Прогностичка улога на срцевите биомаркери кај пациентите со миокарден инфаркт

Позадина: Во дијагнозата на миокардниот инфаркт, освен електрокардиограмот, голема улога имаат и срцевите биомаркери, кои освен дијагностичка имаат и прогностичка улога. Прогностичката улога на срцевите биомаркери е докажана во светската научна литература, но во нашата земја досега не е опишана. Коронарната артериска болест, вклучително и миокардниот инфаркт претставува водечка причина за смрт во светски рамки и како таква претставува важен проблем за јавното здравје. Опис на методологијата: Испитувањето беше дизајнирано како лонгитудинална, проспективна кохортна клиничка студија и истото беше спроведено на Универзитетската клиника за кардиологија во Скопје. Во истражувањето беа вклучени 150 пациенти, хоспитализирани за акутен миокарден инфаркт и третирани со ПКИ реваскуларизација. Клинички податоци, биомаркери како: стрес гликемија, гликемија на гладно, гликолизиран хемоглобин HbA1c, hsTn, NT-proBNP, креатинин, степен на гломеруларна филтрација (eGFR), уреа, крвна слика и електролити беа измерени на прием и при редовните клинички контроли. Исто така, ехокардиографија на прием, и при редовните клинички контроли беше направена за да се класифицираат пациентите со АМИ со редуцирана, лесно редуцирана и/или зачувана ЛВЕФ и да се идентифицира транзицијата на пациенти (особено оние од групата на лесно редуцирана ЛВЕФ). Првата контрола на пациентите беше направена во период од 3 до 6 месеци по индексниот настан, со контрола на варијаблите од интерес (биохемиски, ЕКГ и ехокардиографски параметри). Резултати: Во тек на средниот период на следење од 39,3 месеци, кај пациенти беа регистрирани кардиоваскуларни настани, кои беа поделени во подгрупи – АКС; СС; ЦВИ; смрт (срцева и несрцева). Од вкупно 150, кај 48 (32%) од пациентите беа регистрирани кумулативно 70 МАСЕ, последователно АКС со потреба од хоспитализација и/или реваскуларизација кај 21 (14%), СС со потреба од хоспитализација кај 19 (12,7%), ЦВИ кај 6 (4%), смртен исход кај 24 (16%), и тоа 11 (7,3%) срцева и 13 (8,7%) несрцева смрт. 30-дневната смртност беше 3,3% (5 пациенти), додека едногодишната смртност во првата година по ИМ беше 6,1% (9 пациенти). Од вкупниот број на пациенти со несрцева смрт, кај 5 пациенти истата настапила во тек на КОВИД-19 болест, додека кај 4 пациенти во склоп на малигна болест. Како независни предиктори на мајорни несакани срцеви настани се издвоија: времетраење на хоспитализација во тек на индексниот настан, број на заболени КА, ЛК крајно-систолен дијаметар, примање на loop диуретици при испис од болница и биохемиски обележја NTproBNP и неможноста да се постигне добра глико-контрола. Заклучок: Користењето на срцевите биомаркери, заедно со докажаните биохемиски и ехокардиографски варијабли може да се искористи за оптимизирање на терапијата на пациенти со акутен миокарден инфаркт, како и да се превенираат несаканите срцеви настани по епизода на миокарден инфаркт. Клучни зборови: срцеви биомаркери, акутен миокарден инфаркт, главни несакани срцеви настани, кардиоваскуларни ризик фактори, срцева слабост

Effectiveness Study On longitudinal Laboratory monitoring Of the INR in Patients Receiving Vitamin-K Antagonist For Atrial Fibrilation in R.Macedonia

Atrial fibrillation is preventable cause for ischemic stroke and various other thrombo-embolic events. One of the main agents used in the prevention of the consequences are the vitamin-K antagonists. Although efficacy is proven, studies have questioned their efficiency in this setting. Various factors contribute to variations of their efficiency, which is still underinvestigated in many health systems. Few studies have shown varied estimates and cited different reasons for its effectiveness, ranging from subtle differences in diet, concurrent medications use, variable level of enzyme activity to age and compliance of users, which can vary unexpectedly. The aim of the present study of effectiveness is to describe how often patients that use VKA achieve the targeted values for INR. The population consists of the hospital reach area of Clinical Hospital Tetovo, observed for 6 months with routine laboratory investigation for the values of INR. Our study reveals that 57.4% of all measurements of INR where within the target values between 2-3, while 9.7% of all measurements revealed extreme values that can put patients at risk for further thrombo-embolic events or catastrophic hemorrhagic events

Effectiveness of Vitamin K antagonist for secondary prophylaxis of brain stroke in patients with atrial fibrillation in routine public care settings

Vitamin K antagonists are the mainstay for prevention of strokes in patients with atrial fibrillation (AF) world-wide. Yet estimates on its effectiveness are heterogeneous and reveal stark differences between different health-care systems. The aim of the present study was to assess the laboratory parameters for achieving the goal of the therapy (Time in therapeutic range – TTR) and to describe the effectiveness of the therapy in real-time setting. Methods : Patients treated in our clinic, with confirmed AF were considered in the study. The study was prospective observational study by design, where the participants were assessed at baseline for known risk factors for stroke, diagnosis for atrial fibrillation, use of anticoagulant medication and presence of identifiable ischemic lesions in the brain with non-contrast computed tomography (NCCT). The drug of choice was acenocoumarol, with planned monthly measurements of INR with the duration of 6 months, and the study was concluded with additional NCCT at the end, in order to assess for differences. Results : 96 patients finished the observation. The mean age of the patients was 64.5 years (SD = 6.36), and 50 (52%) were male. Regarding the INR measurement, we collected data from 88.2% of the planed measurements; 69.7% of the patients achieved TTR above 60%. Cross-comparison between groups (TTR 60%) revealed that the first group had statistically significant higher proportion of patients with newly registered lesions on NCCT (p-value < 0.05). Conclusion: Acenocoumarol is the only therapeutic VKA option in our country, despite the availability of other VKA antagonists that show better indices for effectiveness. Our sample confirmed that the proper use of VKA significantly reduces the incidence of new NCCT ischemic lesions in conditions of routine public health care

