Organ Donation and Transplantation - Current Status and Future Challenges
Kidney transplantation has become the primary method of treating severe chronic renal failure. Th... more Kidney transplantation has become the primary method of treating severe chronic renal failure. The first successful kidney transplant was performed in 1954 in Boston, the graft was in function for 7 years, and patient died because of the heart disease. Cardiovascular disease is the leading cause of death in patients with a transplanted kidney. Despite the fact that patients with a transplanted kidney are highly susceptible to infections and have an increased tendency to develop malignant diseases, these patients die mainly of cardiovascular disease. Patients with a transplanted kidney are exposed to atherogenic risk which is associated with previous dialysis treatment and the use of immunosuppressive drugs. An excessive risk of developing cardiovascular disease in patients with a transplanted kidney is due to the high frequency and accumulation of atherogenic risk factors before and after transplantation. Pre-transplant cardiovascular disease is a major risk factor for the development of post-transplant cardiovascular disease. Risk factors for the development of cardiovascular diseases in patients with a transplanted kidney are divided into traditional and nontraditional. Traditional risk factors such as immutable (age, gender, and inheritance) and variable (smoking, hyperlipidemia, hypertension, obesity, diabetes mellitus, physical activity, stress). Nontraditional risk factors such as risk factors related to the status of transplantation and its treatment and risk factors associated with chronic regression in allograft function. The most common cardiovascular diseases in patients after kidney transplantation are as follows: ischemic heart disease, congestive heart failure and left ventricular hypertrophy. Of all cardiovascular complications, ischemic heart disease is by far the most common cause of mortality (more than 50%) in patients with a transplanted kidney. Frequency of left ventricular hypertrophy ranges from 50 to 70% in patients with a transplanted kidney. Early detection of high-risk patients for the development of cardiovascular diseases allows timely application of an appropriate therapeutic strategy that ensures high survival rates for patients with a transplanted kidney.
Introduction: The most common cause of myocardial ischemia is atherosclerotic epicardial coronary... more Introduction: The most common cause of myocardial ischemia is atherosclerotic epicardial coronary artery disease, present in 90% of patients. Risk factors positively correlate with the onset, development and subsequent complications of atherosclerotic disease. Aim: Determine the percentage frequency of classic risk factors for coronary disease in patients with non-ST segment elevation myocardial infarction (NSTEMI), with regard to gender. Methods: A retrospective study was conducted on 600 respondents, treated for NSTEMI at the Clinic for Internal Medicine of the University Clinical Center (UKC) Tuzla, in the period from June 2016 to December 2019. Results: Overall, smoking was the leading risk factor (65%), followed by hypertension (58%), hyperlipoproteinemia (39%), overweight (33%), positive family burden (30%) and diabetes mellitus (19%). In male patients, the leading risk factor was smoking, rating at 74%, while in female patients-it was hypertension at 67%. In younger groups of patients leading risk factors were smoking and a positive family burden. Conclusion: With adequate prevention and treatment measures, a significant reduction in the prevalence of the cardiovascular disease can be achieved, since the risk factors for its development have long been known. Quitting smoking is one of the most effective secondary prevention measure since it reduces the reinfarction risk rate by 50%. Knowledge of coronary risks, as well as success in reducing them, can greatly contribute to patients' overall sense of contentment and significantly raise their self-confidence.
BackgroundAtrial fibrillation (AF) is common amongst the elderly, but this group tends to be subo... more BackgroundAtrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region.AimWe investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region.MethodA 12‐week prospective snapshot survey (2014‐2015) of consecutive non‐valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form.ResultsOf 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA2DS2‐VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS‐BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n ...
The aim of the study was to assess the differences of lipidogram parameters between diabetes mell... more The aim of the study was to assess the differences of lipidogram parameters between diabetes mellitus (DM) group and non-diabetic group of middle aged Lithuanian adults participating in Lithuanian High Cardiovascular Risk primary prevention programme. Methods: During the period of 2009-2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men from 40 to 54 years of age and women from 50 to 64 without overt cardiovascular disease. Subjects were divided into two groups: diabetes mellitus and nondiabetic subjects. Their lipid profile was assessed and used for further statistical analysis. Results: Subjects with diabetes mellitus had higher mean total cholesterol (6.20±1.30mmol/L vs. 6.07±1.20mmol/L, p<0.001), LDL cholesterol (3.91±1.11mmol/L vs 3.87±1.07mmol/L, p<0.001), triglycerides (2.12±1.73mmol/L vs 1.52±1.05mmol/L, p<0.001) as well as lower HDL cholesterol levels (1.41±0.43mmol/L vs 1.56±0.46mmol/L, p<0.001) than a group without diabetes mellitus. 82.7% of subjects with diabetes mellitus had increased level of total cholesterol (>5 mmol/l) compared to 81.6% in control group (p¼0.009), higher levels of triglycerides (>1.7 mmol/l) (50.1% vs. 28.0%, p<0.001) and lower levels of HDL-C (<1.2 mmol/l for women and <1 mmol/l for men) (23.6% vs. 12.5%, p<0.001). There was no statistically significant difference between groups when we compared percentage of subjects whose LDL-C value was above the normal (LDL-C <3mmol/L) range (79.50% vs 79.20%, p¼0.571). Conclusions: Middle aged Lithuanian adults with diabetes mellitus are associated with more atherogenic lipid profile. However, percentage of subjects with LDL-C concentration above normal range did not differ between groups. Aim: The general objective of IBERICAN (IB) is to establish the prevalence and incidence of cardiovascular risk factors and events in Spain.The objective of this study was to determine the characteristics of dyslipidemia (DL) and its association with different vascular risk factor (VRF). Methods: IB is an observational, multicentric study where individuals that attend primary care (PC) centers in Spain,18e85 years. The final cohort will have a follow up of 5 years and the expected final sample will be 7000. In the analyzed (n ¼ 6000), the presence or absence of DL and atherogenic DL was analyzed according to sex, age and the presence of other VRF.
