Influence of fibrinogen and C-RP on progression of peripheral arterial disease in type 2 diabetes: A preliminary report

BACKGROUND: Limited studies have suggested that inflammatory biomarkers play a role in the initiation and progression of atherosclerosis in diabetic patients. This study assesses the effect of inflammatory biomarkers: fibrinogen and C-reactive protein (C-RP) on the progression of peripheral arterial disease (PAD) in type 2 diabetic (T2D) patients. METHODS: Sixty two patients with T2D and PAD (mean age 60.28 ± 27 years and diabetes duration of 8.58 ± 6.17 years) were enrolled in a cohort prospective study of 36 months. Ankle-brachial index (ABI) was measured in all patients at baseline and after 36 months. Multiple linear regression analysis was used to determine the predictivity of variables for fibrinogen, C-RP, plasma lipid fractions, fasting plasma glucose, Body Mass Index (BMI), duration of diabetes status and the age on changes in ABI value. RESULTS: Linear regression analysis defined F as a predictor for endpoint value of ABI (β = 0.469, p = 0.007). Value of C-RP determinates change of minimal value of ABI (β = 0.449, p = 0.037) and change of mean ABI per year (β = 0.442, p = 0.025). CONCLUSION: Our data indicate that plasma determination of fibrinogen and C-RP might have a clinical implication in defining the process of progression of PAD in T2D population

Progression of carotid-artery disease in type 2 diabetic patients: A cohort prospective study

In order to assess the progression of carotid-artery disease in type 2 diabetic cohort (n=207 patients), the dynamic change in carotid intima-media thickness (CIMT) and the occurrence of plaques were followed for a period of 31.35±10.59 months. The mean CIMT at the beginning of the study was 0.9178±0.1447 mm, with a maximal value of 1.1210±0.2366 mm. The maximal value of CIMT changed by 0.07 mm/year. Progression of CIMT was noted in 86.8% and its regression in 7.8% of patients. The occurrence of carotid plaques was detected in 41.8% of patients. Multiple regression analysis revealed the maximal value of CIMT to be associated with diastolic blood pressure, despite mean CIMT being predicted by body mass index. The presence of peripheral arterial disease and hypo-high-density lipoproteinemia were found to be predictors for the occurrence of carotid plaques. Our data have clinical implications in predicting risk factors for the progression of carotid-artery disease in type 2 diabetic patients for their appropriate management

Non-invasive imaging of diabetic vascular disease

A high proportion of diabetic subjects are referred with atherosclerotic disease and higher risk for cardiovascular events. Rapid expansion of the use of non-invasive coronary and peripheral arteries imaging, facilitated by technological advances, have found diagnostic and prognostic roles in this population. This review, which includes important and actual works, guidelines, and algorithms on cardiovascular disease in the diabetic population, indicates mandatory screening for arterial disease in these patients in light of their appropriate management. Nuclear Med Rev 2010; 13, 1: 39–4

Utility of Combined Echocardiography and Lung Ultrasound for Coronavirus Disease-19 Intensive Care Unit Patients: Case Series

BACKGROUND: A little evidence existed for ultrasound evaluation of coronavirus disease (COVID)-19 patients. AIM: We aimed to present combined transthoracic echocardiography and lung ultrasound in 17 COVID-19 patients in the intensive care unit (ICU). METHODS: Patients were on age 57 + 14 years, 9 on mechanical ventilation and 8 on oxygen support, with average 1.2 comorbidities per patient. Ultrasound was performed by a single experienced sonographer and an assistant. RESULTS: Impaired left ventricular ejection fraction (EF) was found in 2 patients (pts) of them (11.8%) and diastolic dysfunction in 7 (41.2%), which was significantly higher in those ones with comorbidities. In 2 pts (11.8%), the presence of pulmonary hypertension with enlarged right ventricle was found. Later one pulmonary thromboembolism was confirmed in them with computed tomography angio. B-lines were found in 8 pts (47.1%), finding that was significantly higher in pts on mechanical ventilation, but not in relation with decreased EF. In one pt (0.6%), pleural effusion was found, but in none of them lung consolidation. CONCLUSIONS: Our findings revealed that combined echocardiography and lung ultrasound in COVID-19 ICU pts have been an accurate method for diagnosing right and left ventricular function and should be a useful one for guiding of their treatment and prognosis

