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Péčová M, Benko J, Péč MJ, Bolek T, Hurtová T, Sokol J, Staško J, Samoš M, Mokáň M. Unilateral upper and lower limb ischemia mimics stroke: a case report. J Med Case Rep 2024; 18:66. [PMID: 38308343 PMCID: PMC10837969 DOI: 10.1186/s13256-023-04240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/01/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Although stroke and acute limb ischemia seem easily distinguishable by anamnesis and physical examination, symptoms may overlap and sometimes mislead the examiner. Such a situation can arise in the occurrence of unilateral neurological symptoms affecting the upper and lower limbs at the same time. As timely diagnosis and a correct therapeutic intervention are crucial to prevent irreversible damage in both diseases, knowledge of the possibility of one disease mimicking the other is essential. We present a unique case of acute unilateral upper and lower limb ischemia mimicking an acute stroke. CASE PRESENTATION A 69-year-old Caucasian patient with known atherosclerotic risk factors was admitted to the emergency department with a suspected stroke with unilateral paresthesia. After a comprehensive examination of the patient with the need for repeated reevaluation and a negative brain computed tomography scan, acute left-sided upper and lower limb ischemia was eventually diagnosed. The patient underwent surgical revascularization of the upper and lower limbs with a satisfactory result and was discharged from the hospital after a few days. CONCLUSION It is of utmost importance to always stay alert for stroke mimics, as overlooking can lead to severe complications and delay adequate therapy. Our case shows that persistent diagnostic effort leads to successful treatment of the patient even on rare occasions, as is the acute unilateral upper and lower limb ischemia.
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Affiliation(s)
- Monika Péčová
- Oncology Centre, Teaching Hospital Martin, Kollárova 2, 036 01, Martin, Slovakia
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Jakub Benko
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia.
- Department of Cardiology, Teaching Hospital Nitra, 950 01, Nitra, Slovakia.
| | - Martin Jozef Péč
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia.
| | - Tomáš Bolek
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Tatiana Hurtová
- Department of Infectology and Travel Medicine and Department of Dermatovenerology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Juraj Sokol
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Ján Staško
- Department of Hematology and Transfusion Medicine, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II., Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH, a.s.), 974 01, Banská Bystrica, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I., Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollárova 2, 036 01, Martin, Slovakia
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Horná S, Péč MJ, Krivuš J, Michalová R, Sivák Š, Galajda P, Mokáň M. Gastrointestinal Complications of Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome Managed By Parenteral Nutrition. Eur J Case Rep Intern Med 2024; 11:004268. [PMID: 38352812 PMCID: PMC10860911 DOI: 10.12890/2024_004268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024] Open
Abstract
MELAS - an acronym for mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes - is a multiorgan disease caused by a mutation in mitochondrial DNA (mtDNA). Its clinical manifestations are highly variable; mainly stroke-like episodes, seizures, recurrent headaches, or muscle weakness. However, gastrointestinal complications such as chronic intestinal pseudo-obstruction (IPO), pancreatitis, gastroparesis and hepatopathy are also common. In this report we describe a young patient with gastrointestinal complication of MELAS which led to superior mesenteric artery syndrome (SMAS). It is rare but not surprising combination and should be considered in cases with significant weight loss and resistance to symptomatic treatment. The optimal energy support is the main pillar of the treatment. LEARNING POINTS Gastrointestinal complications of MELAS such as chronic intestinal pseudo-obstruction, pancreatitis and gastroparesis can lead to undernutrition.Superior mesenteric artery syndrome is a rare condition but should be considered in cases with significant weight loss and resistance to symptomatic treatment.Optimal caloric intake and energy support can improve the condition of patients with MELAS.
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Affiliation(s)
- Simona Horná
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Martin Jozef Péč
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Juraj Krivuš
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Renáta Michalová
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Peter Galajda
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
| | - Marián Mokáň
- Clinic of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital in Martin, Martin, Slovakia
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Péč MJ, Jurica J, Péčová M, Benko J, Sokol J, Bolek T, Samec M, Hurtová T, Galajda P, Samoš M, Mokáň M. Role of Platelets in Rheumatic Chronic Autoimmune Inflammatory Diseases. Semin Thromb Hemost 2023. [PMID: 38016649 DOI: 10.1055/s-0043-1777071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Platelets are essential in maintaining blood homeostasis and regulating several inflammatory processes. They constantly interact with immune cells, have immunoregulatory functions, and can affect, through immunologically active substances, endothelium, leukocytes, and other immune response components. In reverse, inflammatory and immune processes can activate platelets, which might be significant in autoimmune disease progression and arising complications. Thus, considering this interplay, targeting platelet activity may represent a new approach to treatment of autoimmune diseases. This review aims to highlight the role of platelets in the pathogenic mechanisms of the most frequent chronic autoimmune inflammatory diseases to identify gaps in current knowledge and to provide potential new targets for medical interventions.
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Affiliation(s)
- Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Monika Péčová
- Oncology Centre, Teaching Hospital Martin, Martin, Slovak Republic
- Department of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jakub Benko
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
- Department of Cardiology, Teaching Hospital Nitra, Nitra, Slovak Republic
| | - Juraj Sokol
- Department of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marek Samec
- Department of Medical Biology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Tatiana Hurtová
- Department of Dermatovenerology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
- Department of Infectology and Travel Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II, Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH, a.s.), Banská Bystrica, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Péč MJ, Benko J, Jurica J, Péčová M, Samec M, Hurtová T, Bolek T, Galajda P, Péč M, Samoš M, Mokáň M. The Anti-Thrombotic Effects of PCSK9 Inhibitors. Pharmaceuticals (Basel) 2023; 16:1197. [PMID: 37765005 PMCID: PMC10534645 DOI: 10.3390/ph16091197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
Atherosclerosis is the primary process that underlies cardiovascular disease. The connection between LDL cholesterol and the formation of atherosclerotic plaques is established by solid evidence. PCSK9 inhibitors have proven to be a valuable and practical resource for lowering the LDL cholesterol of many patients in recent years. Their inhibitory effect on atherosclerosis progression seems to be driven not just by lipid metabolism modification but also by LDL-independent mechanisms. We review the effect of PCSK9 inhibitors on various mechanisms involving platelet activation, inflammation, endothelial dysfunction, and the resultant clot formation. The main effectors of PCSK9 activation of platelets are CD36 receptors, lipoprotein(a), oxidised LDL particles, tissue factor, and factor VIII. Many more molecules are under investigation, and this area of research is growing rapidly.
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Affiliation(s)
- Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
| | - Jakub Benko
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
- Department of Cardiology, Teaching Hospital Nitra, 949 01 Nitra, Slovakia
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
| | - Monika Péčová
- Oncology Centre, Teaching Hospital Martin, 036 59 Martin, Slovakia
- Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Marek Samec
- Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Tatiana Hurtová
- Department of Infectology and Travel Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Department of Dermatovenerology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
| | - Martin Péč
- Department of Medical Biology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II, Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH, a.s.) in Banská Bystrica, 974 01 Banská Bystrica, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia; (M.J.P.)
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Ságová I, Mokáň M, Tonhajzerová I, Rončáková M, Vaňuga P. Age, body composition parameters and glycaemic control contribute to trabecular bone score deterioration in acromegaly more than disease activity. Front Endocrinol (Lausanne) 2023; 14:1197725. [PMID: 37670889 PMCID: PMC10475557 DOI: 10.3389/fendo.2023.1197725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/30/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Impairment of bone structure in patients with acromegaly (AP) varies independently of bone mineral density (BMD). Body composition parameters, which are altered in patients with acromegaly, are important determinants of bone strength. Purpose The aim of this study was to examine BMD and lumbar trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) and to assess its relationship with disease activity, age, glucose metabolism, and body composition parameters. Methods This cross-sectional prospective study involved 115 patients with acromegaly (70 F, 45 M) and 78 healthy controls (CON) (53 F, 25 M) matched for age, gender, and BMI. Bone mineral density, TBS and body composition parameters were measured using DXA. Results AP presented with lower TBS compared to CON (1.2 ± 0.1 v 1.31 ± 0.1, P< 0.001). No significant correlation was observed between IGF-1/GH levels and TBS. Age, glycated haemoglobin, BMI, waist circumference, fat mass, and lean mass negatively correlated with TBS in both sexes. Multiple linear regression analysis of all these parameters revealed age and waist circumference as independent significant predictors of TBS in AP. We did not find difference in BMD (lumbar and femoral sites) between AP and CON nor between active and controlled AP. We observed negative correlation between age and BMD of the femoral neck and total hip (P < 0.001). Testosterone levels in males, BMI, waist circumference, fat mass, and lean mass positively correlated with BMD in AP, with stronger correlation between lean mass and BMD compared to fat mass. Conclusion Patients with acromegaly have lower TBS than controls, confirming impaired bone microarchitecture in acromegaly regardless of BMD. Age, body composition parameters and glucose metabolism contribute to TBS deterioration in AP more than disease activity itself.
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Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Ingrid Tonhajzerová
- Comenius University Jessenius Faculty of Medicine, Department of Physiology, Martin, Slovakia
| | - Marianna Rončáková
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
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Janíčková M, Bolek T, Stančiaková L, Nagy N, Mokáň M, Samoš M. How to Treat Today? Oral and Facial Cancer-Associated Venous Thromboembolism. Pharmaceuticals (Basel) 2023; 16:1011. [PMID: 37513923 PMCID: PMC10385582 DOI: 10.3390/ph16071011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The exact incidence of cancer-associated venous thromboembolism (CA-VTE) in patients with oral and facial cancer (OFC) is not exactly known, and this risk is empirically considered to be low. However, this suggestion may result in disease underdiagnosis, prolong the initiation of adequate therapy, and consecutively increase CA-VTE-related morbidity and mortality. In addition, there might be specific clinical problems in the treatment of CA-VTE in patients with oral and facial cancer, such as swallowing difficulties, that might limit the possibilities of oral anticoagulation. Finally, there are limited data regarding the optimal treatment of CA-VTE in patients with oral and facial cancer, and this includes data on novel therapeutic strategies, including the use of direct oral anticoagulants. This article reviews current data on the optimal treatment strategy for CA-VTE in patients with OFC.
