Przeglad lekarski最新文献

Introduction: Self-influence on the disease course has a significant impact on coping with disease and adherence to medical recommendations.

Aim: Elaboration of a brief scale for screening of patient perception of self-influence on the course of disease among hemodialysis, which could be used during usual medical practice.

Methods: In the first stage of the study, based on a group focus interview with 6 hemodialysis (mean age 65.2 ± 14.8 year)--5 women (83%) and 1 men (17%), mean time of dialysis 43.8 ± 38 months, a list of 51 characteristics of patients with low (LP) and high perception (HP) of self-influence on the curse of disease, was constructed. In the second stage 99 patients (mean age 66.1 ± 14.7 year)--51 men (52%) and 48 women (48%), mean time of dialysis 48.7 ± 48.1 months, assessed scale reliability. They were selected by their nephrologists to groups with LP and HP. Based on the results 11 items had the strongest power of discrimination of those two groups. 15 (13.2%) hemodialysis refused to participate at this part of study. In a third step 70 (mean age 68 ± 13.3 year) patients--40 men (57.1%) and 30 women (42.9%), mean time of dialysis 48.1 ± 45.6 months, assessed validity of the tool.

Results: The reliability alfa-Cronbach = 0.9 and validity tau-Kendall = 0.6.

Conclusions: Scale has a very high reliability and satisfactory validity. It can be used for those of hemodialysis who have problems with adherence to medical recommendations or have difficulty in contact with the medical staff or other patients.

The aim of this pilot study was to evaluate changes in the concentration of prostaglandin E2 (PGE2) in induced sputum supernatant in 3 groups: sub- jects with NSAID-exacerbated respira- tory disease (NERD), aspirin tolerant asthma (ATA) and healthy controls (HC), before and after oral aspirin chal- lenge test. The study was conducted in the years 2014-2015 at the Clinical Department of the Pulmonology Clinic at the University Hospital in Cracow. 43 patients were enrolled in the study (NERD - n = 15, ATA - n = 15 and HC - n = 13). All of them underwent a placebo-controlled oral aspirin challenge. Sputum was induced 24 hours before the challenge and immediately after the test. Induced sputum was processed in order to obtain cystospin slides to depict inflammatory cell patterns and supernatants, in which PGE2 was measured. The concentration of PGE2 was determined using mass spectrometry coupled with gas chromatography (gas chromatography/mass spectrometry - GC/MS). After aspirin challenge, the concentration of PGE2 in induced sputum supernatant decreased in both asthmatics hypersensitive to aspirin (p = 0.01) and those who tolerated aspirin well (p = 0.17). The change in the healthy control group was not statistically significant. These results support the cyclooxygenase theory of PGE2 inhibition by aspirin. However, the mechanism of bronchoconstriction after aspirin administration alone in patients with NSAID-exacerbated respiratory disease remains unclear.

Background: Myasthenia gravis (MG) is an autoimmunologic disorder. It is characterized by various clinical symptoms and their dependency upon the exertion and the rest as well.

Material and methods: Between 2002-20014 in the Neurophysiology Laboratory at the Chair of Pediatric and Adolescent Neurology, Jagiellonian University in Krakow, the electrophysiological repetitive nerve stimulation study were performed in 44 children. The clinical picture and positive electrophysiological test were the ground to diagnose MG in 19 of them (12 girls and 7 boys). The mean age at onset of MG in the examined group was 12.8 years. In 5 patients the diagnosis was completed using edrophonium test. In 14patients the titer of AchRAb was also tested. In 18 patients with MG the radiological examinations of the chest were performed. In 14/19 patients with MG the control electrophysiological testing was performed 2 to 8 months after the first one.

Results: The gen-ralized MG was diagnosed in 14 patients, and ocular in 2 of them. The amplitude of electro-physiological testing was normal during the first response in all patients, but the decrement of amplitude 4:1 in patients with MG was 26% to 88%. In 3 patients with MG the persisted thymus, while in 7 hypertrophy of thymus, in 2 thymoma nad inl thyinflammation of the thymus was detected. In 5 children the result of chest examination was normal. Among 5/8 patients (62.5%) with positive AChRAb, in one ocular MG was diagnosed, in the other 7 generalized MG. The titer of AChRAb was between 0.4 and 30.8 nmol/l (mean 9.44 nmol/l), and the decrement of amplitude 4:1 was 22% to 58%.. In the treatment pirydostygmine bromide (Mestinon) was used in all children, however in 4 of them together with azathioprine, and in 7 with steroids. In the treatment of myasthenic crisis in 5 patients plasmapheresis was performed. In 42% of patients thymectomy was performed during the first year after diagnosis. The clinical remission was succeed in 90,9% patients. The electrophysiological control examination detected the decrement of amplitude 4:1 in 1% to 80% (mean 36%). The electrophysiological remission, correlating with clinical remission was achieved in 2 patients. In 6/10 patients with clinical remission, the decrement of amplitude 4:1 in electrophysiological examination continued to be at the level similar to initial examination. In 1 patient remission was complete allowing significant reduction of doses of Mestinon, even though in the electrophysiological test the decrement was 80%.

