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Article ; Online: Heart failure therapy challenges in obese patients

Đenić Aleksandar

Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor", Vol 28, Iss 88, Pp 21-

2023 Volume 42

Abstract: Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion of aldosterone and activation of the renin-angiotensin system (RAAS) in obese patients leads to ... ...

Abstract	Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion of aldosterone and activation of the renin-angiotensin system (RAAS) in obese patients leads to sodium retention and an increase in extracellular volume, which contributes to the development of heart failure and increased cardiovascular risk. Abdominal visceral obesity is associated not only with an increased risk for the development of heart failure with preserved ejection fraction (HFpEF), but also with a high risk for the development of diabetes mellitus and hypertension in both sexes, but more dominantly in women, with an increase in incidence with menopause. Multiple studies and meta-analyses have confirmed that obese patients with heart failure regardless of ejection fraction (HFpEF and HFrEF) have better survival compared to those of normal or underweight, a phenomenon known as the obesity paradox. The HF-ACTION trial showed that even small improvements in cardiorespiratory fitness could lead to significant improvements in cardiovascular outcomes, reducing the impact of the obesity paradox on the clinical outcome of heart failure. The ESC recommendations for heart failure advise weight loss in order to prevent cardiovascular disease in obese and overweight patients, and gradual weight loss should be considered in patients with heart failure and BMI > 35 kg/m2 , while in patients with heart failure and BMI<35 kg/m2 , weight loss is not recommended. The goal of bariatric procedures is to prevent or delay the onset of heart failure, not only by reducing body weight but also by reducing risk factors. The randomized DAPA-HF trial showed that the use of dapagliflozin proved to reduce the composite outcome of worsening heart failure or cardiovascular death in heart failure patients with BMI>30 kg/m2 and in HF patients with BMI<30 kg/m2 . The EMPEROR-preserved and DELIVER trials showed that therapy with SGLT2 inhibitors in patients with HFpEF and ...
Keywords	obesity ; heart failure ; the obesity paradox ; cardiorespiratory fitness ; bariatric surgery ; sglt2 inhibitors ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Similarities and differences of cardiovascular complications of COVID-19 infection and COVID-19 vaccination

Đenić Aleksandar

Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor", Vol 27, Iss 84, Pp 69-

2022 Volume 89

Abstract: COVID-19 patients may experience with a wide range of cardiovascular complications during infection: obstructive and non-obstructive coronary artery disease-acute coronary syndrome (myocardial infarction type 1 and type 2), arterial or venous ... ...

Abstract	COVID-19 patients may experience with a wide range of cardiovascular complications during infection: obstructive and non-obstructive coronary artery disease-acute coronary syndrome (myocardial infarction type 1 and type 2), arterial or venous thromboembolic diseases, myocarditis, pericarditis, pericardial effusion, stress cardiomyopathy (Takotsubo syndrome), arrhythmias, acute heart failure, shock and sudden cardiac death (cardiac arrest). Cardiovascular complications that may occur after COVID-19 vaccination are: myocarditis, pericarditis, thromboembolic events, hypertension, acute coronary syndrome, stress cardiomyopathy, arrhythmias and cardiac arrest. Myocarditis and pericarditis occurred in 3/4 of all cases after the second dose of mRNA vaccine against SARS-COV2 virus, most often in young adults. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare condition that occurs after vaccination against SARS-COV2, more prevalently in young women (under 50 years of age). The incidence of acute myocardial infarction is 0.02% and 0.03% depending on the type of mRNA vaccine (Pfizer or Moderna), more common in males and the elderly, with symptoms onset the most frequently up to 24 hours after vaccine application. The most common arrhythmias that occur after COVID-19 vaccination are sinus tachycardia, atrial fibrillation, and supraventricular tachycardia. The benefit-risk ratio of COVID-19 vaccination to the occurrence of cardiovascular complications strongly prevails in favor of vaccines for all age groups (older than 12 years) and for both sexes.
Keywords	covid-19 ; covid-19 vaccination ; cardiovascular complications ; myocarditis ; pericarditis ; myocardial infarction ; thrombosis ; arrhythmias ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics of thromboprophylaxis in elderly patients before and after orthopedic hip and knee surgery

Đenić Aleksandar

Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor", Vol 27, Iss 87, Pp 44-

2022 Volume 63

Abstract: Elderly patients with a hip fracture are at significantly higher risk for developing venous thromboembolism (VTE). The incidence of fatal pulmonary embolism (PE) occurs in 2-3% of patients after elective hip and knee surgery and about 6-7% after hip ... ...

