Hypothyroidism as a factor of heart failure in elderly people

Uvod: Cilj ovog rada je ispitivanje povezanosti hipotireoze sa pojavom srčane insuficijencije kod osoba starije životne dobi i utvrđivanje posebnosti uticaja hipotireoze na način prezentovanja i način lečenja srčane insuficijencije kod osoba starije životne dobi. Metod: Ispitivanje je obuhvatalo 277 pacijenata životne dobi 65 godina i preko, a koji su imali dijagnostikovanu srčanu insuficijenciju. Ispitivana grupa su osobe starije životne dobi sa srčanom insuficijencijom i hipotireozom i kontrolna grupa – osobe starije životne dobi sa srčanom insuficijencijom, ali bez hipotireoze hospitalizovani na kliničkom odeljenju za gerijatriju, Kliničko bolničkog centra Zvezdara u Beogradu u periodu od 2005. Do 2010. godine. Ispitivanje je sprovedeno u skladu sa Helsinškom dekleracijom (revidirana verzija, 1983. godina), a odobrena je od strane etičkog komiteta Medicinskog fakulteta Univeziteta u Beogradu. Svi podaci su obrađeni i prikazani merama deskriptivne staristike. Za poređenje kontinuiranih numeričkih varijabli sa normalnom raspodelom korišćen je t-test., dok je poređenje učestalosti korišćen hi-kvadrat. Nivo statističke značajnosti je bio p<0,05. Rezultati: Prosečna starost u grupi ispitanika je bila 80,35+-6,31, a u kontrolnoj grupi 81,41+-6,34 godina. U grupi sa hipotireozom statistički značajno je češća bila pojava angine pektoris (p<0,001). U istoj grupi bilo je statistički više bolesnika sa predhodnom zamenom veštačke valvule (p=0,022). U ispitivanoj grupi starijih bolesnika sa srčanom insuficijencijom i hipotireozom, u odnosu na kontrolnu grupu, registruju se statistički više vrednosti serumskog ukupnog holesterola (p<0,001), LDL-holesterola (p<0,001) i triglicerida (p<0,001). U odnosu na tiroidni hormonski status, na početku studije u ispitivanoj grupi bolesnici sa SI i hipotireozom su imali signifikantno veće vrednosti serumskog TSH (p<0,001) i fT4 (p<0,048) u odnosu na kontrolnu grupu. Posle godinu dana praćenja, nije bilo više razlike u odnosu na vrednosti TSH, dok statistički značajna razlika ostaje u odnosu na serumske vrednosti fT4 (p<0,001). Tokom pet godina praćenja, broj hospitalizacija je bio signifikantno veći u grupi starijih bolesnika sa srčanom insuficijencijom i hipotireozom u odnosu na kontrolnu grupu (p<0,008). Od specifičnih kliničkih parametara ,u ispitivanoj grupi statistički je češće registrovan: subjektivni osećaj gušenja (p<0,009), nalaz bazalnih pukota (p<0,001), otoka nogu (p<0,004) , ST-T EKG promena apsolutne aritmije, veći broj bolesnika sa NYHA III ili IV klasom (p<0,004), bolesnika sa EF <45%, hipertrofija miokarda LK i perikardni izliv. Učestalost umrlih je bila statistički značajno veća u ispitivanoj grupi (p<0,001). Zaključak: Polazeći od poznatih činjenica da hormoni štitne žlezde utiču na rad kardiovaskularnog sistema sa jedne strane, a sa druge strane da i sama starost utiče kako na pojavu srčane insuficijencije tako i slabije funkcije štitne žlezde, u starijoj životnoj populaciji u prisustvu hipotireoze, hronična srčana insuficijencija ima lošiju prognozu, sa češćim smnrtnim ishodom, sa većim brojem NYHA III i IV klase bolesnika, manjom EF, većim brojem hospitalizacija, češćom pojavom angine pektoris, višim serumskim vrednostima ureje, kreatinina, kao i holesterola i triglicerida.INTRODUCTION: The aim of this work was to investigate the association of hypothyroidism with the emergence of heart failure in elderly people and determining the specific influence of hypothyroidism in the manner of presentation and method of treating heart failure in the elderly. METHOD: Testing has included 277 patients aged 65 years and over, who had a diagnosed heart failure. The study groups are the elderly with heart failure and hypothyroidism and control groups - elderly people with heart failure, but without clinical hypothyroidism hospitalized at the geriatric ward of the Clinical Center Zvezdara in Belgrade in the period since 2005. By 2010 the study was conducted in accordance with the Declaration of Helsinki (revised version, 1983 years) and has been approved by the ethical committee of the Medical Faculty of the University of Belgrade. All data are analyzed and presented measures of descriptive statistics. For comparison of continuous numerical variables with normal distribution was used t-test, while the comparison frequency used chi-square. Level of significance was p <0.05. Results: The average age in the group of respondents was 80.35 + -6.31, and in the control group 81.41 + -6.34 years. In the group with hypothyroidism was significantly more frequent occurrence of angina pectoris (p <0.001). In the same group was statistically higher in patients with previous prosthetic valve replacement (p = 0.022). In the study group of elderly patients with heart failure and hypothyroidism, compared to the control group, registered a statistically higher serum total cholesterol (p <0.001), LDL-cholesterol (p <0.001) and triglycerides (p <0.001). In relation to thyroid hormone status at baseline in the study group patients with SI and hypothyroidism had significantly higher serum TSH (p <0.001) and FT4 (p <0.048) compared to the control group. After a year of follow-up, there were more differences to TSH, while statistically significant difference remains in relation to serum fT4 (p <0.001). During five years of follow up, the number of hospitalizations was significantly higher in the group of elderly patients with heart failure and hypothyroidism compared to the control group (p <0.008). Of specific clinical parameters in the study group was statistically more frequently registered a subjective feeling of suffocation (p <0.009), a finding basal crackles (p <0.001), when legs (p <0.004), ST-T changes in ECG were arrhythmia, a larger number of patients with NYHA class III or IV (p <0.004), patients with EF <45%, LK hypertrophy and pericardial effusion. The incidence of deaths was significantly higher in the study group (p <0.001). Conclusion: Starting from the known fact that thyroid hormones affect the cardiovascular system on the one hand, and on the other side how age affects the occurrence of heart failure and poor thyroid function in the elderly population in the presence of hypothyroidism, chronic heart failure has worse prognosis, with a more frequent fatal outcome, with a number of NYHA class III and IV patients, lower EF, a larger number of hospitalization, higher incidence of angina pectoris, higher serum levels of urea, creatinine, and cholesterol and triglyceride levels

