Central systolic blood pressure (cSBP) to brachial systolic blood pressure (brachSBP) ratio reproducibility during antihypertensive therapy.

OBJECTIVES: Higher CSBP than brachial SBP in individual patient increases cardiovascular (CV) risk. For follow-up it is important to assess the reproducibility of such measurements. The aim of this study was to assess the reproducibility of these differences, expressed as a CSBP/BrachSBP ratios. SUBJECTS AND METHODS: Eighty-three patients on antihypertensive therapy were analysed for the reproducibility of such ratios after time interval of several month up to several years. For CSBP estimation, we used the Arteriograph (Tensiomed Ltd.), based on blood pressure measurements by cuff on oscillometric principle, using pulse wave analysis (PWA) for assessment of CSBP. RESULTS: The proportion of patients retained the same characteristics (either higher central or higher peripheral SBP) between the first and second measurement was 71.1 %. The association between 1st and 2nd measurement, was statistically significant, p < 0.001. CONCLUSION: In our study, a high proportion (60 %) of treated hypertensive patients had CSBP higher than brachial SBP, which may adversely influence their prognosis. This characteristic is highly reproducible. Taking into the account these differences may increase the exactness of CV risk estimation and may contribute to explanation of residual risk of individual patient (Tab. 3, Fig. 1, Ref. 28).

HIV infection and sexual behaviour among homosexual and bisexual men in Bratislava.

OBJECTIVE: To determine sexual behaviour and HIV prevalence in a sample of homosexual and bisexual men in Bratislava. PATIENTS AND METHODS: Participants were recruited at gay discotheque in Bratislava in February and June 1996. Saliva samples were collected for testing the presence of anti-HIV antibodies and a questionnaire regarding sexual practice was completed. RESULTS: In the study 170 men (1st discotheque) and 124 men (2nd discotheque) were enrolled. The prevalence of antibodies against HIV was 5.4% and 1.6%, respectively. A group of 119 attenders (mean age: 25 years) was voluntarily questioned about their sexual lifestyle and related behaviour. Sexual orientation of participants was following: 66.4% homosexuals, 20.2% bisexuals, 13.4% others. Most responders were single and did not ever been married (86.55% vs. 12.6%, respectively). The figures of sexual intercourse were: steady partners: 45.38%, non-steady partners: 49.58%. More individuals were using condoms (70.58% vs. 15.97%, respectively), while only 28.57% were using them by each chance sexual intercourse. 6.7% responders suffered from an other STD and 3.36% were intravenous drug users. CONCLUSION: The HIV prevalence (5.4% and 1.6%) was relatively low. Considering the high prevalence of unsafe sexual practice further spread of HIV infection among homosexual men in Slovakia is to be expected.

Pilot study of risk behaviour, voluntary HIV counselling and HIV antibody testing from saliva among inmates of prisons in Slovakia.

OBJECTIVE: To implement a pilot study of risk behaviour and HIV infection using HIV antibody testing from saliva to improve the situation as regards HIV/AIDS infection in prison institutions in the Slovak Republic. MATERIAL AND METHODS: The study comprised adult and juvenile males of grade one correction categories and prisoners from the prison for juveniles in Martin, as well as females prisoners in Nitra. Preventive activities were implemented in May 1998 in the form of discussions concerning topics related to HIV/AIDS infection. Saliva was collected for the presence of HIV antibodies and a questionnaire regarding sexual practice was completed. RESULTS: 32 persons [8 adult males (25%), 6 juvenile males (18.7%) and 18 females (56%)] were voluntarily tested for the presence of HIV antibodies in saliva. Nobody was HIV-positive. 75 persons (20 adult males, 30 juvenile males and 25 females) were involved in the study of risk behaviour. 40.8% participants had primary education, 28.2% secondary education, 2.8% were students of universities and 28.2% were apprenticies. 60% inmates (mostly females) were religious. Juvenile males reported the highest number of partners while females the smallest (p < 0.001). The more partners were reported by respondents, the lower was condom usage (p < 0.07). 47.6% females relied on credibility of partners, while 75% adult males and 50% adolescent males did not use protection. 0% females, 5% adult males and 10.3% juvenile males reported to have homosexual contacts outside prison while 19%, 5.6% and 8.3% in the prison, respectively. Paid sexual services were offered by 9.1% females, 15.8% adult males and 25% juvenile males. Outside prison adult and juvenile males used non-sterile used syringes as well as tattooing more often than females (p < 0.07 and p < 0.04, respectively). CONCLUSION: The present study provides information on the results of HIV-antibody testing in saliva. The results are based on a study of risk behaviour and difficulties linked with HIV/AIDS prevention among prisoners.

HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia.

INTRODUCTION: Aim of the study was to determine risk behaviour and HIV prevalence among commercial sex workers (CSWs) and intravenous drug users (IDUs) in streets of Bratislava and B. Bystrica, SR. METHODS: HIV antibodies were tested from saliva using ELISA test. Anonymous questionnaire was completed. RESULTS: 121 persons (61 men and 60 women) were involved in the sociological study. Mean age of the participants was 21.9 years. 185.1% of subjects were from Bratislava. 108 participants were tested for the presence of HIV-antibodies, one was confirmed HIV-positive (0.82%). In the past 47.9% of participants and 22.3% of their partners were tested for the presence of HIV-antibodies. 10.8% of subjects proclaimed that they suffered from other sexually transmitted infection (STI) in the past HIV testing of participants significantly correlated with the testing for other STI (p<0.002) as well as with HBV/HCV (p<0.001). 58 participants were using tattooing (47.9%). 46.3% of all participants never used condoms with partners. 31.4% of respondents proclaimed disruption of condom during sexual intercourse. Significant correlation was found between testing of participants for other STI and usage of condoms with their partners (p<0.013). Women used condoms more often by sexual contacts with partners than men used condoms (p<0.094). They were also significantly more tested for other STI in the past (p<0.021) and they suffered from other STI more often than men (p<0.033). 26.5% of person--only women--were involved in commercial sex work. 93.5% of them were taking drugs as well, 21.8% suffered for other STI in the past They were working in sex business on average for 26 months. The average number of their clients per week was 12.3. CSWs used condoms more often with clients than with partners. 98.2% of all participants were taking drugs, 93% of them intravenously. 24.6% of IDUs always used new or their own needles and syringes, while 69.4% shared equipments with the other users. IDUs drug users used condoms significantly less often with their partners than did CSWs (p<0.006). CSWs were significantly more often tested for other STI (p<0.001) and they also more often suffered for other STI than IDUs (p<0.045). CONCLUSION: More effort should be done to decrease risk behaviour revealed in the groups of CSWs and drug users.

[Pharmacotherapeutic profile of patients with acute myocardial infarct in the early hospitalization period]. / Farmakoterapeutický profil chorých s akútnym infarktom myokardu vo vcasnom období hospitalizácie.