Background: Atrial fibrillation, as the most common type of arrhythmia, affects 1-2% of general p... more Background: Atrial fibrillation, as the most common type of arrhythmia, affects 1-2% of general population. Currently more than 6 million Europeans are experiencing this condition, since the average age of population is increasing, and it is expected that this number will rise in next 50 years by 250%. Atrial fibrillation usually leaves lasting consequences on patients overall health. Preventing them is the main therapeutic goal. 1-3 The main objective of this study was to inspect the efficiency of sinus rhythm restoration by means of electrocardioversion. Hemodynamically unstable patients (suffering from angina pectoris or hypertension), unresponsive to resuscitation, are subjected to emergency electrocardioversion. On the other hand, stable patients should undergo electrocardioversion procedure after three week long anticoagulant treatment with warfarin. Patients should continue taking warfarin for four weeks after the procedure in sake of blood clot forming prevention. Case report: From January 2017 to September 2018, 58 elective cardioversion cases were done by the Intensive Therapy Unit of the University Clinical Center of Tuzla, 12 of which were atrial flutter patients, while 40 patients had atrial fibrillation. From those 40 cases of atrial fibrillation, 6 patients underwent two cardioversion treatments using 150 J of energy, followed by single 200 J treatment. In 50 cases patients were brought back to sinus rhythm straightaway after the first treatment. Conclusion: Although efficiency rate is high (96%), qualified personnel and suitable equipment remain the most important requirements for successful and safe electrocardioversion. In long-term fibrillation, success rate of electrocardioversion and sinus rhythm perseverance decreases over time, especially if it lasts for more than a year. In that case, monitoring of the heart rate and anticoagulative therapy should be minded.
congestive heart failure, atrial fi brillation, acute infl ammatory disease. The level of glycate... more congestive heart failure, atrial fi brillation, acute infl ammatory disease. The level of glycated haemoglobin (HbA1c), GFR (CKD-EPI) and blood pressure (BP) were assessed. Oral glucose tolerance test was performed in pts without DM. Serum level of YKL-40 was measured using ELISA kits (Quidel, USA). Data are presented by mediana [25;75 percentile]. Results: A total of 83 patients with HT and CAD were enrolled in the study: 60 pts with T2D (group 1, G1) and 23 pts without DM or glucose intolerance (group 2, G2). The duration of T2D in G1 was 5 [2;10] years. The groups didn't differ by age (63 [58;72] vs 62[55;67] years, p = 0.52) and GFR (87[74;97] vs 93 [81;100] ml/min/1,73 m 2 , p = 0.08). 21/14 pts had normal (GFR>90 ml/min/1,73 m 2) and 27/9 pts had mildly reduced GFR (60-89 ml/min/1,73 m 2) in G1/2, respectively (p = 0,21). HbA1c was higher in G1 (7,6 [7,0;9,1] vs 5,7 [5,5;5,9]%, p < 0.001), but 13 (57%) pts in G2 had HbA1c level more than 5,7% (criteria of prediabetes). YKL-40 level didn't differ signifi cantly between two groups: 67,1 [46,1; 113,2] vs 68,0
Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the pa... more Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs). A 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants). Of 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20-3.56], rhythm control (OR 1.64, 1.25-2.16), and treatment by cardiologists were...
