Effect of L-Arginine on the Serum Level of Advanced Glycation End Products in Patients with Post Infarction Chronic Heart Failure

Post-infarction heart failure with preserved ejection fraction (HFpEF) determines a great morbidity and mortality, and given the physiopathology implications of advanced glycation end products (AGEs) in the genesis of myocardial dysfunction. As known endothelial dysfunction is an independent predictor for cardiovascular disease. L-Arginine is the amino acid with potential to improve endothelial function which leading to prevention and treatment of cardiovascular diseases, and we think that L-Arginine may decrease the serum AGEs. We aimed to estimate the value of AGEs in post-infarction HFpEF patients, and detect the effect of L-Arginine on the serum level of AGEs in post-infarction HFpEF pts. all individuals (25) included aged 40 to 80 years, 20(80%) males and 5(20%) females were diagnosed with (HFpEF) according to ESC guidelines (2012), and their functional class according to NYHA classification for HF. 20(80%) patients of them have myocardial infarction in anamnesis. 1st group:13 patients with HFpEF and history of myocardial infarction with L-Arginine added to their standard treatment. 2nd group:7 patients with HFpEF and history of myocardial infarction with standard treatment (without L-Arginine). Comparsion group: 5 patients with HFpEF with standard treatment. We prescribed L. Arginine aspartate (Tivortin 4.2gm) intravenously once daily for 10 days for all 1st group patients. The levels of total cholesterol, triglycerides, glucose, white blood cells, erythrocyte sedimentation rate and AGEs serum level were deterimined. AGEs serum level increased markedly increased in middle-age pts with post infarction HFpEF. Inclusion of L-arginine aspartate in complex of treatment for post infarction HFpEF contributed to the significant decrease AGEs level in >60 years old patients

Effect of Combination of L-Arginine and L-Carnitine on Serum AGEs Level, Kidney and Endothelial Function in Patients with Chronic Heart Failure

The aim of the study to evaluate the effect of combination of L-Arginine with L-Carnitine on GFR, serum AGEs level and endothelial function in chronic heart failure (HF) patients with preserved ejection fraction (HFpEF). Materials and Methods: 35 patients with mean age 60,1 [56,7; 77,3] years with an established diagnosis of HFpEF were enrolled. The patients were randomly and blindly divided into 2 groups: first (1st) group pts were treated with a combination of L-Carnitine and L-Arginine in addition to standard treatment; 2nd group pts – with L-Arginine in addition to conventional treatment. Standard laboratory blood tests, lipid profile, glucose, renal and liver function tests, serum advanced glycation end-product (AGEs) level, echocardiographic examination, flow-mediated dilatation (FMD%) were performed for all patients baseline and after 10 days of treatment. The glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. Results: Median level of AGEs was 1.72 [1.34; 1.93] mg/ml. The level of AGEs was correlated with age (R = 0.71, p<0.05), disease duration (R = 0.69, p<0.05). After 10 days of treatment with a combination of L-Carnitine with L-Arginine mean AGEs was decreased by 13.1% in comparison with L-Arginine treatment group (p=0.0003). After the treatment in 1st group mean AGEs was significantly lower in comparison with the 2nd group (p=0.004). Baseline median level of GFR was 81.2 [72,1; 86,2] ml/min and correlated with disease duration (R = 0.71, p<0.05), AGEs level (R = -0.73, p<0.05). The inclusion combination of L-arginine aspartate with L-Carnitine contributed to the significant increase of GFR level (p=0.003). The median FMD% level was 6.2 [4.4; 7.9] % and correlated with age (R=-0.61, p < 0.05), GFR (R=0.54, p < 0.05). After the 10 days it had been established significant increasing of FMD% level on 47.9 % in 1st group (p=0.0005), and on 29.3 % in 2nd group (p=0.003). Endothelial function normalizing was achieved in 10 (66 %) pts of 1st group and in 9 (45%) pts of 2nd group (p=0.002). Conclusion: The combination of L-Carnitine, and L-Arginine improves kidney, endothelial function and contributes to decreasing of AGEs level in pts with HFpEF

Analysis of blood pressure control in outpatients with non-dialysis chronic kidney disease referred by primary care physicians: a study from the centre of nephrology care

