To explore the relationship between retinal vessel atherosclerosis and serum concentrations of total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol, high density lipoprotein ...(HDL) cholesterol, HDL(2) cholesterol, HDL(3) cholesterol, apoprotein B, apoprotein A-I, and apoprotein A-II.
Lipids and lipoproteins were measured in 101 male patients aged between 26 and 69 years (median, 48 years), and the degree of their retinal vessels atherosclerosis (stage 1-4 according to Scheie) was determined. Diabetics, alcoholics, hypertensive, extremely obese patients, and patients with thyroid, liver, or kidney diseases were excluded from the analysis. The results were compared with those in 47 apparently healthy men aged between 22 and 65 years (median, 47 years) with no retinal vessel changes. Direct ophthalmoscopy for the fundus examination was carried out by a single ophthalmologist unaware of the patients' group.
Retinal vessel atherosclerosis strongly correlated with total serum cholesterol, LDL cholesterol, triglycerides, and apoprotein B concentrations. The higher these lipid and apoprotein values, the more advanced the stage of the disease. No significant association between HDL cholesterol as well as HDL(2) and HDL(3) cholesterol and atherosclerosis of retinal arteries could be proved but an inverse association, although a very weak one, between the low serum concentration of HDL cholesterol and the stage of the retinal artery atherosclerosis was found.
Changes in lipoproteins and apoproteins associated with atherosclerosis of the retinal arteries correspond well to those associated with coronary artery atherosclerosis.
Fish and fish oil are rich sources of omega-3 fatty acids--essential polyunsaturated fatty acids. These acids in doses of 1 g per day have been shown to significantly reduce the all-cause mortality ...in post myocardial infarction (MI) patients and the risk for sudden death caused by cardiac arrhythmias. One of the recently most studied mechanisms that may contribute to this benefits of omega-3 fatty acids is their anti-arrhythmic effect. Namely, these acids influence membrane ion channels, increase ventricular fibrillation threshold and increase heart rate variability. Although the data concerning primary prevention is less straightforward than the data relating secondary prevention, it seems that the use of omega-3 fatty acids in primary prevention might be justified as well. In higher doses (2 to 4 g per day) they are used to treat hypertriglyceridemia. Potential mechanisms by which omega-3 fatty acids may reduce risk for cardiovascular disease include also antithrombotic (they decrease platelet aggregation/reactivity, reduce plasma viscosity, enhance fibrinolysis) and anti-inflammatory effects (e.g. they decrease IL-6, MCP-1, TNF), improving vascular endothelial cell function (e.g. they increase availability of nitric oxide), reducing expression of endothelial cells adhesion molecules, inhibiting smooth muscle cells migration and proliferation, and reducing blood pressure. Based upon clinical studies the use of omega-3 fatty acids should be considered today at least as a part of comprehensive secondary prevention strategy in post-MI patients. It has been also shown that adding highly concentrated omega-3 fatty acids to standard treatment in the secondary prevention of MI is cost effective versus standard treatment alone. Particularly important is that there are no significant drug interactions with omega-3 fatty acids.
Pučanstvo razvijenih zemalja, uključujući i
Hrvatsku, postaje sve starije i danas su u ovim zemljama
kardiovaskularne bolesti uzrokovane aterosklerozom postale
ubojica broj jedan ne samo osoba ...srednje životne dobi, već i
onih starijih. Ove bolesti i njihove posljedice uvelike utječu na
smrtnost, ali i na kvalitetu života starijih osoba i značajno je
pogoršavaju. Međutim, do relativno nedavno nije bilo jasno
jesu li čimbenici rizika za kardiovaskularne bolesti kao što su
hiperkolesterolemija, arterijska hipertenzija, nedostatak tjelesne
aktivnosti i kretanja te psihosocijalni čimbenici – primjerice
osamljenost, depresija i nedostatna društvena potpora, uistinu
povezani s povećanim pomorom i pobolom u navedenoj dobnoj
skupini kao što jesu u ljudi srednje dobi. Ova je povezanost
dokazana u nekoliko istraživanja koja su podrobno prikazana
u ovom članku, no ovime su potaknuta i pitanja o koristi
liječenja statinima i antihipertenzivima u starijih osoba. Stoga
je načinjeno nekoliko velikih prospektivnih istraživanja, rezultati
kojih su također raspravljeni u ovom članku. Isti jasno ukazuju
da u starijih osoba treba primijeniti jednak pristup prevenciji
kardiovaskularnih bolesti koji je prihvaćen za osobe srednje
životne dobi. Statini smanjuju rizik akutnog infarkta miokarda,
nestabilne angine pektoris, ishemijskoga moždanog udara,
kognitivnih tegoba i invalidnosti zbog ovih bolesti u starijih
kojih već imaju (sekundarna prevencija) ili su u velikom riziku
da obole (primarna prevencija) od kardiovaskularnih bolesti.
Pokazano je također kako različiti antihipertenzivi podjednako
djeluju u prevenciji pomora i pobola od kardiovaskularnih
bolesti, što upućuje da je presudno smanjiti povećani arterijski
tlak bez obzira na način kojim se ovo postiže.
