To assess the prognostic value of capillaroscopy findings for the development of connective tissue disease in children and adolescents with Raynaud phenomenon, we followed up a group of 250 (mean age 15 years) for 1 to 6 years after the first capillaroscopy was performed. Every 6 months they were screened for signs and symptoms of connective tissue disease. Analysis was performed on capillary changes registered 6 months before the development of connective tissue disease. Capillary changes were classified into three types: normal, nonspecific, and sclerodermatous. At the end of the follow-up period, 191 (76%) subjects had primary Raynaud phenomenon, 27 (10.8%) were diagnosed as having undifferentiated connective tissue disease, and 32 (12.8%) fulfilled the criteria for a diagnosis of a specific connective tissue disease. Systemic lupus erythematosus was found in nine (3.6%) patients, rheumatoid arthritis in 10 (4%) patients (six of them with juvenile onset rheumatoid arthritis), and scleroderma spectrum disorders in 13 (5.2%). The mean time for the evolution of Raynaud phenomenon into undifferentiated connective tissue disease or a form of the disease was 2 years. Most of the subjects with primary Raynaud phenomenon (173/191, 91%), undifferentiated connective tissue disease (22/27, 81%), juvenile onset rheumatoid arthritis/rheumatoid arthritis (7/10, 70%), and systemic lupus erythematosus (6/9, 67%) had normal capillary findings. Nonspecific capillary changes occurred in 3 of 10 (30%) patients with rheumatoid arthritis, 2 of 9 (22%) with systemic lupus erythematosus, 4 of 27 (15%) with undifferentiated connective tissue disease, and 18 of 191 (9%) with primary Raynaud phenomenon. Of all the subjects, only 10 (4%) showed sclerodermatous disease type capillary changes 6 months before the expression of a particular disease: eight (62%) of these developed scleroderma spectrum disorders, one expressed systemic lupus erythematosus, and one had undifferentiated connective tissue disease. We concluded that there were no specific capillary changes predictive for future development of systemic lupus erythematosus, juvenile onset rheumatoid arthritis/rheumatoid arthritis, and undifferentiated connective tissue disease in children and adolescents with Raynaud phenomenon. Most of our study subjects with Raynaud phenomenon who developed these diseases had normal capillary findings or nonspecific changes. Children and adolescents who developed scleroderma spectrum disorders showed a sclerodermatous type of capillary changes 6 months before the expression of the disease, indicating that this type of capillary changes in children and adolescents with Raynaud phenomenon highly correlated with further development of scleroderma spectrum disorders.

Preeclampsia complicates about 5% of all pregnancies worldwide. It is a major cause of maternal, fetal and neonatal morbidity and mortality. The aim of this systematic review was to study the literature on the predictive potential of screening for preeclampsia based on serum markers and uterine artery Doppler velocity waveform assessment. First-trimester uterine artery Doppler can identify over half of women who will develop preeclampsia. Detection rates may be increased by a combination with maternal serum markers. In screening for early preeclampsia, the detection rate for a 10% falsepositive rate was 96.3% for a combination of maternal factors, soluble endoglin, placental growth factor and uterine artery lowest Pulsatility Index. First trimester placental protein 13 predicts preeclampsia in women at increased a priori risk and predicts early-onset better than late-onset disease. The Fetal Medicine Foundation has released in 2009 the new software to allow calculation of risks for preeclampsia and gestational hypertension. Uterine artery Doppler velocimetry in combination with some biochemical markers seems to be an effective first-trimester screening tool for preeclampsia and in particular early-onset preeclampsia.

