Streptococcus agalactiae infective endocarditis in Canada: a multicenter retrospective nested case control analysis.

BACKGROUND: Infective endocarditis (IE) caused by Streptococcus agalactiae (GBS) is increasingly reported and associated with an aggressive course and high mortality rate. Existing literature on GBS IE is limited to case series; we compared the characteristics of patients with GBS IE to patients with GBS bacteremia without IE to identify risk factors for development of IE. METHODS: A nested case-control study in a cohort of adult patients with GBS bacteremia over a 18-year period was conducted across seven centres in three Canadian cities. A chart review identified patients with possible or definite IE (per Modified Duke Criteria) and patients with IE were matched to those without endocarditis in a 1:3 fashion. Multivariate analyses were completed using logistic regression. RESULTS: Of 520 patients with GBS bacteremia, 28 cases of possible or definite IE were identified (5.4%). 68% (19/28) met criteria for definite IE, surgery was performed in 29% (8/28), and the overall in-hospital mortality rate was 29% (8/28). Multivariate analysis demonstrated that IE was associated with injection drug use (OR = 19.6, 95% CI = 3.39-111.11, p = 0.001), prosthetic valve (OR = 11.5, 95% CI = 1.73-76.92, p = 0.011) and lack of identified source of bacteremia (OR = 3.81, 95% CI = 1.24-11.65, p = 0.019). CONCLUSIONS: GBS bacteremia, especially amongst people who inject drugs, those with prosthetic valves, and those with no apparent source of infection, should increase clinical suspicion for IE.

Holter ECG findings in diabetics with medial arterial calcification.

OBJECTIVES: Medial arterial calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance. The disease most commonly occurs in diabetes mellitus. Decreased ankle-brachial pressure index (ABI) is a well-known marker of increased cardiovascular mortality. However, also the values of ABI above 1.3, typical in MAC, are associated with increased mortality. METHODS: By means of Holter ECG monitoring, we investigated 41 patients (25 men, 16 women) with mean age of 59±8 years, suffering of type 2 diabetes mellitus and identified as having MAC, and Holter ECG monitoring with an average duration of recording 22.36 hours, was carried out by GE-Marquette MARS ECG Holter system. RESULTS: We found frequent incidence of cardiac arrhythmias and myocardial ischemia in 22 patients (53.7 %). Only 19 patients (46.3 %) had normal Holter ECG recordings. ABI values were significantly higher in patients with abnormal ECG Holter recordings. CONCLUSION: Our results confirm the importance of ABI estimation in clinical practice. As the central goal of therapy for patients with myocardial ischemia and/or complex forms of cardiac arrhythmias is the reduction or elimination of these episodes. Ambulatory Holter ECG monitoring plays an important role in the management of these patients (Tab. 7, Ref. 16).

Would Janus' view on HDL be useful?

Low-density lipoprotein cholesterol (LDL-C) is generally considered to be pro-atherogenic and high-density lipoprotein cholesterol (HDL-C) to be anti-atherogenic. The clinical approach to the diagnostics and treatment of clinical manifestations of atherosclerosis is the examination of the lipid spectrum. In routine clinical practice, the effects of the HDL class are measured only by determining the concentration of HDL cholesterol. It is questionable whether this clinical approach provides sufficient information to evaluate both the overall cardiovascular risk and the effect of hypolipidemic therapy. Recent studies revealed a shift from large to small HDL particles within the HDL family in the state of atherosclerotic cardiovascular diseases (CVD). This trend of lipoprotein constellation seems to be pathognomonic for dysfunctional lipoprotein profile under pathological state of the cardiovascular system. Thus, the diagnostic and therapeutic approach based on "good" cholesterol concept needs remedying (Fig. 1, Ref. 28).

[Lipids and the size of lipoprotein particles in newly diagnosed and untreated patients with type 2 diabetes mellitus]. / Lipidy a velkost lipoproteínových castíc u pacientov s novozisteným a doposial nelieceným diabetes mellitus 2. typu.