Conclusions: (1) Among hospitalized children, the generalized myasthenia was the most common. (2) Neurophysiological studies plays still fundamental role in diagnostic methods in the diagnosis of myasthenia gravis in children. (3) The correlation of the clinical state and electrophysiological results was not established.

Secondary hyperparathyroidism (sHPT) is a common complication being a consequence of metabolic disorders associated with chronic kidney disease (CKD). Treatment of the sHPT should lead to calcium-phosphate management stabilization and parathyroid hormone levels reduction. The phosphate binders, synthetic vitamin D analogs and calcimimetics are used in sHPT treatment. In this paper we analyzed the results of three month paricalcitol treatment of 36 hemodialysis patients with sHPT (serum iPTH> 500 pg/ml). 11 patients have additionally received cinacalcet. Analysis of the results showes a statistically significant reduction in iPTH and alkaline phosphatase. Paricalcitol is effecitve in the tratment of SHPT with favourable profile of side effects. Alcaline phosphatase reduction may be a desirable additional therapeuctic effect. However, it appears that combined therapy with paricalcitol and cinacalcet shoud be offered to selected population of patients i.e. with hypocalcemia after calcimimetics.

The aim of this paper is to presenta case of the patient who was hospitalizedin the Toxicology and CardiologyDepartment because of suicidal digoxinand theophylline intoxication. Bothdrugs have complicated mechanismof action and affect cardiovascularsystem differently, but both predisposeto ventricular and supraventriculararrhythmias. In the presented patientconduction disorders, cardiac musclerepolarization disorders and ventriculararrhythmias typical to digoxinpoisoning were observed. During hospitalizationthe patient experienced theECG and biochemical abnormalitiesresulting from myocardial infarction.In our paper we have analyzed digoxinand theophylline mechanisms of actionand possible impact of each ofthese drugs on the clinical symptomsthat our patient presented.

Recently we observe an increase inthe number of intoxications due to xenobioticsthat may induce acute methemoglobinemia.Our study showed acase of acute methemoglobinemia(MetHb 55..2%) in 25 – year old man.Clinical symptoms were caused by ingestionof “poppers” which was usedby patient as “aphrodisiac”. Summary:Conclusions: 1. Oral intake of alkyl nitrites,including isobutyl nitrite, is burdenedwith the risk of life-threateningmethemoglobinemia . 2. In the case ofpoisonings running with normal pO2,reduced level of oxygen saturation,clinical signs of cyanosis does not reactto oxygen therapy, and “chocolate”tinge of blood methemoglobinemiashould be suspected. 3. In every caseof MetHb the use of antidote, which ismethylene blue, should be considered.4. The severity of cyanosis correlateswith the level of methemoglobin.

Background: Smoking is a majorrisk factor for peripheral artery disease(PAD), which correlates withprogression of the disease, the prevalenceof chronic wounds, amputationincidence and mortality. On theother hand, abstinence from smokinghas a beneficial effect on the bypassgrafts patency after surgical revascularization.Poland fits in the steadydecline in the percentage of smokers,but there is a lack of current data,whether those changes are observedalso in patients with PAD and whetherthey lead to the improvement ofhealth condition.

Objective: This study evaluatedthe impact of smoking and otherknown risk factors for cardiovasculardisease on the occurrence of PAD,the risk of adverse outcomes (death,amputation, tissue necrosis), developmentof chronic wounds and theirhealing after arterial revascularization.

Materials and methods: The study was conducted in groups of 208 patientswith PAD scheduled for surgicaltreatment (28.4% of patients withadverse outcomes of PAD, 38.5%of patients with ischemic wounds)and 190 control subjects. The studygroups were interviewed concerningsmoking, characterized by knownrisk factors for cardiovascular disease,and in the incidence of amputation,and deaths within 30 days aftersurgery. In the group of 48 patientswith ischemic wounds a prospectiveassessment of the progress ofwound healing in terms of changes inthe wound advancement and changesin pain severity associated withwounds was performed.

