Sexual health in Polish elderly men with coronary artery disease: importance, expectations, and reality

Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

Itch in Elderly People: A Cross-sectional Study

Ageing is associated with numerous medical afflictions, including dermatological symptoms and diseases. Chronic itch (CI) in elderly people is a frequent symptom of diverse aetiology. This study assessed the prevalence and detailed clinical features of CI among 153 elderly patients hospitalized in the geriatric ward, including associations with comorbidities and pharmacotherapy. CI affected 35.3% of subjects, most commonly due to cutaneous conditions, mixed aetiology and neurological disorders (53.7%, 25.9% and 11.1% of pruritic subjects, respectively). The mean itch intensity assessed with the 4-Item Itch Questionnaire (4IIQ) was 6.6 ± 2.8 points. Viral hepatitis (p = 0.02), higher serum creatinine concentration (p = 0.02) and coexistent purpuric lesions (p = 0.002) were associated with higher 4IIQ scores. In logistic regression analysis CI correlated positively with female sex, atopic dermatitis, immobility, rheumatoid arthritis and ischaemic neurological diseases, while low-molecular-weight heparins, antipruritic drugs, allergy, rosacea and higher haemoglobin concentration had the contrary effect. CI is a frequent and interdisciplinary problem among elderly subjects, which requires a holistic clinical approach.

The Influence of Socioeconomic Status on the Presence and Degree of Erectile Dysfunction in Men With Coronary Artery Disease—A Cross-Sectional Study

Impairment of social functioning and low economic status may lead to the development of cardiovascular disease (CVD). This study aimed to evaluate the relationship between socioeconomic status (SES) and erectile dysfunction (ED) in patients with clinically significant CVD. A total of 808 male patients with ischemic heart disease (IHD) were recruited. Socioeconomic and demographic data as well as occupational data and the presence of modifiable risk factors were collected. Erection quality was assessed using the International Index of Erectile Function 5 (IIEF-5), while physical activity was evaluated using a modified Framingham questionnaire. Relationships among the presence of socioeconomic factors (marital status, education, income, occupational status, nature of work conducted, and demographic data), intensity of ED, and time from diagnosis of IHD were assessed. ED was diagnosed in 618 men (76.49% overall; severe in 23.14%, moderate to severe in 13.11%, moderate in 32.20%, mild in 31.55%). Patients with ED were older (61 ± 8.6 vs. 53 ± 9.1 years; p < .0001), were less active (6.97 ± 2.18 vs. 8.31 ± 2.34 Metabolic Equivalent [METs]; p < .0001), and had more modifiable risk factors (3.4 ± 1.1 vs. 3.2 ± 1.0; p < .0300). Higher education was associated with a lower probability of the occurrence of ED (OR = 0.7546; 95% CI [0.6221, 0.9153]). In patients with newly diagnosed IHD, SES correlated significantly with the presence of ED (p = .009). Education in patients suffering from CVD has a significant relationship with both the occurrence and degree of ED. Economic status was significantly linked to the presence and degree of ED only in patients with IHD diagnosed less than 2 months before entering the study.

Influence of environmental tobacco smoke on morphology and functions of cardiovascular system assessed using diagnostic imaging

Exposure to tobacco smoke is a significant problem of environmental medicine. Tobacco smoke contains over one thousand identified chemicals including numerous toxicants. Cardiovascular system diseases are the major cause of general mortality. The recent development of diagnostic imaging provided methods which enable faster and more precise diagnosis of numerous diseases, also those of cardiovascular system. This paper reviews the most significant scientific research concerning relationship between environmental exposure to tobacco smoke and the morphology and function of cardiovascular system carried out using diagnostic imaging methods, i.e. ultrasonography, angiography, computed tomography and magnetic resonance imaging. In the forthcoming future, the studies using current diagnostic imaging methods should contribute to the reliable documentation, followed by the wide-spreading knowledge of the harmful impact of the environmental tobacco smoke exposure on the cardiovascular system.

Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies

High-dose chemotherapy (HDC) followed by stem cell transplantation (HSCT) is a well-established method in patients with hematological malignancies, and for last few years, many efforts have been made to estimate short- and long-term efficacy of this method, as well as early and late complications. The present study concentrates on cardiotoxic effects, mainly early changes using biochemical markers such as N-terminal natriuretic peptide type B (NT-proBNP) and cardiac troponins (cTn). Simultaneously, the analysis of 12-lead ECG was done before and after the procedure in which the novel repolarization markers: T_p-e and T_p-e/QT ratio were measured, together with standard markers: QT, QTc. It was found that NT-pro BNP was significantly increased after HSCT in comparison to results before it, and no significant changes were present in Troponin levels. Simultaneously, T_p-e interval and T_p-e/QT ratio were significantly higher after HSCT. The use of cyclophosphamide, advanced age, and higher level of blood cholesterol concentration were risk factors for the increase in NT-proBNP and treatment with cyclophosphamide as well as fludarabine and higher creatinine levels were risk factors for the increase in T_p-e/QT ratio. In conclusion, in the early term evaluation after HSCT in patients with no previously diagnosed heart disease, the mild changes in markers of heart overload and repolarization were noted. The observations suggest that in all patients undergoing HSCT, even the ones without pre-existing cardiovascular disease, the evaluation, and monitoring of heart function should be considered.

Obstructive sleep apnea as a predictor of reduced heart rate variability

PURPOSE

This study aimed to analyze the relationship between the occurrence of obstructive sleep apnea (OSA) and heart rate variability (HRV) in a group of patients with clinical suggestion of OSA.

METHODS

104 patients with clinical suspicion of OSA were qualified to participate in the study (age: 53.15 ± 13.43 years). All participants took part in a survey and were subjected to laboratory tests, 24-hour ECG Holter monitoring, and polysomnography. The participants were divided into groups depending on the criterion of the presence of OSA.

RESULTS

The analysis of time HRV demonstrated lower parameters of SDNN for the entire recording and a 15-minute fragment of daily activity, as well as a lower pNN50 for the entire recording in those patients with diagnosed OSA. A statistically significant difference was observed for the spectral analysis of the LF/HF which was higher in the participants with OSA during the 15-minute fragment of N3 sleep. A negative correlation was observed between AHI and the following parameters: SDSD from the entire Holter recording (r = -0.21, p < 0.05) and from the 15-minute fragment of daily activity (r = -0.19, p < 0.05), mRR from the fragment of N3 sleep (r = -0.19, p < 0.05) and VLF from the entire Holter recording (r = -0.26, p < 0.05). A statistically significant positive correlation between AHI and LF/HF in 15-minute fragments of N3 sleep was found (r = 0.26, p < 0.05).

CONCLUSIONS

The study group of patients with OSA is characterized by reduced HRV. The higher AHI constitutes an independent predictor of reduced HRV, both in the sympathetic and parasympathetic components, and the sympathetic-parasympathetic balance.

Disturbances in intraventricular conduction in children with end-stage renal disease on peritoneal dialysis: A pilot study

BACKGROUND

The progression of chronic kidney disease is accompanied by multi-organ disorders, among which cardiovascular diseases have the status of a serious clinical problem. The body surface potential mapping (BSPM) technique is a non-invasive method which enables the detection of pathological changes in the bioelectrical activity of the heart.

OBJECTIVES

The aim of this study was to identify possible disturbances in the intraventricular conduction system in peritoneally dialyzed children.

MATERIAL AND METHODS

Cardiac examination consisted of 12-lead electrocardiography, echocardiography and BSPM. The evaluation of disturbances in the cardio-electrical field was performed by comparing the qualitative and quantitative features of the heart potentials on the isopotential map.

RESULTS

Data was collected from 10 children treated with automatic peritoneal dialysis (APD) (mean age: 13.6 ±2.3 years) and 26 healthy children. The maps of dialyzed children showed a shift in positive isopotentials toward the left lower part of the thorax, while negative values were observed in its left upper part. A distribution of lines on the isopotential maps revealed disturbances in the stimulation spread within the heart ventricles, especially within the anterior fascicle of the left bundle branch of His.

CONCLUSIONS

Intraventricular conduction disturbances were observed in the left bundle branch of His in the peritoneally dialyzed children. The body surface potential mapping was a more sensitive method in identifying the early stage of conduction disturbances within the heart ventricles than 12-lead electrocardiography. Further research involving a larger population of dialyzed children is planned.