Type 2 diabetes mellitus leads to the typical known form of dyslipidaemia among the patients. This dyslipiademia type re-presents prognostically important type of atherogenic dyslipiadaemia, that significantly increases the risk of atherothrombosis. Estimation of the size of lipoprotein particles with Lipoprint method among newly diagnosed, untreated patients with these patients have not been evaluated yet. Dyslipidaemia among patients with type 2 diabetes mellitus has its course and changes after the treatment. At the beginning i tis characterized by the significant increase of VLDL, large and middle size IDL lipoprotein particles, as well as by lowering of HDL particles. This lipoprotein profile has its own atherogenic potential. The course of the disease later leads to the change of dyslipidaemia, characterized by the increase of LDL levels (small dense particles), triglyceride levels and the persistence of the lower levels of HDLcholesterol. Hypolipidemic treatment leads to the significant lowering of cardiovascular risk, however despite treatment with statin or fibrate residual cardiovascular risk remains still very high.

[The impact of a 14- day regular physical exercise regime on the concentration of the classes and subclasses of lipoprotein particles in young subjects with a sedentary lifestyle]. / Vplyv 14 dní trvajúcej pravidelnej telesnej zátaze na koncentrácie tried a podtried lipoproteínových partikúl u mladých probandov so sedavým spôsobom zivota.

Recommendations from the cardiological professional companies working in the area of primary prevention of cardiovascular diseases put an emphasis on regular aerobic physical activity. Its positive effect on both cardiovascular and overall mortality has repea-tedly been proven by the observations of prospective and cross sectional epidemiological studies. One of the possible explanations of this positive effect is a change in the concentration of lipoprotein classes and their subclasses, which is expressed as a change in their average size. In a group of young healthy men and women with a sedentary lifestyle we observed the effect of medium intensive physical exercise in the form of a 30- minute slow run per day lasting for 14 days. The concentration of lipoprotein classes and subclasses were determined through the method of a linear electrophoresis in polyacrylamide gel. In the observed group we found a statistically significant decrease of VLDL, large IDL particles, medium sized LDL, small dense LDL, and medium sized HDL particles. In the light of current knowledge all these lipoprotein particles are deemed as atherogenic. Thus, as little as 14 days of regular exercising has a positive effect on the concentration of plasmatic lipoproteins, and emphasises the role of regular physical activity in the primary prevention of cardiovascular diseases.

Contribution of the atherogenic lipoprotein profile to the development of arterial hypertension.

OBJECTIVES: Determination of non-atherogenic and atherogenic plasma lipoproteins, including small dense LDL, in patients with newly diagnosed arterial hypertension and identification of the phenotype of lipoprotein profile: non-atherogenic phenotype A vs. atherogenic lipoprotein phenotype B, in plasma of examined subjects. BACKGROUND: Atherogenic lipoproteins play an important role in the pathogenesis of arterial hypertension. Impaired lipoprotein metabolism results in overproduction of triglyceride-rich particles and LDL 3-7 subfractions - small dense LDL - a strongly atherogenic LDL subpopulation accelerating the development of arterial hypertension. METHODS: Total cholesterol and triglycerides were analyzed by enzymatic CHOD-PAP method, Roche Diagnostics, Germany. Lipoprotein profiles of plasma described as atherogenic lipoprotein phenotype B or a nonaterogenic lipoprotein phenotype A were examined by a new method of lipoprotein separation by means of electrophoresis on polyacrylamide gel (Lipoprint LDL system). Prostacyclin and thromboxane A2 in plasma were analysed by ELISA method. Score of Atherogenic Risk was determined as a ratio of atherogenic and non-atherogenic plasma lipoproteins. RESULTS: 1) High percentage of atherogenic hypertriacylglycerolemia (93%) and atherogenic mixed hyperlipemia (86 %) in subjects with arterial hypertension. 2) Low percentage of atherogenic hypercholesterolemia (52 %) in subjects with arterial hypertension. 3) Atherogenic normolipemia (7%) in control group of healthy subject. CONCLUSION: Contribution of this method lies in benefits as follows: A) Quantification of non-atherogenic and atherogenic plasma lipoproteins. B) Identification of high percentage of atherogenic dyslipoproteinemia (86-93%) in subjects with arterial hypertension. C) Presence of small dense LDL in plasma is decisive for declaring the atherogenic lipoprotein profile in both hyperlipemia and normolipemia (Tab. 5, Ref. 24).

