Delayed Antibody Response in the Acute Phase of Infection Is Associated with a Lower Mental Component of Quality of Life in Survivors of Severe and Critical COVID-19.

Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) significantly affects quality of life (QoL) in disease survivors. Delayed development of the adaptive immune response is associated with more severe disease and a worse prognosis in COVID-19. The effects of delayed immune response on COVID-19 sequelae and QoL are unknown. Methods: We conducted a prospective study to assess the relationship between the delayed antibody response in the acute phase of infection in naïve unvaccinated patients suffering from severe or critical COVID-19 and their QoL 12 months after hospital discharge. The 12-item Short Form Survey (SF-12) questionnaire was used for assessment of QoL. The SF-12 evaluates both mental and physical components of QoL, incorporating a mental component score (MCS-12) and a physical component score (PCS-12). A delayed antibody response was defined as testing negative for anti-spike SARS-CoV-2 antibodies at the time of hospital admission. Results: The study included 274 patients (154 men and 120 women). Of the enrolled patients, 144 had a delayed immune response. These patients had a significantly lower MCS-12 (p = 0.002), but PCS-12 (p = 0.397) was not significantly different at the 12-month follow-up compared to patients with positive anti-spike SARS-CoV-2 antibodies. The MCS-12 at the time of follow-up was negatively associated with delayed antibody response irrespective of possible confounders (p = 0.006; B = 3.609; ηp2 = 0.035; 95% CI = 1.069-6.150). An MSC-12 below 50 points at the time of follow-up was positively associated with delayed antibody response (p = 0.001; B = 1.092; OR = 2.979; 95% CI = 1.554-5.711). Conclusions: This study confirmed that, in patients with severe and critical COVID-19, a negative result for anti-spike SARS-CoV-2 antibodies at the time of hospital admission is associated with a lower mental component of QoL in unvaccinated patients naïve to COVID-19 one year after hospital discharge.

Mycotic aneurysm as a hidden cause of treatment failure of pyelonephritis caused by Salmonella enterica, serovar Enteritidis.

Invasive non-typhoidal Salmonella (NTS) infections are rare in developed countries but their incidence is increasing. One of the most severe complications of extraintestinal NTS infection is mycotic aneurysm. Its natural course is usually fatal and its treatment demands complex interdisciplinary management. We present a case of severe NTS sepsis complicated by mycotic aneurysm of the abdominal aorta and left internal iliac artery and obstructive pyelonephritis. Obstruction of the left ureter was caused by pressure from the left internal iliac artery aneurysm and surrounding edema. The patient presented with clinical symptoms of sepsis and pyelonephritis. Despite abdominal ultrasound and native computed tomography, the mycotic aneurysm eluded initial examination. It remained undiagnosed until the patient presented with recurrent symptoms after stopping 17 days of antimicrobial treatment and was finally revealed by magnetic resonance imaging and contrast computed tomography. The patient was successfully treated by ligation of the left internal iliac artery, partial extirpation of the aneurysm and prolonged parenteral antimicrobial treatment. This case raises concerns that mycotic aneurysm might be present in cases of obstructive pyelonephritis caused by NTS and its early recognition is vital for appropriate management.

Lemierre syndrome caused by Klebsiella pneumoniae complicated by epidural abscess - Case report.

Klebsiella pneumoniae is an extremely rare case of the Lemierre syndrome, which is characterized as septic thrombophlebitis of the jugular vein as a consequence of oropharyngeal infection. We present a unique case of Lemierre syndrome caused by Klebsiella pneumoniae, complicated by epidural abscess. The patient presented with fever, severe nuchal pain and stiffness and mild sore throat and headache. Computed tomography revealed a neck abscess localized dorsally to a left mandibular ramus and continuing caudally along the sternocleidomastoid muscle, thrombosis of the left internal jugular vein and fluid collection in the epidural space. Viewed under magnetic resonance imagining, the effusion had the character of an epidural abscess. Cultivation of oropharyngeal swab and blood cultures revealed Klebsiella pneumoniae. The neck abscess was surgically drained, and the patient was treated with a combination of parenteral antimicrobials until complete clinical and radiologic remission. This case highlights the importance of also covering the gram-negative facultative anaerobic rod spectrum in the empiric antimicrobial treatment of Lemierre syndrome.

Effect of 8-weeks intensive lifestyle intervention on LDL and HDL subfractions.

OBJECTIVE: Atherogenic dyslipidemia is a cardinal feature of obesity and the metabolic syndrome, which increases the risk of cardiovascular diseases. Many interventional studies, describing the influence of weight loss on cardiometabolic risks, are bariatric surgery studies. The aim of our study was to analyze the effect of intensive lifestyle changes on LDL- and HDL-cholesterol subfractions and cardiometabolic risk factors in obese subjects. METHODS: A group of 41 patients with obesity (11M/30F; 44.1±12.4 years; BMI 30.2±6.3kg/m2) participated in an 8-week weight loss interventional program (NCT02325804), consisting of caloric intake reduced by 30% and physical activity (150min/week). Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and physical fitness was measured using bicycle ergometry. Lipid subfractions were measured using the Lipoprint system (Quantimetrix Corp., CA, USA). RESULTS: After the intervention, body weight was reduced by 5.4±4.5kg, as well as body fat mass and waist circumference. Physical fitness improved, systolic and diastolic blood pressure as well as heart rate decreased after the intervention. Insulin sensitivity improved after the intervention. Total, LDL, HDL cholesterol, as well as triglycerides decreased after the intervention. Regarding the lipoprotein subfractions, LDL2 and small HDL subfractions decreased, while others have not changed. CONCLUSION: Eight weeks of diet and physical activity intervention led to weight and fat mass loss and induced improvement of insulin sensitivity, as well as atheroprotective changes of lipid profile. However, the weight loss associated changes in cholesterol subfractions as cardiovascular risk biomarkers deserve further studies.

