Body mass index and early outcomes after carotid endarterectomy.

As the existing data on the correlation of adiposity with adverse outcomes of carotid endarterectomy (CEA) are inconsistent, the aim of the present study is to examine the correlation of an increased body mass index with 30-day complications after carotid endarterectomy. The cohort study comprises 1586 CEAs, performed at the Clinic for Vascular Surgery in Belgrade, from 2012-2017. Out of them, 550 CEAs were performed in patients with normal body mass index (18.5-24.9), 750 in overweight (25.0-29.9), and 286 in obese (≥30) patients. The association of overweight and obesity with early outcomes of carotid endarterectomy was assessed using univariate and multivariate logistic regression analysis. Overweight patients, in whom CEAs were performed, were significantly more frequently males, compared to normal weight patients-Odds Ratio (OR) 1.51 (95% confidence interval- 1.19-1.89). Moreover, overweight patients significantly more frequently had non-insulin-dependent diabetes mellitus-OR 1.44 (1.09-1.90), and more frequently used ACEI in hospital discharge therapy-OR 1.41 (1.07-1.84) than normal weight patients. Additionally, the CEAs in them were less frequently followed by bleedings-OR 0.37 (0.16-0.83). Compared to normal weight patients, obese patients were significantly younger-OR 0.98 (0.96-0.99), and with insulin-dependent and non-insulin-dependent diabetes mellitus-OR 1.83 (1.09-3.06) and OR 2.13 (1.50-3.01) respectively. They also more frequently had increased triglyceride levels-OR 1.36 (1.01-1.83), and more frequently used oral anticoagulants in therapy before the surgery-OR 2.16 (1.11-4.19). According to the results obtained, overweight and obesity were not associated with an increased death rate, transient ischemic attack (TIA), stroke, myocardial infarction, or with minor complications, and the need for reoperation after carotid endarterectomy. The only exception was bleeding, which was significantly less frequent after CEA in overweight compared to normal weight patients.

A prospective, randomized, double-blind, placebo-controlled trial of polyphenols on the outcomes of inflammatory factors and oxidative stress in patients with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is commonly associated with hyperglycemia, dyslipidemia, oxidative stress and inflammation which are well known cardiovascular risk factors. Pomegranate peel polyphenols have a proven hypolipemic, antioxidant and anti-inflammatory activity. However, there is a lack of clinical studies that would confirm its antioxidant and anti-inflammatory effects in diabetic patients. The potential of pomegranate peel extract (PoPEx) to counteract inflammation and oxidative stress in T2DM patients was investigated. For this purpose, a randomized, double-blind placebo-controlled study involving adult T2DM patients treated with PoPEx or placebo for eight-weeks was conducted. METHODS: Patients were randomly divided into two groups: the first group (n = 30) received capsules containing PoPEx 250 mg twice daily, while the placebo group (n = 30) received placebo capsules twice daily. Plasma concentration of inflammatory factors (interleukin 6 (IL-6), tumor necrosis factor α (TNF-α) and high sensitivity C reactive protein (hsCRP)), oxidative stress biomarkers (thiobarbituric acid reactive substances (TBARS), nitrites (NO2-), superoxide anion radical (O2-), hydrogen peroxide (H2O2), total antioxidant capacity (TAC)), homocysteine and lipid profile were analyzed. RESULTS: The PoPEx treatment showed a significant reduction of inflammatory factors (IL-6, TNF-α, hsCRP), oxidative stress biomarkers (TBARS, NO2-, O2-) and homocysteine, while the TAC was increased. Moreover, a significant improvement in lipid profile was observed in the PoPEx group. Additional analysis showed a significant inverse correlation between the decrements of all measured inflammatory markers and TAC in the PoPEx group. CONCLUSIONS: The study demonstrated that eight-week-long PoPEx administration had favorable effects on inflammatory status and oxidative stress biomarkers in diabetic patients.

Recording blood pressure and eGFR in primary care after the Belgrade screening study.

BACKGROUND: In 2009, Belgrade nephrologists and general practitioners from thirteen health centers carried out screening for chronic kidney disease (CKD). Three years later, medical records of patients from four health centers participating in the screening study were retrospectively analyzed in order to check whether general practitioners had continued to control patients at risk for CKD in accordance with the recommendations provided. METHODS: The study included 460 patients who visited their doctor at least once in the three-year period. Data on blood pressure, ACEI use, estimated glomerular filtration rate (eGFR) and comorbidities were taken from patients' medical records. RESULTS: Blood pressure was not recorded in any of the three years in 42.8% and eGFR in 36.7% of the patients, but blood pressure was registered every year in 7.8% and eGFR in 4.3% of them. Over the three years, the relative number of patients with recorded blood pressure decreased from 41.7% to 17.8%, and with recorded eGFR from 41.7% to 21.5%. Multivariate linear regression found that Health Center, systolic and diastolic blood pressure and presence of hypertension were negatively associated with number of years with recorded blood pressure. Health Center, systolic blood pressure and sum of years with recorded eGFR below 60 ml/min/1.73m2 were associated with number of years with recorded eGFR. CONCLUSIONS: Under-recording of blood pressure and eGFR in primary care health centers suggests lack of adherence to current guidelines and insufficient care of CKD patients. This implies the necessity for continuous education of physicians.

