Serumska endotelna lipaza, lipidni i upalni pokazatelji u bolesnika s akutnim zatajivanjem srca i metaboličkim sindromom [Serum endothelial lipase, lipids and inflammatory markers in acute heart failure patients with metabolic syndrome]

The study aimed to investigate whether patients with acute heart failure and concomitant metabolic syndrome have worse outcome, longer hospitalisation, higher in-hospital and three-month follow-up mortality; severity of clinical presentation, levels of endothelial lipase, lipids and inflammatory markers; whether female patients have worse clinical presentation and more comorbidities. The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorised according to the ESC and ACCF/AHA Guidelines for HF. Mean age was 75.2 years (SD 10.3), 52% female, mean BMI 28.8 kg/m2 (SD 5.4). Hospital mortality was 14.5%, three-month 27.4%, length of hospitalisation 11.34 (SD 9.26) days. Patients with metabolic syndrome and women had higher endothelial lipase. Higher total cholesterol and LDL were associated with lower in-hospital and three-month follow-up mortality. Lower HDL and higher IL-6 were associated with higher three-month mortality. Results of this study suggest that „Obesity paradox“ and „Reverse epidemiology“ emerged. Patients with metabolic syndrome were longer hospitalised, however patients without metabolic syndrome had higher odds ratio of in-hospital and three-month mortality. Female gender was not associated with higher mortality. To conclude, results emphasise importance of diagnosing metabolic syndrome, hypolipemic therapy re-evaluation and continuous development of diagnostic biomarkers

Unusually difficult clinical presentation of an infant suffering from congenital cytomegalovirus (CMV) infection combined with alpha 1-antitrypsin (A1AT) deficiency

Congenital Cytomegalovirus (CMV) infection and alpha 1-antitrypsin (A1AT) deficiency are separately well described entities, but their simultaneous occurrence can pose a special challenge to a clinician, especially dealing with optimal diagnostic as well as therapeutic approach. Congenital CMV infection is the most common vertically transmitted infection in developed countries. In 85-95% of newborns it runs asymptomatic, while in others it is presented with jaundice, petechias, hepatosplenomegaly and central nervous system damage. A1AT deficiency is on the other hand, the most common genetic liver disease in children, and the clinical spectrum varies from the accidentally detected increased levels of transaminases through to the severe infant cholestasis that can progress to cirrhosis. The following case report describes a two-month old male with severe clinical presentation of congenital CMV infection probably exacerbated due to A1AT deficiency comorbidity. The clinical manifestations and unusually difficult clinical signs this infant presented lead to assumption that the additional liver damage exists. Extensive laboratory analyses were performed, including PCR for CMV DNA, A1AT serum concentration, A1AT genotyping, followed and confirmed with phenotyping. Patient was treated parenteral with ganciclovir, what continued with oral valganciclovir and supportive therapy. Intensive and thorough supportive treatment of the infant resulted in satisfactory progress and excellent outcome. Patient was followed-up till the age of 18 months. The presented case provides excellent example about successful overcoming obstacles in differential diagnosis of A1AT in neonates and infants. Medical charts analysis was the methodology used in making this repor

Razlike prema spolu u bolesnika s akutnim zatajivanjem srca primljenih na hitni prijam

