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Johann Trutz, Aurel Babeș and Katalin Babeș

Abstract

Background and Aims. Several factors are associated with a heightened risk of subsequent events, morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) after an acute coronary syndrome (ACS). Improving the management of these patients is a challenge that requires urgent attention. We aimed to study the long-term effect of the change in treatment strategy depending on the HbA1c level detected during the hospitalization for ACS. Material and methods. The primary endpoints of this study were the major adverse cardiac events (MACE) at 12 months. From the originally included 221 patients 15 were lost (no response to follow-up phone calls). The suboptimal glycaemic control group (HbA1c>7.0%, n=84) was divided in two subgroups: patients who completed a diabetological consult with further treatment changes (intervention group) and patients without this referral (control group). Results. No significant differences in baseline characteristics were found between the 2 subgroups. The second subgroup had a triple risk for a MACE in 1 year (HR=2.8704, 95% CI: 1.109-7.423, p=0.0296) compared to the intervention group. No significant differences were found in secondary endpoints. Conclusion. This study suggests that, after hospitalization for an ACS, diabetologist referral and treatment strategy changes are recommended for all T2DM patients whose HbA1c level is over 7% before discharge.

Open access

Xiao-huan Gong, Jin-ming Yu, Yong Mao and Da-yi Hu

Introduction Acute coronary syndrome (ACS) encompasses unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STE-MI). UA and NSTE-MI are classified as non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Life-threatening NSTE-ACS is a leading cause of emergency and hospitalization in the United States. [ 1 ] It causes a lot of public expenditures. Its cost might account for a large proportion of worldwide health care expenditures in the future. [ 2 ] The basic medicine for

Open access

Tatjana Grdanoska, Planinka Zafirovska, Branko Jaglikovski, Jasmina Trojacanec, Dimce Zafirov, Dejan Neshov, Milena Petrovska, Zhaklina Cekovska and Nikola Panovski

Assessment of Three Inflammatory Markers of Cardiovascular Diseases with a Special Accent on C-Reactive Protein

Background: Elevated levels of CRP, myoglobin and creatine kinase are always associated with pathological changes and hence their values give useful information for exact diagnosis and therapy. They are helpful in monitoring the inflammatory processes and associated diseases.

Aim: The aim of this study was to determine the usefulness and practical value of application of CRP detection by comparing it with the results obtained for the classical enzymes - markers of myocardial damage, myoglobin and creatine kinase isoenzyme MB (CK-MB) in pts with acute coronary syndrome (ACS), pts with chronic coronary artery disease (CAD) and in healthy individuals.

Material and Methods: Sera were taken from a total of 152 individuals (78.9% males, 21.1% females, mean age 61.87 ± 10.32 years). The subjects were divided in three groups: 63 pts with ACS; 52 pts CAD and a group of 36 conditionally healthy individuals. Analysis of patients' sera for presence of markers for myocardial damage: myoglobin, CK-MB along with determination of CRP level was done on the Immulite system, DPC (Diagnostic Products Corporation), Los Angeles, USA.

Results: Comparison of examined biomarker's values in pts divided according to diagnosis showed statistically significant higher levels in patients with ACS vs. others. As for biomarker's cut-off values, out of all CK-MB ≥5.7 ng/mL was found in 34 (53.1%) pts with ACS with significant difference among the groups in favor of its higher values in pts with ACS (p=0.0001). Out of all, myoglobin ≥25 ng/mL was found in 54 (84.4%) pts with ACS without significant difference among the groups. As for CRP, value of ≥3 mg/L was found in 39 (60.9%) pts with ACS and there was significant difference among the groups in favor of higher values in pts with ACS (p=0.001). There was significant positive correlation among the levels of examined three biomarkers: CK-MB in correlation to myoglobin (r=0.460; p= 0.0001) and to CRP level (r=0.204; p= 0.009), as well as myoglobin to CRP level (r=0.218; p= 0.005).

Conclusion: We could conclude that determination of CRP levels is a valid test for detection of acute coronary artery disease in addition to the classical, standard markers for myocardial damage.

Open access

Hektor Sula, Rudin Domi, Arben Beqiri and Andi Koraqi

Abdominal Compartment Syndrome as an Independent Mortality Predictor Factor During Acute Pancreatitis

Aim: The aim was to study the role of abdominal compartment syndrome and intra-abdominal hypertension (IAH) as indipendent predictor factors on outcome and mortality in patients during early phase of acute pancreatitis (AP).

Material and Methods: According the IAP 102 patients with medically treated AP were divided: in the first group (N = 32 patients) the IAP was over 12 mmHg, in second group (N = 27 patients) the IAP was over 20 mmHg (ACS), and the third group (N = 43 patients) with normal pressure. There were recorded APACHE 2 score in admission, the incidence of multiorganic dysfunction syndrome and mortality.

