Apixaban in left ventricular thrombi treatment - a report of seven cases.

Treatment of intracardiac thrombi (ICTs) with direct-acting oral anticoagulants (DOACs) constitutes a new challenge for this group of medications. Left ventricular thrombi (LVTs) occur mainly in patients with severe left ventricular dysfunction. Advanced heart failure is characterized by a high prevalence of chronic kidney disease (CKD). Apixaban has the best renal profile among all DOACs. The authors describe a group of 7 patients with LVTs treated with apixaban; 6 of them had CKD. LVTs were screened and monitored during therapy using a sector, 3-dimensional and high frequency linear probes; the latter to exclusively assess the left ventricular apex. Examination was performed every day during the first 2 weeks, then 2-3 times a week until LVTs disappearance, then every month; transesophageal assessment was done initially and repeated when necessary. Patients' mean age was 65 years. The underlying disease was post-myocardial left ventricular dysfunction (3), dilated cardiomyopathy (3) and heart failure of unknown etiology (1).Three patients had more than one LVT. Also, three had other ICTs, one - in the right ventricle, two - in the left atrial appendage. Three patients used apixaban in a dose of 5 mg twice daily, two - 2.5 mg twice a day, two - in an increasing dose. In all patients, gradual diminishing of LVTs was observed, no complications of apixaban therapy were noted. The time needed for LVTs disappearance was between 7 and 28 days (mean: 17 days).

Severe reversible hypocalcemic cardiomyopathy diagnosed 36 years after subtotal thyroidectomy - a case report.

Chronic hypocalcemia, irrespectively of its etiology, can lead to severe impairment of the left ventricular (LV) contractility manifesting as dilated cardiomyopathy, usually defined as hypocalcemic cardiomyopathy (hypocaCM). This rarely diagnosed type of heart failure (HF), can be completely reversible, when treated properly with calcium and vitamin D supplementation or, in some subjects, with human recombinant parathormone. A CASE REPORT: The authors present a case of a 60-year-old male admitted with advanced pulmonary congestion, recurrent pulmonary edema and pleural effusion. He was refractory to standard HF therapy. One year earlier, the patient was diagnosed with primary dilated cardiomyopathy with ejection fraction decreased to 25% and after coronary angiography, which revealed normal coronary arteries, he received implantable cardioverter-defibrillator (ICD). However, 36 years before, the patient underwent subtotal thyroidectomy, and at the moment presented with multiplicitous symptoms suggestive of profound hypocalcemia. Laboratory investigations confirmed hypocalcemia due to iatrogenic hypoparathyroidism. Improvement of LV function during supplementation with calcium and vitamin D was monitored by echocardiography using two-dimensional longitudinal strain. One should always consider reversible causes of HF, including hypocalcemia, especially when obvious consequences of chronic hypocalcemia as myopathy, depression or cataract are seen. Correct therapy can restore LV function and prevent unnecessary implantation of ICD.

Concentrations of fetuin-A, osteoprotegerin and α-Klotho in patients with alcoholic liver cirrhosis.

The aim of the present study was to evaluate the concentrations of fetuin-A, osteoprotegerin (OPG) and α-Klotho protein in patients with alcoholic cirrhosis at different stages of the disease, and to demonstrate that fetuin-A, osteoprotegin and α-Klotho may be used as markers of the severity of cirrhosis. A total of 54 patients with alcoholic liver cirrhosis treated in various hospitals in the Lublin region of Poland were randomly enrolled. The control group consisted of 18 healthy individuals without liver disease, who did not drink alcohol. Serum levels of fetuin-A, OPG and α-Klotho were measured by ELISA kits. Levels of fetuin-A were significantly reduced in patients with alcoholic liver cirrhosis compared with the control group. OPG levels were higher in patients with alcoholic liver cirrhosis than in the controls, whereas the levels of α-Klotho were comparable in the cirrhosis and control groups. No statistically significant differences in the concentrations of fetuin-A, OPG and α-Klotho protein were demonstrated according to type of liver cirrhosis. The findings of the present study revealed a significant negative correlation between the level of α-Klotho protein and C-reactive protein in the patients with alcoholic liver cirrhosis. Concentrations of fetuin-A were lower, whereas those of OPG were higher, in the alcoholic liver cirrhosis group compared with the control group. Fetuin-A, OPG and α-Klotho may not be good indicators of liver cirrhosis severity. In conclusion, fetuin-A and OPG may be used in the diagnosis of liver cirrhosis.

