Dejan Petrović, Marina Deljanin Ilić, Bojan Ilić, Sanja Stojanović, Milovan Stojanović and Dejan Simonović
Asystole is a rare primary manifestation in the development of sudden cardiac death (SCD), and survival during cardiac arrest as the consequence of asystole is extremely low. The aim of our paper is to illustrate successful cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) and rare and severe form of cardiac arrest - asystole. A very short time between cardiac arrest in acute myocardial infarction, which was manifested by asystole, and the adequate CPR measures that have been taken are of great importance for the survival of our patient.
After successful reanimation, the diagnosis of anterior wall AMI with ST segment elevation was established. The right therapeutic strategy is certainly the early primary percutaneous coronary intervention (PPCI). In less than two hours, after recording the “flatline” and successful reanimation, the patient was in the catheterization laboratory, where a successful PPCI of LAD was performed, after emergency coronary angiography. In the further treatment course of the patient, the majority of risk factors were corrected, except for smoking, which may be the reason for newly discovered lung tumor disease. Early recognition and properly applied treatment of CPR can produce higher rates of survival.
Biljana Popovska-Jovicic, Ivana Rakovic, Sara Petrovic, Petar Canovic, Dejan Petrovic, Sofija Sekulic, Ivan Jovanovic and Nemanja Jovicic
Febrile conditions of unidentified origin are still unknown in modern medicine despite the development of diagnostic procedures. There are various agents of long-term temperature encompassing numerous infectious or non-infectious diseases.
The aim of this study was to determine if there was a statistically significant difference in the values of proinflammatory cytokines (IL-1, TNFα, IL-6) in patients who meet the criteria for febrile conditions of unidentified origin, between the group of infectious, malignant, rheumatic, “other” diseases and undiagnosed patients.
The study was conducted in the Immunology laboratory of the Center for Molecular Medicine and Stem Cells Research of the Faculty of Medical Sciences in Kragujevac. Blood samples were taken from patients tested at the Clinic for Infectious Diseases, of the Clinical Center of Kragujevac, in the period from 2014 to 2016. The study included 70 patients.
The measured values of the level of TNFα showed significantly higher values in a group of malignant diseases than in the group of infectious diseases, while the values of IL-1 and IL-6 did not show statistical significance.
TNFα can improve diagnosing in case of patients with an unknown febrile condition, which can shorten the length of the hospital stay and reduce the volume of performance of diagnostic procedures.
Hyperphosphatemia - The Risk Factor for Adverse Outcome in Maintenance Hemodialysis Patients
Hyperphosphatemia is a potent stimulator of vascular and valvular calcifications in hemodialysis patients. To determine the prevalence of hyperphosphatemia and assess its effect on the outcome of hemodialysis patients, a total of 115 chronic hemodialysis patients were studied. Laboratory parameters were determined at baseline, and after 12 and 24 months of follow-up. Valvular calcification was assessed with echocardiography. Laboratory parameters were statistically analyzed with ANOVA. Survival analysis was performed with the Kaplan-Meier test and Log-Rank test. Hyperphosphatemia was present in 31.30% of the patients, high calcium-phosphate (Ca × P) product in 36.52% and valvular calcifications in 48.70%. Patients with serum phosphate >2.10 mmol/L and Ca × P product >5.65 mmol2/L2 at baseline were at high risk for all-cause and cardiovascular mortality. Hyperphosphatemia is a risk factor for adverse outcome in patients on regular hemodialysis.
Dragana Petrović, Dejan Jančić, Martina Furdek, Nevenka Mikac and Slađana Krivokapić
Skadar Lake is the largest shallow lake in southeastern Europe. It is located within a national park, and is included in the Ramsar List of international important wetlands, so its preservation and protection from pollution is very important. The aim of this study was to investigate bioaccumulation of the ecotoxic metals Cd, Pb and Cr from sediments of Skadar Lake in the aquatic macrophyte Trapa natans L. Samples of sediment and plants were collected at nine locations covering all major water inputs to the lake as well as locations where contamination could be expected. The obtained results indicate that sediments from the Skadar Lake are only locally contaminated with Cd (0.03–1.18 mg kg−1), generally contaminated with Cr (15.8–180 mg kg−1), the concentrations of both elements frequently exceeding sediment quality guidelines, while concentrations of Pb were low (2.7–17.4 mg kg−1). The highest bioaccumulation of all metals from sediment to Trapa natans L. was observed in the root, with accumulation efficiency decreasing in the order Cd > Cr > Pb. Translocation from root to stem was also higher for Cd than for Cr and Pb, while the translocation from stem to leaf was comparable for all three metals. From the three investigated metals Cd showed the highest mobility. The results indicate that Trapa natans L. may be a very promising bioindicator of trace metal contamination in Skadar Lake.
