The association of ABO blood groups with extent of coronary atherosclerosis in Croatian patients suffering from chronic coronary artery disease

Aim: The aim of study was to: 1) examine the relationship between ABO blood groups and extent of coronary atherosclerosis in patients with chronic coronary artery disease (CAD), 2) compare ABO blood groups distribution in CAD patients and general population, 3) examine possible differences in traditional risk factors frequency in CAD patients with different ABO blood groups. Materials and methods: In the 646 chronic CAD patients (72.4% males) coronary angiograms were scored by quantitative assessment using multiple angiographic scoring system, Traditional risk factors were self reported or measured by standard methods. ABO blood distribution of patients was compared with group of 651 healthy blood donors (74.6% males). Results: Among all ABO blood group patients there was no significant difference between the extent of coronary atherosclerosis with regard to all the three scoring systems: number of affected coronary arteries (P = 0.857), Gensini score (P = 0.818), and number of segments narrowed > 50% (P = 0.781). There was no significant difference in ABO blood group distribution between CAD patients and healthy blood donors. Among CAD patients, men with blood group AB were significantly younger than their pairs with non-AB blood groups (P = 0.008). Among CAD patients with AB blood group, males < 50 yrs were significantly overrepresented when compared with the non-AB groups (P = 0.003). Conclusions: No association between ABO blood groups and the extent of coronary atherosclerosis in Croatian CAD patients is observed. Observation that AB blood group might possibly identify Croatian males at risk to develop the premature CAD has to be tested in larger cohort of patients

First case of imported chikungunya infection in Croatia, 2016

In recent years, several European countries reported cases of imported chikungunya infection. We present the first imported clinically manifested chikungunya fever in Croatia. A 27-year-old woman returned to Croatia on 21 March 2016, after she stayed in Costa Rica for two months where she had noticed a mosquito bite on her left forearm. Five days after the mosquito bite she developed severe arthralgias, fever and erythematous papular rash. In next few days symptoms gradually subsided. After ten days she felt better, but arthralgias re-appeared accompanied with morning stiffness. Two weeks after the onset of the disease she visited the infectious diseases outpatient department. The physical examination revealed rash on the trunk, extremities, palms and soles. Laboratory findings showed slightly elevated liver transaminases. Serological tests performed on day 20 after disease onset showed a high titer of chikungunya virus (CHIKV) IgM and IgG antibodies which indicated CHIKV infection. CHIKV-RNA was not detected. Serology to dengue and Zika virus was negative. The patient was treated with nonsteroid anti-inflammatory drugs and paracetamol. Her symptoms ameliorated, however, three months later she still complaint of arthralgias. The presented case highlights the need for inclusion of CHIKV in the differential diagnosis of arthralgia in all travelers returning from countries with documented CHIKV transmission

ANTICOAGULANT THERAPY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION – EVIDENCE BASED MEDICINE AND CLINICAL PRACTICE

Cilj istraživanja bio je procijeniti usklađenost propisivanja tromboprofilaktičkog liječenja u bolesnika s permanentnom atrijskom fibrilacijom (pAF) s kliničkim smjernicama Europskoga kardiološkog društva. U prospektivno presječno istraživanje susljedno su uključena 674 bolesnika (59% muškaraca) otpuštenih s kardiološkog odjela s dijagnozom pAF. Težina tromboembolijskog (TE) rizika procijenjena je CHA2DS2-VASc-sustavom, a rizik od krvarenja HAS-BLED-sustavom. U skupinu velikog TE rizika klasificirano je 578 (86%), umjerenog 57 (8%), a malog 39 (6%) bolesnika. Tromboprofilaksa je primijenjena u 601 (89%) bolesnika: varfarin u 310 (46%), acetilsalicilna kiselina u 258 (38%), a klopidogrel u 33 (5%). Varfarin je propisan u 47% bolesnika velikog, 49% bolesnika umjerenog te u 26% bolesnika malog TE rizika (P=0,03), a acetilsalicilna kiselina u 39% bolesnika malog, 39% bolesnika umjerenog i 38% bolesnika velikog TE rizika (P=0,998). Acetilsalicilna kiselina (P<0,001) i varfarin (P=0,007) bili su značajno češće korišteni u skupini bolesnika s velikim rizikom od krvarenja, u kojoj je zabilježena jednaka učestalost propisivanja varfarina i acetilsalicilne kiseline (53% prema 47%; P=0,416). Dob ³75 godina bila je nezavisni prediktor neprimjenjivanja (OR 1,7; 95% CI 1,2–2,4; P=0,003), a anamneza moždanog infarkta primjenjivanja varfarina (OR 0,47; 95% CI 0,29–0,76;P=0,002). Prilikom propisivanja tromboprofilaktičkog liječenja bolesnicima s pAF liječnici se ne pridržavaju preporučenih smjernica. Unatoč nepostojanju kontraindikacija značajan udio bolesnika s velikim TE rizikom nije dobio varfarin. Istodobno, varfarin je propisivan bolesnicima s malim TE rizikom čime su nepotrebno izloženi neželjenim učincima antikoagulantnog liječenja.Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 Š59%Ć male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs. 38%; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age ³75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2–2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29–0.76; P=0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment

Pozadina izrazitog gubitka težine i slabosti - desni atrijski miksom

A 63-year-old man was admitted in hospital because of extreme weight loss (about 20 kg within 6 months), weakness, fatigue, exertional dyspnea, periods of hacking cough, and laboratory disturbances (elevated erythrocyte sedimentation rate, increased C-reactive protein values, disturbances in the protein electrophoresis), with no proper etiology. Before admission he was extensively examined due to the commonest reasons for the mentioned symptoms – occult malignancy, hematological, autoimmune, and infectious diseases. Since extensive diagnostic evaluation performed before hospitalization showed no discrepancies, we suspected a cardiac myxoma. Echocardiography revealed a large tumor in the right atrium. The histology of surgically removed tumor revealed a cardiac myxoma. Five months later, his body mass increased by 15 kg. The patient remains well, with normal echocardiographic and laboratory findings. Our case suggests that echocardiography should be considered early in the examination of patients with markedly constitutional symptoms and laboratory disturbances in order to detect rare but treatable heart tumors.63-godišnji muškarac hospitaliziran je zbog izrazitog gubitka tjelesne mase (oko 20 kg tijekom 6 mjeseci), slabosti, umora, nedostatka zraka tijekom tjelesnih aktivnosti, povremenog kašljucanja i laboratorijskih poremećaja (ubrzana sedimentacija eritrocita, povećane vrijednosti C-reaktivnog proteina, otkloni u vrijednostima elektrofereze proteina) nepoznatoga uzroka. Pred prijam opsežno je obrađen zbog najčešćih uzroka navedenih simptoma – malignih, hematoloških, autoimmunih i zaraznih bolesti. Budući da dijagnostička obrada provedena prije hospitalizacije nije pokazala odstupanja, posumnjali smo na miksom srca. Ehokardiografskim pregledom zabilježen je veliki tumor u desnom atriju. Histološkom analizom kirurški odstranjenog tumora potvrđen je miksom. Pet mjeseci nakon operacije bolesnik se osjećao dobro, tjelesna masa mu se povećala za 15 kg, a ehokardiografski i laboratorijski parametri bili su u normalnim rasponima. Naš slučaj pokazuje da ehokardiografiju treba primijeniti u ranoj fazi obrade bolesnika s izraženim konstitucionalnim simptomima i laboratorijskim poremećajima, u cilju otkrivanja rijetkih, ali izlječivih tumora srca

Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023

Members of the European Hospital Vaccine Effectiveness Group: Portugal: Ana Paula Rodrigues, Débora Pereira, Susana Costa Maia e Silva, Paula Pinto, Cristina Bárbara, António Pais de Lacerda, Raquel Guiomar and Camila Henriques.The European Medicines Agency (EMA) authorised four adapted bivalent mRNA COVID-19 vaccines for use against COVID-19 in September/October 2022: Comirnaty (BNT162b2; Pfizer-BioNTech) and Spikevax (mRNA-1273; Moderna) Original/Omicron BA.1 and Original/Omicron BA.4–5 [1]. During autumn 2022, all European Union/European Economic Area (EU/EEA) countries had vaccination campaigns in place to administer a booster dose, with several countries using the adapted bivalent vaccines [2]. The Omicron-descendent XBB lineage and XBB.1.5 sub-lineage became variants of interest in March 2023 [3]. We estimated the effectiveness of the COVID-19 bivalent vaccines against hospitalisation with PCR-confirmed SARS-CoV-2 infection among patients aged ≥ 60 years with severe acute respiratory infection (SARI) during the XBB lineage-predominant period.The ‘Vaccine Effectiveness, Burden and Impact Studies studies’ (VEBIS) is a project of the European Centre for Disease Prevention and Control (ECDC) run under the framework con tract No. ECDC/2021/016.info:eu-repo/semantics/publishedVersio