Upplevelsen av stöd och matchning - ur ett deltagarperspektiv

Enligt Statistiska centralbyrån var 349 000 personer arbetslösa i oktober, 2015. Arbetsförmedlingen vidtar olika åtgärder och en av dem är samarbeten med olika leverantörer. Arbetsförmedlingen köper således tjänster från leverantörerna. Tjänsten stöd och matchning påbörjades december, 2014. Arbetssökande som blir anvisade till tjänsten får bland annat stöd i sitt arbetssökande i form av ansökningshandlingar och intervjuteknik. Syftet med den här uppsatsen är att få ökad förståelse för hur deltagarna upplever stöd och matchning i förhållande till sin strävan att få jobb. Sju tematiserade intervjuer har genomförts, varav fyra med deltagare, en med arbetsförmedlare, en med handledare hos leverantören samt en med person som har ansvarsroll inom stöd och matchning på Arbetsförmedlingen. Uppsatsen har en fenomenologisk utgångspunkt där deltagarnas upplevelse ligger i fokus. Resultatet visar att likartade faktorer kan vara bakomliggande orsaker till deltagarnas upplevelser. Faktorerna är byråkrati, kommunikation och anställningsbarhet, vilka tas upp i teoriavsnittet samt analys- och diskussionskapitlet. Uppsatsen kan användas för fortsatt forskning inom stöd och matchning

Prevalence of risk factors and asymptomatic carotid atherosclerosis in diabetic patients screened for silent myocardial ischemia by SPECT myocardial imaging

BACKGROUND: The aim of the study was to evaluate whether there is any association between myocardial ischemia, common risk factors and carotid artery ultrasound parameters in asymptomatic type 2 diabetic (DMT2) patients. MATERIAL AND METHODS: 60 asymptomatic DMT2 patients (pts) without known coronary artery disease (CAD) underwent one day rest Dypiridamole stress Tc-99m sestamibi single photon emission computed tomography myocardial perfusion scintigraphy (MPS). We used 17 segment models for perfusion analysis with the assessment of perfusion scores. Patients were studied for age, sex, hypertension, hyperlipidemia, hs-CRP, smoking, obesity and family history of cardiac disease. Color Ultrasound examination of carotid arteries was performed in all patients. RESULTS: 51 patients (pts) had hypertension, 48 pts had hyperlipidemia, 15 were smokers, 6 pts had BMI > 30 kg/m2 and 26 patients had positive family history for CAD. 18 (31%) patients had myocardial ischemia. Mild ischemia was found in 6 pts, moderate in 7 patients and severe ischemia in 5 patients. Carotid IMT was increased in 34 pts and 15 pts had carotid plaques. Mean c-IMT value in patients with normal MPS results was 0.7 ± 0.1; in moderate ischemia 0.9 ± 0.1 and in pts severe ischemia 1.0 ± 0.2. Multivariate analysis showed obesity, low HDL and increased diastolic blood pressure predictors of increased c-IMT. Increased pulse pressure (PP), age and non-HDL cholesterol were predictors for presence of carotid plaques. Multivariable analysis for prediction of stress induced ischemia showed OR 2.9 (95% CI 2.1−5.1) for male gender, OR 3.1 for systolic blood pressure (95% CI 1.9–3.8) and OR 2.8 for LDL cholesterol (95% CI 1.7−3.6). CONCLUSIONS: Our study has shown high prevalence of traditional risk factors and silent myocardial ischemia in type 2 diabetic patients, with the importance of SPECT imaging in selected diabetes type 2 patients. The study highlights the importance of screening for carotid atherosclerosis, which may be useful to identify diabetic patients at higher risk for coronary artery disease..

Recurrent myocardial infarction in a young football player with antithrombin III deficiency

Acute myocardial infarction is a rare condition in young athletes. One of the causes could be a hypercoagulable state due to congenital antithrombin III deficiency, together with a prothrombotic state soon after strenuous physical training. We present the case of myocardial reinfarction in young football player with antithrombin III deficiency, treated with primary percutaneous coronary intervention and drug eluting stent, as well as the functional repercussions of continuous intensive physical activity