Background. Patients with chronic kidney disease (CKD) have increased all-cause mortality, especially cardiovascular.The majority of patients with CKD have stages 1–3 and are treated by primary care physicians and nephrologists.Arterial hypertension (HTN) is highly prevalent comorbidity among CKD population, but its control remains poor. Material and methods. This retrospective non-interventional cross-sectional study was conducted in the Centre ofNephrology Care in Dnipropetrovsk Mechnikov Regional Hospital, Dnipro, Ukraine. We aimed to select patientswho are supposed to be followed-up by primary care practitioners but due to certain reasons required nephrologist’sconsultation. From 4540 patients who received medical care in the Centre of Nephrology Care 365 patients fulfilledinclusion criteria. They were subdivided by presence of HTN, CKD stage, presence of proteinuria and achievingblood pressure targets according to different standards. All patients were examined and followed-up according tolocal and European standards. Results. Forty-nine percent of patients had known HTN, and 21% had HTN de novo. Advance of CKD stage wassignificantly associated with increase in the most of laboratory findings, age and BP values. Non-proteinuric patientsachieved BP goals significantly more often, than proteinuric ones. Females achieved BP targets more often, thanmales. Monotherapy was the most common treatment regimen. Conclusions. HTN occurs in 70% of patients with CKD and it is controlled in up to 34% of cases. HTN is importantfactor of CKD progression and it is closely connected with GFR and proteinuria

Analysis of ambulatory blood pressure control in patients with non-dialysis chronic kidney disease referred by primary care physicians: study from the center of nephrology care

Background. Patients with chronic kidney disease (CKD) have increased all-cause mortality, especially cardiovascular. The majority of patients with CKD have stages 1-3 and are treated by primary care physicians and nephrologists. Arterial hypertension (AH) is highly prevalent comorbidity among CKD population, but its control remains poor. Material and methods. This retrospective non-interventional cross-sectional study was conducted in the Center of Nephrology Care in Dnipropetrovsk Mechnikov Regional Hospital, Dnipro, Ukraine. We aimed to select patients that are supposed to be followed-up by primary care practitioners but which due to certain reasons required nephrologist’s consultation. From 4540 patients that received medical care in the Center of Nephrology Care 365 patients fulfilled inclusion criteria. They were subdivided by presence of AH, CKD stage, presence of proteinuria and achieving blood pressure targets according to different standards. All patients were examined and followed-up according to local and European standards. Results. 49% of patients had known AH, 21% - AH onset. Advance of CKD stage was significantly associated with increase of the most of laboratory findings, age, BP values and estimated pulse wave velocity. Non-proteinuric patients achieved BP goals significantly more often, than proteinuric ones. Females achieved BP targets more often, than males. Monotherapy was the most common regimen. Conclusions. AH occurs in 70% of patients with CKD and it is controlled in up to 34% cases. AH is an important factor of CKD progression and it is closely connected with GFR and proteinuria. Combined therapy should be preferable for treating AH in patients with CKD

Duration till diagnosis and clinical profile of Sjögren’s syndrome: Data from real clinical practice in a single-center cohort

Aim of the work: To describe the clinical features of patients with Sjögren’s syndrome (SS) in a singlecentercohort and to investigate factors that may influence duration till disease diagnosis.Patients and methods: This cross-sectional study is based on the local registry of SS patients at theRheumatology Department of Dnipropetrovsk Mechnikov Regional Hospital, Ukraine. Data from the firstadmission of 24 patients; 1 male and 23 females with a median age of 54 years (45–61 years) was analyzed.Results: In patients with primary SS (n = 19) the disease appeared at the age of 44 years (37–49 years)and the most common symptom to emerge first was ocular/oral dryness (OOD); in patients with secondarySS (n = 5) the disease mostly manifested with Raynaud’s phenomenon/rash/myalgia at the ageof 28.6 years (27–37 years). Patients with primary SS more commonly had elevated antinuclear antibody(ANA) titer, anemia, higher IgG and lower glomerular filtration rate; patients with secondary SS more frequentlyexhibited skin changes, myocarditis, heart failure and higher IgA. Median duration till diagnosiswas 8.5 years (2.8–17 years). Onset of SS with fever or Raynaud’s phenomenon/rash/myalgia shortenedthe duration till diagnosis. Presence of C-reactive protein >6 mg/dl or ANA > 1:320 may indicate primarySS in patients with symptoms of OOD. On the contrary, combination of OOD at the disease onset and positiverheumatoid factor significantly increased the duration till SS diagnosis.Conclusions: The median duration till diagnosis of SS is prolonged. Patients with symptoms of OOD at diseaseonset had significantly prolonged duration till diagnosis. 2019 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is anopen access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Oral L-Arginine Supplementation Effects on Cardiometabolic Factors in Hypertensive Patients with Rheumatoid Arthritis and its Relationship with Body Mass Index