[The incidence of dyslipidemia in a sample of asymptomatic probands established by the means of Lipoprint system]. / Výskyt aterogénnej dyslipidémie vo vzorke asymptomatických probandov vysetrením pomocou metódy Lipoprint.

Method of lipoprotein determination on polyamideacryl gel Lipoprint enables an exact quantification nonatherogenic and atherogenic plasma lipoproteins. For its use in human medicine this method was recently approved by FDA. According to majority of nonatherogenic, or atherogenic lipoproteins in their spectrum this method can distinguish nonatherogenic type A vs atherogenic type B. After their identification, there is the possibility for exact means of interventions among patients with higher cardiovascular risk. Also in the group of clinically healthy asymptomatic controls with normolipemia it is possible using this method to estimate the certain group of risk of development of premature atherothrombosis.

[The significance of fenofibrate in the therapy of atherogenic dyslipoproteinaemia]. / Význam fenofibrátu v liecbe aterogénnej dyslipoproteinémie.

There are accepted the lipid levels goals in all world, which are needed to achievement in primary and secondary prevention. Despite efficacy of current standards of care (including achievement of LDL-C, blood pressure and blood sugar goals), patients with atherogenic dyslipidemia (DLP) (high TG levels, low HDL-C, high apolipoprotein B and small dense LDL-particles), which is common in patients with diabetes melitus (DM), metabolic syndrome or cardiovascular diseases (KVD), remain exposed to a high residual risk of major cardiovascular events and microvascular complications. Statin therapy does not adequately address vascular risk asociated with elevated triglycerides (TG) and low HDL-C levels. As ACCORD lipid trial last time shows, the addition of lipid-modifying activity of fenofibrate to statin therapy benefited only certain subgroups of patients at increased cardiometabolic risk.

[Serum lipoprotein profile in newly recognized arterial hypertension. The role of atherogenic lipoproteins in the pathogenesis of disease]. / Lipoproteínový profil séra pri novozistenej artériovej hypertenzii. Uloha aterogénnych lipoproteínov v patogenéze ochorenia.

New examination approaches in biochemical analysis of lipoproteins can identify and quantify atherogenic plasma lipoproteins, including small dense LDL and characterise a lipoprotein spectrum as a non-atherogenic lipoprotein profile phenotype A, respectively as an atherogenic lipoprotein profile phenotype B. Identification of a non-aterogenic hypercholesterolemia (48%), atherogenic hypertriglyceridemia (93%), atherogenic normolipemia (13%) in patients with arterial hypertension and an atherogenic normolipemia in control group of healthy subjects (7%), is an essential contribution of this new laboratory diagnostics.

[Changes in lipoprotein spectrum in patients with the diagnosis of extremity vascular ischemic disease]. / Zmeny v lipoproteínovom spektre pri koncatinovo-cievnej isthemickej chorobe.

New method of lipoprotein determination on polyacrylamid gel with Lipoprint LDL system quantifies non atherogenic and atherogenic plasma lipoproteins, including small dense LDL, the potent atherogenic lipoprotein subpopulations. According to majority of non atherogenic versus atherogenic lipoprotein in the whole lipoprotein spectrum, this method distinguishes a non atherogenic lipoprotein profile phenotype A from an atherogenic lipoprotein profile phenotype B. Definitely, the contribution of this method is focusing on the atherogenic lipoprotein profile phenotype B in 80% of patients with an extremito-vascular ischemic disease and on the existence of control subgroup ofnormolipemic subjects with an atherogenic lipoprotein profile (7% ofprobands of control group). These persons represent a risk population. Till now, the facilities for identifying of these "normolipemic persons at risk" are limited.

[Prevention and treatment of extremity vascular ischemic disease]. / Preventia a liecba koncatinovocievnej ischemickei choroby.

Extremitovascular ischemic disease (peripheral arterial disease of extremities - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the anklebrachial pressure index, the greater the risk of serious cardiovascular events (e.g., acute myocardial infarction, stroke). Prevention and treatment ofextremitovascular disease is discussed in this article.

The effect of high density lipoprotein subfractions on endothelial eicosanoid secretion.