BACKGROUND: The early treatment efficacy of patients with acute myocardial infarction (AMI) with thrombolysis, antiplatelet drugs, betablockers and ACE inhibitors has been well documented in randomized mega trials. However, little is known about the fact to what extend the results of these mega trials have influenced the treatment practices. Moreover, in the view of a complete lack of data on management of patients with AMI in Slovak Republic a project of the Ministry of Health "Audit of diagnostic and therapeutic management in patients with acute coronary syndromes" (AUDIT) has been conducted. OBJECTIVES: To obtain preliminary information on the present state of pharmacotherapy of patients with AMI in Slovak Republic during the early hospitalization phase (EHP) from the Pilot Study (PS) of the project AUDIT. METHODS: Pharmacotherapy of AMI during EHP was analysed in 336 patients (232 males and 104 females, mean age 65 12 years, age range 30-93 years). Patients admitted with diagnosis of the first or repeated AMI or with suspect AMI were included. PS was done in prospective multicentric study between November 1, 1996 and December 31, 1996. 23 hospitals from various parts of Slovakia participated in this study. Data were compiled by means of questionaires and were processed by ACCES 97 and EXCEL 97. RESULTS: Antiplatelet therapy with acetylosalicylic acid (almost exclusively Anopyrin) received as much as 87.8% of patients with AMI during EHP. Thrombolytic therapy (TLT), almost exclusively with streptokinase, was performed in 105, i.e. in 31.8% of patients with AMI. TLT was performed in a statistically significantly smaller proportion of patients older than 65 years compared to patients 65 years of age and younger (20.9% vs 41.2%, p < or = 0.01). Females were treated with TLT statistically significantly less frequently than males (24.5% vs 35.1%, p < or = 0.05). The major cause for not performing the TLT was late arrival to hospital (in 32.1% patients). Betablockers were administered to a total of 42.9% of patients during EHP. Betablockers received only 3.6% of patients intravenously (!) and only 39.3% of patients orally. Treatment with oral betablockers was performed in a statistically significantly smaller proportion of patients older than 65 years compared to patients 65 years of age and younger (27.4% vs 49.7%, p < or = 0.01). Up to 49.1% of patients in EHP were treated with ACE inhibitors, however, left ventricular ejection fraction < 40% warranting feasibility of this treatment was achieved only in 26.7% of patients. Nitrates were administered to 62% of patients in EHP, of this number intravenously to 37.4% of patients. Calcium channel blockers were given only to 7.3% of patients. Treatment with heparin was performed in 90.9% of patients. 14.3% of patients received during EHP antiarrhythmics of class I and 2.7% of patients of class III. MgSO4 was used in 26.4% of patients in EHP. CONCLUSIONS: The reported PS of AUDIT Project gives for the first time information on the state of the pharmacotherapy of patients with AMI in Slovak Republic. Some results are relatively encouraging, however, others can not be a reason for satisfaction. The fact, that in Slovakia, adequate number of patients with AMI receive acetylosalicylic acid (Anopyrin) and that Slovakia belongs to countries with the smallest proportion of patients with AMI treated with calcium channel blockers and antiarrhythmics during EHP is encouraging. On the other hand, the use of TLT and betablockers is dissatisfactory. Requirement to increase the proportion of thrombolysed patients with AMI and the necessity for substantially more frequent use of betablockers, especially intravenous, in EHP in these patients result from these findings. In Slovakia, inadequately large proportion of patients with AMI is treated with ACE inhibitors, heparin, and partially also nitrates administered per os during EHP. (ABSTRACT TRUNCATED)

Informacia o niektorych vysledkoch z Pilotnej studie projektu Ministerstva zdravotnictva SR. AUDIT diagnostickeho a terapeutickeho postupu u chorych s akutnymi koronarnymi syndromami

The basic analysis of the Pilot study fully confirms the possibilities of the realization of the project AUDIT ... in the planned form, the necessity to realize this project regarding the discovery of several negative facts in the management of patients with AMI, which can affect infavourable the course of the disease in patients with AMI and their prognosis or unjustifiably increase the economic impact. The most severe of them are investigated in this information and we present them in subsequent order of individual phases of the management of patients afflicted by AMI.

[Liver steatosis and disorders of mitochondrial oxidative phosphorylation after experimental administration of simazine]. / Steatóza pecene a poruchy oxidacnej fosforylácie mitochondrií po aplikácii simazínu v experimente.