Hypertension and rheumatoid arthritis are regarded as a conditions associated with higher risk for cardiovascular disease. As known endothelial dysfunction is an early pathophysiological feature and an independent predictor cardiovascular disease. L-arginine is the amino acid with potential to improve endothelial function and is expected to play a role in the prevention or treatment of cardiovascular disease. In addition, data exists that L-arginine aspartate can reduce insulin resistance. We aimed to evaluate the effects of oral L-arginine supplementation on cardiometabolic factors by determining endothelial function, insulin resistance, adiponectin level in hypertensive patients combined with rheumatoid arthritis and its relationship with body mass index. 69 females with mean age – 54 [50,3; 61,5] years were enrolled. The 1st group made up 29 patients with hypertension combined with rheumatoid arthritis, 2nd group – 20 patients with rheumatoid arthritis, 3rd group – 20 patients with hypertension. In the endpoint patients were randomized to study subgroups patients, which received L-Arginine aspartate 30 ml/day during 4 weeks in addition to standard treatment, and control subgroups – received only the standard treatment. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Insulin resistance, adiponectin level, endothelial-dependent flow mediated vasodilatation of brachial artery were measured at baseline and after 4 weeks. In patients with hypertension combined with rheumatoid arthritis identified a significant increase in insulin levels, insulin resistance, adiponectin, which were associated with cardiovascular risk, abdominal obesity, inflammatory activity levels. Oral supplementation of L-arginine causes multiple beneficial effects on the complex of cardiometabolic factors including: endothelial dysfunction, peripheral insulin resistance, adiponectin level in hypertensive patients with rheumatoid arthritis, mainly in obesity case. With the correction of endothelial function were established more significantly changes in the investigated parameters

ORIGINAL ARTICLE The influence of low-dose atorvastatin on lipid levels and endothelial vascular function in patients with significant coronary artery stenosis

Background: Hyperlipidaemia is a well-established risk factor of the progression of coronary artery disease (CAD). Statins such as atorvastatin, as lipid-lowering agents, can not only normalise serum lipid levels, but also may improve endothelial function, reduce vascular inflammation and enhance plaque stability. Aim: To evaluate the efficacy of a low-dose atorvastatin regimen (10 mg daily) in patients with CAD. Methods: Seventy-nine patients with stable angina of II or III functional class and angiographically significant stenosis of coronary arteries (>70%) entered a 12-week treatment period with atorvastatin 10 mg/day. Lipid profile, which included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were assessed at baseline and after treatment at week 12. In addition, flow-mediated vasodilatation (FMD) and nitrate-induced dilation (NID) of the brachial artery were measured before and after treatment. Results: Among 79 patients included in the study, in 54 (68%) the target TC valueWstęp: Hiperlipidemia jest znanym czynnikiem ryzyka rozwoju choroby wieńcowej (CAD). Statytyny, w tym atorwastatyna, nie tylko obniżają stężenie lipidów ale mogą również poprawiać funkcję śródbłonka, hamować procesy zapalne w naczyniach oraz poprawiać stabilność blaszki miażdżycowej. Cel:Ocena skuteczności małej dawki atorwastatyny u chorych z CAD. Metodyka: Do badania włączono 79 chorych ze stabilną CAD i angiograficznie potwierdzonym istotnym (>70%) zwężeniem naczynia wieńcowego, u których zastosowano przez 12 tygodni atorwastatynę w dawce 10 mg/dobę. Parametry lipidowe oceniano przed włączeniem leczenia i po 12 tygodniach terapii. Ponadto oceniano wazodilatację zależną od przepływu (flow-mediated vasodilatation, FMD) i zależną od nitratów (nitrate-induced dilation, NID) w tętnicy ramieniowej przed i po zakończeniu leczenia. Wyniki: Spośród 79 chorych docelowe stężenie całkowitego cholesterol

Plasminogen Activator Inhibitor‑1 and Circulating Ceruloplasmin Levels in Men with Iron‑Deficiency Anemia and Heart Failure with Concomitant Prostate Cancer and Their Dynamics after Treatment

Introduction: The aim was to determine the activity of plasminogen activator inhibitor-1 (PAI-1) and levels of circulating ceruloplasmin (CP) in men with iron‑deficiency (ID) anemia and heart failure with preserved ejection fraction (HFpEF) with concomitant prostate cancer and their dynamics after  intravenous iron hydroxide sucrose supplementation. Materials and Methods: Dynamic observation and treatment was performed in 53 men with ID anemia and HFpEF with concomitant prostate adenocarcinoma. Serum PAI‑1 activity levels were determined using a modified colorimetric method of tissue-type plasminogen activator determination. Serum CP levels were evaluated by immunoblot assay. Results: After 10 days of treatment in the group of patients treated with intravenous iron (III) hydroxide sucrose, the median PAI-1 activity level decreased by 9.2% (P < 0.001), in Group II, this indicator was not significantly different. After 10 days of treatment, it was estimated decreased median CP level by 35% (P < 0.001), in comparison with standard therapy – on 14.4% (P < 0.001). Conclusions: The infusion of intravenous iron (III) hydroxide sucrose in men with ID anemia and HFpEF with concomitant prostate cancer contributed to a significant decrease of PAI‑1 activity level and CP level