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Affiliation(s)
- Mária Janíčková
- Department of Stomatology and Maxillofacial Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Lucia Stančiaková
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood, Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Norbert Nagy
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Division of Acute and Interventional Cardiology, Department of Cardiology and Angiology II, Mid-Slovakian Institute of Heart and Vessel Diseases (SÚSCCH, a.s.) in Banská Bystrica, 974 01 Banská Bystrica, Slovakia
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Ságová I, Dragula M, Mokáň M, Vaňuga P. Filling the gap between the heart and the body in acromegaly: a case-control study. Endocrine 2023; 79:365-375. [PMID: 36309947 PMCID: PMC9892104 DOI: 10.1007/s12020-022-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. PURPOSE The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. METHODS We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. RESULTS Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation. CONCLUSION Our study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.
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Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia.
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia.
| | - Milan Dragula
- Cardiology clinic University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
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Graňák K, Vnučák M, Beliančinová M, Kleinová P, Pytliaková M, Mokáň M, Dedinská I. Adiponectin/leptin ratio as a predictor of acute rejection in early post-transplant period in patients after kidney transplantation. Front Med (Lausanne) 2023; 10:1117819. [PMID: 36873891 PMCID: PMC9981627 DOI: 10.3389/fmed.2023.1117819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Adipokines are largely involved in the regulation of immune system activity. While leptin is the main pro-inflammatory marker of adipose tissue, adiponectin is characterized by anti-inflammatory effects. The aim of our study was to determine the risk of acute graft rejection in protocol biopsy depending on the adiponectin/leptin (A/L) ratio in patients after kidney transplantation (KT). Materials and methods A total of 104 patients were included in the prospective analysis, in whom the levels of adipokines were examined pre-transplant, in the 3rd month after KT and the A/L ratio was calculated. In the 3rd month after KT, all patients underwent protocol biopsy of the graft and examination of donor-specific antibodies (DSA) using the Luminex method. Results After adjusting for differences in the basic characteristics of the donor and recipient, we identified a subgroup with A/L ratio < 0.5 pre-transplant [HR 1.6126, (P = 0.0133)] and 3 months after KT [HR 1.3150, (P = 0.0172)] as independent risk factor for acute graft rejection. In the subsequent specification of the rejection episode, we identified the risk ratio A/L < 0.5 before KT [HR 2.2353, (P = 0.0357)] and 3 months after KT [HR 3.0954, (P = 0.0237)] as independent risk factor for the development of acute humoral rejection with DSA positivity. Conclusion This is the first study to investigate the relationship between A/L ratio and immunological risk in terms of the development of rejection changes in patients after KT. In our study, we found that A/L ratio < 0.5 is an independent risk factor for the development of acute humoral rejection and de novo DSA production in the third month after KT.
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Affiliation(s)
- Karol Graňák
- Transplant Centre, University Hospital Martin, Martin, Slovakia.,Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Matej Vnučák
- Transplant Centre, University Hospital Martin, Martin, Slovakia.,Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Monika Beliančinová
- Transplant Centre, University Hospital Martin, Martin, Slovakia.,Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Patrícia Kleinová
- Transplant Centre, University Hospital Martin, Martin, Slovakia.,Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Margaréta Pytliaková
- Department of Gastrointestinal Internal Medicine, University Hospital Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ivana Dedinská
- Transplant Centre, University Hospital Martin, Martin, Slovakia.,Department of Internal Medicine, University Hospital in Martin, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
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Blaško P, Samoš M, Bolek T, Stančiaková L, Škorňová I, Péč MJ, Jurica J, Staško J, Mokáň M. Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth? J Clin Med 2022; 11:jcm11237211. [PMID: 36498785 PMCID: PMC9737839 DOI: 10.3390/jcm11237211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/12/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Novel P2Y12 ADP receptor blockers (ADPRB) should be preferred in dual-antiplatelet therapy in patients with acute coronary syndrome. Nevertheless, there are still patients who do not respond optimally to novel ADP receptor blocker therapy, and this nonoptimal response (so-called "high on-treatment platelet reactivity" or "resistance") could be connected with increased risk of adverse ischemic events, such as myocardial re-infarction, target lesion failure and stent thrombosis. In addition, several risk factors have been proposed as factors associated with the phenomenon of inadequate response on novel ADPRB. These include obesity, multivessel coronary artery disease, high pre-treatment platelet reactivity and impaired metabolic status for prasugrel, as well as elderly, concomitant therapy with beta-blockers, morphine and platelet count for ticagrelor. There is no literature report describing nonoptimal therapeutic response on cangrelor, and cangrelor therapy seems to be a possible approach for overcoming HTPR on prasugrel and ticagrelor. However, the optimal therapeutic management of "resistance" on novel ADPRB is not clear and this issue requires further research. This narrative review article discusses the phenomenon of high on-treatment platelet reactivity on novel ADPRB, its importance in clinical practice and approaches for its therapeutic overcoming.
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Affiliation(s)
- Peter Blaško
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Out-Patient Clinic of Cardiology, 957 01 Banovce nad Bebravou, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
- Correspondence: ; Tel.: +421-907-612-943 or +421-434-203-820
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Lucia Stančiaková
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Ingrid Škorňová
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Ján Staško
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 59 Martin, Slovakia
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Samoš M, Bolek T, Stančiaková L, Péč MJ, Brisudová K, Škorňová I, Staško J, Mokáň M, Kubisz P. Tailored Direct Oral Anticoagulation in Patients with Atrial Fibrillation: The Future of Oral Anticoagulation? J Clin Med 2022; 11:jcm11216369. [PMID: 36362597 PMCID: PMC9655219 DOI: 10.3390/jcm11216369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
Direct oral anticoagulants (DOAC) are currently the drug of choice for drug prevention of stroke or systemic embolism in patients with atrial fibrillation (AF). However, repeated ischemic stroke or systemic embolism and bleeding while on DOAC is still a challenging clinical phenomenon in the management of future long-term anticoagulation. It is not known whether tailoring the DOAC therapy to achieve optimal therapeutic drug levels could improve the clinical course of DOAC therapy. To be able to tailor the therapy, it is necessary to have a valid laboratory method for DOAC level assessment, to be aware of factors influencing DOAC levels and to have clinical options to tailor the treatment. Furthermore, the data regarding clinical efficacy/safety of tailored DOAC regimes are still lacking. This article reviews the current data on tailored direct oral anticoagulation in patients with AF.
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Affiliation(s)
- Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
- Correspondence: ; Tel.: +421-907-612-943 or +421-43-4203-820
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
| | - Lucia Stančiaková
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood, Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
| | - Kristína Brisudová
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
| | - Ingrid Škorňová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood, Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Ján Staško
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood, Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03659 Martin, Slovakia
| | - Peter Kubisz
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood, Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia
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Bolek T, Samoš M, Škorňová I, Schnierer M, Jurica J, Bánovčin P, Staško J, Kubisz P, Mokáň M. Rotational thromboelastometry in patients with type 2 diabetes and mild COVID-19 pneumonia: A pilot prospective study. Medicine (Baltimore) 2022; 101:e29738. [PMID: 35777014 PMCID: PMC9239638 DOI: 10.1097/md.0000000000029738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It was repeatedly demonstrated that patients with severe COVID-19 pneumonia, as well as patients with type 2 diabetes (T2D) have higher risk of thromboembolic complications. Rotational thromboelastometry (ROTEM®) is a viscoelastic hemostatic assay which allows complex assessment of hemostasis in whole blood. The aim of this study was to compare changes in hemostasis measured by ROTEM® in diabetic and nondiabetic patients with mild COVID-19 pneumonia. METHODS We performed a pilot, prospective, observational study and enrolled 33 consecutive patients (14 with T2D and 19 nondiabetic ones) admitted to regular ward with mild COVID-19 pneumonia. The control group consisted from 11 healthy, nondiabetic blood donors. Blood samples were tested with ROTEM® using INTEM® and EXTEM® reagents. RESULTS We detected significant differences in EXTEM® clotting time (CT), clot formation time (CFT), and maximum clot firmness (MCF) comparing patients with mild COVID-19 pneumonia and healthy donors. However, there were no significant differences in EXTEM®, INTEM®, and HEPTEM® parameters (CT, CFT, and MCF) according to diabetes status. CONCLUSIONS Our study demonstrated hypercoagulation in patients with mild COVID-19 pneumonia. T2D did not affected ROTEM® parameters in patients with mild COVID-19 pneumonia.
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Affiliation(s)
- Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
- *Correspondence to: Matej Samoš, Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovak republic (e-mail: )
| | - Ingrid Škorňová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Martin Schnierer
- Department of Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Bánovčin
- Department of Gastroenterology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Dedinska I, Baranovičová E, Graňák K, Vnučák M, Beliančinová M, Mokáň M. MO980: Metabolomics Approach and Acute Rejection in Kidney Transplant Recipients. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Non-invasive diagnosis of graft rejection after kidney transplantation is still an unresolved issue. Changes in serum metabolite concentrations reflect the various processes involved in the graft, and thus graft rejection. Metabolomics approach might help with non-invasive diagnosis of graft rejection based on identification of T-cell activation.
