Prognostic study of acute ishemic stroke

Iako je akutni ishemijski moţdani udar (AIMU) jedan od vodećih uzroka obolevanja, invaliditeta i umiranja u populaciji Beograda, podaci o prognostičkim karakteristikama ove bolesti su gotovo nepoznati. Identifikovanje najznačajnijih faktora koji utiču na preţivljavanje, rizik od invaliditeta i recidiva značajno je za planiranje duţine lečenja i rehabilitacije, kreiranje optimalnih dijagnostičkih, terapijskih i preventivnih strategija, kao i za organizaciju odgovarajućih grana zdravstvene sluţbe. Ciljevi rada su bili: procena stopa preţivljavanja bolesnika sa prvim AIMU, procena stopa fatalnosti AIMU u prvih 28 dana i nakon 1. godine praćenja, procena stopa recidiva AIMU, funkcionalnog statusa bolesnika koji preţive AIMU i prognostičkog značaja odabranih varijabli. Prospektivna kohortna studija obuhvatila je 300 bolesnika sa prvim AIMU, koji su se sukcesivno javljali u periodu od mesec dana (2008. godine) u dve glavne neurološke ustanove za lečenje moţdanog udara u Beogradu (Odeljenje Urgentne neurologije Klinike za neurologiju, KCS, i Specijalna bolnica za prevenciju i lečenje cerebrovaskularnih bolesti ''Sveti Sava''). Kod svih pacijenata je pri prijemu primenjen standardizovan dijagnostički protokol koji je obuhvatao prikupljanje svih relevantnih podataka, uključujući informacije o sociodemiografskim karakteristikama i vaskularnim faktorima rizika, neurološki i internistički pregled, uzimanje uzoraka krvi za laboratorijske analize i CT ili MR pregled endokranijuma. Za razmatranje etiologije od značaja su bile i neurovaskularne dijagnostičke metode kao i ehokardiografija. Teţina AIMU je odreĎena prema NIHSS skali, a stepen funkcionalne zavisnosti i invaliditeta na osnovu modifikovanog Rankinovog skora (mRS) i Barthel indexa (BI). Za odreĎivanje tipa AIMU primenjena je etiopatogenetska TOAST klasifikacija. Informacije o ishodu prikupljene su posle prvih 28 dana i po završetku prve godine praćenja. Posle godinu dana od nastanka AIMU ponovo je procenjen funkcionalni status bolesnika, na osnovu mRS i BI. ..Stroke is one of the leading causes of morbidity, disability and mortality in Belgrade population, but predictors of stroke outcome are almost unknown. The identification of the most important predictors of mortality, functional disability and stroke recurrence could be used to select specific management strategies and set realistic therapeutic goals, to improve discharge planning and anticipate the need for rehabilitation and community support. The aims of this study are to determine the 28-day and the 1-year survival probabilities and fatality rates after first-ever ischemic stroke, to determine 1-year functional disability and stroke recurrence rates and to identify the baseline predictors of 28-day and 1-year mortality. We prospectively and consecutively collected data on 300 patients with first-ever acute ischemic stroke admitted to two main neurological institutions for cerebrovascular diseases in Belgrade during one month 2008 (Department of Emergency Neurology, Clinic of Neurology, Clinical center of Serbia, and Special Hospital for Cerebrovascular Diseases "Sveti Sava"). All cases had undergone a standardized neurological assessment at admission included information on demographic characteristics and vascular risk factors, neurological examination, biochemical blood tests, CT or MR of the brain. In order to detect possible stroke mechanisms neurovascular diagnostic procedures and echocardiography were performed. Stroke severity at baseline was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the level of disability or dependence in activities of daily living in stroke victims was assessed with the modified Rankin Scale (mRS) and Barthel index (BI). Each stroke was classified into subtype groups by etiopathogenetic mechanisms using TOAST criteria. Data on stroke outcome were obtained at 28 days and one year after stroke onset. One year after stroke onset, functional status was assessed again, with mRS and BI. The Kaplan-Meier method was used to estimate the cumulative survival probability.