Epidemiological, clinical, and experimental studies have demonstrated that high density lipoproteins (HDL) are protective against atherosclerosis. However, the respective influence of two main HDL subfractions (HDL2 and HDL3) on atherosclerosis process is not yet clear. The present study was designed to determine, which HDL subfraction was antiatherogenic in terms of eicosanoid release by human umbilical vein endothelial cells (HUVEC). Endothelial cells were incubated for 4 hours with HDL2 or HDL3 and prostaglandins 6-keto-PGF1alpha, thromboxane B2 and prostaglandin E2 were measured by RIA in culture supernatant. HDL2 has a dose dependent stimulatory effect on 6-keto-PGF1alpha release without stimulatory effect on thromboxane B2 secretion. The 6-keto-PGF1alpha/thromboxane B2 ratio increased progressively from 1.65 to 4.65 for 0.39 to 6.25 mg HDL protein/ml. The pattern of prostanoid secretion under influence of HDL3 showed a predominant response in 6-keto-PGF1alpha and TxB2 release. As regards PGE2, both HDL subfractions stimulated considerably secretion of this prostanoid in a dose dependent manner. In terms of PGI2/TxA2 balance the better antiatherogenic effect was observed with HDL2 subfraction.

[Disorders of thyroid function and fertility disorders]. / Porucha funkcie stítnej zl'azy a poruchy fertility.

The treatment of young infertile women and women with menstrual cycle dysfunction by thyroid gland extracts and later by pure thyroid hormones led to improvement of their menstrual cycle and frequently also to desired conception. Therefore a functional connection between thyroid and ovary, i.e. an effect of thyroid hormones on ovarian reproductive function was assumed. However, till recently exact scientific evidence did not exist, which could explain the functional connection between these two endocrine glands. The scientific discoveries of the last years in the area of human reproduction (which continues in experimental work on the superfamily of steroid/thyroid receptors, which have been coded by protoonkogen c-erb-A variants), presented proof of the presence of thyroid stimulating hormone (TSH) as well as of T3-receptors in ovary and thus way of direct TSH- and T3-effect on steroidogenesis and oocyte maturation. The authors present scientific discoveries from recent years, which seem to be crucial for the explanation of the thyroid-ovary relation and present the treatment algorithm for practical clinical application of experimental knowledge of human reproduction.

[Serum apolipoprotein B (apoB) in patients with hypothyroidism]. / Apolipoproteín B (apoB) v sére pacientov s hypotyreózou.

The concentrations of serum lipids (total cholesterol, triacylglycerols), apolipoprotein B and thyroid hormones (thyroxine, triiodthyronine) were observed before and during hormone replacement therapy by thyroid hormones in 24 hypothyroid patients (18 women and 6 men) until the state of euthyroidism was reached. The observed parameters regained standard values gradually, while the concentration of apolipoprotein B recovered to normal as the last among them. Therefore the authors recommend to consider apolipoprotein B concentration in serum as a risk factor of the development of arteriosclerosis in hypothyroid patients, the value of apolipoprotein B concentration can serve as a guideline in choosing the optimal hormone substitution therapy. (Tab. 1, Fig. 1, Ref. 5.).

The effect of gamma-linolenic acid on plasma and membrane lipids and renal prostaglandin synthesis in older subjects.

UNLABELLED: Senescence is associated with a decreased activity of enzyme delta-6 desaturase, which converts linoleic acid to gamma-linolenic acid. This enzymatic defect may alter the composition of plasma and membrane lipids, and influences the biosynthesis of renal prostaglandins. Exogenous supplementation of GLA during 3 months increases the plasma level of dihomo-gamma-linolenic acid (p < 0.002), and to a smaller degree, the level in erythrocyte membrane lipids. This treatment was associated with a beneficial reduction of cardiovascular risk factors (arterial hypertension, total cholesterol, apolipoprotein B, HDL-cholesterol, apolipoprotein A-I) and the renal function has become stable reached. Epogam treatment also increased the biosynthesis of renal prostaglandins, especially that of prostaglandin E2, which has a vasodilatory effect on vessel walls and reduces the elevated blood pressure. CONCLUSION: Dietary supplementation of essential fatty acids such as gamma-linolenic acid to old subjects has beneficial effect on their health condition. (Tab. 6, Fig. 5, Ref. 37.)

[Atherogenic and anti-atherogenic plasma lipoproteins modulate secretion of prostanoids by endothelial cells in vitro]. / Aterogénne a antiaterogénne lipoproteíny plazmy modulujú sekréciu prostanoidov endotelovou bunkou in vitro.

