Cardiovascular complications are associated with advanced atherosclerosis. Although atherosclerosis is still regarded as an incurable disease, at least in its more advanced stages, the discovery of ...endothelial progenitor cells (EPCs), with their ability to replace old and injured cells and differentiate into healthy and functional mature endothelial cells, has shifted our view of atherosclerosis as an incurable disease, and merged traditional theories of atherosclerosis pathogenesis with evolving concepts of vascular biology. EPC alterations are involved in the pathogenesis of vascular abnormalities in atherosclerosis, but many questions remain unanswered. Many currently available drugs that impact cardiovascular morbidity and mortality have shown a positive effect on EPC biology. This review examines the role of endothelial progenitor cells in atherosclerosis development, and the impact standard antilipemic drugs, including statins, fibrates, and ezetimibe, as well as more novel treatments such as proprotein convertase subtilisin/kexin type 9 (PCSK9) modulating agents and angiopoietin-like proteins (Angtpl3) inhibitors have on EPC biology.
The metabolic syndrome is a constellation of risk factors for cardiovascular diseases including: abdominal obesity, a decreased ability to metabolize glucose (increased blood glucose levels and/or ...presence of insulin resistance), dyslipidemia, and hypertension. Patients who have developed this syndrome have been shown to be at an increased risk of developing cardiovascular disease and/or type 2 diabetes. Genetic factors and the environment both are important in the development of the metabolic syndrome, influencing all single components of this syndrome. The goals of therapy are to treat the underlying cause of the syndrome, to reduce morbidity, and to prevent complications, including premature death. Lifestyle modification is the preferred first-step treatment of the metabolic syndrome. There is no single effective drug treatment affecting all components of the syndrome equally known yet. However, each component of metabolic syndrome has independent goals to be achieved, so miscellaneous types of drugs are used in the treatment of this syndrome, including weight losing drugs, antidiabetics, antihypertensives, antilipemic and anticlothing drugs etc. This article provides a brief insight into contemporary drug treatment of components the metabolic syndrome.
Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). CFRD has been correlated with important clinical outcomes, including poor nutrition, ...reduced pulmonary function, and earlier mortality. However, clinical decline due to abnormalities of blood glucose (dysglycemia) begins early in CF, before the diagnosis of CFRD by the gold-standard oral glucose tolerance test (OGTT). Continuous glucose monitoring (CGM) has been validated in patients with CF and has been recognized as a valuable tool in detecting early glucose abnormalities in patients with CF. Several CGM parameters have been used to predict CFRD in some but not all studies, and there is no consensus regarding CGM use for diagnostic purposes. Thus, it remains a complementary test to OGTT in CFRD diagnosis. The aim of this review is to provide an update on the pathophysiological mechanisms of CFRD, recent advances in the use of CGM for CFRD screening, and the association between CGM measures and CF-related clinical outcomes.
Diabetes is one of the leading chronic diseases globally with a significant impact on mortality. This condition is associated with chronic microvascular and macrovascular complications caused by ...vascular damage. Recently, endothelial progenitor cells (EPCs) raised interest due to their regenerative properties. EPCs are mononuclear cells that are derived from different tissues. Circulating EPCs contribute to regenerating the vessel’s intima and restoring vascular function. The ability of EPCs to repair vascular damage depends on their number and functionality. Diabetic patients have a decreased circulating EPC count and impaired EPC function. This may at least partially explain the increased risk of diabetic complications, including the increased cardiovascular risk in these patients. Recent studies have confirmed that many currently available drugs with proven cardiovascular benefits have beneficial effects on EPC count and function. Among these drugs are also medications used to treat different types of diabetes. This manuscript aims to critically review currently available evidence about the ways anti-diabetic treatment affects EPC biology and to provide a broader context considering cardiovascular complications. The therapies that will be discussed include lifestyle adjustments, metformin, sulphonylureas, gut glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor analogs, sodium-glucose transporter 2 inhibitors, and insulin.
Objective. Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress ...hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25–96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression. Results. Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p<0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p<0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p<0.05). Conclusion. Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.