Abstract	Elderly patients with a hip fracture are at significantly higher risk for developing venous thromboembolism (VTE). The incidence of fatal pulmonary embolism (PE) occurs in 2-3% of patients after elective hip and knee surgery and about 6-7% after hip fracture surgery, with a higher risk in men (10,2%) than in women (4,7%). The use of pharmacological prophylaxis significantly reduces the incidence of symptomatic VTE. Pharmacological prophylaxis includes the use of antiplatelet drugs (aspirin), unfractionated heparin (UFH), low molecular weight heparins (LMWH), vitamin K antagonists (VKA), Fondaparinux and direct oral anticoagulants (DOAC). The use of low molecular weight heparins (LMWH) - enoxaparin, represents the gold standard of thromboprophylaxis in orthopedic surgery, and for now, they are the only drugs that are recommended for thromboprophylaxis in hip fracture surgery. Rivaroxaban is used in the prophylaxis of VTE in elective hip and knee surgeries at a fixed dose of 10 mg once daily, and apixaban at a dose of 2,5 mg twice daily in knee arthroplasty for at least 14 days, and after hip arthroplasty for at least 35 days. Early hip fracture surgery as soon as possible, preferably within 24 hours, and no later than 48 hours after admission to the hospital, significantly reduces the morbidity and mortality of elderly patients.
Keywords	thromboprophylaxis ; venous thromboembolism ; low molecular weight heparin ; aspirin ; rivaroxaban ; apixaban ; hip fracture ; Medicine ; R
Subject code	616
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
Document type	Article ; Online
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Article ; Online: Structural adaptation to hyperfiltration defines CKD versus healthy aging.

Denic, Aleksandar / Rule, Andrew D

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2024

Language	English
Publishing date	2024-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfae063
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Article ; Online: New anticoagulant therapy aspects to the COVID-19 patients

Đenić Aleksandar

Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor", Vol 26, Iss 81, Pp 33-

From prophylaxis to complications treatment therapy

2021 Volume 51

Abstract: COVID-19 patients have a high risk of thrombosis of the arterial and venous systems due to extensive systemic inflammation, platelet activation, endothelial dysfunction, and stasis. D-dimer is an important prognostic marker of mortality caused by COVID- ... ...

Abstract	COVID-19 patients have a high risk of thrombosis of the arterial and venous systems due to extensive systemic inflammation, platelet activation, endothelial dysfunction, and stasis. D-dimer is an important prognostic marker of mortality caused by COVID-19 patients and its increased values indicate tissue damage and inflammation. The incidence of venous thromboembolism (VTe) is between 16 and 49% as a complication of more severe forms of COVID-19 infection in patients hospitalized in intensive care units. Prophylactic doses of low molecular weight heparin (lMWH) should be given to all hospitalized patients with COVID-19 infection in the absence of active bleeding. The safest way is to adjust the low molecular weight heparin (lMWH) dose according to body weight, especially in obese patients. Unfractionated heparin (UFH) is used in patients with a creatinine clearance of less than 30 ml/min. The therapeutic dose of anticoagulation should be discontinued if the platelet count is <50 × 109 /l or fibrinogen <1.0 g/l. Clinically significant bleeding events are higher in those who received therapeutic doses compared to those with standard thromboprophylaxis doses. Thrombolytic therapy is recommended in patients with proven pulmonary embolism (Pe) and hemodynamic instability or signs of cardiogenic shock, who are not at high risk of bleeding. In hospitalized COVID-19 patients with a high clinical risk of developing venous thromboembolism (VTe) and D-dimer values greater than 2600 ng/ml, the use of therapeutic doses of lMWH in doses adjusted to the patient's body weight should be considered, in the absence of a higher risk of bleeding.
Keywords	covid-19 ; d-dimer ; venous thromboembolism ; pulmonary embolism ; low molecular weight heparin ; anticoagulant therapy ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pulmonary thromboembolism and pericardial effusion as cardiovascular complications of COVID-19 infection

Đenić Aleksandar

Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma "Zlatibor", Vol 26, Iss 80, Pp 34-

2021 Volume 57

Abstract: Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary ... ...

Abstract	Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary thromboembolism) and deep vein thrombosis. Myopericarditis may occurs in COVID-19 patients as part of or after the onset of respiratory symptoms. Minor pericardial effusions up to 1 cm that accompany pericardial involvement are common. In our patient during hospitalization due to bilateral pneumonia caused by SARS-Cov-2 virus during a routine control of D-dimer, elevated values 2.3 fold higher than the reference range were observed, with elevated biomarkers of inflammation. She had symptoms of a respiratory infection and no pronounced clinical symptoms that would indicate pulmonary thromboembolism. MSCT pulmonary angiography was performed and low-risk thromboembolism was confirmed. Anticoagulant therapy was started - therapeutic doses of low molecular weight heparin (enoxaparin), which was extended after discharge from the hospital with DOAC (Rivaroxaban) according to the protocol for the treatment of pulmonary thromboembolism. At the control examination after 3 weeks, pericarditis with moderate pericardial effusion was determined. Anticoagulant therapy (DOAC) was extended with the inclusion of colchicine in the therapy according to the protocol for the treatment of pericarditis with effusion. After 3 months of hospitalization in our patient with mild respiratory symptoms, bronchopneumonia of the right lung developed with slightly elevated biomarkers of inflammation and normal values of D-dimer. With prescribed antibiotic therapy and current therapy (DOAC and colchicine), there was a withdrawal of symptoms and regression of pericardial effusion and a reduction in right ventricular overload. At the follow-up examination 5 months after hospitalization, complete regression of pericardial effusion was confirmed with normal biomarkers of inflammation and D-dimer values. It is ...
Keywords	covid-19 ; sars-cov-2 ; pulmonary thromboembolism ; pericarditis ; pericardial effusion ; d-dimer ; anticoagulant therapy ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Specijalna bolnica za bolesti štitaste žlezde i bolesti metabolizma Zlatibor
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Morphometric analysis of chronicity on kidney biopsy: a useful prognostic exercise.