Risk Factors Associated with Overweight among Adolescents in Serbia.

INTRODUCTION: The pandemic of obesity in adolescents is one of the challenges of public health. AIM: The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents. METHOD: A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model. RESULTS: The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index. CONCLUSION: These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

Assessment of hepatitis C virus protein sequences with regard to interferon/ribavirin combination therapy response in patients with HCV genotype 1b.

Hepatitis C virus (HCV) infection is a major and rising global health problem, affecting about 170 million people worldwide. The current standard of care treatment with interferon alpha and ribavirin in patients with the genotype 1 infection, the most frequent genotype in the USA and Western Europe, leads to a successful outcome in only about 50% of individuals. Accurate prediction of hepatitis C treatment response is of great benefit to patients and clinicians. The informational spectrum method, a virtual spectroscopy method for structure/function analysis of nucleotide and protein sequences, is applied here for the identification of the conserved information of the HCV proteins that correlate with the combination therapy outcome. Among the HCV proteins that we have analyzed the informational property of the p7 of HCV genotype 1b was best related to the therapy outcome. On the basis of these results, a simple bioinformatics criterion that could be useful in assessment of the response of HCV-infected patients to the combination therapy has been proposed.

A bioinformatics approach to identify natural autoantibodies from healthy blood donors' sera reactive with the HCV NS5A-derived peptide by immunoassay.

Natural autoantibodies (NAbs) are continually produced throughout life and have an ability to recognize self and altered self, as well as foreign antigens, by recognizing cellular pattern recognition receptors. Sometimes NAb specificity demonstrates overlap between human and pathologic proteomes. This information can be useful in selecting target sequences for screening purposes. In this study we undertook a multi-step bioinformatics search to predict a virus-derived peptide that can be recognized by NAbs in sera of uninfected individuals. We selected protein hepatitis C virus (HCV) NS5A as a target sequence, motivated by the fact that the HCV proteome is characterized by extensive sequence similarities to the human proteome, and because screening for anti-HCV antibodies, including anti-NS5A, is important clinically, particularly in screening of potential blood donors. The virus-specific peptide P1, and the homologous human peptide derived from enzyme-inducible nitric oxide synthase (iNOS), P2, exhibiting not only simple homology, but also complementarities of physicochemical patterns, were synthesized and 80 HCV-negative and 50 HCV-positive blood donor sera were tested by ELISA. These peptides reacted similarly (p<0.001) with HCV-negative sera, and in several cases the measured reactivity was significantly above the cut-off value of commercial anti-HCV screening assays. In HCV-positive sera, the titers of antibodies reactive with analyzed HCV NS5A peptide were not significantly increased (p<0.001) compared to host peptide, the implications of which are unclear, but may be consistent with these antibodies being "naturally produced." Finally, we extended our bioinformatics analyses to the dataset of human self-binding sequences, and propose a general approach for the selection of specific diagnostic and screening antigens for use in immunoassays.

[Influence of acclimatization on serum enzyme changes in soldiers during exertional heat stress].

BACKGROUND/AIM: Exertional heat stress is common problem in military services. The aim was to exemine changes in serum concentrations of some enzymes in soldiers during exertional heat stress test (EHST) as well as the effects of 10-days passive or active acclimatization in climatic chamber. METHODS: Forty male soldiers with high aerobic capacity, performed EHST either in cool (20 degrees C, 16 degrees C Wet bulb globe temperature--WBGT), or hot (40 degrees C, 25 degrees C WBGT) environment, unacclimatized, or after 10 days of passive or active acclimation. Physiological strain was measured by tympanic temperatures (Tty) and heart rates (HR). Concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and creatine-kinase (CK) were measured in blood samples collected before and immediately after EHST. RESULTS: Exertional heat stress test in hot conditions induced physiological heat stress (increase in Tty and HR), with significant increase in concentrations of all enzymes in unacclimatized group: ALT (42.5 +/- 4.2 before vs 48.1 +/- 3.75 U/L after EHST, p < 0.01), AST (24.9 +/- 5.1 vs 33.4 +/- 4.48 U/L, p < 0.01), LDH (160.6 +/- 20.2 vs 195.7 +/- 22.6 U/L, p < 0.001) and CK (215.5 +/- 91.2 vs 279.1 +/- 117.5 U/L, p < 0.05). In acclimatized soldiers there were no significant changes in concentrations of ALT and AST, while concentration of CK was significantly higher. Concentrations of LDH were significantly higher in all investigated groups, regardless of temperature conditions. CONCLUSION: In trained soldiers, 10-days passive or active acclimatization in climatic chamber can prevent increase in serum concentrations of ALT and AST, induced by exertional heat stress. Increase of serum concentrations of CK and LDH was induced by physical strain itself, with no additional effect of heat stress.

