Unmeasurable capillary C-reactive protein as one of the diagnostic clues of severe hematological pathologies in children in primary settings: Case series.

RATIONALE: The manuscript aimed to show that an unmeasurable capillary C-reactive protein (CRP) should be a red flag that can indicate a possible severe hematological pathology. PATIENTS CONCERNS AND DIAGNOSES: The authors present 3 case reports of children with fever examined at the pediatric emergency department. Fever is among the most frequently exhibited symptoms of acute pediatric infectious diseases. However, sometimes fever can be the manifestation of other serious noninfectious diseases. CRP is a marker widely used in clinical pediatric practice to help us evaluate inflammation and possible bacterial infection. All mentioned patients had unmeasurable CRP from capillary blood, even though venous CRP ranged from 14 to 21 mg/L. All of the patients were consequently diagnosed with severe hemato-oncological disease. Possible explanations are that a change in blood viscosity or an elevation of circulating immune complexes in the blood of patients with leukemia leads to malfunctioning immunoturbidimetry measurement. LESSON: Although these findings are very interesting and could lead to faster recognition of acute leukemia in pediatric clinical practice, further prospective study is needed for their confirmation.

Obesity, elevated levels of fasting plasma glucose and type 2 diabetes are associated with aortic stiffness.

OBJECTIVES: Obesity and metabolic syndrome (MetS) are associated with structural and functional vascular abnormalities. MetS and its components may increase arterial stiffness and the risk of cardiovascular events. However, the relationship of MetS and its components, including obesity, with arterial stiffness is still not fully understood. SUBJECTS AND METHODS: In a group of 116 patients undergoing treatment for hypertension, we searched for the relationships between parameters of MetS and aortic stiffness expressed by pulse wave velocity (PWVAo). PWVAo was measured using an arteriograph working on the oscillometric principle, and pulse wave analysis (PWA) for noninvasive assessment of the parameters of central hemodynamics. RESULTS: From the cluster of parameters of MetS we found a significant association between body mass index (BMI) and aortic stiffness, and between fasting plasma glucose/type 2 diabetes (FPG/T2DM) and aortic stiffness. We did not find significant relationships between other components of MetS (HDL cholesterol and triglycerides) and aortic stiffness, based on the influence of hypolipidemic therapy. Arterial stiffness increased with age and was higher in females. CONCLUSION: Arterial stiffness was associated with age, sex, and MetS components (BMI and FPG/T2DM). Surprisingly, the parameters of dyslipidemia do not influence stiffness parameters, which can be explained by hypolipidemic therapy. The influence of hypolipidemic therapy should therefore be borne in mind when evaluating arterial tree function (Tab. 15, Ref. 62). Text in PDF www.elis.sk Keywords: obesity, fasting plasma glucose, type 2 diabetes, aortic stiffness, metabolic syndrome, arterial hypertension, cardiovascular risk.

Serum butyrylcholinesterase/HDL-cholesterol ratio and atherogenic index of plasma in patients with fatty liver disease.

Cardiovascular diseases on an atherosclerotic basis are a serious health problem. Atherosclerosis is a multifactorial pathological process with complex pathogenesis. Its origin and development is conditioned by a set of several risk factors. Changes in the spectrum of lipoproteins are one of the well-known, serious risk factors for cardiovascular disease. The results of several authors showed, that the examination of the ratio of some lipoproteins can provide more accurate information about the cardiovascular risk in a given individual than the individual lipid parameters alone. Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of chronic hepatopathy. The aim of our study was to examine lipoprotein ratios - atherogenic index of plasma (AIP) and butyrylcholinesterase/ HDL-cholesterol ratio - in patients with NAFLD and to evaluate their changes in relation to the severity of hepatic steatosis. The study group consisted of 64 patients with hepatic steatosis, 32 men and 32 women. Patients were examined for fatty liver index (FLI), with FLI values above 60.0 signaling the presence of steatosis. From the biochemical parameters, we examined the serum concentrations of total cholesterol, HDL- and LDL-cholesterol, triacylglycerols and butyrylcholinesterase activity in patients with fatty liver disease. As the results of our study showed, both basic lipid parameters - total cholesterol and triacylglycerols - were increased in patients with hepatic steatosis compared to the values in the control group (Chol: 3,59 ± 0,16 vs. 5,14 ± 0,14 mmol/l; TAG: 0,85 ± 0,06 vs. 1,86 ± 0,14 mmol/l). Both investigated lipoprotein ratios - AIP and the BChE / HDL-cholesterol ratio were also significantly increased in patients with liver steatosis (AIP: -0,191 ± 0,04 vs. 0,157 ± 0,04; BChE/HDL-C: 3171 ± 123 vs. 4602 ± 291). The value of the BChE/HDL-cholesterol ratio correlated well with the total cholesterol/HDL cholesterol ratio (correl.coeff. 0,802) as well as with the atherogenic index of plasma (correl.coeff. 0,702). The findings of elevated AIP and BChE/HDL-C ratios confirmed the hypothesis of an increased risk of cardiovascular disease in patients with fatty liver disease. The finding of a significant positive correlation between AIP and BChE/HDL-C on the one hand and fatty liver index (FLI) on the other hand suggests that cardiovascular risk increases with the severity of steatotic liver injury.