Fatty acid composition including trans-fatty acids in salty snack food from the Serbian market

The rapid increase in the consumption of salty snack products has led to increased concern about their composition and nutritional value. The aim of this study was to investigate the fat content and fatty acid profile in salty snack products from the Serbian market. A total of 58 different snack products from 3 categories (Baked products, Chips & flips products, Cereal products) were analyzed. The fatty acid composition was determined using gas chromatography. Total fat content ranged from 3.1 % in expanded rice to 35.7 % in potato chips. Palmitic, oleic and linoleic acids constituted gt 80 % of all fatty acids (FAs) in categories Baked products and Chips & flips. Linoleic acid was more abundant in the category Cereal products (15.5-49.3 %). The trans-FAs elaidic (C18:1 - 9t) and linolelaidic FAs (18: 2 - 9t, 12t) were identified in 66 % of the products. The flips products had the highest average t-FAs content (16.3 %), followed by flips group (9.3 %). Potential t-FAs intake from 100 g of analyzed products was in range 0.1-4.9 g. This study provided a large database on saturated fatty acids and t-FAs content in salty snack products and indicated that by consuming only one package of some products, the t-FAs intake could surpass the recommended maximum of 1 % of daily energy

Polinezasićene masne kiseline u zdravlju i bolesti

Polyunsaturated fatty acids (PUFAs) are necessary for overall health. Two PUFAs families, n-6 and n-3 fatty acids, are physiologically and metabolically distinct. The proportion of PUFAs in serum and erythrocyte phospholipids, which depends on endogenous metabolism controlled by genetic polymorphisms and dietary intake, is an important determinant of both health and disease. Both n-3 and n-6 PUFAs are processed to powerful promoters of eicosanoids synthesis at the cyclooxygenase and lipoxygenase level. Evidence from observational and intervention studies suggest that n-3 PUFAs are cardio-protective, perhaps through their anti-inflammatory, anti-arrhythmic, lipid-low­ering and antihypertensive effects. In contrast, dietary n-6 PUFAs have pro-inflammatory effects. Low n-3 and elevated n-6 PUFAs levels were found in patients with cancer on different sites. The present review focuses on current knowledge related to PUFAs intake and status in health and disease, with reference to the Serbian population.Polinezasićene masne kiseline (PMK) su neophodne za normalno funkcionisanje organizma. Dve PMK familije, n-6 i n-3 masne kiseline se fiziološki i metabolički razlikuju. Udeo PMK u fosfolipidima seruma i eritrocita je važan pokazatelj zdravlja i bolesti, i zavisi od endogenog metabolizma, koji je kontrolisan genetskim polimorfizmom, i unosa hrane. I n-6 i n-3 PMK su prekursori za sintezu eikozanoida na ciklooksigenaznom i lipooksigenaznom nivou. Opservacione i interventne studije ukazuju da n-3 PMK imaju kardioprotektivni efekat, delujući anti-inflamatorno, anti-aritmogeno, hipolipidemično i antihipertenzivno. Nasuprot tome, smatra se da n-6 PMK imaju pro-inflamatorno dejstvo. Nizak nivo n-3 i povišen udeo n-6 PMK je pokazan kod pacijenata sa različitim tipovima maligniteta. U okviru ovog rada dat je pregled najnovijih saznanja o dijetarnom unosu i biomarkerima statusa PMK u promociji zdravlja i prevenciji bolesti, sa posebnim osvrtom na rezultate u našoj populaciji

Inflammation, nutritional status, pufa profile and outcome in hemodialysis patients

