Browsing by Author "Nedeljković, Milan (7004488186)"

Disseminated fungal infections are still rare conditions, mostly caused by Candida spp. during immunosuppression. Infection of immunocompetent individuals is uncommon. Endocarditis is a rare manifestation during candidaemia, mostly in patients with prosthetic valves. Affection of previously unaltered valves is uncommon. We presented a case of a young, previously healthy female patient with endocarditis, caused by Candida parapsilosis. The initial symptom, fever, was present four months before hospital admittance. She was febrile without other symptoms and during observation in a local hospital. After her condition deteriorated, she was transferred to the Institute for infectious and tropical diseases, Belgrade. Clinical findings on admission include petechial skin rash and moderate hepatosplenomegaly. Newly developed systolic murmur was noted, and Candida parapsilosis was isolated in multiple blood cultures. Echocardiography revealed 15 × 14 mm vegetations on the right aortic vellum. She was treated with antifungal drugs (fluconasole, liposomal amphotericin B), and the affected valve was successfully replaced. The same strain of Candida parapsilosis was isolated from the intraoperative material of the valve. There were no markers of immunosuppression or other conditions which could affect the immune system. After a prolonged period of treatment she was successfully cured, and she received a long-term intermittent suppressive fluconasole therapy for the time being. © 2013 Pelemiš et al; licensee BioMed Central Ltd.

Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percuta-neous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of met-abolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and meta-bolic variables - glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endo-crinological variables - DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable - SYN-TAX score, and 5) clinical variables in modified age, creati-nine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c - 8%, triglyceridemia - 2.3 mmol/L in patients with insulin therapy, and ACS modality - unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYN-TAX score (c statistic = 0.798), as well as ACF score (c sta-tistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Aims: This study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). Methods: ED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, N = 30) and absence of ACh-induced coronary spasm (group ED− N = 17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8 min of FSIGTT) and by disposition index (DI) (Si × AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. Results: Si was significantly lower (4.22 ± 0.62 vs 6.98 ± 1.47 min−1/mU/l × 104; p < 0.05) while HOMA-IR was significantly higher in ED + group vs ED− group (2.8 ± 0.3 vs 1.7 ± 0.2; p < 0.05). Simultaneously, AIR and DI was significantly lower in ED + vs ED− groups (p < 0.05 and p < 0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (p < 0.01) and higher PAI-1 levels (p < 0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. Conclusions: Both insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes. © 2018 Elsevier B.V.

Aims: This study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). Methods: ED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, N = 30) and absence of ACh-induced coronary spasm (group ED− N = 17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8 min of FSIGTT) and by disposition index (DI) (Si × AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. Results: Si was significantly lower (4.22 ± 0.62 vs 6.98 ± 1.47 min−1/mU/l × 104; p < 0.05) while HOMA-IR was significantly higher in ED + group vs ED− group (2.8 ± 0.3 vs 1.7 ± 0.2; p < 0.05). Simultaneously, AIR and DI was significantly lower in ED + vs ED− groups (p < 0.05 and p < 0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (p < 0.01) and higher PAI-1 levels (p < 0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. Conclusions: Both insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes. © 2018 Elsevier B.V.

Cardiovascular and reproductive health of women have been going hand in hand since the dawn of time, however, their links have been poorly studied and once the basis of their connections started to be established in late 20th century, it depended on local regional abilities and the level of progressive thinking to afford comprehensive women’s care beyond the “bikini medicine”. Further research identified different associations rendering more conditions sex-specific and launching therefore a slow, yet initial turn around in clinical trials’ concept as the majority of global cardiovascular guidelines rely on the results of research conducted on a very modest percentage of women and even less on the women of color. Currently, the concept of women’s heart centers varies depending on the local demographics’ guided needs, available logistics driven by budgeting and societal support of a broad-minded thinking environment, free of bias for everyone: from young adults questioning their gender identity, via women of reproductive age both struggling to conceive or keep working part time when healthy and line of work permits it during pregnancy, up to aging and the elderly. Using “Investigate-Educate-Advocate-Legislate” as the four pillars of advancing cardiovascular care of women, we aimed to sum-marize standing of women’s health in Serbia, present ongoing projects and propose actionable solutions for the future. © 2021, Serbia Medical Society. All rights reserved.