Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30–120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement.

ABSTRACT Aim of the work: Examine clinical characteristics of aerobic vaginitis and mixed infection for the purpose of better diagnostic accuracy and treatment efficiency. Materials and methods: Prospective research has been conducted at Clinic for Gynecology and Obstetrics, Department for Microbiology and Pathology at Polyclinic for laboratory diagnostic and Gynecology and Obstetrics Department at Health Center Sapna. Examination included 100 examinees with the signs of vaginitis. Examination consisted of: anamnesis, clinical, gynecological and microbiological examination of vaginal smear. Results: The average age of the examinees was 32,62±2,6. Examining vaginal smears of the examinees with signs of vaginitis in 96% (N-96) different microorganisms have been isolated, while in 4% (N-4) findings were normal. AV has been found in 51% (N-51) of the examinees, Candida albicans in 17% (N-17), BV in 15% (N-15), Trichomonas vaginalis in 13% (N-13). In 21% (N-21) AV was diagnosed alone while associated with other agents in 30% (N-30). Most common causes of AV are E. coli (N-55) and E. faecalis (N-52). AV and Candida albicanis have been found in (13/30, 43%), Trichomonas vaginalis in (9/30, 30%) and BV (8/30, 26%). Vaginal secretion is in 70,05% (N-36) yellow coloured, red vagina wall is recorded in 31,13% (N-16) and pruritus in 72,54% (N-37). Increased pH value of vagina found in 94,10% (N-48). The average pH value of vaginal environment was 5,15±0,54 and in associated presence of AV and VVC, TV and BV was 5,29±0,56 which is higher value considering presence of AV alone but that is not statistically significant difference (p>0,05). Amino-odor test was positive in 29,94% (N-15) of associated infections. Lactobacilli are absent, while leukocytes are increased in 100% (N-51) of the examinees with AV. Conclusion: AV is vaginal infection similar to other vaginal infections. It is important to be careful while diagnosing because the treatment of AV differentiates from treatment of other vaginitis.

Nowadays, mobile terminal applications rapidly transform the meaning and context of health care services around the globe. Continuous monitoring of physical parameters is very important for improvement of the patient's life quality. Detection of ECG RR interval and QRS complex is crucial for diagnosis of heart diseases. In this paper, we present Bluetooth ECG Sensor Emulator in Matlab. We have tested the computation performances of mobile phones for monitoring and analysis of ECG signals. Three different peak detection algorithms were implemented using Java ME. MIT-BIH Arrythmia database signals were used for testing. Experimental results are discussed in order to determine their applicability to the real-time ECG telemonitoring.

The aim of the study was to determine serum levels of matrix metalloproteinase 9 (MMP-9) and high sensitivity C reactive protein (hsCRP) in patients with diagnosis of acute coronary syndrome (ACS). The study included 150 patients divided in three groups: patients with significant coronary artery disease (CAD), patients without significant coronary artery disease and patients with acute myocardial infarction (MI). Method used for determination of coronary artery disease significance is coronary angiography, and CAD is determined as significant if level of stenosis is > 50%. The group without significant CAD had lower MMP-9 serum concentrations than group with significant CAD, which has lower MMP-9 than group with acute MI. Difference in levels of MMP-9 serum concentration between groups with and without CAD is statistically significant. Level of serum hsCRP in group with MI is significantly higher than in other two groups. There is no significant difference in hsCRP serum level between group of patients with significant CAD and without significant CAD. Our results demonstrate the significance of MMP-9 and hsCRP level determination in assessment of acute coronary syndrome patients in the future as a biomarker of plaque instability.

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can be different forms and degrees of complications, e.g. left ventricular dysfunction. Fibrinolythic therapy is the only non-invasive treatment that directly influences the infarction outcome. The purpose of the study was to compare systolic function of the left ventricle measured by ejection fraction in circumstances in which an acute myocardial infarction was treated by primary stent implantation, by administration of fibrinolytic agent streptokinase, and medical treatment when none of the above mentioned methods has been used. Material and methods: A retrospective-prospective study was conducted with a sample of 90 patients, that were hospitalized in 2005 and 2006 for acute myocardial infarction, mean age being of 56±7. Patients were divided into three groups, with 30 patients in each: a group of patients refered to primary stenting, a group that received streptokinase, and a group of patients that were not treated with either of these methods. Elecrocardiogram and echocardiographic study were performed on all patients. Results: Ejection fraction was 58%±8 in stented group, 47%±7 in streptokinase group, and 33%±8 in group without either (p< .001). Discussion and Conclusion: Global systolic left ventricular function was significantly better in the group of stented patients compared to the one in patients treated with streptokinase. Streptokinase administered in the first 6 hours from myocardial infarction onset significantly improves preservation of left ventricular systolic function compared to conditions in which no fibrinolysis is used.

