Background. Oxidative stress (OS) and inflammation are major mechanisms involved in the progression of chronic heart failure (CHF (E/e' ≥ 13) had higher sUA (8.6 ± 2.3 vs. 7.3 ± 1.4, p=0.08) and NT-proBNP levels (643±430 vs. 2531±709, p=0.003) and lower EF (29.8 ± 3.9 % vs. 36.3 ± 4.4 %, p=0.001). p<0.001), MDA (r= 0.49, p= 0.001), MPO (r=0.34, p=0.001) and p= 0.003).Conclusion. In CHF, hyperuricemia is associated with disease severity. High sUA levels in CHF with normal renal function may reflect increased xanthine-oxidase activity linked with chronic inflammatory response.
696levels, associated with gas within the biliary tree (FIGURE 1A). Abdominal computed tomography (CT) confirmed the acute occlusive distention of the je junum and proximal ileum, as well as pneumobi lia. There was no presence of a gallstone in the air filled gallbladder, but a concentric intraluminal ring was present in the right iliac fossa, suggest ing a migrated gallstone in the bowel lumen, with a secondary ileoileal intussusception (FIGURE 1B -1E). The clinical diagnosis was acute intestinal obstruc tion probably due to gallstone ileus associated with secondary ileoileal intussusception, bilio enteric fistula, and pneumobilia.The emergent surgery revealed a jejunal ob struction by a gallstone of 2.5 cm in diameter, a spontaneous cholecystoduodenal fistula, and a secondary ileoileal intussusception due to gall stone displacement. The gallstone was extracted An 84 year old woman with a history of choleli thiasis was admitted for abdominal pain and per sisting vomiting, which had started more than a week earlier, as well as symptoms of acute small bowel obstruction, which she noted 3 days ear lier. On physical examination, she appeared dis tressed and dehydrated, while her abdomen was distended, diffusely painful, and soft, without re bound tenderness. A laboratory analysis revealed neutrophilic inflammation and mild cholestasis (increased conjugated bilirubin and serum alka line phosphatase levels). The levels of pancreat ic enzymes were normal, and other laboratory test results were unremarkable. Abdominal ul trasound revealed a shrunken gallbladder with the air inside, but without stones, and a nondi lated common bile duct. Plain abdominal X ray showed dilated small bowel loops with air fluid
Background. Patients with nonvalvular atrial fibrillation (NVAF) have five times higher risk of stroke than the general population. Anticoagulation (ACO) in NVAF is a class I indication after assessing the CHA2DS2-VASc and HAS-BLED scores. However, in the real world, NVAF patients receive less ACO than needed due to patients’ comorbidities that can be assessed by the Charlson comorbidity index (CCI). The use of non-antivitamin K anticoagulants (NOAC) has improved the decision to anticoagulate. Objective. We analyzed the factors influencing the ACO prescribing decision in NVAF patients in the real world and the changes induced by the introduction of NOAC. Method. We carried out an observational retrospective cross-sectional study that included consecutive patients with permanent NVAF and CHA2DS2-VASc ≥ 2, admitted to a community hospital between 2010–2011 (group 1, 286 patients), when only vitamin K antagonists (VKA) were used, and 2018–2019 (group 2, 433 patients), respectively. We calculated CHA2DS2-VASc, HAS-BLED, and CCI and recorded the ACO decision and the use of VKA or NOAC in group 2. We compared the calculated scores between ACO and non-anticoagulated (nonACO) patients in both groups and between groups. Results. A 31.5% share of patients in group 1 and 12.9% in group 2 did not receive ACO despite a CHA2DS2-VASc score ≥ 2. In group 1, nonACO patients had higher HAS-BLED and CCI scores than the ACO patients, but their CHA2DS2-VASc scores were not significantly different. Old age, dementia, severe chronic kidney disease, neoplasia, and anemia were the most frequent reasons not to prescribe anticoagulants. In group 2, more nonACO patients had dementia, diabetes mellitus, and higher HAS-BLED than ACO patients. Moderate-severe CKD, neoplasia with metastasis, liver disease, anemia, and diabetes mellitus were statistically significantly more frequent in nonACO patients from group 1 than those from group 2. In group 2, 55.7% of ACO patients received NOAC. Conclusions. In real-world clinical practice, the decision for anticoagulation in NVAF is influenced by patient age, comorbidities, and risk of bleeding, and many patients do not receive anticoagulants despite a high CHA2DS2-VASc score. The use of NOAC in the past few years has improved treatment decisions. At the same time, the correct diagnosis, treatment, and surveillance of comorbidities have cut down the risk of bleeding and allowed anticoagulant use according to guidelines.
Introduction and objective. Blood pressure (BP) goals and glycemic targets are only reached in 40% and 50% of patients, respectively. The objective of this observational retrospective cohort study was analyzing BP control with antihypertensive therapy in patients with diabetes mellitus (DM) and arterial hypertension (HTN) in clinical practice. Methods. 156 hospitalized hypertensive patients with type 2 DM were divided into 2 groups (G): G1 - uncomplicated and G2 - complicated DM, with micro- and macrovascular involvement, followed retrospectively for 2 years. BP control with antihypertensives was analyzed with respect to DM control, complications, hospital readmissions for cardiovascular disease and all-cause mortality. Results. Of the 156 patients, 71 (45.6%) males, mean age 66.7 ± 9.8 years, 94 (60.3%) were included in G2. Ninety-one patients (58.3%) were rehospitalized, G2 patients having a significantly higher risk of readmission (p=0.006). BP was controlled in 57.7% patients at first, and in 59.3% patients on the last hospitalization, while DM was initially controlled in 49.3% patients, and in 54.9% on the last readmission. The number of antihypertensive drug classes was significantly higher in G2 (3.5 vs 3.1, p=0.03). Fifteen (9.6%) patients were initially on fixed-dose combinations (FDC). All-cause mortality after 2 years was 12.2%, strongly associated with DM complications (p=0.005), with a protective effect from controlled DM (p=0.045). Conclusion. More than forty percent of the patients had uncontrolled long term HTN with frequent re-hospitalizations and increased mortality. Better BP control could be achieved by changing therapy, notably by FDC, promoting patient adherence.
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