Overview of the Pathogenesis, Genetic, and Non-Invasive Clinical, Biochemical, and Scoring Methods in the Assessment of NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. It represents a range of disorders, including simple steatosis, nonalcoholic steatohepatitis (NASH), and liver cirrhosis, and its prevalence continues to rise. In some cases, hepatocellular carcinoma (HCC) may develop. The develop;ment of non-invasive diagnostic and screening tools is needed, in order to reduce the frequency of liver biopsies. The most promising methods are those able to exclude advanced fibrosis and quantify steatosis. In this study, new perspective markers for inflammation, oxidative stress, apoptosis, and fibrogenesis; emerging scoring models for detecting hepatic steatosis and fibrosis; and new genetic, epigenetic, and multiomic studies are discussed. As isolated biochemical parameters are not specific or sensitive enough to predict the presence of NASH and fibrosis, there is a tendency to use various markers and combine them into mathematical algorithms. Several predictive models and scoring systems have been developed. Current data suggests that panels of markers (NAFLD fibrosis score, Fib-4 score, BARD score, and others) are useful diagnostic modalities to minimize the number of liver biopsies. The review unveils pathophysiological aspects related to new trends in current non-invasive biochemical, genetic, and scoring methods, and provides insight into their diagnostic accuracies and suitability in clinical practice.

Rat liver intoxication with CCl4: biochemistry, histology, and mass spectrometry.

This work provides complex characterisation of cirrhotic rat liver tissue induced by carbon tetrachloride using biochemical and histopathological analyses, and also presents a novel approach, secondary ion mass spectrometry (SIMS). According to our knowledge, this is the first report that compares these three different approaches in study of liver damage. We observed increased levels of triacylglycerols and total cholesterol in the liver and decreased levels of those parameters in the plasma. Histopathological observations include fat accumulation in the cells and changes in internal configuration of cells such as shift of position of organelles from the centre to the edge. The damage to the rat tissue is additionally determined by SIMS analysis, which characterizes, among other substances, diacylglycerols, cholesterol and fatty acids, such as linoleic and oleic acids. Interestingly, unlike other observed particles, a marked difference in SIMS intensity for diacylglycerol C37H69O4 positive fragment at 575.5 m/u was observed. In fact, there was one order of magnitude difference between intoxicated liver samples and controls and this molecular signal seems to be a potential chemical indicator of the damage. The SIMS images are consistent with histopathological results and they additionally provide information about distribution of chemical compound which is a new potential tool for the liver disease characterisation on molecular level.

Therapeutic effects of N-acetyl-L-cysteine on liver damage induced by long-term CCl4 administration.

N-acetyl-L-cysteine (NAC) is a drug routinely used in several health problems, e.g. liver damage. There is some information emerged on its negative effects in certain situations. The aim of our study was to examine its ability to influence liver damage induced by long-term burden. We induced liver damage by CCl4 (10 weeks) and monitored the impact of parallel NAC administration (daily 150 mg/kg of b.w.) on liver morphology and some biochemical parameters (triacylglycerols, cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, bile acids, proteins, albumins and cholinesterase). NAC significantly decreased levels of bile acids and bilirubin in plasma and triacylglycerols in liver, all of them elevated by impairment with CCl4. Reduction of cholesterol induced by CCl4 was completely recovered in the presence of NAC as indicated by its elevation to control levels. NAC administration did not improve the histological parameters. Together with protective effects of NAC, we found also its deleterious properties: parallel administration of CCl4 and NAC increased triacylglycerols, ALT and AST activity and significantly increased plasma cholinesterase activity. We have observed nonsignificantly increased percentage of liver tissue fibrosis. Our results have shown that NAC administered simultaneously with liver damaging agent CCl4, exhibits not only protective, but also deleterious effects as indicated by several biochemical parameters.

Changes in levels of oxidative stress markers and some neuronal enzyme activities in cerebrospinal fluid of multiple sclerosis patients.

OBJECTIVES: The aim of the present study was to assess cerebrospinal fluid (CSF) levels of malondialdehyde (MDA), F2 isoprostanes (8-iso-PGF2α) and total antioxidant status (TAS) in relapsing-remitting (RR) and secondary progressive (SP) course of MS and neurological controls. These parameters were correlated with brain tissue damage parameters - neuron-specific enolase and 3´,5´-cAMP-phosphodiesterase (PDE) in CSF. METHODS: CSF samples were obtained from MS patients divided into two groups according to the disease severity (EDSS) - RR and SP course of MS. Control group composed of neurological diagnoses without demyelination and neurodegeneration. 8-iso-PGF2α and NSE levels in the CSF samples were determined using specific immunochemistry assays. MDA levels in the CSF were measured by HPLC method after reaction with thiobarbituric acid in acidic conditions. TAS and total PDE activity of CSF was determined spectrophotometrically. RESULTS: There were significant differences in CSF MDA levels between MS group and controls and also between RR and SP disease course. By contrast, CSF levels of 8-iso-PGF2α in MS group and both forms of MS were comparable to control values. In addition, the results show increased CSF levels of PDE in MS group and no changes of NSE in CSF between MS and control group. CONCLUSION: These findings point to a possibility of using the parameters of different specificity to lipid peroxidation for monitoring different stages (acute/progressive) of MS. This study support the idea, that combination of CSF markers is important for monitoring overall brain tissue pathology in MS.

An overview of the healthcare system in the Slovak Republic.

Healthcare system in Slovakia is neither Bismarck nor Beveridge nor National Health Insurance model, although it has certain features of all. The healthcare contributions are mandatory and are paid to the health insurance company. An insured citizen is almost unlimited as for the amount of healthcare spending but the reimbursement limits are set for the particular healthcare providers. Over 98% of the population is covered by health insurance. Public healthcare expenditure has been approximately 3400 millions € in 2009, which represents around 5.36% of gross domestic product. Around 78% of the 5.4 million population may be regarded to as relatively healthy. The 22% suffer of the most common diseases such as cardiovascular diseases, diabetes, respiratory diseases, psychiatric diseases, infectious diseases and cancer. New government has now a unique opportunity to implement the concept of predictive, preventive and personalized medicine for the benefit of each citizen and the entire country.