Possibilities and modes of medical rehabilitation of patients with concomitant occurence of acute coronary syndrome and acute stroke

Background: Being the most austere manifestation of ischaemic heart disease, acute coronary syndrome is one of the most frequent causes of urgent treatment and sudden death in both developed and developing countries as well. Acute stroke is the third cause of death in developed countries, after cardiovascular diseases and tumors, and second worldwide. Besides being a disease with high mortality, it is also a disease with a highest level of disability. Aim: To determine possibilities and modes of rehabilitation of patients with concomitant occurence of acute stroke and acute coronary syndrome. Methods: Retrospective study using hospitalized patients data. 5929 hospitalized patients treated at the Institute for cardiovascular diseases in Sremska Kamenica were analyzed from January 1st 2017 to December 31st 2019, without regarding sex and age. We entered data in created database and analyzed using descriptive statistics and chi-square test. Results: Concomitant stroke and acute coronary syndrome was found in 61 patient (1.0%). There were 32 males and 29 females. Average age was 68.82. Pneumonia occured more frequently in persons with concomitant occurrence of acute stroke and acute coronary syndrome than in persons with acute coronary syndrome without acute stroke. Regarding neurological and/or cardiological condition, only 3 patients (9.0%) were eligible for rehabilitation, and in all others it was delayed or contraindicated. Conclusion: Rehabilitation of patients with concomitant occurrence of acute coronary syndrome and acute stroke was complicated, with high risk, and required multidisciplinary approach to each patient individually

The olfactory bulb - gateway for SARS-Cov-2?

Introduction. Anosmia and ageusia are one of the most common and characteristic symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection, with a frequency of almost 50% in patients in Western countries. Hypotheses proposing that the virus potentially affects the central nervous system (CNS) are on the rise. One hypothesis suggests that the virus enters via nasal mucosa and then enters the olfactory bulb via cribriform plate, with further dissemination to the CNS. Case report. A 34-year-old female patient experienced the loss of the sense of smell and taste about two months before testing positive for SARS-Cov-2. Coronavirus disease 2019 (COVID-19) presented with minor pneumonia and worsening anosmia and ageusia. After treatment, the patient recovered well, but anosmia and ageusia appeared again, varying in intensity, and since February 2021, they have become persistent. The case was evaluated by an otorhino-laryngologist, pulmonologist, and finally, a neurologist. In the meantime, the patient tested negative for SARS-Cov-2 and received two doses of the Sputnik V vaccine. Brain magnetic resonance imaging (MRI) was performed, and it clearly showed severe bilateral olfactory bulb atrophy. The patient has had anosmia and ageusia up to this day, and future MRI follow-up is planned. Conclusion. Loss of sense of smell and taste may be a predictor of further CNS dis-semination of the virus and possible neurological complications (which is still a subject of consideration). The olfactory bulb could be a gateway to COVID-19 intrusion into the CNS, and its atrophy could be an indicator of the process. Further investigation on this topic is required, including a wide application of MRI, in order to come to definite conclusions

Autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis

Introduction. Autoimmune polyglandular syndrome type 2 is defined as adrenal insufficiency associated with autoimmune primary hypothyroidism and/or with autoimmune type 1 diabetes mellitus, but very rare with myasthenia gravis. Case report. We presented a case of an autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis. A 49-year-old female with symptoms of muscle weakness and low serum levels of cortisol and aldosterone was already diagnosed with primary adrenal insufficiency. Primary hypothyroidism was identified with low values of free thyroxine 4 (FT4) and raised values of thyroidstumulating hormone (TSH). The immune system as a cause of hypothyroidism was confirmed by the presence of thyroid antibodies to peroxidase and TSH receptors. Myasthenia gravis was diagnosed on the basis of a typical clinical feature, positive diagnostic tests and an increased titre of antibodies against the acetylcholine receptors. It was not possible to confirm the immune nature of adrenal insufficiency by the presence of antibodies to 21- hydroxylase. The normal morphological finding of the adrenal glands was an indirect confirmation of the condition as well as the absence of other diseases that might have led to adrenal insufficiency and low levels of both serum cortisol and aldosterone. Hormone replacement therapy, anticholinergic therapy and corticosteroid therapy for myasthenia gravis improved the patient’s general state of health and muscle weakness. Conclusion. This case report indicates a need to examine each patient with an autoimmune disease carefully as this condition may be associated with another autoimmune diseases

Chronic inflammation and lipid profile parameters in obese subjects with normal and disturbed glucose metabolism

Introduction/Objective. In different states of increased chronic inflammation, like obesity and diabetes, early changes in lipid metabolism could represent an adaptive response aimed at diminishing the elevated inflammatory reaction. The aim of study was to investigate the impact of glucose tolerance status on relationship between chronic inflammation and lipid metabolism parameters. Methods. The study consisted of four groups (n = 30 for each group): obese individuals with disturbed glucose metabolism (subjects with newly diagnosed type 2 diabetes (T2DM)) before and after metformin treatment initiation, obese subjects with normal glucose tolerance (NGT) and a control group of healthy normal weight subjects. Appropriate anthropometric measurements and laboratory tests were carried out in all participants. Results. Among the sub-group of obese subjects, the association of highly sensitive C reactive protein (hsCRP) with triglycerides and lipoprotein (a) (Lp(a)) was especially pronounced in the group of T2DM subjects before treatment initiation. In this group, the level of inflammation was the highest and correlation coefficients of triglycerides and Lp(a) with hsCRP were significantly different compared with the group of obese without diabetes (r = 0.21 vs. r = -0.36; p = 0.0172) for triglycerides and (r = -0.17 vs. r = 0.36, p = 0.0324) for Lp(a). Correlations of hsCRP with triglycerides and Lp(a) in groups of NGT obese subjects and T2DM subjects after treatment initiation did not differ significantly. Treatment with metformin changed the relationship of hsCRP with triglycerides and Lp(a) to the one which is similar to the relationship observed in obese NGT subjects (r = 0.21 vs. r = 0.38; p = 0.2449) for triglycerides and (r = -0.17 vs. r = -0.27, p = 0.3562) for Lp(a). Conclusion. In subjects with newly diagnosed T2DM, who have the highest level of inflammation, it is probable that the increase in triglycerides is a part of the anti-inflammatory response, whereas Lp(a) is probably produced and used in the reduction of elevated inflammation

The impact of currently used oral antihyperglycemic drugs on dysfunctional adipose tissue

Obesity is a disease with pandemic frequency, often accompanied by chronic metabolic and organic complications. Type 2 diabetes mellitus (T2DM) is among the most common metabolic complications of obesity. The first step in the treatment of T2DM is medical nutrition therapy combined with moderate physical activity and with advice to patients to reduce their body weight. Pharmacotherapy starts with metformin, and in the case of inadequate therapeutic response, another antihyperglycemic agent should be added. The most clinical experience exists with sulfonylurea agents, but their use is limited due to high incidence of hypoglycemia and increase in body weight. Based on the fact that dysfunction of adipose tissue can lead to the development of chronic degenerative complications, precise use of drugs with a favorable effect on the functionality of adipose tissue represents an imperative of modern T2DM treatment. Antihyperglycemic drugs of choice in obese individuals are those which cause maturation of adipocytes, improvement of secretion of protective adipokines, and redistribution of fat mass from visceral to subcutaneous depots. Oral antihyperglycemic agents that can affect the functionality of adipose tissue are metformin, SGLT-2 inhibitors, DPP-4 inhibitors, and thiazolidinediones