Relationship between inflammatory markers and clinical patterns of atrial fibrillation in patients with congestive heart failure

BACKGROUND: Occurence of atrial fibrillation (AF) adversely affects left atrial size and cardiac function. This arrhythmia is also associated with an increase of plasma CRP and fibrinogen concentration. It is not clear whether elevated levels of inflammatory markers in patients with congestive heart failure (CHF) are associated with AF, clinical symptoms or adverse cardiac remodelling. AIM: To investigate the association between levels of inflammatory markers and selected clinical and echocardiographic parameters as well as used treatment in the population of CHF patients with various forms of AF. METHODS: The cross-sectional study included 99 patients with CHF divided into 3 groups. Group I included patients with sinus rhythm. Group II consisted of patients admitted to hospital with AF and discharged with sinus rhythm (the category of paroxysmal and persistent AF). Group III comprised patients with permanent AF. In all patients plasma CRP and fibrinogen concentrations were measured and echocardiographic examination was carried out. Left atrial dimension (LA), ejection fraction (LVEF) and right ventricular systolic pressure (RVSP) were assessed. RESULTS: Mean CRP concentration in group III (5.83+/-5.36 mg/l) was significantly higher than in group I (p=0.001) and group II (p=0.033). In the group with permanent AF mean fibrinogen concentration was elevated to a higher level (391.0+/-77.3 mg/dl) than in group II (p=0.007) and group I (p=0.099). Mean LA and RV dimensions and RVSP in group III were significantly higher than in group I and group II. Multivariable analysis revealed that plasma CRP concentration was significantly associated with the presence of arterial hypertension (p <0.001) and LA enlargement (p=0.007). A significant association between fibrinogen level and CRP level (p=0.038), presence of permanent AF (p=0.045) and metabolic syndrome (p <0.05) was found. Values of ln CRP were significantly correlated with LA diameter (r=0.24; p=0.015). CONCLUSIONS: Increased plasma CRP level in patients with CHF were significantly associated with arterial hypertension and LA enlargement. Permanent form of AF and CRP level have been shown to be significantly associated with increased plasma fibrinogen concentration in the course of CHF.     

5 years after IOM ... the evolving state of patient safety

How much progress has the health care field made in its patient safety endeavors in the five years since "To Err Is Human" sparked major headlines and soul-searching?     

The role of neurotrophic factors in the pathology and treatment of multiple sclerosis

Multiple sclerosis (MS) is a chronic demyelinating disease of primary autoimmune origin with essential component of subsequent axonal degeneration. It has been found that inflammatory cells crucial for MS pathogenesis are able to release neurotrophic factors (NFs). Thus the concept of neuroprotective effect of inflammation has arisen. Over recent years, increasing number of studies has revealed that NFs play an important role in MS and its animal model — experimental autoimmune encephalomyelitis (EAE). In the current review the evidence for the role of NFs in MS pathogenesis the same as their remarkable potential in MS therapy is presented.     

Differential cytokine profile in children with cystic fibrosis

The previously observed occurrence of antineutrophil cytoplasmic autoantibodies (ANCA) in patients who have cystic fibrosis (CF), together with the reported decrease in IgG2, a Th1-controlled isotype, suggests a potential for Th1/Th2 imbalance in CF patients with a possible Th2 predominance. 48 CF patients and 16 controls had levels of IFNgamma, IL-4, and IL-10 measured in supernatants of whole blood cell cultures stimulated by lipopolysaccharide (LPS) and phytohemaglutinine (PHA). The patients were divided into 2 groups: "low responders", having negligible secretion of cytokines (IFNgamma: 10.0-200.0 pg/ml, IL-4: 0.0-0.3 pg/ml) and "high responders", producing high levels of both IFNgamma (500.0-2000.0 pg/ml) and IL-4 (1.0-200.0 pg/ml). There was a statistically significant (P < 0.01) deterioration of lung function measured by an FEV(1) decline by 11.2% over 3 years in the "low responder" group. 10 of 16 "low responders" had chronic lung infections with P. aeruginosa while such infection was less prevalent in the "high responder" group where only 13 of 32 CF patients had positive cultures. A shift towards Th2 response was observed in the "high responder" group as children chronically infected with P. aeruginosa had greater IL-4 production than non-infected CF patients within the same cohort. ANCA autoantibodies were found only in the "high responder" group. Th2 immune response predominance in a subset of CF patients is associated with chronic P. aeruginosa infection.     

Clinical and Economic Outcomes of Infants Receiving Breast Milk in the NICU

ISSUES AND PURPOSE. This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula.
DESIGN AND METHODS. A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula-fed infants.
RESULTS. Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups.
PRACTICE IMPLICATIONS. While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long-term clinical and economic outcomes may be sensitive to this specialized nursing service.     

Hospital Profiling and Hospital Stratification System as a Step for Assessment the Potential of Organ Donation From Deceased Donors

Aim

To be able to calculate the potential of organ donation from deceased donors in a single hospital, region, and country, it is necessary to develop a useful stratification system for all hospitals taking into account their characteristics in having or not having departments crucial for donor identification and recruitment, such as an intensive care unit (ICU or neurology and neurosurgery departments), number of beds, and patient profiles (pediatric vs adult).