EFFICACY AND SAFETY OF FIXED RAMIPRIL + FELODIPINE COMBINATION IN TREATMENT OF ARTERIAL HYPERTENSION: A RETROSPECTIVE STUDY-FORECAST

Approximately 30-50% of the world's adult population suffer from arterial hypertension, and only 30-35% is successfully treated. A large number of patients with arterial hypertension require a combination of antihypertensive medications to achieve target blood pressure. The ESH/ESC recommendations suggest the use of fixed dose combinations for treatment simplification and improved adherence to treatment.The aim of this study was to evaluate efficacy and safety of fixed ramipril + felodipine combination in therapy of essential arterial hypertension.This multicentric, cross-sectional, non-interventional study evaluated 1.341 adult patients with essential arterial hypertension, defined by systolic and diastolic blood pressure increase (BP≥140/90 mmHg), only systolic blood pressure increase or antihypertensive therapy usage. All patients were treated with fixed-dose combination therapy ramipril + felodipine (5+5mg and 2.5+2.5mg) (Triapin® and Triapin mite®) therapy for at least two months. Efficacy was evaluated by proportion of patients who achieved target blood pressure values (<140/90 mmHg and <130/80 mmHg in diabetics) or defined blood pressure reduction (≥15/10mmHg). Safety of ramipril + felodipine therapy was evaluated based on the incidence of adverse events (AE) and therapy discontinuation rate during observational period. Therapy prescription was based on physician decision according to everyday clinical practice and 15 consecutive eligible patients were enrolled by each physician from the cohort of hypertensive patients treated in ambulatory setting.Patient population consisted of 647 (48.4%) males and 690 (51.7%) females (mean age 60.15±11.84 and mean duration of hypertension 9.5±7.34 years). Males were significantly younger (58.74±15.5 vs. 61.45±11.04, p<0.01) without difference in body mass index. There were 47.5% of patients with stage II, 29.2% with stage I and 23.3% with stage III. There was a significant reduction of systolic/diastolic BP and heart rate in patients with ramipril + felodipine combination (162.6±17/97.2±9 mmHg and 79.4±12/min) compared to baseline values prior to treatment (136.9±17/84.2±9 mmHg and 73.2±10 /min, p<0.01). Group with Triapin mite had lower reduction of systolic/diastolic BP compared to Triapin 21.4±15.9/11.6±9.8 vs. 28.9±19.2/14.1±11.0 mmHg and lower reduction of heart rate 6.1 vs. 6.3 /min (p<0.01). In total, 39.3% of patients reached target BP with or without target BP reduction, 30.0% reached only BP reduction and 30.7% did not reach target values. More patients reached target BP (48.4 vs 32.%) and less achieved defined BP reduction (18.8 vs. 38.9%) on Triapin mite therapy compared to Triapin (p<0.01). The proportion of patients who failed to reach any of these endpoints is similar in both treatment modalities. AEs were present in 34 patients (2.5%): headache in 9 (0.7%), lower leg swelling in 8 (0.6%) and dry cough in 4 (0.2%) cases – these were reported as the most frequent. None of reported adverse events was serious. Therapy continuation was reported in 92.6% of patients. Reasons for therapy discontinuation were insufficient drug efficacy in 29 (2.2%) patients; AE in 28 (2.1%) patients and other reasons in 34 (2.6%) patients. Triapin therapy efficacy and safety evaluated by physicians were: excellent efficacy in 824 (61.4%) patients and excellent safety in 870 (64.9%) patients.Fixed dose combination of ramipril + felodipine was shown to be an effective antihypertensive therapy in patients with essential arterial hypertension and an alternative approach to monotherapy for the initial management of essential hypertension. Small proportion of patients discontinued from ramipril+felodipine therapy and rare AEs indicate excellent safety profile

Correlation between 24-hour profile of blood pressure and ventricular arrhythmias and their prognostic significance in patients with arterial hypertension

Background/Aim. Left ventricular hypertrophy (LVH), apart from arterial hypertension, is a risk factor for electrophysiologic heart condition disorder and sudden cardiac death. The aim of this study was to examine a relationship between complex ventricular arrhythmias and parameters of 24-hour ambulatory blood pressure monitoring in the patients with arterial hypertension and left ventricular hypertrophy (LVH), as well as their prognostic significance during a five-year follow-up. Methods. Ninety patients with arterial hypertension and LVH were included in this study (mean age 55.2±8.3 years). There were 35 healthy people in the control group (mean age 54.5±7.1 years). Left ventricular mass index was 171.9±32.4 g/m2 in the LVH group and 102.4±13.3 g/m2 in the control group. Clinical examination, echocardiogram, 24-hour ambulatory blood pressure monitoring and 24-hour holter monitoring were done in all of the examined persons. Ventricular arrhythmias were classified by the Lown classification. Results. In the LVH group there were 54 (60.0%) of the patients with ≥ III Lown class. The best predictor of a Lown class were left ventricular mass index by using multivariate stepwise regression analyses (β = 0.212; p &lt; 0.05) and small decrease of diastolic blood pressure during the night (β = -0.293; p &lt; 0.01). The main predictor of bad prognosis was left ventricular mass index during a five year follow-up (β = 0.302; p &lt; 0.01, for stepwise regression model: F = 8.828; p &lt; 0.01, adjusted R2 = 0.091). Conclusion. Left ventricular arrhythmias are frequent in patients with lower decrease of blood pressure during the night. There was no correlation between the degree of ventricular arrhythmias and parameters from 24-hour blood pressure monitoring and a five-year prognosis in the patients with arterial hypertension and LVH. A bad five-year follow-up outcome of hypertensive disease depends on left ventricular mass index