UČINCI SASTAVNICA OTROVA POSKOKA NA POKAZATELJE SRČANE FUNKCIJE NA MODELU IZOLIRANOG ŠTAKORSKOG SRCA

Poskok (lat. Vipera ammodytes ammodytes) najotrovnija je europska zmija. Otrov poskoka uobičajeno iskazuje hematotoksično, miotoksično i neurotoksično, kao i kardiotoksično djelovanje. U cilju detaljnijeg istraţivanja kardiotoksičnosti, biokemijskim postupcima razdijeljen je cjelokupni otrov poskoka na četiri frakcije (A-D) i podfrakcije (C1- 4). Učinci frakcija A, B i C, kao i navedenih podfrakcija, te amoditina L, ispitani su na modelu izoliranog štakorskog srca. Srčana frekvencija (HR), učestalost aritmija (atrijsko-ventrikularni (AV) blok, ventrikularna tahikardija (VT), ventrikularna fibrilacija (VF) i asistolija), koronarni protok (CF), sistolički (sLVP), razvijeni (devLVP) i dijastolički tlak lijeve klijetke (dLVP), mjereni su prije, za vrijeme i nakon primjene izoliranih sastavnica otrova poskoka u tri različite koncentracije. Biokemijski pokazatelji srčanog oštećenja (kreatin kinaza – CK, laktat dehidrogenaza – LDH, aspartat aminotransferaza – AST, i troponin I) takoĎer su mjereni tijekom razdoblja izloţenosti spomenutim sastavnicama. Frakcija A koja je sadrţavala proteine pribliţne molekularne mase 60-100 kDa nije pokazala nikakav učinak na izoliranom srcu štakora. Frakcije B i C poremetile su srčanu funkciju na sličan način, ali s različitim potencijalom, te je posljednje navedena pokazala snaţniji učinak na srce. Spomenuto se manifestiralo značajnim padom vrijednosti HR i CF, te povišenjem dLVP, kao i sniţenjem devLVP i sLVP, uz značajno povišenje biokemijskih biljega srčanog oštećenja. Sva srca izloţena frakciji C u konačnim koncentracijama od 22,5 i 37,5 μg/mL doţivjela su brz i ireverzibilan nastanak asistolije bez AV bloka, ali uz prethodni nastanak ventrikularne tahikardije i fibrilacije. Frakcija B samo prilikom primjene najveće koncentracije uzrokovala je asistoliju u svih srca, ventrikularnu fibrilaciju u 80%, te ventrikularnu tahikardiju u 70% izloţenih srca. Frakcija C potaknula je nastanak ukupno 71% svih biljeţenih poremećaja srčanog ritma, što je bilo značajnije nego što je to uzrokovala frakcija B (29%). Sekretorne fosfolipaze A2 najzastupljenije su sastavnice unutar frakcije C, te bi daljnja istraţivanja trebala detaljnije istraţiti moţebitne kardiotoksične tvari unutar ove skupine proteina.The nose-horned viper (Vipera ammodytes ammodytes) is the most venomous European snake. Its venom is known as haematotoxic, myotoxic and neurotoxic, but it exerts also cardiotoxic effects. To further explore the cardiotoxicity of the venom, with biochemical methods we separated it into four fractions (A-D) and four subfractions (C1-4). Three fractions that contain polypeptides (A, B, and C), and four mentioned subfractions, along with ammodytin L, were tested for their effects on the isolated rat heart. Heart rate (HR), incidence of arrhythmias (atrioventricular (AV) blocks, ventricular tachycardia, ventricular fibrillation, and asystolia), coronary flow (CF), systolic (sLVP), developed (devLVP), and diastolic left ventricular pressure (dLVP) were measured before, during, and after the application of venom (sub)fractions in three different concentrations. Biochemical markers of myocardial damage (creatine kinase – CK, lactate dehydrogenase – LDH, aspartate aminotransferase – AST, and troponin I) were also analyzed during exposure to mentioned compounds. Fraction A, containing proteins of 60-100 kDa, displayed no effect on the rat heart. Fractions B and C disturbed heart functioning in similar way, but with different potency that was higher by the latter. This was manifested by significant decrease of HR and CF, the increase of dLVP, and the decrease of sLVP and devLVP, accompained with significant increase of biochemical heart damage values. All hearts treated with fraction C in the final CF concentrations 22.5 and 37.5 mg/mL suffered rapid and irreversible asystolia without AV blockade. They underwent also ventricular fibrillation and ventricular tachycardia. Fraction B affected hearts only at the highest dose inducing asystolia in all hearts, ventricular fibrillation in 80%, and ventricular tachycardia in 70% of the hearts. Venom fraction C induced 71% of all recorded heart rhythm disturbances, significantly more than fraction B, which induced 29%. Most abundant proteins in fraction C were secreted phospholipases A2 among which the venom component acting on the heart is most probably to be looked for

First case of imported chikungunya infection in Croatia, 2016

In recent years, several European countries reported cases of imported chikungunya infection. We present the first imported clinically manifested chikungunya fever in Croatia. A 27-year-old woman returned to Croatia on 21 March 2016, after she stayed in Costa Rica for two months where she had noticed a mosquito bite on her left forearm. Five days after the mosquito bite she developed severe arthralgias, fever and erythematous papular rash. In next few days symptoms gradually subsided. After ten days she felt better, but arthralgias re-appeared accompanied with morning stiffness. Two weeks after the onset of the disease she visited the infectious diseases outpatient department. The physical examination revealed rash on the trunk, extremities, palms and soles. Laboratory findings showed slightly elevated liver transaminases. Serological tests performed on day 20 after disease onset showed a high titer of chikungunya virus (CHIKV) IgM and IgG antibodies which indicated CHIKV infection. CHIKV-RNA was not detected. Serology to dengue and Zika virus was negative. The patient was treated with nonsteroid anti-inflammatory drugs and paracetamol. Her symptoms ameliorated, however, three months later she still complaint of arthralgias. The presented case highlights the need for inclusion of CHIKV in the differential diagnosis of arthralgia in all travelers returning from countries with documented CHIKV transmission