22 research outputs found
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
Changes in percutaneous patent foramen ovale closure after the 2019 consensus: single center analysis of referrals and indications
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 (3.99Ā±1.0 IU/g Hb) than in healthy controls (4.61Ā±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 rastuÄih podruÄja danaÅ”nje medicinske znanosti, a tehnoloÅ”ka i farmakoloÅ”ka otkriÄa unutar tog podruÄja unazad samo nekoliko godina dovela su do znaÄajnih promjena u lijeÄenju i prognozi bolesnika sa srÄanožilnim bolestima. Prvenstveno je uloga intervencijske kardiologije u poboljÅ”anju ishoda lijeÄenja najjasnije vidljiva u akutnom koronarnom sindromu, a uspjeÅ”ne mreže primarne perkutane koronarne intervencije u akutnom infarktu miokarda predstavljaju jedno od najveÄih dostignuÄa moderne kardiologije, a možda i medicine uopÄe. 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 lijeÄenju koronarne bolesti srca od 2012. postaju dostupne diljem svijeta, pa tako i u Hrvatskoj, a njihova implementacija iskljuÄivo ovisi o financijskim okolnostima. Novi antitrombocitni i antiagregacijski lijekovi takoÄer su predmet istraživanja, a sve u potrazi za (poželjno) jednim lijekom koji Äe u kardiovaskularnoj intervenciji imati najbolji omjer uÄinkovitosti i sigurnosti. Ova godina bila je i godina punog zamaha intervencijskog lijeÄenja strukturne bolesti srca, napose aortne stenoze i mitralne regurgitacije, a kardioembolizacija, arterijska hipertenzija i periferna vaskularna bolest takoÄer postaju sve Å”ire āigraliÅ”teā za intervencijske kardiologe. U ovom preglednom Älanku 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
Like an ice cream topping ā case report of an asymptomatic saccular aneurysm of the left ventricular outflow tract
PRODUCTION - HEMATOLOGICAL PARAMETERS OF LAMBS FED DIETS CONTAINING PUMPKIN SEED CAKE
Cilj ovoga istraživanja bio je utvrditi moguÄnost zamjene soje, kao najÄeÅ”Äeg izvora bjelanÄevina u obrocima janjadi, pogaÄom sjemenki bundeve, nusproizvoda u proizvodnji ulja te utvrditi njihov utjecaj na proizvodno hematoloÅ”ke 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 bjelanÄevina u krmnoj smjesi i pokusna u kojoj je soja zamijenjena sa 7% pogaÄe 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 izraÄunati su prosjeÄni dnevni prirasti, konverzija hrane i indeksi tjelesne razvijenosti janjadi. Analizom dobivenih rezultata na kraju istraživanja nisu utvrÄene znaÄajne (P>0,05) razlike u tjelesnoj masi (29,80 : 28,98 kg), tjelesnim mjerama i indeksima tjelesne razvijenosti janjadi ovisno o skupini. TakoÄer, nisu utvrÄene statistiÄki znaÄajne (P>0,05) razlike u prosjeÄnom dnevnom prirastu izmeÄu 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. KoriÅ”tenjem pogaÄe sjemenki bundeve kao izvora bjelanÄevina u obrocima janjadi nije doÅ”lo do promjene proizvodno - hematoloÅ”kih pokazatelja janjadi. Upotrebom pogaÄe sjemenki bundeve u obrocima janjadi moguÄa je zamjena soje upitnog genetskog podrijetla i zdravstvene ispravnosti. Zbog ekoloÅ”kog naÄina proizvodnje bundeve, joÅ” viÅ”e se može naglasiti hranidbeno-dijetetska ispravnost janjetine, a ekoloÅ”ki proizvoÄaÄi mogli bi imati na raspolaganju odgovarajuÄi izvor bjelanÄevina.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 lambās meat, and the organic producers might have the adequate protein source available
Povezanost eozinofilnoga kationskoga proteina s uznapredovaloÅ”Äu ateroskleroze karotidne arterije i sveukupnim preživljenjem bolesnika na programu kroniÄne 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 ānewā 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 eosinophilesā 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 ā IMT 0,68Ā±0,19; overall severity of plaque burden ā PS 14,75Ā±14,85) and significantly higher serum concentrations of ECP (ECP 17,01Ā±14,12) in regard to general population (IMT 0,50Ā±0,12, PS 6,57Ā±3,75, ECP 10,78Ā±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