Peter Galajda

Circulating vascular endothelial growth factor in the normo- and/or microalbuminuric patients with type 2 diabetes mellitus.

Relationship between serum vascular endothelial growth factor (VEGF) level and parameters of endothelial injury and/or dysfunction in patients with diabetes mellitus type 2 with or without microalbuminuria was investigated. Eighty-four diabetic patients were divided in two subgroups (42 each): normoalbuminuric (NAU) and microalbuminuric (MAU). Forty-two blood donors were in control group. Serum VEGF and plasma von Willebrand factor, soluble thrombomodulin, plasminogen activator inhibitor 1, thrombin-activatable fibrinolysis inhibitor (TAFI) and tissue plasminogen activator (t-PA) were measured using enzyme-linked immunosorbent assay in all subjects. VEGF was significantly higher in NAU compared to controls. The difference between MAU and controls was not statistically significant, but there was a trend toward significance. Only TAFI correlated with VEGF in MAU. An observed significant increase of serum VEGF level already in NAU suggests that serum VEGF could be a sensitive predictor of endothelial dysfunction in type 2 diabetes.

Prevalence of diabetes mellitus and metabolic syndrome in Slovakia

BACKGROUND Slovakia is a country with high prevalence of diabetes mellitus (DM) and coronary heart disease (CHD), but the reason of west-east gradient prevalence in Europe is not clear. METHODS We analyzed 1517 subjects responding to structure of Slovak adult population according to age, sex and regions. Self-reporting CHD risk factors, waist circumference, body mass index (BMI), blood pressure, levels of fasting and 2h glucose, triglycerides, and HDL cholesterol were examined. Impaired fasting glucose (IFG) and DM were diagnosed according to American Diabetes Association (ADA) criteria and the metabolic syndrome (MS) according to NCEP/ATP III and International Diabetes Federation (IDF) criteria. RESULTS We confirmed 7.0% DM prevalence, including 5.3% of known DM, 1.2% of new DM according to the ADA criteria, and 0.5% of additional new DM cases after oral glucose test (oGTT) in subjects with IFG. Prevalence of MS according to NCEP/ATP III criteria were 20.1% (15.9% in males and 23.9% in females) and 38.1% according to IDF criteria (39.7% in males and 36.6% in females). Low HDL was the most common MS component in the Slovak population (56% total, 45% in male and 66% in female subjects). CONCLUSIONS DM prevalence in Slovakia is higher than in West European countries and equal to the Mediterranean countries. MS prevalence and its components are equal to European population with the exception of low HDL, which is one of the highest in Europe.

ENDOTHELIAL MARKERS IN DIABETES MELLITUS

In this study we examined 22 NIDDM patients without vascular complications and 17 age-matched healthy blood donors. Von Willebrand factor (vWF) levels were significantly increased in NIDDM patients compared to healthy blood donors (1.33 +/- 0.39 vs 1.01 +/- 0.27 IU/ml p = 0.006), while thrombomodulin (TM) levels were similar in the both groups. vWF levels correlated with calcium dependent secretion parameters such as C-peptide (r = 0.680, p < 0.001) and PF4 (r = 0.613, p < 0.01) and did not correlate with calcium-independent markers of endothelial injury such as TM (r = 0.287, p = 0.196) and TFPI (r = 0.296, p = 0.181). Therefore it seems that increased levels of Cai-dependent endothelial and platelet activation markers may precede the signs of endothelial damage. This hypothesis requires further research.

Soluble P-Selectin During a Single Hemodialysis Session in Patients With Chronic Renal Failure and Erythropoietin Treatment:

In several studies, hemodialysis (HD) patients treated with recombinant human erythropoietin (rHuEPO) because of renal anemia showed increased levels of soluble adhesion molecules. The purpose of the study was to investigate the changes of soluble P-selectin (sSELP) and its relationship to platelet activation during a single HD session in patients with long-term rHuEPO treatment. Fifty-two HD patients with chronic renal failure were involved—26 with rHuEPO treatment (EPO group) and 26 without (non-EPO group). Thirty healthy subjects served as the control group. The sSELP, β-thromboglobulin, and platelet factor 4 plasma levels were measured before and after a single 4-hour HD session on a cuprophane dialyzer. The basal β-thromboglobulin and platelet factor 4 plasma levels were significantly increased in both HD groups compared with healthy controls but did not change after a single HD session, except for a significant decrease of platelet factor 4 in the non-EPO group. The predialysis sSELP plasma levels did not differ significantly compared with those of the healthy controls, but there was a significant increase of sSELP levels after a single HD session in both groups (EPO, P < .005; non-EPO, P < .05, respectively). These results suppose that the increased sSELP level was released from platelets during the course of a single HD session. The more significant increase of the sSELP plasma levels in EPO group during HD indicates that platelets are more activated in patients with long-term rHuEPO treatment, and this fact could partially explain the suspected tendency for thrombosis in these patients.

Endothelial and platelet markers in diabetes mellitus type 2.

Diabetes mellitus (DM) is an extremely common disorder which carries a risk of vascular impairment. DM type 2 (DM2) can be characterized by the dysfunction of haemostasis manifesting by stimulated coagulation process, disorder of platelet function and decreased fibrinolytic activity. These all are the reasons why DM2 is the most common acquired thrombophilia. Endothelial dysfunction along with platelet hyperactivity are unquestionably involved in the hyperactivation of platelets and clotting factors in DM. As a natural consequence of continuous investigation, many markers of endothelial dysfunction and diabetic thrombocytopathy have been identified and considered for implementation in clinical practice. Endothelial function can be assessed by the evaluation of endothelial markers, circulating molecules synthesised in various amounts by the endothelium. These markers precede the signs of evident microangiopathy. Platelets have an ethiopathogenic relation to the microangiopathy in DM. Their increased activity was confirmed in both types of DM. Predictors of endothelial and platelet disorder could improve the screening of individuals at increased risk, thus leading to the early diagnosis, appropriate treatment, as well as to the effective prevention of the complications of DM2. In the article we deal with the mechanisms involved in the pathogenesis of endothelial and platelet functional abnormalities, endothelial and platelet markers of DM2 considered for implementation in clinical practice and possibilities of their detection.

The Intricate Network of Adipokines and Stroke.

Cerebrovascular disorders, particularly ischemic stroke, are one of the most common neurological disorders. High rates of overweight and obesity support an interest in the role of adipose tissue and adipose tissue releasing cytokines in inducing associated comorbidities. Adipokines can serve as a key messenger to central energy homeostasis and metabolic homeostasis. They can contribute to the crosstalk between adipose tissue and brain. However recent research has offered ambiguous data on the network of adipose tissue, adipokines, and vascular disorders. In our paper we provide a critical insight into the role of adipokines in evolution of ischemic stroke.

Waist Circumference as an Independent Risk Factor for NODAT

BACKGROUND New-onset diabetes mellitus after transplantation (NODAT) is a serious and frequent complication of solid organ transplantations. NODAT leads to 2-3 times higher cardiovascular morbidity and mortality. Visceral obesity is a key factor for diabetes mellitus type 2 and metabolic syndrome development, and is an independent risk factor for cardiovascular diseases. MATERIAL AND METHODS The series consisted of 167 patients after primary kidney transplantation from a dead donor (64 patients had developed NODAT), average age of the series was 46.1±11.6 years. We retrospectively examined waist circumference, body mass index, and weight gain in the 12th month after transplantation. We examined average level of triglycerides, cholesterol, and immunosuppression throughout the 12 monitored months. RESULTS Patients with NODAT were significantly older (P=0.004) and had greater waist circumference (P<0.0001) and higher average sirolimus level (P=0.0262). We identified the following independent risk factors for NODAT by using multivariate analysis: age at the time of transplantation above 50 years (HR=2.5038, [95% CI: 1.7179 to 3.6492], P<0.0001), waist circumference in men greater than 94 cm (HR=1.9492, [95% CI: 1.1697 to 3.2480], P=0.0104) and in women greater than 80 cm (HR=4.5018, [95% CI: 1.8669 to 10.8553], P=0.009). By using correlation coefficient we have proved that greater waist circumference was related to higher incidence of NODAT (r=0.1935, [95% CI: 0.01156 to 0.3630], P=0.0374). Graft survival (death censored) 12 months after kidney transplantation was 97.1% in the control group and 95.3% in the NODAT group (P=0.5381). Patient survival 12 months after kidney transplantation in the control group was 98.1% and in the NODAT group it was 96.9% (P=0.6113). CONCLUSIONS We identified waist circumference as an independent risk factor for NODAT in our analysis.