Aim: Hemodialysis patients present with signs of chronic systemic inflammation. Periodontitis can also trigger systemic inflammation and thus affect sarcopenia. The aim of the study was to examine ...the presence of sarcopenia and periodontitis in patients on chronic hemodialysis and see whether there is a correlation between them. Methods:The study included 53 patients on hemodialysis. Oral status and routine laboratory parameters, as well as body composition and handgrip strength, were measured. Results: 20.8% of patients had sarcopenia, while 69% had stage 4. periodontitis. No statistically significant correlation was found between sarcopenia and periodontitis, but fat mass (FM%) correlated positively with tooth loss (rho = 0.313, p = 0.027), as well as muscle fat (IMAT) (rho = 0.393, p = 0.005). Percentage of skeletal muscle in relation to body weight (wSMI) correlated negatively with tooth loss (rho = -0.393, p = 0.005), as well as the grip strength of the dominant hand (rho = -0.294, p = 0.043). Conclusion: In this pilot study, the correlation between sarcopenia and periodontitis in patients on HD 'was not determined, but a significant correlation of body composition parameters with tooth loss was found, which should be tested in a larger cohort of patients. Key words: periodontitis, sarcopenia, hemodialysis
The patient was born in 1967. In 2004 the patient started renal replacement therapy with peritoneal dialysis. In 2010, after the first episode of peritonitis caused by Staphylococcus aureus, due to ...poor response to antibiotic therapy, the peritoneal catheter was removed. A month after this episode, pain accompanied by fever and an increase in inflammatory parameters occurred. Initial computed tomography scans did not show any specific abnormalities and the second CT two months later diagnosed sclerosing peritonitis. Corticosteroid and tamoxifen therapy with enteral nutrition was initiated. Five months after the symptoms started, the patient developed intestinal obstruction, so a nasogastric tube was placed and total parenteral nutrition was introduced. After four months, the patient was surgically treated at the Manchester Royal Infirmary, resection of the terminal ileum and caecum was performed, and an ileocecal anastomosis with enterolysis was performed. Then, in 2012, a successful kidney transplant was performed. The patient has since remained without clinical signs of obstruction. Tamoxifen and corticosteroid therapy with adequate nutritional support, surgical treatment, and transplantation with long-term immunosuppressive therapy may be reasons for long-term remission and survival ten years after EPS diagnosis. Key words: Encapsulating peritoneal sclerosis (EPS); peritoneal dialysis (PD); EPS surgical treatment, kidney transplantation EPS
Metabolic syndrome (MetS) is the occurrence of diabetes mellitus/glucose intolerance, arterial hypertension, central obesity, dyslipidemia, and microalbuminuria in the same patient (definition by ...WHO). Presence of metabolic syndrome is associated with larger myocardial infarction size and complications following acute myocardial infarction. Two hundred and thirty patients with acute coronary syndromes were analyzed. Those with MetS (n=141) included patients with diabetes mellitus/glucose intolerance and at least two of the following criteria: hypertension, hypertriglyceridemia/low HDL cholesterol, android obesity/body mass index (BMI) ≥ 30, or microalbuminuria. Control group did not meet criteria for MetS. Presence of heart failure was assigned according to Killip classification. The MetS group had larger myocardial infarction size determined by peak creatine-kinase (CK) (1484±1354 vs. 981±890, p = 0.003) and CK MB (141±117 vs. 95±78, p = 0.002). While in non-MetS group males had larger myocardial infarction than females, in MetS group females had larger myocardial infarction than males. Cardiac failure occurred more in MetS group of patients, again was more prominent in females. Occurrence of metabolic syndrome in acute coronary syndrome patients predisposes to larger myocardial infarction size, more on the account of female patients having MetS. MetS, again particularly in females, predisposes to higher chance of having heart failure during acute coronary syndrome. Recognizing the female group with MetS as of higher risk for large myocardial infarction and heart failure leads us to pay special attention on this patient population.
In this article, we document a conclusive case of nebivolol-induced hyperkalemia
for the first time in the known medical literature. Hyperkalemia is associated with serious conditions
such as cardiac ...arrhythmias and sudden cardiac death. Nebivolol was not known to cause hyperkalemia,
and this event is not listed in its summary of product characteristics (SmPC). For older beta
blockers, hyperkalemia is recognized as a rare adverse event linked to cytochrome P450 2D6 (CYP2D6)
polymorphism and poor drug degradation. Our patient, a 47-year-old woman taking nebivolol for
hypertension developed persistent hyperkalemia, with serum potassium levels up to 6.4 mmol/L.
After extensive diagnostic evaluation and exclusion of other known conditions leading to hyperkalemia,
its cause remained occult. Since hyperkalemia coincided with increased doses of nebivolol, dose
reduction and discontinuation were attempted, resulting in normalized serum potassium. Poor drug
metabolism could not explain this adverse effect, since pharmacogenetic testing showed no relevant
aberrations. In conclusion, hyperkalemia is a harmful adverse event with possible lethal outcome, and
it may be caused by nebivolol. Therefore, medical professionals have to be aware of this side effect and
hyperkalemia should be listed as an adverse event in nebivolol SmPC.
Abstract. Metabolic syndrome (MetS) is the occurrence of diabetes mellitus/glucose intolerance, arterial hypertension, central obesity, dyslipidemia, and microalbuminuria in the same patient ...(definition by WHO). Presence of metabolic syndrome is associated with larger myocardial infarction size and complications following acute myocardial infarction. Two hundred and thirty patients with acute coronary syndromes were analyzed. Those with MetS (n=141) included patients with diabetes mellitus/glucose intolerance and at least two of the following criteria: hypertension, hypertriglyceridemia/low HDL cholesterol, android obesity/body mass index (BMI) ≧ 30, or microalbuminuria. Control group did not meet criteria for MetS. Presence of heart failure was assigned according to Killip classification. The MetS group had larger myocardial infarction size determined by peak creatine-kinase (CK) (1484±1354 vs. 981±890, p=0.003) and CK MB (141±117 vs. 95±78, p=0.002). While in non-MetS group males had larger myocardial infarction than females, in MetS group females had larger myocardial infarction than males. Cardiac failure occurred more in MetS group of patients, again was more prominent in females. Occurrence of metabolic syndrome in acute coronary syndrome patients predisposes to larger myocardial infarction size, more on the account of female patients having MetS. MetS, again particularly in females, predisposes to higher chance of having heart failure during acute coronary syndrome. Recognizing the female group with MetS as of higher risk for large myocardial infarction and heart failure leads us to pay special attention on this patient population.
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