Abstract.In this open, prospective study we assessed the prevalence of antiplatelet resistance among patients subjected to intracoronary stent implantation. In patients treated with aspirin + thienopyridine (N = 32), platelet reactivity index (PRI) significantly decreased after 2 and 7 days of dual antiplatelet treatment in comparison with the same patients on aspirin monotherapy (P<0.001, both). After 7 days of aspirin + thienopyridine treatment, insufficient antiplatelet response was observed in 28% (9 / 32) of the patients. High interindividual variability in response to aspirin + thienopyridine treatment emphasizes the significance of thienopyridine resistance, while the influence of statins on such a treatment should be reassessed. Keywords: antiplatelet agent, stent, vasodilator-stimulated phosphoprotein (VASP) assayThienopyridine resistance is still a matter of debate (1). There is no widely accepted definition, but it could be described as a failure of antiplatelet drugs to produce an expected biological response (platelet inhibition) or their failure to inhibit the target (P2Y 12 receptor-related response in platelets) (2). Thienopyridine resistance may be explained by extrinsic and / or intrinsic mechanisms. The former mechanisms may involve patient nonadherence, underdosing or inappropriate dosing of clopidogrel, and drug-drug interactions involving CYP3A4 isoforms, while the latter may be related to genetic polymorphisms (e.g., P2Y 12 receptors or CYP3As), increased release of ADP, or alternate pathways of platelet activation (3).Since thienopyridines irreversibly inhibit ADP binding to the platelet P2Y 12 receptor and prevent subsequent phosphorylation of vasodilator-stimulated phosphoprotein (VASP), the increase in VASP phosphorylation could be a useful marker of thienopyridine resistance (4).The aim of our study was to assess the prevalence of thienopyridine resistance in patients subjected to intracoronary stent implantation in Serbia, since there is almost no data on this subject. Also, the influence of selected modifying factors to such a prevalence would be analyzed. Thienopyridine resistance was tested with the VASP phosphorylation assay and assessed by platelet reactivity index (PRI). In this open, prospective study, 20 healthy volunteers (14 males, 6 females), aged 49.4 ± 11.4 years, without any medication, were compared to 32 patients (27 males, 5 females), aged 57.1 ± 8.5 years, with ischemic heart disease, undergoing elective percutaneous coronary intervention (PCI) at the Clinical Centre of Serbia (Belgrade, Serbia). In the latter group, all the patients had one or more cardiovascular risk factors, 26 had a previous history of vascular event, and 22 had previous myocardial infarction.The study was conducted according to the Declaration of Helsinki.All the patients were treated with aspirin (100 mg / day) for three consecutive days. Subsequently, they were randomized to aspirin (100 mg / day) + ticlopidine (2 × 250 mg / day) or aspirin (100 mg / day) + clopidogrel (75 mg / day) (N = 15 a...

MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.

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

Baseline patient characteristics and clopidogrel dose modify the antiplatelet response. Also, patients resistant to both aspirin and clopidogrel do no benefit from an increased clopidogrel dose.

SummaryBackgroundSystemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. The brain natriuretic peptide (BNP) is a previously known marker of elevated cardiovascular risk in SSc, but the levels of BNP in various forms of SSc have not been investigated so far.AimThe aim of our study was to evaluate the influence of SSc on the function of the right ventricle and the right atrium using the echocardiographic parameters. Moreover, we examined the levels of BNP in different forms of SSc as well as the association of disease severity with the plasma concentrations of BNP.MethodsWe included 42 patients with newly diagnosed SSc and patients whose disease had been diagnosed earlier. SSc patients and non-SSc control patients were examined by using echocardiography and the concentrations of BNP were determined.ResultsWe analyzed differences in the parameters of right ventricle (RV) function and right atrium (RA) function between SSc patients and healthy controls. The two groups had similar distribution of gender, but SSc patients were significantly older than controls. RV wall thickness was increased in SSc patients (p<0.001), while right ventricular end-systolic area (RVESA; p=0.408) and right ventricular end-diastolic area (RVEDA; p=0.368) did not differ among the examinees. In contrast, RA minor-axis dimension (p=0.001) and the tricuspid annular plane systolic excursion (TAPSE) (p=0.001) were significantly higher in SSc patients. Also, we analyzed differences in brain natriuretic peptide (BNP) concentrations between diffuse cutaneous systemic sclerosis (DSSc) and limited cutaneous systemic sclerosis (LSSc) patients. DSSc patients had significantly higher concentrations of BNP. We found that levels of BNP were in significant positive correlations with age (p=0.007), disease duration (p=0.023), C reactive protein (CRP) (p=0.032), right ventricle fractional area change (FAC) (p=0.022), pulmonary vascular resistance (PVR) and Rodnan score (p=0.019).ConclusionsGiven the obtained results, the laboratory determination of BNP could be useful in differentiating different forms of systemic sclerosis as well as in predicting the severity of the disease and future cardiovascular complications.

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