Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center, prospective longitudinal study

Aim To determine if red cell distribution width (RDW) is associated with all-cause mortality in patients on chronic dialysis and to evaluate its prognostic value among validated prognostic biomarkers. Methods This is a single center, prospective longitudinal study. At the time of inclusion in January 2011, all patients were physically examined and a routine blood analysis was performed. A sera sample was preserved for determination of NT-pro-brain natriuretic peptide (NT-pro-BNP) and eosinophil cationic protein. Carotid intima media thickness (IMT) was also measured. Following one year, all-cause mortality was evaluated. Results Of 100 patients, 25 patients died during the follow- up period of one-year. Patients who died had significantly higher median [range] RDW levels (16.7% [14.3-19.5] vs 15.5% [13.2-19.7], P < 0.001. They had significantly higher Eastern Cooperative Oncology Group (ECOG) performance status (4 [2-4] vs 2 [1-4], P < 0.001), increased intima-media thickness (IMT) (0.71 [0.47-1.25] vs 0.63 [0.31-1.55], P = 0.011), increased NT-pro-BNP levels (8300 [1108-35000] vs 4837 [413-35000], P = 0.043), and increased C-reactive protein (CRP) levels (11.6 [1.3-154.2] vs 4.9 [0.4-92.9], P < 0.001). For each 1% point increase in RDW level as a continuous variable, one-year all cause mortality risk was increased by 54% in univariate Cox proportional hazard analysis. In the final model, when RDW was entered as a categorical variable, mortality risk was significantly increased (hazard ratio, 5.15, 95% confidence interval, 2.33 to 11.36) and patients with RDW levels above 15.75% had significantly shorter survival time (Log rank P < 0.001) than others. Conclusions RDW could be an additive predictor for allcause mortality in patients on chronic dialysis. Furthermore, RDW combined with sound clinical judgment improves identification of patients who are at increased risk compared to RDW alone

Carotid Endarterectomy Unexpectedly Resulted in Optimal Blood Pressure Control

Resistant hypertension is defined as hypertension that remains above 140/90 mmHg despite the provision of three or more antihypertensive drugs in a rational combination at full doses and including a diuretic. It is associated with adverse clinical outcome and therefore requires aggressive medical treatment. We present a case of 70-year-old woman who was treated for resistant hypertension with a diuretic, ACE-inhibitor, calcium channel blocker, and with centrally acting antihypertensive, moxonodine. Despite of aggressive medical treatment her blood pressure remained above 160/90 mmHg continuously. Large diagnostic workup excluded common causes of secondary hypertension, but revealed significant carotid stenosis present on left internal carotid artery. Carotid endarterectomy was performed in order to improve cerebrovascular prognosis, but unexpectedly resulted in optimal control of her blood pressure. Two months after operation patient was on only one antihypertensive drug, having blood pressure below 130/85 mmHg. We suggest that in selected patients resistant hypertension could be associated with carotid stenosis and carotid sinus baroreceptor dysfunction. For definite conclusions further studies are warranted

Malonaldehyde and Erythrocyte Antioxidant Status in Children with Controlled Asthma

In the pathogenesis of asthma, oxidative stress appears to play an important role and existence of an oxidant/antioxidant imbalance is evident. In this study the key markers of oxidative stress and lipid peroxidation in the pathogenesis of asthma in childhood in comparison to healthy subjects were investigated. Plasma marker of the lipid peroxidation: malondialdehyde (MDA), the erythrocytes antioxidative enzymes: glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), glutathione reductase (GR) and cysteine-containing tripeptide glutathione (GSH) were evaluated by spectrophotometric methods using blood samples collected from 37 healthy children and 44 asthmatic patients. The GSH-Px activity was significantly lower in asthmatic children (3.99±1.0 IU/g Hb) than in healthy controls (4.61±1.3 IU/g Hb; p0.05). Lower GSH-Px activity in children with controlled asthma showed deficient erythrocyte antioxidant defence and evidence of association between oxidative stress and asthma in childhood. Preserved activity of GR and SOD, together with concentration of GSH and MDA, still seems to be crucial in controlling antioxidant/oxidant balance of the disease

Interventional cardiology in 2012: comparability of Croatia with international trends.

