Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measuremen... more Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measurements of serum levels. Due to various limitations in its dosing, different challenges still exist in clinical practice. This study aimed to assess digoxin though concentrations after different regimens in adult and elderly patients, and to identify predictor variables for the ratio of given dose and digoxin trough level. This was prospective open-label study. Digoxin was administered per os as 0.125 or 0.25 mg during different continuous and interrupted dosage regimens. Study protocol allowed an additional therapy according to contemporary guidelines. Digoxin concentrations were determined using Abbott AxSYM Digoxin II assay in trough samples (1-3 per patient) after 3-4 weeks stable regimen. In total, 191 concentrations (104 patients) were analyzed. Digoxin weekly dose was in range 0.375-1.75 mg. On average, we observed slightly lower digoxin levels in HF patients. Results showed that in patients receiving digoxin with interrupted dosage regimen post- pause digoxin level was statistically significantly lower than pre-pause (p < 0.05). Based on multi- ple linear regression, the ratio of given dose and trough concentration was mainly predicted by clearance creatinine, and to lesser extent by patient's ideal body weight. Interrupted dosing schedule shows greater variability in drug levels comparing to continuous dosing, and it additionally causes difficulties in reaching and maintaining steady trough levels between doses. Hence, individualization of dosing regimen should be carefully guided based on target levels and not solely on clinical signs and symptoms.
Introduction: Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvu... more Introduction: Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvular, great vessels and CABG surgery. In several large studies TEE has been shown to have higer sensitivity than TTE for native valve (94-100% vs. 44-63%) and prosthetic valves (75% vs 25%) both have high specificity (91-98%). TEE has got its value, particularly when surgeon intends to repair diseased valves, which are favorable operations due to its better survival rate, better ventricular function and fewer tromboembolic events. Most commonly valve repairs performed in patients with mitral and tricuspid valve diseases although reparative procedures have been described for all valve positions. Aim: Our aim is to define how important is TEE during mitral valve repairing operations. Patients and methods: At our institution, during five years period (between may 1999. and may 2004.) 29 patients have been operated with mitral valve repairing and monitored by TEE intraoperatively. They all went through preoperative preparations at the Clinic for Heart diseases and rheumatism, as well as Cardiology dept. of Cardiac surgery clinic KCU Sarajevo. We were following ASE/SCE guidelines for intraoperative examination during four different intraoperative mitral valve surgery stages, using Siemens ultrasound machine Sonoline Versa Plus with TEE multiplane probe type MPT-4. Results: For 20 pts. (71%) mitral valve repairing has been performed solely, in 9 (29%) pts. combined mitral and tricuspide valves repairing. In two cases (6,9%) after not satisfied repairing cardiac surgeon had to replaced native (previously repaired) mitral valve with mechanical prosthesis. 7 pts. (24%) got Carpantier rings and others 22 (76%) have been operated with pericardium patch. Conclusions: IOP TEE proved to be very useful in determination of the nature, severity and egzact anatomic location (scaloping) of the mitral and other valves disorders, in assessment of the urgency and feasibility of valves reparation and in plaining of the surgical procedures. In the case of poor surgical valve reparations, intraoperative TEE is the first method of choice in monitoring the process of valve reparation and in estimating the time for valve replacement.
Introduction: Increased inflammatory markerscorrelate with progressive hypothyroidism. The link b... more Introduction: Increased inflammatory markerscorrelate with progressive hypothyroidism. The link between subclinical hypothyroidism, subclinical inflammation and cardiovascular disease in postmenopausal women still remains unclear.
Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its i... more Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its intracardiac effects include severe valvular insuffi ciency, which may lead to intractable congestive heart failure and myocardialabscesses. This disease still carries a poor prognosis and a high mortality.A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presentedwith prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months) and lumbar pain. He was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showedaortic vegetations and possible periaortal abscess formation. Nonspecifi c infl ammation parameters were high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presentedwith worsening of cutaneous vasculitis, subacute glomerulonephritis ...
Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute... more Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute coronary syndrome. Start time of reperfusion therapy is an important factor which influenced positively on the number of days of hospitalization, and readmission, the risk of reinfarction, as well as both, short and long-term mortality. Today, several models of reperfusion therapy are available: thrombolytic treatment (pre-hospital or in-hospital setting), primary percutaneous coronary intervention (primary PCI or pPCI) or a combination of both. pPCI is preferred, as soon as possible, in centers with experienced teams, especially for patients in shock, or those with contraindicated fibrinolytic therapies. We will compared, very shortly, the daily practices in 4 countries (Czech Republic, Austria, Croatia, Serbia ), where (well) developed primary PCI hospital networks works efficiently for a years, with the current situation in Bosnia and Herzegovina. Our goal is to describe the easiest and quickest way of establishing the primary PCI network in Bosnia and Herzegovina. By combining the efforts of both Entities of Bosnia and Herzegovina will be possible in the forthcoming period, that B&H becomes a participant in the Stent for life initiative.
Dietary interventions with protein and salt restriction, good glucose control, smoking cessation,... more Dietary interventions with protein and salt restriction, good glucose control, smoking cessation, aggressive blood pressure control, good control of cholesterol and triglycerides, use of ACE inhibitors and ARBs can delay the progression of diabetic nephropathy.The aim of this study was to present the effects of aggressive treatment of the multiple risk factors for diabetic nephropathy on proteinuria in patients with type 2 diabetes. In this study we included 15 patients with diabetes type 2 and insufficient regulation of glycaemia. The patients were followed for three months period. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), blood pressure, cholesterol and triglycerides and proteinuria were followed prior and after the study. Prior the study patients were treated with premix insulin divided in two daily doses + metformin after the lunch and they had insufficient regulation of glycaemia. During the study patients were treated with o...
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and i... more Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and its prevalence increases with age. Patients who develop AF also have cardiovascular risk factors, structural heart disease, and comorbidities, all of which can increase mortality. AF causes a significant economic burden with the increasing trend in AF prevalence and hospitalizations. The objective of our study is to evaluate the impact of the most common known risk factors on the incidence of atrial fibrillation as an important precursor of cardiac and cerebrovascular morbidity and mortality among our patients in Bosnia and Herzegovina during median follow up period (September 2006 - September 2016). The other objective is to estimate the CHA2DS2-VASc score among our patients based on clinical parameters. This study includes 2352 ambulant and hospitalized patients with atrial fibrillation. All patients underwent clinical evaluation which includes thorough assessment for potential risk fac...
Medical archives (Sarajevo, Bosnia and Herzegovina), 2017
Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2... more Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2030, 14-17 million AF patients are anticipated in the European Union. Atrial fibrillation remains one of the major causes of stroke, heart failure, sudden death all over the world. The objective of our study is to determine the cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence during 11 years follow up period. This study includes 2352 ambulant and hospitalized patients with atrial fibrillation (AF) who were enrolled during the follow up period. All patients underwent clinical evaluation in order to determine cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence. The results of cumulative incidence for sudden cardiac death was 1.71%, for stroke 2.56%, for myocardial infarction 1.20% and for heart failure was 5.73%. In our stu...
Pleural effusion - Liquidothorax1 (fluid collection in pleural cavity) after cardio surgery is no... more Pleural effusion - Liquidothorax1 (fluid collection in pleural cavity) after cardio surgery is not rare. It is connected to serouse secretion from traumatized surface of parietal pleura, endothoracic fascia, rib periost, after mammary artery harvesting, imperfect haemostasis and immobility of patient particularly breathe immobility. Suppuration of the pleural effusion is extremely rare complication and is related to patient’s co-morbidity. We are going to present a case of 57 years old male patient, insulin dependant diabetic, with polivascular diabetic complication who is operated on at our clinic because of aortic stenosis, and double vessel coronary disease. Patient underwent biological aortic valve replacement and double coronary artery bypasses. After hospital discharge in a good general and local condition his statement at home has been impaired progressively, particularly respiratory function. After undertaken diagnostic procedures, conventional and digital we noticed a huge ...
This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI)... more This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern--concentration in the first measurement is higher than in the second one, and biphasic pattern--concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3 +/- 10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p < 0.001). We found statistically significant real negative correlation (p < 0.05) between BNP concentration and left ventricle ejection fraction (LVEF) ...
Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measuremen... more Being a narrow therapeutic index drug, digoxin may cause harm if dosed without regular measurements of serum levels. Due to various limitations in its dosing, different challenges still exist in clinical practice. This study aimed to assess digoxin though concentrations after different regimens in adult and elderly patients, and to identify predictor variables for the ratio of given dose and digoxin trough level. This was prospective open-label study. Digoxin was administered per os as 0.125 or 0.25 mg during different continuous and interrupted dosage regimens. Study protocol allowed an additional therapy according to contemporary guidelines. Digoxin concentrations were determined using Abbott AxSYM Digoxin II assay in trough samples (1-3 per patient) after 3-4 weeks stable regimen. In total, 191 concentrations (104 patients) were analyzed. Digoxin weekly dose was in range 0.375-1.75 mg. On average, we observed slightly lower digoxin levels in HF patients. Results showed that in patients receiving digoxin with interrupted dosage regimen post- pause digoxin level was statistically significantly lower than pre-pause (p < 0.05). Based on multi- ple linear regression, the ratio of given dose and trough concentration was mainly predicted by clearance creatinine, and to lesser extent by patient's ideal body weight. Interrupted dosing schedule shows greater variability in drug levels comparing to continuous dosing, and it additionally causes difficulties in reaching and maintaining steady trough levels between doses. Hence, individualization of dosing regimen should be carefully guided based on target levels and not solely on clinical signs and symptoms.
Introduction: Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvu... more Introduction: Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvular, great vessels and CABG surgery. In several large studies TEE has been shown to have higer sensitivity than TTE for native valve (94-100% vs. 44-63%) and prosthetic valves (75% vs 25%) both have high specificity (91-98%). TEE has got its value, particularly when surgeon intends to repair diseased valves, which are favorable operations due to its better survival rate, better ventricular function and fewer tromboembolic events. Most commonly valve repairs performed in patients with mitral and tricuspid valve diseases although reparative procedures have been described for all valve positions. Aim: Our aim is to define how important is TEE during mitral valve repairing operations. Patients and methods: At our institution, during five years period (between may 1999. and may 2004.) 29 patients have been operated with mitral valve repairing and monitored by TEE intraoperatively. They all went through preoperative preparations at the Clinic for Heart diseases and rheumatism, as well as Cardiology dept. of Cardiac surgery clinic KCU Sarajevo. We were following ASE/SCE guidelines for intraoperative examination during four different intraoperative mitral valve surgery stages, using Siemens ultrasound machine Sonoline Versa Plus with TEE multiplane probe type MPT-4. Results: For 20 pts. (71%) mitral valve repairing has been performed solely, in 9 (29%) pts. combined mitral and tricuspide valves repairing. In two cases (6,9%) after not satisfied repairing cardiac surgeon had to replaced native (previously repaired) mitral valve with mechanical prosthesis. 7 pts. (24%) got Carpantier rings and others 22 (76%) have been operated with pericardium patch. Conclusions: IOP TEE proved to be very useful in determination of the nature, severity and egzact anatomic location (scaloping) of the mitral and other valves disorders, in assessment of the urgency and feasibility of valves reparation and in plaining of the surgical procedures. In the case of poor surgical valve reparations, intraoperative TEE is the first method of choice in monitoring the process of valve reparation and in estimating the time for valve replacement.
Introduction: Increased inflammatory markerscorrelate with progressive hypothyroidism. The link b... more Introduction: Increased inflammatory markerscorrelate with progressive hypothyroidism. The link between subclinical hypothyroidism, subclinical inflammation and cardiovascular disease in postmenopausal women still remains unclear.
Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its i... more Infective endocarditis is defi ned as an infection of the endocardial surface of the heart. Its intracardiac effects include severe valvular insuffi ciency, which may lead to intractable congestive heart failure and myocardialabscesses. This disease still carries a poor prognosis and a high mortality.A severe case of infective endocarditis with its complications is presented. A man with aortic prosthetic valve due to earlier aortic stenosis and corrected aortal coarctation and implanted pacemaker presentedwith prolonged unexplained fever, malaise, sweating, weight loss (15 kg/4 months) and lumbar pain. He was treated with broad-spectrum antibiotics prior IE diagnosis was considered. Echocardiogram showedaortic vegetations and possible periaortal abscess formation. Nonspecifi c infl ammation parameters were high positive. Cultures were constantly negative. His condition had deteriorated suddenly, and he had presentedwith worsening of cutaneous vasculitis, subacute glomerulonephritis ...
Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute... more Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute coronary syndrome. Start time of reperfusion therapy is an important factor which influenced positively on the number of days of hospitalization, and readmission, the risk of reinfarction, as well as both, short and long-term mortality. Today, several models of reperfusion therapy are available: thrombolytic treatment (pre-hospital or in-hospital setting), primary percutaneous coronary intervention (primary PCI or pPCI) or a combination of both. pPCI is preferred, as soon as possible, in centers with experienced teams, especially for patients in shock, or those with contraindicated fibrinolytic therapies. We will compared, very shortly, the daily practices in 4 countries (Czech Republic, Austria, Croatia, Serbia ), where (well) developed primary PCI hospital networks works efficiently for a years, with the current situation in Bosnia and Herzegovina. Our goal is to describe the easiest and quickest way of establishing the primary PCI network in Bosnia and Herzegovina. By combining the efforts of both Entities of Bosnia and Herzegovina will be possible in the forthcoming period, that B&H becomes a participant in the Stent for life initiative.
Dietary interventions with protein and salt restriction, good glucose control, smoking cessation,... more Dietary interventions with protein and salt restriction, good glucose control, smoking cessation, aggressive blood pressure control, good control of cholesterol and triglycerides, use of ACE inhibitors and ARBs can delay the progression of diabetic nephropathy.The aim of this study was to present the effects of aggressive treatment of the multiple risk factors for diabetic nephropathy on proteinuria in patients with type 2 diabetes. In this study we included 15 patients with diabetes type 2 and insufficient regulation of glycaemia. The patients were followed for three months period. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), blood pressure, cholesterol and triglycerides and proteinuria were followed prior and after the study. Prior the study patients were treated with premix insulin divided in two daily doses + metformin after the lunch and they had insufficient regulation of glycaemia. During the study patients were treated with o...
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and i... more Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and its prevalence increases with age. Patients who develop AF also have cardiovascular risk factors, structural heart disease, and comorbidities, all of which can increase mortality. AF causes a significant economic burden with the increasing trend in AF prevalence and hospitalizations. The objective of our study is to evaluate the impact of the most common known risk factors on the incidence of atrial fibrillation as an important precursor of cardiac and cerebrovascular morbidity and mortality among our patients in Bosnia and Herzegovina during median follow up period (September 2006 - September 2016). The other objective is to estimate the CHA2DS2-VASc score among our patients based on clinical parameters. This study includes 2352 ambulant and hospitalized patients with atrial fibrillation. All patients underwent clinical evaluation which includes thorough assessment for potential risk fac...
Medical archives (Sarajevo, Bosnia and Herzegovina), 2017
Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2... more Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2030, 14-17 million AF patients are anticipated in the European Union. Atrial fibrillation remains one of the major causes of stroke, heart failure, sudden death all over the world. The objective of our study is to determine the cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence during 11 years follow up period. This study includes 2352 ambulant and hospitalized patients with atrial fibrillation (AF) who were enrolled during the follow up period. All patients underwent clinical evaluation in order to determine cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence. The results of cumulative incidence for sudden cardiac death was 1.71%, for stroke 2.56%, for myocardial infarction 1.20% and for heart failure was 5.73%. In our stu...
Pleural effusion - Liquidothorax1 (fluid collection in pleural cavity) after cardio surgery is no... more Pleural effusion - Liquidothorax1 (fluid collection in pleural cavity) after cardio surgery is not rare. It is connected to serouse secretion from traumatized surface of parietal pleura, endothoracic fascia, rib periost, after mammary artery harvesting, imperfect haemostasis and immobility of patient particularly breathe immobility. Suppuration of the pleural effusion is extremely rare complication and is related to patient’s co-morbidity. We are going to present a case of 57 years old male patient, insulin dependant diabetic, with polivascular diabetic complication who is operated on at our clinic because of aortic stenosis, and double vessel coronary disease. Patient underwent biological aortic valve replacement and double coronary artery bypasses. After hospital discharge in a good general and local condition his statement at home has been impaired progressively, particularly respiratory function. After undertaken diagnostic procedures, conventional and digital we noticed a huge ...
This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI)... more This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern--concentration in the first measurement is higher than in the second one, and biphasic pattern--concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3 +/- 10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p < 0.001). We found statistically significant real negative correlation (p < 0.05) between BNP concentration and left ventricle ejection fraction (LVEF) ...
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Papers by Mehmed A Kulic