Computation of generalized inverses by using the LDL∗ decomposition

AbstractAn efficient algorithm, based on the LDL∗ factorization, for computing {1,2,3} and {1,2,4} inverses and the Moore–Penrose inverse of a given rational matrix A, is developed. We consider matrix products A∗A and AA∗ and corresponding LDL∗ factorizations in order to compute the generalized inverse of A. By considering the matrix products (R∗A)†R∗ and T∗(AT∗)†, where R and T are arbitrary rational matrices with appropriate dimensions and ranks, we characterize classes A{1,2,3} and A{1,2,4}. Some evaluation times for our algorithm are compared with corresponding times for several known algorithms for computing the Moore–Penrose inverse

ASSESSMENT OF CARDIOVASCULAR RISK AND COMORBIDITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

High rates of morbidity and mortality in patients with chronic diseases of the kidney are for the most part caused by the high prevalence of cardiovascular diseases and high rates of fatal cardiovascular events. The aim of the study was to establish the prevalence and distribution of cardiovascular risk factors in patients with chronic kidney diseases, in various stages of chronic renal failure. The examinees were classified into three groups based on the level of glomerular filtration rate: over 60 ml/min/1.73m2; 30-59 ml/min/1.73m2; and 15-29 ml/ min/1.73m2. Traditional risk factors of age, hypertension, systolic blood pressure, glycemia, diabetes, serum level of total cholesterol and triglycerides, triglyceridemia, and hypertrophy  of the left ventricle showed a significantly positive rising trend of their mean values or prevalence, inversely dependent upon the level of declining glomerular filtration rates. Mean values of serum HDL cholesterol level demonstrated a significant declining trend, concomitant with decreasing glomerular filtration rate. The prevalence of hypercholesterolemy, smoking and obesity, as well as the mean value of body mass index, showed significant intergroup variations, but without any continuing trend related to glomerular filtration rate. Non-traditional risk factors of anemia, proteinuria, and hypoalbuminemia showed a significant rising trend of prevalence inversely dependent upon the degree of reduction of glomerular filtration rate. The levels of hematocrit and serum albumins showed a positive correlation with the reduction of glomerular filtration rate. In pre-dialysis patients with chronic kidney diseases, a high prevalence of the studied cardiovascular risk factors was found. Cardiovascular risk progressively rises with decreasing glomerular filtration rate, being significantly elevated as early as the initial stages of renal failure

Analyzing Site-Specific Tractor Draft Force in Different Passes during Plowing

The difference in draft force is analyzed for six different passes during longitudinal plowing of the plot. The force is measured indirectly using four strain transducers. Values of the force are obtained by calculation after previous calibration and then measurements in the experimental field. The strain readings on the sensors installed on the outside of the tractor lower links are used. Similar values are obtained on the other two sensors installed on the inside of the links. The biggest difference is observed between the first and second pass, respectively, the second and third one for which the value of effect size amounts to 0,824 and 0,835 respectively. The study highlights draft force in the function of soil resistance as an exceptionally important parameter in the analysis of agricultural soil and suggests the expansion of current routine in precision agriculture mapping

