Psoriasis is the independent factor for early atherosclerosis: A prospective study of cardiometabolic risk profile.

Background/Aim: Psoriasis as multisystemic inflammatory dis-ease is related with an increased cardiometabolic risk. The aim of the study was to analyze risk biomarkers, peripheral and renal arteries ultrasonography and echocardiography for subclinical atherosclerosis and metabolic disease in 106 subjects (66 psoriasis patients and 40 controls, 20 eczema patients and 20 healthy volunteers). Methods: In all exameenes following parameters were analyzed: body mass index (BMI), C-reactive protein, D-dimer, serum amyloid A (SAA), apolipoprotein (Apo) A1, ApoB, ApoB/Apo A1 index, fasting glucose, C-peptide, fasting insulinemia, homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-ß-cell, lipid profile, serum uric acid concentration (SUAC), 24-h proteinuria and microalbuminuria. Carotid, brachial, femoral and renal arteries ultrasonography, as well as echocardiography was also performed. Results: Five of 66 (7.6%) psoriasis patients had metabolic syndrome (not present in both control groups). The following variables were increased in patients with psoriasis compared to both control groups: BMI (p = 0.012), insulinemia (p < 0.001), HOMA-IR (p = 0.003), HOMA-ß cell (p < 0.001), SUAC (p = 0.006), ApoB/ApoA1 ra-tio (p = 0.006) and microalbuminuria (p < 0.001). Also, increased C-peptide (p = 0.034), D-dimer (p = 0.029), triglycerides (p = 0.044), SAA (p = 0.005) and decreased ApoA1 (p = 0.014) were found in the psoriasis patients compared to healthy controls. HDL cholesterol was decreased in the psoriasis patients compared to the control group of eczema patients (p = 0.004). Common carotid (CIMT) and femoral artery intima-media thickness (FIMT) was significantly greater (p < 0.001) and the maximal flow speed (cm/s) in brachial artery significantly de-creased (p = 0.017) in the patients with psoriasis in comparison to both control groups. In multivariate logistic regression analysis, after the adjustment for confounding variables, the most important predictor of CIMT and FIMT was the diagnosis of psoriasis (p < 0.001).. Conclusion: Cardiometabolic risk biomarkers and ultrasonographic signs of early atherosclerosis are correlated with the diagnosis of psoriasis, and not to generalized eczema. Psoriasis was found to be an independent risk factor for subclinical atherosclerosis

Prognostic Value and Daily Trend of Interleukin-6, Neutrophil CD64 Expression, C-Reactive Protein and Lipopolysaccharide-Binding Protein in Critically Ill Patients: Reliable Predictors of Outcome or Not?

BACKGROUND: Severe sepsis and/or trauma complicated by multiple organ dysfunction syndrome are the leading causes of death in critically ill patients. The aim of this prospective single-centre study was to assess the prognostic value and daily trend of interleukin-6 (IL-6), neutrophil CD64 expression, C-reactive protein (CRP) and lipopolysaccharide-binding protein (LBP) regarding outcome in critically ill patients with severe trauma and/or severe sepsis. Outcome measure was hospital mortality. METHODS: One hundred and two critically ill patients admitted to the intensive care unit of a tertiary university hospital were enrolled in this prospective study. Blood samples were collected on admission (day 1), days 2 and 3. RESULTS: CD64 index was 1.6-fold higher on day 1 and 1.78-fold higher on day 2 in non-survivors (p<0.05). The area under the curve (AUC) for the CD64 index on day 1 for outcome was 0.727. At a cut-off level of 2.80 sensitivity was 75% and specificity was 65%. Patients with CD64 index level on day 1 higher than 2.80 had 2.4-fold higher probability of dying. Odds ratio is 2.40; 95% CI 0.60-9.67. CONCLUSIONS: CD64 index on day 1 is a fairly good predictor of outcome. AUCs for IL-6, CRP and LBP were < 0.55, suggesting these biomarkers failed to predict outcome.

Ejection experience in Serbian Air Force, 1990-2010.