METHOD
In a group of 55 patients after primary kidney transplantation (average follow-up 68.4 months, median 59 months) we identified patients with cellular rejection (ACR), antibody mediated rejection (AMR) and control group (CG)—patients without history of graft rejection. We used NMR metabolomic approach to determine the relative levels of metabolites in blood plasma.
RESULTS
From 23 evaluated metabolites: lactate was significantly increased in CG and in ACR against AMR (P < 0.05), whilst plasma glutamine decreased in CG against ACR (P < 0.05) and AMR (P < 0.05) groups. Further, tyrosine was significantly increased in CG against AMR (P < 0.05). All three branched chain α-keto acids (BCKAs) behaved similarly. However, little over significance cut off were CG >AMR. When discriminating CG and AMR, Random Forest discriminatory algorithm performed with AUC = 0.849 when included also evaluated plasma creatinine and with AUC = 0.83 when creatinine was excluded (other metabolites with the highest discriminatory power were glutamine, lactate, tyrosine and BCKAs).
CONCLUSION
Metabolomic approach to blood plasma in patients after kidney transplantation seems to be very promising when looking for non-invasive techniques assessing graft viability/survival. The observed metabolomic changes were able to very well discriminate between patients with AMR and control group. However, discrimination of ACR against CG and AMR was rather poor.
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Affiliation(s)
- Ivana Dedinska
- Jessenius Faculty of Medicine Comenius University and University Hospital Martin, Transplant Center and Internal Department I, Martin, Slovakia
| | - Eva Baranovičová
- Jessenius Faculty of Medicine Comenius University, Biomedical Center Martin, Martin, Slovakia
| | - Karol Graňák
- Jessenius Faculty of Medicine Comenius University and University Hospital Martin, Transplant Center and Internal Department I, Martin, Slovakia
| | - Matej Vnučák
- Jessenius Faculty of Medicine Comenius University and University Hospital Martin, Transplant Center and Internal Department I, Martin, Slovakia
| | - Monika Beliančinová
- Jessenius Faculty of Medicine Comenius University and University Hospital Martin, Transplant Center and Internal Department I, Martin, Slovakia
| | - Marián Mokáň
- Jessenius Faculty of Medicine Comenius University and University Hospital Martin, Internal Department I., Martin, Slovakia
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Ságová I, Dragula M, Mokáň M, Vaňuga P. An atypical cause leading to a diagnosis of acromegaly. Endokrynol Pol 2022; 73:385-386. [PMID: 35381102 DOI: 10.5603/ep.a2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/06/2022] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia. .,1st Department of Internal Medicine, Comenius University Jessenius Faculty of Medicine, University Hospital Martin, Martin, Slovakia.
| | - Milan Dragula
- 1st Department of Internal Medicine, Comenius University Jessenius Faculty of Medicine, University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- 1st Department of Internal Medicine, Comenius University Jessenius Faculty of Medicine, University Hospital Martin, Martin, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
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Grilusová K, Bolek T, Škorňová I, Staško J, Samoš M, Mokáň M. Cancer-associated thrombosis - treatment and prevention with direct oral factor Xa inhibitors. Klin Onkol 2022; 34:283-290. [PMID: 34905929 DOI: 10.48095/ccko2021283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent cause of morbidity and mortality in patients with cancer. Moreover, management of VTE is frequently connected with complications, namely risk of recurrent VTE and bleeding. Low molecular weight heparins (LMWH) therapy administrated for 3-6 months is currently considered a standard for the treatment of cancer-associated VTE (CA-VTE). Direct oral factor Xa inhibitors (FXaI) apixaban, edoxaban and rivaroxaban have emerged as a new possibility for long-term antithrombotic therapy for VTE. These agents expose several advantages in individuals with cancer, and might overcome several disadvantages connected with LMWH therapy. PURPOSE First clinical studies with oral FXaI for the treatment of CA-VTE with very promising results were recently published. The article summarizes current data regarding the use of oral FXaI in the treatment of CA-VTE.
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Ságová I, Kantárová D, Mokáň M, Vaňuga P. Changes in Cross-Sectional Area of the Median Nerve and Body Composition Parameters after Treatment of Acromegaly: 1 year Follow-Up. Int J Endocrinol 2022; 2022:8766046. [PMID: 36277124 PMCID: PMC9584700 DOI: 10.1155/2022/8766046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Median neuropathy is a common manifestation of acromegaly, although its pathology is uncertain. Changes in levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) and body composition are potential parameters in pathology of median neuropathy in acromegaly. We aimed to assess changes in the cross-sectional area (CSA) of the median nerve and body composition in newly diagnosed acromegalic patients 1 year after treatment and to determine their mutual relationships. DESIGN This prospective study included 30 patients with newly diagnosed acromegaly and 30 healthy controls matched for age, gender, and body mass index. Physical and laboratory examinations, dual-energy X-ray absorptiometry (DXA), and ultrasound evaluations were performed at baseline and 1 year after initial treatment. RESULTS The CSA of the median nerve was increased in acromegalic patients compared with controls (13.1 mm2 [12.2-14.9] vs 7.5 mm2 [6.4-8.4], P < 0.001). One year after treatment of acromegaly, GH and IGF-I levels decreased significantly. The median nerve CSA was significantly reduced after treatment (11.6 mm2 [10.2-13.1], P < 0.001). Reduction of IGF-I levels correlated with a decrease in lean mass and increase in fat mass. The median nerve CSA positively correlated with IGF-I levels (R = 0.492, P=0.006) and lean mass (R = 0.419, P=0.021) in acromegalic patients before treatment. CONCLUSION This study demonstrates a reduction in the median nerve CSA 1 year after treatment of acromegaly. These changes are closely associated with a reduction in IGF- I levels and in lean body mass. The enlargement of the median nerve in acromegaly can be reversed with adequate treatment.
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Affiliation(s)
- Ivana Ságová
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Daniela Kantárová
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Marián Mokáň
- Comenius University Jessenius Faculty of Medicine, 1st Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Peter Vaňuga
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
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Benko J, Samoš M, Bolek T, Prídavková D, Jurica J, Péč MJ, Galajda P, Mokáň M. Diabetic Heart Failure with Preserved Left Ventricular Ejection Fraction: Review of Current Pharmacotherapy. J Diabetes Res 2022; 2022:3366109. [PMID: 35296100 PMCID: PMC8920624 DOI: 10.1155/2022/3366109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/15/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetes is associated with several diabetic-related abnormalities which increase the risk of onset or worsening of heart failure. Recent studies showed that the majority of diabetic patients present with heart failure with preserved ejection fraction (HFpEF), and the prevalence of HFpEF in diabetics is alarming. Moreover, outcomes in HFpEF are poor and could be compared to those of heart failure with reduced ejection fraction (HFrEF), with 1-year mortality ranging between 10 and 30%. In contrast to HFrEF, there is very limited evidence for pharmacologic therapy in symptomatic patients with preserved ejection fraction, and therefore, the optimal selection of treatment for diabetic HFpEF remains challenging. This narrative review article summarizes the currently available data on the pharmacological treatment of HFpEF in patients with diabetes.
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Affiliation(s)
- Jakub Benko
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Dana Prídavková
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jakub Jurica
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Martin Jozef Péč
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Ságová I, Mokáň M, Payer J, Vaňuga P. Pegvisomant in the treatment of acromegaly. Vnitr Lek 2022; 68:17-22. [PMID: 36402555 DOI: 10.36290/vnl.2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite improvements in surgical techniques, current radiotherapy options and development of long-acting somatostatin analogues, biochemical control of acromegaly is not achieved in some patients. The failure to achieve optimal serum growth hormone (RH) and insulin-like growth factor-1 (IGF-1) levels means increased morbidity and mortality of acromegaly patients. The RH receptor antagonist pegvisomant (PEG) is a genetically engineered RH analog that prevents of RH receptor dimerization, i.e. a process that is crucial for the action of RH at the cellular level. The effect of the treatment is suppression of IGF-1 production. In pilot studies, normalization of IGF-1 levels was achieved in up to 90 % of patients receiving PEG. However, PEG efficacy in clinical settings is slightly lower (65 to 97 %) than reported in the key studies. A rare side effect of treatment is elevations of liver transaminases. In addition, pituitary tumor growth progression has been reported in several cases. In this review article, we present long-term data on pegvisomant treatment and discuss its associated risks and benefits.
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Škorňová I, Samoš M, Bolek T, Kamenišťáková A, Stančiaková L, Galajda P, Staško J, Kubisz P, Mokáň M. Direct Oral Anticoagulants Plasma Levels in Patients with Atrial Fibrillation at the Time of Bleeding: A Pilot Prospective Study. J Cardiovasc Pharmacol 2021; 78:e122-e127. [PMID: 34173805 DOI: 10.1097/fjc.0000000000001038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
ABSTRACT Patients with atrial fibrillation (AF) on long-term direct oral anticoagulants (DOACs) may be at higher risk of bleeding because of higher anti-Xa or anti-IIa levels. However, there is no postmarketing study investigating these DOAC plasma levels at the time of bleeding. The aim of this study was to evaluate DOAC levels at the time of a bleeding emergency. We analyzed 5440 patients examined at our Emergency Department in from April 1, 2019, to September 30, 2019. During this period, we prospective identified 105 consecutive patients with bleeding while on long-term antithrombotic therapy; 49 patients had AF on DOACs. We compared DOAC levels in patients who bled against a control sample of 55 patients who tolerated long-term high dose DOAC therapy without any emergency. Samples of these patients were tested with drug-specific anti-Xa chromogenic analysis (rivaroxaban and apixaban) and with Hemoclot Thrombin Inhibitor assay (dabigatran). Dabigatran-treated patients who bled had significantly higher anti-IIa levels when compared with trough (261.4 ± 163.7 vs. 85.4 ± 57.2 ng/mL, P < 0.001) and peak samples of controls (261.4 ± 163.7 vs. 138.8 ± 78.7 ng/mL, P < 0.05). Similarly, there were significantly higher anti-Xa levels in rivaroxaban-treated and apixaban-treated patients with bleeding compared with trough control samples (rivaroxaban: 245.9 ± 150.2 vs. 52.5 ± 36.4 ng/mL, P <0.001 and apixaban: 311.8 ± 142.5 vs. 119.9 ± 81.7 ng/mL, P < 0.001), as well as in apixaban-treated patients when compared with peak control samples (311.8 ± 142.5 vs. 210.9 ± 88.7 ng/mL, P < 0.05). Finally, rivaroxaban anti-Xa levels in patients who bled tended to be higher compared with peak control samples (245.9 ± 150.2 vs. 177.6 ± 38.6 ng/mL, P = 0.13). This observational study showed a significant difference in anti-IIa and anti-Xa plasma levels in patients with AF with bleeding complications compared with those who tolerated long-term high-dose DOAC therapy without bleeding complications.