Porast morbiditeta i mortaliteta od kardiovaskularnih bolesti (KVB) zbog razvoja ateroskleroze op... more Porast morbiditeta i mortaliteta od kardiovaskularnih bolesti (KVB) zbog razvoja ateroskleroze opisan je kod nekih autoimunih bolesti kao što je reumatoidni artritis. Postojanje tradicionalnih čimbenika rizika za kardiovaskularne bolesti često je zastupljeno kod bolesnika s reumatoidnim artritisom, ali ne može objasniti povećan razvoj kardiovaskularnih bolesti kod bolesnika s reumatoidnim artritisom. Smatra se da je reumatoidni artritis udružen s povećanim rizikom za razvoj kardiovaskularne bolesti jer kronična sistemska upala predstavlja čimbenik rizika za razvoj kardiovaskularnih bolesti isto kao i hipertenzija, šećerna bolest ili dislipidemija. Ekstrazglobne manifestacije kod reumatoidnog artritisa povezane sa povećanim kardiovaskularnim mortalitetom upućuju na ulogu sistemske nekontrolirane upale u ubrzanom razvoju ateroskleroze. Cilj istraživanja je bio utvrditi učestalost tradicionalnih i netradicionalnih čimbenika rizika za razvoj kardiovaskularnih bolesti kod bolesnika sa reumatoidnim artritisom. Pacijenti i metode: Kod 50 bolesnika sa reumatoidnim artritisom određene su vrijednosti sedimentacije eritrocita (SE), C reaktivnog proteina (CRP), fibrinogena, kolesterola, triglicerida, arterijskog tlaka, reuma faktora (RF), šećera u krvi, spolna distribucija, godine života, vrijednost prema DAS 28 ljestvici. Rezultati: U ispitivanoj grupi srednja životna dob je bila 63,4 godine, postotak ženskog spola je bio 80 %, SE u prvom satu je 60,1 mm, CRP 31,2 mg/l; kolesterol 5,41 mmol/l; trigliceridi 2,76 mmol/l; RF 276; fibrinogen 5,12 g/l; glukoza 6,8 mmol/l, arterijski tlak 140/90 mmHg; vrijednost prema DAS 28 ljestvici 6,4. Zaključak: Povišeni parametri upale, kao što su CRP, fibrinogen i RF, bili su viši što je bila viša aktivnost bolesti prema DAS 28 score. Kod bolesnika sa povišenim vrijednosti prema DAS 28 ljestvici bili su povišeni i tradicionalni čimbenici rizika za razvoj KVB kod bolesnika sa reumatoidnim artritisom. Čimbenici rizika za razvoj kardiovaskularnih bolesti u reumatoidnom artritisu Risk factors for development of cardiovascular diseases in rheumatoid arthritis Prošireni sažetak Čimbenici rizika i životne navike
DijastoliËka funkcija lijeve klijetke u akutnom infarktu miokarda SAAEETAK: PoremeÊaj dijastoliËk... more DijastoliËka funkcija lijeve klijetke u akutnom infarktu miokarda SAAEETAK: PoremeÊaj dijastoliËke funkcije lijeve klijetke (LK) je jedan od prvih poremeÊaja funkcije LK, koji se registriraju prije poremeÊaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom koπu, πto bitno mijenja prognozu pacijenata s akutnim koronarnim sindromom. PoremeÊaj relaksacije LK Ëesto se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremeÊaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraaeenija dijastoliËka abnormalnost uzrokovana ishemijom miokarda je produaeena i usporena relaksacija miokarda. Ehokardiografske tehnike omoguÊavaju evaluaciju di-jastoliËkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoliËku funkciju LK u bolesnika s AIM i usporediti varijable dijastoliËke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraaeivanje ukljuËeno je 60 bolesnika (37 muπkaraca, prosjeËne aeivotne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Pra-Êene su varijable dijastoliËke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u pluÊnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoliËkog punjenja nisu se sta-tistiËki znaËajno razlikovale u obje skupine, ali je bila niaea u odnosu na prosjeËnu vrijednost brzine ranog dijastoliËkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoliËkog protoka pluÊnih vena registrirana je statistiËki znaËajna razlika (p<0,05) izmeu ispitivanih skupina. U prvoj skupini iznosila je 0,48±0,10, a u drugoj iznosila je 0,57±0,14. Maksimalna brzina dijastoliËkog protoka pluÊnih vena u prvoj skupini iznosila je 0,37±0,09, a u drugoj skupini iznosila je 0,43±0,16. Odnos maksimalne brzine sistoliËkog i dijastoliËkog protoka pluÊnih vena je neπto veÊi nego kod zdravih osoba. U bolesnika s AIM dominira (70%) dijastoliËka disfunkcija tipa poremeÊaja relaksacije LK. U ispitivanoj skupini bolesnika s anteroseptalnim AIM dijastoliËka disfunkcija tipa pore-meÊaja relaksacije je dominantna, odnosno registrirana je sta-tistiËki znaËajna razlika u odnosu na oËuvanu dijastoliËku funkciju i na dijastoliËku disfunkciju tipa poremeÊaja restrikcije LK (p<0,05). ZakljuËno, kod AIM, kako anteroseptalne tako i inferiorne stijenke, promijenjeni su parametri dijastoliËke funkcije, odnosno prisutna su sva tri stupnja dijastoliËke disfunkcije LK. Dominira dijastoliËka disfunkcija tipa poremeÊaja relaksacije miokarda. U AIM anteroseptalne stijenke najviπe je prisutna dijastoliËka disfunkcija tipa poremeÊaja relaksacije, odnosno postoji dobra korelacija s infarciranom zonom u odnosu na inferiornu stijenku.