The effect of synthetic pyrethroids on the attachment and host-feeding behaviour in Dermacentor reticulatus females (Ixodida: Amblyommidae).

BACKGROUND: The high competence of D. reticulatus in transmission of tick-borne pathogens prompts investigations of the effect of chemicals used as repellents and acaricides on the behaviour of the tick on the host. Therefore, this paper presents the effect of permethrin and deltamethrin on the attachment and feeding in this tick species. FINDINGS: Attachment to rabbit skin of D. reticulatus females sprayed with pyrethroids and the effect of different doses thereof on feeding were assessed at a temperature of 20 ± 3 °C and 50% humidity. The dynamics of attachment of D. reticulatus females varied in a dose-dependent manner after the application of both pyrethroids. Within the first 0.5 h of the experiments, there was an over six-fold and over twelve-fold increase in the number of females attached to host skin after application of permethrin concentrations of 0.3906-0.7812 µg and 1.5625-3.1250 µg/1 specimen, respectively. In the case of deltamethrin, females treated with the dose of 0.0390 µg of the compound were able to attach to host skin only 4 hours after the infestation. The toxic activity of both pyrethroids increased the duration of the feeding period and decreased the body weight of engorged females and the feeding efficiency index. CONCLUSIONS: The accelerated attachment of D. reticulatus females caused by sublethal permethrin doses and delayed or inhibited attachment caused by deltamethrin suggest a necessity of careful selection of the type and dose of pyrethroids to protect hosts from tick attacks.

Alteration in diurnal and nocturnal melatonin serum level in patients with chronic heart failure.

INTRODUCTION: Melatonin is best known for its influence on circardian physiology. The circulating levels of the hormone vary in a daily cycle, allowing the regulation of the circadian rhythms of several biological functions. Melatonin is now considered as a cardioprotective factor and its secretion might be influenced by the clinical course of CHF. OBJECTIVE: Assessment of the alteration in diurnal and nocturnal melatonin serum levels in patients with chronic heart failure. MATERIAL AND METHODS: The study group consisted of 32 patients diagnosed with CHF according to ESC criteria. The study group was divided into two subgroups: patients in NYHA class II (n=21, 8 women) and patients in NYHA class III (n=11, 6 women). In all patients, serum melatonin levels at 02:00 and at 07:00 were determined using competitive enzyme immunoassay technique. High-sensitive C-reactive protein (HsCRP) was determined with nephelometric method. RESULTS: Mean hsCRP level was 0.368 (0.195; 0.794) mg/l and 0.54 (0.128; 1.04) mg/l in the group NYHA II and NYHA III patients, respectively; the difference was not statistically significant. NTproBNP levels were higher in NYHA III group than in the group NYHA II [2300 (1509;6317) pg/ml vs 7157 (4155; 13339) pg/ml]; the difference was substantial and approached the level of statistical significance (p=0.057). In both subgroups, higher levels of melatonin at 02:00 than at 07:00 was noticed; however, the differences were not statistically significant (p>0.05). In NYHA III subgroup lower levels of melatonin were observed at both time points; the difference was not statistically significant. CONCLUSION: The study results suggest that in patients with advanced heart failure (NYHA III but not NYHA II), nocturnal melatonin secretion is negatively correlated with NTproBNP.

Environmental conditioning of incidence of tick-borne encephalitis in the south-eastern Poland in 1996-2006.