Initial Changes in the Heart Conduction System Illustrated by Difference Map Patterns in Adolescent Patients After Kidney Transplantation: A Pilot Study

BACKGROUND

Cardiovascular complications (CVCs) in patients with end-stage renal disease (ESRD) often require hospitalization and are associated with an increased risk of fatality. Although kidney transplantation (KTx) improves a patient's status, CVCs are still a serious risk factor, so early identification is very important for final therapeutic outcome.

METHODS

This study included 5 post-KTx patients (age, 20.8 ± 1.16 years), dialyzed before KTx, and followed up for 6.7 ± 1.71 years. Body surface potential mapping (BSPM) was performed 4 times: twice before and twice after KTx. Electrocardiographic data were processed into map plotting to illustrate differences in ventricular activation times (VATs).

RESULTS

A comparative analysis of difference maps, both of dialyzed patients and normal subjects, highlighted certain specificities in the distribution of VAT changes for the left anterior fascicle block (LAFB). The maps clearly showed a significant correlation between the intensity of changes and duration of dialysis before KTx. After KTx, VATs seemed to be similar to those in normal subjects; however, this was true only for patients dialyzed for <1 year. The patients dialyzed for >1 year showed persistent conduction abnormalities on their VAT maps.

CONCLUSION

Summary differences in VAT maps can enable diagnostics of initial activation propagation abnormalities in the heart. Short-term dialysis therapy before KTx imposes positive effects with regression of heart conduction changes. These observations need to be verified in a larger study population.

The cardiovascular health score and the volume of carotid body in computed tomography angiography in patients with arterial hypertension

The cardiovascular health (CVH) score constitutes a reliable and measurable indicator of CVH proposed by the American Heart Association (AHA) calculated based on seven fundamental parameters, that is, smoking, body mass index, physical activity, healthy diet score, blood pressure, blood cholesterol, and fasting plasma glucose. The size and activity of carotid body (CB) play an important role in the pathogenesis of the cardiovascular system. The objective of this study was to define the relationship between the AHA CVH score and the volume of CB (V_rCB+lCB) estimated based on computed tomography angiography (CTA) in patients with arterial hypertension. Studies were conducted on a group of 57 patients with arterial hypertension (age: 70.74 ± 8.21 years). The CVH score was calculated, and CTA of carotid arteries was carried out for all patients. The CB analysis was performed based on delayed phase imaging obtained from CTA of carotid arteries. Based on the CVH score value, CVH was determined as optimal (CVH score between 10 and 14 points), average (5 and 9 points), or inadequate (0 and 4 points). CVH score in the studied group of patients was 6.53 ± 1.81, whereas V_rCB+lCB value was 38.58 ± 18.43 mm³. Patients with an inadequate CVH score (0-4 points) have statistically significantly higher V_rCB+lCB, and they are fraught with V_rCB+lCB ≥ median much more often than patients with an optimal CVH score (10-14 points). The receiver operating characteristic curve indicated a CVH score value of 6 as an optimal cutoff point to predict V_rCB+lCB ≥ median. The CVH score ≤6 criterion indicates V_rCB+lCB ≥ median with sensitivity of 58.6% and specificity of 71.4%. In the regression analysis, it was indicated that lower partial scores for physical activity, healthy diet score, and blood pressure in the AHA CVH evaluation constitute independent risk factors for higher V_rCB+lCB. In the studied group of patients with arterial hypertension, an inversely proportional dependence between the CVH score and the size of CB is observed in CTA of carotid arteries.

The analysis of the parameters of 24-hr ECG Holter monitoring in patients with blood neoplasms undergoing high-dose chemotherapy and stem cell transplantation

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) is a widely used procedure in the treatment of malignant diseases, including blood neoplasms and has increased survival in hematological diseases. The aim of the study was to analyze parameters of 24-hr ECG monitoring in patients with selected blood neoplasms in whom the procedure of hematopoietic stem cell transplantation was performed.

METHODS

The study group consisted of 64 adults diagnosed with hematologic cancer qualified for HSCT with the previous high dose chemotherapy (HDC). In all patients 24-hr Holter monitoring was carried out twice. First examination took place prior to the HSCT procedure, and the second after finishing the procedure of HSCT.

