Purpose. Nontraditional cardiovascular risk factors as apolipoprotein A (ApoA), apolipoprotein B (ApoB), and the proprotein convertase subtilisin/kexin type 9 (PCSK9) increase the prevalence of cardiovascular mortality in chronic kidney disease (CKD) or in end-stage renal disease (ESRD) through quantitative alterations. This review is aimed at establishing the biomarker (ApoA, ApoB, and PCSK9) level variations in uremic patients, to identify the studies showing the association between these biomarkers and the development of cardiovascular events and to depict the therapeutic options to reduce cardiovascular risk in CKD and ESRD patients. Methods. We searched the electronic database of PubMed, Scopus, EBSCO, and Cochrane CENTRAL for studies evaluating apolipoproteins and PCSK9 in CKD and ESRD. Randomized controlled trials, observational studies (including case-control, prospective or retrospective cohort), and reviews/meta-analysis were included if reference was made to those keys and cardiovascular outcomes in CKD/ESRD. Results. 18 studies met inclusion criteria. Serum ApoA-I has been significantly associated with the development of new cardiovascular event and with cardiovascular mortality in ESRD patients. ApoA-IV level was independently associated with maximum carotid intima-media thickness (cIMT) and was a predictor for sudden cardiac death. The ApoB/ApoA-I ratio represents a strong predictor for coronary artery calcifications, cardiovascular mortality, and myocardial infarction in CKD/ESRD. Plasma levels of PCSK9 were not associated with cardiovascular events in CKD patients. Conclusions. Although the “dyslipidemic status” in CKD/ESRD is not clearly depicted, due to different research findings, ApoA-I, ApoA-IV, and ApoB/ApoA-I ratio could be predictors of cardiovascular risk. Serum PCSK9 levels were not associated with the cardiovascular events in patients with CKD/ESRD. Probably in the future, the treatment of dyslipidemia in CKD/ESRD will be aimed at discovering new effective therapies on the action of these biomarkers.
Methicillin-resistance phenomenon regarding Staphylococcus aureus which is often met as etiologic agent of severe systemic infections with oral-maxillofacial portal of entry imposes the first-line therapeutic schemes readjustment in patients with significant risk factors. Minimum inhibitory concentration (MIC) determination for every isolated S.aureus strain is useful for the antibiotherapy guiding, in order to choose the appropriate antimicrobial substances and to avoid the selection of resistant mutants. There have been studied and tested 9036 bacterial strains isolated from patients hospitalized in the Sf.Spiridon Emergency County Hospital between 2013-2016. Minimum inhibitory concentrations (MIC), MIC 50 and MIC 90 values were determined for the following antibiotics: Penycilline, Erithromycin, Oxacylline, Tetracycline, Gentamycin, Tobramycine, Kanamycin, Ryfampicyn, Trimethoprim-Sulfamethoxazole, Ofloxacine, Ciprofloxacine and Vancomycin.The classification of each identified bacterial strain into sensitive or resistant was accomplished according to the breakpoints recommended by CLSI 2016 (Clinical and Laboratory Standard Institute). We considered intermediately susceptible isolates as being resistant. S.aureus antibioresistance was high to tetracycline, erythromycin and kanamycin, with elevated MIC 90 values (64�g). The rate of resistance to penicillin in the case of S.aureus was 94.7%. The lowest MIC values regarding Pseudomonas aeruginosa were for imipenem, meropenem and colistin and the highest ones for piperacillin-tazobactam, ceftazidime and amikacin. Third generation cephalosporins demonstrated their inefficiency in the staphylococcal infections� treatment as a consequence of an increasing resistance to this category of betalactams. Vancomycin remains a saving in-hospital therapeutic option in the case of MRSA implication, next to teicoplanin and linezolid.
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