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Affiliation(s)
- Ingrid Škorňová
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic ; and
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic ; and
| | | | - Lucia Stančiaková
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic ; and
| | - Ján Staško
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic ; and
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Vnučák M, Graňák K, Skálová P, Laca Ľ, Mokáň M, Dedinská I. Effect of mycophenolic acid and tacrolimus on the incidence of infectious complications after kidney transplantation. Int Immunopharmacol 2021; 98:107908. [PMID: 34182244 DOI: 10.1016/j.intimp.2021.107908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Infectious complications remain a common cause of mortality after kidney transplantation (KTx). Goal of effective immunosuppressive treatment (IS) must be balanced between decreasing incidence of acute kidney rejection (AKR) and avoiding the incidence of infections, at the same time. MATERIALS AND METHODS The aim of our analysis was to identify the risk of fixed daily dose (DD) of mycophenolic acid (MPA) and levels of tacrolimus (TAC) in the development of a single, recurrent infection and AKR after KTx. RESULTS Our analysis consisted of 100 patients after KTx (66 males, 34 females). MPA DD > 1080 mg was a risk factor (RF) for recurrent infection in general (OR 1.2964;P = 0.0277), for recurrent bacterial infection from 1st to 6th month (OR 1.2674;P = 0.0151), recurrent bacterial infection (OR 1.2574;P = 0.0436), single viral infection (OR 1.2640;P = 0.0398) from 6th-12th month after KTx. MPA DD > 1080 mg and levels of TAC above recommended levels were not independent RF for the incidence of the infection. CONCLUSION MPA DD > 1080 mg as a RF for recurrent infection starting in the 1st month after KTx with significant association between the incidence of infections and MPA DD and TAC levels, without increased risk of AKR. In the centers with fixed dosing of IS, this can lead to lowering the risk of infections by decreasing MPA DD 1 month after KTx without increasing risk of infections.
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Affiliation(s)
- Matej Vnučák
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia
| | - Karol Graňák
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia.
| | - Petra Skálová
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia
| | - Ľudovít Laca
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia
| | - Marián Mokáň
- 1(st) Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia
| | - Ivana Dedinská
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin 03601, Slovakia
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Korpallová B, Samoš M, Bolek T, Kühnelová L, Škorňová I, Kubisz P, Staško J, Mokáň M. ROTEM Testing for Direct Oral Anticoagulants. Semin Thromb Hemost 2021; 47:815-823. [PMID: 34130343 DOI: 10.1055/s-0041-1726372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Direct oral anticoagulants (DOACs) are increasingly used worldwide for the prevention of stroke in patients with atrial fibrillation and to prevent or treat venous thromboembolism. In situations such as serious bleeding, the need for urgent surgery/intervention or the management of a thromboembolic event, the laboratory measurement of DOACs levels or anticoagulant activity may be required. Rotational thromboelastometry (ROTEM) is a viscoelastic hemostatic assay (VHA) which has been used in emergencies (trauma and obstetrics), and surgical procedures (cardiac surgery and liver transplants), but experience with this assay in DOACs-treated patients is still limited. This article reviews the use of ROTEM in the setting of DOACs therapy, focusing on DOACs-associated bleeding and the use of this VHA for the management of reversal strategies for DOACs-associated anticoagulation.
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Affiliation(s)
- Barbora Korpallová
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Linda Kühnelová
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ingrid Škorňová
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Graňák K, Matej V, Skálová P, Pytliaková M, Laca Ľ, Mokáň M, Dedinska I. MO933EFFECT OF PHYSICAL ACTIVITY AND LIFESTYLE CHANGES ON INSULIN RESISTANCE IN PATIENTS AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab110.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
The incidence of post-transplant diabetes mellitus (PTDM) after kidney transplantation (KT) is high and ranges from 15-30%. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of precisely determined physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT.
Method
This is a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 3 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months.
Results
In the observed group we univariately found in the 3rd and 6th month of monitoring significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value glycemia (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) and lower low-density lipoprotein (LDL) at 6 months (P = 0.0444) compared to the control group. We confirmed a statistically significantly lower IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) by multivariate analysis in the observed group. After the end of the follow-up, we identified statistically significantly fewer patients with a negative oGTT result in the control group (P < 0.0001), significantly more patients with impaired glucose tolerance, fasting hyperglycemia (P = 0.0078) and diagnosed with PTDM (P = 0.0212). In the control group, we found a statistically significant increase in glycemia at 30 (P = 0.0034) as well as at 120 minutes (P = 0.0011) during oGTT compared to the observed group.
Conclusion
In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and associated pre-diabetic conditions and PTDM.
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Affiliation(s)
- Karol Graňák
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Surgery Clinic and Transplantation Center, Martin, Slovakia
| | - Vnucak Matej
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Surgery Clinic and Transplantation Center, Martin, Slovakia
| | - Petra Skálová
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Surgery Clinic and Transplantation Center, Martin, Slovakia
| | - Margaréta Pytliaková
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Clinic of Anesthesiology and Intensive Medicine, Martin
| | - Ľudovít Laca
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Surgery Clinic and Transplantation Center, Martin, Slovakia
| | - Marián Mokáň
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Clinic of Internal Medicine I., Martin, Slovakia
| | - Ivana Dedinska
- University Hospital in Martin and Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic, Surgery Clinic and Transplantation Center, Martin, Slovakia
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Matej V, Graňák K, Skálová P, Laca Ľ, Dedinska I, Mokáň M. MO978EFFECT OF MYCOPHENOLIC ACID AND TACROLIMUS ON THE INCIDENCE OF INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION IN CONTRAST WITH THE INCIDENCE OF ACUTE KIDNEY REJECTION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab111.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Kidney transplantation (KTx) remains the most effective type of kidney replacement therapy. Infectious complications remain a common cause of mortality, especially during the first year after KTx. Goal of effective immunosuppressive treatment (IS) must be balanced between the decreasing incidence of acute rejection by maintaining effective levels of IS and at the same time avoiding the incidence of infectious complications caused by dose-dependent toxicity of IS.
Method
The aim of our analysis was to identify the risk of fixed daily doses of mycophenolic acid (MPA) and concentration controlled doses of tacrolimus (TAC) in the development of a single, recurrent infection and acute rejection after KTx.
Results
Our analysis consisted of 100 patients after KTx (66 males, 34 females) with anti-thymocyte globulin as an induction IS. We monitored the incidence of single, recurrent infection in 1st month, from 1st to 6th month and from 6th to 12th month after KTx and the incidence of acute kidney rejection in 1st year after KTx. According to multivariant analysis, Daily dose of MPA > 1080 mg and levels of TAC above recommended levels were not independent risk factors for the incidence of the infection. Daily dose of MPA > 1080 mg was a risk factor for recurrent infection in general (OR 1.2964; P = 0.0277), for recurrent bacterial infection from 1st to 6th month (OR 1.2674; P = 0.0151), recurrent bacterial infection (OR 1.2574; P = 0.0436), single viral infection (OR 1.2640; P = 0.0398) from 6th to 12th month after KTx We did not confirmed levels of TAC, above recommended levels in observed periods, as a risk factor for single or recurrent infection regardless of its etiology.
We confirmed, incidence of mycotic infection in 1st month after KTx correlated with average level of TAC (13.4 ± 3.2 ng/ml) (P = 0.0300) and with average MPA daily doses (1200 ± 360 mg/day) (P = 0.0203). Correlation between the average daily doses of MPA (730 ± 380 mg/day) and the incidence of bacterial infection (P = 0.0161) and viral infection (P = 0.0161) from 1st to 6th month after KTx were found. We confirmed correlation between the incidence of bacterial infection and the average daily doses of MPA (630 ± 340 mg/day) from 6th to 12th month after KTx (P = 0.0479).
By probit dose regression, we confirmed statistical significance between levels of TAC and the incidence of bacterial, mycotic and multidrug-resistant (MDR) infection, correlation between the daily dose of MPA and the incidence of mycotic infection in 1st month after KTx. We found statistical significance between levels of TAC and MDR infection and daily dose of MPA and the incidence of bacterial, mycotic and MDR infection from 1st to 6th month after KTx and we found statistical significance between the daily dose of MPA and the incidence of MDR infection from 6th to 12th month after KTx. In our study, we did not confirmed statistical significance between levels of TAC, daily dose of MPA and the incidence of acute kidney rejection. By logistic regression, neither levels of TAC below recommended values nor daily dose of MPA < 1080 mg were found as an independent risk factors for the incidence of acute kidney rejection.