Patients with end-stage renal disease (ESRD) include a significant percentage of malnourished patients with other risk factors: dyslipoproteinemia, insulin resistance, increased oxidative stress and inflammation that together impair endothelial function. Abnormal polyunsaturated fatty acids (PUFA) patterns are reported in patients with ESRD. The basic mechanisms of these disorders are connected with changes in cell functions at the membrane level. Vascular smooth muscle cell proliferation plays an important role in the pathogenesis of atherosclerosis. We have examined the association between atherosclerotic risk factors and nutritional status in hemodialysis (HD) patients. Mortality was followed for up to 18 month. Forty-three HD patients were examined (20 males, 23 females, ages 55±12 years). Nutritional and inflammatory markers, including serum concentrations of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6), were measured. There was significant positive correlation between the plasma albumin level and CRP. Significant correlation was found between plasma the cholesterol level and some PUFA. Increasing inflammation and endothelial dysfunction predict the development of vascular disease. We report on the relationship between inflammatory markers and nutritional parameter, indices of atherosclerosis and other cardiovascular risk factors in patients on hemodialysis

Susceptibility to antifungal agents of Candida spp. from blood and feces collected in Novi Sad in 3-year period (2008-2010)

Candidemia is an important emerging nosocomial infection in patients with risk factors. Candida species from nonsterile sites can give insight into the characteristics of strains that may cause invasive disease. The aim of this study was to evaluate antifungal susceptibility of Candida blood and fecal isolates in Novi Sad, Vojvodina. During a 3-year period (2008 to 2010), 424 isolates of Candida spp. were collected, 30 bloodstream isolates and 394 strains from fecal samples. In vitro susceptibility of these isolates to five antifungal agents was established using commercial ATB FUNGUS 3 (Bio-Mérieux). Predominant species was Candida albicans (6 isolates from blood and 269 from feces). Resistance to one or more antifungal agents was less common in Candida albicans (3.63%) than in other species (24.83%). Resistance to itraconazole was the most commonly found in both groups of isolates, 9.64% strains from feces and 20% from blood samples. Twelve isolates were multiply resistant, usually to fluconazole, itraconazole, and voriconazole. Resistance to amphotericine B was extremely rare. Although resistance to antimycotics of Candida spp. is rare at present, continued surveillance of antifungal susceptibility is necessary in order to monitor trends, and to choose the right empiric therapy

Zastupljenost n-3 polinezasićenih masnih kiselina u fosfolipidima eritrocita i insulinska senzitivnost kod gojaznih osoba pri tipičnoj ishrani podneblja Srbije

This study examines the relationship between erythrocyte phospholipid FA composition and insulin sensitiv­ity in obese patients on a typical Serbian diet. In 30 patients, two insulin sensitivity groups were formed and their FAs analyzed. The shares of 22:5n-3, 22:6n-3, and total n-3 PUFAs, as well as a measure of Δ5 desaturase activity (the 20:4n-6/20:3n-6 ratio) were lower in the insulin resistance group compared to the normal glucose tolerance group. The fasting insulin level and HOMA value were inversely related to the percentage of 22:5n-3, 22:6n-3, and total n-3 PUFAs. Our data indicate that the percentage of n-3 PUFAs in erythrocyte phospholipids is linked with insulin sensitivity parameters in obese patients.Masnokiselinski sastav membrana, koji se bar delimično može modifikovati dijetarnim unosom masnih kiselina, igra važnu ulogu u senzitivnosti na insulin. Cilj ove studije bio je ispitivanje veze između senzitivnosti na insulin i masnokiselinskog sastava fosfolipida eritrocita kod gojaznih osoba. Trideset umereno gojaznih/gojaznih nedijabetičara sa hiperlipoproteinemijama (ukupni holesterol gt 5.2 mmol/l, LDL-holesterol gt 3.4 mmol/l) podeljeni su u dve grupe, koristeći HOMA vrednost kao parametar senzitivnosti na insulin: grupu sa normalnom tolerancom na glukozu (NTG) i grupu sa rezistencijom na insulin (IR). Ukupni lipidi eritrocita su estrahovani i fosfolipidi izolovani tankoslojnom hromatografijom. Posle metilovanja masne kiseline analizirane su gasno-tečnom hromatografijom. Zastupljenost 22:5n-3 (p lt 0.01), 22:6n-3 (p lt 0.01), ukupnih n-3 polinezasićenih masnih kiselina (p lt 0.001) i odnos zastupljenosti 20:4n-6/20:3n-6 (pokazatelja aktivnosti delta-5 desaturaze) (p lt 0.05) su sniženi u IR grupi u poređenju sa NGT grupom. Nivo insulina natašte i HOMA vrednost inverntno su povezani sa zastupljenošću 22:5n-3 (p lt 0.05), 22:6n-3 (p lt 0.01) i ukupnim n-3 polinezasićenim kiselinama (p lt 0.01). Naši rezultati pokazuju da je nivo n-3 masnih kiselina u fosfolipidima eritrocita povezan sa senzitivnošću na insulin kod gojaznih osoba na ishrani tipičnoj za podneblje Srbije

