Roczniki Akademii Medycznej w Bialymstoku (1995)最新文献

Purpose: It has been reported that Rheumatoid Arthritis (RA) affects 0.5-1% of the adult population in Poland. The condition is two or three times more common among women than among men. The majority of the onsets of disease occur between the ages of 40 and 60. The aim of this study was to assess the functioning and quality of life of patients with Rheumatoid Arthritis treated in Rheumatoid Special Clinic in Poznań, Poland. The specific question was: does the functioning and the quality of life of RA patients depend on demographic variables (gender and age) and duration of the disease?

Material and methods: The study sample consisted of 168 RA patients, including 123 women (73.2%) and 45 men (26.8%). To assess the functioning and the quality of life the Polish version of the Arthritis Impact Measurement Scales 2 (AIMS 2) was applied. The Arthritis Impact Measurement Scales 2 was translated into Polish according to standardized approach (internal consistency reliability for the global score, alpha = 0.78). AIMS 2 scores range from 0-10, with 0 representing high functioning and quality of life, 10 representing poor functioning and quality of life.

Results: The results showed that the mean scores on the AIMS 2 for physical state and mobility was 3.53, which is within the medium section of the average measurement of the quality of life. The quality of life depended on the sex of the patients. Women scored significantly lower in the emotional area than men. Youngest patients demonstrated higher evaluation of quality of life in the area of bending and walking (4.4). Life satisfaction of people with RA is higher among the patients suffering longer than 5 years.

Purpose: Aim of the study is to show problems parents have to account for in the process of treatment and their knowledge how to solve them.

Material and methods: Fifty girls and boys aged 5-12 years were participated in this study. The research employed an own questionnaire prepared for this particular purpose. It consisted of three parts: the first part dealt with social-demographic data, the second one with the age of a child at the onset of asthma and accompanying it problems, and finally, the third part was concerned with the knowledge of parents about asthma and its treatment at the time of exacerbation.

Results: Out of all children under study, 60% were boys and 40% were girls, 85% of them come from a district town and 15% from rural areas. Almost 42% of parents answered that the most frequent reaction of the peers and particularly children attending the same class to this information was understanding. Only 11% of peers were able to help the children with bronchial asthma in difficult moments.

Conclusions: The study has shown that hay fever and atopic dermatitis accompanying bronchial asthma markedly make their functioning among peers difficult. Bronchial asthma makes most children suffering from it resign from favorite games and plays connected with physical effort. The attitude of peers to these children can be described as indifferent.

Cystic fibrosis (CF) is the most common life-limiting, autosomal, recessive genetic disorder. The gene which is responsible for the symptoms of this disease is located on the long arm of chromosome 7 and encodes the protein called Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), an apical chloride channel in epithelial cells. CF is a "multi-system" disease. It affects many parts of the body and it has a varied clinical expression. All patients with CF should have access to specialist services and the treatment must be comprehensive and multidisciplinary. The multidisciplinary team approach is important when trying to optimize care given to the patient and their family. The cystic fibrosis team may include personnel from the following specialist areas: medical, nursing, physiotherapy, dietetics, psychological, social/supportive. Close coordination is vital. Ideally, 'all members of the team' should have had CF care-related training. The specialist team approach ensures that such specialized multidisciplinary expertise is applied in all aspects of care, better knowledge of individual families, continuity, knowledge of treatment advances and the ability to apply these in daily management. Doubtlessly CF team ensures families a specific point of contact and they know who to talk to. In 1997 The Department of Pulmonology Diseases in Poznań started running a programme for CF adults at our University--the second CF adult centre in Poland. Members of our CF team have experience in the management of adults who have cystic fibrosis. Its members include physicians, nurses, a physiotherpist, a dietitian, a social worker and a psychologist. We must to build the team approach in CF care and use effectively talents of multiprofessional team members as fully as possible to deliver better services to patients.

Endothelin-1 is a naturally occurring polypeptide which possesses a broad range of activities including vasospastic, proinflammatory and profibrotic properties. Systemic sclerosis is a multisystem connective tissue disease characterized by vascular damage, inflammatory infiltrates and progressive fibrosis of the skin and internal organs. The results of the recent studies indicate that endothelin-1 may be a key element of the pathogenesis of systemic sclerosis. Accordingly, new class of drugs, endothelin receptor antagonists have been introduced for treatment of patients with systemic sclerosis. This article reviews the role of endothelin-1 in the pathogenesis of systemic sclerosis and the implications of endothelin receptor antagonism in the treatment of systemic sclerosis.