BACKGROUND/AIM: Ejection injuries are the problem for air forces. The present risk for injuries is still too high, approximately 30-50%. The aim of this study was to determine factors responsible for and contributing to injuries in the Serbian Air Force (SAF) in the last two decades. METHODS: All ejection cases in the SAF between 1990 and 2010 were analyzed. The collected data were: aircraft type, ejection seat generation, pilots" age and experience, causes of ejection, aeronautical parameters, the condition of aircraft control and types of injuries. For ease of comparison the US Air Force Safety Regulations were used to define major injuries: hospitalization for 5 days or more, loss of consciousness for over 5 min, bone fracture, joint dislocation, injury to any internal organ, any third-degree burn, or second-degree burn over 5% of the body surface area. RESULTS: There were 52 ejections (51 pilots and 1 mechanic) on 44 airplanes. The ejected persons were from 22 to 46 years, average 32 years. Major injuries were present in 25.49% cases. Of all the ejected pilots 9.61% had fractures of the thoracic spine, 11.53% fractures of the legs, 3.48% fractures of the arms. Of all major injuries, fractures of the thoracic spine were 38.46%. None of the pilots had experienced ejection previously. CONCLUSION: Our results suggest that taking preventive measures is obligatory. Namely, magnetic resonance imaging (MRL) scan must be included in the standard pilot selection procedure and procedure after ejection, physical conditioning of pilots has to be improved, training on ejection trainer has to be accomplished, too.

Melanoma risk is associated with vitamin D receptor gene polymorphisms.

Previous studies have reported that vitamin D receptor (VDR) gene polymorphisms are associated with the occurrence of various cancers, including melanoma. The aim of the current study was to investigate the association of VDR gene polymorphisms with melanoma risk, clinicopathological characteristics, and vitamin D levels. The study group included 117 patients (84 patients with superficial spreading melanoma and 33 patients with nodular melanoma). The control group included 122 sex-matched and age-matched healthy-blood donors of the same ethnicity. VDR gene polymorphisms FokI, EcoRV, TaqI, and ApaI were genotyped by real-time PCR. In 60 patients, the total 25-hydroxyvitamin D levels were evaluated in serum samples by direct chemiluminescence. Associations among parameters were considered to be significant if the P value was less than 0.05. Significant differences in the frequencies of VDR genotypes were observed between cases and the control group for FokI and TaqI polymorphisms (P<0.0001; P=0.005, respectively). Heterozygous Ff as well as mutant FF genotypes of the FokI polymorphism were associated with increased melanoma risk compared with the wild-type form [odds ratio (OR)=3.035, P=0.003; OR=9.276, P<0.0001, respectively]. A significantly increased melanoma risk was observed for the heterozygous Tt (OR=2.302, P=0.011) and the mutated variant tt (OR=3.697, P=0.003) of the TaqI polymorphism in comparison with the wild-type genotype. None of the polymorphisms studied was associated with clinicopathological characteristics and vitamin D serum level. Our results suggest that FokI and TaqI polymorphisms in the VDR gene may be considered as potential biomarkers for melanoma susceptibility. Low vitamin D levels in melanoma patients indicate the need for vitamin D supplementation.

Correlation of N-terminal pro-B-type natriuretic peptide with clinical parameters in patients with hypertension.

BACKGROUND/AIM: Identification of patients with arterial hypertension and a possible onset of heart failure by determining the concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) enables timely intensification of treatment and allows clinicians to prescribe and implement optimal and appropriate care. The aim of this study was to evaluate NT-proBNP in patients with longstanding hypertension and in patients with signs of hypertensive cardiomyopathy. METHODS: The study involved 3 groups, with 50 subjects each: "healthy" persons (control group), patients with hypertension and normal left ventricular systolic function (group 1) and patients with longstanding hypertension and signs of hypertensive cardiomyopathy with impaired left ventricular systolic function (group 2). We measured levels of NT-proBNP, C-reactive protein and creatinine according to the manufacturer's instructions. All the patients were clinically examined including physical examination of the heart with blood pressure, pulse rate, electrocardiogram (ECG) and echocardiogram. RESULTS: Our results showed that the determined parameters generally differed significantly (Student's t-test) among the groups. The mean (+/- SD) values of NT-proBNP in the control group, group 1 and group 2 were: 2.794 (+/- 1.515) pmol/L, 9.575 (+/- 5.449) pmol/L and 204.60 (84,93) pmol/L, respectively. NT-proBNP correlated significantly with the determined parameters both in the group 1 and the group 2. In the group 1, the highest correlation was obtained with C-reactive protein (r = 0.8424). In the group 2, the highest correlation was obtained with ejection fraction (r = -0.9111). NT-proBNP showed progressive increase in proportion to the New York Heart Association (NYHA) classification. The patients in the- group 2 who belonged to the II and III NYHA class had significantly higher levels of NT-proBNP than those in the NYHA class I (ANOVA test, p = 0.001). CONCLUSION: The obtained results suggest that NT-proBNP is a useful biomarker in the treatment of patients with longstanding hypertension who are at risk for heart failure.