Management of diabetic patients with lower extremity peripheral arterial disease.

Extremitovascular arterial ischemic disease (lower extremity peripheral arterial disease - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the ankle-brachial pressure index, the greater the risk of serious acute instable organovascular events (e. g. acute myocardial infarction, stroke). Complex prevention and treatment of extremitovascular arterial disease is discussed in this article. Angiology/vascular medicine is the fastest growing field of internal medicine.

The effects of body weight loss and gain on arterial hypertension control: an observational prospective study.

BACKGROUND: Body weight changes are associated with significant variations in blood pressure (BP). Body mass modifications may, therefore, influence hypertension control in primary care. METHODS: Patients with a history of essential arterial hypertension were observed for 12 months. Anthropometric data and clinical BP were evaluated at the time of the recruitment and after 12 months of follow-up. The association between (body mass index) BMI change and BP control was analyzed by logistic regression. RESULTS: Sixteen thousand five hundred and sixty-four patients were recruited, while 13,631 patients (6336 men; 7295 women) finished the 1-year follow-up. In obese patients, a BMI decrease by at least 1 kg/m2 was negatively associated with uncontrolled hypertension at the end of the follow-up (men p < 0.0001, OR = 0.586, 0.481-0.713, women p < 0.001, OR = 0.732, 0.611-0.876). A similar association was observed in overweight patients (men p < 0.05, OR = 0. 804, 95% CI: 0.636-0.997, women p < 0.05, OR = 0.730, 95% CI: 0.568-0.937). A BMI increase of at least 1 kg/m2 was associated with a significantly higher odd of uncontrolled hypertension in obese (men p < 0.001, OR = 1.471, 1.087-1.991, women p < 0.001, OR = 1.422, 1.104-1.833) and overweight patients (men p < 0.0001, OR = 1.901, 95% CI: 1.463-2.470, women p < 0.0001, OR = 1.647, 95% CI: 1.304-2.080). CONCLUSIONS: Weight loss is inversely associated and weight increase is positively associated with the probability of uncontrolled hypertension in obese and overweight hypertensives.

Atherogenic index of plasma is positively associated with the risk of all-cause death in elderly women : A 10-year follow-up.

BACKGROUND: The blood concentrations of total cholesterol and low-density lipoprotein (LDL) do not predict survival in patients older than 60 years. The atherogenic index of plasma (AIP) is a logarithm of the triacylglycerol to high-density lipoprotein (HDL) ratio and a surrogate for the concentration of small dense LDL. It might be a better reflection of the risk of all-cause death in elderly patients. METHODS: We conducted a prospective observational study of patients with arterial hypertension older than 60 years. The concentrations of total cholesterol, LDL, HDL and triacylglycerol were measured at the time of the recruitment and the patients were observed for 10 years. Cox regression analysis was performed to assess the effects of lipoproteins and AIP on survival. RESULTS: A total of 500 patients were recruited and 473 of them (226 men, 247 women) either died or successfully completed the 10-year follow-up and were included in the analysis. The AIP was positively associated, while HDL concentration was negatively associated with the risk of all-cause death adjusted for age, smoking habits, statin use, history of diabetes mellitus, myocardial infarction, stroke and peripheral artery occlusive disease (PAOD) in elderly women but not in men. The LDL, total cholesterol, triacylglycerol and non-HDL concentrations were not associated with the risk of death in both sexes. CONCLUSIONS: The AIP is positively associated with the risk of all-cause death in elderly women with arterial hypertension independent of age, smoking habits, statin therapy and comorbidities.

Effect of short term aerobic exercise on fasting and postprandial lipoprotein subfractions in healthy sedentary men.

BACKGROUND: Our goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile. METHODS: Healthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75-80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile. RESULTS: 4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest. CONCLUSION: Just 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.

Effect of hyperbaric oxygen on lipoprotein subfractions in diabetic patients.