Purpose: The purpose of the study was the evaluation of usefulness of iontophoresis with hydrocortisone combined with ultrasounds in conservative treatment of the carpal tunnel syndrome (CTS).

Patients and methods: Forty patients (35 women and 5 men), aged 30-72 years, with unilateral CTS confirmed by electromyographic examination were included. The patients were divided into 3 groups based on clinical symptoms according to Whitley. Subjective complaints and objective symptoms were recorded in all patients. The character of the pain, its frequency and intensity (VAS scale) as well as paresthesies was determined. Physical examination consisted of clinical tests according to Phalen and Tinnel, sensation discriminatory test, pressure test and estimation of muscular atrophy of the thenar. All the patients underwent combined physiotherapeutic procedures: iontophoresis with hydrocortisone acetate (25 mg per procedure; galvanic current up to 5 mA, the active electrode--50 cm2, time--20 min) and ultrasounds with direct coupling (the dose of 0.5-0.8 W/cm2, 1 MHz, PIP 1:4, 48 Hz; the time 3-6 min). The number of procedures was 10--one per day.

Results: Decrease of pain and paresthesia were observed in 36 patients (out of 40) with mild and moderate stage of CTS. Objective parameters (Phalen test, Tinnel test, and sensation discriminatory test) significantly improved only in 24 patients with moderate stage of CTS. There was no improvement in 4 patients with advanced form of CTS.

Conclusions: The use of combined procedures of iontophoresis with hydrocortisone and the ultrasound diminishes subjective complaints of patients with the carpal tunnel syndrome. The procedure is most effective in the treatment of mild and moderate stages of the disease.

Purpose: The comparison of nutrition of children with high level of physical activity in dependence on antioxidative efficiency expressed in Ferric Reducing Ability of Plasma--FRAP adapted for saliva.

Material and methods: The group consisted of 74 pupils (43 boys and 31 girls) from swimming classes of Sport Championship School in Kraków. FRAP was measured in saliva with the use of colorimetric method and was presented in calculation per 1 gram of proteins. Three groups were separated on the basis of FRAP/ protein (g) values distribution of 15 and 85 percentile. In each group the comparison of particular nutritional components was done with taking into consideration the 24 hour nutritional recall.

Results: The statistically significant differences in nutrition were observed only in girls group in dependence on the FRAP values. These differences concerned energy and carbohydrates intake. Fats always provided more then 30% of energy, especially among children with high FRAP/ protein (g) value--34.3%. The shortage of proteins was not observed. The mean intake of calcium, and zinc was below and phosphorus, vitamin A and C intake was above the recommended level.

Conclusions: Non-enzymatic mechanisms of antioxidative efficiency (FRAP) are partially being modified by nutritional factors.

Purpose: To determinate glycosylation of selected acute-phase glycoproteins (AGP, ACT, CP) and serum concentration of this proteins in Systemic Lupus Erythematosus (SLE) patients.

Patients and methods: The study was carried out on 35 patients with active SLE and 15 healthy volunteers. The immunological measurements were performed at first day of hospitalisation, before receiving treatment. The concentration of CRP, AGP, ACT and CP were evaluated by electroimmunoassay using anti-AGP, anti-ACT, anti-CP antibodies. CRP levels were determined by radial immunodiffusion with anti-CRP antibodies. The microheterogeneity of the acute phase proteins was assessed by agarose affinity electrophoresis using Con A as a ligand, as was described by Bøg-Hansen.

Results: Between SLE patients and control group statistically significant differences (p < 0.01) were observed in serum concentration of all investigated parameters. There were no significant differences in serum acute-phase proteins levels with regards to patient's age, sex and disease activity. The reactivity coefficients: AGP-RC, ACT-RC, CP-RC in SLE patients were similar to the healthy group. The precipitate curves were similar in both groups. The main difference was in the area of the precipitant, which was bigger in the SLE patients.

Conclusions: Configuration of analysis serum concentration and heterogeneity of acute-phase proteins is one of important diagnostic tests in SLE.

