanhada da caracterização do programa. Descrevemos e analisamos posteriormente as redes cooperativas, observando as relações entre os diferentes atores que dinamizam o programa, a presença de ferramentas de tecnologia da informação e comunicação e o compartilhamento da base técnico-científica entre os projetos das redes cooperativas. Concluímos o artigo tecendo algumas considerações sobre a apropriação local do modelo conceitual de organização da pesquisa técnico-científica - as redes cooperativas. Consideramos que a constituição de um acervo de dados empíricos, de conceitos e de categorias locais de análise contribuirá, decisivamente, para a ampliação do conhecimento gerado pela sociologia e pela antropologia sobre as práticas de pesquisa e gestão da pesquisa em biomedicina.<br>The purpose of this article is to describe and analyze the dynamics of cooperative public health research networks, and their utilization as the principal coordination instrument for a technological development program in a public health research institution. It begins with a few methodological considerations in regard to carrying out surveys and systemizing and analyzing data. Next a brief conceptual explanation of cooperative networks is made along with the characteristics of the program. Then the cooperative networks are described and analyzed, observing the relationships between the various actors that dynamize the program, the presence of IT and communications tools, and the sharing of the techno-scientific base among the projects of cooperative networks. The article concludes by interlacing some considerations about the local appropriation of a conceptual techno-scientific organizational model - the cooperative networks. The creation of a data bank of empirical data, and of local concepts and categories for analyses are considered to be decisive factors for increasing the knowledge acquired through sociology and anthropology about research best practices and administration of biomedical research