The benefits of GLP1 receptors in cardiovascular diseases.

Glucagon like peptide-1 (GLP-1) receptor agonists are well established drugs for the treatment of type 2 diabetes (T2D). In addition to glycemic control, GLP-1 receptor agonists have beneficial other effects. They act by binding to GLP-1 receptors, which are widely distributed in the body, including cardiomyocytes and blood vessels. The aim of this article is to provide a comprehensive review of GLP-1 receptor agonists impact on cardiovascular outcomes and risk reduction. In the last decade, several cardiovascular outcomes trials (CVOT) have been conducted in order to explore cardiovascular benefit of GLP-1 receptor agonists. CVOTs primarily proved cardiovascular safety and tolerability of different GLP-1 receptor agonists, but also showed cardiovascular benefit of specific drugs. CVOTs have shown that GLP-1 receptor agonists reduce MACE in patients with T2D compared to placebo. In addition, they have positive impact on several cardiovascular risk factors such as obesity by promoting weight loss, blood pressure and blood lipid levels. Also, they stimulate the endothelium to produce nitric oxide, reduce oxidative stress, and have antiatherogenic and antiinflammatory effects. Studies have shown their positive impact on kidney outcomes in patients with T2D compared to placebo. The results of previous trials are encouraging in terms of multiple positive effects of GLP-1 receptor agonists. However, further research is needed to understand their full potential and all details of their mechanism of action, which will enable to expand the therapeutic indications and to determine their optimal use in clinical practice.

The incidence of dyslipidemia (hypertriglyceridemia and hypercholesterolemia) in patients treated with the new generation of antipsychotic drugs compared to conventional therapy.

AIM: To investigate the incidence of dyslipidemia (hypertriglyceridemia and hypercholesterolemia) in patients treated with antipsychotics of new generation compared to conventional therapy. METHODS: This retrospective study included 116 chronic psychiatric patients divided into two groups: a test group who were on treatment with antipsychotics of the new generation and a control group who were treated with classical antipsychotics. Laboratory and vital parameters were monitored in a group of patients who were treated with new generation antipsychotics (clozapine, olanzapine, risperidone), as well as in the group of patients who were treated with classical antipsychotics (promazine, levopromazin,haloperidol, fluphenazine). RESULTS: Mean triglyceride level in the test group was 3.13 mmol/L, and for the control group, 2.28 mmol/L, while the mean value for cholesterol test group was 6.12 mmol/L, and for the control group, 5.85 mmol/L. The average age of the test group was 49.6 years, while the control group was 51.47 years. There was a statistical significance in triglycerides (p = 0.004), while the cholesterol (p = 0.239) and age (p = 0.356) had no statistical significance in the test group compared to the patients who were treated by the new generation of antipsychotics, and the control group of patients who were treated with antipsychotics. CONCLUSION: Dyslipidemia in the form of hypertriglyceridemia occurs more frequently in patients on therapy with the new generation of antipsychotics compared to patients treated with conventional therapy. Hypercholesterolemia as a form of dyslipidemia had not been proven as significantly frequent during the therapy with new antipsychotics in relation to classical antipsychotic treatment.

The effects of dipeptidyl peptidase-4 inhibitors in treatment of obese patients with type 2 diabetes.

INTRODUCTION: Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antihyperglycemic drugs that block degradation ofincretin hormones. GOAL: To assess the effects oftreatment with DPP-4 inhibitors on glucoregulation and body weight in obese patients with type 2 diabetes mellitus. PATIENTS AND METHODS: The study included 9 females and 9 males with type 2 diabetes (n=18), BMI=31.24 +/- 2,26 kg/m2, mean age 58 +/- 6,8 years. The patients have been thoroughly evaluated before treatment, and 6 months after treatment with DPP-4 inhibitor (sitagliptin) in combination with metformin. RESULTS: After 6 months of treatment with DPP-4 inhibitors in combination with metformin HbAlc (-1,49%)., FBG (-3.75 mmol/L) and PBG (-5.79 mmol/L) significantly reduced (p=0.000). Mean body weight also significantly reduced (-12.5%; p=0.000). Reduction of mean fasting insulin was 5.46 mIU/L or 27% (p=0.000). Mean HOMA-IR change was -1.64 (p=0.000). Also there was significant decreasing of systolic blood pressure (p=0.001), cholesterol (p=0.004), triglycerides (p=0.001), LDL (p=0.002) and increasing of HDL (p=0.002). Hypoglycaemia was not registered in any of the patients. CONCLUSION: These results show that in obese patients with type 2 diabetes, DPP-4 inhibitors treatment in combination with metformin was associated with improvements in glycaemic control, and a reduction in body weight.