Kardiovaskularne bolesti (KVB) vodeÊi su uzrok smrtnosti u pacijenata na kroniËnoj dijalizi. Paci... more Kardiovaskularne bolesti (KVB) vodeÊi su uzrok smrtnosti u pacijenata na kroniËnoj dijalizi. Pacijenti s kroniËnom bubreaenom insuficijencijom imaju 10-20 puta viπi rizik razvoja 2013;8(1-2):67.
Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian ... more Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary ‘real-world’ AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA2DS2-VASc score was not significantly associated with OAC use. Of the ‘truly low-risk’ patients (CHA2DS2-VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was ...
JZU UKC Tuzla Klinika za interne bolesti ABSTRAKT Uvod: Kardiovaskularne bolesti su jedan od vode... more JZU UKC Tuzla Klinika za interne bolesti ABSTRAKT Uvod: Kardiovaskularne bolesti su jedan od vodećih uzroka morbiditeta i mortaliteta u opštoj populaciji. Učestalost kardiovaskularnih oboljenja u određenih skupina bolesnika je veća u odnosu na opštu populaciju. U navedene skupine spadaju bolesnici sa hroničnom bubrežnom insuficijencijom, bolesnici sa transplantiranim bubregom, bolesnici sa autoimunim i reumatološkim oboljenjima. Bolesnici s hroničnom bubrežnom insuficijencijom imaju 10-20 puta veći rizik razvoja kardiovaskularnih bolesti u odnosu na opštu populaciju. Ovi bolesnici su izloženi tradicionalnim i netradicionalnim faktorima rizika za razvoj kardiovaskularnih komplikacija. Tradicionalni faktori rizika: dob, dijabetes, pušenje cigareta, hipertenzija, hiperlipidemija, pozitivna porodična anamneza. Netradicionalni faktori rizika se mogu podijeliti na hemodinamičke (anemija, retencija Na i H2O, povećan protok krvi kroz vaskularni pristup za hemodijalizu) i metaboličke (hipoal...
JZU UKC Tuzla, Klinika za interne bolesti, BiH SAŽETAK Uvod:Učestalost arterijske hipertenzije u ... more JZU UKC Tuzla, Klinika za interne bolesti, BiH SAŽETAK Uvod:Učestalost arterijske hipertenzije u dijaliznih bolesnika je velika. Na temelju više studija, 50 do 60 posto bolesnika na hemodijalizi (do 85 posto u nekim izvještajima) i gotovo 30 posto bolesnika na peritonealnoj dijalizi imaju arterijsku hipertenziju. Hipertenzija je nezavisan faktor rizika za razvoj kardiovaskularnih komplikacija u bolesnika liječenih redovnim hemodijalizama. Svako povećanje srednjeg arterijskog krvnog pritiska za 10 mmHg nezavisno je udruženo sa progresivnim povećanjem koncentrične hipertrofije lijevog ventrikula, razvojem de novo srčane slabosti i de novo ishemijske bolesti srca. Liječenje arterijske hipertenzije u bolesnika na hemodijalizi još je uvijek veliki stručni izazov za nefrologe. Nedostaju kontrolirane studije o antihipertenzivnoj terapiji u dijaliznih bolesnika, kao i o učinku nefarmakoloških mjera. Terapija antihipertenzivima primarno je indicirana u 25 do 30 posto dijaliznih bolesnika. Bl...
JZU UKC Tuzla, Klinika za interne bolesti, BiH ABSTRAKT Uvod: Bolesnici u terminalnom stadiju bub... more JZU UKC Tuzla, Klinika za interne bolesti, BiH ABSTRAKT Uvod: Bolesnici u terminalnom stadiju bubrežne bolesti izloženi su brojnim faktorima rizika koji doprinose nastanku ateroskleroze: povišen arterijski krvni pritisak, poremećaj metabolizma lipida, mikroinflamacija, hiperhomocisteinemija, oksidativni stres i sekundarni hiperparatireoidizam. Uremijski milje pogoduje nastanku ateroskleroze i aterosklerotskih kardiovaskularnih komplikacija, a često je prisutan i razvoj ubrzane, galopirajuće ateroskleroze. Hiperlipidemija je nezavisan faktor rizika za razvoj ateroskleroze. 30-50% bolesnika u terminalnom stadiju bubrežne bolesti liječenih dijalizom ima povišene vrijednosti LDL-holesterola, snižene vrijednosti HDL-holesterola i povišene vrijednosti triglicerida. Prema National Cholesterol Education Program (NCEP) smjernicama, u bolesnika koji se liječe redovnim hemodijalizama sa povišenim rizikom od razvoja kardiovaskularnih komplikacija, ciljni nivo LDL holesterola treba da bude < ...