THE EFFECT OF DEGREE AND TYPE OF LEFT VENTRICULAR HYPERTROPHY ON VENTRICULAR ARRHYTHMIAS IN HYPERTENSION

Finding the arrythmogenic potential in patients with arterial hypertension as well as its correlation with left ventricular hypertrophy (LVH), and its type and degree. The research included 109 hypertensive patients (pts) (54 male and 55 female), 54.2 ± 7.9 years old  without symptomatic coronary disease, myocardial infarction and  systolic dysfunction. All the pts had a clinical examination, ECG, 24 h Holter monitoring with Lown classification of ventricular arrhythmias, an echocardiogram with left ventricular mass index (LVMI) and a specific type of LVH. QT interval dispersion (QTd) was calculated on 12 leads standard ECG. 75 pts had LVH (LVMI: 172.6 ± 42.95 g/m2) while 35 pts were without LVH (109.3 ± 15.9 g/m2). Non sustained ventricular tachycardia was registered in 13 pts (17.6%) with LVH and 1 female patient without LVH (2.9%). Patients with VT had a considerably higher ILVM (214.9 ± 6.8 vs. 151.9 ± 47.2 g/m2) than the average and higher QTd (73.7 ± 19.1 vs. 55.2 ± 20.2). VT was registered in 3/19 (15.8%) with eccentric nedilated type LVH, 6/38 (15.8%) with concentric LVH, 1/11 (9.1) (disproportional septal LVH) and 3/5 ( 60%) with dilated LVH. Univariate analysis showed a considerable correlation between the degree of arrhythmias and ILVM (p<0.001) and QTd (p=0.012). Ventricular arrhythmias in patients with arterial hypertension are considerably correlated to the degree of LVH expressed in ILVM and QTd

Impact of street level traffic emissions (CO2, CO, NOX, PM AND VOC) on outdoor temperature and thermal comfort in complex urban environment

Abstracts of Keynote Invited Lectures and Contributed Papers : the 6th WeBIOPATR Workshop & Conference - Particulate Matter: Research And Management WeBIOPATR 2017 (6-8 September 2017; Belgrade)Conference proceedings available at [https://vinar.vin.bg.ac.rs/handle/123456789/12219

ANALYSIS OF THE USE OF THE CODE OF ETHICS OF AGRICULTURAL ACCOUNTANTS USING QUANTITATIVE METHODS

This paper investigates the possibility of applying the meta theory of strategic games in the domain of the ethical code of conduct of agribusiness accountants. The focus is on the case when an accountant detected incorrect financial reporting by the client’s management of material nature. As a generally quantitative method, the model of strategic games in such a case allows to quantify and find a balanced relationship between the interests of management and accountants in the world where, there is constantly sustainable problem of ethics and unethics of accountants, which is an extremely important issue in the agricultural sector, which is a developing branch

LUNGWORM INFECTION OF SMALL RUMINANT IN BELGRADE AREA

The grazing diet allows the permanent contact of small ruminants with intermediate hosts and the eggs and larval forms of the parasite. From these reason parasitic infections are present worldvide in a large number of herds. Lungworms of domestic ruminants are nematodes that belongs to the phylum Nemathelmenthes commonly named as round worms; classified under the super family Trichostrongyloidea and Metastrongyloidea of which Dictyocaulus and Protostrongylus are causes of lungworm infection in ruminants. They induce verminous pneumonia which was a significant health problem of small ruminant. Due to their importance in the pathology of small ruminants, in 2020 we conducted a survey of their presence in the Belgrade area. Investigations included 23 herds. In total, 250 fecal samples were examined by the Berman method. Determination of parasites was based on its morphological characteristics. Dictyocaulus filaria was ocurerd at 23.20% of small ruminants heards. The highest prevalence is observed in the places where predominate flat plain pastures. Due to microclimatic conditions, the infection usually occurs in the period April-May when the largest number of animals are grazing. Clinically manifested disease occurs in kids and lambs that are grazed for the first time in the second half of the grazing season. Protostrongylinae are biohelminthes and need intermediate hosts for their development - snails and slugs. Due to microclimatic conditions, the infection usually occurs in the March and April when the largest number of intermediate host are preset at pasture. Protostrongylus rufescens occurred on 21.22%. These nematodes live in bronchioles and alveoli. The prevalence ranges was from 4.23%. Based on the results obtained, we can conclude that a large number of sheep and goats in Belgrade are infected with pulmonary strongilides. Dictyocaulus filaria and Protostrongylus rufescens are the dominant species, while Muellerius capillaris are present in a smaller percentage

Investigation of different extraction procedures for the determination of major and trace elements in coal by ICP-AES and ion chromatography

This paper presents the extraction of major and trace elements from a coal sample, in deionized water, by using three different extraction techniques. Rotary mixing and ultrasonic extraction were examined for different extraction times, while the microwave-assisted extraction was performed at different temperatures. Metal concentrations (Na, K, Ca, Mg, Al, Fe, Mn, Be, Cd, Co, Cr, Hg, As, Ni, Se, Sb and Pb) in solution were determined employing inductively coupled plasma atomic emission spectrometry; whereas the results obtained for Na, K, Ca and Mg were compared employing ion chromatography. Comparing the rotary-and ultrasonic-assisted extractions, it was shown that the former technique was more efficient for the determination of Fe, Na and Pb, whereas the latter one proved more efficient for the determination of Co and Cr ions. Microwave-assisted extraction was shown to be the most efficient method for all the tested elements in coal. In addition, sequential extraction of the elements was realized using microwave digestion. The results of the sequential extraction experiments indicated associations of investigated elements with a mineral phase and organic matrix. Sequential extraction provided information on possible leaching of As, Cd, Co, Cr, Ni, Pb, Fe and Mn under environmental conditions