Cardiovascular risk assessment by electrocardiographic Holter monitoring in patients with chronic hepatitis C.

INTRODUCTION: Cardiovascular diseases are ranked as the third cause of mortality among people infected with hepatitis C virus (HCV), but the relationship of infection with cardiovascular risk remains disputable. We have focused on the comprehensive use of parameters obtainable during long-term electrocardiographic (ECG) Holter monitoring. MATERIAL AND METHODS: Heart rate variability and turbulence (HRV and HRT), deceleration/acceleration capacity (DC/AC), corrected QT interval (QTc) and late potential (LP) were used. 36 persons were included, and 30 healthy subjects formed a control group. All were submitted to 24-hour Holter ECG-monitoring. RESULTS: The studied groups were not statistically significantly different with regards to basic anthropometric parameters. Statistically significantly higher medium and maximum heart rhythm and aminotransferase activities were recorded in patients with hepatitis C. The HRV parameters r-MSSD, p50NN, HF, and absolute DC/AC values were significantly lower in the subjects with hepatitis C than those in the control group. The QTc interval, measured for nocturnal hours, was also significantly longer in that group. There were no differences in the albumin level or basic echocardiographic parameters, including left ventricle ejection fraction. Nor was there any difference in the HRT parameters, or LP. The most interesting observation was the positive correlation among the number of viral RNA copies and DC, and LF. CONCLUSIONS: We confirmed the presence of autonomic disorders with prevalence of sympathetic system activity and prolonged QTc interval in patients with chronic hepatitis C. Those parameters significantly correlated with infection intensity. Our results suggest that HCV infection could be an independent cardiovascular risk factor, not associated with the lipid profile. Further prospective studies are needed.

Treatment of heart failure in the elderly in Poland. The results of the Polish part of EURObservational Research Programme: The Heart Failure Pilot Survey.

BACKGROUND: Pharmacotherapy remains the fundamental method of treating heart failure (HF). Treatment of the elderly is less based on the principles of evidence-based medicine (EBM) and doses do not reach the prescribed value. OBJECTIVES: The aim of the study was to identify any distinct treatment of HF in the elderly compared to those under 65 years of age. MATERIAL AND METHODS: This study describes the Polish part of the EURObservational Research Programme: The Heart Failure Pilot Survey (ESC-HF Pilot). Eligibility to the program was limited to people with HF in 26 centers in Poland. After the first phase, more data was collected at 3 and 12 months. It covered a total of 893 people. RESULTS: Treatment of HF is conducted largely in accordance with the applicable guidelines. The percentage of people over 65 years of age who use angiotensin-converting-enzyme inhibitors/angiotensin-II receptor blockers (ACE-I/ARB), ß-blockers and mineralocorticoid-antagonists remains high. Also, during the 12-month follow-up the frequency of the use of ß-blockers did not decrease, and a decrease in the number subjects treated with ACE-I was compensated by increasing percentage of the use of ARB. A major problem also seems to be the appropriate treatment to prevent thromboembolic complications in the case of coexistence of atrial fibrillation (AF). There is a large group of older people who do not receive proper anticoagulation. CONCLUSIONS: The study showed the existence of differences in the treatment of HF in the elderly. It partly does not proceed in accordance with the guidelines, especially in the presence of multiple comorbidities.

Peptide nucleic acid as a selective recognition element for electrochemical determination of Hg2.

A novel electrochemical PNA-based biosensor for the determination of Hg2+ is described. The receptor layer, containing single strands of polythymine PNA (peptide nucleic acid), was formed at the surface of gold electrode. Due to the presence of thymine bases and peptide bonds, an interaction between Hg2+ ion and receptor layer occurs. The influence of chain modification - PNA vs. DNA - and type of redox marker - anionic AQMS-Na (sodium salt of anthraquinone-2-sulfonic acid) and FeII/III (potassium ferri/ferrocyanide) or cationic MB (methylene blue) and RuHex (hexaammineruthenium(III) chloride) - were studied. Proposed PNA-based biosensor with anionic AQMS-Na as a redox marker demonstrated significantly better analytical parameters, as compared to results obtained for other tested redox markers (for measurements at pH6.0). The linear response towards Hg2+ was in the range from 5 to 500nmol·L-1 with the detection limit of 4.5nmol·L-1. The developed sensor distinguishes itself with high selectivity towards Hg2+, even for solutions containing several interfering cations. Interactions between Hg2+ and PNA receptor layer were studied using square wave voltammetry (SWV) and electrochemical impedance spectroscopy (EIS).