BACKGROUND: Triazine herbicides are widely used in extensive agricultural production, however, some ecological and health hazards occur due to water and food contamination. AIM: The aim of this study was to evaluate the effects of long-term simazine feeding on the steatosis development and the changes of liver bioenergetics in experimental animals. METHODS: A population of B6C3F1 mice were fed with simazine (2 g and 4 g/kg/day, respectively) for 35 weeks. The concentration of cholesterol and triacylglycerols were measured in liver tissue. Liver mitochondria were isolated and parameters of oxidative phosphorylation were assessed polarographically using Clark oxygen electrode with NAD glutamate and/or FAD succinate as substrates. RESULTS: Significant changes (p < 0.001) expressed as medians (with confidence intervals) against control animals were found in both experimental groups after simazine feeding. The concentration of triacylglycerols increased from 10.3 (8.8-10.9) to 20.1 (18.0-20.9) and 47.7 (23.8-56.0), respectively. The parameters of oxidative phosphorylation with NAD substrate glutamate decreased as follows: The index of respiratory control from 7.7 (6.4-9.0) to 4.8 (4.0-6.3) resp. 4.4 (3.9-4.6); the rate of oxygen consumption in the state 3 (with ADP) from 84.2 (82.0-92.3) to 65.4 (50.8-70.7) resp. 69.9 (65.0-78.4) nAtO.mg.prot-1.min-1; and phosporylation rate from 215.3 (204.4-232.2) to 166.3 (120.4-193.6) resp. 169.6 (155.3-176.9) nmolATP.mg.prot-1.min-1. Comparable changes were detected in oxidative phosphorylation with FAD succinate as substrate. CONCLUSIONS: Liver steatosis development and mitochondrial energetics inhibition were determined in mice after long-term simazine feeding, nevertheless, liver energy production was sufficient to satisfy the liver function and the needs of the whole organism. (Tab. 4, Fig. 6, Ref. 24.)

[Effect of demographic, anamnestic and clinical factors on hospital mortality in patients with myocardial infarct]. / Ovplyvnenie nemocnicnej smrtnosti chorých s akútnym infarktom myokardu demografickými, anamnestickými a klinickými faktormi.

The objective of the work was to analyze local priority data on the possible effect of demographic, anamnestic and clinical factors in a non-selected population of 3123 patients with acute myocardial infarction (AIM) on the hospital mortality (HM). 12.6% patients with AIM died in hospital. The mean age of those who died was 71.92 years. There were more than 4 times more patients above 64 years than 64-year-old ones or younger ones who died. The mortality rate of 64-year-old patients and younger ones (5.2% is significantly lower than in patients above 64 years (19%). The mortality rate of patients above 74 years was 27.1%. Important correlations of the HM were moreover found--in women, patients living permanently in rural areas, in widowed subjects, in patients with elementary education, old age, pensioners and non-smokers. The HM was lower (< 10%) in patients with a history of complex ventricular arrhythmias, impaired lipid metabolism and those who had no other serious disease in the case-history. A higher HM (> 15%) was recorded in patients with a history of a cerebrovascular attack, with data on heart failure and in diabetic patients. The majority of patients (39.4% of all who died) died within 24 hours after admission. During the first three days 57% patients died. Analysis of the characteristic of AIM and HM revealed some clinically important data on the HM less than 30% (patients with complicated AIM, with elevated ST segments, with a left ventricular ejection fraction of less than 40% and with and concurrent heart failure). An adverse course of the disease with a high HM (> 30%) was found in patients with complications of AIM. It was highest, more than 60%, in patients after implemented cardiopulmonary resuscitation, in patients with a combination of three markers of imminent shock and patients in shock. The local priority findings on the HM assembled in Slovakia in a non-selected population of patients with AIM confirm that the high HM still persists in patients of advanced age and in women. It is adversely influenced also by some demographic data, educational level, some anamnestic and clinical factors. The HM of patients with AIM may be adversely influenced also by side-effects of protracted economic transformation which is under way. Data assembled in Slovakia are comparable with similar results assembled in other countries.

[Hospitalization of discharged patients with acute myocardial infarction in the thrombolytic era]. / Hospitalizácia prepustených chorých s akútnym infarktom myokardu v trombolytickej ére.