Uticaj masti u obroku na masne kiseline u serumskim fosfolipidima i gojaznost životinja

Dietary fat and its relation to obesity has been a controversial issue for many years. Experimental data shows that most, though not all animals, which consume a high fat diet, will become obese. However, the effect of fatty acids on animal obesity has not been studied in detail. In order to evaluate the effects of low versus high fat diet on serum phospholipids fatty acids composition a 4-wk study was conducted on male Wister rats. The rats were fed low-fat (10% energy) and high-fat (46% energy) foods containing constant proportions of fatty acids. Control group C was fed a standard laboratory diet (polyunsaturated/ saturated (P/S) fatty ratio 1.3), group M was fed a standard laboratory diet supplemented with margarine (P/S ratio 0.95), and the diet of the SL group was additionally supplemented with a sunflower oil-lard (1:1) mixture (P/S ratio 1.3). All lipid supplemented hyperenergetic diets caused an increase in the average daily energy intake. Both the final and the daily body weight gain were significantly higher in M and SL groups than in group C. Additionally, serum triglyceride levels, LDL-cholesterol and total cholesterol were also significantly higher in M and SL groups when compared to the control group. Serum phospholipids fatty acids varied in response to total dietary fat. A significant decrease in saturated fatty acids (SFA) content (16:0 and 18:0) and an increase in monounsaturated fatty acid (MUFA) content (18:1, n-9) was found in the M group when compared to both C and SL groups. In the SL group, SFA content (18:0) was higher and MUFA content (18:1, n-9) was lower than in group C. Polyunsaturated fatty acids (PUFA) content showed an increase in both experimental groups. The PUFA/SFA ratio was higher in the M group than in the C and SL groups. Our study suggests that the amount of dietary fat has a greater influence on obesity than the effects of the type of fat consumed. However, depending on the type of fat present in the diet the differences were observed in the composition of serum PL fatty acid suggesting that both total fat and individual fatty acids have to be considered when reaching conclusions about the effect of dietary fat and obesity in animals.Uticaj masnih kiselina u ishrani i njihov efekat na pojavu gojaznosti kod životinja je kontraverzno pitanje već dugi niz godina. Uticaj pojedinačnih masnih kiselina na pojavu gojaznosti kod životinja nije do sada detaljnije proučavan. Sa ciljem da se ispita efekat dijeta sa niskim ili visokim sadržajem masti na pojavu gojaznosti, izvršena su istraživanja na Wister pacovima u trajanju od 4 nedelje. Pacovi su hranjeni eksperimentalnim dijetama koje su sadržale standardan, nizak (10%) ili visok (46%) energetski unos poreklom od masti. Grupa kontrolnih životinja (C) je hranjena standardnom laboratorijskom dijetom (odnos polizasićenih/ zasićenih masnih kiselina/PUFA, P/S 1.3), grupa M sa standardnom dijetom sa dodatkom margarina (P/S 0.95) i grupa SL sa dijetom kojoj je dodata mešavina 1:1 suncokretovog ulja i masti (odnos P/S 1.3). Obe dijete (M i SL) su uzrokovale povećanje u prosečnom dnevnom energetskom unosu. U grupi M i SL, registrovano je značajno povećanje u telesnoj težini kontinuirano tokom eksperimenta. Nivo serumskih triglicerida, LDL kao i ukupnog holesterola su bili značajnije povećani u M i SL grupi u poređenju sa kontrolom. Promene u profilu serumskih masnih kiselina fosfolipida su zavisile od sastava masti u eksperimentalnoj dijeti. Kod eksperimentalnih životinja grupe M primećeno je značajno smanjene serumskih zasićenih masnih kiselina (SFA, 16:0 i 18:0) kao i porast monozasićenih masnih kiselina (MUFA, 18:1, n-9) u poređenju sa SL i C grupom. Odnos PUFA/ SFA je bio veći u M u odnosu na SL i C grupu. Rezultati naših istraživanja ukazuju da količina masti u ishrani životinja ima veći uticaj na porast telesne mase nego vrsta prisutne masnoće. Promene u sastavu serumskih masnih kiselina fosfolipida u odnosu na tip masti u eksperimentalnim dijetama ukazuju na ulogu pojedinačnih masnih kiselina u procesu nastajanja gojaznosti kod životinja i te mehanizme treba dalje istraživati