Design and characterization of novel all-solid-state potentiometric sensor array dedicated to physiological measurements.

A novel construction of all-solid-state potentiometric sensor array designed for physiological measurements has been presented. The planar construction and elimination of liquid phase creates broad opportunities for the modifications in the sensing part of the sensor. The designed construction is based on all-solid-state ion-selective electrodes integrated with the ionic-liquid based reference electrode. Work parameters of the sensor arrays were characterized. It has been shown that presented sensor design indicates high sensitivity (55.2±1mV/dec, 56.3±2mV/dec, 58.4±1mV/dec and 53.5±1mV/pH for sodium-, potassium-, chloride- and pH-selective electrodes, respectively in 10(-5)-10(-1.5)M range of primary ions), low response time (t95 did not exceed 10s), high potential stability (potential drift in 28-h measurement was ca. ±2mV) and potential repeatability ca. ±1mV. The system was successfully applied to the simultaneous determination of K(+), Cl(-), Na(+) and pH in the model physiological solution and for the ion flux studies in human colon epithelium Caco-2 cell line as well.

Non-sustained ventricular tachycardia during treatment of genotype 3 chronic hepatitis C - a case report.

UNLABELLED: More than 185 million people around the world have been infected with the hepatitis C virus (HCV), of whom 350 000 die each year. HCV is a now a curable disease, and advances in HCV therapy have resulted in steadily higher cure rates. Therapies based on PegINF are still treatment of choice. However PegINF can induce severe adverse events including cardiovascular disease. CASE REPORT: Here we report a 55 year old female patient with the severe hepatitis C and genotype 3 presented with recurring episodes of the loss of consciousness and palpitations in the course of therapy, combining interferon PegINF with ribavirin. During the diagnostics performed the occurrence of non-sustained ventricular. There were no other causes of arrhythmias, such as coronary heart disease or heart failure. It is considered that this is a result of treatment. Because of the confirmed viral clearance completed PegINF therapy at a lower dose, without further complications. CONCLUSIONS: The presented case of our patient illustrates very well the level of difficulty of the taken decisions, especially when treatment complications occurred, while also confirming the fairly assistive and supportive role of the non-invasive methods of cardiovascular diagnostics.

[The evaluation of selected oxidative stress parameters in patients after radioiodine treatment of hyperthyroidism]. / Ocena wybranych parametrów stresu oksydacyjnego u pacjentów leczonych radiojodem z powodu nadczynnosci tarczycy.

UNLABELLED: Oxidative stress is an important factor of the hyperthyroidism pathogenesis. The radioiodine therapy is an approved treatment method of this common disease and it is connected with exposure to ionizing radiation, which induces increased generation of reactive oxygen species in patient's organism. The aim of the study was to estimate the selected oxidative stress parameters in hyperthyroid patients, initially treated with thiamazole and subsequently with radioiodine. The evaluated parameters were the activity of superoxide dismutase (CuZn-SOD), catalase (CAT) and glutathione peroxidase (GPx) in erythrocytes as well as the level of total antioxidative status (TAS) in plasma. MATERIAL AND METHODS: In the study participated 29 healthy volunteers and 27 hyperthyroid patients, treated with thiamazole and prepared for radioiodine therapy. The antioxidant enzymes activity and the level of TAS were measured before administration of radioiodine therapeutic dose (average 18.47 +/- 8.81 mCi) as well as 30 days after treatment and achieving euthyreosis. RESULTS: Hyperthyroid patients prepared with thiamazole for radioiodine therapy demonstrated higher GPx activity (p < 0.0001) and lower TAS level (p < 0.0001) than healthy people. Patients, who become euthyroid after 30 days from radioiodine therapy, were characterised by the increased activity of CAT (p < 0.05) and GPx (p < 0.05) as well as the higher level of TAS (p < 0.05). Patients after radioiodine treatment in comparison to the control group had the same activity of CAT and the level of TAS, although the activity of CuZn-SOD (p < 0.05) and GPx (p < 0.0001) occurred higher than in the control group. Moreover patients with hyperthyroidism before radioiodine treatment showed positive correlation between the level of TSH and TAS, whereas after radioiodine therapy they demonstrated positive correlation between the level of TSH and the activity of CuZn-SOD, CAT and GPx. However, there was no statistically significant correlation between the quantity of administrated radioiodine dose and the value of estimated oxidative stress parameters. CONCLUSIONS: The results of the study show the occurrence of oxidative stress in hyperthyroid patients prepared with thiamazole to radioiodine therapy. Euthyreosis achieved by radioiodine treatment effected on normalisation of the activity of CAT and the level of TAS, although the activity of CuZn-SOD and GPx stayed increased. After the analysis of correlation between TSH level, radioiodine dose and measured parameters we can conclude that the intensity of oxidative stress more depends on current thyreometabolic state than on the therapeutic method applied.

