Glycated haemoglobin - when can we trust it? Analysis of factors affecting the HbA1c level

Epidemiological data leaves no illusions – diabetes mellitus is a real epidemic of a non-communicable disease. Glycated haemoglobin was isolated with chromatography column as a separate subtype of haemoglobin as early as in 1958. An increase in its concentration in response to hyperglycaemia has already been recognized in 1969. Glycated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control in patients with diabetes. With HbA1C measurement we are able to retrospectively assess the average blood glucose levels. HbA1c correlates well with the risk of long-term diabetes complications. However, HbA1C levels may sometimes be misleading as a reliable measure of glycemic control. HbA1c values measurements are prone to diagnostic interference with many factors. The aim of this review was to present the numerous clinical scenarios in which the use of HbA1c levels alone for either diagnosis or as a marker of glycemic control, may lead to false assumptions

Zastosowanie technik nieinwazyjnego wspomagania oddechu w ostrych stanach kardiologicznych

Ostra niewydolność lewej komory serca, a zwłaszcza jedna z jej postaci - obrzęk płuc, jest częstą przyczyną niewydolności oddechowej na oddziałach intensywnej opieki kardiologicznej. Ciężka niewydolność oddechowa to wskazanie do intubacji dotchawiczej i wentylacji mechanicznej. Terapia ta jest jednak związana z ryzykiem powikłań, takich jak zapalenie płuc. Alternatywą jest zastosowanie techniki nieinwazyjnego wspomagania oddechu dodatnim ciśnieniem w drogach oddechowych, tak zwanej NIPPV (non-invasive positive pressure ventilation). Najprostszą i najpopularniejszą formą tej terapii jest CPAP (continuous positive airway pressure), czyli wspomaganie oddechu stałym dodatnim ciśnieniem. W nowszych technikach wentylacji, nazywanych Bi-PAP (bilevel positive airway pressure), wykorzystuje się różne wartości ciśnień podczas wdechu i wydechu pacjenta. W badaniach wykazano, że stosowanie NIPPV w obrzęku płuc wiąże się ze zmniejszeniem ryzyka konieczności intubacji. Nie stwierdzano różnic w zakresie skuteczności i bezpieczeństwie stosowania CPAP i BiPAP. Warunkiem skuteczności NIPPV jest dobra współpraca chorego w zakresie stosowania maski

Retinoic Acid and Its Derivatives in Skin

The retinoids are a group of compounds including vitamin A and its active metabolite all-trans-retinoic acid (ATRA). Retinoids regulate a variety of physiological functions in multiple organ systems, are essential for normal immune competence, and are involved in the regulation of cell growth and differentiation. Vitamin A derivatives have held promise in cancer treatment and ATRA is used in differentiation therapy of acute promyelocytic leukemia (APL). ATRA and other retinoids have also been successfully applied in a variety of dermatological conditions such as skin cancer, psoriasis, acne, and ichthyosis. Moreover, modulation of retinoic acid receptors and retinoid X (or rexinoid) receptors function may affect dermal cells. The studies using complex genetic models with various combinations of retinoic acid receptors (RARs) and retinoid X (or rexinoid) receptors (RXRs) indicate that retinoic acid and its derivatives have therapeutic potential for a variety of serious dermatological disorders including some malignant conditions. Here, we provide a synopsis of the main advances in understanding the role of ATRA and its receptors in dermatology

Mast cell derived carboxypeptidase A3 is decreased among patients with advanced coronary artery disease

Background: Coronary artery disease (CAD) affects milions of people and can result in myocardialinfarction (MI). Previously, mast cells (MC) have been extensively investigated in the context of hypersensitivity,however as regulators of the local inflammatory response they can potentially contribute toCAD and/or its progression. The aim of the study was to assess if serum concentration of MC proteases:carboxypeptidase A3, cathepsin G and chymase 1 is associated with the extension of CAD and MI.Methods: The 44 patients with angiographically confirmed CAD (23 subjects with non-ST-segmentelevation MI [NSTEMI] and 21 with stable CAD) were analyzed. Clinical data were obtained as wellserum concentrations of carboxypeptidase A3, cathepsin G and chymase 1 were also measured.Results: Patients with single vessel CAD had higher serum concentration of carboxypeptidase thanthose with more advanced CAD (3838.6 ± 1083.1 pg/mL vs. 2715.6 ± 442.5 pg/mL; p = 0.02). Therewere no significant differences in levels of any protease between patients with stable CAD and those withNSTEMI. Patients with hypertension had ≈2-fold lower serum levels of cathepsin G than normotensiveindividuals (4.6 ± 0.9 pg/mL vs. 9.4 ± 5.8 pg/mL; p = 0.001). Cathepsin G levels were also decreasedin sera of the current smokers as compared with non-smokers (3.1 ± 1.2 ng/mL vs. 5.8 ± 1.2 ng/mL,p = 0.02).Conclusions: Decreased serum level of carboxypeptidase is a hallmark of more advanced CAD. Lowerserum levels of carboxypeptidase A3 and catepsin G are associated with risk factors of blood vessel damagesuggesting a protective role of these enzymes in CAD

Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors

Background: Postoperative atrial fibrillation (AF) is a common arrhythmia that occurs after coronary artery bypass grafting (CABG). New surgical techniques, particularly off-pump coronary artery bypass (OPCAB), are thought to be less invasive and results in fewer complications, i.e. AF, but available data are inconsistent. The aim of this study is to present the incidence and risk factors of AF in patients operated on with or without cardiopulmonary bypass. Methods: We studied 1836 consecutive patients with stable coronary artery disease who were operated on with (CABG) or without (OPCAB) cardiopulmonary bypass. The patients were monitored using a continuous electrocardiogram monitoring system until the sixth postoperative day. Results: Atrial fibrillation occurred in 18.3% and 19.3% of CABG and OPCAB patients, respectively (p = 0.3). The peak incidence of arrhythmia was observed between the second and third postoperative day in both CABG and OPCAB patients (36% and 41%, respectively). Patient’s age and history of hypertension were significant predictors of postoperative AF (OR 1.38, 95% CI 1.01–1.76, p = 0.0002; and OR 1.38, 95% CI 1.01–1.76, p = 0.008, respectively). Patients who developed AF vs. without AF had significantly higher rates of complications such as death (3.1% vs. 1.2%, p = 0.01), reoperation (5.2% vs. 2.8%, p = 0.02), and the need to utilize intra-aortic balloon pump (IABP) (6.8% vs. 3.4%, p = 0.002). Use of IABP and reoperation were significant perioperative predictors of the arrhythmia (OR 2.1, 95% CI 1.27–3.4, p = 0.003; and OR 1.9, 95% CI 1.09–3.30, p = 0.02, respectively). AF was also associated with a prolonged stay in an intensive care unit (72.5 ± 78.8 for patients with AF vs. 34.6 ± 25.2 for patients with sinus rhythm, p = 0.000001). Conclusions: In patients undergoing CABG, postoperative AF is a common arrhythmia independent of the type of surgical procedure