Cardiovascular Mortality in Hemodialysis Patients: Clinical and Epidemiological Analysis
Cardiovascular diseases are the leading cause of death in hemodialysis (HD) patients. The annual cardiovascular mortality rate in these patients is 9%, with left ventricular (LV) hypertrophy, ischemic heart disease and heart failure being the most prevalent causes of death. The aim of this study was to determine the cardiovascular mortality rate and estimate the influence of risk factors on cardiovascular mortality in HD patients. A total of 115 patients undergoing HD for at least 6 months were investigated. Initially a cross-sectional study was performed, followed by a two-year follow-up study. Beside the standard biochemical parameters, C-reactive protein (CRP), homocysteine, cardiac troponins (cTn) and the echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction) were determined. Results were analyzed using Cox regression analysis, Kaplan-Meier and Log-Rank tests. The average one-year cardiovascular mortality rate was 8.51%. Multivariate Cox regression analysis identified increased CRP, cTn T and I, and LV mass index as independent risk factors for cardiovascular mortality. Patients with cTnT > 0.10 ng/mL and CRP > 10 mg/L had significantly higher cardiovascular mortality risk (p < 0.01) than patients with cTnT > 0.10 ng/mL and CRP ≤ 10 mg/L and those with cTnT ≤ 0.10 ng/mL and CRP ≤ 10 mg/L (p < 0.01). HD patients with high cTnT and CRP have a higher cardiovascular mortality risk.
Prevalence of cognitive disorders is high in maintenance hemodialysis patients. Montreal cognitive assessment (MoCA) is used for detecting and evaluation of cognitive disorder degree in this patient population. In examined patient population, only 5 (12.5%) of them had normal cognitive function (MoCA ≥26). Mild cognitive impairment (MoCA 18-26) was found in 65.9% (29) patients, while moderate cognitive disorder (MoCA 10-17) was detected in 6 (21.6%) patients. Major cognitive disorder wasn’t detected in examined population. Statistically signifi cant correlation was not established between laboratory parameters and overall MoCA score. Statistically signifi cant correlation, however, was established between MoCA item that evaluates space and time orientation and intermediate secondary hyperparathyroidism and space and time orientation and severe secondary hyperparathyroidism. Hemodynamic instability during hemodialysis and silent ischemia of the brain are increasing risk of appearance of cognitive disorders in maintenance hemodialysis patients.
Cardiovascular diseases are the leading cause of death in patients who undergo regular hemodialysis. Oxidative stress is a non-traditional risk factor for the development of cardiovascular diseases in this population of patients. It is defined as tissue damage caused by balance disturbance between the formation of free radicals and the function of protective antioxidative systems. The superoxide anion and hydrogen peroxide are precursors in the formation of stronger oxidants, such as: hydroxyl radical, peroxynitrite and hypochloric acid. Superoxide dismutase is the first line of antioxidant protection while catalase, glutathione peroxidase, trace elements, vitamin C, vitamin E, N-acetylcysteine and coenzyme Q10 also have a significant antioxidative role. Hemo-dialysis is itself a trigger for the increased formation of oxygen free radicals. The two main pathophysiological mechanisms of the increased formation of free oxygen radicals during the hemo-dialysis session are: bionicompatibility of the dialysis membrane and the presence of endotoxins in the hemodialysis solution. The measurement of myeloperoxidase concentration in a patient’s serum during hemodialysis is an indicator of the severity of oxidative stress induced by the dialysis membrane (an indicator of the biocompatibility of the dialysis membrane). The main clinical consequences of oxidative stress include: atherosclerosis, erythropoietin resistance, malnutrition and amyloidosis associated with hemodialysis. The evaluation of oxidative stress in patients undergoing hemodialysis is performed by measuring the concentration of lipid peroxidation products (malonyldialdehyde, 4-hydroxynonenal, TBARS, F2-isoprostane, oxLDL), protein oxidation (AOPP), protein gelling (AGE), and oxidation of nucleic acids (8-OHdG). The antioxidant treatment strategy consists of replenishing vitamin C, vitamin E, selenium, N-acetylcysteine and coenzyme Q10. On-line hemodialysis, a biocompatible vitamin E-coated dialysis membrane, an ultra-pure solution for hemodialysis, prevent oxidative stress, reduce the rate of cardiovascular morbidity and mortality and improve life quality of patients treated with regular hemodialysis.