Intervencijska kardiologija jedno je od najbrže rastućih područja današnje medicinske znanosti, a tehnološka i farmakološka otkrića unutar tog područja unazad samo nekoliko godina dovela su do značajnih promjena u liječenju i prognozi bolesnika sa srčanožilnim bolestima. Prvenstveno je uloga intervencijske kardiologije u poboljšanju ishoda liječenja najjasnije vidljiva u akutnom koronarnom sindromu, a uspješne mreže primarne perkutane koronarne intervencije u akutnom infarktu miokarda predstavljaju jedno od najvećih dostignuća moderne kardiologije, a možda i medicine uopće. Dok je uloga intervencijske kardiologije u akutnoj koronarnoj bolesti jasna, stabilna koronarna bolest srca i dalje ostaje predmet javne rasprave te predmet brojnih istraživanja. Nove tehnologije i materijali u liječenju koronarne bolesti srca od 2012. postaju dostupne diljem svijeta, pa tako i u Hrvatskoj, a njihova implementacija isključivo ovisi o financijskim okolnostima. Novi antitrombocitni i antiagregacijski lijekovi također su predmet istraživanja, a sve u potrazi za (poželjno) jednim lijekom koji će u kardiovaskularnoj intervenciji imati najbolji omjer učinkovitosti i sigurnosti. Ova godina bila je i godina punog zamaha intervencijskog liječenja strukturne bolesti srca, napose aortne stenoze i mitralne regurgitacije, a kardioembolizacija, arterijska hipertenzija i periferna vaskularna bolest također postaju sve šire „igralište“ za intervencijske kardiologe. U ovom preglednom članku prikazali smo sve te moderne trendove u intervencijskoj kardiologiji protekle godine u svijetu i usporedili ih sa stanjem u Hrvatskoj.Interventional cardiology became among the fastest growing areas in clinical medicine, thanks to technological and pharmacological discoveries over the last few years, which brought important advancements in treatment and overall prognosis of patients with cardiovascular diseases. Benefits of primary interventional treatments became particularly evident in management of acute coronary syndrome, especially in circumstances of organized network of primary percuteneous coronary interventions, which represented crucial step in development of modern era in cardiology, or even medicine. On the other hand, interventional management of chronic ischemic heart disease recently came to greater focus of attention as the issue of professional challenge, due to exceedingly grown number of investigations. New technologies and devices for treatment of coronary artery disease become available in 2012 in the world market, as well as in Croatia. However, their implementation for the most depends on availability of financial resources. Further efforts were made around research on novel antiplatelet and antiaggregation drugs, with an aim to develop the agent that would preferably exert greater efficiency, within more favorable safety profile. This was the year in which interventional treatment extended on the structural heart diseases as well particularly due toincrease in treatment of aortic stenosis and mitral regurgitation, whilst cardioembolization, arterial hypertension and peripheral vascular disease become ever more attractive "battlefield" for interventional cardiologists. In this review article, we have presented all those modern trends in interventional cardiology in the past year at an international level and compared them to the situation in Croatia