Procalcitonin and BISAP score versus C-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis.

BACKGROUND/AIM: Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as C-reactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. METHODS: This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. RESULTS: Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001). CONCLUSION: In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

Enzimas salivales y enfermedad periodontal / Salivary enzymes and periodontal disease

Objetivos: Las enfermedades que producen daño tisular producen la liberación de diferentes enzimas relacionadas con la muerte y destrucción celular, como son la aspartato y alanino aminotransferasa (AST, ALT), lactato dehidrogenasa (LDH), creatinin kinasa (CK), alcalina y ácida (ALP, ACP) y gamma glutamil transferasa (GGT). Al tratarse la enfermedadperiodontal (EP) de un proceso inflamatorio con afectación de la encía y periodonto, parece lógico pensar que la actividad enzimática debe reflejar los cambios metabólicos secundarios a esta reacción inflamatoria.Diseño del estudio: En este artículo examinamos la actividad de CK, LDH, AST, ALT, GGT, ALP y ACP en la saliva de pacientes con EP, antes y después del tratamiento periodontal (grupo experimental–30 muestras) así como en la saliva de pacientes sin enfermedad periodontal (grupo control–20 muestras). La EP se diagnosticó en base a parámetros clínicos(índice gingival–GI, sangrado al sondaje-BOP y profundidad al sondaje-PD). Todos los pacientes con enfermedad periodontal recibieron tratamiento convencional de la misma. Se registró la actividad enzimática en todos los pacientes y se cuantificó por espectrofotometríaResultados: Se observó un aumento estadísticamente significativo en la actividad de CK, LDH, AST, ALT; GGT, ALP y ACP en la saliva de los pacientes con enfermedad periodontal en relación a los resultados obtenidos en el grupo control. Se detectó una correlación positiva entre la actividad de las enzimas salivales examinadas y el valor del GI. Después del tratamiento periodontal convencional la actividad de estas enzimas salivales disminuyó significativamente.Conclusiones: Basándonos en estos resultados. Podemos concluir que la actividad de estas enzimas puede ser útil en el diagnóstico y evaluación del tratamiento de la EP

Background: Host responses to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells. There are important enzymes associated with cell injury and cell death like: aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine cinase (CK), alkaline and acidic phosphatase (ALP, ACP), gama glutamil transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation.Design of Study: In this paper we have examined the activity of CK, LDH, AST, ALT, GGT, ALP and ACP in saliva from patients with periodontal disease before and after periodontal treatment (experimental group – 30 samples) and in saliva from healthy patients (control group – 20 samples). Periodontal disease was determined based on clinical parameters (gingival index (GI), bleeding on probing (BOP), probing depth (PD)). Patients with periodontal disease were under conventional periodontal treatment.Results: Obtained results were shown statistically significant increases of activity of CK, LDH, AST, ALT, GGT, ALP, ACP in saliva from patients with periodontal disease in relation to control group. There is positive correlation between the activity of examined salivary enzymes and value of the gingival index. After conventional periodontal therapy the activity of all salivary enzymes was significantly decreased.Conclusions: Based on these results, it can be assume that activity of these enzymes in saliva, as biochemical markers for periodontaltissue damage, may be useful in diagnosis, prognosis and evaluation of therapy effects in periodontal disease

Salivary enzymes and periodontal disease.

BACKGROUND: Host responses to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells. There are important enzymes associated with cell injury and cell death like: aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine kinase (CK), alkaline and acidic phosphatase (ALP, ACP), gama glutamyl transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation. DESIGN OF STUDY: In this paper we have examined the activity of CK, LDH, AST, ALT, GGT, ALP and ACP in saliva from patients with periodontal disease before and after periodontal treatment (experimental group, 30 samples) and in saliva from healthy patients (control group--20 samples). Periodontal disease was determined based on clinical parameters (gingival index (GI), bleeding on probing (BOP), probing depth (PD)). Patients with periodontal disease were under conventional periodontal treatment. RESULTS: Obtained results were shown statistically significant increases of activity of CK, LDH, AST, ALT, GGT, ALP, ACP in saliva from patients with periodontal disease in relation to control group. There is positive correlation between the activity of examined salivary enzymes and value of the gingival index. After conventional periodontal therapy the activity of all salivary enzymes was significantly decreased. CONCLUSIONS: Based on these results, it can be assume that activity of these enzymes in saliva, as biochemical markers for periodontal tissue damage, may be useful in diagnosis, prognosis and evaluation of therapy effects in periodontal disease.