BACKGROUND Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL). RESULTS In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE ( P interaction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with P interaction = 0.43. CONCLUSIONS In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402 )

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Although true treatment resistant hypertension is relatively rare (about 7.3% of all patients with hypertension), optimal control of blood pressure is not achieved in every other patient due to suboptimal treatment or nonadherence. The aim of this study was to compare effectiveness, safety and tolerability of various add-on treatment options in adult patients with treatment resistant hypertension The study was designed as multi-center, prospective observational cohort study, which compared effectiveness and safety of various add-on treatment options in adult patients with treatment resistant hypertension. Both office and home blood pressure measures were recorded at baseline and then every month for 6 visits. The study cohort was composed of 515 patients (268 females and 247 males), with average age of 64.7 ± 10.8 years. The patients were switched from initial add-on therapy to more effective ones at each study visit. The blood pressure measured both at office and home below 140/90 mm Hg was achieved in 80% of patients with add-on spironolactone, while 88% of patients taking this drug also achieved decrease of systolic blood pressure for more than 10 mm Hg from baseline, and diastolic blood pressure for more than 5 mm Hg from baseline. Effectiveness of centrally acting antihypertensives as add-on therapy was inferior, achieving the study endpoints in <70% of patients. Adverse drug reactions were reported in 9 patients (1.7%), none of them serious. Incidence rate of hyperkalemia with spironolactone was 0.44%, and gynecomastia was found in 1 patient (0.22%). In conclusion, the most effective and safe add-on therapy of resistant hypertension were spironolactone alone and combination of spironolactone and a centrally acting antihypertensive drug.

IPAH is a severe heart disease with non-specific signs and symptoms. Screening for IPAH is transthoracic colour Doppler echocardiography shows high correlation with cardiac catheterization.

The aim of this paper is to show our results in the treatment of femur neck fractures in patients on hemodialysis. The femur neck fractures are more common in patients on hemodialysis than in patients without chronic renal failure. From the year 2000. to 2012, in the Traumatologic center of the CHC Zemun, 12 patients in terminal renal failure with femur neck fractures, were treated. The postoperative rehabilitation, occurence of complications and survival rates were followed. The operative treatment of femur neck fractures by implantation of endoprosthesis in patients with chronic renal failure, although followed by frequent complications, gives the patient a chance to return to normal activity. ApstraktCilj ovog rada je da prikažemo naše rezultate le enja preloma vrata butne kosti kod bolesnika na hemodijalizi.Prelomi vrata butne kosti kod bole¬snika na hemodijalizi se eš e javljaju u odnosu na bolesnike bez hroni ne bubrežne insuficijencije.Od 2000 god., do 2012 god., na Traumatološkoj službi KBC Zemun, le eno je 12 bolesnika sa prelomom vrata butne kosti koji su u terminalnoj fazi bubrežne insuficijencije.Pra ena je postoperativna rehabilitacija, nastanak komplikacija i vreme preživljavanja. Operativno leenje preloma vrata butne kosti implantacijom endoproteze. kuka, kod bolesnika sa hroni nom bubrež-nom insuficijencijom, iako je pra eno estim komplikacijama, daje šansu bolesniku da se vrati normalnim životnim aktivnostima.Klju ne re i: prelomi vrata butne kosti, hemodijaliza, endoproteza kuka ORIGINAL ARTICLES UvodPrelomi vrata butne kosti predstavljaju jedan od naj eš ih preloma u populaciji osoba starijih od 65 godina. Prema aktuelnim istraživanjima u najve em broju razvijenih zemalja incidenca iznosi izme u 100-110 na 100.000 stanovnika godišnje. Poslednjih godina konstatovano je zna ajno pove anje broja ovih preloma, a po nekim prognozama, u SAD, u 2050. godini o ekuje preko 6000000 preloma vrata butne kosti 1 . Prelomi vrata butne kosti kod bolesnika na hemodijalizi se eš e javljaju u odnosu na bolesnike bez hroni ne bubrež-ne insu cijencije. Brojni su razlozi koji dovode do toga-poreme en metabolizam kostiju zbog sekundarnog hiperparatireodizma, nizak nivo vitamina D u serumu kao i metaboli ka acidoza 2,3 .Kao posledica dijalize dolazi i do nakupljana beta-2-mikroglobulin amyloida. Koli ina amiloida koja se nakuplja u organizmu direktno zavisi od dužine dijalize, a uzrokuje i druge promene na lokomotornom sistemu-carpal tunel sindrom, bol u predelu ramena, liti ne koštane lezije itd. 4 Kod pacijenata bez hemodijalize le enje preloma vrata butne kosti pra eno je brojnim i estim komplikacijama i mortalitetom u toku prve godine nakon operacije od 15% do 40%. Mortalitet u toku prve godine kod bolesnika sa hemodijalizom je oko 50% 5,6,7 . Kod ovih bolesnika je eš a pojava infekcije, duboke venske tromboze, produžene drenaže rane.Cilj ovog rada je da prikažemo naše rezultate le enja preloma vrata butne kosti kod bolesnika na hemodijalizi.