RESULTS

The minimal and mean heart rate (HR min and HR max) from 24-hr ECG recording was statistically significantly higher after the transplantation in comparison with the first test. The number of premature ventricular complexes (PVCs) was higher in the test after HSCT. In the second examination there was significantly higher percentage of premature ventricular complexes, incidents of tachycardia, and Mobitz type 1 second degree atrioventricular block. In regression analysis, in a group of patients with blood neoplasms after HSCT and HDC, administration of cyclophosphamide, fludarabine and total body irradiation were independent risk factors for electrocardiographic abnormalities in 24-hr Holter monitoring, that is, the increase in HR min, HR mean and PVCs.

CONCLUSION

In patients with blood neoplasms undergoing HSCT more electrocardiographic abnormalities may be found after this procedure in comparison with the 24-hr Holter monitoring before transplantation.

The risk of coronary artery disease estimated non-invasively in patients with essential hypertension environmentally exposed to cigarette smoke

BACKGROUND

The relationship between environmental exposure of non-smokers to cigarette smoke and the coronary artery calcium scores has not been sufficiently documented. The aim of the study was to identify the relationship between environmental exposure to cigarette smoke and the risk of coronary artery disease (CAD) estimated non-invasively through measurement of coronary artery calcium score by computed tomography in patients with essential hypertension.

MATERIAL AND METHODS

The study was conducted on 67 patients with essential hypertension, non-smokers environmentally exposed to cigarette smoke (group A) and on 67 patients with essential hypertension, non-smokers not exposed to cigarette smoke (group B), selected using the case to case. Environmental exposure to cigarette smoke was evaluated using a questionnaire. The risk of development of coronary artery disease was estimated non-invasively through measurement of coronary artery calcium score (CACS) by computed tomography.

RESULTS

Group A was characterised by significantly higher CACS and left anterior descending (LADCS) calcium scores than group B. Compared to group B, group A had significantly higher percentage of patients with significant risk of CAD estimated on the basis of CACS values, and significantly lower percentage of patients with practically no risk of CAD estimated with the same method. Advanced age, peripheral artery diseases and environmental exposure to cigarette smoke are independent risk factors associated with increased CACS and LADCS values. In addition, higher BMI and hypercholesterolemia are independent risk factors for increased values of LADCS.

CONCLUSIONS

In patients with essential hypertension environmental exposure to cigarette smoke may result in elevated risk of coronary artery disease estimated non-invasively through measurement of coronary artery calcium score by computed tomography.

Genetic variability in the system of natriuretic B peptide and principal toxicological parameters in workers exposed to lead

The study was aimed at evaluating the influence of selected polymorphisms of natriuretic peptide B precursor (NPPB) and natriuretic peptide receptor C (NPR3) genes on blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP) in persons occupationally exposed to lead. Investigations were conducted on 360 persons (mean age: 44.49±9.62years), workers exposed to lead compounds. The analysis examined four polymorphisms of BNP gene, i.e.,: rs198388, rs198389, rs632793, and rs6676300; as well as one polymorphism of receptor C for natriuretic peptides, i.e., rs1421811. Heterozygosity in locus rs632793 of NPPB gene may result in higher concentrations of Pb-B, while allele A in locus rs632793 of NPPB gene seems to determine higher concentrations of ZnPP in persons occupationally exposed to lead. Workers exposed to lead and carrying allele C in locus rs198388 of NPPB gene, particularly in the heterozygotic setup, seem to be predisposed to present higher concentrations of ZnPP. Carriership of A allele in locus rs198389 of NPPB gene probably determines higher concentrations of ZnPP in study group. In summary, among persons occupationally exposed to lead, certain relationships were demonstrated between rs632793, rs198388 and rs198389 polymorphisms of NPPB gene and principal toxicological parameters characterizing exposure to lead.

Endothelial Function in Patients with Hematologic Malignancies Undergoing High-Dose Chemotherapy Followed by Hematopoietic Stem Cell Transplantation

The aim of the study was to examine endothelial function in patients with hematological malignancies treated with high-dose chemotherapy followed by hematopoietic stem cell transplantation. The studies were conducted on 43 consecutive patients qualified for HSCT following high-dose chemotherapy based on the current standards. Then, due to exclusion criteria, a group of 38 patients were chosen for further investigations. Evaluation of endothelial function by means of flow-mediated dilatation (FMD) was conducted in patients with hematological malignancies before HSCT (test A) and after HSCT (test B). Brachial artery diameter (BAD) after occlusion, change in BAD and FMD were significantly lower after HSCT as compared to the results obtained before the transplantation (p < 0.05). The regression analysis indicated that administration of fludarabine and cytarabine, and also higher blood concentrations of creatinine represented risk factors for the impairment of endothelial function expressed as decreased FMD value. In patients with hematopoietic malignancies treated with HSCT, endothelial function assessed by the flow-mediated dilatation was impaired after chemotherapy and stem cell administration.