Little is known about gender-associated differences in characteristics and survival of acute heart failure patients. The increasing incidence calls for investigating the possibilities of improved management. The purpose of the study was to determine gender-associated differences among emergency department acute heart failure patients in order to improve treatment quality and survival. A prospective observational study on 22,713 patients was conducted at the University Hospital Center Emergency department during 2010 and included 726 consecutive acute heart failure patients. The most common cause of acute heart failure was worsening of chronic heart failure. Females suffered more frequently from hypertensive acute heart failure and males from acute heart failure associated with acute coronary syndrome. Females were older, with higher body mass index, atrial fibrillation, urinary tract infections, hypertension history, hypertension at admission, and SAPS II score at admission. Males had a higher frequency of ST-elevation myocardial infarction and dilated cardiomyopathy, confirmed by ultrasound as lower ejection fraction and left ventricle dilatation with reduced ejection fraction. Males were more frequently smokers with a history of chronic obstructive pulmonary disease. The importance of treating hypertension and atrial fibrillation in women and acute coronary syndrome and chronic obstructive pulmonary disease in men should be emphasized. Aggressive identification and management of all possible heart failure etiologies should be recommended in the emergency department.Malo toga je poznato o spolno-zavisnim razlikama u značajkama i preživljenju bolesnika s akutnim zatajivanjem srca. Rastuća incidencija obvezuje na ispitivanje mogućnosti poboljšanog liječenja. Svrha ove studije je bila utvrditi spolno-zavisne razlike u bolesnika s akutnim zatajivanjem srca u hitnom prijmu radi poboljšanja kvalitete liječenja i preživljenja. Prospektivna opservacijska studija na 22.713 bolesnika je provedena u hitnom prijmu Sveučilišnog bolničkog centra tijekom 2010. godine i uključila je 726 uzastopnih bolesnika s akutnim zatajivanjem srca. Najučestaliji uzrok akutnog zatajivanja srca bilo je pogoršanje kroničnog zatajivanja srca. Žene su učestalije bolovale od hipertenzivnog akutnog zatajivanja srca, a muškarci od akutnog zatajivanja srca udruženog s akutnim koronarnim sindromom. Žene su bile starije, s višim indeksom tjelesne mase, atrijskom fibrilacijom, infekcijama mokraćnog sustava, anamnezom hipertenzije, hipertenzijom kod prijma i višim zbirom SAPS II. pri prijmu. Muškarci su imali višu učestalost srčanog infarkta s ST-elevacijom i dilatacijske kardiomiopatije, ultrazvučno potvrđenu sniženom izbačajnom frakcijom i dilatacijom lijeve klijetke sa smanjenom izbačajnom frakcijom. Muškarci su učestalije bili pušači s anamnezom kronične opstruktivne bolesti pluća. Treba naglasiti važnost liječenja hipertenzije i atrijske fibrilacije u žena te akutnog koronarnog sindroma i kronične opstruktivne bolesti pluća u muškaraca. Agresivnu identifikaciju i liječenje svih mogućih etiologija zatajivanja srca treba preporučiti u hitnom prijmu

Razlike prema spolu u bolesnika s akutnim zatajivanjem srca primljenih na hitni prijam

Little is known about gender-associated differences in characteristics and survival of acute heart failure patients. The increasing incidence calls for investigating the possibilities of improved management. The purpose of the study was to determine gender-associated differences among emergency department acute heart failure patients in order to improve treatment quality and survival. A prospective observational study on 22,713 patients was conducted at the University Hospital Center Emergency department during 2010 and included 726 consecutive acute heart failure patients. The most common cause of acute heart failure was worsening of chronic heart failure. Females suffered more frequently from hypertensive acute heart failure and males from acute heart failure associated with acute coronary syndrome. Females were older, with higher body mass index, atrial fibrillation, urinary tract infections, hypertension history, hypertension at admission, and SAPS II score at admission. Males had a higher frequency of ST-elevation myocardial infarction and dilated cardiomyopathy, confirmed by ultrasound as lower ejection fraction and left ventricle dilatation with reduced ejection fraction. Males were more frequently smokers with a history of chronic obstructive pulmonary disease. The importance of treating hypertension and atrial fibrillation in women and acute coronary syndrome and chronic obstructive pulmonary disease in men should be emphasized. Aggressive identification and management of all possible heart failure etiologies should be recommended in the emergency department.Malo toga je poznato o spolno-zavisnim razlikama u značajkama i preživljenju bolesnika s akutnim zatajivanjem srca. Rastuća incidencija obvezuje na ispitivanje mogućnosti poboljšanog liječenja. Svrha ove studije je bila utvrditi spolno-zavisne razlike u bolesnika s akutnim zatajivanjem srca u hitnom prijmu radi poboljšanja kvalitete liječenja i preživljenja. Prospektivna opservacijska studija na 22.713 bolesnika je provedena u hitnom prijmu Sveučilišnog bolničkog centra tijekom 2010. godine i uključila je 726 uzastopnih bolesnika s akutnim zatajivanjem srca. Najučestaliji uzrok akutnog zatajivanja srca bilo je pogoršanje kroničnog zatajivanja srca. Žene su učestalije bolovale od hipertenzivnog akutnog zatajivanja srca, a muškarci od akutnog zatajivanja srca udruženog s akutnim koronarnim sindromom. Žene su bile starije, s višim indeksom tjelesne mase, atrijskom fibrilacijom, infekcijama mokraćnog sustava, anamnezom hipertenzije, hipertenzijom kod prijma i višim zbirom SAPS II. pri prijmu. Muškarci su imali višu učestalost srčanog infarkta s ST-elevacijom i dilatacijske kardiomiopatije, ultrazvučno potvrđenu sniženom izbačajnom frakcijom i dilatacijom lijeve klijetke sa smanjenom izbačajnom frakcijom. Muškarci su učestalije bili pušači s anamnezom kronične opstruktivne bolesti pluća. Treba naglasiti važnost liječenja hipertenzije i atrijske fibrilacije u žena te akutnog koronarnog sindroma i kronične opstruktivne bolesti pluća u muškaraca. Agresivnu identifikaciju i liječenje svih mogućih etiologija zatajivanja srca treba preporučiti u hitnom prijmu