The objective of the work is to assess in discharged patients with AIM data on the period of hospitalization in the intensive care unit and the total period of hospitalization and how these were influenced by stratification into patients with complicated and uncomplicated AIM and patients with a low, medium and high risk. Data on hospitalization were analyzed in 2,527 discharged patients with AIM. The median of hospitalization at intensive care units was 5 days and the mean period of hospitalization 6.35 days. The significantly longer hospitalization (p < 0.001) in patients with complicated AIM (median 6 days) as compared with patients with uncomplicated AIM (median 5 days) impliesonly a one-day longer hospitalization in patients with complicated AIM. The median of total hospitalization was 17 days and the mean period of hospitalization 17.95 days. In the majority of patients the period of hospitalization was 15 - 21 days. More than 20% are hospitalized for more than 21 days. A significant difference of the total period of hospitalization in high risk patients and patients with a medium and low risk expressed in medians is only 2 days. The majority of patients in all three sub-groups of patients with AIM is dicharged between the 15th to 21st day of hospitalization. In the period of hospitalization at intensive care units and total hospitalizatiob of different sub-groups there is no substantial difference in their health status, incl. the danger of sudden cardiac death. By reducing the total period of hospitalization in discharged patients without complications it would be possible to save a considerable percentage of costs of hospitalization. The period of hospitalization must be fixed individually in every patient. In early dicharges it is important to consider also the psychosocial impact of discharge on the patient and his relatives.

[The electrocardiogram and thrombolytic therapy in patients with acute myocardial infarct]. / Elektrokardiogram a trombolytická liecba u chorých s akútnym infarktom myokardu.

The objective of the submitted work is to analyze in patients with acute myocardial infarction (AIM) local priority data on ECG markers after admission to hospital, data on some associations of ECG and thrombolytic treatment and to assess in patients with the first AMI data on hospital mortality in connection with some ECG markers. The project was implemented as a prospective multicentre study. An independent audit and collection of data was done in 3123 patients with AIM in 66 departments between Sept. 16 1997 and Sept. 15 1998. The group included patients admitted within 96 hours after development of complaints with the diagnosis or suspicion of AMI who were discharged with the diagnosis of a first/repeated AMI. Elevation of ST segments was recorded in 67.1%, a Q wave in 42.2% and left bundle branch block in 3.7% of the patients. Early diagnosis of AMI based on ECG and data on prolonged stenocardia was made in 55.6% patients. This is the maximal proportion of patients where thrombolytic treatment can be contemplated. Thrombolytic treatment was not administered to 54.9% patients with elevations of the ST segments and in as many as 81.2% patients with left bundle branch block. The hospital mortality in patients with a first AMI is significantly greater in patients with elevations of the ST segment, Q infarction, anterior wall infarction, combined infarction, right ventricular infarction and in patients with bundle branch and fascicular block. It was confirmed that in Slovakia in clinical practice thrombolytic treatment is not always administered consistent with criteria adopted from randomized studies. The result is underutilization or overutilization of thrombolytic treatment to patients with AIM in clinical practice. Underutilization of thrombolytic treatment is generally known. It was demonstrated that attention must be devoted also to overutilization of thrombolytic treatment. All patients where significantly higher hospital mortality was recorded must receive special care already on admission to hospital.

[The prehospital phase in patients with acute myocardial infarct in Slovakia. A challenge]. / Predhospitalizacná fáza u chorých s akútnym infarktom myokardu na Slovensku. Výzva na akciu.

Better management of patients with acute myocardial infarction during the prehospital phase is at present a challenge not only for health workers but for society as a whole. The authors pay attention to knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction which is a prerequisite for finding possible solutions for a favourable effect on their management. The authors analyzed 3,040 patients who were admitted to hospital alive within 96 hours after the development of complaints with suspicion of a first or repeated acute myocardial infarction. They focused attention in particular on prehospital time delay. They found that within a satisfactory time interval (within 2 hours) 29.8% patients were delivered and within a yet acceptable interval of 4 hours 51.6% patients (with respect to effectiveness of thrombolytic treatment). Similarly undesirable are also data on the patient time delay. Within the optimal first hour after development of complaints following the decision of the patient (subjects present) to ask for or seek medical assistance was the decision of 34% patients, during the first two hours 47.5% and within 4 hours 61.2% patients with acute myocardial infarction. The ratio of time delay of the patient in the total prehospital delay is 45.5% even in patients who were admitted during the first hour after development of acute myocardial infarction. In patients who were admitted 4 hours after development of complaints it is 79.5%. The patient is admitted to hospital most quickly if he calls the medical emergency service and latest when he decides to see a doctor. Physicians and other health workers contributed only in 16.4-20.9% patients with acute myocardial infarction to their early decision to seek medical assistance. Patients with an early decision (within one hour) call most frequently the medical emergency service and are taken to hospital by this service. The time delay due to transport is shortest in these patients. The late hospital admission of patients with acute myocardial infarction in Slovakia calls for reduction of the time interval from the development of complaints to hospital admission (total prehospital delay), in particular the time taken by the patient to make up his mind (patient time delay). Early calling of the emergency medical service and transport of the maximum possible number of patients with acute myocardial infarction to hospital by the emergency medical service will greatly improve the management of patients with acute myocardial infarction. Comprehensive implementation of the survival chain (24), the most comprehensive implementation of recommendations of the European Society of Cardiology and the European Resuscitation Council for in the management of patients with acute heart attacks during the prehospital phase (21) and early effective treatment which begins already in the prehospital phase has a favourable impact on the condition of patients with acute myocardial infarction and on their prognosis. Along with early and effective treatment of patients with acute myocardial infarction in hospital and their stratification these are the most important approaches to the development and control of sudden cardiac death. Knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction is the prerequisite for the elaboration of high standard prehospital management of patients with acute myocardial infarction.