The volume of the carotid bodies and blood pressure variability and pulse pressure in patients with essential hypertension

AIM

To assess the relationship between the volume of the carotid bodies (VrCB+lCB) examined by means of computed tomography angiography (CTA) and blood pressure variability and pulse pressure (PP) in 24-hour ambulatory blood pressure monitoring (ABPM) in patients with essential hypertension.

MATERIALS AND METHODS

A group of 52 patients with essential hypertension was examined (mean age: 68.32±12.31 years), the sizes of carotid bodies were measured by means of carotid artery CTA, and 24-hour ABPM was carried out. The 24-hour ABPM established systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), PP, SBP variability (SBPV), and DBP variability (DBPV).

RESULTS

SBP, MAP, and SBPV were significantly higher in the group of hypertension patients with VrCB+lCB equal to or above the median than in the group of hypertension patients with VrCB+lCB less than the median, as well as in the group of hypertension patients with oversized carotid bodies, than in the group of hypertension patients with normal VrCB+lCB. Moreover, the PP was statistically significantly higher in the group of hypertension patients with VrCB+lCB equal to or above the median than in the group of hypertension patients with VrCB+lCB less than the median. The existence of statistically significant positive linear relationships was revealed between VrCB+lCB and SBP, PP, and SBPV. A higher body mass index, older age, smoking, and higher VrCB+lCB are independent risk factors increasing SBPV in the research group.

CONCLUSION

A positive relationship between the size of the carotid bodies and variability of the SBP and PP is observed in patients with essential hypertension.

Echocardiographic evaluation of the early cardiotoxic effect of hematopoietic stem cell transplantation in patients with hematologic malignancies

The purpose was to evaluate the early cardiotoxic effects of the treatment in the course of hematopoietic stem cell transplantation (HSCT) in patients with hematologic malignancies. The studies were conducted on 47 patients qualified for the HSCT. Echocardiography was carried out prior to the HSCT and after the HSCT. It was shown that higher age, administration of cyclophosphamide and higher glucose concentrations represented independent risk factors for the worsening of left ventricular diastolic function. Higher cumulative dose of anthracyclines in the previous cytostatic treatment, higher age and administration of cyclophosphamide represented independent risk factors for worsening of left ventricular systolic function. Peri-transplant therapy in the course of HSCT in patients with hematologic malignancies gives the negative effect on the diastolic and systolic left ventricular function, however, previous treatment is of importance, as higher cumulative dose of anthracyclines represents an independent risk factor for the worsening of left ventricular systolic function.

Successful therapy with bevacizumab in a case of hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT), genetic disorder manifested by uncontrolled multisystem angiogenesis with epistaxis, gastrointestinal bleeding, iron-deficiency anaemia, and arteriovenous malformations (AVM) is often related with increased levels of vascular endothelial growth factor (VEGF). Bevacizumab, a VEGF inhibitor, reduces epistaxis, telangiectasias, and iron-deficiency anaemia. A case of a female patient with HHT and chronic gastrointestinal bleeding is presented. The patient required iron supplementation and multiple blood transfusions. Bevacizumab brought marked symptomatic improvement and allowed for transfusion-independence. It is intended to apply for approval of the indications for bevacizumab administration in HHT as the 'orphan drug'.

Volume of carotid bodies and cardiac autonomic function in patients with essential hypertension

PURPOSE

Determination of the relationship between the estimated total volume of the carotid bodies (VrCB+lCB), assessed by computed tomography angiography (CTA), and the autonomic cardiac function in patients with essential hypertension (EH).