Organ Donation and Transplantation - Current Status and Future Challenges
Kidney transplantation has become the primary method of treating severe chronic renal failure. Th... more Kidney transplantation has become the primary method of treating severe chronic renal failure. The first successful kidney transplant was performed in 1954 in Boston, the graft was in function for 7 years, and patient died because of the heart disease. Cardiovascular disease is the leading cause of death in patients with a transplanted kidney. Despite the fact that patients with a transplanted kidney are highly susceptible to infections and have an increased tendency to develop malignant diseases, these patients die mainly of cardiovascular disease. Patients with a transplanted kidney are exposed to atherogenic risk which is associated with previous dialysis treatment and the use of immunosuppressive drugs. An excessive risk of developing cardiovascular disease in patients with a transplanted kidney is due to the high frequency and accumulation of atherogenic risk factors before and after transplantation. Pre-transplant cardiovascular disease is a major risk factor for the development of post-transplant cardiovascular disease. Risk factors for the development of cardiovascular diseases in patients with a transplanted kidney are divided into traditional and nontraditional. Traditional risk factors such as immutable (age, gender, and inheritance) and variable (smoking, hyperlipidemia, hypertension, obesity, diabetes mellitus, physical activity, stress). Nontraditional risk factors such as risk factors related to the status of transplantation and its treatment and risk factors associated with chronic regression in allograft function. The most common cardiovascular diseases in patients after kidney transplantation are as follows: ischemic heart disease, congestive heart failure and left ventricular hypertrophy. Of all cardiovascular complications, ischemic heart disease is by far the most common cause of mortality (more than 50%) in patients with a transplanted kidney. Frequency of left ventricular hypertrophy ranges from 50 to 70% in patients with a transplanted kidney. Early detection of high-risk patients for the development of cardiovascular diseases allows timely application of an appropriate therapeutic strategy that ensures high survival rates for patients with a transplanted kidney.
Introduction: The most common cause of myocardial ischemia is atherosclerotic epicardial coronary... more Introduction: The most common cause of myocardial ischemia is atherosclerotic epicardial coronary artery disease, present in 90% of patients. Risk factors positively correlate with the onset, development and subsequent complications of atherosclerotic disease. Aim: Determine the percentage frequency of classic risk factors for coronary disease in patients with non-ST segment elevation myocardial infarction (NSTEMI), with regard to gender. Methods: A retrospective study was conducted on 600 respondents, treated for NSTEMI at the Clinic for Internal Medicine of the University Clinical Center (UKC) Tuzla, in the period from June 2016 to December 2019. Results: Overall, smoking was the leading risk factor (65%), followed by hypertension (58%), hyperlipoproteinemia (39%), overweight (33%), positive family burden (30%) and diabetes mellitus (19%). In male patients, the leading risk factor was smoking, rating at 74%, while in female patients-it was hypertension at 67%. In younger groups of patients leading risk factors were smoking and a positive family burden. Conclusion: With adequate prevention and treatment measures, a significant reduction in the prevalence of the cardiovascular disease can be achieved, since the risk factors for its development have long been known. Quitting smoking is one of the most effective secondary prevention measure since it reduces the reinfarction risk rate by 50%. Knowledge of coronary risks, as well as success in reducing them, can greatly contribute to patients' overall sense of contentment and significantly raise their self-confidence.
BackgroundAtrial fibrillation (AF) is common amongst the elderly, but this group tends to be subo... more BackgroundAtrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region.AimWe investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region.MethodA 12‐week prospective snapshot survey (2014‐2015) of consecutive non‐valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form.ResultsOf 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA2DS2‐VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS‐BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n ...
The aim of the study was to assess the differences of lipidogram parameters between diabetes mell... more The aim of the study was to assess the differences of lipidogram parameters between diabetes mellitus (DM) group and non-diabetic group of middle aged Lithuanian adults participating in Lithuanian High Cardiovascular Risk primary prevention programme. Methods: During the period of 2009-2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men from 40 to 54 years of age and women from 50 to 64 without overt cardiovascular disease. Subjects were divided into two groups: diabetes mellitus and nondiabetic subjects. Their lipid profile was assessed and used for further statistical analysis. Results: Subjects with diabetes mellitus had higher mean total cholesterol (6.20±1.30mmol/L vs. 6.07±1.20mmol/L, p<0.001), LDL cholesterol (3.91±1.11mmol/L vs 3.87±1.07mmol/L, p<0.001), triglycerides (2.12±1.73mmol/L vs 1.52±1.05mmol/L, p<0.001) as well as lower HDL cholesterol levels (1.41±0.43mmol/L vs 1.56±0.46mmol/L, p<0.001) than a group without diabetes mellitus. 82.7% of subjects with diabetes mellitus had increased level of total cholesterol (>5 mmol/l) compared to 81.6% in control group (p¼0.009), higher levels of triglycerides (>1.7 mmol/l) (50.1% vs. 28.0%, p<0.001) and lower levels of HDL-C (<1.2 mmol/l for women and <1 mmol/l for men) (23.6% vs. 12.5%, p<0.001). There was no statistically significant difference between groups when we compared percentage of subjects whose LDL-C value was above the normal (LDL-C <3mmol/L) range (79.50% vs 79.20%, p¼0.571). Conclusions: Middle aged Lithuanian adults with diabetes mellitus are associated with more atherogenic lipid profile. However, percentage of subjects with LDL-C concentration above normal range did not differ between groups. Aim: The general objective of IBERICAN (IB) is to establish the prevalence and incidence of cardiovascular risk factors and events in Spain.The objective of this study was to determine the characteristics of dyslipidemia (DL) and its association with different vascular risk factor (VRF). Methods: IB is an observational, multicentric study where individuals that attend primary care (PC) centers in Spain,18e85 years. The final cohort will have a follow up of 5 years and the expected final sample will be 7000. In the analyzed (n ¼ 6000), the presence or absence of DL and atherogenic DL was analyzed according to sex, age and the presence of other VRF.