Deficijencija B12 vitamina kod deteta majke na veganskoj ishrani

Vitamin B12 deficiency usually occurs in exclusively breastfed infants whose mothers have pernicious anaemia or are vegetarian. Early treatment of vitamin B12 deficiency in infants can prevent potentially neurologic sequelae. A male child aged 13 months has been hospitalized due to failure to thrive, feeding problems, pallor, weakness and hypotonia. During the pregnancy mother did not eat meat and during lactation she also excluded eggs and milk. The child was exclusively breastfed. Laboratory investigations showed a haemoglobin level of 3.5 g/dL, haematocrit 10%, red blood cell count of 0.99 × 1012/L, white blood cell count of 4.23 × 109 /L and platelet count of 55 × 109 /L. Vitamin B12 level was low. A bone marrow aspiration finding was consistent with megaloblastic anaemia. The magnetic resonance imaging showed brain atrophy. Vitamin B12 in a dose of 10µg per kg was applied intramuscularly daily for 2 weeks, then once weekly. Three days after initiating B12 vitamin therapy there was an improvement in the blood count with the gradual improvement of neurological state. Vitamin B12 deficiency is a treatable cause of pancytopenia and neurological dysfunction in children and should be considered as differential diagnosis in an infant with neurological symptoms.Deficijencija B12 vitamina se obično javlja kod odojčadi koja su na prirodnoj ishrani a čije majke imaju pernicioznu anemiju ili su vegetarijanci. Pravovremeno lečenje deficijencije B12 vitamina kod odojčadi može da prevenira potencijalne neurološke posledice. Malo muško dete uzrasta 13 meseci je hospitalizovano zbog nenapredovanja, problema sa hranjenjem, bledila, slabosti i hipotonije.Tokom trudnoće majka nije jela meso dok je tokom dojenja iz ishrane isključila i jaja i mleko. Dete je isključivo dojeno. U laboratorijskim nalazima nivo hemoglobina je iznosio 3,5 g/dl, hematokrit 10%, broj eritrocita je bio 0.99×1012/L, broj leukocita 4.23×109 /L i broj trombocita 55×109 /L. Nivo B12 vitamina je bio snižen. Nalaz biopsije kostne srži ukazivao je na megaloblastnu anemiju. Na magnetnoj rezonanci endokranijuma viđena je atrofija mozga. Vitamin B12 u dozi od 10 mikrograma/kg primenjen je intramuskularno svakodnevno tokom 2 nedelje, potom jednom nedeljno.Tri dana od započinjanja terapije zabeleženo je poboljšanje hematoloških vrednosti uz postepeno poboljšanje neurološkog statusa. Deficijencija B12 vitamina je uzrok pancitopenije i neurološke disfuncije kod dece koju je moguće lečiti. Kod odojčeta sa neurološkim simptomima ova deficijencija treba da bude razmotrena kao diferencijalna dijagnoza