Serum concentration of HDL particles predicts mortality in acute heart failure patients

Clinical studies have shown that assessing circulating concentrations of high-density lipoprotein (HDL) particles by nuclear magnetic resonance (NMR) spectroscopy is superior to HDL-cholesterol in predicting cardiovascular risk. We tested the hypothesis that circulating concentrations of HDL particles predict 3-month mortality of patients with acute heart failure (AHF). Out of 152 included patients, 52% were female, additionally the mean patient age was 75.2 ± 10.3 years, and three-month mortality was 27%. Serum lipoprotein profile at admission was determined by NMR spectroscopy. Univariate logistic regression analyses revealed a significant inverse association of total (odds ratio (OR) 0.38 per 1-SD increase, 95% confidence interval (CI) 0.23-0.60, p < 0.001) and small HDL particle concentrations (OR 0.35 per 1-SD increase, 95% CI 0.19-0.60, p < 0.001) with 3-month mortality, whereas concentrations of large HDL particles (p = 0.353) or HDL-cholesterol (p = 0.107) showed no significant association. After adjustment for age, sex, mean arterial pressure, low-density lipoprotein cholesterol, glomerular filtration rate, urea, and N-terminal pro-brain natriuretic peptide, both the total and small HDL particle concentrations remained significantly associated with 3-month mortality. Based on our results, we conclude that total and small HDL particle concentrations strongly and independently predict 3-month mortality in AHF patients

Strana tijela u jednjaku i želucu pasa: učestalost, čimbenici rizika i uspješnost endoskopskog vađenja

Esophageal and gastric foreign bodies (FB) are a relatively common finding in dogs, and in certain cases can also be life threatening. Endoscopic removal of esophageal and gastric FB is the preferred treatment option. This retrospective study evaluated the medical records of 100 dogs that had undergone endoscopic removal of esophageal or gastric FB. The information obtained from the medical records included: age, breed, sex, duration and type of clinical signs, the type and location of the foreign body, the success of endoscopic removal, and short-term complications and outcome. The majority of esophageal FB were bones, while the most common type of gastric FB were toys. Even though the overall complication rate is low, in dogs with esophageal FB the development of complications is associated with the longer duration of clinical signs, whilst in gastric FB a higher rate of complications is associated with FB migration.Ezofagealna i želučana strana tijela česta su u pasa i mogu biti opasna za život. Endoskopsko uklanjanje stranih tijela iz jednjaka i želuca preporučena je i manje invazivna metoda liječenja, ali nije bez rizika. Ovim su retrospektivnim istraživanjem obuhvaćeni arhivski podaci 100 pasa iz ambulantnog protokola, koji su podvrgnuti endoskopskom uklanjanju stranog tijela iz jednjaka ili želuca. Obrađeni podaci uključivali su dob, pasminu, spol, trajanje i vrstu kliničkih znakova, tip i lokaciju stranog tijela, uspješnost endoskopskog uklanjanja, kratkotrajne komplikacije i ishod. Najčešća su strana tijela u jednjaku bile kosti, dok su u želucu to bile igračke. U pasa u kojih je zabilježeno dulje trajanje simptoma, utvrđena je veća vjerojatnost za pojavu komplikacija. Iako je ukupna pojavnost komplikacija niska, mogu se razviti potencijalno životno ugrožavajuće komplikacije, osobito u prolongiranim i neliječenim slučajevima stranog tijela u jednjaku, odnosno u slučajevima kada je strano tijelo u želucu oštar predmet sklon perforaciji