Conclusion
In our analysis, we found dose of MPA > 1080 mg/day as a risk factor for recurrent infection starting in the 1st month after KTx and correlation between the incidence of the infections and daily dose of MPA 1 month after KTx, with significant association between the incidence of infections and daily doses of MPA and levels of TAC, without increased risk of acute kidney rejection. In the centers with fixed dosing of IS, this can lead to lowering the risk of infections by decreasing daily doses of MPA 1 month after KTx without increasing risk of infections.
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Affiliation(s)
- Vnucak Matej
- University Hospital Martin and Jessenius Medical Faculty of Comenius University, Surgery and Transplantation Centre, Martin, Slovakia
| | - Karol Graňák
- University Hospital Martin and Jessenius Medical Faculty of Comenius University, Surgery and Transplantation Centre, Martin, Slovakia
| | - Petra Skálová
- University Hospital Martin and Jessenius Medical Faculty of Comenius University, Surgery and Transplantation Centre, Martin, Slovakia
| | - Ľudovít Laca
- University Hospital Martin and Jessenius Medical Faculty of Comenius University, Surgery and Transplantation Centre, Martin, Slovakia
| | - Ivana Dedinska
- University Hospital Martin and Jessenius Medical Faculty of Comenius University, Surgery and Transplantation Centre, Martin, Slovakia
| | - Marián Mokáň
- University Hospital Martin, 1st Department of Internal Diseases, Martin, Slovakia
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Škorňová I, Samoš M, Bolek T, Stančiaková L, Vádelová Ľ, Galajda P, Staško J, Kubisz P, Mokáň M. Does atorvastatin therapy change the anti-Xa activity in xabans-treated patients with atrial fibrillation? Pharmacol Res Perspect 2021; 9:e00730. [PMID: 33984191 PMCID: PMC8118196 DOI: 10.1002/prp2.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 11/11/2022] Open
Abstract
Atorvastatin and direct oral factor Xa inhibitors (xabans) are frequently co‐administrated in patients with atrial fibrillation (AF). However, no studies investigating the possibility of the pharmacologic interaction between these agents have been conducted. The aim of this prospective observational study was to determine the impact of atorvastatin therapy on anti‐Xa activity in xabans‐treated patients with AF. We enrolled 115 AF patients on long‐term rivaroxaban (52 patients) and long‐term apixaban (63 patients) therapy. Long‐term atorvastatin (40 mg once daily) was administrated to 28 rivaroxaban‐treated patients and to 28 apixaban‐treated patients. Trough and peak samples were tested for anti‐Xa activity with drug‐specific anti‐Xa chromogenic analysis. For rivaroxaban, there were no significant differences in trough activity (45.5 ± 39.5 ng/ml vs. 46.2 ± 30.1 ng/ml; p = .34) and peak anti‐Xa activity (179.2 ± 108.8 ng/ml vs. 208.1 ± 104.1 ng/ml; p = .94) between atorvastatin‐treated patients and those without atorvastatin. Similarly, atorvastatin did not impact the trough activity (127.7 ± 71.1 ng/ml vs. 100.8 ± 61.1 ng/ml; p = .12) or peak anti‐Xa activity (213.8 ± 103.6 ng/ml vs. 179.3 ± 72.9 ng/ml; p = .14) among apixaban‐treated patients with AF. This observational study did not show a significant impact of atorvastatin on trough and peak anti‐Xa activity in xabans‐treated patients with AF.
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Affiliation(s)
- Ingrid Škorňová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Lucia Stančiaková
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ľubica Vádelová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Graňák K, Vnučák M, Pytliaková M, Laca U, Mokáň M, Dedinská I. Rituximab in the treatment of primary glomerulopathies - our experience. Vnitr Lek 2021; 67:3-7. [PMID: 34171944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Since 2012, when The Kidney Disease: Improving Global Outcomes (KDIGO) initiative published the first recommendations for the management and treatment of glomerular diseases, there has been enormous progress in understanding pathogenesis, identifying new diagnostic biomarkers and treating these diseases. Rituximab had become a promisisng treatment option in patients with primary glomerular disease, as confirmed by several clinical studies, where it has led to a significant reduction in proteinuria and a reduction in the incidence of relapses of the underlying disease. In this work we present our experiences with rituximab treatment. MATERIALS AND METHODS We retrospectively analyzed 9 patients with primary glomerulopathy resistant to srandard immunosuppressive therapy who received rituximab as rescue treatment. We evaluated the effect of rituximab induction treatment on the development of quantitative proteinuria. RESULTS By evaluating the 24-hour proteinuria before and after treatment, we demonstrated a statistically significant decrease in proteinuria in our group of patients immediately after the las dose of rituximab. We did not notice a significant change in renal function. CONCLUSION Rituximab represents an effective alternative in the treatment of primary glomerulopathies, especially in cases of resistance to standard immunosuppressive therapy, which is shared by the clinical experience presented by us.
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Beliančinová M, Graňák K, Vnučák M, Skalová P, Laca U, Mokáň M, Dedinská I. Diagnostic hospitalizations before patient inclusion on the waiting list for kidney transplantation. Vnitr Lek 2021; 67:4-8. [PMID: 33752394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION For kidney transplantation is indicated any patient with chronic kidney disease in the terminal stage, unless it has a contraindication for this operation. The aim of this work is to evaluate the benefit of diagnostic hospitalizations of the patients before inclusion on the waiting list for kidney transplantation and to identify the most common differential diagnostic problems for the indication / contraindication for kidney transplantation. MATERIAL AND METHODS This is a retrospective analysis, which included all potential recipients who underwent the examination process before inclusion on the waiting list and living donors in the form of diagnostic hospitalization at the Transplant Center at Martin University Hospital in 2016-2019. RESULTS A total of 49 patients were included in the cohort, the average length of hospitalization was 5.6 days. Kidney trans plantation subsequently underwent 22 of these patients, 3 patients were clearly contraindicated.
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Prídavková D, Samoš M, Kyčina R, Adamicová K, Kalman M, Belicová M, Mokáň M. Insulinoma presenting with postprandial hypoglycemia and a low body mass index: A case report. World J Clin Cases 2020; 8:4169-4176. [PMID: 33024775 PMCID: PMC7520770 DOI: 10.12998/wjcc.v8.i18.4169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/23/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms. Patients characteristically develop symptoms while fasting, but some patients have reported symptoms only in the postprandial state. Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms, and patients may have amnesia, which delays diagnosis.
CASE SUMMARY We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years. Although patients with insulinoma characteristically develop symptoms while fasting, this young man had hypoglycemic symptoms up to one hour postprandially, especially after high-sugar meals and after physical activity. The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results. However, brown adipose tissue exhibited increased metabolic activity, and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography. Glycogen deficiency was also histologically confirmed. The patient’s symptoms progressed over the years and occurred more frequently, i.e., several times a month, and the patient had reduced awareness of adrenergic symptoms. The follow-up fasting test was positive, and the imaging results showed a tumor in the head of the pancreas. The patient underwent laparotomy with enucleation of the insulinoma.
CONCLUSION Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma. In prolonged cases, adrenergic symptoms can be suppressed.
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Affiliation(s)
- Dana Prídavková
- Clinic of Internal Medicine I, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Matej Samoš
- Clinic of Internal Medicine I, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Roman Kyčina
- Clinic of Surgery and Transplant Center, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Katarína Adamicová
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Michal Kalman
- Department of Pathological Anatomy, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Margita Belicová
- Clinic of Internal Medicine I, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
| | - Marián Mokáň
- Clinic of Internal Medicine I, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Martin 03601, Slovakia
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Vnučák M, Graňák K, Skálová P, Laca Ľ, Mokáň M, Dedinská I. Living-Related Kidney Transplantation in a Patient with Juvenile Nephronophthisis. Nephron Clin Pract 2020; 144:583-588. [PMID: 32906116 DOI: 10.1159/000508501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022] Open
Abstract
Nephronophthisis (NPHP) is an autosomal recessive disease manifesting as tubulointerstitial nephritis uniformly progressing to ESRD in approximately 5-10% patients in childhood. Living donor transplantation is the most beneficial mean of renal replacement therapy compared to other methods. However, living kidney donation is contraindicated in potential donor with diseases of autosomal dominant mode of inheritance potentially leading to kidney failure in future. On the other hand, autosomal recessive genetic kidney diseases, such as NPHP, are not usually contraindication to living kidney donation. Herein, we are reporting related living kidney transplantation with a family history of NPHP form 46-year-old mother (heterozygote) to 17-year-old daughter with (autosomal recessive homozygote) with focus on donor follow-up after nephrectomy.