Frequency of depression in diabetic patients in the family medicine.

INTRODUCTION: Depression often accompanies various physical illnesses. OBJECTIVES: Screening for unidentified depression in patients diagnosed with Diabetes mellitus. DESIGN AND METHOD: a retrospective, descriptive study. SUBJECTS: 100 diabetic patients, 53% female and 47% male, age group 18-85. Hopkins Symptom Checklist-25 questionnaire was used on a random sample of diabetic patients in two family medicine outpatient clinics in Health Centre Ilidza and Center, Sarajevo, in period February-May 2007. The cutoff score of > or = 1.75 was used. The occurrence of depression was analyzed with respect to the duration of Diabetes mellitus, type of treatment and average value of fasting blood glucose over the last six months. RESULTS: 36% of subjects scored positive for depression symptoms, 31% of subjects in the group having the illness up to one year, 80% in the group having the illness for 11-15 years. There is a statistically significant difference in depression positive score between the group of patients using insulin, and to the group using oral hypoglycemic therapy, 73% vs. 20% (p< 0.05). In the group with average value of fasting blood glucose < or = 7 mmol/l, 15% of the patients have a positive oepression score, versus 66% of them in the group with blood glucose levels of 13-15mmol/l. CONCLUSION: The number of newly found depressions in diabetic patients increases with the duration of Diabetes mellitus and with higher levels of fasting blood glucose. A systematic screening by family doctors can help identify diabetes-related depression.

Relevance of uric Acid in progression of type 2 diabetes mellitus.

Recent studies have introduced serum uric acid (UA) as a potential risk factor for developing diabetes, hypertension, stroke, and cardiovascular diseases. The value of elevated levels of UA in serum as a risk factor for diabetes development is still under scrutiny. Recent data suggest that clearance of UA is being reduced with increase in insulin resistance and UA as a marker of prediabetes period. However, conflicting data related to UA in serum of patients with Type 2 diabetes prompted us to study the urine/serum ratio of UA levels (USRUA) in these patients and healthy controls. All subjects included in the study were free of evidence of hepatitis B or C viral infection or active liver and kidney damage. Patients receiving drugs known to influence UA levels were also excluded from this study. Analysis of glucose and uric acid were performed on Dade Behring analyzer using standard IFCC protocols. Interestingly, our data demonstrated about 2.5 fold higher USRUA values in diabetic patients as compared to control subjects. Furthermore, there was a trend of correlation of USRUA value with the blood glucose levels in diabetic patients, which was more prominent in diabetic men than in women. With aging, levels of uric acid increased in serum of diabetic patients, and this effect was also more profound in male than in female diabetics. In conclusion, this study showed significantly elevated USRUA levels in patients with Type 2 diabetes, a negative USRUA correlation with the blood glucose levels in diabetic patients, and an effect of sex and age on the uric acid levels. Since literature data suggest a strong genetic effect on UA levels, it would be pertinent to perform further, possibly genetic studies, in order to clarify gender and ethnic differences in UA concentrations.

Evaluation of risk markers fluctuation during an initial therapy with rosiglitazon in patients suffering from metabolic syndrome.

The aim of this study was to examine the effects of hypoglycaemic drug-agonists of PPAR-gama receptors-rosiglitazone (Avandia,4 mg - Glaxo Smith Kline) on values of wide-spread risk - markers-fibrinogen, C-reactive protein and uric acid and glicolysated haemoglobin HbA1C as parameter of metabolic control .We included fourty patients with criteria for metabolic syndrome and evaluated results into groups of diabetic and prediabetic patients according to criteria of IDF (International Diabetic Federation)These risk markers and glicolysated haemoglobin HbA1C were observed at the start of therapy, then after four, eight and twelve weeks and results were compared and statistically calculated. Three months initial therapy with rosiglitazone significantly reduced values of HbA1C, fibrinogen and CRP but not uric acid in prediabetic patients.Rosiglitazone initial three months therapy significantly reduced HbA1C, fibrinogen and uric acid, but not CRP in diabetic patients.

Cardiac sarcoidosis mimicking Takotsubo syndrome.

An unusual case of cardiac sarcoidosis is described. A woman with biopsy proven lung sarcoidosis was presented on admission in hospital as ventricular tachycardia and non Q myocardial infarction. Ultrasound of the heart and coronarography examination presented Takotsubo syndrome, "ballooning heart", and normal blood vessels. Cardiac sarcoidosis and Takotsubo syndrome are diseases where definitive etiological factor was not found. This case report suggests the existence of their similar pathogenesis. As far as we know, this is the first described connection between Takotsubo syndrome and cardiac sarcoidosis.