Sticky platelets syndrome in a young patient with massive pulmonary embolism.

Patient: Female, 51 Final Diagnosis: Sticky platelets syndrome Symptoms: Pulmonary embolism Medication: — Clinical Procedure: Thrombolysis Specialty: Hematology Objective: Disease of unknown ethiology Background: Sticky platelets syndrome (SPS) is an inherited thrombophilia characterized by platelet hyperaggregability, which can lead to the higher risk of thrombosis. The etiology of SPS remains unclear, but several gene polymorphisms have been recently studied and autosomal dominant heredity is suspected. Although SPS is traditionally connected with arterial thrombosis, several cases of SPS as a cause of venous thromboembolism have been described. Case Report: We report the case of a 51-year-old apparently healthy woman with massive pulmonary embolism, who required thrombolytic therapy. In this patient SPS was identified as the only condition leading to higher risk of developing thromboembolic disease. Conclusions: Although at present few physicians have practical experience with SPS, this syndrome may lead to serious health problems or even death. The presented case points to the benefit of SPS diagnostics in standard screening of inherited thrombophilia for effective prophylaxis and treatment in patients with venous thromboembolism.

Twelve-Month and Five-Year Analyses of Risk Factors for New-Onset Diabetes After Transplantation in a Group of Patients Homogeneous for Immunosuppression.

OBJECTIVE In the case of new-onset diabetes after transplantation (NODAT) development, it is suitable to reduce calcineurin inhibitors and corticosteroids. But change of immunosuppression can be counterproductive and can cause development of rejection and leads to further NODAT aggravation. METHODS We retrospectively evaluated risk factors after kidney transplantation. Comparison groups were homogeneous in terms of administered immunosuppression, and individual monitored parameters were not distorted by the immunosuppression administered. RESULTS In the 12-month analysis we identified these risk factors for NODAT: age at the time of transplantation, 50-59 years (P = .0034); age at the time of transplantation, ≥ 60 years (P < .0001); positive family anamnesis for diabetes mellitus type 2 (P < .0001); body mass index at the time of transplantation, ≥ 30 kg/m(2) (P = .0236); prediabetes before transplantation (P < .0009); and proteinuria, >0.15 g/d (P < .0002). In the 5-year analysis, we identified patients who were diagnosed with NODAT after the 1st year. We identified age ≥ 50 years at the time of transplantation to be an independent risk factors for NODAT. CONCLUSIONS It is advisable to carry out the oral glucose tolerance test even in patients with physiologic levels of fasting glycemia.

Clopidogrel resistance in diabetic patient with acute myocardial infarction due to stent thrombosis.

Stent thrombosis is a morbid complication after percutaneous coronary intervention. Dual antiplatelet therapy significantly reduces stent thrombosis risk and forms currently the basis in acute ST elevation myocardial infarction pharmacologic treatment. The introduction of clopidogrel has made a major advance in the acute coronary syndrome treatment. However, there is growing evidence about failure in antiplatelet response after clopidogrel, which may lead to subsequent risk of future thrombotic events. The antiplatelet inhibitory effect of clopidogrel varies widely among individuals. High on-treatment platelet reactivity has been repeatedly associated with a hazard for cardiovascular events, including stent thrombosis. Laboratory monitoring of antiplatelet therapy efficacy may help identify patients with insufficient antiplatelet response. Prasugrel therapy was repeatedly described as an effective method to overcome clopidogrel resistance. We report a case of diabetic patient in whom myocardial reinfarction due to stent thrombosis developed. Clopidogrel resistance was detected in this patient using light transmission aggregometry and vasodilator-stimulated phosphoprotein phosphorylation assessment. After prasugrel administration, no other ischemic event occurred, and patient was released to outpatient care in good general condition.