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Affiliation(s)
- Matej Vnučák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Karol Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia ,
| | - Petra Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ľudovít Laca
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Marián Mokáň
- 1st Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ivana Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Martin, Slovakia
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28
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Graňák K, Kováčiková L, Skálová P, Vnučák M, Miklušica J, Laca Ľ, Mokáň M, Dedinská I. Kidney Transplantation and "Sex Mismatch": A 10-Year Single-Center Analysis. Ann Transplant 2020; 25:e921117. [PMID: 32675801 PMCID: PMC7386832 DOI: 10.12659/aot.921117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The effect of a relative disproportion in the size of a transplanted kidney (KT) on graft function and survival is well documented. However, the importance of the H-Y antigen (male donor and female recipient) has not been unambiguously confirmed. Material/Methods Our retrospective analysis consists of 230 deceased donor/recipient pairs. The aim of the study was to determine the effect of sex mismatch between donors and recipients on the function of the graft and the graft and patient survival. Results In the group of male donors, a statistically significantly lower value of the eGFR (estimated glomerular filtration rate) was recorded for female recipients in the fifth year after the KT (=0.0047). The male donor/female recipient group was an independent risk factor for: eGFR (<60 ml/min (CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration) in the third year after KT [HR 0.1618; (P=0.0004)], acute rejection in the first year after KT [HR 1.8992; (P=0.0387)], and the 5-year graft survival was significantly worse in this group. By adjusting the results for age and induction, this group was at significantly higher risk for decreased graft function (eGFR <30 ml/min) if the age of the donor was ≤50 years old and the recipient was >45 years old in the fifth year [HR 11.1676; (P=0.0139)], the age of the donor was ≤50 years old/recipient was ≤45 years old in the third year [HR 1.2500; (P=0.0050)], and also in the fifth year after KT [HR 8.1993; (P=0.0183)]. Conclusions Based on our analysis, the differences in the incidence of acute rejection episodes as well as in graft survival among the different groups of patients were confirmed. The group with the highest risk, in cases of an acute rejection episode, is a male donor/female recipient.
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Affiliation(s)
- Karol Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Lea Kováčiková
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Petra Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Matej Vnučák
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Juraj Miklušica
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ľudovít Laca
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Marián Mokáň
- 1st Department of Internal Diseases, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
| | - Ivana Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin, Jessenius Medical Faculty of Comenius University, Martin, Slovakia
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29
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Graňák K, Jeseňák M, Vnučák M, Skálová P, Laca Ľ, Mokáň M, Dedinská I. Kidney transplantation as a treatment of choice for AA amyloidosis due to periodic fever syndrome. Clin Rheumatol 2020; 40:763-768. [PMID: 32654081 DOI: 10.1007/s10067-020-05283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022]
Abstract
Renal AA amyloidosis is the most serious complication of periodic fever syndrome, which, inadequate suppression, due to persistent inflammation, leads to nephrotic syndrome and renal failure over several years. In most cases, periodic fever syndromes begin to manifest clinically in early childhood. Occurrence in adulthood is considered rare and is associated with a poorer clinical course. Kidney transplantation (KT) is an effective and safe treatment for end-stage chronic kidney disease (CKD) based on AA amyloidosis. In this paper, we present cases of two patients after deceased donor KT, who have been diagnosed with adult periodic fever syndrome. In the first one, diagnosis and treatment began in advanced stage of CKD and therefore underwent KT with compensated disease, while in the second patient, the disease manifested and diagnosed in the post-KT period. Timely initiation of treatment ensured protection of the graft from amyloid deposition.
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Affiliation(s)
- K Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - M Jeseňák
- Department of Children and Adolescents, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - Matej Vnučák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic.
| | - P Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - Ľ Laca
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - M Mokáň
- 1st Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
| | - I Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Kollárova 2, 03601, Martin, Slovak Republic
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Korpallová B, Samoš M, Škorňová I, Bolek T, Žolková J, Vadelová Ľ, Kubisz P, Galajda P, Staško J, Mokáň M. Assessing the hemostasis with thromboelastometry in direct oral anticoagulants-treated patients with atrial fibrillation. Thromb Res 2020; 191:38-41. [PMID: 32380307 DOI: 10.1016/j.thromres.2020.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Barbora Korpallová
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic.
| | - Ingrid Škorňová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Jana Žolková
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Ľubica Vadelová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Peter Kubisz
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Ján Staško
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak republic
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Buková L, Galajda P, Javorský M, Mokáň M. Glycated haemoglobin as a marker of elevated LDL and TAG: a cohort study. Vnitr Lek 2020; 66:28-34. [PMID: 33380150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patients with less severe glycated haemoglobin (HbA1c) targets may find it difficult to achieve the target values of lipid parameters treatment at high cardiovascular risk. We have been monitoring the correlation between levels of triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) with glycosylated haemoglobin (HbA1c) by IFCC method (method of testing according to the International Federation of Clinical Chemistry and Laboratory Medicine) and by DCCT method (Diabetes Control and Complication Trial) as well as body mass index (BMI) at the time of diagnosis of the disease, that could help identify patients with an increased risk of cardiovascular disease. In the cohort study we were monitoring outpatients with newly diagnosed type 2 diabetes mellitus during a 5 year period. Patients (117 men, 83 women), aged from 30 to 92 years were conducted sampling blood glucose, HbA1c (IFCC/DCCT), HDL, LDL, TG. At baseline, the patients height, weight, waist circumference, calculated BMI and blood pressure were measured. Waist circumference was measured in the horizontal plane in the middle of the distance between the upper edge of the iliac crest and the lower edge of the last rib in the breath. Our study did not exclude patients taking statin or fibrate. The high HbA1c values increased the risk of elevating LDL-cholesterol levels and TAG levels in the whole group (p = 0.012) and (p = 0.017), and the high BMI values increased the risk of lowering HDL-cholesterol levels in the female population (p = 0.010). The results of our study stratify the increased risk of atherogenicity in these groups. HbA1c is a direct marker of elevated LDL and TAG, and indirect marker for coronary artery disease risk assessment.
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Jankovičová V, Belicová M, Ochodnický M, Mokáň M. Dissection of ascending aorta, a diagnosis needs to remember about it. Vnitr Lek 2020; 66:55-60. [PMID: 33740862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute type A aortic dissection is a life-threating condition, and is associated with significant morbidity and mortality. Patients typically present with the acute onset of chest pain, which occurs in up to 85% of cases. Acute chest pain may lead to the suspicion of acute coronary syndrome, and as the electrocardiogram may indicate ischaemia, patients are given anti-throm botic treatment. Some patients can present without chest pain, but with focal neurological deficits, which can occur with involvement of the great vessel. The authors described three patients with acute type A aortic dissection. Two of them did not present with the acute onset of chest pain, but with focal neurological deficits. Third patient presented with the acute onset of chest pain and the electrocardiogram indicated suspected ischaemia, which led to the suspicion of acute coronary syndrome. The authors presented, that diagnosis of acute type A aortic dissection can be easily overlooked and a high index of suspicion is needed to obtain a timely diagnosis such that appropriate initial therapy can be instituted promptly.
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Vorčák M, Zeleňák K, Sýkora J, Ježíková A, Mokáň M. Hemodialysis vascular access dysfunction and its endovascular treatment. Vnitr Lek 2020; 66:14-18. [PMID: 33380148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hemodialysed patients with end stage renal disease are reliant to proper function of vascular access - mostly arterio-venous fistula (AVF). AVF patency is jeopardized by stenosis formation, which needs to be treated before thrombosis. Angioplasty is primarily indicated and prolongs vascular access patency. High pressure balloons and cutting balloons aid to high technical success rate. Angioplasty needs to be repeated in order to maintain long term patency. Drug-eluting balloons prolong long term patency. Stents and stentgrafts are seldom used in inoperable patients and in selected locations. Technical advances allowed endovascular treatment in AVF thrombosis followed by angioplasty of culprit lesion. Vascular access endovascular occlusion is alternative for surgery in inoperable patients. In patients with residual renal function or iodine allergy, intervention could be ultrasound guided or carbon dioxide could be used without the need of iodine contrast.
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Prídavková D, Samoš M, Bolek T, Škorňová I, Žolková J, Kubisz P, Staško J, Mokáň M. Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation. J Diabetes Res 2019; 2019:5158308. [PMID: 31886279 PMCID: PMC6925766 DOI: 10.1155/2019/5158308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.
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Affiliation(s)
- Dana Prídavková
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ingrid Škorňová
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jana Žolková
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubisz
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ján Staško
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Mikler J, Samoš M, Bolek T, Škorňová I, Stančiaková L, Staško J, Mokáň M. Direct Oral Anticoagulants: Novel Approach for the Treatment of Thrombosis in Pediatric Patients? Pediatr Cardiol 2019; 40:1431-1438. [PMID: 31327027 DOI: 10.1007/s00246-019-02159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a rare, but life-threatening disease in those who have not reached their adulthood. This condition is usually treated with heparin or low molecular weight heparins which require parenteral administration and, in case of unfractionated heparin, also frequent laboratory monitoring and dose adjustment. Direct oral anticoagulants (DOACs)-direct thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors rivaroxaban, apixaban, and edoxaban-are currently frequently used for the prevention and treatment of VTE in adult population. In fact, these agents offer several advantages compared to traditional agents, such as oral route of administration, short on-set and off-set of action, predictable pharmacologic profile with low risk of food and drug interactions, and no need for routine laboratory assessment of anticoagulant activity. However, clinical experience with these directly acting oral anticoagulants in pediatric population is very limited as these drugs had been tested and are used mostly in adult individuals. This article reviews the current data from pre- and post-marketing studies reporting the use of DOACs for the treatment of VTE in pediatric patients.
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Affiliation(s)
- Ján Mikler
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovak Republic.
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovak Republic
| | - Ingrid Škorňová
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Lucia Stančiaková
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59, Martin, Slovak Republic
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Bolek T, Samoš M, Škorňová I, Galajda P, Staško J, Kubisz P, Mokáň M. Proton Pump Inhibitors and Dabigatran Therapy: Impact on Gastric Bleeding and Dabigatran Plasma Levels. Semin Thromb Hemost 2019; 45:846-850. [DOI: 10.1055/s-0039-1695735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractDabigatran etexilate, a direct thrombin inhibitor, is now frequently used for long-term pharmacological prevention of stroke or systemic embolism in patients with atrial fibrillation. However, such long-term dabigatran therapy (DT) significantly increases the risk of upper gastrointestinal (GI) bleeding. This increased risk of gastric bleeds might be reduced with gastroprotective agents, such as proton pump inhibitors (PPIs). PPIs coadministrated with dabigatran reduce the risk of upper GI bleeding in patients on long-term oral DT. Nevertheless, there is heated discussion regarding interactions between PPI and dabigatran that lead to decreases in dabigatran plasma levels. This article reviews up to date data about the risk of gastric bleeding on dabigatran, the impact of PPI on the reduction of gastric bleeding, and the interaction between PPI and dabigatran leading to decreased dabigatran plasma levels.