UNLABELLED About 50,000 women dead due to result hypertension in pregnancy every year worldwide. Frequency of hypertension in pregnancy is 5-10% and complicate pregnancy. Control of high blood presure in pregnancy and therapy of hypertension are elements that prevent complication as a praeclampsia, eclampsia, abruption of placenta and operation end pregnancy. Aim of work is to establishing frequency of hypertension of controlled group of pregnen women and determinate results of pregnancy in pregnant women with high blood presure. The sample were 230 pregnant women which we controlled in Health Care Sapna. Hypertension was found at 7 pregnant women or 3.04%, at 14.28% was found chronic hypertension and at 87.1% was found gestation hypertension. Pregnant women were controlled, averagely 4 times and pregnant women with hypertension were controlled 8 times. Hypertension was treated with drugs at 6 pregmnant women with hypertension and one pregnant women did not take a medicine. 28.57% pregnant women with hypertension was delivered Caesarean section and 71.42% was vaginal delivery. Pregnancy of one pregnant women with chronic hypertension who did not take medicine was complicated of abruption of placenta and she was delivered Caesarean section. Pregnant women with gestation hypertension did not complicate during delivery. CONCLUSIONS Regular control and therapy of hypertension during pregnancy can significantly reduce perinatal morbidity and mortality. Health educated pregnant women is important for control pregnancy as using advise and regular treating of medicine of pregnant women.

Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered high risk for coronary artery bypass grafting (CABG). LM disease is mainly considered a relative contraindication for off pump coronary artery bypass grafting (OPCAB) because of the reduced tolerancy of hamodynamic disturbances which occurs during mobilisation and exposition of the heart, necessary for this type of operations. The aim of the study is to show feasibility of OPCAB for patient with occlusion of the LM and 75% stenosis of the right coronary artery. Operation was carried out through median sternotomy, LIMA stitch was used for the exposure, CTS stabilisator was used for local myocardial stabilisation, intracoronary shunt was inserted intraluminary. Three aortocoronary bypasses were created, operation passed without any hamodynamic instability. Main peri and postoperative results: total length of the operation: 265 min; time on respirator: 1 hour; total blood drainage on chest tubes: 532 ml; transfused blood: 0 ml; time in the intensive care unit: 1 day; total hospitalisation time: 7 days. This case review suggest that OPCAB is feasible and safe in the treatment of patients with LM occlusion and significant stenosis of RCA.

Intracardial electrophysiology testing is in use to estimate mechanism of heart rate dysfunction, and is the most useful procedure in treatment of arrhythmias and dysfunction in impulse conduction. QRS complex is main electrocardiographically characteristic for supraventricular and ventricular tachycardia, because of that tachycardia can be with narrow QRS complex or with wide QRS complex. Tachycardia with narrow QRS complex is one where the QRS complex last <120 millisecond. Atrioventricular node reentry tachycardia in reentry flow involves atrioventriculare node and surrounding atrial tissue. Wide QRS tachycardia (120 millisecond) can be supraventricular arrhythmias with continuous or frequent dependent aberrant intraventricular conduction and supraventricular arrhythmias with anterograde preexcitacion and ventricular arrhythmia.Safety and cost effectiveness of radiofrekvent ablation, made ablation method of choise in most patients with supraventricular rhythm disorders.

It is generally accepted that inflammation has an important role, not just in the pathogenesis of atherosclerosis, but also in initiation of acute coronary syndrome (ACS). A number of studies showed, that a high concentration of high sensitivity C reactive protein (hsCRP) is an independent risk factor for the development of cardiovascular disease in a healthy person. HsCRP can predict new cardiovascular episodes, including death, in patients with unstable angina and acute myocardial infarction (AMI). Ability of oxidated low densiti lipoprotein (oxLDL) to induce accumulation of holesterol in macrofage was his first described proaterogenic characteristic and it help in hipotesis that oxidation of low densiti lipoprotein (LDL) can be important step in proces of aterogenesis. Framingham study showed that ther is significant corelation between level of total holesterol in blood and coronary artery disease (CAD). Evaluation of bouth hsCRP and LDL levels is superior in detection of CAD. Aims of this study were to determine values of hsCRP in patients with coronary arteries disease verified by coronary angiography (stenosis>70%), and to check if values of hsCRP higher than 3.0 mg/ dL are better predictor of coronary artery disease then lipid status. A prospective study was conducted on 60 patients, who were divided in two groups in compliance with significance of coronary artery disease. All patients have earlier diagnosis of ACS, and from this study excluded patients with acute infection, chronic, systemic or malignant disease. This research shows that patients with significant coronary artery disease, verified by coronary angiography, have higher values of hsCRP than those without disease that have values within the range of the reference values (0-3 mg/dL). Patients with coronary artery disease verified by coronary angiography have values of hsCRP that put them in a group of patients with intermediate to high risk of a future acute cardiovascular event, by classification of American Heart Association. In group of patients with coronary disease there is significant elevation of LDL and total cholesterol. With elevation of HDL values there is reduction in hsCRP values in patients with no significant coronary artery disease.

This study reviewed the early experience with off-pump coronary artery bypass surgery in treatment of patients with severe left main coronary artery stenosis. From May 2002-December 2003, 75 patients with significant left main coronary artery stenosis (> or = 50%) underwent coronary artery bypass grafting. 35 patients were operated without the use of cardiopulmonary bypass (OPCAB) and compared with 40 patients operated with the use of cardiopulmonary bypass (ONCAB). Mean age, ejection fraction and EUROSCORE were similar in both groups. Average grafts per patients was also similar (OPCAB 3.0 vs. ONCAB 3.2). The incubation time (3.1 vs. 5.8 hours), blood loss (445 vs. 610 ml) and hospital stay (6.8 vs. 8.1 days) were less in OPCAB group. There was no mortality in OPCAB group whereas 2 patients (5.0%) died in ONCAB group. Our early experience suggests that off-pump coronary artery bypass surgery is effective in treatment of patient with severe left main coronary artery stenosis and has advantages compare to operations with the use of cardiopulmonary bypass.