Asghar, Muhammad S / Denic, Aleksandar / Rule, Andrew D

Clinical kidney journal

2024 Volume 17, Issue 2, Page(s) sfad226

Abstract: Chronic changes on kidney biopsy specimens include increasing amounts of arteriosclerosis, glomerulosclerosis, interstitial fibrosis and tubular atrophy, enlarged nephron size, and reduced nephron number. These chronic changes are difficult to accurately ...

Abstract	Chronic changes on kidney biopsy specimens include increasing amounts of arteriosclerosis, glomerulosclerosis, interstitial fibrosis and tubular atrophy, enlarged nephron size, and reduced nephron number. These chronic changes are difficult to accurately assess by visual inspection but are reasonably quantified using morphometry. This review describes the various patient populations that have undergone morphometric analysis of kidney biopsies. The common approaches to morphometric analysis are described. The chronic kidney disease outcomes associated with various chronic changes by morphometry are also summarized. Morphometry enriches the characterization of chronicity on a kidney biopsy and this can supplement the pathologist's diagnosis. Artificial intelligence image processing tools are needed to automate the annotations needed for practical morphometric analysis of kidney biopsy specimens in routine clinical care.
Language	English
Publishing date	2024-02-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sfad226
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Article ; Online: Authors' Reply: Morphometric Approach to Different Nephron Segments.

Denic, Aleksandar / Fnu, Aperna / Mahesh, Kumar / Rule, Andrew D

Journal of the American Society of Nephrology : JASN

2023 Volume 34, Issue 12, Page(s) 2054–2056

MeSH term(s)	Nephrons ; Kidney Tubules, Proximal
Language	English
Publishing date	2023-11-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.0000000000000234
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Article ; Online: Authors' Reply: Urine Metabolomic Versus Standard Chemistry Analysis: What can Metabolomic Analysis Bring to the Treatment and Prevention of Urolithiasis?

Thongprayoon, Charat / Lieske, John C / Rule, Andrew D / Denic, Aleksandar

Journal of the American Society of Nephrology : JASN

2023 Volume 34, Issue 6, Page(s) 1124–1125

MeSH term(s)	Humans ; Urolithiasis/prevention & control ; Urolithiasis/therapy ; Metabolomics
Language	English
Publishing date	2023-04-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.0000000000000138
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Article ; Online: Thyroid replacement therapy effects on cardiac function in patients with hypothyroidism

Đenić Aleksandar / Obrenović-Kirćanski Biljana

Srpski Arhiv za Celokupno Lekarstvo, Vol 149, Iss 1-2, Pp 24-

2021 Volume 29

Abstract: Introduction/Objective. Hypothyroidism is a hypometabolic syndrome with insufficient production or inadequate action of thyroid hormones. It is characterized by hypercholesterolemia, elevated LDL-C. The most common echocardiographic changes are in left ... ...

Abstract	Introduction/Objective. Hypothyroidism is a hypometabolic syndrome with insufficient production or inadequate action of thyroid hormones. It is characterized by hypercholesterolemia, elevated LDL-C. The most common echocardiographic changes are in left ventricular (LV) diastolic function. The aim of this study was to investigate the effects of achieving adequate thyroid hormone replacement therapy in hypothyroid patients on improving systolic and diastolic cardiac function and correcting serum lipid profile. Methods. Prospective study was conducted on 42 patients with newly diagnosed hypothyroidism, both sexes, aged 18–60 years, without comorbidity. The determined blood tests before, six, 12, and 24 weeks after starting the therapy with L-thyroxine were: FT4, TSH, total cholesterol, HDL-C, LDL-C and triglycerides. The effects of thyroid hormone replacement therapy on systolic and diastolic cardiac function were assessed by echocardiography. Results. It was concluded that 25 (59.5%) patients had subclinical and 17 (40.5%) overt hypothyroidism. The LV end-systolic diameter decreased statistically highly significant (p < 0.01) after 12 weeks and enddiastolic diameter of the right ventricle after six months of therapy. There was no significant decrease in LV end-diastolic diameter after six months of thyroid hormone replacement therapy. Mitral annular plane systolic excursion (MAPSE), left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion (TAPSE) values increased significantly (p < 0.01) after six weeks of therapy. Total cholesterol and LDL-C significantly decreased, HDL-C increased (p < 0.01) and there was no change in triglyceride concentrations after 24 weeks of therapy. Conclusions. Thyroid replacement therapy in hypothyroid subjects statistically significantly improves echocardiographic parameters of diastolic and systolic left and right ventricular function, reduces total serum cholesterol and LDL-C, and increases HDL-C.
Keywords	hypothyroidism ; l-thyroxine ; diastolic cardiac function ; systolic cardiac function ; lipid profile ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Serbian Medical Society
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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