Serum concentrations of free fatty acids are associated with 3-month mortality in acute heart failure patients

Background: Plasma free fatty acids (FFA) are higher in heart failure (HF) patients compared to healthy controls. Considering that the extent of FFA elevation in HF might mirror the severity of HF, we hypothesized that the serum levels of FFA may be a useful prognostic indicator for 3-month mortality in acute heart failure (AHF). ----- Methods: We analyzed the serum samples of AHF patients obtained at admission to the emergency department. Serum levels of FFA were analyzed using an enzymatic reagent on an automatic analyzer. ----- Results: Out of 152 included AHF patients that were originally included, serum samples of 132 patients were available for the quantification of FFA. Of these, 35 (26.5%) died within 3 months of onset of AHF. These patients had significantly higher serum levels of FFA compared to AHF patients who were alive 3 months after onset of AHF. Univariable logistic regression analyses showed a significant positive association of FFA levels with 3-month mortality (odds ratio [OR] 2.76 [95% confidence interval 1.32-6.27], p = 0.010). Importantly, this association remained significant after adjusting for age and sex, as well as for further clinical and laboratory parameters that showed a significant association with 3-month mortality in the univariate analyses. ----- Conclusions: We conclude that the admission serum levels of FFA are associated with 3-month mortality in AHF patients. Therefore, measurements of circulating FFA levels may help identifying high-risk AHF patients

Serum concentrations of Citrate, Tyrosine, 2- and 3- Hydroxybutyrate are associated with increased 3-month mortality in acute heart failure patients

Considering the already established relationship between the extent of the metabolic dysfunction and the severity of heart failure (HF), it is conceivable that the metabolomic profile of the serum may have a prognostic capacity for 3-month mortality in acute heart failure (AHF). Out of 152 recruited patients, 130 serum samples were subjected to the metabolomic analyses. The 3-month mortality rate was 24.6% (32 patients). Metabolomic profiling by nuclear magnetic resonance spectroscopy found that the serum levels of 2-hydroxybutyrate (2-HB), 3-hydoxybutyrate (3-HB), lactate, citrate, and tyrosine, were higher in patients who died within 3 months compared to those who were alive 3 months after onset of AHF, which was confirmed by univariable logistic regression analyses (p = 0.009, p = 0.005, p = 0.008, p<0.001, and p<0.001, respectively). These associations still remained significant for all tested metabolites except for lactate after adjusting for established prognostic parameters in HF. In conclusion, serum levels of 2-HB, 3-HB, tyrosine, and citrate measured at admission are associated with an increased 3-month mortality rate in AHF patients and might thus be of prognostic value in AHF

Metrics of high-density lipoprotein function and hospital mortality in acute heart failure patients

OBJECTIVE: The functionality of high-density lipoprotein (HDL) is impaired in chronic ischaemic heart failure (HF). However, the relationship between HDL functionality and outcomes in acute HF (AHF) has not been studied. The present study investigates whether the metrics of HDL functionality, including HDL cholesterol efflux capacity and HDL-associated paraoxonase (PON)-1 arylesterase (AE) activity are associated with hospital mortality in AHF patients. ----- METHODS AND RESULTS: The study was performed as a prospective, single-centre, observational research on 152 patients, defined and categorised according to the ESC and ACCF/AHA Guidelines for HF by time of onset, final clinical presentation and ejection fraction. The mean age of the included patients (52% female) was 75.2 years (SD 10.3) and hospital mortality was 14.5%. HDL cholesterol efflux capacity was examined by measuring the capacity of apoB depleted serum to remove tritium-labelled cholesterol from cultured macrophages. The AE activity of the HDL fraction was examined by a photometric assay. In a univariable regression analysis, low cholesterol efflux, but not AE activity, was significantly associated with hospital mortality [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. In multivariable analysis progressively adjusting for important clinical and laboratory parameters the association obtained for cholesterol efflux capacity and hospital mortality by univariable analysis, despite a stable OR, did not stay significant (p = 0.179). ----- CONCLUSION: Our results suggest that HDL cholesterol efflux capacity (but not AE activity) contributes to, but is not an independent risk factor for, hospital mortality in AHF patients. Larger studies are needed to draw firm conclusions