Background: Atrial fibrillation, as the most common type of arrhythmia, affects 1-2% of general p... more Background: Atrial fibrillation, as the most common type of arrhythmia, affects 1-2% of general population. Currently more than 6 million Europeans are experiencing this condition, since the average age of population is increasing, and it is expected that this number will rise in next 50 years by 250%. Atrial fibrillation usually leaves lasting consequences on patients overall health. Preventing them is the main therapeutic goal. 1-3 The main objective of this study was to inspect the efficiency of sinus rhythm restoration by means of electrocardioversion. Hemodynamically unstable patients (suffering from angina pectoris or hypertension), unresponsive to resuscitation, are subjected to emergency electrocardioversion. On the other hand, stable patients should undergo electrocardioversion procedure after three week long anticoagulant treatment with warfarin. Patients should continue taking warfarin for four weeks after the procedure in sake of blood clot forming prevention. Case report: From January 2017 to September 2018, 58 elective cardioversion cases were done by the Intensive Therapy Unit of the University Clinical Center of Tuzla, 12 of which were atrial flutter patients, while 40 patients had atrial fibrillation. From those 40 cases of atrial fibrillation, 6 patients underwent two cardioversion treatments using 150 J of energy, followed by single 200 J treatment. In 50 cases patients were brought back to sinus rhythm straightaway after the first treatment. Conclusion: Although efficiency rate is high (96%), qualified personnel and suitable equipment remain the most important requirements for successful and safe electrocardioversion. In long-term fibrillation, success rate of electrocardioversion and sinus rhythm perseverance decreases over time, especially if it lasts for more than a year. In that case, monitoring of the heart rate and anticoagulative therapy should be minded.
congestive heart failure, atrial fi brillation, acute infl ammatory disease. The level of glycate... more congestive heart failure, atrial fi brillation, acute infl ammatory disease. The level of glycated haemoglobin (HbA1c), GFR (CKD-EPI) and blood pressure (BP) were assessed. Oral glucose tolerance test was performed in pts without DM. Serum level of YKL-40 was measured using ELISA kits (Quidel, USA). Data are presented by mediana [25;75 percentile]. Results: A total of 83 patients with HT and CAD were enrolled in the study: 60 pts with T2D (group 1, G1) and 23 pts without DM or glucose intolerance (group 2, G2). The duration of T2D in G1 was 5 [2;10] years. The groups didn't differ by age (63 [58;72] vs 62[55;67] years, p = 0.52) and GFR (87[74;97] vs 93 [81;100] ml/min/1,73 m 2 , p = 0.08). 21/14 pts had normal (GFR>90 ml/min/1,73 m 2) and 27/9 pts had mildly reduced GFR (60-89 ml/min/1,73 m 2) in G1/2, respectively (p = 0,21). HbA1c was higher in G1 (7,6 [7,0;9,1] vs 5,7 [5,5;5,9]%, p < 0.001), but 13 (57%) pts in G2 had HbA1c level more than 5,7% (criteria of prediabetes). YKL-40 level didn't differ signifi cantly between two groups: 67,1 [46,1; 113,2] vs 68,0
Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the pa... more Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs). A 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants). Of 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20-3.56], rhythm control (OR 1.64, 1.25-2.16), and treatment by cardiologists were...