Microstructure assessment of Co alloy intended for dentistry

Cobalt–chromium–molybdenum (CoCrMo) alloys are known for medical use due to their biocompatibility, corrosion and wear resistance. The chemical and phase composition, as well as microstructure of the alloy directly affect the mechanical properties. In this investigation, CoCrMo alloy samples were obtained by vacuum precise casting. The procedure of melting and casting process as well as their parameters are given. Molds fabricated of copper, gray iron, steel, ceramics and graphite were used during the casting process. In this way, the cooling rate influence on the obtained microstructure was examined. Besides, different casting temperatures (1400°C, 1450°C and 1500°C) were applied for each kind of mold. After metallographic preparation, the microstructure was examined on the cross section of samples by optical microscopy. The obtained results show that by increasing the cooling rate, the microstructure of samples become finer and more homogeneous

Hypothyroidism as a factor of heart failure in elderly people

Uvod: Cilj ovog rada je ispitivanje povezanosti hipotireoze sa pojavom srčane insuficijencije kod osoba starije životne dobi i utvrđivanje posebnosti uticaja hipotireoze na način prezentovanja i način lečenja srčane insuficijencije kod osoba starije životne dobi. Metod: Ispitivanje je obuhvatalo 277 pacijenata životne dobi 65 godina i preko, a koji su imali dijagnostikovanu srčanu insuficijenciju. Ispitivana grupa su osobe starije životne dobi sa srčanom insuficijencijom i hipotireozom i kontrolna grupa – osobe starije životne dobi sa srčanom insuficijencijom, ali bez hipotireoze hospitalizovani na kliničkom odeljenju za gerijatriju, Kliničko bolničkog centra Zvezdara u Beogradu u periodu od 2005. Do 2010. godine. Ispitivanje je sprovedeno u skladu sa Helsinškom dekleracijom (revidirana verzija, 1983. godina), a odobrena je od strane etičkog komiteta Medicinskog fakulteta Univeziteta u Beogradu. Svi podaci su obrađeni i prikazani merama deskriptivne staristike. Za poređenje kontinuiranih numeričkih varijabli sa normalnom raspodelom korišćen je t-test., dok je poređenje učestalosti korišćen hi-kvadrat. Nivo statističke značajnosti je bio p<0,05. Rezultati: Prosečna starost u grupi ispitanika je bila 80,35+-6,31, a u kontrolnoj grupi 81,41+-6,34 godina. U grupi sa hipotireozom statistički značajno je češća bila pojava angine pektoris (p<0,001). U istoj grupi bilo je statistički više bolesnika sa predhodnom zamenom veštačke valvule (p=0,022). U ispitivanoj grupi starijih bolesnika sa srčanom insuficijencijom i hipotireozom, u odnosu na kontrolnu grupu, registruju se statistički više vrednosti serumskog ukupnog holesterola (p<0,001), LDL-holesterola (p<0,001) i triglicerida (p<0,001). U odnosu na tiroidni hormonski status, na početku studije u ispitivanoj grupi bolesnici sa SI i hipotireozom su imali signifikantno veće vrednosti serumskog TSH (p<0,001) i fT4 (p<0,048) u odnosu na kontrolnu grupu. Posle godinu dana praćenja, nije bilo više razlike u odnosu na vrednosti TSH, dok statistički značajna razlika ostaje u odnosu na serumske vrednosti fT4 (p<0,001). Tokom pet godina praćenja, broj hospitalizacija je bio signifikantno veći u grupi starijih bolesnika sa srčanom insuficijencijom i hipotireozom u odnosu na kontrolnu grupu (p<0,008). Od specifičnih kliničkih parametara ,u ispitivanoj grupi statistički je češće registrovan: subjektivni osećaj gušenja (p<0,009), nalaz bazalnih pukota (p<0,001), otoka nogu (p<0,004) , ST-T EKG promena apsolutne aritmije, veći broj bolesnika sa NYHA III ili IV klasom (p<0,004), bolesnika sa EF <45%, hipertrofija miokarda LK i perikardni izliv. Učestalost umrlih je bila statistički značajno veća u ispitivanoj grupi (p<0,001). Zaključak: Polazeći