Dejan Petrović, Marina Deljanin Ilić1, Sanja Stojanović and Viktor Stoičkov
Acute myocardial infarction (AMI) is a common cause of reduced cardiac capacity and functional status of a patient. Successful primary percutaneous coronary intervention (pPCI) in acute coronary syndrome and appropriate, complex cardiovascular rehabilitation play a major role in preserving left ventricular function and improvement of prognosis and quality of patient’s life. The aim of this paper was to present a clinical course in a patient with acute myocardial infarction who did not have a classic ECG presentation in the form of ST-segment elevation. We showed that in everyday clinical work it is essential to timely recognize the symptoms of acute myocardial infarction, make the proper diagnosis and perform right treatment strategy. The next step is cardiovascular rehabilitation program, which positive effects, in our patient, was achieved through the retrieval of functional capacity and correction of risk factors.
Jelena Nešić, Nenad Zornić, Vesna Rosić and Dejan Petrović
Hepatorenal syndrome (HRS) involves reversible renal failure in patients with advanced cirrhosis or acute liver failure. The aim of the study was to determine the pathogenetic mechanisms of the development of hepatorenal syndrome and to emphasise the clinical importance of early detection and timely treatment of patients with this condition. Th e one-year incidence rate of hepatorenal syndrome in patients with liver cirrhosis is 18-20%. Th e risk factors for the development of hepatorenal syndrome include the following: spontaneous bacterial peritonitis, gastrointestinal bleeding, nephrotoxic drugs, diuretics, non-steroidal anti-inflammatory drugs, and hyponatraemia. The primary plan of treatment is a liver transplantation, while a secondary plan of treatment is the use of a vasoconstrictor in conjunction with albumin. Early diagnosis and prompt appropriate treatment can significantly reduce the mortality rate of patients with hepatorenal syndrome.
Aleksandra Nikolić, Sasa Jaćović, Željko Mijailović and Dejan Petrović
Sepsis is the leading cause of acute kidney damage in patients in intensive care units. Pathophysiological mechanisms of the development of acute kidney damage in patients with sepsis may be hemodynamic and non-hemodynamic. Patients with severe sepsis, septic shock and acute kidney damage are treated with continuous venovenous hemodiafiltration. Sepsis, acute kidney damage, and continuous venovenous hemodiafiltration have a significant effect on the pharmacokinetics and pharmacodynamics of antibiotics. The impact dose of antibiotics is increased due to the increased volume of distribution (increased administration of crystalloids, hypoalbuminemia, increased capillary permeability syndrome toproteins). The dose of antibiotic maintenance depends on renal, non-renal and extracorporeal clearance. In the early stage of sepsis, there is an increased renal clearance of antibiotics, caused by glomerular hyperfiltration, while in the late stage of sepsis, as the consequence of the development of acute renal damage, renal clearance of antibiotics is reduced. The extracorporeal clearance of antibiotics depends on the hydrosolubility and pharmacokinetic characteristics of the antibiotic, but also on the type of continuous dialysis modality, dialysis dose, membrane type, blood flow rate, dialysis flow rate, net filtration rate, and effluent flow rate. Early detection of sepsis and acute kidney damage, early target therapy, early administration of antibiotics at an appropriate dose, and early extracorporeal therapy for kidney replacement and removal of the inflammatory mediators can improve the outcome of patients with sepsis in intensive care units.