OBJECTIVES: Favorable metabolic changes have been observed in many in vitro and animal studies after application of hyperbaric oxygen (HBO2). Metabolic changes after hyperbaric oxygen therapy, especially focused on lipoprotein subfractions, have not been described in humans. Our aim was to investigate possible alteration in concentration of lipoprotein subfractions in diabetic patients after hyperbaric oxygen therapy. METHODS: 58 Type 2 diabetic patients were enrolled in a prospective matched case-control study. A total of 31 underwent hyperbaric oxygen therapy, and 27 were included in the control group without HBO2 exposure. Fasting concentrations of lipoprotein subfractions were measured by electrophoresis in polyacrylamide gel 24 hours before and 24 hours after hyperbaric sessions performed at 2.5 atmospheres absolute for 15 days. Homeostatic model assessment of insulin resistance, C-peptide and glycemic variability were assessed before and after therapy. RESULTS: We observed decreased subfractions of very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL 3), LDL 1, LDL 2 and LDL 3-7 after hyperbaric oxygen treatment. In addition, the IDL 1 subfraction, as well as the concentration of C-peptide, increased significantly in the treatment arm. Glycemic variability improved after therapy. No differences were observed in the control group. CONCLUSION: Hyperbaric oxygen therapy is connected with antiatherogenic metabolic changes. This study demonstrates that hyperbaric oxygen therapy may hold potential for inducing metabolic changes in diabetic patients that may decrease their cardiovascular risk.

Prognostic significance of dipping in older hypertensive patients.

BACKGROUND AND AIMS: Arterial hypertension doubles the risk of coronary heart disease, heart and kidney failure, and peripheral arterial disease. Less variation in diurnal ambulatory blood pressure monitoring (ABPM) patterns may affect mortality outcome. Therefore, as hypertension occurs in over 95% of older subjects, the prognostic value of dipping status in older hypertensive patients will be assessed. METHOD: The retrospective study group consisted of 170 hypertensive patients, aged 75-84 years, enrolled in the years 2005 to 2007. Baseline measures included 24-h ABPM. Diurnal index and dipping status was calculated and stratified the group into dippers (40 patients, 23.5%), non-dippers (65 patients, 38.2%) and reverse-dippers (65 patients, 38.2%). RESULTS: During a 5-year observation, after baseline we have observed 69 deaths (40.9%) from the whole group of 170 patients with 23 (35.4%) being non-dippers and 36 (55.4%) reverse-dippers. There were significant differences between the groups divided according to diurnal dipping status in survival time, number of recorded deaths and night mean blood pressure. We have identified and confirmed risk factors for the all-cause mortality: age, mean systolic and diastolic blood pressure, diurnal index and dipping status (dipping, non-dipping or reverse-dipping). CONCLUSION: Reverse-dippers and non-dippers revealed worse prognosis compared with dippers.

[Mesenterointestinocolonovascular arterial ischemic disease: guidelines of the angiology section of Slovak Medical Chamber (AS SMC, 2013)]. / Mezentériointestinokolonovaskulárna artériová ischemická choroba Odporúcania Sekcie angiológov Slovenskej lekárskej komory (2013).

Organovascular arterial ischemic diseases (cardiovascular, cerebrovascular, extremitovascular, renovascular, genitovascular, pulmovascular, mesenterovascular, dermovascular, oculovascular, otovascular, stomatovascular etc.) are an important manifestations of systemic atherosclerosis and other arterial diseases of vascular system (arteriolosclerosis/arteriolonecrosis; diabetic macroangiopathy; diabetic microangiopathy; Mönckeberg´s mediosclerosis/mediocalcinosis; arteritis - vasculitis; syndromes of arterial compression; fibromuscular dysplasia; cystic adventitial degeneration; arterial thrombosis; arterial embolism/thromboembolism; traumatic and posttraumatic arteriopathies; physical arteriopathies; chemical and toxic arteriopathies; iatrogenic arterial occlusions; dissection of aorta and of arteries; coiling; kinking; complicated arterial aneurysms; arteriovenous fistula, rare vascular diseases). Key clinical-etiology-anatomy-pathophysiology (CEAP) aspects of the mesenteriovascular arterial ischemic diseases are discussed in this article (project Vessels).

Postprandial changes of lipoprotein profile: effect of abdominal obesity.

BACKGROUND: Majority of studies that focused on the influence of abdominal obesity on lipoprotein profile, were conducted in the fasting conditions. The effects of visceral fat accumulation on postprandial lipoprotein concentrations have not yet been studied in details. We therefore focused on the postprandial lipoprotein profile in otherwise healthy men and women with abdominal obesity and their comparison with the control group of volunteers with normal waist circumference. The concentration of lipoprotein classes and subclasses was measured before and 4 hours after a standard meal by linear polyacrylamide gel electrophoresis. RESULTS: A statistically significant postprandial rise in triacylglycerol concentration occurred in all subjects. VLDL increased 4 hours after meal in all subjects except the women with normal waist circumference. The concentration of large IDL particles increased in both non-obese men and women. In women with abdominal obesity, however, it decreased, while in obese men there was no statistically significant change. The concentration of small and medium-sized IDL particles decreased in all volunteers. Analyzing subclasses changes of large, medium-sized and small LDL particles we saw no significant shift in their concentrations except the subclass of large LDL particles, which decreased in men. Concentrations of medium and small HDL particles decreased postprandially in all volunteers with normal waist circumference. However, they remained unchanged in subjects with abdominal obesity. CONCLUSIONS: We observed significant postprandial changes of the lipoprotein profile, but the nature and extent of these changes depended on gender and presence of abdominal obesity.