The authors present the evidence of atherogenic properties of VLDL and LDL potentiation on the model of endothelial cells-human umbilical vein endothelial cells, by preferable stimulation of the endothelial cell to thromboxane A1 production at in vitro conditions by atherogenic lipoproteins. The vasoconstrictive, thrombogenic and atherogenic effects of TXA2 are exerted on the vessel in this way. The ratio prostacycline/thromboxane, decisive for the maintenance of vascular homeostasis, is less than 1, this means the beneficial effect of prostacycline can not be applied. Protective, antiatherogenic effect of HDL and its subfractions HDL2 and HDL3/predominantly through their function in the reverse cholesterol transport from the periphery to the liver, antioxidative influence on LDL, as far as antiaggregation and fibrinolytic effects of HDL/is multiplied by the fact that HDL preferably stimulates the secretion of prostacycline by the endothelial cell. The ratio prostacycline/thromboxane A2 is higher than 1, that means beneficial vasodilative, antiaggregation and antiatherogenic effect of prostacycline on the vessel wall predominate. Quantitative evaluation of antiatherogenic effects of HDL subfractions (HDL2 and HDL3) revealed more significant antiatherogenic effect in HDL2 subfraction-in the sense of prostacycline secretion stimulation and exertion of its beneficial effects on the vessel. (Fig. 5, Ref. 33.)

[Clinical importance of the Gavornik classification of mushroom poisoning]. / Klinický význam Gavorníkovej klasifikácie otráv hubami.

The lack of experience and fundamental knowledge about mycology by some mushroomers is one of the leading causes of increasing occurrence of fatal mushroom poisonings. Mushroom intoxications are caused not only by poisonous mushrooms (true primary intoxications), but under certain conditions also by edible mushrooms (secondary intoxications, false intoxications, pseudo-intoxications). Apart from fresh mushrooms intoxications may result also from preserved mushrooms (sterilized in pickles, soured, dried, used for preparation of mushroom extracts, powders, etc.), which are used as garnish. (Tab. 1, Ref. 44.)

[Lipoprotein(a)--a risk factor for coronary sclerosis in patients with hypothyroidism]. / Lipoproteín(a)--rizikový faktor koronárnej sklerózy u pacientov s hypotyreózou.

In a group of patients with developed primary hypothyroidism the authors investigated in a longitudinal eight-month trial the effect of hormonal substitution therapy with thyroxine (T4) on the serum concentration of lipids, apolipoprotein B and lipoprotein (a)--risk factors for the development of early coronary sclerosis. In some patients--"responders"--gradually euhormonosis, normolipaemia are induced and clinical symptoms of hypothyroidism receded. In the second group of patients with hypothyroidism, so-called "non-responders" (n = 5) after eight months substitution treatment with thyroxine the anticipated effect does not occur and the investigated serum parameters improve only partially. The thyroxine, TSH levels and those of lipid parameters and apolipoprotein B persist in the zone of pathological values. The lipoprotein (a) concentration in both groups of patients with hypothyroidism does not change during thyroxine substitution and varies near baseline values. From the submitted observations the authors of the present work do not assume that thyroxine plays a part in the catabolism of lipoprotein (a) via LDL receptors, the activity and number of which increases along with the effect of thyroxine.

Atherogenic versus non-atherogenic lipoprotein profiles in healthy individuals. is there a need to change our approach to diagnosing dyslipidemia?

The electrophoretic separation of lipoproteins on polyacrylamide gels enables the quantification of nonatherogenic and atherogenic plasma lipoproteins including small dense low density lipoprotein (sdLDL) particles, which represent the atherogenic lipoprotein subpopulations in plasma. This methodology could help distinguish between nonatherogenic hyperlipidemia, normolipidemia with an atherogenic lipoprotein profile, non-atherogenic normolipidemia, and atherogenic hyperlipidemia. According to our pilot research of a normolipidemic population, the atherogenic lipoprotein profile might be present in about 6% of normolipidemic young healthy individuals. Therefore, if confirmed by other studies, it will be necessary to consider a different diagnostic approach and risk stratification for patients with atherogenic normolipidemia (as well as non-atherogenic hypercholesterolemia).