Results: Over 90% of patients withPAD were smokers: 53.8% former and36.5% past in relation to 27.4% and14.7%, respectively, in the controlgroup (p <0.0001). Among patients,a higher proportion of former smokerswas found in those with poorerhealth condition: with adverse outcomes of PAD (48.0%vs 64.1%, p <0.05), and with ischemic wounds (70.7% vs65.1%, p = 0.056). Advanced age, female sex, and the presenceof diabetes were associated with both, the presenceof PAD adverse outcomes, as well as the development ofischemic wounds. In the prospective study, major factorsprolonging the process of wound healing were advancedage, diabetes and smoking (evaluated as peaks years ofsmoking).

Conclusions: Smoking is still the most common riskfactor for PAD, and smoking cessation is the result of thedeterioration of health condition. Simultaneously this factor,in addition to diabetes, advanced age and female sex,affects both the risk of unfavorable course of PAD and decreasethe progress of wound healing. Control of risk factorsfor cardiovascular disease should be especially carefulin women in whom, despite the lower PAD incidence,further prognosis of disease progression seem worse.

Diuretics are the longest-useddrugs in heart failure after digoxin.This is due to their effect on the retentionof sodium and an increase in thevolume of fluid in the extracellularspace secondary to neurohormonaland hemodynamic disorders occursin heart failure, and their effectivenessin the treatment of symptomaticheart failure. Discontinuation of treatmentwith diuretics or use them in toosmall doses is one of the causes ofexacerbation or acute heart failure.Theeffectiveness of most of diuretics doesnot confirm in the clinical trials, andthe indications for their use are oftenbased only on expert opinion. The effectof these drugs on morbidity andmortality in patients with HF was notexamined. Diuretics reduce shortnessof breath and swelling. For this reasonsit is recom-mended to use themin patients with signs and symptomsof fluid retention regardless of the leftventricular ejection fraction.

Introduction: The World HealthOrganization has taken actions atinternational level in order to reducethe tobacco epidemic. ThereforeFramework Convention on TobaccoControl and MPOWER package weredeveloped. The strategies containedin these documents are consideredto be the most effective and efficient.Compliance with these guidelinesand broad public support for the implementedsolutions has positive effectson the population level, and alsoat the local level, eg. voivodeship ordistrict.The aim of the study was to investigatethe attitudes and opinionsof employees of schools on selectedelements of tobacco control policiesand strategies for tobacco control.

Material and methods: During the period from November 2014 and May2015 employees working in 60 schoolsin Piotrkowski county were examined.Conducting a survey among the personnelemployed in schools an anonymousquestionnare adopted fromthe study Global School PersonnelSurvey (GSPS) was applied.

Results: Among all surveyed everythird respondent believes thatsmoking bans in the workplace helpsmokers to stop smoking. Among allrespondents, half of the respondentsbelieve that smoking bans in theworkplace help former smokers tomaintain tobacco abstinence. Amongall respondents 37.4% declared theirsupport for raising taxes on tobaccoproducts.

Conclusions: Effective implementationof smoking ban in publicplaces and the introduction of otherprovisions of the Act on the protectionof health against consequencesof tobacco use and tobacco productsrequire broad information campaignsto increase support to tobacco controlactivities.

Introduction: Glomerular filtrationrate plays a key role in the diagnosis ofchronic kidney disease (CKD). In everydaypractice GFR is estimated usingequations based on serum creatinine.Commonly used abbreviated MDRDformula is not very precise in patientswith mildly impaired renal function,underestimating eGFR when greaterthan 60 ml/min/1.73 m2. CKD-EPI formula,recommended by KDIGO, mightbe a good alternative in this situation.The aim of the study was to comparethe prevalence of consecutivestages of CKD in the group of patientsfrom Emergency Department havingcalculated eGFR according MDRD andCKD-EPI formulas

Materials and methods: The retrospectivestudy was performed in thegroup of 1,452 patients (762 womenand 690 men aged 57.4 years ± 19.8years). Estimated GFR (eGFR) was calculatedbased on MDRD and CKD-EPIformulas and the obtained results wereanalyzed according patients location inthe consecutive group of CKD, usedformulas, sex and age.

Results: The mean values of eGFRfor both formulas were similar and forMDRD was 68.6 ± 22.3 ml/min/ 1.73 m2while for CKD-EPI 69.18 ± 24.4 ml/min/1.73 m2. The highest differenceswere observed in the early stages ofCKD where the calculation of eGFRbased on CKD-EPI vs MDRD formulagives an increase of population instage G1 of CKD by 5.7% (342 vs 241persons) and reduction by 7.8% (625vs 737) in the stage G2.

Conclusions: Both formulas havethe similar value in the estimationof CKD. The differences concerningmainly G1 and G2 stages.