Porast morbiditeta i mortaliteta od kardiovaskularnih bolesti (KVB) zbog razvoja ateroskleroze op... more Porast morbiditeta i mortaliteta od kardiovaskularnih bolesti (KVB) zbog razvoja ateroskleroze opisan je kod nekih autoimunih bolesti kao što je reumatoidni artritis. Postojanje tradicionalnih čimbenika rizika za kardiovaskularne bolesti često je zastupljeno kod bolesnika s reumatoidnim artritisom, ali ne može objasniti povećan razvoj kardiovaskularnih bolesti kod bolesnika s reumatoidnim artritisom. Smatra se da je reumatoidni artritis udružen s povećanim rizikom za razvoj kardiovaskularne bolesti jer kronična sistemska upala predstavlja čimbenik rizika za razvoj kardiovaskularnih bolesti isto kao i hipertenzija, šećerna bolest ili dislipidemija. Ekstrazglobne manifestacije kod reumatoidnog artritisa povezane sa povećanim kardiovaskularnim mortalitetom upućuju na ulogu sistemske nekontrolirane upale u ubrzanom razvoju ateroskleroze. Cilj istraživanja je bio utvrditi učestalost tradicionalnih i netradicionalnih čimbenika rizika za razvoj kardiovaskularnih bolesti kod bolesnika sa reumatoidnim artritisom. Pacijenti i metode: Kod 50 bolesnika sa reumatoidnim artritisom određene su vrijednosti sedimentacije eritrocita (SE), C reaktivnog proteina (CRP), fibrinogena, kolesterola, triglicerida, arterijskog tlaka, reuma faktora (RF), šećera u krvi, spolna distribucija, godine života, vrijednost prema DAS 28 ljestvici. Rezultati: U ispitivanoj grupi srednja životna dob je bila 63,4 godine, postotak ženskog spola je bio 80 %, SE u prvom satu je 60,1 mm, CRP 31,2 mg/l; kolesterol 5,41 mmol/l; trigliceridi 2,76 mmol/l; RF 276; fibrinogen 5,12 g/l; glukoza 6,8 mmol/l, arterijski tlak 140/90 mmHg; vrijednost prema DAS 28 ljestvici 6,4. Zaključak: Povišeni parametri upale, kao što su CRP, fibrinogen i RF, bili su viši što je bila viša aktivnost bolesti prema DAS 28 score. Kod bolesnika sa povišenim vrijednosti prema DAS 28 ljestvici bili su povišeni i tradicionalni čimbenici rizika za razvoj KVB kod bolesnika sa reumatoidnim artritisom. Čimbenici rizika za razvoj kardiovaskularnih bolesti u reumatoidnom artritisu Risk factors for development of cardiovascular diseases in rheumatoid arthritis Prošireni sažetak Čimbenici rizika i životne navike
DijastoliËka funkcija lijeve klijetke u akutnom infarktu miokarda SAAEETAK: PoremeÊaj dijastoliËk... more DijastoliËka funkcija lijeve klijetke u akutnom infarktu miokarda SAAEETAK: PoremeÊaj dijastoliËke funkcije lijeve klijetke (LK) je jedan od prvih poremeÊaja funkcije LK, koji se registriraju prije poremeÊaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom koπu, πto bitno mijenja prognozu pacijenata s akutnim koronarnim sindromom. PoremeÊaj relaksacije LK Ëesto se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremeÊaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraaeenija dijastoliËka abnormalnost uzrokovana ishemijom miokarda je produaeena i usporena relaksacija miokarda. Ehokardiografske tehnike omoguÊavaju evaluaciju di-jastoliËkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoliËku funkciju LK u bolesnika s AIM i usporediti varijable dijastoliËke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraaeivanje ukljuËeno je 60 bolesnika (37 muπkaraca, prosjeËne aeivotne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Pra-Êene su varijable dijastoliËke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u pluÊnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoliËkog punjenja nisu se sta-tistiËki znaËajno razlikovale u obje skupine, ali je bila niaea u odnosu na prosjeËnu vrijednost brzine ranog dijastoliËkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoliËkog protoka pluÊnih vena registrirana je statistiËki znaËajna razlika (p<0,05) izmeu ispitivanih skupina. U prvoj skupini iznosila je 0,48±0,10, a u drugoj iznosila je 0,57±0,14. Maksimalna brzina dijastoliËkog protoka pluÊnih vena u prvoj skupini iznosila je 0,37±0,09, a u drugoj skupini iznosila je 0,43±0,16. Odnos maksimalne brzine sistoliËkog i dijastoliËkog protoka pluÊnih vena je neπto veÊi nego kod zdravih osoba. U bolesnika s AIM dominira (70%) dijastoliËka disfunkcija tipa poremeÊaja relaksacije LK. U ispitivanoj skupini bolesnika s anteroseptalnim AIM dijastoliËka disfunkcija tipa pore-meÊaja relaksacije je dominantna, odnosno registrirana je sta-tistiËki znaËajna razlika u odnosu na oËuvanu dijastoliËku funkciju i na dijastoliËku disfunkciju tipa poremeÊaja restrikcije LK (p<0,05). ZakljuËno, kod AIM, kako anteroseptalne tako i inferiorne stijenke, promijenjeni su parametri dijastoliËke funkcije, odnosno prisutna su sva tri stupnja dijastoliËke disfunkcije LK. Dominira dijastoliËka disfunkcija tipa poremeÊaja relaksacije miokarda. U AIM anteroseptalne stijenke najviπe je prisutna dijastoliËka disfunkcija tipa poremeÊaja relaksacije, odnosno postoji dobra korelacija s infarciranom zonom u odnosu na inferiornu stijenku.