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Affiliation(s)
- Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ingrid Škorňová
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Galajda
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Dedinská I, Mikolajčík P, Skálová P, Mokáň M, Laca Ľ. Acute kidney injury after liver resection in elderly patients. BMC Nephrol 2019; 20:272. [PMID: 31319808 PMCID: PMC6639960 DOI: 10.1186/s12882-019-1449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/01/2019] [Indexed: 12/24/2022] Open
Abstract
Background Acute kidney injury (AKI) affects approximately 13% of patients undergoing major abdominal surgery, and is a common and important clinical sign of perioperative injury. The aim of our analysis was to identify risk factors for AKI in elderly patients with no known kidney disease at the time of surgery, and to evaluate their 30-day, 12-month and 5-year survival. Methods We performed a retrospective analysis on a group of 785 patients after liver resection to determine the incidence of complications (AKI – according to KDIGO classification, sepsis, cardiovascular and surgical complications). All patients had normal kidney function prior to surgery. We determined risk factors for the development of AKI for two groups of patients, stratified for age: patients younger than 65 years, and patients older than 65 years. Results The incidence of complications was significantly higher in the group of patients older than 65 years (n = 76) than in younger patients (n = 119) (P = 0.0496). In the group of younger patients, significantly worse 30-day survival was observed for patients who developed AKI (P = 0.0004). We identified the following independent risk factors for AKI: male gender (HR 10,3834; P = 0,0238), histological identification of colorectal carcinoma metastases (HR 2,8651; P = 0,0499), surgery duration longer than 300 min (HR 6,0096; P < 0,0001), blood loss of more than 500 ml (HR 10,5857; P = 0,0012), and the need for more than 500 ml of fresh frozen plasma during surgery ml (HR 2,4878; P < 0,0317). Age was not confirmed to be an independent risk factor for AKI in our study. Conclusion Approaches to treatment should be highly individualized, with assessment of several variables. According to our findings, age should not present a contraindication for the indication of a patient for surgery.
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Affiliation(s)
- Ivana Dedinská
- Department of Surgery and Transplant Center, University Hospital Martin and Jessenius Medical Faculty, Comenius University, Kollárova 2, Martin, 036 01, Slovak Republic.
| | - Peter Mikolajčík
- Department of Surgery and Transplant Center, University Hospital Martin and Jessenius Medical Faculty, Comenius University, Kollárova 2, Martin, 036 01, Slovak Republic
| | - Patra Skálová
- Department of Surgery and Transplant Center, University Hospital Martin and Jessenius Medical Faculty, Comenius University, Kollárova 2, Martin, 036 01, Slovak Republic
| | - Marián Mokáň
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty, Comenius University Kollárova 2, Martin, 036 01, Slovak Republic
| | - Ľudovít Laca
- Department of Surgery and Transplant Center, University Hospital Martin and Jessenius Medical Faculty, Comenius University, Kollárova 2, Martin, 036 01, Slovak Republic
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Dedinska I, Laca L, Ferko A, Miklušica J, Janík J, Skálová P, Graňák K, Vnučák M, Makovický P, Mokáň M. SP253Acute kidney injury after liver resection in elderly patients. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ivana Dedinska
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Ludovít Laca
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Alexander Ferko
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Juraj Miklušica
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Ján Janík
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Petra Skálová
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Karol Graňák
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Matej Vnučák
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | | | - Marián Mokáň
- University Hospital Martin and Jessenius faculty of Medicne Comenus Unversity, Martin, Slovakia
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Dedinska I, Skálová P, Graňák K, Vnučák M, Miklušica J, Laca L, Mokáň M. FP791ROLE OF SEX IN POST-TRANSPLANT DIABETES MELLITUS DEVELOPMENT: ARE MEN AND WOMEN EQUAL? Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ivana Dedinska
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Petra Skálová
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Karol Graňák
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Matej Vnučák
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Juraj Miklušica
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Ludovít Laca
- University hospial Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Marián Mokáň
- University Hospital Martin and Jessenius faculty of Medicne Comenus Unversity, Martin, Slovakia
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Dedinská I, Graňák K, Vnučák M, Skálová P, Kováčiková L, Laca Ľ, Miklušica J, Prídavková D, Galajda P, Mokáň M. Role of sex in post-transplant diabetes mellitus development: Are men and women equal? J Diabetes Complications 2019; 33:315-322. [PMID: 30755355 DOI: 10.1016/j.jdiacomp.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Sex differences are defined as biology-linked differences between women and men that occur through the sex chromosomes and their effects on organ systems. MATERIAL AND METHODS The objective of this prospective study was to determine risk factors for post-transplant diabetes mellitus (PTDM) in men and women. RESULTS A total of 417 patients (271 men and 146 women) were included in the monitored group. Age at the time of kidney transplantation (KT) >60 years and hypovitaminosis D at the time of KT (<20 μg/l) were identified as independent risk factors for PTDM in both men and women. It was further confirmed as an independent risk factor for men a waist circumference at the time of KT >94 cm, C-peptide at the time of KT >5 ng/ml, HOMA-IR >2 and triacylglycerols at the time of KT >1.7 mmol/l. In case of women, the dominant factor was BMI at the time of KT >30 kg/m2 and menopause at the time of KT. A significant decrease in C-peptide was recorded in women with PTDM. CONCLUSION It was confirmed that there are gender differences with regard to the development of PTDM after KT. Women show pancreas β cell dysfunction, whereas insulin resistance and metabolic syndrome are dominant in men.
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Affiliation(s)
- Ivana Dedinská
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic.
| | - Karol Graňák
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Matej Vnučák
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Petra Skálová
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Lea Kováčiková
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Ľudovít Laca
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Juraj Miklušica
- Department of Surgery and Transplantation Centre, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Dana Prídavková
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Peter Galajda
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Marián Mokáň
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
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Belicová M, Ochodnický M, Sadloňová J, Prídavková D, Mokáň M. Pulmonary embolism: retrospective view at known disease. Vnitr Lek 2019; 65:475-482. [PMID: 31487990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Acute pulmonary embolism, usually caused by thromboembolism is still a serious medical problem in spite of technical progress in diagnostics, as well as the enhancements in prophylactic and therapeutic options. AIM The evaluation of characteristic, incidence, diagnostic, treatment and mortality rate of patients with pulmonary embolism hospitalized at the 1st Internal Clinic, University Hospital in Martin, within the years 1996-2017. METHODS The authors offer retrospective analysis of 699 (359 men) patients with pulmonary embolism. Diagnosis was confirmed by angiography, perfusion scan or computed tomography. The data of patients were collected continuously and they are archived at the workplace of the authors. RESULTS Patients with explicitly confirmed pulmonary embolism created 1.01 % of all hospitalized patients with average age 60.2. The average age of men was lower compared to women (56.6 vs 65.9). As high-risk pulmonary embolism presented 14.88 %, intermediate-risk 40.77 % and low-risk 44.34 % patients with pulmonary embolism. The source of pulmonary embolism was detected in 46.35 % and risk factors were detected in 52.79 % patients with pulmonary embolism. With thrombolytic therapy were treated 23.18 % of all patient with pulmonary embolism and intracranial bleeding occurred in 0.28 % of them. Early mortality rate was 7.58 % of all patients with pulmonary embolism. CONCLUSION The authors detected increasing occurrence of patients with pulmonary embolism and from 2005 increasing occurrence of non-provoked pulmonary embolism. An average age in the patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary was lower in men (53.5 vs 60.9) as well in women (56 vs 67.7). Patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary were more frequent hospitalized because acute coronary syndrome (5.03 % vs 2.91 %) as well ischemic stroke (7.16 % vs 5.61 %) within one year after pulmonary embolism.
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Mokáň M, Galajda P. Primary and secondary insulin resistance. Vnitr Lek 2019; 65:264-272. [PMID: 31091945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Insulin resistance (IR) is defined as insufficient insulin metabolic effect in target tissues, including glucose utilisation in skeletal muscle, suppression of hepatic glucose production and suppression of lipolysis in fat tissue. Primary IR originates as consequence of rare monogenetic defects of insulin receptor or molecules includes to post-receptor insulin signal cascade. Secondary IR originates mainly as a result of metabolic or hormonal changes, most commonly in visceral obesity by multifactorial postreceptor inhibition of insulin signal and it is associated with metabolic syndrome and type 2 diabetes mellitus. It is also present in endocrinopathies with overproduction of contraregulatory insulin hormones (cortisol, growth hormone, catecholamines) and using of some drugs (mainly steroids, immunosuppressive treatment). In practice IR is usually diagnosed by glycemic parameters with confirmation of prediabetic states and type 2 diabetes mellitus. The healthy life style and physical activity associated with weight loss are the most important for type 2 diabetes prevention. According to actual international guidelines metformin is only antidiabetic drug which is possible to use in prediabetic states with high risk of type 2 diabetes development, mainly in obese subjects with BMI > 35 kg/m2, age under 60 years and in women with history of gestational diabetes.