Persistent ductus arteriosus in a 72-year-old woman with paroxysmal atrial fibrillation and depression syndrome: a therapeutic and diagnostic problem.

Treating the elderly is often problematic, especially when congenital heart disease is diagnosed. The aim of this study is to present the case of a 72-year old woman with depression syndrome, paroxysmal atrial fibrillation and past cerebral stroke, in whom persistent ductus arteriosus Botalli was diagnosed. Due to exacerbation of the depressive syndrome, she did not give her consent to further diagnostics, possible interventional procedures and treatment with oral anticoagulants. After intermission of the therapy she was treated with dabigatran. The patient is still undergoing outpatient treatment and so far, no cerebrovascular episodes have been recorded.

Kinetics of jack bean urease inhibition by 2,3-dichloro-1,4-naphthoquinone. Elucidation of the mechanism: redox cycling and sulfhydryl arylation.

The inhibition of jack bean urease by 2,3-dichloro-1,4-naphthoquinone (DCNQ) was studied at ambient temperature in 20 mM phosphate buffer, pH 7.8. The process was investigated by incubation procedure in the absence of substrate. It was found that DCNQ acted as a time- and concentration-dependent inactivator of urease. The time course of the reaction displayed a biphasic mode. Each phase followed a pseudo-first-order kinetics, however the inactivation rate at the first phase was significantly faster than at the next one. The biphasity indicated the complex mechanism of DCNQ action on urease. Quinones action on proteins has been elucidated as at least two processes: direct arylation of essential protein thiols and/or indirect oxidation of essential thiols by reactive oxygen species (ROS) realising during quinone reduction to semiquinones. The next evidence of the studied mechanism was provided by the reactivation experiment that showed the participation of reversible and irreversible processes in the inactivation. The application of dithiothreitol (DTT) into DCNQ blocked-urease solution resulted in an effective enzyme activity regain which quickly returned to 70 +/- 10%. The irreversible inactivation of urease was attributed to DCNQ arylation of thiol residues in the protein. On the other hand, it was assumed that the reversible inactivation was a result of the action of ROS such as H(2)O(2). Presence of H(2)O(2) in the incubation system was proved by an experiment with the use of catalase. The enzyme by the elimination of H(2)O(2) decreased DCNQ inactivating influence on urease. The comparison of participation of the fast and slow phase in the inactivation with the percentage of the process reversibility was assumed that the fast period was a result of the arylation mechanism while the slow phase was related to the oxidative influence of H(2)O(2).

[The erythrocyte membrane structure in patients with mixed hyperlipidemia]. / Struktura blon erytrocytów u pacjentów z mieszana hiperlipidemia.