The clinical presentation of acute pancreatitis varies significantly from mild self-limiting discomfort to a severe life-threatening condition. Once the disease process is initiated, the severity of the disease is largely determined by a complex network of activated inflammatory mediators such as cytokines, proteolytic enzymes, reactive oxygen species, and many more which render the local injury to a systemic disease with multiple organ dysfunction, sepsis, and considerable mortality. Remarkable progress in diagnostic modalities, intensive care technologies, and organ preserving surgical techniques have decreased mortality of severe acute pancreatitis during the past decades. However, the treatment of acute pancreatitis still remains largely supportive and no specific approach exists to prevent evolving complications. A large body of clinical and experimental evidence suggests that cytokines are key factors in the pathomechanism of local and systemic complications of acute pancreatitis. Targeting cytokine activity as therapeutic approach to acute pancreatitis is a challenging concept and the results of modulating activation of TNF-alpha, IL-1beta, IL-2, IL-10, PAF and various chemokines has indeed been promising in the experimental setting even if tested under therapeutic conditions. However, experience from a limited number of clinical trials on anti cytokine strategies in acute pancreatitis has remarkably emphasized that translating successful experimental observations into reproducible clinical associations seems to be difficult.

Purpose: Calcium-phosphate disorders are a frequent finding in HD patients, and, in some cases, may cause an abnormal coronary calcification. Some of the HD patients have increased serum cTnI level without evidence of acute coronary syndrome. The aim of this study was to determine if there is a correlance between increased cTnI levels and presence of stenotic changes in coronary arteries in asymptomatic HD patients.

Material and methods: In 13 of 119 HD patients (M:F 10:3) a coronary angiography was performed. The mean age of the patients was 53 years (33-76) and the mean HD duration was 55 months (3-156). cTnI was analyzed by AxSYM system and, subsequently, by VIDAS system.

Results: A constant or intermittent elevation of cTnI was detected in 5 of 13 patients. In 10 of 13 pts a critical stenosis of at least 1 coronary artery was found. A critical stenosis was found in 4 of 5 cTnI (+) patients and in 6 of 8 cTnI (-) patients. An excess calcification of coronaries was observed in 7 patients, including 1 cTnI positive patient with no evidence of coronary stenosis.

Conclusions: 1. The elevation of cTnI in asymptomatic HD patients is observed when there is: (I) excess calcification accompanied by a critical stenosis of at least 1 coronary artery, (II) a critical stenosis of 2 or more coronaries with no evidence of calcification. 2. We suggest that excess cardiovascular calcification in HD patients may be one of the major factors responsible for the troponin release.

Purpose: The quality could be assessed from two perspectives: internal and external. From the internal perspective the quality means being consistent with particular conditions and standards. The external perspective is based on relative assessment of the product made by a client who is also aware of other competitors' offer. Despite the professional assessment which is focused on providing health services according to medical and managerial correctness, patient's assessment is also relevant. Measuring patient's satisfaction is additional method of health services quality assessment. The aim of the study was to estimate patients' opinion on quality of ambulatory obstetric and gynaecological services.

Material and methods: The study was conducted in 11 obstetric and gynaecological out-patient clinics of Lublin in September and October 2003. The study tool was an author's questionnaire. Patients were asked to assess such areas as registration before visit, their relationship with nurses and gynaecologists and other aspects of services provision like intimacy assurance and respecting Patient's Rights. The collected data was statistically analysed.

Results: 635 patients took part in the study. The biggest groups in the studied population were women at the age of 20-30 years, married, living in cities and secondary educated. It was found that around half of the population is satisfied and 2.2% of them are unsatisfied with the fact that they have chosen particular out-patient clinic. More than 70% of women had positive opinion of following aspects influencing general opinion about service quality: politness of reception desk staff, opening hours, the length of time before a patient is seen by the specialist, intimacy assurance and respect for Patient's Rights in the practice. 80% of patients were satisfied with the relationship with nurses and 3.3% were unsatisfied with it. Eight patients out of ten were satisfied with gynaecological care, less than 2% were unsatisfied. The studied women had also high opinion of the course of visit. More than 90% of studied patients trust their gynaecologists.

Conclusions: More satisfied with the services provided by the obstetric and gynaecological out-patient clinics were women living in cities than in villages and those visiting nonpublic than public practices.