This randomized, double-blind, placebo-controlled crossover study was performed in 67 patients of both sexes aged 20 to 78 years with moderate hypercholesterolemia to investigate the antilipemic ...efficacy and tolerability of food supplement policosanol--a mixture of aliphatic primary alcohols from rice (Oryza sp.). After a 8-week run-in period in which patients were placed on therapeutic lifestyle changes, in particular cholesterol-lowering diet, they were randomly assigned to receive policosanol 10 mg capsules or placebo capsules once daily with the evening meal for 8 weeks. During next 8 weeks those receiving policosanol during the first 8 weeks, received placebo and those taking placebo during the first 8 weeks, received policosanol. Total cholesterol (C), LDL-C, HDL-C, HDL2-C, HDL3-C, triglycerides, oxidized LDL, apoproteins A I and B and lipoprotein (a) as well as AST, ALT, GGT, CK, blood glucose and bilirubin were determined before the treatment, after the first part of the study i.e. after the first 8 weeks and at the end of the study, i.e after the second 8 weeks. Policosanol significantly reduced plasma total cholesterol and increased apoprotein A I but did not change plasma triglycerides, HDL-C, HDL2-C, HDL3-C, LDL-C, oxidized LDL, Lp (a) and apoproteinS. It was well tolerated, with no drug-related effects on safety parameters such as serum aminotransferases, blood glucose, bilirubin, and CK, neither did it cause any clinical adverse reactions.
It is known that coadministration of a statin and certain drugs that inhibit cytochrome P-450 may inhibit catabolism of statin, resulting in an increased concentration of statin in the blood and ...consequently, increased risk of certain side effects, e.g. myopathy. The aim of this study was to establish, for the first time, how many patients in Croatia concomitantly take statins with other drugs, and which drugs. Also, the aim was to determine how often statins are administered concomitantly with cytochrome P-450 inhibitors, and how many patients taking statin are therefore at increased risk of interactions and/or side effects. The data were collected from general practitioners' health records all over Croatia during July and August 2004. The data for patients who were prescribed any statin between June 1, 2003 and June 1, 2004 were analysed. The records of 882 patients were analysed, 446 (50.6%) women, 422 (47.8%) men and 14 (1.6%) of unidentified sex. The average age of women on statin was 65 years and of men 60 years. Of 882 patients, 772 patients (82%) were taking at least one more drug concurrently with statin. Of that number, 24% of patients concomitantly were taking one more drug, 20% two more drugs, 16% three more drugs, 10% four more drugs, 8% five more drugs and 3% six more drugs. The average number of other drugs prescribed together with statin was 2.1 +/- 1.59 in men and 2.2 +/- 1.71 in women. The average age of patients who were taking another drug together with a statin did not significantly differ from that of patients receiving only statin. There were regional differences in the number of drugs prescribed together with a statin. In Osijek, the average number of drugs prescribed with a statin was 2.4 +/- 1.80, in Zagreb 2.2 +/- 1.64, in Rijeka 2.0 +/- 1.60, and in Split 1.8 +/- 1.44. The number of drugs prescribed with a statin in rural areas was 2.0 +/- 1.58, in urban areas 2.1 +/- 1.63 and in semi-urban areas 2.8 +/- 1.85. The therapeutic groups of drugs that are most frequently prescribed with a statin in Croatia are ACE inhibitors and their fixed combinations (32%), beta-receptor blockers and their fixed combinations (23%), selective calcium channel blockers (18%), anxiolytics (18%), vasodilators and organic nitrates (16%), antirheumatic drugs (11%), oral antidiabetics (11%), vitamin K antagonists, analgesics-antipyretics, diuretics (10%), antibiotics (8%), and angiotensin II antagonists and their fixed combinations (5%). All other drugs accounted for less than 5%. Four percent of the patients take cytochrome P-450 inhibitors concomitantly with a statin. The most frequently used drug is verapamil, combination of verapamil and trandolapril, clarithromycin and diltiazem. Consequently, 3% of men and 5% of women are at increased risk of side effects. This sex difference is, however, not statistically significant. Patients between 70 and 74 years of age taking statins are in Croatia at the highest risk of interactions because 8% of them take concomitantly cytochrome P 450 inhibitors.
The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent ...chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of 15.27 +/- 6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.
The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion ...cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10-30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito-palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too.
Hemorrhagic fever with renal syndrome (HFRS) is a rodent-originating zoonotic disease caused by Puumala and Dobrava viruses, which belong to the genus Hantavirus. The most prominent ocular change in ...HFRS is transient myopia, which lasts for up to one week and is due to a forward movement of the ocular anterior diaphragm and thickening of the lens. Other ophthalmic manifestations of HFRS are eyelid edema, conjunctival injection with or without hemorrhages, chemosis, anterior uveitis, retinal edema with or without hemorrhages, and photophobia. Acute glaucoma attacks, which are rare, could be explained by the increased intraocular pressure (IOP) due to edema and hemorrhage in the ciliary body, causing anterolateral rotation, relaxation of the zonules, and anterior movement of the lens. They are treated with mydriatic-cycloplegic and corticosteroid eye drops and with furosemide. However, there are also controversial reports on decreased IOP during the acute phase of HFRS. Despite the fact that ocular symptoms in HFRS are common generally they do not require any medical therapy and the recovery of the patients is complete.
Ophthalmologic causes of headache represent a very complex and extensive problem, and very often differential diagnostic problem too. Many various reasons of headache can be caused by ophthalmologic ...diseases like those of anterior and posterior eye segments, acute and subacute angle closed glaucoma and orbital diseases. Headache can be caused by no or poor correction of the refraction anomalies. Ophthalmologic causes of headache are quite frequently connected with conditions that affect other body systems apart from the eyes, nervous and/or vascular system in particular. Although ophthalmologic examination very provides the clue in patients with headache, the diagnostic and therapeutic approach to the problem has to be interdisciplinary.
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