Навики во исхраната и нутритативниот статус на децата

Раното детство е најважно за целокупниот развој на личноста. Во овој период кај детето се јавува сознание дека тоа е самостојна единка која и припаѓа на својата средина, а се изразува преку определени барања, желби, акции, постапки и однeсување

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score &lt;3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score &lt;3 (mean 1.7), and 82 had score ≥3 (mean 3.5), p&gt;0.001. Patients with ST-segment elevation MI had OR 2.1 (p&gt;0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p &gt; 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after MI

Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases

INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival

Factors Influencing Recurrence Rate and Survival of Patients with Colorectal Metastases after Liver Resection

BACKGROUND: Early recurrence implies low percentage of long survival, whereas the opportunity for re-resection in selected patients represents optimal treatment with long survival. The total 5-year survival rate after hepatectomy is up to 50%, with a number of factors that are independent clinical predictors of long survival. AIM: This study aims to analyze the patient’s data from the clinic of general and hepatobiliary surgery in Aleksandrovska Hospital in Sofia, Republic of Bulgaria, in the treatment of patients with colorectal metastases of the liver and to determine the survival factors in those patients. MATERIALS AND METHODS: A retrospective study was conducted between of January 1st, 2006 and December 31st, 2015. A total of 239 patients were included: 179 patients were treated with radical operation, 5 with palliative intervention, while 55 operative explorations were performed. RESULTS: The type and the extent of resection do not affect the occurrence of local recurrence. The size, number, and metastase localization do not affect the occurrence of intrahepatic recurrence but showed characteristics of significant predictors in cumulative and mean survival. CONCLUSION: Metastases type, number and localization and metastases in lymphatic nodes and other organs were determined as predictors of long survival of patients with colorectal metastases after resection

The Influence of Resection Size and Pringle Maneuver on Operating Time and Intraoperative Bleeding in Patients with Colorectal Metastases in the Liver

BACKGROUND: The extent of the resection, whether clamped or non-clamping resection is factor that influences the operating time and intraoperative bleeding, the development of modern techniques for vascular control and resection, and determine of lesser blood loss, morbidity, and mortality. AIM: The aim of this study was to determine the experience of General and Hepatobiliary Surgery Clinic at Aleksandrovska Hospital Sofia, Republic of Bulgaria in the treatment of patients with colorectal metastases in the liver and to compare literature reports on the influence of the extent of resection and Pringle maneuver (IPM) on operating time and perioperative bleeding. MATERIALS AND METHODS: This retrospective study covers the time period from January 01, 2006, until December 31, 2015. A total of 239 patients were included, from which: 179 patients were treated with radical surgery, 5 with palliative intervention, and 55 were subjected on operability exploration. RESULTS: The use of the IPM for vascular control insignificantly influenced the prolonged operative time, while intraoperative blood loss was significantly lower in patients with Pringle <15 min. There was no association between IPM and resection type, while intraoperative blood loss and operating time were significantly greater in patients with major resection. CONCLUSION: Resection size is directly proportional to operating time and perioperative blood loss, but it does not significantly influence perioperative morbidity. The IPM does not influence operating time, while blood loss is significantly lower in the group of patients with Pringle <15 min

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI). AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI. METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score <3 and ≥3). RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score 0.001. Patients with ST-segment elevation MI had OR 2.1 (p>0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p > 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively). CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after M

Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome

BACKGROUND: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predictors of major adverse cardiac events (MACE) following discharge still remains limited. Assessment of left ventricular (LV) function, combined with the use of cardiac biomarkers, such as NT-proBNP can help in the early identification of patients at risk of developing heart failure and/or other MACE in acute MI (AMI) survivors. AIM: The aim of the study was to identify early predictors of MACE in MI patients, that underwent primary percutaneous coronary intervention, with special emphasis on cardiac biomarkers. MATERIALS AND METHODS: We analyzed clinical, LV functional, angiographic variables, as well cardiac troponin (hsTn), a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study was designed as longitudinal, prospective observational cohort study undertaken on 150 AMI patients hospitalized at University Clinic of Cardiology over the period of September 2018 to March 2019. Inclusion criteria: All incomers hospitalized for AMI over the aforementioned period who were willing to participate in the study and gave signed informed consent. Exclusion criteria: Patients who were not consented to participate in the study, patients who suffered in-hospital mortality over the index hospitalization and those with the previous HF and/or AMI. IBM SPSS statistical software version 22 was used for statistical analysis. Descriptive and comparative statistical methods were applied. Continuous variables were presented as means, while categorical as frequencies and percentages. Comparative statistic tests: Chi-square test, for variables with dichotomous distribution, t-test and one-way ANOVA for continuous variables with two or more categories were applied. Risk ratios with 95% confidence intervals were calculated, and the significance was determined using Cochran and Mantel-Haenszel test (at the level of <0.05). Receiver operator characteristic curves (ROC) were used for prediction capability. Correlations, uni- and multivariate linear, and logistic regression analysis were undertaken to identify significantly associated variables. RESULTS: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p = 0.007), number of diseased vessels (p = 0.027), and need for loop diuretic therapy (p = 0.050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve 0.640, and 0.658, p = 0.025 and 0.011, respectively). CONCLUSION: The combination of biomarkers for myocardial stress and inflammation improves the prediction of MACE in MI survivors