Results: No statistical significance is observed between three groups regarding age, gender, APACHE II score, Ranson score, CTSI. Kruskal-Wallis test resulted positive for all variables suggesting a statistically significant difference between groups. The pairwise test for comparison of subgroups according to Conover, yielded a statistically significant difference of ACS (p<0.05). ACS group resulted with more early deaths (13 patients) and total deaths (15 patients).

Conlusion: The abdominal compartment syndrome and increased intrabdominal pressure occurred during the early fase of AP may be predictors of increased MODS and mortality.

Open access

Zeynep Yildiz, Abdulkadir Koçer, Şahin Avşar and Göksel Cinier

:329-65. 5. Hamm Cw., Bassand Jp., Agewall S., Bax J. Esc Committee For Practice Guidelines. Esc Guidelines For The Management Of Acute Coronary Syndromes In Patients Presenting Without Persistent St-Segment Elevation: The Task Force For The Management Of Acute Coronary Syndromes (Acs) In Patients Presenting Without Persistent St-Segment Elevation Of The European Society Of Cardiology (Esc). Eur Heart J. 2011; 32:2999-3054. 6. Kerr G., Ray G., Wu O., Stott Dj., Langhorne P. Elevated Troponin After Stroke: A Systematic Review. Cerebrovasc Dis. 2009; 28

Open access

Lachezar Grozdinski, Mario Stankev and Kocho Dimitrovski

Efficacy of the Carotid Endarterectomy in Asymptomatic and Symptomatic Carotid Stenosis and in Patients with Multifocal Atherosclerosis

Aim. The aim of the research was to study the effect of carotid endarterectomy (CEA) at patients with asymptomatic and symptomatic carotid stenosis, also in the patients with multifocal atherosclerosis (MFA): carotid stenosis in patients with peripheral arterial disease (PAD) of the limbs and ischemic heart disease (IHD).

Material and methods. Colour Duplex Doppler was used for screening of carotid pathology in 1104 patients with PAD, IHD, transitory ischemic attacks and an ischemic stroke. The group of 205 patients who had stenosis of a. carotis interna >60%, were divided into three subgroups - patients with asymptomatic carotid stenosis (ACS), patients with symptomatic carotid stenosis (SCS) and patients with multifocal atherosclerosis MFA.

Results. All 205 patients were subjected to CEA, conducted by a patch or shunt, which was successful performed at 201 patients (98%). Significant improvement of hemodynamic of the regional carotid as well as intracranial arteries on the side of the surgery was determined using Colour Duplex and Transcranial Doppler Sonography (TDS). At a second stage, after the successful CEA, a vascular reconstruction was carried out or an aorto-coronary bypass created in the case of patients with MFA.

Conclusion. CEA in the case of patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an efficient curative method of removing the carotid pathology with a minimum percentage of vascular complications.

Open access

Anca Bălănescu, Paul Bălănescu, Valentina Comănici, Iustina Stan, Beata Acs, Laura Prisăcariu, Florin Brezan, Tatiana Ciomârtan and Ioan Gherghina

Abstract

Background and aims. The aim of this study is to assess the lipid profile pattern of pediatric overweight and/or obese patients with Non-Alcoholic Fatty Liver Disease (NAFLD) in relation to IDF Consensus Criteria for Metabolic Syndrome (MetS).

Material and Methods. We conducted a cross-sectional preliminary study on 45 consecutive pediatric patients. Overweight or obese children aged from 3 to 18 years were included. Standardized measurement of blood pressure and anthropometric parameters were performed. Biological evaluation included inflammatory status, lipid profile, glycemic profile, full blood count and liver function tests. Abdominal ultrasound was performed in all patients.

Results. Prevalence of MetS was 44.4%. A number of 21 patients (46.7%) had NAFLD. MetS patients had higher risk for NAFLD (OR = 9.5, 95% CI = 2.42-37.24). Also patients with positive familial history of type 2 diabetes had a 6.61 fold higher risk for NAFLD (OR = 6.61, 95% CI = 1.74-25.1). We performed a subgroup analysis in patients under ten years old. Patients under the age of ten which had both NAFLD and MetS met more frequently the hypertriglyceride criterion. After adjusting for age and MetS presence, triglyceride levels independently associated with NAFLD (adjusted R square = 0.46, unstandardized B coefficient = 34.51, 95% CI = 4.01-65.02, p = 0.02).

Conclusion. NAFLD obese patients had higher prevalence of MetS, higher BMI and particular lipid profile pattern. Triglyceride levels independently associated with NAFLD after adjusting for age and MetS presence. According to our findings we suggest early triglyceride testing (even below the age of ten) in selected patients.

Open access

Olga Kokoceva-Ivanovska and Mile Carcev

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Open access

Mirko Spiroski

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Open access

Aleksandra Gavrilovska-Brzanov, Zorka Nikolova, Nikola Jankulovski, Mirjana Sosolceva, Gordana Taleska, Maja Mojsova-Mijovska, Marija Jovanovski-Srceva, Darko Angusev, Darko Sazdov and Nikola Brzanov

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