Aleksandra Nikolić

Analysis of the Factors Influencing Functional Outcomes in Patients with Spinal Cord Injury

[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Cardiovascular diseases are the leading cause of death in patients on hemodialysis. Cardiovascular mortality rate in these patients is approximately 9% per year, with the highest prevalence of left ventricular hypertrophy, ischemic heart disease and congestive heart failure among cardiovascular complications. The aim of this study was to assess cardiovascular risk factors, pathogenetic mechanisms for the development of diastolic dysfunction of heart, and point to clinical importance of early detection and timely application of adequate therapy in patients with diastolic dysfunction. Expert works and clinical studies dealing with diagnostics and therapy for diastolic dysfunction in population of patients on hemodialysis were analyzed. Left ventricular hypertrophy was present in 75% of patients on hemodialysis. Risk factors for development of hypertrophy of the left ventricle in patients on hemodialysis include: increased shunt blood flow, anaemia, sodium and water retention, hypertension, oxidative stress, microinflammation, hyperhomocysteinemia and secondary hyperparathyroidism. Left ventricular hypertrophy is an important cause of diastolic dysfunction of left ventricle in this population. Diagnostic strategy for early detection of high-risk patients for the development of asymptomatic diastolic dysfunction include: echocardiography examination, tests for proving coronary artery disease, as well as tests for myocardial function examination. Early detection of patients with high risk for the development of diastolic dysfunction enables timely application of adequate therapy strategy which provides a high degree of survival in patients on hemodialysis.