Echocardiographic monitoring of patients with heart failure.

Twenty seven patients diagnosed as having systolic heart failure with Ejection Fraction (EF) of less than 40% by echocardiography were monitored over a period of 3 years. The monitored parameters included clinical symptoms, diastolic dysfunction, therapies and survival during three years of treatment. The results indicate a beneficial effect of treatment with high doses of ACE-inhibitors, spironolactone and beta-blockers in improving clinical symptoms and diastolic function. The survival rate was similar to that in the developed European countries.

Acute heart failure after myocardial infarction.

We compared two groups of patients after acute myocardial infarction. First group was treated with fibrinolytics and they were hospitalized within six hours from the beginning of the first chest-symptoms, and second group that did not come within optimal time was treated with anticoagulants only. The patients were classified according to Killip-classification, shock-index and TIMI-risk-score after myocardial infarction. Results prove great benefit of fibrinolytic therapy in optimal time, concerning both keeping myocardial muscle mass and myocardial pump function.

[Porphyria acuta hepatica intermittens]. / Porphyria acuta hepatica intermittens.

It is case report forty years old woman was admitted at Clinic for abdominal surgery of Clinical center University of Sarajevo, than at Clinic for bone surgery because of general weakness, pain in legs and paraparesis lower extremities. Anamnestic data about earlier hospitalisation because of abdominal pain when she was discarged under diagnosis: Dolichomegacolon and data worse status after consuming sulfosalazins aimed diagnostic towards prophyria which was confirmed by quality test (Hoesh). Variety of symptoms this disease which could be considered in young women, pale, with blue eyes, was noticed.

Specificity of electrocardiography and echocardiography changes at the patients with the pulmonary embolism.

We evaluated electrocardiographic and echocardiographic changes of 40 patients with pulmonary thrombo-embolism proved by perfusion scintigrams. ECG-changes included sinus tachycardia or absolute tachyarrhythmia de novo, changes type Q1S3T3 and changes in right precordial leads. Analyses of echocardiography included hyperkinesis and then dilatation and apical hypokinesis of right ventricule and tricuspid regurgitation with maximal transvalvular gradients. We emphasize such a sensibility of echocardiographic changes in early estimation of pulmonary thrombo-embolism severity and necessity for echocardiography as early as possible in suspected patients.

Effects of nebivolol on artery hypertension--multicentre study Bosnia and Herzegovina.

Hypertension is a major risk factor for cardiovascular diseases; drugs that reduce blood pressure and simultaneously improve or reverse endothelian dysfunction, as nebivolol, may be advantageous in terms of cardiovascular protection. The objective of this study is to show the anti-hypertensive efficacy and safety of nebivolol (5 mg once a day) given to patients with arterial hypertension for 3 months. It should also provide information about drug's influence on laboratory tests--fasting blood glucose and serum cholesterol, triglyceride and creatinine concentrations. Six centers--Tuzla, Sarajevo, Mostar, Bihac, Zenica and Banja Luka participated in this prospective study with follow-up period of 3 months that included 3 visits. The study group consisted of 328 hypertensic patients. Results showed a significant decrease in both systolic and diastolic blood pressure and heart rate at the end of the study. Fasting blood glucose level and serum cholesterol, triglyceride and creatinine changed significantly during the study, with lower levels of all the tests. Nebivolol seems to be free from some of the problems that generally accompany not only the classical beta- blockers but sometimes also newer classes of antihypertensive drugs. With its high anti-hypertensive efficiency and safety, and presence of statically significant difference in laboratory tests and beneficial effects, absence of adverse interaction with glucose and lipid metabolism, patients treated with Nebivolol may show an optimal adherence to therapy.

[Myxoma of the right atrium and left ventricle]. / Miksomi desnog atrija i lijevog ventrikula.

In this case report has been shown 63 years old woman who was admitted on internal medicine ward because of chest pain. She said, she has had chest pain for one year, exercise not dependent, connected with shortage of breath and often with coughing mixed with blood. One month before she was discharged from Neurologic Clinic where she had been admitted because of cerebrovascular insult. Echocardiographic analysis shows loose myxoma of right atrium on the thin stalk connected with interatrial septum with very probable myxomatosis in the areas of medial thirdness interventricular septum and inferior wall of left ventriculum, and persistence minor thrombus in acinetic apex of left ventriculum. It was pointed out vera rare location of myxoma and echocardiography as method od choice in its diagnoses.