[Gene similarity between hepatitis C virus and human proteins--a blood transfusion problem].

INTRODUCTION: Hepatitis C is a post-transfusion hepatitis which causes serious problems in blood transfusion. Blood testing requires highly sensitive and specific assays with high predictive value. GENOMIC CHARACTERISTICS OF HEPATITIS C VIRUS: According to recommendations of International Association for the study of Liver Diseases etiological diagnosis of hepatitis is based on highly sensitive third generation assays: epitopes in the NS5 region comprising noncoding sequence UTR with 324-341 well conserved pair of homologous basis in 92% HCV genomes, therefore appropriate for virus RNA detection. DEVELOPMENT OF ASSAYS FOR HEPATITIS VIRUS: The first generation of immunoenzyme tests (IET) were based on detection of antibodies on antigen c 100-3, which is a part of the NS4 region of HCV genome. The second generation of tests with two recombinant proteins--c22-3 and c200, achieved higher sensitivity of assays. The third generation included epitopes from NS5 region, and removed the antigen c100-3. DEVELOPMENT OF AUTOIMMUNITY: Autoimmunity is a pathophysiological mechanism that's leads to chronic inflammatory diseases. Autoimunity is characterized by loss of tolerance towards self-antigens. Viral hepatitis C is associated with development of autoimmune phenomena. MOLECULAR MIMICRY: Molecular mimicry, as a mechanism of autoimmunity, was investigated to establish cross-Reactive immune reactions between HCV antigen and human nitrogen-oxide synthase, Tyrosine kinase Lck and hepatic growth factor activator. CROSS REACTIVITY BETWEEN HCV PROTEINS AND HUMAN PROTEINS: HCV capsid proteins initiate the autoimmune process in the liver because of cross reaction of antibodies with human Gor protein 19-27, which causes autoimmune chronic hepatitis. However, analysis of human protein from protein basis Swiss-prot shows homology between NS5 region and 3 human protein nitrogen oxide synthases, tyrosine kinase-Lck, proto-oncogene and hepatic growth factor activator. According to protein data analysis and competitive in vitro experiments, it was concluded that presence of auto-antibodies is probably the consequence of cross reactive immune response. CONCLUSION: Homology of amino acid sequences in the NS5 region of the HCV genome with nitrogen-oxide synthase, tyrosine kinase-Lck, and hepatic growth factor activator, causes auto-immune phenomena in HC, and can be a model for researching autoimmunity and human virus-induced autoimmune diseases.

[Assessment of diet therapy effect on blood pressure of obese persons with and without antihypertensive therapy]. / Ispitivanje efekta dijetoterapije na krvni pritisak gojaznih osoba sa i bez antihipertenzivne terapije.

BACKGROUND: Arterial hypertension is a multicausal chronic disease often accompanied by obesity. The aim of this investigation was to examine the effect of diet therapy in the treatment of obese hypertensives with and without antihypertensive therapy. METHODS: The investigation was conducted at the Department of Nutrition on a sample of 110 obese hypertensive patients on diet therapy. Subjects were divided into two groups: the group on diet therapy with antihypertensive drugs E1 (n=78), and the group on diet therapy without pharmacotherapy E2 (n=32). Nourishment state i.e., obesity level was assessed by body mass index (BMI). All the patients belonged to the obese group--BMI > 30 kg/m2. Besides blood pressure values, the following parameters were monitored: serum cholesterol, trygliceride levels and BMI. RESULTS: The obtained results in the group with diet therapy combined with antihypertensive therapy showed highly significant decrease of anthropometrical parameters: body weight (99.14 kg vs. 90.16 kg) (p<0.001) and BMI (37.32 vs. 34.09) (p<0.001); percent body fat (41.97 vs. 38.78) (p<0.001); systolic (154.81 vs. 141.91) (p<0.001), and diastolic pressures (95.42 vs. 87.36) (p<0.001); cholesterol (6.39 vs. 5.99) (p<0.002), and triglycerides concentration (2.69 vs. 2.21) (p<0.019). In the group on single diet therapy, highly significant decrease of body mass (99.33 vs. 90.18) (p<0.001), BMI (34.79 vs. 31.58) (p<0.001), percent body fat (39.27 vs. 36.70) (p<0.001), systolic (148.44 vs. 132.74) (p<0.001), and diastolic pressures (93.97 vs. 82.90) (p<0.001), was achieved, while the differences between initial and final cholesterol and triglyceride concentrations, although observed, were not statistically significant. CONCLUSION: The obtained results implicated that diet therapy significantly helped the normoregulation of both systolic and diastolic blood pressure. Considering this, during physicians' routine practice in the treatment of hypertension, attention should be paid on the reduction of the corresponding level of obesity.