Epidemiological studies of tick-borne encephalitis (TBE) conducted in the Swietokrzyskie province (south- eastern Poland) in 1996-2006 demonstrated an increase in the number of registered TBE cases in the last 6 years of the study. The highest risk of TBE virus infections occurs in the summer-autumn period (seasonality factors 96.55% and 248.28%), i.e. in periods of the highest Ixodes ricinus activity in this region. An increased number of registered TBE cases were noted in the regions which provide ticks with favourable habitats and, simultaneously, where the TBE diagnosis and treatment for the inhabitants are more efficient. The increasing tendency in TBE incidence observed even in the non-endemic regions of the Swietokrzyskie province indicates the necessity of education in tick-borne disease prophylaxis and the need to elevate the level of public health care. Differences in the density and activity of various developmental Ixodes ricinus stages were observed in 4 localities in diverse biotopes located at different altitudes a.s.l. This justifies the necessity of environmental monitoring of the threats posed by ticks in various habitats, especially in those frequently visited by humans.

Lyme borreliosis in south-eastern Poland: relationships with environmental factors and medical attention standards.

Yhe aim of the study was the investigation of the dynamics of LB prevalence in central Europe over a 12-year period and estimation of its dependence on the environmental factors and on the level of medical services. Epidemiological studies of LB were conducted in the years 1996-2007 in 9 regions of the Swietokrzyskie province in south-eastern Poland (Central Europe). On the basis of patient registry, the incidence, prevalence in various months of the year, the mean number of cases in various seasons and the seasonality factors (SF) of LB were calculated. Between 2000-2007, an increased borreliosis incidence was observed in the study area. During the entire study period, the highest incidence (25.93 and 30.66) was observed in the regions with the highest density of Ixodes ricinus ticks - vectors of Borrelia burgdorferi spirochetes, and where the inhabitants are offered the best available LB diagnosis and treatment due to a sufficient number of doctors (r = 0.74) and all medical personnel (doctors, nurses and diagnosticians) (r = 0.89). The highest LB incidence was present in the summer and autumn seasons (SF = 113.25 and 155.18%) in the areas with the highest density of nymphs and adult I. ricinus ticks (> =19/1 h of sampling). Improved standards of public medical care as well as environmental monitoring of tick threat may contribute to a decrease in prevalence of LB and to its better detection.

Dendritic cells and lymphocyte subpopulations of the adenoid in the pathogenesis of otitis media with effusion.

OBJECTIVE: To assess dendritic cells and lymphocyte subpopulations of adenoid and peripheral blood in patients with adenoid hypertrophy and otitis media with effusion (OME). To explain the influence of immunological status of adenoid on the development of OME. METHODS: The examined group covered 123 surgically treated patients due to adenoid hypertrophy (39 children with coexisting OME). Preoperative clinical examination included anamnesis and otorhinolaryngological examination with nasofiberoscopy, videootoscopy and assessment of the hearing organ. The material of the study were surgically removed adenoids and peripheral blood samples prepared and then analyzed by the means of tri-colour flow cytometry. The obtained results were statistically analyzed. RESULTS: Significant differences between patients with adenoid hypertrophy with coexisting OME and children without OME concerning CD19+CD69+, CD3+CD69+, CD4+CD69+CD8+CD69+ and CD19+CD25+ cells were observed. No statistical differences were revealed in the blood of patients with and without OME. Several statistical differences were noted between the adenoid and peripheral blood in patients with otitis media with effusion concerning BDCA-2+/CD123+ cells, CD3+ and CD19+ lymphocytes with the markers of their activation. CONCLUSIONS: The adenoid is involved in local immune response regardless of constitutional immunological mechanisms in patients with OME coexisting with adenoid hypertrophy. Significantly lower percentage of CD3+CD69+, CD4+CD69+, CD8+CD69+ and CD19+CD69+ cells of adenoid in patients with OME attests to reduced T-cells activation of the adenoid in relation to patients without OME.