od poznatih činjenica da hormoni štitne žlezde utiču na rad kardiovaskularnog sistema sa jedne strane, a sa druge strane da i sama starost utiče kako na pojavu srčane insuficijencije tako i slabije funkcije štitne žlezde, u starijoj životnoj populaciji u prisustvu hipotireoze, hronična srčana insuficijencija ima lošiju prognozu, sa češćim smnrtnim ishodom, sa većim brojem NYHA III i IV klase bolesnika, manjom EF, većim brojem hospitalizacija, češćom pojavom angine pektoris, višim serumskim vrednostima ureje, kreatinina, kao i holesterola i triglicerida.INTRODUCTION: The aim of this work was to investigate the association of hypothyroidism with the emergence of heart failure in elderly people and determining the specific influence of hypothyroidism in the manner of presentation and method of treating heart failure in the elderly. METHOD: Testing has included 277 patients aged 65 years and over, who had a diagnosed heart failure. The study groups are the elderly with heart failure and hypothyroidism and control groups - elderly people with heart failure, but without clinical hypothyroidism hospitalized at the geriatric ward of the Clinical Center Zvezdara in Belgrade in the period since 2005. By 2010 the study was conducted in accordance with the Declaration of Helsinki (revised version, 1983 years) and has been approved by the ethical committee of the Medical Faculty of the University of Belgrade. All data are analyzed and presented measures of descriptive statistics. For comparison of continuous numerical variables with normal distribution was used t-test, while the comparison frequency used chi-square. Level of significance was p <0.05. Results: The average age in the group of respondents was 80.35 + -6.31, and in the control group 81.41 + -6.34 years. In the group with hypothyroidism was significantly more frequent occurrence of angina pectoris (p <0.001). In the same group was statistically higher in patients with previous prosthetic valve replacement (p = 0.022). In the study group of elderly patients with heart failure and hypothyroidism, compared to the control group, registered a statistically higher serum total cholesterol (p <0.001), LDL-cholesterol (p <0.001) and triglycerides (p <0.001). In relation to thyroid hormone status at baseline in the study group patients with SI and hypothyroidism had significantly higher serum TSH (p <0.001) and FT4 (p <0.048) compared to the control group. After a year of follow-up, there were more differences to TSH, while statistically significant difference remains in relation to serum fT4 (p <0.001). During five years of follow up, the number of hospitalizations was significantly higher in the group of elderly patients with heart failure and hypothyroidism compared to the control group (p <0.008). Of specific clinical parameters in the study group was statistically more frequently registered a subjective feeling of suffocation (p <0.009), a finding basal crackles (p <0.001), when legs (p <0.004), ST-T changes in ECG were arrhythmia, a larger number of patients with NYHA class III or IV (p <0.004), patients with EF <45%, LK hypertrophy and pericardial effusion. The incidence of deaths was significantly higher in the study group (p <0.001). Conclusion: Starting from the known fact that thyroid hormones affect the cardiovascular system on the one hand, and on the other side how age affects the occurrence of heart failure and poor thyroid function in the elderly population in the presence of hypothyroidism, chronic heart failure has worse prognosis, with a more frequent fatal outcome, with a number of NYHA class III and IV patients, lower EF, a larger number of hospitalization, higher incidence of angina pectoris, higher serum levels of urea, creatinine, and cholesterol and triglyceride levels