Ishrana bolesnika sa novodijagnostikovanim rakom pluća

Introduction/Objective Although smoking is the main risk factor for lung cancer (LC), studies have shown that diet could also play an important role. The objective of this study was to analyze dietary intake of newly diagnosed LC patients and to compare with sex- and age-matched healthy controls. Methods Sixty-nine non-treated LC patients (50 male, 19 female, aged 46-80 years), and 70 healthy controls (50 male, 20 female, aged 47-76 years) filled out a validated food frequency questionnaire in the presence of a trained nutritionist. Nutrient intake was calculated using the Serbian Food Composition Database. Results Similar energy intake was reported by both groups. However, the controls had significantly higher intake of total fats, saturated, monounsaturated, and n-3 polyunsaturated fatty acids (PUFAs) and lower intake of carbohydrates and n-6 PUFAs. Patients with LC reported markedly lower intake of milk and dairy products, eggs, seafood, vegetables, and fruits, and higher intake of grains and grain products. Conclusion Patients with LC had significantly different dietary intake of most nutrients compared to healthy participants, suggesting that changes in dietary patterns could contribute to prevention of LC development.Uvod/Cilj Iako je pušenje vodeći faktor rizika za rak pluća (RP), studije pokazuju da i način ishrane igra važnu ulogu. Cilj ove studije je da se analiza ishrana kod bolesnika sa novodijagnostikovanim RP i da se uporedi sa zdravom populacijom istog pola i godina starosti. Metode Šezdeset devet bolesnika sa novootkrivenim RP (50 muškaraca, 19 žena, starosti 46-80 godina) i 70 zdravih ispitanika (50 muškaraca, 20 žena, starosti 47-76 godina) popunilo je u prisustvu lekara upitnik o učestalosti kon- zumiranja namirnica. Nutritivni unos je računat pomoću Srpske baze podataka o sastavu namirnica. Rezultati Obe grupe su imale sličan unos energije, ali je u kontrolnoj grupi zabeležen veći unos masti, zasićenih, mononezasićenih i n-3 polinezasićenih masnih kiselina (PNMK), a niži unos ugljenih hidrata i n-6 PNMK. Grupa bolesnika je imala značajno niži unos mleka i mlečnih proizvoda, jaja, morskih plodova, voća i povrća, a veći unos žitarica i proizvoda od brašna. Zaključak Bolesnici sa RP imali su značajno drugačiji način ishrane od zdravih ispitanika, što sugeriše da promene u načinu ishrane mogu da doprinesu prevenciji nastanka kancera pluća

Effects of Dietary Milled Seed Mixture on Fatty Acid Status and Inflammatory Markers in Patients on Hemodialysis

Background. Plant seeds have gained interest for their health benefits due to their fatty acid content. The objective of this study was to determine the effects of dietary consumption of milled sesame/pumpkin/flax seed mixture on glycemic control, serum lipids, phospholipid fatty acid status, and inflammatory factors in patients on hemodialysis. Methods. Thirty patients with well nutrition status (18 male, 12 female) were enrolled in the study. Participants consumed 30 g of milled sesame/pumpkin/flax (6 g/6 g/18 g, resp.) seeds mixture added to their habitual diet. Results. Total n-6 and n-3 polyunsaturated fatty acids and levels of linoleic, dihomo-gamma-linolenic (DGLA), arachidonic, alpha-linolenic (ALA), eicosapentaenoic, docosapentaenoic, and docosahexaenoic (DHA) acid were increased after 12 weeks of supplementation. A significant decrease of the serum triglyceride level (P lt 0.001), glucose, insulin, calculated IR HOMA (P lt 0.05), and inflammatory markers (TNF-alpha, IL-6, and hs-CRP,P lt 0.001) was observed after seed mixture treatment. The serum levels of CRP and TNF-alpha negative correlate with ALA, DHA, and DGLA. Conclusion. Results of this study indicated that dietary milled sesame/pumpkin/flax seed mixture added to a habitual diet lowered triglyceride and CRP, TNF-alpha, IL-6 levels, affect glycemic control and improved fatty acid profile and pruritus symptoms in hemodialysis patients