In hypercholesterolemia the damage to the plasma membranes of erythrocytes is observed. This may result from higher concentration of cholesterol in plasma and membranes, lipids peroxidation and changes in protein conformation. The aim of the study was to estimate the membrane fluidity, concentration of cholesterol (Ch), phospholipids (PL), ratio of Ch/PL, thiobarbituric acid reaction substances (TBARS) in the isolated erythrocyte membrane of patients with mixed hyperlipidemia. The study comprised 50 patients in the age from 45 to 65 with the initial concentrations of total cholesterol (TC) > 200 mg/dl (5.2 mmol/l); cholesterol LDL (LDL-C) > 160 mg/dL (4.1 mmol/l); triglicerides (TG) > 150 mg/dL (4.5 mmol/L) and 22 healthy controls. The plasma lipids concentrations were determined by enzymatic method, the concentration of cholesterol membrane (by method of Ilcy), phospholipids (by method of Bartlett), lipids peroxidation (by method of Stocks and Dormandy) and the erythrocyte membrane fluidity (by a spin-label paramagnetic resonance method using 5-doxylstearic acid - 5-DSA, and 16-doxylstearic acid - 16-DSA). The order parameter S was determined using 5-DSA; 16-DSA was used to estimate the correlation taub and tauc. In group of patients with mixed hyperlipidemia in comparison to the control group it was noticed a significant increase of the mean values of order parameter S (0.74 +/- 0.01 vs. 0.72 +/- 0.005, p < 0.001), of membrane cholesterol concentration (3.39 +/-0.98 vs. 1.93 +/- 0.93 mmol/l pc, p < 0.001), ratio Ch/PL (2.32 +/- 1.22 vs. 1.22 +/- 0.44; p < 0,001) and TBARS (2.91 +/- 0.74 vs. 1.5 +/- 0.4 nmol/mg protein). The differences of the correlation times and phospholipids concentrations between the groups were not statistically significant. Significant correlation between the order parameter S and concentrations of TC, LDL-C in plasma and membrane cholesterol was observed. On the base of given results we conclude that mixed hyperlipidemia may have influence on the erythrocyte membrane structure caused significant decrease of membrane fluidity in the superficial layer without any significant changes in deeper layer and significant increase of membrane cholesterol and TBARS.

Physicochemical modifications induced by statins therapy on human erythrocytes membranes.

UNLABELLED: In hyperlipidemia damage to the plasma membranes of erythrocytes is observed. It is supposed that statins by their beneficial impact on the serum lipids and pleiotropic effects may modify the membrane cell structure. MATERIAL AND METHODS: The aim of the study was to evaluate the effects of statins on erythrocyte membrane structure in patients (pts) with hyperlipidemia. The study involved 54 pts with the initial total cholesterol (TC) concentration > 200 mg/dl (6.5 mmol/l), low-density lipoprotein cholesterol (LDL-C) > 160 mg/dl (4.1 mmol/l) and triglycerides (TG) < 400 mg/dl (4.5 mmol/l) and 22 healthy individuals as the control group. After 8 weeks of hypolipemic diet, pts were randomized to two groups: A--27 pts treated with atorvastatin in a dose of 10 mg/day; S--27 pts treated with simvastatin in a dose of 40 mg/day. After 8 weeks of active therapy in all pts were determined: the activity of Na+K+-ATPase, erythrocyte membrane fluidity (the order parameter S), lipids peroxidation (thiobarbituric acid-reactive substances - TBARS), content of membrane cholesterol, concentration of SH groups and W/S ratio (which specifies the relations between the two kinds of the SH groups: the weakly--W bound, and the strongly--S bound). RESULTS: In the group of hyperlipidemic patients as compared to the control group we observed significantly higher values of the order parameter S, membrane cholesterol, TBARS, ratio W/S and significantly lower the activity of Na+K+-ATPase, SH groups concentration in membrane erythrocytes. Atorvastatin and simvastatin in a similar degree significantly increased the activity of Na'K'-ATPase (15.7% vs. 20.9%), the SH concentration groups (23.4% vs. 21.2%) and decreased TBARS (-41.8% vs. -41%), W/S ratio (-11.3% vs. S-12.1%). Simvastatin decreased stronger the membrane cholesterol (-30.0% vs. -24.5%; p < 0.05) and the values of parameter S (-5.1% vs. -3.5%, p < 0.05) than atorvastatin. CONCLUSIONS: A short-term therapy with statins exhibits a high hypolipemic efficacy and advantageous effects on the protein-lipid structure of erythrocyte membranes. Simvastatin at 40 mg/day dose increases the fluidity of erythrocyte membrane and decreases the membrane cholesterol level to a greater extent than does atorvastatin at 10 mg/day dose.