[Early diagnosis and reasons for not administering thrombolytic therapy in acute myocardial infarct]. / Vcasná diagnóza a príciny nerealizácie trombolytickej liecby u chorých s akútnym infarktom myokardu.

In Slovakia we are lacking data on early (before examination of serum markers of myocardial necrosis) pertaining to thrombolytic treatment (TLL) which is inevitable in case of acute myocardial infarction (AIM) as well as data on the reasons why TLL is not implemented. This why the authors analyze the results of completed comprehensive project Audit concerned with diagnostic and therapeutic procedures in patients with acute coronary syndromes during the pre-hospital and hospital stage (AUDIT). The investigation was a perspective multi-centre study. Data were collected from 3123 patients with AIM in 66 departments (in 64 health institutions) during Sept. 16 1997 till Sept. 15 1998. The group included patients admitted within 96 hours after the development of complaints with the diagnosis or suspicion of AIM and discharged with the diagnosis of a first/repeated AIM. Early diagnosis of AIM was made in 1736 (55.6%) patients. In the AUDIT study TLL was assessed in 1074 (34.6%) patients. A marked difference between the number of candidates for TLL and the number of patients with TLL where TLL was implemented requires that in analyses of TLL in patients with AIM attention should be paid also to reasons why it was not implemented. The most frequent cause why TLL was nor implemented was late admission of the patient to hospital (in patients who attended hospital < 6 hours, TLL was not implemented in 48.5%, after admission between 6 and 12 hours in 70% and in patients admitted > 12 hours in as many as 90.8% patients), equivocal indication of TLL (in 29.9% patients) and contraindications (in 16.1% patients). The presented results are priority data on the early diagnosis of AIM and reasons why TLL was not implemented. It is part of data essential needed for elaboration of a (national) programme of better care (management) of patients with AIM taking into account also economic factors.

Antibody response to chlamydiae in children with asthma and respiratory illness.

No relation between the occurrence of antibodies to chlamydial agents and asthma in children was found. In asthmatic children, the antibodies to Chlamydia trachomatis occurred in 3.1% and to Chlamydophila pneumoniae in 22.7%, whereas in a control group of children without asthma or other allergic disease in 2.3% and 24.0%, respectively. The occurrence of antibodies of IgA and IgG classes to C. pneumoniae was also very similar; its rise was age-dependent. On the other hand, in the group of children in a pre-school age with respiratory tract infection, anti-chlamydial antibodies were demonstrated significantly more often (18.5% of IgG antibodies to C. trachomatis, 20.0% of IgM antibodies to both C. trachomatis and C. pneumoniae) than in those suffering from other, non-respiratory illness (3.9% of the former and 5.9% of the latter antibodies). However, in these children, we did not succeed in detection of C. trachomatis in conjunctival and nasopharyngeal smears by PCR. Nevertheless, chlamydial agents (C. trachomatis in infants, C. pneumoniae in pre-school children) should be taken into consideration in a differential diagnosis of respiratory tract inflammation.