Kardiovaskularne bolesti (KVB) vodeÊi su uzrok smrtnosti u pacijenata na kroniËnoj dijalizi. Paci... more Kardiovaskularne bolesti (KVB) vodeÊi su uzrok smrtnosti u pacijenata na kroniËnoj dijalizi. Pacijenti s kroniËnom bubreaenom insuficijencijom imaju 10-20 puta viπi rizik razvoja 2013;8(1-2):67.
Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian ... more Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary ‘real-world’ AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA2DS2-VASc score was not significantly associated with OAC use. Of the ‘truly low-risk’ patients (CHA2DS2-VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was ...
JZU UKC Tuzla Klinika za interne bolesti ABSTRAKT Uvod: Kardiovaskularne bolesti su jedan od vode... more JZU UKC Tuzla Klinika za interne bolesti ABSTRAKT Uvod: Kardiovaskularne bolesti su jedan od vodećih uzroka morbiditeta i mortaliteta u opštoj populaciji. Učestalost kardiovaskularnih oboljenja u određenih skupina bolesnika je veća u odnosu na opštu populaciju. U navedene skupine spadaju bolesnici sa hroničnom bubrežnom insuficijencijom, bolesnici sa transplantiranim bubregom, bolesnici sa autoimunim i reumatološkim oboljenjima. Bolesnici s hroničnom bubrežnom insuficijencijom imaju 10-20 puta veći rizik razvoja kardiovaskularnih bolesti u odnosu na opštu populaciju. Ovi bolesnici su izloženi tradicionalnim i netradicionalnim faktorima rizika za razvoj kardiovaskularnih komplikacija. Tradicionalni faktori rizika: dob, dijabetes, pušenje cigareta, hipertenzija, hiperlipidemija, pozitivna porodična anamneza. Netradicionalni faktori rizika se mogu podijeliti na hemodinamičke (anemija, retencija Na i H2O, povećan protok krvi kroz vaskularni pristup za hemodijalizu) i metaboličke (hipoal...
JZU UKC Tuzla, Klinika za interne bolesti, BiH SAŽETAK Uvod:Učestalost arterijske hipertenzije u ... more JZU UKC Tuzla, Klinika za interne bolesti, BiH SAŽETAK Uvod:Učestalost arterijske hipertenzije u dijaliznih bolesnika je velika. Na temelju više studija, 50 do 60 posto bolesnika na hemodijalizi (do 85 posto u nekim izvještajima) i gotovo 30 posto bolesnika na peritonealnoj dijalizi imaju arterijsku hipertenziju. Hipertenzija je nezavisan faktor rizika za razvoj kardiovaskularnih komplikacija u bolesnika liječenih redovnim hemodijalizama. Svako povećanje srednjeg arterijskog krvnog pritiska za 10 mmHg nezavisno je udruženo sa progresivnim povećanjem koncentrične hipertrofije lijevog ventrikula, razvojem de novo srčane slabosti i de novo ishemijske bolesti srca. Liječenje arterijske hipertenzije u bolesnika na hemodijalizi još je uvijek veliki stručni izazov za nefrologe. Nedostaju kontrolirane studije o antihipertenzivnoj terapiji u dijaliznih bolesnika, kao i o učinku nefarmakoloških mjera. Terapija antihipertenzivima primarno je indicirana u 25 do 30 posto dijaliznih bolesnika. Bl...
JZU UKC Tuzla, Klinika za interne bolesti, BiH ABSTRAKT Uvod: Bolesnici u terminalnom stadiju bub... more JZU UKC Tuzla, Klinika za interne bolesti, BiH ABSTRAKT Uvod: Bolesnici u terminalnom stadiju bubrežne bolesti izloženi su brojnim faktorima rizika koji doprinose nastanku ateroskleroze: povišen arterijski krvni pritisak, poremećaj metabolizma lipida, mikroinflamacija, hiperhomocisteinemija, oksidativni stres i sekundarni hiperparatireoidizam. Uremijski milje pogoduje nastanku ateroskleroze i aterosklerotskih kardiovaskularnih komplikacija, a često je prisutan i razvoj ubrzane, galopirajuće ateroskleroze. Hiperlipidemija je nezavisan faktor rizika za razvoj ateroskleroze. 30-50% bolesnika u terminalnom stadiju bubrežne bolesti liječenih dijalizom ima povišene vrijednosti LDL-holesterola, snižene vrijednosti HDL-holesterola i povišene vrijednosti triglicerida. Prema National Cholesterol Education Program (NCEP) smjernicama, u bolesnika koji se liječe redovnim hemodijalizama sa povišenim rizikom od razvoja kardiovaskularnih komplikacija, ciljni nivo LDL holesterola treba da bude < ...
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