Growth differentiation factor 15 as an integral marker of the clinical and functional status of patients with non-valvular atrial fibrillation

Aim. To study the relationship between growth differentiation factor 15 (GDF-15) level in blood serum and patient clinical and functional status parameters, and to determine predictors of GDF-15 level in pts with non-valvular atrial fibrillation (AF).Material and methods. Eighty-seven pts (with the mean age of 56.9±9.2 years) with non-valvular AF were studied. A general clinical examination, as well as echocardiography and laboratory tests were performed. These included fasting serum glucose (mmol/l), highly sensitive C-reactive protein (h/s CRP) (mg/l), creatinine level (μmol/l) and subsequent calculation of glomerular filtration rate (ml/min/1.73m2), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (pg/ml). The level of GDF-15 (pg/ml) in blood serum was determined using an enzyme immunoassay with a human ELISA analytical kit.Results. An increase in GDF-15 level was associated with age, ischemic heart disease, severity of hypertension, and heart failure, resulting in a higher risk of stroke, according to the CHA2DS2 -VASc score, carbohydrate metabolism disorders and obesity, increased h/s CRP and NT-proBNP levels, enlargement of the right and left atria, signs of diastolic left ventricular dysfunction and structural remodeling in the form of eccentric hypertrophy. Multiple linear regression analysis revealed 2 independent predictors of GDF-15 levels: age and fasting glucose.Conclusion. GDF-15 is an integral biomarker of age-related metabolic disorders and structural and functional changes in the heart, which opens up prospects for further study of its prognostic significance in pts with non-valvular AF.

Efficacy and safety of condylectomy with minimally invasive surgery in the treatment of interdigital corns of the lesser toes compared to conservative treatment

Background Minimally invasive surgery (MIS) procedures cause less trauma to the patient and might improve recovery. This study aimed to determine the efficacy and safety of condylectomy with MIS to treat interdigital corns of the lesser toes. Methods This prospective cohort study was conducted in seven podiatry centers. Patients with interdigital corns of the lesser toes, progressing for more than a year, with one or more recurrences in the last year following conservative treatments were eligible. The recruited patients were classified according to their treatment: conservative or surgical (condylectomy with MIS) and were compared. Patient satisfaction, pain, the clinical and functional status of the foot and the appearance of sequelae were assessed at 3 and 6 months after treatment. Results At 6 months, patients in the surgical treatment group showed no pain on pressure, which significantly differed from the conservative treatment group (p < 0.001). They also improved clinical and functional status of the foot, reaching values comparable to those of the standard population. No paresthesia, joint stiffness or instability, toe malalignment, or corn transfer to a contiguous site resulted from the surgical treatment. Conclusions Condylectomy with MIS is effective and safe to treat interdigital corns of the lesser toes.

Short-term results of total hip arthroplasty in patients with ankylosing spondylitis (preliminary report)

Introduction The systemic nature of the disease and the use of modern conservative therapy may cast doubt on the effectiveness and necessity of total hip arthroplasty (THA) in ankylosing spondylitis (AS). A comprehensive assessment of the functional state, quality of life (QOL) and subjective assessment of patients allows the most complete analysis of treatment results. Objective Comprehensive analysis of short-term results of quality of life, clinical and functional status and treatment satisfaction in patients with AS after THA. Materials and methods 17 patients with AS underwent primary THA (5 women, 12 men, average age 43.8 ± 3.1; from 33 to 52 years). Cases of complete bone ankylosis of the hip joint were excluded. An analysis of the functional state using Harris Hip Score and QOL (SF-36v2) was performed before surgery, 2 months, 6 months and 12 months after surgery. Patient treatment satisfaction analysis (VAS) was performed at the same follow-ups. Results A significant improvement in clinical and functional status (HHS) and QOL (SF-36v2) was obtained after 2, 6, 12 months compared with the preoperative level (p < 0.05). High levels of patient satisfaction with treatment outcomes were achieved. Para-articular ossification (3 patients, 18 %), a hematoma in the postoperative wound area (1 patient, 6 %), implant dislocation (1 patient, 6 %) were the main complications. Conclusion THA in patients with AS improves not only the functional state but also the QOL compared with the preoperative level.

Growth differentiation factor 15 as an integral marker of the clinical and functional status of patients with non-valvular atrial fibrillation

Introduction. Growth Differentiation Factor 15 (GDF-15) is known to be an independent predictor of cardiovascular and all-cause mortality, as well as major bleeding in patients (pts) with non-valvular atrial fibrillation (AF). Since GDF-15 is expressed by a wide array of cells in response to inflammation and myocardial stress, it is interesting to study which clinical and functional parameters are most associated with the level of GDF-15 in pts with non-valvular AF and preserved left ventricular ejection fraction. Aim. To study the relationship of GDF-15 level in blood serum with parameters of clinical and functional status and to determine independent predictors of GDF-15 level in pts with non-valvular AF. Material and methods. 87 pts with non-valvular AF were studied, with an average age of 56.9±9.2 years. A general clinical examination, echocardiography and laboratory tests were performed, including fasting serum glucose (mmol/l),highly sensitive C-reactive protein (h/s CRP) (mg/l), creatinine level (mkmol/l) and subsequent calculation of glomerular filtration rate (ml/min/1.73m2), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (pg/ml). The level of GDF15 (pg/ml) in blood serum was determined using an enzyme immunoassay with the help of the human GDF-15/MIC-1 ELISA analytical kit (BioVender, Czech Republic). Results. The increase in the GDF-15 level was associated with ageing, ischemic heart disease, severity of arterial hypertension and heart failure, raising the risk of stroke, according to the scale CHA2DS2-VASc, disturbances of carbohydrate metabolism and obesity, increasing the levels h/s CRP and NT-proBNP, enlargement of the right and left atria, signs of diastolic left ventricular dysfunction and structural remodeling in the form of eccentric hypertrophy. Multiple linear regression analysis revealed 2 independent predictors of GDF-15 levels: age and fasting glucose. Conclusion. GDF-15 appears as an integral biomarker of age-related metabolic disorders and structural and functional changes in the heart, which opens up prospects for further study of its prognostic significance in pts with non-valvular AF.