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Vnučák M, Michalová R, Graňák K, Benko J, Mokáň M. Potential possibility of phosphocreatine usage in internal medicine. Vnitr Lek 2019; 65:30-36. [PMID: 30823835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adenosintriphosphate is basic unit of cellular energetics, although during situations of high energy demand, cell had developed metabolic inert molecules - phosphagens - including phosphocreatine. Nowadays there are not so many recent publications describing positive effect of phosphocreatine supplementation., its potential benefit in supplementation is mainly in cardiology - acute myocardial infarction, acute or chronic heart failure. Another field of medicine with potential use of phosphocreatine is nephrology - in dialysis patients, or in psotemnopausal women in prevention of osteoporosis. In following article, we present review of studies describing positive effect of using phosphocreatine in specific group of patients in internal medicine. Key words: ATP - ischemia - phosphagens - phosphocreatine.
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Sokol J, Nehaj F, Kubašková M, Mokáň M, Kovář F, Péč MJ, Mokáň M. Direct oral anticoagulants in oncology in clinical praxis. Vnitr Lek 2019; 65:45-50. [PMID: 30823837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Relation between oncological diseases and venous thrombo-embolism (VTE) is well known for almost 2 centuries. In 1823 Bouillaud assumed by three patients with tumor and recent deep vein thrombosis (DVT), that peripheral edema of lower limbs emerges as a result of „obturation“ of veins by „fibrinous coagulum“ (caillot fibrineux), which was induced by oncological disease. French physician Armand Trousseau wrote about this relation in his book „Phlegmasia alba dolens” again in the year 1865. Many studies were developed in times of Bouillaud a Trousseau, which just confirmed existence of relation between tumor and VTE. Oncological disease presents a significant risk factor of formation of VTE. Recent references favorising the use of light molecular weight heparin (LMWH) in long-term anticoagulation therapy of patients with cancer. Recently we have just few clinical data about efficiency and safety of direct oral anticoagulants (DOACs) in oncological patients, however many meta-analysis of clinical studies has shown benefit of therapy with DOACs towards conventional therapy. Key words: direct oral anticoagulants (DOACs) - oncology - venous thromboembolism.
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Dedinská I, Mäčková N, Kantárová D, Kováčiková L, Graňák K, Laca Ľ, Miklušica J, Skálová P, Galajda P, Mokáň M. Leptin - A new marker for development of post-transplant diabetes mellitus? J Diabetes Complications 2018; 32:863-869. [PMID: 30049444 DOI: 10.1016/j.jdiacomp.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Obese patients have increased leptin production and selective resistance to its central anti-adipogenic effects, yet its pro-inflammatory immunostimulating effects persist. MATERIAL AND METHODS In a group of 70 patients who underwent primary kidney transplantation (KT) we examined adiponectin and leptin levels at the time of KT and 6 months post-transplantation. Patients with diabetes mellitus type 1 or type 2 at the time of KT were excluded from the study. RESULTS We found that leptin levels significantly increased during the post-transplant period (P = 0.0065). Overall, leptin levels were positively correlated with the level of triacylglycerols, post-transplant diabetes mellitus (PTDM) development and acute rejection (AR). We discovered that, in particular, high leptin levels were associated with AR [OR 2.1273; 95% CI 1.0130-4.4671 (P = 0.0461)] and PTDM development [OR 7.200; 95% CI 1.0310-50.2836 (P = 0.0465)], whereas, low adiponectin levels represent a risk factor for the development of insulin resistance [HR 38.6135; 95% CI 13.3844-67.7699 (P < 0.0001)] and obesity [HR 3.0821; 95% CI 0.8700-10.9192 (P = 0.0053)]. CONCLUSION We found that a high serum concentration of leptin before KT is associated with both PTDM development and AR and merits further investigation in relation to KT.
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Affiliation(s)
- Ivana Dedinská
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic.
| | | | | | - Lea Kováčiková
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Karol Graňák
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Ľudovít Laca
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Juraj Miklušica
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Petra Skálová
- Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Peter Galajda
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
| | - Marián Mokáň
- Ist Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty of Comenius University, Slovak Republic
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Korpallová B, Samoš M, Bolek T, Škorňová I, Kovář F, Kubisz P, Staško J, Mokáň M. Role of Thromboelastography and Rotational Thromboelastometry in the Management of Cardiovascular Diseases. Clin Appl Thromb Hemost 2018; 24:1199-1207. [PMID: 30041546 PMCID: PMC6714776 DOI: 10.1177/1076029618790092] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The monitoring of coagulation by viscoelastometric methods—thromboelastography and rotational thromboelastometry—may detect the contributions of cellular and plasma components of hemostasis. These methods might overcome some of the serious limitations of conventional laboratory tests. Viscoelastic testing can be repeatedly performed during and after surgery and thus provides a dynamic picture of the coagulation process during these periods. Several experiences with the use of these methods in cardiovascular surgery have been reported, but there is perspective for more frequent use of these assays in the assessment of platelet response to antiplatelet therapy and in the assessment of coagulation in patients on long-term dabigatran therapy. This article reviews the current role and future perspectives of thromboelastography and thromboelastometry in the management of cardiovascular diseases.
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Affiliation(s)
- Barbora Korpallová
- 1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Matej Samoš
- 1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Tomáš Bolek
- 1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ingrid Škorňová
- 2 Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - František Kovář
- 1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Peter Kubisz
- 2 Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Ján Staško
- 2 Department of Hematology and Blood Transfusion, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Marián Mokáň
- 1 Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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Bolek T, Samoš M, Škorňová I, Stančiaková L, Staško J, Galajda P, Kubisz P, Mokáň M. Dabigatran Levels in Elderly Patients with Atrial Fibrillation: First Post-Marketing Experiences. Drugs Aging 2018; 35:539-544. [DOI: 10.1007/s40266-018-0552-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dedinská MDI, Mäčková N, Miklušica J, Skalová P, Kováčiková L, Graňák K, Galajda P, Mokáň M. SP704LEPTIN - A NEW MARKER OF ACUTE REJECTION? Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- MD Ivana Dedinská
- Transplantation Department of Nephrology, University Hospital in Martin, Martin, Slovakia
| | - Nadežda Mäčková
- Immunological Laboratory, Immunological Laboratory, Martin, Slovakia
| | - Juraj Miklušica
- Surcical Clinic and Transplant Center, University Hospital in Martin, Martin, Slovakia
| | - Petra Skalová
- Surgery Clinic and Transplant Center, University Hospital in Martin, Martin, Slovakia
| | - Lea Kováčiková
- Surgical Clinic and Transplant Center, University Hospital in Martin, Martin, Slovakia
| | - Karol Graňák
- Surgery Clinic and Transplant Center, University Hospita in Martin, Martin, Slovakia
| | - Peter Galajda
- I. Internal Clinic, University Hospita in Martin, Martin, Slovakia
| | - Marián Mokáň
- I. Internal Clinic, University Hospital in Martin, Martin, Slovakia
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Prídavková D, Samoš M, Kazimierová I, Šutarík Ľ, Fraňová S, Galajda P, Mokáň M. Insulin Pump Therapy - Influence on Body Fat Redistribution, Skeletal Muscle Mass and Ghrelin, Leptin Changes in T1D Patients. Obes Facts 2018; 11:454-464. [PMID: 30537756 PMCID: PMC6341325 DOI: 10.1159/000493734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/14/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To report changes in body composition and biochemical parameters in patients with type 1 diabetes mellitus (T1D) after switching from multiple daily injection (MDI) to continuous subcutaneous insulin infusion (CSII). METHODS 31 patients switched over from MDI to CSII. Body composition, biochemical parameters, glycaemic variability (GV) and level of physical activity were evaluated before and 6 months on CSII. RESULTS In both sexes, we found an increase in skeletal muscle mass (SMM), (p = 0.008; 0.008). In men, there was mainly a decrease in visceral fat area (VFA), (p = 0.028) and in women there was decrease of total body fat (TBF), (p = 0.020) and non-significant decrease of VFA (p = 0.098). SMM inversely correlated with VFA in men (p = -0.001) and with TBF in women (p = -0.005 ). GV was decreased generally and correlated inversely with TBF in men only (p = -0.026). Physical activity was increased and correlated inversely with VFA in men (p = -0.002) and in women (p = -0.006). CONCLUSIONS Using CSII in T1D leads to a significant increase of SMM in both sexes to a decrease of VFA in men and to a non-significant decrease of VFA in women. Changes in adipose tissue and SMM were also related to increased physical activity and to decreased GV.
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Affiliation(s)
- Dana Prídavková
- Clinic of Internal Medicine, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia,
| | - Matej Samoš
- Clinic of Internal Medicine, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Ivana Kazimierová
- 1Biomedical Centre Martin JFM CU and 2Department of Pharmacology JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Ľudovít Šutarík
- Clinic of Internal Medicine, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Soňa Fraňová
- 1Biomedical Centre Martin JFM CU and 2Department of Pharmacology JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Galajda
- Clinic of Internal Medicine, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Marián Mokáň
- Clinic of Internal Medicine, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
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Mokáň M, Nehaj F, Sokol J, Vaňuga P, Mokáň M. [Virilization as demonstration of hypertestosteronism by ovarian tumor: case report]. Vnitr Lek 2018; 64:437-440. [PMID: 29791179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hypertestosteronism as part of hyperandrogenic states in women is generally defined as abundance of male hormones (in this case abundance of testosterone). Spectrum of clinical symptoms include menstrual disorders, amenorrhoea, different range of hirsutism and virilization. Statistically, most androgen secreting tumors are ovarian aetiology (testosterone secreting tumors located in suprarenal gland are very rare). This rare tumor may produce excess amounts of testosterone, as well as its precursor androstenedione. The highest incidence is between 20-40 years and in postmenopausal period. The treatment is essentially surgical; with gradual adjustment of the hormones.Key words: androgen secreting ovarian tumors - hyperandrogenic states - testosterone - virilisation.
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