MATERIALS AND METHODS

The study included 69 patients with diagnosed and pharmacologically treated EH. The estimated volume of each carotid body (CB) was evaluated on the basis of scans obtained in the CTA of carotid arteries, using the following formula: 4/3×π×half of transverse dimension of CB in axial projection×half of longitudinal dimension of CB in the axial projection×half of craniocaudal dimension of CB in the sagittal/coronal projection. Cardiac autonomic function was assessed using time domain analysis of heart rate variability (HRV).

RESULTS

The mean values of SDNNi, rMSSD and pNN50 at 24-h monitoring, during daily activity and during night rest, were significantly lower in patients with hypertension with the values of VrCB+lCB≥median compared to the group of hypertensive patients with the values of VrCB+lCB<median. Moreover, in patients with EH with the values of VrCB+lCB≥median, the mean values of SDNN were lower during daily activity. Based on the regression analysis, it was found out that the higher values of VrCB+lCB are an independent risk factor in HRV reduction (expressed as a reduction in the rMSSD).

CONCLUSION

In patients with EH, a relationship between the volume of CB, assessed by CTA of carotid arteries, and autonomic cardiac function seems to be probable.

Dynamics of changes in heart conduction system in dialyzed young adults after kidney transplantation--pilot study

BACKGROUND

Cardiovascular complications are the main clinical problem in patients with end-stage renal failure (ESRF). After successful kidney transplantation, this situation improves, although cardiovascular complications remain a risk factor for increased mortality in these patients; therefore, their early identification is of key therapeutic and prognostic significance. This study was designed to determine a dynamics of changes in the heart conduction system in hemodialyzed young adult patients after kidney transplantation in a long-term follow-up, based on the body surface potential mapping (BSPM) method.

METHODS

The study comprised 5 patients (mean age, 20.8 ± 1.16 years) after kidney transplantation (KT) who had been chronically dialyzed before. The mean observation period was 6.7 ± 1.71 years. All of the patients were submitted to the following examinations before and after KT: 12-lead electrocardiography (ECG), echocardiography, standard biochemistry, and BSPM (isochronous maps). The mean creatinine concentration was 1.38 ± 0.05 mg/dL. The control group comprised 30 healthy persons.

RESULTS

BSPM maps taken from the dialyzed patients demonstrated disturbed spreading of electric impulses within the heart ventricles in a type of left bundle branch block, despite normal 12-lead ECG and echocardiography results. A relationship was demonstrated between the BSPM changes and dialysis duration. After KT, the abnormal distribution of isochrones and ventricular activation times (VAT) presented some significant and specific regression.

CONCLUSIONS

1) In dialyzed patients, BSPM is a more sensitive method than ECG and enables early identification of changes in the heart conduction system presented as left bundle branch block. 2) Dialysotherapy duration before and after KT determines the extent of the BSPM changes. 3) Successful effects of KT bring about regression of intraventricular conduction disorders. 4) The observations need verification in a larger patient group.

Effect of environmental exposure to cigarette smoke on blood pressure in 24‑hour ambulatory blood pressure monitoring in patients with essential hypertension

INTRODUCTION

A relationship between environmental exposure to cigarette smoke and blood pressure has not been well‑established.

OBJECTIVES

The aim of the study was to evaluate the effects of environmental exposure to cigarette smoke on blood pressure (BP) in patients with essential hypertension.

PATIENTS AND METHODS

The study involved 39 nonsmoking patients with essential hypertension treated with hypotensive agents and environmentally exposed to cigarette smoke (group 1) and 39 nonsmoking patients with essential hypertension treated with hypotensive agents and not exposed to cigarette smoke (group 2). The following variables of 24‑hour ambulatory BP monitoring (ABPM) were measured: systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) during 24‑hour ABPM, and, separately, for the period of daily activity and night rest.

RESULTS

In group 1, the mean values of 24‑hour SBP, DBP, MAP, and PP, daytime SBP, DBP, MAP, and PP, and nighttime SBP, MAP, and PP were significantly higher than those in group 2. Statistically significant positive linear correlations were demonstrated between the mean time of daily exposure (expressed in hours) to cigarette smoke and 24‑hour MAP and PP (r = 0.52 and r = 0.48, respectively, P <0.05). Advanced age, higher low‑density lipoprotein cholesterol and glucose concentrations, and environmental exposure to cigarette smoke were independent factors of elevated 24‑hour PP in the study group.