THE EFFECT OF CHEMOKINE CXCL-13 ON THE CLINICAL AND FUNCTIONAL STATUS OF PATIENTS WITH MULTIPLE SCLEROSIS IN REMISSION

Introduction. CXCL-13 can be involved in the development of MS, and its level in peripheral blood may have diagnostic and / or prognostic significance. The purpose of this study is to assess the level of CXCL-13 in serum and its relationship with the clinical and functional state of patients with remitting MS in remission. Materials and methods. The study involved 67 patients (28 men and 39 women) with a relapsing MS in remission. All patients were examined by scales and questionaries EDSS, Multiple Sclerosis Functional Composite, Multiple Sclerosis Impact Scale 29, Fatigue Severity Scale. On the day of the clinical examination venous blood samples were taken from patients and healthy donors, serum was isolated, and the level of CXCL-13 was assessed by enzyme immunoassay method. Results and discussion. It was revealed that CXCL-13 in the serum in patients with MS was significantly lower than in healthy volunteers. A relationship was found between serum CXCL-13 and the severity of neurological deficit according to EDSS, with walking speed of 25 feet, with an assessment of the quality of life and fatigue. Conclusions. Despite the association of CXCL-13 with the clinical and functional state of MS patients, at present time this chemokine cannot be considered to be a diagnostic or prognostic marker in MS patients.

HAEMOcare: The First International Epidemiological Study Measuring Burden of Hemophilia in Developing Countries

Introduction Optimizing hemophilia care remains challenging in developing countries. Burden-of-disease studies are important to develop strategies for improving hemophilia care. Aim The HAEMOcare study evaluated the factors contributing to hemophilia-related orthopedic disease burden in developing countries. Methods HAEMOcare was a noninterventional, cross-sectional, epidemiological study conducted in Algeria, India, Morocco, Oman, and South Africa. Male patients with severe hemophilia (N = 282) aged ≥6 years, without or with inhibitors, being treated on-demand for bleeding were included. Hemophilia-related orthopedic clinical and functional status was assessed using the Hemophilia Joint Health Score (HJHS), radiological status with the Pettersson Score, and quality of life with the EuroQol five-dimension questionnaire (EQ-5D-3L). Direct and indirect economic costs of hemophilia care were also calculated. Results Patients (mean [standard deviation, SD] age: 20.8 [10.6] years) experienced a mean annualized bleeding rate of 25.8. Overall mean (SD) HJHS and Pettersson score were 17.9 (12.8) and 15.0 (13.5), respectively; scores were similar between patients without or with inhibitors (p = 0.21 and 0.76, respectively). Approximately 70% of adults reported problems relating to pain/discomfort and mobility parameters in the EQ-5D-3L. Mean distance to a hemophilia treatment center (HTC) was 79.4 km. As expected, total costs of hemophilia were statistically significantly higher in patients with inhibitors versus without inhibitors (p = 0.002). Conclusion Inadequate access to HTCs and expert care, along with high bleeding rates, led to equivalent hemophilia-related orthopedic morbidity between hemophilia patients without and with inhibitors. HAEMOcare documented the economic and disease burdens associated with suboptimal hemophilia care in developing countries.

SODIUM PROFILING AND ULTRAFILTRATION IN PATIENTS UNDERGOING PROGRAMMED HEMODIALYSIS: THERAPY OPTIMIZATION

The objective of the study is to evaluate the effect of sodium profiling and ultrafiltration on the clinical and functional status of patients undergoing programmed hemodialysis (HD). Materials and Methods. The study consisted of two stages. During the first stage, a group of patients (n=25) undergoing HD was formed. The follow-up period lasted 20 months. Evaluation of blood pressure levels, interdialytic weight gain and laboratory parameters was carried out taking into consideration five variants of sodium profiling and ultrafiltration. During the second stage a comparative analysis of patients’ clinical and functional status according to the profiling option (3 and 5) was conducted in the group (n=20). Results. During the first stage, the authors found out that profiles 3 and 5 were desirable for blood pressure stabilization, interdialytic weight gain loss and improvement of laboratory parameters. The second stage showed that using profile 5 in case of adequate hemodialysis contributes to improving clinical and laboratory status and reducing concomitant drug therapy in 63.3% of patients. Conclusions. Under profiling patients undergoing hemodialysis demonstrate blood pressure stabilization, interdialytic weight gain loss and improvement in such blood values as total protein, albumin and hemoglobin. Keywords: hemodialysis, sodium profiling, ultrafiltration, blood pressure, albumin, hemoglobin.