PRODUCTION - HEMATOLOGICAL PARAMETERS OF LAMBS FED DIETS CONTAINING PUMPKIN SEED CAKE

Cilj ovoga istraživanja bio je utvrditi mogućnost zamjene soje, kao najčešćeg izvora bjelančevina u obrocima janjadi, pogačom sjemenki bundeve, nusproizvoda u proizvodnji ulja te utvrditi njihov utjecaj na proizvodno hematološke pokazatelje janjadi. Istraživanje je provedeno na 20 Merinolandschaf janjadi u dobi od 70 dana. Janjad je ravnomjerno podijeljena prema spolu u dvije skupine: kontrolna hranjena smjesom sa sojom kao izvorom bjelančevina u krmnoj smjesi i pokusna u kojoj je soja zamijenjena sa 7% pogače sjemenki bundeve. Sijeno i vodu janjad je imala na raspolaganju ad libitum. Tjelesne mase, tjelesne mjere i uzorci krvi janjadi uzeti su 0., 15., i 30. dana istraživanja. Nakon toga izračunati su prosječni dnevni prirasti, konverzija hrane i indeksi tjelesne razvijenosti janjadi. Analizom dobivenih rezultata na kraju istraživanja nisu utvrđene značajne (P>0,05) razlike u tjelesnoj masi (29,80 : 28,98 kg), tjelesnim mjerama i indeksima tjelesne razvijenosti janjadi ovisno o skupini. Također, nisu utvrđene statistički značajne (P>0,05) razlike u prosječnom dnevnom prirastu između kontrolne i pokusne skupine janjadi (232 : 230 g). Konverzija heane je u kontrolne skupine janjadi iznosila 3,54 kg/kg, a u pokusne 3,62 kg/kg. Korištenjem pogače sjemenki bundeve kao izvora bjelančevina u obrocima janjadi nije došlo do promjene proizvodno - hematoloških pokazatelja janjadi. Upotrebom pogače sjemenki bundeve u obrocima janjadi moguća je zamjena soje upitnog genetskog podrijetla i zdravstvene ispravnosti. Zbog ekološkog načina proizvodnje bundeve, još više se može naglasiti hranidbeno-dijetetska ispravnost janjetine, a ekološki proizvođači mogli bi imati na raspolaganju odgovarajući izvor bjelančevina.The aim of the research was to determine the possibility of replacing soybeans as the most common source of protein in the diets with pumpkin seed cake by-products in oil production and to determine the influence on lamb production and their haematological indicators. The study was conducted on 20 Merinolandschaf lambs at the age of 70 days. Lambs were evenly divided by gender and then allotted to two treatment groups: control with the soybean as a source of protein in a fodder mixture and experimental in which the soybean was replaced with 7% of pumpkin seed cake. Lambs had hay and water ad libitim. Body weight and lamb blood samples were taken on day 0, 15, and 30 of the study. In addition, the average daily gain, conversion, and lambs indexes of physical development were calculated. Analysis of the obtained results at the end of the study did not reveal significant (P>0.05) differences in body weight (29.80 : 28.98 kg), body measurements and indexes of physical development of lambs fed soybean and pumpkin seed cake. In addition, there was no significant (P>0.05) differences in average daily gain between the control and experi-mental group of lambs (232 : 230 g). Conversion in the control group of lambs was 3.54 kg/kg and in the experimental group of lambs 3.62 kg/kg. By consummation of pumpkin seed cake as a source of protein in rations of lambs there was no change in production - haematological parameters of lambs. By using pumpkin seed cake in rations of lambs it is possible to substitute soybean of suspected genetic origin and health safety. With regard to ecological pumpkin production, it is possible to emphasize the nutritional and dietary quality of lamb’s meat, and the organic producers might have the adequate protein source available

Povezanost eozinofilnoga kationskoga proteina s uznapredovalošću ateroskleroze karotidne arterije i sveukupnim preživljenjem bolesnika na programu kronične hemodijalize [Correlation of eosinophil cationic protein with severity of carotid atherosclerosis and all-cause mortality in patients on hemodialysis]

The prevalence of cardiovascular diseases in patients with renal insufficiency treated with chronic dialysis is high. It is considered that increased prevalence of cardiovascular diseases in this population is a result of accelerated atherosclerosis which is associated with “new” risk factors such as highly sensitive protein C (hs CRP), proband brain natriuretic peptide (NT-pro-BNP), homocysteine, lipoproteine (a), inflammation and oxidative stress. Eosinophile cationic protein (ECP) is zinc cationic protein which is stored in human organism in the eosinophiles’ granolas. According to the recent studies serum concentration of ECP in proportional to severity of coronary atherosclerosis, and it is considered as biomarker of coronary atherosclerosis. The aim of this study is to investigate the correlation between ECP and surrogates of atherosclerosis and to investigate whether there is prognostic significance of biomarkers such as ECP, hsCRP, red cell distribution width (RDW) in regard to overall survival of patients on chronic hemodialysis. Results of our research show that patients on chronic dialysis have advanced atherosclerotic changes on carotid arteries (intima media thickness – IMT 0,68±0,19; overall severity of plaque burden – PS 14,75±14,85) and significantly higher serum concentrations of ECP (ECP 17,01±14,12) in regard to general population (IMT 0,50±0,12, PS 6,57±3,75, ECP 10,78±9,38) (P<0,0001; p<0,0001; P=0,0012, respectively). According to our results there is no statistically significant correlation between ECP and IMT (rho 0,168, P=0,0938). Between ECP and overall severity of plaque burden of carotid arteries there is statistically significant, but marginal correlation (r=0,234, P=0,0193). We have validated prognostic significance of previously known important biomarkers such as hsCRP. In univariate Cox proportional analysis ECP is identified as statistically significant prognostic marker (HR 1,0322, P=0,049), but after correction for known risk factors for atherosclerosis, it became insignificant. We have identified RDW as strong independent and additive prognostic biomarker of overall survival of patients on chronic dialysis (HR 1,5346; P=0,0028) which remained significant even after correction for known atherosclerotic risk factors. In the population of patients treated with chronic dialysis ECP does not represents significant biomarker of carotid atherosclerosis, and as such it does not have clinical applicable value. RDW seems as an independent and additive prognostic biomarker for overall survival of patients on chronic dialysis