CONCLUSIONS

In patients with essential hypertension, environmental exposure to cigarette smoke may result in elevated BP values in 24‑hour ABPM.

Henoch-Schönlein purpura (HSP) and high-dose immunoglobulin treatment in patient with familiar prostatic adenocarcinoma

A 52-y old man was admitted to our Department because of abdominal pains and diarrhea with fresh blood, with concomitant purpura over the whole body and edema of the both tarsal joints. The medical history of the patient included skin changes of similar character identified once 10-12 y before. The family history revealed prostate cancer (brother and father) and pulmonary carcinoma (mother and mother's sister). An administration of immunoglobulins in the course of HSP is a non-standard clinical procedure and in case of our patient--clinically effective. In the literature, we have found only few articles about intravenous immunoglobulin treatment for acute, adult-onset HSP and only one article about GI bleeding from colonic ecchymoses in HSP. In these cases HSP wasn't associated with prostate cancer. In the first article, authors had seen dramatic responses to intravenous immunoglobulin, like in the case presented by us. IV-IG acts as an immunomodulator by suppression of antibody production, Fc-receptor blockade and anti-idiotypic reaction. In our case, the last two mechanisms could be perceived as favorable effects of IV-IG.

SIRT1 and NAD as regulators of ageing

The recent research on ageing processes in mammals throws new light on the biochemistry of circadian clock. The already known regulatory pathways for biological rhythms and metabolism, combined with newly discovered functions of sirtuins, unveil a perspective for new hypotheses, regarding possible links between ageing and circadian rhythms. The NAD World hypothesis - postulated as a systemic regulatory network for the metabolism and ageing, linked with mammalian, NAD+ dependent Sirtuin 1 - conceptually involves two critical elements. One is the systemic, Nampt-controlled NAD+ (nicotinamide phosphoribosyltransferase) biosynthesis, where Nampt (nicotinamide phosphoribosyltransferase) acts as "propulsion" for metabolism and the other is NAD+ dependent deacetylase (SIRT1) - a regulator responsible for various biological effects, depending on its localisation in organism. In this approach, the role of sirtuins, which are evolutionary conservative, NAD+ dependent histone deacetylases, may be very important for the mammalian metabolic clock. This paper is a review of current research on possible links among SIRT1 (Sirtuin 1), metabolism and ageing with particular consideration of the NAD World hypothesis.

Maps of Ventricular Activation Time (VAT) Differences in Children on Peritoneal Dialysis - a Pilot Study

BACKGROUND

Decrement of glomerular filtration rate leads to many serious complications that cause both functional and structural impairments of the other organs. Long-term clinical observations of children and teenagers with end-stage renal disease (ESRD) showed that more than one third of those patients manifested various cardio-vascular conditions. The aim of the study was to analyze possible disturbances in the heart ventricular conduction system by using a technique of ventricular activation time (VAT) differences in ESRF children on peritoneal dialysis (PD) with normal electrocardiogram (ECG) examinations.

MATERIAL AND METHODS

The study group comprised 10 ESRD children (mean age: 13.6 ± 2.31 years) on peritoneal dialysis - group I. The control group (group II) consisted of 26 age-matched healthy children with no clinical evidence of renal or cardiac disease and with normal 12-lead ECG recordings. Each of the ESRD patients was also subjected to the standard ECG examination. In order to capture possible heart conduction abnormalities, body surface potential mapping (BSPM) recordings were performed in PD patients between the successive dwells ('on empty abdomen') with a HPM-7100 Fukuda Denshi system. Based on the source ECG data, the original technique of a VAT difference map was then applied.

RESULTS

Differences between VAT values for the two examined groups of children, controls and ESRD patients on PD, were significantly pronounced in the region of the right upper anterior thorax, the entire left thorax and nearly in the total back. Such a pattern of VAT delays indicates a pathological electric transmission in the intraventricular conduction system of the left anterior fascicle of His bundle.

CONCLUSION

1. VAT maps (isochrone maps) can be useful to detect abnormal spreading and depolarization through the heart ventricles. 2. Map of VAT value differences makes it possible to identify early disturbances in the left His bundle branch in ESRD children treated with peritoneal dialysis regardless of normal 12-lead ECG. 3. Further studies on a larger group of children with ESRD on PD are required to verify the preliminary observations presented herein.